Letter: Use of drugs and their effects on leprosy patients.

Looking back on the Tenth International Leprosy Congress in Bergen in August, I would like to say it was an interesting and useful time. But , I have a comment to make which I think ought to be said ; if there had been time, I would have commented on it during the discussion periods at the congress. It should be remembered that medical and paramedi ca l workers have on the whole upheld a strict ethical code when dea ling with patients, one point being not to do the patient any harm. In the zeal for research and experiment into drugs and their effects on the patient , the patient' s welfare and good should always be the first consideration, and it would be a grave indictment if this were not so. Therefore, I would draw attention to at least two examples where this consideration appeared to be absent. I. In one drug trial where comparisons were made with two drugs used on patients with chronic neuriti s, one group having dapso ne 50 mg daily with prednisolone, the other Lamprene, with or without prednisolone. As it has been proven already that high doses of dapsone precipitate or worsen neuriti s, was it ethical to give these patients already s uffering from neuritis 50 mg of dapsone daily , even though accompanied by prednisolone, just to show that Lamprene was superior to dapsone in treating leprosy with neuritic complications. It would seem that the first patients were in grave ri sk of further nerve damage. 2. In the pa per read on drug trials with tha lidomide for reaction in leprosy, figures and information had been collected and collated from over 150 hospital s or institutions in different part s of the world, a nd shown on a cha rt. It was therefore alarming to see and hear that in II of these places using thalidomide, that it was given to women of childbearing age without any contraceptives being also given; a nd in others the contraceptives were given sometimes but not always with the thalidomide. If these patients had known the possi ble effects on the growing foetus had they become pregnant, would these women and their husbands have consented to take this drug? Was advantage taken of patients not knowing what they were being given, and of possible ill effects? As a great many patients in developing countries of the world a re ignorant of drugs and their side-effects, it is likely they did not know. T herefore. I protost strongly against drug trials done without proper precautions and such unethical procedures as outlined in the two examples above.