PILLOLA: LA RIVOLUZIONE INTERROTTA - INTERVIEW WITH CARL DJERASSI

Originally published in “Tuttoscienze” of “La Stampa”, 12 June, 2003

Post coitum athletics, linen condom and toxic if not lethal beverages: the history of contraception is millennial and characterized by a paraphernalia of amulets, mixtures and bizarre inventions. But the revolution in the control of human fertility is recent, identified with the invention of the pill and embodied by Carl Djerassi, professor emeritus of chemistry at Stanford University. We interviewed him for a conversation about the contraceptive and reproductive technologies of a world which roughly accounts daily for 100 million sexual intercourses, 1 million conceptions, 250,000 unwanted pregnancies, 150,000 abortions of which 50,000 are illegal and leading to the death each day of 500 women.

Professor Djerassi, could you briefly illustrate how you created the first birth control pill?Our group played the maternal role with the pill, since we brought into the world the compound which constitutes the active ingredient of the pill and which does not exist in nature. The father of the pill is considered the biologist Gregory Pincus. It was well-known already since the '20s that progesterone, the natural female sexual hormone, has a contraceptive role because it inhibits ovulation during pregnancy and this why a woman cannot get pregnant during pregnancy. However, using progesterone was problematic since it is not really active by mouth. In 1951, I was working at Syntex, a small pharmaceutical company based in Mexico City, and we at Syntex succeeded in synthesizing norethindrone, a compound analogous to natural progesterone, but which was active by mouth. In order to test its activity, we sent it to a number of biologists including Pincus who was really engaged in contraception research when that was not a priority. In 1957, the Food and Drug Administration authorised its use for the treatment of menstrual disorders and in the early 1960s extended its use to contraception.

Margaret Mead said the pill was a completely male invention and it was invented by men definitely willing to do experiments on women bodies, but not in their own!In effect, almost all the people who worked on the pill were men and I am afraid as it was due to women discrimination in science. However, if we had worked on a male pill the decision about whether and when to have a child would have remained in men's hands, and furthermore we had a biological hint for women which inspired us: they have a natural contraceptive, namely progesterone. Men contribute to reproduction just through the sperm. All we can do is either to prevent the sperm from arriving at its destination through coitus interruptus, male sterilization, condom or diaphragm, or to block sperm production through a pill for men, but while people have been working on this since the late sixties, a male pill is still not on the market. I am very pessimistic about that.

Why?

Because of the problems it poses. Men produce sperm continuously and they are fertile for a much longer period of time than women. Understanding what happen to the potency and fertility of a man after 20-30 years of pill would require an extremely expensive clinical sperimentation, a much much longer sperimentation that that required by female pill. But if pharmaceutical companies use most of the patent time to test, they could not cover the costs. Yet it would be fair to have a better male contraception as women sustain all the burden of reproduction, it would be right to have the men sustain the burden of contraception. But pharmaceutical industries are private enterprises: they make profits, they do not solve social problems.

The pill is 52-year-old, nonetheless it is the most recent breakthrough in contraceptive technology. Why is the research in this sector essentially stagnant?It has been stagnant from the '70s and the main reasons are two: the legal litigations due to the side effects of some contraceptives and the priorities of pharmaceutical industry, which is interested in the markets of the rich countries, which are "geriatric countries" and then they have geriatric diseases: Alzheimer, cancer, cardiovascular diseases. All these pathologies require expensive drugs which patients had to take for long periods of time and have side effects which patients are willing to tolerate, because people with cancer or Alzheimer disease are in a very different condition compared with a relatively young healthy woman who takes the pill. And then, pharmaceutical companies are no longer interested in contraception: if we consider the 20 giants in the field, we realize that only 2 of them are still marketing contraceptives. And in the United States, the entire market of contraceptives is probably smaller than the market of a single one of the highest selling tranquillizers.

From the fifties to today, we passed from a punitive legislation about contraception to a society which promotes the sexual and reproductive rights. What was the role of the pill on this?Besides having enormously increased the quality of sexuality, the pill gave a great contribution to separate sex and reproduction which are two things completely separate. Of course, there are people who criticize the pill because apparently it seems that, as it eliminates the fear of pregnancy, it encouraged behaviour which some people consider immoral. But moral cannot be grounded on fear.

By permitting having sex without reproduction, the pill spawned the sexual revolution. Will futuristic reproductive technologies such as intracytoplasmic sperm injection (ICSI) spawn the reproductive revolution by permitting reproduction without sex?At the moment ICSI is a powerful tool to treat male infertility. But I think that in a not distant future in the wealthy classes of the developed countries, the fertile people and not only the infertile ones will use expensive assisted reproductive techniques such as ICSI. The more women are highly educated and the more they want to have opportunities and postpone childbearing. But women are born with their supply of eggs, they do not produce them continuously as the men produce the sperm. When a woman is thirty five, she has already lost 90-95% of her eggs, and those remaining not only have problems of fertility, but also of more frequently encountered malformations transmissible to the foetus. If a woman could freeze her eggs when she is young, as men can freeze their sperm, when she is 40-45-year-old, she may still have the possibility of using and fertilizing them through improved techniques such as ICSI. Besides this, in order to check embryo for possible malformations it could be possible also to do genetic screening before putting the embryo back to the uterus.

But, a part the ethical problems it poses, the mechanical reproduction would be completely unnatural.Hundred years ago an European woman had a life expectancy of 40 years roughly. Is it natural that we have doubled it? And it is not doubled for natural reasons. We are practising medical intervention continuously, doing something completely unnatural and contrary to evolution as we keep all people alive whereas in nature those who live longer are the strongest. And we allow to generate children also to people who 30 years ago did not have any possibility of procreating: today over 1 million in vitro babies and 100,000 ICSI babies exist in the world.

Concluding, you are a playwright and in September 2003 there will be the Italian premiere of your play "Oxygen" in Bologna. What made a workaholic chemist become a writer?I am interested in communicating with the public and I decided to do theatre because it permits to use the dialogue, a kind of writing which is precluded to scientists as they always have to use an impersonal stile in their publications. Through my plays, I represent the behaviours and motivations of scientists. I do not revere them, I am interested in describing the tribal culture of scientists' community which is entirely based on the name recognition of the peers, and which practise a brutally competitive activity. Some colleagues of mine accuse me of washing dirty lab clothes in public. And I reply there is nothing wrong with doing this.