Guest: Baulieu, Etienne-Emile
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THE OPEN MIND
Host: Richard D. Heffner
Guest: Dr. Etienne-Emile Baulieu
Title: “Science and Abortion: RU486”
I’m Richard Heffner, your host on THE OPEN MIND…and earlier today I watched and applauded as the coveted Albert Lasker Clinical Medical Research Award for 1989, presented by the Albert & Mary Lasker Foundation, was given to my guest Dr. Etienne-Emile Baulieu, Professor of Biochemistry at the University of Paris School of Medicine, citing his “major contributions to aspects of our knowledge of steroid hormones, the natural messenger molecules that regulate many events of reproductive life, general metabolism, and response to stress”.
Science Magazine, however, set for the Lasker Award winner’s controversial significance perhaps more pointedly, writing: “For the past few years, he has been on a crusade. Ever since the drug he helped create, popularly known as RU486, was shown to be highly effective in putting an end to pregnancy without surgery, he has been arguing in every forum he can for its widespread medical use. In the process, he has drawn the wrath of opponents of abortion, heard his discovery condemned by the Cardinal of Paris, and even seen the company that manufactures the drug…temporarily abandon the first large-scale trials in France in the face of protests. It is an unusual position for a world-class medical researcher”, says Science, and our guest, an authority on steroid hormones, is certainly that.
“An unusual position”, to be sure. But I want to begin our program today by asking my guest just how uncomfortable it is, and does he regret being involved with the issue of abortion?
Baulieu: I wouldn’t say uncomfortable. I don’t think I regret anything because basically I think that when basic research which has been conducted with a group of people in my laboratory, research people, can ultimately lead to produce a drug which is useful to people, useful to women, I think it’s an achievement. So there is no regret, and in fact, to be attacked or to be criticized for having contributed to such a drug which, in fact, modifies the abortion issue…I don’t think it’s bad. I mean it’s not…I don’t find it uncomfortable. To a certain point I enjoy it…I tell you why: Because I think it’s an example where things are really difficult. I mean abortion is not something new under the sun. I mean, unfortunately, this exists since centuries and centuries, and this has created ultimately a major health problem, and this major health problem can be quantified…I mean two hundred thousand women die per year. You have hundreds of thousands of women who are wounded physically, as well as psychologically. It’s a nice story. It’s a difficult problem. Life is difficult…for women, especially. When you have a medical means…I’m a physician, you said…I’m really a physician…I feel I am a physician…even when I do research, which I love, for the beauty of discovery, for the beauty of knowing more about nature, but a physician has a duty, the mission to help when he can. So, when I can, I do it.
Heffner: You say a physician has a “mission to help”…
Baulieu: Yes. True.
Heffner: The Hippocratic Oath is “Do no harm”…
Heffner: There are those who maintain…
Heffner: …that abortion does harm, and I wonder how you’ve responded, to yourself, to that charge?
Baulieu: I responded already…I mean, I contemplate, unfortunately, the disaster of the abortion issues for the world. Those deaths, those wounded persons and so we help. When I was a student…medical school, intern or resident, I had the occasion to treat patients who, at that time, abortion was illegal in France, and so, abortion was stopped by some mechanical means, botched abortion maybe, and they went to the hospital…I think this is really a disaster, and we had other than this country, actually, a number of fatal cases, so legalization of abortion has been a step for one. Now “medicalization” in contrast to some sort of surgical approach, if you like, instrumental approach, I think is another step. Particularly I’m interested in this issue because it’s a powerful and safe drug, but scientists of my sort, they do their work in the laboratory, and their invention may help other types of situations. For instance, I’m working on brain…we discovered a new function of the brain and its other application in the field of aging of the brain, multiple sclerosis and so…when we can help, we try. It’s certainly a goal…it’s not the goal of our work, at least at the personal level. It means that we are confident anyway that what we are discovering in the laboratory will be used sooner or later, sometimes late after we’ve died, for the benefit of people. Basic research is very important.
