It’s time for some more Malcolm Gladwell. Last week we did the article “Most Likely to Succeed,” about football and education, taken from his new anthology What the Dog Saw. Today I want to talk about birth control and cancer. Not my normal subject matter, but there is a connection with religion and with health. This will be longer than my usual, read a little each day.
The piece is called “John Rock’s Error,” subtitled “What the Inventor of the Birth Control Pill Didn’t Know about Women’s Health.” It first appeared in The New Yorker ca. March 2000. John Rock was a devout Catholic, mass every day, at the same time a giant in obstetrics at Harvard Medical School. The Pill, his crowning achievement, was approved by the FDA in 1960. Pope Paul ruled against oral contraceptives in 1968. The debate ran with passion through the whole decade and beyond.
John Rock maintained that his faith and his medicine were perfectly compatible, because he saw the Pill as a natural method of birth control. It didn’t feel natural, but it worked by natural means, mimicking the hormone progestin that prevents any new ovulation so gestation can succeed. Look it up and you will understand better. The Pill basically shuts down ovulation as long as it is taken but in a “natural” way that Rock saw as theologically significant. Kind of like the “rhythm” method that Pius XII sanctioned in 1958 because he viewed it (too) as a natural method of regulating procreation. In fact, rhythm works by limiting sex to the safe period that progestin creates. Pius XII then approved the Pill too. It took ten years for the Church to reverse that.
The action that really captured my attention switches to more primitive lands. Researchers in Mali ca. 1986 found that tribal women there give birth eight or nine times on average. From the age of 20 to 34, they spend so much time either pregnant or breast feeding (which suppresses ovulation) that they average only slightly more than one menstrual period per year. After 34, it’s about four menses a year. All told, women in that Dogon tribe menstruate about 100 times in their lives. By contrast, the average modern western woman is somewhere between 350 and 400 times, because they are not pregnant very often. So what?
It gets more interesting when we study the incidence of certain cancers that women get. Researchers believe that the shift from the more primitive pattern of menstruation of 100 to the 400 pattern subjects women’s bodies to changes and stresses that their bodies weren’t necessarily designed to handle. Incessant ovulation increases the occurrence of abdominal pain, mood shifts, migraines, endometriosis, fibroids. anemia, and (most seriously) the risk of some cancers. Cancer, after all, occurs because as cells divide and reproduce they sometimes makes mistakes that cripple the cells’ defenses against runaway growth. Any change promoting cell division has the potential to increase cancer risk, and ovulation appears to be one of those changes. When a woman ovulates, an egg literally bursts through the walls of her ovaries. To heal that puncture, the cells on the ovary wall have to divide and reproduce, increasing the cancer risk. Every time a woman gets pregnant and bears a child, her life time risk of ovarian cancer drops 10 percent! Why? Her ovarian walls are saved at least a dozen bouts of cell division! So… the Pill really does have a natural effect. By blocking the release of new eggs, the rounds of ovarian cell division are reduced. As a result, a woman who takes the Pill for 10 years cuts her ovarian cancer risk by about 70 percent and her endometrial cancer risk by about 60 percent. Here ‘natural” means something very different than what Rock meant. The Pill is really only natural in so far as it’s radical – rescuing the ovaries and endometrium from modernity.
But you say, don’t women still have their periods while taking the pill? They do/ did. They don’t ovulate but they have their periods. That is because Rock thought that doing away with the monthly menses wouldn’t seem “natural,” so the Pill is only taken for three weeks each four week cycle (or there is a placebo in the fourth week) to allow for menstruation. It would be simple, and not harmful, to prevent menstrual bleeding altogether for months on end, with real benefits. And that is the direction that reproductive specialists are more and more advocating, along with work on a new Pill that would also fight breast cancer.
It is ironic that Rock sold the Pill to the Church as no more than a pharmaceutical version of the rhythm method, when it turns out that the Pill can save lives. Not as a drug to prevent life but as one that can save life. The Church might well have said yes if it understood that. Instead, Rock got to experience the attacks on the Pill from the Church that ultimately left him a broken man. But science, Gladwell reminds us, often produces progress in advance of understanding. If it had been otherwise in this case, the order of events in the discovery of what was “natural” would have been reversed, and Rock’s world, and our world too, would have been different places.
I think I got the science right, but medical people will make it so. Regardless, I think there is much to ponder here about real life and death issues. Write back if you wish. Shabbat Shalom and best regards, Bill Rudolph