The Pill Trial (Contd.)

Ostensibly, the hearings before Senator Gaylord Nelson's monopoly subcommittee in Washington last week did not constitute a trial, either of the Pill or of its proponents. The Wisconsin Democrat repeatedly expressed his resentment of any suggestion that they were so intended. But the atmosphere in the hearing room was tense with ill-concealed hostility between the Pill's attackers and its defenders. The give-and-take between Senators and witnesses, and even between Senators, had the tone of courtroom adversary procedure. The reason was clear: no new medical evidence had been presented in Nelson's first hearings (TIME, Jan. 26), but wide publicity and scare headlines given to one side of the argument had created what some witnesses called a public panic.

Dr. Alan F. Guttmacher, president of Planned Parenthood-World Population and elder statesman of the birth-control movement, tried to turn the tables with a medical metaphor. "There have been undesirable side effects from these hearings," he said. "They have created a sense of great alarm." Guttmacher cited polls indicating that almost one-fifth of the American women who had been using the Pill had abruptly abandoned it, while as many more were thinking of doing so.

"I don't think anyone is saying that your hearings are impregnating women," Guttmacher told Nelson, "but the adverse publicity has caused many women to quit the Pill." Kansas Republican Robert J. Dole interrupted to voice the hope that the resulting babies will not all be named for subcommittee members. But Guttmacher, like a committee of 19 Planned Parenthood physicians that met recently, had a more serious concern. By no means all the unwanted pregnancies will result in babies. As many or more will result in abortions (see following story), most of them illegal, with the attendant hazard of serious illness or death.

Pregnant Brides. Guttmacher insisted that his intention was not to whitewash the Pill but "to place this matter in proper perspective." The Pill, he declared, is "a prophylaxis against one of the gravest sociomedical illnesses--unwanted pregnancy." Experts estimate, he said, that from 200,000 to 1,000,000 abortions are performed in the U.S. each year, with a death rate of 100 per 100,000 illegal abortions performed by non-medical operators. At least one out of six U.S. brides is pregnant when married, and among teen-age brides, one out of two. No fewer than 300,000 illegitimate births are predicted for 1970. At least 750,000 children born each year are unwanted.

Both Guttmacher and Columbia University's Dr. Elizabeth Connell readily conceded that the Pill has some harmful side effects. The side effects are unpredictable in some women. Dr. Connell urged that the Pill never be prescribed for women who already show danger signals. She listed these as persistent headaches, swelling of the legs, vein tenderness and chest pain. One midnight not long ago, she said, a relative called her and described some of these symptoms. Dr. Connell (mother of six who refuses to say whether or not she takes the Pill herself) answered forthrightly: "If you ever take the Pill again, you'd be out of your mind." With Guttmacher, she agreed that patients taking birth-control pills are more prone to the formation of blood clots than those not on the Pill. But the statistics ought to be considered in context. Among women aged 20 to 34, said Guttmacher, there are 1.5 clotting deaths per 100,000 women per year, compared with 22.8 who die as "a consequence of pregnancy"--a ratio of one to 15. Among older women, the ratio is almost the same. Granted, said Guttmacher, not all women who quit the Pill become pregnant, because other contraceptive methods are available. But with them the risk of unwanted pregnancy is far greater: the failure rate is two to four times as high with the IUD (intrauterine device), and ten to 30 times as high with the diaphragm.

Zero Is Too Much. Senator Nelson reiterated that he is not against the Pill as such. "I favor planned parenthood," he said. "I would like to see the perfect Pill. The U.S. is already overpopulated. Zero population growth is even too much, but J also think the public is entitled to the facts." Some of the facts, Nelson contended, have been obscured by drug-company promotion: "The literature that is going out is inaccurate and is misleading 8,500,000 women, and has been doing so for ten years." To prove his point, Nelson quoted from a drug company's pamphlet entitled So Close to Nature, and contrasted its breezy optimism with the cautionary tone of what he said was an official Government document.

At this point, New York's Jacob Javits intervened. He had remarked that he was "only a modest Senator, and an attorney," but not a medical expert. Now Attorney Javits reached for the evidence and read aloud that it had been published by Mead, Johnson back in 1965, and Nelson had failed to mention that it is no longer being distributed. The so-called "official Government document," he found, was in fact a private publication recording the views expressed by many investigators at a seminar financed by the U.S. Public Health Service.

Although Nelson and Guttmacher could agree that the Pill is "a crude, first-generation contraceptive," they could not agree as to how women should be told about its admitted and known dangers so that they can make an "informed decision" about its use. Nelson was all in favor of direct education of women. Guttmacher insisted that it was the doctors who should be educated. If the hearings have prodded more U.S. physicians into prescribing the Pill more carefully and insisting upon examining their patients every six months, as Guttmacher urges, they will have done some good as well as much harm.

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