As scientists inch ever closer toward sequencing the human genome, all eyes are focused on the possibilities -- both monetary and medical -- that lie just over the horizon.
There are reports of gene therapies that will cause cancer tumors to self-destruct and treatments that reverse the aging process. There is the promise of a cure for infertility. There is even talk of quieting the criminal mind.
But for all the money and media flowing to biotech, some scientists complain that one research area gets short shrift from private industry -- an area that directly affects half the world's population.
"There has been a pitiful lack of investment in birth control," said Howard Hughes Medical Institute researcher Dr. David Page, who studies male infertility at the Whitehead Institute for Biomedical Research at MIT.
Major pharmaceutical companies are far more focused on lucrative projects, such as finding a cancer cure or an AIDS vaccine.
"Anything related to contraception is treacherous territory for pharmaceutical companies," Page said. "People see reproduction as being more value-laden of an issue than treatment of cancer."
Pregnancy is not a life-threatening disease, thus it doesn't have the same sense of urgency that ailments like AIDS or Parkinson's have, said Kristin Elliot, a spokeswoman for contraceptive maker Pharmacia-Upjohn.
An ailment doesn't necessarily need to be fatal to attract the interest of the public or the pharmaceutical big guns. But they need to be profitable. Consider Viagra, the blockbuster male impotence drug, which rakes in an astounding $10 per pill.
"Pharmaceutical companies are supposed to make money and that’s okay," said Polly Harrison, director of the Alliance for Microbicide Development, a nonprofit contraceptive research organization. "But women are not making it clear to industry that they'd like an addition to what they have at hand for contraception."
Women already have a number of contraceptive choices, including birth control pills, quarterly injections, the IUD, and the diaphragm. But birth control advocates argue they are outdated methods that don't fully address women's needs. Those needs go far beyond simple birth control.
"Women have indicated that they'd like a morning-after pill, a monthly pill so they don’t have to take a pill every day, protection against sexually transmitted infection, and they'd like men to carry part of the work of contraception," Harrison said. "We think the science is there. We're missing the money."
The pharmaceutical industry recently announced that it will spend $26.4 billion in 2000 for all drug research and development.
Government organizations such as the National Institutes of Health devote some resources to contraceptive development, but it's not nearly enough to develop what's most needed -- a dual action microbicide – or a combination spermicide and sexually transmitted disease killer.
"It’s a real problem," said Dr. Henry Gabelnick, director of the non-profit Contraceptive Research and Development Program (CONRAD). "The public sector is the only group actively involved in developing dual action microbicides. The big pharmaceuticals should be doing this but they're not interested."
The liability alone is enough to scare off many of the major pharmaceutical firms. Notorious disasters past, like the Dalkon Shield IUD and Norplant, have resulted in the payment of untold millions in damages to women who used the products and suffered injury.
"Pharmaceutical companies just don’t want to be bothered," Gabelnick said. "They don't want to invest very much in the research because they've gotten burnt with lawsuits."
And there's the profit problem. Products often take 10 to 15 years of research and testing before they can go to market -- and that's if they get approval from the Food and Drug Administration. Birth control, by design, is no Viagra.
"You can't sell a pill for $10 bucks a pill if you're going to take it every day," Gabelnick said. "Birth control devices aren't very profitable compared to what it used to be -- $100 million used to be a blockbuster and now it’s got to be a billion dollar product to be a success."
But for all the cries of neglect from birth control advocates, pharmaceutical industry reps say there is more than enough investment in the area.
"Currently there are ten [products] in development for contraception, and some of them are very far along in the pipeline," said Jackie Cottrell, spokeswoman for the Pharmaceutical Research and Manufacturers of America, the trade organization that represents the major pharmaceutical research companies.
"For contraception, that shows that this is an issue that the industry is very actively working on. Several [drugs] are awaiting approval from the FDA," Cottrell said. "That tells me that there's a lot of time and resources and energy going into this area."
Despite recent decreases in abortions and teen pregnancies, "the bad news is that we still have a level of unplanned pregnancies in this country much higher than many undeveloped countries," said Susan Tew, communications director for the Alan Guttemacher Institute. The birth control think tank estimates more than 3 million unintended pregnancies occur in the United States annually.
One reason for the high rate, according to Tew, "is the lack of contraceptive choices."
Abortion opponents beg to differ. The high rate of unwanted pregnancies, said Heather Farish, a spokeswoman for the Family Research Council is due to the fact that so many are "happening outside of marriage. It's rare that you have a married couple getting an abortion. The bigger problem is extramarital or premarital sex."
Farish said there doesn’t seem to be a great need for more birth control, but rather a better education in moral judgement. "If we're talking about unwanted pregnancies, we should address the problem, rather than putting a Band-Aid over it. We should encourage parents to talk to their kids about sex rather than learn about it in schools."
Talking about sex won't solve the problem of protection from STDs, Harrison said.
"From a public health standpoint, we have to give people more protection from these diseases," she said. "We need contraceptives that will protect women and couples from [pregnancy] and infection."
