The Nelson Pill Hearings

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to Stuff You Missed in History Class, a production
of I Heart Radio. Hello, and welcome to the podcast.
I'm Tracy V. Wilson and I'm Holly Frying. So hopefully
what we're about to talk about will it be, if

(00:22):
not cleared up, at least like somewhat better understood by
the time this episode comes out. We're in one of
those situations where I'm about to talk about a thing
that may just be different by the time the episode
is audible to other people. When I research today's topic, though,
we were hearing a lot about extremely rare clotting disorders

(00:46):
that are potentially linked to the astra Zeneca and Johnson
and Johnson COVID vaccines, and headlines about those again extremely
rare clouding disorders have led to a lot of comparisons
between the vaccines and oral contraceptives, with the tone kind
of being like, there's a bigger risk for blood clots
or birth control and nobody cares about that, or like

(01:09):
and women just deal with it. Uh. It's it's a
kind of dismissive tone um in all of these contexts.
But that argument is a little bit apples to oranges,
and it also skips over a whole lot, big thing.
And we're not going to get into the weeds because
we're not doctors and this is non medical history podcast.

(01:29):
But the clots that are associated with oral contraceptives are
generally really different from the ones that might be connected
to the vaccines. And all of these clots can be
life threatening, but they form very differently in different parts
of the circulatory system. Also, they typically require very different
treatments because the vaccines, Uh, it's not just a clot,

(01:50):
it's also a low plate link count. So you just
can't give a person anticoagulants like you would with a
lot of other clots. But another big, big difference here
is information, because the connection between oral contraceptives and blood
clots has been established for decades at this point, and
in the United States, the FDA requires that every package

(02:11):
of birth control pills comes with patient literature that explains
this risk and all the other risks. Ideally, there would
also be a thoughtful conversation with a healthcare provider about
the risks and the benefits. Uh, there are a lot
of reasons that might not happen though, and I totally
recognize that. But like these vaccines are brand new and

(02:32):
the potential risk isn't fully understood yet, and you just
can't inform people of what their risk is or trying
to men to mitigate that risk if you don't really
have a handle on what's going on yet. So that's why,
as of when we're recording this, there's been a pause
to try to get a better handle on it. At
the same time, though, in the United States, this whole

(02:53):
idea that people should know about the risks that are
involved with the drugs that they're taking. That's tie directly
to the complicated and honestly pretty troubling sometimes history of
oral contraceptives. So that is what we're going to talk
about today, and just a level set, the social and
political impact of oral contraceptives could be its whole other thing.

(03:15):
We're not really going to talk about that at all
in this episode because this episode is really about safety.
So the first oral contraceptive was called a novid and
it was brought to market in the United States in
nineteen fifty seven. At first, it was only approved for
treating menstrual disorders, but researchers knew that it prevented ovulation,

(03:36):
thus that it prevented pregnancy, temporary infertility, was a known
side effect. It's likely that many of the roughly five
hundred thousand people who took a novid between nineteen fifty
seven and nineteen sixty we're taking it for that so
called side effect, either in addition to or instead of
treating something like irregular menstrual cycles or endometriosis. So getting

(04:00):
innovid approved as a contraceptive that required additional clinical trials
that were specifically for that purpose, and those trials would
not at all meet today's standards for things like ethics
and informed consent. And really this was also true of
the drugs earlier trials. Some of those had been carried
out on patients and a mental hospital. The team that

(04:22):
was developing the pill included guy ecologist John Rock and
reproductive physiologist Griory Pinkas, and they were in Massachusetts, and
in Massachusetts it was illegal to distribute contraceptives or information
about them. The same was true of a lot of
other states. You couldn't have a controlled trial of a
contraceptive in a place where that was illegal, So the

(04:44):
trials had to be carried out somewhere else. And the
location that Rock and pink has chose for some of
this work was Puerto Rico. Rock and Pink has already
had connections there through the University of Puerto Rico School
of Medicine, and contraception was legal there, and there was
already an established network of birth control clinics in the territory. However,

