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A Deadly Mistake That Led to Safer Medicine | Elixir Sulfanilamide

January 21, 2020


The history of medicine is full of some huge
triumphs, but also some pretty terrible mistakes. Like how, in the 1930s, a company out to make
a quick buck took a safe, effective drug and managed to make it a killer.
But surrounding that tragedy are some pretty fascinating stories: how a dye became a wonder
drug, how the US Food and Drug Administration became what it is today, and how one scientist
walked home with a Nobel Prize. The drug in question is called elixir sulfanilamide,
and it was briefly manufactured and sold by the S. E. Massengill Company of Tennessee
in 1937. But before this deadly elixir was concocted,
sulfanilamide had a good rep as an effective drug all on its own.
Sulfanilamide is an antibiotic, so it’s used to fight bacterial infections. It works
by interfering with bacteria’s ability to make folic acid, which they need to reproduce.
It was derived from an earlier drug called Prontosil, which had a vivid red color and
was actually developed by the dye industry. In 1932, chemist Gerhard Domagk found that
this molecule wasn’t just pretty, it could cure bacterial infections in mice.
And once Prontosil hit the market in 1935, it quickly grew popular and saved a lot of
lives. In fact, Prontosil and related compounds were
some of the earliest widespread antibiotics. Penicillin had already been discovered, but
wasn’t easily available yet. Now, further research showed that there were
two parts to the Prontosil molecule. One part was the dye, and the other was the antibiotic.
The antibiotic half was sulfanilamide, which researchers found could be used on its own,
mostly in powder or pill form. While it had potential side effects, it was generally safe.
We actually still use sulfanilamide to treat vaginal infections, though not very often
because there are other antimicrobials out there nowadays.
But the problem was that sulfanilamide had already been synthesized by chemists, and
the patent had expired. So anybody could make and sell variants of it.
Enter the Massengill company, who found that their customers liked their drugs in syrup
form. They set out to make a liquid version of sulfanilamide,
and their researchers eventually found that the powder would dissolve in diethylene glycol.
At the time, diethylene glycol was known as a solvent. It has a sweet taste and smell,
and once the lab added some caramel and raspberry flavoring, they figured they had a nice medicine
and released it as an antibiotic elixir. Frankly, it sounds tastier than some cough
syrups I’ve had. Except for one thing: diethylene glycol is
super poisonous. Back then, there were one or two scientific
studies about its toxicity, but they weren’t widely known. These days it’s used as antifreeze,
among other things, and we know it’s not a sweet treat.
Inside your body, diethylene glycol takes time to do its dirty work. At first, the symptoms
resemble drunkenness. But after several hours, the poisoning gets worse.
While scientists aren’t exactly sure how it kills, we do know it gets broken down by
your liver into a nastier form. From there, it shuts down the kidneys and can affect the
nervous system too. The instructions that shipped with the deadly
elixir sulfanilamide said to keep giving it to patients until they got better.
Which means that some people were poisoned by well-meaning loved ones who fed them antifreeze
for days or weeks until they succumbed, usually from kidney failure.
In total, at least 105 people died. And if Massengill had just fed it to a handful of
mice before shipping a bunch of it out, this tragedy might have been prevented.
Before 1938, the United States FDA only had the power to prevent adulteration and mislabeling.
You couldn’t, for example, sell tablets of flour and say it was medicine. That was
against the law. But you could sell something that was poison
with zero safety testing beforehand — as long as it was what you said on the label.
The Massengill company’s elixir contained exactly what they said it did: sulfanilamide
and diethylene glycol, with some water and flavoring.
But they did technically break the law. They called the stuff an elixir, but that word
was only supposed to be used for products that contained ethyl alcohol. Massengill’s
syrup had none. The FDA seized on this technicality. They
used it to track down the tainted medicine & slap Massengill with an unprecedented fine.
If not for the fine print, they would have been helpless, and many more people could
have died. A new law was rushed through Congress in 1938,
giving the FDA increased power over drug safety. That law is credited with preventing the infamous
drug thalidomide, which was found to cause severe birth defects, from hitting US shelves
many years later. In the aftermath of this tragedy and new legislation,
the chemist responsible for the antifreeze elixir committed suicide. The senator who
sponsored the 1938 drug law died shortly after it passed, reportedly of exhaustion.
Powder and pill forms of sulfanilamide were still being made in labs and widely used as
antibiotics by American soldiers in World War II.
As for Gerhard Domagk, developer of Prontosil, he won the 1939 Nobel prize in physiology
or medicine for helping to usher in the antibiotic era.
Because, really, prontosil, sulfanilamide, and related compounds were used a lot at the
time, and can be safe and effective antibiotics. Y’know, as long as you don’t take them
with antifreeze. Thanks for watching this episode of SciShow!
If you want to learn more about health-related science and policy, you can check out videos
with Dr. Aaron Carroll on our sister channel Healthcare Triage at youtube.com/healthcaretriage.

