“Ask your doctor if medical advice from a television commercial is right for you.”
—Bumper sticker slogan ((www.northernsun.com))
At a the annual conference for the Society for the Scientific Study of Sexuality last year, I heard a researcher describe how the pharmaceutical industry “jukes the stats”—that is, crunches numbers creatively in order to persuade the public that their products actually accomplish their stated tasks. This researcher, Dr. Duryea, offered a succinct finding: Antidepressant manufacturers go to great lengths to disguise the fact that people kill themselves during the “wash out” phase of antidepressants. Once participants stopped taking certain antidepressants (and, in clinical trials, before they resumed taking them again), those taking the antidepressants had an increased risk of suicide compared to their pre-drug state. Of course, since these users were not technically ingesting the drug during this “wash out” phase, the pharmaceutical industry convinced the FDA that antidepressants did not increase the risk of suicide—a creative interpretation with a potentially fatal cost to those who blindly take these drugs. ((Duryea, E. J. (2008, April). What every sexuality specialist should know about ‘sexual numeracy’: How we present quantitative information is important. Paper presented at the annual meeting of the Society for the Scientific Study of Sexuality, Western Region, San Diego, CA.))
I bring up this anecdote because it is one of many in a long list of such problems that occur in the U.S. today surrounding the issue of “lifestyle drugs”—drugs one takes not just for a temporary cure to an ailment (in the way Penicillin kills bacterial infections), but rather, as a response to lifelong, forever ailments (e.g., depression, anxiety, high cholesterol, acid reflux, impotence, and so on). As anyone who has watched television commercials in the last decade can imagine, the pharmaceutical industry expends enormous sums of money to encourage consumers to “ask their doctor” about a host of drugs, nearly all of which advertise “lifestyle” remedies. Get erections that last for days! No more burping up acid after eating mountains of salty, fatty, chemical-laden food! Stop feeling anxious despite chronic sleeplessness and slaving away at your vacationless McJob! And, like all advertising ploys—particularly ones where astronomical sums of money are expended—it works. Not only do people in the U.S. tolerate direct-to-consumer advertising (note that, within the Western world, the U.S. is alone in such a practice), but we indeed do consume more and more lifestyle drugs each year, making us the most medicated, and pharmaceutically-profitable, society around.
So how do we explain this phenomenon? What about the U.S. lends itself to this perfect synthesis of self-medication, corporate greed, and pharmaceutical horsepower? I propose that to tackle such a question, we must consider three separate entities: first, the invention of sickness, whereby normal aspects of daily life get branded as illness, like inventing female Viagra because women may not always desire sex; second, our refusal to live with the most basic elements of the human condition, as evidenced by the multi-billion dollar antidepressant industry; and third, our nearly reckless disregard for common sense, as evidenced by a host of lifestyle drugs, particularly Viagra for men. It is not just that those in the U.S. have been duped, or that the pharmaceutical industry wields uncanny powers, or that we largely cannot decipher the difference between self-generated needs and manufactured needs (all true); additionally, at its most basic level, people in the U.S. have embraced a new wave of pharmaceutical personality sculpting, ((This phrase was first used in Zita, J. (1998). Prozac feminism. Body talk: Philosophical Reflections on sex and gender. New York: Columbia University Press.)) a philosophy arguing that pharmaceuticals can compensate for our unfulfilled desires and needs.
Let’s begin with the case of female Viagra. Six years ago, pharmaceutical efforts to repackage the success of Viagra into a female-friendly version began in earnest. First, Pfizer attempted to replicate the powerhouse success of male Viagra with a simple goal: create physiological arousal in women, simulate lubrication and swelling responses, and (voila!) women would achieve orgasm in unprecedented numbers, thereby ending their relatively higher rates of “sexual dysfunction.” Unfortunately, this did not come to pass as expected. The big problem? Women who became aroused physiologically still did not choose to initiate or submit to sex with their (male) partners. Unlike male Viagra—where physiological arousal and desire for sex allegedly worked more in tandem—female Viagra successfully achieved physiological arousal but failed to generate mental arousal or motive for sex. Women with aroused vaginas still said no. This frustrated Pfizer to the point where, during one interview with the New York Times, researchers declared, “Although Viagra can indeed create the outward signs of arousal in many women, this seems to have little effect on a woman’s willingness, or desire, to have sex…Getting a woman to connect arousal and desire…requires exquisite timing on a man’s part and a fair amount of coaxing. ‘What we need to do is find a pill for engendering the perception of intimacy.’” ((Harris, G. (2004, February 28). Pfizer gives up testing Viagra on women. The New York Times, C-1.))
