I have a minority view (as usual), that off label prescribing can be dangerous, and should be deemed unethical. Off label prescribing is when a drug approved for prescribing for Malady A, is then prescribed for Malady B—even though it may not have been properly tested as a proper treatment for that disease or injury.
Now, it appears off label prescribing has sought to prevent girl fetuses from lesbianism, tomboyism, and ambiguous genitalia (and other gender issues). From ”The Ethics Canary in the Modern Medical Mine,” published in Bioethical Inquiry:
Following extensive examination of published and unpublished materials, we provide a history of the use of dexamethasone in pregnant women at risk of carrying a female fetus affected by congenital adrenal hyperplasia (CAH). This intervention has been aimed at preventing development of ambiguous genitalia, the urogenital sinus, tomboyism, and lesbianism. We map out ethical problems in this history, including: misleading promotion to physicians and CAH-affected families; de facto experimentation without the necessary protections of approved research; troubling parallels to the history of prenatal use of diethylstilbestrol (DES); and the use of medicine and public monies to attempt prevention of benign behavioral sex variations.
This is blatant human experimentation—and on more than one level:
Those internal debates, however, have focused on potential risks and benefits to mothers and children exposed. There are a number of other ethical problems in the history of this intervention also deserving of attention, including: de facto experimentation on fetuses and pregnant women, largely outside of prospective long-term trials and without adequate informed consent; failure to appropriately collect and publish evidence when promoting and providing a high-risk intervention; use of medicine and public monies for research to prevent benign behavioral sex variations, including tomboyism and lesbianism…and inadequacy in the United States of systems designed to protect pregnant women and their offspring.
There have been adverse effects reported, particularly it seems, on the cognitive development of children with long term exposure to the drug.
There is more to this study than I can report here in a blog. For a good more extensive summary, hit this link.
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