Access

You are not currently logged in.

Access your personal account or get JSTOR access through your library or other institution:

login

Log in to your personal account or through your institution.

The DSM, big pharma, and clinical practice guidelines: Protecting patient autonomy and informed consent

Lisa Cosgrove
International Journal of Feminist Approaches to Bioethics
Vol. 4, No. 1, Special Issue: Feminist Perspectives on Ethics in Psychiatry (Spring 2011), pp. 11-25
DOI: 10.2979/intjfemappbio.4.1.11
Stable URL: http://www.jstor.org/stable/10.2979/intjfemappbio.4.1.11
Page Count: 15
  • Download PDF
  • Add to My Lists
  • Cite this Item

To read the article: Download PDF

The DSM, big pharma, and clinical practice guidelines: Protecting patient autonomy and informed consent on JSTOR
ESSAYS
Gender Studies

Abstract

Abstract

The author of this paper discusses why the issue of financial conflicts of interest (FCOI) in psychiatry has important public health implications for women and why FCOI complicate the informed consent process. For example, when psychiatric diagnostic and treatment guidelines are unduly influenced by industry, informed consent becomes a critical issue, because women may be assigned diagnostic labels that are not valid and may also be receiving imbalanced or even inaccurate information about their mental health treatment options. However, mere disclosure of industry relationships is an insufficient solution. Following Ells (2003), the author offers a more robust account of autonomy, inspired by Foucault, to strengthen informed consent practices. In addition to addressing power relations, this Foucauldian account of autonomy emphasizes the relational and dialogical aspect of the physician––patient relationship.

Notes

  1. 1.
    The New View Campaign, a grassroots network aimed at challenging “the distorted and oversimplified messages about sexuality that the pharmaceutical industry relies on to sell its new drugs,” has exposed the extensive conflicts of interest in sexual medicine, see http://www.fsd-alert.org/.
  2. 2.
    According to the report of the DSM-V Mood Disorders Work Group, as of the writing of this paper (6 August 2010), “Sub-work groups are being formed to conduct research in the areas of pre-menstrual dysphoric disorder (PMDD) and seasonal affective disorder (SAD). Advisors to these subgroups will provide evidence concerning the criteria and disposition of these conditions, whether they should be classified as subtypes or dimensional constructs, and how they relate to the spectrum of bipolar disorders,” see www.dsm5.org.
  3. 3.
    Both the title of and criteria for Hypoactive Sexual Desire Disorder are currently undergoing revision. The new title is “Sexual Interest/Arousal Disorder in Women” (incorporating the DSM IV-TR diagnosis “Female Sexual Arousal Disorder”). The rationale for both revised titles “reflect[s] the common empirical finding that desire and (at least the subjective) experience of arousal highly overlap” www.dsm5.org.
  4. 4.
    See also Rawlinson's 2001 excellent essay on the invisible gendering of the universal and the need for a feminist bioethics and Radden's 2002 insightful analysis of the challenges associated with applying the autonomy model to psychiatric patients.

