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John Rock was christened in 1890 and rail-thin, with impeccable manners; and all other “artificial” methods of birth addressed them as “Mrs.” or “Miss.” His still matters, though, for the simple rea- man of great dignity,” Dr. Sheldon J.
son that in the course of reconciling his and nearly every day of his adult life he calls. “Even if the occasion called for ror. It was not a deliberate error. It be- posture, straight as an arrow, even to his that his faith and his vocation were per- freezing of sperm cells, and was the first into the world, his error has colored the "natural" method of birth control. By that he didn’t mean that it felt natural, through its clinical trials. “It was his mate validity to the claims that the pill meant that it worked by natural means.
Rock. Not long before the Pill’s approval, wrote to him, soon after the Pill was ap- before the F.D.A. about the drug’s safety.
favors gestation. “It is progesterone, in 1960, Rock was everywhere. He ap-
pill. "I can still see Rock standing there, menstrual ‘safe’ period,” Rock wrote.
on CBS and NBC, in Time, Newsweek, Life, The Saturday Evening Post. H e later, “and then, in a voice that would produces a stream of progestin in part for toured the country tirelessly. He wrote a congeal your soul, he said, ‘Young man, don’t you sell my church short.“’ can’t be released and threaten the preg- other words, is nature’s contraceptive.
The Pill's designers assumed that monthly menses were part of the natural order, and took pains that they would be preserved Pill, of course, these hormones weren’t the organs, like sterilization. Rock knew so long as it was intended only as a rem-coming in a sudden surge after ovulation edy for conditions like painful menses or and weren’t limited to certain times in nineteen-thirties, at the Free Hospital “a disease of the uterus.” That ruling em- for Women, in Brookline, he had started boldened Rock still further. Short-term the country’s first rhythm clinic for edu- use of the Pill, he knew, could regulate the cating Catholic couples in natural con- cycle of women whose periods had pre- being given with an additional dose of traception. But how did the rhythm viously been unpredictable. Since a regu- estrogen, which holds the endometrium method work? It worked by limiting sex lar menstrual cycle was necessary for thetogether and-as we’ve come to learn- to the safe period that progestin created.
helps maintain other tissues as well. But And how did the Pill work? It worked by to Rock, the timing and combination of using progestin to extend the safe period hormones wasn’t the issue. The key fact to the entire month. It didn’t mutilate was that the Pill’s ingredients duplicated the reproductive organs, or damage any lar menstrual cycle to use the Pill in what could be found in the body natu- natural process. “Indeed,” Rock wrote, oral contraceptives “may be character- And if that was true why not take the ized as a ‘pill-established safe period,’ logic one step further? As the federal and would seem to carry the same moral judge John T. Noonan writes in “Con- implications” as the rhythm method.
traception,” his history of the Catholic The Pill was, to Rock, no more than “an position on birth control: ural” method of regulating procreation: adjunct to nature.”it didn’t kill the sperm, like a spermicide, or frustrate the normal process of pro- Pill for Catholics, so long as its contra- to achieve a regularity necessary for success- fully sterile intercourse, why was it not law- creation, like a diaphragm, or mutilate ceptive effects were “indirect’‘-that is, ful to suppress ovulation without appeal to rhythm? If pregnancy could be prevented bypill plus rhythm, why not by pill alone? In each case suppression of ovulation was usedas a means. How was a moral differencemade by the addition of rhythm? may seem, were central to the devel-opment of oral contraception. It was cided that the Pill ought to be taken overa four-week cycle-a woman wouldspend three weeks on the Pill and thefourth week off the drug (or on a pla-cebo), to allow for menstruation. There typical woman of childbearing age has amenstrual cycle of around twenty-eightdays, determined by the cascades of hor- mones released by her ovaries. As firstestrogen and then a combination of es-trogen and progestin flood the uterus,its lining becomes thick and swollen,preparing for the implantation of a fer-tilized egg. If the egg is not fertilized,hormone levels plunge and cause the lin- ing-the endometrium-to be sloughedoff in a menstrual bleed. When a womanis on the Pill, however, no egg is released, because the Pill suppresses ovulation.
