On any reasonable interpretation, 1961 was a truly disgraceful year for Grünenthal. In the face of an avalanche of warning signs, it fought furiously on multiple fronts to defend thalidomide. The fight was so excessive and so appalling that it later landed some of the company’s most senior executives and scientists in court on criminal charges, including negligent manslaughter.
The year began with Grünenthal dreaming of vast riches through US sales of thalidomide. Just twelve months later that dream had vanished, the drug permanently etched in history as the cause of an unprecedented epidemic of infant death and injury. In November 1961 Grünenthal grudgingly withdrew the drug from sale—a move forced on the company by German paediatrician Widukind Lenz, who had finally connected the rocketing number of seriously malformed German babies to Grünenthal’s super-safe sleeping pill. But, as the documents in Düsseldorf and elsewhere illuminate, the drug should have been withdrawn long before Lenz arrived on the scene.
In January 1961 two Grünenthal executives travelled to East Berlin to try to arrange for the sale of thalidomide products in the communist east. Crossing from east to west was still relatively easy—the Berlin Wall would not go up until later that year—but the trip was a failure. The East German health authorities refused point blank to allow the sale of thalidomide: it was not a vital drug, and the reports of nerve damage demonstrated it was not as harmless as claimed. And there was another factor: the East Germans believed that the chemical structure of the thalidomide compound ‘might [cause] unexpected effects when taken long-term’.
The East Germans were very wise. Across the border the drug was exacting a heavy toll. In April 1961 Grünenthal learned that one thalidomide victim had finished up in a psychiatric hospital after being tormented by severe nerve damage. Grünenthal was also nursing a belief that rival drug companies were collecting nerve-injury cases and using them to damage thalidomide sales. A private detective named Ernst Jahnke was hired and told to investigate thalidomide critics. The detective enthusiastically got to work, using a pretext to check visitor books at rival pharmaceutical manufacturer Bayer. Bingo! He reported to Grünenthal that a number of Contergan critics, including the neurologist Voss, had visited Bayer. The detective began planning checks at Merck, Ciba and Schering. In March 1961, Jahnke told Grünenthal he was eighty-five per cent certain that Bayer was behind the campaign against Contergan. It is hard not to see this nonsensical conspiracy theory as a farce. Later, even Grünenthal’s private eye reported that doctor anger, not commercial envy, was driving the campaign against thalidomide.
During this whole period, the fact that Contergan was freely available over the counter was a boon for sales. Grünenthal regularly—in private—discussed means of preventing a prescription requirement being forced on the drug. And it was not until the German spring of 1961, amid increasing complaints about the unrestricted sale and damaging side effects, that Grünenthal began desultory efforts to have Contergan put on prescription.
The company moved slowly and grudgingly towards regulation, knowing that sales could only suffer. As one observer later put it, Grünenthal wanted to appear ‘conscientious without losing its profitable market share’.
Meanwhile, Grünenthal’s public relations efforts continued. A February 1961 company report stated that efforts to ‘delay and [make] changes to negative publications about Contergan have continued very intensively’. In March 1961 Grünenthal learned that an influential physician in Bonn had banned the use of Contergan at his clinic. ‘The situation is serious, as the Contergan ban will certainly spread,’ the internal Grünenthal report concluded.
As the nerve-damage toll grew, so too did the queries over thalidomide and pregnancy. In the United States in February 1961, a scientist at one of Grünenthal’s licence partners, the US firm Richardson-Merrell, had what would turn out to be a grimly ironic idea: maybe thalidomide could stop women miscarrying their babies. The scientist wrote that thalidomide’s sedative effect might calm women who became ‘emotional about their pregnancies’ and miscarried as a consequence. These ‘habitual aborters’ could be another lucrative market for the drug. If that were the case, the scientist continued, the drug had to be further evaluated and ‘studies in pregnant rats, etc need all to be considered’.
Marketing thalidomide to pregnant women wanting to preserve their babies was in hindsight not the greatest idea of the century, but the call for studies in pregnant rats was sensible. A memo was sent to Grünenthal with a query: ‘Do you have any kind of experiences with Contergan in women who have suffered repeated premature pregnancy losses?’
Grünenthal considered the matter. It knew that pregnant women were being given thalidomide. It knew it had not done ‘studies in pregnant rats, etc’ or any other checks in pregnancy. On 23 March 1961, Grünenthal responded that it had no information on Contergan and pregnancy or whether the drug reached the foetus. ‘Animal experiments on the question of the transfer of Contergan to the foetus are perhaps very useful, although, based on everything we know from animal experiments to date, we do not wish to assume that there is any impact on the foetus.’
Here was the Grünenthal team forced to confront the issue of what thalidomide might do to a foetus. Grünenthal’s conclusion? We don’t know and we are not making any assumptions.
