Carpenters In The Forehead/  Alert To All Women Suffering From HSDD:  Keep Your Eyes, Ears, And Libidos Tuned To June 18th

Yes m’am, this day in June is when the Federal Drug Administration is set to announce whether all you women out there who are suffering from a new-found mental illness will find relief in what is being touted as the “little pink pill.”  Like its male counterpart with the Madison Avenue moniker “little blue pill,” aka Viagra, this potential multi-billion dollar pharmaceutical blockbuster is set to be evaluated by the Reproductive Health Drugs Advisory Committee.  My insider sources say that hedge-fund honchos are betting on approval of the drug.

Full disclosure:  I hold no stock and have no financial ties to Biehringer Ingelheim, but as your fledgling financial adviser, I would put an emphatically strong Buy for all the stock options you can get your hands on.  This drug company in Germany is about to see its fortunes soar as the pharmaceutical industry colludes with psychiatrists to bring you yet another mental illness you didn’t even know existed…..until now.  And, of course, for all you ladies-in-distress, waiting in the wing, and just for you, is a drug to treat it.   But woe to me and any others wanting to strike while the capitalist iron is hot, as unfortunately, when I got out my check-book and went to look up the ticker symbol for this company, I became aware that it is a family-owned German corporation, and we will not be able to share in their up-coming euro-bonanza.

So exactly what is all this hoopla about?  Unless you happen to live under a rock, you are probably aware that some ten years ago the marketing and sale of sildenfil citrate (Viagra) radically changed the world of male erectile dysfunction.  This malady is a physiologic problem encountered by men as they age and relates to a lack of adequate blood flow to the penis, a necessity in maintaining an erection.  It was one of those serendipity discoveries in medicine, whereby a drug being studied for one effect was found to benefit patients with an entirely different problem.  Viagra and similar drugs are what are known as vaso-dilators, causing arterial blood vessels to expand and allow more blood flow, in this case, to the penis. Originally sildnefil was being investigated for the treatment of angina, a condition where arteries to the heart are constricted.  While it was not really all that helpful for angina, men in the study group who had previously experienced difficulty maintaining an erection found that this was no longer a problem, and voila, same drug, different indication, and the rest is history.

Keep in mind, however, that the erectile dysfunction drugs that are prescribed for men have no effect on their libido.  By increasing blood flow to the penis, a man is able to maintain an erection, but the medication is not an aphrodisiac that leads to a heightened desire for sex.  That magical, elusive pill has not yet been discovered for men, or for women, in spite of the claims of Biehringer Ingelheim.

Much ado about men, but what about women who have “sexual dysfunction?”  Where is the research for women and the holy grail-pill to help the gentler gender?  As a practicing physician, I advise you to look no further.  Within the medical profession, our brethren psychiatrists, a group only very loosely based on science, are teaming with drug makers to bring you a newly found diagnosis of mental illness, and naturally, a medicine to treat it.

Do you suffer from Hypoactive Sexual Desire Disorder (302.71)?  More importantly, did you know that if your libido is not what you think it should be and leads to stress, that you have a mental illness?

If there are questions in your mind about these problems, perhaps it would behoove you to consult the Diagnostic and Statistical Manual of Mental Disorders (IV).

If you have never taken the time to peruse DSMD-IV, doing so will be an eye-opener.  Reading through this voluminous psychiatric bible makes you realize that no one is normal.  Shyness is a disorder, having good days fluctuating with bad days is an abnormality, and behaving badly without being sorry for it is a mental illness.  Naturally, all of these problems need to be corrected with drugs.

In previous editions of the manual, homosexuality was a mental disorder, surely in need of psychiatric care.  But as the saying goes, out with the old and in with the new:  the shrinks changed their minds, and what was once considered a mental illness is now off the books, removed from the fourth edition. The field of psychiatry is forever diligent, however, and on the look-out for new maladies.  Consideration for the upcoming revised edition, scheduled for publication in 2012, includes excessive temper tantrums in children, better to be known in psychiatric jargon as “temper dysregulation with dysphoria.”  This will serve to replace the more pejorative label of “bipolar disorder,” but you can rest assured that it will not alter the use, with highly dubious benefits and many side effects, of drugs piled on top of drugs that the medical field pours into children who have disorders of their family interactions rather than any proven so-called chemical imbalance.

But I digress.

So now, women who are stressed out because of difficulty being sexually aroused and/or achieving an orgasm are labeled as suffering from a mental disorder. There is certainly nothing wrong with the realization that a lack of sexual contentment in an otherwise healthy female would be a cause for tension, but it makes no sense to jump to the conclusion that it needs to be treated with drugs, especially when there is nothing but shoddy evidence to back up such claims.

My observation is that the entire focus of psychiatry has shifted to using drugs to alter some elusive, yet-to-be-deciphered brain chemistry.  Never mind that the functioning of the brain is exceedingly complex and essentially unknown, and that no one has the foggiest idea of any specific “chemical imbalances” that result due to stressors, especially those of a sexual nature.  We create disorders and then open the floodgates of drug treatment.  In this case, a new drug is proposed based on just one study which is of questionable validity, fraught with design flaws and lacking in a benefit of statistical significance.

The psychology of sexual relationships has so many factors and permutations that it ends up being someone’s judgment call to say what is abnormal.  But you can bet your bottom-dollar that having stress labeled as an illness means everything to the bottom-line of drug companies, as insurance companies are not going to pay for drugs that can’t be coded from the Diagnostic Manual (like 302.71).

My regrets to the ladies, for I suspect that the new drug touted as yet another aphrodisiac is likely to disappoint you, just another Spanish-fly-in-the-sky routine.  Heck, if it really is an aphrodisiac, make way for the men.  We want to be included as well, for who can be against firing up the libido a bit?

If this drug does get approved, however, I’m certain of one thing:  the many millions spent on clever marketing will make it a huge success.