References

  1. American Psychiatric Association (APA). 2000. Diagnostic and statistical manual of mental disorders: DSM-IV-TR. 4th ed. Washington, D.C.: American Psychiatric Association.
  2. American Psychiatric Association DSM-5. http://www.DSM5.org/, accessed 28 July 2010.
  3. Andreasen, Nancy C. 2007. DSM and the death of phenomenology in America: An example of unintended consequences. Schizophrenia Bulletin 33: 108–12.
  4. Angell, Marcia. 2004. The truth about the drug companies: How they deceive us and what to do about it. New York: Random House.
  5. Applebaum, Paul. 1997. Informed consent to psychotherapy: Recent developments. Psychiatric Services 48: 445–46.
  6. Aubert, Ronald E., Edward J. Stanek, Jiqiang Yao, J. Russel Teagarden, Milayna Subar, Robert S. Epstein, Todd C. Skaar, Desta, Zeruesenay Desta, and David A. Flockhart. 2009. Risk of breast cancer recurrence in women initiating tamoxifen with CYP2D6 inhibitors. Journal of Clinical Oncology 27:18s, (suppl; abstr. CRA508).
  7. Berenson, Alex. 2007. Lilly settles with 18,000 over Zyprexa. http://query.nytimes.com/gst/fullpage.html?res=9f00e5db1430f936a35752c0a9619c8b63, accessed 29 July 2010.
  8. Bluhm, Robyn. 2009. Evidence-based medicine and patient autonomy. International Journal of Feminist Approaches to Bioethics 2(2): 134–51.
  9. Caplan, Paula, and Lisa Cosgrove. 2004. Bias in psychiatric diagnosis. New York: Rowman & Littlefield.
  10. Clayton, Anita, James F. Pradko, Harry A. Croft, C. Brendan Montano, Robert A. Leadbetter, Carolyn Bolden-Watson, Kristen I. Bass, Rafe M. J. Donahue, Brenda D. Jamerson, and Alan Metz. 2002. Prevalence of sexual dysfunction among newer antidepressants. Journal of Clinical Psychiatry 63(4): 357–66.
  11. Cosgrove, Lisa, and Bethany Riddle. 2003. Constructions of femininity and experiences of menstrual distress. Women & Health 38: 37–58.
  12. Cosgrove, Lisa, and Bethany Riddle, Harold Bursztajn, and Sheldon Krimsky. 2009. Developing unbiased diagnostic and treatment guidelines in psychiatry. New England Journal of Medicine 360: 2035–37.
  13. Cosgrove, Lisa, and Bethany Riddle, Harold J. Bursztajn, Sheldon Krimsky, and Maria Anaya. 2009. Conflicts of interest and disclosure in the American Psychiatric Association's Clinical Practice Guidelines. Psychotherapy and Psychosomatics 78: 228–32.
  14. Cosgrove, Lisa, and Bethany Riddle, Harold J. Bursztajn, Sheldon Krimsky, and Maria Anaya, Melissa Pearrow, and Maria Anaya. 2008. Toward a new paradigm for psychiatric diagnoses and clinical research in sexology. Feminism & Psychology 18: 457–65.
  15. Cosgrove, Lisa, and Bethany Riddle, Harold J. Bursztajn, Sheldon Krimsky, and Maria Anaya, Sheldon Krimsky, Manisha Vijayaraghavan, and Lisa Schneider. 2006. Financial ties between DSM-IV panel members and the pharmaceutical industry. Psychotherapy and Psychosomatics 75: 154–60.
  16. Dalton, Susanne, C. Johansen, L. Mellemkjaer, B. Nørgård, H. T. Sørensen, and J. H. Olsen. 2003. Use of selective serotonin reuptake inhibitors and risk of upper gastrointestinal tract bleeding: A population-based cohort study. Archives of Internal Medicine 163(1): 59–64.
  17. De Abajo, Francisco, and Luis Garcia-Rodriguez. 2008. Risk of upper gastrointestinal tract bleeding associated with selective serotonin reuptake inhibitors and venlafaxine therapy: Interaction with nonsteroidal anti-inflammatory drugs and effect of acidsuppressing agents. Archives of General Psychiatry 65(7): 795–803.
  18. Directives for Human Experimentation: Regulations and Ethical Guidelines. Office of Human Subjects Research. http://ohsr.od.nih.gov/guidelines/nuremberg.html, accessed 29 July 2010.
  19. Ells, Carolyn. 2003. Foucault, feminism, and informed choice. Journal of Medical Humanities 24(3/4): 213–28.
  20. Foucault, Michel. 1980. The history of sexuality, Volume I: An introduction. New York: Vintage Books.
  21. Foucault, Michel. 1996. Truth is in the future. In Foucault Live: Collected Interviews, 1961–1984, ed. S. Lotringer, trans. L. Hochroth and J. Johnston, 298–301. New York: Semiotext(e).
  22. Fries, James, and Eswar Krishnan. 2004. Equipoise, design bias, and randomized clinical trials: The elusive ethics of new drug development. Arthritis Research and Therapy 6: 250–55.
  23. Gobal, Abilash, Lisa Cosgrove, and Harold Bursztajn. Forthcoming. The public health consequences of an industry-influenced psychiatric taxonomy: “Attenuated Psychotic Symptoms Syndrome” as a case example. Journal of Accountability in Research.
  24. Gregorian, Razmic, K. A Golden, A. Bahce, C. Goodman, W. J. Kwong, and Z. M. Khan. 2002. Antidepressant-induced sexual dysfunction. Annals of Pharmacotherapy 35(10): 1577–89.
