from the world's big
New Frontiers for Sex
Internationally renowned, Dr. Michael Perelman is Co-Director, of the Human Sexuality Program, New York Presbyterian Hospital. He is a Clinical Professor of Psychiatry, Reproductive Medicine, and Urology at Weill Medical College, Cornell University. A National Institute of Health Fellow, he received his MS, M.Phil. and Ph.D. degrees in clinical psychology from Columbia University--where he wrote the first sex therapy doctoral dissertaion in Columbia's history in 1976.
Dr. Perelman's clients, experience common sense advice filtered through the wisdom of over 30 years of clinical practice. Dr. Perelman has been invited to present his Sexual Tipping Point model at professional meetings around the world and has published widely in the professional literature. He is frequently quoted and often featured by the media.
Besides private practice, Dr. Perelman serves on multiple professional society,editorial, and industry Advisory/Directors Boards. He is the Past-President of the Society for Sex Therapy and Research. His research interests are integrating the use of sexual pharmaceuticals with sex counseling to provide better risk/benefit for men and women suffering from sexual problems.
Question: What is the new frontier for sex?
Michael Perlman: I think the next big thing in sex will be a continuation of what really happened at the turn of this millennium, which it won’t be just for sex but will be for all areas, the biological revolution that is taking place, our ability to influence outcomes within the body to fight disease and really delay the consequences of aging. So whether we are talking about from a sexual point of view or even Alzheimer’s, a big thing is going to be, what is the use of sexually acting drugs in the mind? And by this I mean drugs that affect the brain the spinal cord. The current drugs that you see advertised on television, Viagra, Levitra and Cyalis, are part of a class of drugs called PD-5 inhibitors, and they all act at the periphery, they act at the end organ, they act on the penis; the drugs that will be developing in the next ten years will actually act on the brain. Now, we actually have a long history in psychiatry of using drugs that have an impact on the brain, but this is going to be much more multidisciplinary and focused because there will be work being done by biologists, psychiatrists, psychologists, urologists, gynecologists, primary care physicians, endocrinologists, neurologists, cardiologists, everybody who is involved in sex, which is very multidimensional, multidisciplinary from its scientific focus. Obviously the people who speak about this best are not people like myself, are the poets and playwrights and novelists because they’re the ones with much better words to express the range of human emotion. Having said that, these drugs will begin to impact your threshold for your sexual response. Now, why is that important? If you want to be able to have a sexual experience, a man, and you are using one of the drugs currently available today, that will facilitate your ability to obtain and maintain an erection. But we also know that erections in and of themselves aren’t enough; people have to be in the mood for sex. These drugs do not work particularly well for women, we can talk about what is going to be available for women later, but one of the things that is going to be making a difference for both men and women, are drugs that affect the threshold of their response. I believe in something called the sexual tipping point, and what that is is basically a very simple idea that sex is mental and physical. So what are ways that we can impact sex mentally? What are ways that impact us physically? So disease and illness impact sex physically in a very negative way. The sexual pharmaceuticals can impact sex positively and balance off some of these disease studies. Stress and pressures of modern society in general tend to negatively impact people’s sexuality. Some people are fortunate enough to be able to use sex as a relief from anxiety; most of us have to be somewhat anxiety free and depression free in order to function sexually, and stress free. So what if you got the average couple who is pretty tired at night, has a couple kids, they finally get them to bed, everybody is settled in for the evening, and during the course of the day they had some thought about having sex together, which they know would be good for their health, good for their feelings, good