The line between free range and foolish

How many of you out there have seen this nostalgic ode to a childhood “before the lawyers and the government regulated so much of our lives for our own good” that has been circulating on the Internet for years:

“No matter what our kids and the new generation think about us, WE ARE AWESOME !!! OUR LIFE IS LIVING PROOF !!!
To Those of Us Born 1925 – 1970 :

1930s, ’40s, ’50s, ’60s and ’70s!!

First, we survived being born to mothers who may have smoked and/or drank while they were pregnant

They took aspirin, ate blue cheese dressing, tuna from a can, and didn’t get tested for diabetes.

Then, after that trauma, we were put to sleep on our tummies
in baby cribs covered with bright colored lead-based paints.

We had no childproof lids on medicine bottles, locks on doors or cabinets, and, when we rode our bikes, we had baseball caps, not helmets, on our heads.
As infants and children, we would ride in cars with no car seats, no booster seats, no seat belts, no air bags, bald tires and sometimes no brakes.

Riding in the back of a pick- up truck on a warm day was always a special treat.
We drank water from the garden hose and not from a bottle.

We shared one soft drink with four friends, from one bottle, and no one actually died from this.

We ate cupcakes, white bread, real butter, and bacon. We drank Kool-Aid made with real white sugar. And we weren’t overweight..

Because we were always outside playing…that’s why!

We would leave home in the morning and play all day, as long as we were back when the streetlights came on.
No one was able to reach us all day.
–And, we were OKAY.

We would spend hours building
our go-carts out of scraps and then ride them down the hill, only to find out we forgot the brakes… After running into the bushes a few times, we learned to solve the problem.

We did not have Play Stations, Nintendos and X boxes. There were no video games, no 150 channels on cable, no video movies or DVDs, no surround-sound or CDs, no cell phones, no personal computers, no Internet and no chat rooms…

and we went outside and found them!

We fell out of trees, got cut, broke bones and teeth, and there were no lawsuits from those accidents.
We would get spankings with wooden spoons, switches, ping-pong paddles, or just a bare hand, and no one would call child services to report abuse.
We ate worms, and mud pies made from dirt, and the worms did not live in us forever.
We were given BB guns for our 10th birthdays, made up games with sticks and tennis balls, and
-although we were told it would happen- we did not put out very many eyes.

We rode bikes or walked to a friend’s house and knocked on the door or rang the bell, or just walked in and talked to them.
Little League had tryouts and not everyone made the team.
Those who didn’t had to learn to deal with disappointment. Imagine that!!
The idea of a parent bailing us out if we broke the law was unheard of. They actually sided with the law!

These generations have produced some of the best risk-takers, problem solvers, and inventors ever.
The past 50 to 85 years have seen an explosion of innovation and new ideas..
We had freedom, failure, success and responsibility, and we learned how to deal with it all.

If YOU are one of those born between 1925-1970, CONGRATULATIONS!
You might want to share this with others who have had the luck to grow up as kids before the lawyers and the government regulated so much of our lives for our own good.
While you are at it, forward it to your kids, so they will know how brave and lucky their parents were.
Kind of makes you want to run through the house with scissors, doesn’t it ? ”

Well, actually, no it doesn’t.  It isn’t that I don’t think I and the rest of my generation are awesome — we are!  I played outside all the time as a child, and continue to do so as much as possible as an adult.

Yet, like many tributes to the “good old days,” this message has a very selective view of the past.  It also reminds me a bit of Dana Carvey’s Grumpy Old Man character from Saturday Night Live.

Let’s look at smoking  during pregnancy.  Prior to the 1960s, mothers didn’t know that this increased the risk of premature birth, low birthrate, and fetal and infant death (not to mention increasing maternal morbidity and mortality). Lots of people like myself survived (despite being born eight weeks early in my case), but others didn’t, or were permanently disabled.
Today, we know better.

The same can be said of other “intrusions” listed above.  Maternal and infant mortality has been reduced because of screening for gestational diabetes and high blood pressure. Children no longer suffer serious brain damage from ingesting lead paint chips.  Seat belts, bike helmets, and car seats have saved countless children from death and disability.

I think there’s a lot of good ideas at the blog Free Range Kids.  However, let’s not forget that some “intrusions” are here for a reason.

