The Birth of the Pill: How Four Crusaders Reinvented Sex and Launched a Revolution (43 page)

On the other hand, he was not entirely altruistic. Searle helped pay his salary and provided generous support for the Worcester Foundation. Without its backing, and in particular without the free supplies of progesterone and progestins, his work might never have led to the pill. Pincus was also a Searle shareholder, and if the company’s stock prices rose he stood to benefit, although even with the FDA’s approval there was no immediate spike in the stock’s price.

Once Enovid had been approved, Searle sent its army of sales representatives—or “detail men,” as they were referred to in the pharmaceutical industry—out to the field to meet with doctors and urge them to begin prescribing the new pill. Before the 1950s, prescription drugs had been for the sick. But now new products were appearing that did not necessarily cure ailments so much as reduce the risk factors for future events such as heart disease or heart attacks. Doctors would decide which patients needed these drugs, which meant the detail men (and, yes, virtually all of them were men in 1960) needed to impress upon the doctors that their drugs should be prescribed liberally. Drug companies sometimes overwhelmed doctors with mailings on new products, but the detail men were expected to cut through the clutter and tell physicians what they needed to hear. Doctors, while skeptical, relied on the representatives as an important source of information on new drugs. For Enovid, Searle produced a twelve-page brochure with detailed information on clinical studies, toxicology reports, and animal-test results. In an in-house newsletter, Searle urged its detail men to “
weed out all the negative points
and convince doctors to get patients started on Enovid TODAY.” The subjects of cancer, nausea, and religion were best avoided, the newsletter said. A better way to persuade the doctors was to remind them that patients taking the pill could be examined every month if the doctor or patient wished it. As primary-care physicians became more involved in family planning, their practices would grow. Women in perfect health would come to see them routinely. That, of course, meant money for the doctors as well as for Searle.

The detail men often handed out small presents to the doctors—notebooks, pens, and other trinkets intended to remind them that G. D. Searle had paid a visit. For Enovid, the representatives presented a special gift: a plastic paperweight painted gold. On the front was a three-dimensional representation of a naked, buxom woman, her arms breaking free from a set of heavy chains, her head tilted skyward. On the back was printed this message:

UNFETTERED

From the beginning, woman has been a vassal to the temporal demands, and frequently the aberrations, of the cyclic mechanism of her reproductive system. Now, to a degree heretofore unknown, she is permitted normalization, enhancement, or suspension of cyclic function and procreative potential. ENOVID—the first comprehensive regulator of female cyclic function—is here symbolized in an illustration from ancient Greek mythology: Andromeda freed from her chains.

Almost immediately after winning FDA approval for the birth-control pill, Searle went back to the agency and asked for additional approval to sell Enovid in smaller doses. The FDA stalled, much to the drug company’s frustration, but eventually gave its okay.

For Searle and for doctors, Enovid’s arrival presented an opportunity to expand business and dramatically boost income. In 1957, the majority of family practitioners considered contraceptive counseling outside the scope of their jobs. The introduction of the pill quickly changed that. Even Catholic doctors felt compelled to write prescriptions when their patients requested it. After all, it was federally approved, and doctors who did hold out—either for religious reasons or because they feared the long-term side effects—found that they lost patients.

Searle took a conservative approach to marketing the pill in the first days after receiving FDA approval. The company focused its efforts primarily on doctors, not the public, in part because officials did not want to stir controversy and in part because they recognized that doctors would do most of the advertising for Enovid once they had the chance to see how it worked and how it generated new business. The market for Enovid grew steadily and quietly. Within four years, Searle’s
sales would increase 135 percent
to $87 million, with a 38 percent return on equity for stockholders.

This is when the pill became widely known as The Pill, perhaps the only product in American history so powerful that it needed no name. Women went to their doctors and said they wanted it. They wanted The Pill. Some of them might still have been uncomfortable talking about birth control. Others might have been unsure of its brand name. But The Pill was The Pill because it was the only one that mattered, the one everyone was talking about, the one they needed.

Now that they’d done it, now that they’d finally created the thing that for so long had seemed an impossible dream, Sanger wrote to McCormick, jokingly asking what she intended to do for her next act.

Sanger was eighty. McCormick was eighty-four.

