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Since it was first approved by the Food and Drug Administration in 1982, Accutane has been—and continues to be—one of the most highly effective, profitable, and controversial acne drugs available. Originally studied for use as a chemotherapy agent, the medication also showed an extraordinary ability to clear up the most virulent forms of acne—in particular, severe nodular blemishes.
To date, the drug has been prescribed to more than 13 million patients, and it brings its manufacturer, the New Jersey–based Roche Pharmaceuticals, some $700 million in annual sales. From the beginning, however, the drug’s potential side effects raised deep concerns. Pregnant women, for example, were warned that the medication could cause birth defects. The drug also was linked to premature birth, miscarriage, and infant mortality.
Roche Pharmaceuticals has also admitted that Accutane can cause depression, psychosis, and, in rare instances, thoughts of suicide. Indeed, a product information insert included with the drug warns patients to stop Accutane if they or a family member notices symptoms of depression or psychosis. Those symptoms include the patient’s becoming more “irritable or aggressive” than usual, or “acting on dangerous impulses.”
In addition, a 1998 FDA memo states: “Given all the pieces of evidence available, it is difficult to avoid the conclusion that Accutane can adversely affect the adult human brain in clinically significant ways and that Accutane use is associated with severe psychiatric disease in some patients.” The memo recommended “active consideration of removal of Accutane from the market.”
Accutane remained available, but the FDA ordered Roche to strengthen the warnings on the drug’s packaging to alert doctors to the risks of “depression, psychosis and, rarely, suicidal ideation, suicide attempts and suicide.” The FDA also sent a letter warning Roche to cease “false and misleading” advertisements that promoted Accutane as an “effective treatment of severe acne . . . [that] minimizes negative psychosocial effects such as depression and poor self-image.”
Many of the concerns over the drug have arisen from several high-profile deaths associated with the drug. In 2002, Charles J. Bishop—a 15-year-old high-school freshman who had been prescribed the medication—killed himself by piloting a stolen Cessna 172R into the 28th floor of the Bank of America Plaza in Tampa, Florida. On May 14, 2000, the son of Michigan congressman Bart Stupak shot himself in the head hours after his junior prom. His father blamed psychological side effects from Accutane and launched a campaign against the medication that continues to this day. “This drug represents a public health concern for the American people,” he declared in a congressional hearing. “We cannot allow the drug manufacturer and the FDA to continue to turn a blind eye to the lives lost, families devastated, and dreams dashed by an acne drug.”
Roche maintains that the drug is safe when used correctly and insists that no study “has found any cause-and-effect relationship between Accutane and psychiatric events.” (Roche responded to requests for an interview with a statement reiterating its position.)
Opinions within the medical community continue to vary. “I have myself given it to hundreds of patients and have never seen a significant side effect,” says Robin Gehris, a pediatric dermatologist at Children’s Hospital in Pittsburgh. “I think to say that a person took a drug and four years later that [a crime] was that drug’s fault, I think is just the hugest stretch I’ve heard.”
In a study of Accutane two years ago, J. Douglas Bremner, a psychiatrist at Emory University, found that the drug caused a decrease in brain function in the section of the brain regulating mood and impulse. “My opinion is the risks of depression, suicide, violence, and aggression from Accutane have been downplayed in the past,” he says.
Members of the Cornbleet family scoff at the notion that two doses of Accutane taken four years before their father was killed could lead to murder. Such a claim, says Jocelyn Cornbleet, is simply a ruse to “get the focus off of [Hans Peterson] and put it on the big bad pharmaceutical company.”
Tom Peterson acknowledges the skepticism. “I have to agree, it’s hard to believe,” he says. “But there it is.”
Whether or not Accutane drove Hans Peterson to violence, as he and his father claim, it’s clear Peterson developed an obsession with the drug. On May 12, 2002, using the login name of “hansp,” he signed up for a membership with the Accutane/Roaccutane Action Forum Group—a blog for people who believed they had suffered adverse side effects from the drug. Within five years, he had posted more than 60 times to the blog, starting with his first entry on June 16, 2002: “In late April, I went to see a dermatologist for my very mild, but persistent acne. He was an unethical old man who suggested Accutane. I took it for 2 days. Then I got a bad headache and read about the side effects. I stopped right away. I thought that I was safe having only taken a few pills. However, about 5 days later, I got really depressed and couldn’t sleep. My ears started to ring. . . . My appetite went away. . . . A couple of days after this, my libido vanished and I lost virtually all sexual sensation. . . . It has been over a month and a half since my very brief experience with Accutane and most of these effects have not improved at all. Am I permanently affected from taking an acne medicine for 2 days?”
Several news outlets have reported that Peterson claimed the drug caused him to be impotent. But a posting by Peterson on November 15, 2002, suggests otherwise. “Since taking a relatively high dose of Accutane for a very short period of time 7 months ago,” he wrote, “I have been experiencing persistent sexual problems. I would describe it as a loss of libido and sexual sensation. . . . I can get an erection and otherwise function normally. The pleasurable sensation is just gone.”
In 2002, despite his growing obsession—and seemingly out of the blue, his father says—Peterson decided to take the law school admissions test. “He doesn’t get the book, doesn’t take the class, but scores phenomenally high,” Tom Peterson says.
Shortly after, his son accepted a scholarship to Yeshiva University’s Benjamin N. Cardozo law school in Manhattan and moved to New York from Oregon, where he had been living with his mother. “So starting in January of ‘03 he begins classes,” the father says. “By the fall of ‘04, he’s two-thirds done and in the spring of ‘05 he’s supposed to graduate.” By this point, Hans Peterson lived in an apartment in the East Village with two roommates.
The father says he tried to reach his son there several times as the graduation date approached, but “suddenly, he wasn’t returning my phone calls. I finally called and said, ‘If I don’t hear from you within 24 hours I’m going to call the police and report you as a missing person.’ Well, then he calls back and says, ‘I quit law school. I stopped going to classes four months ago, and I’m doing Internet gambling.’”
Unbeknownst to his father, Hans had turned inward again, and more profoundly than ever. He had grown “increasingly antisocial, manic, prone to isolationist behavior, staying awake for days,” a friend of one of Hans’s roommates wrote to Jon Cornbleet in an e-mail. “He would shun large groups and [the roommate] recalls being unintentionally engaged in discussions about Accutane and the effects of the medicine,” said the friend, a 25-year-old marine who is now in Iraq. At some point, Hans also began talking to the roommate about harming the prescribing dermatologist for what “he had done to him,” the marine added. (Neither the roommate’s name nor that of the marine has been released.)
On October 19, 2006—five days before the murder—Hans set out to do just that, police believe. Renting a car in New York, he left the city, bound for Chicago. Police say he had made an appointment, using a fake name, with Dr. David Cornbleet.
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Photograph: Courtesy of Jonathan Cornbleet