Drugs Companies and The Battle Between Truth and Marketing

Each issue of the news summary magazine “The Week” has a page entitled “Health and Science”. I think it is always entertaining reading. This week it features a column on “The truth and lies about female sexual dysfunction” discussing and summarising commentary in the Guardian newspaper and elsewhere on the subject. As the article explains, The Guardian reported at 20% rise in the incidence of “female sexual dysfunction” from 43% to a fairly staggering 63% in the space of just six years from 1999 to 2005. As always, when such a big change in incidence of health problems occurs quickly, the first questions are “how was the problem defined in each case?-was the same definition used and were the same questions asked?” As the article in “The Week” explains, these turn out to be very pertinent questions. Essentially, the evidence for this “epidemic” of female sexual problems consists of self-reporting in surveys; in many surveys, any woman who answers “yes” to the question “have you experienced any difficulties with sex in the past year, including lack of desire or pain” is considered to be suffering from “female sexual dysfunction”.  Since there are a huge range of psychological and just general life-pressures that can give a temporary reduction in libido in men and women, it does not take an Einstein to see the flaws in this method of reportage.

Aside from the inherent interest of this story, there is another reason for discussing it and that is that it ties in with the arguments of a new book that female sexual dysfunction is, in part, at least, a “disorder….invented by pharmaceutical companies in order to create a market for their drugs”. The book is “Sex Lies and Pharmaceuticals” by academic and health writer Ray Moynihan and, according to “The Week”, it argues that “Companies no longer just sell drugs… Increasingly they create a disease, like female sexual dysfunction and then spend a fortune “educating” doctors to prescribe strong drugs to women that they don’t need and that are unlikely to help them”.

Obviously female sexual dysfunction is not an imaginary disorder- there are clearly women with this problem, but it does seem likely that its incidence has been exaggerated- or that the definition of it has become too liberal- at least as far as these surveys are concerned. What is interesting to me is the wider issue behind this of the conflict within pharmaceutical companies between objectivity and product- research and -development on the one hand and marketing demands on the other. It is obvious that drug companies are not charities and that drug development is an expensive and financially risky task, so clearly they need to employ some business tactics, but it is not provocative to say that “educating” doctors and –worse- patients, about illnesses of questionable prevalence and treatability is clearly unethical. 

The British population is a little isolated –or protected – from some of the drug companies’ marketing techniques in that it falls to family doctors- GPs- and consultants to decide the best treatment for a patient’s condition. In this decision, they are steered by the National Institute for Clinical Excellence- NICE. This situation has its own detractors for several reasons, but it does “buffer” the patient somewhat from the marketing claims of drug companies. This contrasts starkly with the experiences of patients in some other parts of the world- notably America- where patients are often expected to adopt more of a consumer’s role. For example, in his biography (with Sally Jenkins) “It’s Not about The Bike: My journey Back to Life”, the cyclist Lance Armstrong relates his experiences of shopping-around for the best oncology treatment after being diagnosed with testicular, brain and lung cancer. This must have been a frightening situation, to say the least, and was certainly not an ideal position from which to evaluate the scientific evidence about the best treatment options.