You may have read about a miracle drug that improves appearance in the aging face … as Paul Harvey used to say, “Now, you can hear the rest of the story.”
Nearly 40 years ago I met with a colleague who was developing a process to straighten eyes without surgery. This was intriguing and worth exploring so I made the trip to San Francisco. I watched him inject a solution into the eye muscle of an infant who was born with crossed eyes. The next day the eyes turned outward, an overcorrection. “It’s OK,” my colleague said, “the muscle’s strength will return a little less than it was and the eyes will look straight.”
Using this drug was like waving a wand to shorten a board. It worked, but only with experience could you predict how short the board would be. That part was on you. A good thing was that the drug seemed to be free of side effects and an overcorrection (too much effect) would wear off. The next question was how long would a perfect result last?
The takeaway for me was that the drug could temporarily weaken a muscle a graded amount and it was safe. I agreed to be a clinical investigator evaluating a yet-to-be-approved drug. We used it mostly to treat overacting eyelid and facial muscles in elderly patients suffering from a condition called blepharospasm. It was effective. Patients were happy and no adverse side effects were encountered. The drug, Botulinum A toxin and called Oculinum, was approved by the FDA nearly a decade later, in 1989, and we continued to use it for more than 20 years.
In the beginning, adults receiving injections for eye muscle disorders reported that in addition to the effect on their eye muscles, they were noticing fewer wrinkles around their eyes and forehead. This was the impetus for treating blepharospasm in older patients.
Then the avalanche started. Botulinum A toxin began to be used widely to eliminate smaller wrinkles in younger people. The popular indication for Oculinum was elimination of “worry lines, crow’s feet and corrugated foreheads” that were signs of aging. Moreover, aging was becoming a relative term and included people as young as those in their twenties and thirties.
Allergan Pharmaceutical first licensed it and then, in 1991, purchased Oculinum from Alan Scott, who had developed the toxin for use in humans in a multi-million-dollar deal. They gave the product a new name and expanded indications for its use and today it is a multi-billion-dollar industry worldwide. Its use for cosmetic purposes is hyped in fashion magazines and the drug has ever-increasing medical uses that include facial spasm, excessive underarm sweating, migraine headaches, anal fissures, hyperactive bladder, enhanced wound healing, depression, cold hands, sweaty palms, vocal cord spasm, and drooling. Many of these await FDA approval but all have been used “off label,” a practice commonly employed for drugs that are safe but without proof of value for clinical use.
What is this drug? You may have guessed by now it is Botox. The generic name for Botox is Botulinum A toxin. This toxin is produced by the harmless bacterium called Clostridium Botulinum that is found worldwide in the soil, in house dust, in river settlement, and brackish swamps. This harmless bacterium has a double life. With improper canning or other mismanagement of foods, the bacteria can produce the world’s most potent deadly toxin, botulinum, creating extreme widespread muscle weakness, especially in infants under a year, and can result in death if the dose is sufficient and prompt treatment is lacking. Fortunately, botulism poisoning is rare, the antitoxin given promptly is effective, and most affected persons can be treated successfully with no lingering effects.
The Botox story is confirmation of the maxim “all substances are poison, it only depends on the dose”—and that includes oxygen and water.
By Savvy Senior
Note: 100 units of Botox contains 0.73 billionths of a gram . A lethal dose for humans (LD50) is 3000 units.
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