Happy New Year!

Whenever I need a break from the demanding world of pharmacy academia, I indulge in a little television. Every time a television program goes to a break, I can never escape three types of commercials: cars, food, and of course, prescription drugs. Those oh-so-wonderfully-realistic prescription drug commercials are the most noticeable and the most generic. They all start off the same—someone has a problem or a sickness yearning to be fixed which is quickly solved or magically healed by the advertized medication. However, there’s always a catch. All prescription drug advertisements are followed by a quick yet seemingly endless parade of possible side effects. A side effect is defined as an undesirable effect of a drug or a treatment. By the end of the commercial, I contemplate whether taking the drug is worth the risk of suffering from all those side effects. Whatever I conclude at the end of the commercial, I quickly forget it because in the end, if I need to take a drug, I will take it. When we are faced with a situation that could result with a million cons, and one possibly great pro—it is almost instinctive to go for the pro, regardless of the side effects. This is because we all desperately hope that the pro will surpass all of the cons.  With sex, this concept is no different. For those of us who engage in sexual activity, we are opening ourselves up to many potential side effects. A sexual relationship could lead to a broken heart, which could be dramatic. Sex could also lead to a slew of STDs, which could be traumatic. Sex can obviously lead to an unwanted pregnancy, which would be problematic. Yet, we still have sex because of that mind-blowing, earth-shattering orgasm with many more orgasms on the horizon. We have sex to achieve levels of intimacy that may only be expressed with physical love. We have sex because it’s passionate, spontaneous, and fun! As a wise man once said, “Sex is emotion in motion.” The benefits of sex overshadow the risks exponentially—just like how the benefits of a drug overshadow the side effects. Anyone taking a drug is informed of the potential side effects. In fact, finding a drug without a side effect is just as easy as finding an effective female sexual dysfunction drug—it’s practically impossible. So the risks are known, and the benefits are known. Millions of people across the globe entrust that their prescription drugs will make them better despite all the potential or inevitable side effects. When there’s so much risk in the choices we make, why do make choices that neglect the obvious obstacles of side effects?

I decided to meet up with an expert on side effects. I met Greg. Greg is 48, in a relationship, and like most Americans, has prescription medication.  He seems just like any other American, but that’s not the case. He has suffered side effect after side effect, each seeming more serious than the last. This is all because Greg, like millions is experiencing perhaps the ultimate side effect of sex; Greg has AIDS. I had only spoken to Greg via email prior to our meeting in which he agreed to an interview. We decided to meet at a quaint, coffee shop just off Government Center. As I sat, waiting for him I wondered what he would look like. After all, he wasn’t HIV positive; he told me he had AIDS. Based on my perception of AIDS through my studies and through the media, I expected Greg to be gaunt, unable to walk on his own, and on the verge of death. That wasn’t the case. In walked a tall, slightly overweight guy who looked just like anyone else. After shaking hands and chitchatting, he told me his story.

In 2001, Greg noticed that he had a torn retina. After visiting puzzled eye doctors, he eventually got several blood tests done to see if he had any bacterial infections. No one seemed to understand why Greg’s retina was torn. Everything came back negative. Then he was informed that one more test was necessary, an HIV test. Someone from the doctor’s office called him on the phone and told him that he was HIV positive. Just so you know, informing someone of his or her HIV status over the phone is not only illegal, but also extremely dangerous. Naturally the news was devastating to him. He thought his life was over, and many times, even around the time of our meeting, he contemplated suicide.

