The Washington Post

The Dalkon Shield Disaster

By Robin Marantz Henig; Robin Marantz Henig is the author of "The Myth of Senility ,
" and
"How a Woman Ages."
November 17, 1985

AT ANY COST; Corporate Greed, Women and The Dalkon Shield. By Morton Mintz. Pantheon. 308 pp.
$17.95; NIGHTMARE; Women and the Dalkon Shield. By Susan Perry and Jim Dawson. Macmillan. 261
pp. $16.95; LORD'S JUSTICE; One Judge's Battle to Expose the Deadly Dalkon Shield IUD. By Sheldon
Engelmayer and Robert Wagman. Doubleday. 292 pp. $17.95.

WHEN EXECUTIVES of the A.H. Robins Company of Richmond, Virginia, decided in 1970 to buy the
rights to an allegedly "superior" intrauterine device (IUD), they couldn't have known that the device, the
Dalkon Shield, would send the company hurtling down a path of deceit from which its reputation would
likely never recover. And when upwards of 2 million women, most of them young and childless, had the
small crab- shaped device implanted in their uteri for trouble-free contraception, they couldn't have known
that the Dalkon Shield would carry major complications for some 90,000 of them from which they, too,
would likely never recover.

The books at hand tell the gruesome story of the Dalkon Shield, from its dominance of the IUD market in
the early 1970s to its official recall in 1984 for the havoc it had caused. Most particularly, we learn about
the decision-makers at A.H. Robins, a family- owned drug company that made its mark by selling
Robitussin and Chapstick, and how, according to these three books, it engaged in a legal and moral
coverup to rival that of Watergate.

As of mid-1985, at least 21 women are dead, at least 13,000 are sterile or infertile, and probably hundreds
more are the mothers of damaged children -- all as the direct result of the unconscionable actions of, as
Morton Mintz puts it, "a few men with little on their minds but megabucks."

Now there are 16,000 product liability cases logjammed in courtrooms around the country, frozen since
last August, when the A.H. Robins Company declared bankruptcy. The women who say their health and
lives were ruined by the Dalkon Shield may not see their damage claims settled for years.

Women who wore the Dalkon Shield, which was on the market from 1970 to 1974, ran more than twice the
risk of other IUD wearers of developing pelvic inflammatory disease, a severe infection that can lead to
damage to the reproductive organs, sepsis (blood poisoning), infertility or sterility, miscarriage (especially
the potentially lethal mid-pregnancy septic abortion), even death within 48 hours of the first flu-like
symptoms.
The increased risk could be traced to the Shield's tail string, which hung from the uterus into the vagina
and, unlike other IUD tail strings, was made up of several filaments wrapped around each other and
encased in a nylon sheath. An IUD is inserted through the vagina into a woman's uterus, where it
theoretically interferes ith the implantation of a fertilized egg and interrupts a potential pregnancy. A tail
string, which hangs into the vagina, allows a woman to check that the IUD is in place and also simplifies its
removal.

But because the Shield's string had many filaments, bacteria from the vagina were able to collect inside the
spaces and travel, or "wick," up the string and into the uterus, which is normally sterile. The tail string is
what has been blamed for almost all the complications of the Dalkon Shield.

Court testimony shows that Robins officials knew about the wicking problem as early as June 1970, six
months before the Shield went on the market. They refused to do anything about it because it would add to
manufacturing costs and, later, because it would look like an admission that something had been wrong
with the original design.

IRONICALLY, women who suffered Shield-related complications did so for a contraceptive device that
wasn't even very effective. An early study of the Dalkon Shield claimed a low 1.1 percent pregnancy rate,
comparable to the birth control pill and superior to the 2 to 3 percent pregnancy rate of other IUDs. But
that study was severely flawed, and apparently Robins knew it. It was conducted by Dr. Hugh Davis, the
inventor of the Dalkon Shield, who received consulting fees and royalties from Shield sales and therefore
was not an impartial judge. The study followed patients for an average of only 5.5 months after insertion,
during the first three months of which the women were told to use an additional form of contraception.

When more carefully designed studies finally were done, the Dalkon Shield had a pregnancy rate of
between 5 and 10 percent, far higher than other, safer, IUDs. But Robins never publicized this information,
and held on until the end touting Davis's biased study and 1.1 percent pregnancy rate claims.

This tactic illustrates the true horror of the Dalkon Shield story. It is not simply that the device turned out
to be far more dangerous -- and far less effective -- than was orignally thought, but that executives of the
company knew all along that the claims they made for the device were false. And faced with mounting
evidence that their product was causing great pain, damage, and death to women wearing it, they reacted
by stonewalling, denying, and going on with business as usual.

These three new books about the Dalkon Shield tackle the complexities of the Shield story from slightly
different perspectives. At Any Cost examines it as an example of corporate greed gone mad. Nightmare
tries to focus on the personal consequences of impersonal acts. Lord's Justice looks at a few players in the
tragedy, especially the federal judge, Miles Lord of Minnesota, whose experience with the obfuscatory
tactics of the Robins legal team led him to deliver a holy tirade against Robins executives that almost had
him removed from the bench.

Morton Mintz, a veteran reporter at The Washington Post, sees the Dalkon Shield story as proof of "the
chasm between the flesh-and-blood person and the paper corporate person." It is this gulf that most
interests him. "The human being who would not harm you on an individual, face-to-face basis," he writes
in At Any Cost, "who is charitable, civic-minded, loving, and devout, will wound or kill you from behind the
corporate veil." The chairman of A.H. Robins, E. Claiborne Robins Sr., is revered as one of the most
generous philanthropists in Richmond, yet he oversaw the massive Dalkon Shield cover-up -- and to date
has shown no personal remorse.

SCIENCE JOURNALISTS Susan Perry and Jim Dawson (he writes for the Minneapolis Star and Tribune),
choose to focus in Nightmare on the individual tragedies wrought by the Dalkon Shield. But like Mintz,
Perry and Dawson exhaustively outline the steps that led to the tragedy, explaining in great detail what
Robins officials ew and when they knew it. Like Mintz, they have sifted through thousands of pages of
documents that came to light as a result of Dalkon Shield litigation, and they hypothesize about the
contents of the documents that A.H. Robins is alleged to have destroyed to protect itself. And like Mintz,
they tell this incredible story in a straightforward, journalistic way.

The books are both well done. Mintz's is more scholarly, with comprehensive footnotes and always that
theme of the morality of corporate behavior. Perry and Dawson's is perhaps more readable, with a helpful
timeline of important events and frequent breaks for yet another victim's story.

Authors Sheldon Engelmayer and Robert Wagman have done their storytelling differently, and their book
does not work as well. In Lord's Justice, they say they have attempted to write a "docudrama" by taking us
into the courtroom of Miles Lord, a populist Minnesota judge whose forte is meting out righteous justice to
irresponsible corporate giants. But in so doing, they must tell the complex story about the Shield and A.H.
Robins almost entirely in flashback. The result is a zigzag account that often ends up swallowing important
points and repeating unimportant ones.

But Miles Lord is a terrific, eloquent character, and one who deserves the last word here. "The
accumulation of corporate wrongs is in my mind a manifestation of individual sin," he told the A.H. Robins
executives assembled in his courtroom. "You have taken the bottom line as your guiding beacon and the
low road as your route. . . . (But) you are the corporate conscience. Please, in the name of humanity, lift
your eyes above the bottom line."

And that, in the end, is the moral of the Dalkon Shield story.

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