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Is Female Sexual Dysfunction the Next Big Disease?

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Interview with Sex, Lies, and Pharmaceuticals author Ray Moynihan

Interviewer: You write in your new book Sex, Lies, and Pharmaceuticals that alongside Viagra, Sex and the City and the media sexualization of girl children is a paradoxical sexual insecurity and that Big Pharma exploits this anxiety, transforming common sexual difficulties into medical conditions.

Moynihan: Yes, the books reveals how the pharmaceutical industry is no longer simply sponsoring medical science. With the new conditions called "Hypoactive Sexual Desire Disorder," and "Female Sexual Dysfunction" the drug companies are in some cases actually helping to construct the basic scientific building blocks. The aim is to build the market for the so called 'pink' Viagra. The book looks at how industry is exploring different routes - a testosterone patch, an antidepressant and a drug affecting blood flow.

SexLiesPharmaceuticals

Interviewer: FDA advisory committees voted against Procter & Gamble's testosterone patch in 2004 and Boehringer Ingelheim's antidepressant flibanserin in June.

Moynihan: Yes but the FDA has yet to weigh in on the flibanserin recommendation so it is still an open story.

Interviewer: Your description of researchers' attempts to find the location of women's arousal or desire in brain scans, blood tests and genital sensors almost sounds like the Keystone Kops if millions of dollars weren't riding on the studies.

Moynihan: We are living in age where we are obsessed with surrogate markers which has helped drive billions in sales of high cholesterol, blood pressure, blood sugar and osteoporosis drugs to relatively healthy people. But there are as yet no reliable biological markers for female sexual drive or arousal. To get around that problem, drug companies have worked with paid researchers to develop questionnaires to offer what looks like objective evidence that women have FSD, Female Sexual Dysfunction. But as the book reveals these measurement and diagnostic tools are highly controversial - aimed at measuring disorders that may not in fact even exist.

Interviewer: Despite the slow progression from Freud's conception of so-called immature female sexuality, through Kinsey, Masters and Johnson, Shere Hite to the New View which you discuss in the book, sex researchers haven't figured out that the partner matters?

Moynihan: While common sense tells us sexual problems can be a function of a relationship and that if you're tired, busy or over-stressed, you won't be enjoying the sex you want, the problem with the conventional medical definitions of FSD is it has assumed there is an individual dysfunction within the individual woman.

Interviewer: The Viagra material in your book, written by the University of British Columbia epidemiologist Dr. Barbara Mintzes, identifies similar issues for men using Viagra.

Moynihan: The problem of making the "penis the patient" is very similar. While many men may benefit from Viagra, and its promotion certainly helped destigmatize erectile problems, the assumption behind much of the marketing seems to be that a man always wants sex but his body may not cooperate. But as my co-author Barbara Minztes explains in this chapter, its often a lot more complex. One woman we quote says she feels her partner's dysfunction is a problem that belongs to both of them. A man who uses sex drugs recreationally reveals a real vulnerability about what appears to be his growing dependence on them.

Interviewer: You mention at one sexual medicine conference, the idea of taking Viagra not as needed but preventatively is floated. Will prevention of sexual dysfunction be the next big thing?

Moynihan: While you can certainly understand the medical desirability of treating a condition before it surfaces, the danger is that with a medical system so dominated by the pharmaceutical industry, everyone will be a patient. Already, the risk of being at risk is being medicalized- the "risk" of osteopenia, which is the "risk" of osteoporosis, not to mention pre-hypertension and pre-diabetes. While most countries don't allow US style direct-to-consumer advertising, they do allow "disease awareness" advertising which is often just this kind of fear marketing.

Interviewer: In a chapter called "Educating Doctors With Ski Trips and Strip Clubs" you discuss the "salubrious" dinners and posh locations pharma seduces physicians with. Do you believe legislation like the US' Physician Payment Sunshine Act will help?

Moynihan: Encouraging hospitals, universities and medical schools to look at their own links to pharma is positive but transparency is not always enough, and sometimes disentanglement may be the most healthy option - and one being recommended by senior voices within the medical establishment. We also need to look at the links and loyalties of the panels of experts who define treatable illnesses and write guidelines for their treatment. A good place to start would be Female Sexual Dysfunction.

Sex, Lies, and Pharmaceuticals: How Drug Companies Plan to Profit from Female Sexual Dysfunction, Ray Moynihan and Dr. Barbara Mintzes (Greystone Books; 1553655087; Original Paperback)

Martha Rosenberg is a columnist and cartoonist, who writes about public health

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