The Illegitimacy Argument

One of the striking features of reproductive physiology as a line of scientific work was the lateness of its development in comparison with the physiology of other major organ systems. The most common explanation for this lateness emphasizes the illegitimacy of the topic of reproduction: largely because of its association with sexuality, reproduction was not considered a dignified scientific subject and therefore was eschewed by most serious scientists. Countervailing forces were requisite for the reproductive sciences to be worth legitimacy risks for scientists and their institutions. These forces were composed of emergent markets for scientific knowledge about reproduction, including academic departments of biology, medicine, and agriculture, along with birth control, eugenics, and neo-Malthusian movements and philanthropic organizations. These social movements aided reproductive researchers initially by placing reproductive topics at the center of public discussion—bringing them "out of the closet" through the development of a public forum on human reproductive issues between 1900 and 1920. The stature of many advocates—elite groups of scientists, physicians, philanthropists, and other professionals—also enhanced legitimacy. Subsequently, these movements became powerful and well-funded consumer markets and sponsors of the reproductive sciences. Other major markets were animal production industries and the medical specialties of obstetrics and gynecology, as illustrated in Figure 4. Both animal production industries and birth control movements were at the forefront in articulating goals of control over reproduction throughout the "Chain of Being." The "laws of nature" could now be replaced by the scientific ingenuity of humans as the means and mechanisms of rationalization passed from the factory to agricultural and social life.

"New reproductive technologies" for humans have been refined and applied since about 1970. Often initiated in earlier eras in agricultural reproductive sciences, these technologies include artificial insemination, sex preselection by means of sperm filtration, superovulation, embryo recovery and transfer, synchronized estrus, and genetic cloning.^[6] Over the past decades, most of these technologies have been applied as infertility treatments in humans, adding considerably to current controversies in the reproductive arena.

Controversy can cut at least two ways. On one hand it can thrust a field into disrepute; on the other it can be the basis of organizing both supporters and opponents, with varied consequences (cf. Maienschein 1994). For example, it was, ironically, the organization of British anti vivisectionists and their legislative agenda in late-nineteenth-century Britain that led to the founding of the Physiological Society to oppose them (Sharpey-Shafer 1927)! Similar ironies abound in the following analysis.

Association with Sexuality and Reproduction

The first realm of controversy concerns the explicit focus on sexuality and reproduction, which is considered improper and illegitimate by at least some constituencies in most human societies. M. C. Chang (Chang et al. 1977:434), along with Gregory Pincus one of the developers of the Pill, said: "The connection between reproduction and sex has always evoked a degree of emotional inhibition in both Western and Eastern countries. In early times, except for a few embryologists, the study of reproduction was in the hands of animal breeders and gynecologists interested in the improvement of fertility or the cure of sterility." Consequently, the reproductive sciences, and reproductive scientists, have often been stigmatized (Goffman 1963). The very doing of reproductive research was, to some, "dirty work" in Hughes's (1971) sense of work that somehow impugns, sullies, and discredits the identities of those who do it.

This impugning of identity may have very early origins. It has long been known that the renowned English surgeon and anatomist John Hunter (1728–93) had successfully transplanted cock testes into hens. Though he reported this only briefly, specimens remain preserved in London. Money (1983:391–92) suggests that Hunter may have "refrained from reporting to avoid publicity and the possible accusation of witchcraft. Fallout from the gruesome centuries of the Inquisition had still to be reckoned with... and crowing hens and sexually denatured men and beasts were signs of witchcraft."

The interests of the Roman Catholic Church in sex and reproduction have been extensive (e.g., Horn 1994; Kertzer 1994). Such religious concerns were a constant backdrop, and were sometimes foregrounded, during

the formation of the reproductive sciences. Some of the major debates in the history of modern science took up related controversial issues, such as that between Geoffroy and Cuvier (Appel 1987) and between Pasteur and Pouchet (Farley and Geison 1974; Geison 1995). Both of these nineteenth-century debates raised the specter of science as blasphemy and had what we would now refer to as "chilling effects" on certain lines of scientific work. But it should be clear that not only the Catholic Church but also many other religious bodies have proscribed public elaboration of the facts of sexuality and reproduction. Such prohibitions also seep deeply into popular culture.

An early-twentieth-century example concerns the founding of the National Research Council Committee for Research in Problems of Sex (NRC/CRPS) in 1921, which almost foundered around issues of impropriety. According to Aberle and Corner (1953:1), "There had been in the United States no coordinated effort to bring all the available knowledge to a useful focus or to encourage intensive research in the field. It was in fact first necessary to establish and defend the dignity of such studies." The first barrier confronted by the committee's sponsors was finding an administrative home within the NRC. After the Division of Anthropology and Psychology refused to sponsor the committee, the proposal was then greeted coolly by the Division of Medical Sciences, despite promised external support through Rockefeller funds. Only when a physician familiar with venereal disease became chairman of the medical division did the proposal succeed. In ways that foretold the future, the linkage to clinical work carried the day.

