What contraceptive revolution? [letter]

I am probably committing an unforgivable sin by criticizing a well-meaning Perspectives article "The Next Contraceptive Revolution" (18:19 1986) by Linda E. Atkinson and her colleagues. Its purpose a call for increased funding of contraceptive research and development is one I support strongly but I question some of the arguments presented. Unless I am grossly mistaken about the nature of your intended readership the policymaking public rather than the sophisticated specialists who know that "new" is not new that "safe" is not safe and that "1-3 years" is not 1987-1990 a great disservice is being made by the authors promising the public what we cannot possibly deliver. We cannot deliver any kind of "contraceptive revolution" even if the requested $23 million were made available annually. The authors make this typical but still inappropriate American mistake of offering quantitative panaceas: 10 ways of being a more effective after-dinner speaker" or "13 ways of not paying taxes" is not much different form "10 new [contraceptive[ products should be ready for registration in the next 1-3 years." Does anyone really believe that the public will consider a reformulated spermicide a vaginal spermicidal tablet another copper IUD even a cervical cap really "new" or a "contraceptive revolution"? Are any of these "new" methods likely to make even a minute dent in the US teenage pregnancy rate let alone in worldwide population figures? Is it honest to suggest that within 5 years a microencapsulated testosterone preparation will be ready for registration by the Food and Drug Administration as a male contraceptive? Does anybody in the male contraceptive field give such a prospect a ghost of a chance even with 10 times the amount of money requested for its development? Is it honest to request more money for male contraceptives because "among the methods under preclinical investigation to stop sperm production [is[ gossypol..." when gossypol has already been tested clincally in several thousand men in China for over a decade? The reason why gossypol is still in a preclinical phase in the US has nothing to do with money but rather with policy. Furthermore while gossypol is an intriguing lead hardly any expert in the field believes that gossypol itself will ever become a practical male contraceptive. I could go on and on with such criticism but the mainpoint I wish to make is that the overwhelming problems hindering the next contraceptive revolution are of a public policy rather than a financial nature. I predicted many of these problems more than 15 years ago and I am more than sorry that many of my predictions were so close to the mark. In the 2nd part of their article Atkinson and her coauthors address themselves to several of these policy issues and much of that material is of a higher caliber than what is contained in the 1st portion. However even some of these conclusions especially as they pertain to industry are simplistic probably because of the authors unfamiliarity with the pharmaceutical industry. Thus to everyones surprise (including my own) the current lack of patent protection in the OC field has had no important effect: No significant newcomers have entered the field no generic versions have been introduced in the US and prices have risen steeply rather than declined. The chief reasons has been the bizarre increase qualitatively and quantitatively in our litigious practices. Alleviation of this problem is likely to have a much bigger impact on the "future contraceptive revolution" than adding $23 million annually to the budgets of the public-sector agencies working on new contraceptives even though I strongly support this latter recommendation. One can make a very good case for the need for such additional funds without promising the impossible or listing piddling variations of existing methods as "new products." Of almost 3 dozen methods listed in Table 1 only 1 with a sporting chance for success in this century can be described as really new: the antiprogestin once-a-month pill which could have a real impact on US teenage pregnancies and 3rd world programs. Although I agree with much of what is said about public-sector programs much of the science and most of the initial funding for such a fundamentally "new" contraceptive came from industry just as they did with OCs. (full text)