Fifties (98 page)

Later, some critics claimed that Rock was no more than a front man. In fact he was a good deal more than that. He was the perfect choice, as a doctor, to take the experiment from the lab and move it into the real world of people. His was a powerful presence, a doctor of great distinction and originality whose own work and social ideas were taking him ever closer to the work of Pincus and his team. “If you went to doctors in New England in those days,” said Oscar Hechter, “and asked who was the best obstetrician in the region, you would almost surely be told that it was John Rock—he was a formidable figure.” He was also a man of singular independence. Rock’s courage was admired by both Hoagland and Pincus, but they knew he was a brilliant clinician as well, not merely a theorist as they were. When they had created the Worcester Foundation, they had wanted more than anything else to make it a
relevant
institution (after all, they spent much of the war studying the biological aspects of fighter-pilot fatigue, and they had also done advanced work on the biochemistry of schizophrenia), so Rock was a man whom they would have invented had he not lived, a bridge from their world of the abstract to a world of real people with real medical problems.

Rock was the son of a small-town businessman in Marlborough, Massachusetts: His ancestors were Irish Catholics. He finished Harvard College in three years, went on to Harvard Medical School, and soon became a prominent professor of gynecology. When he married Anne Thorndike in 1925, the cardinal of Boston himself performed the ceremony, something he had done only once before, for Joe and Rose Kennedy. But the Catholic Church almost stopped the ceremony. The day before his wedding, Rock performed a cesarean section, an operation then forbidden by the Catholic Church. At confession, a local priest refused to absolve him and thus it was impossible for him to receive the sacrament of marriage. But William Cardinal O’Connell overruled the priest.

Rock was in many ways a very conservative man. He argued against the admission of women to Harvard Medical School and often told his own daughters that he did not think women were capable of being doctors. But his views on birth control evolved steadily. In 1943, when he was fifty-three years old, he had come out for the repeal of legal restrictions on physicians to give advice on medical birth control. But he added at the time: “I hold no brief for those young or even older husbands and wives who for no good reason refuse to bear as many children as they can properly rear and as society can properly engross.” In the mid-forties, although scrupulous about not offering contraceptives to his own patients, he
began to teach his young students at Harvard Medical School how to prescribe them. Years later he would pinpoint the late forties as the time when he became aware of what he called “the alarming danger of the population explosion.” He began to fit some of his patients with diaphragms, which so enraged some of his Catholic colleagues that they tried to have him excommunicated. In 1949 he wrote a book with David Loth called
Voluntary Parenthood,
which was a comprehensive survey of birth-control methods available for the general public. His colleagues admired him because he so seriously wrestled with questions of morality. In many ways the transformation of his own values reflected those taking place among many in the middle class. Although he remained a serious Catholic who regularly attended mass, he became even blunter about his changing views on population control. Indeed, after the introduction of the Pill, he said, “I think it’s shocking to see the big family glorified.” When the Pill first came out, he received an angry letter from a Catholic woman who excoriated him for his role in its development. She told him, “You should be afraid to meet your maker.” “Dear Madam,” he wrote back. “In my faith we are taught that the Lord is with us always. When my time comes, there will be no need for introductions.” Still, Rock’s primary motivation in joining with Pincus was for the opposite problem that Pincus and his team were working to solve. He wanted to help couples who, despite all physiological evidence to the contrary, were unable to have children. In the past he had had some success injecting the women with natural progesterone.

He gave the progestin steroids to a group of fifty childless women at his clinic, starting in December 1954. The dosage was 10–40 milligrams for twenty successive days for each menstrual cycle. When the women came off the progestin, seven of the fifty, or 14 percent, were able to get pregnant. That was wonderful news for Rock. In addition, there was among the fifty a virtual 100 percent postponement of ovulation. That was wonderful news for Pincus and Chang. Pincus became so confident that he had begun to refer to “the Pill.”