Not everyone was as uninterested. In March 1961 Professor Fritz Kemper of Münster University asked Grünenthal for some thalidomide for animal experiments. By October 1961 Kemper had concluded that thalidomide interfered in the sexual function of chicks by blocking their absorption of folic acid. He thought that if thalidomide had that effect in humans it might explain the nerve damage, as one known cause of nerve damage was drugs that inhibited vitamin absorption. Kemper discussed his work with Grünenthal and then began work on the effect of thalidomide on the foetus, using chick eggs for his experiments. Kemper found malformed chick embryos, though this finding was made after the drug had been withdrawn from sale in November 1961. Grünenthal, defending the criminal prosecution, dismissed Kemper’s chick malformations as irrelevant. Many safe drugs, it asserted, given in similar massive doses would also have caused malformations.
Yet Kemper’s work is important because that exact train of inquiry was open to Grünenthal at any time. As the archive documents demonstrated, its staff—like Kemper—had independently suspected that thalidomide might have a vitamin-blocking effect, and vitamin deficiencies were a known cause of birth defects.
Some basic medical concepts appeared foreign to Grünenthal, including the fact that thalidomide would certainly pass the placenta and reach the foetus. As other scientists at the time knew, molecules with a molecular weight of less than 1000 were believed to pass the placental barrier and reach the foetus. Thalidomide has a molecular weight of 258, meaning, as one scientist later testified, that it was ‘obvious’ thalidomide would reach the foetus. But when a gynaecologist questioned Grünenthal about this in July 1961, the response was that there ‘is no indication that Contergan crosses the [placental] barrier to the foetus’. (In preparation for the later criminal trial the Grünenthal men changed tack and claimed they had always known thalidomide would reach the foetus, and that any earlier statement to the contrary was a misunderstanding.) On 14 July 1961 Heinrich Mückter, belatedly and only briefly, appeared to see the thalidomide debacle for what it was. ‘If I were a physician, I could not now prescribe Contergan,’ he told colleagues.
In the same month, July 1961, far away in Australia Wendy Rowe had begun taking the thalidomide tablets that would render her unborn daughter limbless.
Consider Grünenthal’s position at this point: the torrent of severe nerve injuries, the questions about malformations and pregnancy, the protests by doctors, the company’s professed ignorance about what effect the drug might have on a foetus, the lack of pregnancy testing. Why on earth was the drug still on the market?
And what might Wendy Rowe have thought if she’d known of the sobering news sent to Grünenthal bosses by Arthur Tachezy (the sales rep who had mocked psychiatric patients as idiots)? In May 1961 Tachezy told his superiors that even Grünenthal employees were now refusing to use thalidomide drugs. ‘[A] very real fear of side effects has set in which has even led to a rejection of the product when it comes to use within [staff] families.’
Obviously Wendy Rowe would have been concerned had she known about this, and even more so had she known the full story of the escalating German thalidomide debacle. Many others might have been concerned too, including Wendy’s doctor—any doctor—health authorities and Grünenthal’s licence partners. The problem was that only Grünenthal was in full possession of the facts, and it was not budging. In fact Grünenthal was doing its best to keep the true story under wraps. Worse, thalidomide was still being promoted around the world as an exceptionally safe medication.
In late June 1961, at almost exactly the same moment Wendy Rowe was taking her thalidomide pills, Inge Eisenberg took her baby boy to a doctor in Cologne, Germany. Joachim was sleeping badly and was becoming agitated. The doctor recommended Contergan Saft, the liquid version of thalidomide intended especially for children. And take some yourself, the doctor told Inge, it will help you sleep.
Inge Eisenberg took just one teaspoon. It made her feel numb and sick, and her husband Hans poured the rest of the bottle down the toilet. Eisenberg did not know she was newly pregnant with her second child but that solitary teaspoon of Contergan Saft was enough to severely damage the embryo inside her. Eight months later, in February 1962, Monika Eisenberg was born. Her left arm was short and her left hand had four fingers and no thumb. Her right hand had five fingers but no thumb. Both hips were profoundly damaged, making it impossible for Monika to crawl or walk as a baby. Her shoulders and back were also malformed.
In late 2012 I spent a day with Monika Eisenberg in Aachen, home to Grünenthal’s global headquarters. Eisenberg, known to her friends and family as Moni, lived in Belgium just across the border from Aachen, and was deeply engaged in thalidomide activism. She met her husband Rainer when he volunteered to help at a hunger strike by thalidomide survivors. Eisenberg’s brother Joachim married another of Germany’s several thousand survivors of the drug. When Moni and Rainer offered to give me a tour of Grünenthal’s local history, I accepted gratefully.