The NRC/CRPS sponsored publication of Sex and Internal Secretions (Allen, ed., 1932) which, as described in chapter 5, was the bible of the American reproductive sciences for fifty years. In his foreword to the third edition, George Corner (1961:x–xi, emphasis added) observed:

The younger readers of this book will hardly be able to appreciate the full significance of such an alliance between biologists, psychologists, and physicians on one hand, and social philanthropists on the other. It represented a major break from the so-called Victorian attitude which in the English-speaking countries had long impeded scientific and sociologic investigations of sexual matters and placed taboos on open consideration of human mating and childbearing as if these essential activities were intrinsically indecent. To investigate such matters, even in the laboratory with rats and rabbits, required of American scientists ... a certain degree of moral stamina. A member of the ... Committee once heard himself introduced by a fellow scientist to a new acquaintance as one of the men who had "made sex respectable. "

Many early investigators who did select reproductive problems felt they were placing themselves beyond the pale of propriety by doing so. They repeatedly stated to the NRC/CRPS that reluctant administrators in their univer-

sities had finally approved their proposed investigations only because they had the backing of an NRC grant (Aberle and Corner 1953:89). Frank Lillie (1938:68–69) wrote: "We are accustomed in our free society to hold that the development of all science is good; in certain countries less free it is ruled that only those aspects of science that contribute to their special national ideologies are good. But there is agreement that in science is power. ... [Yet science] has often had to fight its way ... [and] restrictions are placed on the teaching of the facts concerning human reproduction."

On a more humorous note (and humor is a key strategy used by reproductive scientists to manage controversy), Carl Hartman reported that his paper "How Large Is the Human Egg?" was rejected by the Ladies' Home Journal as too close to the pornographic! It ended up in Scientific American . Further, when George Streeter, the head of the Carnegie Department of Embryology, was asked to give a public talk about human developmental anomalies, he was cautioned not to use the word uterus . For Solly Zuckerman's lecture before the Royal Society, "he was told he must not use the term menstrual cycle as laymen would be present and even women!" (Hartman 1967:6).

The uproar in the 1950s over Alfred Kinsey's research demonstrates the continuity of opprobrium adhering to sex-related topics (Pomeroy 1982). It cost Kinsey some of his research funding. George Corner (1981:316), then chair of the NRC/CRPS, reported that when the Rockefeller Foundation was under attack as a left liberal organization by "rabid anti-Communists of the McCarthy type" during the early 1950s, Dean Rusk, the head of the foundation, surreptitiously called him. Rockefeller Foundation support of Kinsey through the NRC was soon terminated.

The association of the reproductive sciences with issues of sexuality and sex education remains highly problematic today (e.g., Booth 1989; Holden 1989). In 1991, a major study of human sexuality, led by sociologist Edward Laumann of the University of Chicago, was defunded by the National Institute on Child Health and Human Development (NICHHD) of the National Institutes of Health (NIH). Intended to update Kinsey's research, now over forty years old, the research was also intended to improve AIDS prevention education. Laumann responded that it "challenges the integrity of the whole system of peer review. It represents a chilling of the scientific discipline" (Moffat 1991:1483). A much abridged study has been completed (Laumann et al. 1994). On the lighter side, a recent joke does illustrate change: A man goes into a drugstore and says to the druggist, "I'll have a dozen condoms, please." Then he leans forward and says, under his breath, "And a pack of Marlboros" (Treichler 1993).

The stigmatization of the reproductive sciences because of associations with sexuality could be viewed as a self-constructed and self-serving myth used rhetorically by scientists to improve their status. However, the histori-

cal record supports scientists' claims to being hobbled in the competition for respect and resources.^[7] Of course, this does not mean that their stigmatization did not also help their cause in some situations, especially with certain funding sources. Scientists' appeals for support assuredly drew upon this aspect in constructing "progressive" research programs (e.g., Aberle and Corner 1953).

Association with Controversial Social Movements

The reproductive sciences have long been associated with the birth control, eugenics, and population control movements, and thus both directly and indirectly with national and international imperialism. All three social movements share the goal of enhanced control over human reproduction, although their emphases differ considerably. Separating sexuality from reproduction is controversial, and all three of these science-based social movements have sought to do so for over a century. During the first half of this century, American reproductive scientists valiantly attempted to distinguish their work from these quite controversial movements. But after World War II, this became increasingly difficult and, for many reproductive scientists, an undesirable strategy. The association of the reproductive sciences with these controversial social movements has been complicated, producing both positive and negative consequences for those sciences. Initially, these movements generated much support, funding, and legitimacy for the scientific study of reproductive phenomena. But they have also served to mobilize oppositional and/or critical movements focused on five major issues related to the reproductive sciences: contraception, abortion, sterilization, infertility services, and reproductive (especially fetal) research.

