Pushkin. It's nineteen sixty four. NBC News anchorman David Brinkley has come to Boston to meet John Rock. Doctor Rock, who is seventy three years old, lives and works in Brookline, Massachusetts. Mainly he worked at his clinic or center, devoted to the study of human reproduction and the treatment of problems in an area of 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 thirty years of fertility clinic at the Free Hospital for Women, and now goes to mass every day at clan's Saint 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 Saint Mary's Catholic Church and then helped create the pill, something his church could not accept. One of the events would shape my later life to a great degree was an experience I had a father, Finnic, who was a cured in Marlborough. Rock is tall, distinguished, looks like Carrie Grant. His interview at Brinkley was over a century ago, so forgive the quality of the tape. I was just about fourteen and in walking out of Mars one Sunday when Father finnickback and me and asked me if I would like to drive down with him to visit the old folks home all we children called a poor fa Father Finnick was a quiet and unobtrusive man. When he was holding fourth the first Communion class or confirmation class, he put across what he intended us to learn with clarity and vigor, so that 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 have added sound effects. God bless them. We had never been more than just friends, but some are remember quite distinctly that rider. 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. I'm 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, et 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 Ronner, who wrote a book called The Fertility Doctor. It's the definitive account of rock life. You go first. I'm Margaret Marsh, and I'm a university professor. That's a title, university professor at Regers University. Yeah. I'm Wanda Ronner 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 your 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 families still there in Vineland. Oh see you, so I'm seeing your Catholic or we're 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 guess how we worked 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 is 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 nineteen hundreds, 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 clothes. 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 ears 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 pen named Luigi mastro Yani, 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 where 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 that minute. 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. Did you grow up Catholic too? Like I said, I want to be Catholic, not the real thing. 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 satisfactory. That's all. That's all, it's mandatory to She's very she's very good, loved, she's one of the most beloved parish, one of the most loved. Your sister is allowed to boast about you. I don't know why you're why you're trying to stop her? Wait? Where were we got involved with birth control? Almost by accident. He was more interested in treating infertility, and in the nineteen fifties he started working with two hormones that had only just been isolated, estrogen, and progesterone. What's his theory that progesterone inestrian 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, yes, was he said some women seemed to have underdeveloped systems. He sets systems, he 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 you know, they didn't know the kinds of things we know now. So it's all observational lines. 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 seemed to be developed in the analogy of a car with a dead battery, Jump start the battery, and then after that the battery works. Think yes, so that's how Rock got interested in the role of hormones in reproduction. Meanwhile, fifty miles away in Worcester, a scientist named Gregory Pincas 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 nineteen fifties, 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 appointer 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 Kerry Grant, the most famous doctor in America, knocked on the man's door. He had had all material, the right stack of stuff on it yet and he hadn't even looked at it. So we talked about it, and he said, well, he would go throw it as soon as he could, and I went over the then Tamna, you have no time, you'll do it now. And they said all right, and so he signed to what's ther call it? That was it? One of the two or three most important drugs of the twentieth century was approved. Is one of the drugs inventors took the train to Washington, marched into the FDA and said, you'll do it now that I probably the government in taking the final step, but we knew which 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 Kasti canoebe Papal encyclical of nineteen thirty. In it, Pope Pious the eleventh declared that and a quote, any use whatsoever of matrimony exercise 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 to John ROC'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 Martian wander Or tell the story in their book of when Roc was nineteen 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 that United Fruit and 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 Anny of Coursie. They cut the wages on his farm. Then there's this huge strike and he says, well, he writes to the president of the companies, 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. He's like nineteen years old. He wades into this wildcat strike, gets the injured men, brings them to the hospital. And you wonder, where does the nineteen 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 of Hill, 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 know 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. Yeah. Yeah, So that gives you a flavor of I suppose of the culture. His mother was devout. His mother was very different. Yeah. One of my colleagues, who's a James Joyce scholar, told me about a line in one of James Joyce's book where the hero and his friend are walking around. Then 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 nineteen sixties. 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 Barnard. He's a professor at the University of Pennsylvania Medical Center in Philadelphia, an ob gyn who does research in reproductive biology. Barnhart's kind of a modern day verse of John Rock. Only now we know a lot more about female reproduction than we did in the nineteen sixties. I mean to insult you with a student level lecture, but you know 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 bedstand. Yeah, 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 opulation. 