BRIAN
DEER: LOVE SICKNESS Page 1
The
Sunday Times Magazine (London) September 28 2003
By
Brian Deer
Nine
years before she would announce the discovery of a
new disease, Dr Rosemary Basson, consultant in the
Centre for Sexual Medicine at Vancouver General
Hospital, Canada, got a phone call from a medical
research company working for the New York-based drug
giant Pfizer. Would her clinic be interested in
joining a trial of Viagra, the now-famous
penis-stiffening blue pill?
Today,
sitting at a grey steel desk in her 9-by-12ft
white-painted office, she smiles, recalling the
ignorance of the caller: he didn't know
"generalised" from "situational"
dysfunction. But she accepted his offer, which
brought a tidy wad of dough that would strengthen her
department's work. The British-born Basson was at the
time nudging towards her fifties, and struggling to
advance understanding of vaginismus, an anxiety
complaint in which a woman seems to tighten in reflex
opposition to penetration.
She
was no great researcher. Her love was clinical
medicine: hands-on caring for patients. Taking
referrals from throughout the province of British
Columbia, she saw only the most intractable sexual
problems that had defeated family doctors or smaller
hospitals. Of her caseload, 60% were women, mostly
complaining of the pain condition dyspareunia, with
men presenting with erection problems or difficulties
with ejaculation.
With
a demeanour that reminds me of an English sitcom
actress, Basson had published nothing in medical
journals before the Viagra call came through. And
although she holds a professorship in the University
of British Columbia's psychiatry and gynaecology
departments, records show that in the year before
Viagra's launch in 1998, three projects she hoped to
undertake went unfunded due to lack of wider
interest.
But
the landscape changed in the blue pill era as profits
from the penis poured in. Although by no means
Pfizer's most popular line (grossing only a quarter
of Lipitor, the world's No 1 prescription drug),
Viagra brought the company windfall revenues:
currently $2 billion a year. And with the launch of
"me too" competitors - such as Cialis from
Eli Lilly, and Levitra from Bayer and GlaxoSmithKline
- the Cinderella speciality of sexual medicine was
suddenly dressed for the ball.
These
days, Basson snags sponsorship deals like a sports
star spotted by Nike. Pfizer commissioned her to look
at the effects of Viagra in women with sexual arousal
difficulties. Then came finance from Lilly to
psychologically profile patients. More Pfizer work
followed on women's orgasm problems, then
"questionnaire validation" for Procter
& Gamble. Currently, she is testing a new
oestrogen receptor blocker for her longtime
companions at Pfizer.
Nourished
by funding, she blossomed with ideas that have now
lifted her to guru status. Mostly promoting what she
calls a "new model" of female sexuality,
her journal publications jumped from a single paper
indexed by the Medline database for 1999, to three
for 2000, six for 2001 and seven for 2002. She wins
finance to lead panels and to attend international
conferences concerned with "female sexual
dysfunction". And she's currently co-authoring a
global textbook that will be translated into half a
dozen languages.
Having
scaled this platform, what she says from it is
startling, "It's as big as [the feminist
sexologist] Shere Hite," she claims. Arguing
that healthy women in established relationships may
experience "interest" but rarely
"desire" before sex with their partners,
she goes on to claim that many of those who don't may
be suffering from a mental illness. Out goes passion
as motivation for lovemaking, and in comes a
diagnosis for a medical condition that she compares
to a broken leg or appendicitis.
With
industry-funded colleagues, she has suggested,
astonishingly, that one third of all women
may suffer from this condition - this "sexual
interest disorder", as she calls it. "If
they truly have no interest in sex, yes, you could
say they have a disorder," she tells me on the
phone, setting me scrabbling for a flight to
Vancouver. "It's a disorder because it's out of
line with the expected situation, and the range that
seems to be normal."
Can
this be right? Now is the time to find out. Rosemary
Basson is the new Queen of Desire. Even as we spoke,
her ideas were being prepared for a sexual
dysfunction brochure to be pounded out for doctors
around the world. Footnotes to her textbook will
cascade through the literature, giving the impression
of a new-found consensus. And in a softly-softly
move, official disease definitions are being targeted
for wholesale revision.
