The pharma industry has no shortage of critics, but perhaps one of the most fervent is Ray Moynihan, an Australian writer intent on exposing a host of pharmaceutical evils: disease-mongering, price-gouging, fraudulent reporting of clinical trial data – the list goes on.
Co-written with Barbara Mintzes, Sex, Lies and Pharmaceuticals suggests that an old tactic – the tendency of the pharma industry to "invent" new diseases – is being applied to a new area: female sexual dysfunction.
A few pages in, it's hard not to feel déjà vu. Moynihan came out a few years ago with Selling Sickness, a book tackling the problem of medicalization, the tendency for typical life phases or human behaviour such as shyness to be medicalized – treated as disorders and diseases requiring medical treatment.
The economic motivation for medicalization is obvious. Once something is labelled a disease, it requires intervention, often in the form of a pharmaceutical cure. Profits expand, the sicker we are exhorted to feel.
A long list of human behaviour has swung back and forth beneath the gaze of physicians. The famous example is homosexuality, listed until the 1970s in the Diagnostic and Statistical Manual of Mental Disorders, a handbook that classifies psychiatric disorders.
More recently, it has been suggested masculinity has become medicalized, with traits that are common among boys and men deemed damaging to their own health. An obvious case is baldness, something that has no health consequences but has nonetheless been touted as an ailment requiring intervention by the makers of hair-replacement therapies. More alarming has been the explosion of attention deficit hyperactivity disorder (ADHD) among boys displaying a degree of "boyish" unruliness deemed abnormal or self-destructive.
Moynihan and Mintzes tackle a new area: female sexual dysfunction – defined as inadequate sexual function in women. FSD has spawned a litter of umbrella disorders, such as female sexual arousal disorder (FASD), the equivalent to male impotence. Moynihan and Mintzes suggest that the holy grail of the female sexual dysfunction movement is the quest for a female equivalent to Viagra.
Viagra has earned billions for its maker, Pfizer. Other manufacturers raced to launch competitor drugs, such as GlaxoSmithKline's Levitra and Eli Lilly's Cialis. Aware that at least half the population was missing out, companies first tried the obvious – testing Viagra in women. Women failed to respond as hoped, and the view among specialists today is that a pill is needed to target women's brains the same way Viagra targets the vascular system.
While they search for this pharmaceutical gold mine, industry groups are prepping the public for pink-coloured Viagra, launching campaigns to educate doctors and patients about the pervasiveness of female sexual dysfunction – alleged to afflict more than a third of women. A 1999 study in the Journal of American Medical Association suggested that 43 per cent of women suffered from some sort of sexual dysfunction, a statistic that must have been manna to the ears of manufacturers.
It's a statistic that also reflects the tough task facing Moynihan and Mintzes. They want to condemn industry for preying on human insecurity and profiting from the oldest adage in the book: Sex sells. The problem is, just as Viagra has been embraced by millions, its pink equivalent would be a sure seller – and not because consumers are dupes, or because industry is inherently malevolent, or because doctors are in the pockets of companies. Sure, some are, but such a thesis always oversimplifies the links between human disease and human desire. Most of them time, people want to be told that a problem is medical in orientation. It helps to exonerate a sense of personal blame.
Some suggest a problem with the trend toward medicalization is that many things labelled as medical disorders stem from social, and not biological, causes. As the authors write, "labelling a woman with a medical condition when she mightn't actually have one can mean failing to get the root of the problem – especially if it's not her problem alone but has risen from her relationship."
True enough, and yet most people experience times when as much as it's blindingly obvious a problem is not theirs alone, it's up to them alone to fix it – and a pill is often the quickest or only means.
Philosopher Jacques Derrida called attention to the ancient Greek word pharmakon, which has a range of ambiguous meanings: drug, poison, remedy, charm. Related to the word pharmakos, or human scapegoat, these terms are etymologically linked to pharmacology today – an astounding field responsible for chemical cures and chemical albatrosses alike.
Perhaps the ancients were more comfortable with ambiguity than Moynihan and Mintzes are. Well-written as the book is, it suffers from a limitation they accuse big pharma of: patronizing female consumers with myths of their own inadequacy. If the equivalent to Viagra is found, it will probably be embraced by millions – and it's not for any one person to determine whether such a solution is a remedy or a mere pharmaceutical escape. Maybe it will be both.
Linsey McGoey teaches sociology at the University of Essex in Britain. She has published numerous academic articles on the global pharmaceutical industry.