My historical detective work on #Emergency Contraception coverage in New York Times

Over the past two weeks there has been a robust discussion on the International Consortium for Emergency Contraception listserv about reporting in the New York Times discussing recent findings on how emergency contraception works.  According to this article, “an examination by The New York Times has found that the federally approved labels and medical Web sites do not reflect what the science shows. Studies have not established that emergency contraceptive pills prevent fertilized eggs from implanting in the womb, leading scientists say. Rather, the pills delay ovulation, the release of eggs from ovaries that occurs before eggs are fertilized, and some pills also thicken cervical mucus so sperm have trouble swimming.

It turns out that the politically charged debate over morning-after pills and abortion, a divisive issue in this election year, is probably rooted in outdated or incorrect scientific guesses about how the pills work. Because they block creation of fertilized eggs, they would not meet abortion opponents’ definition of abortion-inducing drugs. In contrast, RU-486, a medication prescribed for terminating pregnancies, destroys implanted embryos.

The notion that morning-after pills prevent eggs from implanting stems from the Food and Drug Administration’s decision during the drug-approval process to mention that possibility on the label — despite lack of scientific proof, scientists say, and objections by the manufacturer of Plan B, the pill on the market the longest.”

I’ll let scientists comment on the emerging scientific consensus on this and comment on what this says about historical research. While researching my book, I’ve spent countless hours reading and re-reading FDA transcripts and I have no recollection of any such objections from the manufacturer of Plan B, which at that time was Women’s Capital Corporation.  Shortly after this article appeared,  Newsweek Senior Editor Sarah Blustain contacted me to find out more about the FDA’s decision. She asked whether this was a political compromise imposed on the manufacturers of Plan B by FDA.  I told her that I didn’t recall any of this so went back and looked at the transcripts available on the FDA website.  I couldn’t find anything in the original New Drug Application for Plan B filed by Women’s Capital Corporation.  After some further digging, I found the relevant discussion in a transcript from a joint meeting of the FDA Non-prescription Drug Advisory Committee (NDAC) and the Advisory Committee for Reproductive Health Drugs (ACRHD) held on December 16, 2003. However, I didn’t find any objections from scientists who presented on behalf of the manufacturer of Plan B.  The relevant section starts on page 288 of the PDF version.  First, Dr. Joseph Stanford, a member of the ACHRD asks:

“I understand, again, that the data that we have on mechanism of action for Plan B is imperfect, incomplete, but I think it’s a
critical issue for those women who want to understand how it works and have informed consent for use. So along those lines I have a question from Appendix 6 from the sponsor’s book. They list all of the answers to Question 7 about — after they
showed the women the package, they said, “Without looking at the label, tell me what Plan B is used for,” and then classified answers as either correct and acceptable or correct but not acceptable or not correct and not acceptable, and they list them
verbatim. And among the ones that are listed as correct and acceptable are a number of women who said that — one of them is, for example, an abortion type  thing for the day after. One was them was to kill a fertilized egg, and basically showing that some women had that understanding, and it was classified by the company as a correct and acceptable understanding of
what the product is for. And so I’m just wondering for the FDA did they also classify those particular answers as correct
and acceptable for what the product is for.”

NDAC chairman Louis Cantilena  then called Karen Lechter from FDA Dr. Leonard Segal answered, “Dr. Lechter unfortunately had to leave, and I don’t know that I can actually specifically address how she did hercalculation in her review on that particular issue. My assumption is though that she probably followed the sponsor’s categorization.” Chairman Cantilena answers, “There were a few tables that she showed in her presentation where she had asterisks where there was, you know, a difference between her, you know, assessment and the sponsors. But I don’t recall if that specific issue was asterisked or not.”

Dr. Valerie Montgomery Rice from ACRHD says, “I think that one of the things that Dr. Stanford is getting to — and you can tell me if I’m wrong — is a matter of informed consent such that the patient is as fully informed as possible based on all of the information that we know about how this product works.

So I guess I would ask the sponsor first.  When you’ve done surveys, if you have — and you may not have this information — in women who have taken emergency contraception and then you’ve asked them the question of how they  perceive, first of all, the medication worked, besides one of these studies because during that time, I think when you are dealing with that immediate issue of needing emergency contraception or even within the first couple of weeks while you’re waiting for that cycle to come, your perception of how it works may be different than when you sit down and really think about it.  So I think that’s one point.

