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Take your business further at T-Mobile.com slash now. It's 1964. NBC News anchorman David Brinkley has come to Boston to meet John Rock. Dr. Rock, who is 73 years old, lives and works in Brookline, Massachusetts. Mainly he works at his clinic or center devoted to the study of human reproduction and the treatment of problems in an area where, when you get down to it, remarkably little is known.
John Rock, the most famous physician in the United States, co-inventor of one of the most important drugs in human history, the birth control pill. He went to the High School of Commerce in Boston, to Harvard, to Harvard Medical School, interned at Massachusetts General Hospital, directed for 30 years a fertility clinic at the Free Hospital for Women, and now goes to Mass every day at Brookline's St. Mary's Church.
My name is Malcolm Gladwell. You're listening to Revisionist History, my podcast about things overlooked or misunderstood. This is the second of three episodes on how to think like a Jesuit. This one is about John Rock's great dilemma. A man who went to Mass every day at St. Mary's Catholic Church and then helped create the pill, something his church could not accept.
One of the events which shaped my later life to a great degree was an experience I had with Father Finnick, who was a curate in Marlborough. Rock is tall, distinguished, looks like Cary Grant. His interview with Brinkley was over half a century ago, so forgive the quality of the tape. I was just about 14 and I was walking out of mass one Sunday.
When Father Finnick beckoned me and asked me if I would like to drive down with him to visit old folks' homes, all we children called the poor farm. Father Finnick was a quiet and unobtrusive man. When he was holding forth the first communion class or confirmation class...
He put across what he intended us to learn with clarity and vigor. So much of it has remained with me all my life. At this point, NBC shows B-roll of a horse and carriage, something Rock would have ridden in his youth. And they've added sound effects. God bless them. We had never been more than just friends. But somehow or other, I remember quite distinctly, in that ride he was sounding off, saying, John, always stick to your own conscience.
Let no one ever keep it for you. It's clear, as Rock tells that story, that it has stayed with him his whole life. And just as I was beginning to get that, and then there was a moment's pause, and then he said, and when I say no one, I mean no one. I've never forgotten those words. So I just want to talk about him, because I find him, as I'm sure you do, to be
Such a fascinating figure, extraordinary figure. Really complicated. I don't feel like I ever really understood him. All those years in those papers, I feel like I understood him partly, but I don't feel like I ever completely understood him.
I went to Pennsylvania Hospital in Philadelphia to talk to the two people who probably know more about John Rock than anyone else, Margaret Marsh and Wanda Rauner, who wrote a book called The Fertility Doctor. It's the definitive account of Rock's life. You go first. I'm Margaret Marsh, and I'm a university professor. That's a title. University professor at Rutgers University. Yeah.
I'm Wanda Rahner, and I'm a gynecologist. I work for Penn Medicine. I'm a professor of clinical obstetrics and gynecology, and I work at Pennsylvania Hospital. And you're sisters. We're sisters. Where did you guys grow up? Around here? Is that why you're in this? We grew up in Vineland, New Jersey. We grew up with our father's family, Italian-Americans. We're the granddaughters of immigrants.
and a lot of our family is still there in Vineland. Oh, so I'm assuming you're Catholic, or were. Many years ago. Many years ago, I see. But this is not foreign territory for you. Not at all. To be talking about Catholics. Everyone in this episode is Catholic, except for me. I'm a wannabe. Well, we always have this joke when people ask us how we work so well together, and we always say...
I always say, "I'm the oldest sister, so I get to be the boss." And she says, "I'm the younger sister, so I always get my way." Which is true. It's true. The two of them spent years on John Rock, tracking down relatives and colleagues, slowly working their way through his papers.
Rock's daughter told them that he had been undecided about what kind of medicine to practice. But then, in the early 1900s, he had a rotation as a medical student, delivering babies in the Irish tenements of Boston. He saw a wretched poverty. Young women overwhelmed with five or six or seven children, families they could barely feed or clothe. The overwhelming...
sorrow he felt for the women and their difficult situations was what decided him to go into obstetrics and gynecology. Rock founded the Fertility and Endocrine Clinic at the Free Hospital for Women in Brookline, where he served the Irish poor of Boston through the difficult years of the Depression and the Second World War. He was never terribly interested in charging for his services. I think, and you know, okay...
