Most importantly, the book readily acknowledges that women’s sexual problems can sometimes be disabling, and proven therapies—including pills—may be extremely valuable for some people. Yet it also asks very directly how much discontent is being manufactured through the creation of new sexual norms, and how much dissatisfaction is being exploited for corporate gain.
Finally, Sex, Lies and Pharmaceuticals is offered by co-author Barbara Mintzes and me as an opportunity to join this global debate about the making of a new medical condition. It is part of a conversation, its ideas to be discussed with family and friends, criticised in book clubs and on blogs and debated at public meetings around the world. Please join in, and feel free to bring tomatoes, a copy of the book for signing, or both.
Ray Moynihan Byron Bay, June 2010 www.raymoynihan.net
Introduction Sex, lies and pharmaceuticals
Not tonight, dear, the dog ate my testosterone patch.
—Dr Leonore Tiefer
During the last year or so, has there been a period of several months or more when you lacked interest in having sex? When you felt anxious about your sexual performance or were unable to achieve an orgasm? Was there an extended time when you had trouble getting aroused, experienced pain on intercourse or just didn’t find sex pleasurable? If you answered ‘yes’ to just one of these survey questions, and you’re a woman, you could easily be classified as suffering from a brand new medical condition called ‘female sexual dysfunction’, or FSD. First described in the textbooks only a few decades back, FSD is set to become the next blockbuster medical condition, coming soon to a doctor’s surgery near you. As the ups and downs of daily life are re-categorised as the symptoms of medical diseases, soon all of us will be sick.
One of the women who actually helped write the definitions of female sexual dysfunction puts it very clearly. ‘[W]hat once was considered normal,’ wrote American psychologist Sandra Leiblum, ‘has come to be considered dysfunctional.’1 Nowadays, if a woman lacks the desire for sex, and is bothered by it, she could be diagnosed with a disorder of low libido. That’s just one of the four main disorders of female sexual dysfunction described in one of the leading manuals of diseases.2 The others include disorders of arousal, orgasm and pain. As the evidence plainly shows, forces are fast amassing to tell you, and your doctor, that close to one in every two women suffers from some form of this new medical condition.
The giant pharmaceutical industry—with worldwide sales now approaching a trillion dollars a year—is hungrier than ever for new markets.3 In order to maximise sales, the industry must ‘create the need’ for its newest and most expensive products. Sometimes that means selling sickness to the wealthy healthy, helping transform common ailments into widespread conditions that require treatment with the latest pills.4 Applauded for producing medicines that extend life and ameliorate suffering, drug companies no longer simply sell drugs; they increasingly sell the diseases that go with them.
Female sexual dysfunction is perhaps the perfect example of selling sickness, and the commercial firepower behind its forthcoming promotion is simply awe-inspiring. ‘With more than 50 million potential sufferers in the United States, FSD could offer a larger market than male sexual dysfunction,’ wrote a pair of enthusiastic market observers. ‘FSD could be the next boon for pharma companies . . .’5 If a drug is approved to treat this condition in the United States, the tsunami of marketing that will be unleashed in the media and on the web will soon swamp the shores of nations everywhere. According to industry reports, one company on the verge of having its product approved for women had set aside $100 million for the drug’s advertising budget alone.6
Three global corporations in particular have been at the forefront of the race to spread the word about this new medical condition, and get their drugs approved to treat it. Pfizer, the biggest pharmaceutical company in the world and currently worth well in excess of $100 billion, has had high hopes that its wonder drug for men, Viagra, will also work for women. Procter & Gamble, with global annual sales of almost $80 billion, is famous for selling soap to housewives, but it also wanted to sell them testosterone patches as well.7 The third corporation featuring in this drama is the family-owned German outfit Boehringer, which boasts just over forty thousand employees and has affiliated companies in almost 50 countries. The German company’s pill targets the brain, with claims it can give women back their lost desire.
So what exactly is this condition called FSD? The answer depends a little on the solutions being sold at the time you ask the question. If Pfizer is promoting a drug that enhances blood flow to the genitals, then the condition might best be described as an ‘insufficiency’ of vaginal engorgement. If Procter & Gamble is pushing its testosterone patch as a cure for women, the sexual disorder is discussed as a ‘deficiency’ of hormones. And if Boehringer has a pill that affects the mind’s neurotransmitters, women with low libido may have a ‘chemical imbalance’ in their brains. In a strange way, the disease seems designed to fit the drug.
That’s not to say that medicines don’t have a role to play in treating some sexual problems. There are women for whom a medical label and a medication may be extremely valuable. The problem is that when the drug company-sponsored tsunami of marketing reaches its full fury in your corner of the planet, women’s common sexual difficulties will likely be portrayed not as aspects of normal sexuality, but as the symptoms of medical conditions that are widespread and treatable with pills. The fact that sexual difficulties are often caused by a raft of complex factors, from relationship stresses to religious taboos, may well be washed away in the coming flood of pharma-funded magazine features, celebrity interviews on breakfast TV and plain-talking advice from sexy bloggers. The first unmistakeable signs of this marketing are already appearing. ‘What is female sexual dysfunction?’ asks one online personality known as Katie, on her educational website. ‘This health problem is a genuine problem that needs medical attention. Most women suffer from this problem without actually realising it.’8
Yet even before the king tide of corporate marketing has really begun to flow, a backlash has been brewing. Working out of her small home office in Manhattan, not too far from the headquarters of the world’s biggest drug giant, a smart feminist scholar has launched a pre-emptive strike. Together with a small group of colleagues, sex therapist and New York University associate professor Dr Leonore Tiefer has started a grass-roots campaign. The fight is against what Dr Tiefer and her colleagues see as Big Pharma’s attempt to help turn the ordinary ups and downs of women’s sex lives into medical diseases in order to sell them drugs. Instead of a medical dysfunction with four neat sub-disorders, the campaigners are proposing a radically different approach to understanding women’s sexual difficulties. As we’ll learn, during the extended combat there have been many colourful skirmishes, like the time Leonore Tiefer won a major award from her peers in the sex research community and delivered a speech titled ‘Not Tonight, Dear, the Dog Ate My Testosterone Patch’.
Pushed for a public response to the criticisms, the powerful pharmaceutical industry has been uncharacteristically shy, rejecting the idea that it creates diseases and arguing simply that it is sponsoring a legitimate field of medical science. For their part, the doctors and psychologists who work closely with the industry believe they’re raising awareness of the under-recognised suffering of women with a genuine sexual dysfunction. More importantly, they say, they’re helping to give those women access to much-needed treatments.
The broader context for this extraordinary fight over female sexuality has been the paradox, in Western countries at least, of an increasing sexual openness accompanied by what appears to be a growing sexual anxiety. The promise