Addyi, the drug to boost libido for women, hits the market today.
Let’s take the fact that the women in the studies for the medication do not reflect the average patient in the gynecologist’s office reporting low libido and that even for this highly select group of women only 9-14% responded and the definition of response was very modest and put it aside.
Let’s focus instead on the “doctor training.” By now most people have heard that Addyi has a potentially dangerous interaction with alcohol and other medications. But no fear, we doctors who prescribe Addyi are “well-trained to do so!” I read about that in several posts.
Except we are not.
To prescribe Addyi a doctor has to read 13 power point slides and sign an attestation that basically says they will assume the risk if their patient drinks while taking Addyi. Four of the slides contain no medical information, so eight slides with relevant information (it’s so basic though it is hard to call it relevant) to the drug. The company itself calls the program “3 easy steps” – read, review, and enroll! (how is that even 3 steps, isn’t read and review part of the same thing – learning?). It takes less than that 5 minutes. Now if 5 minutes and 3 easy steps doesn’t say well-trained I don’t know what does!
In my opinion it’s not any kind of training, it’s a shift of risk from the manufacturer to the provider. If a patient takes Addyi, drinks alcohol, and suffers harm the company can simply say the doctor didn’t screen and prescribe appropriately. Tidy,
This is the extend of the information on patient selection:
Addyi is indicated for the treatment of premenopausal women with acquired generalized hypoactive sexual desire disorder (HSDD) as characterized by low sexual desire that causes marked distress or interpersonal difficulty and is NOT due to: A co-existing medical or psychiatric condition, Problems within the relationship, or The effects of a medication or other drug substance.
Most of the slides focus on the fact that mixing Addyi and alcohol is potentially dangerous (this interaction, as I have reported before, was studied mostly in men).
The people best able screen for suitability for the drug are sex therapists, but seeing a sex therapist isn’t a requirement. Believe me when I say the average gynecologist has no idea how to screen for sex disorders. What will happen is women will call for the drug. They won’t get screened for relationship issues or depression and sex technique won’t be discussed. The easy thing to do will be to read 13 slides and sign an attestation and then give the drug. I expect several enterprising OB/GYNs to set up specific sex clinics for this purpose – come in for a private $500 consultation, leave with a prescription for Addyi. (Just remember, and expensive placebo works best).
No doctor is “trained” to prescribe Addyi specifically because there is no training program, just some cursory information on the drug and a warning about alcohol and a few other drugs. It’s not about patient selection or safety, it is a paper shell game designed to shift risk.