I love the man. What can I say? I think of him as an unusual figure in medicine. But, you know, he had that gift of being able to communicate with women from all different classes. One of Rock's friends was a researcher at Penn named Luigi Mastroianni, who was still alive when the sisters were doing their work. It was Luigi who said he would come out
This was whether it was a clinic patient or a private patient. He'd come out, he'd greet the patient, he'd walk her back in, sit her down, talk to her. And always direct, you know, not... He would always have a direct conversation with the patient, you know, like directly look at them. Not to push the Catholic thing too far, but it's very...
He has a touch of the parish priest in him. A touch? A touch. That's really good. That's very good. Did you grow up Catholic too? Like I said, want to be Catholic, not the real thing. I think that's very, I think that is, good doctors always have a touch of the parish priest or the minister or the rabbi or because if you don't, you're less effective. And not to brag about my sister, but she does have
the second highest patient satisfaction. Come on. That's old. That's old. Now we all have high ranks. Now you all have high ranks. It's mandatory to keep your job. She's very beloved. She's one of the most beloved clinicians. I haven't touched a parish nun. She's one of the most beloved clinicians. Your sister is allowed to boast about you. I don't know why you're trying to stop her. Wait, where were we?
Rock got involved with birth control almost by accident. He was more interested in treating infertility. And in the 1950s, he started working with two hormones that had only just been isolated, estrogen and progesterone. What's his theory that progesterone and estrogen might be useful in combating infertility?
Okay, okay. I'll tell you my conjecture was that I think it came out of looking at the endometrium. You know, to seeing that some women did not have the secretory changes that would have been anticipated after ovulation. I think that makes sense because the way he would explain it was he said some women seemed to have underdeveloped
He said systems? Underdeveloped reproductive systems.
And he thought that this underdevelopment was due to a problem with the hormones. And this was all observation. Remember, they didn't know anything. I mean, they didn't know the kinds of things we know now. So it was all observational. And he would say some of them get pregnant on their own. And then after they get pregnant once on their own, their systems, quote, seem to be developed. In the analogy of a...
Car with a dead battery. Yes. Jumpstart the battery, and then after that, the battery works. Yes. Is that sort of what he's thinking? Sort of, yes. So that's how Rock got interested in the role of hormones in reproduction. Meanwhile, 50 miles away in Worcester, a scientist named Gregory Pincus was working on the same idea. Only he thought that estrogen and progesterone might actually work to prevent pregnancy. Pincus and Rock started doing research together, which is how the birth control pill came about.
Pincus was the hard scientist. Rock ran the clinical trials. They took their data to the Food and Drug Administration in the 1950s, asking it to approve the pill as a prescription drug. The FDA dragged its feet. So Rock paid a personal visit, as he told David Brinkley in the NBC profile. When we went down, we had an appointment with the director of FDA or something like that.
because all the material had been sent to Washington and no response. Tall distinguished John Rock, the Catholic Cary Grant, the most famous doctor in America, knocked on the man's door. He had all the material, a great stack of stuff on his desk, and he hadn't even looked at it. So we talked about it, and he said, well, he would go through it as soon as he could. And I went over there and tapped him. You have no time. You'll do it now.
And they said, "Oh, all right." And so he signed the, what's it called, and that was it.
One of the two or three most important drugs of the 20th century was approved because one of the drug's inventors took the train to Washington, marched into the FDA, and said, you'll do it now. Then I browbeat the government into taking the final step. But we knew it was all right. I mean, I was convinced. My conscience was clear about that. How much do you love John Rock?
But now, John Rock has a problem. He's helped create the world's greatest contraceptive, and yet he's a devout Roman Catholic, and his church doesn't believe in contraception. Consider the Costi-Canubi Papal Encyclical of 1930. In it, Pope Pius XI declared that, and I quote, "...any use whatsoever of matrimony exercised in such a way that the act is deliberately frustrated in its natural power to generate life."
is an offense against the law of God and of nature, and those who indulge in such are branded with the guilt of a grave sin. The act is deliberately frustrated in its natural power to generate life. That's what a contraceptive does. And what is John Rock's birth control pill? It is a pill that deliberately frustrates the natural power to generate life. Let's run through John Rock's options.
