In Our Control (43 page)

By the mid 1960s, young scientists inspired by the female pill began to pursue further research on a male alternative. The voices of feminists from
northern nations were joined by those of political leaders from the southern ones. Governments concerned with population growth, particularly China and India, called for the advancement of the technology.

Gender and technology professor Nelly Oudshoorn studies the path from scientists’ first tentative steps to today in
The Male Pill: A Biography of a Technology in the Making
. Oudshoorn identifies several hurdles that had to be overcome before progress could be made on the new drug. Significantly, many of these hurdles aren’t related (at least directly) to gender issues, although closer analysis reveals connections. Oudshoorn dismisses the notion that male contraceptive technology has evolved slowly out of happenstance, either because women are more biologically suited to be the subjects of pharmaceutical birth control or because accidents of fate have simply prevented the product from emerging.

The first problem scientists faced was one of basic biology. In considering whether to pursue a hormonal or nonhormonal approach to pregnancy prevention through male bodies, would-be pill makers were at a loss because so many key pieces of information about the male reproductive system simply remained ambiguous. The reproductive systems and cycles of women had been of interest to the medical community since before the 1920s and 1930s, when a generation of groundbreaking scientists mapped the reproductive cycle and began synthesizing female hormones. By the 1950s and 1960s there were many compounds available for testing and many more in development. A lack of equivalent chemicals for male hormones—particularly affordable, practical ones—posed a huge problem for potential drug innovators. Still, because of the success of the female pill, taking a hormonal approach to male contraception seemed to be the most likely path.

One of the early steps, then, was to create more chemical compounds. The male pill, like the female pill before it, struggled at first because there was a lack of interest and financial investment from pharmaceutical makers. Although drug companies got on the contraceptive bandwagon in a big way after Searle’s success with Enovid, they played only small roles in the Pill’s development, and indeed a female pill would never have been successful without substantial and continued private investment from Katherine McCormick. Pharmaceutical companies have always been reluctant to invest in contraceptive research and development because of
concern that there will be a cultural backlash to the drugs and devices produced. They like to play it safe, but as the female pill demonstrated, they are willing to get in the game once it is clear that there will be general acceptance of the drug.

Contraceptive development has always made drugmakers more vulnerable to lawsuits. A male pill promised to be even more risky because men would take it not to prevent health risks to themselves, but theoretically to prevent them in their sexual partners. There was simply no precedent for such a thing: a drug whose physical risks were borne by one population but whose benefits were transferred to another.

Oudshoorn writes that intellectual, financial, social, physical, and scientific supports must be in place to encourage the creation of a new technology. The male pill has suffered the lack of these supports. In the 1970s, in addition to the lack of prior scientific work to draw on and a dearth of serious financial resources, there was no male equivalent for the medical specialty of gynecology or the social networks developed in women’s public health clinics—both of which were invaluable buttresses for the research and popularization of female birth control. And even if money and the required chemicals could be found, it would be difficult to mount serious clinical trials, because the networks and resources needed to recruit the appropriate male populations and conduct trials simply didn’t exist.

So how do new products, pharmaceutically speaking, come into the world? For drug technologies, one way is by creating a protected space
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where the scientists involved don’t have to play by the usual rules and can think outside the box (or the laboratory, as it were). For Gregory Pincus, this involved the patronage of a wealthy woman who supported his work. For male contraception, it involved the intervention and support of powerful international organizations and foundations, primarily the World Health Organization (WHO), but also to some extent the Population Council.

WHO had been interested in getting involved with global population issues since the early 1950s, when India requested help with natural contraception. Birth control was still deeply controversial business, and WHO backed off involvement when several member states threatened to leave if the group continued to pursue it.
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By the 1960s, anxieties about
global population growth and its relationship to the spread of Communism had made the topic of international contraception fashionable.
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Among other projects, WHO—through avenues that included the Male Task Force—made a serious commitment to aiding the development of innovative contraceptives for men. Note that only in the context of global hysteria about the fertility of poor people in the developing world did male birth control become a serious option. That is to say, male bodies became public in this way only by exploiting fears about marginalized communities of men, not through a desire to address the needs and responsibilities of all men. From the beginning interest the male pill was at least somewhat about maintaining inequality, not about creating a more even reproductive playing field.

Whatever the motivation, WHO crossed boundaries when they got into contraceptive research and development. In the past, research and development had always been the terrain of big pharmaceutical firms. Even Pincus had relied on the material support of Syntex and Searle to provide him with steroid compounds. WHO accomplished this task by thinking creatively. One good reason for trying to make drugs without industry involvement was that it allowed WHO to start imagining a world where it would have access to the drugs it wanted without payouts and concessions to big pharmaceutical companies. While they lacked the infrastructure of a large drug company—they didn’t have large centralized facilities, for example—they created a new model based in international cooperation. Instead of relying on one or two large laboratories, the Male Task Force established a network of laboratories around the world working to create new chemicals that could be used for future drugs. The success of this program created a model that WHO would return to in the future for the establishment of clinical trials. Bringing several laboratories together had additional benefits. For one thing, it hastened information gathering and brought together the few experts who existed in the field. Second, the broad geographic scope of the laboratory network helped to anticipate ethnic and cultural differences that would prove important in troubleshooting drugs from both a medical and a social standpoint.

