Botulinum toxin: Bioweapon and magic drug (2010) | Hacker News Reader

Botulinum toxin: Bioweapon and magic drug (2010)

ncbi.nlm.nih.gov

57 pointsredbell53 comments

Botox for migraine absolutely changed my life. I went from almost continuous daily migraines to 2 or 3 4-hour migraines per week.

Each treatment is progressively more effective, this change happened for me over the period of a year.

It got me to a point where I could show up at the gym and, between those two things, I’ve been back to work full-time again.

I've been thinking about doing this for a while. I grind and clench my teeth quite a bit at night. How often did you have to get it done? Did your insurance cover it or is this something you can use HSA money for? What's your cost per treatment?

Also does it in any way effect your chewing strength or ability to make the full range of facial expressions?

Many Thanks!

Insurance covers it, but I had to try (I think) four other treatment modalities and show that they weren’t sufficient first.

My neurologist is really tuned into the insurance process because she’s seen Botox help so many people and we were able to eliminate four modalities in about a year.

If you aren’t lucky enough to have a doctor willing to play the insurance game, you might have to do your own legwork with insurance but, at least in my experience, it’s worth it.

Edit: forgot to mention — I’m lucky enough not to deal with bruxism so I don’t get injections low enough in my face to know if it affects jaw strength. Mine are mainly in my scalp, shoulders and forehead. It does reduce the expressiveness of my forehead a little bit, but I consider it a fair trade considering the alternative.

I have the impression from my neurologist that insurance companies are now steering patients towards the prophylactic cgrp blockers like Ajovy. It’s got to be much cheaper to give a patient a self injectable than pay a neurologist for dozens of injections. Personally I’d much rather not risk the headaches coming back to make a change.

I used to get debilitating monthly headaches, they faded and stop happening over a few years with no change in diet or lifestyle. The brain is very strange

Does your neurologist have any idea what’s causing the migraines?

Some find where to inject with a radio signal and electric probes. It can hear the firing of muscles. If you’re relaxed and it’s still firing that’s where to inject.

Migraines are caused by many things. But having screwed up trapezious muscles probably contributes to many.

I don't normally get migraines but I'd like to second that. When I do get a debilitating migraine it is always originating from my trap.

Botox may also be a helpful tool against seizures: https://pubmed.ncbi.nlm.nih.gov/28475998/#:~:text=After%20bo....

Huh, didn't realize botox could be an effective bioweapon.

I get regular botox injections to help with my headaches. It works really really well. Takes a couple weeks to kick in then lasts for a couple months before dissipating naturally.

The Botox-like family are the most potent substances by weight, whether they're used for medication or poison. It's kind of crazy when you consider it. It takes thousands of botox doses to kill you. That's not dissimilar from most drugs- take a thousand advil and you'll certainly die.

One unit dose of botox is 50 picograms. A lethal intramuscular dose is ~160 nanograms. A lethal inhaled dose is ~1 microgram. That's crazy. Inject any other chemical into the heart, brain, wherever you want- you will not be able to kill someone with a smaller dose of anything.

The next most potent drugs (eg LSD, actually) create perceptible effects at fifty times the lethal dosage of botox. LSD is noticeable at <25 micrograms. Ricin is lethal at 1.6 milligrams. Fentanyl is lethal at 2 milligrams and dosed at 50 micrograms.

Even covid the vaccines have 30+ micrograms of RNA that makes the larger amount of protein that trains your immune system. 50 picograms is only ~50,000 individual virus, about half of what is released by the infection of a single cell.

Botox is within spitting distance of the lethality of a nuclear fission reaction. 160 nanograms of U-235 releases ~16 kJ, a bit under the energy in two AA batteries or ten 5.56 rifle shots. That's more than enough energy to cauterize a critical cardiac artery, or pop your skull... but it's less than an M80.

Realistically (lol) if you pulled 160 nanograms of material from the center of our sun (or probably any star short of a neutron star), it's going to stop fusing immediately since it'll be too busy exploding. I've got no idea what the math on that is, but I'd be pretty surprised if it beat out botox for lethality. Which is crazy.