The fluxes of estrogen and progestin that cause the lining of the uterus togrow are dramatically reduced, becausethe Pill slows down the ovaries. Pincus and Rock knew that the effect of thePill’s hormones on the endometrium to menstruate. “In view of the ability ofthis compound to prevent menstrualbleeding as long as it is taken,” Pincus acknowledged in 1958, “a cycle of anydesired length could presumably be pro-duced.” But he and Rock decided to cutthe hormones off after three weeks andtrigger a menstrual period because they continuation of their monthly bleedingreassuring. More to the point, if Rock no more than a natural variant of therhythm method, he couldn’t very welldo away with the monthly menses.
the Pill had to produce regularity as well.
recognizable by its packaging: that small,round plastic dial pack. But what wasthe dial pack if not the physical embod-iment of the twenty-eight-day cycle? It to fit into a case “indistinguishable” froma woman’s cosmetics compact, so that itmight be carried “without giving a visualclue as to matters which are of no con- cern to others.” Today, the Pill is still them have held on to their ancestral cus- ers, in many respects, live much as people of that region have lived since antiquity.
cise reproductive profile of the women in of birth control seem as natural as possi- the tribe, in order to understand what fe- ble. This was John Rock’s error. He was ouflaged coil on the seat she sat on while bathing. The villagers, she says, were of two minds: was it a deadly snake---Kere natural after all, and the Pill he ushered thing other than what he thought it was.
In John Rock’s mind the dictates of reli- sixties: What is natural? Only, her sense of “natural” was not theological but evo- treat. “I told him that white people aren’t ural selection established the basic pat- totem,” Strassmann says. "I can still see In 1986, a young scientist named Bev- history of our species-how often did it. Bloated and charred. Stretched by research site was the village of Sangui in thorn Savannah, green in the rainy sea- fore, but never so thoroughly that an- and a half years. “I felt incredibly privi- son and semi-arid the rest of the year.
leged,” she says. "I just couldn’t tear my- onions, raise livestock, and live in adobe houses on the Bandiagara escarpment.
the fringes of the village. In Sangui,there were two menstrual huts-dark,cramped, one-room adobe structures, to stay outside on the rocks. “It’s not a place where people kick back and enjoythemselves,” Strassmann says. “It’s sim-ply a nighttime hangout. They get there at dusk, and get up early in the morningand draw their water.” Strassmann took urine samples from the women usingthe hut, to confirm that they were men- the women in the village, and for herentire time in Mali-seven hundred kept track of everyone who visited thehut. Among the Dogon, she found, a at the age of sixteen and gives birtheight or nine times. From menarche,the onset of menstruation, to the age oftwenty, she averages seven periods a greatly affected by differences in diet or through the pages until she found them.
"Look, she had twenty-nine menses over significant factors, S trassmann says, are things like the prevalence of wet-nursing three.” Next to each of their names was a or sterility. But over all she believes that solid line of X's. “Here’s a woman ap- fifty, as her fertility rapidly declines, she page. “She’s cycling but is a little bit er- the “demographic transition’ of a hun- tionary tems abnormal. “It’s a pity that few periods, then got pregnant again.
of a converted stable next to the Natural study period.“There weren’t a lot of X’s of evolutionary medicine, this shift from page listed, on the left, the first names line, broken into thirty-day blocks.
statistics apply to every preindustrial so- marked with an X. In the village, Strass- they call “incessant ovulation’ has be- cell division. Progestin also counters the who takes the Pill for ten years cuts her ovarian-cancer risk by around seventyper cent and her endometrial-cancer risk by around sixty per cent. But here “nat- Pill was natural because it was an unob-trusive variant of the body’s own pro-cesses. In fact, as more recent researchsuggests, the Pill is really only natural inso far as it’s radical-rescuing the ovariesand endometrium from modernity. ThatRock insisted on a twenty-eight-daycycle for his pill is evidence of just howdeep his misunderstanding was: the real promise of the Pill was not that it couldpreserve the menstrual rhythms of the twentieth century but that it could dis-rupt them.
child, her lifetime risk of ovarian cancer cebo interval to two days. Patricia Sulak, a medical researcher at Texas A. & M.
associated with breast-feeding, she stops cell division. The argument is similar for the Pill’s monthly “off” week is. In a paper in the February issue of the journal of potentially dangerous cell division.
they point out, is “one of the most serious quently spare the endometrium that risk.
