Ever wonder why the birth control pill exists? Naturally, there were great scientists behind the Pill. Folks like John Rock and Gregory Pincus had the ideas and scientific skill to make it happen. And there was Margaret Sanger who pulled everyone together. Sanger was a spokesperson of sorts and an expert networker. Smart people with good ideas within contraceptive technology have rarely been in short supply. What has been in short supply, however, is philanthropic support. Drug development is really expensive. Developing a drug is nothing like other inventions. With a drug, you need to show proof of concept that your idea works, and then you work on what’s called a lead compound. This is a version of the drug that’s more selective and does only (or mostly) what you want it to do. Then you take the drug through toxicology testing to make sure it doesn’t hurt anyone. After all this testing, much of it on rodents and then primates, you need to test on humans. This has three phases where experimenters hone in on the proper dosage and test progressively larger samples of people. All of this is done under tight regulation requiring highly trained individuals. On the lower end for cost, you’re looking at several hundred million dollars. Now take all that cost and complexity, and stigmatize it with the fact that your drug helps people have sex without having children. That was the barrier Katharine McCormick overcame when she single-handedly funded the Pill. Katharine McCormick. She’s the woman we need to thank. While you’re thanking McCormick for the Pill, you can also thank her for the later developments that stemmed from the Pill’s success. These developments are approaches like Nexplanon, the Ortho Evra Patch, Nuva Ring, and Depo-Provera. If the pill hadn’t been funded when it had, it’d be anyone’s guess how many decades we’d be waiting for all this. McCormick, as you might imagine, had an interesting background. She inherited her considerable wealth—tens of millions of dollars between 1937 and 1947—from her mother, and then her husband. She was also smart, one of the first women to graduate from MIT with a science degree. By the time McCormick had met with Sanger, she was already comfortable with giving. She’d donated to Harvard Medical School and funded a dormitory for women at MIT, enabling more women to enter scientific fields. McCormick was also hands-on in the women’s suffrage movement. She took on multiple officer positions for National American Woman Suffrage and later for the League of Women Voters. McCormick died seven years after the FDA approved the pill in 1960, having lived into her 90’s to see its success. But contraception for women wasn’t the only thing on her mind. McCormick funded work by Gregory Pincus in 1957, work explicitly for male contraception. She clearly appreciated the value of more effective contraceptive options for men alongside women. Unfortunately, the hormonal approach Pincus followed used progestins, which proved too challenging at the time. Pincus’ options were limited since the nonhormonal approaches being developed today had yet to be invented. McCormick was successful in her dream to allow women to control their fertility. But 50 years after initially funding male contraceptive research, nothing has happened. And as anyone following our work at MCI knows, it’s not for lack of possible leads. Where is our modern-day Catherine McCormick? The most likely suspect, Bill Gates, has been out of the picture. He hasn’t shown any interest in male contraception to date. But the list of the super rich extends beyond Gates, and the list isn’t short. Society would clearly benefit from a better male contraceptive. But what could be the draw for someone who’s been extremely financially successful? Those who have accumulated great wealth have an unimaginable variety of choices. One of them is choosing to have enormous impact on the world around them. Rang Yai Island, Philippines ($160M) There are more satisfying ways to spend a fortune than to collect yachts and jet planes, or even an island or two. Imagine if you were to instead go down in history as the person who changed the status quo on contraception. Imagine being responsible for helping billions of people better plan their families and future. You’d alleviate the one-sided contraceptive burden borne by women. Simultaneously, you’d empower men to better manage their own fertility. Big Pharma is afraid of the liability involved with developing drugs for healthy people. They’re not interested. But there are non-profit drug companies that, with adequate funding, are able to take researchers’ leads from the bench to the market. For example, Medicines 360 has a proven track record of not only bringing a new IUD onto the market, but also keeping it affordable. With the right funding, there’s a clear path. The development of a new male contraceptive would likely do more than just offer one new method for men. Like the Pill, it would likely spark further advances in contraception, leading to even more effective options. Think of a male patch or a method that avoids any user error like an implant device. That’s an exciting world to look forward to—an obviously better world. Right now, it’s unclear who the next Katharine McCormick will be. But whoever that person is, they’ll have a long-lasting legacy. r. John Amory is Professor of Medicine at the University of Washington where his research focuses on the development on novel forms of male contraception. Dr. Amory is also on the Male Contraception Initiative advisory board.
References 1. Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat. World Population prospects: the 2008 revision. Available at http://www.un.org/esa/population/ (Retrieved 09/30/11). 2. Speidel JJ, Grossman RA. Addressing global health, economic, and environmental problems through family planning. Obstet Gynecol 2011;117:1394-1398. 3. Singh S, Sedgh G, Hussain R. Unintended pregnancy: worldwide levels, trends and outcomes. Stud Fam Plann 2010;41:241-250. 4. Shah I, Ahman E. Unsafe abortion in 2008: global and regional level and trends. Reprod Health Matters 2010;18:90-101. 5. Singh S, Darroch ME, Ashford LS, Vlassoff M. Adding it up: the costs and benefits of investing in family planning and maternal and newborn health. New York (NY). Alan Guttmacher Institute, 2009. 6. Piccinino LJ, Mosher WD. Trends in contraceptive use in the United States: 1982:1995. Fam Plan Persp 1998;30:4-10. 7. Trussell J, Vaughan B. Contraceptive failure, method-related discontinuation and resumption. of use: results from the 1995 National Survey of Family Growth. Fam Plann Perspect 1999;31:64-72. 8. Li S-Q, Goldstein M, Shu J, Huber DH. The no-scalpel vasectomy. J Urol 1991;145:341-344. 9. Martin CW, Anderson RA, Cheng L, et al. Potential impact of hormonal male contraception: cross-cultural implications for development of novel male preparations. Human Repro 2000; 15:637-645. 10. Heinemann K, Saad F, Wiesemes M, White S, Heinemann L. Attitudes towards male fertility control: results of a multinational survey on four continents. Human Repro 2005;20:549-556.
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