The Koyal Group InfoMag: Is the Contraceptive NuvaRing Killing Thousands?

Danger in the Ring

When 24-year-old Erika Langhart—talented, beautiful, bound for law school—died on Thanksgiving Day 2011, she became one of thousands of suspected victims of the birth-control device NuvaRing. Elite army athlete Megan Henry, who survived rampant blood clots in her 20s, is another. With major suits against NuvaRing’s manufacturer, Merck, headed for trial, Marie Brenner asks why, despite evidence of serious risk, a potentially lethal contraceptive remains on the market.

Karen Langhart never had the slightest doubt about her 24-year-old daughter Erika’s ability to organize meticulously every detail of her life. For months in 2011, Erika’s Thanksgiving plans had been locked in place. On November 23 she was set to arrive from Washington, D.C., on U.S. Airways, landing in Phoenix, Arizona, at five P.M. Erika and her mother would go straight to Sprouts, a local gourmet grocery store, to shop for a turkey, corn bread, yams, and the ricotta and walnuts needed for the signature cheesecake they served at their restaurant, the Red Snapper, one of Durango, Colorado’s best. The Red Snapper, designed by Karen and her husband, Rick, restaurateurs and land developers, had been, for the 25 years they owned it, the center of the family’s life.

Lanky and athletic, Erika had a toothy smile, a raucous laugh, and a lush beauty; her long blond hair bounced when she spoke. She carried herself like a debutante, and she made light of her leadership awards and magna cum laude degree at Washington’s American University. On Sundays, when the Denver Broncos played, Erika wore their colors, orange and blue. Almost six feet tall, she often wore big hats, short designer wrap dresses, and high heels or expensive cowboy boots, playing her height to maximum advantage. Chosen to represent her university at leadership conferences in China and Tibet, Erika seemed on her way to more honors at Georgetown Law School and a career in politics.

Taking off a semester to work on John McCain’s 2008 presidential campaign, she was quickly promoted to be the liaison between the Republican National Committee and the campaign on the road, a demanding job of keeping records of travel contracts and renting venues for events. “I was stunned when someone told me Erika was only 21,” McCain later told Karen. “She ran an entire arm of my campaign.” All day long, Erika would pace back and forth in her heels and wrap dresses at the candidate’s Crystal City, Virginia, headquarters, earpiece in place, her voice cascading through the cluster of desks: “Where is the addendum? I need the addendum. I can’t release the senator without the addendum.” The other interns had a game, her friend Katelyn Roberts recalled: “How many times will Erika use the word ‘addendum’ this afternoon? We didn’t even know what an addendum was.”

The Monday before Thanksgiving, Erika and her boyfriend, Sean Coakley, planned to stay in after work so that Erika could pack. Coakley worked for a government agency, Erika for a branding company not far from their apartment, in Arlington, Virginia. All that day, they messaged back and forth. Sean was to stop at the store to pick up dinner; Erika would already be home. When Sean arrived at 6:30, he found Erika writhing on the floor, struggling for air. Moments later, a local emergency medical team was at the door. Just before Erika had collapsed, she had somehow managed to call for help.

Karen was on the golf course when she saw Erika’s number on her cell phone. “We can’t wait to see you!” she said. Then, she would recall, “my world stopped. It was Sean, telling us that Erika had collapsed and that the E.M.T.’s were in the apartment.” In the ambulance Erika had two heart attacks, and she was semi-conscious by the time they reached Virginia Hospital Center. According to Karen, a doctor in the emergency room asked her over the phone: “Was your daughter using birth control?” Karen said, “Yes, NuvaRing.” He removed the device and said, “I thought so, because she’s having a pulmonary embolism.”

Racing for the last flight to Washington, Rick and Karen Googled “double pulmonary embolism NuvaRing.” Dozens of results came up—“NuvaRing side effects,” “NuvaRing lawsuits.” Karen knew little about class-action mass-tort litigation, the battles between the tort bar—lawyers handling cases of victims of every conceivable malady, including asbestos exposure, diabetes, defective hip implants, arthritis, and birth-control complications—and the law firms specializing in defending drug and medical-device companies under siege. Strapped into her seat on the plane, she wrote down one of the first names that came up under “NuvaRing lawsuits,” Hunter Shkolnik, of New York’s Napoli Bern Ripka & Shkolnik. His office was in the Empire State Building—a fact that impressed Karen and Rick. “I never even considered that I would need a lawyer,” Karen later told me. “But Hunter’s name kept coming up in all the articles. It was obvious he was an expert.”

Before Karen and Rick reached the hospital, Erika was placed on life support. She died on Thanksgiving Day. On the program for her daughter’s memorial service, Karen stated, “Cause of Passing: Massive, Double Pulmonary Embolism—a direct result of the NuvaRing.” She had entered, she told me, “another phase of life. How I wish I could change places with my daughter.” Then her voice broke. “I am living every parent’s nightmare.” Thanksgiving 2011 was for Karen the start of the mission that now obsesses her. “I want to warn every mother and every daughter: do not use the product that killed my child.”

Erika’s Friend Megan

In June of this year, a thick dossier of legal documents and e-mails was delivered to my house. The documents came in part from Barbara Henry, the first selectman—essentially the mayor—of Roxbury, Connecticut. She, like Karen Langhart, was on a crusade against NuvaRing. In the folder was an e-mail she had circulated to friends about her daughter Megan’s history with the device. “Some of you know that Megan is in the hospital in Danbury How life changes at the flip of a switch,” she wrote soon after her daughter was stricken, in August 2012.

A member of World Class Athletes, the army’s elite team of soldier-athletes, Megan Henry competes in skeleton, a form of high-speed downhill sledding. The sled resembles a fiberglass baking sheet with metal handles the athlete uses for control. Megan races at a speed close to 80 miles per hour, achieved through a grueling daily regimen of sprints and power lifting. In Utah, training for the 2014 Olympic Games in Russia, she found herself, like Erika, gasping for breath. Ten days earlier, Megan had started using NuvaRing, her first experience with birth control. “Do you smoke?” a doctor asked her. “Of course not, I’m an athlete,” she said. “Oh well, you should be fine,” the doctor said. In perfect health up to then, Megan could not stop fighting for air. Her teammates blamed the altitude. “One doctor I went to told me I was under stress, or maybe I had asthma,” she told me. “He gave me an inhaler.” On a flight to Florida for more training, she almost collapsed. “At Urgent Care, I was given an X-ray—it was clear. I said, ‘Could this be the NuvaRing?’ ‘Absolutely not,’ the doctor said.”

A quick check of the Web would have shown that more than 1,000 lawsuits had been filed against Merck & Co., the manufacturer. “Megan, you need to come home now, and I will get you an appointment with a pulmonologist,” Barbara told her. After a second flight—she later learned that that alone could have killed her—Megan told her history to a Connecticut doctor, who ordered a CT scan. It revealed dozens of blood clots in her lungs. Rushed to the hospital, she was put on blood thinners in the E.R., and she remained hospitalized for a week. “I was told, ‘Your career as an athlete is over,’ ” she said. “If you weren’t in the shape you are, you would be dead,” her doctor informed her.

Friends at American University, Megan Henry and Erika Langhart had not seen each other since graduation. After college, Megan joined the army reserves to help pay for her graduate studies in intelligence work. In the hospital, she learned that Erika’s parents believed her death had been caused by NuvaRing. “This is serious. . . . Make sure to tell this story. It may save somebody’s life. I’m just praying for my own daughter now. I’m asking you to, too,” Barbara Henry e-mailed friends and colleagues.