And then, you know, even with my background, having a lot of experience with infertility and giving a lot progesterone, et cetera, and I’ve reviewed the literature, there is some data out there that really does suggest at very high dosages that there may be the possibility that you’re interfering with the implantation.

And so I guess my comfort level would definitely — I would definitely be a lot more comfortable making sure that the patient or the woman who makes that decision is as informed as possible that there potentially is a possibility that still gives that woman enough information to make an informed decision and not dilute any of her rights in deciding to proceed with this medication.”

Dr. Carole Ben-Maimon, one of the physicians presenting on behalf of Women’s Capital Corporation, answered:

“We are very sensitive to the fact that there are differing views not only of how this could potentially work, but also when pregnancy begins.  And so there are actually statements in the labeling with regard to the implantation issue in order to provide women information so that they understand and that they know that this could potentially prevent implantation.

Again, we believe the data is overwhelming.  We believe the medical definition, which is that pregnancy starts at implantation, is a critical point to keep in mind, but we are sensitive to the issues that others — the opinions of others.”

In other words, not only was there no objection from those representing Women’s Capital Corporation, they actually provided the information about possible effects on implantation that went into the label for Plan B. Now, this doesn’t meant that there weren’t objections from someone either from WCC or elsewhere — but I can’t find this in the official record.

So what’s the point here?  Well, what bugs me about the New York Times coverage is that it grossly oversimplifies the FDA approval process and assumes that anyone who worked for FDA or served on its advisory committees were only there to enforce the political will of the Bush administration.  In fact, the committee members mentioned above are respected members of the reproductive health community who were asking important, nuanced scientific and ethical questions that had nothing to do with the culture wars over reproductive rights.  (Dr. Montgomery Rice, for example, is Dean of Morehouse School of Medicine who has worked extensively on health issues affecting women of color — and we historians of women’s health all know how poorly women of color were and sometimes still are treated by medical researchers — e.g. the field trials for the original contraceptive pills in Puerto Rico and Haiti).  So, naturally informed consent would be a critical concern for her.

I would be interested to find out whom the NYT reporter interviewed for this story. I don’t think anyone is purposely trying to rewrite history but they may have selective memories.

Invigorated and Exhausted from American Association for the History of Medicine meeting

I got back from the annual meeting of the American Association for the History of Medicine meeting yesterday as as usual am bursting with ideas and buried in work.  So, this will be quickie overview with more reflection and analysis at a later date.

First, I’d like to report that my forthcoming book  (cover photo at left) is moving much closer to actually being out.  I received the page proofs about a week ago and am working on getting them back ASAP.  Unfortunately the editor decided not to have them available at the meeting because they aren’t corrected — but there’s always next year.  Hopefully they will be available at the Berkshire Conference of Women Historians next month.

Meanwhile, I got an opportunity to plug my book and establish myself as an authority on the “morning after pill” in an interview for a documentary by Caryn Hunt, President of the Philadelphia chapter of the National Organization for Women.  It was a lot of fun and I wasn’t as nervous as I expected.  Also, I got a new suggestion for a doppelganger. Thanks,  I agree!

My presentation on The Pill at 50: Scientific Commemoration and the Politics of American Memory went very well and I had a substantial audience (at least 30) despite it being on first thing on the last day of the conference.  The reaction was enthusiastic (especially from this leading authority on the history of the Pill) so I’m planning to expand this and submit it to the Bulletin of the History of Medicine.

Since I’m teaching in a public history graduate program, and living in Connecticut, my “commemorative mania” will continue with some kind of commemorative event celebrating the 50th anniversary of Griswold v. Connecticut in 1965 (which follows soon after my own half-century mark).  Not sure what this will be but the folks at Yale and Planned Parenthood are keen so looks like it will happen.  I also told the editor at Rutgers that I’m interested in doing a narrative history (as opposed to a legal history that uses Griswold as a lead-up to Roe v. Wade rather than an event in it’s own right).  As it turns out, a very distinguished senior historian of medicine and public health was one of the witnesses who testified.  It seems that the New Haven police was willing to shut down the clinic so that birth control advocates in the state could use this as a test case, but they needed evidence that the clinic was dispensing birth control.  This historian was a graduate student at Yale and was one of Dr. Buxton’s patients.  She volunteered to get the evidence (a tube of contraceptive jelly) and then went straight to the police department to turn in the incriminating evidence and give a statement.  When she blurted out that contraception was “women’s right”, the Irish cop asked her, “don’t you mean a married woman’s right?” What a story!

