Botox: "Naturally" Wrinkle-Free

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I once had a high school history teacher who would put Scotch tape between her eyebrows in a desperate attempt to stop frowning and prevent wrinkles. Those were the pre-Botox days. Now, she could very easily just stop by one of the growing number of Botox parties, munch on sushi, sip champagne, and be shot with a diluted-form of botulism a "natural" toxin known for causing disability and death. Everyone seems to be doing it, yet no one seems to be concerned or discussing its "toxic" nature. Should they be?

The number of individuals seeking out Botox treatments for cosmetic reasons has increased dramatically in the last few years. According to the American Society for Aesthetic Plastic Surgery, in 1997 65,000 Botox procedures were performed and in 2001, 1.6 million procedures were performed, a 2356% increase in four years. Botox is now the most common medical cosmetic procedure in the United States and only recently received approval from the U.S. Food and Drug Administration (FDA) for cosmetic uses. It has already been accepted by the FDA for effectively treating certain types of chronic pain, severe underarm sweating, migraines, muscles spasms caused by cerebral palsy, and eyelid twitching, and for correcting crossed eyes.

There seem to be few side effects from its use besides the desired paralysis of the frowning muscles. Occasionally, there can be bruising, usually resulting from the injection needle hitting a vein. Other times, you can develop a droopy eyelid from the Botox being introduced into the wrong muscle area. And, in rare cases, patients can have severe headaches. But never fear: if your doctor gets a little injection-happy, there is a counter-injection to correct a botched Botox job.

Since doctors get three or four applications out of a single Botox vial and since the vials are expensive, must be refrigerated, and must be used within twenty-four hours of being mixed with saline, patients are being scheduled for treatments in clumps on the same day. As a result, Botox parties are beginning to spring up in the United States and the United Kingdom. Patients find that not only do they get support from friends, but they also get a discount as much as 20% by doing it together. One fitness instructor was quoted in The Atlanta Journal and Constitution saying: "It's much more relaxing and enjoyable to do it this way than just coming into the office during the day for an injection and sitting in a room by yourself. It's kind of like a party and you know, all the movie stars are doing it, having Botox parties."

Other times, doctors go to a home as a "party guest of honor" and the host receives a discount on his or her Botox treatment. However, Dr. Darrick Antell, professor of plastic surgery at Columbia University and spokesperson for the American Society of Plastic Surgery, warns: "Although Botox is the best thing since sliced bread and I've had it done six times, a quick fix at a party doesn't sit well with me. When you move away from a medical environment, you risk not using sterile technique or keeping track of and disposing of the needles in the right way." Also, Botox parties frequently involve alcohol. In the United States, they are being referred to as "sip-nip-and-tuck" affairs, and in the United Kingdom as "Bolly and Botox" events, referring to the Bollinger champagne drunk at these parties. One should be aware, though, that the ingestion of alcohol before any medical procedure might increase bleeding.

Botox is manufactured by Allergan, Inc., which saw its revenue triple from 1997 to 2001. Allergan sells Botox to doctors for $400 per vial and doctors treat three or four patients per vial at about $450 a patient (the procedure is not covered by health insurance). That means consumers who get three or four treatments a year because they only last roughly three to six months will spend $10,000 over the course of five years. One twenty-four year-old quoted in the _New York Post_ has no qualms about injecting botulism into her face but adds: "I'm worried about the financial obligations of keeping it up."

Now consider how that same woman would feel if she were injecting PCBs into her face. (PCBs, despite being harmless in the amounts that they're found in the Hudson River and elsewhere, are the target of an ongoing health scare that will soon lead to a highly expensive clean-up.) If she were injecting these notorious chemicals, would her main concern still be "financial obligations"? Botox is generally considered a safe and natural procedure, so people find it a lot less distressing than synthetically-made PCBs. Yes, it's "natural," like many other items on the market that are in high-demand, from food to vitamins to cleaning agents, but do people realize that it is derived from the most potent lethal substance known to man?

Botox is a derivative of botulinum toxin, which causes botulism, a severe and potentially fatal form of food poisoning. Yet, people don't seem to be concerned with the "toxic" nature of this substance. Swallowing a small amount (1 billionth of a gram per kilogram of weight) can paralyze or kill you. However, injecting a miniscule amount of Botox doesn't have quite the same effect on the body: instead, it locally paralyzes the muscles in that part of your face and prevents you from using those muscles to, let's say, crinkle your nose. Botox is diluted with saline and injected at such a small dose that it is harmless. The New York Post even referred to it as "Botox a safe form of botulism." And, according to Dr. William Robertson, head of the Washington Poison Center, an injection of Botox affects only the muscle area it is injected into, and it is metabolized in a few hours, so it won't collect in the body. Therefore, you won't experience full-body paralysis or suffer respiratory distress from the injections the way you would if you ate botulism-contaminated food, further evidence that it really is the dose that makes the poison.

The American Council on Science and Health's "Holiday Dinner Menu" explores this topic in much greater depth: "Foods abound in natural chemicals that are toxic or potentially toxic because all chemicals will be toxic at some dose...Moreover, all chemicals, whether natural or synthetic, are potential toxicants at high doses but are perfectly safe when consumed in low doses...When it comes to toxicants in the diet natural or synthetic the dose makes the poison." While it is true for botulism, it is also true for other toxins, such as furfural a furan derivative which is a natural, proven rodent carcinogen and found throughout our food supply. Did you know that white bread contains furfural? Are you putting your life in jeopardy every time you eat a peanut butter sandwich? No, far from it. When you calculate the amount of white bread a person would have to consume taking into account the difference in body weight between a rodent and a person and the available carcinogenicity data a person would have to eat 82,600 slices of bread per day for years. That's 41,300 peanut butter sandwiches a day before it would affect your risk of cancer. And don't forget: peanuts contain furfural too!

Environmental activists presume that natural chemicals are not hazardous while synthetic ones are, and they demand that the water, air, and food supply be free of these "dangerous" man-made substances. However, natural chemicals that are proven rodent carcinogens are found in far greater amounts in the food and water supply than are synthetic chemicals such as pesticides nearly 99.99% of the chemicals humans come into contact with are natural, not man-made. So, why aren't we all dead? Is it because "natural" chemicals are inherently harmless while man-made ones are inherently dangerous? No, it's because we ingest these natural chemicals at such small doses that they have a negligible, if any, effect on us (we ingest the synthetic ones at small doses too). Demands from activists that our environment be 100% free of carcinogens and toxins are absurd. Such a feat would be impossible and have little or no health benefit.

While Botox is "safe," consumers should be concerned about the rationale for its use. Botox is being used to reverse the effects of poor health behaviors. A February 7 New York Times article about Botox use quoted Dr. Nancy Etcoff, a psychologist at Harvard Medical School, who said: "We will look at wrinkles the way we look at cracked or discolored teeth remnants of the past, just something to be fixed. You still see young women smoking and sitting in the sun, and they can just get rid of the wrinkles." It isn't the Botox that's going to kill you but rather habits that negatively affect your overall health, such as smoking and sunbathing.

It's important not to think of it as a cure-all, but it can be useful. "With Botox, you look like you're having a good day," commented one thirty-seven year-old woman in the Seattle Times. I never expected botulism to become a "key" ingredient in staying younger and appearing to have a great day. But let everyone Botox to their heart's content while learning a lesson from this: that the ingestion of miniscule amounts of toxins is safe, normal, and can be fun when done with a group of friends. Now, let's see if we can find a medical use for those much-maligned traces of PCBs!