The New York Times, writing about a new Pfizer drug designed to help men who suffer from premature ejaculation, resurrects a stale old debate about what constitutes a "legitimate" disease.

It's a discussion that has been raised by critics of the pharmaceutical industry in connection with a multitude of new therapies--treating mental illness, cholesterol, erectile dysfunction, female sexual dysfunction and more--over the past couple of decades.

The Times article acknowledges that premature ejaculation is a problem, but questions whether it is a medical condition, quoting Leonore Tiefer, a clinical associate professor at NYU's School of Medicine: "Rapid ejaculation as opposed to slow ejaculation is common, but there is slow and fast everything in the world: slow and fast walkers, slow and fast eaters, slow and fast breathers... It is going to become a problem once enough publicity is given to it."

It seems to me that if people have a problem that makes their life less pleasant, and if there's some sort of product that can eliminate or reduce that problem and make their life more pleasant, putting a label on that problem (is it a "real" disease?) or on the product (is it a "real" therapy?) is neither relevant nor helpful.

The Guardian's Ben Goldacre reports on a Vioxx lawsuit in Australia that doesn't seem to have gotten much coverage in the U.S. media, but probably should, because what it says about the culture at Merck & Co.--and the pharmaceutical industry generally--is worth a discussion, at least.

Says Goldacre: "The first fun thing to emerge in the Australian case is email documentation showing staff at Merck made a 'hit list' of doctors who were critical of the company, or of the drug. This list contained words such as 'neutralise,' 'neutralised' and 'discredit' next to the names of various doctors.

"'We may need to seek them out and destroy them where they live,' said one email, from a Merck employee. Staff are also alleged to have used other tactics, such as trying to interfere with academic appointments, and dropping hints about how funding to institutions might dry up. Institutions might think about whether they wish to receive money from a company like that in future."

But Goldacre is particularly concerned that Merck paid the publisher Elsevier to produce a publication that "resembled an academic journal, although in fact it only contained reprinted articles, or summaries, of other articles. In issue 2, for example, nine of the 29 articles concerned Vioxx, and a dozen of the remainder were about another Merck drug, Fosamax. All of these articles presented positive conclusions. Some were bizarre: such as a review article containing just two references."

The process of having a company sponsored publication masquerading as a legitimate medical journal is troubling; misleading at best, deceptive at worst. (It's also as much of a reputational issue for Elsevier--why should anyone trust information from them again?--as it is for Merck.

As to the question of the pharmaceutical company's other aggressive behavior, it's hard to know whether Merck's Australian operations had somehow "gone rogue" of whether this kind of behavior is universal within the Merck culture globally. Certainly, a little aggressive digging by plaintiffs' attorneys in the U.S. and the U.K. might yield interesting results.