Jefferson M Fish Ph.D.

Looking in the Cultural Mirror

Thalidomide in Brazil—Again!

Thalidomide, a treatment for leprosy in Brazil, is causing birth defects again

Posted Jul 24, 2013

Terminal Transverse Hemimelia of Right Forearm

Thalidomide is a tranquilizer and sedative, initially used for anxious people who had trouble sleeping—including expectant mothers. The drug was developed in Germany in 1954, and its use spread rapidly throughout much of the world. A dramatic rise in birth defects was soon detected, and these were eventually traced to the use of Thalidomide during pregnancy.

“Arms, hands, legs, and feet were either not present at all (amelia) or were present in greatly atrophied form. Sometimes they would just emerge from the trunk; for example, a few fingers or flipper-like hand appendages would extend from each shoulder. The latter condition was named phocomelia, derived from the Latin word for seal. There were also other kinds of disfigurement, including facial abnormalities and eye problems.” (P. 85 in my book chapter, cited below.)

With rare exceptions, abortion was illegal, in the United States in the 1950s and 1960s. (The Supreme Court decided Roe v. Wade in 1973.) Sherri Finkbein—a pregnant woman who had taken Thalidomide—was the focus of much media attention when she flew to Sweden in 1962 for an abortion. The fetus was, in fact, found to be deformed; and the case brought increased attention to the dangers of the drug.

In recent years, Thalidomide has made a comeback in Brazil to treat skin lesions caused by leprosy—a disease that, unfortunately, has not been eradicated from that country. Now we have learned that, despite warnings and attempts to prevent women from using the drug, there has been a rise in Thalidomide-like birth defects.

Unfortunately, Brazil, despite recent economic and educational progress, still suffers from widespread poverty and illiteracy. As a result, poor people often share pills—apparently including Thalidomide. Furthermore, while warning labels are important, and may even include pictures of Thalidomide-related deformities, they are of limited effectiveness with people who cannot read.

The main problem for Brazil is to figure out a public health strategy to prevent these birth defects. As to the affected children already born, my students’ research does offer a glimmer of hope.

There was a wide range in the deformities of the affected children we studied. “They varied from one subject, who was missing all four limbs and had problems with both her eyes, along with some other malformations, to a subject who was missing one finger and had some deformation of a second finger, both on his right hand.” (P. 86.) In order to study such a varied group, we went to great lengths to find physically normal controls whom we could match on a case-by-case basis.

“Pairs of subjects were matched according to sex, age, socioeconomic level (which varies greatly in Brazil, particularly at the lower end of the scale, in comparison with that in the United States), and residence (urban, suburban, and rural). Once again, the terms “suburban,” and particularly “rural” in Brazil, given the severe problems of poverty and illiteracy, are quite different from the corresponding terms in the United States....In the end, we wound up with 22 pairs of subjects, 14 male and 8 female.” (P. 87.)

We found no clinically meaningful differences in the cognitive and emotional development of the preadolescents and adolescents we studied; and if their disabilities did not interfere with a given motor task (admittedly a big if, for some of them) we found no clinically meaningful differences there either. So there is reason for hope for the futures of those already born.

Reference

Fish, J. M., Monte Serrat, S. and Tormena Elias, M. E.  (1989).  Thalidomide adolescents and preadolescents in Brazil.  In L. L. Adler (Ed.) Cross-cultural research in human development:  Life span perspectives.  New York: Praeger.  Pp.85-92.

Image source:

Photograph of right forearm affected by birth defect Amelia (specifically, Terminal Transverse Hemimelia) in a Caucasian male, by Onearmedbandit86

http://en.wikipedia.org/wiki/File:Amelia_right_forearm.jpg

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