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People & Events: The Pill in America

There is only one drug in the world so well known that it's called "the Pill." In 1968 a popular writer ranked the Pill's importance with the discovery of fire and the development of tool-making. Twenty-five years later, the leading British weekly, The Economist, listed the Pill as one of the seven wonders of the modern world. For more than forty years, more people have taken it than any other prescribed medicine in the world.

In Demand from the Start
The birth control pill was the first medication ever designed for purely social, rather than therapeutic purposes. At first the pharmaceutical company G.D. Searle and Company was dubious that healthy women would take a drug on a daily basis just to prevent pregnancy. In 1957 the company took a tentative step into the market. They applied for U.S. government approval of the drug, Enovid, as a treatment for gynecological disorders. Searle was shocked when less than two years later, more than 500,000 women were taking their pill. Clearly, women were using it for contraceptive purposes. It was an eye opener for Searle, and they moved quickly to get further approval for Enovid to be used as a contraceptive.

Millions of Prescriptions
When Enovid officially came on the market in 1960 as a contraceptive, the response was astonishing. In less than two years, 1.2 million women were on the Pill. By 1965 over 5 million women were using it. Despite the fact that the original Pill contained very high doses of estrogen and progesterone, causing an array of side effects, women preferred it to other methods like the diaphragm, condoms, and douches. Douches were not very effective. Condoms required the cooperation of a partner and reduced pleasure. Diaphragms were awkward, required a lot of care and took the spontaneity out of sex. Many women were willing to put up with nausea, bloating, weight gain and other side effects in exchange for an easy and practically foolproof birth control method that separated contraception from the act of sex.

Lower Doses
The original Enovid pill contained 10 milligrams of progesterone and .15 milligrams of estrogen. The progesterone inhibited ovulation and the estrogen was used to ameliorate problems like breakthrough bleeding. The scientists working on the Pill settled on the 10-milligram dose because they knew it was certain to prevent ovulation. Researchers would later learn that lower doses would suffice. After the original drug went on the market, Searle applied for FDA approval of a version of Enovid that contained only .1 milligram of estrogen and either 5 milligrams or 2.5 milligrams of progesterone. The lower dose Pills caused far fewer discomforting side effects and were cheaper to manufacture, making the Pill even more profitable for the pharmaceutical company.

Popular, but Risky?
Searle's monopoly on the Pill lasted only two years. By the late 1960s, seven manufacturers were producing oral contraceptives, and in 1968 annual Pill sales hit $150 million. Worldwide, more than 12 million women took the Pill. But at the height of the drug's popularity, Senate hearings focused the nation's attention on potentially deadly health risks posed by the high dosage Pill. As a result of the hearings, pharmaceutical companies lowered the dosages even further and doctors advised women who were obese, smoked, had high blood pressure or a family history of blood clots against taking the Pill.

A Low-Dose Pill
In the 1980s, the high dosage 10-milligram pill was removed from the market and biphasic and triphasic oral contraceptives were introduced. These low-dose pills varied the amount of progesterone and estrogen content in the pill during a 21-day cycle so that the user did not take more progesterone or estrogen than absolutely necessary. Today, women can get a prescription for a Pill containing 1 milligram of progesterone, one tenth of the original dose, and containing as little as 20 micrograms of estrogen.

Still Popular
Over the past two decades, the dangers of sexually transmitted diseases and AIDS have led to an increased reliance on barrier methods of contraception, but in America the Pill still remains the most popular form of reversible birth control. Today the debate is not over the safety of the Pill, but over the question of whether it should remain a prescription drug or become available over the counter.





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