100 Comments

  • Reply Cookieglue January 16, 2018 at 4:50 am

    Wait isn't this the same medication that made the FDA pass a law that you can't have objects in food (so we can't have kinder surprise eggs)?

  • Reply Sara Anne Willette January 16, 2018 at 5:03 am

    While the sulfa class of antibiotics are great, I personally go into anaphylactic shock when exposed. I almost died when I was six months from being given sulfa septra for an ear infection.

  • Reply Justin Mielke January 16, 2018 at 5:04 am

    Do exceptions prove the rule?

  • Reply Justin Mielke January 16, 2018 at 5:06 am

    Why were the dangerous effects not known when used as a antibiotic before the syrup form

  • Reply Chris Young January 16, 2018 at 5:17 am

    Why does my left arm randomly start hurting sometimes? I'm a hyperchondriac so first thought is heart attack, then the placebo affect seems to make me show more symptoms of a heart attack as I start freaking out, then am fine five minutes later

  • Reply Tim O'Brien January 16, 2018 at 5:20 am

    Bah! Just another business-crushing regulation!

  • Reply LMacNeill January 16, 2018 at 5:21 am

    So… Don’t drink the stuff that’s in your car’s radiator — good tip!

  • Reply Poly- Gone January 16, 2018 at 5:29 am

    What about this, verses DNP? I won't to know the difference

  • Reply sagerobot January 16, 2018 at 5:32 am

    "You dont need regulations" – Republicans and Libertarians

  • Reply 21 Cabbage January 16, 2018 at 5:50 am

    Antifreeze is yummy

  • Reply Jaeden van der Berg January 16, 2018 at 6:00 am

    Educational.

  • Reply Meghan Ushman January 16, 2018 at 6:02 am

    Great episode! I especially liked the mention of how it connected to Thalidomide.

  • Reply Nick Walker January 16, 2018 at 6:05 am

    to be honest, with how cold its been, some anti-freeze and shot of whiskey doesn't sound half bad…

  • Reply Mattteus January 16, 2018 at 6:06 am

    Massengill… the company that makes douches?

  • Reply The British Patriot January 16, 2018 at 6:24 am

    Funny how people are making this about modern politics & regulation. Some regulation is good, most people from all sides of the isles agree with that, but excessive regulation is simply money grabbing bureaucracy that helps no-one except for the politicians in government trying to line their pockets and influence the markets.

  • Reply joe nodden January 16, 2018 at 6:30 am

    For some reason I thought the thumbnail said sulfur hexafluoride

  • Reply MrWombatty January 16, 2018 at 6:32 am

    At least your liver & kidneys won't freeze in sub-zero weather!

  • Reply Akron162 January 16, 2018 at 6:35 am

    Back when they actually moved fast to pass useful laws. If this happened today, congress would have fought over it for a couple of years, while some republican paid off by the pharma industry keeps declaiming poems about how this regulation would be bad for kids or grandmas or whatever.

  • Reply Philippecr January 16, 2018 at 6:50 am

    Is it just me, or really does his voice and the video lost synced?

  • Reply Admlcamus January 16, 2018 at 7:06 am

    Can you believe that almost 8 year ago, here in Panama, our own central social Centers was giving almost the same "cocktail" to patients with some cold Problems. almost 370 die from diethylene glycol intoxication…

  • Reply Ari Lunarium January 16, 2018 at 7:14 am

    Obviously those people should have tested it before they consumed it, the corporation isn't at fault… Yay libertarianism!

  • Reply shingshongshamalama January 16, 2018 at 7:45 am

    Lesson learned: don't take antifreeze.

