Media Hyping Viagra for Women for Drug Company Greed

When headlines from 500 news sources screamed Women Need Viagra Too! on the basis of a new JAMA study this month, it looked like more Viagra huckstering as usual.

The study boasted that 72 percent of its participants -- women with antidepressant-associated sexual dysfunction (AASD) who had previously had normal sexual function and whose depression had lifted -- responded favorably to Viagra. That's an impressive claim until you see that the study size was only 98 -- or that Pfizer, the blue pill's manufacturer, paid for it.

What's more, its two lead authors, H. George Nurnberg, M.D. and Paula L. Hensley, M.D., report being paid consultants to Pfizer (among dozens of other drug companies) and were participants on its speaker bureau in a previous JAMA study about Viagra for men with antidepressant-associated sexual dysfunction.

And, Pfizer may be in trouble as it approaches the 2011-2013 Viagra/Lipitor "patent cliff" -- the sales falloff expected when patents expire. This comes on the heels of the Federal Aviation Administration's recent action banning pilots and air traffic controllers from taking Pfizer's anti-smoking drug Chantix. (Sell the company for parts, says Citigroup analyst John Boris, noting steady prescription decline since 2004.)

Viagra use itself might be down as the economy squeezes consumers, since the prescriptions are often paid out of pocket, suggests CNBC pharmaceutical reporter Mike Huckman. Men may be cutting Viagra from their budgets -- or cutting pills in half.

But the JAMA article might have less to do with opening new Viagra markets than with keeping the nation's 150 million antidepressant users -- 16 percent of all women between the ages of 20 and 44, according to one estimate -- from going off their meds because of sexual dysfunction side effects.

Especially since Pfizer also makes the antidepressant Zoloft.

About half of all people taking selective serotonin reuptake inhibitors (SSRIs) like Zoloft experience sexual dysfunction such as loss of libido or anorgasmia, and as many as 90 percent go off their meds because of it, say researchers. That's a lot of lost patients.

Viagra, or sildenafil citrate, works by inhibiting "cGMP catabolism" in the smooth muscle tissue of the clitoris and penis, which enhances the "cGMP activity" that enables tissue to respond to sexual stimulation -- possibly even when serotonin-altered, as is the case with women on antidepressants.

Still, the study of women's sexual functioning even without the complication of other drugs is a science in its infancy: Not until June of 2005 did the first MRI of the clitoris show that it has 17 parts, with nerve endings extending deep inside a woman's body.

Research suggests that male and female sexual functioning differ considerably, and past Viagra studies have failed to show convincing evidence of the drug's ability to increase sexual response in women.

While one study in the British Journal of Obstetrics and Gynaecology in 2001 showed potential, subsequent studies of sildenafil citrate in women didn't -- a Journal of Women's Health & Gender-Based Medicine study in 2004 concluded, "Any genital physiological effect of sildenafil was not perceived as improving the sexual response" -- and the search for parallel Viagra benefits was largely abandoned.

Until now.

The chance that a Viagra for women could still be viable was so riveting to the mainstream, scientific and investment press that some headlines this month declared that Viagra works in "depressed women" instead of "women on antidepressants" -- a big conceptual difference.

Big pharma's male domination -- and Wall Street's -- has led feminists and sexuality researchers to question the whole pursuit of a female sexuality drug.

If improving women's lives were really the goal, then why would the morning-after pill and other important reproductive drugs continue to languish while pharma forges ahead, trying to rope women into its renewed Viagra propaganda?

Perhaps the answer lies in drug companies' uncanny ability to overlook more serious health concerns and instead exaggerate relatively minor ones. Market directly to consumers, and worried patients will ask for the drug by name. Pay off physicians, and they will overprescribe. Then, as drugs approach the end of their patents, discover a new use for them -- treating the side effects of other drugs. Call it disease-mongering with a side of sexism.

If that is, in fact, pharma's strategy, based on the number of women taking antidepressants, it looks like it's working: A whopping 20 percent American women are being treated with prescription drugs for a variety of mental health disorders including depression, anxiety, seasonal affective disorder, obsessive-compulsive disorder, bipolar disorder, panic disorder, social anxiety disorder, posttraumatic stress disorder, eating disorders, premenstrual dysphoric disorder -- even compulsive shopping.

They are treated so aggressively that doctors will add a second drug or third drug for side effects rather than stop the first.

The Zoloft page on the Pfizer Web site hucksters -- "If you have premenstrual dysphoric disorder you experience severe changes in your mood and body around the time of your period. Those changes can get in the way of day-to-day living" -- and the Viagra page is just a mouse click away.


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