When Greg went to the doctor for his first HIV check-up, it was discovered that he had only 46 CD4 cells. A healthy, HIV-negative, person has anywhere between 500 and 1,500 CD4 cells/mm³.  His doctor was wondering how he was still alive. People are generally diagnosed with HIV first. An AIDS diagnosis is typically confirmed after an HIV diagnosis and when a patient’s CD4 count is 200 or less. It was discovered that Greg had been living with HIV for at least a decade, perhaps even two decades. He never thought for a second that he was HIV positive. At his doctor’s office, he took his first HIV drug treatment, azidothymidine, commonly known as AZT. AZT was the first FDA approved drug treatment for HIV. It is typically the drug an HIV positive person gets started on during his or her HIV drug therapy. AZT is an antiretroviral drug that inhibits reverse transcriptase, the enzyme that the virus uses to copy its RNA into DNA so it can replicate. AZT has side effects of nausea, vomiting, body-fat changes, headache, muscle aches and even more serious side effects of anemia, discoloration of eyes, and lactic acidosis. Greg said that he experienced vivid nightmares every night while taking AZT. Nightmares aren’t uncommon with HIV antiretroviral treatment. He eventually stopped taking AZT because it nearly cost him his life. He developed lactic acidosis, which is a build-up of lactic acid in the body. He is now taking Atripla. Atripla is a combination of 3 HIV medications (600 mg Efavirenz, 200 mg Emtricitabine, and 300 mg Tenofovir) that is one pill to be taken once daily on an empty stomach. He said the side effects are mild, although it makes him feel tired from time to time.

AZT was just the first of many prescription drugs that Greg would have to incorporate into his lifestyle. Because of his AIDS diagnosis, he has developed numerous conditions which include asthma, hypertension, severe cough, diabetes, insomnia, night sweats, thrush, rotted teeth, spinal meningitis—the list goes on. So because of these conditions, he is on a strict, thorough drug regimen to treat these illnesses. Greg takes over 30 pills per day. In addition to Atripla, Greg is on Thiamine, Ribloflavin, Folate, Vitamin B-12, Nizoral cream, Lantus, Actos, Allegra, Singulair, Rhinocort Aqua, Advair, Lisinopril, Calcium carbonate, Nexium, Hydrochlorothiazide, Aldara, Sonata, Wellbutrin, Depakote, Gabapentin, and Lamotrigine. For those us who work in a pharmacy, every now and then we get a patient calling in to ask the pharmacist about certain side effects of a particular drug. Imagine a patient asking about side effects of the twenty prescription drugs they’re taking. Each one of these drugs has side effects and when these drugs are taken together, they have even more side effects. Greg has suffered side effects from all of these drugs, most noticeably—he gained weight. He once tipped the scale at 300lbs. Also because of his drug regimen and his AIDS diagnosis, Greg has developed severe depression, which has made him required to visit a therapist weekly.

The side effects of AIDS and his drug regimen go well beyond clinical symptoms. Because of AIDS, he has been declared disabled, which has left him unemployed. He couldn’t physically work because his body would exhaust easily. Another side effect of his AIDS diagnosis is the ending of his relationship. His partner isn’t HIV positive. Greg contracted the virus while he and his partner were together. This has put a severe strain on his relationship; the two are parting ways after two decades of being together. Greg has lost his job, his love, friends, control over his body, and worst of all, his will to live. This is all a side effect. This is all because of one moment in which he made a choice, a choice that consequently left him HIV positive unknowingly for years, a choice that leaves him, relatively alone with AIDS. Greg falls into the category of the 32% of people in the United States who contract HIV through non-regular partners. Greg lives with his mistake every day and is reminded of it with each pill he takes, each job he gets turned down from, and each person who quivers when he reveals he has AIDS. Greg told me that people are afraid to shake his hand because they’re afraid of getting HIV or AIDS. The social stigma associated with people who have HIV and AIDS is an unfortunate obstacle Greg and others have to face. It is also a serious side effect of the ignorance that exists with regard to HIV and AIDS. It must be reiterated that HIV cannot transmitted through casual contact. It is only transmitted through bodily fluid transfer, and this doesn’t include saliva. It includes blood, vaginal, and seminal fluid.

As he left the coffee shop, I saw a man with no hope or will to live. The irony of it all is that Greg is relatively healthy. His CD4 level is roughly 500 cells/mm³. His viral load is low and his body has become so used to his prescription drug regimen that the side effects are less severe. He has made a fantastic turn-around from the time of his diagnosis in 2001. Before parting ways, he and I agreed to meet again to check up on how he was doing, not for my article, but as a friend.

I didn’t see him for a month because he was admitted to the hospital for his mental health. His depression and suicidal thoughts were so rampant that he wouldn’t take his medication.  When I eventually did see him, I saw a different Greg. He was happier and surprisingly optimistic. He told me of his stay at the institution and how angry and depressed he was. He said the therapy there did him some good. Although he continues to struggle with his illness, he hopes to move forward. He told me of his plans to move to Boston and start over. Although regret follows him, his hopes remain high. My hope in him is very strong, and our friendship has been good for us both.

