How a Nightmare Neurotoxin Became the Beloved Botox

The story tore across media outlets all over the world last year. In Saudi Arabia, a dozen camels had been disqualified from a beauty contest at the King Abdulaziz Camel Festival. A story that ran in The National, a paper published out of the United Arab Emirates, revealed that a crooked veterinarian had been caught trying to improve the facial appearance of his camels—especially the lips. His weapon of choice? Botox. 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. [kickout id="9"] 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. [kickout id="6" label="Botox the SImpsons"] 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!’” [kickout id="7" label="Dr. Brin Botox"] 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. [kickout id="1" label="Camel Botox"]

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How a Nightmare Neurotoxin Became the Beloved Botox

Oddly enough, 30 years ago, this life-improving drug began with death

Robert Klara

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Robert Klara