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Diethylsilbestrol (DES): damage after 30 years

DES, a drug at the centre of a very serious mass medical error, should be held up as an example to prevent similar medical errors continuing for so many years.

The September issue of la revue Prescrire revisits the history of diethylstilbestrol (DES), a drug prescribed to pregnant women in France between 1948 and 1981. The effects of the damage it caused are still being felt today. In 1946, researchers in the USA published findings demonstrating their success in reducing the frequency of some pregnancy complications by administering DES to pregnant women. As early as 1947, studies failed to corroborate these results; a 1953 study shows on the contrary a greater number of complications during pregnancy. And yet, the use of DES continued to be recommended by universities and health authorities.

In 1971, the link was established between the use of DES during pregnancy and the occurrence of vaginal cancers in women born of these pregnancies (in 1 out of 1,000 to 10,000). In 1977, it was proved that DES was the cause of abnormalities of the uterus in these women. DES also affects their obstetrical future, which requires specific gynaecological and obstetrical monitoring.

DES was contra-indicated in the USA in 1971, i.e. 6 years earlier than in France. Altogether, 160,000 women were exposed to the risk in France.

La revue Prescrire believes the example of DES should still be held up as a warning against the consequences of insufficient evaluation before commercialisation of a drug, and against not reacting swiftly enough to adverse effects.

©Prescrire September 2007

Source: Diéthylstilbestrol (DES) : des dommages trente ans plus tard" Rev Prescrire 2007 ; 27 (287) : 700-702.

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