I heard lots a great papers and connect with all my history of medicine buddies.  However, work awaits so I’ll have to continue these conference report later (most likely much later since research papers and finals will be landing on my desk shortly).

Blogging for Emergency Contraception

via Back Up Your Birth Control.  Today is the 10th annual national day of action for Back Up Your Birth Control, a media campaign sponsored by the National Institute for Reproductive Health. I’ve agreed to blog to raise awareness about this.

Because I’m a shameless self-promoter, I’m also going to start with an update on my forthcoming book, The Morning After: A History of Emergency Contraception in the United States.  The page proofs will be arriving in a couple of weeks.  Meanwhile, here’s the blurb that will appear on the publisher’s website, catalog, and the book cover:

“Since 2006, when the “morning-after pill” Plan B was first sold over the counter, sales of emergency contraceptives have soared, becoming an $80 million industry in the United States and throughout the Western world. But emergency contraception is nothing new. It has a long and often contentious history as the subject of clashes not only between medical researchers and religious groups, but also between different factions of feminist health advocates.

The Morning After tells the story of emergency contraception in America from the 1960s to the present day and, more importantly, it tells the story of the women who have used it. Side-stepping simplistic readings of these women as either radical feminist trailblazers or guinea pigs for the pharmaceutical industry, medical historian Heather Munro Prescott offers a portrait of how ordinary women participated in the development and popularization of emergency contraception, bringing a groundbreaking technology into the mainstream with the potential to radically alter reproductive health practices.”

I had to stop somewhere, so the book shortchanges the most recent developments — especially the most recent efforts to use of social media to raise awareness of EC. [BTW, the Back Up Your Birth Control campaign has a Facebook page and you can find related posts on Twitter using #backitup and/or by following @nirhealth).

The use of the Web to promote EC originated in the early 1990s with the emergency contraception website at Princeton. The Back Up Your Birth Control Campaign began amidst the battle to get the FDA to approve Plan B as an over-the-counter drug.  What’s interesting to me as a historian is the use of graphic artist J. Howard Miller’s “We Can Do It” poster, which he created for Westinghouse under the sponsorship of War Production Board (this image should not be confused with the Norman Rockwell painting “Rosie the Riveter” that appeared on the cover of the Saturday Evening Post May 29, 1943, and is still under copyright.  The Rockwell paiting was recently acquired by the Bentonville Museum in Arkansas, founded by Wal-mart heiress Alice Walton and the Walton Family Foundation — oh the irony!).  Personally, I like the Rockwell image better, but do you think the Waltons will allow anyone to use it without paying major $$ — not bloody likely!  “We Can Do It” does not have such copyright restrictions, so various groups use it freely.  (for more on these images and American popular culture, go here).  It’s become a feminist icon of female empowerment, but this article demonstrates that “during World War II the empowering rhetorical appeal of this Westinghouse image was circumscribed by the conditions of its use and by several other posters in its series.”

Returning to EC — the history of the various awareness campaigns over the years is fascinating but was nearly impossible to illustrate in the book because, like many of us, the organizations that created these images didn’t preserve them once they were no longer useful.  Others put them on their websites, then discarded the original files.  Then there’s the problem of finding the copyright holder and getting permission from him/her.  Here’s an image that I couldn’t use because there was no digital file that had a high enough resolution for reproduction — it also nicely sums up my frustrations with the whole process:

image courtesy of Canadian Federation for Sexual Health

So, here’s a recommendation for the Back Up Your Birth Control Campaign — back up your “born digital” materials and preserve your digital heritage!

