Making the lineup for the big game

It's an odd setting for romance. In separate bathtubs, overlooking a coastal vista, a middle-aged couple lounge naked. But there's a spark within this surreal landscape. The woman reaches out to lightly caress a masculine wrist.

The overwhelming reaction to the 15-second television advertisements for Cialis, a new drug to treat male sexual impotence, has been, Huh?

For the befuddled who saw these teaser spots during the National Football League conference championship games Jan. 18, the Super Bowl will offer an answer. Sometime during the on-field skirmishing between the New England Patriots and the Carolina Panthers, the Cialis manufacturing team of Eli Lilly and ICOS Corp. will roll out a 60-second advertisement to explain it all -- and much more.

But don't worry, said Leonard Blum,, vice president for sales and marketing at ICOS. "They don't get out of the bathtubs."

Sunday's Super Bowl is the first to feature ads for drugs for erectile dysfunction. The debut llustrates not only the increased competition between impotence treatments, but the drug companies' increasing reliance on sports to transmit their messages to middle-aged men.

Levitra, manufactuered by GlaxoSmithKline and Bayer, is an NFL sponsor. Cialis has a contract with the PGA. Pfizer Inc.'s Viagra sponsors Major League Baseball and has its name on a NASCAR automobile.

Competing for attention with the bathtub couple on Sunday will be former Chicago Bears coach Mike Ditka, in a retooled campaign for Levitra.

Viagra is on the questionable list. Pfizer, which spent an estimated $50 million in 2003 to advertise its famous blue bill for impotence, won't say if it plans a Super Bowl commercial.

The spots will be seen by an enormous audience, including more women than typically watch NFL games. It is no surprise that drug marketers would want to introduce products to restore sexual vigor during the Super Bowl, the pinnacle of athletic achievement, said Kevin Grace, a professor in the University of Cincinnati College of Education who has written about marketing and the role of sports in society.

"They're saying, `If your team's not scoring, you bring in a new quarterback. If you're not scoring, take this drug -- be your own athlete in the bedroom,' " Grace said. "They're making a direct connection."

The average price of a 30-second spot in this year's Super Bowl is a record $2.3 million, according to Advertising Age magazine.

The Cialis ads will clearly state what the drug treats, a marked departure from the strategies employed by Viagra and Levitra. Commercials for those drugs have avoided mentioning erectile dysfunction, relying instead on wink-heavy metaphor, such as Levitra's spot that shows a middle-aged man in a suburban backyard tossing a football through a tire swing.

Lilly-ICOS is getting specific because it wants to draw attention to what it considers the Cialis advantage: Its effects last up to 36 hours. Because the spot says what the drug does, it also triggers a Food and Drug Administration requirement that potential side effects be disclosed, in this case headache and upset stomach. The commercial will lack the usual emphasis on men, Blum said.

"We focus continually on couples, in contrast to the competition, where the focus is on the man and concerns about his manliness and the partner is just sort of an object," said Blum. "For us, erectile dysfunction is a burden not only for the man but also for the partner."

GlaxoSmithKline and Bayer are sticking with their tough-guy image -- once again fielding Ditka, who has been growling at male viewers throughout the playoffs to "stay in the game." There was a 40 percent increase of men seeing their doctors about erectile dysfunction throughout the regular NFL season, said GlaxoSmithKline spokesman Michael Fleming. The company believes its Levitra ads were responsible.

"The campaign had high recall among viewers and high impact, and people really liked it," Fleming said. "It hit just the right note and motivated men to take action." Levitra has not revealed earnings, he said, but has taken a percentage of the market in the "high teens" since its August launch.

With spokesmen like Ditka, and former Republican Senator Bob Dole, and Texas Rangers star slugger Raphael Palmeiro (both for Viagra), the industry has made strides in getting Americans to talk more openly about sexual problems.

The word Viagra, said Dr. Pablo Gomery, a urologist at Massachusetts General Hospital, has become part of the national lexicon.

With the introduction of Levitra and Cialis in 2003, the big issue for doctors now is figuring out which drugs work best for which patients, he said.

"People come in wondering which drug they should be on," he said. "Right now, we give them a choice -- take a couple of pills of each and see which one works best for you."

Christopher Rowland can be reached at crowland@globe.com.