Wednesday, November 16, 2005

Thalidomide eyes

Mondays are medical education day at SMAC-HEAD, so last Monday saw us clustered together in the old drawing room in the organisation's central offices, listening to a talk on drugs in pregnancy.

And it was actually a very good talk - interesting, realistic and on occasion, blow-you-away mindboggling. A few things that stick in my mind:

Paroxetine, a very popular anti-depressant marketed over here as Aropax, may cause cardiac valve abnormalities in the womb. The speaker mentioned this as a "minor abnormality", which is probably true, since 'minor' is the usual medical term for 'something that someone else gets'.

I don't know how close to 'truth' this is - if it's a slight perturbation in the background rate of abnormalities in a minor study, or if it's generally widely known. I didn't know it, but there's a lot i don't know. Medicines/chemicals/etc cause only a small fraction of abnormalities, by the way, something like two thirds are "God knows".

An advertisement for an early anti-depressant, marketed by Roche, featuring a picture of a depressed looking woman, with arrows pointing to her face, demeanour, etc., illustrating various diagnostic features of depression. This was meant to help the concerned physician to better diagnose this subtle and frequently missed condition. Among the warning signs were (and all this without an irony at all), were "poorly applied lipstick" and "wrinkled stockings".

Psychiatry apparently, isn't a branch of medicine, it is a subspecialty of haberdashery.

If you're bipolar and find out you have become pregnant, it's better to be on lithium than valproate. Both cause abnormalities, but the more we learn about lithium the less terrifying it becomes, whereas every other mood stabiliser I know of is truly horrible in utero.

And lastly, a section on thalidomide, originally marketed as a safe and effective anti-nausea medication... and I believe now making a comback in some parts of the world as an anti-leprosy medication, under the name of Thalomid. And we saw shot after shot of phocomelic (literally "seal limbed") babies whose mothers had taken thalidomide.

One of the areas most often affected by 'medicines (and other causative agents) that cause deformity' is the ears. There is some embryological explanation for all this that remains in my head for a picosecond every time I hear it. The interesting thing is how many syndromes cause subtle or gross alterations in the shape of the ears.

And so the most remarkable image that remains in my mind from that talk is of a child's face, a black and white photo, one from the side and one from the front, like prisoner's photographs. The child himself had an expression of mingled defiance and melancholy, someone taken to the doctor against his will. A perfectly normal child, mentally, physically, socially, except for two subtle signs: an underdevelopment of the lobule of the external ear, the archetypal "funny looking ears", and pupils that were permanently of different sizes.

Odd, maybe something to cause him some hassle at school, but nothing truly out of the ordinary. But that kid must have reckoned he was the luckiest kid in America. Because all through his pregnancy his mother had had terrible nausea, and on the advice of her physician had treated it with thalidomide.

Anyway, I should work. Thanks for listening.



Blogger Benedict 16th said...

So has the old drawing room still got some of the ceiling missing, where about 4 years ago when it was an inpatient room, some inmates (no not a typo) were using the ceiling as a conduit outside to help their mates inside get over their terrible withdrawal pangs?

A B&W of a classic seal anatomy

11:38 PM  
Blogger Chade said...

I always wondered what the strange red headed kid had happen that he had no lobes and most of the ridge was melded into the skin covering his skull. Then I saw that Alien Nation film. Suddenly he seemed not that weird.

6:34 PM  

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