Dr. Jennifer Berman was the golden newcomer to the burgeoning world of women's sexual health when, in 2001, UCLA lured her from Boston University with a prestigious fellowship and groomed her to open its Female Sexual Medicine Center.
Her promise of an innovative approach to an array of disorders grouped under the newly minted term "female sexual dysfunction" had rocketed her to the forefront of the hunt for a drug to enhance female sexual pleasure. Viagra's manufacturer, Pfizer, stood at the head of a long line of companies eager to work with the articulate and telegenic sexpert.
But early this year, the UCLA clinic quietly closed its doors amid what the 41-year-old Berman describes as tension between her and certain colleagues over the direction of her career. They were "jealous" and "mean," she says, about her supposed transformation--with the help of a cable-TV show that cast her as a hip Dr. Ruth Westheimer--from a "real doctor" into a "media personality."
It probably didn't help that the notion of female sexual dysfunction, or FSD, had begun to take a beating, including a sharp jab from the British Medical Journal. "The corporate-sponsored creation of a disease is not a new phenomenon," a 2003 article said, "but the making of female sexual dysfunction is the freshest, clearest example we have."
Berman's critics consider her a suspect prophet who uses TV and other media platforms to help redefine complex female sexual problems as dysfunctions that require medical intervention. They wince at her endorsements of medical solutions to what may well be complex interpersonal sexual issues. And they would probably raise eyebrows at her venture in Beverly Hills, where on a hot August afternoon she is walking down the street with her publicist and planning the fall launch party for her sexual medicine practice at the Rodeo Drive Women's Health Center.
"There'll be food and drink and music. Just like the BCBG store's launch, same concept," Berman says. Word had it that the L.A. clothier's grand-opening party promised a bash with Sharon Stone, Paula Abdul and Sarah Michelle Gellar.
"Get me on the list," Berman instructs, as her tan, blond reflection glides past BCBG's plate-glass windows.
"I will," her publicist vows.
Although Rodeo Drive seems an unlikely location for a research urologist, Berman expresses relief at escaping the stuffy confines of "the academic status thing." Her openness with journalists has steadily paid off with flattering stories in People, Vogue, Elle, Glamour and other publications. And since leaving UCLA, she seems to welcome any and all questions: What couldn't she live without? "My horse and my vibrator," she says in an online feature promoting her Lifetime TV special "Secrets of the Sexually Satisfied Woman." Her favorite place in the house for sex? "By the pool." Who should play her in a movie? "Jennifer Aniston."
But there are limits to her candor in an interview for this article. How much has she earned over the years as a consultant to Pfizer, Vivus, Cellegy, Bayer, Procter & Gamble and other drug companies?
Berman pauses, turns to her publicist and asks a question of her own. "Am I supposed to be answering this?"
The private sector has long been a major source of medical research money. Studies on sexual health in particular, including the voluminous Kinsey Report underwritten by the Rockefeller Foundation in the 1940s and '50s, have largely depended on non-government sponsors. It's an accepted practice for researchers to list their benefactors, usually in fine print, when delivering their findings in journals or at conferences.
Berman follows this protocol, but otherwise she has been discreet about her corporate ties, as most doctors are. Apparent conflicts of interest compromise their influence as opinion makers. And most patients want to view physicians as advocates for their health--not for drug companies.
The glossy magazine interviews don't say, for example, that while at UCLA, Berman was a paid drug company expert for media campaigns that publicized low female libido and other maladies. By her account, Pfizer paid for studies she developed and conducted, including some that measured Viagra's effects on women. She broadcast the drug's potential benefits for women on "Berman & Berman," the Discovery Health cable-TV series that she co-hosted with her younger sister, sex therapist Laura Berman.
Berman is right when she says it's hypocritical for any doctor who has accepted drug-company payments to skewer her for conflicts of interest. But her critics, including the former director of the Kinsey Institute, assert that Berman further blurred the boundary between science and marketing when she and other FSD proponents maintained close financial ties to drug companies that they say helped to develop the concept of female sexual dysfunction. To these observers, FSD looked like a creation, as erectile dysfunction was, of a drug company marketing department.
Berman did help to define--or create, critics would say--the disorder, claiming in the Journal of Sex and Marital Therapy that as many as 50% of American women suffer from a sexual dysfunction. FSD disorders include, according to the American Foundation for Urologic Disease (now known as the American Urological Assn. Foundation), sexual arousal disorder, orgasmic disorder and hypoactive sexual disorder--a lack of interest in sex.
When FSD gained momentum as a hot topic of conversation, Jennifer Berman and her sister--nicknamed the Baby Ruths, the Love Doctors, the Viagra Twins--did most of the talking, on "Good Morning America," "Larry King Live," "48 Hours" and other national TV shows. "I was sort of taking off where Masters and Johnson left off," Jennifer Berman says.