On the outskirts of Aachen, we found Grünenthal’s bright, shining corporate offices and production facilities. These replaced Grünenthal’s headquarters during the thalidomide era, a decaying gothic complex nearby. Visiting the modern factory, we found bright pink banners bearing the English words ‘Made in Grünenthal—Successful in the World’. Eisenberg, whose warmth and easygoing manner can give way to outrage and disgust when Grünenthal enters the conversation, suggested I photograph her in front of the banner. ‘After all, I’m made by Grünenthal, or at least parts of me are. And I hope I’ve been successful in the world.’
Moni and Rainer also drove me to Stolberg, just east of Aachen, where we walked around the attractive but economically depressed town. The old Grünenthal factory, spectacularly grim and foreboding, looks like a deserted movie set. Not far away, the Wirtz family’s imposing stone compound, where some members of the founding Grünenthal family still live, warrants its own tourism plaque installed by the local authority. When we visited there was no security in sight, but Eisenberg has often been asked to move on when showing other guests around.
Close by is the Stolberg library, where a statue of a thalidomide survivor stands in the foyer. It was at the unveiling of the statue in 2012 that Grünenthal chief executive Harald Stock offered his ‘apology’. Eisenberg was in Greece and was surprised and pleased when she heard about the apology. But then she found the text of Stock’s comments on the internet. ‘It was pure bullshit. Grünenthal was sorry for being quiet, for being in shock. Grünenthal didn’t express any remorse or apologise properly,’ Eisenberg said. ‘Anyway I don’t want an apology. What I really want is revenge. Grünenthal damaged my body, damaged my family, damaged thousands of others and killed thousands of babies. We survivors live with pain. Pain in our bodies and pain in our souls.’
Like many mothers of thalidomiders, Inge Eisenberg was traumatised and shocked by her daughter’s birth. ‘The birth is usually a special moment of bonding,’ Moni Eisenberg said. ‘Mother Nature does everything to create a strong connection. But my mother and many other mothers could not feel it. My mother was in complete shock. She was functional but numb and it took her a few months until she could even talk about the situation.’
Because there were so many thalidomide children in Germany, all close to the same age, special facilities were established and Moni Eisenberg was able to receive medical attention and therapy during the school day. Later she trained as a teacher and then also as a family therapist and social worker. Years of treatment and therapy allow her to walk well, although not without pain. When I visited she was commuting weekly between her home in Belgium and her job as a social worker in Cologne.
In about 1972, when she was ten years old, Eisenberg began receiving an annual payment from the compensation fund established by the German Government and Grünenthal. ‘It was a pittance. Almost useless.’ In 2013, the German Government put more money into the fund, substantially raising the pensions. ‘It’s better now but still not enough,’ Eisenberg said.
Grünenthal didn’t contribute a single euro to the new pensions. Instead Grünenthal has set up its own fund which they say is for one-off special needs. So if you need an electric toothbrush because your arms don’t work you can go to Grünenthal and fill in forms and beg—that’s what I call it, begging—and if you’re successful they’ll give you an electric toothbrush.
Eisenberg’s scorn is complete. ‘Grünenthal is rich and so is the Wirtz family. They should put more money into pensions for the people their precious drug maimed. Not toothbrushes.’
Eisenberg has spent some time at the Düsseldorf archive looking at Grünenthal’s internal documents and is appalled at what she read. ‘It did not have to happen to me or many others. All the nerve damage was bad enough. But then there were people telling Grünenthal about the damage to babies.’
A few years ago Eisenberg made contact with the son of Heinrich Mückter, the Grünenthal doctor who was paid a percentage of thalidomide sales and was charged with criminal offences over his thalidomide conduct. Mückter’s son, Harald, was a highly regarded toxicologist at a leading German research institute. ‘We met three or four times, and kept in contact via email afterwards,’ Eisenberg said. The meetings were emotionally charged for both of them, and Eisenberg and Mückter agreed to keep the content of their discussions private. ‘But it was a good experience for me. I have always felt anger at Heinrich Mückter [who died in 1987] because as much as anyone he was responsible for the way I was born. But his son Harald Mückter is a very nice man, extraordinarily nice, very decent. It was a good experience for me, to meet him and find him so supportive.’
These days, when Eisenberg hears about the death of a German thalidomider she takes flowers to Grünenthal’s front gate. ‘The security guards recognise me, and at first the flowers were removed straight away. But the last time a security man gave me water for the flowers.’ Eisenberg makes these flower trips in part to ‘shame Grünenthal at their home, in public’, she says.
They have to know we are still here and the public has to know that too. People are scared of Grünenthal, especially journalists, and that’s why there’s not much said in Germany about Grünenthal’s treatment of us or the way they handled the drug. When I was a child I was scared too. But now I’m just furious. If Grünenthal can get away with how they have acted in the case of Contergan then there are really no boundaries between right and wrong.