(05:05):
the reasons for all of that were tied to the
eugenics movement and to an effort led by US officials
to curb poverty in Puerto Rico by lowering the birth rate.
There was just a huge propaganda campaign that promoted the
idea that smaller families would mean more money and a
better quality of life. And then on top of that,

(05:25):
officials sent medical practitioners to Puerto Rico to carry out
a mass sterilization campaign. This was one that was often
coercive and deceptive, with women being sterilized without their knowledge
or without being told that this procedure they were about
to undergo was permanent. Another rationale for selecting Puerto Rico
for these trials was racist and paternalistic, stereotyping Puerto Ricans

(05:49):
as ignorant and uneducated, so basically, if they could successfully
use the pill, than anyone could. And then added to
all of that, the idea of informed can scent wasn't
really established in the world of medicine at this point.
The people who were participating in these trials weren't informed
that the drug they were taking was experimental or that

(06:11):
they were taking part in a clinical trial. The trials
conducted in Puerto Rico and elsewhere confirmed that anoviad was
an effective contraceptive. No one who took the drug as
directed got pregnant. However, a lot of people reported side effects.
In Puerto Rico, sevent of the trial participants reported things

(06:31):
like headaches, dizziness, nausea, and vomiting. Twenty five of two
participants ultimately withdrew from the study because of these issues.
Three women died, but no post mortem exams were conducted,
so it wasn't clear whether their deaths were caused by
the pill or not. Medical personnel who were monitoring these

(06:52):
trials were really focused on the possibility of several specific
possible issues, cancer damn us to the reproductive system, and
liver damage, so they didn't really connect all of these
other reported side effects to the pill. A lot of
the doctors just wrote them off as unrelated or as
psycho somatic. At the same time, though Dr dress Rice Ray,

(07:16):
who was in charge of the trial, wrote that the
pill quote causes too many side reactions to be acceptable generally.
She wrote that when she made her first report later
on though she would say quote, we could not have
been more wrong. The Puerto Rico trials are the most
widely known at this point, but trials were also conducted

(07:36):
in Haiti and in several cities around the US where
it was legal to do so. In the end, when
drug manufacturer G. D. Searle and Company applied for FDA
approval for an ovid as a contraceptive, it included data
on eight hundred ninety seven patients who had taken ten
milligram doses of the drug and nine who had taken

(07:57):
a five milligram dose. Use reports later gloamed onto the
number of a hundred and thirty two. The number had
come up in some senate hearings. That was the number
of patients who had taken the drug continuously for a
year or more. But really the documentation that Searles submitted
as part of this approval process was at the time

(08:19):
the largest package the f d A had ever received.
There were twenty volumes of data from trials that had
been conducted in Puerto Rico, Haiti, Los Angeles, and Massachusetts.
That was earlier research into safety. It was not the
contraceptive f x C. As part of that trial, the
FDA also pulled seventy five O, B, G, U, I,

(08:41):
N s about their opinions on the pills safety. At
the same time, the FDA recognized that the pill had
not existed long enough to be certain of long term
effects it might cause, so when it approved in ovid's
use as a contraceptive, the FDA required that patients be
prescribed the pill for no more than two years. The
FDA approved an ovid as a contraceptive on June twenty three,

(09:05):
nineteen sixty, and its popularity spread really rapidly. We'll talk
about that more after a sponsor break. As we've established,
the clinical trials on a novid would not have met
today's standards, but even if they had, they're almost certainly

(09:29):
would have been some side effects that were only discovered
after the drug had been approved. Today, drugs are approved
after several phases of trials that typically include thousands of participants,
but once drugs are on the market, they may be
taken by millions of people so extremely rare side effects
or side effects that only show up among groups that

(09:51):
were screened out of the clinical trials for some reason,
like those can show up afterward. In terms of oral contraceptives,
after a novid's approval, other drug makers soon submitted their
own new drug applications. Within five years, seven different drug
companies had an approved oral contraceptive in the US, all
of which contained estrogen and a progestin. The pill became

