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Yes, absolutely one must not get pregnant while on Accutane. It is a very effective, and very powerful drug. While the suicide link may be merely annecdotal, the severe birth defect link is quite well proven.

But I have known a few people with acne bad enough to warrent taking a super powerful drug to cure it. However, It seems to me that acne is declining. My daughter is 17, and I can't think of seeing even one of her friends, teamates, or even just the kids at the HS in general who has really bad acne, as did quite a number of kids I went to HS with.

However, It seems to me that acne is declining.

I don't think that is the case. Rather kids with significant acne are getting more and better treatment than in the past. And a big part of that, for the really severe cases, is Accutane. Before Accutane came out (in either '82 or '84, I forget which) much of the really severe acne failed all treatment and left people scarred for life. After Accutane those kids usually do well. The downside of generally successful treatment is that kid's expectations have risen to unrealistic levels. The only perfect treatment for acne is more birthdays.