Tuesday, December 1, 2009

The Feminine Mystique?

Ok, here's a story that was the second most emailed article at the New York Times website for most of Monday.  Oddly, a story about hiking the Grand Canyon had even more appeal than this one, and this morning, a story about kindergartners in forests is number one.  But, in keeping with Holly's racy tendencies, we could hardly pass up this also-ran (its place in the queue suggesting that New Yorkers crave nature more than they crave sex?).  Called "Women Who Want to Want", the story is about curing an affliction that is apparently common among women, to judge by interest in this article -- lack of sexual desire.  It's also about whether that's a disease or not -- pharmaceutical companies seem to be training us to think it is in case they come up with a female form of Viagra, so we'll all get in line to buy it when they do, but that's not news (in fact, the Times also ran a story saying that there's already a product that will do the trick, but that's beyond our scope today, and anyway, no brand names here).

All that is interesting enough, sociologically and so on, but here's what really interests us about the article, given all our posts on how to determine cause-and-effect, and evidence-based medicine etc.  Bear with us as we quote at length, just so you get the full effect.
Various pharmaceutical companies, at various times, have pursued testosterone as a remedy for women’s lack of desire, and some doctors prescribe it for the condition — Laura Berman, Oprah's anointed sex expert, avidly promotes this method — though the Food and Drug Administration hasn’t approved this use. Brotto and Basson [sexologists] are about to publish research demonstrating that low levels of testosterone in women do not correspond with low libido. Yet there is a paradox. Brotto explained that giving extra testosterone to women with desire problems can, it appears, spike sexual interest. For reasons unknown, the administered hormone has a unique effect. But there’s a further complication. In studies, women given a placebo report a similar result, not quite as marked but definitely not insignificant either. To add to the intrigue, the women using a placebo often report testosterone’s unwanted side effects: facial hair; acne. Speaking about all this, Brotto smiled in bewilderment — and in something close to awe at the inscrutability of the human mind, the organ that is the locus of desire.
Did you get that??! Giving women a placebo instead of testosterone can cause the same unwanted side effects, facial hair and acne, as giving them the hormone itself! That is so beautiful, and says more in one sentence than anything we've come up with yet about the difficulty of determining causation.


Holly Dunsworth said...

But did the placebo raise testosterone? That's what I want to know. Because it's possible that facial hair and acne did not actually increase, just their awareness of it did, thanks to the scientists' questionnaire.

If it is a real effect, then does this mean that if we think (real or not) that we're feeling friskier thanks to a pill, then we can trick our bodies into acting the part? Wouldn't this imply that drugs aren't always the best solution? *wink*

This is sinking in for me now... okay, this is pretty cool because it could mean that we're not a species of desperate dopes who have fallen for thousands of years for the potions and dragon bones and all the other snake oil-style promises... they actually DO work for sexual interest and libido because the process of buying them and ingesting them tricks our brains into doing what we hoped for.

Ken Weiss said...

It would mean we're not nearly as specifically pre-programmed as we have liked to fancy ourselves in the recent couple of decades of the 'genetics era'.

And, as a recent article the other day said (I forget where I saw it, in the flood of news stories and journals), that ants are less pre-wired, too.

Maybe we have to re-think what thinking is all about.

Or maybe this is just another story interpreted and written by men to serve their wishful thinking?

Holly Dunsworth said...

"Maybe we have to re-think what thinking is all about." AMEN! (and AWOMEN too).

Anne Buchanan said...

Exactly, Holly, whether or not the placebo raised testosterone is not the issue. And, you're right, whether or not facial hair and acne actually increased is a good question -- it's the kind of problem that haunts epidemiological (and psychological etc) studies, so that we end up not knowing what causes what at the most basic level. E.g., do low vitamin D levels cause depression, or does depression cause lower vitamin D? A careful study would anticipate the possibility that facial hair and acne might increase with a placebo, and measure before and after, but not all possible outcomes can be anticipated.

Epidemiologists go by a standard set of criteria for determining cause, called the Hill Criteria.

1. Strength of association
2. Consistency, or repeatability
3. Specificity, or a cause must lead to a single effect
4. Temporality, or the cause must precede the effect
5. Biologic gradient, that is, the dose-response curve goes in one direction (more smoking = higher likelihood of lung cancer)
6. Plausibility -- the hypothesis makes sense biologically
7. Coherence, similar to 6, the explanation fits with what's known about the disease
8. Experimental evidence supports the hypothesis
9. Analogy

Unfortunately for the ease of disease causation, not a single one of these, except perhaps for temporality, is an essential criterion. And some people even argue that temporality can't always be demonstrated. So, with no formal or rigorous or reliable way to demonstrate causation, epidemiology still can't tell us really whether eggs are healthy, or what caused the current epidemic in asthma among kids.

This is all a long-winded way to say that whether or not a testosterone placebo causes acne and facial hair -- or increased desire -- would be hard to determine. Which makes it just as hard to determine what effect actual testosterone might have!

Ken Weiss said...

Maybe what we need to learn is to acknowledge the mystique and enjoy it.

Maybe evolution didn't want us to be so analytical as to make such a subject dry and impersonal. Maybe while scientists are being so analytical, others are having their sport....

Anne Buchanan said...

Oops, scratch my last dry and analytical comment then!