(10:13):
the most widely used contraceptive in the US, and it
made its way to other countries as well. A lot
went into this rapid and widespread, although definitely not universal,
acceptance of the pill. Drug manufacturers advertised directly to doctors,
both through in person visits from sales reps and through
advertisements in medical literature. Doctors liked that the pill was

(10:38):
easier to prescribe and to use than something like a diaphragm.
Doctors also saw a financial benefit, since patients were supposed
to have an office visit every six months to get
their prescriptions renewed. People also got around that whole requirement
that they were only supposed to be on the pill
for a maximum of two years by either switching doctors

(10:58):
or switching brands. There were advertisements aimed at consumers as well,
and newspapers and magazines covered the pills debut with a
lot of generally positive fanfare, and of course, a lot
of people were just really eager for a convenient, effective,
discrete way to prevent pregnancy for all kinds of reasons.
Planned Parenthood had been operating birth control clinics and advocating

(11:22):
for birth control to be legalized for decades. At this point,
they worked out a deal with Searle to purchase pills
directly from the company, rather than having to go through distributors.
They did this to cut costs and to make the
pill more affordable for people with lower incomes. By the
end of nineteen sixty one, almost of Planned Parenthood clinics

(11:42):
were offering the pill, but it didn't take long before
people started reporting a lot of side effects like new
or worsening migraines, nausea, depression, water retention, weight gain, spotting,
and breakthrough bleeding, breast tenderness, reduced sex drive, and reduced
fertility after stopping the pill, and by nineteen sixty one,

(12:04):
doctors were also starting to report serious and even life
threatening potential issues, including blood clots, heart attacks, and strokes
that were brought on by both clots and by high
blood pressure. A report on fatal clots in Britain was
published in The Lancet in nineteen sixty one, but it
wasn't completely clear whether those clots had actually been caused

(12:28):
by the pill. As other reports of clotting issues and
other serious side effects started to come in, G D.
Sterling Company arranged a one day conference in nineteen sixty
two to review all the evidence. At that point, an
estimated one million people were taking an ovid and there
had been twenty eight documented cases of blood clots, six

(12:48):
of which had been fatal. The assembled group at this
conference unanimously approved a resolution that called for more research
into this issue, but the vast majority also felt that
the available data didn't indicate a causal relationship between the
pill and the clots, and the FDA maintained that the
rate of serious adverse reactions translated to about one point

(13:12):
three out of a hundred thousand users, and that was
a lot lower than the rate of deaths from pregnancy
related complications at the time that was almost thirty seven
out of a hundred thousand. However, after this conference and
its results were publicized. There were a hundred and thirty
two more cases of blood clotting issues that were reported

(13:33):
in just amount of months. These were probably not clots
that happened just then, but people hadn't realized there might
be an connection, so after it was reported, they started
realizing that there might be. As this was happening, news
broke that the sedative the Lidamne, which had been prescribed
as a treatment for morning sickness, had caused a range
of illnesses and disabilities and babies who were exposed to

(13:55):
it in utero. We covered this medical disaster in August
of twenty nineteen. The news about the litamine temporarily overshadowed
the growing safety concerns about the pill, but it also
led to much tighter restrictions on drug testing and safety afterward.
This was also happening at the same time as a
generally increased scrutiny into chemicals and environmental pollutants and other

(14:19):
issues and what effect they might have on the human body.
For example, Rachel Carson's Silent Spring, which included a chapter
on things like pesticide poisonings and a connection between pesticides
and cancer that came out in nineteen sixty two. That
book is when we've had a lot of request to cover.
It's a tricky one because it covers a lot of

(14:41):
different territory. Yeah. Yeah, the potential health connections is just
one chapter of the longer book. Yeah. Through the early
to mid sixties, there was more research into whether the
pill was causing blood clots and other serious health problems,
but a lot of it was really contradictory. The f
d A formed an ad hoc committee to investigate the

