45 ms·

Are there any authorized or approved drugs that are taken over a short-term (say less than a month) that have been shown to cause long-term death?

tharkun__ 5y ago
This immediately jumped to mind (Contergan): https://en.wikipedia.org/wiki/Thalidomide_scandal https://en.wikipedia.org/wiki/Thalidomide_scandal The total number of people affected by the use of thalidomide during the mother's pregnancy is estimated at more than 10,000, of whom approximately 40 percent died at or shortly after the time of birth. Those who survived had limb, eye, urinary tract, and heart defects [...] The severity and location of the deformities depended on how many days into the pregnancy the mother was before beginning treatment; thalidomide taken on the 20th day of pregnancy caused central brain damage, day 21 would damage the eyes, day 22 the ears and face, day 24 the arms, and leg damage would occur if taken up to day 28. Thalidomide did not damage the fetus if taken after 42 days' gestation. So ~280 days for a pregnancy, minu 21-41 still leaves way more than half a year after taking the drug for when death occurred. And I wouldn't say the non-lethal effects are to be dismissed. If you ask me they're way up there for making sure something like that doesn't happen again. The system today (hopefully) is better than back then. And yes, personally I think it's a good thing when the approval process for drugs assumes that "every new molecule should be treated as if it were a prion".
- jdavis703 5y ago
  If I’m reading this correctly, Thalidomide caused damage to fetal tissue, but didn’t actually kill the parent? This is still an awful burden for the parent, but there’s lots of drugs that are known to cause tissue damage during pregnancy. I believe this is why pregnant people are often excluded from clinical trials.
  - tharkun__ 5y ago
    Yes, it didn't kill the parent. You might have missed the part where it killed 40% of the children at or shortly after birth. And yes, that's (one reason) why the recommendations for the Covid vaccine were not given for pregnant women at first. The point wasn't that there are drugs known to be dangerous to pregnant women (mainly the unborn child). The ask was for an approved drug that caused delayed death. There were definitely so many things going wrong w/ that specific drug but it serves as a really good example for why all these precautions are taken and should be taken and any new drug should not be presumed safe but presumed dangerous and proven to not be harmful. The specific time frames and measures can of course be debated to find a good spot on the spectrum and an active pandemic can influence the choices. The discussion was going in the direction of some posters saying we should assume safe first and the Contergan case very clearly shows why assuming safety is the wrong choice.
    - wussboy 5y ago
      I think the ask was actually for an approved drug, taken briefly, that caused a delayed death in the person who was taking it. If we’re going to count prenatal effects, we can come up with thousands of examples. This is why pregnant women are always studied separately.
      - tharkun__ 5y ago
        Let's take that apart: Are there any authorized or approved drugs that are taken over a short-term (say less than a month) that have been shown to cause long-term death? authorized or approved. Check. Contergan was approved and used in 46 countries. Notably in East Germany there are no known cases of this, because "thalidomide was rejected by the Central Committee of Experts for the Drug Traffic in the GDR, and was never approved for use." taken over a short-term (say less than a month) Check. As quoted before, taking Contergan past day 42 didn't harm the fetus and deformities seem to have started on day 21. Less than a month. cause long-term death Check. Over the long term (>6 months) it caused death in 40% of the babies born. Nowhere in there does it say to exclude any drugs than only cause direct death to the taker. Nor do I think should that matter. I do agree that pregnant women are studied separately precisely because the risks there are higher. To quote from the wikipedia article again: The Society of Toxicology of Canada was formed after the effects of thalidomide were made public, focusing on toxicology as a discipline separate from pharmacology. The need for the testing and approval of the toxins in certain pharmaceutical drugs became more important after the disaster.
        wussboy 5y ago
        Sure. But that’s not what they meant. Can you name any drug that, when taken over a short course, has had long term detrimental effects to the person taking it?
