In the 1950s, four people — the founder of the birth control movement, a controversial scientist, a Catholic obstetrician and a wealthy feminist — got together to create a revolutionary little pill the world had never seen before.
They were sneaky about what they were doing — skirting the law, lying to women about the tests they performed and fibbing to the public about their motivations.
"They absolutely could've been imprisoned for some of the work they were doing," journalist Jonathan Eig tells Fresh Air's Terry Gross. "These guys are like guerrilla warriors — they're always having to figure out ways to do this thing that will attract the least attention. ... They can never really say they're testing birth control."
Eig tells the history in his new book The Birth of the Pill: How Four Crusaders Reinvented Sex and Launched a Revolution.
The four people who created this revolution were: Margaret Sanger, who believed that women could not enjoy sex or freedom until they could control when and whether they got pregnant; scientist Gregory Pincus, who was fired from Harvard for experimenting with in-vitro fertilization and bragging about it to the mainstream press; John Rock, who was a Catholic OB-GYN and worked with Pincus to conduct tests of the pill on women; and Katharine McCormick, who funded much of the research.
In the '50s, selling contraception was still officially illegal in many states.
But Sanger and McCormick, a feminist who had been active in the suffrage movement, wanted women to enjoy sex — without fear of getting pregnant.
After McCormick's husband died, McCormick got in touch with Sanger.
According to Eig, McCormick said, "What's the most important thing we could possibly work on?"
"Sanger said, 'The best thing we could possibly do is work on this pill, this miracle tablet ... something that would give women the right to control their bodies for the first time.' And McCormick said, 'I'm in: Whatever you need.' "
On why Eig wanted to write the book
I was listening to a rabbi's sermon — this was maybe five or six years ago — and he began by saying that the birth control pill may have been the most important invention of the 20th century. My immediate reaction was, "That's nuts. That can't possibly be. I can think of six things off the top of my head that seemed more important than that." But it stayed with me. I kept thinking about it.
A couple of years went by and I was still thinking about it. His case was that it had changed more than just science, more than just medicine. It had changed human dynamics. It had changed the way men and women get along in the world. It changed reproduction, obviously, but it also created all kinds of opportunities for women that weren't there before, it had spread democracy. ...
If it really was the most important invention of the 20th century, and maybe he was right, why don't I know how we got there? I don't know the inventor of the pill. I can tell you the inventor of the telephone and the telegraph and the light bulb, but I have no idea where the pill came from.
On American Birth Control League founder Margaret Sanger seeking a "magical pill"
Sanger's story is personal in some respects. She had seen her own mother die after having given birth to what she felt like were far too many children and far too great a sexual drive on her father's part. She went to work in the slums of New York City where women were having eight, nine, 10 children with no idea how to stop it, other than having abortions, which were often poorly performed and very dangerous. So she saw this stuff very up close. ...
There had been this backlash against the control of fertility in the late 1800s and early 1900s, where it had been made illegal even though the fertility rates had been dropping over the course of the 18th century.
But by the time you get to Sanger and she's a young woman working in New York City, it's very hard for women to get any kind of education even about birth control, much less birth control products. She has this plan to improve education for women. But her dream, and it's really just a dream, is that there should be some kind of magical pill — something that would allow women to turn on and off their reproductive systems.
On scientist Gregory Pincus and his controversial work
Pincus was fired from Harvard. In fact, he was denied tenure because he was far too controversial. In the 1930s, he was not only experimenting with in-vitro fertilization, he was bragging about it to the mainstream press, which is something serious scientists weren't supposed to do.
Instead of just publishing his results in medical journals, he was taking them to popular magazines and saying, "This is the brave new world!" And people were scared of the Brave New World because of the Huxley book, but Pincus didn't mind the comparisons. He said, "Someday we will control [how] babies are born. We might not even need men in the process. We will be able to control the giving of life through science." This scared the hell out of people.
Harvard, which had once hailed Pincus' research as some of the most important research it had ever done, suddenly quit on him, cut ties completely and he was unable to find a job anywhere else in the world of academics. He ended up working out of a garage for a little while, out of a barn for a bit, and then founded his own scientific institution on really a wing and a prayer, going door-to-door in the community of Worcester, Mass., knocking on doors, asking people to contribute to his scientific foundation. So he was a real fringe character at the point that Margaret Sanger and Katharine McCormick found him.
On Pincus working with fertility gynecologist, John Rock, testing injections on unknowing women
There's a lot of lying in this process of creating the first oral contraceptive. That's what they have to do. You can really have a wonderful ethical discussion and debate about whether it was worth it, whether they were doing things that were beyond the bounds. The laws and the ethics of science were very different in the 1950s than they are today — you didn't have to give informed consent, you didn't have to have anybody sign forms giving away their rights, telling them about what these experiments are for. So in a way, we do have women being treated like lab animals so that we may find a form of birth control that frees them. There's a great irony there.
