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PEDIATRICS Vol. 111 No. 3 March 2003, pp. 712

The Schizophrenic Career of a "Monster Drug"

To the Editor.—

The events surrounding Sheskin’s discovery showing the effect of thalidomide in treating leprosy patients with erythema nodosum leprosum (ENL) are vividly described in Dark Remedy. The Impact of Thalidomide and Its Revival as a Vital Medicine¹ and recounted in Silverman’s review of the book. Silverman² quotes Stephens’s and Brynner’s statement that "because of Dr Sheskin’s discovery, 90% of leprosy hospitals around the world were shut down." Leprosy hospitals, it is true, have been shut down, but this is attributable to the widespread use of dapsone and multidrug therapy, rather than thalidomide, which has no antibacterial effect. For example, in Benin, a country of 6 million people, 20 leprosaria have been closed or turned into health centers since the World Health Organization (WHO) decided to eliminate the disease.³ Moreover, WHO no longer recommends the use of thalidomide for treating ENL.⁴

Brynner, in beginning treatment with thalidomide for pyoderma gangrenosum, was so concerned about developing nerve damage that he wrote, "I had read all about that [nerve damage], and the fact that it could be permanent terrified me more than anything else." Yet he makes no attempt to explain why thalidomide neuropathy has not been reported in leprosy patients given the drug. In patients with nonleprous disorders the frequency is at least 21%.⁵

C.L. Crawford, MRCP
Imperial College School of Medicine
Chaning Cross Hospital
London W6 8RF, United Kingdom

REFERENCES

1. Stephens T, Brynner R. Dark Remedy. The Impact of Thalidomide and Its Revival as a Vital Medicine. Cambridge, MA: Perseus Publishing; 2001

2. Silverman WA. The schizophrenic career of a "monster drug." Pediatrics.2002; 110 :404 –406[Free Full Text]

3. Benin: phasing out the leprosaria. In: Leprosy. Learning from success. Geneva, Switzerland: World Health Organization, 2001:30–33. WHO/CDS/CPE/CEE/2001.20

4. World Health Organization. The final push strategy to eliminate leprosy as a public health problem–questions and answers. 1st ed. Geneva, Switzerland: World Health Organization; 2002

5. Ochonisky S, Verroust J, Bastuji-Garin S, Gheradi R, Revuz J. Thalidomide neuropathy incidence and clinicoelectrophysiologic findings in 42 patients. Arch Dermatol.1994; 130 :66 –69[Abstract/Free Full Text]

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PEDIATRICS (ISSN 1098-4275). ©2003 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Crawford, C.L. Search for Related Content PubMed PubMed Citation Articles by Crawford, C.L. Related Collections Related AAP Red Book topics: Leprosy Social Bookmarking                         What's this?