Botox: HOW A NIGHTMARE NEUROTOXIN BECAME ALLERGAN'S DRUG OF DREAMS.
If nothing else, the story was proof of just how omnipresent the drug has become. Botox is now approved for use in 98 countries. In the U.S., it's found its latest fan base among millennials, who rush to their dermatologists for wrinkle-fighting injections despite the fact that they're years from having actual wrinkles. Not that middle-aged Americans don't still get pricked. To date, some 13.5 million vials of cosmetic Botox have been sold here. And while Botox might feel like a recent medical breakthrough, the prescription drug turned 30 this year.
It's hard to think of a prescription drug (maybe Viagra?) that's more of a household name than Botox. For that, we can thank drugmaker Allergan's direct-to-consumer advertising, but also Botox's place in the popular culture. When a prescription drug shows up on The Simpsons, and when Kelly Ripa and Kim Kardashian admit they've used it, you remember the name.
What's surprising, perhaps, is that Botox is now more frequently used to treat a variety of medical conditions that have nothing to do with wrinkles, and Allergan actually produces two formulas: Botox and Botox Cosmetic. Whichever you choose, the total global market for the brand in 2017 was estimated at north of $3.8 billion.
But how'd we get here? Oddly enough, this life-improving drug began with... death.
Botox is neurotoxin made from the bacteria Clostridium botulinum. Botulism, to use the common parlance, is usually found in foods that have been improperly canned, and it can be fatal. Botulism kills by paralyzing the muscles used for breathing. In tiny doses, however, the toxin's paralytic effects can actually be beneficial. Botox essentially inactivates the nerves that prompt muscles to contract and cause wrinkle lines.
Not that this usage was always obvious. In 1978, California ophthalmologist Alan Scott was searching for a remedy for strabismus (crossed eyes) when he got the FDA's green light to try botulinum toxin type A on his patients. In time, other physicians had joined Scott in searching for uses for Oculinum--the name he'd given to his formulation. One of them was Dr. Mitchell Brin, a Columbia University neurologist who used the drug to treat blepharospasm, which is uncontrolled blinking. As Brin recalls today, Oculinum worked on that condition--and on something else, too.
"I observed that [in] people I was treating for blepharospasm, the wrinkles between their eyes would be improved," he said. "I vividly recall a patient with spasm on one side of the face saying, 'My wrinkles are gone!'"
And the rest, he said, is history. Allergan acquired Oculinum in 1991, then changed its name to Botox (see sidebar). For the next decade or so, the use of Botox to treat wrinkles was off-label, so sales were modest. But once the FDA gave its nod for the cosmetic use of the stuff in 2002, the drug went supernova. In 2005 alone, doctors performed 3.3 billion cosmetic procedures with Botox. From the $310 million in sales it had done in 2001, Botox exceeded $1 billion in sales by 2006.
To date, the FDA has approved Botox to treat nine medical conditions including overactive bladder, cervical dystonia and eye-muscle disorders, though off-label use by physicians has come to include literally hundreds of conditions, ranging from sweaty palms to depression to erectile dysfunction. In theory, Botox's potential is greater than it's ever been.
Except, of course, for use in camels.
BY ROBERT KLARA
Clostridium botulinum (1) can be fatal, but thanks to pioneering work by physicians including Dr. Mitchell Brin (2,1, the medical establishment discovered that Botox (a formulation that contains the bacteria in very low concentrations) can treat wrinkles in humans. (It apparently also works on camels (3) as a 2018 scandal in Saudi Arabia revealed.) Drugmaker Allergan began advertising Botox in 2002 (4) and, since then, the drug has injected itself into pop culture everywhere from Sex and the City (5) to The Simpsons (6).
A FRIENDLY NAME FOR A TOXIN
Pharma companies spend untold years and fortunes coming up with brand names for their drugs, but Botox came pretty easily. When Dr. Brin was conducting early trials with Oculinum (the name given to the drug when it was thought to have only potential to treat ocular conditions), he didn't want to use a trade name in the research papers he was publishing. "I thought a more general way of referring to it was Botox," he said--a shortening of botulinum toxin type A. "The name stuck," Brin added.
Please Note: Illustration(s) are not available due to copyright restrictions.
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|Date:||Apr 8, 2019|
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