He could renounce his work on the pill and accept the teaching of the church. Only, he's not going to do that, is he? He remembers what his priest told him when he was a boy. John, always stick to your own conscience. Let no one ever keep it for you. Margaret Marsh and Wanda Rahner tell the story in their book of when Rock was 19, and he got a job with the United Fruit Company in Guatemala.
He was responsible for a group of Jamaican migrant workers when United Fruit decided to cut everyone's wages. And who did Rock support? His workers. He just defied all the bosses at United Fruit. He said, they don't need a wage cut. There's no reason for a wage cut. I'm not cutting the wages on my farm. Kind of, then he, of course, they cut the wages on his farm. Then there's this huge strike. And he says, well...
He writes to the president of the company and says, "This is ridiculous. If you were here, you would know that this is wrong. They don't need a wage cut." And then there's the strike, and one of the Jamaican workers is very gravely injured, and two of the others aren't. So he's like 19 years old. He wades into this wildcat strike, gets the injured men, brings them to the hospital,
And you wonder, where does a 19-year-old who's probably never had a deep thought about racial injustice in his life, where does he get that reservoir? John Rock always kept his own conscience. Many years later, in his dilemma over the church and the birth control pill, he had another option, of course. He could leave the church. Lots of people have left the Catholic Church over disagreements with its teachings.
But Rock can't leave the Catholic Church. Are you kidding me? Leaving Catholicism would have, I don't think he would have ever thought of it. Well, I noticed there was a little line that you quoted from, I think, one of his diaries about a day where he said he attended Mass in three different churches in one day. Yep.
Yeah, so that gives you a flavor of, I suppose, the... Of the culture. His mother was devout. His mother was very devout. Very devout, yeah. One of my colleagues, who's a James Joyce scholar, told me about a line in one of James Joyce's books where the hero and his friend are walking around, and one of them is saying to the other one, I've lost my faith, man, I've lost my faith.
And so the other one says, are you going to become a Protestant? And he says, I lost my faith, man. I didn't tell you I lost my mind. And that's very John Rock. So he's not going to put his head down and go along. And he's not going to abandon the church. That leaves only one option. He's going to stay and try to convince the church to change its mind. Now, how do you do that if you're a devout Catholic in the 1960s? The answer is, you think like a Jesuit.
Let's leave John Rock for a moment and let me run a thought experiment by you. It comes out of a conversation I had with a scientist named Kurt Barnhart. He's a professor at the University of Pennsylvania Medical Center in Philadelphia, an OBGYN who does research in reproductive biology. Barnhart's kind of a modern-day version of John Rock, only now we know a lot more about female reproduction than we did in the 1960s.
I don't mean to insult you with a student-level lecture, but progesterone is pulling the plug out from the street to turn the lights off in your house. It's not turning the lamp off on your bed stand. We're still trapped, in other words, in a relatively crude conceptual model about how to prevent. Yeah, right, right. And it would be better if you could prevent ovulation. I mean, the home run, I'll share the Nobel Prize with you, would be
There's an atresia of eggs with women's aging. If I could stop women's eggs from growing and not losing them, not only would I prevent, I would allow you to get pregnant when you want, I would remove the biological clock and you could get pregnant at 60.
You mean you could decouple the aging of a woman's eggs from the regular aging process? Theoretically, I mean, molecularly. A woman is born with all the eggs that she ever makes and they're all sitting in the ovary. And what's really neat is, and we don't understand this, but in one month a group of eggs starts growing and competing. That's the one that ovulates and all the other ones die off. When you run out of groups, you run out of menopause. But we don't understand what tells the group to grow.
So if we could say, don't grow your follicle this month, grow it next month. Putting it on pause. Right. A woman is born with a fixed number of eggs. You don't make any new ones. By puberty, you might have 300,000 to 400,000 eggs. And every month, like clockwork, you lose about 1,000 of them. That's the iron logic of female fertility. But Barnhart says we might have found a drug that would allow a woman to stop the clock, to hit pause.
It's being developed by several of his colleagues, Kara Goldman at Northwestern among them. It's called mTOR. Now, understand that this approach, under the best of circumstances, is years and years away from ever becoming available. That's why this is a thought experiment. So, here's the question. Is mTOR a contraceptive? I wouldn't pitch it as contraception. I wouldn't. I would pitch it as delay. Okay.
