The DES (diethylstilbestrol) years: Bridging the past into the future

Between the years 1941-1971, it is estimated that between 5 million and 10 million pregnancies were exposed to diethylstilbestrol (DES). The adverse consequences of this exposure in utero had been reported as early as 1949. However, it was not until the development of a rare vaginal cancer known as clear-cell adenocarcinoma in 1971 that the implications with regard to teratogenicity of this steroid were identified. The use of anecdotal reports to develop preventive treatments cautions physicians regarding the consequences that may result when anecdotal reports are relied on to determine medical management rather than evidence-based research. This article will review the history and pathology of DES and alert the primary care physician to the misfortunes of our past and the implications they may have in the future. With the increased prevalence of alternative treatments and homeopathic remedies, the contemporary physician must be mindful of the importance of evidence-based medicine when prescribing therapeutics. Finally, this article will discuss the importance of evidence-based medicine and remind us to learn from our past experiences when we introduce new treatments in the future.