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Old 08-12-2003, 02:35 PM   #1
Gurdur
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Default Thalidomide and ethics

Something new and different from the usual crap that goes down here.

Watched a very interesting report on modern use of thalidomide against leprosy (Scigirl-but-with-an-o-not-an-e's disease) in South America.

The ethical dimensions were very well shown by the packaging of thalidomide tablets.

The packaging shows a man's head, in a circle; then a crossed-out woman's head in a circle, to indicate that only men should take it.
The international medical aid agencies refuse to prescribe thalidomide at all for women of child-bearing age, roughly 12 to 50 I suppose in that context. This is of course a tragedy for non-pregnant female sufferers of Hanson's disease, who are only prescribed cortisone preparations (*) instead, but the aid medicos explain the risk is otherwise too great.

They also explained that they couldn't simply show a pregnant woman crossed out within the circle on the packaging, because in a very largely illiterate society, many women thought the symbol meant that the medicine was an abortificant, and deliberately used it as such, only to be unpleasantly surprised,

Very interesting illustration of ethics in packaging and prescription.

Apart from comments, I have a couple of questions to any expert here:
(*) WTF ? I thought there were antibacterials that could tackle leprosy reasonably well. Why is the choice here only between thalidomide and fucking cortisone ? (**)

Chalmoogra oil (from the chalmoogra tree in India) was once used as an (inefficient) anti-leprosy therapy.
Anyone know much about that, and its success rates, if any ?

Ta muchly.
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Old 08-12-2003, 02:43 PM   #2
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Default Re: Thalidomide and ethics

Heya Gunther! (Sorry couldn't resist).

Quote:
Originally posted by Gurdur
Watched a very interesting report on modern use of thalidomide against leprosy (Scigirl-but-with-an-o-not-an-e's disease) in South America.
Yes I'm an O, but the disease is with an E.

Very interesting dilemma they have. I remember reading a similar paper about the warnings on radioactive waste, and what they should look like for all cultures/populations.

I'll have to see what PubMed can do for me, in terms of your science questions.

scogirl
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Old 08-12-2003, 02:51 PM   #3
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Default Re: Re: Thalidomide and ethics

Quote:
Originally posted by scigirl

Heya Gunther!
Opportunist.
Quote:
Yes I'm an O, but the disease is with an E.
So I got it the wrong way round. So sue me.

Quote:
I'll have to see what PubMed can do for me, in terms of your science questions.
Possibly I didn't get part of it, and they're using thalidomide as an amelliorant (as with cancer patients) as adjunct to antimycobacterial therapy, not instead.
But it didn't sound like that; it sounded like they were using it as the only antimycobac therapy.
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Old 08-12-2003, 03:52 PM   #4
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Default Re: Re: Re: Thalidomide and ethics

Quote:
Originally posted by Gurdur
But it didn't sound like that; it sounded like they were using it as the only antimycobac therapy.
I'll have to print out one of the articles - I love having full-text access to lots of journals! My first idea is that perhaps there are antibiotic-resistant strains of M. leprae. But barring that, there may be other reasons to prescribe thalidomide. I'll check it out.

But in the meantime - to keep this thread in MF&P rather than S&M (OOPS I mean S&S, bad scigirl!), I will say: I think it's unethical to deny women a treatment simply because they might become pregnant. That sounds like an anti-abortionist's wet dream, though doesn't it?!

scigirl
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Old 08-12-2003, 04:33 PM   #5
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It's been a while since I looked at all this, but my recollection is this: There's two enantiomers (mirror image versions of the same molecule) of thalidomide, one of which does whatever it does to reduce pain, and the other which reacts totally differently to cause the birth defects. Back when thalidomide was a mainstream treatment, they obviously just used a racemic mixture so that half of it was helping and half was screwing up the baby.
I was under the impression that they had come up with a technique for asymmetric synthesis of thalidomide now (through chiral lithium amides?) to be able to produce a (mostly) enantiomerically pure version of the drug. The problem of course being that it'd be about as marketable as uranium tablets by this stage (Thalidomide - New improved: 90% reduction in horrible birth defects!)
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Old 08-12-2003, 04:34 PM   #6
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Default Re: Re: Re: Re: Thalidomide and ethics

Quote:
Originally posted by scigirl
....
I think it's unethical to deny women a treatment simply because they might become pregnant.
Why ? Pregnancy is common enough in South America.
And there are large numbers of newly thalidomide-affected children there.
I think your stance needs more justification.

Let's talk tacheles:
We're talking brutal triage here, but triage forced by two factors:
1) The nature of the drug
2) Widespread illiteracy and poverty

Quote:
That sounds like an anti-abortionist's wet dream, though doesn't it?!
Life in poor countries is significantly different from in rich ones. It affects practical ethics, too.
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Old 08-12-2003, 04:40 PM   #7
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Quote:
Originally posted by Polycrates
.....
I was under the impression that they had come up with a technique for asymmetric synthesis of thalidomide now (through chiral lithium amides?) to be able to produce a (mostly) enantiomerically pure version of the drug. The problem of course being that it'd be about as marketable as uranium tablets by this stage (Thalidomide - New improved: 90% reduction in horrible birth defects!)
Personally, I have no idea, yet as far as the report went, this has absolutely nothing to do with positive marketing of thalidomide.
The thalidomide used now in South America against leprosy, and also BTW as a palliative treatment for certain cancer patients in Germany, still would cause developmental defects in foetuses.

And since German medicine is world-class, I would immediately assume if there was a safe version of thalidomide around, most certainly the Germans would be using it.

So for the moment, with all respect, I'm assuming your info is wrong.

But I'm always happy to be corrected.
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Old 08-12-2003, 05:18 PM   #8
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This article is slightly outdated but it suggests that thalidomide could be used for AIDS treatment as well. The US FDA has also approved it for leprosy there, and apparently routine pregnancy testing (monthly) for women is indicated but treatment is not denied to women of child-bearing age.
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Old 08-12-2003, 05:26 PM   #9
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Quote:
Originally posted by Purple Smartie
.....
The US FDA has also approved it for leprosy there, and apparently routine pregnancy testing (monthly) for women is indicated but treatment is not denied to women of child-bearing age.
Because women in the USA are usually literate, have knowledge about medications, usually have some access to abortion facilities, have access to birth-control, and have much power over their own lives.

And not one single one of those factors commonly applies to the women the news report was speaking of in South America.
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Old 08-12-2003, 05:28 PM   #10
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P.S. Thanks for the linked article. From that:
Quote:
...A key reason for thalidomide's revival is that a panel of outside experts thinks that it is effective in treating a complication in leprosy that causes skin lesions, fever and other symptoms. The FDA now says its manufacturer, Celgene Corporation, of Warren, New Jersey, has met an obligation to show that the benefits outweigh the risks. Leprosy affects about 7,000 people in America and 250 of them are already receiving thalidomide. ....
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