Comment by bede | Hacker News Reader

Comment by bede | Hacker News Reader

I agree with the point of you are making, but feel the need to question your use of the term 'wonder drug' when describing accutane, also known as isotretinoin. HN readers should know that isotretinoin is a profoundly dangerous chemotherapy drug which was only by coincidence discovered to cure acne. The side effects of isotretinoin can be permanent [1] to the extent that the drug's inventor Hoffman-La Roche stopped selling it in 2009 because it was losing so many lawsuits. Yet the FDA (and all the rest) refuses to withdraw this drug from market. It is a modern pharmaceutical scandal which is still in progress.

If a woman becomes pregnant while taking isotretinoin, her children WILL have birth defects. The drug also causes depression in far more cases than Roche's data suggest. The side effects are as diverse as they are serious – there exist entire forums dedicated to sufferers of this drug's permanent adverse effects.

This drug cures acne like nothing else we know. However, the same poorly understood mechanism that enables it to dry out one's skin also systematically dries one's joints of the hyaluronic acid that is so necessary for their lubrication. Since ceasing my treatment four months ago after researching causes for the cartilage damage in my right kneecap, I have been transformed from a healthy and sport-playing science undergraduate to finding even typing this message uncomfortable because of pains in my fingers. So much that I have taken for granted as a 21 year old has been taken away from me by this drug, and I'm not alone in this. I don't like to overdramatise things, and my situation should improve to some extent given time, but taking this drug is the worst decision I have ever made, and the young, impressionable people who are all-too-readily prescribed this drug must be made more aware of its risks.

Remarkably effective acne cure, yes. Wonderdrug, absolutely not. Calling it one is just disrespectful to those who have killed themselves [2] and whose lives it has damaged [3].

[1] http://en.wikipedia.org/wiki/Isotretinoin#Permanent_side_eff...

[2] http://rense.com/general32/scu.htm

[3] http://jacquelinefox.wordpress.com/2011/04/01/ibs-sufferers-...

I've taken this drug, the potential side effects are definitely scary. I was lucky enough to only suffer from dry skin and increase sun sensitivity (which is still existing to this day).

I know that when I was taking it (that was 12 years ago), the dermatologist would only prescribe it as a last resort, and, in case of a girl/woman, would always proceed with a pregnancy test first.

I personally am happy I took this drug but I can fully understand it's not your case.

I'm genuinely happy for you. I know what it's like. When isotretinoin works — and it usually does — it has an amazingly powerful effect on one's self esteem.

Since you took the drug 12 years ago, Roche has been quite aggressive in its marketing of accutane for treating more mild acne – not necessarily as the last resort that you describe. I think it's reasonably well prescribed here in the UK, but I get the impression that it is handed out somewhat too readily in many nations, including even the USA.

The wikipedia references for IBD/Accutane association seem to be all case studies except for one population study. However, perusing google scholar shows several population studies that show no correlation: http://dermatology.co.za/images/IsotretinoinIsNotAssociatedW...

Why do you think it causes depression more than the Roche data suggests? The studies about depression and suicide are similarly inconclusive: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1463189/

Is the data from the Roche lawsuits available? I'd like to know what evidence is resulting in these multimillion dollar IBD/Crohn's cases.

I took two courses of Accutane after reading several research papers and population studies of side-effects. I came to the conclusion it's safe, and would be interested in seeing any data that shows otherwise.

You're right to mention the conflicting nature of much of the data available. I quite agree that there is noteworthy evidence both for and against the IBS link, but the fact that IBS lawsuits led Roche to pull the drug off the market in 2009 suggests that there must be some compelling evidence of a link.

It's anecdotally accepted that isotretinoin users have a tendency to avoid reporting depression so as to continue being prescribed the drug. It's common sense – of course there will be underreporting in cases where the reporting will prevent someone being prescribed a drug they wish to take.

Do you know what dosage your treatment consisted of?

Full 5 month treatment at slightly under 1mg/kg/day (60mg).

A second, unfinished, 10 month treatment aborted after around 7 months at 0.5mg/kg/day (40mg – I'd put on 10kg of muscle). The lower dose was to reduce the almost daily nosebleeds I was experiencing on 1mg/kg/day.

1 mg is an insane dosis. No wonder you had to endure that shit.

A study suggests that doses as low as 0.25-0.4 mg/kg are sufficient: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2133.2010.....

While I have to agree, 1mg/kg seems to be by far the most commonly prescribed dose at present. Perhaps that will eventually change in light of the recent research you've mentioned.

Yeah, no doubt. That's what bothers me; sometimes, your doctor is prescribing treatment that could harm you, even though they may not know it.

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