On how they sought Food and Drug Administration approval
This is the first pill ever created for healthy women to take every day. There's never been anything like this and the idea of seeking FDA approval for something women are going to take every day without studying it for years and years and checking out the long-term side effects, this is scary stuff! But Pincus also feels like he's racing the clock, that if the word gets out about this and the Catholic Church and the federal government realize what they're doing, the opposition will mount and he'll have no chance of getting it through. ...
In 1955, when they've really only tested the pill on maybe 60 women for more than say, six months or a year, Pincus goes to a conference and declares victory. He declares that we've invented the pill. The media picks up on this and it becomes this huge story. ... Thousands of women are writing to their doctors and writing directly to [Pincus and Rock] saying, "I've heard about this pill and I need it, I need it now!" ... There was this huge outpouring and it had a huge effect on Pincus and on the other scientist working on this because they began to see there was an enormous demand for this and they began to see they had to push harder, they had to go fast. When you go fast in science, you're taking great risks. ...
It's one of the great bluffs in scientific history. [Pincus] knows that he has the science. He's not sure that it's really ready; he hasn't tested it on nearly enough women. His partner John Rock is saying, "Don't you dare announce that we're ready to do this yet. If you do, I'm out." He's furious with Pincus. But Pincus does it anyway. He realizes that they've got some momentum and they need to keep it going, this whole thing could fall apart if too much opposition is raised.
On manufacturing the pill
As a result of all of the publicity, the G.D. Searle pharmaceutical company agreed to manufacture the pill and to apply to the FDA for approval, but Pincus and Searle come up with yet another sneaky but brilliant idea. They decide, "We're not going to ask the FDA to approve it as birth control because that will raise a whole bunch of other issues. ... Let's just ask them to approve it for menstrual disorders." ... Almost any woman can go into her doctor and say, "I've got an irregular cycle. I'd like to have this new pill." And that's exactly what happens. The pill has a label on it that says, "Warning: This pill will likely prevent pregnancy." And it's the greatest advertisement they could ever have — because this is what women want.
On McCormick realizing her accomplishment
One of the scenes in this book that I love is — Katharine McCormick, who is even older than Sanger, she's 80 now and the pill is approved, it's available, and she goes into the drugstore with a prescription from her doctor and asks for it. This 80-year-old woman is going in and asking for a prescription for the birth control pill and obviously she wasn't planning to use it — she just wanted to be able to buy it. It meant so much to her to know this was available now to women, 60 years too late for her, in many ways, but she had done it and that was an amazing accomplishment.
TERRY GROSS, HOST:
This is FRESH AIR. I'm Terry Gross. For as long as men and women have been making babies, they've also been trying not to, writes my guest Jonathan Eig. His new book is a history of how the birth control pill was created. It's titled "The Birth Of The Pill: How Four Crusaders Reinvented Sex And Launched A Revolution." The four people he writes about are Margaret Sanger, the mother of the birth control movement who believed that women could not enjoy sex or freedom until they could control when and whether they got pregnant, Gregory Pincus, the scientist Sanger enlisted to lead the research effort into the pill, John Rock, a Catholic obstetrician gynecologist who worked with Pincus and conducted tests of the pill on women, and Katharine McCormick, the wealthy feminist who funded much of the research. Eig also writes about the social climate during the '50s when the research was conducted and contraception was still officially illegal in many states.
Jonathan Eig, welcome back to FRESH AIR. Why did you want to write a book about the history of the pill?
JONATHAN EIG: You know, I was listening to a rabbi sermon - this is maybe 5 or 6 years ago - and he began by saying the birth control pill may have been the most important invention of the 20th century. And my immediate reaction was, that's nuts; it couldn't possibly be. I could think of six things of the top of my head that seemed more important than that, but it stayed with me. I kept thinking about it, and then I thought if it really was the most important invention of the 20th century, why don't I know how we got there? I don't know the inventor of the pill. I can tell you the inventor of the telephone and the telegraph and the light bulb, but I have no idea where the pill came from. And it struck me as odd that it would have been invented at all, especially in the 1950s when men were controlling all of business and all of the pharmaceutical industry. So my curiosity really got peaked by that and I started looking into the story.
GROSS: It's so interesting that a rabbi (laughter) inspired you to write the book (laughter).
EIG: Right. Not a Catholic priest. That would have made a better story.
GROSS: Not Catholic priests, yes, very much (laughter). So, well, let's start with Margaret Sanger, which is where your story really begins. She was the founder of what became Planned Parenthood. She was a staunch advocate of birth control in the early 20th century and onward. To her, a birth control pill was essential if women were going to be equal to men and free to choose their life. Why did she emphasize the importance of the development of a birth control pill?
EIG: Well, Sanger's story is personal in some respects. She had seen her own mother die after having given birth to what she felt like were far too many children and far too great a sexual drive on her father's part. And she went to work in the slums of New York City where women were having eight, nine, 10 children with no idea how to stop it other than having abortions, which were often poorly performed and very dangerous. So she saw the stuff very up-close and saw it very personally and took it very personally. And there had been this backlash against the control of fertility in the late 1800s and early 1900s where it had been made illegal even though fertility rates had been dropping over the course of the 18th century.
