Pink Pills

How the pharmaceutical industry is medicalizing women’s sexuality.

Big Pharma, Women and the Labour of Love by Thea Cacchioni is a timely and acutely disappointing book that makes some excellent side points.

Cacchioni, a sociologist at the University of Victoria, begins with an important question: is human sexuality being reduced to a medical problem by “disease mongers” who want to peddle expensive pills? She takes a refreshingly skeptical approach to Big Pharma’s claims about the millions of women who are said to suffer from sexual dysfunction. Unfortunately, the book is really a political tract that builds on shoddy research and the flawed ideology of gender feminism.

The Food and Drug Administration in the United States has just approved “Pink Viagra,” which is the main focus of Cacchioni’s book. From now on a pill for women will sit on pharmacy shelves beside the estimated 26 different pills available to men with erectile dysfunction.

The timing is good for pharmaceutical companies. Pfizer’s patent on Viagra has expired in several countries and it will fizzle out in the United States in late 2019. America alone is said to be a market worth $2 billion a year for that one drug. Forbes predicted in 2013 that “owing to generic intrusion, the global market for branded erectile dysfunction drugs is forecast to decline at a compounded annual rate of 4.5% from 2013 to 2019.” Generic intrusion has also battered Eli Lilly and Bayer, the producers of Cialis and Levitra, which compete with Viagra.

Suddenly, Big Pharma has noticed women.

Big Pharma is not primarily an attack upon the outrageous misuse of patents or power by drug companies. Instead, the book attempts to construct an alternative theory of female sexuality in order to explain the “dysfunction” that is being medicalized. The goal of sketching alternatives is worthwhile. To this reader, Cacchioni’s approach at first seemed intriguing. Her introduction opens with: “As the significant critique of the medicalization of women’s sexual problems in the sexual pharmaceutical era unfolded in academic, media, and activist circles, I could not help but notice how infrequently we heard from women who identify as having sexual problems.”

But Cacchioni’s reconstruction of sexuality uses the voices of women simply as vehicles to advance the politics of gender feminism.

Cacchioni is a living embodiment of gender feminist research methodology, which differs sharply from the traditional focus on objectivity and experimental controls. Indeed, her book’s introduction freely admits this fact. “The style of qualitative research I conducted,” she writes, “was informed by my feminist and social justice principles, ‘emphasizing non-exploitative, non-hierarchal approaches to research subjects’.”

Adherents disagree on the specifics of feminist methodology but the basics were fairly rendered in a 2000 book by Michèle Ollivier and Manon Tremblay, Questionnements féministes et méthodologie de la recherche. The authors identified three defining features: a basis in feminist principles, the construction of “new knowledge” aimed at achieving cultural change (that is, social justice), and a focus on sexual diversity, which means including populations deemed to be marginalized.

From reading many feminist papers, I could add several characteristics that are common if not defining. One is the excessive quoting of studies and papers that support the researcher’s political bias. In one paragraph of 15 lines, for example, Cacchioni cites ten works that appear to be as politicized as her own and, therefore, arguably as flawed. Nevertheless, the hyper-citations gives the impression of research that is thoroughly done.

Cacchioni’s work is not.

The study Cacchioni conducted upon which Big Pharma is based has problems that extend far beyond my disagreement with feminist research methodology. It is shoddy by any methodological standards. The work is already being hailed as pioneering by politically kindred spirits but Cacchioni’s data are useless for the purposes to which they are put.

The study was conducted with 31 female participants in Vancouver, a notoriously upper-middle class city. The last point is significant because findings about social or sexual attitudes cannot be generalized from one location to another. Both the size of Cacchioni’s sample and the limitations of location should have made the data nothing more than an intriguing glimpse that could indicate promising areas for further research.

The list of invalidating flaws scrolls on and on.

Cacchioni wants to argue that women’s sexual dysfunction is not a matter of biology but of choice—bad choices that block their functioning. She concludes Big Pharma with the observation, “although many [of the 31 participants] engaged in the labour of love [heterosexual sex] as an immediate way of dealing with sexual dissatisfactions, their wishes were much deeper.”

Earlier in the book, however, Cacchioni states of the participants, “the majority remained firmly entrenched in a heterosexual identity.” If the majority expressed a solid heterosexual identity, then Cacchioni could only discern their deeper wishes by knowing more about their sexuality than they did. In other words, having heard the voices of the ignored women, she proceeds not only to ignore but also to contradict them. It is difficult to understand why Cacchioni bothered with the research at all, given she knew the proper results in advance.

But, of course, the purpose of the research was to establish a basis and hook for the book. The purpose of the book is to argue against hetero­normality and to challenge even the “firmly entrenched” sexual identities of women.

The most frustrating aspect of Big Pharma? Cacchioni offers flashes of insight that could have been expanded into a fascinating book. For example, she correctly challenges the statistics floated by advocates of medicalizing sexuality. A widely circulated one is that 43 percent of women are dysfunctional. Cacchioni claims the number comes from a 1994 survey published in the Journal of the American Medical Association. Women were asked if they had experienced any sexual problem over the last twelve months. A list of broad problems was identified, including a lack of interest, anxiety about performance or the absence of an orgasm. If any option was chosen, then the woman was classified as sexually dysfunctional. Other plausible explanations for her reactions, such as being overworked or in a bad relationship, were not explored.

A book on that theme would have sparkled. If that is the next book from Cacchioni, then I would be an eager reader. I would not even mention that Cacchioni holds the 1994 survey up to higher standards than she applies to her own research.