In the case of acne, the cure is sometimes worse than the ailment   

On January 5 of this year, fifteen year old Charles Bishop stole an airplane and crashed it into a Florida office.  He killed himself but no on else was hurt.

In light of September 11, it looked like the act of a pathetic copy-cat.  Newspapers reported the contents of a suicide note left behind.  In it, Bishop claimed that Afghanistan’s al-Qaida had tried to recruit him.


What most newspapers didn’t report was that Bishop had been taking the powerful prescription drug Accutane.  Used in the treatment of skin acne, Accutane has dangerous side effects including depression, suicide and psychosis, according to the U.S. Food and Drug Administration.

The suicidal side effects are significant enough that the maker of the drug, Roche, had to retract claims that Accutane was useful in treating “psychological trauma” and “emotional suffering” associated with acne.

Accutane is one of many prescription drugs being marketed directly to the general public.   Direct marketing is illegal in Canada but legal in the U.S.   As a result Canadians see the ads that pour over the U.S. border on television and in magazines.  Canadian media, anxious to get advertising dollars, have been dodging the law.

The law is there for a good reason.  Direct marketing bypasses the expertise of the doctor by appealing directly to consumers.   Canadians who view the ads innocently diagnose their real or imaginary problems and insist that doctors write out prescriptions.  Unfortunately, those who diagnose themselves have a fool for a patient.

Drug companies have convinced governments to look the other way.  Governments are told to get out of the way of big business and reduce regulations.  And isn’t consumer choice the saviour of us all?

Not that acne doesn’t cause “emotional suffering.”  I know because as a teen, I suffered through the “psychological trauma” of acne.  In desperation, I would have bought any drug I thought might work.  But the cure is sometimes worse than the ailment.  Direct marketing preys on the vulnerable.

Along with suicidal tendencies, another known side effect of Accutane is a risk of severe birth defects if taken during pregnancy.  They include mental disabilities, missing ears and heart problems.  Despite warnings from doctors, by 1988 there had been over 500 children worldwide had been born of Accutane users with such defects.

The tragic birth of deformed babies prompted calls for Health Canada to ban the drug.  Instead of banning the drug, with the regulators’ approval, the manufacturer set up this pregnancy prevention programme.   But it didn’t happen.

Doctor Gideon Koren  at Toronto’s Hospital For Sick Children reports four women became pregnant while taking Accutane in a six month period alone.  All had been warned of the risk, but only one had been given the pregnancy prevention programme.

The pressure on doctors to prescribe drugs is great when patients insist on getting them, convinced of the drug manufacturers claims.  Doctors are only human and give in to this pressure, despite misgivings.

Accutane is not alone in the flogging of prescription drugs directly to consumers.  A smiling woman beckons you to ask your doctor for Sarafem to treat the world’s newest disease, Premenstrual Dysphoric Disorder.  Ex-NHL great Guy LaFleur is pushing Viagra in his battle against erectile dysfunction.  The ads appeal to vanity, hypochondria, and human frailty.

The cost of drugs to our health care system is enormous.  We already spent more money on drugs than we do on doctors wages.   But that fact sometimes gets buried in the health care debate. The reason is purely political.

It’s easy for the B.C. Liberal government, for example, to moan at the recent wage increases for doctors.  But you don’t see them trying to regulate the obscene profits of drug manufactures.   Health care workers are fair game for this government.

Beware of governments who offer choice in health care.  In this case, they advocate the urge of consumers to choose potentially dangerous, inappropriate, and expensive treatments.

On a recent visit to Canada, Dr. Peter Mansfield from Australia urged Canada to start enforcing its law against U.S. style direct-to-consumer advertising.  Only the U.S. and New Zealand have not yet banned the practice. “The drugs are the newest, and often most expensive drugs, but not necessarily the best,” he says.  Such advertising distracts doctors and patients from safer, cost effective therapies.


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