Monday, August 10, 2015

The petition against Flibanserin


Flibanserin (trade name: Girosa) is a drug that treats low sexual desire in women (Female Sexual Interest/Arousal Disorder, or FSIAD).  It is not publicly available because it has not (yet) been approved by the FDA.  The FDA will approve or disapprove of it by the end of the week.

Flibanserin is not like Viagra, although that's a common misunderstanding.  Viagra does not treat low sexual desire, but rather erectile dysfunction.  Furthermore, Flibanserin is intended to be taken on a regular basis.  Trials show that women with acquired sexual desire disorders who take Flibanserin had on average 0.7 more satisfying sexual events per month, as compared to placebo.  Specifically, it increased the number from 2.8 to 4.5, whereas placebo increased it from 2.7 to 3.7.  There are also side effects, though I'm not too familiar with what they are.

The Ace Flibanserin Task Force is circulating a petition among aces to recommend that the FDA disapprove.  The existence of Flibanserin would encourage doctors to diagnose asexuals with FSIAD, and it is likely that the Flibanserin/Girosa ad campaign will involve shaming women for low sexual desire.

This has sparked some argument over whether the petition is right.  Asexuals may be "happy" with a lack of sexual desire (though there are always external factors affecting their happiness), but that doesn't mean that everyone is happy with it, and perhaps some people have conditions that are best treated within a healthcare framework.  Is it right for asexuals to take away that choice?

These are good questions to ask.  Way back in 2010, Flibanserin was also being considered for approval by the FDA (it was rejected), and a similar petition was being circulated.  So I helped create this interview with a sexual dysfunction activist, so that we could learn what the "other side" is concerned about.

Why I support this petition

Is it right for asexuals to take away the choice of people who want effective treatment for sexual desire disorders?  While this is an important question, it is not the same as the question of whether to sign the petition.  A petition simply doesn't have the power to take away an effective medical treatment.  The petition is neither created or signed by scientific experts, and the FDA knows this.

The purpose of the petition, in my view, is to ask the FDA to consider the externalities of approving Flibanserin.  Principally, I am worried about that public ad campaign which will amplify the social shaming of low sexual interest, and doctors' inability to distinguish between asexuality and sexual desire disorders.  The harms caused by these externalities would be difficult, if not impossible to measure with scientific studies, but they are still real harms.  And without a petition, the FDA would not have much of a basis to consider these harms.

In many of the arguments over the petition, people are talking about the scientific research into Flibanserin, and its exceedingly marginal effect.  If you're willing to read the research, you may let that inform your decision.  However, in principle, you shouldn't have to.  It's the FDA's job to consider the body of research, and as a non-expert I cannot meaningfully contribute to that.

All that matters is that, at a glance, the effects of Flibanserin look marginal, so there's a chance that the external costs might matter.  The FDA can weigh the petition in their own cost-benefit analysis, and can still decide either way.  Since I am not an expert, I trust the FDA's judgment more than my own.

On people with sexual dysfunction

In the interview with the sexual dysfunction activist in 2010, we learned a few important things. 
While it is true that many asexuals have difficulty getting their doctors and therapists to recognize their asexuality, the flipside is that people with sexual dysfunctions have the same difficulty.  Even when the dysfunction literally causes pain, doctors may not recognize it or offer treatment.

Furthermore, there are also many feminists who oppose any drug to increase sexual desire, even if effective.  Instead they take the view that "low sexual desire" is a social problem, or that we're socialized to think it's a problem.  I looked around to see what feminists are saying against Flibanserin now, and they do raise many valid concerns.  On the other hand, the articles minimize or wave away people with sexual dysfunctions.  As our interviewee observed in 2010, voices from people with sexual dysfunctions are entirely absent.

Though I support the petition, I do not support the silencing of the concerns of people with sexual dysfunctions.

Corrections 8/18/2015: Flibanserin's brand name is Addyi, not Girosa, and it was tested to treat Hypoactive Sexual Desire Disorder (HSDD) rather than FSIAD.