        tharkun__ 5y ago
        It's debatable what someone meant or didn't mean, if they don't say it. I tend to go by what someone actually said. Especially on the internet (or writing in general) i.e. people you don't know, whose background you don't know, without intonation etc. There's very little to no information for interpretation. Now you asked a new question. Fair enough. Unlike the previous question, where Contergan immediately jumped to my mind, for your question nothing jumps to mind. But google helped. I think you wanted to ask a different question, more like what I originally answered to, e.g.: Can you name any approved drug that, that when taken over a short course, can over the long term cause the death of the person taking it? You did ask though: Can you name any drug that, when taken over a short course, has had long term detrimental effects to the person taking it? Yes I can, for example: Heroin. https://en.wikipedia.org/wiki/Heroin https://en.wikipedia.org/wiki/Heroin Let's take that apart: name any drug Check. Heroin is a drug. It's even been prescribed as a pain killing opioid. The UK Department of Health's Rolleston Committee Report in 1926 established the British approach to diamorphine prescription to users, which was maintained for the next 40 years: dealers were prosecuted, but doctors could prescribe diamorphine to users when withdrawing. In 1964, the Brain Committee recommended that only selected approved doctors working at approved specialized centres be allowed to prescribe diamorphine and cocaine to users. The law was made more restrictive in 1968. Beginning in the 1970s, the emphasis shifted to abstinence and the use of methadone; currently, only a small number of users in the UK are prescribed diamorphine. taken over a short term Check. Heroin is apparently way up there in addictiveness. After a very short period of time, you will be addicted (even if not like some people claim, after the very first use and regardless of dose or your own addiction susceptibility. However, contrary to Bayer's advertising as a "non-addictive morphine substitute," heroin would soon have one of the highest rates of addiction among its users. Also https://web.archive.org/web/20100213101818/http://www.drugrehabtreatment.com/most-addictive-drugs.html https://web.archive.org/web/20100213101818/http://www.drugre... which curiously notes that nicotine is even more addictive than heroin. I'll not mention nicotine further here though, because the detrimental effect come from the other substances usually taken with it when ingested via tobacco as far as I am aware (tar). long term detrimental effects to the person taking it Check. Detrimental effects of heroin are numerous. And given it's addictive very fast, even side effects that only turn up later, I would definitely include. Common side effects include respiratory depression (decreased breathing), dry mouth, drowsiness, impaired mental function, constipation, and addiction.[12] Side effects of use by injection can include abscesses, infected heart valves, blood-borne infections, and pneumonia.[12] After a history of long-term use, opioid withdrawal symptoms can begin within hours of the last use. Not to mention the constant possibility of overdosing. Meaning death. The ultimate detrimental effect.
- fastaguy88 5y ago
  It is perhaps worth mentioning that our ability to detect compounds that are mutagenic or teratogenic, or are likely to cause developmental abnormalities, has improved dramatically in the past 60 years, as has the stringency of drug testing. I'm not an expert, but I can certainly imagine that some of the animal testing that goes on today before a drug is approved is designed to identify problems in offspring. (The problem with thalidomide was not that its problems could not have been identified even 60 years ago; the problem was that the testing was not done or was suppressed.) So the previous poster's question about drugs given for a short time causing long delayed effects and approved in the last 20 years stands. If a drug is not a mutagen, it is harder to imagine how it could have a long-term effect.
  - tharkun__ 5y ago
    No idea how I missed this for three days, I'm sorry. I absolutely agree that they could have tested for certain things but didn't. It's a product of its time in that sense: One reason for the initially unobserved side effects of the drug and the subsequent approval in West Germany was that at that time drugs did not have to be tested for teratogenic effects. They were tested on rodents only, as was usual at the time (side note, not to start a flame war on that, but this is a prime example of what happens thanks to regulation but not market forces) While a lot has improved in that regard through regulation, one thing that sticks out is how similar some of this is to how things are still happening in much more recent times: While initially considered safe, the drug was responsible for teratogenic deformities in children born after their mothers used it during pregnancies, prior to the third trimester. In November 1961, thalidomide was taken off the market due to massive pressure from the press and public Purdue pharma and Oxycontin come to mind. I wasn't even aware of this one until I just tried to find something else I vaguely remembered for you via a quick Google: https://www.reuters.com/investigates/special-report/usa-courts-secrecy-propecia/ https://www.reuters.com/investigates/special-report/usa-cour... I doubly apply to medications that can potentially eff your one body/mind you have up for good what I practice in software development and try to teach my teams: assumptions make an ass out of you and me. If a drug is not a mutagen, it is harder to imagine how it could have a long-term effect. Harder, sure. I'm not a doctor, pharmacologist or anything like that. But I doubt that somehow doctors, pharmacologists, chemists et al are somehow immune to making assumptions. Test the hell out of this stuff. Check the "impossible" things and sometimes you will find that the "impossible" really just wasn't impossible, we just didn't think of something or didn't know about it yet. It's why general regression testing in an area can very easily find bugs. "But that's impossible, how's that related?" Well, I also can't tell you, it doesn't make immediate sense to me either but you will surely find out once you start debugging this and figure out how you broke that other downstream system, two steps removed from your change.