Trumbull Library presentation on Henrietta Lacks and the Immortal Life of Health Care Inequalities

Earlier this week, I helped lead a discussion of Rebecca Skloot’s book The Immortal Life of Henrietta Lacks as part of the Trumbull public library‘s One Book One Town series.  My co-leader was Laura Stark from the Science and Society/Department of Sociology at Wesleyan University.  Laura was a fact-checker for the book while she was a fellow at the Office of National Institutes of Health History.  Laura focused on points raised in her forthcoming book, Behind Closed Doors: IRBs and the Making of Ethical Research, which will be published in November with The University of Chicago Press.  She looked at how the treatment of human subjects in the United States has evolved since the Second World War and this impacts Institutional Review Boards today.  My emphasis was on standards of care for cervical cancer patients then and now, and how this intersected with prevailing issues of race, gender, and class.   As Skloot observes, Henrietta’s care was typical of teaching hospitals at this time, and Johns Hopkins was one of the few in the region that admitted African American patients (albeit in segregated wards).  During the 1940s and early 1950s, there was no Medicaid and third party private insurance was only beginning to become an employee  benefit.  So, as a “charity patient” Henrietta received state of the art cancer treatment that many at that time could not afford.  The care would have been the same had she been white.  Yet, the prevailing attitude at the time was that since “charity cases” were treated for free, doctors were entitled to use them in research, whether the patients realized it or not. Henrietta’s doctor once wrote, “Hopkins, with its large indigent black population, had no dearth of clinical material.”

Also, epidemiological studies of cervical cancer tended to reinforce cultural prejudices about race and socioeconomic status of the time period. By the early 1950s, researchers noticed that cervical cancer was common in prostitutes and others with multiple sexual partners; rare in Jewish and Muslim women; and practically non-existent in nuns and virgins.  There was considerable debate about whether this was due to an infectious agent or genetics. The notion that different races had propensity to certain diseases was common  — e.g. blacks were characterized as a “notoriously syphilis-soaked race” while Jewish persons were believed to be more prone to respiratory illnesses like TB. So, “race medicine” included the theory that Jewish and Muslim women were more likely to develop cervical cancer because of their “race.”  We now know that male circumcision helps prevent the transmission of sexually transmitted infections, such as the human papilloma viruses that cause many genital cancers. Starting in the 1950s, scientists explored the link between adolescent sexual activity and the development of cervical cancer later in life. Several epidemiological studies published in the 1950s and early 1960s indicated that women who married before age 20 appeared to be at higher risk for cervical cancer. Some speculated that women who had multiple “broken marriages” were especially susceptible. Some cancer researchers hypothesized that some kind of infectious agent transmitted by male partners was a contributing factor, and that the adolescent cervix was especially vulnerable to “epithelial transformation” by exposure to such an agent. Given that a disproportionate number of patients were nonwhite, non-Jewish women of low socioeconomic status, recommended that routine pap smears were especially important for “nonvirgins” from underprivileged groups. These findings also tended to reinforce prevailing stereotypes about the links between disease risk, race, and class – those living in poverty – especially if they were nonwhite – more likely to be “promiscuous.”

At the same time, the introduction of Pap smear led to the notion that “cancer was curable” if caught early — this provided the justification for annual gynecological examinations.  Prior to Medicaid,  a young woman of Henrietta’s social class would not have had access to routine preventive medical care. Thus, the health disparities indicated by cervical cancer studies were used to justify government funded preventive screening for those living in poverty.

Another recent development has been efforts by health activists to make medical research more inclusive.  As Eileen Nechas and Denise Foley show in their book Unequal Treatment reformers fought to make sure that all studies funded by NIH included women, racial minorities, children and adolescents, where appropriate, historically “decisions on what aspect of health to study, on what research protocol to fund” were based “not only on scientific merit . . . but on a judgment of social worth. What is valuable to medicine is who is valuable to society, and that is white men.”  Since the late 1980, health activists fought to make sure that all studies funded by NIH included women, racial minorities, children and adolescents, where appropriate; and made sure that diseases that disproportionately affected these groups got “equal time” and money.

Here are the discussion questions we gave to the audience:

Should people have a right to control what’s done with their tissues once they’re removed from their bodies? And who, if anyone, should profit from those tissues?

Deborah says, “But I always have thought it was strange, if our mother cells done so much for medicine, how come her family can’t afford to see no doctors? Don’t make no sense” (page 9).   Should Lacks family be compensated by those who profited from research on HeLa cells?

How does this story relate to recent history of health care reform, and attempts to expand access to medical advances made possible by research on HeLa and other human tissues?

How can medical professionals recognize that certain diseases affect certain racial/ethnic groups without replicating prejudices of old “race medicine”?

My blogging gets me on a conference program

Hey folks,

I turned my ramblings on the 50th anniversary of the contraceptive pill into a paper proposal for the 2011 annual meeting of the American Association for the History of Medicine.  Yay!   The title of my paper is “The Pill at 50: Scientific Commemoration and the Politics of American Memory.”  I’ll write more later but just thought I’d share this exciting news!