Grünenthal’s determination to protect its drug in 1961 meant that something or someone extraordinary was going to have to intervene. And that intervention, by the extraordinary German doctor Widukind Lenz, was still five months away when Wendy Rowe and Inge Eisenberg were unwittingly exposing their babies to Grünenthal’s poison. In the months afterwards, as Grünenthal proceeded on its grim and determined way, several thousand German babies and many others around the world joined the death and malformation toll.
On 5 July 1961 the nerve-damage situation was dire enough for Grünenthal’s internal lawyers to produce a long memo agonising over its insurance coverage. It predicted the insurer would blame Grünenthal for the whole problem, and try to limit any insurance payout.
For the members of Lyn Rowe’s legal team, seeing this internal legal advice was remarkable. As lawyers you never get to see the other side’s legal advice. Plaintiff lawyers often wonder what the defendant’s lawyers are saying in private to their client. We speculate but we never know. Yet in the Düsseldorf archive there was a pile of 1960s memos by Grünenthal’s legal department written before and after thalidomide was withdrawn from sale. This was as unexpected as it was hard to believe. It felt like eavesdropping to read the translated documents and learn what Grünenthal’s lawyers had said in private.
In short, the lawyers were extremely critical of their own company. In July 1961, with the drug still a bestseller, Grünenthal’s legal department warned that Grünenthal may not have done sufficient animal testing with thalidomide, and that a caution about nerve damage should have been put on the medication from May 1960. Calling thalidomide ‘safely effective’ and ‘non-toxic’ had been ill-advised, the lawyers said, and so too was implying that nerve damage would clear up when thalidomide use ceased. The legal department was perfectly clear about Grünenthal’s prospects when faced with a claim by a nerve-damage victim. ‘Under these circumstances it does not seem justifiable to conduct a trial in this matter.’ The cases should be settled, the lawyers advised. And so they were: that month the first payment was made to a nerve-damage victim, and by the end of September another twelve cases had been settled.
Grünenthal’s legal department was now ringing the alarm bell loud and clear and repeatedly. Another memo in August 1961 described the thalidomide situation as ‘dangerous and uncomfortable’. Unbelievably, in the midst of all this internal handwringing, Grünenthal had still not ensured that all doctors had been told that nerve damage even existed. ‘Up to now doctors abroad have not been informed about the side effects of Contergan in any form,’ an internal memo on 10 August 1961 admitted. ‘Various European countries still have brochures with the wording “completely atoxic”. Immediate change necessary.’ Grünenthal’s ceaseless thalidomide promotion was increasingly angering the medical profession. ‘The only thing that makes sense is: Get rid of Contergan!’ one doctor who was suffering from nerve damage wrote to Grünenthal in September 1961.
By the next month, October 1961, Grünenthal was facing almost one hundred legal claims over nerve damage, and its lawyers were warning that a legal misstep ‘would indeed unleash an avalanche coming at us’. Yet, despite the alarm at Grünenthal, the drug was still being widely prescribed across Germany and was also freely available over the counter in seven German states. And the mountain of damning reports and acute legal danger did not slow the fiction pouring out of company HQ. On 17 November 1961, Grünenthal wrote to a doctor advising that it was ‘unlikely’ that his patient’s nerve damage had been caused by Contergan. ‘We have never heard of any such complaints before.’ When one of the prosecutors read this document years later, he was so shocked he scribbled ‘unbelievable!’ in the margin.
One wonders how the management of a modern pharmaceutical company would react in a similar situation: a flood of serious injuries, lawsuits, highly critical journal publications, a revolt in the medical profession and increasingly damning indictments from the company’s own lawyers. With panic, anxiety and terror presumably. Not so for Grünenthal’s hard men. By now they were seasoned veterans of the thalidomide campaign and unshaken in their determination to keep the product on the market.
The United States was spared a major thalidomide catastrophe, as we’ll see in chapter 8, because an astute and courageous FDA doctor, Frances Kelsey, read about nerve-damage reports in a medical journal in early 1961 and became suspicious about the drug. One of her concerns was that thalidomide could conceivably harm a vulnerable and growing foetus. Kelsey was operating on the basis of sketchy reports. In contrast, Grünenthal was at the coalface: it knew of literally hundreds of reports of serious nerve damage, and its staff had heard about birth damage potentially connected to the drug. Yet Grünenthal was deeply reluctant to take the Kelsey question seriously: what might this toxic drug do to a foetus?
Grünenthal had repeated opportunities to front up to the foetus issue. Another one came and went in July 1961 when Grünenthal received three critical questions about thalidomide from a Finnish doctor. The first: if thalidomide is given to pregnant patients, does it cross the placenta? The handwritten Grünenthal response was: Not known. The second question: can thalidomide have a damaging effect on the child in the event that it crosses to the child via the placenta? Grünenthal’s response: Improbable. And the third question: in which part of the body is thalidomide broken down? Probably by the liver.
