Actually, in the case of thalidomide, the stereochemistry is fairly irrelevant, one isomer is a potent teratogen, and does what thalidomide is best known for doing, but the other is not, problem is, the nonteratogenic isomer is enzymatically interconverted to the teratogen in vivo.
So your screwed either way if you happen to be in the womb at the time.
Blowupeverything, good example, Shulgin and Shulgin are two of my heroes when it comes to pharmacology, those two, sheesh, they really broke the mold when that pair came to be, few and far between, and they have cast iron balls, metaphorically speaking, to stand tall against the fascist bullying on the part of the DEA thats been thrown their way (despite Alexander Shulgin WORKING for the bastards at the time, disgusting, it just goes to show, the DEA filth are nothing but a nest of vipers, and will betray even their own at the drop of a hat should it suit them)
Not to mention being the first in many cases to do a human bioassay of so many novel compounds.
And the same goes with MDA (the primary amine counterpart to MDMA, 3,4-methylenedioxyamphetamine), the R isomer I think, is the more active stimulant, while the S isomer is more active as a serotonin releaser/reuptake inhibitor and produces the entactogenic effects, unusually, as its usually the R isomer amongst the more complex (I.E I mean psychedelic/entactogenic) amphetamines thats the more potent by far, as is the case with DOB, DOI, DOC and their likes.
As well as having differing selectivity for enzyme active sites, which can be completely specific for a single isomer, the same can apply to the binding sites on a metabotropic/ionotropic receptor on the surface of a synaptic terminal as well, or a transport protein for a neurotransmitter, for instance, D-amphetamine is taken up by dopamine transporters in the synaptic terminals, enters the vesicles that store dopamine, and displaces it, whilst forcing the transporter to essentially work in reverse, pumping dopamine out into the synaptic cleft, getting one euphoric and twacked off one's mammary apparati, whilst the L-isomer has primarily noradrenergic effects, and as a single isomer, L-amphetamine is jittery and unpleasant to most people (personally I find either, or the racemate just as unpleasant, but thats just me)
Also the stereochemisty of the amino acids in a peptide can alter/abolish activity, with almost all naturally occuring peptides using l-amino acids, as these are the only ones coded for in DNA, with a few exceptions, notably dermorphin, a potent kappa agonist opioid peptide from the frog Phyllomedusa Bicolor (the dow-kietl!), and a few bacterial peptides/enzymes, but on the whole, life on earth uses almost exclusively L-amino acids in protein and peptide synthesis.