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 what you want. I would remove the biological clock and you could get pregnant at sixty right. So I mean, I mean you could decouple the aging of a woman's eggs from the regular aging process. Is that? What is that? Theoretically? I mean, luckularly, 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 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 ran out of menopause. But we don't understand what tells the group to grow. So if we could say, don't throw your follicle this month, throw 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 three hundred to four hundred thousand eggs, and every month, like clockwork, you lose about a thousand of them. That's the iron logic of female fertility. But Barnhardt 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 m tour. 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 emptor a contraceptive? I wouldn't pitch it as contraception. I wouldn't. I would. I would pitch it as delay, you know where. It's not like I'm trying to not get pregnant today. I need a contraceptive right, I mean no, Let's go, Wow, this is interesting, right, um, because I'm thinking you're, you know, 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 are opposed to artificial contraception, but what if this is not? Is this plausibly not contraception? Yeah? I'm Catholic, and I struggle with us all the time. Like I said, everyone in this story is Catholic. On the one hand, Barnhardt says, emptor is obviously something that allows a woman to have sex without the possibility of getting pregnant. You take a pill and you knower ovulate. As the Pope wrote in nineteen thirty, those who indulge in such are branded with the guilt of a grave sin. How is the pope when to agree with emptor? But on the other hand, well, you could say that this is a way of controlling your aging, or postponing or prophylaxing or being sure. But I'm open to having a family, and I'm open to life, and I'm opened later. It's just it's just not right now. So that may be a plausible argument if you look at it that way. Emptor is actually not a means to suppress your fertility, but it 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. Barnard 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 emptor 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? Chemotherapy is designed to kill dividing cells, and 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 consequence intour could stop, could stop the development of the eggs such that they're no longer receptive to the chemotherapy 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 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, Emptor 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 from 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 live 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 unstone tablets. They are things that have to be negotiated. Casuistry is a method of doing that negotiation. You see you're a Catholic. Yeah, yeah, And I struggle with that. Do I know more scientifically in the popes to 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 casuists 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 casuitical 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 nineteen thirty 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 nenteen fifty one, Pope Pius the twelfth addressed a group of midwives in Italy, and in his speech he explicitly gave his blessing to the rhythm method of birth control. His statement on the rhythm method, how does he resolve the issue of whether the whether the rhythm method is contraception or not? Oh, I just by ignoring it. That's a time lunered 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, the Congress of Italian Midwives, and I presume what it reflects is the reality of war tour in Italy, you know, of a country that's really been desmated, where people are desperately poor. So, in a fact, he's saying, I know you're phasing problems out there. And here is mother Church's pastoral response. So there are some kinds of birth control the Catholic churches, 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 nineteen fifties. Walk the naive listener through what practicing the rhythm method of fifties met, right, Well, it was new and improved rhythm in the fifties, and in the beginning, you just you sort of looked at the calendar. You assume that your menstrual period would occur at such and such a point in the cycle, and there'd be no variations, so you just count. Right. This doesn't work very well at preventing pregnancy. The one that dominates in these is the so called basal temperature method, whereby apparently when a woman opulates, there'll be a very slight increase in her body temperature. But that means that every morning you have to take your temperature rectily, because that's the most sensitive way, and recorded before you get out of bed, before you do anything, which is not always easy if you already have a houseful of young children. Yes, you had seven kids screaming and you're taking your temperature, that's right, which in the screaming might I should think have caused your temperature to rise? For only independent reasons Teler is Catholic, of course, and as someone who grew up in the nineteen sixties, this is a world she knew. Intimately. I'm married into a family where my husband's considerably older brothers, who'd had their kids in the forties and fifties, had ten and twelve 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 can 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 ROC'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 subscript in these pills acts in the body exactly like progesterone to the mother's over reproducers. 