Tuesday, July 21, 1998

Thalidomide will never be OK for some

Thalidomide - one of the most chilling words in medical lore - is coming back on the market.

Under rigid, but not foolproof, federal restrictions, the drug has been approved to treat a painful leprosy condition, afflicting only 50 or so people in the United States. The use will be broader than that because thalidomide seems useful in treating certain AIDS-related conditions and shows promise in treating certain cancers.

Controlled use seemed better than the inevitable black market.

The problem with thalidomide is that only the smallest amount administered to a pregnant woman causes heart-breaking birth defects, typically flipper-like appendages in place of the arms and legs. The drug was banned worldwide in 1962.

The cold, medical calculation is that the suffering thalidomide will relieve, and maybe even cure, is worth the slight certainty that somewhere, somehow, through some misuse or mischance a woman will give birth to a deformed child.

In one of the Food and Drug Administration's great moments, the agency blocked the use of thalidomide, then prescribed as a sedative and to relieve morning sickness, in the United States. Worldwide, the drug caused about 12,000 birth defects, in the United States perhaps about two dozen.

Statistically, it was not a medical crisis, but thalidomide, with the images of deformed children, became one of those peculiar psychological turning points that shattered a complacent faith in medical progress.

For a certain generation, thalidomide will never be legitimate.