Even some fellow proponents of FSD disapprove of the sisters' drift into pop culture. These days, pioneer sex researcher Dr. Irwin Goldstein, a longtime Berman mentor, pointedly demands not to be placed in the same league with the sisters--both his former protegees at Boston University. "These people are into aromatherapy and media and massage," he says. "[Jennifer] didn't want to be in our world. I presume her world may be more lucrative."
When the UCLA David Geffen school of medicine tapped Berman in 2000 for a female urology and reconstructive surgery fellowship, the university portrayed her as a refreshing champion of empowerment in a society that exploits sex yet undervalues female sexuality. When the center officially opened in July 2001, a UCLA news release with the headline "Our Bodies, Ourselves"--the title of the groundbreaking 1970 women's health bible--hailed it as "the first on the West Coast to address the physical, psychological and emotional issues that can cause sexual problems in women."
Berman brought along Laura as the center's co-director. The daughters of a colorectal surgeon, they grew up on Manhattan's Park Avenue before the family moved to St. Simons, a resort island off the Georgia coast. Frank discussions and humor about below-the-belt bodily functions were staples at the dinner table.
Jennifer Berman graduated from the Boston University School of Medicine in 1992. And as she developed her urology specialty, she became interested in women's sexual issues. In 1997, while still a resident at the University of Maryland Medical Center and before Viagra hit the market in 1998, she conducted a small pilot study on Viagra's effects on women with arousal and orgasm difficulties. "I was probably the first doctor to give [Viagra] to women," Berman says with pride. "I was a pioneer." The early findings caught the attention of Pfizer, she says, which used the research as a "premise to support the hypothesis that their drug might work" in women.
Pfizer gave her its Scholar in Urology Award in 1998. She also won a prestigious appointment at Boston University School of Medicine, where Goldstein was director of the Institute for Sexual Medicine. He invited her to co-found its Women's Sexual Health Clinic. Partnered with Laura, who had earned a doctorate in health education and therapy at New York University, Berman set out to explore the physical and psychological components of female sexuality.
In the fall of 1998, Berman says, she teamed up with other health professionals to define symptoms ascribed to female sexual dysfunction. The published account of the panel's findings in the Journal of Urology disclosed financial sponsorship from eight pharmaceutical companies. In its withering article on FSD, the British Medical Journal would later report that all but one of the 19 authors, who described themselves as "thought leaders," had ties to 22 drug companies, including Pfizer. For Jennifer, 1998 was a banner year. While on vacation, she met a professional yachtsman, Greg Moore, and later married him.
It was a big year for Pfizer as well. When Viagra hit the market, it didn't just rejuvenate the sex lives of middle-aged men--it touched off a landslide of research money. Promising young urologists, who could be the intermediaries to hugely profitable new markets, found themselves being offered ski trips and first-class plane tickets. "It was at its peak, all of the schmoozing and wining and dining," Berman recalls. The industry also helped sponsor medical events, Berman says, focused on the release of research results. "Every night you're out--one night with Bayer, the next night out with Pfizer," she says. Berman said she declined any vacation enticements, but she didn't shut down her suitors. "They needed my expertise."
The drug companies represented financing and encouragement that was largely unavailable from public agencies such as the National Institutes of Health. While in Boston, Berman began consulting with Pfizer, Bayer, Procter & Gamble, Eli Lilly--"all of them." According to Berman, the companies figured out that "Hey, she's pretty nice and great, and can communicate." They asked her to do educational campaigns. "Once you deal with the marketing side," she says, "there's usually more resources."
Then in 1999, an article by other researchers in the Journal of the American Medical Assn. reported that 43% of women in a study group suffered from a female sexual dysfunction. The figure quickly reverberated in the mainstream media, including a 2001 "Oprah" segment titled "Advice for Wives Who Don't Want Sex," as a sign of a near-epidemic.
Berman was prescribing the hormone testosterone to boost female libido. She also prescribed Viagra for some female patients on the theory that the drug, which increases blood flow to the genitals, would increase sexual pleasure. Neither had received FDA approval for these uses, but both are commonly prescribed "off-label."
John Bancroft, a senior research fellow at Indiana University and former director of the Kinsey Institute there, says marketers for pharmaceutical companies have played too great a role in dictating the direction of female sexual research. He believes the Berman sisters, in particular, have contributed to the "medicalization" of benign sexual behaviors by healthy women who are too tired or stressed to enjoy sex.
"It's crazy," Bancroft says. "To call anything that 43% of the population experiences a 'dysfunction' is questionable. There's been very vigorous research in this field, almost all of it funded by the pharmaceutical industry, and I think it has ended up with having a bias toward medicalizing these problems. The Berman sisters have been quite successful in getting into the media and bringing attention to themselves. I don't have a lot of respect for them scientifically.... They haven't let any scientific evidence get in their way."
