Pills, polygamy and Nobel lust

September 28, 2001

Miriam Stoppard takes a peek at the life of a scientific warrior.

In the early 1960s, the public's expectations of new medicines were unreasonably high. Efficacy was taken for granted and so was the absence of side-effects. Such a zero-risk mentality is always dangerous, but it is especially unforgiving in relation to preventive medicines, for example vaccines or the oral contraceptive pill. The Pill was the most powerful preventive medicine ever made, designed as it is to prevent what we all think of as a normal event with, as many wrongly suppose, zero risk.

Doctors, of course, are more resistant than most to the presumption of zero risk, not only because their priority is nipping diseases in the bud but also because they trade benefits and risks with every prescription. So, as a junior doctor, I readily embraced the idea of manipulating my fertility with synthetic hormones, not as yet formulated into a single pill. At that time, the British Medical Journal and The Lancet were publishing research almost weekly on the effectiveness of oestrogen and progestogen (synthetic progesterone) in preventing pregnancy. Armed with these papers I cooked up my own contraceptive recipe of one oestrogen tablet and one progestogen tablet taken 21 days out of 28.

Why would I anticipate the pill in this Heath Robinson way? It is difficult to convey the fear of pregnancy women felt then; fearless sex was beyond the imagination. And I was a newly qualified doctor with a burgeoning career that I did not want interrupted. Best of all, the power to separate sex from conception was intoxicating.

It was not surprising therefore that when my two pills were rolled into one, I was one of its first and most enthusiastic subscribers. The market was flooding with rival contraceptive pills. To weigh up my options I sent off for the manufacturers' literature, assessed each, chose the best one and stayed happily on the same oral contraceptive for several years. I was still on it when I left the National Health Service in a fit of pique after an inferior man got the job I was up for and I found myself doing clinical research for the pharmaceutical company whose pill I was taking, which was run by the author of this book.

Carl Djerassi's face is on the cover with "his" Pill held in close-up to his eye. Despite Djerassi's disclaimers - the Pill had many progenitors - the effect is proprietorial. But it is not until the end of the book that you feel the force of the possessive pronoun. This Man's Pill is a backward look that takes in not only the chemical sleuthing that led to the pill's invention but also its ripple effect on society and the way in which Djerassi's involvement with it has become a lifelong theme, leading him far from his chemist's bench to become a novelist and playwright.

His formative years as a research chemist, with their emphasis on painstaking reporting, have resulted in this sometimes astonishingly open account of his life and the demons that drive him. This is Djerassi's book of his life: the life of, as he describes it, a professional polygamist who unabashedly invites us to eavesdrop on his "autopsychoanalytical" musings.

Djerassi is best when he is on his own territory. The story of his part in making the active ingredient of the Pill, synthetic progesterone (natural progesterone is not active when taken by mouth), is as glamorous and page-turning an account as you will read in popular science. And Djerassi's slotting together of disparate bits of information to make the puzzle fit was truly inventive.

The central piece of the jigsaw is the steroid nucleus, common to the sex hormones in men and women, and to the steroids we use for arthritis, asthma and skin conditions because of their ability to stop the body damaging itself through inflammation. Djerassi knew that almost any alteration to this steroid skeleton, with its four fused rings of carbon and hydrogen atoms, would drastically change the effect it has in the body, be this male or female. In steroid terms, the only difference between men and women is one atom. Oestrogen, the conveyor of all things feminine, is actually testosterone - the conveyor of all things masculine - minus one carbon atom, number 19.

Djerassi was all too well aware that messing around inside this nucleus was dynamite but mess around he did, with literally world-changing effect. In 1951, he and his boss, George Rosenkranz, prepared pure 19-norprogesterone, similar to oestrogen but with the carbon atom 19 replaced by a hydrogen atom. The novel steroid was four to eight times more potent than natural progesterone. The drawback was that it did not work by mouth.

Undeterred, Rosenkranz and Djerassi drew on testosterone research showing that the addition of a pair of carbon atoms, this time at position 17 in the steroid nucleus, made it absorbable. So they did the same thing to their 19-norprogesterone. Bingo! The first oral contraceptive had been synthesised.

What follows gives us a peek into the turbulent emotional baggage of scientists (including Djerassi himself) who are single-mindedly preoccupied with priority: who did what first, who should or should not have the credit - the unseemly internecine squabbling that scientists are heir to.

The noises off get quite loud at times. Heaven knows what scores are being settled in this book. One senses pitched battles being fought just out of frame by warring factions of pharmaceutical chemists, patent officials and corporate lawyers, not to mention potential Nobel laureates, bickering over who owns what.

Much of the book dwells on scientific ownership: ownership of ideas, ownership of invention, ownership of patents, processes, publications. And also proof of ownership. The arcane rituals of scientific research go only part of the way to explaining Djerassi's relentless jousting with journals, jockeying with competitors, questing for academic tenure, and his sensitivity to authors' pecking order - even his Nobel lust (there are five puffs from Nobel prizewinners on the dust jacket).

Djerassi is quite open about his competitive drive, his preoccupation with not only being first, but with being seen and acknowledged as first. In science, he contends, second may as well be last. His desire for acceptance, his urge for publication under his own name, his need for the nourishment of peer approval is clear on almost every page. As he explains, scientists never write under a nom de plume : their egos, their hunger for recognition, will not allow it.

And it was this particular scientist's obsession with being widely known and accepted that led him to try to narrow the gap between the two cultures, arts and science. As a scientific tribesman and warrior of more than 40 years, it is important to Djerassi that people do not see scientists as "anoraks". He has a touching fervour to illuminate scientific culture for a broader public that cares little about it. Can he not infiltrate fiction with science to correct this illiteracy?

The popularisation of science by whatever means is not to be disdained, the less well briefed having the same right to the same information as the well briefed, and it was this worthy pursuit that helicoptered Djerassi into his career as a writer, most recently as a playwright.

He is a proselytiser at heart. With an evangelist's zeal he asks if what he calls "science-in-theatre" can have a pedagogic function. He expects the answer yes. Or perhaps drama and pedagogy are antithetical? Here he expects the answer no. But unfortunately there is a case for saying no to the first question and yes to the second one.

He quotes liberally from his own novels and plays as conduits to inform a non-scientific public about the science he loves, arguing that science and art can happily mix. But the real question is whether mixing is enough? Science-in-theatre may well exist but does it automatically make for great theatre?

When Tom Stoppard wrote Hapgood - an example of the science-in-theatre Djerassi cites - I do not think he set out to teach us about quantum mechanics. It was just that the untrackability of an electron was a sweet metaphor for a pair of foreign spies who happen to be twins. To MI5 it looked as though one spy was in two different places at the same time. Now you see me, now you don't. It is scientific ideas, not scientific facts, that make theatre succeed.

Alas, just because Stoppard or Michael Frayn (with Copenhagen ) can make theatre out of science, it does not mean a chemist can. Djerassi is a paradox. Why should a man whose discovery liberated women, changed social mores for ever and offered us the best hope yet of saving our overpopulated planet, still feel the need to draw our attention to his inclusion in The Sunday Times 's Top Thirty Persons of the Millennium, his National Medal of Science from President Nixon in 1972, and over and over again to the glowing reviews for his novels?

The Pill is enough.

Miriam Stoppard, MD, FRCP, is a doctor and writer.

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