P RES IDEN T ’S LET T ER | P EDRAM S ALIM P OU R, M D
PA I N S TA K I N G WA R O N S C I E N C E :
The Attack on Women’s Sexual Health (The Sham Drug Idea of the Year: ‘Pink Viagra’)
There are two kinds of people in this world: those who look down on other people, and those who don’t look down on other people. And those two groups of people look down on each other. Such is the state of the groups who advocate for and against medical management or prevention of certain illnesses. We have entered a time when even illness and medicine are politicized as aggressively as ideology. And this is unfortunate because unlike ideology, diseases and their therapeutic options are not simple matters of opinion. Pathophysiology of disease is, in fact, a rigorously studied state of biological being. And clinical interventions are, like the diseases they work against, subjects of equally rigorous investigation to which our best and brightest minds devote their careers, and lives. It is of course understandable that the slick, highly produced, and absolutely relentless television advertising for all things medical can make us weary. But for those who suffer from diabetes, dry eyes, depression or whatever illness the medication is hoping to treat, these drugs and their competitors offer options that allow our patients to work, play and function more effectively and efficiently alongside everyone else. Still, as a clinician it’s difficult not to encounter abrupt diversions from scientific issues critical to our health. Childhood immunizations, treatments for genetic disorders, and others have fallen into a malaise of ideological distraction. But arguments based on ideology often discount legitimate health needs and objective clinical evaluations of whether a treatment is safe and effective. We have read in recent months about the refusal of some families, based entirely on this pseudoscience, to vaccinate their children. Sadly, that ideology is creeping into other areas of medicine too, and soon politicized medicine may involve something you need. But for now, let’s add to the mix of crusades the dubious campaign against women’s sexual health. My involvement in the study of male and female sexual dysfunction spans two decades. In the late 1990s, I worked in Dr. Irwin Goldstein’s laboratory at Boston University School of Medicine on various sex4 P H Y S I C I A N M A G A Z I N E | D E C E M B ER 2014
ual dysfunction projects. Some projects included basic science research on animal cells and tissue others were studies on individuals or populations. All were ethically sound and scientifically robust. So much so that Dr. Goldstein was selected as first author of the New England Journal of Medicine paper on sildenefil citrate, the scientific article that introduced Viagra to the world. For the next few years, I had the opportunity to travel around the world, presenting results of our findings on the burgeoning new science of male and female sexual dysfunction. There was extraordinary excitement around the field. But at times, when I ran into people whom I considered colleagues, I encountered astonishing resistance. On an occasion I’ll never forget, I was asked to speak to an undergraduate psychology class on sexual dysfunction. The professor refused the offer of pizza for the students, saying she didn’t want the class to be swayed by the medical perspective. But the medical and scientific perspectives point to something that cannot be ignored: Sexual dysfunction in women, like that of erectile dysfunction in men, is real and ought to be studied and eventually treated. Almost two decades after I started work in Boston, there are no FDA-approved treatments for women. That, despite the fact that today, for the first time, we have a far better scientific understanding (different from just “knowing”) about the critical role that the human brain plays in regulating a woman’s sexual drive. We finally understand the scientific basis for persistent and recurrent low sexual desire, the root cause of which appears, based on advanced brain imaging, to stem from an imbalance of neurotransmitters in the brain. Yet there are no solutions that address this remarkable biology. All of us deserve to benefit from the advancement of science, including women and men who suffer from something the rest of us may think is funny. The stigma was overcome for men with the unprecedented clinical success of Viagra, which was followed by commercial success (not the other way around). Women still have a little way to go. The advancement of science and medicine coexists in a societal context formulated by everyday points of view, but we all must balance the hyperbole with the facts. Steve Jobs lost his life because he chose to ignore the scientific evidence in favor of the clinical options for his cancer. Too late to turn back, according to his biographer, he regretted his decision. The pseudoscience that has grown up in the Western world is dangerous not because it advocates against the application of science to women’s health. It’s dangerous because it advocates against science. It is human nature to judge. In medicine, we strive to overcome that human temptation through the application of rigorous science to understanding disease and its treatment options. And we don’t judge.