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 the releasing eggs. If 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. It may believe pregnancy early on. Leslie Tatler 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 uncontraception 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 into it 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 roc 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 thirty. The cardinals and the Pope were the front lines like he was. They were sitting celibate behind the walls of the Vatican. We take John Paul a second for example. We're leaping ahead a bit from the sixties here, but you know it's still the sixties issues. Yeah, all his talks on theology of the body, which are lovely and lyrical and also make the case for not using a 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 it's ye, that's the weird thing that you have this incredibly intimate discussion of female reproduction done by essentially middle age Selivan men. Yeah, exactly. And you know, a lot of the men I interviewed, because they were ordained in the forties and the fifties, some even in the late thirties, they had gone to seminary at the age of fourteen. And I really think that many of them, certainly during the period of upheaval around birth control I 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 ROC's challenge, the Vaticans set up an international commission in the early nineteen sixties seventy two people, theologians, medical experts. They deliberated for three years, and they end up voting sixty eight to four in favor of the pill. And what is the commission's argument for voting in favor a Jesuits 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 soften his commitment to principle. In the early nineteen sixties, 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 roc 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 late people on the commission, and the late people start talking in a way that they're entertaining particularities that he never entertained. That's father Keenan, who he 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 and 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. The 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 six pondered the commission's findings. Finally, in the Humane Vite Encyclical of July twenty eighth, nineteen sixty eight, he made up his mind. He looked back at the nineteen thirty 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 the sixth 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 as day reading and answering mail critical and otherwise from readers of his book advocating the birth condrol 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 as rather nauseating. Did you ever think of the day you would meet your God an account for your work while on earth. I can hardly believe that you or anyone else can interfere with a divine natural law. God will provide. I am. I'm sorry I have set Joe stomach. You may be very sure that I've gone through some inner pains myself. Oh there's problem that I a I'm 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. I've been taught him. I believe that he's here with me all the time, as I have to meet him every day. I really tried to conformed what he tells him. Here's the thing to do. He shared the obligation of the Jesuits to console those in need of consolation. Perhaps I'm a little hardly hearing at times, but I do my best. As wander Runners said, I think I love the man. Revisionist History is produced by mil La Belle and Jacob Smith with Camille Baptista. Our editor is Julia Barton. Flawn Williams is our engineer. Fact checking by Beth Johnson. Original music by Luis Guerra. Special thanks to Carly Migliore, Heather Fane, Maggie Taylor, Maya Kane, and Jacob Wesburg. Revisionist history is brought to you by Pushkin Industries. Him Malcolm Gladwell

Pushkin. It's nineteen sixty four. NBC News anchorman David Brinkley has come to Boston to meet John Rock. Doctor Rock, who is seventy three years old, lives and works in Brookline, Massachusetts. Mainly he worked at his clinic or center, devoted to the study of human reproduction and the treatment of problems in an area of 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 thirty years of fertility clinic at the Free Hospital for Women, and now goes to mass every day at clan's Saint 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 Saint Mary's Catholic Church and then helped create the pill, something his church could not accept. One of the events would shape my later life to a great degree was an experience I had a father, Finnic, who was a cured in Marlborough. Rock is tall, distinguished, looks like Carrie Grant. His interview at Brinkley was over a century ago, so forgive the quality of the tape. I was just about fourteen and in walking out of Mars one Sunday when Father finnickback and me and asked me if I would like to drive down with him to visit the old folks home all we children called a poor fa Father Finnick was a quiet and unobtrusive man. When he was holding fourth the first Communion class or confirmation class, he put across what he intended us to learn with clarity and vigor, so that 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 have added sound effects. God bless them. We had never been more than just friends, but some are remember quite distinctly that rider. 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. I'm 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, et 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 Ronner, who wrote a book called The Fertility Doctor. It's the definitive account of rock life. You go first. I'm Margaret Marsh, and I'm a university professor. That's a title, university professor at Regers University. Yeah. I'm Wanda Ronner 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 your 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 families still there in Vineland. Oh see you, so I'm seeing your Catholic or we're 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 guess how we worked 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 is 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 nineteen hundreds, 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 clothes. 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 ears 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 pen named Luigi mastro Yani, 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 where 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 that minute. 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. Did you grow up Catholic too? Like I said, I want to be Catholic, not the real thing. 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 satisfactory. That's all. That's all, it's mandatory to She's very she's very good, loved, she's one of the most beloved parish, one of the most loved. Your sister is allowed to boast about you. I don't know why you're why you're trying to stop her? Wait? Where were we got involved with birth control? Almost by accident. He was more interested in treating infertility, and in the nineteen fifties he started working with two hormones that had only just been isolated, estrogen, and progesterone. What's his theory that progesterone inestrian 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, yes, was he said some women seemed to have underdeveloped systems. He sets systems, he 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 you know, they didn't know the kinds of things we know now. So it's all observational lines. 