Historically, Roman Catholic and other religious groups have opposed the reproductive sciences as enhancing the capacity for intervention in natural processes, viewed by them as sinful. There have been papal encyclicals against abortion (Mohr 1978:186–87), against sterilization for contraceptive eugenic purposes (Editor 1931:73), against "unnatural" methods of contraception, and against infertility treatments (E. Moore 1931; Dienes 1972). Birth control advocates were highly sensitive to Catholic objections, and a significant impetus in the 1940s to rename the movement "family planning" and/or "planned parenthood" and to begin offering infertility services was intended to address Roman Catholics and gain legitimacy (Gordon 1976; Reed 1983). "Morality is first and foremost a matter of how things are named" (Schneider 1984:182).

The fight for legal abortion, like that for legal contraception in the United States, was long, is ongoing, and has become violent to the point of full-blown terrorism and multiple murders.^[8] The antiabortion movement has increasingly extended its objections to contraceptive research and to

federal and state distribution of contraception through family planning programs (e.g., Rosoff 1988). There has clearly been a chilling environment in the United States for RU486, the "French abortion pill," also used as a morning-after pill, although it is now being tested here.^[9] Moreover, antiabortionists' increased use of fetal imagery in popular appeals has had negative consequences for fetal research on reproductive and other problems (CIBA Foundation 1986; Petchesky 1987), although reproductive and other scientists have developed new guidelines for such research (Gerrity 1993; Annas and Elias 1989).

Sterilization abuse—terminating the reproductive capacity of women and men without their full knowledge, understanding, or consent—has a long history in the United States that has done little to advance the reproductive sciences. Eugenic sterilization laws of the first half of the twentieth century, aimed largely at institutionalized retarded and mentally ill people, fell into disrepute with the rise of the Nazis. Further controversies related to sterilization without consent have erupted, concerning "Mississippi appendectomies" in the American South during the civil rights movement, several cases of abuse of Black, Mexican, and Native American women during the 1970s, and cases involving poor women in Puerto Rico and Central America. Then and now these controversies are reinvoked via "temporary sterilization" threats to welfare mothers, including requiring use of implanted contraceptives such as Norplant. To many communities, especially communities of color in the United States and elsewhere, the reproductive sciences and their technoscientific products are viewed as tools of racist repression and coercion.^[10] It was no accident that The Bell Curve took up the fertility of African-American and Latina women along with IQ (Herrnstein and Murray 1994), despite scientists' repudiation of any biological "meaning" of race.

Over time, the association of the reproductive sciences with controversial social movements has both benefited the reproductive sciences and entrenched them ever more deeply in highly controversial arenas. In the eyes of some constituencies, it has made reproductive scientists "moral entrepreneurs" (Becker 1963) by the very nature of their work.

Association with Clinical Quackery

The third realm of controversy is the historical and contemporary association of the reproductive sciences with clinical quackery and problematic or hotly debated treatments. The modern form of this association began with one of the "founding fathers" of the modern scientific study of reproduction, Charles-Edouard Brown-Séquard (1817–94). This renowned French neurologist and physiologist taught in the United States, did major work on the adrenal glands, and assumed famed physiologist Claude Bernard's

chair at the Collège de France upon Bernard's death in 1878 (Olmstead 1946). In 1889, he made the following announcement: "I sent to the Society of Biology a communication, which was followed by several others, showing the remarkable effects produced on myself by subcutaneous injection of a liquid obtained by the maceration on a mortar of the testicle of a dog or of a guinea pig to which one has added a little water" (Medvei 1982:289). Many people thought this could be the start of something big. As documented by Borell (1976a:309): "Within weeks, testicular extract was being given to patients with every kind of illness. Within two years, many physicians thought that not only the testes but every organ of the body possessed some active principle which might be of immediate therapeutic value. Organotherapy, or the method of Brown-Séquard, as it was often called, came to be the therapeutic hope of physicians from Cleveland to Bucharest." Brown-Séquard had considerable scientific stature—he was a fellow of the Royal College of Physicians, a Fellow of the Royal Society, and recipient of an honorary degree from Cambridge University (Medvei 1982:291). Three weeks after his announced use of testicular extract, the British Medical Journal snidely reported it in an article titled "The Pentacle of Rejuvenescence," referring to a symbol used in magic (Borell 1976b). Reflecting on these events some years later, the reproductive endocrinologist Herbert Evans said, "Endocrinology suffered obstetric deformity in its very birth" (Borell 1978:283).

Shortly after Brown-Séquard's work, the discovery that extracts of thyroid alleviated myxedema (1891) and the identification of adrenaline (1894) and secretin (1902) added fuel to the organotherapy fire between clinicians and laboratory scientists. The "use of organ extracts by practitioners ... quickly outstripped study of these same preparations by experimentalists" (Borell 1985:3). Both were viewed as new miracles of scientific medicine. Sensationalism endured. Well into the 1920s, Harvey Cushing of Harvard was still concerned about practitioners' prescription of dubious substances to "credulous people" (Medvei 1982:504). Another endocrinologist wrote: "Certain therapeutic products are particularly suited to the game of racketeers. ... The products of the endocrine glands are also particularly adapted to exploitation" (Pottenger 1942:846). The resulting "tension between the clinic and the laboratory became a major feature of the early years of endocrinological research"; this was especially true with regard to the evaluation of extracts of the tests and ovaries, where "particularly controversial therapeutic claims were made" (Borell 1985:4).

