Public relations case study: Toxic Shock Syndrome

In a new occasional feature, I'll look at public relations challenges of the past and how they were handled.

This post begins with a brief history of the tampon. While tampon-like solutions have been around for centuries, none met the needs of women entering the 20th century workplace until the modern tampon was invented in 1936 by a Denver physician named Earle Haas.

Haas sold his patent to Tampax Incorporated, and before long, 90 percent of all tampon users relied on Tampax.

Author Laurie Garrett points out in her book "The Coming Plague" that, "though history showed that other approaches to the bleeding problem had been associated with elevated risks of some infectious diseases, commercial tampons were sold without any more regulation than hammers or soap."

With the huge baby boomer market of young women that came along in the 1970s, four multinational corporations (The Kimberly-Clark Corporation, Procter & Gamble, Playtex, and Johnson & Johnson) decided to enter the tampon market.

Competition got more intense when, in the mid-1970s, the National Association of Broadcasters lifted its longtime ban on radio and television advertising of tampons. The two key focal points in tampon ads were comfort and security.

Absorbency became a way to chip away at Tampax's domination of the market, and a breakthrough came in 1974 when Procter & Gamble engineers developed a product based not on cotton and cardboard but on polyester fibers and plastic. The use of synthetic fibers provided a practically unlimited number of ways to vary the shape and relative absorbency of tampons.

In 1979, Procter & Gamble launched Rely, a synthetic tampon that could absorb nearly 20 times its own weight in fluids. The Rely tampon was comprised of highly compressed beads of, alternately, polyester and carboxymethyl cellulose. Rely tampons became popular quite quickly thanks to a huge advertising campaign and its superabsorbency.

The superabsorbency had issues, though: some women had pain when the tampon was removed, residue of synthetic pieces was left behind in some instances, and other women needed medical assistance to get the tampon removed because it became too big.

Around 1979 to early 1980, some states started reporting higher instances of Toxic Shock Syndrome (TSS), an illness marked by a fever greater than 102 °F, red rashes, a marked drop in blood pressure, vomiting, and more. A common denominator of most of the TSS cases was that most of the patients were menstruating females.

According to Garrett's book "The Coming Plague," news coverage of TSS cases was "terrifying":

• "Teenager dies of tampon use. Details at eleven!"
• "Toxic Shock Syndrome survivor tells her story tonight on Eyewitness News."
• "Centers for Disease Control warning women to beware of tampons. Stay tuned for more!"

The outbreaks of TSS notably were clustered in Wisconsin and Minnesota. Most of the female TSS cases involved individuals who used superabsorbent tampons. On Sept. 19, 1980, the Centers for Disease Control (CDC) released a report taking aim at Rely tampons, stating that a controlled study showed that other brands had a much lower incidence of TSS.

Procter & Gamble then made a bold move, according to "The Coming Plague":

On September 22, just days after the release of the CDC report, Procter & Gamble voluntarily removed Rely from the marketplace. And they went a step further: together with the Food and Drug Administration, the company designed a massive ad campaign telling women not to use their product. The campaign, which began October 6, ran on network television and radio and in over 1,200 newspapers nationwide for four weeks. The FDA, meanwhile, urged women to get rid of their existing supplies of Rely, and recalled inventories of the product from stores nationwide.

Said Procter & Gamble company representative at the time, Marjorie Bradford, "Procter & Gamble makes over 88 consumer brands of household and hygiene products. We must maintain a reputation for safe and effective products."

Some non-CDC scientists were unsure of the CDC's position, though.

Public hearings were held and the first tampon regulations were issued.

Something strange happened in Minnesota: four weeks after the Rely tampons went off the market, a surge in TSS cases occurred. In addition, Rely was never sold in Connecticut, yet the state still had TSS cases.

A scientist from UCLA, Patrick Schlievert, discovered that a staphylococcal poison caused TSS. The menstrual cycle provided the ideal vehicle for hosting bacteria and a tampon provided a great growth surface.

TSS faded from media headlines as cases declined. Why the geographic cluster in Wisconsin and Minnesota, though? Turns out that TSS had the highest incidence among people of Scandinavian and German heritage.

In the end, the CDC discovered that "tampon absorbency was strongly correlated with the risk of contracting TSS, though the chemical content of the tampons was not."

Because of the incident, tampon boxes now have messages about TSS and the terms related to absorbency were standardized. Procter & Gamble still has a sterling reputation.