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 seemed to be developed in the analogy of a car with a dead battery, Jump start the battery, and then after that the battery works. Think yes, so that's how Rock got interested in the role of hormones in reproduction. Meanwhile, fifty miles away in Worcester, a scientist named Gregory Pincas 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 nineteen fifties, 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 appointer 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 Kerry Grant, the most famous doctor in America, knocked on the man's door. He had had all material, the right stack of stuff on it yet and he hadn't even looked at it. So we talked about it, and he said, well, he would go throw it as soon as he could, and I went over the then Tamna, you have no time, you'll do it now. And they said all right, and so he signed to what's ther call it? That was it? One of the two or three most important drugs of the twentieth century was approved. Is one of the drugs inventors took the train to Washington, marched into the FDA and said, you'll do it now that I probably the government in taking the final step, but we knew which 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 Kasti canoebe Papal encyclical of nineteen thirty. In it, Pope Pious the eleventh declared that and a quote, any use whatsoever of matrimony exercise 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 to John ROC'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 Martian wander Or tell the story in their book of when Roc was nineteen 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 that United Fruit and 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 Anny of Coursie. They cut the wages on his farm. Then there's this huge strike and he says, well, he writes to the president of the companies, 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. He's like nineteen years old. He wades into this wildcat strike, gets the injured men, brings them to the hospital. And you wonder, where does the nineteen 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 of Hill, 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 know 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. Yeah. Yeah, So that gives you a flavor of I suppose of the culture. His mother was devout. His mother was very different. Yeah. One of my colleagues, who's a James Joyce scholar, told me about a line in one of James Joyce's book where the hero and his friend are walking around. Then 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 nineteen sixties. 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 Barnard. He's a professor at the University of Pennsylvania Medical Center in Philadelphia, an ob gyn who does research in reproductive biology. Barnhart's kind of a modern day verse of John Rock. Only now we know a lot more about female reproduction than we did in the nineteen sixties. I mean to insult you with a student level lecture, but you know 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 bedstand. Yeah, 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 opulation. 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 what you want. I would remove the biological clock and you could get pregnant at sixty right. So I mean, I mean you could decouple the aging of a woman's eggs from the regular aging process. Is that? What is that? Theoretically? I mean, luckularly, 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 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 ran out of menopause. But we don't understand what tells the group to grow. So if we could say, don't throw your follicle this month, throw 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 three hundred to four hundred thousand eggs, and every month, like clockwork, you lose about a thousand of them. That's the iron logic of female fertility. But Barnhardt 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 m tour. 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 emptor a contraceptive? I wouldn't pitch it as contraception. I wouldn't. I would. I would pitch it as delay, you know where. It's not like I'm trying to not get pregnant today. I need a contraceptive right, I mean no, Let's go, Wow, this is interesting, right, um, because I'm thinking you're, you know, 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 are opposed to artificial contraception, but what if this is not? Is this plausibly not contraception? Yeah? I'm Catholic, and I struggle with us all the time. Like I said, everyone in this story is Catholic. On the one hand, Barnhardt says, emptor is obviously something that allows a woman to have sex without the possibility of getting pregnant. You take a pill and you knower ovulate. As the Pope wrote in nineteen thirty, those who indulge in such are branded with the guilt of a grave sin. How is the pope when to agree with emptor? But on the other hand, well, you could say that this is a way of controlling your aging, or postponing or prophylaxing or being sure. But I'm open to having a family, and I'm open to life, and I'm opened later. It's just it's just not right now. So that may be a plausible argument if you look at it that way. Emptor is actually not a means to suppress your fertility, but it 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. Barnard 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 emptor 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? Chemotherapy is designed to kill dividing cells, and 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 consequence intour could stop, could stop the development of the eggs such that they're no longer receptive to the chemotherapy 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 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, Emptor 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 from 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 live 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 unstone tablets. They are things that have to be negotiated. Casuistry is a method of doing that negotiation. You see you're a Catholic. Yeah, yeah, And I struggle with that. Do