MENSTRUATION MATTERS

There’s a new book about the intimate role of the pharmaceutical industry in the construction of diseases, using the example of FSD (female sexual dysfunction). The authors are Ray Moynihan, an Australian investigative journalist with a longstanding interest in this topic, and Barbara Mintzes, Assistant Professor in the Department of Pharmacology & Therapeutics at the University of British Columbia. I haven’t yet seen the book, but listened to the webinar, which is now available on the Canadian Women’s Health Network (CWHN) website.

There were a few things that struck me. One is how blatant the interference of the pharmaceutical industry can be. For example, the webinar includes a reference to an email sent to Lenore Tiefer letting her know that a formative 1997 meeting about female sexual dysfunction was only open to those who were either part of or willing to work with the pharmaceutical industry. Another was the way in which the language about the medical understanding of the cause of FSD tracked the introduction of 3 different potential drugs, each with different targets and different mechanisms. So far, each drug has failed in clinical trials.

The medicalization of human sexuality separates our bodies from our emotional lives, and creates a framework within which emotional or relationship difficulties are seen as being caused by the biological, rather than being interdependent. And little attention is paid to the ways in which pharmaceutical cures may even create relationship problems that were not there before.

There are, of course, parallels with other cases. For example, the idea that menopausal is a hormone deficiency disease makes it much easier to argue that every healthy menopausal woman should take hormone replacement therapy. This replacement language is unfortunately still alive and well in both medical and popular usage.

Another parallel is the construction of “premenstrual syndrome” into a psychiatric diagnosis. This has been provisionally incorporated into the Diagnostics and Statistics Manual (DSM) of the American Psychiatric Association, initially as “Late Luteal Dysphoric Disorder”, now “Premenstrual Dysphoric Disorder”. Among other things, this construction supported the repackaging and marketing of Prozac as Sarafem for this newly created psychiatric disorder, extending the marketability of Prozac beyond its patent expiry date.

The APA is currently working on DSM V, to be published in May, 2013, and there is an opportunity for activism. So far, PMDD is listed in the “needs more research” section. But chances are it will be put forward again for the next edition.

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