December marks the ending of an era, the last month of a year that has gone by so quickly. December also marks the beginning of AIDS Awareness Month. The Center for Disease Control and Prevention (CDC) concluded that nearly 56, 300 people in the United States were infected with HIV in 2006 (2006 is the most recent year available). The CDC also estimates that 36,828 cases of AIDS were reported in 2006. After reading this article, I would expect no one to take this month lightly. Take time to educate yourself about HIV and AIDS. What people seem to forget is that HIV and AIDS are illnesses. HIV/AIDS patients deserve the same level of compassion that we would give to those with Alzheimer’s, Breast Cancer, Multiple Sclerosis, and other debilitating diseases. Greg has met some amazing doctors. His doctors are his friends. As future health care professionals, we need to have hope in our patients especially when they have no hope from others or hope in themselves. Will Cribby, the former director of Residence Life left me a powerful quote, framed as gift to remind me of my experiences on the Wellness Floor. The quote states, “In times of change, there is no incentive so great, and no medicine so powerful as a hope for a better tomorrow.” This quote remains true for patients such as Greg and for health care professionals of tomorrow, such as ourselves. So this brings us back to my initial question: When there’s so much risk in the choices we make, why do make choices that neglect the obvious obstacles of side effects?  We may not be able to overcome the inevitable side effects of medical treatment, but we can overcome the side effects of ignorance, social stigma, broken hearts, and even the deadliest disease on the planet. We can bear all side effects with hope and compassion. As one can see, side effects may include many things but hope includes much more.

© 2008

Things don’t always turn out the way you plan. I, like many other students don’t always get my studying done at the time I planned. I don’t always make it to the bank before it closes. And occasionally, I find myself unable to get up on time, despite the fact that I set my alarm for 6am. Life just works out that way sometimes, because we as individuals don’t always follow through with our plans. A plan, in simplest terms, is a commitment and although we break our commitments all of the time, most of the time, we manage to follow through with them. Why? Simply because we have a back-up plan, often times dubbed as “Plan B.” Why do we have back-up plans? Well if we didn’t, the world would crumble; nothing would ever get done. We have back-up plans because, if we break a commitment, dire consequences could arise. If I break my plans to study without a Plan B, I would fail the exam. If I never make it to the bank, I wouldn’t have money for coffee. And if I didn’t have a back-up plan for over-sleeping, then I would miss out on whatever I slept through. Consequences are the consequence of unfulfilled plans. Therefore, we must have a Plan B. This is no different in the world of sex. If we engage in sex without proper plans or back-up plans, serious consequences could occur. Pharmacy is a science that seems to have a devotion to following through with plans especially with our sexual plan B’s.  

There is nothing better than spontaneous sex. One of the best feelings in the world is to wake up to your lover arousing you, starting off an otherwise dull morning with great sex. Another great feeling, is leaving a party with the intentions of going home and calling it a night only to realize that special, sexual someone gazing into your eyes desiring what you’re desiring: hot sex. Yes, spontaneity is a great quality to have in all aspects of a relationship whether it is sexual or not. However, spontaneous sex is unexpected sex; and sometimes when we engage in unexpected sex, it could quite possibly be or lead to unprotected sex. In this day and age, unprotected sex requires a back-up plan. So when the condom breaks, or when that prescription for birth control needs a refill and you suddenly find yourself engaging in unplanned and unprotected sex, where could you turn to? —Your local pharmacy, of course. When plans fail by uncontrollable forces, you have to take control with emergency birth control.

