The Thalidomide Tragedy: Lessons for Drug Safety and Regulation

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Many children in the 1960's, like the kindergartner pictured above, were born with phocomelia as a side effect of the drug thalidomide, resulting in the shortening or absence of limbs. (Photo by Leonard McCombe//Time Life Pictures/Getty Images)

In a post-war era when sleeplessness was prevalent, thalidomide was marketed to a world hooked on tranquilizers and sleeping pills. At the time, one out of seven Americans took them regularly. The demand for sedatives was even higher in some European markets, and the presumed safety of thalidomide, the only non-barbiturate sedative known at the time, gave the drug massive appeal. Sadly, tragedy followed its release, catalyzing the beginnings of the rigorous drug approval and monitoring systems in place at the United States Food and Drug Administration (FDA) today.

Thalidomide first entered the German market in 1957 as an over-the-counter remedy, based on the maker’s safety claims. They advertised their product as “completely safe” for everyone, including mother and child, “even during pregnancy,” as its developers “could not find a dose high enough to kill a rat.” By 1960, thalidomide was marketed in 46 countries, with sales nearly matching those of aspirin.

Around this time, Australian obstetrician Dr. William McBride discovered that the drug also alleviated morning sickness. He started recommending this off-label use of the drug to his pregnant patients, setting a worldwide trend. Prescribing drugs for off-label purposes, or purposes other than those for which the drug was approved, is still a common practice in many countries today, including the U.S. In many cases, these off-label prescriptions are very effective, such as prescribing depression medication to treat chronic pain.

However, this practice can also lead to a more prevalent occurrence of unanticipated, and often serious, adverse drug reactions. In 1961, McBride began to associate this so-called harmless compound with severe birth defects in the babies he delivered. The drug interfered with the babies' normal development, causing many of them to be born with phocomelia, resulting in shortened, absent, or flipper-like limbs. A German newspaper soon reported 161 babies were adversely affected by thalidomide, leading the makers of the drug—who had ignored reports of the birth defects associated with the it—to finally stop distribution within Germany. Other countries followed suit and, by March of 1962, the drug was banned in most countries where it was previously sold.

In July of 1962, president John F. Kennedy and the American press began praising their heroine, FDA inspector Frances Kelsey, who prevented the drug’s approval within the United States despite pressure from the pharmaceutical company and FDA supervisors. Kelsey felt the application for thalidomide contained incomplete and insufficient data on its safety and effectiveness. Among her concerns was the lack of data indicating whether the drug could cross the placenta, which provides nourishment to a developing fetus.

She was also concerned that there were not yet any results available from U.S. clinical trials of the drug. Even if these data where available, however, they may not have been entirely reliable. At the time, clinical trials did not require FDA approval, nor were they subject to oversight. The “clinical trials” of thalidomide involved distributing more than two and a half million tablets of thalidomide to approximately 20,000 patients across the nation—approximately 3,760 women of childbearing age, at least 207 of whom were pregnant. More than one thousand physicians participated in these trials, but few tracked their patients after dispensing the drug.

The tragedy surrounding thalidomide and Kelsey’s wise refusal to approve the drug helped motivate profound changes in the FDA. By passing the Kefauver-Harris Drug Amendments Act in 1962, legislators tightened restrictions surrounding the surveillance and approval process for drugs to be sold in the U.S., requiring that manufacturers prove they are both safe and effective before they are marketed. Now, drug approval can take between eight and twelve years, involving animal testing and tightly regulated human clinical trials.

Despite its harmful side effects, thalidomide is FDA-approved for two uses today—the treatment of inflammation associated with Hansen’s disease (leprosy) and as a chemotherapeutic agent for patients with multiple myeloma, purposes for which it was originally prescribed off-label. Because of its known adverse effects on fetal development, the dispensing of thalidomide is regulated by the System for Thalidomide Education and Prescribing Safety (S.T.E.P.S.) program. The S.T.E.P.S. program, designed by Celgene pharmaceuticals and carried out in pharmacies where thalidomide prescriptions are filled, educates all patients who receive thalidomide about potential risks associated with the drug.

Thalidomide has also been associated with a higher occurrence blood clots and nerve and blood disorders. Northwestern University’s pharmacovigiliance team, Research on Adverse Drug Events And Reports (RADAR), has launched a joint project with the Walgreens pharmacy at Northwestern Memorial Hospital so that these side effects may be understood and monitored, like those affecting fetal development. RADAR, led by Dr. Charles Bennett of the Feinberg School of Medicine, combines the expertise of clinicians, academics, pharmacists, and statisticians to monitor and disseminate information about adverse drug reactions to cancer drugs.

