Thalidomide: What is it?

Thalidomide was originally created in Germany to be a non-addictive sedative with a lower risk of dependency for sleep. The drug became popular because it was a morning sickness reprieve that was over the counter and affordable. This drug had an unforeseen effect on fetuses. It caused an influx of miscarriages and congenial mutations. One of the mutations is “the hands and feet are bound to the child’s trunk, absent or underdeveloped” ( Fact Check-FDA did not approve thalidomide for pregnant women in 1950s or 1960s). Other mutations include ocular, auricular, and internal organ mutations. Children unborn and born suffered the effects of Thalidomide. “An estimated 80,000 fetuses had mutations, and 20,000 more who survived were born without limbs” (1). These connections were not found until a significant amount of children were born. Thalidomide was not safe for pregnant women, but we did not find that out until Thalidomide submitted an application to the FDA for the drug to be approved in America.

 

 

FDA not approved!

This was Frances Kelsey’s second NDA case, meaning she didn’t yet have a backlog of reviews to get through. She dismissed physicians’ testimonies in favor of actual scientific evidence. She asked for more information from the developer, but they responded with another application. Knowing that thalidomide causes neurological toxicity in adults, she was wary of what effect it would have on human fetuses. Kelsey kept digging and stalled the FDA’s approval (McNeill). There have been no mutations caused by Thalidomide in the US because of Kelsey’s thoroughness. “Kelsey received the President’s Award for Distinguished Federal Civilian Service for her work in protecting the public from the drug.” (1) This very public case increased the basic testing done on pharmaceuticals so much so that “the 1962 drug amendments bill passed that year to change drug regulation” (1). Through Kelsey’s discretion, the US has more regulation and testing required for FDA approval saving countless lives. Thalidomide is not a very safe drug to use and many have suffered because of it, however it’s creation led to the FDA bolstering their requirements for our future.

 

Other Uses!

In general, Thalidomide helps prevent skin symptoms, nerve damage caused by leprosy, and blocks certain natural substances that cause swelling. Some more uses for Thalidomide is that it treats certain complications of HIV, HIV-associated diarrhea, HIV-associated wasting syndrome, a type of skin cancer. It also treats multiple myeloma by strengthening the immune system to fight cancer cells (Thalidomide: Medlineplus Drug Information). Thalidomide has also been used to treat some types of cancer and tumors, severe weight loss in patients with weakened immune systems, chronic graft versus host disease, and Crohn’s disease (4). A side effect in using Thalidomide to treat cancer is damage to nerves in the fingers and toes. There may also be blood clots, drowsiness, rashes, or dizziness. Some “Doctors found that it helps regulate the body’s immune system and helps control inflammation” (Thalidomide: Research advances in cancer and other conditions). The risks associated with Thalidomide are very high, therefore they must match the risks of illness to be treated.

 

Creating a safer Thalidomide!

Thalidomide has some benefits for other illnesses, which led to the investigation and creation of drugs that were safer. Two chemically similar drugs are Revlimid and Pomalidomide (Pomalyst). “Pomalidomide is the generic name for the trade name chemotherapy drug Pomalyst ” (Cancer, Cleveland Clinic). There are normally no side effects with this Pomalidomide and if there are side effects, they are reversible and stop when the treatment stops (5). It should never be taken during pregnancy, just like thalidomide. What causes this drug to work against cancerous cells is unknown. It may act by inhibiting the growth of new blood vessels in tumors, enhancing the immune system, or decreasing cytokine and growth factor production (5). Pomalidomide lowers the risks and side effects of Thalidomide. Revlimid is an oral cancer drug that is used for the treatment of multiple myeloma, myelodysplastic syndrome, and mantle cell lymphoma (Revlimid Drug Information: The MMRF). It works against cancer cells partly by supporting the immune system. Revlimid side effects are reversible and has a clearer treatment process, but it has fewer uses. Pomalidomide is effective for many things, however it is not known how it helps decrease cancerous cells. There are pros and cons to both medications, but they are safer than Thalidomide. Thalidomide had an extremely negative effect on the world, but Thalidomide’s errors led to safer regulations and more scientific advancements.