Heffner: But in this instance, which came first? The discovery, or your intention, your own feeling of a need to provide for…what you call the “medicalization” of abortion?
Baulieu: No. I don’t know how to answer your question. I just can tell you the data I found myself. I was interested, not in abortion specifically, but in fertility control because when I was working at Columbia University, once I was invited by Gregory Pincus, he’s the man who was the…devised the first oral contraceptive, “The Pill”, and at that time I was not working at all in this field of reproductive medicine. I had discovered a hormone, adrenal hormone…different…and I was just invited to give a seminar, and Pincus told me about contraception, and since I had a little bit of expertise in the field of steroid hormones, and as you know The Pill is composed of chemicals which are steroid analogs, so this led him to propose to me to attend a WHO, World Health Organization, a sort of committee in charge of promoting fertility…anti-fertility matters, control of fertility matters all overt the world. And so I watched the scene for several years, not doing anything concrete, but giving advice or “this is better”, or whatever. Then I was, myself, working on what we consider and, in fact, which has been the frontier of hormone research that is discovering and studying receptors…that is sort of machine that the cells have to recognize incoming hormones, and doing that clearly we had a tool to test molecules which instead as hormones being active would be inactive and then take the place of hormones within the site, the wall…whatever you like to call it…of the receptor and then preclude the receptor to work…in other words, invent anti-hormones, or hormone antagonists. Now when you have this possibility, you just tell your friends, and there was consultant for a drug company and I said “It’s time to check molecules for anti-hormone activity in the progesterone field”, and you know that progesterone is a hormone of pregnancy, so that’s where we go. But there are other things that they have tested and which are still progressing, and so, between other things it was possible to devise an anti-progesterone, and for a variety of reasons, these worked rapidly well and is relatively easy to test in humans, because you need to give an anti-progesterone for stopping the development of a continuation of pregnancy only for a very short period of time.
Heffner: Safely, safely?
Baulieu: Absolutely safe, sure.
Heffner: You say “absolutely” safe.
Baulieu: Absolutely safe because there is no side effects, it’s a…for many reasons, I mean the drug is well-targeted to the receptor and, as you probably know, this progesterone hormone has a relatively limited number of targets in the body, so it goes where it should go. And the mechanism of action of these hormones, something we’ve studied since decades, I must say, teaches us that this sort of action is reversible, so you give it…it works, and then it is excreted and so you don’t have a permanent effect. It’s really safe. It’s as simple as that. And we can say that without having any problem of conscience, I mean it’s really safe. Anyway, so you give it and then…just once…and you interrupt pregnancy so you, you can accept the idea that to do the toxicological study that you have to do before giving a compound to a human being naturally, since you’re going to give that compound only once, for a very short period of time an it’s reversible, studies are less heavy than if you are going to propose a drug which you have to take for months then, as for The Pill, the ordinary Pill. You have to perform toxicological studies for years and years and years, and that’s why this anti-progesterone, which particularly has other applications than pregnancy interruption, has been rapidly proposed at the same time to help women and to see, just to see, if it was working in human beings. It was, at the same time, a trial…a medical trial, and a scientific trial, so it was safe. It was easy to do, and then, partly, it met a big problem which is the abortion issue, but we were not really looking for years and years for a new method of fertility control. But naturally, as far as things progressed…I mean you start to think, “Oh, it’s more important than I thought, and why don’t you do this?” and so on, so I don’t know how it started. I had an interest in this field of human reproduction and its control. I have always been on the side of women, generally speaking. I think there are a number of problems in society and in health problems that women have and that we try to help, of possible. In addition, I had the tool…of the thinking for helping, so all these things merged naturally…I mean…
Heffner: You make it sound so logical and so natural…
Baulieu: No, instinctive…more than rational…I mean it’s natural, just like…
Heffner: And yet the…
Baulieu: I live for that…I really live for my work, so it’s alright.
