August 2020 Edition. Volume XX

“Falling Into Disuse” has become one of the most fascinating terms in the medical lexicon.  Most health care professionals are more familiar with the terms:



Banned From Use

Falling Into Disuse” describes the unique situation when a drug, device, or procedure which has been found to be ineffective or actually harmful, and is not specifically identified as such officially by the medical profession, government, or other responsible agencies and is allowed to be withdrawn from the marketplace without public notice.  By allowing drugs,  devices, and procedures to “fall into disuse” the public never becomes informed or aware that there were problems associated with them.  Examples of “falling into disuse” abound.  In addition to there then being a failure of public informed consent the medical profession itself continues to be deprived of the opportunity to learn from this experience.

Prominent examples of harmful substances used in myelography in the past which subsequently which “fell into disuse” are:

Thorium Dioxide (Thorotrast®)
Iophendylate (Pantopaque® and Myodil®)

The following substances when introduced into the subarachnoid space (purposely or inadvertently) have significant adverse effects for the patient because they contain neurotoxic agents such as ethylene glycol (the active ingredient of anti-freeze).  The following have not yet “fallen into disuse.”


The legacy of “falling into disuse” means that legions of physicians and patients continue to be in the dark regarding the real risks inherent with the use of these substances in common therapies such as epidural steroid injection.  This also means that the use of these substances continues to be unaccompanied by true “informed consent.”  The success of this euphemism being applied to drugs,  devices and certain procedures has been, and continues to be, a disgrace to the American health care system (as well as other health care systems around the world).

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