The questions and answers expose Grünenthal’s ignorance. It did not know if the drug reached the foetus and could not say categorically that the drug did not damage the foetus. ‘Improbable’ was the best it could do. Grünenthal had no idea how its drug—Germany’s best-selling sleeping pill—behaved inside a pregnant woman.
The Finnish inquiry seemed to kick off some soul-searching at Grünenthal. At a meeting of scientific staff the possibility of tests to see whether thalidomide passed the placenta and reached the foetus was discussed. One senior Grünenthal employee later told the prosecutor that during the middle of 1961 there was concern at the company that thalidomide might be causing injuries more severe than nerve damage: animal tests were discussed as a way to ‘determine the possibility of damage to the foetus’.
Finally, on 13 September 1961, Grünenthal reached out to an external expert for help. It wrote to Dr Ernst-Albrecht Josten, who in 1956 had written a journal article on the effect of medications on the foetus.
Dear Dr Josten, we have learned by chance through one of our employees that you used to be particularly involved in the issues of effects of medication on the foetus and the newborn respectively. We therefore take the liberty today of inquiring whether you still have the ability to perform such tests or, if this should not be the case, who in your opinion within the Federal Republic would be particularly capable of carrying out such tests?
Nothing came of the inquiry and Grünenthal did not pursue it. Much later Josten could not recall what his response had been. Certainly there were no tests, and the drug continued to be promoted as safe.
It was now the eleventh hour for Grünenthal and thalidomide. A handful of German doctors, working largely in isolation and in ignorance of most of the disturbing information Grünenthal had about thalidomide, were closing in on the drug as the cause of the rising death and injury toll. While those doctors worked feverishly, Grünenthal continued to ignore red flags. On 3 October 1961 Grünenthal received a letter from the National Drug Company in the United States noting that the FDA had inquired ‘whether Contergan is transferred to the foetus. I presume they want to incorporate a special warning for pregnancy’.
What Grünenthal made of the FDA query is not known, but there’s an intriguing claim that the company privately prepared its own pregnancy warning stickers. In 1969 Dr Günter von Waldeyer-Hartz, a chemist who was disturbed at the progress of the trial of Grünenthal executives, wrote to the German Government stating that in October 1961 he had visited Grünenthal and had been shown a packet of Contergan with an attached sticker bearing the words NOT FOR PREGNANT WOMEN. Von Waldeyer-Hartz’s letter found its way to the chief prosecutor but the evidence was not presented at trial.
While there remains a serious question mark over Grünenthal’s pregnancy stickers, there is none over a query it received from Dr Hermann Brandt in Lübeck, northern Germany. ‘In March 1961 I was called out to attend to a malformed child. It was the first time that I ever saw such a child. It had severe malformations of the upper extremities,’ Brandt later told the prosecution team. On 15 September 1961 the father telephoned Brandt, told him that he knew of a number of malformed babies born in the area and that Contergan was widely prescribed. The father told Brandt he believed thalidomide was causing malformations.
Brandt told the father he would discuss it with Grünenthal, and a few weeks later he told a Grünenthal sales rep about the case and the suspicions about thalidomide. ‘[The sales rep] promised me that he would discuss this set of questions with his company and notify me, should anything be known about it.’
Years afterwards the German lawyers prosecuting Grünenthal were intrigued by Brandt’s story. They kept digging, conducting further interviews to find out what happened to Brandt’s report. What they learned was that the first Grünenthal sales rep passed Brandt’s report to his local Grünenthal superior. That man thought the link between thalidomide and malformations was impossible. But he too, it appeared, passed the report up the Grünenthal chain, telling Grünenthal’s ‘manager of scientific field services’ about the warning.
But nobody from Grünenthal contacted Brandt or the family. ‘I did not hear anything more in regard to this matter until I happened to read about Lenz’s suspicion in the newspaper at the end of November 1961,’ Brandt later recalled.
Dwell for a moment on this episode. Certainly it was late in the piece—Grünenthal would soon be forced to withdraw the drug. But Grünenthal’s response is telling: three Grünenthal employees knew of Brandt’s report, yet nothing happened. No inquiry. No follow-up contact with Brandt. No contact with the family. No attempt to check for other cases of malformations in the area. Silence.
To a citizen of the twenty-first century it seems remarkable that the German medical community took so long to notice an epidemic that damaged and ended so many lives. Thalidomide had been causing shocking malformations in Germany for more than three years before the rising toll was even identified and the hunt for a cause begun. On one hand, the time lag is explicable. This was the late 1950s and early 1960s. Doctors shared their experience through printed papers and conferences. They communicated by letter and telephone. Specialists could be completely unaware of events in a nearby city for weeks at a time. And the thalidomide victims were spread across Germany. Doctors who had seen only one or two cases might justifiably write them off as random occurrences, unaware of the total numbers.
