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Manufactured diseases
Scripps Howard News Service


January 25, 2006

A couple of years ago, as my father and I watched a telecast of an NFL playoff game, we were bombarded with commercials for erectile dysfunction drugs. Every one included the tag line, "Ask your doctor if Viagra (or Cialis or Levitra) is right for you." After about the 10th one, my father, a retired physician, exclaimed with exasperation, "How the hell am I supposed to know if Viagra is right for you?"

This comment pointed toward a couple of truths.

First, like almost any other doctor, my father's knowledge of the pharmacological effects and potential risks of an erectile dysfunction drug would be limited to what a pharmaceutical-company sales representative had told him about that drug. (The notion that your doctor "knows" something as immensely complex as the field of medicine is as misguided as the idea that your lawyer knows "the law.")

The more important truth implied by his comment was the point that, when considering whether something like an erectile dysfunction drug is "right for you," the scientific information available on the subject is probably a minor consideration. After all, there is surely at least one other person whose opinion on the matter ought to be far more crucial than your doctor's.

Indeed, the concept of what counts as a disease or a dysfunction is in many ways a product of social and economic factors, as well as the definitions of medical science - or rather, the latter definitions are to a great extent driven by the former factors, rather than simply being objective scientific observations.

This is especially true in the case of something like erectile dysfunction. The phrase itself was invented fairly recently, to replace the old term "impotence." This was done in part because of the negative metaphorical connotations of the old word, but also because "erectile dysfunction" sounds more like a treatable medical condition.

Once something that was formerly considered merely another fact of life has been transformed into a medical condition, that is, a kind of disease, the boundaries of that disease tend to get defined by cultural and economic considerations. What is now called "erectile dysfunction" describes a much broader range of physiological outcomes than were covered by the old term "impotence," which signified that a man was more or less completely incapable of engaging in sexual intercourse.

Now, "erectile dysfunction" has come to mean what was formerly known as "low sex drive." In other words, older men who notice that their interest in, and performance of, sexual activities is not as enthusiastic or frequent as it was when they were 25 - which is to say almost all older men - are being encouraged to think of themselves as having a syndrome or disease. (Another, obviously problematic, market for these drugs consists of young men who wish to be able to have sex while drunk).

It may well be that for most of the men who make up the target market for erectile-dysfunction drugs, the only "disease" they are suffering from is that they are getting older. Yet it is clearly in the interest of many economic actors, and most especially in the pharmaceutical industry, to transform as many of the natural processes of aging as possible into diseases.

Indeed, the makers of the three major ED drugs, concerned about what they perceive as relatively slow growth in a market that produced "only" about $3 billion in sales last year, are launching ad campaigns to make more men aware that, contrary to their previous self-perception, they may be suffering from erectile dysfunction.

What they (and we) are really suffering from is considerably more difficult to cure.


Paul Campos is a law professor at the University of Colorado
and can be reached at Paul.Campos(at)

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