Even sociologist Ed Laumann, coauthor of the article that stated that 43% of women had recently reported a female sexual dysfunction, and a Pfizer consultant since 1998, agrees that women's so-called dysfunctions often stem from everyday life, relationship troubles and, in some cases, harsh taboos about female sexuality. "It doesn't take a rocket scientist to figure out they're not interested in sex when they're exhausted taking care of a kid," Laumann says. "I would see it as part of the normal human condition." He now says his findings were appropriated for other purposes. "Obviously the pharmaceutical industry was taken aback by the remarkable success of Viagra, and that's where it goes over the line. There's a process of medicalization."
But the most dogged critic of FSD is respected sex therapist Leonore Tiefer, an associate clinical professor of psychiatry at New York University School of Medicine, who in July convened a scientific conference in Montreal on "Female Sexual Dysfunction: A New Medical Myth," where clinicians, researchers and activists decried "the hidden hand of big Pharma" in shaping perceptions of sexual health.
"The minute it was clear that Viagra was going to sell a billion dollars' worth, the industry needed [a condition] for women that they could market Viagra for," Tiefer says. "There is a constant effort to manufacture new diagnoses so people will label parts of their personalities in need of drugs."
When Berman started her Pfizer-funded research in Boston, Tiefer says, "Jennifer had some interesting scientific plans." Then "this whole PR thing exploded. As soon as [the Bermans] got [to Los Angeles], I saw much more commercialization than research. It's a shame.... "
In Jennifer Berman's view, though, "there is no such thing as too much funding for research, wherever it's coming from." She says her critics, specifically Bancroft and Tiefer, shortchange women with their narrow approach to sexual health issues. "They say we're medicalizing sex and in bed with the pharmaceutical companies," she says. "For these people to say ... that all women need are happier emotional lives is doing women a disservice. I'm incorporating mental health in my practice. These people should be incorporating medical solutions."
The UCLA female sexual medicine center opened in a 1,500-square-foot clinic. "It was something [the university] thought would draw women to [its] hospital," Laura says. "That would make them unique as an institution. A combination of a business opportunity and a way to reach out to women." Jennifer puts it more bluntly: "UCLA was hoping for a cash cow."
The sisters' book "For Women Only"--coauthored with New York Times journalist Elisabeth Bumiller--was published in January 2001, and it shot up the New York Times bestseller list. Its message? Sexual satisfaction is something women deserve--and should expect. When the clinic opened, it was swamped.
"We had a 1,000-person waiting list," says Laura. "We ended up with a lot of upset, frustrated women calling from all over the country. I can't tell you how many women would be sitting in my office just crying from relief. It was almost like a grass-roots movement."
In addition to seeing patients, Jennifer worked with Pfizer to develop the protocol for a clinical study measuring Viagra's effects on 200 women at 31 medical centers throughout the country. While at UCLA, the sisters also found time to develop "Berman & Berman," a Discovery Health channel show that aired for three years and earned them more than $1 million for 65 episodes. They planned a second book, "Secrets of the Sexually Satisfied Woman," a self-help manual that covers physical and psychological factors affecting sexuality, with tips on aids from candles and massage oil to off-label Viagra and testosterone. It came out in April and generated a TV-special spinoff.
Less visible was another joint Berman endeavor, orchestrating media campaigns via satellite. "You sit down in front of a camera in a studio and go on lots of news programs around the country, talking about the issue of the day or the public awareness issue you're promoting," Laura says. For Procter & Gamble--which was hoping to market its own testosterone patch to increase female sexual desire--they heightened awareness of female libido issues. They discussed bladder health for Ocean Spray, herpes for Levitra, birth control for Seasonale and spotlighted other issues for Bayer and other clients. Jennifer didn't see any conflicts of interest with her scholarly work, because "I was very careful not to endorse any particular product, just create awareness of a particular disease."
Jennifer says UCLA took a commission from fees earned from the TV show and media campaigns, which Laura says brought from $10,000 to $75,000 or more per day. Roxanne Yamaguchi Moster, media relations director for UCLA Health Sciences, says the university collected its "standard overhead deduction" of 12.5% for the Discovery Health show. The university was unaware of corporate payments to the Bermans for media campaigns, she says, but it did receive donations from Ocean Spray, Pfizer, UroMetrics, Pharmacia and other companies. She adds that UCLA received financial support from other firms--Procter & Gamble, Vivus, Farr Laboratories--that helped offset the training expenses of the female sexual medicine fellow who worked with Jennifer.