for their relationship, but basically, they are just like, you know, they’re done, they’re ready to go to sleep. And they are sort of in the mood and perhaps one rolls over and attempts to initiate it, and the other one sort of just is not quite there. What if there was a drug you could take earlier in the evening when you thought I would like to have a sexual experience, that would lower your threshold so you would be a little more responsive, and that’s a drug that would have to take place in the brain, not the periphery. It is not a question of increasing blood flow; it is a question of lowering your threshold. So it’s just like do I want to, don’t I want to, yeah, sure, why not? Now that is a very subtle thing because you do not want to develop a drug that just makes everybody hot and horny which is what everyone imagines, you know, people like myself must be involved with. We are not at all because, God forbid you had something like that on the market, it would a dangerous and hence criminal, it would be a date rape drug. So this is not what we want to do. So if we go back to the sexual tipping point idea, we want something that just slightly tips the balance, that allows people to do what they want to do anyway, and just do not have the same energy for or the same youthful vitality for, because, then, as we age, and we know with age, there is a diminishment in sexual response. You can compensate for that. Just like there will be drugs that will be developed that will help people remember better and will start minimizing the impact of the various diseases that affect the brain, that really actually are devastating to individuals and families, like Alzheimer’s, so there is work in that area. The other area that there is work in goes back to the peripheral, because even if you are sort of in the mood, we have fixed that in some way, both through a combination of counseling with people like myself or just people’s own natural good mental health, and the use of these pharmaceuticals, what if the end organs just don’t work so well? What if you have recently had a prostatectomy from prostate cancer and you are recovering nicely, but we know that the drugs we have available only work about half the time. What if there was something else that could be done to help these people or a woman who has gone through an early menopause secondary to hysterectomy and there has been some atrophy of the vagina? What else might you do? Well, as you’ve probably heard, there is a lot of experimentation with gene therapy, and while there is nothing available today, I think one of the things we will see in the future is our ability to use various vectors, that is the sort of term for it, how do you introduce some new genes into cells so that essentially you are growing new cells inside your penis or your vagina, so that your capacity to function has now been improved not by using a medication that facilitates blood flow, but instead, you are just kind of getting back to the way you were in a very, very real way. So I’m very optimistic for our future. I just think it is important that those of us involved in this maintain a very, very strong ethical standard and help maintain the basically competing pressures of pharmaceutical companies who have a profit motive, understandably, but that we’re able to help guide them more towards what is best for people’s health in general and yet keep ourselves cognizant of other people’s viewpoints that a better life is not necessarily coming from better chemistry.
Recorded on: 6/20/08
Michael Perelman says we are pushing the age curve further and further.
Sallie Krawcheck and Bob Kulhan will be talking money, jobs, and how the pandemic will disproportionally affect women's finances.
Vaccines find more success in development than any other kind of drug, but have been relatively neglected in recent decades.
Vaccines are more likely to get through clinical trials than any other type of drug — but have been given relatively little pharmaceutical industry support during the last two decades, according to a new study by MIT scholars.
An article in Journal of Bioethical Inquiry raises questions about the goal of these advocacy groups.
- Two-thirds of American consumer advocacy groups are funded by pharmaceutical companies.
- The authors of an article in Journal of Bioethical Inquiry say this compromises their advocacy.
- Groups like the National Alliance on Mental Illness act more like lobbyists than patient advocates.