Perhaps said in jest, this statement nevertheless perfectly illuminates the first of three problems that contribute to the age of pharmaceutical personality sculpting: illnesses are invented, often for profit, by industries that have a serious investment in making people believe they are sick when they are not. In a for-profit healthcare industry where sickness is money, invented sickness makes even more money. Case in point, a recent psychological study by Jan Shifren and her colleagues found that, though 43.1% of women reported feeling that they had some form of sexual dysfunction, less than half felt troubled by this fact. ((Shifren, J. L., Monz, B. U., Russo, P. A., Segreti, A., & Johannes, C. B. (2008). Sexual problems and distress in United States women: Prevalence and correlates. Obstetrics & Gynecology, 112(5), 970-978.)) Rather than rely upon women’s self-description, the pharmaceutical industry instead convinces women through conversation and commercials that their inconsistent sexual desire is a defect, and that their bodies are imperfect and in need of drug treatments to “repair” their “dysfunctional” libidos. We live in an age where illness makes profit, and where the invention of “disorders” improves the economic bottom-line of the health care industry. Such profit-driven health care requires the consumer to imagine these invented illnesses as real. Unless people learn to call out and resist such inventions, pharmaceutical personality sculpting will become the mainstay of the industry.
Step two in the process of selling people on lifestyle drugs involves an almost laughably ill-advised premise: convince people that the human condition no longer entails sadness, anxiety, depression, loneliness, social unease, lost erections, ups and downs in libido, and grief. Indeed, the antidepressant industry has swooped in during a time when we have a lot to be unhappy about: unprecedented class warfare (the top 1% of U.S. earners now make more than the bottom 95% combined!), new and insidious forms of sexism (women’s desires usurped by the whims of patriarchy, ongoing failure of the Equal Rights Amendment, increasing reports of eating disorders and body dysmorphia, alarmingly high rates of women faking orgasm, national failure to recognize working mothers’ needs, and so on), rampant and shameless forms of racism (states retaining rights to block interracial marriages, anti-Obama rhetoric latching onto anti-socialist rhetoric throughout the nation, erosion of communities of color, overrepresentation of men of color sent to Iraq, etc.), and, in essence, a whole lot of things to be anxious, depressed, and un-aroused about!
Again, denying the difficulties of human existence seems to be a peculiarly U.S. phenomenon. Along with their ironic taste for high cholesterol foods, plentiful red wine, and good health, the French (yes, the French!) construct tragedy as an unavoidable process of the human existence. It is entirely remarkable that people in the U.S. want to manufacture an existence without such tragedy, yet this is exactly what antidepressant manufacturers count on. They make a bargain, albeit without full consent: Take these drugs and you’ll feel less—both positive and negative. Those on antidepressants report exactly this: they feel less sadness, they can get out of bed in the morning, and they can go to work and walk their dogs and enjoy modest pleasures. However, they no longer feel the same happiness they once felt either. They are dampened down, as the clinical literatures say. The antidepressant industry wants to trick us out of experiencing ourselves as fully human, as fully engaged in the process of being alive. How bad for business if we accepted that, when people die, grief is a horrendous, sometimes long, and certainly painful process, but one that we need to experience in order to process death. What a blow to their bottom line if people in this country started considering what their anxiety at work meant about their job satisfaction? What a downer to the share holders’ stock portfolios if we stopped to consider that feeling bad might propel us to take action in order to feel better? After all, aren’t we at least a little bit suspicious that Prozac and Zoloft and Wellbutrin create obedient, gracious, mellow, toned-down citizens, ready for the work of tolerating gender inequities, pay inequities, class inequities, and race inequities? What if people instead confronted their reasons for being upset, depressed, and anxious?
