Book Review

From the Lab into the World: A Pill for people, pets, and bugs

N Engl J Med 1995; 332:544-545February 23, 1995

Article

From the Lab into the World: A Pill for people, pets, and bugs
(Creators of Modern Chemistry.) By Carl Djerassi. 230 pp., illustrated. Washington, D.C., American Chemical Society, 1994. $24.95. ISBN: 0-8412-2808-6

In terms of the range of his interests and his degree of success, Carl Djerassi is a pioneering model of what has recently become more common: the gifted laboratory scientist with entrepreneurial and humanistic ambitions. If not the “father of the Pill” (that honor, according to the author, goes to the late Gregory Pincus of G.D. Searle), Dr. Djerassi was the first to synthesize the active ingredient of all oral contraceptives, norethindrone (19-nor-17α-ethynyltestosterone), in 1951 when he was 28 years old. Now in his 70s, Djerassi has assembled the present collection of 24 essays, most of them published originally in the 1960s and 1970s, in a book that gives the general reader an overview of his multifaceted thought.

By any standard, Djerassi has enjoyed a remarkable career. Concentrating as an organic chemist on steroids and mass spectroscopy of organic compounds, Djerassi has also been active as a laboratory entrepreneur (chief executive officer of Syntex and other companies), international spokesman for oral contraception, writer of fiction and poetry, and patron of the arts. The book is divided into four sections, in which the essays focus on the early history of steroid contraceptives, future prospects for birth control, scientific cooperation in the developing world, and miscellaneous topics including women in laboratory science, mentoring in science, contraception for pets, and philanthropy in the arts, among other subjects.

This is a large menu, and, although some of the pieces are so short that the collection at times seems scattershot, a few general themes emerge. One of the most engaging to me is Djerassi's advocacy of the establishment of scientific research centers in developing countries. Having begun his own career as a newly minted Ph.D. chemist in the then tiny firm of Syntex in Mexico City in 1949, the author provides well-thought-out arguments in support of laboratory science in developing countries. Wisely, he points out that the establishment of such research centers cannot take place through a traditional route involving a country's development of home-grown researchers in many fields. But if — and these are big ifs — the research field is well defined and appropriate to the needs of the country, if the working teams consist of a part-time supervisory scientist of international repute and a few gifted postdoctoral fellows, and if the funding is in place, the results can be spectacular. Djerassi provides as an example the International Center for Insect Physiology and Ecology in East Africa.

Local research in the developing countries is imperative in birth control, in Djerassi's view, for the simple reason that little research on birth control is done any more in industrialized countries. Indeed, as of 1988, birth-control research did not rank in the world's top 35 categories of research-and-development expenditure in medicine. After describing population growth as “an intrinsically gray problem” in the preface, Djerassi later emphasizes the importance of local approaches if the political and cultural issues inherent in population control are to be resolved successfully.

The color gray may describe the position of successful scientific entrepreneurs in late-20th-century life, as well. Given the profound social consequences of the Pill, a development as far-reaching, perhaps, as the vaccines of Louis Pasteur a century ago, it is surprising that Djerassi — or Pincus, for that matter — has received relatively little popular acclaim. Pasteur, after all, has had more roads named after him in his native country than any other Frenchman. Both literally and metaphorically, the road “from the lab into the world,” to use Djerassi's title, seemed more glorious at the dawn of big-time laboratory science than it does today. Though the logic of science has been incorporated into our imaginations and practices to a degree unimagined a century ago, we have not made our Djerassis into public heroes.

In Djerassi's case, the lack of celebrity reflects, I think, continuing social and political ambivalence about techniques of population control. But I also think it reflects ambivalence about the increasingly private nature of progress in medical therapeutics. Pasteur's laboratory, funded by the state, was operated for the benefit of the French nation. Djerassi's discoveries, and those of his successors in the study of genetically engineered drugs and the like, may benefit our nation, too, but the profits will accrue to a few individuals. Society is more than a collection of markets, however, and it is difficult to garner unalloyed public approval for scientists who insist on obtaining the rewards of the market as well as the laboratory. On the other hand, I have seen Carl Djerassi's ranch, and it is lovely.

Robert Martensen, M.D.
Harvard Medical School, Boston, MA 02115