Long Tail Strings: Impact of the Dalkon Shield 40 Years Later

Intrauterine devices (IUDs) are the most effective, reversible and longest acting birth control method. They require no effort for compliance and avoid systemic synthetic hormones. Evidencebased effectiveness and safety studies have demonstrated IUDs rival sterilization. IUDs low cost make them the most popular method worldwide. Despite these benefits, IUDs have minimal market penetration in the United States where they are expensive, disparaged by an older generation of physicians, and withheld from teenagers, nulliparous women, and women not in mutually monogamous relationships, i.e., those who would most benefit. This article reviews the nearly forgotten history of the IUD that resulted in broadening the Food and Drug Administration’s oversight of medical devices, brought needed transparency to physicians’ conflicts of interests, uncovered a corporate scandal with a whistleblower that led to a major pharmaceutical bankruptcy, and involved 327,000 women (though only 195,000 met strict criteria for claims) in the largest US personal injury case.