Friday, June 5, 2015

Flibanserin and the Politics of Medicine

After huge pressure, an FDA panel has approved the drug flibanserin to treat the lack of sexual desire in women. This has been very controversial because the positive effects of flibanserin barely meet the standard of statistical significance, and it comes with serious side effects (low blood pressure, fainting, dizziness, nausea).

In this case the usual lobbying by a manufacturer in search of fat profits was supported by a coalition of women's groups who call themselves Even the Score:
which accused the F.D.A. of gender bias because it had approved Viagra and other drugs to help men have sex while leaving women without options. The participants in the campaign had been brought together by a consultant to Sprout Pharmaceuticals, the developer of flibanserin.
I think this is crazy. Viagra treats a physical inability to have sex, not a lack of desire; without desire it makes no sense to take Viagra. Women's desire for sex is, as all men of my generation have been hearing since we were 16, a hugely complicated thing all wrapped up with emotions and relationships and so on. I suppose the point is that many women have lost desire even when all the things that used to make them hot are there, which implies some sort of physiological factor. Maybe. But if that is true, flibanserin isn't the cure, since as I said it performs only a little better than placebos in the biggest trials.

The positive way to spin the FDA panel's decision would be like this:
The unmet need seems to be so strong that even for a drug with rather modest benefit, I think approving the product with strong limitations seems to be the right step at this point.
But you could also wonder why we are always looking to drugs to solve our problems, and why we are always blaming complex physiological or technical problems on Bad People -- we don't have a male pill because of sexism! we don't have affordable electric cars because of oil companies! If any company came up with a drug that would make women want and enjoy sex, they would earn billions overnight; since no such drug exists despite the huge incentives, this must be a very hard problem. Lobbying and wishful thinking will not solve it.

4 comments:

G. Verloren said...

"Viagra treats a physical inability to have sex, not a lack of desire; without desire it makes no sense to take Viagra."

You're confusing "desire" and "libido". Flibanserin doesn't create the desire for sex. It simply enhances the libido - it facilitates the biological response of physical arousal. It treats the exact same problem as viagra.

A man can desire sex, but be unable to become physically aroused. His body chemistry simply isn't correct - his biology fails to function properly, despite personal wants.

The exact same thing is true of women. A woman can desire sex, but be unable to become phnysically aroused. Her body chemistry simply isn't correct - her biology fails to function properly, despite personal wants.

G. Verloren said...

"But you could also wonder why we are always looking to drugs to solve our problems, and why we are always blaming complex physiological or technical problems on Bad People

Drugs solve problems. That is literally what they do. And they make people's lives objectively better in doing so.

If you come to me with a new drug that solves - or even just helps with - a problem that previously had no remedy, I'm all for it. Having more options available to us is always preferable - even if we have to be judicious about when and how we use those options.

The problems we humans have with drugs don't come from their use, but from their abuse. Exploitation of our fellow humans - typically in form of the exploitation of poor human judgement - is the root evil at work here. And the kind of people who manipulate the availability and usage drugs to exploit others for profit are exactly the "Bad People" you seem to be dismissing as imaginary.

"-- we don't have a male pill because of sexism! we don't have affordable electric cars because of oil companies!"

You jest, but in actuality for generations we DIDN'T have certain drugs because of sexism. (And yes, oil companies have at times actively pushed to hinder the development of electric cars. They are, of course, NOT the primary reason such technology is still unfeasible, but they have certainly demonstrated a ready willingness to have been said reason, if it had been necessary.)

Drug usage his a long and storied history of sexual bias. Drinking and smoking were for rather a long time completely unacceptable - even at times illegal - behaviors for women, despite their being quite a large market to sell into. Birth control has existed in a variety of forms for well over a century, but it was widely outlawed in the aftermath of the American Civil War and only as recently as the 1970s did all Americans win the right to legal access, despite more than ample demand and ready capacity for supply.