Which brings us to the third point: The pharmaceutical industry relies upon our most basic denial of common sense, intuitive wisdom, and self-affirmation. Consider the recent discussions about the paradoxes of the modern food industry. As Michael Pollan has pointed out, we have lost touch with common sense about eating because the food industry has systematically done three things. First, the food industry has asserted a singular, authoritative knowledge of what kinds of food make us healthy. Second, it has extracted, via “nutritionism,” the elements of food that yield health without considering the interplay between enzymes and vitamins within a whole piece of food (e.g., Eat Omega-3s! ((Pollan, M. (2009). In defense of food: An eater’s manifesto. New York: Penguin.)) Don’t worry if it comes from actual salmon or fish oil tablets! It’s all the same!). Third, the food industry has assaulted our common sense by forcing us to rely upon their definitions of “healthy food” at the expense of what our grandmothers and great-grandmothers already knew to be true (e.g., we eat processed boxes of chemical goo that claim to be “low fat” and “enriched with vitamins” rather than simply eating an apple or a carrot or a head of lettuce in the produce aisle). The same process has occurred with other elements of health, particularly mental health. Rather than considering the ways that our unhappiness, anxiety, and grief stem from elements in our lives that deserve our attention, “experts” feed us insights about how pill-popping and pharmaceutical personality sculpting will come to the rescue.
Case in point: A friend of mine once dated a man who had erectile dysfunction with onset in his early 20s. All physiological tests came out normal, indicating that doctors could find no physiological reason why he had erectile dysfunction. He tried Viagra for four or five years, with decreasingly successful outcomes. He had a more and more difficult time becoming erect, and often could not get an erection even in the most stimulating of circumstances. Viagra eventually stopped working entirely (as it often does). The man sought out psychological therapy to discuss his distress about his seemingly inexplicable erectile dysfunction. Frustrated by his lack of success at relying upon Viagra, he eventually discovered, during the course of a multi-year therapy, that his lifelong incestuous relationship with a family member—one in which he consistently became aroused in situations of potential punishment and shame—had contributed greatly to his current erectile dysfunction. Indeed, all of the signs pointed to his traumatic sexual history as a culprit to his current dysfunction. He had begun to masturbate at work, and could get aroused only right before his boss walked in on him. He had asked his partner to have sex in crowded movie theaters, subway cars, and park benches. He could never become aroused while at home in bed with her. During this course of treatment, he began a slow and difficult recovery, disentangling his associations with shameful early life experiences and replacing them with healthier models of consensual, non-punitive sex. I tell this story because it represents, most basically, a truth that should seem obvious to most people if they consider common sense: erectile dysfunction, like most “illnesses” treated by lifestyle drugs, is rooted in a person’s reality, and without addressing that reality, the drugs simply mask the underlying issues.
Yet, we in the U.S. continue to perfect our skills at denying common sense to the point of rapidly dismissing the real rootedness of our psychological problems in the reality of our existences. We do this with food and we do this with mental health. We eat fewer and fewer apples because food-industry consultants have told us to eat fiber-enhanced apple-flavored fruit-roll-ups. We deal less and less with the complexities of our psychological lives because “scientists” have told us that a pill will solve the problems of our brain chemistry and will repair our wounded histories. We rarely stop to consider why unhappiness pervades our culture because the “experts” have told us that it not only is possible to medicate this away, but is in fact medically sound to do so! This all comes at a great cost, personally, socially, and culturally. A generation raised on Lean Cuisine and Paxil has learned to condition away the intuition of mind and body. As a consequence, we do not recognize what tastes good any longer because experts have successfully tricked our taste buds into believing we are eating “butter” when we aren’t. We do not recognize that unhappiness can have positive, affirming, enriching results on our lives (as in, motivation toward something else—a new partner, a new job, activism on behalf of oppressed groups, and so on) because we have become susceptible to marketing campaigns selling us on the fundamental lie that life is pleasant. We have already begun selling women on the promise of pharmaceutically terminating menstruation for “convenience” and trimming their labias in order to generate better orgasms, despite known tissue damage and reduced sensation from such surgeries. Just last week, advertisements promoted a new “mint” that will disguise the vagina’s natural smell. We sculpt and trim, tweak and prune. This comes at a considerable cost, as individuals, as a society, and as a potentially toxic contagion within the global community. Until we seriously challenge the impact and reach of the pharmaceutical industry, these assaults on our most basic ways of being human will continue in earnest.