MiSTed: The Lesson of Thalidomide, Part 4 of 4


Part 1, introduction and John Glenn.

Part 2, German cows and procognition.

Part 3, how can a woman be right?

A bit about the actual history of thalidomide. Dr Frances Kelsey was neither acting arbitrarily nor capriciously when she refused to approve thalidomide. What she did was read the data which manufacturer Richardson Merrell had submitted to prove the drug’s safety and notice that it didn’t actually demonstrate that. She had also read in the medical literature the then-new discovery that drugs could pass through the placenta, from mother to fetus, and she requested evidence that thalidomide wasn’t doing that. And she had encountered a British study which found a nervous system side-effect from the drug and asked the maker to explain that. In short, she looked at the data, and where it was lacking, asked for more data; she read the medical literature and understood it; and she thought about consequences and asked about them. Thalidomide’s disastrous side was a horrible surprise. But it was a surprise that a curious and alert mind paying attention would catch.


>
> Test 1 is the animal test. Thalidomide proved
> completely harmless — in fact completely ineffective!
> — to the usual laboratory animals.

CROW: We’ve sent them a stern note about not being visibly harmed by drugs earlier and more clearly.

> (Since the blowup,
> it’s been found that enormous doses of thalidomide will
> not make a rabbit sleep

MIKE: But a cup of cocoa and a nice bit of reading will.

> . . . but will cause a pregnant
> rabbit to produce abnormal young.

TOM: So it would have passed animal testing as long as nobody noticed the deformed animals.

> Equally massive doses
> of barbiturates don’t do that; they kill the rabbit.

ALL: [ A few seconds of Elmer Fudd-style cackling before giving up with an ‘ugh’. ]

> It
> wouldn’t have indicated anything to the investigators
> except that thalidomide was safer than barbiturates!

CROW: And to be fair, who could foresee humans being pregnant just because rabbits can be?

> And
> it has now been discovered that, for reasons so far known
> only to God, thalidomide does make horses sleep! But who
> uses horses as “convenient laboratory animals for testing
> new drugs”?

MIKE: So how do we know thalidomide makes horses sleep?

TOM: Who looks at a drug that makes horribly deformed human babies and asks, ‘What will this do for horses?’

> And why should they; horses are herbivores,
> with a metabolism quite a long way from Man’s. Monkeys
> are expensive — and they don’t really match Man.)

CROW: Unlike mankind’s closest living relatives, rabbits.

>
> Test 2 — trying it on a small group of patients
> first.

MIKE: Is that a few patients or just on patients who are very tiny?

TOM: Picturing a study on human adults each eighteen inches tall?

MIKE: Pretty much.

>
> Now the first slight indication that thalidomide
> could have some bad side-effects was that neuritis
> business. It results from prolonged overuse of the drug.

TOM: Also the deformed babies, but that could just be the mothers’ fault.

>
> The doctors administering the first test-use of
> the new drug would, of course, regulate it carefully.

CROW: Unlike in the real world, where they gave out two and a half million tablets to a thousand doctors while waiting for the FDA to approve selling them.

> There would be no long-continued overuse under their
> administration — and therefore thalidomide wouldn’t
> have produced any neuritis.

TOM: As long as they didn’t do anything that produced any problems there’d never be any problems turning up.

>
> On that first, limited-sample test, there would
> be an inevitable, human tendency to avoid pregnant young
> women as test subjects for so experimental a drug.

CROW: Because it’s only a scientific test if you avoid real-world conditions that would be messy or hard to deal with.

>
> Result: thalidomide would have checked in as one
> hundred per cent safe and effective.

MIKE: Except for rabbits.

>
> The final two-year test was several thousand
> people. On this one we don’t have to guess; we’ve got the
> statistics.

TOM: Knowing the answers as we do, we can sound smarter than the people who were asking questions.

>
> During the time thalidomide was being considered
> by the Federal Drug Administration for licensing in this
> country, selected physicians in the United States were
> sent supplies of the drug for experimental use.

CROW: Under the ‘What the heck, like something could go wrong?’ program.

>
> Under this program, 15,904 people are known to
> have taken the pills.

MIKE: But we probably should’ve written down who they were, somewhere.

> Certainly that’s a good-sized
> second-level testing group for our proposed
> hyper-cautious test system.

TOM: I’d like to see it bigger and less cautious, of course, but we make do with what we have.

>
> Of those nearly 16,000 people, about 1 in 5 —
> 3,272 — were women of child-bearing age, and 207 of
> them were pregnant at the time.

CROW: 86 of those listened to and enjoyed The Button-Down Mind of Bob Newhart. This is irrelevant to my point but is interesting nevertheless.

>
> There were no abnormal babies born, and no cases
> of polyneuritis reported.

TOM: And by ‘no’ I mean ‘seventeen’, but that’s close enough to ‘no’ for real science.

>
> Thalidomide passed the cautious tests with flying
> colors.

MIKE: Melting off the walls and pooling into a flavor of brick.

>
> Now the abnormalities that thalidomide does cause
> are some kind of misdirection of the normal growth-forces
> of the foetus.

TOM: But in the future we could have limitless abnormalities!

> The abnormalities are of a type that was
> well known to medicine long before thalidomide came along
> — abnormal babies have been produced for all the years
> the human race has existed, remember.

CROW: Heck, all things considered it’s the non-deformed babies that are the real sickos.

MIKE: Yeah, after this one I’m going to my bedroom and cry.

>
> Suppose that in our test, some women did bear
> abnormal babies. Say three of them were abnormal, and
> lived.