But by the time you get to Sanger and she's a young woman working in New York City, it's very hard for women to get any kind of education even about birth control, much less birth control products. And she has this plan to try to improve education for women, but her dream - and it's really just a dream - is that there should be some kind of a magical pill, something that would allow women to turn on and off their reproductive systems. And she spends 30, 40 years on this quest looking for a birth control pill and being told by every scientist she approaches that no way, they wouldn't go near it and even if they could go near it, it probably wouldn't work.
GROSS: So she wanted birth control so that women could choose how many children they had and when they had children, and she was also very pro-sex and wanted women to be able to enjoy sex without fearing that it was going to lead it to pregnancy.
EIG: That's right. Sanger was a beautiful, young woman and had a great many affairs, had a couple of husbands and encouraged her husbands to have affairs. And she really thought that sex was an important part of not just a marital relationship, but it was good for the soul. And, you know, she came from this Freudian school where she believed that there was just great power to be derived, great joy to be derived from sex and that it was an important part of developing your psyche.
GROSS: So another key person in your story is Katharine McCormick who married a very wealthy man who turned out to be schizophrenic. He died years later and left her the sole heir to his estate. So suddenly she was a very, very wealthy woman and she wanted to use some of her money to help fund birth control. So she would write Margaret Sager. And what's the outcome of the relationship that they create together?
EIG: These two older women now - they're both in their '70s - come back together. They had worked together in the suffrage movement. Before Katharine McCormick had gotten married, she'd been active in the suffrage movement. Once her husband got sick and became institutionalized, she devoted most of her life to his care and to research trying to find a cure for schizophrenia. But after he was gone and left her all this money, she got back in touch with Sanger and said, what can we do? What's the most important thing we could possibly work on? And she's basically saying, I want to do the biggest possible thing we can. Where are we on birth control? Because she'd been active in that, too, during the suffrage movement. And Sanger said the best that we can possibly do is work on this pill - this miracle tablet she called it - something that would give women the right to control their bodies for the first time. And McCormick said, I'm in, whatever you need; tell me how much money it's going to cost.
GROSS: So how much money did McCormick end up giving over the years?
EIG: Oh, many millions, certainly in today's dollars. At the time she was really just a blank check. She would write for new labs, for creating whole new buildings. She single-handedly funded this entire project. There was no government money that went into the development of the pill, no university money. There was a little bit of money from the pharmaceutical company, Searle. They got involved very late in the process, but in the beginning was all Katharine McCormick.
GROSS: And this starts in around 1950, that she writes to Sanger and says, what should I be doing? I want a new project.
EIG: That's right. She's ready to go, and Sanger is thrilled to have somebody wanting to fund the project, but she's got nowhere to go with it; she's got nobody to give the money to because there's not a single scientist in America that she's found that's willing to go anywhere near this project.
GROSS: So Margaret Sanger has the drive. She thinks the birth control pill is the most important thing that women can have. Katharine McCormick has the money to fund the research. They need scientists to do the work, and not only aren't scientists reaching researching a birth-control pill, it's illegal in some states - including in Boston where the research ends up getting done - to do anything related to contraception.
EIG: That's right. Birth control is illegal in 30 states, and the federal government has laws against it. You're not allowed to even give out information about fertility control. Condoms are available widely, so there's this great discrepancy and great sexism involved there. Men can get this fairly crude form of birth control, but women have nothing.
GROSS: So how did Margaret Sanger find Gregory Pincus, the scientist who ends up being the key person in the development of the pill?
EIG: Well, interestingly enough when Katharine McCormick was working on cures for schizophrenia, she became interested in hormones. And Katharine McCormick was not just a wealthy heiress; she was a scientist. She had been one of the first women to graduate from MIT with a degree in science. So she knew a little bit about this new research going on in hormones, and mankind was really just beginning to understand how hormones control the body. And she began to think that maybe hormone research would cure her husband's schizophrenia.
And during her research, McCormick met some scientists doing work on hormones in the Boston area. And one of them was Gregory Pincus, this biologist who was at Harvard at the time and was doing some of the most interesting work on human reproduction. And she asked him if she would consider doing work on schizophrenia. But after husband died, she came back and remembered that this guy, Gregory Pincus, had been doing some interesting work with hormones. And she wondered if Pincus might be interested in taking up this project on what would become the birth control pill.
GROSS: But he wasn't researching contraception. He was in use researching in vitro fertilization in lab animals, like rabbits.
EIG: That's right. Gregory Pincus was perhaps the worst world's leading expert on mammalian reproduction, mostly working on animals. And he was mostly concerned with how you might produce more farm animals more efficiently. But he knew his way around the human body, and he knew his way around hormones, which were still pretty new at the time. And there weren't that many doing people doing this kind of research, so McCormick just sort of made a connection that maybe Pincus would be interested.