Bibliography

  1. “Fact Check-FDA Did Not Approve Thalidomide for Pregnant Women in 1950s or 1960s.” Reuters, Thomson Reuters, 27 Aug. 2021, https://www.reuters.com/article/factcheck-thalidomide-fda/fact-check-fda-did-not-approve-thalidomide-for-pregnant-women-in-1950s-or-1960s-idUSL1N2PY2F7. \
  2. “Thalidomide: Research Advances in Cancer and … – Mayo Clinic.” Thalidomide: Research Advances in Cancer and Other Conditions, 3 July 2021, https://www.mayoclinic.org/diseases-conditions/cancer/in-depth/thalidomide/art-20046534. 
  3. McNeill, Leila. “The Woman Who Stood between America and a Generation of ‘Thalidomide Babies’.” Smithsonian.com, Smithsonian Institution, 8 May 2017, https://www.smithsonianmag.com/science-nature/woman-who-stood-between-america-and-epidemic-birth-defects-180963165/. 
  4. “Thalidomide: Medlineplus Drug Information.” MedlinePlus, U.S. National Library of Medicine, 15 Aug. 2009, https://medlineplus.gov/druginfo/meds/a699032.html. 
  5. Cancer, Cleveland Clinic. “Pomalidomide.” Pomalidomide | Chemotherapy Drug Information | Chemocare.com, https://chemocare.com/chemotherapy/drug-info/pomalidomide.aspx. 
  6. “Revlimid Drug Information: The MMRF.” Themmrf.org, 10 June 2020, https://themmrf.org/multiple-myeloma/treatment-options/standard-treatments/revlimid/#:~:text=Revlimid%2C%20also%20known%20as%20lenalidomide,Revlimid%20is%20manufactured%20by%20Celgene. 

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  Timothy Durham was convicted of rape when a test showed his DNA genotype matched the DNA recovered from the crime scene. Eye witnesses testified that Durham was in a different state at the time of the incident, but he wasn’t exonerated from his 3000 year sentence until follow up DNA analysis showed that the preliminary forensic analysis used in the trial was misinterpreted (Thomas et al.). DNA testing serves an invaluable part in our criminal justice system, but it comes with complications and bias that can lead to wrongful convictions and misinformed juries.  

Background:

Forensic genetics aims to identify the origin of a biological sample. It can be traced back to Karl Landsteiner who discovered human ABO blood groups. With blood groups, suspects could be eliminated based on their blood type. For example, if a suspect had type A blood and there was type B blood left at the scene by the perpetrator, the investigators could rule out the suspect. Unfortunately, the reverse didn’t work. If the suspect and perpetrator both had the same blood type, it can’t be concluded that the suspect was guilty. Blood identifiers evolved into 8 distinct categories which improved the ability to eliminate suspects, but could only conclude that (if the system matched) it might be the perpetrator or this person might be related to the perpetrator (Jobling and Gill). The field evolved in the 1980s with the discovery of Minisatellites, lines of repetitive DNA that don’t encode proteins. Minisatellite patterns in DNA create what we know today as the DNA fingerprint, and it has a much higher accuracy rate than previous methods (Augustyn et al.). Around the same time, a breakthrough for victims of sexual assault was discovered. In the case of assault, bodily fluids of both the victim and the assaulter can get mixed. A process called differential lysis was created which could selectively increase the concentration of sperm in a fluid sample thereby allowing for accurate DNA testing (Jobling and Gill). Forensics evolved to use single-locus probe testing after several years because of its ease of interpretation. It looked at specific minisatellites that had high variability between subjects. This was the first DNA-based method to be used in a criminal investigation. Two murder homicides from several years apart were connected using DNA evidence. The evidence was then used to exonerate an innocent man, and the guilty party was found when he tried to evade mandatory DNA testing for all men in the small town. His guilt was then reinforced when the DNA profiles matched, and he gave a confession (Jobling and Gill). Finding DNA at a crime scene doesn’t guarantee that you’ll find a murderer. There are issues with non-pure samples and limited samples that make DNA work difficult, and accreditation of facilities and new techniques and take time (Jobling and Gill).  

