Monday, January 10, 2011

Sex, Lies, and Pharmaceuticals

Ily has written a number of book reviews in the past, but I think that this is my first one ever. So, here goes...

Sex, Lies, and Pharmaceuticals: How Drug Companies Plan to Profit from Female Sexual Dysfunction (2010) by Ray Moynihan and Barbara Mintzes.

For a book titled Sex, Lies, and Pharmaceuticals, I was surprised at how well balanced this book is. The authors track the creation of the category "Female Sexual Dysfunction" (FSD) by Big Pharma in the 90s, and the many subtle ways that Pharma's generous financial support of research, conferences, and the "education" of doctors blurs the lines between science and marketing in very disturbing ways.

The picture that is painted is troubling, but is not a picture of science being bought and paid for by Pharma or a picture that ignores the real sexual problems that some people have. The complexities of the situation and the admirable motives that often lead researchers to work with Big Pharma are acknowledged. It's not that getting industry money automatically makes someone their puppet, but people with views that Big Pharma likes have access to a lot of money, thereby getting their voices amplified. Money for sex research is very limited, and industry money has enabled a lot of research to happen that couldn't have otherwise. Some people's labs couldn't exist without industry money. Close collaboration with industry offers to the promise of making "sexual medicine" a legitimate branch of medicine, a very desirable prospect given the way that sexology has long been a marginal branch of academia. Dissatisfaction with the efficacy of talk-therapy leads people to want medical solutions to (at least some of the) problems that people present with when seeking clinical help for sexual problems.

Yet Pharma's financial influence tends to lead to surveys that focus on the kinds of problems that drugs could potentially be solutions for, and tend to ignore problems where they wouldn't. There is a tendency toward biological reductionism that ignores the social and relationship factors of sexuality. Advertising campaigns reinforce insecurities and dissatisfaction. The benefits of drugs are exaggerated and side-effects swept under the rug.

There is a curious fact of history that the book doesn't get into as its effects are yet to be seen: at the same time that Big Pharma is trying to sell FSD and create distress and insecurity around lack of interest in sex, there is a growing community on the internet identifying as asexual, and they're asserting that there's nothing wrong with not being interested in sex, and they're getting themselves plugged into the LGBT community and working with people's beliefs about sexual orientation and sexual diversity to promote their own visibility and acceptance. In the Prause and Graham's 2007 paper about asexuality, they sum it up nicely:
Implicit in the debate about what constitutes a “normal” level of sexual desire is an assumption that some level of sexual desire is normative.
Asexuality draws this assumption into question. The affirmation by the asexual community that it's OK to not be interested in sex is fated for collision with the ongoing debates about female sexual function/dysfunction that have been prominent in sexology for the past decade or so, and probably most of the papers on asexuality so far have at least made mention of some relationship between asexuality and HSDD, often noting that asexuality may challenge some common assumptions.

Right now, some people up at UBC are among the leaders in the study of asexuality; they are some of the very same people very much involved in ongoing debates about FSD. Recall that the study that I just linked to a few days ago (by UBC folk) is about differentiating asexuality from HSDD.

I see asexuality as coming to play an increasing role in these ongoing debates. So far, only people favorably disposed towards us have even cared enough to take us seriously, but I wonder how long this will last. Given my own position in the asexual community (and my interest in the relationship between asexuality and HSDD), it seems inevitable that I will play a role in the coming controversies.

Reading this book made me very circumspect about what the role of the asexual community--and myself in particular--will be as what I see as an inevitable debate arises. For anyone interested in the future asexual politics, especially regarding medical diagnosis, this book is a must read. It's not that long, and is a very engrossing read. I highly recommend it.

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