Thalidomide is a very controversial medication for well-known reasons. In the modern world, it has two very specific uses: it is used in myeloma, a type of bone marrow cancer, and also to treat erythema nodosum leprosum (ENL), a common complication of multibacillary leprosy. While alternative drugs are in development, the availability of thalidomide remains very restricted. Strict controls are in place where the drug is used in myeloma, but leprosy occurs in areas where the pharmaceutical infrastructure is weak, and so thalidomide is often not legally available, even though it can be regarded as a life-saving treatment in many cases. Dr. Ruth Butlin and colleagues have written a very helpful Editorial on the current situation regarding ‘Access to Thalidomide’ in leprosy endemic areas.
Adherence to treatment is a difficult subject to study, as people who drop out are not easily reached for interview. A small study from Costa Rica used a theoretical framework (the Health Belief Model) to examine patients’ understanding of adherence and the pressures to drop out, with interesting results.
The case report concerning ocular leprosy is very challenging. While the focus for many of us is on finding and treating the dwindling numbers of new cases as early as possible, it is easy to forget that quite large numbers of former patients have complex problems that can be eased through skilled rehabilitative surgery. Perhaps the main obstacle, besides the availability of the surgical skills required, is again the issue of access, with the opportunity for expert care denied to so many.
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