The Battle for the Pill
As Loretta Lynn sang:
“This old maternity dress I’ve got
Is goin’ in the garbage.
The clothes I’m wearin’ from now on
Won’t take up so much yardage.
Mini skirts, hot pants
And a few little fancy frills.
Yeah, I’m makin’ up for all those years
Since I’ve got the pill.”
In our cultural lexicon, the term “the pill” doesn’t mean OxyContin, Viagra or aspirin. In The Birth of the Pill, author Jonathan Eig writes, “There was no such thing as The Soap or The Vacuum or The Car…. [T]his wasn’t merely an incremental improvement; this was a radical reinvention, and it was exactly what women needed.” The birth control pill is arguably one of the most important technologies of the past 100 years. Its development is recounted—thrillingly—by Eig, whose previous books include biographies of Al Capone, Jackie Robinson and Lou Gehrig.
How did a writer drawn to the testosterone-infused stories of gangsters and sports heroes become interested in a story that is essentially about research chemistry, clinical trials and fundraising? He credits his wife, who pointed out that women buy a lot of books—although it would be a shame if The Birth of the Pill were pigeon-holed as a book aimed exclusively at women. Eig makes the familiar story of the development of the pill exciting and personal by focusing on four “crusaders” and exploring the motivations—money, power, sexuality and, most of all, commitment to a personal mission—that drove these four and others to charge on with great tenacity over many frustrating years.
The crusaders were all notable individuals, each of whom has been the subject of at least one full-length biography. Eig highlights the relationships between the four and clarifies how each of them played a role in this most important of scientific endeavors. In some sense, each of the crusaders is an archetype of the four efforts that are still needed to develop new health technologies today: the scientist, the doctor, the donor and the advocate. Yet the pill itself feels like the center and the true hero of the story.
For his archetypal scientist, Eig focused on Gregory Pincus, a brilliant but difficult chemist who was famously fired by Harvard and subsequently founded an independent research institute, which he initially supported by collecting donations door to door. There are some contradictions inherent in Eig’s choice to focus on just one scientist. Science in general tends to be the work of teams, even if brilliant individuals are a part of that team (one reason why Nobel Prizes in science are so often shared). One of the more fascinating chapters in the book is a short one focusing on a chemist named Russell Marker, who learned how to synthesize hormones from vegetables, including sarsaparilla root and a Mexican yam. This allowed the drugs to be synthesized much more cheaply than the previous methods that used animal tissue or urine. He founded a company called Syntex to take this work forward. Syntex hired a young chemist called Carl Djerassi, who is often called “the father of the pill” and whose work on synthetic progesterone paralleled that being undertaken by Pincus and, separately, a third scientist, Frank Colton.
Eig’s other three subjects are well known to many. Margaret Sanger, as the advocate, brought tremendous passion to her life’s mission of helping women avoid unwanted pregnancies. Her story has been more fully covered elsewhere (particularly in Ellen Chesler’s 1993 book, Woman of Valor), and Eig focuses on her work in securing funding commitments for Pincus’ research on the pill. Sanger had a strong understanding of the role of money and advocacy, and she played matchmaker between a wealthy donor, Katharine McCormick, and Pincus’ institute.
McCormick, from a wealthy midwestern family (she was born Katharine Dexter of Dexter, Michigan), was one of the earlier women to graduate from the Massachusetts Institute of Technology (MIT). But instead of attending medical school as planned, she married the even wealthier Stanley McCormick, who was diagnosed with schizophrenia shortly after their marriage and was institutionalized for most of the rest of his life. She dedicated her life to caring for him and to her causes: housing for women at MIT, the early women’s rights movement and later, through Margaret Sanger, the birth control movement. McCormick was more than a philanthropist; she was a public speaker and an organizer, and she served on many committees and in leadership positions. In the 1920s, when contraception was still illegal in the United States, she carried a thousand diaphragms from Europe to the US, carefully sewn into her new clothes in eight steamer trunks. These diaphragms supplied Margaret Sanger’s Brooklyn birth control clinic for a year.
