Nand Peeters

Ferdinand "Nand" Peeters (Mechelen, October 13, 1918 – Turnhout, December 27, 1998) was a Belgian (Flemish) obstetrician and gynecologist, whose research led directly to the development of Anovlar, the first combined oral contraceptive pill introduced outside the United States, in 1961, the first whose side-effects were acceptable, and the first that was used world-wide (Albach 1997:939). It remained in production, in its original formula, from its introduction until 1986 — although, beginning in 1964, Schering AG (the company that produced it) also marketed variants with lower doses of hormones, some of which continued to be named Anovlar. Nand Peeters's research also contributed substantially to the treatment of Rh-disease.

Biography

Nand Peeters was a son of Désiré Peeters, a surgeon who founded his own clinic in Mechelen. After attending the local Saint Rumbold's high school, he studied at the Catholic University of Leuven, intending to become a gynecologist. But he finished his training in a maternity ward in Bruges.

In 1945 he married Paula Langbeen, with whom he had six children, and who was his book-keeper all his life—Peeters detested all administrative work.

In 1946 he settled as an ob-gyn in Turnhout. At the time Turnhout had none, even though it was (and is) the largest town in the northern part of the Campine, with a population then of about 32,000.[1] Perinatal infant mortality in Turnhout was between 10 and 12% before his arrival; in his first year in Turnhout he managed to bring it down to two cases in some 500 deliveries.

He was appointed head of the Maria Gabriël Maternity and of the gynecology department of Turnhout's municipal Saint-Elisabeth hospital in 1951. Under his direction, that department became one of the best in the country.[2] He acquired the most modern technology available, did innovative research, encouraged young and promising doctors that he hired to do likewise, and introduced new techniques like echography. In 1952 Leuven University appointed him as one of its supervisors of trainee doctors. This appointment was withdrawn in 1963, for reasons that remain unclear.[3]

In 1953, also in Turnhout, he founded the Saint-Elisabeth nursing school, where he taught gratis. Naturally the school provided him with well-trained nursing staff, whom he entrusted with far greater responsibilities than was customary at the time.

He retired in 1986. An intracranial hemorrhage in 1988 ended his active life—communication became impossible. He lived another ten years, dying on December 27, 1998.

Ob-gyn

Peeters was first and foremost a practicing ob-gyn, a very busy and highly competent one, who stopped counting the number of deliveries that he had done when he reached the number of 30,000.

Throughout his career his abiding concern was for the comfort of his patients. He was a man of few words, but a good listener, and the stories told by his patients[4] testify to the respect in which they held him and the trust they put in him.

He did research, taught, and lectured to and published for both health care professionals and the general public. But he did all this because he hoped thereby to improve the welfare of his patients and of pregnant and nubile women in general. Typically, pain management during delivery was the first problem he tackled as a researcher, while still a trainee in Bruges.

The development of Anovlar

Peeters closely followed the development of various hormones and their uses in the nineteen-fifties. He was aware of the work of Pincus and of the serious side-effects of Pincus's Enovid, which was first introduced as a remedy against menstrual disorders in 1957. He knew that Schering AG had developed a number of hormones, and when Jean Frenay, a representative of Schering, told him the firm had combined two of them, norethisterone acetate and ethinyl estradiol into an experimental preparation called SH-513 (containing 2 mg of the former and 0.01 mg of the latter) he asked for enough SH-513 to test it on a number of his patients. Peeters, wrote Frenay to Schering, "principally thinks of ovulation inhibition for contraceptive purposes."[5] Thus the idea of developing SH-513 into a contraceptive pill stemmed from Peeters, not from Schering. In fact, initially Schering's principal gynecologist wanted Peeters to test SH-513 as a treatment for dysmenorrhea. But eventually Peeters got formal permission from Schering to test SH-513 for the purpose of contraception.

Peeters selected from his patients those whose prognosis envisioned the risks of dying in childbirth, of stillbirth, and/or of Rh disease. He told them explicitly that he was developing a new medication, and got their permission to test it on them. The results of his small-scale trial (on no more than 50 fertile married women)[6] led him to conclude that a dose of 3 to 4 mg of norethisterone acetate and 'at least' 0.05 mg of ethinyl estradiol was both efficient and had few side effects. Schering then made its SH-639 using this dose, and had it tested in trials in Germany, Australia, Japan and the USA on 14,038 menstrual cycles of 2433 women. The conclusion was an outright recommendation to introduce SH-639 as a hormonal contraceptive.

