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The pill — a modern philosopher’s stone

Malcolm Potts, professor of population and family planning | May 12, 2010

Medieval alchemists, and more recently Harry Potter, spent time seeking the Philosopher’s Stone. It was thought to be the elixir of life, bestowing long life and perhaps even immortality. Fifty years ago this month, a genuine philosopher’s stone was discovered — only it was a small, white, circular tablet called Enovid, the first oral contraceptive.

I knew the biologists who developed “the pill” and the doctors who tested it. In the 1960s, as a young obstetrician in Britain, I began prescribing oral contraceptives. I saw how they gave women a freedom they’d never known. For the first time in history, women could choose if and when to have a child with relative ease. No uncertain rhythm method, no embarrassing interruption of lovemaking to put on a condom. Just a highly effective, easy-to-use method.

Yet from the get-go the pill was intensely controversial. Would women become sexual hedonists? Would the pope approve its use? Was the pill so dangerous it should be taken off the market? The early oral contraceptives had much higher doses of hormones than are used today, and there were deaths from blood clotting. The dangers hit the headlines.

Ultimately, the real test of whether any drug is safe to use for long intervals is to follow users for long intervals. I remember the decision made in Britain in 1968 to study 23,000 women using the pill and to compare them with 23,000 women not using the pill.

In March, the British Medical Journal published a stunning 39-year follow-up of these same women, with a mind-boggling cumulative total of 1.2 million women-years of observation. At last we have the information we needed for so many decades. We can say with unprecedented confidence that the pill is indeed a philosopher’s stone, extending life by a measurable amount.

The pill is the only drug a doctor can prescribe that is known to prevent cancer. The reasons go back a long way in human prehistory. In the 1920s, explorers in the highlands of New Guinea found 1 million people literally living in the Stone Age — the people we must look to for understanding the patterns of success in evolution. Studies show that these women did not have their first menstruation until they were 18 to 20 years old. They spaced their children several years apart by long intervals of breastfeeding. Most women had 50 or fewer episodes of ovulation and menstrual periods in their lifetime. In the modern world, the age of puberty has plummeted and few women breastfeed for a long time. Today’s woman may ovulate 300 times, which we now know can increase the risk of certain cancers. In short, modern living places some unnatural stresses on evolved patterns of female reproduction.

The pill suppresses ovulation, and in doing so, it halves the risk of developing uterine or ovarian cancer. Women who have used the pill are less likely to develop colon cancer and have fewer melanomas. The protective effects of having taken birth-control pills persist for many years after swallowing the last tablet. Over the long term, even heart disease deaths are fewer.

This does not mean that the pill is safe for everyone, and certainly women who smoke and are over age 35 should not use the method.

The pill and other methods of contraception also have important non-contraceptive benefits. Babies born too close together have an increased infant mortality rate. If all pregnancies in the world were spaced three years apart by using modern contraceptives, there would be 2 million fewer infant deaths each year. About half of the spectacular decline in maternal deaths in the West over the last century is because women are having fewer children.

So why does the pill continue to have a bad image? Contraception on the whole challenges strong patriarchal traditions. It took Japan 40 years to register the pill but only six months to approve Viagra. John Rock, the obstetrician who conducted the first trials of the pill in Boston, was a devout Catholic who went to Mass every day. He argued that the pill was natural because it imitated pregnancy and breastfeeding, and most people expected the Vatican to bless the new method as licit for Catholics. Instead, in 1968, Pope Paul VI issued the encyclical Humanae Vitae condemning the pill. Rock and millions of Catholics stopped going to Mass, but popes up to and including Pope Benedict XVI have continued to tell Catholic women not to use birth-control pills.

Finally, the pill is misunderstood because it has remained a prescription drug. There is no reason why women need pelvic examinations before being prescribed an oral contraception. Scientifically, there is no reason not to sell it over the counter. It is safer than aspirin. Off-patent oral contraceptive pills, which are the ones we know the most about and which I would give my loved ones, cost less than 20 cents a pack to manufacture. The pill remains on prescription for reasons of pharmaceutical companies’ profit rather than for the welfare of women. Not until the pill is on sale next to Extra Strength Tylenol will women believe how safe it really is.

There are, of course, in the era of HIV, many reasons to use condoms. But the pill can save the lives of infants and prevent maternal deaths. It reduces the burden of abortion. It is prerequisite for the autonomy of women, and it enables couples to express their love in physical ways without the fear of unintended pregnancy. The pill is truly a philosopher’s stone. In a very real way, the pill is less unnatural in the modern world than doing nothing.

This article was also published in the Los Angeles Times.