On the other hand, even given the time and context, there was a distinct lack of curiosity and engagement within the German medical profession. It took so long, and the tragedy had to reach such a boiling point, for the malformations to be noticed that one wonders what was going on. These were not trivial malformations: they were rare, once-in-a-lifetime events for most doctors and there were a lot of them. Enough for many lifetimes. Yet it took years until a handful of curious and energetic doctors realised this was an epidemic and started hunting for the cause.
The first mention of what turned out to be a thalidomide baby in a German medical publication came in December 1959, when Dr Arnulf Weidenbach of Munich published a short article in a magazine for obstetricians and gynaecologists about a baby with shortened arms and legs, a very rare condition known as phocomelia (from the Greek for ‘seal limb’). In his article Weidenbach speculated about possible causes but acknowledged that the case was a mystery. Years later Weidenbach said he had received many requests for copies of his article, but could not recall any doctor telling him of a similar case.
By that time in Germany there had in all likelihood been about two hundred children born with thalidomide malformations, including many cases of phocomelia. At least one hundred recognised thalidomide babies born prior to this time survived into their teenage years, and studies have suggested that about fifty per cent of all thalidomide babies died at (or shortly after) birth or during infancy. So the one hundred long-term survivors would have been about matched by an equal number who did not survive. Yet not a single one of these cases was reported to Weidenbach, and no alarm was raised.
The next milestone came in October 1960 when two German doctors, Wilhelm Kosenow and Rudolf Pfeiffer, set up a display about two malformed babies at a national paediatric conference in Kassel. The babies were phocomelic, and one had a blocked small intestine, injuries that would later be recognised as typical of thalidomide. Kosenow and Pfeiffer did not give a speech, but merely presented an exhibit that attending doctors were welcome to inspect.
By this time there had been more than six hundred thalidomide babies born in Germany and many of the attendees would have seen one or more, yet apparently none mentioned that they too had seen something similar. The exhibit attracted little comment.
But the disaster was now rapidly gathering pace. In March 1960 Contergan had become Germany’s most popular sleeping medication, and by the middle of the year it accounted for almost half of Grünenthal’s revenue: ‘Everything is done to keep this apple of our eye secure,’ one company report stated. In January 1961 sales peaked at 1.6 million marks for the month.
As more and more pregnant German women took the drug, the number of damaged babies escalated. By the end of 1960 more than one thousand thalidomide babies had been born, and about half of them survived. The toll had started slowly but by late 1960 it was reaching full speed. Yet still this massive outbreak of death and injury had not been identified.
Dr Hans-Rudolf Wiedemann, a paediatrician who headed the children’s hospital in Krefeld, near Düsseldorf, started seeing a surge of unusually malformed infants in late 1960. He questioned the parents, made inquiries of colleagues in nearby towns and decided that something recently introduced into daily life was responsible. In September 1961 Wiedemann published an article dealing with thirteen cases in Die Medizinische Welt, but noted that he was aware of a total of twenty-seven such cases in the area of his clinic. He suggested similar malformations might be spread across Germany and that the nationwide toll could approach a hundred, a ‘frightening’ figure he deemed an epidemic. In fact, probably more than 2500 thalidomide children had been born by the time he published. Wiedemann had drastically underestimated the magnitude, but he had—finally and thankfully—publicly identified the epidemic. Wiedemann was not the only doctor on thalidomide’s trail. Others in Scotland, Australia, Japan and Sweden were investigating, but Germany was the epicentre of the tragedy and Wiedemann was among a number of German doctors who came agonisingly close to solving the mystery.
Through painstaking investigation Wiedemann was able to eliminate a number of possible causes including botched abortions, infections and some medications. But he had not yet solved the puzzle when a change of jobs and a move to another city diverted his attention.
Heinz Weicker, a Bonn paediatrician, saw his first thalidomide baby in January 1961. When he started seeing further cases he realised from the birth dates that the wave of malformations had begun in late 1958 or early 1959. Weicker wanted to know if similar births were occurring elsewhere and wrote to colleagues in fifty large clinics in Europe, the United States and elsewhere. Almost all of the clinics wrote back advising they had seen no increase in such malformations, advice that later turned out to have been wrong in many cases. Weicker worked feverishly, seven days a week, on his investigation, visiting dozens of afflicted families and questioning them extensively. He briefly considered thalidomide as the cause because about twenty per cent of his mothers had mentioned taking it. But thanks to his correspondence he believed that there had been no cases in the US, where he mistakenly thought thalidomide was very popular. In fact, thalidomide had not been approved for sale in the US. But Weicker’s thalidomide suspicions were weakened as a result. By late 1961 thalidomide was only eighth on his list of suspected causes, a list topped by three similar detergents. (Wiedemann—and later Lenz—also suspected detergents, which had only recently come into widespread use in Germany.) Other products Weicker had ahead of thalidomide on his list included an anti-nauseant medication and a widely used hormonal pregnancy test. Later, when the truth about thalidomide emerged, Weicker went back to his group of mothers and learned, on more detailed questioning, that almost all recalled taking it.