  25. Gussin, Bruce, and Jonathan Raskin. 2000. Anti antidepressants? Drugs, depression, and the medical model. Ethical Human Sciences and Services 2: 161–79.
  26. Ioannidis, John. 2010. Adverse events in randomized trials: Neglected, restricted, distorted, silenced. Archives of Internal Medicine 169: 1737–39.
  27. Kaschak, Ellyn, and Leonore Tiefer. 2002. A new view of women's sexual problems. Binghamton, N.Y.: Haworth Press.
  28. Kelly, Catherine, David N. Juurlink, Tara Gomes, Minh Duong-Hua, Kathleen I. Pritchard, Peter C. Austin, and Lawrence F. Paszat. 2010. Selective serotonin reuptake inhibitors and breast cancer mortality in women receiving tamoxifen: A population based cohort study. British Medical Journal 340: c693.
  29. May, Thomas. 2002. Bioethics in a liberal society: The political framework of bioethics decision making. Baltimore: Johns Hopkins University Press.
  30. Minztes, Barbra. 2006. Disease mongering in drug promotion: Do governments have a regulatory role? Public Library of Science Medicine 3(4): 461–65.
  31. Montejo, Angel, G. Llorca, J. A. Izquierdo, and F. Rico-Villademoros. 2001. Incidence of sexual dysfunction associated with antidepressant agents: A prospective multicenter study of 1022 outpatients. Spanish working group for the study of psychotropicrelated sexual dysfunction. Journal of Clinical Psychiatry 62(3): 10–21.
  32. Moran, Mark. 15August2008. Senator wants APA records of drug-industry interactions. Psychiatric News 43(16): 1. http://pn.psychiatryonline.org/content/43/16/1.1.full, accessed 28 July 2010.
  33. Moynihan, Roy, Iona Heath, and David Henry. 2002. Selling sickness: The pharmaceutical industry and disease mongering. British Medical Journal 324: 886–91.
  34. Olfson, Mark, and Steven Marcus. 2009. National patterns in antidepressant medication treatment. Archives of General Psychiatry 66: 848–56.
  35. Penston, James. 2007. Patients' preferences shed light on the murky world of guidelinebased medicine. Journal of Evaluation in Clinical Practice 13: 154–59.
  36. Pitrou, Isabelle, I. Boutron, N. Ahmad, and P. Ravaud. 2010. Reporting of safety in published reports of randomized clinical trials. Archives of Internal Medicine 169: 1751–56.
  37. Radden, Jennifer. 2002. Psychiatric ethics. Bioethics 16(5): 397–411.
  38. Rawlinson, Mary. 2001. The concept of a feminist bioethics. Journal of Medicine and Philosophy 26(4): 405–16.
  39. Romans, Sarah, M. M. Cohen, T. Forte, J. Du Mont, and I. Hyman. 2008. Gender and psychotropic medication use: The role of intimate partner violence. Preventive Medicine 46: 615–21.
  40. Spina, Eduardo, Vincenza Santoro, and Concetta D'Arrigo. 2008. Clinically relevant pharmacokinetic drug interactions with second-generation antidepressants: An update. Clinical Therapeutics 30: 1206–27.
  41. Stockbridge, Lisa. 2000. FDA warning letter, Eli Lilly (Sarafem [fluoxetine HCI] Tablets). www.PharmCast.com, Internet for the Pharmaceutical Community, http://www.pharmcast.com/WarningLetters/November2000/EliLilly1100.htm, accessed 28 July 2010.
  42. Tiefer, Leonore. Sex is not a natural act. 2nd ed. Boulder, Colo.: Westview, 2004.
  43. Tuccori, Marco, A. Testi, L. Antonioli, M. Fornai, S. Montagnani, N. Ghisu, R. Colucci, T. Corona, C. Blandizzi, and M. Del Tacca. 2009. Safety concerns associated with the use of serotonin reuptake inhibitors and other serotonergic/noradrenergic antidepressants during pregnancy: A review. Clinical Therapeutics 31(1): 1426–53.
  44. Ussher, Jane, Myra Hunter, and Susannah Brown. 2000. Good, bad or dangerous to know? Representations of femininity in narratives about PMS. In Culture and Psychology, ed. C. Squire, 87–99. New York: Routledge Press.
  45. Wilson Duff. 28February2004. Pfizer gives up testing Viagra on women. New York Times. http://www.nytimes.com/2004/02/28/business/pfizer-gives-up-testing-viagra-on-women.html, accessed 22 November 2010.
  46. Wilson Duff. 28April2010a. For $520 million, AstraZeneca settles case over marketing of a drug. The New York Times—Breaking News, World News & Multimedia. http://www.nytimes.com/2009/10/30/business/30drug.html, accessed 29 July 2010.
  47. Wilson Duff. 18June2010b. Drug for sexual desire disorder opposed by panel. http://www.nytimes.com/2010/06/19/business/19sexpill.html, accessed 30 July 2010.
  48. Wood, Jill, Patricia Koch, and Phyllis Mansfield. 2006. Women's sexual desire: A feminist critique. Journal of Sex Research 43: 236–44.
  49. World Medical Association. Declaration of Helsinki: Ethical principles for medical research involving human subjects. Office of Human Subjects Research. http://ohsr.od.nih.gov/guidelines/helsinki.html, accessed 29 July 2010.
  50. Zucker, Kenneth J. 2010. Reports from the DSM-V work group on sexual and gender disorders. Archives of Sexual Behavior 39: 217–20.

