Ask Dr. H: Thalidomide has benefits

Question:

I can remember when they took the drug thalidomide off the market because it caused serious birth defects. Now, I'm reading that doctors are again using it. Why would such a dangerous drug ever be used again?

Answer: Thalidomide has an interesting history with a very sad chapter. Developed in 1953 as a non-addictive, relatively "risk free" sedative, it became popular worldwide in the late 1950s and early 1960s as a very effective drug pregnant women were using for morning sickness. It was thought to be so safe that it was available over the counter in several countries.

At the time, it was not thought likely that a drug could pass from mother to fetus across the placenta barrier and harm a developing fetus. But more than 10,000 children in 46 countries were born with birth deformities directly as a result of thalidomide use in pregnancy.

About 40 percent of the babies died before their first birthday. Media reports showed shocking pictures of children born with limbs that looked like flippers. Thalidomide was banned worldwide in 1962.

Despite its notoriety, thalidomide has proven medical benefits. It turns out that thalidomide's mechanism of action that destroys embryonic limb formation - killing new blood vessel growth - makes it ideal as an anti-cancer and anti-inflammatory drug.

Thalidomide is now FDA-approved for the treatment of multiple myeloma. It has also been used to treat myelofibrosis, Kaposi sarcoma, and renal cell cancer along with the pain of leprosy. Many more uses for thalidomide are under study. Thalidomide is dangerous only when used in the wrong patients.

nolead begins

Q:

At a recent doctor's appointment, my doctor noticed my ears were full of soft, gooey wax. I mentioned to him that I heard an association between soft earwax and heart disease, but he'd not heard of it. Do you think there's anything to it?

A: There is a very "soft" association between having gooey earwax and a somewhat increased risk of heart disease. In the early 1960s, one small study found a weak association between the presence of soft earwax (as opposed to the hard, dry, flaky type) and atherosclerosis. Furthermore, Lithuanian researchers in 1993 found that people with soft earwax were somewhat more likely to have higher levels of "apo B," a protein associated with LDL "bad" cholesterol. These weak associations are far from an established connection with heart disease risk.

There is a similar "soft" association between soft earwax and a somewhat increased risk of breast cancer. In 2009, Japanese researchers discovered that the gene that codes for soft earwax (yes, the type of earwax you have is genetically predetermined) also codes for a transport protein involved in breast cancer.

One should not read too much into these associations. It's like making an association that folks with gray hair have a greater risk of death simply by virtue of their hair color. While folks with gray hair are generally assumed to be older, it would be incorrect to make assumptions about an individual's health purely on that basis.