  • Reply Max Fung January 16, 2018 at 7:56 am

    His dad an elephant

  • Reply oli godendrocyte January 16, 2018 at 8:06 am

    wait…. 105 died but you didnt say how many had success so its hard to say it was a bad idea…. as soon as i saw the drug name i cringed but still you didnt explain if there was any Pro to that con

  • Reply Dylan T January 16, 2018 at 9:03 am

    wait. I though drug companies had my best interests in mind?

  • Reply Sooty Grunter January 16, 2018 at 9:46 am

    And also gave birth to over regulation and government overreach. Also another reason cannabis based medicines were made illegal.

  • Reply Nick S January 16, 2018 at 10:31 am

    Holy ears, Batman!

  • Reply artistwithouttalent January 16, 2018 at 10:49 am

    Weirdly, it also led to us Americans being unable to get Kinder Surprise.

  • Reply RicoChavez1 January 16, 2018 at 12:06 pm

    Your survey does not have "Hong Kong" as a country option, FYI.

  • Reply Mageneated January 16, 2018 at 12:46 pm

    Editing error at 3:51, the clip cuts off before he finishes saying safety

  • Reply Spearka January 16, 2018 at 1:18 pm

    The moment I heard "diethylene glycol" I knew exactly where this was going and was recoiling harder than a artillery gun

  • Reply M E January 16, 2018 at 1:41 pm

    2:57 Wow! Mice Lives Matter!

  • Reply ntlespino January 16, 2018 at 1:54 pm

    "diethylene glycol"
    Cue screaming

  • Reply Kevin Said Avila Matamoros January 16, 2018 at 2:24 pm

    I watch this channel for sometime now but I came for the manga Dr. Stone who made sulfa antibiotic recently and want to now more about that drug.

  • Reply Povl Besser January 16, 2018 at 3:12 pm

    Ever seen old WW2 movies where they sprinkle the contents of small bags on war wounds? That's sulfo packs containing sulfanilamide.

  • Reply Gabriel Lorquet January 16, 2018 at 3:58 pm

    I like Stefan, he's a great host. Wish he was featured in more videos!

  • Reply Justin Salazar January 16, 2018 at 4:09 pm

    Do you juggle invisible balls. Apply now!

  • Reply Bits of Pulp January 16, 2018 at 4:18 pm

    A new law rushed through Congress to prevent loss of life? My, how far it's fallen.

  • Reply D Hawthorne January 16, 2018 at 4:21 pm

    Propylene glycol, another anti-freeze compound, is used to get flavoring compounds to stick to those flavored coffee beans. While significantly less toxic than Ethylene glycol, it can still cause adverse health affects such as metabolic acidosis. This can compound with other causes of acidosis such as lactic acidosis (muscle burn from exercising or insufficient oxygen levels in the blood) or Ketonic acidosis (caused by the body burning lipids before carbs do to insufficient levels of insulin).

  • Reply Tuco Pacifico January 16, 2018 at 4:30 pm

    Those Massengil people sound like a bunch of douches.

  • Reply Heather Vandagriff January 16, 2018 at 4:54 pm

    Y'all need to get your hand talking game under control. It's distracting.

  • Reply princeofexcess January 16, 2018 at 5:32 pm

    It's not how medicine became safe. It's how it became over-regulated and expensive.
    Medicine became safer when regulation was passed (still not as safe as today) but medicine would become safer over time anyways as markets would do their magic.

    Just like food became healthier because people demanded healthier food not because government forced everyone to eat organic.
    If people care for something the markets provide it.

  • Reply TheNinjutsustudent January 16, 2018 at 6:11 pm

    Now big pharma uses these safety rules to keep out new and better drugs for their own profit . . . can't wait till this becomes a history lesson.

  • Reply Eulogy January 16, 2018 at 6:28 pm

    Wtf is this dudes haircut

  • Reply Danyal Ahmed January 16, 2018 at 6:37 pm

    Barney Stinson's Fixer Elixir!

  • Reply Brandon Diaz January 16, 2018 at 6:42 pm

    I have to raid Sci Show now…, They have all the elixir.

  • Reply space ghost coast to coast January 16, 2018 at 7:48 pm

    Why does the fda approve ssri's? Nobody even knows why they work sometimes and why the have no effects in others

  • Reply fatpatMC January 16, 2018 at 8:40 pm

    PLEASE do a video on vaping and the effects it causes on the eye PLEASE

  • Reply Tony Green January 16, 2018 at 9:13 pm

    Can you do a video on the ingredients in vaccines? Explain in depth how aluminum and formaldehyde are healthy and necessary.

