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?

Jen Graves (The Stranger’s former arts critic) mostly writes about things you approach with your eyeballs. But she’s also a history nerd interested in anything that needs more talking about, from male...

98 replies on “Faceless Babies and Acne”

  1. I don’t know what other drugs, if any, are controlled this way, but I do know that Accutane has been targeted with huge numbers of lawsuits by women who were warned about birth defects, but got pregnant anyway. I’m guessing that I Pledge is all about doctors and pharmaceutical companies covering their asses via FDA requirements.

  2. If you participate in a research study for any type of an investigational drug, you often have to sign a consent stating that you’ll use two forms of birth control.

  3. I had to take the pledge. I wasn’t too offended because I was 16 at the time, and all 16 year olds are retarded. Imagine an acne ridden, retarded 16 year old with a faceless baby.

    Anyway, you are a grown woman, so your offense makes perfect sense. BUT GOD WHAT ABOUT THAT FUCKED UP BABY! Take the pledge, Jen Graves. Your skin will thank you (your diseased half-dead accidental baby will NOT).

  4. Watch out, because that shit will dry out and irritate your skin. Your lips will pretty much slough off. My friend was on it for a long time, and it did clear up his skin for a few years, but his skin was always dry and irritated and it made his back hurt.

  5. oh, also, they put an illustration of the faceless baby on every pack of the ‘tane. there’s also an illustration of a pregnant lady with a big red x over her belly, just to remind you not to fuck up.

  6. I take methotrexate for arthritis and my doctor repeats and has me swear up and down every time I visit him that I am using super birth control because it causes defects and miscarriages. This one can also cause birth defects through guys as well so if they want to get their gal pregnant, they have to go off the med for at least three months prior (same with the ladies). I didn’t have to sign anything or swear on a bible but maybe that’s because I live in Canada. Perhaps the US is different?

  8. Yes, nothing is more offensive than being told you have to be responsible for your behavior because it could negatively effect others. Your right to behave as selfishly as possible is the only right that matters anymore.

  12. I was on Accutane in high school, and they don’t mess around with it. Each pill was trapped behind a plastic bubble (like Dentyne) and to get it out you had to push it through a picture of a pregnant woman circled and crossed out like a no-smoking sign.

    Also, it makes you suicidally depressed, so be careful!

  13. I was on drugs that would cause my child to have yellow teeth. That is permanently yellow teeth. According to my doctor the teeth would still be functional just yellow. My doctor was seriously concerned for this potential yellow toothed kid and we had lots of fights about me going on the pill. I didn’t want to go on the pill because I was too sick to have sex anyway. If for some reason I decided to have sex I would use a condom. If the condom broke I would use plan B. If Plan B failed I would use abortion. That’s 3 forms of birth control, I pointed out, 4 if you count illness induced abstinence. But eventually I just had to lie to him. It was an expensive lie.

    I don’t have any kids, yellow toothed or otherwise.

  15. I never had to take this alleged Pledge while I was on Accutane (I think I was 14 when I started, 16 when I ended). Maybe I was too young, maybe they hadn’t made it up yet. On the other hand, Accutane is pretty much a selfish drug…you’re doing it for how you LOOK, after all.

    I will say, your skin gets paper-thin and one time I yawned and the right side of my mouth cracked open about a half-centimeter. I still have a dark patch where it was split for a couple months. Keep a good cocoa-butter/Vitamin-E lotion on hand for your face.

    It causes depression in some teens, but I suspect this has to do with them going from pizza-faced to paper-faced within a month.

  16. I sincerely don’t understand why you should be offended at this. It sort of seems like the people who get angry when they’re carded buying alcohol–“Are you calling me a liar?” Your doctor does not have the discretion to decide that you’re a responsible person who can be trusted to take precautions, and there’s no apparent reason why he SHOULD be given that discretion. Besides, responsible people can make mistakes, too. Nobody seems to be advocating for the right to get pregnant while using this drug, so why is it a problem for them to say that you can’t, and to ask for your guarantee that you’ll take reasonable measures to prevent it?

