First of all: people are starving and being tortured and killed for no reason the world over, so what I’m about to say does not much rate, but I’ll just give it a go anyway.
So I go to the acne doctor this morning. I am 33 and got acne about two years ago. I did nothing about it for the longest time, because it’s just acne, and who cares, and then I finally went to the dermatologist, who put me on antibiotics that I’m supposed to take for six months, and this was my six-week checkup. The acne is mostly gone but not all gone. The doc says: If you want it completely gone, the only thing that makes a permanent difference is Accutane. Accutane, evidently, is the wonder drug of the acne world. (Or maybe it isn’t, but this is how it sounds when I’m sitting there.) She says it will actually change my glands, or somesuch, and that I have to take it for six months. She says it is essentially a huge blast of vitamin A.
The only twist is that in order to take Accutane, you have to join an FDA program called “I Pledge,” which sounds creepily like an abstinence cult—and actually isn’t all that far off from an abstinence cult. Before you can get the drug, you have to take not one but two pregnancy tests. The dosage is six months. Every month you have to take another pregnancy test. The reason is that Accutane causes severe birth defects, she says. The way she rests on the word “severe” makes me think it causes babies not to have faces, not just miss a finger or something. Then she tells me that in addition to the tests, you also have to prove that you are on not one but two forms of birth control. “We prefer a hormonal course,” she says, meaning the pill, along with condoms. I am not accustomed to being told what other people prefer I do with my uterus quite so starkly. Evidently you sign something saying you’re using the condoms and the doctor prescribes you the pills, too. Or you get an IUD implanted. I didn’t get the sense that, say, pledging to use condoms and a diaphragm would be sufficient.
I have to admit that I was offended. On the other hand, I don’t take babies without faces lightly. I couldn’t help but wonder: Are there lots of drugs out there that have this kind of FDA pledge program for women attached to them? (The vitamin A doesn’t touch sperm, the doc said, so men can do what they want with Accutane and sex.) Or is Accutane singled out because acne commonly appears in horny and irresponsible teenagers?
Guess why they do that? Because no matter how many warnings they give you or documents they force you to sign, if they didn’t do it there were but a small but significant minority that would get pregnant, have a deformed baby and sue the doctor and the company that makes the drug. And given our legal system, even if they didn’t win (they very well might), it would cost the company a small fortune to fight in court.
Seconding the commenter above who recommended reading the Wikipedia article if you really want to understand what this is about: http://en.wikipedia.org/wiki/IPLEDGE.
Requiring you and your doctor to ensure you’re on birth control is one thing. Forcing you to give your entire sexual history (including STDs) to some stranger via a not-secure-enough Web site is another. And really, do you want to wait for the government to rubber stamp every refill? This is so much more draconian than procedures for other teratogenic drugs, or even for addictive drugs like Ritalin and strong opiates.
You thought wrong. I’m certain that a teenager who took the drug and got pregnant could sue on the grounds that the doctor and pharmaceutical company are obligated to demonstrate to her how not to get pregnant. The information they give to patients makes it clear that the FDA knows that people are fucking idiots. Among the questions I had to answer to prove I know how reproduction works:
Can someone get pregnant from having sex in a pool?
Does hormonal birth control have to be taken every day?
Can a woman get pregnant from having sex during her period?
A smart lawyer could absolutely sue the shit out of a doctor who failed to instruct and monitor his/her borderline retarded patients.
@53,
There’s no waiting whatsoever.
count me in on being severely offended by “the pledge” and all it covers. I think it is sexist and a violation of civil rights, how do they get away with it?
Need to prove non-pregnancy prior to [any] prescription? FINE! Need it be a pledge? Just pee on the stick, sign a waiver and move on!
pledging to get not pregnant, pledging to take hormonal birth control, only asking women to make “a pledge” a promise -it’s fucking mind baffling…
This is the 21st century, this is all we got? This is the first world we live in..
There are newer laser therapies that apparently can help with acute acne.
http://www.acne-resource.org/understandi…
Results are supposed to be comparable or better than other treatments, including Accutane. Not only do you get to avoid the nasty known side effects of Accutane, but you get a freakin’ laser! (You should avoid extended expose to the sun, but that’s easy in Seattle.)
I still think signing a bunch of forms, watching a video about birth defects and answering questions to prove you watched it, that kind of thing should be sufficient. Having your medical history entered in a federal database is NOT necessary.
@54 — instructing is fine. Give them some literature, make them answer a multiple choice questionaire. In fact, with the state of sex ed in this country the kids might learn something new.
That is completely different than (a) forcing them to take hormonal birth control, (b) forcing them to submit personal medical information to a government website that may not be secure.
Two birds, one stone: the birth control pill, Yaz, is also very effective at eliminating acne. It worked wonders for me!
oh suck it, inkweary. it should be clear that most lesbians (those who sleep solely with women, at least) get pregnant intentionally.
