On the Pill: A Social History of Oral Contraceptives, 1950-1970.

On the Pill: A Social History of Oral Contraceptives, 1950-1970. By Elizabeth Siegel Watkins. Baltimore: The Johns Hopkins University Press, 1998, 183 pages. Cloth, $25.95.

Watkins has written a low key, well documented account of the development of the oral contraceptive pill (the Pill). Her account is mostly impersonal and unexciting. For example, she mentions Gregory Pincus and his development of the Pill, but gives very little information on Pincus or any of the others involved in the battle. In a sense she is a facts, just-the-facts writer, and in the process of writing this way much of the drama is lost. There could be drama everywhere. For example, there were two contending forms of progestins (synthetic progesterones), Searle's norethynodrel and Syntex's norethindrone. Both were equally effective, but because of Searle's connection with Pincus and the fact that Syntex at that time could not match Searle's distribution network, Searle won out and was able to hit the market first with Enovid. There were dramatic tales to tell in the Puerto Rican trials, but these are not included in Watkins' account. Interestingly, Searle's compound benefitted from an accidental contamination of norethynodrel with a tiny amount of estrogen (mestranaol), a combination which reduced breakthrough bleeding during the cycle of treatment. Searle was so impressed that it revised the manufacturing process to include its incorporation.

The early trials demonstrated that the chemical formulation worked, but the long term effects were left unexamined in the rush to get approval. The FDA got around this by approving use of the Pill for no more than two years at a time.

Inevitably, however, the long term effects became a source of controversy, and Watkins devotes considerable time and space to this. The author attributes this controversy to a growing loss of public confidence in the medical professional in general, the growing strength of consumerism, and the feminist movement. She does not, however, examine or even mention the reformulation of the Pill with much lower doses, which weakened much of the criticism. If she had done so, it would help explain why the issues which roused so much heat, in the long run did not change American support for the Pill. This was true of the issue of thromboembolism which was heatedly debated, but eventually much of the public became convinced that the dangers were slight. The association of the Pill with breast and cervical cancer came later and was also rather heated, but with a similar resolution. She argues, however, that one result of the controversies was the development of a new kind of consumerism. Consumer involvement was encouraged by the press, which sometimes sensationalized the news. This seemingly standard journalistic tactic consisted of presenting testimonials from women who believed they had suffered ill effects from taking the Pill, while at the same time the physicians involved were portrayed as insensitive or negligent. To avoid such charges many physicians simply discouraged their patients from taking the Pill. Planned Parenthood worked hard to counter publicity about the negative effects of the Pill, but in spite of this many women were frightened off.

One result of the controversies was a series of congressional hearings on the Pill under the direction of Senator Gaylord Nelson, who had been investigating the pharmaceutical industry in general. Nelson's committee concluded that both physicians and the FDA relied heavily on the pharmaceutical industry for information about drugs, that the FDA itself was totally dependent on the pharmaceutical industry to arrange for tests and clinical trials, and that the medical profession itself received most of its information from the pharmaceutical industry either in throw away advertisements or from detail men. One good result came from the hearings. Better information accompanied distribution of the Pill, including a required discussion of potential side effects. In retrospect, much of the controversy over the Pill was similar to the controversy over abortion. Many became involved, not simply because they feared the Pill, but because they were opposed to contraception or had some other agenda which the controversy allowed them to publicize. Eventually the public concluded that although there were dangers associated with the Pill, its advantages on the whole more than offset the disadvantages and dangers.

Interestingly, most of the users of the Pill during the period under study were married women, in part because until Bill Baird won his suit, Eisenstadt v. Baird in 1972, physicians were reluctant to prescribe the Pill to single women. The changes was dramatic. Between 1970 and 1975 the number of college women reporting having had sexual intercourse jumped twenty points, from 37 per cent to 50 per cent.

The book concludes with a brief discussion of possible future changes in the history of the Pill, the most radical of which would be to change the Pill from its prescription only status to an over-the-counter drug. Whether or not this happens (and the author summarizes briefly the arguments for both sides), she concludes that in the final analysis, the Pill's legacy to women is the belief in their ability and right to have greater control of their bodies through simple, safe, and reliable contraception. The book has twenty pages of endnotes and a bibliographical essay.

Vern L. Bullough, Ph.D., University of Southern California. Home address: 3304 West Sierra Dr., Westlake Village, CA 91362; e-mail: vbullough@ csun.edu.