The much trumpeted launch last week of a drug to treat low libido in women highlights one of the great paradoxes of the modern world: although public hygiene and medical science have largely wiped out old diseases like smallpox and polio, other diseases and mental disorders increase and multiply, so that humanity seems to be as sick as ever. Are we responding to these epidemics in the most effective way?
Sceptics contend that hypoactive sexual desire disorder (HSDD) – the condition that the drug Addyi, dubbed “pink Viagra”, is meant to alleviate — is not an illness at all, but the medicalisation of women’s problems with their relationships, or their biological rhythms, by drug companies eager to create a new market. They are probably right.
But there is no denying the reality of the cancer, heart disease and diabetes epidemics that encircle the world. Type 2 diabetes is expected to affect more than 10 percent of the adult population in many countries in the next two decades, driven by an obesity pandemic. Globally, around 35 percent of the adult population are overweight and 12 percent are obese, while the proportion of overweight and obese children and adolescents is also rapidly increasing.
The glamour of medical technology
Those figures are from an article published last year in the BMJ’s Journal of Epidemiology and Community Health by four public health specialists from the University of Navarre and from the Carlos III Institute of Health, Madrid, warning against the medical (Viagra/Addyi) approach to these epidemics. While medicine is necessary and works wonders for some people, it increasingly displaces simple remedies accessible to everyone. The experts point to large swaths of the adult population on statins, recourse to costly lung cancer screening, and the rise of diabetes and obesity pills as examples of health authorities prioritising medical devices over lifestyle changes – in diet, exercise and smoking, for example — that would prevent up to 90 percent of such diseases.
Their caution against being seduced by “the glamour of technology” anticipates a theme in Pope Francis’ recent encyclical on the environment. In Laudato Si the Pope talks about the “dominant technocratic paradigm” as the path by which human beings have devastated the natural environment, and calls instead for “self-restraint” (105) and the cultivation of a lifestyle which makes us “capable of deep enjoyment free of the obsession with consumption.” (222)
If the health of the earth depends on self-restraint, how much more must the health of our own bodies — and minds – depend on it.
It is easier, of course, to take a pill, go for check-ups and continue on as before, or make only token efforts at change. But, as with the case for sparing the environment, there are good reasons against relying on technology. Here are three:
You are likely to die sooner anyway, because medicine is less effective for prevention than lifestyle change. In fact, it could make you even more careless – behaviour known as risk compensation. “Believing in a new preventive technology may lead to a dangerous sense of immunity,” say the Spanish authors.
There is an issue of justice here. Technology comes at a high price to national health systems – a price that will be unsustainable as politicians respond to pressure for more and more screening programmes, vaccinations and drug therapies. The burden of disease is carried by everyone but falls unfairly on those who look after their health.
A related issue is equity. If national, taxpayer funded systems do not provide these medical remedies the poor miss out. If the public health system collapses, the next generation misses out. Already the developing world cannot afford much of the medical technology taken for granted in the rich countries, even though we have shared our lifestyle diseases with them.
A case study: cervical cancer prevention
One of those diseases is cervical cancer, most of which is caused by the sexually transmitted human papillomavirus (HPV). Between 2006 and 2009 a vaccine against HPV was rolled out in many countries with the aim of achieving universal coverage of young (12-13 year old) girls.
However, as the Spanish authors point out, “The vaccination programmes have mostly been implemented and publicly funded in higher-income countries although most of them have very low rates of HPV-related diseases.” At the same time, “very few developing countries have introduced the HPV vaccine into their national programmes although the burden of HPV-related diseases is highest there. At the current cost, mass vaccination is unaffordable in low-income and middle-income countries.”
Even in developed countries full coverage with three doses has not been achieved. It is the girls most at risk of HPV who tend to miss out – in the US in 2012 only one third of girls had received all their shots; some parents object to the programme on moral or other grounds. No doubt the vaccine has done some good, but in view of the mismatch between need and access, if for no other reason, it would be better, as the Spanish experts argue, to give priority to changing the behaviour that puts people at risk of HPV:
“HPV infection strongly depends on partners’ number and other sexual risk behaviours. Long-term primary prevention strategies are needed, which include structural interventions and sexual education with correct and complete information to increasing awareness about the basic facts of HPV infection. These simple, affordable and sustainable measures are absolutely essential for cancer prevention, especially in developing countries.”
Empowerment and structural changes
Some people object to any mention of behaviour – particularly in the context of sexually transmitted diseases — as it suggests moralising and “blaming the victim”. Yet people moralise and demand behaviour change when it is a question of saving the planet. Why should we expect people to cut back on waste, recycle and use cleaner energy if we don’t think they are capable of cutting back on sugar, smokes and sexual partners?
As for blame, the Spanish team lay that at the door of “global commercial powers [that] have fostered a pleasure-seeking cultural environment” which impacts especially on the poor.
Today people cannot make choices about behaviours in the circumstances of their own choosing. On the contrary, the promotion, price, availability and marketing of products affect their perceived costs and benefits, and consequently their choices. Decisions about lifestyles depend now on choices/interests of governments, producers and multinational companies and consequently, on the incentives of financial institutions. A few powerful institutions and decision-makers who set the agenda and decide what is fashionable and what is not, are making unhealthy choices the easiest choices, shaping the preferences of the population at large and encouraging them to make unhealthy choices. Consequently, as a result of the conflict with the dominant economical interests, wealth is being placed before health and an overemphasis on expensive technologies has led to underfunded prevention strategies. Public health intervention policies are often failing to overcome these powerful forces.
They call for empowerment of the individual through cultural change – a task for all the institutions of society, from the family, through business, to the government.
Strict controls on the marketing of tobacco products in some countries (bans on display and advertising, high taxes and plain packaging) show what can be done when behavioural change is seriously addressed. In the US the FDA is close to banning artery-clogging trans fats in the food supply. Unfortunately, no Western government seems equally courageous when it comes to fighting the pornification of society that encourages so much unhealthy sexual behaviour.
Perhaps the last word should go to Pope Francis, who points out that we cannot hope for clean and healthy physical environment without embracing neglected moral values in our own lives:
Sobriety and humility were not favourably regarded in the last century. And yet, when there is a general breakdown in the exercise of a certain virtue in personal and social life, it ends up causing a number of imbalances, including environmental ones. That is why it is no longer enough to speak only of the integrity of ecosystems. We have to dare to speak of the integrity of human life, of the need to promote and unify all the great values. (224)
“[S]obriety, when lived freely and consciously, is liberating,” the Pope says. Similarly, “happiness means knowing how to limit some needs which only diminish us, and being open to the many different possibilities which life can offer”. (223)
Self-restraint may not be the answer to whatever is troubling women in their romantic lives (although one shouldn’t exclude the possibility) but, certainly, it is a great starting point for fighting some other lifestyle diseases.
Carolyn Moynihan is deputy editor of MercatorNet.