(15:02):
pill in nineteen sixty three, which ultimately found no increased
risks for issues like blood clots. In other studies, findings
disagreed with one another, and published research often concluded mostly
the more research was needed. There were also a lot
of questions about whether the pill could increase the risk
of cancer, but because cancers can take a long time

(15:24):
to develop, it wasn't possible to even really study that yet.
In November of nineteen a report came out that advised
further study into whether the pill was causing neuro optimal
logic issues, and the FDA advised drug manufacturers to add
eye problems to the list of contraindications that was provided
to doctors and pharmacists when they were prescribing and dispensing

(15:47):
the pill. The FDA's Advisory Committee on Obstetrics and Gynecology
formed four task forces to do more research into the pill,
one on thromboembolic disease, one on car synergenic potential, one
on endocrine and metabolic effects, and one on efficacy. But
the report it issued in nine once again mostly called

(16:09):
for more research, describing a lot of results as quote inconclusive,
and acknowledging that it was simply too soon to know
whether contraceptives taken now would have an impact on someone's
body thirty years down the road. There were also lots
of unanswered questions about whether demographic groups that were more
likely to be on the pill we're predisposed to various

(16:31):
potential side effects or not. Compounding all of this was
the fact that the medical community as a whole was
debating exactly how to weigh the pills risks and benefits.
All drugs have side effects, but before the pill was introduced,
virtually all the prescription drug is on the market were
meant to treat a specific illness or condition. Questions of

(16:54):
whether a drug was safe enough we're also connected to
how serious that condition was and what it would to
treat it. Although birth control was sometimes being prescribed to
treat things like painful or irregular periods, in a lot
of cases the patient was young and healthy and just
wanted to prevent pregnancy. So it just left this big

(17:14):
question what was an appropriate level of risk for a young,
healthy person who wanted to prevent pregnancy For years or
even decades. Meanwhile, the news media was generally interpreting no
conclusive evidence to mean that there's not a problem. So,
even though doctors and researchers had been reporting at least
the possibility of serious issues for six years, reporting on

(17:38):
the pill in the mainstream press continued to be pretty positive.
In April of nineteen sixty seven, the tone of all
this started to shift. More reports started to suggest a
definitive link between the pill and blood clots. In May
of nineteen sixty seven, the British Medical Journal printed the
results of a study that found that fifty out of

(18:01):
a hundred thousand oral contraceptive users would be hospitalized for
thrombo embolism every year. That was ten times higher than
the rate of hospitalizations among people who were not on
the pill. This report showed a similar dramatic disparity in
death rates. For people between the ages of twenty and
thirty four, one point five per one hundred thousand pill

(18:24):
users would die of complications from a thrombo embolism. Among
non users, that number was only zero point two, and
for pill users between the ages of thirty five and
forty four, the death rate was three point nine per
one hundred thousand users, but it was only zero point
five per one hundred thousand non users, So this seemed

(18:46):
pretty clear. But this report only led some more debate,
with doctors and pharmaceutical companies arguing about whether the study
was accurate or whether it had been correctly designed. But
news reporting on the pill started to become a lot
more critical. There's a lot more first person testimony from
people who had been harmed, like patients who had experienced

(19:08):
blood clots or family members whose loved one had died.
There was also just a lot more reporting on the
more vague and inconvenient problems that were associated with the pill,
like breast tenderness, spotting, and nausea. By nineteen sixty nine,
the medical community was increasingly recognizing a clear connection between
the pill and blood clots. It was also clear that

(19:30):
the pill was causing some kind of metabolic effects, although
it really wasn't yet clear what those were, and they
still really didn't know whether the pill increased the risk
of various cancers. But then individual doctors were all over
the place and how much they knew about this and
how it affected their work with their patients. Communication about

(19:52):
these issues within the medical community was just not very robust.
A lot of the studies that suggested the strongest connection
between the hill in a specific problem, a lot of
those were printed in specialist journals, so, for example, papers
about blood clots in the eye were being printed in
journals of optimology. General practitioners and gynecologists who were likely