- darthvoldemort 5y ago
  The biggest problem with Thalidomide is that THALIDOMIDE IS PERFECTLY SAFE for the fetus! But the molecule has 2 different shapes, one being the mirror image of the other. All testing was done using the correct version, but during the MANUFACTURING PROCESS, the mirror image was created, and that's what caused all the problems! There are many many ways that problems can occur. The fact that one configuration of a molecule is safe and effective and the other configuration of that same molecule causes disastrous effects is just another example of how thorough testing is necessary when drugs are given to millions of people. How many people either died or were deformed because of lack of testing? When drug companies skip the necessary testing because they know they can make billions upon billions, they aren't doing it because it keeps people safe. They love it because it makes things cheaper for them. I have a friend that works at Gilead and runs clinical trials. He is shocked at how quickly the vaccine was approved for EUA, because his trials take years upon years. I'm not saying that the vaccines aren't safe, but I am saying that the more drugs we let skirt through the full testing period, the worse it is for all of us. Look at remdesivir. It was approved from a single trial that showed lukewarm results and at the cost of thousands per dose. And now the empirical evidence is that it either does nothing, or might actually be harmful.
  - tptacek 5y ago
    This "how did the vaccines get approved so quickly" thing has to be one of the most asked- and- answered questions of the entire pandemic. The basic delivery platform for the vaccines had already been in human trials before the pandemic. We've also been doing rapid development of vaccines for many, many years to combat things like influenza. Coronaviruses had already been well studied, and we had dry-runs for vaccine design with SARS and MERS. You can just do a Google search to read about 1,000 articles about how the vaccines got approved as quickly as they did. You don't need to ask your friend who works at Gilead. Not for nothing: their clinical trials would probably go a lot faster with a global pandemic lighting a fire under them. We've administered these vaccines to almost four billion people. "COVID vaccines are dangerous" has become an extraordinary claim, demanding extraordinary evidence. There are people who sincerely believe that aspirin is dangerous, and yeast, and "mycotoxins" on coffee beans, and on and on. We're not required to take these arguments seriously on faith.

tharkun__ 5y ago

This immediately jumped to mind (Contergan): https://en.wikipedia.org/wiki/Thalidomide_scandal https://en.wikipedia.org/wiki/Thalidomide_scandal The total number of people affected by the use of thalidomide during the mother's pregnancy is estimated at more than 10,000, of whom approximately 40 percent died at or shortly after the time of birth. Those who survived had limb, eye, urinary tract, and heart defects [...] The severity and location of the deformities depended on how many days into the pregnancy the mother was before beginning treatment; thalidomide taken on the 20th day of pregnancy caused central brain damage, day 21 would damage the eyes, day 22 the ears and face, day 24 the arms, and leg damage would occur if taken up to day 28. Thalidomide did not damage the fetus if taken after 42 days' gestation. So ~280 days for a pregnancy, minu 21-41 still leaves way more than half a year after taking the drug for when death occurred. And I wouldn't say the non-lethal effects are to be dismissed. If you ask me they're way up there for making sure something like that doesn't happen again. The system today (hopefully) is better than back then. And yes, personally I think it's a good thing when the approval process for drugs assumes that "every new molecule should be treated as if it were a prion".

jdavis703 5y ago
If I’m reading this correctly, Thalidomide caused damage to fetal tissue, but didn’t actually kill the parent? This is still an awful burden for the parent, but there’s lots of drugs that are known to cause tissue damage during pregnancy. I believe this is why pregnant people are often excluded from clinical trials.
- tharkun__ 5y ago
  Yes, it didn't kill the parent. You might have missed the part where it killed 40% of the children at or shortly after birth. And yes, that's (one reason) why the recommendations for the Covid vaccine were not given for pregnant women at first. The point wasn't that there are drugs known to be dangerous to pregnant women (mainly the unborn child). The ask was for an approved drug that caused delayed death. There were definitely so many things going wrong w/ that specific drug but it serves as a really good example for why all these precautions are taken and should be taken and any new drug should not be presumed safe but presumed dangerous and proven to not be harmful. The specific time frames and measures can of course be debated to find a good spot on the spectrum and an active pandemic can influence the choices. The discussion was going in the direction of some posters saying we should assume safe first and the Contergan case very clearly shows why assuming safety is the wrong choice.
