Some therapeutic drugs go beyond saving lives and reducing morbidity. Here is a ranked list from ChatGPT of important drug categories that became widely available since World War II and had a big cultural impact:

Top-Tier Culture-Changers (1–7)

These rearranged fundamental social norms:

1. Oral Contraceptives Enabled sexual autonomy, women’s labor-force participation, delayed marriage/childbearing, redefined gender norms.

2. SSRIs / Antidepressants Normalized pharmacological mood modulation; reshaped emotional expectations and concepts of self.

3. Antibiotics beyond Penicillin Removed infection as a central existential threat; allowed modern surgery and global interconnection.

4. Antipsychotics Destigmatized psychosis (partially), began deinstitutionalization, made “mental illness as brain illness” mainstream.

5. ADHD Stimulants Changed educational culture and the meaning of “attention,” productivity, and achievement.

6. HAART / HIV Antiretrovirals Reversed a cultural trauma; reshaped sexual norms and the identity landscape of LGBTQ+ life.

7. GLP-1 Agonists / Tirzepatide-Class Weight Drugs Currently destabilizing global aesthetics, diet culture, stigma structures, and food economics. (Impact is accelerating.)

Second-Tier Cultural Influence (8–15)

These reshaped life-course expectations and the body, but more gradually:

8. IVF & Assisted Reproduction Decoupled reproduction from sex and age; redefined family boundaries.

9. Hormone Replacement Therapy Reframed menopause; extended professional and social continuity of women across lifespan.

10. Opioids (Modern Pain Standards) Altered society’s tolerance for pain → major cultural & political consequences.

11. Viagra & PDE5 Inhibitors Reframed aging male sexuality as fixable, not inevitable.

12. Benzodiazepines Cultural paradigm of “medicalized calm” and normalized management of anxiety.

13. Stimulants for Wakefulness (Modafinil, etc.) Influenced elite knowledge work culture; altered sleep norms.

14. Monoclonal Antibodies for Autoimmunity Reintegrated millions into fully active life; changed disability identity.

15. Organ Transplant Immunosuppressants Challenged identity boundaries (self/non-self) in philosophy and religion.

Third-Tier: Culturally Modifying but Less Foundational (16–25)

16. Proton Pump Inhibitors Changed food culture and normalized constant GI medication.

17. Biologic Anti-Inflammatories (Anti-TNF, etc.) Made chronic illness socially invisible.

18. Asthma Inhaled Corticosteroids Enabled full athletic childhood participation.

19. Ketamine & Rapid-Acting Antidepressants Reopened the psychotropic–consciousness frontier.

20. Psychedelic-Assisted Psychotherapy Emerging shift in spirituality and trauma theory.

21. Statins Normalized “numbers as health identity.”

22. Beta Blockers Expanded expectation of calm performance.

23. Oral Antivirals (Herpes, Hep C) Reduced stigma and fear; changed intimacy discourse.

24. Modern Chemotherapy Protocols Altered cultural narratives of “fighting” illness.

25. Hep C Curative Antivirals Major medical advance, modest cultural footprint (so far).

Key Pattern

The most culturally powerful drug categories are those that:

1. Change sex & reproduction

2. Change emotion and identity

3. Change the body’s relationship to social meaning (e.g., obesity, attention, disability)

4. Diffuse across healthy populations rather than only treat disease

Those shape culture, not just health outcomes.

Now, I want to predict a few drugs being researched that are likely to have a big cultural impact:

Dialogue with ChatGPT on Libido, Kisspeptin, and the Refractory Period (Edited by ChatGPT)

Miles: Libido rises and falls at fast frequency. Is testosterone really the main hormone that mediates that? Or are there some other hormones that mediate the high frequency rise and fall of libido?

ChatGPT: Testosterone sets the baseline of libido, but it changes slowly. The rapid fluctuations come from fast-acting neuromodulators—especially dopamine (wanting), norepinephrine (arousal), oxytocin (bonding), and kisspeptin, which links emotional meaning to sexual motivation.

Miles: Okay, the new one I've never heard of before is Kisspeptin. Tell me all about Kisspeptin.

ChatGPT: Kisspeptin is a peptide produced in the hypothalamus. It stimulates the reproductive hormone axis, and also increases the emotional salience of sexual cues. It doesn’t create desire directly; it restores the capacity to want when emotional context is appropriate.

Miles: Its name sounds like a joke, like it was named after kissing.

ChatGPT: The name comes from Hershey, Pennsylvania, home of Hershey’s Kisses. The gene was first described there. The romantic implication came afterward by coincidence.

Miles: Does it work as a metastasis suppressor?

ChatGPT: Yes. The KISS1 gene was originally identified because it suppressed metastasis in melanoma and breast cancer models. Only later was it discovered to regulate reproductive signaling. Evolution often reuses molecular pathways.

Miles: So, in terms of metastasis suppression, what are the side effects that keep it from being used all the time?

ChatGPT: For cancer, you’d need long-term, systemic kisspeptin signaling, which could affect tissue remodeling. In sexual function applications, doses are short-term, so those risks are much smaller.

Miles: How is Kisspeptin taken? Could it be used off-label for low libido now?

ChatGPT: Kisspeptin is currently in Phase II trials for sexual desire. It’s administered by subcutaneous injection. It is not FDA-approved yet, so no off-label use is possible.

Miles: So what about delivery systems? A pill? A patch? A hypospray?

ChatGPT: A pill won't work, because kisspeptin is a peptide and would be digested. The likely first form is injection pens. Later, microneedle patches are realistic—painless, dissolving micro-projections that deliver peptides through the skin.