The Corruption That Brought Prozac to Market — Robert Whitaker, Journalist<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="bea9cff2b25efc18b663a011a679ba16"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/UyaJExxFPAE?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>Consumer-oriented groups gained steam over the ensuing decades. Their efforts helped inspire the 1938 Food, Drug, and Cosmetic Act after over 100 people (mostly children) died from a sanctioned drug, Sulfanilamide. If not for the hard work of these advocates, this case might have been overlooked.</p><p>Early efforts also focused on the food industry, which was increasingly using chemical preservatives. The origin of Consumer Reports can be found in the consumer advocacy movement. Both the food and drug industries were getting a free pass to experiment on citizens with few repercussions.</p><p>These movements provided a social foundation for important advocacy work in the second half of the century. Female-led groups evolved to focus on women's reproductive rights, AIDS, and mental health. As the authors write, these groups struck a balance between working <em>with</em> and <em>against</em> current trends. Sometimes you need to craft legislation with officials; at other times, you have to rage against the machine with everything you've got. </p><p>Advocacy marked an important turning point in public health (and culture in general). These groups were tired of placating to a medical model that treated the male body as the standard. This wasn't limited to anatomy. As I <a href="https://bigthink.com/coronavirus/pandemic-warnings-rp-eddy" target="_self">wrote about last week</a>, a high-profile 1970s-era conference about the role of women on Wall St featured no women on stage. You can imagine what reproductive health looked like during that time. </p><p>Advocacy groups made real impact in public health. Then the money began pouring in. </p><p style="margin-left: 20px;">"These groups were funded largely by individual donations with some foundation support, but in the late 1980s, newer women's health groups moved to professionalize, effectively splitting the women's health movement."</p><p>A number of groups resist corporate ties to this day, such as the National Women's Heath Network and Breast Cancer Action. Too often, however, groups argue that their existence depends on corporate funding. This can lead to uncomfortable compromises. </p><p>An estimated two-thirds of patient advocacy groups in America accept funds from the pharmaceutical industry. Pharma companies gave <a href="https://link.springer.com/content/pdf/10.1007/s11673-019-09956-8.pdf" target="_blank">at least $116 million</a> to such groups in 2015 alone.</p><p>For example, over a three-year period, the National Alliance on Mental Illness (NAMI), which was founded by two mothers whose sons suffered from schizophrenia, received nearly $12 million from 18 pharmaceutical companies. The largest donor was Prozac manufacturer, Eli Lilly. By 2008, three-quarters of NAMI's budget was funded by the pharmaceutical industry. It gets worse:</p><p style="margin-left: 20px;">"An Eli Lilly executive was even 'on loan' to NAMI, paid by Eli Lilly, while he worked out of the NAMI office on 'strategic planning.'"</p>
A customer waiting for his medication at the Headache Bar in a pharmacy in Sydney, Australia. Among the items on sale are 'Paigees with Chlorophyll' and Alka Seltzer on tap.
Photo by Dennis Rowe/BIPs/Getty Images<p>This influx of cash skews public understanding of drugs. It also influences advocates to overlook real problems caused by pharmaceutical interventions, especially when it comes to mental health.<br></p><p>For a real-world example, consider how Xanax came to market. As journalist Robert Whitaker <a href="https://www.youtube.com/watch?v=2e829xdb4AA" target="_blank">explains</a>, an <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1463502/?page=1" target="_blank">initial study</a> was conducted to determine efficacy in treating panic attacks. After four weeks, Xanax was outperforming placebo, which is common with benzodiazepines over short-term usage. But it wasn't a four-week study; it was a 14-week study.</p><p>At the end of eight weeks, there was no difference in efficacy between Xanax and placebo.</p><p>At the conclusion of the study after 14 weeks, the placebo outperformed Xanax. By a lot.</p><p>Why is Xanax still prescribed for panic attacks? Because the pharmaceutical company, Upjohn, only published the four-week data. The 14-week data was not in its favor. Nearly forty years later, over <a href="https://www.statista.com/statistics/781816/alprazolam-sodium-prescriptions-number-in-the-us/" target="_blank">25 million</a> Americans receive a prescription despite its <a href="https://drugabuse.com/xanax/effects-use/" target="_blank">long list</a> of side effects and addictive profile. </p><p>As the authors note, many consumers are not aware of how advocacy groups are funded.</p><p style="margin-left: 20px;">"An international study of groups in the United States, United Kingdom, Australia, Canada, and South Africa found that the extent of relationships with industry was inadequately disclosed in websites that addressed ten health conditions: cancer, heart disease, diabetes, asthma, cystic fibrosis, epilepsy, depression, Parkinson's disease, osteoporosis, and rheumatoid arthritis."</p><p>That's a tangled web of relationships. Pharmaceutical industry funding negatively impacts the work advocacy groups should be focused on: protecting us. NAMI, for example, claims that as a "natural ally" to the pharmaceutical industry, it helps consumers access "all scientifically proven treatments." When the industry ignores evidence of long-term damage caused by its treatments, you have to wonder what's being advocated. </p><p>Although, as the authors conclude, that question is easy to answer. </p><p style="margin-left: 20px;">"Instead of drawing insights from patient experience to set organizational agendas and challenge industry agendas, today's groups are silent on high prices and drug harms, oppose efforts to regulate these basic rights, and demand access to drugs that challenge the safety and effectiveness."</p><p><span></span>--</p><p><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank">Twitter</a>, <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank">Facebook</a> and <a href="https://derekberes.substack.com/" target="_blank">Substack</a>. His next book is</em> "<em>Hero's Dose: The Case For Psychedelics in Ritual and Therapy."</em></p>
Health officials in China reported that a man was infected with bubonic plague, the infectious disease that caused the Black Death.