Heffner: And yet you live now, according to Science magazine, as the headline says, “In the eye of a storm” and I wondered about the seeming contradiction between the naturalness of it all.
Baulieu: But you know…
Heffner: …of it all.
Baulieu: …I thought the eye of a storm was a very calm site anyway, so…
Heffner: But the storm is raging all around you…seemingly…in this country, wouldn’t you say?
Baulieu: I tell you if the storm means that people are going to give another look at a problem which we have not invented, which is the abortion issue and which lasts for centuries and centuries and which poses very important questions, and which has to be treated decently, that is, given…giving to people choice and particularly science, the mission of science, in my opinion is not to dictate behavior or beliefs. The mission of science in society is to give to people choices, and everybody’s entitled to argue.
Heffner: No responsibility on the scientific…
Baulieu: Oh, yes.
Baulieu: Oh, yes.
Heffner: …for the use of the choices that will then be made?
Baulieu: Yes, because…two things…number one, we are human beings, after all, and we say, “We give you choices”, but we say, “this is better than the other”, and number two, when people are going to make a decision, we can speak out. We can fight against or approve. No, I think we have responsibility, and, as you know, scientists have already demonstrated that they know what sort of responsibility we have. Let me recall in the filed of biology and of molecular biology, that is a gene business, the fear at the beginning that we could spread cancer all over the world through microbes infected with genes and so on. So there was this famous conference at Asimilar, where there was a sort of self-control of the scientific community. I think that each of us, to a certain point, is running an Asimilar conference in his activity. We have to, I mean, science is part of the work conscience, and we stick to that, and we’ll stick to that.
Heffner: It’s so interesting that you say that each of us is conducting a sort of an Asimilar Conference…
Heffner: …of our own. But leaves the moral decisions to be made individually by individual scientists, doesn’t it. And doesn’t that present some problems?
Baulieu: Give you an example…let me give you an example, which I’ve just gone through, personally. When we had, thanks to the work of my co-worker in my research laboratory which is a public university lab, okay…and the help and the synthesis made by the drug company of RU486…when we had that I asked for toxicological studies are made, and the, what to do with the compound. As I said, voluntary pregnancy interruption which is legal in France, or in Switzerland, or in Sweden, in the United States was the perfect target for such a trial because you give the compound only once and even we had also precautions with animals…suppose there is a problem, I mean there is the possibility of mechanical abortion. Okay, so it was decided to interrupt pregnancy to women who were asking for that. Now in France at that time there was not ethic committee, there was no organization of that sort, whereas you know you have not only scientists and doctors, but lay people, people from various opinions, religious people and so on and so forth…for years…so for this reason, this specific reason, plus a few others including my friendship with him, I went to my colleague, Professor Herrmann who was the Chief of Obstetrics and Gynecology in Geneva, Switzerland, and his department, the department he was head of…he is at the University Hospital, and at the hospital, they had an ethics committee and the project was submitted to their judgment before doing anything, in spite of the fact that naturally, the people, I mean the women…the patients were volunteers for pregnancy interruption and naturally they were told, “we are trying a new product”. So I think there are rules that we can follow. I think it’s good that among us, I am proud to be one of those, there are scientists of different origins, some are chemists, some are veterinarians, like animals, some are medical people, I’m one of those, and that take care of human problems. Your science is such that…the essence of science…that sooner or later…and sooner rather than later, people will verify, will evaluate…we work anyway under the public eye and it’s very difficult because the public does not understand our language, technically. So, but we know that…we have to tell the truth. Not because we are superior morally to other people, just because we have to…I mean, it’s just good practice. If not, we fail…we fail, and failure…the real failure, which is the most important to us…is to fail…to be judged as a failure by your colleagues. So we have to…ultimately, to tell the truth, to be open. Science does not…I said that before…is not in a position to dictate behavior, but at least science gives a very good model of human attitude which is, in my opinion, of great quality. That is trying to be objective, open and realizing that we ask questions more than we give answers.
