BRIAN
DEER: LOVE SICKNESS Page 1
The
Sunday Times Magazine, 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."
*****
Responses,
information and other feedback concerning this
resource on efforts to win acceptance for sexual
interest disorder are appreciated - via the briandeer.com homepage.
|
