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The Intrinsa testosterone patch was rejected by the U.S. Food and Drug Administration in 2004. (AFP/Getty Images/AFP/Getty Images)
The Intrinsa testosterone patch was rejected by the U.S. Food and Drug Administration in 2004. (AFP/Getty Images/AFP/Getty Images)

Q&A: Sex, lies and pink Viagra Add to ...

Last week, the German drug maker Boehringer Ingelheim announced it would abandon work on an experimental pill for low female libido: Flibanserin, its failed antidepressant, had also failed to arouse much desire.

It's the latest hurdle in the controversial race to produce a "female Viagra," a lucrative pursuit described in the new book Sex, Lies and Pharmaceuticals: How Drug Companies Plan to Profit from Female Sexual Dysfunction . In it, Australian investigative journalist Ray Moynihan exposes the pharmaceutical industry's obstinate push to manufacture drugs - and reap billions - for a disease it helped construct.

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"Female sexual dysfunction" - a much-debated term that includes lack of desire and inability to reach orgasm - was entrenched when a 1999 article in the Journal of the American Medical Association announced that 43 per cent of women suffer from some form of sexual dysfunction.

Problematically, the lead author was revealed to have financial ties to Pfizer, but it didn't stop pharmaceutical giants from rushing - and failing - to treat the condition with testosterone patches, pills that tweak the mind's neurotransmitters and drugs that enhance blood flow to the genitals.

"In a strange way, the disease seems designed to fit the drug," writes Mr. Moynihan, who co-authored the book with Barbara Mintzes, a University of British Columbia professor and world expert on drug promotion. Mr. Moynihan spoke with The Globe and Mail.

What was your reaction to Boehringer giving up its pink Viagra?

It was an extraordinary announcement. The Food and Drug Administration's analysis of the Boehringer trial data is absolutely devastating. It shows that the drug failed to meet pre-agreed efficacy endpoints and carried a range of serious side effects including fainting and accidental injury.

One of the big questions this raises is how there can be such a discrepancy between what was being said about this potential new panacea and the reality of the trial data. There is just a huge chasm between the marketing claims about these drugs for women and the reality.

Pfizer gave up on its female Viagra in 2004, the same year the FDA rejected Intrinsa, Procter & Gamble's testosterone patch , noting it only produced one more sexual "event" per month than a placebo. Who's jumping on the train next?

Testosterone is one of the products in the pipeline, but it hasn't fared very well in Europe because any rational assessment of the data comes to the conclusion that it's barely distinguishable from a dummy pill but carries potentially serious side effects.

There's LibiGel [a testosterone gel]note/>, and BioSante Pharmaceuticals the treatments but also toward the claims about the disorders themselves.

What about the criticism that all of this anti-pharma activism is doing a disservice to postmenopausal women with real lagging sexual desire and arousal"

The book is not some moral, judgmental tract on people's individual decisions to deal with their difficulties however they like. It's simply trying to expose the marketing behind these purported conditions.

There would be a cohort of women with nerve damage after surgery, or sexual side effects of SSRIs, for which a health professional could be extremely helpful. But to categorize the changes in desire that happen as we move through our lives and relationships as symptoms of a disorder or a dysfunction is highly controversial and questionable. I'm not sure that women going through absolutely normal changes in desire want to identify themselves as suffering from some medical disorder.

You describe the "Decreased Sexual Desire Screener," a checklist developed by Boehringer that would have allowed doctors without expertise in sexual disorders to diagnose women using just four questions.

The suggestion that this little checklist could diagnose women in just a few minutes with this disorder, it's incredibly nasty, bad medicine. The marketing is a lot more than just the ads on television. It's things like the checklist that you could be presented with in the doctor's office in the next couple of years if one of these drugs is approved - diagnostic tools that the companies themselves have helped create.

You write about a major shift in the hunt for a pink Viagra - away from treating a disorder and toward a pursuit of happiness and well-being, with the new target being "non-dysfunctional" women.

That's a fascinating development. At the beginning, the marketing for Viagra involved treatment for a medical condition. Now, it's marketing for a sex aid for almost every man, any time.

A sex drug for women would be approved in the frame of, "Here is a much-needed treatment for a medical disorder," and then in the blink of an eye it would be promoted as a way to enhance a flagging sex life. This blurs into a much wider discussion about the ease with which we can medicate away all the challenges of our lives.

The promotion of simple, chemical solutions to the complexities of life is such a distortion, and that distortion comes about because of the large marketing budgets of drug companies and the closeness between the industry and the [medical]profession.

Still, you believe there is some good news in all of this: increasing scrutiny on medicine and marketing.

This entanglement between the industry and the profession is still out of control. There's so much awareness of the unhealthy dangers of that closeness now, and yet the profession largely doesn't want to give up the quality hotel accommodation at conferences, and the good meals, and the industry doesn't want to give up its superb access to prescribing physicians.

This interview has been condensed and edited.

Follow on Twitter: @ZosiaBielski

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