Two other ultimately hormonal interventions to achieve rejuvenation—also both for men—were popular. One was a surgery that internally opened the vas deferens so that sperm were resorbed rather than exiting the body. Perfected by Eugen Steinach in Vienna, the technique was informally called the "Steinachschnitt" (Steinach-cut) in a play on words echoing

"Caesarschnitt" for Caesarian section in women. (Later, Hitler's forced sterilizations were called "Hitlerschnitts.") A number of well-known men underwent this surgery, including Freud (Sengoopta 1993). American reproductive scientist Carl Moore at the University of Chicago engaged in prolonged debate with Steinach about his claims of hormonal antagonism on which this surgery was based.

The most outrageous therapeutic claims were made in what came to be called "the monkey gland affair" (Hamilton 1986). Several practitioners transplanted monkey and other testes into men, sheep, prize bulls, horses, and dogs for purposes of sexual and geriatric rejuvenation. The most renowned practitioner was Serge-Samuel Voronoff, Russian émigré to France, a surgeon who held an appointment in physiology at the Collège de France. Voronoff began his testicular transplantation practice in 1917, operating on hundreds of men and animals in Europe and the Middle East through 1930, when the surgery began to lose credibility. Another major practitioner was the American John R. Brinkley, who advertised his goat gland transplants on his own radio station in rural Kansas and ran for governor. Despite his dubious medical credentials, Brinkley became a millionaire. Other practitioners used similar approaches. Interestingly, it was agricultural scientists who first seriously criticized Voronoff's lack of scientific method in his efforts to create "supersheep." They especially criticized the omission of random selection for treatment and the lack of control groups. Scientific developments also contributed to the gradual abandonment of the surgery, notably animal studies of the actual effects of testosterone and Mayo clinic research on graft rejection that essentially repudiated the effectiveness of glandular grafting (Hamilton 1986:136–37). But the popular press was riveted and created an intense public discourse (Rechter 1997). That discourse echoes even today in connection with DHEA, the new candidate for "the hormone of youth." Samuel Yen and Etienne E. Baulieu, the latter famous for his work on the development of the abortifacient RU486, are pursuing trials of DHEA (Perlman 1995). In 1997, the National Institute on Aging began distributing public service announcements for TV and radio warning men of the potential dangers of hormones such as DHEA and melatonin (Rosenblatt 1997).

Why did these extracts and surgeries seem so reasonable to so many—scientists, physicians, and lay people alike? The promise of clinical endocrinology was at its height. Organotherapy had achieved signal successes with insulin and thyroid extracts. And transplantation techniques had been pioneered by Nobelist Alexis Carrel of the Rockefeller Institute. Glandular transplantation linked these cutting-edge sciences in clinical practice, for it made both common and medical sense that transplanting a gland would have beneficial effects. Moreover, specific testicular therapy to aid rejuvenescence and sexual capacity built upon John Hunter's eighteenth-century

transplantations and Brown-Séquard's technique of ingesting testicular extracts for these purposes. Medical miracles were becoming commonplace. Last, and very far from least, as Sengoopta notes (1993:55), "Much of this research was conceived along accepted scientific doctrine of the time."

In its effects on the legitimacy of the sciences, organotherapeutic sensationalism cut two ways. On the one hand, according to laboratory scientists, it cast an illegitimate pall over endocrinology through continued association with quackery. On the other hand, it brought publicity to the science of hormone study as offering great clinical promise. When more biologically controlled substances were found specifically effective, prestige was heightened. Sensational or not, endocrinology was cutting-edge research, and the reproductive sciences benefited from the association, especially between the two world wars.^[11]

Subsequently a wide array of drugs and clinical treatments, developed through the reproductive sciences and built upon principles of organotherapy, have caused serious and extended controversies of several types. In the late 1930s, diethylstilbestrol (DES), a synthetic estrogenic substance, began to be used for numerous "female problems" associated with reproduction. Its carcinogenic risks were ignored by clinicians despite researchers' repeated publication of evidence.^[12] One use was in estrogen replacement therapy (ERT) for menopausal women, the sequelae of which have included cancer and other serious problems, generating heated debate about its necessity and the means used to convince patients of its worth. Prescription of ERT is much higher in the United States, with its for-profit health system, than, for example, in the British National Health Service.^[13]

ERT was specially promoted from the outset, as the following excerpt from an article in Fortune Magazine on "Abbott Laboratories" (1940:62) illustrates. The article describes a (seemingly fictitious) meeting between "Mr. Miller," the Abbott traveling sales representative (or "detail man"), and "Dr. Brush":

The subjects of vitamins and sex hormones came up without any effort; everybody was talking about them these days. ... Mr. Miller felt encouraged to chat with assurance about epithelial stimulation, the work of Doisy, and the definition of the International Units; wisely ducked all discussion of dosage (because of the trickiness of the substance), and offered to have the medical director in Abbott's home office write to Dr. Brush. Estrone was too expensive for routine sampling, but Miller resolved to wangle a half-dozen 1-mg. ampoules ($4.89 wholesale) for Dr. Brush if he could.

