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Old 08-12-2003, 05:45 PM   #11
Loren Pechtel
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Default Re: Re: Re: Re: Thalidomide and ethics

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Originally posted by scigirl

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
Depends on the risk to the woman vs the risk to the fetus.

The FDA will only permit women of childbearing age to take it with doubled contraception or else sterilization.
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Old 08-12-2003, 05:47 PM   #12
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What I find interesting is that they think it might be helpful for treatment of Crohn's disease and other ulcery auto-immune type things. Dr Rick out there??

This is an interesting halfway on topic article.

This article says that there have only been a few birth defect cases recorded in South America since 1965 that they can actually attribute to thalidomide, but admits that it is difficult to keep track.

PubMed abstract with further details of thalidomide use in South America if anyone wants to do some reading.

As for the ethical dilemma, I'm not sure exactly what you are referring to - that women can't use the drug because nobody can think of a proper label, or that the health care system is so poor that they can't control or keep track of who takes the drug? If it helps some people, that is better than helping no people. Or is your concern that they are using thalidomide at all in an area where its effects can't be monitored and controlled? If that is the case, the World Health Organization says that a multi-drug combo of dapsone, rifampicin and clofazimine will cure leprosy without killing the patient, and that Novartis drug company provides these FREE drugs to anyone with leprosy worldwide.
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Old 08-12-2003, 05:56 PM   #13
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Quote:
Originally posted by Purple Smartie
......
As for the ethical dilemma, I'm not sure exactly what you are referring to - that women can't use the drug because nobody can think of a proper label, or that the health care system is so poor that they can't control or keep track of who takes the drug? If it helps some people, that is better than helping no people. Or is your concern that they are using thalidomide at all in an area where its effects can't be monitored and controlled?
Usually, this Morality forum bores the living daylights out of me.
Therefore, when I saw the news report, I thought it might be interesting for others here as well as myself.
The ethical dilemma seems to be solved more or less satisfactorily; I just wanted to present it for people here to examine.

The ethical dilemma lies in 2 things:
1) The packaging of the thalidomide ---- the warning signs detailed in my OP. It's simply an interesting fact to learn.

2) No thalidomide whatosever in those poor South American areas to women of child-bearing age.
It's not at all a small dilemma; cortisone is much less effective than thalidomide in these cases, and has a whole range of very nasty side-effects that thalidomide doesn't have.

BTW, thanks for the additional info; it would seem then that thalidomide/cortisone are merely palliative/symptomological/preventative treatments ancillary to the antibiotic treatment.
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Old 08-12-2003, 08:26 PM   #14
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What if thalidomide was offered to childbearing-age women along with an effective contraceptive (I'm thinking of the Norplant types of things, but contraception hasn't been a concern of mine for some decades so I could well be out of date on what constitutes a long term implantable effective contraceptive)?

I'm unclear if the thalidomide effects cease once the drug is no longer being taken, but if they do, the combination would seem to kill a couple of birds with one stone.

If thalidomide effects are long term, than it would seem like offering it with sterilization might be the only choice, though that gets into a "healthy child with unhealthy mother vs healthy mother and no child" conflict.

cheers,
Michael
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Old 08-12-2003, 08:31 PM   #15
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Quote:
Originally posted by The Other Michael

If thalidomide effects are long term, than it would seem like offering it with sterilization might be the only choice, though that gets into a "healthy child with unhealthy mother vs healthy mother and no child" conflict.
It's not long term. Quit taking it and the risk is soon gone.
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Old 08-12-2003, 08:56 PM   #16
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Default There are enantiomers...

There are enantiomers to thalidomide, one is a teratogenic the other is a mild sedative and there is a way of manufacturing a sample of thalidomide that is purely the "good" isomer. The problem is that it when introdued to the body the isomer reverses back to a racemic mixture, so it's useless in the end.
Thalidomide
Quote:
There has been research performed for the separation of both isomers. Techniques for separation of racemic mixtures, which contain both enantiomers, include performance liquid chromatography (HPLC), and capillary electrophoreses (CE). These techniques achieve enantiomeric purity by adding chiral substances such as surfactants, proteins, bile salts, and macrocyclic antibiotics. The key problem with this useful information is that the living organism can not maintain either thalidomide isomer in the body. A group of Swedish researches, determined that within four to six hours of exposure to human blood, an individual isomer is converted to an equal mixture of both enantiomers.
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Old 08-12-2003, 08:58 PM   #17
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Quote:
Originally posted by The Other Michael

What if thalidomide was offered to childbearing-age women along with an effective contraceptive (I'm thinking of the Norplant types of things, but contraception hasn't been a concern of mine for some decades so I could well be out of date on what constitutes a long term implantable effective contraceptive)
Actually, this is an excellent idea --- as long as done with full informed consent of the woman in question.

But let me ask you a nasty question:
do you donate ever to such aid- or medical-aid-organizations ?
Since your idea involves a rather massive financial outlay.
And there are a lot of women with leprosy in South America, AFAIK.
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Old 08-12-2003, 08:59 PM   #18
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Default Re: There are enantiomers...

Quote:
Originally posted by Adrammalech

There are enantiomers to thalidomide, one is a teratogenic the other is a mild sedative and there is a way of manufacturing a sample of thalidomide that is purely the "good" isomer. The problem is that it when introdued to the body the isomer reverses back to a racemic mixture, so it's useless in the end.
...
Ahhhh, then many thanks to all for all the info.
This is becoming a very good thread.
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Old 08-13-2003, 05:19 AM   #19
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I guess I don't quite understand the need to use thalidomide at all, when other drugs are available at no cost.
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Old 08-13-2003, 08:59 AM   #20
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Quote:
Originally posted by Purple Smartie

I guess I don't quite understand the need to use thalidomide at all, when other drugs are available at no cost.
I'm not a profi medico, so you're better off with an answer from Scigirl or Dr Rick, or one of the others on this thread.
But here's my take on it anyway:

The drugs that are free are certain antibiotics. They are used to kill the leprosy bacterium.

However, it is difficult to kill the bacterium (I think leprosy, being a mycobacterium IIRC, produces maybe a waxy coating like its far cousin tuberculosis, protecting it; but I'm no medico).

Therefore the treatment takes a long time.

In the meantime, there are othe accompanying symptoms of the disease that may occur, like inflammation, ulcers etc.

Thalidomide is used in the treatment and prevention of these accompanying symptoms; it has great value in treating inflammation and certain ulceration (which is why it is alos used with cancer patients).

The only substitute in practice there for thalidomide would be cortisone, which is also not free, and has a range of interestingly nasty side-effects, unlike thalidomide in that case.
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