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http://bmj.com/cgi/content/full/326/7379/45
BMJ 2003;326:45-47 ( 4 January )
Education and debate
Is a new disorder being identified to meet unmet needs or to build markets for new
medications? [Fred A. Baughman Jr., MD: "Close ties" means they, the researchers, are given sufficient money to assure the result/conclusions desired by the pharmaceutical corporation(s) sponsoring the researchers, their departments, their institutions. Without exception, the commission of all in psychiatric research/academia is to sustain the validity of the invented disease (all psychiatric "disorders"/ "diseases) and to uphold the "necessity", safety and efficacy of the drug(s) manufactured for the invented disease by the corporation(s) in question] are working with colleagues in the pharmaceutical industry [Fred A. Baughman Jr., MD: Paid, hardly less, by their Pharma employer than the supposedly independent researcher. Despite protestations to the contrary, the "researcher" is no more able to defy the pharmaceutical corporation(s) than are their "colleagues in the pharmaceutical industry" ] to develop and define a new category of human illness at meetings heavily sponsored by companies racing to develop new drugs. The most recent gathering, featured Pfizer as chief sponsor and Pfizer-friendly researchers as chief speakers. The venue? The Pfizer Foundation Hall for Humanism in Medicine at New York University Medical School. [Fred A. Baughman Jr., MD: The NYU School of Medicine is my alma mater. They have chosen the slippery slope of industry sponsorship to such a degree that nothing they say or do regarding Pfizer or Big Pharma, generally, can be believed. The activities of those in the NYU Child Study Center and department of psychiatry, generally, has long had me wondering about industry ties; it all comes into focus now. See attachment re the Smithsonian, AACAP, NIH and Pfizer] Since the launch of sildenafil (Viagra) in 1998, more than 17 million men have had prescriptions written for it as a treatment for erectile dysfunction [Fred A. Baughman Jr., MD: elevated, with the help of Bob Dole of Kansas to male disease status] , with Pfizer reporting sales in 2001 of $1.5bn.2 The emerging competitors, Bayer's vardenafil and Lilly-ICOS's tadalafil, are likewise expected to have annual markets in excess of $1bn each. To build similar markets for drugs among women, companies first require a clearly defined medical diagnosis with measurable characteristics to facilitate credible clinical trails. [Fred A. Baughman Jr., MD: When I discovered "curly hair, ankyloblepharon, nail dysplasia syndrome-- CHANDS (syndrome = disease, or, at least, it should) in 1971, one had but to delineate an objective physical abnormality or abnormalities (saying a disease was present) that had never been described before (saying a new, never-before-described, disease was present. Today, as with "female sexual dysfunction" and with every single psychiatric "disorder"/ "disease" in the DSM, the drug, strangely, comes first and then the "researchers"/academics and "their colleagues from industry" huddle and conjure up contrive the "disease", whereafter this same cohort of researchers/academics begins publishing "research" on the disease in journals, the editors of which, are from the same cohort of researchers/academics. It has become ever so much more complicated, the business of discovery and research on new diseases, notably those destined for treatment with drugs, known or as yet unknown, manufactured by one or several pharmas. ] Over the past six years the pharmaceutical industry has funded, and its representatives have in some cases attended, a series of meetings to come up with just such a definition (table).
