Book Book

Sexual Chemistry: A History of the Contraceptive Pill

BMJ 2001; 323 doi: http://dx.doi.org/10.1136/bmj.323.7305.171 (Published 21 July 2001) Cite this as: BMJ 2001;323:171
  1. James J Schlesselman (JSchless{at}med.miami.edu), professor
  1. Department of Epidemiology and Public Health, University of Miami, USA

    Lara V Marks

    Yale University Press, £20, pp 372 ISBN 0 300 08943 0

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    The double entendre in the title of this book hints provocatively at its author's purpose—to chronicle the development, marketing, benefit risk analysis, acceptance, and rejection of the oral contraceptive pill, and to highlight the significant role of women in all of these events. The story is set brilliantly in the context of ever changing social and scientific milieus, which often gave rise to controversy, some of which continues to this day.


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    America led the world in marketing the pill and taking credit for its discovery, but it was European chemistry and Mexican yams—which figure prominently in this story (with five out of the book's 17 photographs to their credit)—that were central to the commercially viable products. Gregory Pincus, John Rock, and Carl Djerassi, who are popularly regarded as the “big three males” behind the pill's development, drew inspiration and funding from visionary women such as Margaret Sanger, who promoted the concept of oral contraception, and Katherine McCormick, who financed early research. The author uses women's poignant stories of the burden of unintended pregnancies and their eagerness to participate in clinical trials to highlight the human condition that gave rise to Sanger and McCormick's vision. Like modern day post-docs who ghost write their professors' grant proposals, women also played important but often forgotten roles in the basic science and clinical investigations that led to the pill's appearance as a highly effective, female controlled, physician prescribed contraceptive in 1960.

    Findings over the past 40 years about the pill's side effects, vascular disease (bad news) and cancer (some bad, but mostly good news) in particular, have led to swings in public concern about the pill, women's acceptance of it, and occasionally emotional confrontations between the scientific protagonists. A photograph of epidemiologists grappling over microphones at a 1989 conference, organised in Britain to discuss breast cancer and the pill, would have been worth two photos of Mexican yams. The author gives an even-handed account of the arguments and findings, most recently risk of thrombosis from use of third generation pills.

    The obstacles encountered in clinical trials of the pill's efficacy and safety, and the problems of postmarketing surveillance, are well described. These vignettes provide an outstanding perspective on the difficulties and uncertainties of pharmaceutical research.

    Even God may not have known where his handiwork of six days, described in “Genesis,” would lead, so one should not be surprised that the women who championed the pill, and the Catholic church which opposed it, would not fully anticipate its human repercussions.

    Footnotes

    • JJS has been paid by manufacturers of oral contraceptives (Organon and Ortho-McNeil) for consulting on several projects and for participating in one conference.

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