  - wussboy 5y ago
    I think the ask was actually for an approved drug, taken briefly, that caused a delayed death in the person who was taking it. If we’re going to count prenatal effects, we can come up with thousands of examples. This is why pregnant women are always studied separately.
    - tharkun__ 5y ago
      Let's take that apart: Are there any authorized or approved drugs that are taken over a short-term (say less than a month) that have been shown to cause long-term death? authorized or approved. Check. Contergan was approved and used in 46 countries. Notably in East Germany there are no known cases of this, because "thalidomide was rejected by the Central Committee of Experts for the Drug Traffic in the GDR, and was never approved for use." taken over a short-term (say less than a month) Check. As quoted before, taking Contergan past day 42 didn't harm the fetus and deformities seem to have started on day 21. Less than a month. cause long-term death Check. Over the long term (>6 months) it caused death in 40% of the babies born. Nowhere in there does it say to exclude any drugs than only cause direct death to the taker. Nor do I think should that matter. I do agree that pregnant women are studied separately precisely because the risks there are higher. To quote from the wikipedia article again: The Society of Toxicology of Canada was formed after the effects of thalidomide were made public, focusing on toxicology as a discipline separate from pharmacology. The need for the testing and approval of the toxins in certain pharmaceutical drugs became more important after the disaster.
      - wussboy 5y ago
        Sure. But that’s not what they meant. Can you name any drug that, when taken over a short course, has had long term detrimental effects to the person taking it?
        tharkun__ 5y ago
        It's debatable what someone meant or didn't mean, if they don't say it. I tend to go by what someone actually said. Especially on the internet (or writing in general) i.e. people you don't know, whose background you don't know, without intonation etc. There's very little to no information for interpretation. Now you asked a new question. Fair enough. Unlike the previous question, where Contergan immediately jumped to my mind, for your question nothing jumps to mind. But google helped. I think you wanted to ask a different question, more like what I originally answered to, e.g.: Can you name any approved drug that, that when taken over a short course, can over the long term cause the death of the person taking it? You did ask though: Can you name any drug that, when taken over a short course, has had long term detrimental effects to the person taking it? Yes I can, for example: Heroin. https://en.wikipedia.org/wiki/Heroin https://en.wikipedia.org/wiki/Heroin Let's take that apart: name any drug Check. Heroin is a drug. It's even been prescribed as a pain killing opioid. The UK Department of Health's Rolleston Committee Report in 1926 established the British approach to diamorphine prescription to users, which was maintained for the next 40 years: dealers were prosecuted, but doctors could prescribe diamorphine to users when withdrawing. In 1964, the Brain Committee recommended that only selected approved doctors working at approved specialized centres be allowed to prescribe diamorphine and cocaine to users. The law was made more restrictive in 1968. Beginning in the 1970s, the emphasis shifted to abstinence and the use of methadone; currently, only a small number of users in the UK are prescribed diamorphine. taken over a short term Check. Heroin is apparently way up there in addictiveness. After a very short period of time, you will be addicted (even if not like some people claim, after the very first use and regardless of dose or your own addiction susceptibility. However, contrary to Bayer's advertising as a "non-addictive morphine substitute," heroin would soon have one of the highest rates of addiction among its users. Also https://web.archive.org/web/20100213101818/http://www.drugrehabtreatment.com/most-addictive-drugs.html https://web.archive.org/web/20100213101818/http://www.drugre... which curiously notes that nicotine is even more addictive than heroin. I'll not mention nicotine further here though, because the detrimental effect come from the other substances usually taken with it when ingested via tobacco as far as I am aware (tar). long term detrimental effects to the person taking it Check. Detrimental effects of heroin are numerous. And given it's addictive very fast, even side effects that only turn up later, I would definitely include. Common side effects include respiratory depression (decreased breathing), dry mouth, drowsiness, impaired mental function, constipation, and addiction.[12] Side effects of use by injection can include abscesses, infected heart valves, blood-borne infections, and pneumonia.[12] After a history of long-term use, opioid withdrawal symptoms can begin within hours of the last use. Not to mention the constant possibility of overdosing. Meaning death. The ultimate detrimental effect.
fastaguy88 5y ago
It is perhaps worth mentioning that our ability to detect compounds that are mutagenic or teratogenic, or are likely to cause developmental abnormalities, has improved dramatically in the past 60 years, as has the stringency of drug testing. I'm not an expert, but I can certainly imagine that some of the animal testing that goes on today before a drug is approved is designed to identify problems in offspring. (The problem with thalidomide was not that its problems could not have been identified even 60 years ago; the problem was that the testing was not done or was suppressed.) So the previous poster's question about drugs given for a short time causing long delayed effects and approved in the last 20 years stands. If a drug is not a mutagen, it is harder to imagine how it could have a long-term effect.