Notes

  1. 1.
    The New View Campaign, a grassroots network aimed at challenging “the distorted and oversimplified messages about sexuality that the pharmaceutical industry relies on to sell its new drugs,” has exposed the extensive conflicts of interest in sexual medicine, see http://www.fsd-alert.org/.
  2. 2.
    According to the report of the DSM-V Mood Disorders Work Group, as of the writing of this paper (6 August 2010), “Sub-work groups are being formed to conduct research in the areas of pre-menstrual dysphoric disorder (PMDD) and seasonal affective disorder (SAD). Advisors to these subgroups will provide evidence concerning the criteria and disposition of these conditions, whether they should be classified as subtypes or dimensional constructs, and how they relate to the spectrum of bipolar disorders,” see www.dsm5.org.
  3. 3.
    Both the title of and criteria for Hypoactive Sexual Desire Disorder are currently undergoing revision. The new title is “Sexual Interest/Arousal Disorder in Women” (incorporating the DSM IV-TR diagnosis “Female Sexual Arousal Disorder”). The rationale for both revised titles “reflect[s] the common empirical finding that desire and (at least the subjective) experience of arousal highly overlap” www.dsm5.org.
  4. 4.
    See also Rawlinson's 2001 excellent essay on the invisible gendering of the universal and the need for a feminist bioethics and Radden's 2002 insightful analysis of the challenges associated with applying the autonomy model to psychiatric patients.