Their project tracks the number of patients who get a blood clot after receiving thalidomide, whether or not the patient received an anticoagulant drug, which are used to help prevent clotting, and if so, which drug was used. Tracking this information will help researchers better identify the incidence and prevention of thalidomide-associated blood clots, allowing the drug to continue to serve as an effective therapy for many patients.

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Comments

It was doctors who prescribed

<p>It was doctors who prescribed this and pharmaceutical companies who made Thallamide who are to blame - not "the women who took it."</p><p>When I was expecting my first son and was so very sick the doctor prescribed me pills to keep me from vomiting so much.&nbsp; It was Thallamide.&nbsp; Fortunately, I was naiive and did not know that one was supposed to go to the pharmacy and pick up the prescription.&nbsp; I had assumed it would arrive at my door in the mail.&nbsp; It didn't, I got over the sickness and on my next visit the doctor asked how it went and if the prescription helped?&nbsp; Thank heavens I was naiive.&nbsp; I now question medical treatment and prescriptions.&nbsp; Americans are too over-prescribed.&nbsp;</p>

I was born in Stamford CT in

I was born in Stamford CT in January 1956. I have a birth deformity of both arms that is exactly like that caused by Thalidomide. I get this from medical professionals too. My brothers, born 3 and 6 years after me, are both normal. The doctors back then called it a 'congenital deformity'. My mother said she was given DES, another drug. According to my mother, DES has been linked to cancers of the sex organs of female and male children (None of us have any problems there.), but, it has never been linked to birth defects. My mother would NEVER have lied to me. Does anyone have any evidence that my mother may have UNKNOWINGLY been given Thalidomide or that DES can cause birth defects similar to those of Thalidomide? Please e-mail to FirewalkingWheelman@yahoo.com. No anonymous e-mails please.

Not likely. The drug was

Not likely. The drug was first marketed in November 1956 in Germany, and was in Clinical trials (Germany only) in Mid to late 1954. Basically, the timing was wrong. The issues come when taking thalidomide prior to the 3rd trimester. Being born Jan 1956, we are talking October 1955 at the latest

Based on the information

Based on the information presented in the article, your limb anomalies do seem to fit the description of deformities caused by thalidomide. Can you ask your mother about this, or hunt down old medical records?

I was born in 1962. My mom

I was born in 1962. My mom took thalidomide when she was pregnant with my sister. It doesn't effect the baby being carried, it defects the eggs waiting to be fertilized. Me too. I am one of those eggs, defected, born.

I know a thalidomide-affected

I know a thalidomide-affected person (severely foreshortened arms) who was born about 1937-1938. Although it was not marketed (reportedly) until the mid 1950s, thalidomide must have been available as early as the 1930s !

Thalidomide wasn't invented

Thalidomide wasn't invented that early on. it wasn't available, however it isn't the only drug out there that could've induced deformities. You should try to talk to someone and find some old medical records and see what caused it.

You're wrong. It totally

You're wrong. It totally affects the fetus. My mom took it. I was blessed to have all my limbs and fingers, and no other true problems although I have minor spinal issues from time to time. What I am missing is my pectoralis major, and I have met 2 other men in my lifetime in the U.S.A. with the same defect. We were born with a mastectomy on one side of our chests. Other than that we're normal. After reading about it I guess we were all victims of the clinical trials, and I guess we didn't have as strong of doses as those other poor children. Nevertheless, it's still always been quite an embarrassment of a body issue. At 54 I am still not comfortable when I have to be shirtless like in swimming pools.

My Mother Barbara told me

My Mother Barbara told me when I was young that in Switzerland it was legally forbidden to give medicinal drugs to pregnant women because they might harm the baby, and consequently this law prevented thalidomide in their country.

HI I was born 7 th August

HI I was born 7 th August 1961 at Royal Womens Hospital in Paddington Sydney did thalidomide have any other affects learning development side affects my Mum was given thalidomide all the time i am normal i think

FDA inspector Frances Kelsey

FDA inspector Frances Kelsey just passed away and that is likely why there will be renewed interest and a new generation of people learning about this drug and the side effects associated with it. Her obit in the Washington Post. http://www.washingtonpost.com/national/health-science/frances-oldham-kelsey-heroine-of-thalidomide-tragedy-dies-at-101/2015/08/07/ae57335e-c5da-11df-94e1-c5afa35a9e59_story.html

I was born in 1956. Are there

I was born in 1956. Are there any other deformities related to thalidomide besides limbs? I was born without a uterus, have only 1 carotid artery and have a horseshoe kidney. Perhaps someone has some information.

I was born feb 1960 Melbourne

I was born feb 1960 Melbourne Australia. Apparently my mother took thalidomide. I do not have anything wrong apart from normal ailments, however my teenager has many issues. Could it be related? Does it skip? are there other side affects? would my mother had access to it in 1959?

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