designers about non-users, who tend to be characterized as stubborn and unwilling to accept progress or change. Sally Wyatt, who studies digital technologies, has argued for more robust understandings of non-use. She identifies four types of non-users: (1) resisters, who do not want to use a technology; (2) rejecters, who have voluntarily stopped using a technology; (3) the excluded, those for whom the technology was not initially intended; and (4) the expelled, who have stopped using the technology involuntarily.57 These categories are extremely helpful in understanding why technologies are not adopted, and they move beyond blaming the non-users for their misguided ways. The flip side is to imagine an unwanted or unintended user. For example, a whale as a “technological bystander” becomes an unintended nonhuman user of low-frequency sonar, which is harmful to its existence.58 In the case of TSS, the S. aureus bacterium became a nonhuman unintended user of tampons, able to exploit the technology. The superabsorbent tampons served its interests, and the bacterium capitalized on them to grow and flourish. As biocatalytic agents, bacteria become the reimagined users of technology.
It is important that scientists, engineers, and designers move beyond a mechanical understanding of the body to envision it as a robust ecosystem with bacterial constituents that have the potential to become users. Researchers must ask how medical and bodily technologies will interact with bacterial constituents. This approach challenges the current embrace of nanotechnology and its applications for human health and welfare. Tinier in size than one-celled bacteria, these technologies may become objects to them. This is not a moot point; there is a new menstrual pad in development that incorporates nanofibers.59 This new pad may be a wonderful innovation, but we are not asking about the nonhuman users and what they may do with the technology.
The technobiological illness of TSS engages the two nonhuman entities of tampon and bacterium as necessary and vital cofactors.60 Furthermore, the powerful biocatalytic relationship between technology and bacterium was not just overlooked (since this would imply willful disregard) but, worse, it was unimagined as a possibility because the tampon was presumed to be inert. In addition, menstruation was dismissed as an insignificant fluid of a leaky mechanical body fixed with a menstrual plug. Even James Todd, who first identified and published results about TSS in 1978, lamented that “it should have been obvious that the group of young women with ‘vaginitis’ were of menstruating age and, in fact, three of our original patients, in retrospect, were menstruating at the onset of their illness, but we missed completely the possibility of any connection with tampon use.”61 In some ways, it was refreshing that Todd did not immediately fall into the essentialist trap of linking menstruation to illness in girls. Yet the relationship of the vaginal flora to technology was overlooked and dismissed as inconsequential. The historical legacy of minimizing women’s health concerns came to bear, and scientists were unaccustomed to thinking about bacteria as acting independently of the menstruous human body in their interactions with seemingly inert technology.
Risk and Injury
Imagining technology to have biocatalytic potential will change and expand the scope of risk. Though stakeholders look to science as a means to provide measurable data about risk, managing risk turns out to be as much of an art as it is a science. What exactly is risk and who holds responsibility for it? The answer to this question has changed over the twentieth century in the United States, with culpability falling across the spectrum to the individual, government officials, and corporations and their scientists and engineers. In part, an ethic of paternalism and social engineering marked a shift in the early- to mid-twentieth century from blaming individuals who were simply accident-prone and apt to injury, to an ethos that incorporated safety precautions into the very design of factory equipment “to solve the problem of accidents.”62 While shouldering responsibility for better equipment and design, engineers also exposed themselves to blame when things went awry. Henry Petroski, a civil engineer, has enumerated technological disasters such as bridge failures that haunt many engineers, and he argues we must continue to learn from these mistakes in order to prevent their reoccurrence.63 Arwen Mohun, a historian of technology, argues that publics in the first part of the twentieth century were painfully aware of work-related risks inherent to dangerous jobs, yet they were unwilling to relinquish risk altogether. Thus, they demanded the safe, circumscribed risk in their consumer consumption of roller coasters, for example, that engineers accommodated in the design process.64
What is truly a risk, and what is perceived as a risk, means something different to many individuals, and there are a number of means to gauge this perception.65 Building a nuclear plant and driving cars both pose risk, but often it is the nuclear power plant and its imminent breach of radioactive materials that cause more fear than the possible car accident when driving to the grocery store. Alvin Weinberg, a nuclear physicist and a research director at Oak Ridge National Laboratory from 1955 to 1973, proposed the idea of “trans-science” in 1972 to think about risk. He argued that science has the ability to pose questions, but not always the means to answer them, noting “they transcend science.”66 Thus, scientists have difficulty providing “facts” about risk “when scientists can offer only trans-scientific answers to questions of public policy in situations in which laymen, politicians, civic leaders, etc., look to scientists to provide scientific answers.”67 Weinberg’s concept of trans-science suggests that policy makers will never have the data that they really need to make informed decisions because the science to produce the data does not exist. The most we can ask for is good judgment, which by definition, is not science.
Many disciplines have taken up the study of risk: cognitive psychology, sociology, communication, and others. How experts and laypeople view risk variables is a concept many have tried to assess. Others have examined how both men and women express concerns about risk through their gendered identities.68 Yet it is important to the story of tampon-related TSS that scientists’ perceptions about gender have influenced assessments of risk for women users. Most of these scientists were men, and though it is problematic to assume that an essentialized woman scientist would make better judgments, as the story unfolds it was clear that the women who made decisions at crucial junctures shaped the trajectory of policy concerning tampons and TSS in ways that were influenced by their experiences as mothers, friends to other women, and as community members with women. From protesters to epidemiologists to lawyers to health advocates, women’s understandings of menstruation and how it was managed through menstrual hygiene technologies mattered greatly. Their identities as women at that particular historical moment did influence views of the science and the risk posed by tampons.
The significance of this is that the risks perceived to be low resulted in great harm to some women and was particularly gendered because of the manner in which injury occurred. Superabsorbent tampons such as Rely did not fit the mold for usual measures of product injury. They differed because they possessed the potential to precipitate a reactive consequence, but not necessarily direct injury from the object per se. The uneven injuries were difficult to track both medically and from a legal, compensatory model as well.
S. Lochlann Jain, an anthropologist who studies design and law, has theorized the social and economic consequences from manufactured goods wounding humans. She argues that injury is not merely an unfortunate accident but is integral and assumed within consumption, and therefore capitalism itself. She suggests “injury law demonstrates the recursive way in which design issues also materialize and naturalize sets of injuries as visible and compensable or invisible and non-compensable.”69 Jain looks at examples such as the Ford Pinto, cigarettes, and keyboards, to name a few. In these types of cases, the relationship of technology to injury can be interpreted as causal.
The likes of lead poisoning, asbestosis and mesothelioma, and other environmental pollutants are constant reminders of damage caused by human-created products.70 Gregg Mitman, a historian of the environment and ecology, in the introduction to Landscapes of Exposure writes, “The preponderance of toxic, over infectious, agents of illness … reflects a long-term ‘epidemiological transition.’”71 Usually, epidemiological transition refers to stages of improved health directly attributable to a higher-quality standard of living as well as access to medical care, with correlating improved longevity and decreasing birth rate. However, it may be that “a range of medico-environmental materials
