Ron Frezieres' job requires not only scientific skill but also a knack for asking nosy questions and getting honest answers.
As a contraceptive researcher, he asks couples to discuss intimate details of their sex lives so he can publish the findings and try to improve the status quo of birth control.
An epidemiologist by training, Frezieres, 43, has devoted the past 17 years to research, studying a variety of new contraceptive methods and publishing 10 scientific papers in medical journals. In the March-April issue of Family Planning Perspectives, he is a coauthor of a study reporting that the breakage rate of the polyurethane condom is higher than that of the latex condom; last month in Lancet, another study he coauthored talked about the value of giving women antibiotics before inserting intrauterine devices.
Frezieres, the director of the research division at the California Family Health Council in Los Angeles since the council's inception in 1985, must first gather a willing and honest pool of subjects. Then he pulls together research teams from major universities and other centers, sometimes conducting research for private companies and sometimes for the government. The council is one of only eight centers in the nation hand-picked by the National Institutes of Health to serve in the clinical trials network for contraceptive research.
Recently, Frezieres' efforts were applauded by the National Family Planning and Reproductive Health Assn., a Washington, D.C.-based organization devoted to protecting access to family planning and reproductive health care services. He won the association's Scientific Contribution Award.
Frezieres, who lives in Valencia with his wife, April, their toddler sons Derek and Dustin and teenage stepdaughter Lindsay Marsalis, is clearly immersed in his work. One wall of his sunny sixth-floor office on Wilshire Boulevard has a poster showing long-gone birth control methods, some of them torturous-looking contraptions. There's also a colorful poster with a cartoon couple riding a condom--one of his latest attempts to recruit study subjects.
But he's not a center-of-attention kind of guy. During an interview, he first shows off family pictures and then praises colleagues--especially Dr. Gerald Bernstein, a veteran USC researcher and his mentor, and Terri Walsh, the council's director of operations--for contributing to much of his success. Credit given, he then pauses to retrace his steps, discuss his current research projects and predict what might be on the contraceptive horizon.
Question: How did you get into this field?
Answer: I fell into it. I had received training in epidemiology from UCLA in study design, clinical trials design and analysis. Then I was hired by UCLA to direct a study of the relationship between benign breast disease and breast cancer. They liked the results. The faculty recommended me to the California Family Health Council (then called the LA Regional Family Planning Council) to direct their first contraceptive trial of a new barrier method, the Prentif cervical cap [and how effective it was compared with a diaphragm]. I remember saying d-d-diaphragms? I had difficulty even saying the word. I really didn't know much about contraceptive research at all.
And I have been here ever since.
Q: So what happened with the cap study?
A: It took about four years to do the study. We didn't have all the creative ideas we have now [for recruiting subjects]. Back then, we linked up with clinics and waited [for volunteers]. Now, we are expected to do a study in two years. The unique thing about this cap was that it was a device that could be left in place for about three days and you had a little bit more spontaneity than with the diaphragm. The cervical cap was found to be as effective as the diaphragm, which was the current barrier method, and the cap was marketed.
Q: What other studies are memorable?
A: The next study--I really like this one--was a benzalkonium chloride sponge. This is not the Today sponge [now off the market]. This was a polyvinyl sponge, not polyurethane. The key thing was it was premoistened. Remember, the Today sponge you had to find a source of water? And the spermicide wasn't the typical spermicide, nonoxynol-9. It was an alternative, benzalkonium chloride, because it was thought to be less irritating. The sad thing is, the manufacturer, a European company, decided not to market it.
We [also] studied the first ever nonlatex condom, the polyurethane condom, Avanti. It has an advantage for people who are latex-sensitive. These condoms are substantially thinner than latex, which may offer enhanced sensitivity.
Now, we are testing the Persona monitor [a small hand-held device that reads urine test strips to predict ovulation].
[Next up, studies of the Janesway female condom, another cervical cap and Lea's Shield, a vaginal contraceptive that has a one-way valve allowing fluid to flow out but not sperm to flow in.]
I'd also like to develop a line of personal lubricants, not irritating to the vagina, with microbicide properties that could be used with any method.
Q: How would you describe the field of contraceptive research today?
A: It's a field that is awfully underfunded, and it has been that way for some time. Pharmaceutical companies are reluctant to invest in new methods largely because of liability and also because there is not a huge profit. There's very little profit, for instance, in condoms, the manufacturers tell us. If we could get rid of the liability, it might make the field more profitable. Now, there is not a lot of profitability and a high amount of liability. The risk is pregnancy or the risk of sexually transmitted disease, which is the thing that has people more scared.
The majority of funding now is coming from the federal government. Research is extremely time-consuming and expensive. You are following many couples over the course of a year. The studies take two to four years. The product had to be tested for safety before being tested in couples. So it's not uncommon for a product to take 10- plus years from the time it was developed until the time it went to market. It's a huge investment for companies to come up with. The government has tried to fill the gap. Contraceptives have become like orphan drugs and will probably continue on this path.
Q: How do you hook up with companies--do they find you or you find them?
A: Within the last two years, it's been incredible word of mouth. In terms of pharmaceuticals, we're getting referrals left and right because we have developed a reputation as one of the few doing contraceptive research. I get calls on a regular basis from companies saying, "We have such and such a product. . . ." If companies pay, an independent oversight committee reviews the project.
Q: Is it difficult to recruit people to test the methods?
A: Yes. Try to find a couple willing to use your experimental method of birth control in the privacy of their home, keep an intimate diary on how often they have intercourse for a year of their lives and then share all this information. We have to get creative. One recruiting poster has a couple riding on a condom rocket to the moonlit sky, with a heading that says "Journey into the Condom Future: Couples Wanted to Test Space Age Condom."
One of the most challenging things we do is penis measurements. It's very important to be sure the condom fits. We sat around as a group and asked how are we going to get measurements of an erect penis? We don't want to embarrass people. So we developed a kit. It has a couple strips of colored paper [used to measure length and circumference by tearing the strips to proper size]. They are given an envelope to return it in. No names are used.
Q: So what convinces people to enroll?
A: One thing they like most about the studies is they get free contraception. Also, the contribution they make to research.
Q: Are subjects reimbursed?
A: Each month we typically give them four free movie passes or a $20 gift certificate for a video or discount store. At exit visits, we typically give a couple $60. If the money is too good, they may not tell you they have stopped using the method.
Q: What's the reward for you?
A: This is one of those fields where you see results. I start work on a product, and two, three or four years later I know if I am going to see that on the market. When I see it on the shelf, I feel a great sense of pride.