Étienne-Émile Baulieu’s development of RU-486, a progesterone antagonist used to induce early abortion in humans, gave rise to both success and controversy.
Étienne-Émile Baulieu literally rescued the steroid (derivative of cholesterol) compound mifepristone from certain oblivion at the drug company Roussel Uclaf,
In 1980, in the chemistry laboratory of Georges Teutsch at Roussel Uclaf, Alain Bélanger synthesized several steroids that bound to steroid receptors. These researchers’ main interest was in studying alterations in the steroids that affect binding capacity. Teutsch and Daniel Philibert had established a research project looking for glucocorticoid
French professor Étienne-Émile Baulieu holds the RU-486 abortion drug that he invented.
Baulieu convinced the company to examine the product’s action in fertility control tests, largely because RU-486 bound tightly enough to the receptor to outcompete successfully the natural steroid progesterone. Many tests performed on rabbits, rats, and monkeys showed that even in the presence of progesterone, RU-486 prevented the formation of secretory tissue in the uterus, could induce a premature menstrual cycle, and could terminate a pregnancy. As it was found to be nontoxic even in high doses, in October of 1981, Baulieu began testing with human volunteers.
By 1985, large-scale testing had been conducted in France, Great Britain, Holland, Sweden, and China. The tests produced an 85 percent success rate for RU-486 as a contragestive agent. With a relatively low dose of the drug administered orally, there was complete expelling of the embryo and all the endometrial surface. When a low dose of a prostaglandin
In a detailed study reported in the March, 1990, issue of the New England Journal of Medicine, Baulieu and others found that with one dose of RU-486, followed in thirty-six to forty-eight hours by a low dose of prostaglandin, 96 percent of a sample of 2,040 women had a complete abortion with few side effects; 1 percent failed to abort, and 3 percent had an incomplete expulsion or excessive bleeding and required surgical intervention. Each woman was kept in the clinic for four hours after she received an injection or suppository of prostaglandin so that she could be observed for side effects, which were usually mild and included nausea, vomiting, abdominal pain, and diarrhea. Less than 2 percent of the women complained of any further side effects when they returned for a checkup; these included the side effects mentioned plus dizziness, headache, rash, and, rarely, fever. The researchers used two different prostaglandins and found that the higher doses of one of them caused a faster expulsion but also caused more pain and a longer period of bleeding. The frequency of bleeding problems was the same in the study as in the most frequently used surgical procedure for the early stages of pregnancy termination.
Some animal studies reported harm to the fetus from RU-486 and prostaglandins, but a preliminary study of the effects of RU-486 on early monkey embryos, with and without progesterone, showed high tolerance in most cases.
In September, 1988, the French government approved RU-486 for use in state-controlled clinics. In October, 1988, Roussel Uclaf withdrew the product from the market because of pressures from antiabortion activist groups and anticipated boycotts of other company products. After petitions and boycott threats from the members of the World Congress of Obstetrics and Gynecology as well as other sources, the French government (which has a 36 percent interest in Roussel Uclaf) ordered the company to resume distribution of RU-486. By the fall of 1989, between one-fourth and one-third of the early abortions performed in France involved the use of RU-486 and a prostaglandin, and in 1990, the French government started subsidizing the cost of using the drug. In the succeeding decade, other nations tested mifepristone and some approved its use; the U.S. Food and Drug Administration granted its approval in 2000.
Baulieu’s discovery that RU-486, in conjunction with a dose of a prostaglandin, allowed early abortions to be performed without surgery or major side effects added to the polarization of groups for and against the right to end unwanted pregnancies. Threats were made against producers of the drug, and loud outcries were heard from some groups on both sides of the issue. The controversy continued into the twenty-first century, although mifepristone was eventually approved for use in several nations.
In addition to its use as a contragestive agent, RU-486 showed potential usefulness in the treatment of breast cancers that require progesterone for growth and possibly for other tumors when the cells have steroid receptors on their surfaces. Mifepristone also gained research attention for its possible use in the treatment of glaucoma (to lower pressure in the eye that may be caused by an increased level of steroid hormone), in promoting the healing of skin wounds, and in softening the cervix at birth and thus aiding in normal delivery. The most promising of all the drug’s uses may be as a real contraceptive that is, as an agent that can prevent ovulation without the addition of estrogen, a potential cancer-causing compound.
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Baulieu, Étienne-Émile. “RU-486 as an Antiprogesterone Steroid: From Receptor to Contragestion and Beyond.” Journal of the American Medical Association 262 (October 6, 1989): 1808-1814. Somewhat technical article, written for a wide audience, includes several diagrams that help illustrate meanings. Includes background information and explanations of terminology, the chemical structures of steroids, and how RU-486 works. -
Cherfas, Jeremy. “Étienne-Émile Baulieu: In the Eye of the Storm.” Science 245, no. 21 (September 22, 1989): 1323-1324. Provides some background on Baulieu and his general work in endocrinology and, more specifically, his search for molecules similar to progesterone. Interesting view of Baulieu and his area of science research. -
Fraser, Laura. “Pill Politics.” Mother Jones 13 (June, 1988): 31-33. Presents good basic information on the testing of RU-486 and the politics of the drug’s distribution, with a focus on why it is not available in the United States. Includes some information on contraceptive methods in general and compares other methods with the potential of RU-486. -
Halpern, Sue M. “RU-486: The Unpregnancy Pill.” Ms., April, 1987, 56-59. Article makes some grandiose predictions about RU-486 but is otherwise informative. Asks critical questions about why the drug does not work in some women and discusses aspects of its potential harms to women. -
McFarlane, Deborah R., and Kenneth J. Meier. The Politics of Fertility Control: Family Planning and Abortion Policies in the American States. New York: Chatham House, 2001. Scholarly work reviews and analyzes American public policy concerning contraception and abortion in the last decades of the twentieth century, with a focus on the influence of morality politics. Includes tables, figures, bibliography, and index. -
Palca, Joseph. “The Pill of Choice?” Science 245 (September 22, 1989): 1319-1323. Reviews the history of the development of RU-486 and discusses the controversy surrounding the drug. Written for the general audience. -
Ulmann, André, Georges Teutsch, and Daniel Philibert. “RU 486.” Scientific American 262 (June, 1990): 42-48. Article aimed at the general reader includes many diagrams and other illustrations. Presents a history of the synthesis of RU-486 and related compounds and explains how they work.
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