GROSS: And Pincus, the scientist, was considered kind of disgraced because some people thought of him as, like, a Frankenstein because he was experimenting with in vitro fertilization.
EIG: That's right. And Pincus was fired from Harvard, in fact, and denied tenure because he was far too controversial. In the 1930s, he was not only experimenting with in vitro fertilization, he was bragging about it to the mainstream press, which is something serious scientists weren't supposed to do. Instead of just publishing his results in medical journals, he was taking them to popular magazines and saying, this is the brave new world. And people were scared of the brave new world because of the Huxley book. But Pincus didn't mind the comparisons. He said, someday, we will control the way babies are born. We might not even need men in the process. And this scared the hell out of people. And Harvard, which had once hailed Pincus' research as some of the most important research it had ever done, suddenly quit on him and cut ties with him completely. And he was unable to find a job anywhere else in the world of academics.
He ended up working out of a garage for a little while, out of a barn for a bit and then founded his own scientific institution on really a wing and a prayer, going door-to-door in the community of Wooster, Massachusetts, knocking on doors asking people to contribute to his new scientific foundation. So he was a real fringe character at the point that Margaret Sanger and Katharine McCormick found him.
GROSS: And so he certainly needed Katharine McCormick's money to do the work.
EIG: Yeah, that was the first thing he said when he met Sanger. And Sanger said, do you think you could make a birth control pill? His first answer was, yes, absolutely I can, if you have the money.
GROSS: This is FRESH AIR. If you're just joining us, my guest is Jonathan Eig, author of the new book "The Birth Of The Pill," which is the history of the invention of the birth control pill. The pill was researched and developed in the 1950s. You point out that at the time, sex was rarely studied by scientists. Place this early research on the pill in the context of the research that Kinsey was doing and that Masters and Johnson were doing on human sexuality.
EIG: This began before Kinsey and Masters and Johnson really made their splash. So they're really far ahead of the curve here. And it's important that Pincus and Sanger are really able to get this going by not talking too much about sex. They talk more about the population control issue. Sanger's very clever about this. For her, it begins with sex. And she's very interested in allowing women to have sex for pleasure, but she never talks about that. She talks more about population control because that's the issue that's on the agenda in 1950.
After the war, people are concerned that population is growing too quickly, especially in developing countries and that these countries might turn over to Communism. So that's the issue they key on as much as possible. There's really very little talk about sex, and Sanger and McCormick and Pincus are very careful in those early years not to make this about sex. They know what it can do, but they're not talking about that yet.
GROSS: And as we mentioned, contraception is still illegal outside of certain dire circumstances where a woman is at risk and her doctor can prescribe contraception for those women, but that's it. So describe what the Comstock Law was. This is a law passed in 1873.
EIG: Yeah, Anthony Comstock, after the Civil War began getting Americans fired up about improving our morals - the morals of this country - that pornography was out of control and began passing laws - first the federal law, and then other states passed their own. They called them mini-Comstock Laws. And every state in the union began to not only outlaw pornography, but outlawed contraception along with that because it was seen as contributing to immorality.
And, you know, in these early days of outlawing abortion and outlawing attempts to control fertility, they were never talking about the rights of the fetus. It was not really a religious or a moral issue so much as it was about the role of women. It was about women not being allowed to behave in ways that were seen as un-motherly. A woman's role really was to have children. And sex was for having children, and anything other than that was not acceptable.
GROSS: So the Comstock Law, or the Comstock Act, banned the use of the mail - it's a federal law - so it banned the use of the mail for transporting, quote, "any obscene, lewd, lascivious or filthy book pamphlet, picture, paper, letter, writing, print or other publication of an indecent character." And then you say each state enacted its own obscenity laws, many of which include selling or disseminating information on contraception, and Massachusetts was one of those states that passed such a law.
One of the things I found fascinating in your book, which I didn't know, was that Anthony Comstock, who had been a special agent for the YMCA Committee for the Suppression of Vice when he persuaded Congress to pass the Comstock Act, he as a young man had been an obsessive masturbator. And he blamed - later, he blamed this obsessive masturbation on - you know, on smut. And that's why he became such, like, an anti-pornography, anti-obscenity activist. That's pretty interesting.
EIG: Freud would have had a field day with Anthony Comstock. And so often we see that - we see that these things come out of personal experiences, that there's really no rational reason that Comstock would make this his crusade that - after the Civil War, we had a lot bigger problems to worry about in our cities and all over the country. But he makes this his crusade to wipe out vice and along the way, to wipe a contraception, which really, you know, has very little to do with that. But it's about repression.
GROSS: So the scientists in Massachusetts who were doing work on the birth control pill, if authorities, legal authorities, knew that their real goal was a birth control pill, would they have been subject to imprisonment?