What muscles does your treatment target? It's pretty surprising to me that it helps with headaches. I'm very curious, and very interested in getting rid of headaches of my own.

It varies per person, but for me, surprisingly, muscles in the occiput, temples, and around the trapezius. It was amazing for me to realize that tension in my shoulders, back, and neck could contribute to headaches, but it really is all interconnected.

Did you have other options for relieving that tension? Or was Botox the most effective?

Like the other commenter said on this page, I tried other stuff first — medications, acupuncture, and daily stretches/exercises for a year. The acupuncture and daily stretches were helpful and I still do them, but out of compassion for myself I wanted something that would work more deeply and immediately to provide relief. And there are no side effects of Botox (for me) which is amazing.

I think it was in a Michael Crichton book that I read that something like a couple of pounds of this toxin would be enough to kill all mankind and that stuck with me. No idea if it’s accurate though.

Also I guess in terms of toxins a couple of pounds is a lot.

I think it has the lowest known LD50. The amount they must dilute it by would probably make homeopaths blush.

On the contrary, the article says it would only take 39.2 grams to kill every human on the planet. Wild.

Seems like a good thread to ask (I brought this up a few weeks ago too): Why not use little bits of botox to prevent wisdom teeth from growing in the first place? It'd be a heck of a lot less invasive than removing them later.

How common is it to need wisdom teeth removed these days? Eg mine came up slowly but having them out wasn’t even something I discussed with my dentist

I would hazard a guess that you and GP live in different countries. In Europe it is generally rare to remove wisdom teeth after the mid 20s, as if they haven't caused acute problems while erupting then they probably won't.

In the US it is a routine procedure to remove wisdom teeth that would be considered healthy and non-problematic elsewhere, even in older adults.

Source: my mother is dentist, and I've known multiple people move to the US and suddenly as a middle aged adult need their wisdom teeth removed.

That's an interesting parallel to circumcision, which is also an unnecessary routine procedure in the US, but generally only done for acute medial reasons in Europe (ignoring Muslims who do it for religious reasons presumably in both).

Dentists have been telling me to remove my wisdom teeth for about 15 ~ 20 years so far and I keep not seeing a reason to

The best reason is that Beechcraft Bonanza your dentist wants isn’t going to pay for itself.

For some reason Americans are more enthusiastic about unnecessary medical interventions. The pediatric ear tube surgery is another example.

If you're going to a normal dentist in USA then they don't even do wisdom teeth, that's done by an oral surgeon.

That depends. US dentists are definitely licensed to do extractions, but you’re right it often gets referred to an oral surgeon, especially in bigger cities.

Are there no referral fees for such things? I always assumed that there must be.

Mine were removed when I was in the 9th or 10th grade. They were impacted and had to be cut out in pieces. It was an outpatient procedure but I was under anesthesia.

I don't remember having any particular pain or anything beforehand, I was just told I was getting them out. There was no discussion about whether I wanted to do that or not. I had already had braces at that point, and they were causing my teeth to shift again, so maybe that had something to do with it.

Feeling back there with my tongue now, I think there's room for another tooth on each upper side, but there is no room for more on the lower jaw. This makes sense with what I remember being told, that they were 'growing in sideways'. In a scenario like this I wonder if they are concerned about being able to keep those very back teeth clean, in addition to the cosmetic issue with movement of other teeth.

I don't understand: why would botox prevent wisdom teeth from growing? I fail to see the connection.

It could kill the tooth bud before it develops into a tooth.

What is a "tooth bud"?

Botox works by blocking neuromuscular signals. As far as I'm aware, wisdom teeth coming in is a bone-tooth interaction. Botox would do nothing.

Every tooth you're ever going to have develops during gestation. A tooth bud is a tooth at a particular early development stage. It's not much more than a differentiation of cell types in the area where there will later be a tooth.

Maybe botox would do nothing. Maybe it would disrupt further development of the tooth.

I almost died due to sepsis after a wisdom tooth removal - interestingly the bacteria smelled like butterscotch, and my long term chronic paroxysmal hemicrania went away.

That's a pretty fantastic idea!

Of course, I'm far from an expert in anything related to medicine and I'm sure there's some reason this is dangerous/wouldn't work but I'd love to know why...