Why can’t you use a topical antibotic/benzoyl peroxide combo? I’m in my 30s and I use Benzoclin everyday, which keeps my acne almost completely in check and, more importantly, doesn’t FUCK UP MY SYSTEM. I took all those antibiotics for years and my stomach/immune system seemed to take years to recover.
Jen: Don’t take the drug. It sounds like it will be hell on your body. What if it does permanent damage?
I had a bout with acne myself and I have found Clinique’s Acne Solutions bar soap to be an over-the-counter godsend.
http://www.clinique.com/templates/produc…
@ 62
Because some acne is worse than others and that stuff doesn’t work.
Accutane worked wonders for me when nothing else did the trick. I’m talking like 10 years of “solutions”.
No depression. And I drank while taking it.
Plenty of dry skin though while on the stuff though.
For one thing, it’s not something that anyone has to do. Don’t like it? Don’t take the medication.
My grandmother took Thalidomide in the years leading up to my mother’s birth; she had one horribly deformed baby that died and then my mom. Although physically my mother not have any obvious birth defects, around the age of 30 her body basically turned on her – her immune system went haywire and basically stopped functioning, she had osteoporosis and multiple surgeries to correct broken and fractured bones, degeneration of the discs in her spine, and all kinds of uterine problems like endometriosis. She spent most of the last half of her life in and out of hospitals and medical treatment and died at the age of 51. So, don’t be offended. I suspect they made up this pledge for good reason.
I hear you, sister. I was on the antibiotics for years. When I went off them, the acne came roaring back. I didn’t want to try Accutane. The only thing that’s worked for me was checking “The Acne Prescription” out of the Seattle Public Library and following it’s recommendations to the letter. Worked for me. Also, it is free.
@61 and what if they are raped? Or just don’t take the warning seriously?
The reason for the elaborate prescribing guidelines is that prior to the pledge there were many women who ignored all of the counseling and became pregnat while on the drug. Then blamed the doctors and the drug company.
@41 – Not to mention depression. I’ve done 3 different formulations, including a mini-pill, and I was clinically depressed each time. Now, I am a recurrent depressive, so occasional depressive episodes are things I deal with anyway, but going on antidepressants just so I could take birth control pills seemed stupid.
ESPECIALLY since if you weigh over 200lbs you are twice as lucky to have an “accident” on the pill. LOVE how a pill that makes you gain weight becomes less effective when you gain weight. 🙁
Jen, did they point out that antibiotics can make birth control pills not work?
Half of my graduating class (2008) did Accutane at one point during high school, including my boyfriend. It makes your skin kind of gross and peel-y. If kids with bad acne started re-applying Chapstick constantly, you asked how many months into the treatment they were. One girl showed me her ‘Accutane manual,’ a huge binder detailing all the horrible things that can happen to a baby.
Maybe we need to direct our anger towards people like this.
http://www.cbc.ca/health/story/2004/02/2…
I was prescribed it in the UK about 10 years ago. The dermatologist asked about pregnancy tests and contraception but when I told them I was a lesbian, they were satisfied with that – no need to take the pill or have any pregnancy tests. It sorted my acne out but yes, did dry my skin out a lot and leave it very thin. No after effects now except that my skin is more sensitive to the sun.
WHO CARES
You know, I thought about adding “as long as they aren’t raped” but I figured that no one would seriously keep pursuing my statement to ensure that I added every possible disclaimer. Whoops.
I work in the pharmaceutical research industry. Yes, there are a number of drugs that have you sign a “no baby” pledge. Retin-A can make you have a baby with no HEAD, let alone no face.
If you’re that concerned, try something less threatening first like Phisoderm washes followed by Oxy 10, and if that doesn’t work move to Cleocin-T before Retin-A.
Did she tell you that accutane makes you loose your mind as well?
Just in case she didn’t: ACCUTANE MAKES YOU LOOSE YOUR FUCKING MIND.
When will the ugly learn that God intends for them to be ugly. Trying to undue his will with tricksy drugs will only cause him to smite you with an even uglier baby.
Try Prosacea. It’s for rosacea, but I have a zitty form of rosacea, and can’t go a day without it or I get a major outbreak. The downside is it contains sulfur, so your face and pillow start smelling like sulfur. But at least it doesn’t make you kill yourself or have faceless babies.
I loved Accutane. I didn’t have any side effects except for dry lips (chapstick etc. works fine to combat that), it cleared my skin like a charm and my skin is still pretty good, 6+ years out after my year on the drug in college.
I am a lesbian, and yes, even I had to do pregnancy tests monthly. It wasn’t a big deal. Any depression I had lifted once I had clear skin. I even drank alcohol while I was on Accutane and nothing weird happened.