(20:15):
to be prescribing the pill to their patients weren't necessarily
reading these particular journals. GPS often found about really concerning
studies only after they were picked up and reported on
by mainstream news outlets, and as a trend, doctors often
weren't talking to their patients about risks at all. If
you wanted oral contraceptives, you went to your doctor and

(20:37):
asked for them, and a lot of the time you
just got a prescription with no discussion about the pills
potential side effects, or whether you had any kind of
illness or condition that might make you more prone to
those side effects. All of this came to a head
in nineteen sixty nine, which we will get to you
after a sponsor break. In nineteen sixty nine, journalist Barbara

(21:04):
Semen published The Doctor's Case Against the Pill. It documented
numerous accounts of serious problems that were associated with the pill,
although some of these connections were anecdotal and were later disproven.
A lot of the book documented side effects that were
well known but which patients were not being informed of

(21:24):
before taking the pill. Siemen was particularly driven by the
idea that patients had a right to be informed of
the risks that were involved in any drug or other
medical treatment that they took. Her aunt had actually died
of a uterine cancer that was connected to high estrogen
levels in a hormone replacement therapy that she was taking,

(21:45):
and then her son had also nearly died as a
baby because she had been prescribed a laxative that was
passed to him through her breast milk. On September twenty
three nine, Siemen wrote to U S. Senator gay Lord
Nelson of Wisconsin. Her letter read, in part, quote, I
wish you would seek out ten randomly selected women who

(22:06):
have been on the pill for any length of time
and ask them whether they have had any other medications
to control pill side effects. You may be amazed, as
I was, to find that a high proportion six or
seven out of ten have had to take other powerful
medications to counteract pill side effects. These include diuretics to
control bloating, pain killers for headaches, et cetera, anti nausea preparations,

(22:31):
tranquilizers for nerves, pep pills for lethargy, and perhaps most alarmingly, anticoagulants.
Some doctors appear to be handing these out for any
suspicious swelling and a pill user, not just for established clots.
She also wrote, quote, never before in history have so
many millions of people taken such a powerful and unnecessary drug.

(22:55):
Nelson read Siemens book. He was on the Senate Subcommittee
on Monopoly, which was under the Select Committee on Small Business,
and he was conducting hearings into the pharmaceutical industry. On
December twenty second, nineteen sixty nine, he announced that the
committee would hold hearings into the safety of oral contraceptives.
These hearings started on January fourteenth, nineteen seventy, and they

(23:18):
lasted into March. On the first day, Nelson gave a
statement that said, in part quote, the aims of these
hearings are to present, for the general public's benefit, the
best and most objective information available about these drugs. First
whether they are dangerous for the human body, and second,
whether patients taking them have sufficient information about the possible

(23:40):
dangers in order to make an intelligent judgment whether they
wished to assume the risks. Many of the people who
were invited to testify were people who had been featured
in Siemens book. Most were doctors, biologists, physiologists, professors of medicine,
and other experts of the pills original co developers dot
or John Rock was still living but was not invited

(24:02):
to testify, and many of the people who did speak
were deeply critical of the pill, enough that Senator Bob
Dole of Kansas criticized the hearings as unbalanced. In general,
the criticisms made at these hearings were about purported problems
being caused by the pill itself, not about the FDA
approval process that had led to its being made available

(24:25):
because of the Theldomide disaster. The process for that in
nineteen seventy was much different than it had been ten
years earlier, so picking apart the pills development and testing
process did not seem quite as relevant. A key figure
and the first person to testify, was Dr Hugh J. Davis,
who taught obstetrics and gynecology at Johns Hopkins. Davis described

(24:48):
oral contraceptives as an experiment that was being carried out
on millions of healthy women. He argued that the synthetic
hormones being used in contraceptives were carcinogens in various animals,
and that he was certain that would also be true
of humans. He also described them as causing metabolic problems
and criticized the pharmaceutical industry for trying to protect their

(25:10):
own profits instead of finding safer options. However, Davis had
an enormous conflict of interest here. He was developing an
intra uterine device that would, in his opinion, be a
much safer option than oral hormones were. He thought this
was going to be a completely effective method of contraception
that had no side effects. So even though he said

