The Great Thalidomide Caper

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1. In the beginning, life looked rosy for thalidomide. Advertised under the names "Distaval" and "Thalomid", this drug came about when a failed anti-allergy drug proved to be somewhat of a wonder cure for people suffering from anxiety disorders. These included morning sickness, which in the swinging 60's, was seen to be a result of stress. Why was thalidomide such a breakthrough? It was a tranquilliser that was impossible to overdose on. It appeared to cure psoriasis, an immune disease in which skin is produced faster than it can be got rid of. It proved to suppress the appetite better than any other drug available at the time. It is a powerful yet essentially harmless steroid for treating eczema.

2. Unknowing, thousands of mothers were taking thalidomide pills to combat their morning sickness and dizziness, blissfully unaware of what was going on with their poor foetuses. The shock came when the children were born and the mothers were not allowed to see their offspring. What are the symptoms of thalidomide damage? Deformed heads, some born without features Hare lips and cleft palates Tears in the heart and lungs of the newborn baby A normal head and trunk with shortened or no limbs

3. After the foetal damage, thalidomide soon went out of vogue. It was put on the shelf for years after the dangers became apparent, and it was only when a doctor in Israel was searching for a cure to the horrible disease leprosy that thalidomide was considered. Which of the following symptoms of leprosy does thalidomide prevent? ENL Sores (skin lesions) Nasal Congestion Heavy Epistaxis (heavy nosebleeds) Hardened Dermis (hard skin)

4. Thalidomide was then found to be something of an immune system regulator, and was used to treat certain immune system diseases. One of the success stories was that of Sarah Craven, who suffered from Behçet’s disease. Behçet’s causes horrible ulceration of the tongue and genitals as the immune system refuses to believe that these areas belong to the sufferer. In what way does thalidomide help sufferers of this grisly disease? It suppresses immune receptors, which decreases ulceration It retards the ulceration process by creating an antiseptic environment The drug increases blood supply to aid recognition of organs All of these things and more. Thalidomide is truly amazing

5. Sarah Craven was lucky to have been given thalidomide, as within three weeks, the ulceration caused by her Behçet’s disease cleared up completely on both her tongue and genitals. She soon became healthy enough to have a child, and staved off thalidomide for the first five months of pregnancy so as not to damage to unformed foetus. Sadly, her Behçet’s symptoms soon came back, and by the sixth month of her pregnancy, she had to take the drug again. There were fears that at this stage, thalidomide could still harm the child, but how? Children can be born blind and deaf. It can cause severe neurological impairment. The effects can cause diseases such as Huntingdon's chorea later in life. The child has an increased chance of being born dead.

6. Nothing happened to Sarah Craven's child at all, and she now has a healthy son named Jake. Sadly, most people who take thalidomide and then become pregnant have children who suffer terribly from the afflictions of the drug. When thalidomide was licensed to treat the effects of leprosy, the recipients of the drug has to sign a legal form. What did this form declare? Any children conceived would be subject to mandatory abortion. That the drug's recipients would use two forms of contraception during intercourse while using thalidomide. Children born of thalidomide (that is to say, those who suffered the usual deformities) would be used for experimentation. That intercourse would be disallowed during the use of this drug.

7. After being used to treat leprosy and Behçet’s disease, the life of thalidomide suddenly got a lot more interesting. While treating cancer sufferers, it was found that thalidomide could help to kill solid tumours within the body by preventing angiogenesis. What is angiogenesis? The cancerous infection of bone marrow, ensuring that all white blood cells produced leave the marrow containing cancer. The abrasion of the tumour by blood, resulting in cancerous cells being carried around the body. An action whereby the tumour ensures a copious blood supply by creating blood vessels that feed the tumour and nothing else. The entrance of cancer cells into the blood via the lymph system.

8. Not only solid tumours can be treated by thalidomide. In another famous case study, it was found that the usually fatal blood cancer multiple myeloma can be treated with the drug. Nancy Touhey found that thalidomide stopped the myeloma attacking the blood cells by preventing blood vessels growing around the bones. This prevents cancerous white cells generating. She also claimed that it was much better to use than chemotherapy. Why would thalidomide be better than chemo- or radiotherapy? Thalidomide doesn't kill healthy cells All of these reasons make thalidomide a better choice It is a pill and so is easier to take and less time consuming than other cancer therapies There is no hair loss or vomiting

9. After all of the positive attributes of thalidomide came to light, many companies tried to make the drug safer. Celgene have manufactured "Revomid". This drug was created by altering the make up of thalidomide, producing a pill that is far safer to use. It is also more effective. How did they engineer this new, more effective form? They removed an oxygen atom and replaced it with a nitrogen atom. They altered the complex bivalent structure into a trivalent form. They added caffeine to increase the uptake of the thalidomide. All ammonia atoms were removed to ensure the production of dilute urine and faster absorbtion.

10. But after all the success and all the research into thalidomide, there was still one major problem. Thalidomide is unstable, but clearly restricts blood flow. This treats cancer, but also causes the deformation of foetuses. Which component of the drug actually restricts the blood supply, producing the aforementioned effects? No one knows for sure Dioxo-3-Piperidinyl Phthalimido-Glutarimide 1H-isoindole-1,3(2H)-dione