- tharkun__ 5y ago
  No idea how I missed this for three days, I'm sorry. I absolutely agree that they could have tested for certain things but didn't. It's a product of its time in that sense: One reason for the initially unobserved side effects of the drug and the subsequent approval in West Germany was that at that time drugs did not have to be tested for teratogenic effects. They were tested on rodents only, as was usual at the time (side note, not to start a flame war on that, but this is a prime example of what happens thanks to regulation but not market forces) While a lot has improved in that regard through regulation, one thing that sticks out is how similar some of this is to how things are still happening in much more recent times: While initially considered safe, the drug was responsible for teratogenic deformities in children born after their mothers used it during pregnancies, prior to the third trimester. In November 1961, thalidomide was taken off the market due to massive pressure from the press and public Purdue pharma and Oxycontin come to mind. I wasn't even aware of this one until I just tried to find something else I vaguely remembered for you via a quick Google: https://www.reuters.com/investigates/special-report/usa-courts-secrecy-propecia/ https://www.reuters.com/investigates/special-report/usa-cour... I doubly apply to medications that can potentially eff your one body/mind you have up for good what I practice in software development and try to teach my teams: assumptions make an ass out of you and me. If a drug is not a mutagen, it is harder to imagine how it could have a long-term effect. Harder, sure. I'm not a doctor, pharmacologist or anything like that. But I doubt that somehow doctors, pharmacologists, chemists et al are somehow immune to making assumptions. Test the hell out of this stuff. Check the "impossible" things and sometimes you will find that the "impossible" really just wasn't impossible, we just didn't think of something or didn't know about it yet. It's why general regression testing in an area can very easily find bugs. "But that's impossible, how's that related?" Well, I also can't tell you, it doesn't make immediate sense to me either but you will surely find out once you start debugging this and figure out how you broke that other downstream system, two steps removed from your change.
darthvoldemort 5y ago
The biggest problem with Thalidomide is that THALIDOMIDE IS PERFECTLY SAFE for the fetus! But the molecule has 2 different shapes, one being the mirror image of the other. All testing was done using the correct version, but during the MANUFACTURING PROCESS, the mirror image was created, and that's what caused all the problems! There are many many ways that problems can occur. The fact that one configuration of a molecule is safe and effective and the other configuration of that same molecule causes disastrous effects is just another example of how thorough testing is necessary when drugs are given to millions of people. How many people either died or were deformed because of lack of testing? When drug companies skip the necessary testing because they know they can make billions upon billions, they aren't doing it because it keeps people safe. They love it because it makes things cheaper for them. I have a friend that works at Gilead and runs clinical trials. He is shocked at how quickly the vaccine was approved for EUA, because his trials take years upon years. I'm not saying that the vaccines aren't safe, but I am saying that the more drugs we let skirt through the full testing period, the worse it is for all of us. Look at remdesivir. It was approved from a single trial that showed lukewarm results and at the cost of thousands per dose. And now the empirical evidence is that it either does nothing, or might actually be harmful.
- tptacek 5y ago
  This "how did the vaccines get approved so quickly" thing has to be one of the most asked- and- answered questions of the entire pandemic. The basic delivery platform for the vaccines had already been in human trials before the pandemic. We've also been doing rapid development of vaccines for many, many years to combat things like influenza. Coronaviruses had already been well studied, and we had dry-runs for vaccine design with SARS and MERS. You can just do a Google search to read about 1,000 articles about how the vaccines got approved as quickly as they did. You don't need to ask your friend who works at Gilead. Not for nothing: their clinical trials would probably go a lot faster with a global pandemic lighting a fire under them. We've administered these vaccines to almost four billion people. "COVID vaccines are dangerous" has become an extraordinary claim, demanding extraordinary evidence. There are people who sincerely believe that aspirin is dangerous, and yeast, and "mycotoxins" on coffee beans, and on and on. We're not required to take these arguments seriously on faith.