Toxic Shock. Sharra L. Vostral

chapter 1. In order to think through this relationship of bacterium and technology as active co-agents, I develop the term “biocatalytic technology.” The tampon, conceptualized as an inert plug to stop up the fluids of a mechanical body, instead served as a catalyst, prompting a bacterium that was at best in stasis to begin producing toxins. Individually both the tampon and bacterium were neutral, but due to ecological circumstances they triggered a harmful consequence. Constituent bacteria, menstruating bodies, and a reactive rather than inert technology converged to create the ideal environment for the S. aureus bacterium to live and flourish in some women. Opportunistic, the bacterium became the unintended user of the tampon technology. The inability to recognize the agency of these microbial entities within the larger scope of women’s bodies—historically constructed as “problematic”—has profound effects on everyday health. Tampon-related TSS is an unintended consequence of technological innovation engaging with vaginal microbes, resulting in an emergent illness. Accounting for microbial constituents and the ecological landscape of gendered bodies would help imagine and mitigate deleterious outcomes. The term “biocatalytic technology” highlights the interactive rather than inert capacity of tampons, and it helps to explain the potential consequences of bacteria as technological users on women’s health.

      Chapter 2 addresses the medical facets of TSS and how a set of symptoms was stabilized into a defined illness with correlative healthcare practices. The illness challenged a medical assumption that tampons did not cause illness because they were an inert medical device. As such, scientific evidence was all the more crucial, and counterintuitive, to create a convincing case for tampon-related TSS. Medical professionals, including family physicians, pediatricians, nephrologists, and specialized epidemiologists at the state and national levels, encountered ill girls and women, and they puzzled over the quick decline of otherwise healthy individuals. Important to physicians in identifying this illness were their robust social networks, in which they described symptoms to each other, shared case studies, and suggested treatments while “in the field.” These networks influenced national-level conversations to establish a definition for the syndrome, and a comprehensive system of monitoring was developed for current and emergent cases. TSS arrived at a transitional time for the CDC, as the failed flu vaccine of 1978 created bad publicity about the effectiveness and necessity of the organization. AIDS also came on the heels of TSS. In retrospect, TSS was but a blip compared to the now global spread of HIV/AIDS, but by comparison TSS came to be viewed sympathetically, as an illness killing cherished mothers and daughters. Public health advocates’ work was also called into question by corporate researchers who represented tampon manufacturers who were none too keen on this illness threatening projected tampon sales and profits. They argued that the epidemiologic methodology was circumscribed as well as skewed toward finding fault with synthetic tampons. This resulted in conflicting hypotheses about the mechanism and role of the tampon in TSS, with many competing studies sponsored by corporate grants.

      Following the medical identification of tampon-related TSS, there was an urgent need to alert the hundreds of thousands of women using tampons that they were potentially dangerous and deadly. Disseminating a message of risk challenged status quo journalistic practices, and chapter 3 examines the media coverage of a health crisis centered on women’s reproductive health and menstrual management practices. The press had to figure out a way to talk about TSS in overly simplistic terms, in an era when the Federal Communication Commission (FCC) had only recently allowed feminine hygiene sprays, and then sanitary napkins and pads, to be advertised on television. Despite the loosened policy, the words “tampon,” “menstruation,” and “period” were considered socially inappropriate for general audiences, and arguments about maintaining propriety versus informing women led to newsroom fights. As the CDC released findings from its studies linking superabsorbent tampons to TSS, the media’s squeamishness transformed into paternalism, with safety messages cast on a perceived audience of needy women. By September of 1980, the Food and Drug Administration (FDA) threatened P&G with a product recall, causing P&G to voluntarily withdraw Rely from store shelves, and it also required the company to alert women to stop using the product. Journalistic reports of TSS helped to shape women’s reception of the recall, both instilling fear and caution but also providing gentle assurances about the safety of tampons. This contributed to a sense that the problem had been solved, when only the issue of Rely tampons had been eliminated. Other biocatalytic tampons remained on the market.

      Though the majority of women did not suffer from TSS, others experienced a flu-like illness, hospitalization, and even death from using Rely and other superabsorbent tampons. Lawyers filed lawsuits against all the major companies for selling a faulty product and failing to adequately disclose risk. Chapter 4 explores the 1982 federal court case Kehm v. Procter & Gamble in which the plaintiff’s argument sought to prove that tampons were not inert, thereby exposing that corporate presumption as well as announcing it to the broader public. The lawsuit also provides a window into the emotional suffering of the Kehm family, who lost a mother, wife, sister, and daughter with Patricia Kehm’s death as a result of using Rely during the fall of 1980. Much of the trial strategically deployed scientific witnesses from both sides to sway the jury. Corporate managers and scientists cast tampons and their components as inert, women’s bodies as interchangeable lab instruments, and vaginal microflora as unimportant, all of which were positions challenged and ultimately undermined by the plaintiff’s experts. Though P&G researchers tested individual components to ensure that they did not cause birth defects or cancers, and were neither poisonous nor prone to cause irritations, the trial revealed that, due to their assumptions, corporate-generated data did not predict the emergence of tampon-related TSS. In part, the ritual of safety testing proved to be a reassuring yet futile exercise that did not generate data indicative of true risk. Leaders at P&G insisted that TSS was an industrywide issue, tampons had a long record of safety, and Rely was singled out unfairly, despite the results garnered by the CDC indicating otherwise. Some of their points were credible, yet the lawsuit highlighted the need for better testing and product labeling in order to avert more TSS-related injuries and lawsuits.

      Since the threat of TSS subsided but remained, how to manage it became a politically contested issue. Chapter 5 addresses the political stakes of science-based policy used to warn women about the risk of tampon-related TSS. Different stakeholders, including the federal government, corporations, and women’s health activists, exerted pressure to control the terms of policy, product labeling, and the language of warnings printed on tampon boxes. Damage to women’s bodies did not end with the removal of Rely from store shelves. The solution entailed corporations calling on women to practice autosurveillance and self-police their bodies for symptoms of TSS, in essence exonerating manufacturers and outsourcing responsibility to women themselves by urging them to use the least absorbent tampon possible. But, without accurate labeling, this advice rang hollow. How to educate women and protect them from contracting TSS became a contentious labeling issue because corporations were not forthcoming with material ingredients, product absorbency, or a clear warning about TSS. To help women make informed decisions, feminist health advocates sought to provide science-based information about tampon absorbency rates, implement federal standards for descriptions such as “regular” and “super,” and also lobby for legislation demanding that tampon material contents be labeled on the box. In particular, Esther Rome of the Boston Women’s Health Book Collective (BWHBC) imparted feminist-minded standards challenging androcentric methods and models of the lab that determined these absorbencies, exemplifying why science and scientists must be accountable to communities and not just corporate data production.

      The book concludes by examining the results and consequences of the bacteriological, technological, medical, journalistic, legal, and political influences on current-day understandings of TSS in the contemporary United States. Most are aware of controversies of hormonal birth control or the questionable safety of breast implants. However, the history of federal regulation of personal hygiene products, and activists’ efforts to improve safety, arguably touched more women than these other more familiar stories. Significantly, the actions of labeling tampon boxes,