Another investigator, Dr Hans Wegerle in Marburg, came within a hair’s breadth of establishing the link. Wegerle first suspected Contergan in October 1961 for a number of reasons: its chemical composition; it appeared in some of his case histories; and the malformation epidemic had started about the time thalidomide sales began. Like Weicker, Wegerle corresponded with colleagues overseas and concluded that Germany was ‘obviously preponderantly affected’. He had considered but discarded other possible causes including radiation fallout from bomb tests, abortifacients, vitamin deficiencies, disease, fertilisers and pest control agents. He had collected eleven Contergan-positive cases but was warned by colleagues to strengthen his evidence. Wegerle therefore was busy making further investigations when he was beaten to the punch by Widukind Lenz. Generously, Lenz later credited Wegerle with suspecting thalidomide before he did.
In 1961 Widukind Lenz was the forty-two-year-old head of the children’s clinic at Hamburg University. He had qualified as a doctor in 1943 and then worked at military hospitals, including in occupied France. Lenz was captured and taken to Britain, where he was held until his post-war return to Germany.
Lenz’s first unknowing brush with thalidomide damage came in early 1961, when he was consulted about a baby with unusual malformations. Lenz thought the probable cause was a gene mutation. In June 1961, after being consulted about two further cases, Lenz again suggested gene mutations.
Then, on 22 June 1961, came a visit that changed Lenz’s life. Two months earlier, Karl Schulte-Hillen’s wife Linde had given birth to a son with shortened arms and missing fingers. ‘What’s with your husband? Has he got no arms?’ one of the midwives asked Linde Schulte-Hillen shortly after Jan’s birth. Six weeks earlier, Schulte-Hillen’s sister had given birth to a baby with almost identical malformations. Schulte-Hillen, a lawyer who represented the thalidomide children’s interests during the trial of Grünenthal executives, was so distressed by these events that he wandered around Hamburg in disbelief. ‘For days I didn’t see people’s faces or bodies,’ he later said. ‘All I saw were their hands.’
When Schulte-Hillen asked a senior doctor at the hospital for an explanation he was told: ‘There’s no special reason, we see one or two cases a year.’ Given his sister also had an afflicted baby, Schulte-Hillen initially believed there must have been a genetic problem in his family. Then he learned there were several more malformed children in his home town of Menden. One had been born the day before his son, in the same hospital, with very similar malformations. He became convinced a geographical issue was at play and soon afterwards a friend suggested he contact Widukind Lenz. ‘He has no car, only an old military coat,’ the friend said. ‘And he rides an old bicycle, a woman’s bicycle, but he’s the man for you.’ Schulte-Hillen met with Lenz, who was sceptical about his visitor’s geographic theory and equally sceptical that there could be as many similar cases as Schulte-Hillen claimed. But he promised to make some inquiries. Soon afterwards Lenz telephoned a Menden obstetrician, and was shocked to be told there had been many babies born with limb malformations in Menden, Beckum and Münster, three towns not far from each other in north-west Germany.
Soon Lenz was in touch with other doctors and found many other cases. By August 1961 Lenz firmly believed that ‘one single common cause must be responsible’. At a meeting with Schulte-Hillen, Lenz remarked that the search needed a detective rather than a doctor. He wondered whether a new lipstick or face cream was responsible, and also questioned Schulte-Hillen about the family’s use of detergents.
Lenz had previously studied the rate of various birth malformations in Hamburg. Using those figures, he calculated that the new malformations were about two hundred times as frequent as they had been: there had been one case of phocomelia in Hamburg in the twenty-eight years up to 1958, and eight cases in just the last year. He realised a massive epidemic was underway.
Lenz’s investigations continued and by 8 November 1961 he was focused on ‘a single new factor…a noxious agent which has never previously been prevalent to a similar extent’. Lenz considered a food additive possible; he doubted the culprit was a drug because he had not been able to find one consistently taken by the mothers of the damaged babies. Only once had Lenz’s attention been directed to thalidomide at this point: by a mother who had taken thalidomide throughout her pregnancy and developed nerve damage. She told Lenz she thought her baby’s malformations had been caused by the drug.
Then on 11 November 1961 the mother of a baby girl without arms told Lenz she had taken Contergan during early pregnancy, and so had a friend with a similarly injured child. The following day the father of another malformed baby told Lenz he blamed Contergan for his baby’s injuries because he knew it caused nerve damage. Lenz was closing in. That day, 12 November 1961, he wrote to a colleague saying that he had a ‘hot lead’ in his hunt for the cause of the malformations.