Birth Control has been a part of mankind for millennia. However, it wasn’t until the development of rubber condoms in which contraception became not only popular and fairly effective, but a profitable industry. Despite the fairly effectiveness of the condom (prior to the effectiveness of present-day condoms), many women still craved birth control that was more in their power. Decades ago, if a man refused to wear a condom; women had little say in the matter and therefore, relatively no say in the most effective means of birth control of the time. However, thanks to pioneering efforts of Margaret Sanger, Katherine McCormick, and the research of Gregory Pincus under the Searle pharmaceutical company, the modern-day oral contraceptive was born. For the first time in history, women had a primary say in birth control that had no effect on their male partners. Although it took several years for the birth control pill to be perfected, it has become a success. Oral contraceptives are not only simple and easy to use but also 95 to 99% effective. According to sales and the latest studies, roughly one hundred million women across the globe use oral contraceptives—twelve million of those women in the United States alone. Every day, thousands of women are flocking to pharmacies refilling their birth-control pill prescriptions. Women are also flocking in great numbers to refill all kinds of prescription birth control that range from pills, to vaginal rings, to monthly shots, and to patches. Birth Control is an aspect of health that has not only been proven to be safe and effective but also available in a variety of choices that suits one’s particular needs.

As one can clearly see, when it comes sex—people have plans. Birth control is the plan of choice and it just so happens to be a very effective plan. However, when the initial plan of Birth Control fails, or when we just engage in unprotected sex for what ever reason, what’s the Plan B? Well the Plan B is “Plan B®,” popularly referred to as the “Morning After Pill.” Pharmaceutical company, Duramed Pharmaceuticals has come with a back-up plan for us— Plan B®. Plan B® is an emergency contraceptive that can prevent pregnancy for up to 72 hours after unprotected sex; the earlier the drug is taken after sexual intercourse, the more effective it will be. Plan B® contains two pills that contain levonorgestrel. What makes these pills different from other birth control pills is that they each contain .75 mg of the hormone. In other words, Plan B® is simply an extremely high dose of birth control pills. The side effects of Plan B® can include dizziness, diarrhea, headaches, nausea, and uterine bleeding. It must be noted that Plan B® is not an abortion drug. However there is such drug that induces abortion, called RU-486—but that’s another article. Plan B® is not effective if a woman is already pregnant and therefore, cannot terminate a pregnancy. These pills prevent a fertilized egg from implantation in the uterus. The drug was once available by prescription only but it is now available behind-the-counter for individuals 18 years and older (those, 17 or younger must have a prescription).

As many of us know, the United States has a high demand for pharmacists. This is in part due to the fact that the need for medication outweighs the pharmacists available to dispense them. In some areas of the country, three counties depend on one pharmacy. For me, as a New Yorker and a Bostonian student, it is rather difficult to imagine a world without a CVS on every corner let alone one pharmacy for three counties. It is even more difficult to imagine going into a pharmacy to get my prescription filled only to receive a “No,” with the reason being that the pharmacist was morally objected to filling my prescription. This unfortunately is a sad truth and a reality for some women across the country looking to get emergency contraception.

Upon its release, Plan B® seemed like a back-up plan to end what some consider the absolute back-up plan, abortion. However, controversy still followed. The drug has everyone yelling from everyday women, to abortion-rights groups to religious leaders including Pope Benedict XVI himself, who urged pharmacists not to dispense drugs that “have the goal of preventing the implantation of the embryo.” However, it wasn’t until the accumulation of local news reports about pharmacists refusing to dispense Plan B® that the nation took notice. In fact, many pharmacists across the country refuse to dispense or stock Plan B® on grounds that it conflicts with their moral convictions. In certain states, if a 17 year-old in a rural community has a prescription for Plan B®, and the pharmacist refuses—she would be responsible to find another pharmacist that would. And since pharmacies are scarce in certain regions, the time it takes for the patient to find another pharmacist is detrimental to the patient’s goal. Remember, the drug is most effective the earlier it is taken after unprotected sex, which means that every moment of waiting increases the chance of an unwanted pregnancy. These events have sparked debate in not only a re-evaluation of the duties of the pharmacist, but also a debate concerning the rights of the pharmacist.

During my pursuit to understand the severity of pharmacists’ refusal to dispense Plan B®, I came across a survey, conducted by the National Association for the Repeal of Abortion Laws (NARAL): Pro-Choice about pharmacies and their policies regarding Plan B®. The survey took place in the state of Washington in October of 2007. In Washington, there are 1,190 pharmacies. NARAL interviewed 1,014 of those pharmacies and discovered startling results. 7.4% of the surveyed pharmacies do not stock Plan B®. The study also showed that 3% of the pharmacies surveyed have pharmacists who refuse to dispense Plan B®. It must also be noted that 4% of the pharmacies in Washington refused to speak with NARAL Pro-Choice surveyors.

