The High Price of Perfect Skin

Retin-A used to be the magic cure for acne until it was found to help with wrinkles. That means people over a certain age would have to pay cash for it. Some insurances limited it to age 18, some to age 25, and after that the lengthy and unpleasant prior authorization process is necessary. I have seen many requests for authorization denied. So pony-up and break out a credit card or cash and get your wrinkle cream... I harken back to my acne filled days of youth when insurance gave me the 45gm tube for $3. It was a steal!

Other costly methods for perfect skin include but are not limited to laser resurfacing, chemical skin peels, repeated facials, photo facials, specialty OTC creams, etc. What happened to staying out of the sun and moisturizing? It has worked great for me so far. I am going to be 33 and got carded for cigarettes last year before I quit smoking. Thank you kind gas station attendant for the compliment! I have even been carded at liquor stores and bars...woohoo!

The allegedly greatest product for acne is Accutane. This wonder cure has serious problems if given to pregnant women. For those of you not in the know, there was the SMART system for prescribing that told women all the horrible things that happen with this drug especially if you get pregnant. It didn't work. So the iPledge system was introduced.

A study done by the Slone Epidemiology Center at Boston University followed about 500,000 female patients on Accutane for a 140 day course. Only 447,679 completed the study requirements. The results were not reassuring. The study found a rate of 2.5 per 1000 of the 447,679 that completed the study got pregnant while on Accutane. This is even after enrollment in the iPledge program, the pregnancy tests prior to each prescription, agreeing they would use 2 forms of birth control, and answering all the surveys. They were even told of the birth defects.

Let me put this into perspective. That means that out of 447,679 women about 1,119 of them showed a blatant disregard for their baby's health. They were told this can cause miscarriage or birth defects. End of story. This is category X which means it causes damage EVERY time, hence the iPledge precautions and requirements.

Even more disturbing was the first year of iPledge which was supposed to prevent the shortcomings of the SMART prescribing system before it. There were 122 reported pregnancies. Ten of them were pregnant prior to starting Accutane. Um hello, who's doctor forged a pregnancy test.....that is unethical, immoral, and disgusts me that a healthcare practitioner would sink so low to make a buck. A warning to all healthcare practitioners: These systems are put in place to prevent imminent harm! Bypassing them means you don't care and have no right to call yourself "doctor"... The first rule of medicine is to knowingly do no harm or put a patient in a position of harm unnecessarily. Bypassing these safeguards also means you are going to get sued, big time, because the manufacturer is not liable for practitioner negligence and willingness to disregard FDA sanctioned safeguards. There are thousands of lawyers waiting to profit from your carelessness. Do a Google search. I found pages and pages of them...

Even more disturbing are the number of online "pharmacies" that sell Accutane without a prescription. Sure they print the warnings on the web page but there is NO system in place there to prevent a person from taking it and harming themselves or an unborn child. Because the iPledge system is apparently only enforced in the U.S. there are sure to be many more medical misadventures with Accutane. I wonder where the liability lies there. I guarantee if something goes wrong your lawyer is going to have a damned hard time locating someone from that "pharmacy" when the shit hits the fan.

But wait, there is more! By December 2000 there were 66 documented suicides of Accutane patients and another 1,373 cases of severe psychiatric problems. It was reported that these psychiatric manifestations happen approximately 6 weeks into treatment and were not gradual. It would be like the kid is okay at 2PM but started acting weird and was in the basement building a noose and dead by the next morning. It has been correlated with a severe depletion of serotonin levels in the brain. This sh*t should be pulled from the market. I wouldn't recommend it to ANYONE and recommend to patients that they try topical treatments like Proactive instead. It has shown good results, even with cystic acne.

Just remember kids: Safety First!!! Acne is not the end of the world. I still get it and I am over 30.