  17. @14: The pill is important with various drugs, not just for prevention. Spironolactone usually comes with a side-order of ortho-tricyclen, to keep hormones balanced.

  18. I took Accutane when I was 20 and it made my terrible acne go away and stay away. The dry skin sucks, but Cetaphil moisturizer works fine (just carry it around with you) — use Aquaphor for your lips. The depression thing affects teenagers, but not adults as far as I know. It worked when nothing else did. I’d recommend it, personally.

  20. @10 Oh yeah…I forgot. Not only can you NOT DRINK on Accutane, you can’t drink for 6 months after you get off the pill. It’s no joke.

    One of the ways they found if a specific group of proto-humans ate meat was that they found bone growths on a fossil that suggested the proto-human had eaten the entire liver of a large animal, or perhaps lived off liver. Your body can’t deal with very much Vitamin A, much less so when your liver is already stressed with booze.

  23. actually, the emphasis on “hormonal birth control” makes me think that it’s not just the “Birth Control” aspect that they are worried about.

    unstable and unpredictable hormonal cycles ARE a problem for drugs interactivity in women. it’s one of the (and pretty much the ONLY) good reasons for the disparity in medical testing on women vs men. women have a MUCH more volitle hormonal cycle (that varies EXTREMELY widely from person to person)–and the chemicals we have messing with our systems mess up drug effects. for a drug that, presumably, acts on the hormones–I’d say the precautions are necessary for Accutane to work predictably.

    for men–the hormonal cycle is less volitile, and much more standardized between individual men on a general basis. they don’t need to regulate and norm out thier cycles in order to get standard results.

  24. I know two people who went on Accutane and afterward had to be treated for depression. The FDA jury is still out, but that stuff is scary.

    They both did have clearer skin afterward though

  26. I’m pretty sure my older brother’s best friend committed suicide after having been on Accutane. There is a major cover-up by industry lobbyists about the effects of Accutane, but I believe someone else in this thread also mentioned the depression effects. Just be careful.

    I actually also concur with @9, because I think it’s somewhat selfish to declare “How dare you say I can’t have a retarded baby?!?”

    I mean, this isn’t just a genetic-mutation baby because you boinked someone. You’re being specifically notified that your baby will come out like a mutant from Beyond Thunderdome and you’re getting offended? I mean, aren’t Stranger writers supposed to be all pro-science and appreciative and stuff?

  27. Just my two cents: I had a good friend who used Accutane. I wouldn’t say it made him depressed, but it did give him drastic mood swings and fits of rage. He was a pretty soft-spoken guy, but I saw him stop his car in the middle of traffic and threaten to beat up a 12-year old kid for crossing the street too slow. Scary.

    It did clean up his zits, though!

    BTW, the liver of the polar bear is toxic to humans, specifically because of a Vitamin A overdose. Or so says Isaac Asimov.

    I’m also confused as to why you’re offended. It’s a potentially dangerous drug with severe side effects. Why shouldn’t health care providers take some reasonable precautions to make sure you use it responsibly?

  28. Accutane DOES affect sperm and boys have to pledge to not make babies too — we’re just not tested for pregnancy or told to get vascetomies every doctor visit.

    I’ve never been depressed while on it and my doctor told me it’s OK to drink as long as my blood tests don’t show signs of liver damage.

    That is all.

  29. The medication for pin worms is one that doctors stress you NOT be pregnant and take precautions to NOT become so. I don’t remember any pledge per se, but things could have changed in the last few years.

    Another interesting side effect of Accutane is that it causes many people’s hair to become curly. Weird.

  31. Thalidomide is used for cancer treatment now. If you need to take it (and you’re female), you have to sign something saying you won’t get pregnant.

  32. @28: When my roommate told me about the pledge, I was momentarily offended as well, but I really think it has to do with the fact that its called The Pledge. Most government-sponsored honor codes are stupid or destructive (see: Loyalty Oath).

  33. It’s very well and good that you (claim to) have the brains not to get pregnant while using a drug that can cause “severe, life-threatening birth defects if the mother takes the medication during pregnancy…even one dose of Accutane can cause major birth defects of the baby’s ears, eyes, face, skull, heart, and brain.”

