Clinton St. Quarterly, Vol. 5 No. 2 | Summer 1983 (Seattle) /// Issue 4 of 24 /// Master# 4 of 24

Depo Another Shot By Mary Deaton Drawings^y Salise Hughes n 1973 Port Angeles, on the tip of the Olympic Peninsula, had three doctors, all in the same clinic. Nardi Townsend went to one for pre-natal care. She trusted him. He looked like Abraham Lincoln. At her first examination the doctor asked Nardi what she would do for birth control after the baby came. Nobody had ever talked to her about birth control. That was why she was pregnant when she got married at age 17. The doctor suggested she use a new drug, a shot. She would get an injection every three months. Her periods would stop and it would increase her breast milk. The U.S. Food and Drug Administration (FDA) had not yet declared “ the shot" safe but, Nardi was assured, by the time her baby was born that would be taken care of. Every time she went to see the doctor he mentioned the shot. Nardi delivered a healthy baby boy in April, 1974. At her six week checkup she remembers the doctor saying, Great, now its time for the birth control shot. He left the room. In came the nurse. Nardi lowered her pants and the nurse stuck the needle in her rear. The Upjohn Company first introduced Depo Provera (medroxyprogesterone acetate) in 1959. They said it would prevent miscarriages and control irregular menstrual patterns. It was also a great contraceptive for dogs. Based on Upjohn’s initial research, the FDA approved Depo for these uses. In 1960 it said the drug was also safe for easing discomfort in patients with inoperable cases of cancer of the endometrium (uterine lining). Depo is a synthetic formulation which mimics the chemical properties of progesterone, a hormone produced In countries where medical help is often miles and miles away, the convenience of “the shot was a major factor in its acceptance and use. by a woman's body as part of the hormonal pattern which controls fertility. While scientists are not exactly sure how Depo works, they do know it effects the ability of the ovaries to release eggs and changes the character of the uterine lining. In 1966 Upjohn voluntarily withdrew Depo from the veterinary market after it was discovered that dogs using Depo had developed abnormalities of the uterus. In 1974 the FDA said Depo should no longer be used to treat threatened miscarriages. Upjohn’s own studies showed the drug was no more effective in preventing spontaneous abortion than a placebo. It was also suspected of causing birth defects. That same year, however, Upjohn asked the FDA to approve Depo for use as a human contraceptive. In 1968 the company began tests on beagle dogs and rhesus monkeys, tests required by the FDA to determine if a proposed contraceptive might cause cancer. Clinical trials of Depo were also being conducted on women in the United States. The largest began in 1967 at Grady Memorial Hospital in Atlanta, GA. In Seattle, Dr. Nora Davis of Children's Orthopedic Hospital used it in trials on her mentally retarded patients. Dr. Raymond Clark, a Seattle doctor with a private practice on Broadway, would, along with his partner, use it on some’ 7,000 Seattle women over a period of 18 years. When the FDA studies Upjohn’s test results on beagle dogs in 1974, it decided it was not ready to allow Upjohn to advertise Depo as a human contraceptive. The refusal, said the FDA, was based on research results showing “ an increased incidence of mammary carcinomas” (breast tumors) in the beagle dogs. Lack of FDA approval did not mean the drug was banned in the U.S. It could still be sold for its approved uses and doctors still prescribe it for whatever use they felt indicated. Depo was no longer an experimental drug, however, and it could not be exported from the United States until the FDA declared it “ safe.” In 1975 several million women in Third World countries had already been given Depo through programs funded by the U.S. government, the International Planned Parenthood Federation (IPPF) and other population control organizations. The man who then headed the IPPF, Malcolm Potts, had enthusiastically encouraged use of Depo in Thailand, Kenya, Sri Lanka, Botswana, Tanzania, Zaire and Jamaica. In Thailand Ed McDanial of McCormick Hospital, Chiang Mai Province, was equally thrilled with the results he was getting using Depo on several thousand Thai women a year. He preferred it to the pill or IUD because, he felt, it had fewer negative side effects. It also did not require the women using it to follow a daily regime or remember to insert a barrier before intercourse. In countries where medical help is often miles and miles away, the convenience of “ the shot” was a major factor in its acceptance and use. The IPPF, the World Health Organization and other users of Depo had gotten their supplies from Upjohn plants in the U.S. The FDA’s refusal to approve the drug forced the company to move Depo’s manufacture Clinton St. Quarterly