  • Reply Shiny sylveon M.L.G. January 16, 2018 at 9:48 pm

    Nice typo

  • Reply DannyDonut January 16, 2018 at 10:43 pm

    wow crazy like ratio

  • Reply Blake F January 17, 2018 at 12:36 am

    What an idiot shudda used diethyl ether. 100% legit no side effects

  • Reply gubx42 January 17, 2018 at 12:38 am

    And the antidote for diethylene glycol poisoning is ethyl alcohol (yep, booze).
    Which mean if they had followed the technicality of the law and added alcohol to their elixir, it may actually have prevented deaths.

  • Reply H Jones January 17, 2018 at 2:41 am

    Someone’s a half breed.

  • Reply Serenity Feueropal January 17, 2018 at 9:56 am

    3:51 there is literally another video from the same people talking about how many lives thalidomide ruined. Way to do your research.

  • Reply canoooples - January 17, 2018 at 10:28 am

    Why does this guys hair bother me so much

  • Reply Karthik Mulpuru January 17, 2018 at 1:04 pm

    america is stupid

  • Reply sam hope January 17, 2018 at 1:04 pm

    Can you not say things like "These days its used in antifreeze". Its the same logic anti vaxers use regarding mercury and other vaccine components. Its a small change of language but we should aim to avoid reinforcing this type of logic.

  • Reply Karthik Mulpuru January 17, 2018 at 1:05 pm

    oh no killing a 100 humans by mistake is NOT OKAY but capturing innocent mice against their will and kept in captivity and using em for experiments to see if they die is alright.

  • Reply Chinmay Shanbhag January 17, 2018 at 3:48 pm

    Why do I think that you guys just saw "today I found out"'s video on why kinder eggs are banned in the US

  • Reply HappyHusbandn Wife January 17, 2018 at 3:56 pm

    Can Darth Vade use the force to forced him not …Anti freeze

  • Reply Charlie C January 17, 2018 at 6:43 pm

    Naaah, who's this mr potato head lookin ass

  • Reply Tyler Strider January 18, 2018 at 12:45 am

    Whenever I see something like this I think of libertarians

  • Reply Ethan C January 18, 2018 at 1:46 am

    that hair line look like your barber was a deadly mistake.

    chill I'm just a troll

  • Reply Inqu'aanate January 18, 2018 at 2:34 am

    Diethylene glycol… some say… the forbidden sweet treat.

  • Reply Ideoform Sun January 18, 2018 at 4:17 am

    We should all use the safer antifreeze. Ethylene glycol in antifreeze can cause cancer and kidney failure in cats, because they lick their paws.

  • Reply Tessa T January 18, 2018 at 5:04 am

    Thanks to sulfa drugs, not one solider or sailor died of infection after the Japanese bombing of Pearl Harbor. This was a huge change over WW 1 casualties who often succumbed to infection after being wounded. A doctor was lecturing on their use on December 7 and people kept getting called out of the lecture and slipping away to see what was going on.

  • Reply Osama Is my bff January 18, 2018 at 11:39 pm

    NOBEL PRIZE AWARD FOR MR KRABZ

  • Reply GrapeTheArmadillo January 19, 2018 at 2:28 am

    Sulfa is still a commonly used antibiotic in horses!

  • Reply Dave B January 19, 2018 at 6:38 am

    *trump is taking away the FDA's ability to thoroughly test drugs before putting them on the market*

  • Reply Franklin Allen January 19, 2018 at 4:49 pm

    They should have used propyleneglycol.

  • Reply TheStoneSpiral January 20, 2018 at 1:08 am

    And people think the modern pharmaceutical companies are dangerous today and that regulations are a terrible burden on the market. No way man.. before regulation just about anything could kill you and no one really knew what they were doing and you were SOL to get justice for it.

    Preserve common sense regulations, it's the only thing that'll keep us safe from greed and ignorance.

  • Reply WillyWanker January 21, 2018 at 4:14 am

    What happens if you only eat dog food?

