The other obvious problem is that the patient is too often left out of this picture. Too often the worlds of our leading medical experts are lubricated with drug company largesse, the friendly marketing staff constantly picking up the tab for the doctor’s food, wine, travel and accommodation. Far too frequently, the scientific debates about how to understand and treat sexual problems are taking place in restaurants or lecture halls sponsored by those with a financial interest in widening the reach of a condition, and narrowing the range of solutions offered to treat it.
Apart from sponsoring many of the surveys, questionnaires, seminars and conferences, the drug companies have also been doing a lot of old-fashioned drug testing. They’ve been trial-ling different sorts of medicines to try and fix women’s sexual problems: trying to get more blood flowing to the genitals, boosting testosterone levels or correcting those so-called chemical imbalances in the brain. A slow trawl through the medical literature reveals the industry has been busy funding many studies, including full-scale placebo-controlled trials enrolling thousands of women around the world. But by and large, the much-anticipated female aphrodisiac seems to have remained an elusive fantasy.
The industry has bumped up against an unexpected enemy, surprisingly enough in the shape of one of its own pills. The humble placebo, or dummy pill, appears to be holding its own in the company-funded drug trials, causing great consternation in the corridors of medical power. It turns out that for a lot of women said to suffer with sexual dysfunction, a dummy pill may be just as good as the company’s drug in helping bring modest improvements to their sex lives. The plans being hatched to finally beat that placebo once and for all are yet another fascinating thread in the story of the making of this new medical condition.
The placebo, though, is not the only problem facing those who want to portray common sexual difficulties as sexual disorders. The campaign kicked off by Leonore Tiefer and her feminist colleagues has quickly gained traction around the world, scoring high-profile media coverage of its own, running education programs for health professionals, and winning influential friends among the mainstream of the sex research community. What started as guerrilla warfare has become a full-blown battle over how we understand and deal with what is going wrong in our bedrooms.
Being sceptical about marketing messages, though, doesn’t mean ignoring sexual problems that might benefit from being addressed. Pain associated with sex, for example, is common and can be extremely troubling. As many women already know all too well, seeking help for such problems—also known as dyspareunia or vaginismus—can prove extremely challenging, because in some places there is such poor understanding of the causes and potential solutions. Sadly, much of the recent high-profile scientific activity sponsored by the drug industry appears to focus more on problems of desire and arousal, with the expectation that these complaints might be more amenable to drug treatment.
In a sense Sex, Lies and Pharmaceuticals is less about the sex and more about the lies and pharmaceuticals: the the fictional narratives that flow from the marketing in all its visible and hidden forms. The big picture in this story will reveal how the industry is helping to manufacture new norms and market sexual disorders, trying to create a climate where drug solutions to sexual problems are frequently sought. It will offer evidence to support what others have so astutely observed: that the goal of much modern marketing is not only ‘to make people dissatisfied with what they have, but also with who they are’.11 And it will show how a small grass-roots campaign is exposing and challenging that process. It’s a picture projected on to a giant global canvas, but it will also illuminate the most intimate spaces of our lives for both women and men. As we uncover the details of this captivating conflict, we can’t help but reflect on our own sexual situations—the delights and uncertainty, the pleasures and pain. As Simone de Beauvoir wrote half a century ago in her feminist classic The Second Sex, ‘in sexuality will always be materialised the tension, the anguish, the joy, the frustration, and the triumph of existence’.12
Sex, Lies and Pharmaceuticals makes no assumptions about the sexuality of its readers. It assumes instead the infinite variation that is the reality and the beauty of human sexuality. While most of us live with partners, many of us live alone and a significant minority of us are now single. Most of us are attracted to the opposite sex, though many of us aren’t, and for others sex is simply not on the agenda. Some of us are enjoying regular lovemaking with a new partner, while others among us find joy in an occasional encounter during a long-term loving relationship. As a work of investigative journalism, the book offers compelling insights into the making of this particular condition. But once you identify the common patterns of disease promotion here, you’ll see the strategies appearing more and more often elsewhere with other conditions, as the boundaries of treatable illness are inexorably widened. It is important to note that this book does not assume we are passive victims of that promotion or the many other powerful forces at work within our cultures. On the contrary, the detail in the pages that follow is designed deliberately to inform and empower its reader in the face of a coming corporate onslaught.
One of the benefits of drilling into all this detail about sexual disorders is that when you get up close, the very foundations of the conditions start to look decidedly shaky. Similarly, a close reading of the current medical literature reveals that tolerance of the entanglement between doctors and drug companies is waning within the ranks of the scientific establishment itself. Unease about the blurring of medicine and marketing appears to be growing steadily. High-profile reports are finding that the web of financial ties with industry can bring the risk of ‘undue influence’ on doctors’ decisions, potentially jeopardising the care of their patients, the integrity of scientific studies and the objectivity of medical education.13 As Sex, Lies and Pharmaceuticals goes to print, there are calls for a major clean-up coming from senior figures within the worlds of politics and medicine. But let’s not get ahead of ourselves. Let’s start the story at the point when excitement about the next billion-dollar disease was first beginning to build.
One Difficulties or dysfunctions?
We’re hoping to be able to expedite the process . . . of disease development . . .
—Drug company manager Darby Stephens
The woman looking confidently into the camera lens must be in her late twenties or early thirties, her long black hair falling over strong shoulders, a slip of striped blue material tied into a bow around her neck. Her red lips and good looks are striking, but it’s her words that are most captivating. Her name is Darby Stephens, and she’s a research manager at a California-based drug company called Vivus. The company is testing a drug for women said to suffer from a new condition called female sexual dysfunction or FSD. As Darby Stephens explains in an extremely candid on-camera interview for a documentary, FSD is so new that the drug company itself has had to help work out what the condition actually is: ‘In order for us to develop drugs, we need to better and more clearly define what the disease is,’ she said.1
The frankness of the comments may be unusual, but the marketing activity being described is becoming commonplace. Pharmaceutical companies now assist in shaping the very diseases their drugs are targeting. Through its close ties to the medical profession and its influence over public debate, the industry is now helping to determine whether we see our sexual problems as everyday difficulties or medical dysfunctions, and whether female sex drugs become a permanent feature in the bedrooms of our future.
The Californian company where Darby Stephens was manager of clinical research had started testing a pharmaceutical cream for women to rub on their genitals, to see whether it could enhance blood flow and boost their level of sexual arousal. Before the drug testing could go into full swing, however, there was a problem that needed to be addressed. As Stephens tells it, in order to get a drug formally approved and have insurance companies pay for its use, it has to be shown to work against a specific medical condition: ‘The whole thing is kind of complicated because you have to have a disease before you can treat it.’
The difficulty with