The pharmaceutical industry's dreams of making large profits from treating female sexual dysfunction are starting to look like premature speculation. Forty years later, long term hormone replacement has been exposed as doing more harm than good, drug sales have collapsed, and Wilson's thesis is rightly ridiculed as corporate sponsored disease mongering. In addition, the meaningful benefits of experimental drugs for women's sexual difficulties are questionable, and the financial conflicts of interest of experts who endorse the notion of a highly prevalent medical condition are extensive. These controversies have been brought into focus by the rejection of Proctor and Gamble's experimental testosterone patch by advisers to the US Food and Drug Administration in December
Is a new disorder being identified to meet unmet needs or to build markets for new medications? The corporate sponsored creation of a disease is not a new phenomenon, 1 but the making of female sexual dysfunction is the freshest, clearest example we have.
A cohort of researchers with close ties to drug companies are working with colleagues in the pharmaceutical industry to develop and define a new category of human illness at meetings heavily sponsored by companies racing to develop new drugs. The most recent gathering, featured Pfizer as chief sponsor and Pfizer-friendly researchers as chief speakers. The venue?
To build similar markets for drugs among women, companies first require a clearly defined medical diagnosis with measurable characteristics to facilitate credible clinical trails. Over the past six years the pharmaceutical industry has funded, and its representatives have in some cases attended, a series of meetings to come up with just such a definition table.
Researchers with close ties to drug companies are defining and classifying a new medical disorder at company sponsored meetings. The role of drug companies in the construction of new conditions, disorders, and diseases needs more public scrutiny. The goal is to foster active and positive collaboration between the two groups.
Only investigators who have experience with, or special interest in working collaboratively with the drug industry have been invited.
Publication of the proceedings of the consensus conference disclosed support from eight pharmaceutical companies and showed that 18 of the 19 authors of the new definition had financial interests or other relationships with a total of 22 drug companies. In October the Boston University School of Medicine hosted a further conference, which was supported by 16 companies. In a response to a question from a speaker at the conference, a show of hands at one session revealed that around half of the participants were connected to the drug industry.
Interviewed just before ChristmasPfizer's Urology Group's leader, Dr Michael Sweeney, said the company had played a passive role in sponsoring a series of discussions about the disorder, simply providing unrestricted grants in response to requests from physicians. On the international stage, female sexual dysfunction was discussed as part of the first international consultation on erectile dysfunction in Paris inhosted chiefly by urology associations and sponsored heavily by pharmaceutical companies. All three Boston meetings were chaired by Dr Irwin Goldstein, professor of urology and gynaecology at Boston University School of Medicine, who is also a key figure at the international gatherings.
Originally trained as an engineer, Goldstein has widened his focus in recent years from male to female sexual dysfunction. Greater public awareness and acceptance of SD [sexual dysfunction] as a common and treatable disease will heavily influence market growth, predominantly for women. About women were asked to answer yes or no to whether they had experienced any of seven problems, for two months or more, during the year, including a lack of desire for sex, anxiety about sexual performance, and difficulties with lubrication.
If the women answered yes to just one of the seven questions, they were included in a group characterised as having sexual dysfunction. New York University's clinical associate professor of psychiatry, Dr Leonore Tiefer, contends that the medical model itself is severely limited for dealing with problems of sexuality because of its mind-body split, biological reductionism, focus on diseases rather than people, and reliance on norms.
While the measurement of sexual problems in men has focused almost exclusively on erections, female sexual responses have proved much more difficult to quantify, creating problems for researchers testing pharmacological therapies. In recent years, however, a host of new methods have been identified, and some clinicians now recommend, along with a physical and psychosocial examination, a comprehensive evaluation that can include the measurement of hormonal profiles, vaginal pH, and genital vibratory perception thresholds, as well as the use of ultrasonography to measure clitoral, labial, urethral, vaginal, and uterine blood flow.
It's a form of medicine. I think physicians are most appropriate. That's a question for some philosopher. But your doctor doesn't take a dance history and wouldn't advise you whether your dancing is normal. The medical model is about defining what's healthy and what's sick—but sex isn't like that.
The potential benefits of this current medicalisation campaign are a more humanised doctor-patient relationship, effective and safe new drugs, and increased public and research attention to the complexity of female sexual problems. The potential risk, in a process so heavily sponsored by drug companies, is that the complex social, personal, and physical causes of sexual difficulties—and the range of solutions to them—will be swept away in the rush to diagnose, label, and prescribe.
The making of a disease: female sexual dysfunction
These revelations about female sexual dysfunction should spark a more widespread and rigorous investigation into the role of drug companies in defining and promoting new diseases and disorders. Competing interests: None declared. National Center for Biotechnology InformationU. Journal List BMJ v.
Ray Moynihanjournalist. Author information Copyright and information Disclaimer. This article has been cited by other articles in PMC. What is healthy and what is sick? Open in a separate window. Table Drug company sponsored meetings to define new disorder.
Footnotes Competing interests: None declared. References 1.
Selling sickness: the pharmaceutical industry and disease mongering. Annual report Special supplement. Int J Impotence Res. The Cape Cod conference: sexual function assessment in clinical trials, May, Hyannis, Massachusetts, USA. Report of the international consensus development conference on female sexual dysfunction: definitions and classifications.
The marketing of a disease: female sexual dysfunction
Kaschak E, Tiefer L, editors. A new view of women's sexual problems. Binghamton, NY: Haworth Press; Second international consultation on erectile and sexual dysfunctions, Paris, June July 3, Female sexual dysfunction: incidence, pathophysiology, evaluation, and treatment options. Cooke R. There's gold in them there pills. Observer October Bancroft J.
The medicalization of female sexual dysfunction: the need for caution. Arch Sex Behavr.
Sexual and reproductive health is more than a hope. it's a human right.
Segraves R, editor. Historical and international context of nosology of female sexual disorders. J Sex Marital Therapy. Tiefer L. The medicalization of sexuality: conceptual, normative, and professional issues. Annu Rev Sex Res. Sexology and the pharmaceutical industry: the threat of co-optation. J Sex Res. Effect of sildenafil on subjective and physiologic parameters of the female sexual response in women with sexual arousal disorder.
Efficacy and tolerability of sildenafil citrate in women with sexual arousal disorder: a double-blind, placebo-controlled study [abstract]. Vasculogenic female sexual dysfunction: the hemodynamic basis for vaginal engorgement insufficiency and clitoral erectile insufficiency.
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International consensus development conference on female sexual dysfunction: definitions and classifications—American Foundation for Urologic Disease, Boston. Perspectives in the management of female sexual dysfunction—Boston University School of Medicine. Female sexual function forum—Boston University School of Medicine. International consultation on erectile and sexual dysfunctions—to endorse instruments for assessment of sexual function, Paris.