I personally spoke with the Public Policy & Field Director of NARAL Pro-Choice (Washington), Alissa Haslam who that said the key to resolving this issue is through education. Education indeed is perhaps the best method to end this debate. Alissa mentioned a study done right here in our backyard of Jamaica Plain about pharmacists and Plan B®. So I got in touch with Stacie Garnett, the Director of Health Equity and Access at NARAL Pro-Choice Massachusetts and the Coordinator of the Massachusetts EC Network. She provided me with information about a recent survey done by NARAL Pro-Choice in Massachusetts. The organization conducted a survey in which they sent a “mystery client” to 275 pharmacies across the Bay State to “gauge the degree of difficulty young women might face in obtaining Plan B®.” The study showed that 90% of the pharmacies surveyed stocked Plan B yet “6% gave the wrong information about how Plan B® works”, with 4% confusing Plan B® with RU-486, the abortion drug. Perhaps this confusion with RU-486 is the source of the controversy. NARAL Pro-Choice is an organization devoted to educating everyone, especially pharmacists and patients about emergency contraception.

Opponents of Plan B® argue that emergency contraception isn’t pro-life despite the fact that abortion rates have dropped in certain areas that have access to Plan B® (according to nwlc.org). Several weeks ago, a new pharmacy opened in Virginia called Divine Mercy Care. It became the seventh pharmacy in the nation to proclaim its refusal to stock or dispense any form of contraception including condoms. This trend has sparked state governments to re-evaluate legislation concerning the pharmacists’ decisions. In seven states, the pharmacist has absolute say in what he or she dispenses. Pharmacists in other states have the right not to dispense emergency contraception but have an obligation to refer the patient to another pharmacy location where the patient can receive the drug in a timely manner. There is no federal law on the pharmacist’s right to withhold dispensing or stocking certain drugs. Remember what Carla Oliveri always says, “There are 54 different jurisdictions, 54 different ways of doing things.” Despite the differences in laws and policies across the nation, one thing remains clear. There isn’t adequate access to emergency contraception to all of those who need it. This is because pharmacists do not dispense it, do not stock it, or simply the price is too high (Plan B® is roughly $50.00)

The million-dollar question is: Does the pharmacist reserve the right to refuse dispensing a drug because of personal convictions? How can we as a society deal with this issue when everyone has a wide variety of morals and ethics. What is to stop a pharmacist from dispensing HIV medication to a homosexual because the pharmacist disagrees with someone’s sexuality, believing that HIV is God’s curse on homosexuals? What is to stop a pharmacist from dispensing Suboxone because the pharmacist doesn’t want drug users in his or her pharmacy? What is to stop a pharmacist who shares Tom Cruise’s ideals that anti-depressants are the wrong route to treat depression? Apparently, in certain states, no one has stopped the pharmacist from interfering with our sex lives, our right to emergency contraception.

As future pharmacists, should we draw a line between personal conviction and professional duty at the counter or should our personal convictions be the major factor for our duty behind the counter? At last month’s White Coat Ceremony, I was told by my dean, faculty, and fellow students about the most important obligation of the pharmacist, which is commitment to the patient, no matter what. Pharmacy is an industry that allows everything to go according to plan. Doctors diagnose and prescribe, pharmacists counsel and dispense, and patients receive and heal. This is how our system was planned. This system cannot afford a Plan B for if we do not follow through with these plans, the system will fail, we will fail and the patient will fail. Our authority, as future health care professionals exists for the patient, not over the patient. In a world full of people in need of care (what ever the care may be), who are we to interfere with a patient’s Plan B? 
 
 

© 2008

Keep Reading! The next release of “Sex & Pharmacy” will be up quicker than you can say “prescription medical aphrodisiac!” 

Sex is the world’s most performed extracurricular activity. Do you find this fact surprising? If you do, you should probably go back to Mars where there’s no sex. Because this is Earth, and here, there’s sex—lots of sex! According to several studies by the Kinsey Institute, the average person between the ages of eighteen and twenty-nine has sex roughly one hundred twelve times per year. Yeah, I was shocked, too. That means the average person is having sex at least twice a week. Let’s face it; sex is everywhere. Sexuality is in the music we listen to, the fashion we decorate ourselves with, and of course in our general everyday behavior. However, when one thinks of sex, the last thing that generally comes to mind is pharmacy. After all, how could the art of preparing and dispensing drugs relate to sex? I will gladly answer this question, for I am fascinated with sex and pharmacy.