But
is she using industry help to understand women? Or do
those who pay the piper call the tunes? Is a well of
unfulfilment at last being recognised, or is modern
life being fashioned into a disease? At a time when
"big pharma" is hunting sex-related
products that could dwarf Viagra's sales, is Dr
Basson's recent rise a sign of social maturity, or of
foundations being laid for new drugs?
"Why
has she been anointed? That's a good question,"
Dr Leonore Tiefer, a New York clinical psychologist
and author of A New View of Women's Sexual Problems,
told me before I flew to the beautiful Canadian west
coast city squeezed between mountains, sea and the US
border. "I've been to all the relevant
sexological meetings since before you were born, and
she wasn't at any of them."
*****
Well,
she has been at some - at least in recent years. I
saw her in Paris in July. Basson had flown in at
industry expense as vice-chair of the Second
International Consultation on Erectile and Sexual
Dysfunctions - which, although almost entirely
financed by at least seven drug companies, brought a
thousand doctors and scientists from all over the
world to the vast Palais des Congrés, west of the
Arc de Triomphe.
Claiming
to be "transforming data into knowledge and
knowledge into action", the £1m conference's
aims, like a similar meeting four years ago, were to
hammer out definitions of sexual dysfunctions; to
agree means of measuring them in both men and women;
and to create benchmarks for trials of new products.
The visual landscape was dominated by
motor-show-sized stands for Pfizer, Lilly, Bayer and
GlaxoSmithKline.
Into
this event she strode, in a sleeveless cocktail
dress, to unveil her new model and disorder.
Presenting the findings of a powerful international
committee she chairs, which has met over the past two
years to rule on definitions of female problems, she
stood at a lectern and rattled through blue slides as
if reporting from some frontier of knowledge.
Her
model, in a nutshell, rejects conventional wisdom
about what makes women want sex. Whether from the
austere teachings of 1960s sexologists, such as
William Masters and Virginia Johnson, or from
headline-grabbing feminists such as Shere Hite in the
1970s, Basson fears we've got the message that
women's responses are like men's - or, if they're
not, then they ought to catch up.
Au
contraire, she argues. Women are
different. But not in the way feminists suggest.
While men may be prisoners to testosterone-driven
urges, trying to mate with what moves and pull the
ring on what doesn't, Basson thinks women mull
precoital calculations enough to double their
cellphone bills.
"When a
woman senses a potential opportunity to be sexual
with her partner," she explained in a recent
article in the Journal of Sex and Marital Therapy,
"although she may not 'need' to experience
arousal and resolution for her own sexual wellbeing,
she is motivated to deliberately do whatever is
necessary to facilitate a sexual interaction as she
expects potential benefits that, though not strictly
sexual, are very important."
To me, this
sounds sneaky, but she shows us a slide: a
reinforcing feedback loop of sexual interest.
Starting with "One or more reasons for
sexual activity; not currently aware of sexual
desire", Basson takes her audience
clockwise around a diagram that she says maps the
sexual encounter. "Willingness to be
receptive," the cycle continues, then "subjective
arousal", "more intense arousal and
responsive desire", "emotional and physical
satisfaction". And, at cigarette time,
"positive influence on motivation".
In less than
bonkbuster language, she elaborates on this process
with an erection-killing description if ever there
was one. "The increased emotional closeness,
bonding, commitment, tolerance of each other's
imperfections, and expectation of increased wellbeing
of the partner all serve as highly valid motivational
factors that activate the cycle."
There's a
sidebar to all this about "information
processing", but "need a hard shag" is
nowhere on the screen and even "orgasm" has
dropped off the map. As she elaborated in the
International Journal of Obstetrics and Gynaecology
last year: "In this cycle, departing from the
traditional one... [physical] arousal is experienced
before desire, and orgasm is not mandatory for a
normal response."
As a gay man,
I luxuriate in the ninth row of the conference hall
feeling eerily untroubled by all this. But Basson is
proposing a concept that, should her campaign
succeed, could transform medical involvement in sex.
"I have presented a model that more accurately
depicts the responsive component of women's desire
and the underlying motivational forces," she
wrote in 2000. "The purpose is to prevent
diagnosing dysfunction when the response is different
from the traditional human sex-response cycle, and to
define subgroups of dysfunction. The latter is
necessary before progress in newer treatment
modalities, including pharmacological, can be
made."
*****
