I am continuing my weekly blog built around the large undergraduate class I co-teach on Poverty and Population. The philosophy of the class has been well summarized by the economist Partha Dasgupta in a recent Science article. He pointed out that, “Family planning is not subject to the play of free markets; it is biased by restrictive laws, widespread misinformation, and rules not based on evidence.”
The history of oral contraceptive illustrates such biases in a compelling way. In the 1960s I had helped found a clinic for the unmarried in Cambridge, England when offering contraception to couples having premarital intercourse was still highly controversial.
Many women wanted the Pill but were afraid to use it. Early formulations of oral contraceptives had a much higher dose of hormones than today’s products and they did cause a slight, but still tragic increase in the risk of death from cardiovascular disease. The deaths that occurred hit the headlines. A US congressional committee wanted to take the Pill off the market.
Nearly all preventive measures have a downside and one of the conundrums of public health is how to express such risks in readily understood terms. I did a quick calculation and began telling women wanting oral contraceptives that the risk of death was approximately the same as that of smoking one third of a cigarette each day. The women would visibly relax. Today’s much lower-dose Pills have almost eliminated cardiovascular risks, but the aura of yesterday’s adverse publicity and misinformation persists.
In the 1960s the British Medical Research Council had the good sense to begin a trial of 27,000 women using the Pill and 27,000 matched controls. Thirty nine years later a follow-up, involving 1.2 million women years of observation, demonstrated that women who took the Pill (usually, of course, for only a few years) enjoyed life-long, non-contraceptive health benefits. Oral contraceptive use significantly reduces the risk of ovarian and uterine cancer, and also of bowel cancer and melanoma. There is no other drug that I can prescribe as a doctor which offers a significant and proven reduction in the risk of dying from certain cancers.
But why is such a safe drug on prescription in the first place?
A remark that I made on a television show in the 1960s – a sort of Jon Stewart show of the time – that Pills should be in vending machines and cigarettes on prescription went viral. Today the scientific evidence that oral contraceptive should be sold over-the-counter (o-t-c) is impeccable and it has been endorsed by the American College of Obstetricians and Gynecologists.
Big pharma makes more money from prescription drugs than o-t-c and refuses to make the switch. Anyone who has got to the end of this blog and knows an entrepreneur willing to challenge big pharma please contact me. The first in the o-t-c market for oral contraceptives could make a substantial profit.