EIG: Yes, they absolutely could have been imprisoned for some of the work they were doing. It's important to remember that Pincus began his research with lab animals. There's nothing wrong with that. You can certainly do that. But when they begin testing on women, that's a different story. And that's why they had to be so clandestine about the whole thing. One of the things I love about this story is that these guys are like guerrilla warriors. They're always having to figure out ways to do this thing that will attract the least attention or in ways that are disguised so that they can never really say they're testing birth control.
GROSS: So what do they say?
EIG: Well, it's important just for a little bit of background. When Sanger comes to Pincus and says, can you make a birth control pill, Pincus has this immediate response; well, there already is a birth control, hormone. And the body produces it. It's called progesterone, and when a woman gets pregnant, she doesn't get pregnant again because the body is producing progesterone to protect the fetus. So if we could just take that progesterone and give it to women in the form of an injection or a pill, she presumably would not get pregnant. That's his theory that he's operating on. And he tests that in lab animals, begins giving progesterone to rabbits and rats, and sure enough they don't get pregnant.
When it comes time to test it on humans, though, that's a very different story. Nobody knows what effect this is going to have. You know, they're petrified that this could permanently render women infertile. Margaret Sanger has been very explicit about this. She wants a pill that will work when women want to protect themselves, but when they stop taking this pill, they need to be able to get pregnant again. So when Pincus gets ready to start thinking about testing this progesterone on women, he's got a real issue; how's he going to find women to do this? How's he going to do it without getting arrested? And this is where he comes up with the first of his brilliant and somewhat sneaky ideas.
He goes to one of the world's leading fertility specialists and leading gynecologists - a man named John Rock, a doctor at Harvard, a Catholic, one of the most respected men in his field. And he says, I hear you've been working with women who are seeking help with their infertility. How would you feel about giving them progesterone? And Rock, says, well, won't that shut down their reproductive systems? And Pincus says, yeah, exactly. But then when they stop taking it, maybe they'll get pregnant, and it'll be kind of like, you know, giving their bodies a rest, giving their reproductive systems a rest. They won't get pregnant while they're on the progesterone, and then when you stop taking it, maybe they'll get pregnant again.
And Rock thinks this seems plausible, you know, he's worked with progesterone before, actually. He's experimented with it. And he approaches his patients, who trust him completely because he's such a wonderful doctor and just a - has a great way with his patients. And that's how they begin. They begin by giving the pill to - actually they start with injections because they haven't found yet the way to make it into a pill - but they start by giving progesterone to women who are coming to their gynecologists, seeking help with infertility.
GROSS: That seems like such a lie.
EIG: There's a lot of lying in this process of creating the first oral contraceptive. That's what they have to do, and you can really have a wonderful ethical discussion and debate about whether it was worth it, whether they were doing things that were beyond the bounds. Now, the laws and the ethics of science were very different in the 1950s than they are today. You didn't have to give informed consent; you didn't have to have anybody sign forms giving away their rights, telling them about what these experiments were for. So in a way, we do have women being treated like lab animals so that we may find a form of birth control that frees them. There's a great irony there.
GROSS: Of course, I guess you could also argue in terms of the ethics, it was absolutely the only way that scientists could do the research since things pertaining to birth control were outlawed.
EIG: That's right. If they weren't willing to do this thing on the sly, they weren't going to be able to do it at all.
GROSS: So John Rock, the scientist who'd been experimenting with hormones, one of the reasons why Gregory Pincus chose him is that Rock was Catholic. And that was important to Pincus because Pincus was Jewish, and he was afraid that if he enlisted one of the Jewish researchers - and there were a couple of top researchers who were Jewish working in the area of hormones - that anti-Semitism would kick in for him.
EIG: Pincus was very good at public relations, sometimes a little too good. He loved the attention too much, and that got him in some hot water. But he did recognize - he felt like part of the reason he'd been dismissed from Harvard was anti-Semitism. And he worried that if his team was too Jewish, this would look like some kind of a conspiracy and certainly Catholics were going to be - the Catholic Church was going to object to any form of birth control anyway. So bringing on a Catholic doctor was a great opportunity for him, especially finding one who was so widely respected and one who was willing to fight the church. He - John Rock had believed, because he worked so closely with women and had seen what they went through, when they had too many children - more than they wanted - and he had seen how important he felt sex was to a loving relationship and not just for the purposes of procreation. Rock was a great candidate to bring on board because he was willing to confront the church and say, well, maybe it's time to rethink where we are on this issue.
GROSS: Jonathan Eig will be back in the second half of the show. His new book is called "The Birth Of The Pill." I'm Terry Gross, and this is FRESH AIR.
GROSS: This is FRESH AIR. I'm Terry Gross back with Jonathan Eig, author of the new book "The Birth Of The Pill." It's the story of how the birth control pill was created and the key figures who made it possible, including Margaret Sanger, the mother the birth control movement and the scientists who researched and developed the pill. So once these two researchers who we've been talking about, these two scientists Gregory Pincus and John Rock, get together to do research on the birth control pill, they have some problems with progesterone. What are the problems that they encounter?
