Up, Up, and Away

A New Sexual Drug Works on the Brain. But What Are the Uses of Lifestyle Meds?

Viagra works on the penis, but in the pipeline is another impotence drug that works on the brain. Guilty about a secret affair? Worried about getting downsized? Viagra won't help, but apomorphine might.

Currently in clinical trials, apomorphine (brand name Spontane) is not technically an aphrodisiac. It does not produce passion where none exists. But the drug amplifies the desire you've already got, overriding what's holding you back.

Apomorphine acts on the part of the brain that apparently integrates various sexual stimuli--smells, sights, sounds--and coordinates the whole complex operation that creates an erection. Apomorphine enhances the flow of sexual brain signals, thus giving desire the upper hand on anxiety or inhibition. That's a remarkable pharmaceutical feat, but also an unsettling one.

Consider two insurance executives struggling with extra work in companies that had been downsized. "Their penile blood vessels were fine," says Jeremy Heaton, who treated them, and who has researched apomorphine for 11 years. "What knocked them off was their stress level, but there was no way to change that without losing their jobs." So they opted for a pharmaceutical fix, enrolling in a trial for apomorphine.

Did these men really need medication? Answers Heaton, "It's very hard to stand in judgment of someone else's erection." It's also hard to judge anyone else's moods, or memory, or any of the other targets of so-called lifestyle drugs.

But patients aren't just diagnosing themselves, they are also choosing the quick fix. Heaton notes that a week in the Bahamas might have buoyed the two execs, "but it's probably cheaper to take a drug than a vacation." No wonder Prozac has been given to mopey dogs, and Viagra is logging 10,000 scrips a day.

What will happen if apomorphine, which basically promises to vanquish performance anxiety, is approved? To get an idea, turn to the Viagra bible, The Virility Solution, coauthored by Dr. Steven Lamm, whose last book championed the now infamous fen-phen diet regimen, which was later withdrawn from the market for fear it could damage heart valves. That debacle has hardly made Lamm cautious. Men as young as 35 have trouble getting it up, he notes, and "many of these patients have expressed to me the opinion that fast lifestyles, pressured careers, and lack of down time have contributed to their ED [erectile dysfunction]." He concedes that a pill is "no cure for too intense a life," but in the very next sentence he's pounding his pro-drug message: "a man who feels better about himself is bound to have a positive effect on his partner, his family, his work, and the world he lives in."

If the fate of the world hangs in the balance, why rely on only one drug? "If a man has ED, why shouldn't he take two different erection pills simultaneously, thereby producing a more potent treatment package?" In fact, Lamm notes, the issue is "not why two or more drugs will be prescribed . . . but when."

Lamm asks, "Should a man take the pill to improve erections if he doesn't think he has ED?" Answer: how else can he be sure he's really potent? "If a man takes the pill and his erections improve, then he had ED after all." Even celibate men can benefit: "Some experts are predicting that, in the near future, the drug will be taken . . . even when a man is not engaging in sex, to ensure erectile health." And better masturbation.

No wonder people are flocking to lifestyle drugs. But why, exactly, do we "need" them? And what purpose will they ultimately serve?

A recent study found that healthy people on Paxil, a Prozac cousin, worked better in groups and got less irritable, raising concerns that companies might opt for better teamwork through chemistry. Memory-enhancing medications are on the way, and a drug that allows people to go for more than two days without sleep--but with very few side effects--might soon help workers and students pull more productive all-nighters.

Sure, pharmaceuticals can sometimes solve personal problems. But collectively, lifestyle drugs could reinforce the status quo, especially the rush to squeeze ever more productivity out of each worker. This danger is especially high for psychological drugs that promise to "improve" moods, or, like apomorphine, help us override pesky unwanted feelings.

But emotions contain information. For philosophers like Sartre and Kierkegaard, they reveal the very nature of existence. What's revealed to insurance executives so pressured that they can't get it up may be less profound, but it is very political. A drug that overrides anxiety might harden the penis, but it will hardly stiffen the resolve to fight for better working conditions.

The great insight of the '70s was that the personal is political. Now it's time to sound a new watchword: the pharmaceutical is political. Lifestyle drugs could be the new opiate of the masses.

Research assistance: Sam Bruchey

 
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