(25:34):
he didn't have any conflicts of interests. It was in
his personal and financial interest if people stopped trusting the
pill and started looking for other forms of birth control.
And we should also note that I U D was
the Dalkon Shield, which hit the market in nineteen seventy one.
The Dalkon shield was associated with at least eighteen deaths
and more than two hundred thousand infections, miscarriages, and other

(25:57):
serious problems because it's multi filam string could draw bacteria
into the uterus. A H. Robbins sold two point eight
million of them before it stopped making them in nineteen
seventy four, although it didn't actually recall them for another
decade and covered up what was going on. More than
three hundred thousand lawsuits were filed against A. H. Robbin's company,

(26:19):
which ultimately filed for bankruptcy in nine five. Yeah, they
were still telling people who had these inserted that they
needed to go to the doctor to have them removed,
recently enough for me to remember seeing news reports about
it when I was a kid. Same. Yeah. In addition
to that, like I, a member of my extended family

(26:41):
actually had a stroke from her birth control pills before
I was born, So it's like multiple overlapping aspects of
this episode have like a personal connection for me. Back
to the Senate hearings. Though only four of the people
who testified at these hearings were women. The first woman
to testify was Dr Elizabeth Connell. That was on February,

(27:04):
which was well into the hearings themselves. The only woman
to testify that she personally had used the pill was
Dr Mary E. Laine, who was clinical director of the
contraception service at Margaret Sanger Research Bureau. Of course, the
fact that an all male Senate committee was holding hearings
into birth control without involving many women, and without inviting

(27:26):
women who were directly affected by the pill to testify,
made people angry. On January twenty three, protesters interrupted the
testimony of Philip Corfman, director of the Center for Population
Research at the National Institutes of Health. They were members
of the feminist group d C Women's Liberation, led by
Alice Wolfson and General Wilson and the other women agreed

(27:49):
with the basics of what Korfman was saying, which was
that oral contraceptives caused all kinds of effects throughout the body,
and that these effects were poorly understood, that women were
not being told about them, but they objected to the
fact that everyone who had testified at that point was
a man, and that women whose experiences had been covered
in Siemen's book semen herself, none of them were being included.

(28:14):
DC Women's Collective also distributed flyers to the hearings attendees
with questions that echoed what they shouted during the proceedings.
These flyers read, why are no women testifying? Why are
no women on the subcommittee? Why is the profitable relationship
between doctors and drug companies whitewashed by the press and
in these hearings. Why isn't there a mail pill? Why

(28:36):
are contraception and medicine profit making industries rather than free
public services. Why are drug companies deliberately withholding available information
on side effects. Why is our government's solution to world
hunger to control population rather than the redistribution of resources.
Why are these hearings not discussing the issue of abortion

(28:57):
on demand. What kind of reparation will be made by
the white male medical establishment to women who have been
used as guinea pigs in this mass experiment. Nelson cleared
the room after this disruption and then only allowed the
press back in when the committee reconvened. His treatment of
these women and his discussions of them during the hearings

(29:19):
and afterwards that was pretty dismissive and patronizing, including calling
them girls and lecturing them about appropriate behavior. These hearings
really didn't uncover any new information about oral contraceptives. Most
of the testimony repeated details that had already been published
in journals or in Siemens book, And they didn't really

(29:41):
answer the questions of whether the risks of blood clots
and other potential health issues outweighed the pills benefits. But
they made it abundantly clear that people were not being
informed of these risks now, like a lot of this
had been documented that people didn't know until they heard
about it in these hearings, and and this had a
dramatic impact on the pill itself and on its acceptance. Initially,

(30:06):
these hearings were expected to take place over five days.
All three major American TV networks covered at least four
of those five days, and according to a Gallop poll
that was released shortly after that, about eighty seven percent
of women in the US who were between the ages
of twenty one and forty five had heard or read

