Introduction - Uppsala Monitoring Centre

Persistence of drugs
As explained above some drugs continue to be used for very specific purposes
despite having ADRs that should otherwise exclude their use. Again this is seen
with venesection which has persisted for the removal of a specific blood constituent
such as: primary haemochromatosis (ferritin), polycythaemia (haemoglobin) and
porphyria cutanea tarda (ferritin). Of the 50 drugs dealt with in this chapter the
following are still used for specific indications:
Thalidomide – leprosy and other skin diseases, multiple myeloma and
myelodysplastic syndromes
Mercury (Thiomersal) – vaccine antiseptic
Antimony – leishmaniasis (pentavalent antimonials)
Arsenic – trypanosomiasis (trivalent arsenic) and dermatitis
herpetiformis (Fowler’s solution)
Bismuth – peptic ulceration (tripotassium dicitrato bismuthate)
Urethane – animal anaesthetic
Phenobarbitone – epilepsy
Oxyphenisatin – enema
Stilboestrol – hormonal-dependant cancer
Chloramphenicol – eye ointment.
Panaceas
Named after the daughter of Aesculapius and similar to the Greek word ‘panakeia’ with
‘pan’ meaning ‘all’ and ‘akos’ cure, a universal remedy, which cannot exist. The
panacea in 1916, seems to have been potassium iodide as it was used for: syphilis,
yaws, gonorrhoea, leprosy, gout, chronic rheumatism, rheumatoid arthritis, hepatic
cirrhosis, amyloid liver, pericarditis, myocardial disease, arterio-sclerosis, aneurism of
the thoracic aorta, acute bronchitis, asthma, disseminated sclerosis and goitre. Most of
the known active drugs were used for diseases other than their main indication. e.g.
chloroform for angina pectoris, hydrophobia, laryngitis stridulosa, asthma, epilepsy and
infantile convulsions. Other panaceas were: bleeding, mercury, antimony, quinine, gold
and digitalis (Ackerknecht, 1973). Since the drugs had no benefit to the patient, unless
they had the specific disease which it might heal, any adverse effects were not
balanced by the chance of benefit.
The strength of the evidence that an adverse event was caused by a
drug
The evidence varies from the weak case reports (1) to the strong randomised