In other words, it's not like I'm trying to not get pregnant today, but I need a contraceptive, right? I mean, no, that's got, well, this is interesting, right? Because I'm thinking you're now up against the exact same dilemma John Rock was up against, which is, you know, could you, for example, could you, how would the Catholic Church view such a measure? They're opposed to artificial contraception, but what if this is not, is this plausibly not contraception?
Yeah, I'm Catholic and I struggle with this all the time. Like I said, everyone in this story is Catholic. On the one hand, Barnhart says, mTOR is obviously something that allows a woman to have sex without the possibility of getting pregnant. You take a pill and you no longer ovulate. As the Pope wrote in 1930, those who indulge in such are branded with the guilt of a grave sin. How is the Pope going to agree with mTOR? But...
On the other hand... Well, you could say that this is a way of controlling your aging or postponing or prophylaxing or being mature. But I'm open to having a family and I'm open to life and I'm open later. It's just not right now. So that may be a plausible argument. If you look at it that way, mTOR is actually not a means to suppress your fertility, but a means to extend your fertility.
How is the Pope going to have a problem with a mechanism that allows women to have more children later in life? If this way of thinking sounds familiar, it should. Barnhart is doing a nice little bit of casuistry here, the kind of thinking we described in the previous episode. Casuistry, remember, begins with a descent into the particular. What exactly am I dealing with? Well, a drug that effectively freezes your eggs inside your own body.
Then casuistry involves an exercise in taxonomy. Where does this new case fit in relation to existing cases? And Barnhart's point is that mTOR is often the corner with fertility drugs, not over here with the traditional contraceptives. Barnhart said that the first thing his group is going to try and do is a study with women who are undergoing chemotherapy. Because chemotherapy, in many cases, destroys a woman's eggs.
Not all of them? In some cases, yeah. Are you serious? The chemotherapy is designed to kill dividing cells, by definition, right? That's what it's killing. And it also kills many other slowly dividing cells. That's why you get GI upset and you lose your hair. But it also kills women's eggs. So one of the consequences could stop the development of the eggs such that they're no longer receptive to the chemotherapy. So by hitting pause on the whole thing... Right.
Oh, I see. That's what a clever. Oh, so pitch that way. You're not even talking. You're talking about this is an agent of the preservation of fertility. Right, right. Now, notice what Barnhart is doing here. He's not saying the church's position on contraception is crazy and needs to be changed. He's saying this new thing that we've come up with may actually be consistent with the church's teaching.
Isn't the church interested in creating life? Well, mTOR is very much in that spirit. Look at its potential for creating life. Is this hair-splitting? Casuistry is sometimes criticized on just those grounds, that it's a way for smart people to rationalize doing whatever they want. That's why the term Jesuitical has a slightly derogatory connotation. But that's not what's happening here.
This isn't cynical rationalization. Right now, the Catholic teaching on contraception makes it harder for millions of women in developing countries to get access to birth control, despite the fact that controlling fertility is one of the easiest ways to lift families out of poverty. We can wait for the Pope one day to change his mind, or we can come up with a contraceptive that is different enough from traditional contraceptives that it no longer has to be called a contraceptive.
The rules of how to behave ethically in the modern world do not come down from the heavens on stone tablets. They are things that have to be negotiated. Casuistry is a method of doing that negotiation. You say you're a Catholic. Yeah, yeah. And I struggle with that. Do I know more scientifically than the popes do? Sure. Does that allow me to get different interpretations? I don't know.
You are in a line of research that if the Pope were here sitting in his chair, he would disagree with what you do for a living. I would hope not, but he probably would, I guess. Just that idea that the Pope would disapprove seemed to pain him. And that's exactly how John Rock must have felt half a century ago. He helped to invent a method of birth control, and he worried that the Pope might sit down next to him one day and disapprove of his life's work.
So he decided to put on his casuist's cloak and try to change the Pope's mind. John Rock's argument in favor of the pill begins with a nice little bit of casuistical taxonomy. On the one hand, he said, there are the barrier contraceptives that the Church has explicitly called sinful. Condoms, the diaphragm.
That is what the Pope was talking about in 1930 when he referred to methods that frustrate the natural power to generate life. On the other hand, though, there was the rhythm method. Rhythm is the idea that a couple might prevent pregnancy by not having sex during a woman's fertile days, when she's ovulating.
