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skeptikal

Accutane & Moral Hazard

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So, I've recently been debating why after 2 years of treatment of my moderate acne, my physician still appears to not want to give me Accutane. I also have bad back acne, and multiple scars to prove it. Though I will admit my face and back are probably clearer than those suffering from severe acne.

I have tried Retin-A, Differin, Antibiotics, Clindamycin, you name it I have tried it.

Maybe I'm just being paranoid, but does this seem like a case of moral hazard? Here we have this "wonder pill" that has a high success rate, and yet in order to procure said drug we must ask our physicians for it, the ones who charge high fees each time we see them for another useless prescription. And I don't mean to not imply that Accutane does not have serious side effects, I am aware they do. I just can't understand why, suffering from moderate acne, he refuses to give it to me.

If you don't know what moral hazard is, it is where in a contract or relationship, one of the people benefits from a negative action, contrary to logic. For example, a doctor giving preventative diabetes treatment to a patient would earn the doctor $300, but charging fees once said patient develops diabetes would earn the doctor $3000. Or, when you purchase a car insurance policy, you are less likely to practice safe driving.

Or maybe I'm underestimating the seriousness of this drug?

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So, I've recently been debating why after 2 years of treatment of my moderate acne, my physician still appears to not want to give me Accutane. I also have bad back acne, and multiple scars to prove it. Though I will admit my face and back are probably clearer than those suffering from severe acne.

I have tried Retin-A, Differin, Antibiotics, Clindamycin, you name it I have tried it.

Maybe I'm just being paranoid, but does this seem like a case of moral hazard? Here we have this "wonder pill" that has a high success rate, and yet in order to procure said drug we must ask our physicians for it, the ones who charge high fees each time we see them for another useless prescription. And I don't mean to not imply that Accutane does not have serious side effects, I am aware they do. I just can't understand why, suffering from moderate acne, he refuses to give it to me.

If you don't know what moral hazard is, it is where in a contract or relationship, one of the people benefits from a negative action, contrary to logic. For example, a doctor giving preventative diabetes treatment to a patient would earn the doctor $300, but charging fees once said patient develops diabetes would earn the doctor $3000. Or, when you purchase a car insurance policy, you are less likely to practice safe driving.

Or maybe I'm underestimating the seriousness of this drug?

u might not respond well to acutane, and it is only used in severe cases. but i recognize what ur describing. u should try going on a less serious anti-biotic. doxycyclin (spell check) should really help with ur acne. ask ur dermatologist about it. (or just get a second opinion from another derm.)

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You are unlikely to ever talk that doctor into prescribing it. I doubt it's really as you describe - that the doctor is cynically milking you for money, it's much more likely that the doctor is holding to the prescription guidelines which state that Accutane is to be prescribed only for severe nodular/cystic, recalcitrant acne. It is a very serious drug, but it's so tightly controlled because of the birth defects. Other serious side effects occur at a very low rate, the common side effects are more uncomfortable than anything else. Liver-related side effects can be head off at the pass with regular blood testing.

And then there is the IPLEDGE factor. If your doctor is in the US it's possible that he simply doesn't want to deal with the huge hassle of IPLEDGE and may not be enrolled in the program at all, in which case he couldn't prescribe it legally.

The only way around this is to find a doctor who is more liberal about prescribing. It sounds sexist, but i've found female dermatologists to be much more sympathetic than males. Find a new doctor and bring a list of everything you've tried and for how long.

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It took me just under 2 years of fighting cystic acne until my derm prescribed accutane for me. Now I am dealing with all this Ipledge shit, and It's been a month and I am still not on it yet. I don't think he is trying to get you to keep coming back.. regardless he would make money on you for at least 6 months because you have to come in for monthly checkups.. By not prescribing it for you, he runs the risk of you giving up and never coming back.. So, I dunno..think of it that way, ya know?

The whole situation sucks. I had a derm tell me "Oh yeah, you definately have cysts. Definately. Accutane would clear you up beautifully, but Im not giving it to you. Too many lawsuits." I was like dumbfounded at that. How are you gonna tell me something would work beautifully but I cant have it? I was SO upset over that. But, thank God I have a great derm now who is really strange (she's kind of... like a mad scientist or something. Liberal and super happy, lol) Anyway- She's really nice and gave me Accutane finally. I don't have severe acne by any means at all.. I have what I call Moderate. During certain points in the month it is worse than others. I get only cysts, though.. I never have gotten a whitehead in my life...And at some points I have anywhere from 6-10 cysts at a time mainly on my chin. It sucks. I get them on my chest and back, as well.

Just keep trying, and you will get it eventually. You have to be really firm and just explain yourself and your treatments in the past and you really want to give accutane a try.

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