CROW: They can be an example to the rest of us!

> (A goodly number of the thalidomide-distorted
> babies died within hours.

MIKE: Technically everyone dies within hours if you count high enough.

> It doesn’t only affect arms and
> legs; thalidomide can mix up the internal organs as
> though they had been stirred with a spoon.)

TOM: Thanks, that detail doesn’t make me want to kill myself.

>
> So . . . ? So what? Aren’t a certain number of
> abnormal babies appearing all the time anyway?

TOM: Yeah! Well, one in four million, born like that.

> And with
> all this atomic-bomb testing going on . . . and this
> woman was examined repeatedly by X ray during pregnancy .

CROW: Really, with how complicated life is how can we ever really blame anything for anything?

> . . and remember that in the normal course of nine months
> of living, she will have taken dozens of other drugs,

MIKE: Because it’s the early 60s and we don’t want to think about what we’re pumping into our bodies.

> been exposed to uncountable other environmental
> influences, perhaps been in a minor automobile accident .
> . .

TOM: And you know how scaring the mother will leave a permanent mark on the children, right?

>
> Not until the drug is “tested” on literally
> millions of human beings will it be possible to get
> sufficiently numerous statistical samplings to be able to
> get significant results.

TOM: Slightly more, in Canada.

> Toss a coin three times, and it
> may come heads every time. This proves coins fall
> heads-up when tossed?

CROW: And even if it did, how would we know coin-tossing was causal and not merely correlated to coins coming up at all?

MIKE: It’s basic logic.

>
> Another drug was introduced for experimental
> testing some years ago.

TOM: Case closed.

> The physicians who got it were
> told to check their experimental patients carefully for
> possibilities of damage to liver, stomach and/or kidneys,

CROW: Also if the drug punched anyone in the face and ran off with their wallet.

> the expected possible undesirable side-effects of the
> drug. Practically no such damage was found — the drug
> was effective, and only in the very exceptional patient

TOM: The best kind! Everyone needs to be more like them.

> caused sufficient liver, stomach or kidney reaction to
> indicate it should be discontinued.
>
> Only it caused blindness.

MIKE: Well, what was it supposed to do?

CROW: Risk damaging the liver, stomach, and kidneys, apparently.

MIKE: Man, the eyes are nowhere near any of those, no wonder they didn’t approve it.

>

TOM: I hope they didn’t.

> The reaction was frequent and severe enough to
> make the drug absolutely impossible as a medicament —
> and was totally unexpected.

CROW: Nobody saw the blindness coming — oh, now I feel like going to my bedroom and weeping.

TOM: Yeah, this is a brutal one.

> It had not caused any such
> reaction in any of the experimental animals.

MIKE: In retrospect, testing exclusively on star-nosed moles may have been a mistake.

>
> No — the lesson of thalidomide is quite simple.

TOM: It’s ‘thalidomide’, not ‘thalidomine’, however much you think you remember it the other way.

MIKE: Hey, wait, it is, isn’t it?

>
> So long as human beings hope to make progress in
> control of disease and misery, some people will be lost
> in the exploration of the unknown.

CROW: Don’t go looking for them. There’s grues there.

>
> There is no way to prevent that. There is no
> possible system of tests that can avoid it — only
> minimize the risk.

TOM: By shoving unproved drugs down millions of people’s throats just in case one of them is good for something! The drugs, I mean, not the people.

>
> We could, of course, simply stop trying new drugs
> at all.

MIKE: Gotta say, it does sound like we’re not very good at making them.

> The animals never did try the pain and the risk
> of fire. They’re still animals, too.
>
> January 1963 John W Campbell

TOM: Who died of drinking DDT in a lead-lined glass while smoking an asbestos-filtered cigarette laced with cyclamates.

CROW: And saying none of it was statistically proven.

MIKE: John Glenn, everybody. John Glenn.

TOM: Let’s just get out of this popsicle stand.

[ ALL exit. ]

[ 1… 2… 3… 4… 5… 6… ]

[ SATELLITE OF LOVE DESK. TOM SERVO, MIKE, and CROW are in a line. ]

MIKE: Well, Pearl, wherever you are … I hope you’re satisfied with this heap of misery you’ve inflicted on us.

TOM: I think the only thing that’ll rescue our mood is the lighthearted yet barbed whimsy of the Rankin/Bass universe.

CROW: Rudolph’s Shiny New Year is on.

MIKE: The one where our hero Rudolph is searching for the Baby New Year, which will make thousand-year-old Aeon die.

TOM: Oh good heavens.
[ CROW flops over, defeated. ]

MIKE: Happy new year, everyone, and to all … guh.



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Mystery Science Theater 3000 and the characters and situations therein are the property of Best Brains, Inc, so I’d appreciate if you didn’t tell them what I’ve been up to all these years. The essay ‘The Lesson Of Thalidomide’ by John W Campbell was originally published in Analog and appeared in the archive.org resource Collected Editorials From Analog, https://archive.org/details/collectededitori01camp where it and much other writing can be enjoyed at your leisure. Nothing untoward or mean is meant toward John W Campbell or anyone at Analog, and I’m not irritated with archive.org or anything either. If you’re feeling bad about all this, consider: the word ‘bunny’ seems to come from Gaelic ‘bun’, referring to their tails, and doesn’t that make you grin some?

> for all I can know, she may have perfect and
> reliable trans-temporal clairvoyance, so that, in 1960,
> she was reading the medical reports published in late
> 1961, and basing her decisions very logically on that
> trans-temporal data.

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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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