The fourth crusader was the charismatic Dr. John Rock, who specialized in treating infertility and was part of the early effort to use hormones to regulate women’s cycles to promote fertility. A devout Catholic, Rock was convinced for many years that the Catholic hierarchy would accept hormonal birth control as “natural,” akin to the rhythm method—and different from intrusive devices like the condom and diaphragm. Rock worked closely with Searle, the manufacturing company, to develop promotional literature that would be acceptable to Catholic readers, using the term “family planning” instead of contraception or birth control and emphasizing the “natural” character of the drug. At age 70, after the pill was approved by the US Food and Drug Administration, Rock campaigned vigorously for the pill’s acceptance by the hierarchy, appearing on television, going to the Vatican and publishing a book about the church and contraception. He would be disappointed when Pope Paul VI rejected all methods of “artificial contraception” in 1968.
The four individuals played essential parts in the development of the pill, and each is charismatic enough to deserve a highlight in Eig’s book. However, the title is somewhat misleading. While the author frames his story in terms of the contributions of these four, his extensive research shines light on what is quite literally a cast of thousands. From the scientists studying hormone synthesis to the doctors and nurses who ran the early clinical trials of the pill in Boston, Puerto Rico and Haiti, to the thousands of brave women who enrolled in the trials at a time when the dose of hormones was high and the side effects considerable, the development of the pill was truly a group effort. Even the invention of the “DialPak” by a man who wanted to help his wife remember whether she had taken her pill is a part of the story.
The role of the pharmaceutical industry is explored in fascinating detail. The drug companies involved in the early development of the pill took substantial risks, but they also stood to make significant amounts of money. Often “industry” is painted as merely profit-driven and even exploitative, and thus it is refreshing to read a nuanced description of the way Searle, a small Chicago company, took on the risk of being the first company to bring a hormonal contraceptive pill to the market through the personal commitment of the company’s owners and senior staff. They hedged their bets by first launching their pill, “Enovid,” as a tool for regulating menstruation, but Eig is clear that Searle executives felt that investing in a contraceptive product was a big risk for a small, family-owned company.
Another important and often under-recognized player in the development of any new health technology is the regulatory agency. Eig provides rather painstaking details about the process by which the FDA examined and ultimately approved the drug for contraception after its first approval for menstrual irregularities. The extremely understaffed FDA assigned the Enovid application to a young obstetrician-gynecologist who worked for the agency part-time while completing his medical residency. As it happens, the reviewer, Pasquale DeFelice, was a Catholic (and went on to have 10 children). While DeFelice disagreed with the institutional church’s position on birth control, his job was only to decide whether this new hormonal product was safe for use by large numbers of healthy women on a daily basis and over a period of many years. This was a different question than approving a drug for sick people, and DeFelice initially rejected the proposal, noting that while the researchers had presented their data in terms of numbers of cycles studied, the actual number of women in the trials was, at this point, still small. He sent Searle back to collect more data and conducted his own survey of doctors (not women) who had experience with Enovid. Ultimately, DeFelice could find no safety-related reason to reject the application. The agency’s announcement in May 1960 stated, “Approval was based on the question of safety. We had no choice as to the morality that might be involved.” By 1965, more than 6.5 million American women were taking the pill.
While the pill was credited for massive changes in social norms and sexual behavior, Eig takes care to emphasize that movements for social change, including rights for women, were underway well before it was approved in 1960. Still, it is hard to imagine that any aspect of contemporary American women’s lives—professional and personal—has not been touched by the availability of the birth control pill. Despite the fact that contraception is far from perfect and millions of women still experience unintended pregnancy each year, the very existence of this technology means that women can make the choice to be both sexual and professional, to bear children on their own schedule and live their lives according to their own design.
Jonathan Eig is currently writing a book about the boxer Muhammad Ali. That seems like an appropriate next topic for a writer who has spent so many years researching and writing about a tiny little pill that, by every definition, punches above its weight.
The Birth of the Pill: How Four Crusaders Reinvented Sex and Launched a Revolution
(W.W. Norton, 2014, 400 pp)