Thus was Brown-Séquard's organotherapeutic tradition sustained in Fortune Magazine a half century later, as was the controversy.

Even more provocative of controversy were the sequelae of the use of DES by pregnant women to prevent miscarriage, begun during World War

II and approved by the FDA in 1947. Because DES had not been patented, it could be distributed for profit by any pharmaceutical company. Again, warnings of serious problems were ignored, only to resurface in 1971 with diagnoses of adenocarcinoma of the cervix in daughters of women who took DES in pregnancy, various congenital sexual abnormalities in their sons, and higher rates of infertility in both. Probably about 20,000 to 100,000 DES-exposed babies were born every year between 1960 and 1970 (Bell 1980:6). More than sixty-seven different brand-name preparations containing DES and related substances may have been prescribed to pregnant women.^[14] A strong "victims" movement for education, research, and improved clinical treatment has extended the controversy.^[15]

DES had major consequences in agriculture as well. It was widely used in feedlots during the 1950s and 1960s to accelerate weight gain in cattle. The original research for this had been undertaken at Iowa State College and, in 1954, "according to [Wise] Burroughs, placing 11 milligrams of the hormone in the daily ration ... 'resulted in 37 percent faster gains, 15 percent greater corn consumption, 20 per cent less feed required per pound of gain, and 1/6 less costs per pound' ... [with] no side effects during the feeding period. ... Word leaked out that something big was afoot at Iowa State," and promotion of DES was extensive (Marcus 1993:81–82; 1995). As late as 1978, over thirty tons of DES were used annually as an animal feed additive because it dramatically reduced the costs of meat production. In 1979 the FDA withdrew its approval for feedlot use when DES was detected in edible tissue as long as seven days after administration. DES implants, however, were used illegally after that date, causing further controversy. Some breast cancer activists attribute the recent rise in breast cancer rates in the United States to consumption of additives such as DES in meats and other foods. "Natural" beef, guaranteed to be unexposed to additives, has been one industry response, a particular market niche.^[16]

Contraceptives such as the Pill, IUDs, and injectables like Depo-Provera have also generated many public, heated, and prolonged controversies since the 1930s. Contested issues have included the general morality of contraception, the ethics of contraceptive testing and distribution in Third World countries and other areas with limited medical follow-up, coercion into use, medical risks to users, and fears of "medicalization" of women's health.^[17] Women's health movements in the United States and transnationally have mounted powerful campaigns against the birth control pill (Seaman 1969/1980; Ruzek 1978); against FDA approval of Depo-Provera as a contraceptive (Rakusen 1981; National Women's Health Network 1985); and in support of women maimed and killed by the Dalkon Shield IUD (Mintz 1985; Grant 1992; Hicks 1994). Seemingly all IUDs are capable of causing infections that can lead to infertility, a risk vehemently noted by more cautious clinicians in the 1930s. Only a very few IUDs are currently on the U.S.

market. One company planning to manufacture and distribute another kind will not carry product liability insurance and will be fiscally structured so that it can quickly go into bankruptcy while protecting its assets should consumer product liability grow too costly (Klitsch 1988).

The most recent controversies surrounding contraception center on hormonal implants (notably Norplant) and on vaccines. Norplant, which is effective for about five years, consists of six Silastic rods containing the progestin levonorgestrel. The rods are implanted in the upper arm during outpatient surgery. Developed by the Population Council and produced since 1983, the implants had been used by about half a million women by 1990. In poorer countries, the major medical risks are anemia and liver problems; many women may also be coerced into using the implants (a problem also common in the West). Difficulties in removal are common (usually because of extensive scar tissue buildup at the implant sites). There have been claims as well that clinical trials did not obtain adequately informed consent from participants.

In addition to implants, several vaccines focused on intervening in the action of sperm, eggs, and (especially) hormones are coming into use. The risks here are autoimmune diseases, compromised immunity adding to AIDS risks, unwanted permanent sterility, and risks to fetuses of unknown or subsequent pregnancy. Both implants and vaccines require more elaborate health care systems than are available in much of the world. Provider refusal to remove Norplant during clinical trials in Egypt despite repeated requests was documented. Some women's health groups have called for research on vaccines to be stopped completely, especially because of the associated increased risk of AIDS and other sexually transmitted diseases. Numerous suits involving problematic removal of Norplant have been filed in the United States, with considerable national media coverage, even though the implant has only been available for a short time.^[18]

Today, American pharmaceutical companies consider federal regulation of contraceptive research and development so stringent, and the risks of product safety liability so high, that few are willing to undertake such work (e.g., Mastroianni, Donaldson, and Kane 1990). A movement for federal sponsorship of private pharmaceutical contraceptive research and development has been growing.^[19] The days of birth control as a modern medical miracle are over.

