For pink Viagra, a double standard
Let's get one thing straight. The discovery and development of flibanserin -- the so-called pink Viagra -- by a German pharmaceutical company is not "disease mongering."
The drug, which will be considered for official federal endorsement by the FDA's Reproductive Health Drugs Advisory Committee on June 18, is indicated as treatment for female sexual dysfunction, or hypoactive sexual desire dysfunction (HSDD), and it is something of an unofficial younger sister to Viagra, which Pfizer first delivered to Americans in 1998.
But Ray Moynihan, a lecturer at the University of Newcastle in Australia and the author of the forthcoming book "Sex, Lies and Pharmaceuticals," thinks the drug's development smacks of disease mongering, telling The Post, "People think they are sick when they are not. People become patients when they don't need to be."
Moynihan has been studying and critiquing disease mongering for nearly 25 years. In 2005 he noted that the United States accounts for half of the international drug market. "That doesn't mean the U.S. takes 50 percent of pills," he told Newsweek. "But it does account for half of total spending on drugs." Yet even such statistics are suggestive, not conclusive. Ultimately, his and others' flibanserin critique comes down to a delicate judgment call -- that a lack of female sexual satisfaction isn't really a problem.
Other critics contend that studying the condition in a traditionally "medical" framework at all is inappropriate, wrongly placing HSDD into a purely urogenital context. Sex therapist and feminist Leonore Tiefer founded the New View Campaign in 2000 "to challenge the distorted and oversimplified messages about sexuality that the pharmaceutical industry relies on to sell its new drugs." In the New View Manifesto, she writes, "Because there are no magic bullets for the sociocultural, political, psychological, social or relational bases of women's sexual problems, pharmaceutical companies are supporting research and public relations programs focused on fixing the body, especially the genitals." Critics such as Tiefer charge that the invention of pink Viagra created the false notion that a problem as multifaceted as female sexual dysfunction could be cured in an overly simple, chemical way.
Since 1997, when the United States legalized direct-to-consumer advertising for prescription drugs, critics have regularly argued that the pharmaceutical industry manufactures a cure, then invents -- or, in many cases, re-brands -- a disease or disorder that needs that new cure. The result, not surprisingly, can be an "over-medicalization" of conditions that people have for years been content to treat without medicine.
Admittedly, the drug industry doesn't help itself. A particularly ridiculous example of over-medicalization is Solvay Pharmaceuticals' "Is It Low T?" campaign, which demands in its TV spots that men who suffer from a number of vague and fairly common symptoms ("Have you noticed a decrease in your enjoyment of life?") go to a Web site just to determine what, exactly, the corporately branded "Low T" is (testosterone deficiency).
But the assumption that pink Viagra is a scam is reactionary and, at worst, chauvinistic and cruel. Tiefer's assessment notwithstanding, there seems to be a sexual double standard at work here. Contrast the criticism of flibanserin with that leveled at Viagra upon its FDA approval a dozen years ago. In March 1998, press coverage focused far more on the drug's implications for Pfizer's stock price and on the parade of aging baby boomers expected to descend upon the dispensary than on the legitimacy of erectile dysfunction as a medical condition. Not so for Viagra's new analogue, which has been covered with considerably more skepticism.
Yet in a sponsored study flibanserin developer Boehringer Ingelheim reported that premenopausal women aged 18 to 50 who took the drug for a month enjoyed almost two more "satisfying sexual experiences" than they had the previous month; those taking a placebo reported about one more satisfying experience. When the initial results of the study were released last November, critics demanded peer review and pointed to Boehringer Ingelheim's sponsoring of the study as proof that the company was subordinating science to sales. But the study was presented last month at the annual meeting of the American College of Obstetricians and Gynecologists, which may give flibanserin the credibility it needs to pass muster with FDA regulators.
In a way, Tiefer is right. The female libido is complex, and each person has a sui generis relationship with sex. All the more reason not to dismiss blithely those extra two monthly "experiences" -- or the drug that seems to result in them -- as easily as the critics do.
Katrina vanden Heuvel is editor and publisher of the Nation and writes a weekly column for The Post.