McCormick’s reply was no joke. She wrote:

What I am busy over
is as follows:

1.
Keeping on with the five branches of the Worcester Foundation and oral contraceptive work, namely, a) Dr. Rock’s clinical tests on his patients; b) the Puerto Rico and Haiti field tests on women; c) clinical tests at the Worcester State Hospital, with intensive laboratory testing and study of long-term effects; d) laboratory research at WFEB to perfect Enovid.

2.
Providing Shrewsbury housing for the fifteen post-doctoral students [working for Pincus].

3.
First plans for the women’s dormitory at MIT. I am particularly happy to be able to provide a dormitory on the Tech campus for women students there. This has been my ambition for many years, but it had to await the oral contraceptive for birth control.

McCormick was indeed proud of her accomplishment, but she was also beginning to realize that the pill might not do as much to stem overpopulation as she had hoped. The high price of the medicine would prevent it from reaching many of the countries where it was needed most. That’s why it was so critical that Pincus make improvements. Even if he did make the pill more effective and affordable, however, McCormick recognized that politics in some countries still might limit its reach. The best way to fight population growth, she admitted, might be to have
more men undergo vasectomies
. But even she didn’t have enough money to make that happen.

Sanger, meanwhile, was
struggling to kick her addiction
to painkillers and to cut her alcohol intake. Though she still enjoyed periods of lucidity, she was showing signs of senile dementia. She managed to make headlines again in the summer of 1960 when she told reporters that if John Kennedy were elected president she intended to leave the country. “
No one will really miss you
,” read one of the many angry responses she received.

“My heart aches for her all the time,” one of Sanger’s closest friends wrote in a letter to Sanger’s son Stuart, who would soon ask a judge to rule his mother incompetent. A woman who had fought a thousand fights and won more than her fair share of them was, as a close friend described her, finally surrendering to “the ignominy of a
rudderless drifting towards death
.”

Without Sanger to push them, Planned Parenthood did not embrace the pill right away. In fact, within weeks of the FDA’s approval of Enovid, Planned Parenthood informed Pincus that it was cutting off all funding for his research; he didn’t need the support of Planned Parenthood, officials said, now that “
so much government and other money
” was becoming available.

In the first years after Enovid’s approval by the FDA, many Planned Parenthood officials continued to recommend IUDs, especially to poorer patients. These recommendations were in part because the price of Enovid remained high, in part because IUDs required no prescriptions, and in part because they were not sure poorer and less well-educated women could be trusted to take the pill every day. It was an old argument. For years, leaders of the population control movement had assumed that the poor lacked the proper motivation to make good use of contraception. But women of all income and education levels were now learning that contraception was more widely available and effective than ever before. They were beginning to understand that they didn’t need to have seven or eight children and that once they controlled the timing of childbirth, they might begin to control all sorts of other things.

Sanger’s crusade had begun when Woodrow Wilson was president and ended with Kennedy. It had begun when a woman devoting herself to anything but motherhood was by definition a radical.

Sanger and the pill did not quite ignite a sexual revolution, but they didn’t have to. That fire was already burning by 1960; the pill only accelerated it. Yet in the grandest sense of all, Sanger’s goal had been to make sex better—more pleasurable and loving—and by 1960, she had done just that.

As doctors and clinics embraced the pill and offered birth control to more women, John Rock led an aggressive public campaign to persuade ordinary Catholics and Catholic Church leaders to join the movement. He argued now, more loudly than ever, that the pill was a natural extension of the rhythm method and ought to be accepted. He appeared everywhere—in
Newsweek
,
Time
,
Reader’s Digest
, the
Saturday Evening Post
, and on CBS and NBC. With his dignified air and impressive credentials, he gave the pill a kind of respectability that would have been impossible for Sanger or even for Pincus. FDA approval was important for women still uncertain whether to try the pill, but this seventy-year-old physician’s sanction may have mattered even more, especially for Catholic women.

Rock wrote in
Good Housekeeping
: “
The church hierarchy opposes
use of the pill as immoral, but among communicants there is an increasing willingness to accept it. Close to half a million women are using the pill for contraceptive purposes. And it is hard for me to believe these women are all Protestants.” Rock understood that most Catholic women were not waiting for an official pronouncement from the pope. They would decide for themselves. He made it his mission to help them choose correctly.

In the end, the Church disappointed him. Pope Paul VI ruled that the pill was just another form of artificial birth control and would not be permitted. But Rock never gave up hope. As he grew older and settled into retirement, he no longer attended daily Mass, but he always kept a crucifix above his desk, and he always believed that the next pope, or the one after that, would come around and see things his way.