References

  1. American Psychiatric Association (APA). 2000. Diagnostic and statistical manual of mental disorders: DSM-IV-TR. 4th ed. Washington, D.C.: American Psychiatric Association.
  2. American Psychiatric Association DSM-5. http://www.DSM5.org/, accessed 28 July 2010.
  3. Andreasen, Nancy C. 2007. DSM and the death of phenomenology in America: An example of unintended consequences. Schizophrenia Bulletin 33: 108–12.
  4. Angell, Marcia. 2004. The truth about the drug companies: How they deceive us and what to do about it. New York: Random House.
  5. Applebaum, Paul. 1997. Informed consent to psychotherapy: Recent developments. Psychiatric Services 48: 445–46.
  6. Aubert, Ronald E., Edward J. Stanek, Jiqiang Yao, J. Russel Teagarden, Milayna Subar, Robert S. Epstein, Todd C. Skaar, Desta, Zeruesenay Desta, and David A. Flockhart. 2009. Risk of breast cancer recurrence in women initiating tamoxifen with CYP2D6 inhibitors. Journal of Clinical Oncology 27:18s, (suppl; abstr. CRA508).
  7. Berenson, Alex. 2007. Lilly settles with 18,000 over Zyprexa. http://query.nytimes.com/gst/fullpage.html?res=9f00e5db1430f936a35752c0a9619c8b63, accessed 29 July 2010.
  8. Bluhm, Robyn. 2009. Evidence-based medicine and patient autonomy. International Journal of Feminist Approaches to Bioethics 2(2): 134–51.
  9. Caplan, Paula, and Lisa Cosgrove. 2004. Bias in psychiatric diagnosis. New York: Rowman & Littlefield.
  10. Clayton, Anita, James F. Pradko, Harry A. Croft, C. Brendan Montano, Robert A. Leadbetter, Carolyn Bolden-Watson, Kristen I. Bass, Rafe M. J. Donahue, Brenda D. Jamerson, and Alan Metz. 2002. Prevalence of sexual dysfunction among newer antidepressants. Journal of Clinical Psychiatry 63(4): 357–66.
  11. Cosgrove, Lisa, and Bethany Riddle. 2003. Constructions of femininity and experiences of menstrual distress. Women & Health 38: 37–58.
  12. Cosgrove, Lisa, and Bethany Riddle, Harold Bursztajn, and Sheldon Krimsky. 2009. Developing unbiased diagnostic and treatment guidelines in psychiatry. New England Journal of Medicine 360: 2035–37.
  13. Cosgrove, Lisa, and Bethany Riddle, Harold J. Bursztajn, Sheldon Krimsky, and Maria Anaya. 2009. Conflicts of interest and disclosure in the American Psychiatric Association's Clinical Practice Guidelines. Psychotherapy and Psychosomatics 78: 228–32.
  14. Cosgrove, Lisa, and Bethany Riddle, Harold J. Bursztajn, Sheldon Krimsky, and Maria Anaya, Melissa Pearrow, and Maria Anaya. 2008. Toward a new paradigm for psychiatric diagnoses and clinical research in sexology. Feminism & Psychology 18: 457–65.
  15. Cosgrove, Lisa, and Bethany Riddle, Harold J. Bursztajn, Sheldon Krimsky, and Maria Anaya, Sheldon Krimsky, Manisha Vijayaraghavan, and Lisa Schneider. 2006. Financial ties between DSM-IV panel members and the pharmaceutical industry. Psychotherapy and Psychosomatics 75: 154–60.
  16. Dalton, Susanne, C. Johansen, L. Mellemkjaer, B. Nørgård, H. T. Sørensen, and J. H. Olsen. 2003. Use of selective serotonin reuptake inhibitors and risk of upper gastrointestinal tract bleeding: A population-based cohort study. Archives of Internal Medicine 163(1): 59–64.
  17. De Abajo, Francisco, and Luis Garcia-Rodriguez. 2008. Risk of upper gastrointestinal tract bleeding associated with selective serotonin reuptake inhibitors and venlafaxine therapy: Interaction with nonsteroidal anti-inflammatory drugs and effect of acidsuppressing agents. Archives of General Psychiatry 65(7): 795–803.
  18. Directives for Human Experimentation: Regulations and Ethical Guidelines. Office of Human Subjects Research. http://ohsr.od.nih.gov/guidelines/nuremberg.html, accessed 29 July 2010.
  19. Ells, Carolyn. 2003. Foucault, feminism, and informed choice. Journal of Medical Humanities 24(3/4): 213–28.
  20. Foucault, Michel. 1980. The history of sexuality, Volume I: An introduction. New York: Vintage Books.
  21. Foucault, Michel. 1996. Truth is in the future. In Foucault Live: Collected Interviews, 1961–1984, ed. S. Lotringer, trans. L. Hochroth and J. Johnston, 298–301. New York: Semiotext(e).
  22. Fries, James, and Eswar Krishnan. 2004. Equipoise, design bias, and randomized clinical trials: The elusive ethics of new drug development. Arthritis Research and Therapy 6: 250–55.
  23. Gobal, Abilash, Lisa Cosgrove, and Harold Bursztajn. Forthcoming. The public health consequences of an industry-influenced psychiatric taxonomy: “Attenuated Psychotic Symptoms Syndrome” as a case example. Journal of Accountability in Research.
  24. Gregorian, Razmic, K. A Golden, A. Bahce, C. Goodman, W. J. Kwong, and Z. M. Khan. 2002. Antidepressant-induced sexual dysfunction. Annals of Pharmacotherapy 35(10): 1577–89.
