Reconsidering Thalidomide

320px-Thalidomide-structuresLast week I made a throwaway comment about thalidomide as part of a statement about dangerous drugs, and how”I wouldn’t touch [it] even on a doctor’s recommendation.” Because, I mean, thalidomide, right? Deformed babies and lawsuits and the poster child for irresponsible science and stronger FDA regulations — who could argue with that?

Only, people did. And in doing so they taught me a lesson in challenging assumptions and thinking skeptically.

First, a quick history for those who want to skip the Wikipedia article. Thalidomide was an anti-nausea medication that became popular in parts of Europe in the 1950s as an effective treatment for morning sickness in pregnant women. Unfortunately, thalidomide interfered with fetal development, and an epidemic of so-called “thalidomide babies” were born with significant physical disabilities such as deformed or missing limbs. The drug was eventually pulled off of the shelves, doctors the world over stopped prescribing it, and thalidomide became the poster drug for anyone pushing a pro-naturalistic, anti-Big Pharma health agenda.

One assumption I had made about thalidomide was that after the tragedy they had destroyed all the existing thalidomide, burned every copy of the recipe, and permanently blacklisted the stuff from ever being taken again. So when one commenter said that “thalidomide is back as a cancer treatment,” my first thought was, They still prescribe thalidomide?!

Yes, they do. In fact, the United States FDA, which during the thalidomide scandal was heralded for their refusal to grant approval to the drug and saving thousands of American babies from deformity and death, has since given approval for thalidomide to be used in treating both multiple myeloma and leprosy. It is tightly controlled, and usage of the drug is governed by a a process of screening that protects pregnant women from being exposed to it; but there it is, legal in the U.S. in 2013 (and in other countries as well).

How could this be? How could thalidomide gain FDA approval after what it had done?

Because science is a rational and progressive philosophy. While thalidomide became a bogeyman in the popular culture, it remained a drug open to further study by pharmacists and doctors. The initial development and marketing of thalidomide may have been tragically marred, but that doesn’t mean the drug itself is inherently bad. And so science studied it; and science learned a lot more about how it worked and why it did what it did; and science started finding ways to use it.

Even thalidomide’s origin as an anti-nausea medication hasn’t been forgotten. In recent years it has been studied as, amongst other things, a drug to combat the nausea caused by chemotherapy. One study called it “highly effective in controlling delayed nausea and vomiting episodes in patients induced by moderately emetogenic chemotherapy” and another declared it “a safe, effective antiemetic.”

Skepticism means being willing to challenge all notions, even our own. I was wrong about thalidomide. The thalidomide tragedy was something that no sane human would ever want to see repeated, but even such a horrible history needs to be considered in a reasoned, scientific way. With modern safety procedures, plus advances in understanding the drug itself, there is still a place for thalidomide in the lexicon of modern medicine.

About Alison Hudson

Alison is a writer and educator living near Ann Arbor, MI. She blogs regularly about skepticism, games, and the transgender experience.
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18 Responses to Reconsidering Thalidomide

  1. Chuck Walworth says:

    I have read elsewhere that the problem with thalidomide was that the manufacturing process was flawed. It created both left-handed and right-handed molecules, and it was, I believe, the right-handed molecules that caused birth defects.

    • Argent47 says:

      It’s not that the process was flawed, really — when stereoisomerism is possible, such processes ordinarily (and inescapably) produce both isomers. As I noted, it’s the separation of the isomers that is prohibitively difficult.

  2. Stephen Propatier says:

    Wonderful article nicely done!

  3. Argent47 says:

    It turns out that there is a version of thalidomide that would be safe for use even in pregnancy. The drug has two stereoisomers, only one of which is teratogenic. Unfortunately, however, it would be prohibitively costly to isolate the safe isomer for use against morning sickness.
    (Fortunately, though, as stated, it has other therapeutic uses. Yay science!)

    • Darrell says:

      It is not prohibitively expensive to synthesize an enantiopure thalidomide or to resolve the enantiomers. The problem is the imide stereocenter. At physiological pH, it easily racemizes. Thus, even if you administer the safe enantiomer, the body converts half of it to the teratogenic enantiomer.

      • Rob Hooft says:

        I still have the feeling there is a bit of urban myth remaining…. If it is racemizing in the body, how do we know that only one of the two is teratogenic? Do we have a perfect scientific model of the teratogenic action? And is that model so good that we can use it to prove that the other enantiomer is not teratogenic?

      • argent47 says:

        OK—I was basing my statement on the known difficulty of isolating certain other stereoisomers. I presumed that the difficulty was general; my bad.

    • Alison Edwards says:

      Given the state of regulation today, any variety of thalidomide that claimed to be “safe” for pregnant women would probably have to pass through some ridiculously high standards of proof before any country would feel confident enough to approve it. Besides, thalidomide wasn’t some miracle wonder pill for pregnant women. It happened to effectively quell nausea, but it’s far from the only anti-nausea medicine out there. I imagine no drug company would be willing to fight the fight for “safe” thalidomide rather than just market other drugs with similar antinausea effects.

  4. lilady says:

    A close friend was diagnosed with multiple myeloma ~ 6 years ago and has been prescribed Thalomid and other chemotherapeutic drugs to keep her in remission. Those regimens have enabled her to survive to see her first two grandchildren (twins) and to make a long trip to tour spectacular Alaska with me and other friends.

    Great article.

  5. Jon Richfield says:

    Good Stuff Ali! I echo the foregoing remarks, factual and evaluative.

  6. mikeb609 says:

    Imagine if alcohol was treated in the same way that substances such as thalidomide and DDT have been treated historically! We probably still wouldn’t be able to get a drink.

    • Jon Richfield says:

      I am uncertain how bad that would be, because most of us would never miss it without having tried it thoroughly enough to care, but perhaps more relevantly there are a lot of “natural” substances that occur in “natural” foods and supposedly medicinal materials such as sarsaparilla, mustard, almonds, fugu, poppies and citrus, that could easily have been proscribed if they had first been discovered in the lab. Just a thought; not original. Not worth thinking about… 😉

      • Magnanamous Dinoflagellate, says:

        I like the inverted commas there.. we all know cows, chickens, beer and crude oil are just as natural as squirrels, cocaine, boeing jets and large hadron colliders.

        Ironically, those who use the word as it has a magic meaning most likely never have studied nature…

        Well posted.

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