Added later:  here’s the abstract:

This paper will use coverage of the 50th anniversary of the contraceptive pill as a case study of collective memory and commemorative practice in the history of science and medicine. As Pnina Abir-Am observes in her introduction to Commemorative Practices in the Sciences, a “commemorative mania” has swept the world in the past several decades and relationship between memory and historical writing has become “a major element of both scholarly and public discourse in the twenty-first century.” I will show that like the Clemence Royer centennial celebration described by Joy Harvey in the same volume, celebration of the Pill’s 50th anniversary was a “focal point for feminism, politics, and science” in the United States. For the scientists who developed and tested the first contraceptive pills, the anniversary of the Pill was a way to affirm their collective professional past as well as reassert their professional authority in the present. The celebrations also illustrated culture wars over reproductive rights and the meaning of controversial events in the history of science and medicine in the United States. Finally, I will show that feminist analysis of this historical event was not monolithic, but reflects the complicated history of women’s relationship to contraceptive technology and medical experimentation since the 1960s.

Learning Objectives:

  1. Explain the ways in which different political, scientific, and social groups commemorated the 50th anniversary of the contraceptive pill.
  2. Understand how memory studies can be used as an analytical tool in the history of medicine.
  3. Explore the difficulties historians face in interpreting a politically controversial subject for the public.

History of Health Activism Conference at Yale

Here is a Yale Daily News report on the conference, “Health Activism in the 20th century,” that I participated in at Yale last weekend.  (minor correction — MADD stands for Mothers Against Drunk Driving!)  As the reporter was only there for Saturday (bright and early at 8:30am!) and I was the first presenter, he didn’t get a chance to observe my brilliant presentation, Creating a Middle Ground: Feminist Health Activists and Emergency Contraception in the United States, 1970-2000! (I’m giving a shorter version of this paper at the History of Science Society meeting next weekend )  Here are the main points:

This paper looks at the changing position of the National Women’s Health Network (NWHN) on emergency contraception, aka the “morning-after pill.” Initially this group was a vehement opponent of emergency contraception and other forms of hormonal birth control.  By the early 1990s the organization had joined broader efforts to develop a dedicated emergency contraceptive product.  NWHN found that there was sufficient evidence about the safety and effectiveness of this contraceptive method to “cautiously support its use.”
More importantly, increasing restrictions on abortion and access to federally-funded birth control under Presidents Ronald Reagan and George H.W. Bush convinced the organization that they needed to help ensure that women had access to emergency contraception when other birth control methods failed.

This paper is a chapter out of a book-length project on the history of emergency contraception in the United States, which is under contract with Rutgers University Press. This project aims to use the history of emergency contraception to illuminate key themes in the politics of birth control and abortion since the 1960s.

In terms of relevance to other issues in health activism in the twentieth century, one of my main points is how the history of emergency contraception reflects the professionalization of the women’s health movement. Since the 1970s, feminist health activists had gradually become insiders in reproductive health by earning professional credentials, which gave them the ability to reform organized medicine and health care policy from within. Although some of their contemporaries accused these newly-minted professionals of “selling-out” rather than furthering the cause of women’s self-empowerment,” the corresponding radicalization of the medical “establishment” was equally significant. This book is intended to contribute to recent scholarship on how women have used experience of the physical body as a source of knowledge production and feminist practice regarding women’s health issues. For example, Wendy Kline argues that “body knowledge” was central to the women’s health activism of Second Wave feminism, and that this feminist framework was abandoned as the women’s health movement adopted the professional credentials and scientific language of the health care establishment.
I suggest that rather than being a departure from Second Wave feminist strategies that were based on knowledge of the biological body, recent activism on emergency contraception demonstrates how women have continued to use personal histories of their bodies to transform reproductive health research and healthcare policy. Since the early 1990s, emergency contraception has served as a “bridge issue” that brought together former adversaries, including feminist health organizations, population and family planning people, and groups representing women of color who were the main targets of attempts to control the “population crisis” in the United States.

This coalition did not arise without a struggle and had to overcome much bad faith generated by sexism in the medical profession and the racist and coercive policies of the population movement. My book shows how these diverse groups created a “middle ground” between an older liberal feminist position that tended to support technological innovations such as hormonal contraception; and a more radical feminist position that criticized the use of hormones but was otherwise in favor of reproductive rights.

