When they land, the seeds of the corporate-backed campaign to transform common sexual difficulties into medical conditions will fall on the fertile ground of considerable female insecurity. Yet backward-looking moral panic about a permissive society may not be a helpful response. Perhaps it would be better to confront the reality of women’s sexual dissatisfactions head on, tease out the cultural processes exacerbating their vulnerabilities, and identify the commercial forces seeking to exploit them. The dramatic story documented in Sex, Lies and Pharmaceuticals calls for a much greater scepticism towards simplistic claims that women’s sexual difficulties are somehow due to chemical deficits rather than a complicated set of causes, including the way we relate to each other, our cultures, and our individual and collective histories. With much attention to detail, this book seeks to enable you to make your own decisions about whether to accept the labels your doctor might soon offer you, or reject them if they’re not needed by viewing them as the latest products brought to you by one of the most sophisticated and profitable marketing machines on the planet.
So what exactly is all this marketing, and what form will it take? In some ways, the answer depends on where you are in the world. In the United States, drug company television advertisements will likely be the most popular way of telling people about the new disorders of sexual desire. In other places, the public face of this promotion will take a more subtle form, like an interview with an academic discussing his latest survey of sexual dysfunction. Behind the scenes, however, the drug companies are already helping to build the scientific foundations of this big new condition. As we’ll discover, experts with financial ties to drug companies have been conducting sponsored surveys, designing diagnostic tools and educating your local doctor about this ‘widespread’ condition. And when you look closely at the small print in the disclosure sections of a plethora of medical journal articles about FSD, you’ll find something even more extraordinary. Drug companies are no longer just passively funding these important milestones in the making of a new disease; in some cases, their employees are actively engaged in constructing the basic building blocks of this whole new field of medicine.
Fundamental to the building of this new science are the special relationships between the drug companies and the leading researchers. These are the respected doctors and esteemed psychologists who’ve actually helped revise the medical definitions of female sexual dysfunction and its four disorders. When one distinguished group of researchers sat down to refine the definitions of FSD, 95 per cent of them had financial relationships with the drug companies hoping to develop drugs for the very same condition.10 The conflicts of interest for this group were clear. As they met to work out what could best be described as normal female sexuality, and what might better be labelled as a dysfunction, many of them had been taking money or receiving other support from companies with an interest in seeing the boundaries of this new condition broadened as widely as possible. In the end, that group chose to define FSD as arising from biological, psychological and interpersonal causes, and claimed it was ‘highly prevalent’, potentially affecting ‘20% to 50% of women’.
Once you have a workable definition of a new dysfunction, you need the surveys to confirm just how widespread it is among the general population. Commonly, that has meant asking women how often they experience things like lacking interest in sex or having trouble getting aroused. By simply ticking the box that says ‘yes’ in these surveys, a woman can be classified as having a condition—even though she may not even see herself as having a sexual difficulty, far less a medical dysfunction. The totals of all those little ticks in the ‘yes’ box are then presented as evidence of alarmingly high rates of women suffering, and scientific proof for a new epidemic. The survey findings will then be followed by the inevitable claims of a massive ‘unmet need’ for new treatments, including the drugs made by the company that might happen to have sponsored the survey in the first place.
The next building block to be laid into the scientific foundations of this new dysfunction is the toolkit that doctors need to measure women’s pleasure and diagnose their sexual disorders. Health professionals are increasingly poking and probing women in their most intimate spaces, in the research labs and commercial clinics out on the new frontier of what’s called ‘sexual medicine’. With ultrasounds, doctors have been measuring the flow of blood to a woman’s clitoris; with blood tests, they’re assessing the levels of her testosterone; and with high-tech imaging machines, they are trying to track the reactions in her brain. At the same time, a battery of new questionnaires is being created to gauge a woman’s sexual success. Yet, while the results of all these tests can appear to offer a woman objective evidence of her sexual dysfunction, there are serious questions about how useful many of the test findings really are. If a potentially dangerous drug improves your desire scores by a few points on a company-funded scale, is it really that meaningful? The facts are stark and incontestable: drug companies have started to help design the very tools used to diagnose these new disorders in your doctor’s surgery. Those same tools could then provide millions of women with a medical label, opening the door to widespread prescribing of the sponsor’s drug.
Next comes the ‘education’, during which your family physician learns about the latest definitions, the survey findings and the new diagnostic tools at company-sponsored seminars featuring company-sponsored speakers. From universities in the American Midwest to prestigious international meetings in Paris, drug company money is providing the platform for much of what our health professionals see and hear about women’s sexual problems. In a fundamental way, corporations driven solely to maximise their drug sales are helping to shape the science of the new sexual disorders, even before their drugs are approved to treat them. The company executives are not actually writing the technical definitions of female sexual dysfunction, but they are bankrolling its creation as a looming twenty-first-century epidemic. This merging of marketing and medical science is not a conspiracy; it’s all entirely legal. And for the time being at least, it’s also perfectly acceptable under the self-regulatory codes of conduct governing the behaviour of scientists, doctors and drug companies. Many might think it’s unhealthy, but with pharmaceutical companies still funding medical associations, patient advocacy groups and even universities, change may be some time coming.
This emerging field of sexual medicine is, after all, no different from almost every other corner of the medical establishment, which—as many of us are already aware—is entangled in a vast web of financial relationships with the drug or device makers. It is important to remember, though, that just because a doctor works as a consultant or speaker for a company doesn’t mean he or she becomes a paid stooge for the sponsor, or conducts lesser quality science. This is not a case of individual professionals somehow changing what they say or do because they’re being paid for specific pieces of work by industry. Usually doctors and drug companies choose to collaborate as partners because of their shared enthusiasm for finding new treatments. The relationships are mutually beneficial, with the companies in need of the doctors’ expertise and credibility as much as the doctors are in need of the industry’s research funding or consultancy fees.
Still, as a result of all these collaborations, in the broad church of differing scientific opinions, people with particular perspectives are provided with influential platforms. Certain voices are amplified through company press releases and medical journal articles, via prominent presentations at scientific conferences and educational seminars, and through the hundreds of millions that may soon be spent on drug company advertisements for new medicines.