So these three very different men began to work together. Each of the three had his own private doubts. Rock, the good Catholic, still worried about the morality of what he was doing; Chang was wary of capitalist exploitation, uneasy about placing his scientific skills in the service of drug companies (Pincus had to reassure him constantly that what he was doing was for the good of the society and that the drug companies did not matter); and Pincus himself,
constantly racing against the clock, wondered if what they were doing was safe. But even as they were making rapid progress, Kate McCormick remained impatient. On one occasion, after John Rock returned from a brief vacation, she wrote Margaret Sanger, “I was able to get hold of Dr. Rock today.... I did not want to leave him for fear that he would escape!” What seemed to them a speedy process was terribly slow to McCormick.

By the fall of 1955 Pincus was so optimistic that he decided to go and talk publicly about his research at the International Planned Parenthood meeting in Tokyo. He asked Rock to join him, but Rock was uneasy about it; he felt that the results while so far very positive, were not yet adequately conclusive and that Pincus was on shakier ground than he realized. He was also sensitive about making the announcement at what he considered a politicized event—a meeting of birth-control advocates. It was the closest the two men came to a break. Pincus and Chang desperately wanted Rock to add his name and considerable prestige to the announcements they intended to make in Tokyo. At the time, a disappointed Pincus felt that Rock was being too timid. Rock, by contrast, felt his colleagues were going too fast for the evidence. “He [Pincus] was a little scary,” Rock told Paul Vaughan years later. “He was not a physician and he knew very little about the endometrium, though he knew a good deal about ovulation.” If anything, noted Mahlon Hoagland, the son of the director, who himself later became the Worcester Foundation’s director, Rock was right, and Pincus and Chang probably did exceed their evidence, by talking not just about what they had accomplished with animals, but dwelling on the implications for humans. “They did it,” the young Hoagland noted, “because they were restless, talented mavericks, cocky and arrogant, very good and aware of being very good—it was what made Worcester such a wonderful place to work.” Rock did not go, and in fact urged Pincus not to go.

What they all needed now were more patients and a broader selection of them: It was one thing to succeed with middle-class, college-educated women, who would be disciplined about taking the Pill, but what about poorer, less well educated women? Would they be as careful? Puerto Rico and Haiti were chosen as locales for mass testing. These places were perfect for their needs—poor and overcrowded. Public officials were more than ready for a serious study of birth control. (There was no small irony in the choice of Puerto Rico. At that time the primary birth control was for a woman to go to the hospital and demand the
operación,
which was a sterilization procedure. As Puerto Ricans migrated to New York, they went to New
York’s hospitals with the same request, but under New York law, not every woman who wanted to be sterilized had that right. Under pressure from this growing new Hispanic population, the law was changed.)

In April 1956, the tests began on one hundred women in a poor suburb of San Juan. It had been exceptionally easy to get volunteers; the problem was keeping other women out. The pill used was Enovid, made by Searle, whose officials were nervous about being associated with Pincus in the program and whose top public relations officials warned that this activity might destroy their good name. (A few years later, as they were preparing to market Enovid publicly in America and their research showed overwhelming public acceptance, they swung around 180 degrees and considered calling it The Pill. “After all, if you could patent the word Coke for Coca-Cola why not ‘The Pill’ for the oral contraceptive? So we kicked the idea around. But we never took any action,” said James Irwin, a Searle public relations executive.) The early returns from Puerto Rico were very good: In the first eight months, 221 patients took the Pill without a single pregnancy. There were some side effects, primarily nausea, but Pincus was able to reduce them, by adding an anti-acid. Soon the tests were being expanded to other areas in Puerto Rico, and to Haiti as well.

