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First the pill, then the disease

Pharmaceutical company Boehringer Ingelheim doesn’t have an approved solution, but that hasn’t kept it from marketing the problem. The German firm, which touts its new but as yet unapproved drug flibanserin as a treatment for women with low libido, has sponsored a website about the issue. It sent a soap-opera star on tour to discuss the problem, and, according to the New York Times, sponsored a Discovery Channel show on female sexual disorders and an online course for doctors that included a quiz question about an overworked, stressed middle-aged woman who had lost interest in sex. The “correct” response was for the woman to be evaluated for “hypoactive sexual desire disorder,” a severe lack of libido.

We don’t pretend to know exactly how much sex a woman should want, or when a low libido constitutes a medical disorder, but it’s hard to avoid the impression that Boehringer Ingelheim is actively encouraging doctors to diagnose the sexual dysfunction more often than they have in the past.

The disorder does exists, and it is distressing to the small proportion of women who have it. We hope a good treatment comes their way. But flibanserin doesn’t appear to be it. We agree with the staff of the U.S. Food and Drug Administration, and with a subsequent advisory panel recommendation on Friday, that the agency should reject the company’s application.

The staff report had little positive to say about the drug. In studies, flibanserin increased the number of satisfying sexual encounters only moderately compared with a placebo, while causing nausea, dizziness, depression and/or fatigue in a significant number of women. Studies failed to show evidence that the drug helped boost sexual desire. Perhaps most troubling, the drug must be taken every day, like an antidepressant in order to provide a benefit of one or two more sexual encounters per month. In contrast, men take Viagra on an as-needed basis.

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For those reasons, women might not flock to flibanserin even if it is approved. Perhaps that’s why the company appears to be undertaking a marketing program to suggest to women that they might have a problem — a problem that could be solved by the new drug.

This wouldn’t be the first time a drug that treats a serious problem is marketed into common use. Antidepressants have been lifesavers for people with serious clinical depression that cripples normal daily function but, as a result of ubiquitous advertising, many people who felt a little down thought perhaps they should try medication to cheer up. A study published this year in the Journal of the American Medical Assn. found that antidepressants generally had a “negligible to nonexistent” effect on mild to moderate depression. The FDA criticized Viagra ads implying that the drug, a treatment for erectile dysfunction in men, could be used as a sexual enhancer for men who wanted to feel younger.

In an episode of the medical show “House,” an older woman describes her male friend’s frequent use of Viagra. “With all these male enhancements,” she complains, “the pressure to put out’s incredible. It’s worse than high school!” As it turns out, her lover also has been feeling pressured to perform.

Whether we’re aware of it or not, drug advertising affects how we see ourselves and our perception of whether we need medical intervention. A better drug for sexual desire disorder might come before the FDA, but that won’t solve the bigger issue of how much we allow marketing to encourage our use of pharmaceuticals for things we hadn’t necessarily thought of as pathologies before.


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