Defining the new disorder [Fred A. Baughman Jr., MD: what did I tell you! First they decide on a name for the "new" disease, then they decide who will author and conduct the trials and which, of the editors in the group, will publish the trials/research providing friendly editorial comment, which will have as it's main goal to put forth, far and wide, the name of the new disease until it gains acceptance as a disease, not scientifically at all, but by acclaim] in this area, against a backdrop of "widespread lack of agreement about the definition" of female sexual dysfunction.3 [Fred A. Baughman Jr., MD: Whats more the "clinicians, researchers, and drug company representatives" who met for two days at a Cape Cod hotel to plan the invention of this disease were all funded by Pfizer, at that time and every step of the way since until the invention of the "disease" was complete, and it was accepted by acclamation by "treating" physicians everywhere and they had taken to "treating" it with the Pfizer product. ]
In response to an email inquiry about the Cape Cod meeting, co-chair Raymond Rosen wrote: "The meeting is completely supported by pharmaceutical companies, and approximately half of the audience will be pharmaceutical representatives. [Fred A. Baughman Jr., MD: what did I tell you?] The goal is to foster active and positive collaboration between the two groups. Only investigators who have experience with, or special interest in working collaboratively with the drug industry have been invited. [Fred A. Baughman Jr., MD: There can be no doubt they are bought and paid for and they are by no means free to conduct science or practice scientific-based medicine] " The subsequent publication of the meeting's presentations and discussions acknowledged sponsorship from nine drug companies.3 Eighteen months later, in October 1998, the first international consensus development conference on female sexual dysfunction took place in Boston under "closed session" deliberations.4 Participants for this multidisciplinary meeting were hand picked by a group from the American Foundation for Urologic Disease on the basis of their research or clinical expertise and their positions as "thought leaders." [Fred A. Baughman Jr., MD: I thought it was "Only investigators who have experience with, or special interest in working collaboratively with the drug industry have been invited."] Working with existing classification systems, including the American manual of psychiatric disorders (Diagnostic and Statistical Manual of Mental Disorders, 4th edition), participants produced a new definition and classification featuring disorders of desire, arousal, orgasm, and pain, to be used in "medical and mental health settings."4 [Fred A. Baughman Jr., MD: leave it for the American Psychiatric Association and the DSM Committee to provide the forum. The DSM is a manual of fictions of which there are literally hundreds more each edition.] Publication of the proceedings of the consensus conference [Fred A. Baughman Jr., MD: simple proof—a macroscopic, microscopic or chemical abnormality demonstrated to the satisfaction of scientists on a scientific journal's editorial board or board of referees, has, in this new industry-directed, pseudo-science of discovery been replaced by the consensus conference, or by a show of hands. This is the DSM way; the biological psychiatry way and it has worked so well in psychiatry why shouldn't other specialties, beset as all of them are by generalist-specialist excess/glut, invent diseases also, so one and all have enough to diagnose as well as prescribe as well as bill for. Every pseudo-disease that is voted into the DSM gets near-automatic acceptance by government and insurance payers.] disclosed support from eight pharmaceutical companies and showed that 18 of the 19 authors of the new definition had financial interests or other relationships with a total of 22 drug companies.4 [Fred A. Baughman Jr., MD: what results, and is straight-faced, called a disease, even to trusting human beings in distress, is pure, unadulterated scientific fraud. Physicians (all of whom are responsible for knowing disease from no disease) who lie to patients, telling them they have a disease when they know otherwise, are guilty of abrogation of informed consent/medical malpractice, and, perhaps of slander, as well.] In October 1999 the Boston University School of Medicine [Fred A. Baughman Jr., MD: It is not just researchers and academics that are bought, and not just research teams or departments but entire medical schools. It is doubtful today that any medical school in the US is free to do science, and surely this conclusion pertains to every area with a potential pharmaceutical application/interest] hosted a further conference, which was supported by 16 companies. [Fred A. Baughman Jr., MD: Ah! Yes, all in the interest of pure science] In a response to a question from a speaker at the conference, a show of hands at one session revealed that around half of the participants were connected to the drug industry.5 [Fred A. Baughman Jr., MD: A voluntary show of hands, always voluntary. You try to get the details of the financial connections out of any of the individuals—good luck. And yet the evidence is right in front of their eyes: sufficient money has made it's way from the Pharma's to all researchers, academics, teams, departments and medical schools that that none are free to do or to speak true science or practice, true, Hippocratic, scientific medicine] In 2000 and 2001, the newly formed Female Sexual Function Forum hosted annual conferences in Boston supported each time by more than 20 companies, with Pfizer as a key sponsor. [Fred A. Baughman Jr., MD: "20 companies, with Pfizer as a key sponsor" and you are going to believe the "researcher" or "professor" who asserts that he/she is "above" being spoiled by industry support, that science could not possibly proceed without this (ever so convenient, comfortable) industry-academia collaboration. So comfortable that some lowly professors of psychiatry manage, somehow to garner nearly a million dollars a year, jetting about the world participating in "continuing education conferences" presenting