The Birth of the Pill: How Four Crusaders Reinvented Sex and Launched a Revolution (19 page)

Pincus was pleased with the early tests on rabbits and rats and equally pleased, if not more so, with John Rock’s work, which showed that progesterone caused no serious harm to women. Rock wasn’t testing the hormone directly as a method of birth control, but that was a minor concern to Pincus. Whether the women were fertile or not didn’t matter. He needed warm bodies. He needed women willing not only to take an experimental drug but also to submit to daily tests of their body temperature, daily vaginal smears, urine tests every forty-eight hours, and occasional endometrial biopsies, which involved doctors taking small samples of tissue from the lining of their uteruses. Rock’s patients were motivated to do so because they believed that in the long run Rock would help them get pregnant. Without such an incentive, it was unlikely that Pincus would have been able to round up volunteers. Also, by billing the experiment as part of Rock’s fertility work, Pincus could reasonably claim that he was not engaged in the administration of birth control. Had he been transparent in his objective, he and Rock both would have been in violation of the Massachusetts law banning all forms of contraception, and they would have been subject to prison sentences of five years and fines up to one thousand dollars.

In his application for additional Planned Parenthood grant money, Pincus wrote that he intended to conduct the tests through “two to three menstrual cycles in
thirty to forty women
.” Meanwhile, lab tests on animals would continue.

Here was another one of Pincus’s great improvisational bursts—a scheme so bizarre it could have come from Hollywood. He intended to test a birth-control formula by calling it a fertility treatment. If he had still been on the faculty at Harvard, or even if he had still been operating in affiliation with Clark University, he never would have gotten away with it. A university department head, fearing legal trouble or bad publicity, might have forbidden him from giving contraceptives to women. But Pincus was a free agent and unafraid to take risks. When Henshaw asked if Pincus was running the risk of breaking the law by giving birth control to women in Massachusetts, Pincus gave a stern response:
“The fundamental facts may be established in Worcester or Timbuckto [
sic
],” he wrote. The tests were not for birth control, he continued. “They are concerned with the quite specific effects of the compounds with which we have been working, and a study of the biology of these effects is not against any law existing in Massachusetts.” Testing on a large number of women in Massachusetts might attract unwanted attention, he admitted, but that was a matter for another day. The first thing to do was to find out if progesterone worked. He concluded: “I should therefore like to learn from you just what you think is possible in view of your available resources.”

Pincus believed that it was the scientist’s duty to be aggressive. Too many of his colleagues, he complained, were satisfied writing for scientific journals when they should have been thinking about how their work could be used to effect change. “The call-for-action programs,” he wrote, “have largely
passed over the research laboratory
.”

Pincus saw himself as more than a research scientist now. He was an activist, a crusader, and a businessman. He was also a builder of coalitions, however unlikely. He was not the first to experiment with progesterone or even the first to propose that progesterone might work as a contraceptive in women. He was simply the first to make the necessary connections, bringing together gynecologists, drug companies, and biologists with shared interests. By now, Pincus wasn’t looking for a “eureka” moment; he was looking for pieces of the puzzle that might fit the rough image he had in mind for a functioning birth-control pill. But instead of keeping the project to himself or giving up because he had hit another roadblock, he pushed on, using every tool and every ally at his command.

John Rock was already giving progesterone and estrogen to women to see if it would help them get pregnant. Pincus wasn’t doing anything different—he was merely doing it for a different reason.

Was it dishonest? Most would say yes. But it did not violate any of the laws or medical standards of the day.

In the 1950s the United States had some of the most progressive laws in the world when it came to testing experimental drugs, but there was still no law on the books requiring doctors to inform patients they were being included in an experiment. Rock’s patients were not exactly hoodwinked. They were told that the progesterone they were receiving would shut down their ovaries and make it impossible to get pregnant. They were told the treatment would simulate pregnancy and might cause nausea. And they were told, honestly, that Rock believed they would have a better chance of becoming pregnant when the experiment was complete.

There was only one small piece of information missing.

Beginning in 1953, Pincus and Rock enlisted twenty-seven of Rock’s patients at the Free Hospital for a three-month trial. This study would be different from Rock’s previous experiments with progesterone. This time, because Pincus wanted to be certain that the hormone was effective in halting ovulation, women who failed to ovulate regularly were not included. The women enlisted were still infertile, but Rock didn’t know what was causing their infertility. Instead of the progesterone-estrogen mix that Rock had used in the past, the women in this experiment received only progesterone. And they received the tablets daily for only three weeks out of each month, stopping for a week to allow them to menstruate.