Thus not only those who oppose the use of birth control but also health care consumers seeking safe and reliable modern scientific contraception and other reproduction-related medications and treatments have objected to the reproductive sciences.^[20] Many feminists consider it no accident that no hormonal or implantable contraceptives have been developed for men (Lissner 1992) in the thirty-five years since the start of the "Contraceptive Revolution." Many believe the exclusive focus on women reflects a sustained

intentionality on the part of developers that women should bear the burden of contraception as well as of pregnancy and birth. Certainly the many agencies sponsoring contraceptive research during these decades have not strongly promoted development of male methods (Oudshoorn 1995, 1996b, 1997a). An ambitious national and transnational infrastructure of women's health groups has emerged, consisting largely of nongovernmental organizations committed to improving the situations of women concerning contraception and health broadly conceived. Part of their task is technology assessment and organizing resistance as appropriate. Despite over twenty-five years of such efforts, feminist women's health activists in interaction with reproductive scientists do not feel heard or understood. A recent paper was titled "Are We Speaking the Same Language? Women's Health Advocates and Scientists Talk about Contraceptive Technology" (Germain 1993). In these spheres of activity, controversy is quite unlikely to abate. Instead it could intensify.^[21]

Other reproduction-related treatments, such as infertility treatments, have been extensively scrutinized over the past decade. One study placed the average cost of in vitro deliveries at $72,000 (Associated Press 1995). Misrepresentation of conception and delivery rates has been a grave charge against some facilities, leading to new legislative efforts at regulation of a range of laboratory practices (Gerrity 1993). Laboratory registration, certification, inspection, and participation in proficiency testing are all now (varyingly) mandated by law, affecting reproductive endocrinology, andrology, and embryology. Several professional societies collaborated in developing the new regulations. Still, public and media opinion are mixed at best. While in 1996 the New York Times ran a front-page series on the miracles of infertility treatments (Gabriel 1996), the Ladies Home Journal ran a critical piece focused on the high costs for patients and high profits for service providers (Fessenden 1996).

The reproductive sciences have long been associated with an array of practices that can be described as quackery and with medical interventions that have been disastrous for patients/consumers. Some of these disasters were scientifically unnecessary. The lack of accountability, other than through product liability (itself now threatened by federally imposed limitations in the United States), seems to place the reproductive sciences quite visibly outside the social order—at risk of a continuing reputation as "outlaw science."

Association with "Brave New Worlds"

Since the turn of the twentieth century, the reproductive sciences have been associated by some constituencies with creating "brave new worlds," evoking Huxley's (1932) dystopia. Here the reproductive sciences are viewed

as rupturing the situatedness of human reproduction in "nature," as "natural" and properly inviolate phenomena. The reproductive sciences thereby challenge or threaten the "natural order" of life. They substitute a technological order, usually with scientists "at the helm," as Sanger put it. Such accusations have taken many forms over the years.

The first dramatic events in this realm were Jacques Loeb's experiments in artificial parthenogenesis. In 1899, Loeb succeeded in artificially producing normal larvae from the unfertilized eggs of the sea urchin by altering the inorganic salt solutions in which the urchins lived. This process had formerly required the sperm of the male urchin. Suddenly the physical chemistry that Loeb believed should be the basis of modern biology "could be a tool for altering the basic process of reproduction" (Pauly 1987:93). Loeb was a major public figure in turn-of-the-century biology who held a number of prestigious university positions at Chicago, Berkeley, and the Rockefeller Institute. He has come to symbolize both the pioneering and the ultimate success of reductionist approaches in the life sciences, such as molecular biology. Loeb served as the model for the modern research scientist in Sinclair Lewis's Arrowsmith . His work brought him both scientific fame and popular notoriety as a modern Faust through popular accounts of his work in newspapers and magazines. Loeb believed that control over both heredity and reproduction could and should be achieved. Moreover, as Pauly notes (1987:94): "The invention of artificial parthenogenesis represented an attack on the privileged status of natural reproduction. ... The possibility of human parthenogensis, the sort of basic social reformation to which science could provide the key, was evident from the start. Artificial parthenogenesis was a vindication of Loeb's hopes and a model for science to come, in which biologists would constantly work to reconstruct the natural order to make it more rational, efficient and responsive to the ongoing development of engineering science." Such programs for "man remaking the world in his own image" have not always been well received.

