Toxic Shock. Sharra L. Vostral

orders the questioning. When we are busy arguing about the questions that appear with a certain frame, the frame itself becomes invisible; we become enframed within it.”76 Thus, the shape of knowledge had to change to see tampon-related TSS and, moreover, to address the gendered technology and indirect injury manifesting in women’s bodies.

      In addition, injury from bacterial activity does not fit a traditional model of liability with financial compensation rewarded to victims, because bacteria cannot be sued. Bacteria are not persons in the sense of an individual, legal entity, or even a corporation, from whom monetary remuneration may be sought. There is no money in blaming bacteria—perhaps in human error in regard to medically unsterile practices, or the spread of E. coli with unsanitary farming methods—but not for generalized infections or bacterial toxins, especially from constituent bacteria residing on a person that suddenly goes rogue. Yet still, the injury of TSS in this particular case had the cofactor of the tampon to precipitate bacterial growth in some women, and manufacturers are responsible for tampon design and production.

      Trusting Consumer Goods

      Though my interest is in exploring tampons as technological artifacts, they also have an identity in the marketplace as a commodity, premised on producers and manufacturers delivering goods that consumers purchase for a price. Though debating the nuances of capitalism is not central to this book, it is worth noting that American consumers have come to an implicit agreement with manufacturers about commodities that they purchase. In the case of the sale of goods in the United States during the twentieth century, consumers submitted their health and well-being, and—importantly—money to corporations, in exchange for goods of reasonable quality and no danger. How deeply this understanding of safe commodities is naturalized in contemporary U.S. society can be seen in the outrage leveled against corporations, such as the case in China of melamine added to milk in 2009, responsible for the deaths of at least four babies and illnesses in 53,000 others.77 Cloaked in nationalistic righteousness, some vowed to boycott all imported food from China, others lamented that industrialism was occurring at the expense of health, and still others complained that policies about pure food were not up to the standards set in the United States. Besides fueling fears about the interdependency of global economies, the “bad” milk revealed an important naturalized assumption: in the United States, it is simply common knowledge that “good” milk should be produced and sold, and we are dumbstruck when systems fail to guarantee a safe product, and incensed when it causes illness instead of health.

      This confidence in milk in the United States is also narrowly defined. In his lecture “The Cow Tipping Point,” David Ehrenfeld, a biologist, looks at the ways recombinant bovine growth hormone (rBGH) as a biotechnology is not well understood, sometimes purposefully, in terms of both direct and indirect injury and harm.78 For lactating cows treated with rBGH, the injury is often similar to other regularly lactating cows, such as mastitis and sore knees, though rBGH-treated cows suffer more and more often. Peer-reviewed papers by both industry and independent scientists often contradict one another, muddying the differences between naturally occurring BGH and rBGH. Despite animal suffering and the economic impact on producers to replace milk cows that die prematurely, these costs are not part of the “science” of whether or not to use the growth hormone. Questions for human health that are not obvious in terms of direct injury include the cross-species genetic exchanges in bacteria that weaken antibiotics, and rBGH’s role in that. Ehrenfeld concludes that, due to our faith in science, “we forget that technology is unable, both in theory and in practice, to resolve most of the practical problems that it itself creates.”79 Furthermore, technical or scientific facts will not produce a moral resolution, because their scope simply is too narrow.

      This viewpoint paints a discouraging picture for the ability of regulating bodies to provide intervention concerning risk and injury, especially in relation to indirect harm. Government intervention, testing, and regulation have also been tempered through politics and legislation over the course of the twentieth century, with many arguing that neoliberalism has put us all at risk by reducing oversight and asking corporations to regulate themselves.80 Risk, limited safety, and tolerance for injury continue to be built into consumer goods, and tampons are caught in the crosshairs of these assumptions and ideologies. The complexity of tampon-related TSS is that the tampon causes indirect harm to some and not all menstruators, and the science supporting these claims has been very difficult to unpack because it is produced by both corporate-sponsored and independent scientists.

      Technology’s Double Edge

      DuPont’s now-famous slogan, “Better Things for Better Living … through Chemistry,” evokes the ethos of progressive technoscience in twentieth-century United States culture. Consumers have been well trained to expect more from their purchasing power and for corporations to deliver scientifically managed products, including food. In her book Empty Pleasures: The Story of Artificial Sweeteners from Saccharin to Splenda (2010), Carolyn Thomas, an American studies scholar, notes that many women in particular came to rely on saccharin as a low-calorie sugar substitute, and in light of health warnings and recommendations to possibly discontinue it, women rallied to the support of saccharin, despite its risks. The links to cancer were insignificant to people following reduced-sugar diets, to people with diabetes, and to others who simply liked the pleasure of being able to eat sweet treats. Women flooded the FDA with handwritten letters and notes, begging for saccharin to remain on the market as a sugar substitute. Modern chemistry had delivered a miracle sweetener, and many chose to trust their taste buds rather than scientists’ data pointing to saccharin’s danger. In fact, the New York Times reporting on the recall of Rely in 1980 referred to the similarities between the two. An unnamed advertising executive noted to a reporter that “the reaction could be like saccharin. There’s such a strong preference for tampons that it might outweigh the degree of risk.”81 There was some truth in this since the risk was low for most women. This attitude, however, pushed the burden of the illness onto women, citing their “preference” and choice to use tampons knowing that they were dangerous, rather than holding the companies responsible for the manufacture, design, and distribution of synthetic superabsorbent tampons.

      There were plenty of mixed feelings and mixed messages about tampons. Before the recall during the 1970s, tampons, including Rely, enjoyed widespread support. For many women tampons were their only choice, and there was no going back to sanitary pads with cellulose wadding and elastic belts. For most young women who suffered through pads chafing the inner thighs, the discomfort of a bulky pad worn between their legs, and the awkward gait of walking around a pad, wearing a tampon, whatever its composition, eliminated these problems. In light of the superabsorbents that were readily available to manufacturers, and consumers’ willingness to try more technologically sophisticated products, it is no wonder that more and more tampons incorporated synthetics and that women would like them.

      In addition, tampon technology was particularly linked with women’s liberation. Advertisers equated bodily freedom to political freedom, a claim that was hard to contradict and was reinforced in advertisements with women in white outfits undertaking all sorts of desirable activities. After using tampons, most women had no intention of returning to pads. Many women incorporated tampon technology into their daily lives, and this object became an important item in what I refer to as the “feminist toolbox.” Like other tools such as birth control, trousers, and the right to enter a contract, tampons offered a unique vehicle to support personal independence and agency, and to absorb bodily fluid while remaining unencumbered. Because of this very personal and intimate relationship of the tampon to women’s sense of freedom and well-being, the emergence of TSS seemed both impossible and particularly destabilizing. How could this object, so normalized and domesticated, suddenly become deadly? Some women, like the saccharin users, refused to believe that products might cause harm and continued on as before, their faith in Rely clouding facts and adding to denial. Others acquiesced to warnings and limited their tampon usage or switched back to pads. Others got angry and boycotted, and some sued manufacturers for product liability.

      Many scientists continue to be divided about what exactly triggered the outbreak; with a strong history of scientific method and inconclusive results, it was and continues to be difficult to make scientifically informed recommendations in the face of contradictory evidence. Even in 2012, researchers publishing in the Australasian Journal of Dermatology asked as part of their article