If any company came up with a drug that would make women want and enjoy sex, they would earn billions overnight; since no such drug exists despite the huge incentives, this must be a very hard problem."

This may surprise you, but women do want and enjoy sex. Your notions otherwise are, I suspect, the product of your self-admitted generational indoctrination - for which you have my sympathies.

You suggest that untapped drug markets would be an absurdity, that capitalism abhors a vacuum, but as I mentioned above, for generations of women eager for drugs that could easily have been supplied to them, such untapped markets were the historical reality.

Why? For the same reason women were once denied the vote; for the same reason they were once denied the right to own property; for the same reason they are still today denied equal pay, and why . For the sake of control. For the sake of the continued cultural dominance of patriarchy.

You think this new drug being made available is crazy? People once thought the same thing about women wearing pants and riding bicycles.

G. Verlore said...

Barring substantial side effects, I see no reason for this drug not to be made available.

On that note, I feel it would be informative to list the absolutely staggering amount of potential side effects of Viagra - some of which are absolutely terrifying - for comparison. (Source http://www.drugs.com/sfx/viagra-side-effects.html)

More common

Aches or pains in the muscles
bloody nose
diarrhea
difficult or labored breathing
flushing
headache
pain or tenderness around the eyes and cheekbones
redness of the skin
sneezing
stomach discomfort following meals
stuffy or runny nose
trouble sleeping
unusually warm skin

Less common

Bladder pain
burning feeling in the chest or stomach
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
cloudy or bloody urine
dizziness
increased frequency of urination
indigestion
pain on urination
stomach upset
tenderness in the stomach area

Rare

Abnormal vision
Abdominal or stomach pain
abnormal dreams
anxiety
behavior change similar to drunkenness
bleeding of the eye
blurred vision
bone pain
breast enlargement
chest pain
chills
clumsiness or unsteadiness
cold sweats
confusion
convulsions (seizures)
cool and pale skin
cough
deafness or hearing loss
decrease in amount of urine or the frequency of urination
decreased vision
diarrhea or stomach cramps (severe or continuing)
difficulty in concentrating
difficulty in swallowing
dizziness or lightheadedness, especially when getting up from a lying or sitting position suddenly
double vision
drowsiness
dry eyes
dry mouth
dryness, redness, scaling, or peeling of the skin
ear pain
excessive hunger
eye pain
fainting or faintness
fast, irregular, or pounding heartbeat
feeling of something in the eye
fever or chills
headache (severe or continuing)
increase in the size of the pupil
increased amount of saliva
increased skin sensitivity
increased sweating
increased thirst
lack of coordination
loss of bladder control
lower back or side pain
mental depression
migraine headache
nausea (severe or continuing)
numbness or tingling of the hands, legs, or feet
nervousness
nightmares
numbness of the hands
painful, swollen joints
prolonged, painful erection of penis
rectal bleeding
redness, burning, or swelling of the eyes
redness, itching, or tearing of the eyes
redness or irritation of the tongue
redness, soreness, swelling, or bleeding of the gums
restless sleep
ringing or buzzing in the ears
seeing shades of colors differently than before
sensation of motion, usually whirling, either of one's self or of one's surroundings
sensitivity to light
sexual problems in men (continuing), including failure to experience a sexual orgasm
shakiness
skin lesions with swelling
skin paleness
skin rash, hives, or itching
skin ulcers
sleepiness
slurred speech
sore throat
sores in the mouth and on the lips
sudden weakness
swelling of the face, hands, feet, or lower legs
tense muscles
trembling and shaking
trouble breathing
twitching of the muscles
unusual feeling of burning or stinging of the skin
unusual tiredness or weakness
vision changes
vision loss, temporary
vomiting
waking to urinate at night
worsening of asthma

Incidence not known

Blindness

Anonymous said...

G.Verloren, whoever you are (female or male) - kudos to you. I couldn't have said it better.