While early programs were promising, old problems were not entirely overcome. Doctors proved unwilling to refer male patients for trials, and
no male equivalent of the public health clinic existed, so it was tough finding men willing to give the male pill a go. The media provided one limited way to convince men to participate. Today, the problem of trial scope and size remains a significant one for the development of male contraceptives. The largest trials have been performed in China under authoritarian rule. In the West there is (thankfully) no comparable means of “encouraging” participation.

Of course, not all problems with making the male pill are logistical. Perceptions about gender have always lingered in the foreground of this debate. A 1999 Canadian documentary on the Pill shows footage from a 1960s news program on contraception. A handsome, thirty-something male doctor who works for the drugmaker G. D. Searle is being interviewed by a strikingly pretty blonde reporter. He talks to her about potential innovations in pill technology, including a long-acting contraceptive injection that, he opined, would make the Pill obsolete. Intrigued but unconvinced, the young woman looks him in the eye and asks, “What about the Pill for men?” Almost embarrassed, the doctor laughs at the question and answers with a slightly patronizing tone that “the hormones or chemicals that might halt sperm production are very toxic,” adding that besides, what woman would trust her husband to take the Pill?
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Arguments about masculinity and male character have reappeared at various points in the past fifty years to suggest that ultimately male contraception is a doomed project. Most of these are based on either erroneous or outdated stereotypes of male/female relationships and gender ideologies. Some are based on outright mythology. They include the notions that men (unlike women, of course) don’t want to do anything that would interfere with their reproductive systems; that they (in particular those who are low income or live in the developing world) have no interest in family limitation and in fact consider large numbers of children to be status symbols; and that they are unreliable and untrustworthy. According to this reasoning, the physical risks incurred by a woman in accepting contraceptive responsibility are worth the psychological benefit of not having to sit up nights worrying whether her partner has remembered to do his part. Finally, some worry that men would never be willing or tough enough to tolerate the pain and discomfort inherent in pharmaceutical approaches. These old-fashioned ideas about men—they are
tough, virile, and in control while also irresponsible and afraid of pain—are contradictory. This sort of gender kitsch isn’t helpful to women and should be insulting to men.

Whatever the perceptions about masculinity, the underlying concern that men simply wouldn’t be willing to use contraception has always presented a major stumbling block for potential pill makers. In the 1960s it was clear that cultural perceptions would need to be scientifically and repeatedly proven false if the male pill was to gain any ground.

On Gossypol: The Male Pill Comes of Age in the 1980s and 1990s

If interest in the male pill seemed promising in the late 1960s, it had dimmed by the early 1980s. Backlash against the female pill contributed to a dwindling interest in male methods. Then, without warning, Gossypol entered the public consciousness. A nonhormonal, botanical drug derived from the seed, stem, and roots of the cotton plant using hot alcohol, Gossypol was introduced to the world by Chinese scientists who announced, around 1979, that they had created and were already testing a pill for men.
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While the reports of this triumph had been announced preemptively, China and male contraception suddenly had the world’s undivided attention.

The cotton plant’s amazing fertility-curbing properties were first discovered in parts of China where, particularly during droughts, the cakelike substance left over after the plant’s fiber and oil had been removed was used as an alternative food source.
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The plant has a brilliant natural defense system: it contains a chemical that renders bugs that feed on it infertile, strategically limiting future generations of predators. So when men and livestock ate the cotton product, they stopped fathering offspring. By the 1970s, more than eight thousand Chinese men were taking the drug at a clinical dose.

For the most part, men did well on the drug. Unlike hormonal alternatives, it didn’t change endocrine function or cause libido problems. It didn’t adversely affect blood pressure or cause weight gain like testosterone.

Unfortunately, Gossypol failed in two key respects. It lowered blood potassium (which can cause liver problems), and more importantly, it
proved irreversible in a significant group of men.
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Because of this, initial enthusiasm for the drug petered out, and by 1986, after a WHO- and Rockefeller Foundation–sponsored symposium on the subject, investigators concluded that Gossypol had little promise of becoming a generally accepted method of birth control.
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What had been accomplished, however, was the revival of organizational enthusiasm, and WHO began pouring money into research in China.

In the 1990s, WHO began conducting larger, multicenter clinical trials of testosterone therapy. This moved hormonal options up the scientific development chain, but didn’t advance the drugs to a point where they were ready for marketing. Despite the impressive accomplishments of WHO and other public sector organizations, the fact remains that it is almost impossible to conduct advanced clinical trials (phase 3) and bring a drug to market without the involvement of the pharmaceutical industry.

Women’s activists again played a key role in the story of male contraception in the 1990s. By taking key positions at population and public health organizations, such as the Population Council and WHO, women began to slowly change the agenda of international family planning efforts. Journalist Michelle Goldberg points out that “women needed power, not just pills, and population programs could be harnessed to improve their health and status.”
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Shifting the focus from the xenophobic frenzy of fertility control that had driven efforts in the 1960s and 1970s to concerns about “reproductive health and rights,”
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feminist leaders were able to put reproductive equity at the center of the international agenda. Their agenda at two conferences—the United Nations International Conference on Population and Development held in Cairo in 1994 and the United Nations Fourth World Conference on Women held in Beijing in 1995—characterized birth control as a shared responsibility. Leaders specifically identified the importance of increasing the role of “men as partners” and “male responsibility” in contraception. In this formulation, male contraception became a women’s health issue.