Medical History - Thalidomide

As aspiring doctors, you probably hold modern medicine in high regard. You wouldn’t be working so hard on your GAMSAT® Exam preparation or spending so much money on GAMSAT® Exam preparation courses if you didn’t. Yet it is a fact that medicine hasn’t always been as clean, efficient, and safe as we think it to be now. Even just a few decades ago, some medical practices were doing insurmountable damage to patients through poor recommendations, negligent advice, or just baffling techniques and treatments.

Thalidomide was such a treatment, which was used in the late 1950s and early 60s, and caused some 10,000 children worldwide to be born with significant birth deformities. Thalidomide was synthesised by chemists at the German company Gruenthal, and was utilised as a treatment for nausea during pregnancy.

The major concern in the 1950s, as it related to pregnancy and medication use, was frightful addiction and withdrawal symptoms that occurred with pregnant women medicated both with sedatives and stimulants for both pain, nausea, and depression. Thalidomide was hailed as something of a wonder drug – animal testing progressed well, patients suffered almost no side effects with thalidomide’s sedation profile,

Thalidomide use spread rapidly to most major European nations and as far afield as Australia. However, in the early 1960s, German paediatricians started noticing a new wave of deformities in children sweeping across the nation. As more and more cases began to occur, scientists initially blamed some unknown radiation leak, or a similar environmental toxin that may have been a remnant of the Great War.

However, as obstetricians began to quiz mothers about drugs taken during pregnancy, the association between thalidomide and birth defects began to grow more obvious. By the end of 1961, medical journals began to reference a strong association between thalidomide use and unusual ‘malformation of the limbs’ cases, the major piece published by Australian gynaecologist and obstetrician William McBride. Swiftly following these revelations, thalidomide was pulled from the shelves.

In the late 1960s, the German government issued a criminal complaint against 18 executives and scientists from Grünenthal. However, state prosecutors ultimately dropped all charges in exchange for Grünenthal’s agreement to establish a fund for injured children.

Interestingly, and despite the catastrophic actions of the drug when used in pregnant women, thalidomide is now enjoying something of a renaissance. Thalidomide has been shown to possess a potent ability to inhibit the body’s inflammatory response as well as prevent blood vessel formation in the adult. It is now being used successfully in a wide range of clinical conditions from cancer to leprosy. Thalidomide has been effective in the treatment of multiple myeloma, HIV and its complications, prostate cancer, brain tumours, Behcets disease, hereditary haemorrhagic telangiectasia, and even in tuberculosis meningitis.

Despite its continued use, thalidomide still often causes peripheral neuropathy. Where thalidomide is used for the conditions above and a lack of appropriate control exists (for instance in rural Brazil where leprosy is rife), new cases of thalidomide damaged children are being identified.

It goes to show that medicine cannot forget its dark past, which is exactly the point of this blog! Proper processes and research must ensure appropriate clinical effects are weighed against the risk of side-effects, and this remains a major challenge for thalidomide. To further medicine into the future, we can never forget about its past!

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