(30:27):
about the hearings, and two thirds of the women polled
said their doctor had never informed them of the risks
that were associated with the pill. After these hearings, the
number of people taking the pill dropped sharply, with about
eighteen percent of people who had been taking them stopping
and another roughly considering it. In the months after the hearings,

(30:49):
Doctors reported an uptick in unexpected pregnancies. In the wake
of these hearings and this growing body of information about
the dangers that were associated with the pill, pharmaceutical companies
lowered the amount of hormones in their contraceptives dramatically. The
first formulation of a novid contained ten thousand micrograms of

(31:13):
progestine and a hundred and fifty micrograms of estrogen. Today,
a low dose contraceptive pill is more like between fifty
and a hundred and fifty micrograms of protestine and between
twenty and fifty micrograms of estrogen. A lot of different formulations.
They can vary pretty significantly and exactly what dosages of

(31:34):
what are in there, but that is a lot less.
This decrease also led to a reduction in the occurrence
of blood clots. Today, the FDA estimates that for every
ten thousand people on oral contraceptives, between three and nine
will develop a blood clot every year. These hearings also
led to the inclusion of the patient package insert that

(31:56):
is required in birth control pills and other medications in
the US today. The first proposed draft of this insert
was a six hundred word piece called what You Should
Know about Birth Control Pills. It went over the risk
of blood clots and noted that anyone who had a
history of clots, serious liver disease, breast cancer, certain other cancers,

(32:17):
or unexplained vaginal bleeding should not take the pill. It
also noted that anyone with kidney disease, asthma, high blood pressure, diabetes, epilepsy,
uterine fibroids, and migraines should take it only with special
medical supervision. It listed possible reactions and noted that while
these hormones had caused cancer in animals, there was no

(32:38):
proof that they did in humans. It then read quote,
because your doctor knows this, he will want to examine
you regularly. Okay that last sentence. That's one of many
assumptions that this pamphlet made about the doctor patient relationship.
It assumed that the doctor was male, and it said

(32:59):
things like your doctor has taken your medical history and
has given you a careful physical examination. He has discussed
with you the risks of oral contraceptives, and has decided
that you can take this drug safely. Of course, that
is something a pre printed piece of paper had no
way of actually knowing. The American Medical Association opposed this insert,

(33:22):
saying it would undermine relationships between doctors and patients. Drug
companies were also opposed, and the Pharmaceutical Manufacturers Association submitted
a list of objections in June of nineteen seventy. The
f d A ultimately decided on a much shorter information
card that described the risk of blood clots as quote
the most serious known side effect. It was only seven

(33:45):
sentences long, about half of which explained that patients could
get a copy of the longer piece from their doctor.
This made oral contraceptives the first drug in the US
to come with a warning meant for consumers. Yeah, they
were warning before this point, but they were for the
doctors and the pharmacists, not for the people actually taking

(34:06):
the drug. DC Women's Liberation and other feminist groups protested
the watering down of this statement, which, to be clear,
was kind of a mixed bag in the first place.
They sat in at the Office of Health, Education, and
Welfare Secretary Robert Finch. They met with officials. They petitioned
to reinstate the longer and stronger version of that warning,

(34:28):
but that nothing changed at that point. Between nineteen seventy
and nineteen seventy five, there were about ten million prescriptions
written for the pill, but only about four million copies
of that longer informational statement were distributed. A more thorough
pill insert with all the information actually on it, became

(34:49):
mandatory and birth control pills in nineteen seventy eight, and
in nineteen eighty the FDA mandated that this had to
be understandable to the average consumer. I don't know if
it's a understandable to average consumers now, because I know
every time I've gotten a package of birth control pills,
it's been like very thin paper with tiny, tiny type

(35:10):
on it and a whole lot on there. Yeah, it's
like a small novelette. Um, yeah, I agree. I mean
I haven't I haven't seen one in a long time,
but last time I did. Yeah, we we might talk
about that more on the means. In addition to the
patient packet insert, the pill hearings and the overall debate
over oral contraceptives had a huge impact on the consumer

