Introduction and Main Arguments
Fishman in “Manufacturing Desire: The Commodification of Female Sexual Dysfunction”, begins with the premise that medical experts have the authority to mediate between pharmaceutical companies and the consumers. She explores the connections between academic researchers and drug manufacturers, specifically pertaining to Female Sexual Disfunction, as they introduce and market these drugs into the consumer market. She argues that the researchers as well as the companies stand to make profit from the arrangement to present data in favour of a particular drug produced by a particular drug company. As the pharmaceutical companies have to provide medico-scientific knowledge alongside introducing any commercial drugs, they support and develop the market for drugs (188). In other words, they only produce the drugs that can be mass consumed. In order to create such a drug and a market for it, the relationship between clinical researcher, clinician, consumer and pharmaceutical company is heavily manipulated by the corporation. This complicated system, thus, Fishman argues affects the culture, market and consumer. However, she is not concerned with the ethics of the research on Female Sexual Disfunction, as opposed to evaluating the means by which the research done is constantly evolving based on the standards that are present.*
Consumerism and Disease Concept
An industry is generally defined, according to Fishman “as a relentless and [an] unscrupulous force with which academic research has either willingly or reluctantly (depending on who is telling the story) become entangled in the name of power and proﬁt” (189). However, she argues that it is actually the introduction of new ways to commercialize drugs. In particular, she focuses on the networking connections amongst the private industries, clinical trial researchers and institutions. These complexities in the relationships between the pharmaceutical companies, regulatory bodies and the consumers collectively comprise of the moral economy of sexual dysfunction research, for instance, which has coevolved with the changes in culture and technology. In specific, she claims that technologies need consumerist processes for their success, such that they inform each other: without a demand, there would not need a supply (of marketing and the actual drugs).
Fisherman agrees with Clarke in that the first part to the process of drug commodification is the biomedicalization of a condition. By actually acknowledging that it is a disease, it becomes a cause of concern, a thing to be treated. This need for treatment leads to a drug to gain approval in the pharmaceutical industry. She claims that this need for approval indicates the creation and conﬁguration of a ‘market’ of potential users rather than individual users in the process of production of a technology or, specific to her article, the drug. Furthermore, it also identifies the manner in which people can become consumers (i.e. the change in an individual’s mindset to be able to become a consumer). This idea is connected to the transformation of a drug to a marketable product. Technoscience studies, thereby converges with consumption studies, such that the development of a network is multidirectional. For example, she considers ADD and the introduction of Ritalin. The availability of Ritalin leads to a rise in the diagnosis of ADD. This is referred to as the “diagnostic basket creep” as Peter Kramer claims (192). This is similar to the Looping Effect discussed by Hacking in “The Looping Effects of Human Kinds”. So, the disease, once formalized, becomes a ‘thing’ that needs treatment (or a drug). The treatment requires researchers, drug producers, clinicians (who prescribe the drug) and the consumer (also the patient). She argues that the patient and clinicians become consumers through the complex relationship between the FDA and pharmaceutical companies.
The process of the medication going through FDA approval, wherein the clinical trial endpoints are already chosen based on the classification guidelines that are co-produced for any new drug that is being considered. This co-production is the product of the link between the development of a disease category, the purpose of a conference which seeks to understand the disease and the approval of the drug into the market. Several problems are associated with the FDA’s method of determining the credibility of the drug: they only rely on observations in behavioural changes, but not the subjective assessments of changes in mood or attitude towards the particular dysfunction (196). Thence, the guidelines alter the ways in which the drugs are approved and which ones are introduced into the market. This, further, shapes ideas of normalcy. As discussed through Duffin’s piece, “The Disease Game”, normalcy becomes a reason to market it to a consumer that wants to rid themselves of even the smallest hindrance that disallows them to lead a ‘normal’ life, without necessarily defining ‘normalcy’.
This affects the manner in which the pharmaceutical companies promote their product to the public on their websites, through peer-review boards and any other academic journals. They work around the medical code of ethics as well as the FDA policies (198). The significance of this is the fundamental objectivity that the clinical research promotes as a set of scientific data. The data is manipulated by avoiding outliers, while still being advertised as unbiased research with the consumer’s best interests at the forefront.
Marketing – Advertising and Commercials and Cultural Effects
Researchers are the mediators between pharmaceutical companies and other clinicians. These researchers lecture at medical education conferences (MEC) mandatory for clinicians to renew their licence. These MECs obscure the relationship between the clinical trial researcher and the clinicians. The MECs, furthermore, lack regulation, which complicate the relationship between the clinicians and the researchers: in educating clinicians about the new developments in medicine, there is an underlying pharmaceutical promotion and marketing. Hence, the clinicians become the target end-users.
Although the MECs are supposedly education conferences and not intended for commercial or advertising purposes, the court rules any commercial style speech as “commercial free speech”. Due to this ruling it is acceptable to use these events as a means of indoctrination for the pharmaceutical companies’ personal agenda. Majority of these problems arise from changes in the system itself as well as the corruption and privatization of research and medical care, specifically in the USA. Consumerism is connected to clinical practice and research and they are intractable and medical exceptionalism is an idea of the past.
* Without going into too much detail about the specific issues related to FSD in the article, I will deal with the networking aspect of the consumerist system.