33:T420,The story of thalidomide is often employed as a cautionary tale - why testing a drug’s safety during pregnancy is crucial or why it’s important to choose the right animal models. Or it’s framed as a success story for drug repurposing or regulation. But those tellings often gloss over the darker lesson of thalidomide: that for some companies, the bottom line is more important than human life. This week, we explore all elements of this infamous drug. We start by examining what we know about how thalidomide causes the severe congenital malformations it’s associated with, and then we dive into the deep, dark history of the drug, complete with a full cast of villains and heroes. Finally, we discuss thalidomide’s controversial comeback as a treatment for myeloma and complications of leprosy. Get out your angry hats for this one, people, because you’ll find yourself asking along with us, “why are humans the way we are?”

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We chronicle the epic struggle to get drugs that treat very rare diseases on the market, and the unintended consequence of that fight, which affected the cost of all kinds of drugs. This is a strange story that involves a hit 70s TV show, a fake march on Washington, a courageous advocate, a carnival concessions wholesaler, and a new drug law that helped a lot of people, made drug companies billions of dollars, and opened a whole can of worms.

Adapted from the new podcast An Arm and a Leg by Dan Weissmann

Orphan Drugs

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It’s the early 1960s and the German pharmaceutical market is booming. A sedative called Contergan is one of the bestselling drugs. Contergan’s active ingredient is thalidomide and it is touted as a wonder drug, a non-addictive sedative safer than barbiturates. In the U.S., the drug is called Kevadon, and its distributor is impatient to get the drug on the market. But Dr. Frances Kelsey, a medical examiner at the U.S. Food and Drug Administration, is stalling the approval of Kevadon. She wants more information from the manufacturer to prove it is safe. Meanwhile, doctors in Scotland and Australia are beginning to suspect thalidomide might, in fact, be very toxic. And in Germany, reports are beginning to emerge of a mysterious epidemic of babies born with missing limbs and other serious medical conditions, but doctors have no idea what's causing it.

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Thalidomide