Beyond thalidomide. Birth defects explained. Janet McCredie. Oxford: Royal Society of Medicine Press, 2007 (xii + 418 pp). ISBN 978 1 85315 741 7.

From Goya’s remarkable image on the cover to the wide margins, simple fonts and crisp illustrations, this book is a delight to hold and stimulating to read. And how many different ways it can be read — from a lucid scientific account of a medical disaster, to a social commentary on politics and extraneous influences in science; from history as experienced by a mature protagonist in the thalidomide saga, to contemporary medical hypotheses where new routes are charted in neurotoxicology.

This book does much more than trace the history of how a drug, tested repeatedly on animals and released as “safe” for humans, was found to cause tingling and damage to peripheral sensory nerves. It is no wonder that thalidomide’s locus of action in human embryos is the neural crest, which is the more sensitive precursor of peripheral sensory nerves — in embryos however, thalidomide causes much more than “tingling”.

Unfortunately, little attention is paid to the biomechanical aspects of human musculoskeletal development and the way that nerves act as lines of tension between ectoderm and central nervous organs. Our modern bias is to interpret processes as biochemical events. However, no developmental process can occur by purely biochemical means; it must always entail components with force vectors. This suggests that a rich lode of drug-effect research remains to be mined, perhaps starting with a re-examination of the 1967 paper by Blechschmidt and Petersen (Ergeb Chir Orthop 49: 62-111), where limb malformations are interpreted biokinetically as boundary states of normal development. Furthermore, the hypothesis that cells migrate during normal embryonic development is not proven; in fact, there is ample evidence that sclerotomal, neural crest, and germ cells do not migrate in growing organisms.

This book is a high-value, intellectually stimulating monograph for anyone who wishes to obtain a perspective on the science and history of the thalidomide disaster.