Pincus’s daughter, Laura, took some time off from her studies at Radcliffe to help with the tests in Puerto Rico. Upon her return to Boston she was sent to brief Kate McCormick, who lived in a grand mansion in Back Bay, a foreboding house that seemed to have neither lights nor life to it. Laura Pincus was, in her own words, rather naive about sex and she got a little flustered talking to this old woman about the experiments then taking place. But Kate McCormick did not become unsettled: She talked openly and frankly. The sex drive in humans was so strong, she kept insisting, that it was critical that it be separated from reproductive functions. She followed that with a brief discussion of the pleasures of sex and then added rather casually that sex between women might be more meaningful. This was spoken dispassionately, not suggestively. Nonetheless, young Ms. Pincus was stunned. Here she was in this nineteenth-century setting hearing words that seemed to come from the twenty-first century. Then, knowing that her visitor had to take the subway back to college, Mrs. McCormick summoned her butler, who brought her a silver tray with coins. She reached down and picked out two dimes and handed them to her visitor. Later, after she left, Laura Pincus looked down at the coins and noticed they were minted in 1929.

But if the breakthrough was near, Margaret Sanger remained on a wartime footing. In 1957 she made her first television appearance, on the Mike Wallace show, and the reaction stunned even Sanger. There was so much hostile mail that for the first time in her life, she was wary of reading it. “The R.C. Church,” she wrote in her diary at the time, “is getting more defiant and arrogant. I’m disgusted and worried. No one who was a worker in defense of our Protestant rights has got to accept the Black Hand from Catholic influence. Young Kennedy from Boston is on the Stage for President in 1960. God help America if his father’s millions can push him into the White House.”

It was an extraordinary triumph for Pincus. Pincus, claimed Oscar Hechter, was the prototype of a new kind of biologist, the engineer of “a conscious use of science to effect social change in the interests of man and civilization.” By so doing he was able to “liberate humanity from an immediate social threat and to remove restraints from the full development of uniqueness of men and women alike.” Pincus began to travel around the world, talking with great enthusiasm of the coming breakthrough in contraception. He would tell his audiences “how a few precious facts obscurely come to in the laboratory may resonate into the lives of men everywhere, bring order to disorder, hope to the hopeless, life to the dying. That this is the magic and mystery of our time is sometimes grasped and often missed, but to expound it is inevitable.” It was, his friends thought, the great validating moment of his professional life.

Some people in Planned Parenthood still thought Pincus was too optimistic and precipitous, but his optimism was now shared by Rock. They were both now pushing for acceptances of the Pill, and they were getting results: In 1957, the U.S. Food and Drug Administration authorized the marketing of the Pill for treatment of miscarriages and some menstrual disorders. By 1959 both Pincus and Rock were convinced that Enovid was safe for long-term use by women. In 1959 Pincus completed a paper on the uses of Enovid for oral contraception and sent it to Margaret Sanger. “To Margaret Sanger,” he wrote, “with affectionate greetings—this product of her pioneering resoluteness.”

In May 1960, the FDA approved Enovid as a contraceptive device. By the end of 1961 some 408,000 American women were taking the Pill, by the end of 1962 the figure was 1,187,000, and by the end of 1963 it was 2.3 million and still rising. Of it, Clare Boothe Luce said, “Modern woman is at last free as a man is free, to dispose
of her own body, to earn her living, to pursue the improvement of her mind, to try a successful career.”

The discovery made Searle a very rich company. To Chang’s great regret, the Worcester Foundation never took any royalty. Nor, in the eyes of the Worcester people, was Searle generous in later years. Despite several representations on behalf of Pincus’s family and of the Worcester people, Searle paid only three hundred dollars a month in benefits to his widow. When the Worcester people suggested repeatedly to Searle that the company might like to endow a chair at the Worcester Foundation in Pincus’s honor, Searle not only declined but soon afterward donated $500,000 to Harvard to endow a chair in reproductive studies. It was the supreme indignity—rewarding the institution that had once denied Pincus tenure with a chair in his own specialty. To Pincus’s colleagues in Worcester, it appeared that no good deed went unpunished. Nor were the Searle people very generous with Chang. Years after the Pill’s development, Hudson Hoagland suggested that Searle (which was making millions) might give some financial aid to Chang, who was by the standards of science making very little. “Who the hell is M. C. Chang? We’ve never heard of him,” a Searle executive asked. When that story was related to Chang, he quoted Confucius: “Do not get upset when people do not recognize you.” “I hope,” he added with a sardonic touch, “Chairman Mao will say the same.”