BRIAN
DEER: LOVE SICKNESS Page 2
As her slides
sped by, many of her mostly male audience talked
among themselves, fired off text messages or fiddled
with drug company gifts. After an afternoon session
on phosphodiesterase (PDE-5) inhibitors, which sent a
hundred fingers tickling free Viagra
computer mice, Basson's lecture on the finer points
of female motivation failed to trigger a mexican wave
in the Palais des Congrés. There was still no pill
for an ugly spouse that, if prescribed, wouldn't send
you to jail.
But her model
was a centrepiece for the Paris event's sponsors:
there's gold in that feedback loop. With men's
treatable concerns mostly confined to (a) penis
hardness, or (b) penis hardness, drug companies are
sure how to keep consumers happy. The benchmark of
success is conspicuous. But if women are more subtle
and their concerns less clear, then industry needs to
know PDQ.
Enter the
disease she unveiled from the lectern: the previously
unheard-of sexual interest disorder. "There are
absent or diminished feelings of sexual interest or
desire, absent sexual thoughts or fantasies and a
lack of responsive desire," was how her
committee's report described the problem.
"Motivations (here defined as
reasons/incentives) for attempting to become sexually
aroused are scarce or absent."
More dry
words, but do they mean or change anything? You can
bet your underwear they do. Describing disorders is
like sizing goal mouths: allowing the guys with the
tape measures and spirit levels a say in what reaches
the net. "Diseases are not just out there in
nature," says Dr Richard Smith, editor of the
British Medical Journal (BMJ), who questions the very
existence of many industry-backed dysfunctions.
"They are creations in many ways, and where you
draw the boundaries, and what you define as a
disease, is a very tricky business indeed."
The boundaries
Basson challenges are some of medicine's most
authoritative, thrashed out over decades of debate.
Currently, the consensus-setting Manual of Mental
Disorders, issued by the American Psychiatric
Association - which in turn feeds into the World
Health Organization's (WHO's) International
Classification of Diseases - recognises a condition
called "hypoactive sexual desire disorder",
described as "a deficiency or absence of sexual
fantasies and desire for sexual activity".
This might
sound similar to what she's suggesting, but, as so
often, the devil is in the detail. The concept of
"interest" is plainly bigger than
"desire", so already we get dysfunction
inflation. But even widening the net with a broader
definition is only the start of the reconstruction
she seeks. At present, the psychiatric association
has an essential requirement to diagnose a disorder: "marked
distress or interpersonal difficulty". And
the WHO includes a crucial prerequisite that for a
person to have a problem they must be "unable
to participate in a sexual relationship as he or she
would wish".
But these
criteria will be dumped if the plans unveiled in
Paris gain a foothold in official classifications. In
place of the requirement that a patient must complain
of a problem, Basson wants to substitute
"descriptors", including a "scale of
distress" which, according to her committee,
includes "none".
"So,"
I debate her on the phone from London before catching
my flight to Canada. "You are saying that women
can have this sexual interest disorder even if they
don't feel they have a problem themselves?"
"Yes,"
she says. "It's a bit like saying a man can't
ejaculate. Now, he's not trying to be a father. He
doesn't care. He enjoys everything he does - the
arousal and intercourse - if he wants to. He just
doesn't ejaculate, and he doesn't mind. Does he have
a disorder or not?"
Ouch.
"I'd say he probably did."
"Why?"
she hits back. "If it doesn't bother him?"
"For the
same reason you could have a broken leg and not be
concerned," I joke.
"I agree
with you on both of them," she says.
"You've still got a disorder. I think the man's
got a disorder. And it's reasonable to say the
woman's got a disorder, even though it doesn't bug
her. Because it's a kind of assumption that most
women have an interest in sex."
Hey presto,
the numbers with a disorder hit the ceiling like a
guy with no problem at all. Although research
published in June from the world-famous Kinsey
Institute in Indiana suggests that only 7.2% of women
complain of this problem, according to a stream of
papers recently pumped into the medical literature,
the number of women who say they "lack interest
in sex" is between one third and 40%.
Here's a
vision of a market to restore vigorous appetite to
the most dysfunctional pharmaceutical boss.
*****
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