If you start by asking the wrong question, you’re pretty sure to wind up with the wrong answer.
Consider, for example, the case of flibanserin, a drug whose manufacturer purports that it works on the central nervous system (suppressing serotonin and releasing dopamine and norepinephrine) to increase libido in women. The data are so-so: women using the drug in a 24-month study reported 4.5 “sexually satisfying events” per month, compared to 3.7 for those given a placebo and 2.7 for those given no pill at all. [This sentence edited to remove gibberish.]
Naturally, the drug has side-effects, including dizziness, nausea, and fatigue. (If there are long-term effects, we’ll learn about them after the drug is approved.)
Now, is the risk of those side-effects, plus the cost of the drug, compensated for by a 25% gain sexual gratification? That isn’t really a medical question, is it?
In any case, it’s not the one the FDA is called on to answer. Instead, the FDA must decide whether there exists a disorder called “female sexual dysfunction,” and whether flibanserin is a safe and effective treatment for that disorder.
Of course the critics are all over the drug company for inventing a new disease so that people will think they’re sick. Fair enough. But note that the company couldn’t have said “We think some women want to pay for having more libido, and here’s a drug that does that.” They had to study specifically women with unusually low libido.
With respect to male sex-enhancers, the market has spoken: Viagra and its competitors, though approved for “erectile dysfunction,” are used mostly by men who want to improve their performance. (Those drugs act on blood flow rather than directly on desire.) Is there anything wrong with that?
Maybe health insurers ought not to have to cover drugs to enhance normal performance as opposed to those prescribed to treat deficiencies, but the current standard doesn’t make any sense. A drug that could raise an I.Q. of 75 to 85 would obviously be approvable as a treatment for cognitive impairment, but one that raised an I.Q. of 130 to 140 could never make it. That, I submit, is insane.
Yes, there are going to be all sorts of problems about competitive economic pressure to use cognitive enhancers which may turn out to have nasty side-effects. But we ought to debate those questions on their merits, not with scholastic arguments about how many symptoms can dance on the head of a diagnosis.