Is Addyi coming to a drugstore near you?
With the Canadian purchase of Sprout, the company that convinced the US Food and Drug Administration to approve flibanserin (now marketed as Addyi), Canadian approval may not be far behind. Does this medication really “even the score” with men by increasing women’s sexual desire?
The New View Campaign (http://www.newviewcampaign.org/) has been arguing for years that female sexual dysfunction was manufactured to pave the way for a medication to treat it. The Journal of Medical Ethics agreed in their commentary, “Hypoactive sexual desire disorder: inventing a disease to sell low libido” (http://jme.bmj.com/content/early/2015/06/28/medethics-2014-102596.short).
But female sexuality and desire are complex. Back in 2004, a CME (continuing medical education) guide was written to help doctors integrate the “New View” approach. They included a section on the medicalization of male sexual problems and a similar history for women, including an account of the search for a female medication akin to Viagra, which had already begun by the late 1990s. The CME detailed a step by step response to this medicalization. They began by explaining that women’s sexual problems may be due to:
- sociological, political or economic factors
- problems relating to their partner and relationship
- psychological factors
- medical factors
Clearly, no medication is going to address all of these issues.
The big sell for a female equivalent to Viagra began with faulty research, which soon became medical gospel. The New View Campaign repeatedly criticized the oft quoted 43% figure, which was said to represent the total prevalence of sexual dysfunction for women 18 – 59. Where did this figure come from? The researchers, including two authors paid by Pfizer, asked 1500 women to answer “yes” or “no”, if they had experienced any of seven problems – for example, lack of desire or difficulty with lubrication – two months or more in the past year. If they answered “yes” to even one of these questions, they were popped into the sexual dysfunction category.
There is no clear biological indicator for abnormally low desire because desire is entirely subjective. In order to be diagnosed with female sexual interest/arousal disorder, one must report “significant distress” which is also highly subjective. Given the above list, what woman has not had life experiences that tamp down her desire or ability to lubricate? Just had a baby? Don’t touch me. In a loveless relationship? You don’t need lube or a pill.
There were already two failed attempts to get the FDA to approve flibanserin despite their widely publicizing the (manufactured) need for it. The FDA cited lack of effectiveness (4.4 satisfying sexual experiences vs. 3.7 for women taking a placebo: a whopping difference of 0.8%). There was also concern about side effects (e.g., dizziness, nausea, fatigue, insomnia). In fact, many women discontinued participation in the clinical trials because of these side effects. And for women who like a glass of wine before sex, forget about it. Flibanserin’s concentration – and accompanying side effects – increases with alcohol. There is a similar increase if she is using oral contraceptives or other common medications. Moreover, a woman would have to take a daily pill without expecting any change for weeks, as is the case with anti-depressants.
The International Business Times agrees “it is more like an antidepressant and works by changing brain chemistry over time, in a similar way to serotonin and dopamine. While male Viagra is taken before engaging in sexual activity to increase blood flow to areas of the body to help treat erectile dysfunction, Flibanserin is to be taken daily to improve sexual desire over time.” (http://www.ibtimes.co.uk/female-viagra-addyi-approved-us-what-flibanserin-how-does-it-work-1516090)
What’s a drug company to do?
The third attempt was preceded by the creation of Even the Score (http://eventhescore.org/the-problem/), backed by pharmaceutical companies – a brilliant marketing ploy. They argued that medical sexism was withholding medication from women whose sexual desire was perceived as less important than men’s. Co-opting feminism is an old game, but one which, in this case, was very effective. They won the American round.
It remains to be seen if Canadian women will fall for the same ploy.
Don’t believe the hype.