The Birth of the Pill: How Four Crusaders Reinvented Sex and Launched a Revolution (37 page)

“Presumably,” Pincus told Sanger in a letter, “
any physician may prescribe it
for any purpose which he considers valid.”

In other words, with the arrival of Enovid, a pill for birth control was on the market and available by prescription for the first time, even if it was not yet official and not yet openly referred to as a birth-control pill.

That, however, did not mean Pincus’s work was done.

“
While we are convinced
of its contraceptive action,” Pincus said, “Dr. Rock and I are not ready to recommend its universal use.” They were still concerned with long-term health risks and short-term side effects. Studies on the long-term effects would take at least another year or two, he said. But there was good news: If doctors all over the country began prescribing Enovid, whether for menstrual disorders or for birth control, Pincus and Rock would soon receive more feedback on the drug’s effects than they could ever hope to glean from ongoing studies in Puerto Rico. They wouldn’t get blood and urine tests from these new customers, but they would receive anecdotal evidence. If the pill worked, women would tell their friends, and sales would take off. If it did not, or if the side effects were too great for many women to tolerate, Searle would see a drop in orders and Pincus and Rock would no doubt hear directly from many of the prescribing physicians.

Convinced he was on the brink of a great accomplishment and that his progestin-based pills really might be the world’s answer to the problem of birth control, Pincus began spreading the word. He used the connections he had long been building as the leader of the Laurentian Hormone Conference, and he encouraged scientists around the world to launch their own experiments with Enovid. Around this time, he made a trip to Paris to give a lecture on his latest findings. When the sponsor of his lecture presented him with an honorarium, rather than taking the check home and depositing it in the bank or turning it over to the Worcester Foundation, he decided to
give himself a treat
. He applied the money toward the purchase of a silver Citröen DS 19, acclaimed at the time as the most technologically advanced car in the world, with power steering, power disc brakes, and a hydropneumatic suspension that would raise the car ten inches off the ground with the tug of a lever. The Citröen was sleek, sexy, and looked like something out of the future. Pincus had it shipped home, where he became even more of a terror on the roads of Worcester and Shrewsbury.

Pincus’s days of hardship were long behind him now, and it was apt that he was driving faster than ever in a car that called attention to its driver. His work on the birth-control pill was a full-throttled race to the finish. But in the 1950s, such bold and hurried approaches to new medicine were not unusual. To receive government approval for a new drug, the manufacturer needed to submit the results of animal and human testing, as well as materials showing how the drug would be marketed. But the FDA, overwhelmed at the time by requests for new drug approvals and badly understaffed, paid more attention to some things than others. It looked carefully to see if drugs were effective, for example, but less carefully at whether the drugs were safe. In part, that explains why all along Pincus wanted to keep doses of the pill at ten milligrams, which he knew was perhaps higher than necessary. Above all else he wanted to be certain Enovid would prevent pregnancy. The FDA’s final decision, he understood, would not be based on how many women were tested or on how many of those women experienced side effects. The key was the pill’s success rate, and Pincus was determined that the rate should be very near 100 percent.

If the pill was more effective by a wide margin than any other form of contraception, Pincus felt confident the FDA would approve it. The agency approved other drugs with known side effects, including penicillin, which caused life-threatening allergic reactions in some patients; tetracycline, which interfered with bone growth and discolored teeth; and Dilantin, which was known to cause heart irregularities. In all those cases, the rewards were deemed greater than the risks. Pincus believed the same standard would apply to Enovid.

To help encourage doctors to prescribe the pill, Searle sent a letter in July to hundreds of obstetricians, gynecologists, and general practitioners, informing them that Enovid was on the market and that it might do more than its advertisements suggested. “There is adequate evidence,” the letter said, “to indicate that the drug will inhibit ovulation when the physician so chooses and that it is
safe for this purpose in short term medication
.”

It was not the ideal way to get feedback. There was an obvious risk involved. If the drug did serious damage it would be too late for many of the women using it.

On October 1, 1957, a few months after Enovid went on sale in the United States, another so-called wonder drug reached the market in Europe. It was advertised as a sleeping pill so safe and free of side effects that even pregnant women could safely use it. In fact, it also had the benefit of reducing morning sickness, so pregnant women began using the drug even if they weren’t suffering from insomnia. In some European countries, the medicine became more popular than aspirin.

Within months, a few physicians began to report problems. Some elderly patients using the new drug experienced giddiness and a slight disturbance of balance. Others suffered dizziness, trembling, and cold hands and feet. But the drug’s manufacturer, Chemie Grünenthal, shrugged off the reports, assuming that there was nothing seriously wrong with their hottest-selling new product, that it was doing far more good than harm, and that in the end it would prove perfectly safe.

But thalidomide proved far from safe.

In the years to come, thousands of children around the world whose mothers had taken the drug while pregnant were born with serious physical disabilities, including flipper-like arms and legs. Many of them were abandoned by their parents and institutionalized. Others had their flippers amputated so they could be fitted with prosthetic arms and legs.

But as Enovid went on sale in the United States, the horrors of thalidomide had yet to be discovered. The age of the wonder drug rolled on, unblemished, as Enovid got its chance.