on the latest disease that he or she has discovered…I mean, invented. Do not buy into their moral outrage at being questioned or doubted, they have no such thing, stand your ground and their faux outrage will pass. They do not like confrontation with others not of the same ilk and they do everything possible to avoid it] Interviewed just before Christmas 2002, Pfizer's Urology Group's leader, Dr Michael Sweeney, said the company had played a passive role in sponsoring a series of discussions about the disorder, simply providing unrestricted grants in response to requests from physicians. [Fred A. Baughman Jr., MD: "Unrestricted grants" this is where, for pivotal disease inventors (more valuable even than those who invent new, unnecessary treatments) the gross incomes become suddenly so un-academic, un-professor like. All pharmas give unrestricted grants sufficient to assure compliance, sufficient to assure that they continue their unquestioned control over all that is medical academia] On the international stage, female sexual dysfunction was discussed as part of the first international consultation on erectile dysfunction in Paris in 1999, hosted chiefly by urology associations and sponsored heavily by pharmaceutical companies. A second meeting is planned for Paris in June 2003, with one aim being the adoption of an "internationally accepted instrument for assessment of sexual function."6 [Fred A. Baughman Jr., MD: Even before an abnormality has been demonstrated to validate female sexual dysfunction as a disease, an "accepted instrument for assessment" must be voted in, no doubt to tell patients of to further the illusion of legitimate medical practice, research and science, where none exists, where the "patient" not a patient at all becomes a profit- point] All three Boston meetings (1999-2001) were chaired by Dr Irwin Goldstein, professor of urology and gynaecology at Boston University School of Medicine, who is also a key figure at the international gatherings. Originally trained as an engineer, Goldstein has widened his focus in recent years from male to female sexual dysfunction. A regular speaker at meetings funded by industry and a consultant and lecturer for virtually every pharmaceutical company, he is a passionate advocate for building a new discipline of sexual medicine, because, as he told the recent New York gathering, in this emerging field "there is such joy in treating these people successfully." [Fred A. Baughman Jr., MD: Is not Goldstein's presence as a professor at the BU School of Medicine a blight on the reputation of that once-fine medical school. But again, although not to excuse BU, the pollution—for that is exactly what it is—is of medical academia, nation-wide. Is it any wonder we spend nearly double the amount for medical services for each citizen, every year as in any other country in the world but leave so much necessary care un-done and 43 million working Americans unable to afford basic health care coverage. In the state of Washington, the invented/fraudulent "disease" ADHD is the number one health expense in that state's Medicaid program. ] All three Boston meetings (1999-2001) were chaired by Dr Irwin Goldstein, professor of urology and gynaecology at Boston University School of Medicine, who is also a key figure at the international gatherings. Originally trained as an engineer, Goldstein has widened his focus in recent years from male to female sexual dysfunction. A regular speaker at meetings funded by industry and a consultant and lecturer for virtually every pharmaceutical company, he is a passionate advocate for building a new discipline of sexual medicine, because, as he told the recent New York gathering, in this emerging field "there is such joy in treating these people successfully." when the attention should be paid to other aspects of the woman's life. It's also likely to make women think they have a malfunction when they do not," he said during a telephone interview. In response, Laumann defends his use of the term "dysfunction" but concedes that many women among his 43% are "perfectly normal" and that a lot of their problems "arise out of perfectly reasonable responses of the human organism to challenges and stress." 's clinical associate professor of psychiatry, Dr Leonore Tiefer, contends that the medical model itself is severely limited for dealing with problems of sexuality because of its mind- body split, biological reductionism, focus on diseases rather than people, and reliance on norms.12 She claims pharmacological research runs the risk of oversimplifying the sexual difficulties of both men and women because it "promotes genital function as the centrepiece of sexuality and ignores everything else"13
What is healthy and what is sick? Goldstein regularly cites the 43% prevalence figure and dismisses suggestions from his colleague Dr Leiblum that it may indicate the prevalence of difficulties rather than real dysfunction: "I love psychologists but they don't deal with evidence." Asked during a break in the gathering about criticisms that medicine may not be best equipped to deal with sexual problems, Goldstein's replied: "Who's best equipped to deal with it? The horticulturists? It's a form of medicine. I think physicians are most appropriate." He added that he worked within a "mind-body relationships" framework and a multidisciplinary team that includes psychologists and nurses. The pharmaceutical industry's role in helping build the science of this new disorder has been "paramount," according to Goldstein, and he rejects suggestions that closeness between drug companies and academic researchers may be inappropriate. Asked whether marketing campaigns worth hundreds of millions of dollars may ultimately tend to amplify particular views of sexual difficulties and promote certain therapeutic options over others, he said: "I'm an academic clinical doctor. That's a question for some philosopher."
Another view of women's problems
Acknowledgments
Footnotes
References
1.
Moynihan R, Heath I, Henry D. Selling sickness: the pharmaceutical industry and disease mongering.
BMJ 2002; 324: 886-891Free Full Text.
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