Subjectivity of DNA Interpretation:

In a 2009 publication, the National Academy of Science discusses the possibility for subjective influence in lab based forensics. The interpretation bias happens in complex cases where, for example, there could be a mixture of DNA. A study published in 2011 looked specifically at this issue. A gang rape happened in Georgia, and the mixture in DNA from the case was used to prosecute one suspect after another suspect took a plea bargain to testify against him. With DNA mixtures, there are three possible conclusions: suspect excluded, suspect cannot be excluded, and inconclusive. If the suspect is excluded, it means that there’s little to no possibility that his DNA is part of the sample. If the suspect cannot be excluded, it means that there’s a possibility that his DNA is part of the sample. In the trial, the DNA examiners who knew the context of the case concluded that the suspect being prosecuted could not be excluded. The 2011 study gave the DNA evidence from this case and the DNA profiles of the suspects to 17 forensic examiners. These examiners had no context of the case, and they all worked independently. Of the 17, only 1 came to the same conclusion (suspect cannot be excluded) as the examiners who knew the context of the case. Twelve of the 17 concluded that the suspect who was prosecuted and convicted had no relation to the DNA found in the sample. Not only does this show that subjectivity occurs due to the context of the case, but the 17 examiners came up with different findings based on their past experiences meaning that not all DNA analysis is objective. Some organizations like the Scientific Working Group on DNA Analysis Methods say that quantitative statistical evidence should be presented with every categorical conclusion, but the US doesn’t require this (Dror and Hampikian).

False Positives:

There are two categories that cause wrongful identification in a DNA report: coincidental matches and false positives. Coincidental matches are DNA matches between two unrelated people. The probability of these matches is about 1 to 500,000 for white individuals and about 1 to 350,000 for black individuals. This small probability of coincidental matches makes people feel confident in DNA evidence. False positives, on the other hand, are matches between DNA and test DNA that result from issues in the forensics lab. There have been multiple cases of forensics labs accidentally switching victim and suspected rapist DNA which lead to convictions that were later overturned when the lab realized the error. There are also cases of misreading or misunderstanding a sample. In a case from 1993, a man was convicted of rape because someone interpreted a mixed sample of victim and perpetrator DNA as an individual sample. The conviction was again overturned. To prevent false convictions, retesting DNA is allowed, but it’s not an efficient solution. Many people are pushing for statistical information on the probability of false positives, so that the jurors can make accurate judgements based on DNA evidence (Thomas et al.).  

Conclusion:

DNA analysis is a useful tool for the criminal justice system, but subjectivity can be an issue in forensic testing. To combat wrongful convictions, there are organizations like The Innocence Project who use DNA testing to free the innocent, but reformed forensic testing standards should be put in place to prevent subjectivity and to ensure juries are correctly informed during trials. https://www.innocenceproject.org/    

Citation:

Augustyn , Adam, et al. “DNA Finerprinting.” Encyclopedia Britannica , 26 Apr. 2018, www.britannica.com/science/DNA-fingerprinting#ref153186. Dror, Itiel E., and Greg Hampikian. “Subjectivity and Bias in Forensic DNA Mixture Interpretation.” Science & Justice, vol. 51, no. 4, 2011, pp. 204–208., doi:10.1016/j.scijus.2011.08.004. Jobling, Mark A., and Peter Gill. “Encoded Evidence: DNA in Forensic Analysis.” Nature Reviews: Genetics, vol. 5, no. 10, Oct. 2004, pp. 739–751., doi:10.1038/nrg1455. Thompson, William C, et al. “How the Probability of a False Positive Affects the Value of DNA Evidence.” Journal of Forensic Sciences, vol. 48, no. 1, Jan. 2003, pp. 1–8., doi:10.1520/jfs2001171.