The Birth of the Pill: How Four Crusaders Reinvented Sex and Launched a Revolution (34 page)

Dr. Rice-Wray began distributing birth-control pills in early April 1956. She would give each woman a bottle full, enough to last twenty days. “When the bottle is over and you start menstruating,” she would tell her patients, “you count one, two, three on your fingers and when you have counted all your fingers that is the time to
start again” on a new bottle.
Even though she tried to keep the instructions simple, mistakes occurred. At least one patient went home and
took all the pills at once
. Others shared them with friends. The doctor, nurses, and social workers tried handing out calendars. They tried giving the women beads on a string to help them count. Nothing worked.

Still, Rice-Wray assumed that over time women would get the hang of it.

Soon another problem arose. Less than three weeks into the trials, a reporter for
El Imparcial
, a San Juan newspaper, learned of the experiment and called public health officials for comment. Was it true that a birth-control pill was being tested in Rio Piedras? Rice-Wray received a call from one of her supervisors, asking her to confirm that she was in fact working on a birth-control experiment. Rice-Wray said yes, but she was doing it on her own time, with private funding. The public health office had nothing to do with it. Patients were not being seen in health department offices or by health department personnel.

Her boss was skeptical but took her word for it.

The newspaper story that ran the next day began, “
A woman dressed as a nurse
and who alleges to be working for the state government is distributing . . . some pills to avoid conception and to counteract the increase in population in Puerto Rico.” The article went on to claim that Dr. Rice-Wray had “confessed” to directing the project. Her boss was quoted saying he believed it was a “bad combination” for government employees to participate in such work.

After the newspaper story appeared, thirty women dropped out of the trials. Some of them did so because their husbands objected, others because they were worried about what their priests would say, and still others because they were
experiencing unpleasant side effects
. Soon, a group of Catholic social workers sponsored a program on one of the local TV stations in San Juan in an attempt to discourage women from participating in the trials. After six months, an additional forty-eight women had quit, leaving only about
twenty of the original one hundred
. The controversy also forced Rice-Wray to resign from her job at the health department, although she would continue working for the Family Planning Association of Puerto Rico. “It’s obvious,” she wrote in a letter to Pincus, that she caused her boss at the health department “too much discomfort with my planned parenthood activities. I was told by someone . . . ‘They respect you but
they are afraid of you
.’ ” Rice-Wray worried about how to replace the lost income. She had two children to care for, and she was concerned that she might soon be too old to find a job that would pay well and offer long-term security. She warned Pincus that, while she was committed to their work in Puerto Rico,
she would have to drop it
if a good job came along.

Over time, the Catholic propaganda campaign backfired and the controversy disappeared, although Rice-Wray would soon announce plans to leave Puerto Rico for a job in Mexico. In the meantime, though, she and the nurse Iris Rodriguez went door to door in Rio Piedras and wrote an article of their own for a local newspaper. In the article and in their conversations with the women of Rio Piedras, they offered reassurance about the safety of the pill while intentionally leaving out mention of the fact that the pill was still experimental. “
We will only say
that it is being made by the Searle Co. and well known manufacturers, that it is not in the market, that it has proved to be a wonderful contraceptive and that we only have a small amount for special cases,” Rodriguez wrote in a May 8 letter to Pincus.

In some cases, women who had not yet heard about the new contraceptive learned about it in church. They would listen on Sunday as their priests made fiery sermons about a forbidden pill, and on Monday they would arrive at Dr. Rice-Wray’s office asking what exactly was forbidden and
how they could get it
.

“Continually they are ringing this office and asking for the pill, going to see Dr. Rice-Wray and
calling on me when I make the visits
,” Rodriguez wrote.

There was another unintended consequence of the Catholic campaign: Many of the women who dropped out of the program quickly became pregnant. As they walked through the streets of Rio Piedras, their stomachs swollen, they served as moving billboards for birth control. Or, as one doctor involved in the testing put it, “their unwanted plight became
a major convincing influence for others
where they lived.”

After a slow start, the study was never again at a loss for volunteers. By the end of 1956, 221 women had participated. Seventeen of those women had gotten pregnant—a fact that might have been troubling to some scientists, but not to Pincus. The pregnancies had nothing to do with the pill, he told Katharine McCormick in a letter following his visit to the island. Women were getting pregnant because they weren’t following instructions. They either forgot to take the pill every day or chose not to take it because the
side effects were becoming too much
to bear. There were two ways to fix that problem. First, he would need to work with the Puerto Rican doctors and social workers to help them better educate the women participating in the experiment and have doctors give them more regular checkups. Second, he would see if he could do something to reduce the pill’s side effects.

To Pincus, however, the success stories registered more than the side effects. On his visits to Puerto Rico he met or heard the stories of some of the women taking his pill.

Herminia Alicoa was thirty-two years old, with three children from her first husband and two from her second. Her husband had recently been released from an insane asylum (for the third time) but refused to undergo sterilization. She began taking the birth-control pill
seventeen days after delivering
her youngest child.

Julia Garcia was thirty years old and had ten children between the ages of sixteen years and ten months. Her husband was sick and he drank heavily, forcing Garcia to perform odd jobs to support her family. Her husband refused to be sterilized or to let her undergo sterilization. Her husband had never allowed her to use any form of contraception and insisted on having sex with her every day. She signed up for trials of the pill because it was the first form of contraception she’d encountered that she could use without her husband’s knowledge.

