Douglas on Diethylstilbestrol (DES)
Sep 14, 2011 by Matthew J. Brown
From Tom Boyett, an auditor to the class who practice as an OB-GYN for 40+ years.
One thing that we did not have time for in class last week was Douglas’ 3-4 page illustration of errors in methodology using diethylstilbestrol (DES) as an example. Interestingly, although her points were excellently made, some of the facts were not exactly correct. The real disaster was that in the early 1960s OB doctors were using DES in very early pregnancy when a person had previously experienced a miscarriage totally incorrectly, without studies, thinking that if it were a cheap form of estrogen, perhaps it would prevent miscarriage from recurring. Not only was that a false premise…but the big disaster…when these babies who were exposed in utero got to be in their teens, there was a literal epidemic of a previously rare but often fatal cancer of the cervix & vagina called “clear cell carcinoma”. Treatment was to remove the vagina, cervix and uterus. Many, many died…many more mutilated surgically to save their lives because their mothers had been given DES. In those who did not get cancer including men, there were structural abnormalities causing infertility etc. Fortunately, I myself never prescribed DES but did have several patients with clear cell carcinoma and many more who were infertile because of DES exposure.
Interestingly, at this time and in this place (right now) we are doing the same thing again using a synthetic progesterone (a female hormone) to reduce repeated premature deliveries even thought recent studies have shown conclusively that it doesn’t work. It is still being prescribed if a patient had a premature delivery, then used the progesterone next pregnancy and carried further or to term (anecdotal evidence at its worse). It is hard to not give it again in the third pregnancy because she thought it worked, some doctors are not following the current literature and the FDA while clearly curtailing the indications has not banned its use entirely possibly because of public backlash knowing that in a few years its use will die of attrition. There are those of us who keep saying, “Remember DES.” We will see if 15 years or so if yet another disaster occurs…of course, hoping not, this fits so well with the topic last night of “no benefit…terrible risk” yet use it anyhow!!!!!! I thought that the class would be enlightened about the cancers of DES and possibly also to clearly see that the things we are discussing are more than theoretical…in this case, it was and may be again a matter of the terrible deaths and disfigurements of thousands of young women due to faulty reasoning, oversight, using unacceptable value judgments etc.