(35:32):
health movement, especially as it related to women. In nineteen
Seamen Wolfson and three other activists founded the National Women's
Health Network. You'll see that listed as n w h N,
and that still exists today and it combines lobbying, activism,
and education. Yeah, this was it was part of a
much bigger movement that was about like consumer education and

(35:54):
informed consent and people having the right to know what
the potential side effects are of any rug that they're taking. Uh. Today,
to just circle back to Gaylord Nelson for a minute, Um,
he is not best known for these pill hearings. He's
best known as the founder of earth Day, which he
also did in nineteen seventy. So that's that's kind of

(36:15):
the story of how we got to this point that
you're supposed to be informed of the risks of things,
of drugs that you take before you actually take them,
which hopefully we will understand better whether these like what
exactly these very rare risks with the vaccines maybe, and
and how best to tell people about them. What's going

(36:37):
on with listener mail for you? Wow? I have listener
mail from Ian. Ian is the person who had suggested
the rum rebellion episode and uh, and wrote in again
to say thanks for doing that suggestion, and to thank
the person who wrote in about the gum nut baby
and and Cookabara illustration that we talked about in listener mail. Um,

(37:00):
and then to just skip ahead. Ian has sent some
interesting information related to cardboard boxes and a Christmas story. Uh.
And so I'm going to read just that part of
this email. Ian says, quote, I too think a wooden
box was used for dramatic effect. However, I did also
think about intermodal containers as they became popular in the

(37:21):
nineteen seventies. Before containers, just about everything being shipped, from
lamps to pianos to sacks of flour to car parts
and so on had to be manually loaded and onloaded
onto every form of transport it traveled on, from ship
to truck to train car. This resulted in a lot
of breakage and also theft when containers came along. Something

(37:42):
like say, a leg lamp could be loaded onto a
container and a factory in China and then not be
touched until it got to a distribution center in Atlanta.
The reduction in damage meant it could now be shipped
in a cheaper, lighter, cardboard box rather than a heavy
wooden box. I will not suggests an episode on intermodal
containers because I think that might be too geeky for

(38:04):
listeners who are not railroaders or similar like me. For instance,
before containers, ships were often limited in size because if
they got any bigger, they would spend more time in
port than at sea. For instance, the Liberty ships which
were mass produced during World War Two, we're ten thousand
tons in size, but the ever given the ship that

(38:25):
recently made headlines by getting stuck in the Suez Canal
is two hundred thousand tons. Also, waterfronts of many cities
of the world, from London, England, to Wellington, New Zealand,
to Sydney, Australia to Baltimore, USA, have been changed by
container shipping. Container ships needed new types of cranes and
open spaces next to the wharfs store containers instead of warehouses.

(38:48):
This often meant new purpose built ports had to be
built for them. This left the old wharves and warehouses
free to be redeveloped into everything from waterfront apartments to
tourist areas to new business centers, and that there's a
little further detail on there, but I'm gonna wrap this
email at this point. Thank you Ian for writing this. UM,

(39:09):
the setting of Christmas story is a little earlier than
was described in the listener mail that we originally read. UM,
but it doesn't change the bulk of my answer, which
was that, Um, the cardboard boxes existed early enough that
there's like, there are pictures of things like World War
One gas masks being distributed in cardboard boxes. UM. So

(39:31):
that would not have changed the answer. But I felt
like this information about shipping containers was a really interesting
add on to the whole specific conversation. So thank you
Ian number one for suggesting the Rum Rebellion episode, but
and also number two for writing in with this additional information. UH,
if you would like to write to us about this
or any other podcasts were at history podcast that I

(39:51):
Heart radio dot com. And we're also all over social
media at Myston History That's Real Hunter, Facebook and Twitter
and Pinterest in Instagram, and you can subscribe to our
show on the I Heart Radio app and Apple podcasts,
and anywhere else that you get your podcasts. Stuff you
missed in History Class is a production of I heart Radio.

(40:14):
For more podcasts from i heart Radio, visit the i
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