In a flurry of activity over the next few days Lenz visited affected families to check drug histories, asked his colleagues at the university clinic to help him with his research and called on other German doctors to check their files. By 15 November 1961, Lenz had gathered fourteen cases in which there was evidence that the mother of a typically malformed infant had taken thalidomide. This, he later wrote, warranted ‘practical steps’ even though it fell short of proof.
So on that day, 15 November 1961, Lenz telephoned Heinrich Mückter at Grünenthal, outlined his evidence and asked for the drug to be withdrawn from sale. Mückter would not agree but said he would send someone to talk with Lenz. Lenz thought this an inadequate response. To increase the pressure, he put his concerns in a letter which he sent to Grünenthal by registered express mail. His letter concluded by warning that it would be irresponsible to ‘wait for the strict scientific proof. I consider it necessary to withdraw the drug immediately from the market until its innocuousness as a teratogenic agent in man is proved with certainty’.
The next day, Thursday 16 November 1961, Grünenthal arranged to meet with Lenz the following Monday to discuss his concerns. But in the meantime Lenz attended a paediatric meeting on the Saturday. Concerned about the delayed Grünenthal response, he shared his information with the shocked attendees.
On Monday 20 November 1961, Lenz met with the Grünenthal executives, a meeting that was quickly shifted (by Lenz) to the health authorities’ offices. Lenz later said he thought
the Grünenthal representatives showed no interest in the facts, or the arguments that pointed towards thalidomide being the root cause of the deformities. Quite the reverse. They showed a lively interest in every detail which showed up the quality of my research in an unfavourable light.
Lenz also said he was threatened with legal action. Grünenthal concluded the meeting by refusing to withdraw thalidomide from sale.
Bizarrely, even now, Grünenthal was focused on selling more thalidomide. The German prosecutor later found that on the same day it was meeting with Lenz, Grünenthal sent out 66,957 copies of a pamphlet addressed to doctors in which Contergan was described as a ‘safe medicine’.
Later that week, Friday 24 November 1961, there was another meeting between Lenz, Grünenthal and ministry officials. Grünenthal was again aggressive, threatening a legal action for compensation if the drug was banned. As the meeting wore on the company eventually offered to attach a sticker to the medication warning against use in pregnancy. The ministry officials refused to accept this and told Grünenthal to withdraw the drug voluntarily or it would be banned.
The following day, Saturday 25 November 1961, Grünenthal’s top executives gathered in Stolberg where Mückter shocked his colleagues by producing a letter from Distillers in London. The letter reported six malformed (and subsequently deceased) babies, noted that thalidomide was suspected as a possible cause and asked whether Grünenthal had any similar reports.
Incredibly, that still was not enough for Mückter to agree to withdraw the drug. While most present were now resigned to thalidomide’s demise, the best they could get from Mückter was an agreement that doctors be informed of Lenz’s views. Mückter insisted that the drug remain on sale. (Grünenthal says the decision to withdraw the drug was taken at that meeting, a disputed view of history.)
But the next morning, a prominent article in the newspaper Welt am Sonntag (World on Sunday) sealed thalidomide’s fate. Though it did not name the drug, the article cited Lenz’s fears that a popular sleeping pill was malforming babies, reported that the company involved had not withdrawn the drug and called on the authorities to intervene. Later that day Grünenthal finally capitulated: thalidomide was withdrawn, and in follow-up press releases Grünenthal blamed the media frenzy for the withdrawal rather than the grave suspicion about the drug being deadly.
It had taken sustained pressure from Lenz and the health authorities, and the start of a media campaign, to force Grünenthal to withdraw thalidomide. Grünenthal had fought to the end and the company’s bitterness about Lenz was palpable. One senior Grünenthal man later recalled the response of senior staff when told of Lenz’s charge. ‘I still remember that several gentlemen from the research department—I can no longer recall individual names—made ironic remarks about Dr Lenz—son of a top Nazi, nothing sensible could be expected from somebody with the first name “Widukind”, or similar remarks of this ilk.’
This obsession with Lenz’s father was not a one-off. Dr Fritz Lenz had been a high-profile advocate of eugenics, or scientific racism, who firmly believed in the superiority of the Aryan race. Grünenthal seemed to think the fact that Lenz had a notorious father might be helpful. In January 1962 a memo circulated at Grünenthal attaching an article about Fritz Lenz and asking: ‘Is this the father of the Hamburg paediatrician Dr Lenz? What do we know about the “racial hygiene” this man advocated and what he did during the NS-time?’ NS is short for Nationalsozialistische, usually abbreviated in English to Nazi. A curious tack for Grünenthal to take.