  • Reply John Dee January 22, 2018 at 9:03 am

    Someone give this man a haircut

  • Reply Nik Xau January 23, 2018 at 3:10 am

    your intro kinda explains why Rx is in the prescription
    R=right
    x=wrong
    thats why youre always told by your doctor to comback after

  • Reply Hoshimaru57 January 24, 2018 at 11:06 am

    And while I’m not sure how much I should believe it, Today I Found Out informs me that this incident (if I remember right), is the actual reason Kinder Eggs are illegal in the US. There’s a stipulation in that law that bans anything not meant to be eaten from going into food products even though Kinder Eggs are basically harmless. Or at least that’s the story.
    Of course I’ve had recollection issues for a while now. I know everything and can’t remember it properly.

  • Reply Steve Collins January 26, 2018 at 5:47 am

    whos dis nerd

  • Reply Johanna Bonana January 29, 2018 at 6:23 am

    Learn from mistakes and improve, amirite?

  • Reply Oddman1980 January 29, 2018 at 9:37 am

    Anyone ever notice how many medicines are based around one or more benzene rings?

  • Reply Timmy Dirtyrat January 30, 2018 at 4:22 am

    "I don't feel good."
    "Here, drink some red dye."

  • Reply No Celebrity February 2, 2018 at 12:30 pm

    Come to think of it, the mistake was rather grave.

    It's like saying, "Oh, we can't use sodium chloride to make the soup taste saltier? Let's just use hydrogen chloride instead!"

  • Reply Dea Likes Bands February 10, 2018 at 4:22 pm

    Where TF did Hank go

  • Reply Elizabeth Shaw February 12, 2018 at 5:50 am

    Massengill weren't they the people who made douches?

  • Reply Fithrildith February 13, 2018 at 4:10 pm

    Thanks for the succinct explanation! The hand gestures are a bit off-putting though…

  • Reply ihartevil February 22, 2018 at 7:47 pm

    seems like we are still allowing that but without saying what is in it because there are juices that have fake sugars in them and arent labeling them

    then we have lead being in vaccines and most peoples dont know about that if they did do you really think anybody would give their children the HPV vaccine

    thx for this ha bisky vid i enjoyed this history video

  • Reply Ali Hassan February 24, 2018 at 6:54 am

    elixir

  • Reply The Outsider February 28, 2018 at 10:10 am

    Needs to be sweeter. Deandra, go get daddy some antifreeze.

  • Reply Brother Bear February 28, 2018 at 8:05 pm

    Can I still take antifreeze with Tylenol or is that dangerous too?

  • Reply Domminigan March 7, 2018 at 8:38 pm

    I'm sorry, did you say Elixir Sulfa Limeade?
    Sounds delicious!

  • Reply Najmah Chant March 11, 2018 at 4:00 pm

    Poor company just wanted to make medicine taste less medicine-y 🙁

  • Reply Jillian Michelle March 14, 2018 at 7:04 am

    Gee look at that regulations are actually good? Who would have thought laws PROTECT PEOPLE?!?! 0_o

  • Reply logan manko July 4, 2018 at 4:36 pm

    Wait antifreeze is sweet ?

  • Reply Joseph Ademir Cedeño Bonilla August 2, 2018 at 12:11 am

    In 2008, in Panama the governmental medical dep. produced medicines with diethylene glycol who killed and harmed a lot of patients. It was an horrible tragedy atributed to confounding it with glycerine. A big lie. Who will in your country counfound something with no color with something coloured?

  • Reply NewLife August 17, 2018 at 6:19 pm

    Umm from a scientific based channel I'd expect better than saying it's toxic because it's used as antifreeze and do you want to know what else is an antifreeze because it's we need to live

  • Reply Emily Carter September 23, 2018 at 1:51 am

    Diethylene glycol is still in most deodorants

  • Reply cleveque September 23, 2018 at 6:55 am

    Ahem: sul-FAHN-il-uh-mide.

  • Reply trinthetrex September 27, 2018 at 7:22 pm

    I learned about this in pharm tech class.

  • Reply trinthetrex September 27, 2018 at 7:27 pm

    Diethylene glycol binds to the cells and prevents them from working. That’s what causes the drunkenness. They used to treat antifreeze poisoning with alcohol because alcohol binded stronger than the diethylene glycol so the idea was to get drunk to get rid of it.

    However, if you get antifreeze poisoning, there are less harmful, more effective treatments nowadays and you should go to the emergency room instead.

    The things you learn in a pharmacy.

  • Reply Angelica Ortiz October 12, 2018 at 1:40 am

    Como lo pongo en español?

  • Reply Abhay Rajkarnikar November 2, 2019 at 4:46 pm

    I guess Senku from dr stone watched this 😆😆

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