Toxic Shock. Sharra L. Vostral

to illness in girls. Yet the relationship of the vaginal flora to technology was overlooked and dismissed as inconsequential. The historical legacy of minimizing women’s health concerns came to bear, and scientists were unaccustomed to thinking about bacteria as acting independently of the menstruous human body in their interactions with seemingly inert technology.

      Risk and Injury

      Imagining technology to have biocatalytic potential will change and expand the scope of risk. Though stakeholders look to science as a means to provide measurable data about risk, managing risk turns out to be as much of an art as it is a science. What exactly is risk and who holds responsibility for it? The answer to this question has changed over the twentieth century in the United States, with culpability falling across the spectrum to the individual, government officials, and corporations and their scientists and engineers. In part, an ethic of paternalism and social engineering marked a shift in the early- to mid-twentieth century from blaming individuals who were simply accident-prone and apt to injury, to an ethos that incorporated safety precautions into the very design of factory equipment “to solve the problem of accidents.”62 While shouldering responsibility for better equipment and design, engineers also exposed themselves to blame when things went awry. Henry Petroski, a civil engineer, has enumerated technological disasters such as bridge failures that haunt many engineers, and he argues we must continue to learn from these mistakes in order to prevent their reoccurrence.63 Arwen Mohun, a historian of technology, argues that publics in the first part of the twentieth century were painfully aware of work-related risks inherent to dangerous jobs, yet they were unwilling to relinquish risk altogether. Thus, they demanded the safe, circumscribed risk in their consumer consumption of roller coasters, for example, that engineers accommodated in the design process.64

      What is truly a risk, and what is perceived as a risk, means something different to many individuals, and there are a number of means to gauge this perception.65 Building a nuclear plant and driving cars both pose risk, but often it is the nuclear power plant and its imminent breach of radioactive materials that cause more fear than the possible car accident when driving to the grocery store. Alvin Weinberg, a nuclear physicist and a research director at Oak Ridge National Laboratory from 1955 to 1973, proposed the idea of “trans-science” in 1972 to think about risk. He argued that science has the ability to pose questions, but not always the means to answer them, noting “they transcend science.”66 Thus, scientists have difficulty providing “facts” about risk “when scientists can offer only trans-scientific answers to questions of public policy in situations in which laymen, politicians, civic leaders, etc., look to scientists to provide scientific answers.”67 Weinberg’s concept of trans-science suggests that policy makers will never have the data that they really need to make informed decisions because the science to produce the data does not exist. The most we can ask for is good judgment, which by definition, is not science.

      Many disciplines have taken up the study of risk: cognitive psychology, sociology, communication, and others. How experts and laypeople view risk variables is a concept many have tried to assess. Others have examined how both men and women express concerns about risk through their gendered identities.68 Yet it is important to the story of tampon-related TSS that scientists’ perceptions about gender have influenced assessments of risk for women users. Most of these scientists were men, and though it is problematic to assume that an essentialized woman scientist would make better judgments, as the story unfolds it was clear that the women who made decisions at crucial junctures shaped the trajectory of policy concerning tampons and TSS in ways that were influenced by their experiences as mothers, friends to other women, and as community members with women. From protesters to epidemiologists to lawyers to health advocates, women’s understandings of menstruation and how it was managed through menstrual hygiene technologies mattered greatly. Their identities as women at that particular historical moment did influence views of the science and the risk posed by tampons.

      The significance of this is that the risks perceived to be low resulted in great harm to some women and was particularly gendered because of the manner in which injury occurred. Superabsorbent tampons such as Rely did not fit the mold for usual measures of product injury. They differed because they possessed the potential to precipitate a reactive consequence, but not necessarily direct injury from the object per se. The uneven injuries were difficult to track both medically and from a legal, compensatory model as well.

      S. Lochlann Jain, an anthropologist who studies design and law, has theorized the social and economic consequences from manufactured goods wounding humans. She argues that injury is not merely an unfortunate accident but is integral and assumed within consumption, and therefore capitalism itself. She suggests “injury law demonstrates the recursive way in which design issues also materialize and naturalize sets of injuries as visible and compensable or invisible and non-compensable.”69 Jain looks at examples such as the Ford Pinto, cigarettes, and keyboards, to name a few. In these types of cases, the relationship of technology to injury can be interpreted as causal.

      The likes of lead poisoning, asbestosis and mesothelioma, and other environmental pollutants are constant reminders of damage caused by human-created products.70 Gregg Mitman, a historian of the environment and ecology, in the introduction to Landscapes of Exposure writes, “The preponderance of toxic, over infectious, agents of illness … reflects a long-term ‘epidemiological transition.’”71 Usually, epidemiological transition refers to stages of improved health directly attributable to a higher-quality standard of living as well as access to medical care, with correlating improved longevity and decreasing birth rate. However, it may be that “a range of medico-environmental materials from those used in medical devices implanted in bodies to waste products discharged into the environment” are marking a new transition to degenerative health, and that transition is characterized by David Morris, a scholar of medical humanities, as both postmodern and biocultural.72

      The resulting injury brought about by Rely was complicated to delineate because the causal model of disease or acute poisoning, for example, did not fully account for relational injury. In and of itself Rely was not defective. It was not composed of toxic materials producing direct harm or triggering cancerous growths. As a medical device it was presumed inert, and Rely did not directly cause TSS. The injury incurred was biocatalytic. Once lodged in a vaginal canal, Rely held the strong potential to interact with bacteria that may be present as constituent communities within some women’s bodies. Because makers considered tampons to be inert, the leap to the reactivity of the technology seemed far-fetched.

      It is only recently that the idea of indirect harm has gained some traction, and this can be seen in new policies by the EPA to limit perchlorates in drinking water. According to Sanjay Gupta, a physician and CNN’s chief medical correspondent, “It’s the first time we’ve ever regulated a chemical not because of what it does directly to you, but because it has an impact on iodine uptake that might affect your child down the road.”73 Thus, the capabilities to cause indirect harm were not well appreciated in the case of TSS. Yet, despite the prevailing wisdom of direct harm and inert technology, the live bacterium and synthetic superabsorbent tampon energetically interacted and were cofactors in producing illness. As Jain points out, design flaws may materialize as visible, requiring compensation, or remain invisible, and go unrecognized.

      What people “see” is crucial. Take, for example, “the invisible gorilla” perception studies conducted by Christopher Chabris and Daniel Simons, which find that when people are asked to focus on one specific thing on a video, they miss the big picture of the costumed gorilla sauntering across the screen. Another attention researcher, Trafton Drew, used this same idea to test a highly skilled and trained set of experts who read data on screens: radiologists. Presented with multiple X-rays, and then an image of the gorilla, 83 percent were so focused on their object of intent that they missed it. This “inattentional blindness” allows them to home in on important and specific data, but since they are not looking for a gorilla they do not see it.74 This indicates that the framing of a data set is highly important regarding what a researcher can “see.” Jennifer Croissant, who studies the sociology of science and technology, discusses a finer point of agnotology, that is, absences of knowledge, not just rejected knowledge or purposeful ignorance, but “absent knowledges as forms of non-knowledge.”75 As Kathy Ferguson, a political and feminist theorist, suggests, “The questions that we can ask about