Advocates for survivors of thalidomide defects are calling for efforts to develop analogues of thalidomide without the harmful side effects. But analogue development may take some time because researchers are not sure exactly how thalidomide works. Its immunomodulatory effects may occur through selective inhibition of tumor necrosis factor, the inflammatory cytokine involved in many diseases. It may also block angiogenesis, the most likely reason for its reported effectiveness against some solid tumors and perhaps the method by which it blocks fetal limb and organ development. Thalidomide will likely spark disagreements both within the medical community and between medicine and the public about what limits, if any, to impose on use in fertile women.
Informed consent becomes much more important here.
Our obligation goes way up. We need to be very clear that use is experimental. It would be unfortunate if thalidomide was considered too risky because of its past. Physicians just need to work closely with patients. A program to reduce pregnancies in women who use isotretinoin, a known teratogen, for severe, cystic acne is being considered as a model for thalidomide.