Comments to “The pill — a modern philosopher’s stone

  1. If the pill where to appear in supermarkets it would be fantastic. I was brought up a Catholic and in the 60’s the church used intimidation and fear to stop girls like me using it. Thank god we have moved on a bit from those days.

  2. Professor Potts:

    I’m afraid I don’t share your enthusiasm for the contraceptive pill for the following reasons:

    You say the pill is the only drug a doctor can prescribe that is known to prevent cancer. In 2005 the International Agency for Research on Cancer (a technical arm of the World Health Organization) declared the combined oral contraceptive (the most commonly used form of the Pill) a carcinogen due to its documented negative effects on the risks of breast, cervical, and liver cancers. It is classified as a Class A1 carcinogen in the same category as asbestos and cigarettes. Overall, women on the Pill are at about a 24 percent increased risk of breast cancer. For women who use the Pill for four years or longer prior to their first full-term pregnancy, the risk is 52 percent higher than women not on the Pill. Is anyone telling young women this when they fill their prescriptions?

    A recent study from Fred Hutchinson Cancer Center concluded that women younger than 45 who are using oral contraceptives are at a 2.5-fold higher risk for triple negative breast cancer (this type represents about 10 percent of all breast cancer cases and generally has a bad prognosis for long term outcome). The study also found those who started taking oral contraceptives before age 18 were at a 1.9-fold increased risk for any type of breast cancer. Would mothers allow their teen daughters to use the Pill to treat acne if they knew this?

    A 2009 study from the Mayo Clinic examined the risk of smoking on breast cancer. Expectedly, the survey found smoking increased breast cancer risk by 25 percent. The same study observed, however, that women who had been using oral contraceptives for 11 years or more, more than doubled their risk of breast cancer.

    You say it reduces the rate of abortion – well here’s a quote from yourself Professor Potts in your capacity as Medical Director of International Planned Parenthood 1970: “Abortion and contraception are inextricably intertwined in their use. As the idea of family planning spreads through a community there appears to be a rise in the incidence of induced abortion at the point where the community begins to initiate the use of contraceptives”.

    It seems strange, that since the advent of the pill, which is freely available, we have still racked up 53 million abortions. Perhaps you could explain to me how that works?

    I would also like your readers to consider the possible ramifications of administering the birth control pill to minors, a large percentage of whom statistics have shown to be victims of sexual abuse by older men.

    • i couldn’t really follow
      the stern tone of your
      critique, but, what i’m attempting
      to resolve is , is that American
      teenagers don’t date each other?
      or consenting adults need supervision
      from An Authority?
      or that preventing pre-marital sex
      is a simple matter of proximity
      and its needed restraints of passion?

  3. I’ve always wondered what the effect of the pill is on woman’s bodies and it’s great to read Claudine’s comment above and find that she’s in great health after all these years. Thanks for the info!

  4. I’ve always wondered what the effect of the pill is on woman’s bodies and it’s great to read Claudine’s comment above and find that she’s in great health after all these years. Thanks for the info!

    African Mango

  5. A very interesting article. The pill is a wonder, however, I wonder what the major impacts have been on women contracting disease because of unprotected sex.

  6. The Pill certainly has changed life for women letting them stay in control of when and how many children they have.

    I guess one downfall if you could call it that is that women are leaving it later and later to have children which can cause problems for some as their fertility decreases with age. But there are ways around this.

  7. Given that many of the best scientists in the world believe we will drive ourselves & up to 95% of the other species on the planet extinct, it’s a crime to prevent women having access to the pill. Who is speaking for the billions of homo sapiens who will never exist if we continue to go past the 9 boundaries that will make life impossible for all but single-celled creatures to live on our planet?
    See: Johan Rockström. 2009. Planetary Boundaries: Exploring the Safe Operating Space for Humanity. Ecology and Society 14(2): 32

  8. Dear Dr. Potts: In catholic Italy, most women, fortunately, do not care much about the Pope’s opinion on the pill. At present however the Pope is working very hard to stop the authorization for the use of RU486. Medical doctors are also a major barrier to the adoption of the pill, especially among the less educated and immigrant women. I wish your story was published in an Italian newspaper… Best regards.

  9. I can’t wait for the fuss and carry one from everyone from the president to the pope when the Pill is on the supermarket shelf next to tylenol. While I agree, I don’t think it will ever happen , too many wowsers out there in too many positions of power and authority

  10. Dear Dr. Potts, thank you for clarifying the miss-information that goes around the globe. We need people like you to educate the people who are often bewildered by the gossip that goes as science. I am an 80 year-old woman who used the pill for about 40 years, one of the first ones to use it while it was quite strong. I have 3 children (the number I wanted). I am in excellent health, so a living example of the safety of the pill for ordinary people.
    PS. I am also a PhD in epidemiology and believe in good controlled studies….

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