If you’re the type of reader who is convinced by mountains of statistics without caring what those statistics were derived from, and you’re an active believer in the narrative, then you’ll enjoy this book. But the conclusion that Viagra for PMS pain is a "gold plated opportunity," and the men who control all the funding just don't care is just plain wrong. ![]() This, of course, is not as flashy a conclusion as “Men don’t care and control all of the money.” This is NOT to say dysmenorrhea is no big deal and women have plenty of perfect treatment options. The real story is 1) There's little if any benefit compared to the existing standard of care (ibuprofen) 2) The demand for this particular treatment, as measured by the number of women who were willing to participate in such a clinical trial, is low 3) Women may not be terribly inclined to administer Viagra directly into their vaginas (this is how it was administered in the study for reasons of safety and to avoid potential adverse effects) every 4 hours for several days each month while menstruating when they can swallow a pill instead and 4) The long term safety of chronically administering Viagra into the vagina is not established these are women of child-bearing age, and any adverse effects – which are much more likely to be observed with a larger patient cohort observed over a longer time period – could be devastating. And there are myriad ways for a pharma company to patent new uses of a generic drug (new formulations, for example - which is highly relevant in this case). In fact, it was a man who ran the initial study (Dr Richard Legro) and applied for additional funding. Perez claims that follow up studies were not funded because 1) Men don't care about menstrual pain and 2) pharma companies wouldn't fund a study for a generic drug that is off patent. So, the study did not meet its primary endpoint. But the prospects are not encouraging: the authors stated that they wanted to see an improvement in TOPAR4 score of 6.5 units (speculating: perhaps this is a score one would expect with ibuprofen treatment?), but in fact they only saw improvement of 5.3 units. We have no way of knowing how that score of 11.9 would compare to treatment with ibuprofen. ![]() Further: the study compared Viagra treatment with placebo. This is a smaller number than even the study authors expected and does not support the conclusion that women are just dying to get into these studies, but men prevent them from doing so. Of the 69 women they deemed eligible to participate in the study, only 29 women agreed to do so. There are additional issues: they had a hard time getting women to enroll in the study. In fact, the scale goes from 0-20, and the average score for the 13 women in the study was 11.9. "Total pain relief over 4 hours" – TOPAR4 – is the scale that is used to assess the level of pain relief it is not a result in and of itself. The study (in the journal Human Reproduction, 2013, volume 28, pages 2958-2965) showed that a fraction of the women experienced some pain relief (statistically significant) over the 4-hour studied time period. Imagine." Except that's not what the study showed. ![]() To quote the book directly: "The primary outcome of a double-blind, randomized, controlled trial of sildenafil citrate, was, ladies, you may want to sit down for this: total pain relief over 4 consecutive hours, with no observed adverse effects. Here's one example (and curious readers can and should find others this review is long enough already): the discussion of the use of Viagra for period pain (PMS/dysmenorrhea). ![]() I'm sure there is a lot of good information in this book, but it's impossible to know which are real issues and which are misrepresented to exaggerate the narrative. The result, for this curious reader anyway, is that I don't have faith that what Perez presents is factually or summarily true. Unfortunately, it’s impossible to know prima fascia which is which. If you do this, you'll find the narrative summary is sometimes right on, sometimes misleading, and sometimes just plain wrong. If you read/listen to this book with genuine curiosity, you’ll want to check into some of the data that are presented. Some fraction of the statistics and studies presented in this book are either misrepresented, misinterpreted, or flat out wrong, and the fraction is significant. This won't be a popular review, but here goes.
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