Introduction

Robert Wilson's bestselling book Feminine Forever helped persuade the modern world that the menopause was a “disease” of hormone deficiency, to be cured with hormone replacement.1 The book's 1966 front cover promised, “Every woman no matter what her age, can safely live a fully-sexed life for her entire life,” and the hormones sold by Wilson's sponsor duly became best sellers. Forty years later, long term hormone replacement has been exposed as doing more harm than good, drug sales have collapsed, and Wilson's thesis is rightly ridiculed as corporate sponsored disease mongering.2 3

In the shadows of this overmedicalisation, the pharmaceutical industry is meeting unexpected resistance to its attempts to sell women the next big profitable “disease,” female sexual dysfunction. This condition is claimed by enthusiastic proponents to affect 43% of American women,4 yet widespread and growing scientific disagreement exists over both its definition and prevalence. In addition, the meaningful benefits of experimental drugs for women's sexual difficulties are questionable, and the financial conflicts of interest of experts who endorse the notion of a highly prevalent medical condition are extensive. These controversies have been brought into focus by the rejection of Proctor and Gamble's experimental testosterone patch by advisers to the US Food and Drug Administration in December 2004.5

Controversy about the condition

The first step in promoting a blockbuster drug is to build the market by raising public awareness about the condition the drug is designed to target.6 In anticipation of regulatory approval of its testosterone patch—the first drug assessed for female sexual dysfunction—Proctor and Gamble unleashed a multilayered global marketing campaign. It sponsored key scientific meetings in sexual medicine, hired leading sex researchers as consultants, funded continuing medical …