Don't blame it on the Accutane
by Howard Fienberg
When 15-year-old Charles Bishop crashed a plane into an office building in Florida on 5 January 2002, the media wondered whether he was emulating the 11 September terrorists.
A few days later, when the acne drug Accutane was discovered in his room, the question changed: did Accutane make him do it? 'Teen pilot may have been taking acne drug linked to suicide', screamed the front page of USA Today on 10 January.
Accutane has been on the market since 1982 and has been used by about 12million people. In 1998, the US Food and Drug Administration (FDA), Accutane's manufacturers and dermatologists all asserted that the medication should only be prescribed by doctors well-versed in both its intended and adverse effects. Some patients claimed to suffer depression as an adverse side-effect of taking Accutane, which then subsided when they stopped taking it. Congressman Bart Stupak of Michigan blamed his 17-year-old son's suicide in May 2000 on Accutane, prompting more headlines and congressional hearings.
The FDA has found 66 instances of Accutane users committing suicide. Of course, we don't know how many might have been missed, and it is possible that more suicides occurred before suicide became an Accutane-linked concern.
Yet, based on the FDA data, the known suicide rate for Accutane users is approximately 0.00055 per 100,000 - while the suicide rate for the general population is 10 per 100,000. Suddenly the number of Accutane-user suicides doesn't look so bad.
Also, suicide is the third-leading killer of Americans in the age range most likely to be using Accutane - 15- to 24-year olds. Their suicide rate is 11.3 per 100,000 - a whole lot more suicides than we know of among Accutane users.
So how good is the scientific data on Accutane's psychological side effects? Not very. Previous research took a retrospective look at patient records rather than following them through the treatment. Since few patients had been psychologically evaluated before they started taking Accutane, finding psychological changes proved difficult. And researchers have not yet found a plausible biological mechanism to link the drug to depression. Studies have, however, found concrete links between bad acne and depression.
All drugs have some side-effects. Usually, the positive benefits of the medication outweigh adverse side effects. There is no evidence that Accutane leads to suicide. In some people, it could possibly even prevent suicide.
As for Charles Bishop - he never took it. Toxicology tests on 16 January found no trace of Accutane in his body. But few media consumers outside of Florida will have come across that important bit of information, seeing as it was largely confined to the 'news in brief' sections of newspapers.
Howard Fienberg is senior research analyst with the non-profit non-partisan think-tank the Statistical Assessment Service (STATS), in Washington, DC.
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