The pharmaceutical industry looks to identify new diseases so it can push new drugs on the market, and patients play along. The approval of reduced female libido as a pathology is a case in point.
MUNICH — A woman doesn't want to sleep with her husband anymore. She still loves him, and she once enjoyed having sex with him. But now, she's never in the mood. What sounds like a common problem among couples who have been together for a long time is now being treated as a pathology.
These days, not wanting to have sex can be cured. There's a pill for that, and it has been approved by the U.S. Food and Drug Administration (FDA). But this certainly is no proof that a woman not having any more sexual desire towards her partner has anything to do with a pathological disturbance.
Critics say a woman's lagging libido is the latest in a number of "made-up diseases." There is a major operation behind a typical life difficulty being officially declared an illness by the pharmaceutical industry, eager to open up new markets.
Shyness as illness
Gerd Glaeske is a health economics professor at the University of Bremen and one of the harshest critics of Germany's pharmaceutical industry. He cites several examples, including the claim that six million German men are suffering from "erectile dysfunction," needing to be treated with Viagra.
He also notes how being shy becomes a "social phobia;" the cure: tranquilizers. And supposedly 800,000 children distracted as kids can be are victims of attention deficit disorder, and are prescribed the drug Ritalin as a treatment.
Pharmaceutical industries have always tried to expand their market, but they are just half of the problem, says Glaeske. The other half are the patients themselves.
People prefer to be a patient, than to actually deal with life's impositions. "We have all gotten used to there being a cure for any complaint," he says. So the pharmaceutical industry's ambitions are simply meeting people's expectations.
"A diagnosis absolves the individual as well as society," says Gisela Schott of the German Medicine Commission, where she deals with the phenomenon of "Disease Mongering," a term used to describe the phenomenon of turning non-medical conditions into affirmed illnesses.
The pharmaceutical industry is at the movement's origin, but we should also cast a critical eye on ourselves. "We tend to read too much into our conditions, and so we pathologize, which ultimately does us harm," she says.
Schott has focused her studies on the syndrome of "burnout." She claims that there are neither clear criteria for a diagnosis, nor any agreed upon treatment of it.
Stress and sex
Before giving the final green light this summer for Addyi, the treatment against lagging female libido, the FDA listened to women who claim they suffer from the dysfunction. Reading the reports of the hearings, you quickly understand what Gisela Schott means when speaking of "absolved by the diagnosis."
Those who testified last October in the U.S. state of Maryland included 50 women or their representatives — "the woman's partner," for instance — between 30 and 70 years old, mostly with the same partner for years.
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Addyi, the "female viagra" — Photo: Compra Viagra Italia
What was the dysfunction they wanted to be treated for? Many complained about stress, anxiety attacks, relationship problems and identity disorders — because their sex life had changed. Not because they didn't have sex anymore. It had just gotten more difficult, less enjoyable, than before. "I want to think of sex. I want to initiate it. I want to get more out of it," says a woman.
This supposed women's illness had originally been identified some 16 years before the arrival of the pill in the 1960s, its name has changed several times, so has the description of the symptoms. The FDA now calls it "acquired generalized hypoactive sexual desire disorder," or HSDD.
In 1990 it was a "sexual dysfunction." An article in a medical journal reported for the first time about the alarming numbers: 43% of American women suffered from such a dysfunction. This number has been widely cited, including in Addyi's advertising campaign.
The story behind this number sounds like a bad joke, but it can be looked up in the original article everything started with, when in 1992 researchers asked exactly 1,749 women if they had encountered any sex-related problems in the last 12 months.
Six potential conditions have been identified: loss of libido, a dry vagina, women having no orgasms, women climaxing too quickly, pain during intercourse or a general feeling of discomfort during sex. Six symptoms, 12 months — one problem was enough to be attributed to these 43% of supposedly sexually disturbed women.
The article's authors handed in a supplement after its publication: they had forgotten to mention their personal link to the pharmaceutical industry, which is common in medical studies. One author had been working for Pfizer, the manufacturer of Viagra. The product was launched in 1998, and opened up the query for a female version of it.
Between 1997 and 2002, there were seven congresses, of which six had been financed by pharmaceutical companies, where experts discussed the origin of sexual troubles among women.
The FDA had repeatedly refused to approve several drugs and substances that are supposed to restore women's libido. Flibanserin, the active component that has been authorized now, had been rejected three consecutive times, in 2010, 2013 and 2014.
"Viagra for women — that was foreseeable," health economist Gerd Glaeske says.
Despite all the criticism, Viagra had been a true innovation. Men who had been suffering from erection problems before could now be treated in a more gentle way. But they also now had to bear the costs on their own because there were millions of new patients. Health insurance companies scratched "erectile dysfunction" from their catalogue of coverage.
Sprout advertised the female Viagra with a campaign titled "Even the Score." It was women's turn now. More fun in the bedroom for all. A textbook case, Glaeske says, of pure disease mongering, .
"You need experts, patients, congresses. An everyday problem we all know becomes a situation that requires action," he adds. It was a huge success, particularly in the U.S., where the companies were legally allowed to advertise the prescription drugs.
A long history
Pure fiction? Medical historian Michael Stolberg wouldn't use that term. "Each disease is a construction," he says. What's sick, what's healthy? How do you draw the line between two diseases? Which symptoms can be considered bearable, which can't? This is being constantly redefined.
Stolberg has discovered a paper from 1786 where a Scottish doctor reflects on "fashionable complaints." That's how doctors would cover their own professional doubts. Each new decade creates its own diseases.
When the first doctors reported on scurvy, their colleagues suddenly discovered the same symptoms in their own patients as well. For hundreds of years women suffered from "hysteria," anxiety, shortness of breath, some said they felt their uterus move. Around 1900, many middle-aged men suddenly complained about a lagging libido and fatigue. The idea of male menopause had come up for the first time.
Disease patterns reflect people's perceptions of their bodies, their relationship with nature and relationships between genders.
Signs of the times
Human sexuality has ever since been a source of insecurities, anxieties, desires. What is normal, what is pathological?
For a long time, a "wrong desire" was problematic. Same-gender sex, a fondness for S&M. These days, for many, pretty much anything sane grown-up and consenting people do is considered unproblematic, says Verena Klein, psychologist at the Institute for Sexual Research at the University Medical Center of Hamburg-Eppendorf.
And if they don't do anything at all? If sex is considered healthy and desirable, good for blood circulation, the immune system and the preservation of relationships — the lack of it, shouldn't it be pathologized? That the desire for sex declines over time, especially in long-term relationships, is normal and natural, Klein says.
This female sexual reluctance disease, is it for real? This remains controversial among experts, says Klein. "The pressure to perfom is key."
But there are women, as well as men, who truly suffer from a low libido. Approximately 10 to 15% of women are concerned. Sometimes couple or sexual therapy may help. Klein says a drug that is supposed to alter the brain's neurotransmitters isn't a solution: "The problem isn't exclusively related to the brain's chemistry."
Initially the active ingredient in Addyi was intended as an antidepressant. Women who wanted to increase their libido should take a pill in the evening, before going to bed, in order to avoid side effects such as dizziness and fainting. They should take one pill a day, avoding alcohol.
The recommended daily dose: 100 milligrams. If the symptoms don't improve within eight weeks, they should abandon the treatment, the FDA advises. During last year's hearing, one woman said she found relief from low libido by using a completely different substance: marijuana.