BRIAN
DEER: LOVE SICKNESS Page 4
While Basson
makes tea, I study her office, which faces downtown
Vancouver and the Burrard Inlet. Often when I have
interviewed doctors and scientists, their walls have
been spattered with certificates and awards - and
occasionally a Nobel prize. But her space is spartan.
Her priority has been patients. She's a late bloomer
in the pharmaceutical garden. Pride of place goes to
a poster of a Eugene Smith photo and a group portrait
of the King's College London Medical Society when she
was a student there in 1967.
So why front a
campaign with a working clinician? Why not wheel out
some established big cheese? As we talk in her
office, that mystery fades: if she didn't exist, they
might need to invent her. Of course, they need a
women to medicalise female sexuality - and the key
players in urology are all men. They need a medical
doctor - and the field of sexology is overrun by
PhDs. To pluck a leader from Canada is a political
masterstroke: it plays well in both the US and
Europe.
But the
married mother-of-two argues that medicalising
sexuality is the opposite of what she intends. Her
model, she says, is "bio-psycho-social",
requiring doctors to elicit a rounded picture.
"All of us aren't like little robots," she
tells me. "Because the pharmaceutical industry
is now interested, and maybe now there are drugs for
various aspects of the physiology that can go wrong,
it doesn't mean it's all a medical entity."
Some of her
research, she says, points to Viagra's limitations,
and she argues that the impact of defining sexual
interest disorder may actually reduce drug
prescribing. "The data to date suggests that
most women who go ahead and have sex with their
long-term sexual partners do it for reasons of
emotional closeness," she says. "There's
not going to be a drug to increase emotional
closeness."
Well, I think
she's wrong. Ecstasy does that now, admittedly with
quite some downside. Testosterone, meanwhile, is used
to raise women's libido, and oestrogen to create
"wellbeing". Drug companies are doing
nicely with products for inattentiveness (Ritalin),
shyness (Paxil or Seroxat) and life's futility
(Prozac). And last month American researchers
reported that the selective serotonin reuptake
inhibitor citalopram was effective in
"compulsive shopping disorder".
In my view, I
told her, her ideas could be used to sell Viagra to
women today. Although research looks thin on its role
for female problems, mysterious new conditions, such
as "vaginal engorgement insufficiency" and
"clitoral erectile insufficiency", are
emerging, for which her model may be invoked to
address. If, as she says, (a) different stages in the
sexual response cycle reinforce each other, and (b)
physical arousal precedes feelings of desire, she may
be opening the door for prescribing drugs for arousal
when the patient has ticked "lack of
interest" in the quiz.
But more
important is the direction of scientific research,
for which her model may map new routes. For hospital
ethics committees to approve new-product trials, they
must first have a disease for the product to treat.
No disease, no treatment. End of story. But if the
campaign Basson launched to change definitions
succeeds, "sexual interest disorder"
becomes a bona-fide problem to which remedies may be
properly addressed.
There will be
no quick fix and, as research goes on, her
announcement in Paris may be forgotten. But, no
question, from the lectern she proposed a new
paradigm that chimed well with the spirit of big
pharma. Just as television audiences have fractured
in the face of cable and satellite, so markets for
medicines are threatening to shatter as gene-based
personalised therapies loom larger. As generic
manufacturers gnaw at patent rights, the
research-based industry lusts for new blockbusters
for us all to swallow daily for life.
As Rosen's
colleague and Paris attendee Leiblum hints at the
priorities in the introduction to her book, Getting
the Sex You Want: "While the search is on for a
miracle potion or fail-proof device that will
transform sex and make it magical, it is my belief
that ultimately, women hold the tools necessary to
get the sex they want. It is their willingness to do
what needs to be done - whether it means taking hormones,
starting therapy, or believing that they are
entitled to sexual pleasure." [My italics]
By an
astounding coincidence, Leiblum was in Vancouver and
hijacked my first session with Basson. But back to
one-on-one, we return to my worry that the British
doctor may be pathologising untroubled, healthy
women, bringing medicine where it doesn't belong. It
seems to me that if a person isn't interested in sex
and doesn't want to train a partner to change that,
they might take up tennis, read Anna Karenina, or in
some other way get on with their life. I also found
it troubling to see a model implying that women
merely responded to men.
"I could
argue it from either side," she says. "I
could argue it from a feminist side, saying, 'Look,
if you don't care about a disorder, even though
you're totally different from everyone else on the
planet, who cares? It's not a diagnosis. It's not a
disorder.' Then you could argue it from the other
side and say, 'Look, if your appendix is inflamed and
it's pus-y, it's going to burst,' and you reply, 'I
don't care. I don't mind the pain. I do not have
appendicitis.' Well, of course you have appendicitis.
Whether you care about it or not, in the medical
world, is irrelevant."
"But that
doesn't happen," I say. "Except in weird
religious groups. If you're in a situation when you
have no interest in sex - even an 'abnormal' lack of
interest in sex - but it doesn't bother you, and
you've not presented yourself to physicians saying
you have a problem, your position is that their
condition still exists."
"That's
right," she says.
"Now that
creates the opportunity for all your little
questionnaires in the waiting room - tick, tick,
tick, tick. 'Speak to the doctor about this', and the
doctor will flog you a drug."
"But
women who have no interest in sex and don't care are not
going to take a drug," she hits back. "Why
would they? They don't care."
"Because
then you're into fashion, social pressures, cultural
pressures."
"If
you've got no interest, you've got no interest. By
definition."
"But if
you turn on your TV and it says, 'Are you feeling
this?' and you start to think: 'Maybe...' Then it
says: 'Are you bored?' And you think: 'Oh, well...'
And maybe it ties in with depression. 'Maybe the
reason you're depressed is because you're not getting
enough sex.' And you say: 'Oh, I'm not interested in
sex...' And they say: 'Well, we have a product for
that'."
"We
haven't got a product for women's sexual
interest."
Well, no. She
is right. Not yet.
The blue pill
era has barely dawned. We've only five years of
erection enhancement. There will be many more
conferences, foreign trips and research papers before
big business sells drugs to turn us on.
| briandeer.com |
Read an
investigation by Brian Deer into sexual medicine five
years earlier in Pfizer's Viagra, or into the
pharmaceutical industry at its weirdest in Bactrim - Septra -
Septrin
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