Avoiding misconceptions

Sexual Chemistry: A History of the Contraceptive Pill. By Lara Marks. Yale; 352 pages; $29.95 and £20

This Man's Pill: Reflections on the 50th Birthday of the Pill. By Carl Djerassi. Oxford University Press; 308 pages; $22.50 and £12.99

THOUSANDS of drugs have been launched during the past half century, but only one is known simply as “the Pill”. The oral contraceptive, which celebrates its half century on October 15th, was arguably the first lifestyle drug to control a normal bodily function—fertility—rather than a dread disorder. It transformed the lives of millions and also helped reshape the role of medicine in reproduction. Now, the medical, religious and social furore which greeted the Pill is largely forgotten. But it is admirably recalled by two new books which trace the Pill's tumultuous history and its uncertain future.

Carl Djerassi's is by far the more personal account; and with good reason. Fifty years ago it was in his lab, at a small company called Syntex, in Mexico city, that a synthetic female sex hormone, called norethindrone, was first synthesised from a most unlikely source—yams. Syntex's goal was to create a drug for infertility and menstrual disorders which could be swallowed rather than injected. That it could also suppress ovulation, and thereby prevent pregnancy, was demonstrated by Gregory Pincus at the Worcester Foundation in Massachusetts, though the idea that naturally occurring hormones could be used as oral contraceptives was recognised as early as 1919 by Ludwig Haberlandt, a brilliant scientist now largely forgotten.

Mr Djerassi does a good job at explaining the chemistry behind the Pill and tracing the family tree of scientists which led to its creation. Lara Marks adds to this a thorough account of what happened to the Pill once it left the laboratory, and the long and complex clinical trials conducted by Dr Pincus and his colleague, John Rock, that were needed to get it to market. She also fleshes out the roles of Margaret Sanger, an American birth-control advocate, and Katherine McCormick, a rich philanthropist who supported Dr Pincus but whom Mr Djerassi largely ignores.

Both authors are critical of feminist attacks on the Pill and of claims that it was foisted on women by male scientists without adequate testing. As “Sexual Chemistry” points out, it is unfair to measure the drug's clinical development—much of which took place in Puerto Rico and other poor places—by today's standards. When the Pill came of age, the “population explosion” in developing countries was believed to be a fast track to communism and as dangerous to the western world as the atomic bomb. It was also before the thalidomide scares of the 1960s, which helped introduce tougher testing requirements.

The Pill has received much undeserved blame, as well as credit. It did not create the “sexual revolution”, nor has it destroyed family values. As both authors point out, all the Pill did was to expedite social changes already under way. It was revolutionary only in a technical sense, being the first drug that women could take on their own, at any time, to separate sex from procreation. The next generation of technologies to combat infertility—from in-vitro fertilisation to cloning—merely extend the great divide created by the Pill.

More than 80m women still use a variation of the Pill. Yet its popularity has declined since the 1960s, partly because of fears over thrombosis and cancer, and partly because the rise of AIDS has led to greater condom use and a rebalancing of the responsibility for contraception between men and women. Nor are there many drug companies interested in contraceptive development, largely because of the costs involved and fears of litigation due to complications. And yet there is a crying need for new methods of contraception, particularly ones better suited to people in the developing world. Although Mr Djerassi worries that contraceptive research is winding down, there have been a few interesting advances, particularly in regulating male fertility (see article). As the Pill enters middle age, contraception is still ripe for development.