on the Pill: during the placebo week, the sequences, in part, of a century in which after all, occurs because as cells divide mistakes that cripple the cells’ defenses most fifty per cent. In other words, some a “natural” effect. By blocking the release ence the kinds of side effects associated erally increases as we age: our cells have traceptives reduces the rounds of ovarian per is a short, dry, academic work, of the also means that any change promot- ing cell division has the potential to in- crease cancer risk, and ovulation appears quences of John Rock’s desire to please his church. In the past forty years, mil- that puncture, the cells of the ovary wall to what end? To pretend that the Pill was no more than a pharmaceutical versionof the rhythm method? sity of Southern California, travelledto Japan for six months to study at the Pike wasn’t interested in the effects ofthe bomb. He wanted to examine themedical records that the commissionhad been painstakingly assembling onthe survivors of Hiroshima and Na- that would ultimately do as much tocomplicate our understanding of the Pill as Strassmann’s research would a decade breast-cancer rates six times lower thanAmerican women? around the world, and the breast-cancerdisparity between Japan and Americahad come to obsess cancer specialists.
The obvious answer-that Japanesewomen were somehow genetically pro- tected against breast cancer-didn’tmake sense, because once Japanese often as American women did. As a re-sult, many experts at the time assumedthat the culprit had to be some unknowntoxic chemical or virus unique to the Pike’s at U.S.C. and his regular collabo-rator, says that when he entered the field,in 1970, “the whole viral- and chemical-carcinogenesis idea was huge-it domi-nated the literature.” As he recalls, “Breastcancer fell into this large, unknown boxthat said it was something to do withthe environment-and that word ‘envi-ronment’ meant a lot of different thingsto a lot of different people. They mightbe talking about diet or smoking orpesticides.” came fascinated by a number of statisti-cal pecularities. For one thing, the rateof increase in breast-cancer risk rises sharply throughout women’s thirties and forties and then, at menopause, it starts to slow down. If a cancer is caused bysome toxic outside agent, you’d expect that rate to rise steadily with each ad- had their first period at fourteen. That difference alone, by their calculation, was sufficient to explain forty per cent of the tablet that suppressed ovulation-and breast-cancer rates. “They had collected gestin that come with it-obviously something specific to a woman’s repro- amazing records from the women of that ductive years. What was more, younger area,” Pike said. “You could follow pre- breast-cancer drug. But the breast was women who had had their ovaries re- cisely the change in age of menarche breast cancer; when their bodies weren’t cancer because it suppressed ovulation.
producing estrogen and progestin every age of menarche of Japanese girls went It was good for preventing endometrialmonth, they got far fewer tumors. Pike nutrition and other hardships. And then lating effects of estrogen. But in breast it started to go back down after the war. cells, Pike believed, progestin wasn’t the cell division similar to that of ovarian That’s what convinced me that the data solution; it was one of the hormonesand endometrial cancer. The female that c a u s e d cell division. This is one ex- breast, after all, is just as sensitive to the level of hormones in a woman’s body then folded in the other risk factors. Age as the reproductive system. When the at menopause, age at first pregnancy, that it has no effect one way or the other breast is exposed to estrogen, the cells of and number of children weren’t suffi- on breast cancer: whatever beneficial ef- American woman weighed a hundred body’s own contraceptive. But Pike saw amounts of progestin, the pace of cell di- nothing “natural” about subjecting the plained another twenty-five per cent of breast to that heavy a dose of proges- It made intuitive sense, then, that a the difference. Finally, the researchers tin. In his view, the amount of prog- analyzed blood samples from women in estin and estrogen needed to make an rural Japan and China, and found that effective contraceptive was much greater posed to during her lifetime. How old a extremely low-fat diet-were produc- woman is at menarche should make a ing about seventy-five per cent the excess was unnecessarily raising the risk big difference, because the beginning of amount of estrogen that American factors, added together, seemed to ex- press ovulation without using progestin.
cells of an adolescent appear to be highly plain the breast-cancer gap. They also Throughout the nineteen-eighties, Pike recalls, this was his obsession. “We were pregnancy the cells of the breast mature more weight, and produced more es-and become much more resistant to trogen. The talk of chemicals and tox- P ike’s proposed solution is a class of aside. “When people say that what we disrupt the signals that the pituitary how much estrogen and progestin her understand about breast cancer explains gland sends when it is attempting toovaries actually produce, and even how only a small amount of the problem, order the manufacture of sex hormones.
that it is somehow a mystery’ it’s ab- It’s a circuit breaker. “We’ve got sub- solute nonsense,” Pike says flatly. He is a stantial experience with this drug,” Pike South African in his sixties, with gray- says. Men suffering from prostate can- ing hair and a salt-and-pepper beard.
