Kate Grauvogel Discusses Her Work During Her Fellowship

'My project uses the concerns launched by Seaman as a starting point for a new investigation of the pill’s development and women’s roles in it.'

The US Food and Drug Administration (FDA) approved Enovid, the first oral contraceptive, in May of 1960. “The Pill” was the culmination of decades of efforts by doctors, scientists, and activists who succeeded in engineering synthetic hormones to prevent ovulation in women. Its debut also marked a significant step forward for women, by giving them control over their own reproductive destinies. But as women in the United States began taking the pill in droves, some women’s health feminist activists expressed outrage because the estrogens used in the pill were dangerous and caused side effects like depression, stroke, and deadly blood clots. Barbara Seaman’s book, The Doctor’s Case Against the Pill, (1969) alleged that many doctors, including those at the pharmaceutical manufacturer, Searle, were well aware of the pill’s untoward side effects and denied women key information regarding the safety of the pill.

My project uses the concerns launched by Seaman as a starting point for a new investigation of the pill’s development and women’s roles in it. I examine what the pill’s developers, especially Katharine McCormick, Dr. Edris Rice-Wray, and Dr. John Rock, knew about risks, what they made of the risks, and how and why they responded to the reported side effects that emerged in the clinical trial phase in the 1950s. A few of the questions that motivate my research include: To what extent did women partake in the development of the pill, as researchers, activists, and patients? Was knowledge of potential risks intentionally dampened in order to push the pill to the market? Were the risks covered up? Were women willing participants, or was the pill pushed on women with little regard for their safety?

Through the generous support of the Women in Medicine Legacy Foundation Fellowship, I was able to spend six weeks at the Francis A. Countway Library. To address the questions posed above, I consulted the John Rock and Clarence Gamble collections, focusing on correspondence between Rock and the other developers of the pill, especially Rice-Wray, and McCormick. I found that Rock responded to the reported side effects and actively worked to minimize them in trial participants by introducing lower-dose pills. Women taking the low dose pills reported fewer side effects like nausea and breakthrough bleeding, but what about the major risks?

Edris Rice-Wray, the doctor who conducted some of the clinical trials, played a crucial role in the development of the pill. Rice-Wray’s tests of pill trial participants, including vaginal smears and blood work, were critical to the formulation of an effective oral contraceptive. She reported a few isolated cases of blood clots in women taking the pill. John Rock investigated the possibility that the pill caused the clots but concluded that, “because the trials were conducted for only two years, caution should be used in prescribing the pill because we do not know of all the risks.” (Report in the John Rock papers). Rice-Wray’s interpretation of that data and her careful reporting of any side effects the participants experienced shows that women guided the project and took reports of side effects seriously.

Katharine McCormick, often noted only for her feminist activism and philanthropy, was an accomplished biologist. Correspondence between Rock and McCormick reveals her eagerness to see the pill materialize, her appreciation for the magnitude of the work, and also her understanding of the nature of the scientific work: “I realize how much important progress you and Dr. Garcia have accomplished and are daily accomplishing. I doubt if you can know how significant the work is that you are maintaining and developing. I only wish there was some way practically to increase it many fold, though I do appreciate that such research is so essentially one of careful individual investigation that it does not lend itself to as much expansion as one would like.” (Katharine McCormick to John Rock, May 14, 1957)

This project is part of my dissertation about the history of blood clotting disorders and their associations with reproduction, inner secretions, and hormone treatments, from 1784-1969.

Kate Grauvogel: 2016-2017 Countway & Foundation Fellow, Doctoral student in the History and Philosophy of Science and Medicine Department at Indiana University-Bloomington