BRIAN
DEER: LOVE SICKNESS Page 3
On
either side of the waiting room at Vancouver's Centre
for Sexual Medicine are tables loaded with industry
literature - for the most part aimed at men.
Questionnaires are in vogue, and I find myself
scanning them, while Rosemary Basson finishes up with
a patient. "Do you remember a time when you felt
better about your ability to have sex?" asks
GlaxoSmithKline's brochure, Intimacy, Depression and
Antidepressants. "Do you find yourself falling
asleep after dinner?" inquires Organon's leaflet
Testosterone and Andropause.
I
tear a four-by-eleven-inch quiz form from a pad that
gives no clue to its publisher or printer. But I have
seen it before, and even know who wrote it:
psychologist Dr Raymond Rosen of New Jersey. Asking
stuff like "How do you rate your confidence
that you could get and keep an erection?" and
"During sexual intercourse, how difficult
was it to maintain your erection?" it draws me
into scoring myself on a scale of 1 to 25 - with
"21 or less" a reason to see the doctor.
The form
looked official, perhaps from the Vancouver hospital,
but it was really a crafty Pfizer sales tool. Rosen,
a professor at Robert Wood Johnson Medical School in
Piscataway, is a pre-eminent drug company consultant
in this field - financed by Pfizer, Merck, Lilly,
Bristol-Myers Squibb, Procter & Gamble and Icos -
and has cornered the market in consumer surveys that
lay the bedrock of industry campaigns.
But confusions
are as common in the field of pharmaceuticals as they
are in the world of double glazing. A Basson abstract
on the Medline database, for instance, implies that a
study of Viagra comes from the Vancouver hospital -
while the text shows it's really from Pfizer. The
grandly-named International Index of Erectile
Function and the Female Sexual Function Index are
merely formats for Rosen's Q&As. And the
influential Consensus Development Panel on Female
Sexual Dysfunction is just 19 specialists, Basson
included, of whom 18 admit receipt of industry money.
Even the Paris
conference wasn't quite what it seemed - at least to
some of those who sat around me. Vice-chair Basson,
two members of the scientific committee and various
other participants all told me that the Palais des
Congrés gathering was a WHO event. "It's a
consultation to them, to guide them when they make
their decisions," Basson explained. "Plus
the financing of the consultation comes from
them."
This was news
to the WHO, who e-mailed me from Geneva dissociating
the agency from the meeting. Although participants
told me they thought that travel grants for a
"faculty" of around 200 key opinion-formers
(a free hotel room each and $1,700 expenses) came
from the United Nations health body, the whole
shebang was essentially an industry jamboree, as was
the previous Paris bash four years back.
"For the
1999 conference, WHO agreed to co-sponsorship on the
understanding that there were no commercial interests
involved," the director-general's office told
me. "We later learnt that satellite symposia
[advertising segments] organised by pharmaceutical
firms were included in the programme. We asked the
organisers to remove this from the programme, but due
to the intervening lapse of time, our records are
incomplete on the follow-up to this request."
This didn't
stop a 750-page colour book being published from the
1999 conference bearing the WHO crest - and I found a
certain murkiness, even for pharmaceuticals, when I
tried to nail down the book's status. Co-authored by
Rosen, it purported to be published by "Health
Publication Ltd", a company with nothing more
than a Jersey, UK, post office box. Another Jersey
box in the name of "Signet Media", to whom
conference cheques were paid, didn't come up on the
3.3-billion-page world wide web. And the
registered address of the organisers' domain was the
unhelpful not @available.com.
When I raised
these with Basson, she said she didn't know, but she
must have felt the hand of business. The Paris events
were just two of seven industry-backed gatherings in
the past six years that laid the ground for the
definitions she announced. The founding event, held
in May 1997 at a hotel on Cape Cod, was sponsored by
nine drug companies. "The meeting is completely
supported by pharmaceutical companies, and half the
audience will be pharmaceutical
representatives," Rosen wrote to colleagues at
the time. "Only investigators who have
experience with, or an interest in working with the
drug industry have been invited."
Basson knows
the score. It's how the system works: how industry
holds the ring for medical discourse. "There's
not a lot of money in medicine, period, and for
research in the area of sex it's just dismal,"
she tells me, arguing that without such support
leading experts around the world would never meet
face-to-face. "So what do you do? You just sit
in your little clinic and you can't help
anyone."
But he who
pays the piper at least expects to enjoy the music -
and not to hear notes of discord. "Industry has
a narrowing effect on how we see problems through
various mechanisms, all of which are to do with
money," says Amy Allina, policy director of the
Washington-based National Women's Health Network, who
points to the many causes of poor sex lives that may
be overlooked in drug-based research.
What happens,
for instance, to headaches, stress, fatigue or
boredom? What about the lack of physical exercise or
poor diet? And what about life with a partner you
don't like, much less want to be physically involved
with? Does industry want to pay for highlighting such
topics? You had better believe it does not.
"Bias is
very subtle," says Smith of the BMJ. "There
are many more people who want to do research than
receive funding, and if you have the huge resources
of the pharmaceutical companies, you can say you'll
fund these people and not those people because these
people view the world in a way that looks good to
you."
Industry's
current favourite is a dramatic expansion in the
numbers alleged to be dysfunctional. According to
scores of scientific papers, including one with
Basson's name on it, 43% of women (and 31% of men)
have a sexual "dysfunction",
"problem" or "complaint". And as
New Jersey psychologist Dr Sandra Leiblum, who has
worked with Rosen for years, told an event sponsored
by 17 companies in 1999: "Especially remarkable
was the finding that one out of three women said they
were uninterested in sex."
Remarkable,
indeed, since they didn't exactly say that - and
there is no data that any complained. The figures
being used to build the new market have been cribbed
from work led by a Chicago sociologist, Dr Edward
Laumann, (sponsored, like Rosen's medical school, by
the philanthropic arm of Johnson & Johnson). But
all he asked women was: "During the past 12
months, has there ever been a period of several
months or more when you lacked interest in having
sex?"
Well, so what
if there was? Does that fix them as uninterested? Is
that a basis for diagnosing a disorder? If a woman
isn't turned on by the father of her children, does
that really mean she's mentally ill? "I think we
should be very suspicious of these figures,"
says Dr Ellen Laan, professor of clinical psychology
at Amsterdam University.
Laumann's
figures might have faded like a magazine sex survey, with little
more reaction than "fancy that". But
in 1999 his data resurfaced on the new tide of
industry cash. For some reason, the otherwise
prestigious Journal of the American Medical
Association republished his seven-year-old research
as an "original contribution", now
co-authored by industry man Rosen. Two months later,
the journal issued a "correction".
"Since 1997," it said, "Dr Edward O
Laumann has served on the Scientific Advisory
Committee to Pfizer."
*****
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