woman born at the turn of the century understand breast cancer extraordinar- had her first period at sixteen and a half ily well. We understand it as well as we understand cigarettes and lung cancer.” sexual maturity. If you give GnRHAs to well, a little bit pregnant, Pike’s pill avoid side effects.’ So we did a study, and we found that there were huge changes.” firm operates out of a small white indus- had published in the Journal of the Na- tional Cancer Institute showing breast tle the size of a saltshaker, with a white plastic mister on top. It will be inhaled paint store, another looks like some sort of export company. Balance’s offices are fore they start,” he said. Amid the grainy is a tiny reception area, a little coffee table and a couch, and a warren of desks, kind of relentless cell division that in- creases breast-cancer risk. Next to those puters. Balance is testing its formulation for breast cancer, and if the results con- the Pill. Ideally, Pike says, the estrogen the activity inside the breasts,” Pike went of years ago,” Pike said recently, as he on. “White is a proxy for cell prolifera- tion. We’re slowing down the breast.” Balance garage, “he said, ‘Why don’t year mythology of “natural” and sweep it aside. “Women are going to think, I’m of Santa M o n i c a arguing that he knew being manipulated here. And it’s a per- fectly reasonable thing to think.” Pike’s years of stimulating the breast. If you cut thousands of women around the world.
South African accent gets a little stron- risk not by half but by half raised to the power of 4.5." He was working with a
extraordinary change in female biology.
out of a bottle. This was, to say the least, calculate breast-cancer risk. “That’s lawyers, doctors, presidents of countries.
are trying to do isn’t abnormal. It’s just it would be otherwise. It won’t be zero.
You can’t get to zero. If you use this for ten years, your risk will be cut by at least half If you use it for five years, your risk will be cut by at least a third. It’s as if your least, had lent the cause of birth control ten years younger—forever." The regi- Pill seem like the least radical of inter- woman’s purse and pass without notice.
was thirty-one. That’s the way manywomen are now. They ovulate from twelve or thirteen until their early thir- ties. Twenty years of uninterrupted ovu-lation before their first child! That’s abrand-new phenomenon!” JohnRock’s long battle on behalf of his just after Rock’s book was published, a Planned Parenthood. That summit wasfollowed by another, on the campus ofthe University of Notre Dame. In the summer of 1964, on the eve of the feastof St. John the Baptist, Pope Paul VIannounced that he would ask a commit- tee of Church officials to reexamine theVatican’s position on contraception. Thegroup met first at the Collegio San Jose,in Rome, and it was clear that a major-ity of the committee were in favor of leaked to the National Catholic Register be winning. Rock was elated. Newsweekput him on its cover, and ran a picture century that the sun was the center ofthe planetary system has the Roman perilous collision course with a new body of knowledge,” the article concluded.
Paul VI, however, was unmoved. Hestalled, delaying a verdict for months,and then years. Some said he fell underthe swav of conservative elements withinthe Vatican. In the interim, theologiansbegan exposing the holes in Rock’s argu-ments. The rhythm method ‘prevents’conception by abstinence, that is, by thenon-performance of the conjugal actduring the fertile period,” the Catholic journal America concluded in a 1964 ed- itorial. “The pill prevents conception bysuppressing ovulation and by thus abol-ishing the fertile period. No amount of July 29, 1968, in the “Humanae Vitae” encyclical, the Pope broke his silence,declaring all “artificial” methods of con-traception to be against the teachings of opportunity that Rock missed. If he hadknown what we know now and hadtalked about the Pill not as a contracep-tive but as a cancer drug-not as a drug to prevent life but as one that would save life-the Church might well have saidyes. Hadn’t Pius XII alreadv apnroved as Pike thinks of it: as a drug whose con- his reasons aren’t hard to imagine. The attracting users, of getting, as Pike put it, nis. In 1983, he gave his last public in- ments of its faith with the results of his science, and if the Church couldn’t rec- ing time of his life was. “Right now,” the inventor of the Pill answered, incredibly.
He was sitting by the fire in a crisp white he loved most. This was not John Rock’s shirt and tie, reading “The Origin,” Ir- error. Nor was it his church’s. It was the ving Stone’s fictional account of the life fault of the haphazard nature of science, mid-seventies and the early eighties, the of Darwin. “It frequently occurs to me, advance of understanding. If the order of responsibilities, and I have everything I ical School, meanwhile, took over Rock’s our world, too, would have been a differ- a year to live. “I was an ardent practic- ing Catholic for a long time, and I really whether he still believed in an afterlife.

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