Gregory Pincus was one of the next generation of biologists to carry Loeb's mantle. Unlike Loeb, Pincus became a full-fledged reproductive scientist. Born into a family of agricultural scientists, he brought practical as well as theoretical concerns to bear upon his work. Pincus's early efforts focused on artificial insemination, in vitro fertilization, and artificial parthenogenesis. In 1934, his work on in vitro fertilization became a hot media item. The story on the science page of the New York Times contained the headline "Rabbits Born in Glass: Haldane-Huxley Fantasy Made Real by Harvard Biologists." This referred directly to Huxley's (1932) work Brave New World , which itself was based on a book by British geneticist J. B. S. Haldane.^[22] In 1936, Pincus declared that he had succeeded in producing artificial parthenogenesis in the rabbit. The media renamed the process "Pincogenesis," which may well have been a form of red-baiting given

Pincus's progressive politics. Whether Pincus had actually succeeded has been hotly debated.^[23] Regardless, reception of this work by the media was dubious and sometimes highly negative, making it important for our understanding of the illegitimacy of the reproductive sciences. This was in sharp contrast to the neutral to miraculous portrayals that had greeted Loeb's similar efforts in an earlier era when the miracles of modern science were unquestioned. An article on Pincus's work in Collier's in 1937, titled "No Father to Guide Them," combined antifeminism, anti-Semitism, and criticism of the "tricks" that biologists were playing on nature in what historian Reed (1983:323) termed a "subtle but vicious report." The article caused a sensation in Cambridge. Pincus was soon denied tenure at Harvard and eventually ended up at the Worcester Foundation for Experimental Biology (Pauly 1987). It was there Margaret Sanger and Katharine McCormick went in 1953 to get him to continue his work on reproduction that led to the Pill (as described in chapter 6). Pincus was thus connected with two realms of reproductive scientific controversy—problematic treatments and brave new worlds. Squier (1995) characterized such early twentieth-century visions as "babies in bottles."

More recent reproductive science applications such as artificial insemination, in vitro fertilization, embryo transfer, superovulation, sex preselection, and related technologies in humans, including their use in surrogacy arrangements, have received constant media coverage over the past decade. On the one hand, consumers both recognize and express appreciation of the daring of reproductive scientists. For example, an unsolicited letter to a developer of sex preselection techniques said, "Thank you for being brave enough to develop your sperm separation technique. I'm sure you get threatening mail saying you are tampering with a divine process." Another consumer wrote, "It must take much bravery to even enter such 'sacred ground' as sex selection" (Chico 1989:224). In the United States, sex selection is generally sought for a third or later child of the other sex than those already produced by the couple. In India and China, on the other hand, sex ratios have already changed because of the wide application of sex preselection to detect and abort female fetuses (Luthra 1994; Greenhalgh and Li 1995).

Tampering with fetuses in fetal tissue research, surgery, and/or treatment is also controversial. To date, fetal tissue research has yielded treatments for Parkinson's disease and certain cancers; it is also being pursued for wound healing interventions, since fetuses themselves heal without scarring. Regulation of this research has been a key concern in the West; there have been prohibitions against such research in the United States and elsewhere. While still rare, fetal treatment and in vivo surgery also raise ethical, political, and financial issues—concerning not only the fetuses but also the

women in whom they are embedded. These issues are likely to expand in the future, and the fetus will become even more a site of controversy.^[24]

Genetic screening, testing, and therapies are widely recognized as controversial for moral, political, economic, and many other reasons—including the problematics of screening accurately. New approaches to screening are routinely sought; in the United States, state organizations proliferate, offering increasingly elaborate testing to more and more pregnant women while not having any "treatment" to offer other than abortion for fetuses with many serious hereditary conditions.^[25]

But human cloning and related genetic manipulations stand out as the most radical and controversial interventions made possible by the reproductive sciences to date—long anticipated by science fiction (Bann 1994). They offer not only the modern potential to control life but also the postmodern potential to transform life itself. Brave new worlds indeed were heralded by the media fanfare given to Dolly, the Scottish sheep cloned in 1997. Time Magazine led off its primary coverage: "One doesn't expect Dr. Frankenstein to show up in a wool sweater, baggy parka, soft British accent and the face of a bank clerk. But there in all banal benignity he was: Dr. Ian Wilmut, the first man to create fully formed life from adult body parts since Mary Shelly's mad scientist" (Krauthammer 1997:60–61).

What is scientifically special is that this sheep was made by cloning from adult cells, not embryonic cells. She was named after Dolly Parton because she was cloned from mammary gland cells. Cloning by splitting embryo cells has been done for years and is routine in the cattle industry. This process creates identical twin or multiple embryos from the sperm and eggs of known parents. Figure 6 shows this process in cattle. Human cloning through embryo splitting received an "amber light" in 1994 in the United States from the National Advisory Board on Ethics in Reproduction (1994). This kind of cloning is viewed as highly desirable by most infertility physicians and their patients/consumers, since fewer surgical and hormonal procedures on women are needed to produce multiple embryos, while still increasing chances for successful conception, implantation, and birth.

In contrast, the capacity to clone from adult cells means one can know in advance many aspects of the outcome by knowing the living organism itself. As explained in Time , "With adult-cell cloning, you can wait to see how well an individual turns out before deciding whether to clone it" (Nash 1997:64). If embryo cloning has offered an array of economic advantages, adult-cell cloning is even more promising. A Wall Street Journal headline asked, "Who Will Cash In on Breakthrough in Cloning?" The article answered that a tiny company could emerge a big winner (Krauthammer 1997:60). Wilmut did patent his process before announcing it to the world.