But Schering hesitated to introduce it in Germany, fearing comparison with Nazi eugenics, still a painful memory in that country.[7] It was first introduced in Australia, on February 1961, as "Anovlar", a name intended to mean 'without ovulation'. The following table[8] shows Anovlar’s introduction times in a number of countries:

Fame …

The results of Peeters's research were published as Peeters F., M. Van Roy & R. Oeyen 1960. (Van Roy was Peeters's clinical biologist; Oeyen, his assistant.) Requests for offprints came flooding in from all over the world, especially after the introduction of Anovlar, over 50,000 of them.

He addressed the Third World Congress of Gynecology and Obstetrics (Vienna, September 1961) and the 60th Congress of the North-West-German Gynecological Society (Kiel, 1961). He also spoke at the Second Fertility Congress in Brussels, where he met with Eleanor Mears, co-author of a highly favorable[9] report of a large-scale clinical trial of Anovlar, published in the prestigious BMJ.

In the early sixties, his reputation was considerable.

… and silence

But in his own country, Peeters faced problems. Until 1973, publications on birth control were liable to fall foul of Belgian law, which considered them obscene. In Belgium, Peeters had to keep quiet about his work.[10]

In addition, Belgium was a very Catholic country, and at the time the Catholic Church's controlling document on hormonal contraception was Casti connubii, which flatly forbade it. Peeters's employ was in the hands of the town council of Turnhout, entirely dominated by the Christian People's Party. The threat of losing his job, which he loved, was real, and he had to tread very carefully as long as the Catholic Church forbade artificial contraception and as long as Turnhout remained monolithically catholic, i.e., throughout his active life.[11]

However, since October 1958, John XXIII was pope, and Aggiornamento seemed possible, even in the Catholic Church's view on birth control. Nand Peeters thought so. On May 1, 1963, he was granted a short private audience with John XXIII, from which he came away with the impression "that the pope provided support for the pill".[12] At any rate, in 1963 John XXIII established the Pontifical Commission on Birth Control, which continued its work under the aegis of pope Paul VI, though in a much expanded composition. In 1964, Paul VI convened the First European Congress of Catholic Doctors (Malta, 1964), which was almost entirely devoted to birth control. Peeters was one of the speakers.

When Paul VI confirmed the Catholic Church's total rejection of birth control by "artificial methods" in his Humanae vitae in 1968, Peeters was greatly disappointed and angry.[13] But he was a devout and committed catholic, and he could not square it with his conscience to publicly distance himself from the teaching of his church.

The Catholic Church’s ban on birth control as well as the political situation in Turnhout left him no choice but to withdraw into silence. This he did so successfully that his own children knew only vaguely that he had had something to do with Anovlar. That it was he who actually developed it they discovered only in 1995, when Schering, ignorant of Peeters's medical condition, asked him for help in contributing to the eponymous catalog (Staupe & Vieth 1996) of Die Pille: Von der Lust und von der Liebe, an exhibition put on by the German Hygiene Museum.

The result was that his name fell into oblivion. When he died, only the local Turnhout press reported on his death.

Peeters's ethics about the pill

Peeters never accepted his church's absolute prohibition of the pill. He never repudiated his work on Anovlar. On the contrary, he was quietly proud of it. When he was asked to contribute an article on himself in a Dutch version of Who's Who, he cited just one publication, Peeters 1970, his Dutch adaptation of a German work on hormone treatment, intended for doctors. He wanted them to continue to use hormones, including Anovlar, which he discussed in this book without mentioning his role in its development. And he continued to do research, not only on Anovlar, but also on other pills, such as Eugynon, Aconcen and Sequilar. However, he published his results only in medical journals.

More importantly, he unhesitatingly prescribed the pill when he deemed that a patient's health was threatened by too many pregnancies (too often life-threatening ones—ten or twelve children was not unusual in the Campine in the sixties), by late pregnancies or by the threat of yet another stillbirth, due, e.g., to Rh-disease. He would not have others, whoever they might be, influence his medical judgment, and for him the health of his patient always remained paramount. Also, he defended in no uncertain terms a couple's right to decide on the number of children they would have: "It is you and your husband who decide the number of your children, and that's not the pope's business."

Even so, Peeters remained a fundamentally conservative catholic, who strongly disapproved of the loose mores of the sexual revolution, largely due to the pill,[14] and who agreed with his church that coitus should only take place within marriage.

