“Pregnant” would not be the word to describe the present state of contraceptive research and development in this country. We’re way behind in devising new birth-control methods and in marketing those already available in other parts of the world, according to a report released last Valentine’s Day by the National Academy of Sciences (NAS).
In Finland, Sweden, and ten other countries, couples regularly use contraceptive implants such as the highly effective Norplant, a long-acting (three to five years) hormone-secreting device that’s implanted under the skin of a woman’s upper arm. Depo-Provera, which is injected every three months, was developed in the U.S. but never passed FDA muster; it is used today in 90 countries. Multiload IUDs, which secrete hormones, are used by a large minority of European IUD users; the manufacturer has declined to introduce it in the U.S. because of the high cost of liability insurance. In the Netherlands women can be sterilized with Ovablock silicone plugs, which increase the chance of reversibility if the user wants that. In England and Canada women can have their fallopian tubes closed with Filshie clips made of rubber-lined titanium, which are less damaging to the tubes and make reversal more likely.
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But Perkin also understands that the United States is unique in its proclivity for public debate. “Collectively, China has the largest choice of contraceptive methods available in any country. But there’s not much public outcry, about either what they do have or what they don’t.”
Abortion is linked to contraception in other ways, according to the report. Studies in other countries have shown that, “If abortion is safe, legal, and readily available, a woman might choose a safer but less effective contraceptive method. Conversely, if abortion is not readily available, a woman might select a more efficacious but also riskier contraceptive. One recent study indicates that as many as half of all unwanted pregnancies resulting in abortion were the result of contraceptive failure.”
If the FDA were to go to a specific-indication method of approval (which is already used for other types of drugs, such as beta blockers), the NAS report claims there would be a “healthier match of method to user.” The report also notes that while the FDA has been criticized for not being stringent enough in its safety requirements, many nonscientists don’t understand the meaning of “safety” in the context of FDA approval. It is “scientifically incorrect,” according to the report, to assume that “the safety of a drug can be conclusively determined before it is approved. The clinical testing of a drug in a few thousand human subjects ordinarily can identify the drug’s relatively common side effects, but it cannot identify the relatively uncommon effects.”
The Copper-T IUD, one of only two types now available in this country, further illustrates the dilemma of the drug companies. “The Copper-T represents a very advanced and improved form of contraception. But it was approved by the FDA, and not a single company chose to market it for almost three years. It’s now marketed by a small company in New Jersey [GynoPharma Inc.] that markets only contraceptive devices. If it were any other drug, an antidepressant, or something for hypertension or gastric conditions, they would have been tripping over each other to get to it.”