Finally, I work in clinical research, and as far as side effects go this drug isn’t too terrible in comparison to many other drugs I see.
All in all I think it’s an effective drug and I recommend it. Just have them put you on a low dosage.
I know this is unsolicited medical advice from a non-medical person, but I had something similar where I never had skin problems in high school but started breaking out really bad in my late twenties and thirties. I met someone who had a soy sensitivity and who used to have similar skin problems until she quit soy – since I was regularly eating energy bars w/ soy protein isolates and soy milk, tofu, etc. I decided to go off soy for awhile and see what happened. And my skin got a lot better! It’s not perfect, and I don’t totally avoid everything with soy, but it’s so much better.
I don’t know what you eat, but if you are eating a lot of stuff with soy I would recommend trying a dietary change first before Accutane. Takes about a month to see if it makes a difference. I’m guessing the soy was messing with my hormones, which apparently can get really out of whack in your thirties.
I don’t think it’s *wrong* to make patients sign pledges and so forth in order to gain access to the drug; the drug companies and doctors are just covering their asses. However, it does make the drug sound pretty damn scary. I was offered the accutane regimen by my dermatologist for bad acne in my early 30’s and I ended up not doing it. Any drug that does this much crazy stuff to your body is just not worth it. I just stuck with the antibiotics and they cleared my skin up enough that it didn’t look awful anymore, even if it wasn’t perfect. Eventually my acne was cured – by a (planned) pregnancy. Apparently massive doses of preggo hormones will do the trick for some women. I, uh, don’t recommend this course of treatment, however, unless you’re interested in having a dependent. 😉
79
“I am a lesbian, and yes, even I had to do pregnancy tests monthly. “
What!
Why?!
Since you ARE a lesbian and therefore a non-reproductive being why did you have to test for (impossible) pregnancy? Doesn’t the medical profession realize that Mother Nature doesn’t make mistakes?
@71
Whom are we angry at; the woman or her doctor?
49
WHAT?!!
see #82 above.
@71 – “The prescription itself did have an information package, but I didn’t look at it.” *sigh*
Here’s the easy solution to your dilemma, Jen: post a nice, clear picture of your acne-ridden face, and we, the readers of Slog, will vote on whether or not it’s bad enough to justify using Accutane! Problem solved!
Jen, I agree you should be annoyed.
Having seen your face it would be a blessing if your offspring had zero chance at a dip from that gene pool.
Jen asked if there are other drugs that require such a pledge. Yes, I was on a drug named Cytotec [spelling?] about 10 years ago and it, too, required a pledge not to get pregnant. But all I had to do is sign a form swearing I wouldn’t try to get pregnant and, if I did, I wouldn’t sue the manufacturer for anything that happened. And the bottle had about 13 stickers on it saying not to get pregnant, don’t take it if you are pregnant or planning to get pregnant or nursing, etc. all over it.
I don’t know if it is still on the market – it had awful, awful side effects – but if it is, I’m sure they’ve tightened up the no-pregnancy thing.
FYI, Cytotec is an arthritis drug [I have it pretty bad] and a relative of RU-486. It causes birth defects and miscarriages. RU-486 was originally designed to be an arthritis medication, until they knew the side effects [miscarriage]. Cytotec is not only less effective than RU-486 as an arthritis medication, it also has worse side effects. But the American Taliban couldn’t allow an ‘abortion drug’ in this country, now could they?
@85
Thanks.
stupid bitch…
Accutane scares the heck out of me. I wouldn’t let myself be exposed to it let alone some poor little baby. I hate to give advice on this sort of stuff but you did ask….Being a fellow 30 something acne sufferer(it really sucks) I would recommend checking out the homeopathic cures at Whole Foods. I used that and it really helps! Plus they are only like $7! That and Proactiv, which really works miraculously well. I also do use Retin-A microgel(formulations other than microgel cause me to break out!). Try the less invasive stuff first as Accutane can have long term side effects and it is some pretty scary stuff. It was linked to suicidal depression, not the stuff I’d want to be taking during a gray and rainy Seattle winter!
Accutane is fucking great. You look like a lizard for a few months, followed by a lifetime of near-perfect skin. And we’re not talking a few pimples, we’re talking covered-in-giant-zits-and-terrible-infections. Great stuff.
Mood swings? Wouldn’t know. Bipolar–the manic kind. I’m super polite and sweet mostly now, but I will fight you with my fists if you talk in a movie theater.
Is that a side effect?
@37: women can’t be sure that they don’t want children until they’ve already had them or are past the childbearing age.
Seriously?
To all you people saying “Why don’t you try this, why don’t you try that”: Don’t you fucking think that any person with half a brain would have tried just about EVERYTHING OUT THERE AND HAD IT FAIL before going on a drug with such serious potential side effects?
