Re Thalidomide, its popularity was in part due to concerns over the toxicity of barbiturates, which were widely used as sedatives at the time – overdoses of which are highly toxic and difficultt to manage – or at least that’s what the marketing said.

I once worked in a hospital DI centre where we had some old promotional material for thalidomide from the time. There was a poster of a toddler with a bottle of mummy’s tablets, and the strapline was something to the effect that he could be in danger of a fatal barb OD, so the caring, responsible GP should prescribe thalidomide

(presumably, the idea of using child-resistant containers and keeping meds out of sight and reach of children, or even that people didn’t really need the seadtive, hadn’t dawned on people).

Re “Widespread use of the drug in West Germany was only halted when the paediatrician, Lenz, publicized its association with the birth of nearly 4,000 children exhibiting abnormal limb growth” – I think “only” may be unfortunate. Obviously you’d continue using an evidently effective drug while there was no evidence of problems with it.

I think the only-one-isomer-was-tested story is not sound – rather that they’d not really investigated the question of isomers. When they did, and found that one was the effective drug and one was the cause of side-effects, they got excited about it again until they found that each naturally turns into the other when used – which of course weakens (well, complicates) the story further if you wanted a simple demonstration of Why Isomers Matter, but you can probably gloss over the nasty fiddly bits, as long as you don’t leave them with the impression that the problem was solved.

Another apparent mystery at one point, I think I recall, was a claim that people affected by their mother’s thalidomide use went on to to have children with similar disabilities. What came of that one? I’d guess genetics…

One of the stories running through Irvine Welsh’s book “Ecstacy” (not the one that is being turned into a film) strongly echoes what happened with thalidomide. The story portrays the “scientists” as knowing that the drug would cause birth defects and were paid off by the drug company. It is possible ths story has entered pop culture and could have been mixed up with the real truth (whatever that is).

- Have to ‘fess up on optical isomerism – it was the ludicrous way they had THREE different systems for classifying it that got me. (dl, DL and RS)… I have to admit to a B.Sc. degree in Chemistry but always prefered (bio)organic and transition metal chemistry. Although in my career in biomedical research it is the physical chemistry I (reluctantly) studied that has proved the most useful… another of life’s little ironies.

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Art West wrote (re doctors knowledge anbout the stuff in the late 50s) “Of course, it could have been a lucky hunch, but if he had any real knowledge, however vague, on which to base his opinion then that information was probably pretty widespread to have reached a small town Midlands GP.”

- I would suspect it was because the drug was very experimental in 56-57, plus the dictum “don’t mess with what you don’t understand”, i.e. a 50s doc would probably know that loads MUST be going on in the first three months of pregnancy, but would also know the details of the underlying processes were pretty much a mystery. To give a powerful drug during that period if not absolutely needed would seem like a needless risk (it is quite interesting that the modern medical view of early pregnancy, based on a lot more knowledge, seems prett y much to bear out this piece of ancient wisdom). I was also born in the thalidomide era, though rather later, and my mother said she refused the drug for just this reason when the doctor suggested it for morning sickness.

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Coracle wrote:

“The rehabilitation of thalidomide has always amazed me. In combination with dexamethasone it’s now treatment of choice for multiple myeloma, I seem to remember a documentary some years ago about its use in untreatable ulcers.

I believe it has an anti-TNF mode of action which I think is the presumed mode of action for its anti tumour activities”

- It seems to do a bunch of things, anti-angiogenic actions, anti-cytokine, modulating cell adhesion etc. It intercalates into DNA at lots of sites, though NOT randomly, probably accounting for the widespread effects.

My reading was that treating leprosy (or “Hansen’s Disease” as the Yanks rather confusingly call it) was the major modern use, but it has been tried for a lot of other stuff, as mentioned by others here. Some kinds of Lupus (SLE) is another example.

Of course, re-use of it has sadly led in some places (e.g. Brazil) to MORE birth defects, as the stuff is so potent in its teratogenic effects that doctors AND patients have to be INCREDIBLY careful with it. One dose at the “wrong” time in early pregnancy is enough to cause tragic consequences, and it gets to all sort of places in the body. For instance, if a man takes thalidomide it the stuff can be detected in his ejaculate (strange but true) – so potentially it could affect any woman who he gets pregnant. In the US when the FDA re-licenced it they passed special rules about its use to try and avoid more childhood deformities.

I believe it has an anti-TNF mode of action which I think is the presumed mode of action for its anti tumour activities.

I’ve taken a quick look at the social history of medicine paper, I don’t think it’s massively useful. It’s short on details of the testing that it went through and focuses on the regulatory responses since the exposure of its teratogenic effects.

A Tale of Two Experts: Thalidomide and Political Engagement in the United States and West Germany

Author: Daemmrich A.1

Source: Social History of Medicine, Volume 15, Number 1, April 2002, pp. 137-158(22)

Publisher: Oxford University Press

Abstract

The physicians, Widukind Lenz and Frances Kelsey, played crucial roles in the thalidomide drama of the early 1960s. Widespread use of the drug in West Germany was only halted when the paediatrician, Lenz, publicized its association with the birth of nearly 4,000 children exhibiting abnormal limb growth. Few cases were reported in the United States because Kelsey, a medical officer at the US Food and Drug Administration, repeatedly delayed thalidomide’s marketing approval. Experts in both countries were expected to demonstrate publicly the professional ‘objectivity’ of medicine and the institutional ‘disinterestedness’ of regulatory bodies. These norms were invoked both by industry representatives seeking to undermine the two experts and by critics desiring stronger regulatory controls. Comparing Lenz with Kelsey demonstrates how institutional structures shape an expert’s social and scientific roles. While the United States provided important protection from external pressure for Kelsey through her regulatory position at the FDA, Lenz was open to sharp criticism, especially when giving expert testimony during a lengthy court trial. The degree of exposure to politically motivated attacks differed for these two experts; they nevertheless faced similar threats to their professional credibility and personal integrity when they publicized links between thalidomide and birth defects.

They do. But it was just never tested on pregnant animals.
(references on the RDS Website already posted)

For the real health problems, thalidomide and BSE/JKD leap to mind. Other possibilities are the early stage of the AIDS epidemic, the recent drug trial near disaster, or any recent major drug recall.

For false health problems: MMR, polio vaccine (false rumours about the vaccine caused an outbreak in parts of Africa a few years ago), the McBride beat-up mentioned above.

anyway, are we basically saying that anyone claiming thalidomide was a medical profession cover up is talking nonsense?

Thanks to you and superburger for setting the record straight.

And balls to The Man.