The expanded Viagra research, meanwhile, yielded promising news for Pfizer. In September 2002, the Bermans posted an update on their website at www.newshe.com stating that their findings, published the following year in the Journal of Urology, suggested that the drug could heighten sexual arousal for some women who had undergone menopause or a hysterectomy. "As the evidence of Viagra's success in women begins to develop, it will still be quite awhile before both sexes can pop their little blue pills and enjoy an enhanced sexual experience," the sisters wrote.
Their enthusiasm about Viagra was less guarded on "Berman & Berman." According to a transcript of a 2002 segment posted on their website, Laura explains that physicians can prescribe Viagra for women even though it's not FDA-approved for that use.
"I thought it was just for men," a guest on the show says. "Well, you're gonna learn," Jennifer responds, handing another woman 100 milligrams of Viagra and a vibrator and leaving her behind a partition with an erotic video while Jennifer measures her physical responses.
Later in the same show, Laura welcomes Hugh Hefner, "the poster child for Viagra," and a voice-over says: "Thinking about trying Viagra? It's now available from your doctor in a free six-pill sample box." Pfizer eventually dropped its efforts to prove Viagra works for women, saying that although it appeared to produce signs of physical arousal in some women, it did not seem to make women more desirous of sex. And Procter & Gamble has failed, so far, in its attempt to win FDA approval for a testosterone patch for women, with government officials citing concerns about unknown long-term effects.
Laura Berman left Los Angeles in late 2002 to get married and move to Chicago, where she started her own sexual health center offering, among its services, an "intensive week of sexual and personal make-over."
Jennifer, meanwhile, started feeling the impact of her high-profile extracurricular activities. She attributes the "weird undermining stuff happening" at UCLA partly to sexism in the male-dominated urology department and partly to jealousy about her television appearances and cash-based medical practice. Early this year, she decided to accept an invitation from doctors who had been trying to woo her into private practice.
Jennifer believes that a viable sexual medicine practice within academia is an uphill battle. On this point, her onetime mentor, Goldstein, seems to agree. He decamped Boston University in May and says he's searching for a more supportive academic environment in which to practice sexual medicine. He compared his frustrations to those of pioneer sex researcher Alfred Kinsey, who toiled in the not-so-distant dark ages of American sexual ignorance. "The humiliation and embarrassment and frustration and lack of acceptance he had to go through as a scientific investigator is as evident and permeating today," Goldstein says.
UCLA says it closed the center in February because the Bermans' departure left it without leadership. "They were the center," university health systems spokeswoman Dale Tate says. "It's not like there are 50 Jennifer and Laura Bermans out there for us to go and try to hire." Other university officials, including the head of the medical center, declined to comment on the Bermans.
One former UCLA colleague, who declined to be quoted by name, says, "Academically, we didn't feel it was productive to our department. Academically, it didn't work out."
At the new setup in the rodeo Drive Women's Health Center, a light-filled penthouse, Jennifer envisions a "boutique practice, outside of academia, to deliver quality care in a spa-like high-end environment." She talks about hosting a vaginal physical therapist and women's therapy groups to deal with pregnancy, infidelity and stress. She also wants to offer acupuncture, nutrition and diet advice, yoga, meditation and Pilates.
Without the credibility she acquired at UCLA "as a thought leader and an opinion leader, starting out like this would have been very difficult," she acknowledges.
Yet on that hot August afternoon, she can't help but feel liberated. "In the real world out here on Rodeo Drive," she says, waving at the clothing stores, "nobody knows from grants or papers, or for that matter cares. They want you to be respected and knowledgeable and a good doctor."
At lunchtime, she and her publicist head for the neo-Spanish cafe in the Frederick Fekkai salon. Berman thinks aloud about a newspaper story that day that discussed whether autistic traits might be linked to the amount of testosterone exposure in the womb. "The question is, how do you get too much testosterone?" Berman asks. "With all these women taking testosterone for their libido, how are they getting too much testosterone?"
It's an interesting question, coming from a doctor who--like many of her colleagues--has prescribed off-label testosterone for years, and defends its use to treat the supposedly ailing American female libido. It's the type of unknown long-term effect that the FDA might have had in mind when it declined, for the time being, to approve testosterone patches for women.
The question hangs in the air, then Berman's publicist interrupts. "That's Nicky Hilton," she says in an excited stage whisper, pointing to a polished brunet sauntering by in huge sunglasses, shorts and flip-flops. "I tried to do Paris Hilton's PR once," she continues, "but whenever I called her on her cellphone, she never called me back. She told me she kept losing her cellphone."
Out here in the real world of Rodeo Drive, the epicenter of perpetual desire and everlasting youth, there is none of the resistance that made the ivory tower so inhospitable, Berman says. "Inside those walls, it's a lot of stress and a lot of pressure--and a lot of frustration."