Heffner: And yet there is, today, at least in this country, not an enormous amount of questioning, but some considerable questioning about the potential of and the presence of fraud in science. How do you explain that if you say inherent in the scientific method…
Heffner: …is a basic honesty.
Baulieu: In fact you have to make sort of difference…real boundary between the very few cases of fraud which are, in fact, stupid, because it’s easy to detect, and we are going to kill…I mean professionally kill, the people who do that, and what is wrongly called fraud, which I would like to call more “mistakes”, and the root of that is wishful thinking. That is, scientists who are doing experiments in fact what they are projecting their imagination onto nature…I mean objectivity…and is one thing which is very difficult to define because it’s clear that we think of what we’d like to find…happily we do not find, usually, what we have predicted, but something else…we have to keep our eyes very open. But come back to the fraud…so we have that sort of wish to find something we’ve dreamed of, imagined, and some scientists they like to see among ten experimental results the two which coincide with their hypothesis and they neglect the eight other. So the two which are read are not necessarily wrong. They may be even the right answer to the question and the eight others may be artifacts, something went wrong. But nevertheless, one thing to do, for instance, is to tell ”I ran ten experiments. Now those two said, according to my report and so on”, so some scientist from time to time publish, as you know, what we call an abstract…I mean a very short publication announcing a result so they say “We had data. It produced this, and we found…” and they just tell you what was found in two experiments and what I say is there are ways to be protected against that sort of…it’s not fraud, it’s just…
Heffner: Wishful thinking, you said before.
Baulieu: Wishful thinking…and then mistakes. They have said…what they say was real, but insufficiently controlled and the quality of most great scientists is that they have been able to ask as many questions against their own conclusions as possible. I used to say to my students, “we sometimes like to publish…” not that we have “publish or perish” as you have in this country. We have a permanent position, most of us, and so we can go slowly. But in any case, people for…enthusiastic…approval…they are enthusiastic about what they have or like glory of some sort or why not…they like to publish soon and they are afraid because of competition somebody else will say it before them, and so on and so forth. So they want to publish and I used to tell them, “You should do this experiment and this experiment in order to try to contradict what you believe we should write”. Better we pose that question ourselves that if it is posed by the future reader of your work, and I think that…we know that, I mean just because the scientific war goes that way. You know our ambition is build a wall collectively and each of us may put a brick or another brick, but if…these bricks should be solid…and if it is not, you’re not a scientist.
Heffner: Dr. Baulieu, we have half a minute left…I need to ask you whether you feel that the quality of science, in terms of what you’ve just said, is different in your country than in mine.
Baulieu: No, no, no. The quality of science is very good in the United States. I think you have a sort of superiority upon ourselves…that is the public is more scientifically oriented in spite of probably what you think, than ours. Latin countries are more on the side of literature and art than that of science. I think here you recognize that science is really a most important activity of the man in the modern time.
Heffner: And the science of time-keeping is such that I’m getting the sign that we have to cut and end our conversation, but thank you so much for joining me today.
Baulieu: Okay. Thank you to you.
Heffner: And thanks, too, to you in the audience. I hope you’ll join us again next time. And if you care to share your thoughts about today’s program, please write to THE OPEN MIND, P.O. Box 7977, FDR Station, New York, NY 10150. For transcripts send $2.00 in check or money order. Meanwhile, as an old friend used to say, “Good night and good luck”.
Continuing production of this series has generously been made possible by grants from: The Rosalind P. Walter Foundation; The M. Weiner Foundation of New Jersey; The Mediators and Richard and Gloria Manney; The Edythe and Dean Dowling Foundation; The Lawrence A. Wien Foundation; The New York Times Company Foundation; and, from the corporate community, Mutual of America.