Tag Archives: pharmacology

Flibanserin: Viagra for ladies?

Viagra pillI guess we can look forward to a new pharmacological trade name appearing in our spam folders in the near future. A failed antidepressant, flibanserin will soon enter clinical trials in the UK to determine whether it’s safe to be marketed as the Female Viagra, accompanied by pointed questions from sexual health experts as to whether there’s really any genuine need for it:

Doctors involved in the study said the drug may prove to be an effective treatment for low libido, a problem they estimate affects between 9% and 26% of women, depending on their age and whether they have been through the menopause.

The drug has proved controversial among sex researchers. Some argue pharmaceutical companies are exaggerating the number of women affected by low libido to expand their market, and are pushing a pill that will not deal with psychological issues that might put someone off sex, such as poor body image or stress.

With the hopefully obvious caveat that I’m not a woman, I’m siding with the skeptics on this one. Viagra solves a, er, mechanical problem that prevents men from having sex, whereas flibanserin appears to be psychological in effect from the details described – a ‘randiness’ pill, to put it crudely.

Personally, I’m all for personal pharmacological freedom – if there’s a pill out there that does something positive for you, then who are you harming other than yourself? But I’m not sure that that a lack of libido in women is a pathological problem in the same way as erectile dysfunction, and this has all the hallmarks of Big Pharma rolling out another “lifestyle” drug designed to cure something that isn’t really an illness. [image by Felixe]

I remain surprised that libido suppressants aren’t so readily available as their opposites, though. If there’s a market for chemicals to switch on a certain body response, surely there’s going to be one for chemicals to switch them off? One might argue in response that libido suppressants could be easily misused, given to people who neither wanted or needed to take them… to which I’d respond that the same surely applies to flibanserin and Viagra.

New PlaceboTM! Now 50% more effective!

pillsYou’ve heard of the placebo effect, right? Well, apparently it’s becoming stronger, much to the chagrin of the pharmaceuticals industry who are finding that less drugs are passing clinical trials as a result:

MK-869 wasn’t the only highly anticipated medical breakthrough to be undone in recent years by the placebo effect. From 2001 to 2006, the percentage of new products cut from development after Phase II clinical trials, when drugs are first tested against placebo, rose by 20 percent. The failure rate in more extensive Phase III trials increased by 11 percent, mainly due to surprisingly poor showings against placebo. Despite historic levels of industry investment in R&D, the US Food and Drug Administration approved only 19 first-of-their-kind remedies in 2007—the fewest since 1983—and just 24 in 2008. Half of all drugs that fail in late-stage trials drop out of the pipeline due to their inability to beat sugar pills.

The upshot is fewer new medicines available to ailing patients and more financial woes for the beleaguered pharmaceutical industry. Last November, a new type of gene therapy for Parkinson’s disease, championed by the Michael J. Fox Foundation, was abruptly withdrawn from Phase II trials after unexpectedly tanking against placebo. A stem-cell startup called Osiris Therapeutics got a drubbing on Wall Street in March, when it suspended trials of its pill for Crohn’s disease, an intestinal ailment, citing an “unusually high” response to placebo. Two days later, Eli Lilly broke off testing of a much-touted new drug for schizophrenia when volunteers showed double the expected level of placebo response.

It’s not only trials of new drugs that are crossing the futility boundary. Some products that have been on the market for decades, like Prozac, are faltering in more recent follow-up tests. In many cases, these are the compounds that, in the late ’90s, made Big Pharma more profitable than Big Oil. But if these same drugs were vetted now, the FDA might not approve some of them. Two comprehensive analyses of antidepressant trials have uncovered a dramatic increase in placebo response since the 1980s. One estimated that the so-called effect size (a measure of statistical significance) in placebo groups had nearly doubled over that time.

