The Treatment of Nausea and Vomiting In Pregnancy: A Shakespearean Approach

Vomiting or Nauseated when pregnant? It's disturbing to patients because of how they feel, and even more disturbing if they worry about the treatments.  We have several effective therapies! But maybe your doc has forgotten them!
Juliet bemoaning the ire the last name of her beloved Romeo would inspire in her family cried out in some of the most oft recited lines of Shakespeare:
     What's in a name? that which we call a rose
      By any other name would smell as sweet;
      So Romeo would, were he not Romeo call'd,
      Retain that dear perfection which he owes
      Without that title. Romeo, doff thy name,
      And for that name which is no part of thee
      Take all myself.
And so too is the treatment of nausea and vomiting of pregnancy. There is a medication that was once one of the most popular medications prescribed to anyone. It was called Bendectin. It's use has mostly passed on. The widely prescribed Bendectin long went off the market in 1983, yet this "rose" has only lost it's name and the American Congress of Obstetricians and Gynecologist practice guidelines continue to recommend giving as a first line doxylamine and vitamin B6 as fist line therapy. Bendectin itself was pulled by the ill fated Merrell-Dow company, already long stung by it's mess with the drug thalidomide, which when used for nausea in pregnancy caused the horrific birth defects of phocomelia. It took the birth defects of over 10,000 babies in dozens of countries before the obstetrical community listed to an Australian obstetrician Dr.William McBride who recognized the link. Dr. McBride had fallen from grace however as some of his dog research was found to have been flawed or falsified. The Although true for thalidomide, it was teratogenic, and remains avoided, the obstetricians, recognized the junk science for what it was, and the case against Bendecin was just pure junk science, led by the flamboyant and horrifying to this gyno: Melvin Beli. Bendectin was pulled from the shelves in 1983, and pregnant women all over the country were hospitalized in almost double the numbers they had ever been according to recent reviews of the medical care of the time. Although the Bendectin case in legal circles was revolutionary at the time, with the Supreme Court even formulating a principal, the Daubert principal, that was supposed to be 'against the use of junk science' in these types of cases it has remained a travesty in the medical world and even some legal scholars have been quoted, This is as might be expected, for the Bendectin litigation can be seen, as Professor Green asserts, as "the taj mahal of horror stories about the tort system: ...
So we look at the roses, and regardless of naming them, choose to continue the scientific quest. The Scientific Quest continues in this story. 75% of moms will experience nausea or vomiting in pregnancy, and many will need treatment. The most mild and safest treatment is what each gyno wants for her patients. So Canadian gynos published a study of an improved formulation of this "rose", bendectin by the drug name of Diclectin in Canada. There were 256 women, that were treated with this drug v placebo for about two weeks each. Brave women, given the ferocity of Beli's words which probably still echo over his Montgomery Street pirate flag, the women both did well and had no serious adverse events. What do you think of when you see a rose?


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