Shouldna Taken That Shot

It was a heady time to be a scientist.  Albert Einstein was still alive, and his special and general theories of relativity changed our understanding of the universe.  Quantum physics predicted space travel and limitless energy.  We had a brand-new theory of gravity, of space-time, of waves and particles, and of the atom.  Vaccines had nearly wiped smallpox off the earth.  We had penicillin, saving many lives and limbs.  Science, it seemed, could conquer all.  So, when your doctor said you needed a shot to prevent a miscarriage, you took an injection without question.

DES (diethylstilbestrol) is a synthetic estrogen created by Sir Charles Dodd in 1938.  Cheap and easy to produce, pharmaceutical companies marketed DES for prevention of menopause symptoms in women.  In 1947, the FDA approved DES for use to prevent miscarriages, and such use was advocated by an article published in the American Journal of Obstetrics and Gynecology.  American obstetricians enthusiastically embraced the new drug as a cure for one of the most unhappy outcomes in their profession.  Although some physicians questioned its effectiveness, DES continued to be commonly prescribed in the United States to women with threatened miscarriages until 1971.  

That’s when a bombshell was published in the New England Journal of Medicine.  The daughters of women who received DES during pregnancy had an unignorably high rate of clear cell adenocarcinoma of the vagina, an extremely rare tumor in women whose mothers had not received DES. That’s right—a drug manufactured and sold in the United States, approved by the FDA, prescribed as intended by licensed physicians—caused a rare cancer in young women.  And not just clear cell adenocarcinoma.  The daughters of women who received DES during pregnancy have higher rates of breast cancer, abnormal cells on their pap smears, anatomic defects in their reproductive organs, trouble getting pregnant, and problems during pregnancy.  And not just the daughters—the sons too have increased rates of benign tumors and structural defects in their reproductive organs.  Even the mothers are affected.  Women who received DES during pregnancy have an increased risk of breast cancer.  Does it stop there?  Research is currently ongoing on the third generation, the grandchildren of women who received DES during pregnancy.

Although it’s not a story my profession likes to tell, the lessons of the DES tragedy must never be lost.  Before we accept the opinions of experts, we must be mindful of the limitations of science.  Before we are swept along with the crowd, we must recognize the possibility of unintended consequences.  Before we act on conventional wisdom, we must think; think with our own brains, and make up our own minds.  We must ask questions, critically examine data, and make judgements by what we know from experience.  We must all be scientists now.