In 1951, Pope Pius XII addressed a group of midwives in Italy, and in his speech, he explicitly gave his blessing to the rhythm method of birth control. In his statement on the rhythm method, how does he resolve the issue of whether the rhythm method is contraception or not?
Oh, just by ignoring it? That's a time-honored way of solving problems. That's the historian Leslie Woodcock Tentler, who wrote a brilliant book on the church's history with contraception. He's speaking to Italian midwives, a congress of Italian midwives, and I presume what it reflects is the reality of war-torn Italy, you know, of a country that's really been decimated and where people are desperately poor. So, in effect, he's saying...
I know you're facing problems out there, and here is Mother Church's pastoral response. So there are some kinds of birth control the Catholic Church is okay with, natural kinds. And there are some kinds it opposes, artificial kinds. But let's descend into the particulars here for a moment.
It's not quite true that the rhythm method is perfectly natural, at least not as it was being practiced in the 1950s. Walk the naive listener through what practicing the rhythm method of the 50s meant. Right. Well, it was new and improved rhythm in the 50s.
In the beginning, you just, you sort of looked at the calendar, you assumed that your menstrual period would occur at such and such a point in the cycle, and there'd be no variation. So you just count, right? This doesn't work very well at preventing pregnancy. The one that dominates in the 50s is the so-called basal temperature method, whereby apparently when a woman ovulates, there'll be a very slight increase in her body temperature.
But that means that every morning you have to take your temperature rectally, because that's the most sensitive way, and record it before you get out of bed, before you do anything, which is not always easy if you already have a house full of young children. You've got seven kids screaming. That's right. And you're taking your temperature rectally. That's right, which in the screaming light, I should think, could cause your temperature to rise for wholly independent reasons.
Tentler is Catholic, of course. And as someone who grew up in the 1960s, this is a world she knew intimately. I married into a family where my husband's considerably older brothers, who'd had their kids in the 40s and 50s, had 10 and 12 each. His only sister, very sensibly, joined a religious order and only left after her reproductive years were over. Although I don't really think that was her motivation, but who could tell?
Birth control was a big part of what Catholics talked and thought about in those years. And Rock is right in the middle of that obsession. He actually runs a rhythm method clinic in Boston. He's one of the researchers who helps establish when in a woman's cycle ovulation occurs. That's how he makes his reputation. So after John Rock gets FDA approval for his birth control pill, he writes a best-selling book called The Time Has Come, where he does a brilliant bit of casuistry.
Is the pill more like a classic artificial method like the condom, or is it more of a semi-natural method like rhythm? And Rock's answer in his book is, the pill is like rhythm. It uses the very same hormones found in a woman's body, estrogen and progesterone. And what does it do? It mimics pregnancy, which is the most natural of states. The chemical substance in these pills...
acts in the body exactly like progesterone, which the mother's ovary produces. It's Rock again, explaining the science to David Brinkley. And it has the same effect on the regulating mechanism for ripening eggs and for releasing eggs. If a woman takes the pill month after month after month, and continuously, not missing any day at all,
she is in effect establishing just a pseudo-pregnancy, a make-believe pregnancy. Early on, Leslie Tentler says, many people in the Catholic Church, important people, theologians, church leaders, sided with Rock's argument. All the language, all the logic of Catholic teaching on contraception presumes a barrier method, you know, kind of intervening in the midst of this act.
I think many of them see the pill as something completely different. You take the pill in the morning, it has nothing to do with the sexual act unless you're in a very unusual relationship. And you don't have to mess about in the genital area. You don't have to think about interrupting the sex act. It's great stuff. You know, it's psychologically unhooked from all the messiness of traditional contraception. And I think...
theologians intuit that this might be a way to pry the whole thing open, to at least create a debate where at least officially none can exist. It helps that Rock is who he is, a doctor on the front lines, who's been serving the Catholic poor of Boston his whole career, listening to the troubles of women who had eight children and too many miscarriages to count all by the time they were 30. The cardinals and the pope weren't on the front lines like he was.
They were sitting, celibate, behind the walls of the Vatican. If you take John Paul II, for example, we're leaping ahead a bit from the 60s here, but, you know, it's still the 60s issues. You know, all his talks on theology of the body, which are lovely and lyrical, and also make the case for not using contraception. But when you finish reading them, which is hard, you come away with a sense that he's not talking about real bodies.