    You can also use a computer, have critical thinking skills, and post blog items to the Web.

    Many, many people out there lack these brains, and the same people risk being unaware they are pregnant (or have wacky ideas how not to get pregnant), thus bringing to full term a human being who will suffer greatly and likely die shortly after birth (hopefully).

    Doctors cannot tell who has brains and who doesn’t, so you get the spiel just like everyone else to minimize the likelihood of something tragic from happening. Don’t take it so personally. It’s not about you.

  34. I was on accutane for about 8 months and have no regrets at all. The birth control thing was a pain in the ass, admittedly, and the dry skin and lips were uncomfortable, but the results were so amazing (and I’d been struggling with severe acne for the year before) that I would do it again. Every month you see your doctor, do a pregnancy test, get another prescription, and then answer some questions about sex and pregnancy that are straight out of 7th grade health class (can you get pregnant having sex in a swimming pool? can you get pregnant if it’s your first time?). You can drink while on accutane, and it has been known to cause depression in a small number of people, most of this is anecdotal evidence–I didn’t feel depression, mood swings, or anything out of the ordinary except so so happy that my skin was clear. I did use two moisturizers on my face (try Moor Balm, expensive but totally worth it)and kept aquaphor around at all times–which my husband hated as my lips were always greasy. You do have to be organized about it as once you see your doctor and he/she enters the information they’re required to on the ipledge site you have a week to do so yourself and fill the prescription.

    Overall, it’s a year later and my skin is still great. I would do it again if my skin got worse and if your doctor recommends it to you I would do it.

    The pregnancy thing is a big deal, though. 100% incidence of SEVERE malformations among children born to mothers on accutane.

  35. I’m with @28, why are you offended at being fully informed of the risks of this otherwise very useful drug? If you had cancer and were pregnant, your physician would counsel you to get an abortion or wait until after delivery for radiation, and most chemo, because both are deleterious to the developing fetus. He or she can’t make that decison, you have to. Do you risk dying yourself and try to carry the baby to term, or abort now and increase your chances of survival? It is a tough call, but you have to be informed.

    The pledge is intended to make it absolutely clear that you understand the risks of taking the drug and getting pregnant. The reason that they are so strict about compliance with women who *can* or *may* become pregnant, whether they intend to or not is that physicians have had to pay out massive settlements to women who were informed of the birth defect risk but became pregnant anyway and sued on the basis of not fully understanding the warning. Acutane was known to cause birth defects when it was released and the drug always carried a warning not to become pregnant but many people just don’t believe what they are told until the worst comes to pass.

    There are amny drugs which are known to cause birth defects but which also have great benefit to society. They also have warnings. A useful drug should not be withheld from society at large because it poses a risk to a discreet population, such as gravid or potentially gravid women.

  36. 24 – The emphasis on hormonal birth control is probably because it’s the most effective form, aside from sterilization. And most doctors won’t perform a sterilization on someone your age with no children, because women can’t be sure that they don’t want children until they’ve already had them or are past the childbearing age.
    Aside from the how not to get pregnant for idiots warnings, this stuff sounds scary. I would run away.

  37. My father died of Multiple Myeloma. One of the treatment options was Thalidomide. He was 70 when he died, my mother was 68 – long past menopause. They had to sign something and promise that they would use birth control if he took the drug… I don’t know how many simultaneous methods, but the fact that my mother was 68 was not sufficient. The doctor/pharmacist/whoever was pretty serious about it.

  38. Accutane is pretty good but it does have the side effects noted.

    Including drying out.

    Anyone on Accutane really really needs to use two forms of birth control. Including men (who should at least provide one of the two forms).

  39. @10 – no, no problem drinking, and I didn’t notice depression, but then back then I ran marathons and the endorphins from a 10-20 mile run every day may have made that not noticeable.

  40. Wow.

    1) If, as some posters have suggested, the hormonal birth control is important for hormone issues connected to accutane and not just for birth control, then the doctor should have explained that. Since it wasn’t mentioned I’m assuming here that that was not the reason.

