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.