When a medicine is prescribed and then dispensed using an electronic prescription service, the drug in question is prescribed because it is safe to use as directed in the doses provided, effective for treating the condition in question and appropriate for the person and severity of the condition.
Part of this is seen in the NHS prescribing policy, where there are medicines that are either not proven to be effective or there are safety concerns that are simply not prescribed.
This is vitally important in order for pharmacists and doctors to follow the core of the Hippocratic Oath and prescribe only beneficial treatments and avoid causing harm.
However, there is one particularly odd case of a medicine that is still rarely prescribed today that due to an oversight in testing caused one of the biggest medical tragedies of the 20th century.
The Two Legacies Of Thalidomide
There are two legacies surrounding the medication thalidomide, one of which is far more striking and far more tragic than the other.
The thalidomide most people know is one associated with tragedy and scandal, one that completely changed how medicines were tested, regulated and monitored to try and avoid anything similar from happening again.
For context, thalidomide was originally made in 1952 but it took until 1957 for its antiemetic qualities to become known.
It was powerfully effective at helping with the symptoms of nausea and sickness in rodent testing and was primarily sold as a treatment for morning sickness, a type of particularly unpleasant nausea found during pregnancy.
However, the testing for thalidomide only checked for symptoms in rodents and was never tested on pregnant women, something that was not common practice until the 1960s as a direct result of what happened next.
At the time, pharmaceutical researchers did not think that any medication could pass through the placenta and into the child, something that turned out to be devastatingly incorrect.
Reports of children born from birth defects to parents who had taken thalidomide started to appear with increasing regularity within a year of the drug’s launch as an over-the-counter panacea for headaches and nausea.
By 1961 it was pulled from the market entirely in the countries that had approved it, which did not include East Germany and the United States, with estimates claiming that as many as 2000 children died, with 10,000 more suffering serious birth defects requiring lifelong care.
This somewhat undermined the claims by thalidomide’s manufacturer, The Distillers Company (now part of Diageo), which sold it under the name Distaval and claimed that it could be taken “with complete safety” by pregnant women without causing any harm to either mother or child.
A long legal battle led to a multi-million-pound settlement that included compensation and a trust to support the children who had disabilities related to thalidomide.
For many people, that is the legacy of thalidomide; an oversight with testing led to an unprecedented medical tragedy, the only positives coming through a correction of the clinical trial failings which allowed such a tragedy to take place to begin with.
However, it is not quite that simple, because thalidomide is still prescribed today and even as The Thalidomide Society and The Sunday Times were tirelessly campaigning for justice for those harmed by it, thalidomide was being used as an experimental medicine again.
In 1964, the Russian-born Israeli doctor Jacob Sheskin was treating a patient who was suffering from a serious case of leprosy, a disease that had been difficult to treat since Biblical times.
In particular, he was treating a man suffering from erythema nodosum leprosum, a complication of leprosy which includes big red lesions, arthritis, fatigue and fever. He was in agony and Dr Sheskin was looking for anything that could ease him.
One medication he had available was thalidomide, despite it having been banned. Knowing that it had some sedative qualities, Dr Sheskin tried it anyway and was astonished by the result.
Not only did he sleep for hours, but a side effect of thalidomide was that the symptoms of his leprosy started to clear up. They had not gone away entirely but they had been distinctly suppressed.
It is not the frontline treatment for leprosy anymore due to the enduring concerns regarding birth defects given that clofazimine works better for the same condition, but it has been used in the treatment of multiple myeloma in combination with other medications.
Myeloma, a form of bone marrow cancer, is typically treated with triplet therapies which use a combination of medications, most commonly bortezomib, lenalidomide and thalidomide, to help inhibit its progression and reduce its symptoms, although the cancer cannot typically be cured.