    2) Hormonal birth control has side effects. They’re usually not that bad and lots of women choose to take it, but there ARE side effects and so it should be your choice. The side effects range from weight gain, vaginal irritation and pain during sex, to increased chance of death from blood clots. I take the pill myself, but I researched all these risks first and decided to make that choice. I wouldn’t take kindly to someone telling me I HAD to be on it for a non-medical reason (and it is non-medical because you could always use other forms of birth control).

    3) The doctor definitely should emphasize how bad the birth defects are and how important it is to make sure you don’t get pregnant while on accutane. But this pledge stuff IS offensive. They can tell you they prefer for you to use two forms of birth control because its the smart thing to do, but it still should be your choice. If you mess up and get pregnant, then luckily its your legal right to abort the deformed fetus.

    4) I’ll give them a little bit of a pass on the grounds that they are probably trying to avoid a costly lawsuit, but I think you should have to sign a form only saying you’re aware of the birth defect issue and have been advised that you should be on birth control. That’s enough to cover their asses. This pledge stuff is creepy and offensive.

    5) I guess you could lie about taking the pill but that would be expensive. Will they actually check if you filled the prescription? Will they check your hormone levels later??? So creepy.

    6) I do think the pregnancy tests are a good idea though. No side effects there. But do they just tell you to do them at home, or do you have to come in to the office and waste a lot of time? if its home pregnancy tests, hopefully you’re aware that you can get a pack of them online for much cheaper than getting one at a time at the supermarket.

    (My boyfriend was on accutane years ago and now has back problems. It seems there’s some anecdotal evidence about them being related but no real proof.)

  41. Dry skin? Birth defects?
    Sounds a bit like Harlequin Syndrome to me.
    Although, apparently Harlequin Syndrome can be treated with Accutane. So who knows.

  43. Women taking Acutane who mess up, get pregnant, and have faceless babies will sue the doctor/pharmacist/drug company. A couple of those cases and the product is taken off the market. Thus, the pledge.

  45. There have been several attempts to get Accutane pulled from the market because of the potential for birth defects. I’m somewhat surprised it’s still available.

  46. Considering that they make me show ID and enter it into a computer to buy Sudafed, this level of precaution for something that will cause MAJOR problems isn’t all that unreasonable.

    And really, you know now that you’d get an abortion. But even when it’s the right decision to make at the time, it can be hard to do when faced with it. And sometimes people have an entire change of values when pregnant. So it’s not something to mess with.

  47. I was on Accutane for about two years in college and was seriously depressed the whole time. I ended up on anti-depressants as well. I can vouch for the noticeable, permanent skin and mucous membrane dryness afterward. It’s been 10 years since I stopped taking Accutane and I still have very little sense of smell left.

    The cystic acne, however, did eventually clear up during those two years.

    If you can at all avoid it, I’d suggest sticking to the antibiotics and benzoyl peroxide lotions. In the few recurrances of acne I’ve had, I’ve found that the “Proactiv Solution” products work very well, though they’re a bit pricey. They’ll try to get you to sign up to have them delivered on a subscription, but be sure to call and cancel or at least reduce the rate of shipment if you’re still using it.

  49. I’ve just started Soriatane for psoriasis, which is related to Accutane. They have the same laundry list of precautions and conditions. As a male, I was not required to sign any pledge (perhaps also because it’s not the same exact drug), but I was told not to let the medicine anywhere near a child, a woman who is pregnant, or a woman who thinks at some point in the next few years she might possibly have the chance of getting pregnant. Apparently this is nasty stuff. The warnings that came with it also said not to give blood for something like 3 years after you *stop* treatment. I don’t find all these rules and regulations that unreasonable–obviously they’re not doing it to step on your rights, but to prevent birth defects. They’re so worried that they won’t even let you donate blood, on the off chance that there is enough in your system to damage some *other* mom or potential mom.

    Having said all this, now I’m wondering if my face will fall off and if this was a good idea…

  50. Actually it is all a coverup. Heroes is a show based on reality and the reason that these people had these powers is because of the link that their mothers got pregnant while on Accutane.

    (i’m lying – for anyone who couldn’t tell already. Don’t sue me if you have a faceless baby with no super powers please).

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