Should the Pill be Set Free from the Prescription?

via Newsweek, which reports on the work of the Over-the-Counter Oral Contraceptives Working Group.  As it so happens, this is not the first time this question has been asked — something I’m exploring in an article I’m revising for a edited volume on The Prescription in Perspective: Therapeutic Authority in Late 20th Century America edited by Jeremy A. Green and Elizabeth Siegel Watkins for Johns Hopkins University Press.  Historically, the arguments in favor have tended to come from public health experts who see the prescription as paternalistic and an unnecessary barrier to timely access.  This is the position taken by Kathleen Reeves at RH Reality Check, who says that the prescription “seems like a holdover from the days when contraception was forbidden: when women who wanted it were reprimanded and those who provided it were jailed.”

[P.S. here’s another article on this same subject from RHReality Check].

Meanwhile, Elizabeth Kissing over at the Society for Menstrual Cycle Research’s blog re:Cycling has this to say:

“I have mixed feelings, myself. I’m in favor of just about anything that makes contraceptives more accessible to the people who need them, but I fear that the likely increase in cost of OTC pills means the availability won’t benefit those who most the need them – the young and the poor. Also, there are some contraindications for pill use, such as high blood pressure, history of migraine, and use of certain anti-seizure drugs for epilepsy. And despite the happy, shiny images of Yaz and Seasonique commercials, some women just can’t tolerate the side effects, for any number of reasons.”

This is pretty much the argument that was made by the National Women’s Health Network and other consumer protection groups the last two times this issue was raised — in 1993, and again in 2000.   Despite claims by FDA Center for Drug Evaluation and Research direct Phillip Corfman that the Pill was “safer than aspirin” and should therefore be sold over the counter, these consumer protection advocates argued that the pill was just too dangerous for OTC use.

Now the issue has come up again, no doubt because the success in getting emergency contraception sold, well, not quite OTC, but at least behind the counter without a prescription.   The OTC OCs working group includes representatives from NWHN and others who were against nonprescription status for birth control pills.  It will be interesting to see how this develops, and whether it will get in my paper.  Now, this is the problem with doing very recent history — the history keeps on happening while you’re writing it and there are continual updates!

According to the OTC OCs Working Group’s July newsletter, the Newsweek article does a nice job of summarizing the issue, but here are some corrections:

  • Regarding the timeline for an OTC switch, the article says, “They hope to have a proposal before the FDA within the year and an over-the-counter pill available in five years.” When I spoke with the author, I said that we hoped to have a meeting within a year (and hopefully this year) with the FDA to get feedback on the draft study protocols and labeling the working group has developed. The actual use and label comprehension studies would need to be completed before an application could be submitted, and those studies will take time–and additional funding. The working group is still in the process of exploring partnerships with pharmaceutical companies, since such a company would likely be the sponsor of a switch application to the FDA. I also said that the five-year goal of having an OTC pill on the market depended on a lot of factors, including an assurance that low-income women would be able to access such a product.
  • The article confuses the FDA advisory panel’s recommendation on the EC product ella with an actual approval, and incorrectly describes ella as containing progestin when it is composed of ulipristal acetate.
  • The article misquotes the Pharmacy Access Partnership’s national survey, which asked women about pharmacy access to hormonal contraception, rather than OTC access.
  • The article references our paper on contraindications among Mexican OC users, but that paper did not find “that women who buy pills directly from pharmacies often have greater understanding of the contraindications than women who visit clinics.”
  • The working group is currently supported by a grant from the Hewlett Foundation, which is misspelled in the article.

So, what do readers out there think?  Should women be freed from the tyranny of the prescription?  Or do we need the Rx to protect us from unsafe products?  [remember there’s a class action lawsuit against the manufacturers of Yaz and Yasmin filed by women who have suffered strokes and blood clots and other serious side effects)?

Happy Belated Birthday to Griswold v. Connecticut

Last week I was so buried in my writing that I plumb forgot to honor the 45h  anniversary of  the U.S. Supreme Court decision Griswold v. Connecticut (June 7, 1965).   So, here’s some history (based on information from contemporary newspaper accounts, as well as  David J. Garrow, Liberty and Sexuality:  The Right to Privacy and the Making of Roe v. Wade (Berkeley:  University of California Press, 1998) and John W. Johnson, Griswold v. Connecticut:  Birth Control and the Constitutional Right of Privacy (Lawrence:  University of Kansas Press, 2005) ).