Other research

In 1964, Ortho Pharmaceutical asked Peeters to participate in a clinical trial of a variant of RhoGAM, its Rho(D) immune globulin. He accepted. Peeters took the lead of a small team of doctors and a great number of midwives, whom he alerted to the problem of Rh-disease and who, aware of his excellent reputation in the region, willingly cooperated. The medication was tested on more than 700 women, and the trial was a resounding success: not a single case of Rh-disease was reported, leading one of his colleagues to say that it made the Campine the first Rh-disease free region in the world. When he presented the results to a Berlin conference attended by over 2500 gynecologists and pediatricians,[15] it turned out that his was by far the most extensive clinical trial. But he ascribed its success to the midwives and the maternities involved in the study, and he did not even publish his results. He was too busy lecturing and teaching refresher courses to doctors.

Nonmedical activities

Whilst studying and for some time after his study, he was also a prominent leader in a catholic youth movement, the "Katholieke Studenten Actie" (KSA). His was a serious and time-consuming commitment: he wrote a brochure (Peeters 1944) for them, and until the day before his marriage, he could not be reached for a while, because he was inspecting KSA summer camps (together with Pieter De Somer, another KSA-leader who was to become a noted medical researcher).

In 1948, upon the death of Jozef Simons, Nand Peeters succeeded him as chairman of the Turnhout branch of the Davidsfonds, a function which he retained until 1965.

Trivia

Sources

Unless otherwise indicated, all information in this article is based on Van den Broeck 2014. A great deal of information in English can be found in Van den Broeck, Janssens & Defoort 2012 (an article in a peer-reviewed journal) and in Hope 2010. German publications are Albach 1993 [in particular pp. 922–999, "Case F: Die Entwicklung der «Pille» (Oral Contraceptives)"] and Sieg 1996.

All websites mentioned in this article were consulted in the second half of 2014.

Notes

  1. ↑ Verslag over het Bestuur en de Toestand der Zaken van de Stad Turnhout … 7 Juni 1948, available on this page of the Turnhout City Archives.
  2. ↑ Even as early as January 1954 the statistics about his department that he presented at a meeting at Leuven University turned out to be the best in the country.
  3. ↑ As late as 2011, the university claimed his file, likely to reveal the reason, "was hard to find".
  4. ↑ Both in De pil van dokter Peeters, a documentary broadcast on March 8, 2012 by Canvas, and in Van den Broeck 2014. Van den Broeck describes his interviews with the first patients that volunteered for Peeters's tests on what was to become Anovlar as the most probing (original Dutch "de meest indringende") of his entire career of 25 years as a journalist.
  5. ↑ Letter of May 5, 1959, quoted in Van den Broeck, Janssens & Defoort 2012:322.
  6. ↑ Van den Broeck, Janssens & Defoort 2012:323.
  7. ↑ Understandably so. Carl Clauberg, for example, had taken part in Schering clinical research programs before WWII (Van den Broeck, Janssen & Defoort 2012:324) and had experimented with progestins. — On the relationship between Schering AG and Nazism, see Wlasich 2011.
  8. ↑ From Albach 1997:939.
  9. ↑ From the Summary: "this would appear a most acceptable form of contraception. The product was well tolerated and side-effects were few. … Cycle control was remarkably good … As a result of this [trial] …, the Council for the Investigation of Fertility Control has recommended anovlar for use as an alternative oral contraceptive in F.P.A. clinics."
  10. ↑ A meeting of the Flemish Society of Obstetrics and Gynecology Peeters co-hosted on May 1960 in Turnhout had as its subject "ovulation suppressors". But its minutes make no mention of "birth control" or "contraception", subjects which might well have led to its being considered an obscene meeting.
  11. ↑ It is possible, but not certain, that a presentation Peeters gave at a congress of the International Fertility Association held at the Catholic University of Leuven in 1963 led to the withdrawal of his appointment to supervise trainee doctors.
  12. ↑ A somewhat literal translation from the original Dutch: "dat de paus zijn steun verleende aan de pil".
  13. ↑ At one point he fumed: "We'll go to the pope and we'll tell him that he should write an encyclical Pacem in Utero: peace in the womb." The allusion is to John XXIII's last encyclical, Pacem in terris.
  14. ↑ One of his sons claims that this disapproval was also one of the reasons Peeters did not discuss Anovlar, which was in effect his indirect contribution to this sexual revolution.
  15. ↑ This information (in Van den Broeck 2014:209) is based on a reminiscence of a collaborator of Nand Peeters’s, who puts the conference (which he does not specify further) in 1967 in Berlin. Probably it was the first European Congress of Perinatology, held in Berlin in 1968.
  16. ↑ Het Laatste Nieuws April 2, 2014.
  17. ↑ Considered a Belgian invention, because it is based on research by the Belgian mathematician Ingrid Daubechies.
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