The ‘Pinking’ of Viagra Culture: Drug Industry Efforts to Create and Repackage Sex Drugs for Women Hartley, Ch. 23, pp. 287-296

Female sexual dysfunction With the success Viagra-like drugs for men, women's sexual problems have become medicalized just as men's were – defined and understood as a largely physiologically based set of conditions called female sexual dysfunction (FSD)

2 main strategies of drug industry a search for a Pink Viagra to treat the "disease" of FSD, shifting from products to treat arousal problems to those targeted at desire problems the increasing promotion and normalization of off-label uses of men's sex drugs for women

Inflated epidemiology and the institutionalization of FSD In pursuing these strategies, the pharmaceutical industry has relied on inflated epidemiology and the institutionalization of FSD

Inflated epidemiology: Widespread dissemination of disease prevalence estimates, namely the '43-31' study, which found that more than 4 out of 10 women (43%) have sexual problems, a rate of dysfunction higher than that of men (31%) Even the author of the original study himself has gone on record saying the findings were misappropriated to promote the medicalization of sexual problems

The institutionalization of FSD FSD has become institutionalized in academic circles. Key events in institutionalization process: Development of systems of disease classification amenable to medical approaches Creation of a legitimized infrastructure for disseminating supporting research and education Formation of an attendant professional organization Establishment of an appropriate medical specialty

Institutionalization Widely used term in social theory to denote the process of making something (e.g., a concept, social role, particular values or norms, or modes of behavior) become embedded within an organization, social system, or society as an established custom or norm within that system

Strategy I: Securing FDA Approval for a Women's Sex Drug At least 7 drug companies are developing testosterone products for women When Viagra trials for women failed, there was a shift in the definition of FSD, from an arousal problem to a desire problem

Strategy II: Off-label Prescribing of Men's Sex Drugs to Women While none of the existing ED drugs have been sufficiently tested and proven for use in women, increasingly women are given off-label prescriptions for them and now approximately 1/5 of all the prescriptions of testosterone products approved for men are actually written (off-label) for women Off-label prescribing is now seen as a way to circumvent the (time-consuming and expensive) FDA-approval process altogether in some cases

The Bermans: a case study in the commercialization of FSD Sisters, Laura Berman, PhD (sex therapist) and Jennifer Berman, MD (urologist) Used crossover appeal to leave academia for profit-driven commercial sectors Built a multimedia company specializing in women's health, particularly in the treatment of FSD Offer "quality care in a spa-like high-end environment“ that is expensive and usually not covered by health insurance Claim approach combines strengths of psychotherapy with benefits of medication, but ultimately give preference to biomedical perspective

Nutraceuticals Currently the only FSD products widely advertised are those from the OTC herbal/botanical/dietary supplement market that do not fall within the FDA's jurisdiction Two most visible products are Avlimil and Zestra - the marketing platforms for both products attempt to make them seem like prescription drugs