Yale New-Haven Hospital was at the center of birth control politics in both the state of Connecticut and the nation. In 1958, Dr. C. Lee Buxton, chair of the department of Obstetrics and Gynecology at Yale Medical School, along with three of his patients, filed a lawsuit claiming that the state’s laws prohibiting the sale, distribution, and use of contraceptive drugs and devices were unconstitutional. The suit reached the U.S. Supreme Court in June of 1961, but the Court dismissed the case since no state laws had been violated. Yet, the court opinion that accompanied the decision also declared Connecticut laws were “dead words and harmless, empty shadows.” On November 1 of that year, the Planned Parenthood League of Connecticut, led by Buxton and PPLC Executive Director Estelle Griswold, decided to test the validity of the court’s opinion, and opened a birth control clinic in New Haven. Nine days later Buxton and Griswold were arrested for violating state laws outlawing contraception. The defendants appealed their case all the way to the U.S. Supreme Court culminating in the court’s decision in Griswold v. Connecticut (1965) declaring “Connecticut’s birth-control law unconstitutionally intrudes upon the right of marital privacy.”

Immediately following the Griswold decision, the Connecticut Birth Control League opened the New Haven Planned Parenthood clinic. Initially, league officials reported an “uphill fight” in gaining acceptance, due to a lingering “moral stigma” against family planning among some individuals. By 1967, “unbelievable change” had occurred, and “birth control is booming in the Elm City” — especially among female graduate students at Yale University (this is before the undergraduate college admitted women).

Unmarried women in other states were not necessarily so fortunate: in Massachusetts, Bill Baird was arrested for “crimes against chastity” for giving contraceptive foam to an unmarried teenage girl following a lecture at Boston University in 1967.  His conviction was overturned in the decision Eisenstadt v. Baird (1972), in which the Supreme Court rule  “If the right of privacy means anything, it is the right of the individual, married or single, to be free from unwarranted government intrusion into matters so fundamentally affecting a person as the decision whether to bear or beget a child.”

As a recent editorial in the Roanoke Times observes, these rights to privacy still “remain suspect”.   So, go out and enjoy them while you still have them!

More on the History of the Pill

via –  This is an editorial by University of Minnesota Professor Elaine Tyler May, whose new book America and the Pill: A History of Promise, Peril, and Liberation (pictured at left) was just released.   I’m glad to see that May deflates the truism that the Pill caused the sexual revolution — as Kinsey observed, the sexual revolution was well underway before 1960.  Furthermore, as said in my previous post, the Pill wasn’t available to many women when first released.  Even married women in the state of Connecticut could not legally obtain the Pill until 1965 and it took another seven years for the “right to privacy” to be extended to unmarried women as well.

Since Knitting Clio never misses an opportunity to plug her own work, I’ll mention that the Pill is the subject of my paper at the upcoming annual meeting of the American Association for the History of Medicine .   The title is “Safer Than Aspirin: The Campaign for Over-the-Counter Oral Contraceptives.” A longer version of the paper will appear in The Prescription in Perspective: Therapeutic Authority in Late 20th Century America. Edited by Jeremy A. Greene and Elizabeth Siegel Watkins, under contract with Johns Hopkins University Press.

Here’s the abstract:

On January 21, 1993 the U.S. Food and Drug Administration (FDA) announced in the Federal Register that the agency’s Fertility and Maternal Health Drugs Advisory Committee would hold an open public hearing to discuss issues related to providing oral contraceptives without prescription. Philip A. Corfman, director of the Center for Drug Evaluation and Research, stated the agency’s reasoning for this hearing:”I think the pill is safer than aspirin and aspirin is available over the counter.”

One week after the posted Federal Register notice of the open hearing, FDA officials canceled the session. The reasons for this abrupt move, and subsequent failures to make oral contraceptives available over-the-counter, are the subject of this paper. I will use the discussion about nonprescription status for oral contraceptives as a case study in the history of the switch from prescription to over-the-counter drugs. This paper will highlight the conflicting positions of the various stakeholders invested in restricting or promoting consumers’ direct access to their medications.