Could an acne drug have driven boy to fly a plane into a tower?

London Independent

By Steve Boggan
10 January 2002

The author of the suicide note does not give an age or sex, only an impression of terrible despair left by the web name, "Hopeless". Then, on an internet noticeboard, the author types: "I have had this terrible disease for many years now. I have been on Roaccutane. It worked for a few months. I now see death as my only escape. It is the combination of acne and Roaccutane which has killed me."

This message appeared on the internet yesterday only hours after the news that Charles Bishop, the 15-year-old who flew an aircraft into a skyscraper in Tampa, Florida, on Sunday, had been prescribed Roaccutane, an acne drug that opponents claim can render those who take it suicidal.

Whether the author killed him or herself may never be known. But what is clear is that the drug has been linked to at least 138 suicides worldwide and many more suicide attempts. And, given that until recently most of those who took it were unaware of the alleged side-effects, there may be many more deaths where a link was not even considered.

Concern over Roaccutane, marketed in the United States as Accutane, has been steadily growing in recent years. Yesterday that concern turned to alarm with the disclosure that Bishop might have been on it when he stole a flying school plane and crashed it into the 28th floor of the Bank of America Plaza. A note found in his pocket expressed sympathy for Osama bin Laden, even though neither his family nor his friends had ever heard him express any support whatever for the founder of al-Qa'ida.

Police found a prescription for Accutane during a search of the boy's home but said toxicology tests on his body would not be completed for two weeks.

Already, however, Accutane's critics are pointing the finger of suspicion. It could, they claim, explain why a boy whose family said that he had never shown any signs of depression should suddenly kill himself.

The drug's active ingredient, isotretinoin, a derivative of vitamin A, was given a licence in the United States in 1982, and in the UK and Ireland in 1983 but it soon prompted concern, particularly over birth defects. Within a year, Public Citizen, an American consumer group, had called on the Food and Drugs Administration to demand that the drug's manufacturer, Roche, post warnings of possible serious side-effects on packaging.

In 1990, an FDA memo recorded: "The magnitude of injury and death has been great and permanent, with 11,000 to 13,000 Accutane- related abortions and 900 to 1,100 Accutane-related birth defects." In Britain, there have been 1,192 "adverse drug reactions" reported during the past 18 years, including 15 suicides. Given that research suggests only one in 10 adverse reactions is reported to the Medicines Control Agency, the suspicion is that the true figures could be much higher.

During the 1990s, the FDA continued to insist on ever more stringent side-effect warnings while the US market for Accutane grew to 535m.

Currently, the American packaging carries this advice: "WARNINGS Psychiatric Disorders: Accutane may cause depression, psychosis and, rarely, suicidal ideation, suicide attempts and suicide. Discontinuation of Accutane therapy may be insufficient; further evaluation may be necessary. No mechanism of action has been established for these events."

Pat Tebby's son, David, was using the drug when he jumped to his death from a multi-storey car park in Newport, south Wales, in February 1998.

"David was 18 when he killed himself and was on Roaccutane for the second time for acne on his back," Mrs Tebby said yesterday. "He first went on the drug when he was 16. He became a different boy and I became very concerned for him. We did not think he was suicidal but he became very depressed. "Before he went on the drugs he was a very confident boy. His ambition was to make television programmes. In the sixth-form of his school he had some lovely friends and a good social life but he still continued to suffer from depression. We were aware of some of the side-effects of the drug but not that it could cause depression and suicide. If we had known that, I think David would still be here today.

"I would advise any parent to be very careful before allowing their children to take this. The son of an acquaintance of mine had very bad acne and they decided he should take Roaccutane, so they made sure they watched him very closely. He completed his course of pills, and it did help his acne, but he said the medication made him feel very dark and awful."

In response to Congressional hearings in America after the suicide of B J Stupak, the 17-year-old son of Congressman Bart Stupak, tougher prescription regulations were introduced under which anyone being prescribed Accutane must first read detailed warnings and sign a form before they can be given the drug. The Roaccutane/Accutane Action Group, based in Dublin,which has highlighted concerns over the medication, wants similar rules to be introduced in Britain and Ireland. It is a demand that the Medicines Control Agency said yesterday was unnecessary.

One of the group's researchers, disagreed. "At the moment, in Britain and Ireland, people can be prescribed this and then just take it without realising the dangers," she said. "There are similar warnings here, but a lot of people simply don't read them." The action group is also concerned because the drug's licence was granted for the treatment of very severe acne only as a last resort. However, it is being prescribed for people with much less serious conditions.

The group says that research has shown that the problems of up to 80 per cent of those prescribed Accutane or Roaccutane do not warrant it. At its Swiss headquarters, Roche rejects criticism of the drug. Its spokesman, Horst Kramer, said more than 12 million people had taken it over the past 20 years. "In society in general, there are 20 suicides per 100,000 deaths," said Mr Kramer. "If you consider that in America about six million people will have taken our medication but there have been only 147 suicides or suicide attempts every one of them an individual tragedy the figures do not look disproportionate.

"This is a very important drug to us and we have been conducting a lot of research in this area. There are always people who would like to conduct other studies and there is always the potential for disagreements. We believe the drug is safe." Supporters of Accutane argue that the very people most often prescribed it adolescent teenagers with unsightly acne are relatively more prone than others to bouts of depression. And the company claims there are those in the scientific community who believe that more youngsters might have committed suicide had their acne not been cured by Accutane. Indeed, on the Roaccutane/ Accutane Action Group noticeboard, where the suicidal author had left his or her note, there are many other messages from people who say the drug changed their lives for the better.

Several have said that they were on the brink of suicide before being prescribed it. In America, Roche has recently been ordered to co- operate with the FDA in further research intended to solve the Accutane mystery once and for all. Inevitably, the work is bound to be hampered by the loss of the people who might have been able to help the most those who took the medication and then took their lives. The dangers of 'wonder drugs' Concerns about so-called "wonder drugs" have increased because of the ominous warnings of side-effects many have.

The anti-smoking drug, Zyban, is under review by the Medicines Control Agency (MCA) after reports that 37 British patients died and 5,000 suffered bad reactions while taking it. Since Zyban was licensed in the UK nearly two years, 473,000 patients have had the treatment, which works by altering the chemical balance in the brain. Doctors say it has a high success rate in helping people overcome years of nicotine dependence. But the risk of fits, seizures, chest pains and depression forced tighter controls last summer. Initial doses of Zyban were reduced and doctors now give stronger warnings. Ritalin is the most commonly prescribed drug for children with attention deficit hyperactivity disorder, with 25,000 British children over six taking the mild amphetamine to calm them. It has been regarded as very effective, with no severe side-effects apart from lethargy or depression.

But scientists said the drug could cause long-term changes to the brain similar to those produced by cocaine. The safety of the drug is being monitored by the MCA. Anti-depressants such as Prozac, Seroxat and other SSRIs (selective serotonin re-uptake inhibitors) are not always a one-way road to happiness. They can cause severe withdrawal symptoms in some people, leaving them agitated, angry or even suicidal. Warnings about suicidal behaviour are on packets. And Lariam, one of the strongest anti-malarial drugs, can cause a range of neuro-psychiatric reactions, including depression and suicidal tendencies, anxiety, panic, confusion, hallucinations, paranoid delusions and convulsions. Studies suggest one in every 10,000 has a serious problem, but about 20 per cent of patients experience vomiting, loss of appetitite or sleep disorders. The MCA has reminded doctors that travellers must be warned of the danger of neuropsychosis, even if they have no history of mental illness.

Lorna Duckworth