Fanny Quines was thirty years old with five children ranging in age from eight years to sixteen months. Although she was a Seventh-day Adventist and her religion prohibited her from using birth control, she had tried several methods in the past. Since the birth of her youngest child, she had not menstruated. But when she enrolled in the trials and started taking the birth-control pill, her normal periods returned.

Pincus and Rice-Wray were both pleased with the results of women such as these, but Rice-Wray continued to worry about the side effects more than Pincus did. She tallied the numbers: Among the first 221 women in the study, 38, or about 17 percent, reported negative reactions to the drug, and at least 25 women withdrew from the study specifically because of those reactions. There were twenty-nine complaints of dizziness, twenty-six complaints of nausea, eighteen for headaches, seventeen for vomiting, nine for abdominal pain, seven for weakness, and one for diarrhea. Other women complained of bleeding in between their periods, but Rice-Wray said most of those women were able to stop the bleeding by doubling their doses of the pill.

In December 1956, she and Pincus traveled to Skokie, Illinois, to present their findings to top officials at G. D. Searle, who would soon face a decision about whether to offer Pincus’s pill to the masses and put their company’s reputation and financial future on the line. The company had already patented norethynodrel and had recently trademarked a name for the new drug. They called it Enovid.

Jack Searle, the company’s president, sat in on the all-day meeting of scientists. John Rock was there, too, along with Dr. Celso-Ramón Garcia, who was working in Rock’s clinic and assisting with the research in Puerto Rico.

Pincus, of course, remained bullish. He was ready to expand the studies with an eye on seeking approval from the Food and Drug Administration. Rock was more cautious. He called the data collected so far “meager” and pointed out that about 20 percent of women participating in the trials reported nausea or breast pain. Rock made no comment, however, on how seriously those side effects should be taken. He was certainly not suggesting that the tests should be suspended.

There was only one woman in the room that day, and that was Rice-Wray. She didn’t raise her voice or accuse the men of callousness. She spoke to them in the language they understood best, that of the scientist.

“Enovid gives 100 percent protection against pregnancy in ten-milligram doses taken for twenty days of each month,” she said. “However, it causes too many side effects to be acceptable generally.” In her view, Enovid was not good enough. Not yet, anyway.

TWENTY-SIX

Jack Searle’s Big Bet

“S
EX BEFORE MARRIAGE?”
Sue Dixon asked with a chuckle. “Well, maybe some of my friends. I was married a virgin.”

She gave her husband a warm grin before adding, “But it was nip and tuck.”

Sue Dixon’s father was Jack Searle, the man who would make the final decision in 1956 as to whether the Skokie, Illinois–based drug company would attempt to become the first in the world to market an oral contraceptive.

Sue’s husband, Wes Dixon, smiled across the living room at his wife and elaborated on some of the nipping and tucking that took place in the early 1950s, before they were married. “
I took her up to Michigan
on a hunting trip and I tried to get into her bedroom,” he recalled, “and she said, ‘Nope, we don’t do that.’” And they didn’t. Not until they were married.

Sue and Wes met at a cotillion dance in 1951. They married in May 1953, had their first daughter eleven months later and their first son eighteen months after that. Then, while some of her friends continued to have babies every year or so, Sue took a break. How?

“I went on the pill,” she said. “No side effects. Nothing. It was great.”

The pill had not yet been approved by the FDA. In fact, Goody Pincus (“Nice, fun guy,” Sue said) was still tinkering with its composition. But Sue and Wes Dixon had no second thoughts about becoming early adopters. “When you’re in the pharmaceutical business, your outlook is different,” Wes recalled.

Sue remembered discussing the pill with her gynecologist, who was also one of her father’s golf partners. Her gynecologist wasn’t concerned with her taking an experimental drug, but he was concerned with the social aspects of such an innovation. What would happen, he asked, if men and women could have sex “anytime, anywhere, without having a baby?” What would it do to marriage, to relationships, to the nip and tuck of courting?

It was not a question Pincus or officials at Searle were asking. They were like pioneers pulling wagons west across uncharted lands, focused only on the terrain immediately before them and the promise of something better but as yet only glimpsed far in the distance. Would the pill work? Was it safe? Would the FDA allow them to sell it? Would American women go for such a thing? If the answers to those questions came back in the negative, everything else—including Sue’s gynecologist’s concerns about sex “anytime, anywhere”—would be moot. It was best not to focus too much on the unknowable.

But Sue Dixon was one of the first women in America to try the birth-control pill for birth control. Her experience not only offered an important clue as to how women would respond to the new contraceptive, it also may have informed her father’s decision about whether to put his company’s reputation and resources behind one of the most daring and controversial pharmaceutical products in history.

In 1956, G. D. Searle was one of the country’s smaller drug companies. Gideon Daniel Searle, a Civil War veteran, had founded the business in 1888 with a partner in Omaha, Nebraska, after building a small chain of drug stores in Indiana. Family legend has it that Gideon distinguished himself as a caring pharmacist and a smart businessman by dyeing aspirin in a range of colors and selling them to patients based on their various ailments—pink for headaches, blue for general pain, and so on. Two years after founding the company, they moved it to Chicago. Soon after, Searle split with his partner and started calling his operation G. D. Searle & Co.

Gideon’s son Claude, a physician, took over the company in 1909. But it was Claude’s son, John G. Searle, who made the business big. Jack, as everyone called him, joined the company in 1923 after studying pharmacology at the University of Michigan. Instead of copying drugs already developed by other companies, Jack Searle hired researchers to design new products. That was his most important contribution early on. In 1934, the company hit on a winner with Metamucil, a laxative, and by 1936 the firm had sales of more than one million dollars.