The Accutane Blame Game; Dissatisfying Answers

Is this a great country or what? Bad things that happen to us or to those around us are never our fault. Moreover, repeatedly it turns out that the responsible party is a huge corporation with deep pockets for suing!

Consider the sad and bizarre case of 15-year-old Charles Bishop, who in January swiped a small plane from St. Petersburg, Florida and smashed it into the 28th floor of a building across the bay in Tampa. Found on his body was a note pledging allegiance to Osama bin Laden and praising the September 11 attacks.

That was newsworthy enough, but the media went gaga when they discovered Bishop had received a prescription for Hoffman-LaRoche Inc.'s acne drug Accutane, which had earlier been linked (albeit mainly by the media itself) to suicidal behavior. As it happens, the medical examiner later reported no trace of the drug in Bishop's system.

Accutane does not cause suicide, but broken homes do. No matter, for Charles's mother, Julie, has now filed a $70 million suit again Roche. Apparently we're supposed to believe the psychotic effect of the drug is so powerful that merely having a prescription for it can make you suicidal. But if that strikes you as strange, there are a few other things you should know ? both about the drug and about Julie Bishop.

There are several links between suicide and Accutane, but they're hardly cause-and-effect.

One is that the drug is used primarily by people in the age group especially prone to suicide. According to the U.S. Centers for Disease Control and Prevention (CDC), for persons "15-24 years old, suicide is the third leading cause of death, behind unintentional injury and homicide." Males are four times as likely to kill themselves as females, while white males like Charles are more likely to do so than black ones.

Further, the problem is getting worse. "From 1952-1995, the incidence of suicide among adolescents and young adults nearly tripled," says the CDC. "From 1980-1997, the rate of suicide among persons aged 15-19 years increased by 11% and among persons aged 10-14 years by 109%." Accutane, introduced in 1982, arrived about 30 years too late to have been the cause of this increase.

Another link researchers have found is that even mild acne can cause depression. Consider that Accutane is prescribed for severe acne. Depression is a major cause of suicide. If you want to call that an Accutane-suicide link, so be it.

Nevertheless, while the overall rate of suicide in the general population is about 11.1 per 100,000; that of Accutane users, according to a Roche survey, is 1.8 per 100,000. There have been about 90,000 U.S. suicides since 1982 compared to about 170 FDA adverse reports for Accutane-related suicides among the five million users of the drug.

Further, nobody has found any kind of biological plausibility for how the drug might even cause depression. The active ingredient in Accutane (isotretinoin) is a Vitamin A derivative and overdoses of Vitamin A can be toxic. But there is no evidence that hypervitaminosis A can cause psychiatric reactions.

Accutane is also a powerful teratogen, meaning it can cause severe birth defects. That's why both the FDA and Roche have labored mightily to keep it out of the hands of women who are or may become pregnant. But again, there is no biological link between psychosis and teratogenicity.

Nothing salves a wound like cold, hard cash. Yet another important contributor to the media Accutane myth are the sharks in suits. After all, suicide cases are natural heart-tuggers and you never know when you'll get lucky before a judge or jury. (Though a judge did just toss out an Accutane-suicide case.) If you go to a website with an innocuous-sounding name like "www.accutane_suicide_help.com you'll find you've actually come across a lawyer-referral service.

But here are a couple of factors that the media hasn't talked much about and that Julie Bishop will certainly not wish to address during her obligatory Larry King appearance.

First, Charles came from a broken home. His parents divorced shortly after he was born and there was almost no contact between father and son. Divorce does have a powerful cause-and-effect association to all sorts of childhood psychological problems. Among studies published in medical journals or by official agencies you'll find such observations as:

Charles Bishop's parents apparently fancied themselves a modern Romeo and Juliet. But it gets worse yet.

According to a St. Petersburg Times article in January, Julie Bishop (nee Detore) and fiance Charles had formed a suicide pact in 1984 after the paperwork for their marriage license was rejected. When they failed to suffocate themselves with carbon monoxide, Julie agreed to stab Charles with a 12-inch butcher knife after which she would then slash her wrists. They were to exit this veil of tears like Romeo and Juliet. Alas she only partly succeeded, sticking him in the ribs before laying down the weapon. Julie was arrested and committed to a mental institution for observation. The paperwork problem was resolved shortly thereafter and they consummated their brief marriage.

