Charming

Zwichenzug at The Bellman spells out a charming little sequence of events:

The only drawback -- and this is why the FDA has only approved Accutane for the most extreme cases -- is that pregnancies which begin while a woman is using Accutane display a disturbing tendency toward miscarriages and birth defects.

But did I mention that Accutane is a miracle cure? Miracles being in high demand, American dermatologists write about 170,000 prescriptions a month for Accutane even though there are only about 6,000 cases for which the drug is approved.

Let's pause a moment to suss out the causal chain here. Step one: each month, some number of women have severe enough acne to warrant seeking medical advice. Step two: 85,000 of those women are given prescriptions for the miracle cure Accutane. Step three: 85,000 clear skinned women look out on a bright new day. Step four: sex! Step five: pregnancy. Step six: side effects.

Now, obviously, it would be unreasonable to expect dermatologists to refrain from prescribing Accutane for dangerous, unapproved uses. Not only would that make it tough for the dermatologists to attract repeat business, but it would also cut into drug industry profits.(Links and emphasis mine.)

The 170,000 prescription for a 6,000-strong problem link is an August 2005 New York Times article which detailed a new FDA program that attempts to use an electronic database to keep track of the prescriptions and certified pregnancy tests. As far as I could tell the program does not attempt to do anything about 79,000+ excess prescriptions dermatologists seem to be writing to women--not to mention all the excess men! Note that this Accutane stuff also seems to have high risks for causing mental health problems, according to the FDA site. (first link) Even if this particular FDA program solves this particular problem, handing out prescriptions at an excess of 10-fold too much, despite such dangerous risks, seems to indicate a medical profession gone rather awry. From the NYT article:

Dr. Sidney Wolfe, director of Public Citizen's Health Research Group, a consumer advocacy organization, said the F.D.A. was recognizing that patients needed protection from irresponsible physicians and pharmacists. Dr. Wolfe added that drug companies were largely to blame, though, saying their huge marketing efforts often encouraged doctors to prescribe drugs excessively.

But Dr. Mark Naylor, an Oklahoma dermatologist, said with regret that many doctors would stop prescribing Accutane because of the F.D.A.'s new restrictions. While it is unfortunate that some doctors may have failed to follow earlier, voluntary guidelines on Accutane, Dr. Naylor said, "it's up to physicians and patients to decide how the drug gets used, not the F.D.A."

Despite the fact that the D in FDA stands for Drug. Granted, it's always a little zing to be reminded that the prescription drug industry spent $2.5 Billion in 2000 on direct-to-consumer advertising alone (page8). That year's $16 Billion total expenditure on promotional activity would be quite a sad waste of money if it didn't influence any doctors at all. Still it seems to me that a group of professionals with a four-year rigorous scientific education should be just a little more immune to the marionette-hooks of a marketing department--and would not, as a group, overprescribe by almost a factor of 30. Unless at least some of them were being, um, a little greedy or negligent. Good thing Bush wants to make it harder to sue them.