The tests were demanding. Among nurses and lab workers in Rock’s office, the new round of testing was referred to as the Pincus Progesterone Project, or the PPP. Some of the staff joked that PPP stood for “pee, pee, pee,” because so many urine specimens were tested. When enough bottles of urine were amassed, Rock would send a technician from Boston, and Pincus would send a technician from Shrewsbury. They would
meet somewhere in the middle
, with Pincus’s man taking the urine and driving it back to Shrewsbury.

Pincus was so excited about this approach that he couldn’t wait to enroll more women. In the spring of 1953, as Rock’s trials were beginning, he approached scientists and gynecologists in Israel, Japan, and Worcester, asking if they would enlist their patients in similar studies. He also recruited nurses at the Worcester State Hospital to participate. The nurses might have been hugely important to Pincus because, unlike Rock’s patients, they were not being treated for infertility. Presumably they were fertile women, some of whom were using other forms of birth control. Unfortunately for Pincus, the nurses turned out to be lousy patients. Most of them dropped out.

In Worcester, a forty-seven-year-old gynecologist named Henry Kirkendall agreed to help Pincus by enrolling some of his patients in the study. Kirkendall was a member of the staff at St. Vincent Hospital and the senior obstetrician at Memorial Hospital,
both of which were in Worcester
. If you were born in or around Worcester in the 1940s or early 1950s, there was a strong chance it was Dr. Kirkendall who delivered you. Like John Rock, Kirkendall was a staunch Catholic and, also like Rock, his work with women had made him sympathetic to the cause of family planning. Pincus met with Kirkendall and asked the gynecologist if he could find thirty women willing to participate in a study similar to Rock’s. The women would need to take their own temperatures every day and record the findings. They were also expected to take daily vaginal smears and collect their own urine for hormone analysis or else visit the doctor’s office to have it done by a nurse. The progesterone dosage would be extremely high—between
250 and 300 milligrams a day
. The women were not paid for their participation, nor were they informed that the results might lead to the invention of a new form of birth control. Most of them were doing it simply because a trusted doctor had asked them to.

The tests began in June. All through the summer, Dr. Kirkendall would load the trunk of his baby-blue Pontiac convertible with vials of urine and slides containing vaginal smears and drive them over to the
Worcester Foundaton in Shrewsbury
for testing, or he would ask his son to drive them there.

In the first year of trials, Pincus, Rock, and Kirkendall enrolled sixty women in their study. That alone was something of an accomplishment, given that they’d been forced to go about their work surreptitiously. But half of the women enrolled dropped out along the way, either because the test procedure was too demanding or because the side effects were too disturbing. And while Rock was pleased with the results—four of the thirty infertile women completing the study got pregnant on the so-called rebound—Pincus was disappointed: About 15 percent of the women showed signs of ovulation while taking progesterone, significantly worse results than he’d seen with rabbits and rats. To complicate matters, the results were the same for women whether the dosages of progesterone were two hundred milligrams or four hundred.

Until that moment, everything had been happening quickly and encouragingly. But a contraceptive with an 85 percent success rate was no good to anyone.

Suddenly, Pincus had reason to doubt his own elegant solution.

THIRTEEN

Cabeza de Negro

G
REGORY PINCUS DIDN’T
know that the missing piece of his scientific puzzle had been discovered a decade earlier. No one knew it yet.

In 1942, weeks after the Japanese bombed Pearl Harbor, an American chemist named Russell Marker boarded a train for Mexico in search of an enormous root plant the locals called
cabeza de negro
, because from a distance the round part of the plant that stuck out of the ground looked like the top of a black man’s head. The American embassy had been advising citizens to stay out of Mexico, Marker recalled, “because no one knew whether we were going to get into the war or whether Mexico would be in on it and
on our side or not
.” Marker’s employer, Pennsylvania State College (now known as Pennsylvania State University), also urged him to postpone his research mission, but Marker refused. He traveled to Mexico by train, carrying with him a map from a botany book that indicated
cabeza de negro
could be found in the Veracruz province of the country where the road between Orizaba and Córdoba crosses a river gorge.

In Mexico City, Marker, who spoke no Spanish, hired a local botanist and the botanist’s girlfriend to accompany him by truck to Veracruz. But after three days on the road, the botanist and his girlfriend became frightened, saying there was too much animosity toward Americans in the area. It was unsafe to go on. Marker drove back to Mexico City with them and then boarded a rickety old bus bound for Veracruz, sitting next to a woman carrying live chickens. When he arrived in Orizaba, he switched to another bus, this time headed for Córdoba. Spotting a small stream between the two towns, he asked the bus driver to stop and let him off. Not far from the bus stop Marker found a small grocery store, went in, and asked the owner in English if he knew where to find
cabeza de negro
. The storekeeper told him to come back the following day—
mañana
, he said. That much Marker could understand. When he returned in the morning, the storekeeper presented him with two plants, which Marker put in bags and tied to the roof of the bus that carried him back to Mexico City.