DESIGNING THE POPULARITY OF THE DALKON SHIELD by KATHRYN GOLDBERG Submitted in partial fulfillment of the requirements for the degree of Master of Arts Thesis advisor: Dr. Jonathan Sadowsky Department of History CASE WESTERN RESERVE UNIVERSITY May, 2012 CASE WESTERN RESERVE UNIVERSITY SCHOOL OF GRADUATE STUDIES We hereby approve the thesis/dissertation of Kathryn Goldberg ______________________________________________________ M.A. History candidate for the ________________________________degree *. Dr. Jonathan Sadowsky (signed)_______________________________________________ (chair of the committee) Dr. Alan Rocke ________________________________________________ Dr. James Edmonson ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ 4/2/12 (date) _______________________ *We also certify that written approval has been obtained for any proprietary material contained therein. ii Copyright © 2012 by Kathryn Goldberg All rights reserved iii For my mother, For my father, who taught me the who taught me the value of empathy. joy of curiosity. iv Table of Contents List of Figures …………............................................................................................................................. 2 Acknowledgements ................................................................................................................................. 3 Abstract ......................................................................................................................................................... 5 Text ................................................................................................................................................................. 6 I. Introduction ................................................................................................................... 7 II. Historiography ........................................................................................................... 14 III. Development .............................................................................................................. 20 IV. Re-Marketing and the End .................................................................................... 62 V. Conclusion ................................................................................................................... 68 Appendix..................................................................................................................................................... 71 Research Locations ............................................................................................................................... 72 Works Cited .............................................................................................................................................. 73 1 List of Figures Figure 1 Dr. Hugh J. Davis ........................................................................................................ 11 Figure 2 Dalkon Shield Distribution Data......................................................................... 12 Figure 3 A Dalkon Shield.......................................................................................................... 27 Figure 4 The Flying Uterus Advertisement...................................................................... 45 Figure 5 They Like the Boss.................................................................................................... 56 Figure 6 “How Much They Made”......................................................................................... 65 2 Acknowledgements This paper could not have been completed without the considerable support of many individuals and organizations. Dr. Jonathan Sadowsky sparked my interest in the history of medicine in the Fall of 2008. The discussion-based style of the class made me want to be a historian from the first day. The Dittrick Museum of Medical History and its employees, especially Dr. James Edmonson and Ms. Jennifer Nieves, encouraged this interest and were always generous when imparting knowledge of contraceptive history. Dr. Alan Rocke has continuously offered his thoughtful advice and read several drafts of this thesis, having been kind enough to step in as an acting thesis advisor. Dr. Kenneth Ledford offered considerable knowledge of how to construct a Dalkon Shield historiography. I would like to thank the SAGES program for their generous financial support, without which I could not have gone to Washington D.C. and Charlottesville, VA in order to conduct the requisite primary research for this project. The SOURCE office at Case Western Reserve University graciously arranged for the funding from SAGES to be administered. In Washington, Dr. Stephen Garber offered considerable advice on how to manage government archives and documents. There are few words to describe my gratitude to the individuals at the University of Virginia Law Library. The friendship and unwavering support from Special Collections Archivist, Ms. Cecilia Brown, meant the world to me. She helped me with everything from finding a place to live, to navigating the enormous breadth 3 of documentation in the Dalkon Shield Claimants Trust Collection. In every archive and library I encountered, I found friendly faces and welcome advice. This work would not have been possible without the support of my friends and family. Many of these wonderful individuals have read through several drafts of my thesis, or patiently sat through one of my excitable rants on an obsolete medical device. Any mistakes in this document are solely of my own doing and appear despite the excellent advice and guidance of the people mentioned in this section. 4 Designing the Popularity of the Dalkon Shield Abstract by KATHRYN GOLDBERG The 1960s were a time of rapid change in the field of contraception. A few ambitious physicians saw an opening in the birth control market for a highly effective contraceptive that would not contain synthetic hormones. The Dalkon Shield, an IUD, developed by Dr. Hugh Davis, was one such contraceptive. However, the device that Davis promoted and the A.H. Robins Company sold was neither as effective nor safe as claimed. There were numerous instances of corporate misconduct on the part of Robins. Many have decried the device as a deadly tool of corporate henchmen. The truth is more complicated than such a simple morality tale. Loopholes in federal legislation permitted a faulty device to be released in the consumer market, and cultural deference for physicians came before the complaints of female users. This combination of male-dominated social structures, and a lack of governmental consumer protection, permitted this modern medical disaster. 5 Highlight our ‘success-story’ (we certainly have one to tell) to the non-believers and non-users, dwelling on the fantastic acceptance of the Dalkon Shield… George J. Mancini1 A ‘Non-believer’ Mary Bolint had plenty to celebrate.2 She was engaged to a wonderful man, Ned Ripple, and a junior at the University of Arizona with plans to continue onto law school. This proactive woman refused to blindly entrust her birth control choices to a physician. Mary carefully studied her contraceptive options and the available statistical information prior to making a birth control decision. The Dalkon Shield seemed the clear winner among health conscious feminists in 1970. Her physician agreed with the decision, and he inserted the device shortly before her wedding. The first several months were plagued with heavy and intolerably painful periods. Mary’s doctor patronizingly disregarded her concerns, and eventually the uterine pain lessened. However, about a year after the insertion, Mary was overcome by a wave of nausea while grocery shopping. That night she was rushed to the hospital on suspicion of appendicitis. The surgeons were surprised to find a healthy appendix, but large infectious abscesses covering her ovaries. The abscesses 1 George J. Mancini, ‘National Review: Sales and Marketing’, March-April 1972, Reel 20, Dalkon Shield Claimants Trust, University of Virginia Law Library, page 2. This quote has been included to demonstrate the dichotomy between Robins’ employee’s perception of the Dalkon Shield and the public uproar against the device. 2 Mark Dowie and Tracy Johnston, “A Case of Corporate Malpractice.” Mother Jones Magazine, November 1976, 36-50. 6 were drained and she was sent home. At this time, there were no public reports of infections caused by IUD use. The Dalkon Shield was left in place. Over the next four months Mary would undergo four more surgeries, be legally dead for a brief time, and have the IUD and her reproductive organs removed. Mary Bolint would never have children, and her health would be forever altered by the lack of essential hormones the ovaries normally release until menopause. She was one of the many women who brought suit against the A.H. Robins Company, but the money could not reverse the resultant infertility. I. Introduction The 1970s were a challenging time for many Americans. Their faith in trusted institutions was shaken as scandals splashed across the front pages of newspapers. The American public, reading about Watergate and watching the horrors of the Vietnam War play out on television, began to have serious doubts about the abilities of their government. The Thalidomide disaster and the racism of the Tuskegee experiments