- The case was reported in the city of Bayannur, which has issued a level-three plague prevention warning.
- Modern antibiotics can effectively treat bubonic plague, which spreads mainly by fleas.
- Chinese health officials are also monitoring a newly discovered type of swine flu that has the potential to develop into a pandemic virus.
Bacteria under microscope
needpix.com<p>Today, bubonic plague can be treated effectively with antibiotics.</p><p style="margin-left: 20px;">"Unlike in the 14th century, we now have an understanding of how this disease is transmitted," Dr. Shanthi Kappagoda, an infectious disease physician at Stanford Health Care, told <a href="https://www.healthline.com/health-news/seriously-dont-worry-about-the-plague#Heres-how-the-plague-spreads" target="_blank">Healthline</a>. "We know how to prevent it — avoid handling sick or dead animals in areas where there is transmission. We are also able to treat patients who are infected with effective antibiotics, and can give antibiotics to people who may have been exposed to the bacteria [and] prevent them [from] getting sick."</p>
This plague patient is displaying a swollen, ruptured inguinal lymph node, or buboe.
Centers for Disease Control and Prevention<p>Still, hundreds of people develop bubonic plague every year. In the U.S., a handful of cases occur annually, particularly in New Mexico, Arizona and Colorado, <a href="https://www.cdc.gov/plague/faq/index.html" target="_blank">where habitats allow the bacteria to spread more easily among wild rodent populations</a>. But these cases are very rare, mainly because you need to be in close contact with rodents in order to get infected. And though plague can spread from human to human, this <a href="https://www.healthline.com/health-news/seriously-dont-worry-about-the-plague#Heres-how-the-plague-spreads" target="_blank">only occurs with pneumonic plague</a>, and transmission is also rare.</p>
A new swine flu in China<p>Last week, researchers in China also reported another public health concern: a new virus that has "all the essential hallmarks" of a pandemic virus.<br></p><p>In a paper published in the <a href="https://www.pnas.org/content/early/2020/06/23/1921186117" target="_blank">Proceedings of the National Academy of Sciences</a>, researchers say the virus was discovered in pigs in China, and it descended from the H1N1 virus, commonly called "swine flu." That virus was able to transmit from human to human, and it killed an estimated 151,700 to 575,400 people worldwide from 2009 to 2010, according to the Centers for Disease Control and Prevention.</p>There's no evidence showing that the new virus can spread from person to person. But the researchers did find that 10 percent of swine workers had been infected by the virus, called G4 reassortant EA H1N1. This level of infectivity raises concerns, because it "greatly enhances the opportunity for virus adaptation in humans and raises concerns for the possible generation of pandemic viruses," the researchers wrote.
Want help raising your kids? Spend more time at church, says new study.
- Religious people tend to have more children than secular people, but why remains unknown.
- A new study suggests that the social circles provided by regular church going make raising kids easier.
- Conversely, having a large secular social group made women less likely to have children.