Book Review

Sexual Chemistry: A History of the Contraceptive Pill

N Engl J Med 2001; 345:1136October 11, 2001

Article

Sexual Chemistry: A History of the Contraceptive Pill
By Lara V. Marks. 372 pp. New Haven, Conn., Yale University Press, 2001. $29.95. ISBN: 0-300-08943-0

The history of the development of the ovulation-suppressing oral contraceptive known today simply as “the Pill” has been told before, but Lara Marks, a senior lecturer in the history of medicine at Imperial College, London, takes several particularly important approaches. First, her history has an international focus and, at times, a comparative focus that significantly broaden our understanding. Second, readers will be grateful for Marks's judicious analysis of what continue to be contentious issues about the testing, safety, and impact of oral contraceptives. A third attraction is the succinct but compelling story Marks weaves in the middle chapters of the book about the ways in which discoveries in medicine and chemistry, explorations in Mexico, pharmaceutical manufacturing, and the international drug business all led to the development of birth-control pills.

The book focuses on the medical and scientific history of the Pill from 1920 to 1960 and its impact from 1960 to 1990. In both the first and last chapters, Marks provides an international overview. Chapter 1 examines the policies that democracies and dictatorships alike adopted, once nations began to equate national strength with population growth. Most policies promoted births, but many nations also adopted strategies to discourage reproduction by persons deemed unfit. The final chapter returns to the global perspective, summarizing international policies with respect to family planning and the contraceptive pill. The main part of the book has two general story lines: the scientific history of the development of the Pill (chapters 2, 3, and 4) and reactions to the Pill — in particular, reactions in the United States and the United Kingdom to evidence that the Pill might increase the risk of thrombosis and cause cancer and reactions among physicians, leaders of the Catholic Church, and individual women around the world.

Marks outlines the changes in scientific knowledge that, by the 1930s, suggested sex hormones as the path toward the invention of oral contraceptives. Once scientists recognized the contraceptive potential of progesterone, estrogen, and testosterone, they still needed to find plentiful sources. Animal ovaries and testes yielded hormones, but only in minute quantities (80,000 sows' ovaries provided only a tiny amount of estrogen). Progesterone cost $1,000 per gram in the 1930s and was therefore used mainly in the “highly profitable business of improving the fertility of world-class racehorses.” The search centered, therefore, on plants containing steroids that could be chemically modified into progesterone and estrogen, and it led scientists to scores of botanicals, including those with reputations as agents of fertility inhibition in folk medicine. They eventually found success with a species of wild Mexican yam. Marks weaves into this history new material about the contributions of European Jewish scientists fleeing the Nazis, the work of the Mexican pharmaceutical laboratory Syntex, and the competition among European, American, and Japanese companies for the key to cheap steroids.

Marks also traces the history of the early clinical trials of various types of oral contraceptives in the 1950s. American researchers conducted the first small-scale tests in patients with schizophrenia in a Massachusetts psychiatric hospital and in American nursing students in Puerto Rico. Large-scale trials were conducted in 1956 and 1957 in women in Tennessee, Seattle, Chicago, and Los Angeles and in Haiti, Mexico City, Hong Kong, Australia, Ceylon, Japan, and Britain, but Marks provides details only about the studies conducted in the United States. She disagrees with critics who claimed that the investigators treated women as guinea pigs and that the tests were racist and unethical. She defends the early developers of the birth-control pill, noting their serious fears about the safety of the Pill, and she reminds readers that the environment of medical testing in the 1950s differed greatly from that of today. She notes that the least ethical trials involved the psychiatric patients, but in general, she defends the early researchers against the criticisms leveled at them from the 1960s to the present.

This is a deeply researched book, one based on considerable archival research and an impressive number of oral histories. There are places, however, where Marks does not engage as deeply as she might with the extensive literature on the history of birth control. She gives short shrift to the long and contentious history among Catholic theologians, church officials, parish priests, and the laity over reproductive control. Historians John Noonan and Jean Louis Flandrin have amply documented this history, which began centuries before the Pope objected to the birth-control pill in the 1960s. Similarly, Marks's discussion of physicians and the Pill would be even stronger if she acknowledged the deep involvement of the 19th century medical profession in opposing (and only occasionally promoting) contraception and abortion.

Authors should be commended for their smaller points as well as their overarching themes. Marks is especially good at explaining the chemistry involved in the development of the Pill, making it clear and comprehensible to general readers. She also deserves special approbation for interviewing the often anonymous technicians (usually women) who provided crucial oversight of the early clinical trials of pills that inhibited ovulation. She movingly documents the valuable work of Anne Merrill, Mary Ellen Fitts Johnson, and Miriam Menkin, among others.

Janet Farrell Brodie, Ph.D.
Claremont Graduate University, Claremont, CA 91711