scigirl

Gurdur - I read a great review, and have some points to make on the science and the ethical questions. But it will have to wait till perhaps tomorrow - very busy at work!

scigirl

Adrammalech

The current standard sets of treatment are dapsone and rifampin.

Info can be found from Mereck here. (Hansen's disease is the last one listed so scroll near the bottom)

It says that dapsone is marginally effective and that rifampin is far too expensive for poorer areas. Not only that, the drugs that can be used have some unpleasant side effects.

The Other Michael

Hi Gurdur,

There are waaaaaay more deserving causes than I could ever afford to underwrite, so I tend to put my donations closer to home. A person doesn't have to look too hard to find worthy causes not far from their own back yard, and the people in need locally are a bit harder to ignore than those half-way around the world.

Which gives me an idea for a topic to start, so you may want to address comments in that thread.

cheers,
Michael

Jackalope

Coming to the thread late, as usual.

Thalidomide is a tumor necrosis factor inhibitor. Anti-TNF drugs are often used in inflammitory conditions, like autoimmune diseases. Enbrel, Remicade and Humira are examples of TNF inhibitors that are currently in use. The problem is, they're all monoclonal antibodies and both extremely expensive and difficult to produce in quantity. Since I'm taking Enbrel right now, I can tell you that the cost is about $1100/mo, or about $275/dose. No one is going to be giving that out in a free clinic anytime soon. The drugs are also difficult to keep (have to be refrigerated, have to be reconstituted before injection, mixture cannot be shaken, and Remicade has to be given IV). So Thalidomide starts looking like a very attractive alternative in places where the monoclonal antibodies are too hard to maintain.

This debate has actually come up in the lupus and arthritis support newsgroups on USENET news. Among other things, Thalidomide doesn't look half-bad compared to taking chemotherapy drugs like methotrexate or cyclosporine. The chemo drugs can also cause birth defects and MTX in particular is used as an abortifacient both by itself and in conjuction with RU486. If you have no drug coverage, can't tolerate the recombinant anti-TNFs, or simply can't obtain them (there was a huge shortage of Enbrel that lasted almost a year because they killed off some of their cell lines while trying to scale up their production), Thalidomide starts to look like a pretty good alternative. And it's a hell of a lot cheaper than the other choices (okay, MTX is cheap, but it's almost as nasty as Thalidomide).

The real problem is one of informed consent. A lot of adults here in the US are incapable to understanding the tradeoff of risks and benefits with any medication. And people are at least mostly literate here. In a largely illiterate country, the problem is multiplied.