Branded as “The Little Pink Pill” and “Female Viagra,” flibanserin, Sprout Pharmaceuticals’ only drug, was recently resubmitted to the Food and Drug Administration for approval for hypoactive sexual desire disorder (HSDD), a questionable condition promoted by pharmaceutical companies to sell questionable drugs. Flibanserin, a failed-antidepressant-turned-libido-boosting-drug, has already been rejected twice by the FDA due to a lack of proven efficacy in the face of possible safety concerns.
Rather than putting this drug to sleep, Sprout attacked the FDA for, of all things, sexism. Sprout created a public relations campaign called “Even the Score” that has misled several consumer groups, congresswomen, and many reporters into believing that the FDA is willing to approve male, but not female, treatments for sexual dysfunction. After all, they approved Viagra, the little blue pill, so shouldn’t the little pink pill get approved as well?
Well no, actually. Prescription drug regulation is driven by safety and efficacy, not parity. Promoting a lower standard of efficacy and safety in drugs for women is not feminist. Nor is drawing comparisons to unrelated drugs.
That Viagra comparison, for example. “The little blue pill” does not affect libido. Viagra and similar medications treat physical sexual dysfunction caused by arterial disease, diabetes, or other blood flow disorders. These drugs enable men who are already aroused, but who have a physical limitation, to have sex. Flibanserin isn’t female Viagra. The closest thing to female Viagra is a personal lubricant, which treats a common cause of physical sexual dysfunction, is used before sex, can be used at any age, and eases the way when the spirit is willing but the flesh isn’t cooperating.
Flibanserin, on the other hand, is more like Spanish fly, or horny goat weed, or one of the other aphrodisiacs that have been disappointing humans for millennia. Even Sprout admits the effect of flibanserin is mild: flibanserin increases the number of “satisfying sexual events”—including masturbation, but not necessarily orgasm—by less than one event per month.
Sprout has reframed this negligible effect as if it were a good thing, implying that flibanserin promotes a modest, ladylike sex drive. Invoking the sexually voracious woman is classically antifeminist. Women who loved sex were once burned as witches, had their ovaries removed, or were locked up in mental asylums. Yet, Sprout’s rhetoric suggests we ought to increase women’s sexual desire just enough to meet its standard of “normal,” but not so much that we threaten the social standard of proper behavior.
Some women really are troubled by low libido; others may be relieved, or indifferent. Who gets to decide what low libido is, anyway? This seems like just another way to make women feel bad about their bodies because they don’t fit some societal (or in this case industry-generated) sexual standard.
The point at which Sprout Pharmaceuticals’ innovative marketing bends sinister is in its misappropriation of feminist concepts. An oft-heard argument for approving flibanserin is “choice,” with the unstated subtext that women should decide about the risks and benefits of a drug on their own, sans pesky government interference. This implies that the FDA, the government agency charged with protecting the public from unsafe and ineffective drugs, is superfluous. That’s the way it was in the 19th century, pre-FDA, when we were giving children cocaine toothache drops.
The freedom to express one’s sexuality has not been fully won in any society. On a global scale, the way forward is discourse and dialogue, community and conversation. It turns out that this is true on an individual level as well. The most effective treatment for women with low desire is therapy. And—bonus—psychological therapy has no side effects. In clinical trials for flibanserin about 15 percent of women dropped out due to side effects such as dizziness, sedation, and nausea.
Moreover, the existence of an ostensible cure may silence women who are sexually dissatisfied. Why address your sexual issues with your partner, therapist, or doctor, when you can just take a pill? Sure, there is a bevy of potential causes of decreased libido, including the birth control pill, antidepressants, depression, having children, an abusive partner, a noncommunicative partner, stress, work, and aging. Sometimes what looks like a low libido is simply a reflection of being with an oversexed partner. Yes, “oversexed” is a vague, subjective term. So is “low libido.”
How then has Sprout managed to convince not only the public, but also some women’s groups that flibanserin is a feminist cause? First, by creating a narrative that pits anyone against flibanserin as anti-woman. Sprout hired two feminists to lobby women’s groups, including National Organization for Women. They convinced NOW and others to join Sprout’s cause. Some groups, however, derided the notion that the FDA was sexist: the American Medical Student Association, American Medical Women’s Association, Breast Cancer Action, Connecticut Center for Patient Safety, the Jacobs Institute for Women’s Health, National Women’s Health Network, New View Campaign, Our Bodies Ourselves, and Woody Matters all applauded the FDA’s insistence on efficacy and safety.
After encountering opposition from feminist groups about their feminist stance, Sprout pivoted its campaign to focus on “scientific” evidence, specifically the nebulous world of “brain chemistry.”
Sprout waves an fMRI study like a banner that supposedly demonstrates the difference between the brains of women with and without HSDD. This, Sprout says, reveals the real issue behind HSDD: abnormal brain chemistry. There are, of course, many things that cause changes in what parts of the brain light up. To name a few: mood, looking at pornography, and being a dead fish (A 2009 study on a deceased Atlantic salmon found fMRI activity.)
It’s in Sprout Pharmaceuticals’ interest to sell flibanserin to as many people as possible. Making healthy women feel sick is a good way to do that. Feminism cannot be represented by a company that commercializes women’s sexual insecurity for profit.
Alessandra Hirsch, M.S., is the project manager at PharmedOut, a Georgetown University Medical Center project that advances evidence- based prescribing and educates health care professionals about pharmaceutical marketing practices. Rebecca Holliman is a graduate student in Biomedical Science Policy at Georgetown and a volunteer staff member at PharmedOut. Adriane Fugh-Berman, M.D., is the director of PharmedOut.