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Nov. 12th, 2018 02:04 pmPhilcon is this Friday. I am really looking forward. Rooming with my brother and ![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png)
freeradical42.
Friday night I'm running a D&D 5E oneshot. Saturday evening I'm on a panel about new deliberately retro SF. Sunday I'm on a panel about flaws in the lone scientist inventor paradigm of science fiction. Otherwise the plan is to chill out with friends and spend time in the game room. Also I should try to dig up my copy of Cowboy Feng's for GoH Steven Brust to sign. The only part of the con I am nervous about is some rumblings of potential Jew drama.
Dark Remedy: The Impact Of Thalidomide And Its Revival As A Vital Medicine - Trent Stephens and Rock Brynner
The new medical history book I've been babbling about to anyone who will listen. My knowledge of thalidomide had been sketchy before this. I knew it had something to do with birth defects, but I didn't really know the story.
The authors describe thalidomide as a 'drug in search of a disease'. When German researchers discovered it in the 1950s, they knew two things about it: It had really powerful, dramatic effects on people who took it, and when they tried dosing rats with it to determine a lethal dose, they could not kill the rats no matter how much thalidomide they gave them. Taking these two things together, they went off and started dosing humans with it en masse to try to discover a specific therapeutic use for it. Ultimately, they decided to market it, first in Germany, as a safe alternative to presently marketed sedatives, while also touting various off-label uses.
Thalidomide was safe, notably, in that unlike kids who got into mommy's barbiturates and died, there were famous cases, heavily promoted by the company, of kids getting into mommy's thalidomide and being just fine, no need to call poison control. Being as how it was perfectly safe, doctors started seeing it as a great thing to prescribe to relieve morning sickness for pregnant mothers, at a time when other drugs were starting to be contraindicated during pregnancy. Also, some women happened to be taking thalidomide when they got pregnant. It turns out that thalidomide is extremely teratogenic, that is, it causes birth defects, particularly those involving the development of the limbs. Why? It turns out we still don't really know.
When information about the side effects and teratogenicity of thalidomide starting getting back to its manufacturers, they went full-on supervillain and tried to suppress it. Stephens and Brynner argue that there may have been some of the hangover of Nazi scientific training at work, with doctors and researchers trained by the people responsible for unthinkable atrocities during the war inevitably hardened to the ethical consequences of their actions. Money was also at stake, needless to say.
This is the infuriating part of the book, but it gets happier. Two later passages give one optimism, as well as food for thought:
1. The tale of Frances Kelsey, FDA badass. While thalidomide was approved for use in Germany, the UK, Australia, and various parts of Europe, Kelsey withstood strong pressure from American commercial interests and her superiors and delayed approval of thalidomide in the US, demanding further medical evidence of its safety and efficacy, until the news broke in Europe and she finally gained the support to reject it entirely. It is not a completely happy story- the North American manufacturer engaged in wildly unethical trials while it waited for approval- but America did not face a thalidomide problem remotely to the extent that Europe did, because a bureaucrat actually did their job. Frances Kelsey is awesome and I am trying to read more about her.
2. It turns out thalidomide is surprisingly effective against a variety of otherwise untreatable medical ailments, including some forms of leprosy, myelomas and other forms of cancer, Crohn's disease, and others. You know how there used to be leper's colonies everywhere and now there aren't? Apparently that's in part because of thalidomide. In these cases, the diseases are so serious and otherwise untreatable that prescribers made a judgement that provided a protocol is followed to avoid pregnancy, thalidomide is a lesser evil. Research has also gone into developing thalidomide analogues with less side effects, and some of those are now replacing thalidomide.
freeradical42. Friday night I'm running a D&D 5E oneshot. Saturday evening I'm on a panel about new deliberately retro SF. Sunday I'm on a panel about flaws in the lone scientist inventor paradigm of science fiction. Otherwise the plan is to chill out with friends and spend time in the game room. Also I should try to dig up my copy of Cowboy Feng's for GoH Steven Brust to sign. The only part of the con I am nervous about is some rumblings of potential Jew drama.
Dark Remedy: The Impact Of Thalidomide And Its Revival As A Vital Medicine - Trent Stephens and Rock Brynner
The new medical history book I've been babbling about to anyone who will listen. My knowledge of thalidomide had been sketchy before this. I knew it had something to do with birth defects, but I didn't really know the story.
The authors describe thalidomide as a 'drug in search of a disease'. When German researchers discovered it in the 1950s, they knew two things about it: It had really powerful, dramatic effects on people who took it, and when they tried dosing rats with it to determine a lethal dose, they could not kill the rats no matter how much thalidomide they gave them. Taking these two things together, they went off and started dosing humans with it en masse to try to discover a specific therapeutic use for it. Ultimately, they decided to market it, first in Germany, as a safe alternative to presently marketed sedatives, while also touting various off-label uses.
Thalidomide was safe, notably, in that unlike kids who got into mommy's barbiturates and died, there were famous cases, heavily promoted by the company, of kids getting into mommy's thalidomide and being just fine, no need to call poison control. Being as how it was perfectly safe, doctors started seeing it as a great thing to prescribe to relieve morning sickness for pregnant mothers, at a time when other drugs were starting to be contraindicated during pregnancy. Also, some women happened to be taking thalidomide when they got pregnant. It turns out that thalidomide is extremely teratogenic, that is, it causes birth defects, particularly those involving the development of the limbs. Why? It turns out we still don't really know.
When information about the side effects and teratogenicity of thalidomide starting getting back to its manufacturers, they went full-on supervillain and tried to suppress it. Stephens and Brynner argue that there may have been some of the hangover of Nazi scientific training at work, with doctors and researchers trained by the people responsible for unthinkable atrocities during the war inevitably hardened to the ethical consequences of their actions. Money was also at stake, needless to say.
This is the infuriating part of the book, but it gets happier. Two later passages give one optimism, as well as food for thought:
1. The tale of Frances Kelsey, FDA badass. While thalidomide was approved for use in Germany, the UK, Australia, and various parts of Europe, Kelsey withstood strong pressure from American commercial interests and her superiors and delayed approval of thalidomide in the US, demanding further medical evidence of its safety and efficacy, until the news broke in Europe and she finally gained the support to reject it entirely. It is not a completely happy story- the North American manufacturer engaged in wildly unethical trials while it waited for approval- but America did not face a thalidomide problem remotely to the extent that Europe did, because a bureaucrat actually did their job. Frances Kelsey is awesome and I am trying to read more about her.
2. It turns out thalidomide is surprisingly effective against a variety of otherwise untreatable medical ailments, including some forms of leprosy, myelomas and other forms of cancer, Crohn's disease, and others. You know how there used to be leper's colonies everywhere and now there aren't? Apparently that's in part because of thalidomide. In these cases, the diseases are so serious and otherwise untreatable that prescribers made a judgement that provided a protocol is followed to avoid pregnancy, thalidomide is a lesser evil. Research has also gone into developing thalidomide analogues with less side effects, and some of those are now replacing thalidomide.