I know more scientifically in the popes to 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 casuists 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 casuitical 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 nineteen thirty 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 nenteen fifty one, Pope Pius the twelfth addressed a group of midwives in Italy, and in his speech he explicitly gave his blessing to the rhythm method of birth control. His statement on the rhythm method, how does he resolve the issue of whether the whether the rhythm method is contraception or not? Oh, I just by ignoring it. That's a time lunered 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, the Congress of Italian Midwives, and I presume what it reflects is the reality of war tour in Italy, you know, of a country that's really been desmated, where people are desperately poor. So, in a fact, he's saying, I know you're phasing problems out there. And here is mother Church's pastoral response. So there are some kinds of birth control the Catholic churches, 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 nineteen fifties. Walk the naive listener through what practicing the rhythm method of fifties met, right, Well, it was new and improved rhythm in the fifties, and in the beginning, you just you sort of looked at the calendar. You assume that your menstrual period would occur at such and such a point in the cycle, and there'd be no variations, so you just count. Right. This doesn't work very well at preventing pregnancy. The one that dominates in these is the so called basal temperature method, whereby apparently when a woman opulates, there'll be a very slight increase in her body temperature. But that means that every morning you have to take your temperature rectily, because that's the most sensitive way, and recorded before you get out of bed, before you do anything, which is not always easy if you already have a houseful of young children. Yes, you had seven kids screaming and you're taking your temperature, that's right, which in the screaming might I should think have caused your temperature to rise? For only independent reasons Teler is Catholic, of course, and as someone who grew up in the nineteen sixties, this is a world she knew. Intimately. I'm married into a family where my husband's considerably older brothers, who'd had their kids in the forties and fifties, had ten and twelve 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 can 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 ROC'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 subscript in these pills acts in the body exactly like progesterone to the mother's over reproducers. 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 the releasing eggs. If 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. It may believe pregnancy early on. Leslie Tatler 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 uncontraception 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 into it 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 roc 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 thirty. The cardinals and the Pope were the front lines like he was. They were sitting celibate behind the walls of the Vatican. We take John Paul a second for example. We're leaping ahead a bit from the sixties here, but you know it's still the sixties issues. Yeah, all his talks on theology of the body, which are lovely and lyrical and also make the case for not using a 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 it's ye, that's the weird thing that you have this incredibly intimate discussion of female reproduction done by essentially middle age Selivan men. Yeah, exactly. And you know, a lot of the men I interviewed, because they were ordained in the forties and the fifties, some even in the late thirties, they had gone to seminary at the age of fourteen. And I really think that many of them, certainly during the period of upheaval around birth control I 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 ROC's challenge, the Vaticans set up an international commission in the early nineteen sixties seventy two people, theologians, medical experts. They deliberated for three years, and they end up voting sixty eight to four in favor of the pill. And what is the commission's argument for voting in favor a Jesuits 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 soften his commitment to principle. In the early nineteen sixties, 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 roc 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 late people on the commission, and the late people start talking in a way that they're entertaining particularities that he never entertained. That's father Keenan, who he 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 and 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. The 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 six pondered the commission's findings. Finally, in the Humane Vite Encyclical of July twenty eighth, nineteen sixty eight, he made up his mind. He looked back at the nineteen thirty 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 the sixth 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 as day reading and answering mail critical and otherwise from readers of his book advocating the birth condrol 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 as rather nauseating. Did you ever think of the day you would meet your God an account for your work while on earth. I can hardly believe that you or anyone else can interfere with a divine natural law. God will provide. I am. I'm sorry I have set Joe stomach. You may be very sure that I've gone through some inner pains myself. Oh there's problem that I a I'm 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. I've been taught him. I believe that he's here with me all the time, as I have to meet him every day. I really tried to conformed what he tells him. Here's the thing to do. He shared the obligation of the Jesuits to console those in need of consolation. Perhaps I'm a little hardly hearing at times, but I do my best. As wander Runners said, I think I love the man. Revisionist History is produced by mil La Belle and Jacob Smith with Camille Baptista. Our editor is Julia Barton. Flawn Williams is our engineer. Fact checking by Beth Johnson. Original music by Luis Guerra. Special thanks to Carly Migliore, Heather Fane, Maggie Taylor, Maya Kane, and Jacob Wesburg. Revisionist history is brought to you by Pushkin Industries. Him Malcolm Gladwell