Once upon a time, the general consensus regarding foreplay was that it was the most effective method one could practice to provoke sexual arousal. Foreplay is defined as physical and psychological erotic stimulation that occurs prior to sex. Foreplay includes, but is in no way limited to kissing, touching, and/or stroking your partner or partners. Foreplay is probably the most fun aspect of sex (aside from the sexual act itself) because it allows one to just engage with his or her partner(s) in ways that can be both playful and intimate at the same time. If I had a dime for every time I saw a couple engaging in foreplay by groping and making out on some random couch at a typical party at Northeastern, I would probably have enough money to cover my textbooks for the spring semester. The bottom line is, foreplay is fun and many of us who engage in sexual activity, embrace it. Our generation is in the prime of foreplay just as we are in the prime of exploring our sexuality. Everything about sex is still new and exciting. Nothing’s too old or dull, yet (for most of us). However, can that be said for a certain percentage of an older generation? The average person between the ages of forty and forty-nine has sex roughly sixty-nine times a year while those in their thirties have sex roughly eighty-nine times a year. Those who are older don’t seem to be having as much sex as we do. Perhaps they have lost the thrill. Maybe there’s just no time to have sex one hundred twelve times a year. Whatever the case may be, it is apparent that the infrequency of sex has little do with the fact that many individuals over forty still crave sex—good sex, physically satisfying sex to be precise. How did I come to this conclusion? That answer is simple. All I have to do is glance at a market of prescription drugs.

Unless you were in a coma for the past decade, there is no way you haven’t heard of Viagra. Viagra has that special zing to make a special man get sprung. All jokes aside, Viagra is a drug that treats erectile dysfunction (commonly referred to as ED). To be technical, Viagra has an active ingredient known as Sildenafil with a chemical name of 1-[[3-(6,7-dihydro-1-methyl-7-oxo-3-propyl-1H-pyrazolo[4,3-d]pyrimidin-5-yl)-4-ethoxyphenyl]sulfonyl]-4-methylpiperazine citrate. Try drawing that structure off-hand for your organic or medicinal chemistry course! Sildenafil inhibits the enzyme, phosphodiesterase type 5 (PDE-5), which then, in turn allows more blood to flow to the penis. In other, more blunt terms, when using Viagra, a man can become as hard as a rock when aroused. Since it’s release back in 1998, more than twenty-five million men in over 120 nations have used Viagra! This means that at least twenty-five million prescriptions were filled in millions of pharmacy locations dispensed by millions of pharmacists across the globe.

Another hot drug on the market is Levitra. Levitra, like Viagra treats erectile dysfunction. Levitra also contains a PDE-5 inhibitor, called Vardenafil hydrochloride that also allows more blood flow into the penis. Levitra isn’t as commercially successful as Viagra. In 2004, Levitra ranked in domestic sales of $174 million while Viagra accumulated $919 million in domestic sales. But don’t write Levitra off! $174 million in annual sales isn’t bad for a drug that is relatively new on the market. Present day, Levitra is proven to be effective in men who do not see results with Viagra. Another ED drug that’s increasing in popularity is Cialis. Cialis like Viagra and Levitra is a PDE-5 inhibitor. What distinguishes it from Viagra and Levitra is its half-life. Cialis has a half-life of about seventeen hours while Viagra and Levitra both have half-lives of about five hours. All it really means is that Cialis’ effects lasts longer than it’s most famous competitors.

Okay, so you’re probably wondering: What about women? Women don’t experience erectile dysfunction—obviously. But what options do women have for improving their sexual dysfunctions? Let me enlighten you. Women do not have as many options as men do despite the fact that approximately 43% of women suffer from some form of sexual dysfunction (according to an FDA report). In fact, the term, “female sexual dysfunction” wasn’t prevalent until 1997 during the development of Viagra. The clinical definition and major symptoms of female sexual dysfunction are a lack of desire and the inability to achieve an orgasm.

