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February 28, 2009
death by acne treatment or not?
In a interesting abstract from Archives of Dermatology published in JAMA (current issue not yet on-line as of this writing , which is curious in this day and age), the VATTC study from 2005 is reported. This caught my eye for several reasons.
The study was stopped in 2005 due to the excessive number of deaths in the tretinoin-treated group. It was not published in the AD until January 2009. Why was it delayed and what was the point of publishing it now?
Secondly, it is not clear to my reading what they were treating and what they were expecting. It appears that they were treating a certain type of skin cancer which has responded to systemic (as opposed to topical) medicines like this one. There is evidence of increased deaths among smokers treated systemically. Yet they claim that death was not a contemplated end point, when they were evaluating the "relation of topical tretinoin... with all-cause mortality... ."
I am even more curious about the view of science exhibited herein. There was a clear and significant association between use of this cream and death, yet the authors are unwilling to infer a causal association. The endpoint they were studying was a type of cancer. If there had been that association, would they have published? If the trial had shown an association of desired benefit, would they have inferred causality? By what right do we decide when an association is causal?
Disclaimer: This does not constitute advice to anyone using this acne cream.
| By Robert Maddox | 4:17 PM