Many people know Accutane (isotretinoin) as a controversial drug with a double-edged sword: A panacea for those with severe and resistant acne, but one with the most serious of risks ranging from depression and suicide to bowel disease. What’s the truth, and is it an appropriate choice for me?
Anxiety about the risks of any medical procedure or drug is common and not restricted to Accutane. Assessing risk and reward for medical matters often presents a stumbling block for a lot of people. Some people feel anxiety at the thought of it, and some may become overly paranoid about possible negative complications. Others may underestimate or entirely neglect the possibility of risks. Although every person must ultimately decide on elective treatments themselves, this guide can help you ask the right questions.
Let’s go back to Accutane as an example:
Isotretinoin, better known in public by its brand name, Accutane, has been proven to be one of the most effective and possibly the only effective solution for severe acne and has seen extensive use by dermatologists since 1982. Despite its widespread use and its unique ability to effectively treat severe cases of acne, this drug has a reputation as a high-risk, high reward solution. Accutane, as a drug used in dermatology, has undoubtedly had a controversial history.
- Several class-action lawsuits focus on its correlations with birth defects, depression and suicide, and inflammatory bowel disease.
- Accutane (isotretinoin) is a known teratogen: It can cause severe birth defects if taken during pregnancy or if adequate time is not given to clear the medication out of the body before pregnancy.
- Roche, the company that had a patent on Accutane at the time, has reportedly paid more than 50 million in suits.
Many of the potential adverse side-effects of this drug are extremely serious, and the large judgments against the drug manufacturer reflect this. Does this mean that I should dismiss this drug as a possible treatment plan?
It depends. As with non-medical decisions, you have to weigh the potential risks against the potential benefits. Many people are turned off by news of these extremely negative medical consequences. The potential risks need to be taken into account. On the other hand, potentially dangerous side-effects should not automatically eliminate a medical procedure or a drug. Rational people often accept even severe risks if the benefits are large enough or if the chances are improbable enough. Driving vehicles is an example of an activity that can have fatal consequences. The probability of adverse events is certainly not insignificant in this case, and outside of people interested in actuarial trivia, very few people know the actual odds of dying in a vehicular accident. Many people consider driving to be an acceptable risk due to the significant convenience that driving offers. Some important questions that you might want to ask are:
- What are the more minor side-effects that occur more commonly, like nausea or drowsiness? How common are these side-effects in the general population, and how serious are they?
- What, if any, are the potentially serious side-effects that could occur? How commonly do these occur in the population?
These questions are not always easy to answer. Still, they can be researched, and your dermatologist or the person prescribing medication or performing a procedure should be able to answer these questions. The other questions that should be asked relate to you personally. As with the decision to drive, a person with epilepsy or a person with extremely poor eyesight would have different risk factors and expectations than the general population. Each individual has a different risk profile. These questions are relevant and need to be asked.
- How important is it for you to take isotretinoin? Are there alternative treatments that offer similar results? Is your acne resistant to other forms of treatment?
- How negatively is your acne affecting your quality of life?
- Do you have any other medical problems that may make it more likely for you to have unwanted side-effects?
- Think about what your priorities are. How important are some of the possible benefits of the drug or procedure for you? How seriously would some of the negative consequences affect your quality of life?
You will need to answer these questions yourself and set your priorities, but some resources can help you make a good decision. Consult and talk to your dermatologist about any drugs or procedures that you are considering. They are in an excellent position to understand relative risk, and they are also in a position to balance your personal risk, as they have your medical records. Finally, if you decide to take Accutane, or another drug, listen to your body for warning signs. Every individual is unique. Statistics can only give you an idea of the overall risk in a population. If you notice any early warning signs, do not ignore them just because a particular consequence is statistically rare in a vacuum.