To solve the problem of female sexual dysfunction, many pharmaceutical researchers have focused on developing treatments to allow more blood flow to female genitals, like how erectile dysfunction drugs allow more blood flow into the penis. There are several treatments available such as creams containing L-arginine, and herbal medications that do so. The most popular herbal treatments are Sentia and Avenavin. Although these herbal treatments claim to increase desire and make orgasms more “earth-shattering,” it must be noted that these treatments don’t require a prescription—and the FDA did not approve any statements regarding Sentia and Avenavin. The FDA also didn’t approve another treatment for female sexual dysfunction: Intrinsa. Intrinsa is a treatment, developed by Proctor & Gamble that was originally designed for Hypoactive Sexual Desire Disorder in surgically menopausal women. The treatment is a patch in which the patient places on her lower abdomen. The patch injects 300 micrograms of testosterone over a period of 24 hours. The FDA didn’t approve Intrinsa because the drug’s benefits did not outweigh the side effects and possible dangers of the drug. With any hormone injections, cancer is generally a major factor to consider as well as other complications of the body’s delicate hormonal balance. And most importantly, it is impossible to evaluate the long-term effects of the drug. So, where does that leave women who desire the “desire” to get and achieve an orgasm? Well, it leaves women nowhere because there is no FDA-approved medication for female sexual dysfunction.

Is this unfair? Is this inability to develop a female sexual dysfunction drug the work of advocates of the Double Standard? Perhaps. Or is it the result of a serious question that has been asked for many years, yet remains unanswered: how clinical is sexuality? When it comes to erectile dysfunction drugs, the problem seems visible—a man cannot get an erection. Therefore, there is a drug that inhibits an enzyme to allow him to get an erection. However, it doesn’t necessarily fix why the patient didn’t get an erection in the first place, the possible psychological reason. It is a fact that a man’s potential to get an erection is a sign of his overall health condition. In other words, if a man gets normal erections periodically, it is a sign he is in good health. If a man suffers from erectile dysfunction but is in otherwise great health, psychological reasons may be the cause of his sexual dysfunction. If a man has trouble getting aroused, no erectile dysfunction drug on the market today will help him.

A common misconception about sexual dysfunction drugs is that they are modern, medical aphrodisiacs. That is completely false. Aphrodisiacs are agents that supposedly arouse or provoke sexual desire. Remember, Viagra, Levitra, and Cialis affect blood flow and have no effect on arousal. A man can pop all the Viagra he wants, but if he isn’t turned on, he isn’t going to have an erection. Female sexual dysfunction is more complex because it’s rooted in a lack of desire and the inability to orgasm. It has been shown in numerous studies that women prefer intimacy with their sexual relations.  All a woman needs is an aphrodisiac, right? Wrong—there is no scientific proof of aphrodisiacs, and therefore there is no medical drug. Intimacy is a component of sexuality that cannot be fixed with a drug that allows increased blood flow to the genitals or hormone injections throughout one’s body.

We are living in a world that seems to be “medicalizing” everything, including sexuality. And where there’s medicalization, there are drugs; and where there are drugs—there’s pharmacy. As future health-care professionals, we must examine all aspects of health, both the physical and psychological components of the patients we are helping. Sexual Dysfunction may have clinical symptoms, but the causes, as many experts argue, can very well be psychological. If the pharmaceutical industry could deliver a drug to provoke arousal, perhaps a homosexual man can take a drug to get him aroused to a woman. Or perhaps a pedophile could take a pill so he or she will never be attracted to children. These ideas may seem farfetched, but drugs to provoke arousal are in the works. However, arousal is completely psychological. No drug at this time can substitute foreplay and if a drug did, it would be controlling the mind, which in turn would lead to even more ethical questions to consider. Those who are having trouble sexually in their relationships should not seek Viagra or hope for some female desire and orgasmic inducing wonder drug, but seek measures to improve their sex lives through therapy, communication, and of course, foreplay. And when that fails, one should then consult his or her physician and then, if necessary, consult the pharmacist. Sex and drugs have been intertwined for years, but as we can see, sex and pharmacy will be something intertwined for years to come.

© 2008

KEEP READING! THE NEXT ARTICLE OF “SEX & PHARMACY” WILL BE UP SOON!!!