EIG: Well, there are a lot of side effects with progesterone, especially because they're giving it in these giant doses -10 milligrams - which is far, far larger than they need to give. But they're mostly concerned with stopping pregnancy. They feel like if this thing's effective, if it's 100 percent effective, they'll have a decent chance of getting it approved. So they're ramping up the doses and - in part because they're men, they don't care so much about the side effects. Ironically, they do try giving it to men at one point, too. They give some progesterone to men in a mental hospital, and immediately the side effects are considered too great. They shut it down because the men are complaining that it's giving them feminine characteristics. It's shrieking their testicles, and their voices are changing. So immediately the male end of this research is shut down.
But for women, they don't really mind if they're complaining about nausea and dizziness and even, you know, more serious kinds of things like migraines. They're willing to overlook that as long as they feel like it's working. So they keep those doses far higher than they need to.
GROSS: So some of the problems the scientists were having with the progesterone were solved by a form of progesterone created by Carl Djerassi at a pharmaceutical company called Syntex. What was the key thing that Djerassi had done that made the pill possible?
EIG: Well, the pill - if you just use progesterone, progesterone was far too expensive. This was, you know, a hormone that had to be extracted from animals. But once they figured out how to synthesize it, how to make an artificial version in effect, which is what Djerassi did, then they were able to make it much more powerful at much smaller doses, and they were able to figure out ways to make into a pill. And that was Djerassi's great contribution.
GROSS: So the scientists who were experimenting with the pill needed women to be subjects for their experiments. We talked about some of the problems that they faced since contraception itself was outlawed in most of the country. They end up going to Puerto Rico and using a lot of women there as their subjects. Why did they choose Puerto Rico?
EIG: Well, Pincus and John Rock in Massachusetts had a huge problem finding women who would agree to participate in this kind of research. As I mentioned earlier, they used some women who were seeking help with fertility problems. Then they went to mental hospitals and tried giving it to women there, but those people were not having sex, so that created a problem.
Just by chance, Pincus was invited to give a lecture in Puerto Rico, and while down there, he realized that this was an unbelievably ideal proving ground for the pill because first of all, you had American doctors working down there; you had good hospitals; you had good nurses who had been trained in the United States, and you had this enormous population of women. There's a huge population problem in Puerto Rico. You've got this massive exodus of people leaving the island to come to the United States. The population is growing very rapidly, enormous poverty, and birth control is legal in Puerto Rico. There has long been an infusion of money, mostly from the eugenics movement, to try to control the population in Puerto Rico. And one of the results is that population clinics, birth control clinics, are open all over the island. So Pincus sees this as a potentially great place to do research on the pill.
GROSS: How honest was he with the women there who he was experimenting with?
EIG: Well, not so honest. I think most of the women in Puerto Rico did not know that this was an experimental drug. They knew that this was an American drug and that if it was coming from America, it must be something good. These were American scientists doing this research. Interestingly, he began...
GROSS: But were they told it was a birth control pill?
EIG: Oh, yes, they did. And in fact, that was really the key. In the beginning, they had a hard time finding women even in Puerto Rico. They began by trying nurses and medical school students, women who were studying medicine. And they were even threatening them, you know, if you want to get - if you want to pass this class, you have to sign up to participate in this experiment and try this birth control pill. But the women refused. They wouldn't do it; the side effects were too great.
Then finally, Pincus found some doctors, some women doctors, in Puerto Rico who said, you know, really all you need to do is go into the poorest communities where these women are having more children than they want, and they'll line up for this if you tell them what it is. And once they did that, once they went to these slums of San Juan, it absolutely took off. They had women lining up, and the Catholic Church opposed it. Priests in churches were saying, do not take this pill that you've heard about. And the more the priests talked about it, the more women came lining up to get it.
GROSS: So at what point do the scientists who invent the pill think that it's ready to go to market and ready for FDA approval? What year is it?
EIG: Well, it's complicated because they had - even with the tests in Puerto Rico, they had only tested it really on dozens of women. I mean, this is the first pill ever created for healthy women to take every day. There's never been anything like this. And the idea of seeking FDA approval for something that women are going to take every day without studying it for years and years and checking out the long-term side effects, this is scary stuff. But Pincus also feels like he's racing the clock, that if the word gets out about this and the Catholic Church and the federal government realize what they're doing, the opposition will mount and he'll have no chance of getting it through. So they're really being aggressive.
And in 1955, when they've really only tested the pill on maybe 60 women for more than say, 6 months or a year, Pincus goes to a conference and declares victory. He declares that we've invented the pill. And the media picks up on this, and it becomes this huge story. And women, thousands of women, are writing to their doctors and writing directly to Pincus himself and to John Rock, saying, I've heard about this pill. I need it. I need it now. I mean, you have to remember that in the 1950s, family sizes were growing. This was, you know, after the war. Women were having three, four, five, six, seven children in a row. You know, there was very little chance for them to control the size of their family or to time the birth of their children. And when they heard that there might be a pill that might do this for them, there was this huge outpouring. And that had a huge effect on Pincus and on the other scientists working on this because they began to see that there was an enormous demand for this, and they felt like they had to push harder. They had to go fast. And, you know, when you go fast in science, you're taking great risks. But they felt like this was something they had to do. So by 1956, they're ready to apply to the FDA for approval.
