PRO & CON.

Is Accutane overprescribed?

YES

Acne may be discomforting, even debilitating, but severe birth defects are truly tragic.

There is no question that Accutane is overprescribed. The number of prescriptions written annually rose from 70,000 in 1989 to an estimated 210,000 in 1999.

The approved indication for Accutane (oral isotretinoin, Roche Laboratories, Nutley, N.J.), according to its own packaging, is for "severe, disfiguring nodular acne that is recalcitrant to standard therapies." There are not that many cases of disfiguring, nodular acne.

Casual prescribing is inappropriate for a drug that is akin to thalidomide. Thirty-five percent of pregnancies exposed to oral isotretinoin in the first trimester of pregnancy will result in major structural malformations. Hydrocephalus is the most common, followed by cardiovascular abnormalities. Children are born without ears and with abnormalities of the thymus.

We should be using this drug only with the utmost caution. Instead, we have a situation where the drug is marketed specifically to teenagers via magazine and television campaigns. I have no doubt that acne can be extremely distressing, but when one weighs birth defects against a cosmetic issue it is clear which one should win.