Tuesday, January 22, 2013

Penicillin, not the pill, may have launched the sexual revolution

The 1950s were not as prudish as they seemed on the surface, says economist Andrew Francis. 

By Carol Clark

The rise in risky, non-traditional sexual relations that marked the swinging ‘60s actually began as much as a decade earlier, during the conformist ‘50s, suggests an analysis recently published by the Archives of Sexual Behavior.

“It’s a common assumption that the sexual revolution began with the permissive attitudes of the 1960s and the development of contraceptives like the birth control pill,” notes Emory University economist Andrew Francis, who conducted the analysis. “The evidence, however, strongly indicates that the widespread use of penicillin, leading to a rapid decline in syphilis during the 1950s, is what launched the modern sexual era.”

As penicillin drove down the cost of having risky sex, the population started having more of it, Francis says, comparing the phenomena to the economic law of demand: When the cost of a good falls, people buy more of the good.

“People don’t generally think of sexual behavior in economic terms,” he says, “but it’s important to do so because sexual behavior, just like other behaviors, responds to incentives.”

Syphilis reached its peak in the United States in 1939, when it killed 20,000 people. “It was the AIDS of the late 1930s and early 1940s,” Francis says. “Fear of catching syphilis and dying of it loomed large.”

Penicillin was discovered in 1928, but it was not put into clinical use until 1941. As World War II escalated, and sexually transmitted diseases threatened the troops overseas, penicillin was found to be an effective treatment against syphilis.

“The military wanted to rid the troops of STDs and all kinds of infections, so that they could keep fighting,” Francis says. “That really sped up the development of penicillin as an antibiotic.”

Right after the war, penicillin became a clinical staple for the general population as well. In the United States, syphilis went from a chronic, debilitating and potentially fatal disease to one that could be cured with a single dose of medicine.

From 1947 to 1957, the syphilis death rate fell by 75 percent and the syphilis incidence rate fell by 95 percent. “That’s a huge drop in syphilis. It’s essentially a collapse,” Francis says.

In order to test his theory that risky sex increased as the cost of syphilis dropped, Francis analyzed data from the 1930s through the 1970s from state and federal health agencies. Some of the data was only available on paper documents, but the Centers for Disease Control and Prevention (CDC) digitized it at the request of Francis.

For his study, Francis chose three measures of sexual behavior: The illegitimate birth ratio; the teen birth share; and the incidence of gonorrhea, a highly contagious sexually transmitted disease that tends to spread quickly.

“As soon as syphilis bottoms out, in the mid- to late-1950s, you start to see dramatic increases in all three measures of risky sexual behavior,” Francis says.

While many factors likely continued to fuel the sexual revolution during the 1960s and 1970s, Francis says the 1950s and the role of penicillin have been largely overlooked. “The 1950s are associated with prudish, more traditional sexual behaviors,” he notes. “That may have been true for many adults, but not necessarily for young adults. It’s important to recognize how reducing the fear of syphilis affected sexual behaviors.”

A few physicians sounded moralistic warnings during the 1950s about the potential for penicillin to affect behavior. Spanish physician Eduardo Martinez Alonso referenced Romans 6:23, and the notion that God uses diseases to punish people, when he wrote: “The wages of sin are now negligible. One can almost sin with impunity, since the sting of sinning has been removed.”

Such moralistic approaches, equating disease with sin, are counterproductive, Francis says, stressing that interventions need to focus on how individuals may respond to the cost of disease.

He found that the historical data of the syphilis epidemic parallels the contemporary AIDS epidemic. “Some studies have indicated that the development of highly active antiretroviral therapy for treating HIV may have caused some men who have sex with men to be less concerned about contracting and transmitting HIV, and more likely to engage in risky sexual behaviors,” Francis says.

“Policy makers need to take into consideration behavioral responses to changes in the cost of disease, and implement strategies that are holistic and longsighted,” he concludes. “To focus exclusively on the defeat of one disease can set the stage for the onset of another if preemptive measures are not taken.”

Images are vintage health messages from NIH National Library of Medicine.

Skeletons point to Columbus voyage for syphilis origins
Your brain, in love and in lust


  1. I wonder if the same could be said of any generation. For instance, the Victorian era in England was not very prudish either.

    The 1930s might have been much less prudish if not for the Great Depression and its consequences.

  2. This also can be seen with the emergence of HAART and how AIDS is perceived now as a chronic disease and not a fatal disease. Patients I see in the public health clinic I work in cont to have unsafe risky sexual behaviors.

  3. Fascinating article, and I love that it was written by an Economist, not a scientist; and that she was able to access and retrieve records from the CDC. Also interesting is that the government was able to prioritize the development of penicillin after it had been sitting on a shelf/clinical waitlist for 13 years.

    1. Since economists would classify what they do as a science, unless you intention is to give offence, it might be best not to set Economics and science up as contrasts. Since it is primarily engaged in decision processes, and how people make choices between alternatives, it is often recognized as a branch of psychology, particularly the burgeoning field of neuro-economics

  4. You won't hear about it often but the 1950s were actually when the mini-skirt was invented, porn magazines became popular, strip clubs became popular, PDA's became extremely common (often in the form of making out), and when married and unmarried couples had so much sex in the 50s and 60s that we had the largest amount of babies born in US history. If you don't believe me about the mini-skirt being invented in the 1950s look no further than the poster for attack of the 50 foot woman. Now there was more sex and more permissive attitudes towards sex in the 1960s than the 50s. However, the 1950s were still very permissive. In fact they were probably slightly more permissive than people today are, at least in the US.