GROSS: So when Pincus said that the research was done, ready to market it, was that intentionally to get this groundswell of support by women insisting they need it now so that the authorities would be pressured to approve it as opposed to suppress it?
EIG: I think it's one of the great bluffs in scientific history. He knows that he's got the science. He's not sure that it's really ready. He hasn't tested it on nearly enough women. And his partner, John Rock, is saying, don't you dare announce that we're ready to do this yet. If you do, I'm out. He's furious with Pincus, but Pincus does it anyway. He realizes that they've some momentum, and they need to keep it going because this whole thing could fall apart if too much opposition is raised.
GROSS: And was it effective in helping him move forward?
EIG: It was. And as a result of all the publicity, the G.D. Searle pharmaceutical company agreed to manufacture the pill and to apply to the FDA for approval. But Pincus and Searle come up with yet another sneaky but brilliant idea, and that is they decide, we're not going to ask the FDA to approve it as birth control because that will raise a whole bunch of other issues; that will be controversial; that will attract too much attention. Let's just ask them to approve it for menstrual disorders.
EIG: It has a much lower bar here. And, you know, what is a menstrual disorder? Even the definition of the term is very loose. Almost any woman can go in to her doctor and say, I've got, you know, an irregular cycle. I'd like to have this new pill, and that's exactly what happens. The pill has a label on it that says warning, this pill will likely prevent pregnancy. And it's the greatest advertisement they could ever have because this is what women want. They're looking for a way to control their fertility. And once they hear about this, they began lining up at their doctors' offices. Doctors begin to understand what they're doing. They're prescribing this thing off-label. And Searles sees the demand growing, and they realize they've got a winner on their hands here. So everybody doubles down on their research and on their investment.
GROSS: So not long after that, the FDA approves the pill for birth control, but only for a two-year period because the FDA's concerned that the long-term side effects haven't been adequately tested.
EIG: That's right. And it's really a shockingly small number of women who have been a part of these clinical trials. Even by 1959, when Searle and Pincus go back to the FDA, and they say remember that pill that you approved - they were calling it an Enovid - remember that pill that you approved for menstrual disorders? We'd like to just add another use. So they didn't re-file the application, they didn't submit a new drug application. They said, we'd like to extend that and add a new use. It also controls fertility, so we'd like to just tack that onto the application. And, you know, the FDA realized what was going on here. They weren't hoodwinked. But they considered it, and they looked at the data that was available. And they gave approval.
By then, they also began to realize that the doses could be a lot lower and that it would work effectively at two-and-a-half milligrams and five milligrams and not the 10 milligrams that they were originally giving out, so these side effects did start to come down a little bit. So in 1957, the FDA approves the pill for menstrual disorders. And then in 1960, the FDA approves for birth control.
GROSS: If you're just joining us, we're talking about the history of the invention of the birth control pill with Jonathan Eig, the author of the new book "The Birth Of The Pill." Let's take a short break. Then we'll talk some more. This is FRESH AIR.
GROSS: This is FRESH AIR. And if you're just joining us, my guest is Jonathan Eig, the author of the new book "The Birth Of The Pill," which is a history of the invention of the birth control pill. So, you know, we had talked earlier about how it was difficult to do this research. It had to be a little clandestine because anti-birth control laws that were still on the books in many states, including Massachusetts, where a lot of this research was done, even though those laws weren't being, you know, seriously enforced; they still existed. It's not until 1965 that Griswold versus Connecticut overturns those anti-birth control laws. And then Margaret Sanger dies 8 months later. What point was the pill at in terms of popularity when Griswold overturns those anti-birth control laws?
EIG: The pill was an immediate hit. It was approved, and almost instantly, millions of women in the United States began taking it. By 1963, you had 2.3 million women on the pill in America. By 1965, when Griswold was argued before the Supreme Court, it was up to 6.5 million American women. So it was definitely on its way and was definitely becoming a major factor in the United States. And people were already debating what effect it was having on our promiscuity, on our morals, on things like divorce rates, as well as on things like education and women's ability to go to college and enter the workforce. So by 1965, it was already a huge factor in our public and already changing our way of life in America.
GROSS: So how does the pill that you write about, that was created by John Rock and Gregory Pincus, with a form of progesterone that was created by Carl Djerassi - how does that pill compare to the pill that women take today?
EIG: It's very similar. The doses are lower now. We realize that they were overdoing it and giving women far more progesterone than they needed to. But the concept is basically the same. The invention that they came up with is the one that is still affecting the lives of millions and millions of women all over the world. And, you know, it has had some side effects, and there've been some serious medical issues around it. And there's been a great deal of controversy on the medical side as well as on the social side, but the pill hasn't changed.
