Is Accutane To Blame?

by Howard Fienberg
April 18, 2002

America’s blame culture was in evidence when 15-year-old Charles Bishop crashed a plane into the 28th floor of the Bank of America building in Tampa on Jan. 5. The media first asked whether he was emulating the 9/11 Al Qaeda terrorists. A few days later, when the acne drug Accutane was discovered in his room, the question changed: Did Accutane make him do it? USA Today’s headline on Jan. 10 was typical: “Teen pilot may have been taking acne drug linked to suicide.”


The case disappeared from media radar for months, but the litigious side of the blame culture surfaced April 17 with news that Charles mother Julie is suing the maker of Accutane, Hoffman-LaRoche Inc., for $70 million. Peter McNulty, Julie Bishop’s lawyer (whom The New York Times describes as a specialist in Accutane cases) said that Charles, as a result of the drug, had “became severely psychotic and lost touch with reality, consequently flying into the side of a building.”


Facts After Fiction


Accutane has been on the market since1982 and has had some 12 million users. In 1998, the FDA, the medicines manufacturer and dermatologists all asserted that the medication should only be prescribed by doctors well versed in both its intended and adverse effects. Some patients who reported depression as an adverse side effect of Accutane said that their depression subsided when they stopped taking it and returned when they resumed taking it. Those anecdotal reports got a lot of press attention when Michigan Rep. Bart Stupak blamed his 17-year-old son’s suicide on Accutane, prompting congressional hearings.


Figures from the Food and Drug Administration as of March 2001 (the most recent data available) found 66 instances of Accutane users committing suicide. Of course, we dont know how many might have been missed. It is possible that more suicides occurred before suicide became an Accutane-linked concern.


Based on the FDA data, however, the known suicide rate for Accutane users is approximately 0.00055 per 100,000. Meanwhile, the suicide rate for the general population is 10 per 100,000. Suddenly, the number of Accutane-user suicides doesn’t look so bad.


For an even better perspective, consider that suicide is the third-leading killer of Americans in the age range of Americans most likely to be using Accutane, 15-24 years old. Their suicide rate is 11.3 per 100,000. Thats a whole lot more suicides than we know of among Accutane users.


Suicidal Effects?


How good is the scientific data on Accutanes 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 the Accutane regimens, finding psychological changes proved difficult. The data needed in order to separate the few reported suicides from random noise is not yet available. Luckily, a new study is in the works to provide it.


But researchers have not yet found a plausible biological mechanism to link the drug to depression. Meanwhile, studies have found concrete links between bad acne and depression.


All drugs have some kind of side effects. Usually, the positive benefits of the medication well outweigh any possible adverse side effects. There is no evidence that the medication leads to suicide. To the contrary, by ridding already-angst-ridden teens of one more thing that depresses them, Accutane could possibly prevent some suicide attempts.


It is even possible that it could have prevented Charles Bishop from doing so, but there is no evidence he was taking it when he killed himself. Despite the current insistence of his mothers lawyers that he was taking the medication twice a day when he died, toxicology tests on Jan.16 revealed no trace of the drug in his body.


Depressing Media


If you had not heard that, you are not alone. Few media consumers outside of Florida would have encountered that important bit of information, unless they were scouring the news wire briefs sections of their newspaper. Carolyn Susman of the Palm Beach Post (Jan. 30) summed the affair up best, saying, “The media ended up looking like purveyors of sensationalistic hype.” Now, thanks to the generosity of American tort law, media will have yet another opportunity to stir up unnecessary fear, and the blame culture will carry on, emboldened.   

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