Benzoyl peroxide doesn’t work.
Salicylic acid doesn’t work.
Diet changes don’t fucking work.
Proactive doesn’t work.
Your homeopathic crap doesn’t work.
Antibiotics don’t work (and have their own crappy side effects).
Lasers don’t work (plus, see above) and cost waaay too much.
Retin-A doesn’t work.
Birth control doesn’t frikkin’ work (for zits).
All the 5+ topical prescription drugs for acne that I’ve tried DON”T WORK.
Hence, Accutane.
Thanks for coming out.
To all you people saying “Why don’t you try this, why don’t you try that”: Don’t you fucking think that any person with half a brain would have tried just about EVERYTHING OUT THERE AND HAD IT FAIL before going on a drug with such serious potential side effects?
Benzoyl peroxide doesn’t work.
Salicylic acid doesn’t work.
Diet changes don’t fucking work.
Proactive doesn’t work.
Your homeopathic crap doesn’t work.
Antibiotics don’t work (and have their own crappy side effects).
Lasers don’t work (plus, see above) and cost waaay too much.
Retin-A doesn’t work.
Birth control doesn’t frikkin’ work (for zits).
All the 5+ topical prescription drugs for acne that I’ve tried DON”T WORK.
Hence, Accutane.
Thanks for coming out.
Is your acne really that bad? When I get a pimple, I get it badddd, and I put a little dab of neosporin or triple antibiotic with pain relief on it at night and it clears up in the morning if I get a good 8 hours of sleep. Acne is a build up of staph bacteria… and I think some antibiotics/treatments may not work if their bacteria has developed a resistance to whatever remedies they’re using. After I got a nasty MRSA infection and had to take sulfa antibiotics for it, I’ve had fewer problems with acne. So that’s where my theory comes from.
@95 If your little pimple clears up overnight, then it’s not “baddddd”.
Baddddd is being 30 years old and still covered in 15+ huge, deep, painful pimples at once.
SO. I’m 16 and have had acne since about the 5th grade honestly (my parents had it pretty bad esp. my mom…) I’ve tried “everything” and am on proactive now. When I first started using proactive it worked pretty dang well, but like everything else your skin and body gets use to it so it stopped working. Along with proactive being very expressive, I really feel like I deserve to try something else. Something that will work. I’ve known for as long as I can remember that I’m not having sex until I’m married so this whole birth defect thing isn’t a concern for me, BUT as I’ve been reading peoples comments the suicidal topic is really freaking me out. I’m a happy person, but of course like everyone else in the world I get mad and annoyed. I really don’t want to be suicidal or depressed though…UGH. I just want to try this stuff….what to do. what to do.
Women who were warned of the dangers of getting pregnant on accutane and gave informed consent — a verbal contract, which is legally binding — cannot win their lawsuits, and won’t get a single penny. Informed consent is not new. It existed before IPledge. The issue at play here had nothing to do with anyone losing money over accutane pregnancies and now needing to cover their behinds. This is the US government slowly stripping women of our privacy rights and freedom to make our own decisions about our bodies… Hmmm, ever hear the expression “slippery slope?” It does indeed seem as though women are being regarded by our government as potential incubators for fetuses rather than autonomous individuals. I don’t care what they try to dress this up as. It’s unacceptable.
Also, Ipledge is a shady organization seeking to profit monetarily from their government-backed monitoring program. They might have changed their privacy policy by now (due to being legally forced to) but they have/had been using the personal information they gained from the women they were monitering as a data mining technique so as to contact these privacy-stripped women with “offers,” and they also reserved the right to share the personal information with unnamed “marketing partners.” Um, this is called SPAM. That’s who the government put in charge of highly sensitive medical records. Direct marketers. Spammers. Good job, USA!
Women who were warned of the dangers of getting pregnant on accutane and gave informed consent — a verbal contract, which is legally binding — cannot win their lawsuits, and won’t get a single penny. Informed consent is not new. It existed before IPledge. The issue at play here had nothing to do with anyone losing money over accutane pregnancies and now needing to cover their behinds. This is the US government slowly stripping women of our privacy rights and freedom to make our own decisions about our bodies… Hmmm, ever hear the expression “slippery slope?” It does indeed seem as though women are being regarded by our government as potential incubators for fetuses rather than autonomous individuals. I don’t care what they try to dress this up as. It’s unacceptable.
Also, Ipledge is a shady organization seeking to profit monetarily from their government-backed monitoring program. They might have changed their privacy policy by now (due to being legally forced to) but they have/had been using the personal information they gained from the women they were monitering as a data mining technique so as to contact these privacy-stripped women with “offers,” and they also reserved the right to share the personal information with unnamed “marketing partners.” Um, this is called SPAM. That’s who the government put in charge of highly sensitive medical records. Direct marketers. Spammers. Good job, USA!