GROSS: One of the things you do in your new book is print some letters that were sent to Margaret Sanger and to other leaders of the birth control movement about why birth control would be so important in the lives of the women who are writing the letters. And I was wondering if you would like to read one of those letters that had a big impact on you.
EIG: Sure, I'd be glad to. This is one of the many letters that Sanger received from women who felt like they needed help. (Reading) I am today the mother of six living children, she writes, and have had two miscarriages. My oldest son is now 12 years old, and he has been helpless from his birth. The rest of my children are very pale, and I have to take them to the doctor quite often. One of my daughters has her left eye blind. I have tried to keep myself away from my husband since my last baby was born, but it causes quarrels. And once he left me, saying I wasn't doing my duty as a wife.
GROSS: So did you find a lot of letters like this in your research?
EIG: Hundreds and hundreds - not only to Sanger, but to Pincus and to Rock. Once the news began to spread that they were working on this pill, women were writing them desperately, saying I need them now. And in fact, you know, Pincus started giving them to women he knew even before it was approved by the FDA. So if you were lucky enough to live nearby or to work in the laboratory or to know one of Pincus's relatives, you might be able to get your hands on these things. It was very much a, you know - he was throwing it out there, wanting to get as many people on it as he could.
GROSS: So, you know, at some point - and I don't know whether this was the scientists you write about or other scientists - estrogen was mixed in with the progesterone in the birth control pill. And, like, who was responsible for that, and what did they discover about the benefits of adding estrogen?
EIG: When Gregory Pincus began his research, he knew that progesterone and estrogen were the two hormones that were released during pregnancy and that these might control fertility. But he avoided estrogen. He didn't want to work with it because it was thought to be cancerous. So he really focused on progesterone and was constantly tinkering with the formula to try and get the most effective chemical balance that he could and also to reduce the side effects as much as possible.
And there was one batch of progesterone pills that was sent by Searle that seemed to be working better than all the others. The side effects were much lower; the women were complaining less about nausea. And when he went back and looked at why this pill was working better, it turned out that it had been accidentally contaminated with a small amount of estrogen. And of course, you know, any kind of contamination could be a disaster, but in this case, he found that it worked. And he began then revising his formula and intentionally adding a small amount of estrogen and that became the foundation.
GROSS: Did Gregory Pincus end up getting really rich because of the research he did on the pill?
EIG: No, none of these pioneers made any money on it. And Pincus really got nothing but some stock options. You know, he did buy some Searle stock, and the stock rose tremendously in price, but it was not enough to make him rich. And he made the choice that he did not want to try to patent this himself. He felt like it was, first of all, more important to get this thing out as fast as possible and that having a big drug company behind him was the way to do that.
If he had tried to keep this thing to himself, it would not have reached the market as quickly, and women would've been suffering for longer. So in many ways, it was an unselfish decision on his part. He had also felt like he made a deal with Searle early on that they would give him support, they would give him free supplies, that they would pride progesterone for his research and that he owed it to them to give them the rights to the patent.
GROSS: I just want to point out that Sanger's an older woman by the time this research starts in the '50s. She's in her 70s by then. The pill is not going to personally benefit her own sexual or reproductive life. I mean, reproduction is over for her. So I think it's interesting that she remains such an advocate of the pill, and so it's, like, not about her.
EIG: That's right. This was her life's dream, and the same thing for McCormick. One of the scenes in this book that I love is Katharine McCormick, who's even older than Sanger - she's 80 now - and the pill is approved. It's available. She goes into a drugstore with a prescription from her doctor and asks for it. This 80-year-old woman is going in and asking for a prescription for the birth control pill. And obviously, she wasn't planning on using it. She just wanted to be able to buy it. It just meant so much to her to know that this was available now to women. You know, 60 years too late for her in many ways, but she had done it. And that was an amazing accomplishment.
GROSS: And did Margaret Sanger leave behind any writing about her reaction to the actual accomplishment of having a birth control pill that women could take?
EIG: Oh, yes. Sanger was very proud of it. She said, I was right. One of the last interviews she gave to a journalist shortly before she died, she was positively gloating - we did it, I was right, everything I said about this pill was right. It really did not just give women the chance to have sex without worrying about having children, but it changed the way we view women. It gave women a greater shot at equality than they've ever had before. She believed that the pill had been the culmination of all of her life's work.
GROSS: Well, Johnathan, I thank you so much for talking with us.
EIG: Thank you.
GROSS: Jonathan Eig is the author of the new book "The Birth Of The Pill." We have an extra from the interview that there wasn't time for in the broadcast. It's about the invention of the pill dial pack. You can hear that on SoundCloud at soundcloud.com/freshair. You'll find other interview extras there too, including ones with Lena Dunham and Jenny Slate. Coming up, Kevin Whitehead reviews a new release of a John Coltrane concert, recorded at Temple University 8 months before his death. This is FRESH AIR. Transcript provided by NPR, Copyright NPR.