There’s Toxicity, and There’s Toxicity (2017)
blogs.sciencemag.org
blogs.sciencemag.org
When the tiny vial arrived in a very large multilayered package, I sat down and read the Materials Safety Datasheet and contemplated the implications. I then decided never to open the package. We stored it under a big hollow block of concrete until the hazardous waste disposal people could figure out what to do with it.
I bought some for a project in the lab, then just disposed of it. Wasn’t worth the risk and found an alternative.
Imagine you have a liquid which is toxic enough to kill nerves, muscles and so on in an incredibly localised way, but the body does not try to heal the damage afterwards.
That's essentially what botox is.
In the U.S., licensed M.D.* can prescribe any approved drug for any reason (note this doesn’t mean they’d be immune for a malpractice suit if it didn’t work out, nor that someone might not taken a look if they wrote a lot of opiate prescriptions. And insurance companies may decline to pay). However the drug companies can’t advertise for any use, or any consequences, that they haven’t sought approval for and demonstrated in the lab. Allergan’s sales people (and those of many other companies) would “just visit” and just happen to drop off a scientific paper that looked at research use for other indications…papers that Allergan might have funded. There’s been some crackdown on these practices but of course they still go on.
* The “label” is the package insert with the formula, mechanism of action, side effects etc. It’s not really aimed at the consumer. Your clinical trials are aimed at writing that label, and everything in it is supposed to be supported by your submitted studies.
* M.D.s only, not other prescribing practitioners like dentists, podiatrists or PAs.
Original approval was in 1989 and now it has 9 approved indications and many more unapproved ones.
$3.5B in global sales and likely no competition as who has the setup to make something that toxic? Plus with such an entrenched product people will probably ask foe the branded version.
https://en.m.wikipedia.org/wiki/Botulinum_toxin
This leads to some absurd looking people whose lips or eyes don't work to make expressions, and they look like uncanny valley robots.
I was pretty amazed reading a writeup about the facility in either Irvine or Anaheim CA that the toxin is processed at. They take the delivery/transport security incredibly fucking seriously because the amount is enough to kill a lot of people if used as a bioweapon iirc
For what I was referring to - take Neurogenic Thoracic Outlet Syndrome for example. This is a very tricky medical condition, not yet fully understood in all cases, and requires ruling out a lot of other things.
For example, you're having symptoms of carpel tunnel or tennis elbow. Normally docs would do an EMG to see if the nerve has been damaged in the wrist or elbow. Nerves end up coming back fine - in the sense that there's no permanent damage, but the symptoms are still obviously there... now obviously, there's a larger tree of things to rule out/processes to do, but to keep it simple, we get to a point we suspect the issue is coming from the brachial plexus nerve bundle... we then inject Botox to the pec minor and scalenes. This eliminates the symptoms for some short amount of time, and thus indicates you would be a good surgical candidate to have your pec minor, anterior scalenes (or more), and first rib surgically removed, so that the nerve/arteries are no longer being impinged upon by the muscles/bone structure.
That is what I mean in the sense of using it as a "diagnostic tool"
However - Botox also helps with things like cervical/other dystonias. Sometimes, completely curing, but they really don't know exactly why in many cases. That is somewhat more of the turning nerves off w/Botox alone.
As with all toxins, the dosage makes the poison. It's deadly yet has medical applications. Can be used to treat muscle spasms, neuropathic pain... Most famous for its cosmetic applications though: it relaxes the muscles of the face, removing wrinkles. I know doctors who literally live off of this stuff.