Pharmac and Isotretinoin

Congratulations to Pharmac, New Zealand’s government drug funding agency, for its long overdue move to give family doctors prescribing rights to isotretinoin, also known as Roaccutane or Isotane.

Over the years, the fact that access to this drug was only from a specialist dermatologist meant that many teenagers with severe and even scarring acne could not access it because their parents could not afford to pay for the visit. Hospital appointments for acne care for teenagers have been impossible to get.

This announcement is great news for those teenagers at high risk of scarring acne who need access to this drug. General practitioners are certainly more than capable of prescribing it and following the teenager’s progress on it.

I note with interest that New Zealand and Australian dermatologists have been concerned about Pharmac’s decision. This is typical of some medical specialists’ attitudes to general practitioners. Our specialist colleagues think that just because they have huge knowledge of a narrow area of medicine, that they are somehow better placed to do certain things. Yes, of course, they are, in their fields of expertise.

However, general practitioners are worth their weight in gold because they need to know most things about most things, and are able to diagnose and treat most things. Imagine if everyone had to see a specialist for every medical condition!

New Zealand general practitioners are some of the best trained in the world. The public do not know that New Zealand trained doctors are welcomed all over the world where they are known as intelligent, hardworking and resourceful.The ongoing continuing medical education of general practitioners in New Zealand means that they are always up to the play with the latest in drug therapy. Our GP’s will easily be able to prescribe and monitor Isotrtetinoin treatment.

I also note with interest that clinics are offering access to this drug as well as other acne therapies. I believe that most teenagers with acne would cure it just by cleaning up their diet. Sceptical you think? Just look at some of the Asian teenagers on our streets and notice that some of them have no acne at all and others have lots of acne. The Asian kids with acne are eating a western diet.

It has long been known that the high sugar, starch and processed foods in the western diet causes many health problems including acne. Part of what contributes to the problem of acne in the diet is that we are overloaded with sugar and starch which causes inflammation in the whole body, including the skin.

In addition, upsetting the balance of essential fatty acids in the body by eating too many processed foods, like spreads and packaged processed foods, causes more inflammation as well.

A well known coffee house has no reasonable alternatives for a teenager who wants to meet their friends for coffee – it is just buns, bread, more sugar and more starch. International research has shown that a low sugar, low starch diet, or even the Mediterranean diet has substantial effects on inflammation in the body generally and also with acne.

Certainly facial treatments, light therapies and laser therapies are helpful, as are creams, but they will control the condition and not cure it.

So in most cases of teenage acne, try diet first. Only a small proportion, then will need a strong drug.

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