The article about birth control in
Ladies’ Home Journal
triggered a chain reaction. Soon there were articles in
Science Digest
, the
Saturday Evening Post
, and newspapers all over the world. The waves of publicity did more than rouse the ire of officials at Searle and leaders of the Catholic Church. It sent women in search of the drug, which Searle was still in the process of rolling out. Some of them, frantic, appealed directly to Pincus for help.

A woman from Indianapolis wrote:

I’m about 30 years old [and] have six children. . . . We have tried to be careful and tried this and that, but I get pregnant anyway. When I read this article I couldn’t help but cry, for I thought this is my ray of hope. As of yet can these anti-pregnancy pills be purchased? Where—How can I get them? Please help me. . . .
I beg you please help me if you can
.

A man who worked at the University of Chicago wrote, “
To save my married daughter
from risking her life by making 3 times of artificial abortions during last year’s time, I beg you to send her some of the tablets.”

“
I absolutely need your help
,” wrote a thirty-year-old woman in Canada who was pregnant at the time with her fifth child. “I do not think that I am fitted to raise 10 or more children—it costs too much and my husband is not giving me much help to educate my [here she crossed out “our”] children. . . . Please help me!”

But if officials at Searle were angry with Pincus for attracting too much attention, their anger didn’t last. It quickly became clear that demand for the new drug was greater than anyone had imagined.

For young women, the arrival of Enovid in 1957 was a major event. All their lives women had been told birth control was illicit, forbidden, a violation of nature. Now, the federal government declared that if you had an irregular cycle—and every woman could reasonably claim her cycle was irregular—you could get a prescription for a pill that would make you regular and also protect you from pregnancy.

Some doctors asked more questions than others, and some asked no questions at all. But women—married and not—quickly learned which physicians were willing to write prescriptions and made a beeline to their offices.

Men noticed, too.

“I remember . . . when it became legal,” Hugh Hefner said. “It made a big impression on me at the time. I recognized the importance of it. . . . I recognized it as exactly what it was:
a powerful weapon
.”

In the years ahead, Hefner would argue in the pages of
Playboy
that this weapon should be used to launch a sexual revolution, making intercourse an expression of love instead of merely a means of procreation. Asked if he could remember the first time he had sex with a woman who was taking Enovid, Hefner laughed. “
I don’t remember that
,” he said. “The nature of the pill is such that a guy would not necessarily be focused on that. Of course, from 1960 on I think all the women I knew were on the pill.”

The weapon was being put to use with verve, with joy, with excitement, trepidation, passion. Searle did not have to market the pill as birth control because men and women were learning for themselves what it could do. It didn’t hurt, either, that the FDA had required the drug company to include a warning on each bottle that said Enovid prevented ovulation. In other words, the real purpose of the drug was listed as if it were a side effect.

As it turned out, said Searle’s I. C. Winter, “
It was like a free ad
.”

TWENTY-NINE

The Double Effect

“G
OOD EVENING,” THE
TV newsman said, his shoulders squared, eyes locked on the camera, cigarette smoke drifting toward his resolute face. “What you’re about to witness is an unrehearsed, uncensored interview on the issue of birth control. It will be a free discussion of an adult topic. . . . My name is Mike Wallace, the cigarette is Philip Morris.”

It was September 21, 1957, an
unusually warm and humid day
in New York City, when Sanger arrived at the studio to be interviewed. Wallace, her interviewer, was thirty-nine years old, a former radio and stage actor, and had risen to fame on television a year earlier as a confrontational interviewer who seemed to enjoy making his interview subjects, and perhaps even his audience, uncomfortable. He described his own style as “
nosy, irreverent, often confrontational
.” Wallace might have liked Sanger. They both were tireless combatants, after all, as well as massive egotists. But Wallace wasn’t looking for a friend as he sat down with her for their interview; he was looking for a fight. Sanger’s chief appeal to him at the time, he said, “was as a figure of controversy,
an intrepid gadfly who had the temerity
to challenge the moral authority of the Roman Catholic Church.” Wallace came out swinging, and Sanger, appearing uncomfortable on camera, stepped into every punch.

Wallace asked long and complicated questions, at times quoting newspaper articles and Sanger’s personal letters that dated back decades, and asking her to respond to controversial comments she or others had made. Sanger pursed her lips and nervously scratched at her neck and scalp. She had difficulty completing her thoughts at times.

Wallace began by accusing Sanger of abandoning her children and husband as a young woman because she craved “this joy, this freedom” that the birth-control movement offered. After that, he began pushing Sanger to explain her religious beliefs. Did she believe in God? In sin? Did she consider infidelity a sin? Divorce? Murder?

Sanger tried to respond assertively, saying she believed the greatest sin was bringing unwanted children into the world. But Wallace wasn’t having it.

“
May I ask you this
?” he continued. “Could it be that women in the United States have become too independent—that they followed the lead of women like Margaret Sanger by neglecting family life for a career? Let me quote from your biography describing your second marriage to Noah Slee. Quote, ‘In New York Mrs. Sanger maintained every clause of their compact of independence. They had separate apartments—they telephoned each other for dinner or theatre engagements or passed notes back and forth.’ Would you call this a sound formula for marriage Mrs. Sanger?”