In short, young Charles grew up with a mom who seemed, at one point at least, to think not only that suicide was an acceptable last recourse but rather more of a first recourse. That can really mess with a kid's head, to say the least. (The family lawyer claims Charles knew nothing about the suicide pact.)

Finally, if you're wondering about the bin Laden stuff, you should know that Julie changed the family name from "Bishara" during the Gulf War. Yes, Charles was of Arab descent. And while there's nothing wrong with that, another problem often suffered by boys from fatherless homes is an identity crisis.

No suicide is inevitable, but this poor kid really had the cards stacked against him ? with most stacked by the same mother who wants a pharmaceutical company to feather her bed with a cool $70 million. Certainly Charles's fatherlessness, his suicide legacy, and possible concern over his ethnicity go further to explain his death than a drug that doesn't cause suicide and that he apparently wasn't even taking.

But the more obvious explanations don't leave Julie Bishop with anybody to blame but herself and her ex-husband. And that is neither satisfying nor lucrative.

In addition, something else is going on. In the liberal view of human nature, there is no evil. Humans are at worst blank slates to be written on by the benign interventions of the culture ( via the government, such interventions to be managed by liberals, of course ). When some monstrous act has been committed, there is always a rush to find some morally neutral independent factor that is amenable to intervention. Why the liberals fear to face the reality that humans are tragically flawed, and always prone to evil? A big question, but I think that with the decline of traditional religion, and the belief in any ultimate moral order to the universe, people are simply too frightened to contemplate the reality of human nature.

That was newsworthy enough, but the media went gaga when they discovered Bishop had received a prescription for Hoffman-LaRoche Inc.'s acne drug Accutane, which had earlier been linked (albeit mainly by the media itself) to suicidal behavior. As it happens, the medical examiner later reported no trace of the drug in Bishop's system.

So you can sue for $70 million for having a prescription that you never filled? Cool! Time to sue the makers of Prozac. Never used it, but I'm going to get me a prescription right now! That 1 piece of paper is better than betting on the lottery!

Don't get me wrong suing deep pockets is destroying companies, but the way Accutane is being protrayed is also a joke. As a friend, microbiologist, put it "Accutane is a carcinogen," and would never ever prescribe. A good dermatologist will talk extensively with a person seeking to take the medication, no matter what age the patient, because of the very real high risk of depression/suicide associated. The possibility of birth defect is virtually 100%. Derms require women to be on the birth control pill for 30 days prior to starting Accutane treatment, and two other forms of birth control while taking the medication. Laboratory studies are performed prior to each new 30-day prescription, pregnancy testing required prior to each new prescription. Yes, there are a lot of women that have and are taking the course of this medication. The FDA and drug companies know this is a very dangerous drug, yet hey there's some very very big bucks to be made because it is used by so many. Many docs will not prescribe this medication.

"Accutane is a carcinogen,"

Not to the best of my knowledge. As a Dermatologist who trained under the man who conducted much of the original research on Accutane for acne I think I'd know if it was. It certainly is a teratogen so great lengths are and should be taken to avoid exposing pregnant women to it, but it is not a carcinogen. Actually Accutane has been used to prevent certain cancers with modest success. As for the alleged suicide link, what real science I've seen agrees with Fumento's article.

Thanks for the post, John. I was going to post a few links on the subject if he had responded, but your post is better.

As far a carcinogenicity goes, Dosis facit venenum; the dose makes the poison. Many things in high enough doses (bacon, alcohol, etc....) can cause cancer, it's just a matter of shoving enough of it down a rats throat.

He also makes another intersting point:

The FDA and drug companies know this is a very dangerous drug, yet hey there's some very very big bucks to be made because it is used by so many.

Seeing as how Accutane is made by ONE drug company (Roche), and other companies produce drugs to compete with it, we are to believe these other companies are conspiring to keep a competetors drug on the market, to their own detriment. Not likely.

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