You’ll not find me shedding many tears for Big Pharma, frankly; as pointed out in the rest of the article, their profit margins of the last few decades has been based on turning psychiatric treatments into mental cosmetics, and the increase in the placebo response may well be tied to their incredibly effective marketing procedures – by associating drug consumption with positive images of well-being, they’ve stimulated our response to all pills, regardless of their chemical make-up. Research is increasingly suggesting that one of the biggest prerequisites for getting better is simply a reasonable expectation that one actually will. [via BoingBoing]

I’ve got something of a personal stake in this, having seen far too many friends diagnosed with one form or another of psychiatric condition and promptly put on a regime of drugs that have shattered their personalities – and lives – permanently. I’m not denying the existence of mental illness, but I’m quite convinced that overdiagnosis is rife, with many drug-treatable “syndromes” being little more than completely natural phases of mental development or reasonable responses to environmental conditions which would respond far better to counselling and emotional support. Hence I was intrigued to read an article by medical anthropologist Eugenia Tsao [via @somatosphere], who recommends that members of her profession and others should start pushing back against the relentless attempts to pathologize (and hence monetize) our reactions to our social environment:

What is revealed about a society, in which drugs are touted with increasing regularity as a treatment of choice for entirely natural responses to conditions of unnatural stress? How have we been persuaded to equate such things as recalcitrant despair (“Dysthymic Disorder,” DSM-IV-TR 300.4), adolescent rebellion (“Oppositional Defiant Disorder,” DSM-IV-TR 313.81) and social apathy (“Schizoid Personality Disorder,” DSM-IV-TR 301.20) with aberrant brain chemistry and innate genetic susceptibilities rather than with the societal circumstances in which they arise? What does it mean when increasing numbers of people feel as though they have no choice but to self-medicate with dubious chemical substances in order to stay in school, stay motivated, stay employed, and stay financially solvent?

Anyone here remember an obscure industrial band called Consolidated? They had a lyric on their Business of Punishment album that went something like “they must remain sick / so we can continue to treat them”. [image by neur0nz]

Editing the memory movie

pre-silicon memory aidWell, looks like we can chalk up another predictive success for a Futurismic author! This time it’s the turn of Marissa Lingen, whose Erasing the Map” seems eerily prescient of recent research at Oxford University into the selective editing of memories:

Wired.com: How selective will memory editing be?

Sandberg: Current research seems to suggest that it can be pretty specific, but there will be side effects. It may not even be that you forget other memories. Small, false memories could be created. And we’re probably not going to be able to predict that before we actually try them.


Wired.com: It seems that it would be easy to test “tip of the tongue” drug effects on the sorts of small things one recalls on an everyday basis. But what if it’s old, infrequently recalled but still-important memories that are threatened by side effects?

Sandberg: It’s pretty messy to determine what is an important memory to us. They quite often crop up, but without us consciously realizing that we’re thinking of the memory. That’s probably good news, as every time you recall a memory, you also tend to strengthen it.

Wired.com: How likely is the manipulation of these fundamental memories?

Sandberg: Big memories, with lots of connections to other things we’ve done, will probably be messy to deal with. But I don’t think those are the memories that people want to give up.  Most people would want to edit memories that impair them.

Of course, if we want to tweak memories to look better to ourselves, we might get a weird concept of self.

Indeed we might… but I’d say the odds are good that people will try to do exactly that. The street finds its own use for things, right? [image by ebbdog]

But what will happen if you try to edit a memory that is false – the repressed memory of abuse that may not have actually happened, for example? If memories are interlinked, what might you lose along with the bad stuff? And if memories can be expunged, could they also be inserted? We’re deep into Philip K Dick territory right here…

The male birth control pill is not a feminist issue

Contraceptive pill blister packGeorge Dvorsky has a lengthy post discussing the development of the Male Birth Control Pill … or rather the lack of development, which he puts down to a number of factors including male reticence and reluctance from the big pharmacological companies. And militant feminists, too:

“For those men who truly don’t want to have children—something that is completely within their rights—the MBCP will help them achieve that level of control.

And again, female claims that this will allow men to forever shirk their paternal responsibilities and live in perpetual adolescence are not just gross generalizations, but sexist statements of the highest order.”

Now, I’m pretty positive Dvorsky is overstating the case here so as to provoke some discussion; it wouldn’t be the first time (e.g. “meat-eaters are bad people“), and I can’t think of any women I know who’d argue the line described above.

But the issue of complete control over the functions of one’s own body that Dvorsky raises – his central theme as a transhumanist – is an interesting one, because it has wider implications. Moving towards equality, across lines of gender or otherwise, may come with costs as well as gains at an individual level.

What do we want to gain, and what are we prepared to give up for it? [image by Beppie K]