The Birth of the Pill: How Four Crusaders Reinvented Sex and Launched a Revolution (29 page)

Sanger was becoming increasingly self-absorbed. Her behavior was too erratic to make her effective as a leader of a big organization like Planned Parenthood. But she was still able to focus on smaller, more precisely targeted projects, and the conference in Japan was just such a project.

By the 1950s, Japan’s population was about ten times denser than that of the United States. Abortion rates in Japan were so high that the government, hoping to promote better safety, became one of the first in the world to legalize the procedure. In 1951, more than
638,000 legal abortions
were performed there. More than twenty thousand midwives worked in Japan, and Sanger was convinced that if the Japanese government supported the introduction of a birth-control pill, the midwives would promote its use and quickly change women’s practices. Once the pill came into use, she said, she was confident that the
demand for abortions would decline
. If it worked in Japan, the same approach might work throughout Asia, where the looming population crisis was most pronounced.

In Tucson, Pincus and Sanger huddled over the program and schedule of presentations for the conference, with Pincus suggesting
“more scientific” titles
for some of the sessions. Sanger hosted a dinner party for the Pincuses, inviting the president of the University of Arizona among other college officials. She also invited a group of young women—“and their Gynecologist”—to a cocktail party. When Pincus told the young women about his progesterone experiments, several of them volunteered to be his subjects, saying “they would like very much to
be progesterone guinea pigs
.”

After the party, Sanger wrote to McCormick, sharing her impressions of the Pincuses. “I hope to tell you how important it is for his wife to be with him,” Sanger wrote, “especially to guard against his Bohemian apparel. She is quite a person in her own, and is
evidently a very necessary help to him
.”

Like McCormick, Sanger trusted Pincus. When he told them not to worry about the clinical trials, they believed him. Then again, they had little choice.

By the fall of 1955, John Rock wrote to I. C. Winter at Searle with the preliminary results of his tests with the new progesterone compound, known among the scientists as norethynodrel, or SC-4642.

“
It looks pretty good
,” he wrote.

At that point, he had only tested it on four women.

When Rock told Searle he thought it would be a good idea to expand the experiment by providing the progestin to other researchers, Winter, the company’s clinical research director, said he wasn’t sure he could encourage scientists to try a compound when he didn’t understand how or why it worked. Rock’s tests showed that progestins stopped the pituitary gland from producing the hormones that signaled the ovaries to release eggs. But the pill had other effects that were not yet clearly understood. It also appeared to change the consistency of the cervical mucus, for example, making the mucus more hostile to sperm. Progesterone also seemed to make the endometrium less hospitable to eggs. Were all of these effects combining to prevent pregnancy, or would any one of them have worked alone? And what if the progesterone compounds had other effects? What if it stopped the production of cortisone? What if the progestins did some damage to the ovaries that Rock’s tests had not yet revealed? What if there were long-term effects no one could imagine?

Rock said he was relatively confident that the Searle progestin was safe and that it wouldn’t affect a woman’s ability to get pregnant. He was optimistic enough to encourage Searle to promote the drug more widely, but he was nowhere near as optimistic as Pincus. He wanted more tests, and he wanted to publish the results of those tests in a respected journal before making any announcements. If the pill proved flawed in any way, the publicity would backfire. Women would become wary. Testing would become even more difficult. The Catholic Church would harden in its opposition. For all those reasons and more, Rock urged Pincus not to go to Japan.

As the conference approached, Pincus made no progress in Puerto Rico. Testing there was at a standstill. Back in Boston, Rock continued to plug away with his small group of patients. Though the size of the study was ridiculously small, the results were good. Both norethynodrel and norethindrone—the former made by Searle, the latter by Syntex—appeared effective. Best of all, they worked at doses of only ten milligrams per day, which was one-thirtieth of the progesterone dose Pincus and Rock had been giving earlier. Perhaps losing faith in Puerto Rico, Pincus told McCormick that he hoped during his visit to Japan he might find doctors willing to start clinical trials in and around Tokyo.

Pincus was always respectful and appreciative in his letters to McCormick, but he was also often vague. He mentioned “
a fair drop off
” in the number of women participating in trials in Puerto Rico, but he didn’t tell her that the drop off was from twenty-three to ten. Nor did he let on that even among the ten women who participated, some had done so haphazardly, failing to take all their pills and failing to submit to all their tests. Nor did he mention that some of the lab specimens couldn’t be tested because they’d been accidentally overheated during transport
between San Juan and Shrewsbury
. In a letter to Dr. Tyler, Pincus confessed that “there is
very little [data] worth reporting
,” but he was not so frank with his biggest sponsor. He neglected to mention that he was coming up empty in his attempts to recruit more women for the study.

