Physicians’ Moral Dilemmas in the Age of Viagra

Abstract Oral phosphodiesterase5 inhibitors (PDE5i; e.g., Viagra®) have become the first line of treatment of erectile dysfunction in men. Relying on interviews with 38 physicians, this study explored moral dilemmas associated with the prescription of PDE5i to older men. Moral dilemmas at the micro level concerned the interest of the patients to receive medical treatment, even when this was counter-indicated. At the meso level, physicians expressed their concerns about the impact of PDE5i on their patients’ partners. At the macro level, physicians discussed the substantial contribution of the pharmaceutical industry to the education of patients and physicians about pharmacological treatments for sexual problems. Physicians reported no moral concerns about industry involvement and reported only the benefits associated with it. The study raises moral issues associated with the treatment of erectile dysfunction. As such, it stresses the importance of facilitating a bio-psycho-social approach to treat sexual dysfunctions.


WHY AGE AND AGING RESEARCH MATTERS: A CHAT WITH NIA SENIOR LEADERSHIP Chair: Marie Bernard
The National Institute on Aging (NIA) at the National Institutes of Health, Department of Health and Human Services, is the federally designated lead agency on aging research, and has supported significant research on aging as a life-long process. In the last five years, NIA experienced a tripling of its budget. Although much of this funding is targeted to Alzheimer's disease (AD) and AD related dementias (ADRD) research, there was an increase in funds allocated to non-AD research in keeping with the overall growth of NIH. This symposium will provide a forum for exploration of the implications of the budget increases for the general research community. It will involve NIA's senior staff discussing research priorities and programs supported by the Institute. A question-and-answer session will follow brief introductory remarks on current funding and future priorities and research directions of NIA.

DIVISION OF EXTRAMURAL ACTIVITIES
Kenneth Santora, National Institute on Aging, Bethesda, Maryland, United States Dr. Santora will discuss research priorities for the Division of Extramural Activities. He and his team will in addition be available for small group discussions

UPDATE ON NIH INCLUSION ACROSS THE LIFESPAN Marie Bernard, National Institutes of Health, Bethesda, Maryland, United States
The National Institute on Aging (NIA) at the National Institutes of Health, Department of Health and Human Services, is the federally designated lead agency on aging research, and has supported significant research on aging as a life-long process. In the last five years, NIA experienced a tripling of its budget. Although much of this funding is targeted to Alzheimer's disease (AD) and AD related dementias (ADRD) research, there was an increase in funds allocated to non-AD research in keeping with the overall growth of NIH. This symposium will provide a forum for exploration of the implications of the budget increases for the general research community. It will involve NIA's senior staff discussing research priorities and programs supported by the Institute. A question-and-answer session will follow brief introductory remarks on current funding and future priorities and research directions of NIA. Traditionally, gerontology research has been relatively genderless. When the intersection of age and gender was explored, this was done primarily by focusing on the experiences of older women. Much less is known about the experiences of older men. The present symposium brings together work from the humanities and the social sciences in order to explore societal images and personal experiences of aging men. The paper by Maierhofer and Ratzenböck provides a theoretical outlook on this intersection from the humanities perspective, followed by empirical applications from the social sciences. Next, Armengol uses contemporary American literature to challenge the traditional stereotype of decline in sexuality and masculinity. The paper by Ni Leime & O'Neill examines stereotypes of aging masculinities, but this time from the perspective of older men as the audience who react to their portrayal in visual culture. Finally, Ayalon and Gweyrtz-Meydan present ethical dilemmas faced by physicians who treat older men's sexuality in light of active marketing campaigns of the pharmaceutical industry, which advocate for a model of successful aging and ongoing sexual intercourse. The discussant, Kimmel, will conceptualize the four papers by stressing the different types of information that can be obtained via different methods of inquiry. The complementary information provided by the different papers and the integration of methods and findings from the humanities with the social sciences will be discussed.

PHYSICIANS' MORAL DILEMMAS IN THE AGE OF VIAGRA Liat Ayalon, Bar-Ilan University, Ramay Gan, HaMerkaz, Israel
Oral phosphodiesterase5 inhibitors (PDE5i; e.g., Viagra®) have become the first line of treatment of erectile dysfunction in men. Relying on interviews with 38 physicians, this study explored moral dilemmas associated with the prescription of PDE5i to older men. Moral dilemmas at the micro GSA 2020 Annual Scientific Meeting Innovation in Aging, 2020, Vol. 4, No. S1 level concerned the interest of the patients to receive medical treatment, even when this was counter-indicated. At the meso level, physicians expressed their concerns about the impact of PDE5i on their patients' partners. At the macro level, physicians discussed the substantial contribution of the pharmaceutical industry to the education of patients and physicians about pharmacological treatments for sexual problems. Physicians reported no moral concerns about industry involvement and reported only the benefits associated with it. The study raises moral issues associated with the treatment of erectile dysfunction. As such, it stresses the importance of facilitating a bio-psycho-social approach to treat sexual dysfunctions.

