Death to Beauty, livre ebook

In the 1970s, Dr. Alan Scott sought to selectively weaken eye muscles to treat strabismus (when one or both eyes are misaligned) without surgery. After failed attempts with other agents, Scott developed a method to stabilize the bacteria that causes botulism, culminating in a drug that eventually became known as Botox.

In Death to Beauty, Eugene M. Helveston, MD, follows the unlikely story of botulism's 1817 discovery in contaminated German sausages, to its use in military and research facilities, to Scott, an ophthalmologist who aimed to safely use the drug in humans. Scott struggled alone as an unknown in the pharmaceutical industry, searching for clinical trial financing and FDA approval, which he achieved at a fraction of the billions big pharma usually spends to bring a drug to market. Eventually, the company Allergan bought him out, capitalizing on the possibilities for cosmetic uses. Scott's formula was renamed "Botox" and reached annual sales in the billions. After the sale, Scott received no further compensation from Botox sales and remained the same unassuming man.

A fascinating walk through the intricate history of how the world's deadliest toxin starting as a treatment for crossed eyes became a routine tool for the cosmetic industry, Death to Beauty will make you rethink success, beauty, and deadly bacteria.

From Chapter 1

Clostridium Botulinum

The bacterium Clostridium botulinum has been on earth for a billion years. In the last two hundred years, through the efforts of a few dedicated people, this single-cell life form and its lethal toxin have been miraculously transformed. This amazing story begins with death and culminates with a purified and diluted Clostridium botulinum A toxin that wasapproved for human use by the Food and Drug Administration.

Alan Brown Scott was an ordinary man who led a small team that accomplished the extraordinary feat of developing Botox. This Californian, who could be called taciturn, finished training as an ophthalmologist and elected to pursue a unique career path. He divided his time and effort equally while consolidating his focus. He treated patients in his office with the tools available to the practice of medicine now and worked in his laboratory searching for new methods to be used tomorrow.

After spending a decade studying how the extraocular muscles worked in a human, Alan Scott started to look for a method to change eye alignment without using surgery. Finding the right substance, he injected a potent toxin in the extraocular muscle of a monkey. The year was 1972. It worked and had a lasting effect. This was the first step in his search to find a novel way to treat patients with abnormal alignment of the eyes, otherwise known as strabismus.

Building on these results, Scott became the first person to inject the world's most lethal poison into a human. After this, he launched the most remarkable drug development story of the century—perhaps of all time!

The toxin Scott employed is produced by Clostridium botulinum. The effect of this bacterium was noticed for the first time in the late eighteenth century when unexplained deaths occurred in epidemic proportion in southern Germany. A study of the deaths led to blame being placed on a common food—blood sausage—which contained a fatty material that was thought to contain a toxic substance. This was a start but much more work was needed to isolate the pure toxin embedded in the fat; the kind of work done through meticulous efforts carried out by scientists in a laboratory, peeling away until the pure molecule of toxin is exposed and can be dealt with for what it is.

Two characters in this story played pivotal roles, one at the beginning and the other at the end. In the century and a half between them were many others who toiled to uncover the mysteries of this toxin, speaking only to it and to the disease it caused. In their special roles, the other men introduced the toxin topatients and explained what it could do for them. These men were Justinius Kerner and Alan Scott.

In 1822, Kerner identified a toxin-laden fatty substance that caused a fatal disease in his patients. When he put a daub of the fat on his tongue and felt a sensation in this throat, he predicted the toxin could treat a hyper-excited nervous system in a human. In 1978, Alan Scott fulfilled Kerner's prophesy when he became the first person to inject botulinum toxin in the eye muscle of a human to weaken the effect of that muscle. Each man was speaking to a human audience on behalf of or through the toxin that could be likened to a ventriloquist's dummy "on their knee." Kerner and Scott provided the voice and took responsibility for the message that the toxin delivered. The scientists who worked to purify and explain how it worked in the years between had perfected the substance that would define the dummy literally on his knee (purified toxin) that Scott would finally give voice to.

The narrator in the story, me, can be likened to an interested bystander pulling the curtains when the show starts. I remain in the wings as an observer, looking on and participating in a small way as a reviewer of Scott's initial proposal to the National Institutes of Health (NIH) for a grant. He described the project employing botulinum toxin clearly and it was exciting. I championed it during the review process. I was just one. Others on the panel must have agreed. This grant, the only one I know of that Scott received from the NIH, was approved. That grant was only the beginning of the story of Alan Scott and his relationship with botulinum toxin. This association with Clostridium botulinum and its toxin defined Scott's life's work. His devotion to the project that resulted in the approval of botulinum toxin as a drug began immediately after he completed training and continued with no let-up for more than 60 years.

Preface
1. Clostridium Botulinum
2. The World's Deadliest Poison
3. The Canning Industry
4. An Outbreak in the United States
5. A Still Rare But Deadly Disease
6. World War II Sets the Stage
7. Fort Detrick—U.S. Army Chemical Warfare
8. Fort Detrick and the CIA
9. The Government Steps In
10. Edward Schantz Testifies
11. Back Home in Madison
12. Dr. Alan B. Scott
13. Progress in the Lab
14. First Injection in a Primate
15. First Injection in a Human
16. Joining the Team
17. Manufacturing Begins
18. Marketing and Selling a New Drug
19. Jean Carruthers's TEDx Talk
20. Dermatology Opens the Floodgates
21. Botox and Neurology
22. The Legacy
Epilogue
Appendices
Glossary