The Contraception Pioneers
It's time to give these researchers their due.
It doesn't take a scientist to figure out that unprotected sex leads to babies. It does, however, take one to figure out how hormones in a 3-inch adhesive patch will cross layers of skin, muscle, and blood vessels before tweaking chemicals in the brain and ovaries to prevent pregnancy. For these contraceptive researchers, there's no real fame to be had, and the pay is just so-so. But after decades of struggling to win support from the scientific community, they've re-established themselves as dedicated to a deserving craft with impressive developments that redefine conventional birth control.
The creators of contraceptives are a rarely recognized class of inventors. They've produced birth-controlling breakthroughs like implantable hormonal rods, through-the-skin hormone patches, and T-shaped copper devices that prevent pregnancy from the uterus out. Their goal is not original—a second-century diaphragm made of hardened elephant and crocodile dung is on display at the Toronto Museum of Contraception. But with innovative devices in the works, like a translucent body gel that suppresses ovulation through an estradiol and progestin (Nestorone) mix, their golden age is now.
Their research is focused on the cleverly inconspicuous—novel, even invisible methods that make the pill look as outdated as the eight-track. One method in development is a spray-on hormone that looks like a cross between Neutrogena's Wave facial cleanser and a Star Trek laser pistol. The hormones are delivered transdermally, as with the OrthoEvra patch. But instead of wearing your progestin continuously like a scarlet P on, say, your stomach or back, you'll spray some hormones onto your forearm, where they can absorb into the bloodstream. The spray (a so-far unnamed product from the Australian pharmaceutical firm Acrux Limited) might be less irksome for users, as it could avoid potential skin irritation and the dirt build-up that comes with a weeklong adhesive like the patch. Even better: When combined in its estrogen and progestin form, the risk of blood clots with the spray appears to be almost four times lower than with the average birth control pill.
Further along in development is a yearlong vaginal ring that's made from the same hormones as the contraceptive body gel—a nice partway between the five-year Mirena IUD and the current vaginal ring, which users leave in place for three weeks and then remove for one. For the absolutely fearless, also in the works is a contraceptive nasal spray for men that combines an anti-cancer derivative, lonidamine, with an isolated hormone precursor from insect cells.
The problem with most of these new methods is that production is slow. Unlike a Steve Jobs creation, there isn't enough consumer or industry demand to drive full-scale funding and production efforts. When a method does finally materialize, there are still several rounds of safety and efficacy testing to get through.
Take Richard Cone. His work on contraceptive development using mucosal immunity has earned him a throne in the contraceptive kingdom. But his most recent creation—BufferGel, a dual-action spermicide and STI-killer—recently crumbled in the face of testing. It wasn't able to protect against HIV in women, a disappointing blow to Cone and his team of researchers. Thankfully, resilience is a prerequisite for scientists. Cone's predecessors have made an art out of it.
In its heyday in the 1950s and '60s, contraceptive research was sex research, and sex research was undistinguished. The medical community called it pseudoscience and second-tier research. It was overlooked by the world of academia, often receiving little to no funding. Perhaps it is for this reason that, even today, the think tanks of contraceptive invention are as modest as the day they were born, with nary a uterus paperweight in sight. Daniel Mishell, founder of the academic journal Contraception and one of the original creators of the vaginal contraceptive ring, says these scientists have been waiting a long time for scholarly recognition: "Gregory Pincus invented birth control pills, and nobody knows who he is. He should have received the Nobel Prize." Instead, Pincus was a vilified maverick, a so-called, "Dr. Frankenstein" who spent most of his career defending the academics of both in vitro fertilization and contraception alike.
There is relatively no profitability in contraceptive evolution. Development is governed first by sales potential and only later by public health need. This means that all the pills, patches, and implantable rods that have been created specifically for use by men probably won't reach the market anytime soon. It's not because they don't work. The Population Council has a slew of projects under way, using a synthetic steroid called MENT, that promise to temporarily reduce sperm count. It's because Big Pharma thinks they won't sell, or so one theory goes. Without a new blockbuster, there's little opportunity to gain prominence.
The low profile of contraceptive pioneers also has something to do with opposition to a field of science that "promotes promiscuity." In 1873, 24 U.S. states passed Comstock Laws prohibiting the distribution of "obscene, lewd and/or lascivious" materials—including contraceptives—through the mail. It took almost 100 years to reverse all of these laws. While it may seem like a lot has changed since the days of smuggled birth control, federal funding for this area of research is still an issue.
In 1973, near the peak of reproductive research funding, the field's financial support made up just 2 percent of all U.S. medical research spending. Since then, it has just been a downward slope. The problem with this decline is one of fiscal responsibility: By skimping upfront, we might actually be losing money in the long-term. Proponents argue that if you can increase contraceptive funding and create more effective, reliable, and easy-to-use methods, you can later save millions of dollars in federal health spending on terminations and the costs of raising a child on welfare. Clearly, it's a complicated and deeply polarized balance. But for the researchers involved, it's an issue of livelihood. If the government won't help out and private funding is limited, what's a contraceptive inventor to do?
Just keep plugging along, it would appear. And that's just what Richard Cone has done. Thirty years ago, while teaching physiology to several hundred preppy Johns Hopkins undergraduates, he had a birth-control epiphany. * He asked his pupils to show, by hand, how many were the fruit of "surprise" pregnancies. At least one-quarter of their hands went up. Once Cone realized that everyone had a birth control problem, not just teenagers and poor people, he was sold.
A dozen successful scientific publications and a few setbacks later, he is still in the lab. Microbicides did not work this time: Cone speculates the gel's time-sensitive protection span was to blame. Like a birth control pill taken at the wrong hour of the day, poorly timed gel use could have skewed the results. But there is still hope for a future gel that will kill sperm and HIV alike and not detract from intimacy like a condom or irritating spermicide. It's this hope that keeps contraceptive researchers searching. There might not be much glory in finding the ideal lube, but in bedrooms, the backseats of cars, and everywhere in between, their products make a difference daily.
Correction, March 12, 2010: The article originally and incorrectly referred to John's Hopkins. It is Johns Hopkins. (Return to the corrected sentence.)
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Jennifer Austin is in her final year at the University of California-San Francisco School of Medicine and is a graduate of the Columbia University School of Journalism. In July, she will begin residency training in obstetrics and gynecology.
Photograph of birth control by Photodisc/Getty Creative Images.