MiSTed: The Lesson of Thalidomide, Part 2 of 4


Part 1, introduction and John Glenn.

John W Campbell was, as you might’ve gathered, a wee bit cranky. By a wee bit I mean “almost cranky enough to be an old white guy in science fiction today”. When he started editing Astounding Science Fiction — the magazine which would become Analog and which is the best-read of the surviving science fiction magazines — he insisted on greater levels of competence and thoughtfulness than were common in the field before, though. And his attitude of challenging accepted wisdom is not a bad starting point for fiction writers. But he was also, as best I can tell, never plagued with doubts about his own wisdom. Someday I promise I will share the very funny thing he said about tungsten, and why it’s funny.


>
> Study the history of thalidomide briefly: It was
> synthesized first by a Swiss pharmaceutical firm.

MIKE: When you put it like that, it’s amazing anyone ever had questions about it.

> Tests
> of the new compound were made on animals, and it was
> found that thalidomide had no effects — either positive
> or negative.

CROW: Of course Switzerland would make a neutral drug.

TOM: Way to fight the stereotype, guys.

> It was an “inert ingredient” so far as the
> animals were concerned; the substance was abandoned in
> 1954.

MIKE: To be held in reserve in case we ever needed animals to feel more nothing particular.

>
> Then the West German company, Chemie Grunenthal,
> started further investigations on it.

CROW: Thinking, I guess, ‘we need to get in on this chemical that’s too boring for Switzerland’.

> Their careful tests
> also showed that it had no pharmacological effects on
> animals.

TOM: I’m picturing whole flocks of German cows being stuffed full of thalidomide and looking confused about it.

> The only reason they persisted was that
> thalidomide had now acquired a “crucial experiment”
> importance, practically.

MIKE: It was the mid-50s. We had to find ways to not affect animals!

> According to the best
> theoretical understandings, that particular type of
> molecular structure should have sedative effect — and
> if thalidomide did not have any effect, the theory needed
> some serious reworking.

TOM: So Germany moved on to the next step, looking for restless bunnies.

CROW: Felix Salten does not approve.

>
> So Grunenthal tried it on human patients — on
> epileptics as a possible anticonvulsant. It did not act
> as an anticonvulsant, but did act as an excellent
> sleep-inducer, in human beings.

MIKE: Is it possible it just did so much nothing subjects were bored to sleep?

> It gave restful,
> all-night sleep without after-effects, and was remarkably
> safe — so safe it could be sold without prescription.

CROW: As long as nobody required a prescription.

> It was, literally, safer than aspirin; would-be suicides
> have succeeded by taking sufficiently massive quantities
> of aspirin — but would-be suicides who tried massive
> doses of thalidomide simply woke up after a somewhat
> prolonged sleep.

TOM: Forcing them to resort to pop rocks and Diet Coke.

> It was far safer than the barbiturates;

MIKE: Far easier than teasing a rampaging horde of barbiturates into invading your castle and clonking you on the head.

CROW: That’s … oh.

> Marilyn Monroe’s death by barbiturates would not have
> succeeded, had thalidomide replaced the barbiturates as
> tranquilizer-sedatives.

MIKE: That’s literally true, but doesn’t say as much as he thinks it does.

>
> The “goofball” addiction would not be able to
> replace barbiturates with thalidomide; it doesn’t act
> that way.

TOM: Without ‘goofballs’ they’d have to resort to ‘knuckleheads’ or even ‘jackanapes’.

>
> Thalidomide, as of 1960, had proven itself to be
> by far the safest, gentlest, most nearly fool-proof
> sedative pharmacology had yet discovered. Even by intent,
> a man couldn’t hurt himself with the stuff!

CROW: Then some dinkbrain let a woman touch them.

TOM: Tch. Figures.

>
> The situation then was that a drug which could
> replace the very useful, but somewhat dangerous,
> barbiturates had become available — a drug so safe
> small children could use it

MIKE: Also miniaturized adults. Just saying.

> — and so safe small
> children getting into the forbidden medical cabinet
> wouldn’t kill themselves with it.

TOM: The kids will just have to try harder.