  25. Gussin, Bruce, and Jonathan Raskin. 2000. Anti antidepressants? Drugs, depression, and the medical model. Ethical Human Sciences and Services 2: 161–79.
  26. Ioannidis, John. 2010. Adverse events in randomized trials: Neglected, restricted, distorted, silenced. Archives of Internal Medicine 169: 1737–39.
  27. Kaschak, Ellyn, and Leonore Tiefer. 2002. A new view of women's sexual problems. Binghamton, N.Y.: Haworth Press.
  28. Kelly, Catherine, David N. Juurlink, Tara Gomes, Minh Duong-Hua, Kathleen I. Pritchard, Peter C. Austin, and Lawrence F. Paszat. 2010. Selective serotonin reuptake inhibitors and breast cancer mortality in women receiving tamoxifen: A population based cohort study. British Medical Journal 340: c693.
  29. May, Thomas. 2002. Bioethics in a liberal society: The political framework of bioethics decision making. Baltimore: Johns Hopkins University Press.
  30. Minztes, Barbra. 2006. Disease mongering in drug promotion: Do governments have a regulatory role? Public Library of Science Medicine 3(4): 461–65.
  31. Montejo, Angel, G. Llorca, J. A. Izquierdo, and F. Rico-Villademoros. 2001. Incidence of sexual dysfunction associated with antidepressant agents: A prospective multicenter study of 1022 outpatients. Spanish working group for the study of psychotropicrelated sexual dysfunction. Journal of Clinical Psychiatry 62(3): 10–21.
  32. Moran, Mark. 15August2008. Senator wants APA records of drug-industry interactions. Psychiatric News 43(16): 1. http://pn.psychiatryonline.org/content/43/16/1.1.full, accessed 28 July 2010.
  33. Moynihan, Roy, Iona Heath, and David Henry. 2002. Selling sickness: The pharmaceutical industry and disease mongering. British Medical Journal 324: 886–91.
  34. Olfson, Mark, and Steven Marcus. 2009. National patterns in antidepressant medication treatment. Archives of General Psychiatry 66: 848–56.
  35. Penston, James. 2007. Patients' preferences shed light on the murky world of guidelinebased medicine. Journal of Evaluation in Clinical Practice 13: 154–59.
  36. Pitrou, Isabelle, I. Boutron, N. Ahmad, and P. Ravaud. 2010. Reporting of safety in published reports of randomized clinical trials. Archives of Internal Medicine 169: 1751–56.
  37. Radden, Jennifer. 2002. Psychiatric ethics. Bioethics 16(5): 397–411.
  38. Rawlinson, Mary. 2001. The concept of a feminist bioethics. Journal of Medicine and Philosophy 26(4): 405–16.
  39. Romans, Sarah, M. M. Cohen, T. Forte, J. Du Mont, and I. Hyman. 2008. Gender and psychotropic medication use: The role of intimate partner violence. Preventive Medicine 46: 615–21.
  40. Spina, Eduardo, Vincenza Santoro, and Concetta D'Arrigo. 2008. Clinically relevant pharmacokinetic drug interactions with second-generation antidepressants: An update. Clinical Therapeutics 30: 1206–27.
  41. Stockbridge, Lisa. 2000. FDA warning letter, Eli Lilly (Sarafem [fluoxetine HCI] Tablets). www.PharmCast.com, Internet for the Pharmaceutical Community, http://www.pharmcast.com/WarningLetters/November2000/EliLilly1100.htm, accessed 28 July 2010.
  42. Tiefer, Leonore. Sex is not a natural act. 2nd ed. Boulder, Colo.: Westview, 2004.
  43. Tuccori, Marco, A. Testi, L. Antonioli, M. Fornai, S. Montagnani, N. Ghisu, R. Colucci, T. Corona, C. Blandizzi, and M. Del Tacca. 2009. Safety concerns associated with the use of serotonin reuptake inhibitors and other serotonergic/noradrenergic antidepressants during pregnancy: A review. Clinical Therapeutics 31(1): 1426–53.
  44. Ussher, Jane, Myra Hunter, and Susannah Brown. 2000. Good, bad or dangerous to know? Representations of femininity in narratives about PMS. In Culture and Psychology, ed. C. Squire, 87–99. New York: Routledge Press.
  45. Wilson Duff. 28February2004. Pfizer gives up testing Viagra on women. New York Times. http://www.nytimes.com/2004/02/28/business/pfizer-gives-up-testing-viagra-on-women.html, accessed 22 November 2010.
  46. Wilson Duff. 28April2010a. For $520 million, AstraZeneca settles case over marketing of a drug. The New York Times—Breaking News, World News & Multimedia. http://www.nytimes.com/2009/10/30/business/30drug.html, accessed 29 July 2010.
  47. Wilson Duff. 18June2010b. Drug for sexual desire disorder opposed by panel. http://www.nytimes.com/2010/06/19/business/19sexpill.html, accessed 30 July 2010.
  48. Wood, Jill, Patricia Koch, and Phyllis Mansfield. 2006. Women's sexual desire: A feminist critique. Journal of Sex Research 43: 236–44.
  49. World Medical Association. Declaration of Helsinki: Ethical principles for medical research involving human subjects. Office of Human Subjects Research. http://ohsr.od.nih.gov/guidelines/helsinki.html, accessed 29 July 2010.
  50. Zucker, Kenneth J. 2010. Reports from the DSM-V work group on sexual and gender disorders. Archives of Sexual Behavior 39: 217–20.