John Rocks ErrorIt’s time for some posts on how science can be influenced by sexist perspectives in a way that is or can be harmful to women.  My last post re-posted an article by Moira Weigel on how the concept of the biological clock, invented in the late 1970’s, has become a metaphor, which is invoked as proof that women should not venture too far from their traditional roles.  As such it has been used to counteract the effects of women’s liberation.

The current post is about John Rock who invented the Pill.  In a Malcolm Gladwell blog post, titled “John Rock’s Error” Gladwell described the way in which John Rock decided that the Pill ought to be taken over a four-week-cycle—a woman would spend three weeks on the Pill and the fourth week off the drug (or on a placebo) to allow for menstruation.  “THERE WAS AND IS NO MEDICAL REASON FOR THIS.” 

Rock knew that when a woman is on the pill, no egg is released because progestin suppresses ovulation.  Interestingly, he knew that the hormonal flux the Pill produced was so modest that WOMEN COULD CONCEIVABLY GO FOR MONTHS WITHOUT HAVING TO MENSTRUATE.  But Rock, a devout Catholic, wanted the approval of the Catholic Church.   The strategy he decided on to woo the Church into supporting the use of the Pill was to mimic the so-call “natural” menstrual cycle of women.  Thus the three-week-on-fourth-week-off the drug was created to make the drug seem as “natural” as possible.Menstruation drop in

John Rock’s error was to think that he could influence the Church to support the Pill and protect women against unwanted pregnancies.  Thus we ended up with a drug shaped by the dictates of the Catholic Church even though the Church outlawed the use of the Pill for Catholics.  For John Rock, the dictates of religion and the principles of science got mixed up.  While it was not a deliberate error, John Rock was responsible for the way the Pill came into the world.

What is a “natural” menstrual cycle?

Gladwell introduces us to Beverly Strassman who studied Dogon women from a tribe in Mali in which contraception was never used.  She found that the average Dogon woman has her first period at age 16 and gives birth 8 or 9 times.  From the onset of menstruation to the age of twenty, the Dogon women average 7 periods a year.  From 20 to 34, she spends much of her time either pregnant or breast-feeding, averaging only slightly more than 1 period a year.  From 35 to menopause at around 50, as fertility rapidly declines, she averages 4 periods a year.

Dogon women menstruate about 100 times during their lifetime; contemporary Western women average between 350 and 400 times during their lifetime. 

OvulationStrassman argues that this is the evolutionary “natural” menstrual cycle of women.   She believes the current 28-day cycle deemed “natural” is the result of decreasing fertility rates associated with demographic and cultural changes over the last century.   Dr. Elsimar Coutinho and Dr. Sheldon Segal, two prominent contraceptive researchers that Gladwell cites propose in their provocative book, “Is Menstruation Obsolete?” that this transition to low fertility with its corresponding “incessant ovulation” is a serious problem for women’s health.  They argue that “incessant ovulation” is related to a greatly increased risk of ovarian and endometrial cancer.  These cancers are characteristically modern diseases, which are, in part, the consequences of a century in which women menstruate four hundred times in a lifetime.

As Gladwell comments, “In fact, as more recent research suggests, the Pill is really only natural in so far as it’s radical—rescuing the ovaries and endometrium from modernity.  That Rock insisted on a twenty-eight-day cycle for his pill is evidence of just how deep his misunderstanding was: the real promise of the Pill was not that it could preserve the menstrual rhythms of the twentieth century but that it could disrupt them.”

Gladwell ends his post by introducing us to Malcolm Pike who is a member of the Epidemiology Service at Memorial Sloan-Kettering Cancer Center in New York and the Department of Preventative Medicine at the University of southern California Norris Cancer Center in Los Angeles.  Dr. Pike is widely known for his research on the etiology and chemoprevention of breast, endometrial, and ovarian cancers and has conducted landmark research to clarify our understanding of how pregnancy and oral contraceptives affect these cancers. Dr. Pike’s major interest is in designing an oral contraceptive that could reduce the risk of breast cancer without losing the protection offered by these drugs against endometrial and ovarian cancers.

He is working on an inhaled drug that can strike the right balance between hormone levels that prevent pregnancy, avoid the hormonal ravages of 28-day cycling, and keep women healthy.  Pike is going to take the mythology of “natural” and sweep it away.  As Pike says,

“But the modern way of living represents an extraordinary

change in female biology.  Women are going out and becoming

lawyers, doctors, presidents of countries.  They need to

understand that what we are trying to do isn’t abnormal.  It’s

just as normal as when someone hundreds of years ago had

menarche at seventeen and had five babies and had three hundred

fewer menstrual cycles than most women have today.  The world is

not the world it was.  And some of the risks that go with the

benefits of a woman getting educated and not getting pregnant all

the time are breast cancer and ovarian cancer and we need to deal

with it.  I have three daughters.  The earliest grandchild I had was when

one of them was thirty-one.  They ovulate from twelve or thirteen

until their early thirties.  Twenty years of uninterrupted ovulation before

their first child!  That’s a brand new phenomenon!”

The story of the Pill as well as the story of the biological clock are stories about how sexism, in particular religious sexism in the former case, influences the priorities of scientific research.  And, these stories demonstrate how scientific discoveries can be used to serve sexist ends.  We become used to thinking about the metaphor of “the biological clock” as if it were simply a neutral description of facts about the human body.  So it is with the concept of the “natural menstrual cycle”, a notion that is used to support the teachings of a particular religious system, which then becomes what should be the case ignoring anthropological data and data which points to the influence of the so-called “natural” cycle on the development of cancer in women.

Gladwell’s post is a really good read!

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