NEW YORK -- The success of Viagra has companies racing to achieve a female equivalent, and one herbal product's claims of effectiveness are stirring debate on whether any one drug can be the answer for women.
"They have Viagra. Now we have Avlimil," its makers boast in magazine and television advertisements.
As an herbal treatment, Avlimil didn't require the extensive study and tests necessary for U.S. Food and Drug Administration approval. But that does not prevent it, and others like it, from promoting themselves as giving women what Viagra offers men.
Since the 1998 launch of Viagra, which racked up $1.7 billion in sales last year for New York-based Pfizer Inc. as a treatment for male sexual disfunction, at least 10 pharmaceutical companies have undertaken development of a similar drug for women, according to market research firm Decision Resources.
Their efforts were spurred on by a 1999 study said 43 percent of women have difficulties with sex. Decision Resources estimates the global market for an effective treatment at between $2.7 billion to $3.2 billion by 2006.
Avlimil's splashy promotion has helped intensify debate over how to help women with sexual problems, as has a January article in The British Medical Journal that accuses drug companies of exaggerating female sexual dysfunction to peddle medicine.
No one questions that many women have difficulties with libido, arousal and orgasm. But because women's sexuality is more complicated and psychologically driven than that of men, many question how key any drug would be to treatment.
"For women, arousal and desire starts in the brain. Women's sexual dysfunction often has a psychological component," says Dr. Adelaide Nardone, a gynecologist and obstetrician who is also a consultant to Vagisil, a line of women's health products.
Nardone said drugs may help the women whose sexual difficulties are tied to physical conditions. But since the conditions are diverse, it is unlikely one drug will help all women. For example, desire problems could stem from low testosterone levels while arousal difficulties may be a result of low blood flow to the clitoris.
Avlimil claims it can help in all types of sexual problems. The assertion is based on a company-sponsored, three-month trial of 49 women. Trials for prescription drugs usually take years and often include thousands of patients.
Since Avlimil's launch two months ago 30,000 people have purchased it, said Susan Cossman, vice president of marketing of Warner Health Care, a division of Wagner Pharmaceuticals. A month's supply of the pills costs $49.25
Wagner was founded a year ago by a private investor group to purchase the rights to Avlimil. Cossman declined to say how much Wagner paid for Avlimil or who developed it.
Avlimil sales to hit $110 million in 12 months, Cossman said. Wagner is spending between $3 million to $5 million on ads in magazines such as Health and Ladies Home Journal and women-oriented cable television stations like Lifetime.
The polished campaign, which says that 50 million women suffer from sexual dysfunction, sets Avlimil apart from scores of other herbal remedies, many sold on the Internet, which have less visible - but often more steamy - marketing approaches.
"It is intentional for us to use quality in the ads because we want women to look seriously at the issue of sexual dysfunction," said Cossman.
Not every one is buying the marketing.
"Just what we need - more ads that try to appeal to a woman's fear that she isn't normal,' said Dr. Leonore Tiefer, an associate professor of psychiatry at the New York University School of Medicine. "Fifty million is a ludicrous number. There may be 50 million women dissatisfied with their sex lives, but it is probably for 50 million different reasons."
Cossman says the 50 million figure was derived from the 1999 study in the Journal of the American Medical Association, which said 43 percent of women experience sexual dysfunction. Now even some in the drug industry believe the article overstated the problem.
Tiefer believes drug companies are trying to create medical problems out of the natural ebbs and flows of a women's sex life. She says as females age they may not have as much intercourse or as many orgasms, but enjoy other sensual pleasures.
"Not having an orgasm is not a medical problem," said Tiefer, who started www.fsd-alert.org to highlight what she says in the hyping of the condition. "Sex isn't like a broken ankle or a gold bladder operation. It is arbitrary and is about what you do and what you like."
Other doctors say women with sexual problems deserve medical help.
"Pfizer didn't create female sexual dysfunction," said Dr. Andrew Goldstein, director of the Sexual Wellness Center in Annapolis, Maryland. He is working on a testosterone patch, designed for women with low sexual desire, for Procter & Gamble.
"There is a generation of women getting older who started the sexual revolution," he said. "They bought vibrators, read the Kama Sutra and when their sex lives aren't good they get [filtered word] off about it."
"Osteoporosis is a natural part of aging but that doesn't mean we don't keep people from trying to break their hips," added Goldstein
Procter & Gamble, and Pfizer, which is testing Viagra in women, are giants in the race to find a drug for female sexual dysfunction. Most of the others are smaller biotech firms.
Pfizer was singled out in the British Medical Journal article for funding conferences and research on female sexual dysfunction, including the JAMA study. The article alleges drug-funded studies are biased to conclude medicines are necessary.
Pfizer spokesman Geoffrey Cook denies the company is trying to manufacture a disease to sell more Viagra, and is instead contributing to a better understanding of the condition. In fact, he says tests show Viagra won't work across the board for women with sexual problems.
And comparisons to Viagra by herbal treatments aren't appreciated. "Herbal treatments aren't tested like pharmaceutical problems so patients should be careful," said Cook.
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