In addition to "simple cloning," genes in sperm can now be altered,

"passing the changes to the animal's progeny ... [and] bring[ing] the brave new world of gene manipulation hurtling ever closer" (Kolata 1996). The means of accomplishing genetic selection have recently been termed "trait-selection technologies" and justified in a legal journal on the grounds of man-made evolution (Jones 1993). What Hartouni (1997) calls "replicating the singular self" profoundly violates assumed "natural" features of familial and individual identity. The social body is deeply threatened if not torn asunder. Yet "in vitro man" has already been to some degree domesticated if not displaced by media images of "the desperately infertile." "The border over which cloning intensifies reflection, in other words, is hardly untrafficked territory" (Hartouni 1997:130). Regardless, cloning and genetic manipulation are quite likely to be the most controversial of all reproductive technologies, exceeding in the twenty-first century the controversy surrounding birth control and abortion in the twentieth.

But it is not only manipulations of humans which have been highly controversial in terms of creating "Brave New Worlds" where life itself is transformed. Agricultural reproductive scientists have also been the focus of controversies posed by animal rights movements, by ecological groups concerned about the costs and safety of protein derived from meat and dairy products, and by groups concerned about the "pharmaceutical farm," biotechnologies, the survival of small farmers, and related issues. Scientists' biotechnological creation of a "leaner" pig that could not stand up and was also otherwise deformed did little to reduce such controversy. Genetically engineered calves have been more successfully reproduced with embryosplitting techniques.^[26] Interspecies pregnancy by means of in vitro fertilization is another focus of recent research (Fields 1992) that is likely to engender even greater controversy. Tensions here are likely to be generated in part by the reproduction programs in zoos for endangered species by in vitro fertilization with gestation in other species. Nonhuman primates are likely to be further colonized for transplantation purposes rather than as surrogates for human mothers.

Growth hormone controversies have also been especially heated. Growth hormone, "discovered" by reproductive scientist Herbert Evans, who regularly traversed the boundaries among reproductive, endocrinological, and nutrition research, has recently found new applications. Bovine growth hormone (recombinant bovine somatotropin) can dramatically increase milk production in cows. Although it has been approved for use in American dairy cattle, the possibility of complications both in the cows and in people who eat their products has aroused criticism.^[27] Human growth hormone has also come under attack (Cassidy 1991). Currently Genentech is being sued for racketeering because of its methods of promoting sales (Bloomberg Business News 1994).

While not causally attributable to the reproductive sciences, the recent and ongoing controversy about the human sperm count implicates those sciences. A book called Our Stolen Future: Are We Threatening Our Fertility, Intelligence and Survival? A Scientific Detective Story (Colborn, Dumanoski, and Myers 1996), with a foreword by Vice President Al Gore, has been widely reviewed. The news has been full of related coverage (e.g., Kolata 1996). The gist of this issue is whether and/or how severely the human sperm count has been reduced by environmental toxins of various kinds. The sperm counts of different countries have been pitted against one another in newly nationalized measurements of masculinity. The reproductive sciences have responded with proposals to implant frozen human sperm in an animal host such as a rat or mouse that would then produce the donor's sperm. Researchers have already successfully transplanted testicular stem cells across the species barrier (Avarbock, Brinster, and Brinster 1996). Such manipulations are guaranteed to deepen the controversial status of the reproductive sciences.

The reproductive sciences in biology, medicine, and agriculture are each and all quite controversial and illegitimate. Almost every moment in the reproductive process offers an opportunity for contested intervention. Different constituencies are distraught for different reasons. Conservative leaders, along with Catholic and fundamentalist theologians, object to interventions in "natural" processes (e.g., Dienes 1972). Some feminists view these technologies as rendering women as breeders on the one hand, while potentially denying them motherhood on the other by developing artificial wombs, and as raising a host of both medical and ethical problems.^[28] Others are concerned about the high costs of these technologies, which typically are not covered by insurance, both as they compare with costs of health care in general and because poorer people are less likely to have access to them.^[29] Disabled communities have found much to object to in terms of both their access to and applications of reproductive technologies. Disabled people have often been the focus of eugenic efforts to prevent and/or dissuade them from reproducing. Some disabled people also view genetic screening for certain disabilities, with abortion as the preferred or only treatment, as direct attacks on disabled fetuses—people-to-be. Lawyers and ethicists are also kept rather busy addressing these issues.^[30]

Of all the controversial realms in which the reproductive sciences have been embedded, their association with "brave new worlds," the capacity to radically manipulate and even create new forms of life, from nude mice to "designer" humans, is the most significant. The capacity to manipulate both human and animal capital and liabilities is truly revolutionary (Austin and Short 1972/1986). While the first three realms of controversy are distinctively modern, the capacity to create "brave new worlds" bridges modern

and postmodern approaches to reproduction. It is characteristic not only of the past but even more so of the future. The illegitimacy of the reproductive sciences is thus not likely to abate.