Toxic Shock. Sharra L. Vostral

      

      TOXIC SHOCK

      Toxic Shock

      A Social History

      Sharra L. Vostral

      NEW YORK UNIVERSITY PRESS

      New York

      NEW YORK UNIVERSITY PRESS

      New York

       www.nyupress.org

      © 2018 by New York University

      All rights reserved

      References to Internet websites (URLs) were accurate at the time of writing. Neither the author nor New York University Press is responsible for URLs that may have expired or changed since the manuscript was prepared.

      Library of Congress Cataloging-in-Publication Data

      Names: Vostral, Sharra Louise, 1968– author.

      Title: Toxic shock : a social history / Sharra L. Vostral.

      Description: New York : New York University, 2018. | Includes bibliographical references and index.

      Identifiers: LCCN 2018012210| ISBN 9781479877843 (cl : alk. paper) | ISBN 9781479815494 (pb : alk. paper)

      Subjects: LCSH: Toxic shock syndrome. | Toxic shock syndrome—Social aspects. | Tampons—Complications.

      Classification: LCC RG220 .V67 2018 | DDC 614.5/797—dc23

      LC record available at https://lccn.loc.gov/2018012210

      New York University Press books are printed on acid-free paper, and their binding materials are chosen for strength and durability. We strive to use environmentally responsible suppliers and materials to the greatest extent possible in publishing our books.

      Manufactured in the United States of America

      10 9 8 7 6 5 4 3 2 1

      Also available as an ebook

      To everyone who has ever used a tampon

      CONTENTS

       Abbreviations

       Introduction: Toxic Shock Syndrome

       1. Unexpected Consequences

       2. Mystery

       3. The Media Sounds the Alarm

       4. Grounds for Liability

       5. Health Activism and the Limits of Labeling

       Conclusion: Managing Menstruation and Beyond

       Acknowledgments

       Appendix

       Notes

       Index

       About the Author

      ABBREVIATIONS

ASTM	American Society for Testing and Materials
BWHBC	Boston Women’s Health Book Collective
CDC	Centers for Disease Control
CMC	carboxymethylcellulose
CMDA	Center for Medical Device Analysis
EIS	Epidemic Intelligence Service
FCC	Federal Communication Commission
FDA	Food and Drug Administration
FFDCA	Federal Food, Drug and Cosmetic Act
HHS	Health and Human Services
ICD	implantable cardioverter defibrillator
IUD	intrauterine device
JAMA	Journal of the American Medical Association
MDA	Medical Device Amendments
MMWR	Morbidity and Mortality Weekly Report
MRSA	methicillin-resistant Staphylococcus aureus
NCL	National Consumers League
NEJM	New England Journal of Medicine
NIH	National Institutes of Health
OBOS	Our Bodies, Ourselves
OMB	Office of Management and Budget
P&G	Procter & Gamble
RBGH	recombinant bovine growth hormone
TSS	toxic shock syndrome
TSST-1	toxic shock syndrome toxin-1

      Introduction

      Toxic Shock Syndrome

      I became aware of toxic shock syndrome (TSS) after my first period in 1982, while in eighth grade. During a subsequent menstrual cycle, I caught a cold and became increasingly worried that I had contracted TSS. This was not such an outlandish conclusion on my part. TSS was the third most reported-on news story in 1980, behind the Iranian hostage crisis and the presidential election. The NBC Nightly News was a dinnertime staple, I had a subscription to Seventeen magazine, and I flipped through my mother’s Good Housekeeping, and all had reported on this new illness. I absorbed reports of current events, and news sources warned that a tampon plus a fever equated to a scary disease, possibly even to death. My mother, a nurse, quickly rebuffed my concerns. She was a longtime Tampax user who trusted the safety of the product. I suspect she interpreted my concerns as the manifestations of an overreactive teenager. Despite her assurances, the message I received was loud and clear: TSS was a possible side effect from wearing tampons, and I must be vigilant to monitor my body for any sign of potential disease when I used them.

      As I grew older and continued to use tampons, I neither contracted TSS nor died from using a tampon. My experience with them was incongruous with the warning label on the box, and I always wondered about these heavy-handed labels. Was I being reckless by disregarding the warning? Or was TSS still lurking, and only I could save myself from corporate malfeasance? For how long could I use tampons and not fall ill, thus have my cake and eat it, too? As an adult who has spent many years contemplating TSS, I am more sympathetic to the conundrum. While it is true that a confluence of corporate interests, epidemiological studies, women’s health activism, and women’s desires to use tampons influenced the politics of tampon-related TSS, there is one important common denominator. All were influenced by the belief that tampons are inert. This faulty premise and the consequences of assuming that tampons are inert provided the backdrop for the new illness. The prevailing notion of the inert nature of tampon technology explains why the devastating outcome of women’s deaths were so difficult to study and understand; this traditional way of thinking about disease, technology, and women’s bodies was insufficient in encountering what came to be identified as tampon-related TSS. Though it is not recognized as such, tampon-related TSS was a paradigm shift in the way that illness manifests because the supposedly inert tampon interacted with a common bacterium to cause sickness in otherwise healthy women. No longer was an infection the origin of disease, or a faulty product the direct cause of injury. Together, a new pathway to an illness formed, in which a supposedly inert tampon became interactive, and a bacterium, once held in bodily equilibrium, grew dominant and produced