A bitter pill

This Man's Pill. Reflections on the 50th Birthday of the Pillby Carl Djerassi. Oxford University Press, 2001. US$22.50 (308 pages) ISBN 19 850872 7Most people consider Gregory Pincus to be the father of the birth-control pill. Some people consider Carl Djerassi father of the pill, and some people, primarily clinicians, believe John Rock who initiated the first clinical trials to be the father of the pill. In the present memoir, This Man's Pill, Carl Djerassi (a chemist actively involved in pharmaceutical chemistry, particularly of steroids at the time the birth-control pill was conceived) remembers his involvement in this most important pharmaceutical discovery. Carl Djerassi recounts the fascinating story of the development of the pharmaceutical chemical industry, particularly relating to steroid hormones, that originated in the 1940s and 1950s.The initial work that was to change the way steroid hormones were synthesized in the laboratory was based on using precursors found in the Mexican yam. Djerassi holds the patent, awarded in 1951, for norethisterone, the first orally active progestational agent. He was also pre-eminent in the formation of the Syntex Company, which was based on production of these steroid precursors and on the ability to provide either precursors or synthesized steroids to several companies. He apparently became independently wealthy because of his initial involvement with Syntex, although he does not cover that in this book. His financial status has given him the freedom to become involved in many other areas, which he recounts later in the book. The first clinically developed birth-control pill, Enovid, used a different orally active progestational agent, norethynodrel, patented some 18 months after norethisterone and Djerassi seems to be distressed, even after 50 years, that his progestational agent was not the first used in this study. This might have been a result of corporate involvement, because Searle held the patent on norethynodrel and released the first birth-control pill, and also (not coincidently) sponsored the studies by Pincus. The first few chapters of This Man's Pill are fascinating and describe the development of the birth-control pill, the chemistry of the times and the politics of getting the use of birth-control pills started. Djerassi then goes on to describe the sociology of birth-control pills, including Japan's approach to contraception and additional chapters on the philosophy of sex and the birth-control pill as a liberating force in society.In the last half of the book, the tide begins to turn, and Djerassi begins, little by little, to introduce the reader to his involvement in artistic endeavors. He is a writer and has published several novels and plays, presumably facilitated by the financial freedom granted by his original Syntex involvement. His books and plays have all related to the topic of research and how science and medicine interact with society, and he apparently has been reasonably successful in this regard. He has extended his interest in the arts to starting an art colony, supporting music and other philanthropic efforts. This emphasis is particularly interesting as one person's, albeit unilateral, memoir of the heyday of steroid biochemistry and the role of contraception in society 50 years ago, and because of his forays into the literary world, Djerassi writes very well. That said, each successive chapter begins to feel like another bitter pill to swallow, as Djerassi's impressive opinion of himself becomes more and more obvious.If you want to know the roles played by Gregory Pincus or John Rock, other volumes are likely to be more important and more balanced. But for those with their heads buried too long in technical volumes, this could provide a refreshing change of pace.