The Director’s Cut

A while ago I wrote a piece for GUM (Glasgow University Magazine) as part of a collaborative effort between themselves and The GIST. Due to the word count limitation, I had to cut the article down to 800 words (feel free to read it; pages 34-35). There was originally a plan to publish the longer article (which I like a little more) on The GIST’s website but As I’ve handed off most of my responsibilities to a new generation of GISTers I suspect that this article will fall to the bottom of their to-do list and I’ve decided to post the full article here. I hope you enjoy it.

Dying For Clarity

How do you begin to respond to an emotional story of loss and tragedy when you think that the methods used to tell the story are wrong? Not only wrong, but an affront to science? Couple this with the fact that the tragic story is conveyed via a heart-felt documentary told by a grieving father and you have a delicate situation on your hands. Essentially, arguing against this story’s conclusions will make you out to be a heartless monster who wilfully ignores the plight of others to focus on “mere” facts. None of this, however, changes the point that the methods used are wrong (or at least inappropriate for this context). Being part of a growing number of people that harp on about badly communicated science at every chance they get, I must say something.

Roaccutane - Image credits: Jpogi e André Teixeira Lima via wikicommons

Roaccutane – Image credits: Jpogi e André Teixeira Lima via wikicommons

In November 2012 I sat down to watch a documentary on BBC three called Dying for clear skin. The show focused on the use of the drug Roaccutane as a treatment for acne. Many readers I’m sure will be familiar with this drug and maybe even the documentary itself (if not, it’s available on YouTube). Very quickly the show centred on the more serious potential side-effects of the medication and told a heart-wrenching story of suicide that could perhaps, have been triggered by taking this drug. With the BBC being an institution desperate to provide balance on all its topics I had suspected that this emotional-rollercoaster would be countered at some stage by a good scientific argument to provide evidence for or against the banning of this drug, which was ultimately the point of the show. Sadly however, I was disappointed. Instead, the show relied almost exclusively on personal accounts to paint a picture that didn’t accurately reflect the whole story. By cherry-picking the personal accounts of a few they told an inherently biased story and although I suspect that this approach made for excellent television, it effectively removed the science from what was a valid scientific argument.

The personal accounts used to tell the story here were touching and at some points wholly concerning. But it’s important not to get drawn into these stories without further checking the facts (something I suspect most viewers wouldn’t do). When I checked some of the sources I was further disappointed. One of the people interviewed in the documentary, a 22 year old man named Stefan Lay, told his tale of how Roaccutane led to feelings of depression and sexual dysfunction. He appeared as an intelligent young man with an honest story to tell. However when I later found his YouTube channel I quickly realised that he is a person who not only hates Roaccutane but seemingly all prescription drugs. His YouTube channel is called FireYourDoctor, where he tries to discourage people from taking any medication whatsoever. With the dawning of this fact I began to worry about this person’s motives and I can’t help but question his inclusion in the documentary. The makers and presenter of the documentary found him by searching online and selected him on the basis of his YouTube videos. Videos where he expresses views like this:

But I do believe there is a cause. Like, people don’t get cancer for no reason. I don’t think so anyway. I think they’ve got to be a bit run down, or their body has been playing up and they’ve not really noticed the signs of that and they’re not taking their health seriously or they’re not eating well enough… I don’t think the cancer just pops out from nowhere.[1]

Oh dear. Undeterred, the film-makers interviewed him and used the footage where he stated that Roaccutane had caused his inability to have sex and caused him to “feel dead inside”. Yet in his own review of the show, posted on his channel, he stated that these side-effects weren’t as bad as reported and that in fact, he was still able to have sex.[2] I suspect that he was used as an interviewee because he was young, photogenic and told a story that suited the film makers (perhaps after some editing or careful scene selection).

After a few more personal accounts the documentary finally focuses on the evidence that is available in an attempt to link Roaccutane to depression or suicidal tendencies. In the 2 minutes (out of 57) dedicated to this, the facts were glossed over as irrelevant (presumably as they didn’t agree with the points being made) and fobbed off as incomplete. Sadly the film missed its chance to have a serious debate about the drug by ignoring the science. The fact is this. Out of half a million people who have been prescribed Roaccutane worldwide, reports of nine people committing suicide whilst taking the drug were made to the drug’s manufacturer. To add some context to this, that is 88% lower than the UK average (17 per 100,000 population[3]). Not only this, but the film didn’t properly explain to its audience that these suicides could have been caused by any number of different reasons. You’ll hear it time and time again; correlation does not equal causation.

Roaccutane description

What is very disheartening though is that I think there is a serious debate to be had here. Roaccutane usage is surprisingly common. The drug is not without its (proven) side-effects,[4] the mechanism of action is not fully understood and, worryingly, it appears that this “last option” treatment is sometimes used earlier than needs be.[5] Yet all these points were forgotten in favour of the emotionally-manipulative story of an unproven link to suicide made through the use of questionable and unscientific sources. The calls that came from the makers of this documentary (and some viewers) to ban Roaccutane were reactionary and misinformed. This sort of knee-jerk reaction to an emotional story is unsurprising but the fact that it’s the aim of the documentary is discouraging to say the least. This should have been a scientific argument. Scientific evidence is how we decide if drugs get their licence. Shouldn’t the story have followed the narrative that Roaccutane usage is on the increase, and GPs and dermatologists need a reminder that they are prescribing an incredibly potent drug to potentially vulnerable users? Maybe a call to monitor side-effects much more closely would have been sensible. Perhaps tackling a blasé attitude to the drug would have been much more productive. If nothing else, a call for more studies and more information would have been the logical thing to do. However that’s not what BBC three thinks its viewers want to see and instead they peddled a heart-felt but irrelevant story to an audience it clearly doesn’t respect enough. Not everybody tunes into the BBC to watch ‘Snog, Marry, Avoid?’. Come on BBC, you can do better.

[1] http://bit.ly/rmMxAl

[2] http://bit.ly/WdqYTs

[3] http://bit.ly/10Pb5XS

[4] http://bit.ly/16GOqfl

[5] http://bbc.in/19KgvnD and http://bbc.in/V1mhI1

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