into the environment” are marking a new transition to degenerative health, and that transition is characterized by David Morris, a scholar of medical humanities, as both postmodern and biocultural.72
The resulting injury brought about by Rely was complicated to delineate because the causal model of disease or acute poisoning, for example, did not fully account for relational injury. In and of itself Rely was not defective. It was not composed of toxic materials producing direct harm or triggering cancerous growths. As a medical device it was presumed inert, and Rely did not directly cause TSS. The injury incurred was biocatalytic. Once lodged in a vaginal canal, Rely held the strong potential to interact with bacteria that may be present as constituent communities within some women’s bodies. Because makers considered tampons to be inert, the leap to the reactivity of the technology seemed far-fetched.
It is only recently that the idea of indirect harm has gained some traction, and this can be seen in new policies by the EPA to limit perchlorates in drinking water. According to Sanjay Gupta, a physician and CNN’s chief medical correspondent, “It’s the first time we’ve ever regulated a chemical not because of what it does directly to you, but because it has an impact on iodine uptake that might affect your child down the road.”73 Thus, the capabilities to cause indirect harm were not well appreciated in the case of TSS. Yet, despite the prevailing wisdom of direct harm and inert technology, the live bacterium and synthetic superabsorbent tampon energetically interacted and were cofactors in producing illness. As Jain points out, design flaws may materialize as visible, requiring compensation, or remain invisible, and go unrecognized.
What people “see” is crucial. Take, for example, “the invisible gorilla” perception studies conducted by Christopher Chabris and Daniel Simons, which find that when people are asked to focus on one specific thing on a video, they miss the big picture of the costumed gorilla sauntering across the screen. Another attention researcher, Trafton Drew, used this same idea to test a highly skilled and trained set of experts who read data on screens: radiologists. Presented with multiple X-rays, and then an image of the gorilla, 83 percent were so focused on their object of intent that they missed it. This “inattentional blindness” allows them to home in on important and specific data, but since they are not looking for a gorilla they do not see it.74 This indicates that the framing of a data set is highly important regarding what a researcher can “see.” Jennifer Croissant, who studies the sociology of science and technology, discusses a finer point of agnotology, that is, absences of knowledge, not just rejected knowledge or purposeful ignorance, but “absent knowledges as forms of non-knowledge.”75 As Kathy Ferguson, a political and feminist theorist, suggests, “The questions that we can ask about the world are enabled, and other questions disabled, by the frame that orders the questioning. When we are busy arguing about the questions that appear with a certain frame, the frame itself becomes invisible; we become enframed within it.”76 Thus, the shape of knowledge had to change to see tampon-related TSS and, moreover, to address the gendered technology and indirect injury manifesting in women’s bodies.
In addition, injury from bacterial activity does not fit a traditional model of liability with financial compensation rewarded to victims, because bacteria cannot be sued. Bacteria are not persons in the sense of an individual, legal entity, or even a corporation, from whom monetary remuneration may be sought. There is no money in blaming bacteria—perhaps in human error in regard to medically unsterile practices, or the spread of E. coli with unsanitary farming methods—but not for generalized infections or bacterial toxins, especially from constituent bacteria residing on a person that suddenly goes rogue. Yet still, the injury of TSS in this particular case had the cofactor of the tampon to precipitate bacterial growth in some women, and manufacturers are responsible for tampon design and production.
Trusting Consumer Goods
Though my interest is in exploring tampons as technological artifacts, they also have an identity in the marketplace as a commodity, premised on producers and manufacturers delivering goods that consumers purchase for a price. Though debating the nuances of capitalism is not central to this book, it is worth noting that American consumers have come to an implicit agreement with manufacturers about commodities that they purchase. In the case of the sale of goods in the United States during the twentieth century, consumers submitted their health and well-being, and—importantly—money to corporations, in exchange for goods of reasonable quality and no danger. How deeply this understanding of safe commodities is naturalized in contemporary U.S. society can be seen in the outrage leveled against corporations, such as the case in China of melamine added to milk in 2009, responsible for the deaths of at least four babies and illnesses in 53,000 others.77 Cloaked in nationalistic righteousness, some vowed to boycott all imported food from China, others lamented that industrialism was occurring at the expense of health, and still others complained that policies about pure food were not up to the standards set in the United States. Besides fueling fears about the interdependency of global economies, the “bad” milk revealed an important naturalized assumption: in the United States, it is simply common knowledge that “good” milk should be produced and sold, and we are dumbstruck when systems fail to guarantee a safe product, and incensed when it causes illness instead of health.
This confidence in milk in the United States is also narrowly defined. In his lecture “The Cow Tipping Point,” David Ehrenfeld, a biologist, looks at the ways recombinant bovine growth hormone (rBGH) as a biotechnology is not well understood, sometimes purposefully, in terms of both direct and indirect injury and harm.78 For lactating cows treated with rBGH, the injury is often similar to other regularly lactating cows, such as mastitis and sore knees, though rBGH-treated cows suffer more and more often. Peer-reviewed papers by both industry and independent scientists often contradict one another, muddying the differences between naturally occurring BGH and rBGH. Despite animal suffering and the economic impact on producers to replace milk cows that die prematurely, these costs are not part of the “science” of whether or not to use the growth hormone. Questions for human health that are not obvious in terms of direct injury include the cross-species genetic exchanges in bacteria that weaken antibiotics, and rBGH’s role in that. Ehrenfeld concludes that, due to our faith in science, “we forget that technology is unable, both in theory and in practice, to resolve most of the practical problems that it itself creates.”79 Furthermore, technical or scientific facts will not produce a moral resolution, because their scope simply is too narrow.
This viewpoint paints a discouraging picture for the ability of regulating bodies to provide intervention concerning risk and injury, especially in relation to indirect harm. Government intervention, testing, and regulation have also been tempered through politics and legislation over the course of the twentieth century, with many arguing that neoliberalism has put us all at risk by reducing oversight and asking corporations to regulate themselves.80 Risk, limited safety, and tolerance for injury continue to be built into consumer goods, and tampons are caught in the crosshairs of these assumptions and ideologies. The complexity of tampon-related TSS is that the tampon causes indirect harm to some and not all menstruators, and the science supporting these claims has been very difficult to unpack because it is produced by both corporate-sponsored and independent scientists.
Technology’s Double Edge
DuPont’s now-famous slogan, “Better Things for Better Living … through Chemistry,” evokes the ethos of progressive technoscience in twentieth-century United States culture. Consumers have been well trained to expect more from their purchasing power and for corporations to deliver scientifically managed products, including food. In her book Empty Pleasures: The Story of Artificial Sweeteners from Saccharin to Splenda (2010), Carolyn Thomas, an American studies scholar, notes that many women in particular came to rely on saccharin as a low-calorie sugar substitute, and in light of health warnings and recommendations to possibly discontinue it, women rallied to the support of saccharin, despite its risks. The links to cancer were insignificant to people following reduced-sugar diets, to people with diabetes, and to others who simply liked the pleasure of being able to eat sweet treats. Women flooded the FDA with handwritten letters and notes, begging for saccharin to remain on the market as a sugar substitute. Modern chemistry