Miles: How fast acting would microneedle patches be?

ChatGPT: 10–30 minutes to first effect, peak at around 1 hour, lasting 4–8 hours. The change is in receptivity and emotional openness, not mechanical arousal.

Miles: But women have multiple orgasms. How does their system allow satisfaction while still wanting more?

ChatGPT: After orgasm, men typically have a sharp prolactin spike, which shuts down desire. Women usually have a smaller prolactin rise and stronger oxytocin, which creates satisfaction without shutting desire down. The difference is neurochemical timing, not psychology.

Miles: So pharmacologically we want men to get the oxytocin signal, but not the prolactin signal.

ChatGPT: Exactly: completion without shutdown.

Miles: The dopamine route to suppress prolactin doesn’t seem good. I want another way.

ChatGPT: The best route is prolactin receptor antagonists. They let prolactin rise—so satisfaction remains—but block the signal that stops further desire. This softens the refractory period without creating compulsion.

Miles: How are prolactin receptor antagonists delivered? Could they be used off-label now?

ChatGPT: The main candidate, LFA102, is a Novartis antibody tested in oncology. It’s delivered via IV infusion, and not commercially available. So there is currently no off-label path.

Miles: So what is the clinical justification? We can’t say it’s for multiple orgasms.

ChatGPT: The legitimate indication is post-orgasmic sexual dysfunction, which includes:

• Prolonged refractory period causing distress

• Post-orgasmic dysphoria

• Prolactin-linked POIS

Multiple orgasms would be a secondary effect, not the stated purpose.

Miles: In terms of patents and commercialization, who controls the key elements?

ChatGPT: Kisspeptin program: Sumitovant / Sumitomo Pharma (originally Takeda).
Prolactin receptor antibody: Novartis (LFA102).
Microneedle peptide delivery: Vaxxas or Micron Biomedical.

A realistic path would be:
Sumitovant (kisspeptin) → Novartis (PRLR antagonist) → Vaxxas (microneedle delivery).

Commercialization, Regulatory Positioning, and Market Strategy

Miles: So let’s talk about commercialization. If kisspeptin comes to market for low libido, and prolactin antagonists for post-orgasmic dysfunction follow, what are the realistic business paths?

ChatGPT: There are three commercialization avenues:

1. Sexual Medicine Therapeutics (regulated, prescribable drugs)

2. Well-being / Relationship-Health Market (medical-but-lifestyle communication strategy)

3. Partnership with Existing Pharma in Fertility, Endocrine, or Sexual Health (co-promotion and lifecycle expansion)

These are not mutually exclusive — they build on each other.

Miles: Explain the first avenue: sexual medicine therapeutics.

ChatGPT: The most straightforward route is to treat clinical dysfunction, which is already recognized and diagnosable:

• For kisspeptin: Hypoactive Sexual Desire Disorder (HSDD)

• For prolactin antagonists: Post-orgasmic dysfunction syndromes (including excessively long refractory period when it causes distress)

This keeps FDA framing clean:

• You are restoring function, not enhancing performance.

• The commercial model resembles Viagra, Cialis, Flibanserin, etc.

• Reimbursement is possible when the condition is documented.

Miles: And the second path — the lifestyle / relationship market?

ChatGPT: Once a drug is approved for a dysfunction, physicians may legally prescribe it off-label for quality-of-life use.
This is how:

• SSRIs escaped anxiety/depression into general emotional regulation

• GLP-1 agonists expanded from diabetes into weight loss and appetite control

• PDE5 inhibitors expanded from hypertension → erectile function → sexual confidence initiation

The kisspeptin + prolactin-antagonist suite would naturally expand into:

• Sustaining intimacy in long-term relationships

• Restoring sexual openness after stress, childbirth, or illness

• Supporting sexual expression in aging

This is where the large cultural market exists, even if the regulatory approval is narrow.

Miles: And the third path — partnering with existing pharma?

ChatGPT: The strategic players are already clear:

DomainLogical PartnerReasonKisspeptin drugsSumitovant / Sumitomo PharmaOwn the clinical-stage lead kisspeptin analogProlactin receptor antagonistsNovartisOwn the clinically tested PRLR antibody scaffoldPeptide delivery technologyVaxxas or Micron BiomedicalHave scalable microneedle platforms

A commercialization move could be:

1. Acquire or license the prolactin antagonist program (from Novartis or from academic peptide-variant IP families).

2. Develop microneedle formulations in partnership (Vaxxas / Micron).

3. Position the drug as the “post-orgasmic continuity therapy” — medically framed as refractory-period dysregulation.

Sumitovant is the natural co-launch partner, because:

• They are already developing kisspeptin for sexual desire.

• They have existing urology and women’s health physician networks.

• They understand how to frame psychosexual outcomes in FDA-acceptable terms.

This creates a combination therapy ecosystem without selling it as a combination therapy.

Miles: What is the investment thesis, in one sentence?

ChatGPT:

Sexual connection is one of the primary regulators of emotional stability and relationship durability; restoring it reliably is a high-value clinical outcome with a large, under-served, psychologically important market.

Miles: And what is the cultural implication?

ChatGPT: Viagra and Cialis changed performance.
Kisspeptin and prolactin antagonists would change meaning and continuity.

• Viagra: Can the body perform the act?

• Kisspeptin: Does the mind want the connection?

• PRL antagonists: Does desire remain open after intimacy?

This moves sexual medicine:

From mechanics → to motivation → to relational bonding dynamics.

Which is where sexuality actually matters most.