>
> As of late 1960, then, Dr. Kelsey’s whimsical,
> arbitrary, and unjustified action — or inaction —

CROW: I can’t decide which. I need someone like Dr Kelsey to tell me — say!

> was
> keeping from the American public a drug which could
> replace a definitely dangerous, definitely toxic, and
> somewhat habit-forming drug, the barbiturates.

MIKE: Hey, maybe we should’ve had a word with the guy who okayed barbiturates?

>
> Thalidomide had been tested again and again by
> major ethical pharmaceutical houses,

TOM: And some of them it even passed!

> had been approved
> for nonprescription sale by government after government,

CROW: ”Well, German chemists think it’s a good idea — who are we to doubt their good will?”

> and had been widely and safely used by many millions of
> people all through Europe.
>
> Dr. Kelsey was, by nit-picking and dillydallying
> tactics,

TOM: Like actually reading the safety studies.

> blocking the licensing of a safe, proven, and
> cheap replacement for a known-to-be-somewhat-toxic drug.

MIKE: The company said it was perfectly safe, and they wouldn’t like about a thing like that!

>
> Logically, that position was totally
> unjustifiable.

CROW: You can’t go basing scientific decisions on scientific evidence! That stuff takes years to find.

>
> It had all the earmarks of a petty Civil Servant
> tyrant, fussing endlessly, delighting over the power
> red-tape gave . . .

MIKE: … to read medical journals for comprehension …

>
> At this time — say January, 1961 — there was
> no scientific reason to doubt that thalidomide was one
> hundred per cent safe, and a very successful drug.

CROW: And when were the first thalidomide-deformed babies born?

TOM: 1956, but that doesn’t count, because the manufacturer said it was safe!

>
> In early 1961, some reports of a polyneuritis
> effect due to long-continued massive dosing with
> thalidomide began to appear.

MIKE: Fortunately, it was easily treated by being soaked in DDT.

> Its symptoms were a tingling
> “leg’s gone to sleep” sort of feeling in hands and feet;

CROW: Followed by a sensation of ‘leg’s gone to flipper’.

> discontinuation of the thalidomide dosing cleared up the
> cases usually, fairly promptly.

TOM: On the other hand, there’s always amputation.

MIKE: Well, for up to two hands.

>
> Be it remembered that the barbiturates, which
> thalidomide sought to replace, were favorite suicide
> pills, were habit forming,

MIKE: Well, not as suicide pills.

TOM: Ow.

> and had plenty of not-so-good
> possibilities latent in them.

CROW: Over twenty percent of all barbiturates take up candy store robbery!

> Of the two, thalidomide was
> far and away the safer . . . on the basis of all
> available data.

TOM: On the Worp reaction.

>
> But that slight tendency to peripheral neuritis
> when overused for long periods was the only slightest
> indication that thalidomide had any untoward effects.

MIKE: And mankind will never succeed in space if we don’t learn to overcome peripheral neuritis so that’s all the more reason to take it!

>
> Dr. Kelsey promptly used that data as a basis for
> more, and more elaborate nit-picking and inaction. She
> demanded more reams of then-unobtainable data.

CROW: Like, that there be data.

> Her
> position was, at that time, for the first time, faintly
> logical

TOM: I mean, for a girl.

> — slightly defensible on the basis of
> scientifically acceptable data. But it would still be
> rated as poor judgment and exaggerated caution.

MIKE: I bet she cried.

> The
> American pharmaceutical company seeking to market
> thalidomide, naturally, was growing quite impatient with
> the unjustifiable and indefensible,

TOM: They should’ve taken a tranquilizer — say!

> and thoroughly
> illogical delaying tactics that were blocking them.

MIKE: Like this time she asked for ‘a bowl of French hair’, what does that even mean?

>
> Neither “womanly intuition” nor “a strong hunch”
> has ever been held to constitute adequate grounds for
> governmental rulings,

MIKE: It’s all coin tosses and rock-paper-scissors.

> and precognition isn’t considered
> to exist.

TOM: As I told you it wouldn’t be.

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Author: Joseph Nebus

I was born 198 years to the day after Johnny Appleseed. The differences between us do not end there.

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