the Female Body GOVERNING

The Pill in Puerto Rico and the Mainland United States 177
dropped out because of side-effects (1957), while Satterthwaite (1957,
1958) believed that there were signifi cant, potentially precancerous
changes in the cervices of patients using the Pill—they had had Third
World overpopulation in mind. When the FDA presented reports of
thromboembolis in British and North American women using the Pill
to them, the Pill’s defenders continued to cite “overpopulation” as the
major reason to continue to support it.
In my research, I followed this debate through several organizations,
but found one particularly revealing and candid source: the editor’s fi les
for Rockefeller University’s Medical Letter. The Medical Letter was sent to
physicians and described new drugs, questions about side effects, and
controversies over older ones. In the fi rst years of the 1960s, following
FDA approval of the Pill as a contraceptive, the Medical Letter’s editor,
Harold Aaron, sent a series of drafts of articles out about the Pill to all
the major players in the fi eld—policy makers, researchers, corporations,
and physicians. The reviewers of these articles were and, unfortunately,
must remain anonymous because of restrictions attached to the papers
by their donor and enforced by the archive. These reviewers were
not, however, obscure; they encompassed some of the most signifi cant
researchers and advocates in the fi eld. Together, they produce a fascinating
ensemble of voices and suggest a great deal about what questions
and arguments seemed possible to those involved in making decisions
about the Pill.
In 1960, the Medical Letter ran an article that was warmly positive
about the Pill. Its tone was one of certainty; it assured readers that a
considerable amount was known about the effect of estrogen-progestin
oral contraceptives. The only hint of concern about the effects of these
drugs was that one reviewer insisted that a line that described the Pill
as being “as safe as the condom and the diaphragm” be changed to “as
effective as,” arguing that unknown side effects were still possible.
By 1962 and 1963, however, the Medical Letter was grappling with how
to report 28 cases of thromboembolic disease, including one death,
which had been reported to the FDA and linked with the use of the
Pill. Articles in the newsletter tried to strike a balance between warning
of potentially serious effects on the one hand, but on the other not
overreacting to anecdotal reports when there was little agreement over
what the rate of clotting disorders should be in the general population,
and whether 28 out of approximately 1 million users was too high (or
whether there were others who had not been recorded as having to do
with the Pill). However, guarded language met with little approval by
either side. One article reproduced a pharmaceutical company’s advice
to physicians that they “should be alert to the possible occurrence