The Riddle of Gender - Deborah Rudacille [142]
Doctors often prescribed massive doses of DES to prevent miscarriage in the first trimester of pregnancy—but as researcher Lindsey Berkson discovered, even a single shot of DES in the first trimester could have devastating results. The protocol recommended by Smith and Smith “began during weeks 5 and 6 of fetal life and the dosage increased until the 36th week of pregnancy.” Thus, precisely at the crossroads when the developing embryo begins to differentiate sexually, the children of DES mothers were subjected to a barrage of synthetic estrogen. “Most of the first trimester, when embryonic development is most active and differentiation of structures is rapid, was blanketed by DES,” say Apfel and Fisher. “The dosage schedules used in other studies varied somewhat but all included significant doses during the first trimester and increasing doses until at least mid-pregnancy” DES was administered in pills, injections, vaginal suppositories, and vitamins. The DES Cancer Network estimates that approximately ten million mothers and unborn children were exposed to DES from 1941 to 1971. A great many of these individuals, both mothers and children, have no idea that they were unwitting participants in the DES experiment. “Many of these people are not aware that they were exposed,” the National Cancer Institute admits on its website. Lindsey Berkson says that the estimate of ten million Americans exposed to DES either during pregnancy or in utero “probably underestimates the number of in utero exposures of DES since many private physicians administered the drug and hospitals often did not keep records of ‘enhancement’ treatments. Even if they did not receive direct injections of DES, many of our mothers ate contaminated food before and during their pregnancies.”
In April 1971, a paper published in the New England Journal of Medicine noted the appearance of a rare form of vaginal cancer among very young women. Though the first case of clear cell adenocarcinoma (CCA) had been diagnosed in 1961, doctors at Massachusetts General Hospital stumbled on a cluster—eight women under the age of twenty—with a disease that normally manifested itself only in much older women, and then quite rarely. One of the mothers wondered if her daughter’s cancer could be related to the DES she took during her pregnancy. It was a smart guess; a search of medical records revealed that seven of the eight young women treated at Mass General had been exposed to DES in utero. Those seven cases were followed by others. By November 1971, twenty-one cases had been reported. The snowballing cases led to an FDA bulletin to all physicians in the United States, warning them that the use of DES was “contraindicated in pregnancy.”
Because the first victims were young women, and because the health effect that was first identified was a rare carcinoma, DES very quickly became a story about mothers, daughters, and cancer. The DES narrative shaped by the media (and by women’s health advocates) was in many respects a product of the 1970s and two of that decade’s major preoccupations—the plight of women under patriarchy and the carcinogenic potential of chemicals. First (and most explicitly) DES illustrated the evils of medical paternalism. The first visible victims were very young women, whose sexuality, fertility, and very lives were threatened by an awful, disfiguring disease. The CCA daughters and their heartbroken mothers were an appealing patient group whose plight would move the hardest of hearts. DES was viewed as a textbook example of the male medical establishment’s abuse of women,