As he prepared to depart for Tokyo, Pincus was about to make one of the greatest bluffs in the history of modern science. He was preparing to announce that an oral contraceptive for humans was nearly ready when, in fact, he had not yet decided which form of the contraceptive worked best and at which dose. If that weren’t enough, he still hadn’t found enough women willing to serve as test subjects.

Some scientists would have been uneasy, but not Pincus, who had the IQ of an Einstein and the nerves of a card shark. He had shown it at Harvard, where he boldly pronounced successes that might have benefited from more careful review. He’d shown it when he’d seduced Lizzie by telling her he was a sexologist. And he’d shown it again when he rebuilt a career that had been in tatters, launching the Worcester Foundation and taking charge of the Laurentian Hormone Conference. Now, in his pursuit of a birth-control pill that might have enormous social and economic impact, he was relying not only on that bravado but also on cunning.

Even the people working most closely with him did not know some of the crafty calculations Pincus had made. McCormick, for example, had no idea that Pincus was drawing pay and receiving stock from G. D. Searle & Company. When Pincus told McCormick that Searle had agreed to supply drugs for testing at no charge, he didn’t let on that they might have had a financial interest in doing so. He also didn’t mention—although McCormick might have noticed if she checked his expense reports—that when Goody and Lizzie traveled as part of their research work, Lizzie went on shopping sprees and
charged her purchases to McCormick
.

It’s possible McCormick knew about the travel expenses and didn’t care, just as she didn’t care when she agreed to pay for the renovation of a motel to provide housing for visiting researchers in Worcester; Pincus hired his wife as the decorator and his wife purchased the
furniture from an uncle in Montreal
. It was not unusual in the 1950s for scientists to accept gifts from drug companies or to let those same companies sponsor their travel. Pincus’s behavior was not far from the norm. But it was also true that McCormick was generous and tolerant. Money meant little to her. She had no children to inherit her wealth. She did not collect art or amass real estate. The Pincus project was her great passion. If Mrs. Pincus wanted to buy paintings or pearls, McCormick was not going to raise a fuss about it.

Pincus planned to take not only Lizzie with him to Japan, but also his daughter Laura and one of Laura’s college roommates. The two young women would serve as assistants to Sanger, arriving well before the start of the conference to help take care of logistics. Goody and Lizzie would spend a few days in Los Angeles, followed by a few more in San Francisco, and a few more after that in Hawaii before reaching Japan on October 15. After Tokyo, they planned to visit Hong Kong, Bombay, and New Delhi, where they would meet with researchers, doctors, and political activists concerned with birth control.

Before leaving on his journey, Pincus received a $10,000 check (the equivalent of about $87,000 today) from McCormick’s personal account to pay for his continued work in Puerto Rico and
his upcoming travels
. As always, she was prepared to spend whatever the job required, and as always, she wanted the action to unfold quickly. When John Rock asked if he might accompany Pincus to Japan, perhaps because Rock hoped to keep Pincus from making too many promises, McCormick said no. It wasn’t that she didn’t want to spend the money; it was that she couldn’t bear the thought of having both men
stop work on the pill
.

Despite her health problems and despite the seemingly endless delays in testing the new pill formulas, Sanger was once more filled with hope. The publication of Lader’s biography had given her a new round of press attention. It had been forty years since she’d fled to England to escape a federal indictment. Now, at seventy-five, she was seen not merely as a relic but as a legendary if somewhat wobbly crusader. Women had been more tenacious when she herself was a young woman, she told a young female reporter for the United Press syndicate. Now, the rebellious spirit seemed to have died in many of them. “
You talk to young college women
now and they say there isn’t anything to do,” Sanger complained. The reporter asked her to name the cause she would champion if she were young. Assuming that the birth-control problem had been solved, she said, she would battle to improve the
conditions of women in prison
. She encouraged women to find the issue that mattered most and fight for it. “You must have faith in it,” she said. “I still have it.”

Sanger had faith, but it was still not clear if she would live to see it rewarded. With less than three months to go before the conference in Japan, sharp pains radiated from her chest and she checked into Cedars of Lebanon Hospital in Los Angeles, afraid she was having yet another heart attack. After three days of observation, doctors said it had probably not been a heart attack but angina, chest pain caused by heart muscles that don’t get enough oxygen-rich blood. It was another sign of her advanced coronary heart disease, but it was not serious enough to keep her in the hospital. In a concession to her health, she told her family she planned to retire as president of the International Planned Parenthood Federation—but only after she
attended the conference in Japan
.

TWENTY-TWO

“The Miracle Tablet Maybe”

O
N A COOL
October day in 1955, Margaret Sanger arrived in Japan. Her supporters waved Japanese and American flags. A man cradled a big bouquet of flowers. Newspaper reporters crowded around, their pens ready, and photographers aimed, clicked, and wound their film to snap again, capturing her every move as she stepped off the
President Cleveland
and onto the dock at Yokohama.