The redemption of thalidomide: standardizing the risk of birth defects.

In this paper we examine how a standardized drug distribution system contributed to a therapeutic and symbolic make-over of thalidomide. In the 1960s, thalidomide was seen as a horror drug that caused severe birth defects among over 10,000 babies who were exposed to it in utero. Currently, thalidomide is viewed as a potentially life-saving drug which is being distributed in the USA. We discuss this transformation from a social worlds perspective, showing how the standardized drug distribution system normalized the risk of foetal birth defects, while preserving the autonomy of health care professionals. The distribution system accomplished this transformation by focusing on the risk associated with female reproductive behavior, and by providing close reproductive surveillance of female patients. This standardized system solidified social inequalities and professional power relationships, revealing assumptions about trust, responsibility and risk.