‘Never let an aircraft take you where your brain didn’t get to five minutes earlier’ – this is a commonly understood concept amongst pilots.

While none of us can predict the future, the ability to anticipate problems that might arise given a particular set of circumstances is a basic requirement for many high risk jobs such as fire fighting, policing, armed combat and medicine. Doctors do have a licence to kill and they inadvertently use it when they can’t or don’t anticipate problems. Working backwards, if we don’t think the worst might happen, we don’t actively look for it and definitely don’t plan for it. Before we know it, it’s too late and the adverse outcome is inevitable.

Four days into it’s maiden voyage, the largest passenger liner of its time, the Titanic sank. It received six warnings of sea ice on 14 April 1912 but continued travelling near her maximum speed when her lookouts sighted an iceberg in its path. Unable to turn quickly enough, the ship suffered a killer blow and slowly sank over the early hours of 15^th April. 1635 of the 2224 people on board died.  The vast majority of the crew were not trained sailors but were either engineers, firemen, or stokers, responsible for looking after the engines or stewards and galley staff, responsible for the passengers. They were taken on at Southampton on short notice and had not had time to familiarise themselves with the ship. Knowing what we know now, is it surprising that the ship sank?

Saagar gave us warnings but we didn’t pick them up. Shouldn’t alarm bells be ringing nice and loud when a young man with a recent diagnosis of a mental illness is discharged in a hurry from Psychiatric services and he scores 27/27 on his PHQ-9? Whose responsibility is it to join up the dots?

When a plane goes down, the pilot goes down with it. When a patient dies, often nothing happens to anyone else. There is no black box. Tracks get covered, mothers over-react, things get forgotten and life goes on….

‘Dying from Clear skin’ is a BBC documentary on Jesse Jones, a teenager dealing with acne like many others one might think. But he ended up taking his own life. Elements of low self esteem and bullying cannot be separated from the issue of acne. Jack Bowlby, a 16 year old from Wantage in Oxfordshire, killed himself at Cheltenham College. His inquest was told he experienced “dark thoughts and violent mood swings” after taking Roaccutane. Jon Medland, a medical student from Devon did the same after 3 weeks of starting the same medication.

Accutane (Isotretinoin) is a medicine used for treatment of acne.

Although it’s main desired effect is on the oil glands in the skin, it works on the whole body. Side effects are numerous and widespread, and affect at least 8 out of 10 patients. Side effects are most often mild to moderate and reversible, but in some cases can be severe or long-term. Accutane can cause severe birth defects if taken during pregnancy.

In reduces blood flow to the brain, causing headaches and depression as well as hearing and visual impairment.

I am no dermatologist but in my experience as a patient and a carer, doctors are not very good at telling us the side effects of the medicines they might start us on.

Parents have been noticing the connection between suicide and Roaccutane and lobbying against the drug for the past few years.

In a statement, Roche said: “Whilst no definitive cause and effect relationship has been established to directly link mood swings and depression with the drug, there have been rare reports, amongst both those taking Roaccutane and acne sufferers in general.” Figures show one in 10,000 people will experience serious side-effects. More than half a million people all over the world have been prescribed this potentially lethal medicine.