THEORIZING CULTURAL AND SOCIAL INTERSECTIONS OF AGE AND GENDER: THE APPROACH OF ANOCRITICISM Roberta Maierhofer, University of Graz, Graz, Steiermark, Austria
This contribution discusses empirical applications of the approach of 'anocriticism' in interdisciplinary gerontological research. Despite the connection in terms of epistemology and ontology, the intersection of gender and age has been mostly ignored, privileging works focusing either on age or gender (Calasanti & Slevin 2001:27; Denninger & Schütze 2017:7). Age/ing Studies, however, would not have been established as a field without the theoretical and methodological approaches of feminist theory (Maierhofer (2019:2). Anocriticism was originally developed in order to investigate cultural representations of age/ing (Maierhofer 2003(Maierhofer , 2004b(Maierhofer , 2004a(Maierhofer , 2007(Maierhofer , 2012, but has recently been taken up in social sciences (Ratzenböck 2016a(Ratzenböck , 2016b(Ratzenböck , 2017a(Ratzenböck , 2017bGales and Loos 2020, forthcoming) in order to draw attention to four dimensions: (a) age and aging's collective cultural construction and relation to gender, (b) the individual dimension of aging, (c) people's interpretative power and narrative performance, and (d) age/ing's potential for resistance and change.

MASCULINITIES AND AGING IN IRELAND Aine Ni Leime, NUI Galway, Galway, Galway, Ireland
There is a need for research to gain understanding of the social and cultural constructions of ageing masculinities that, as Gullette emphasises, operate together to construct a 'culture of decline'. This presentation explores how cultural images of older men inform constructions of ageing and lived realities in Ireland. It draws on the Irish findings from a cross-national, inter-disciplinary project conducted in 2019 investigating older men's perceptions of how they are represented in film and advertising. It applies innovative narrative and thematic analysis to data from four focus group discussions, interviews and reflective diaries, to explore participants' (Irish men aged 65+) reactions to the portrayal of older men in TV and film. Stereotypes identified included older men as conservative, grumpy, sad, streetwise, trickster, or action hero. Thematic analysis identified themes including men's identification with their jobs; their diminishing roles in the family; and old age as a matter of perception.

SEX AND TEXT: QUEERING OLDER MEN'S SEXUALITY IN CONTEMPORARY U.S. FICTION Josep Armengol, Universidad de Castilla-La Mancha, Ciudad Real, Castilla-La Mancha, Spain
This paper will explore the representation of men's aging experiences in contemporary U.S. fiction. While most gender-ed approaches to aging have focused on women, which has contributed to the cultural invisibility of older men, this study focuses on men's aging experiences as men, thus challenging the inverse correlation between masculinity and aging. To do so, the study draws on a selected number of contemporary U.S. male-authored fictional works, which question the widely-held assumption that aging is a lesser concern for men, or that men and women's aging experiences may be simply defined as opposed. The literary corpus includes male authors from different backgrounds so as to illustrate how (self-)representations of aging men vary according not only to gender but also class (Richard Ford), race (Ernest Gaines), and sexual orientation (Edmund White), amongst other factors. The presentation will thus end up challenging the conventional equation of men's aging processes with (sexual) decline, exemplifying their plurality as well as irreducible contradictions.

MAINTENANCE OF HEALTH BEHAVIORS: EXPLORING THE CONSTRUCT AND ITS IMPLICATIONS ON RESEARCH, EDUCATION, AND PRACTICE
Chair: Jaime Hughes Modifying health behaviors, including diet, physical activity, sleep, and/or medication adherence, can have a range of positive effects on older adults' overall health, function, and well-being. Although many evidence-based programs exist to support the initiation of health behavior changes, few address longterm maintenance. Emerging research suggests initiation and maintenance are distinct constructs, each requiring unique skills. Furthermore, maintaining health behaviors depends upon health promotion programs that are sustained, or continually delivered with high fidelity, at community and population levels. The objective of this symposium is to present findings from a series of research projects designed to investigate the concept of behavior change maintenance. Activities were supported by NIA Research Centers Collaborative Network (RCCN) funding and included community listening sessions plus an interdisciplinary think tank of national thought leaders. This symposium will begin with an overview of health behavior change, including the rationale for studying maintenance as a critical yet overlooked phase of successful behavior change (J. Hughes). A proposed conceptual model of maintenance will then be discussed, including constructs distinguishing maintenance from initiation (Raj). These introductory presentations will be followed by a discussion of multi-level barriers and facilitators related to maintenance on individual, community, and population levels (S. Hughes). The session will close with implications for research, education, and practice (Bettger).