You know, not bodies that get tired, that get hungry, that ache to love someone, that can have too many children, that can't get pregnant right now. But that's the weird thing that you have this incredibly intimate discussion of female reproduction done by women.
essentially middle-aged, celibate men. Yeah, exactly. And you know, a lot of the men I interviewed, because they were ordained in the 40s and the 50s, some even in the late 30s, they had gone to seminary at the age of 14. And I really think that many of them, certainly during the period of upheaval around birth control, had themselves not had sexual experience. One of them said to me, he said, you know, when I was a young priest,
I really hated for anyone to confess to sexual sin because I didn't know what I was talking about. In response to Rock's challenge, the Vatican set up an international commission in the early 1960s. 72 people. Theologians, medical experts. They deliberated for three years. And they end up voting 68 to 4 in favor of the pill. And what is the commission's argument for voting in favor? A Jesuit's argument.
They say that you can't make a general rule about contraception, that each case is different. Every family, every woman faces her own unique set of issues. When the Pope gave his blessing to the rhythm method, it was because he saw that the women of Italy were suffering in the years after the war, poor, overwhelmed. That Pope, that consideration of the particulars of their situation, softened his commitment to principle.
In the early 1960s, the papal commission took the same position with the pill. The chairman of the majority report was a priest named Joseph Fuchs, and everyone thought he was going to rule against Rock because he was a conservative, but he was also a Jesuit. Funny thing happens is that Fuchs, while he's on the committee, starts listening to the laypeople on the commission, and the laypeople start talking in a way
that they're entertaining particularities that he never entertained. That's Father Keenan, who we met in the previous episode, the Jesuit scholar in Rome. Only the married couple fully understands that as a matter of fact, this husband or this mother is going to lose their job. They have to take care of this. They can't stay at home. All of a sudden, all these different issues are not being entertained. And he realizes we have to be teaching people
how to make judgments in conscience because they're going to have circumstances that we can never anticipate. And they're going to have the better ability than we who don't have that information. There are too many cases and too many particulars. So in the end, Fuchs says that the decision ought to lie with the wife and the husband.
that birth control is a case that each Catholic must decide for herself. He's teaching that you don't need to go to a priest for a casuist, you have to become a casuist. That's what he's doing. For two years, Pope Paul VI pondered the Commission's findings. Finally, in the Humanae Vitae encyclical of July 28, 1968, he made up his mind. He looked back at the 1930 ruling of his predecessor, and he said...
All of this elegant casuistry around the pill is irrelevant. I cannot overturn received papal teaching. At the Church's crucial moment, when Pope Paul VI had the chance to offer consolation to millions of Catholics around the world, he flinched. He put a principle ahead of the particulars. Don't let anyone tell you that the courageous man is the man of principle.
The courageous person is actually the one who knows when to put principle aside. John Rock retired to a small town in New Hampshire. Because he was never interested in charging for his services, he ran out of money in his later years. He had to live simply. He starts his day reading and answering mail, critical and otherwise, from readers of his book advocating the birth control pill. David Brinkley sat with him in his office, and they reenacted his daily ritual.
John Rock holds a letter in his hands. Your article in the magazines in regard to birth control is rather nauseating. Did you ever think of the day you would meet your God and account for your work while on earth? I can hardly believe that you or anyone else can interfere with the divine natural law God will provide. I'm sorry I upset your stomach. You may be very sure that I've gone through
some inner pains myself over this problem that I am so concerned with. For John Rock, his obligation as a Catholic was never to the mute enforcement of natural law. He went into the tenements of Boston, remember, and felt overwhelming sorrow. As far as meeting my God, I have been taught and I believe that he's here with me all the time. As I have to meet him
He shared the obligation of the Jesuits to console those in need of consolation. As Wanda Rahner said, I think I love the man. I love the man.
Revisionist History is produced by Mia LaBelle and Jacob Smith with Camille Baptista. Our editor is Julia Barton. Flan Williams is our engineer. Fact-checking by Beth Johnson. Original music by Luis Guerra. Special thanks to Carly Migliore, Heather Fane, Maggie Taylor, Maya Koenig, and Jacob Weisberg. Revisionist History is brought to you by Pushkin Industries. I'm Malcolm Gladwell.
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