Wisdom teeth started growing at the age of 14-15. Are you willing to inject botox to your child?

> Are you willing to inject botox to your child?

You're framing this as if it's a mortal sin to administer medicine to children. Botox is well studied. If there is medical benefit, it would be fine.

Actually, he just asked a question.

Relevant (and entertaining) “In the Pipeline” article.

https://www.science.org/content/blog-post/there-s-toxicity-a...

I have severe bruxism and Botox treatments of my masseter muscle has made a huge difference. It’s something I was very reluctant about initially but I’m glad I ultimately tried it.

And yet people continue to inject it into their faces, because wrinkles.

¯\_(ツ)_/¯

I saw the title and that was the first thing I thought of.

I was sincerely hoping that "magic drug" wasn't referring to its use in cosmetic surgery[0].

As I'm not a member of anything medical-field related I was unaware that it had been used to treat "blepharospasm"[1]. Having gone through that to the point of actually seeking treatment, I'm disappointed my doctor wasn't aware of that option. At the point -- two days with no sleep -- I would have raided the drawers and given myself a shot.

But, really, Botox is what most people think of when thinking "magic drug." I'm not sure that's the word I'd use.

I'm a guy in my 40s with a pretty typical subset of people categorized as "I used to know them in High School". Literally in the period of 4 years about 25% of the women in my friends list were very clearly talked into getting Botox. One woman must be involved in some multi-level marketing scam related to Botox because she's frequently posting pictures of her face "post treatment" (and, I'm sorry, it's grizzly)

I have to believe that some people have good results. But, no joke, I can pick out at least 10 women who have what I call "Botox Face". You notice it first in the lips -- "permanent semi-duck-face". Then they start talking -- large portions of their face don't move as expected. I had a co-worker who had it done, missed a few days of work, and when she returned I had assumed she suffered a stroke (thank God I didn't say anything). I had known she had Botox before (she had the lips already) so this was a second course of treatment.

Despite how this sounds, this wasn't intended as an attack on folks who use Botox. I'm truly curious -- it seems like a lot of people have this done and the results are much worse than before for many of them. How many is anyone's guess ... in theory, it would be impossible to tell the difference between good Botox and "natural" but I can't think of another form of cosmetic surgery that has worse results. But considering how many people have bad results, why do so many people continue to get it done (including folks who previously had bad results!)

[0] Ok, maybe just a little, because it's an "easy target".

[1] Such a fun word -- one that people know if they've ever had their eye twitch consistently for a month (try sleeping that way).

> You notice it first in the lips -- "permanent semi-duck-face"

This is filler. Botox doesn't plump out features. (I've never had botox, but I have friends who have. The difference between discount and top-tier Manhattan plastic surgeon administration is noticeable. Or, I suppose, not.)

You're right -- I mix the two up because I've rarely seen someone get injections that hasn't done the Botox thing. I assume it's the Botox that makes their lips move ... strangely?

Fun fact: cosmetic Botox led directly to the discovery that it could be used to treat chronic migraine — some people who received it for cosmetic reasons noticed that it improved their headache symptoms and reported this to their doctors.

I was in Botox for migraine in the early days. Had more than one conversation with someone who was clearly mistaken that I’d said I was taking Botox for cosmetic purposes very probably because they had. Made for a funny conversation, but not bad. And others asking whether it’s like cosmetic Botox.

I’ll be forever grateful to the people who noted it helped their headaches!! I don’t want to imagine how different my life would be without it.

Misunderstanding of Botox procedure aside ("duck" lips being filler rather than Botox), is this just not a restatement of the toupee fallacy?

Probably. IIRC the price of Botox injections has come down a lot in recent years, and it's a relatively safe outpatient procedure, so if social media trends are anything to go by I'd assume quite a few people are getting it.

Any good cosmetic work should be almost invisible to someone who isn't looking at a before-and-after photo. I recently got some work done (long story, but one of the best decisions I've ever made) and my doctor said he strives to do work that's so discreet no one will notice and so gratifying that you'll tell everyone anyway.

"Having gone through that to the point of actually seeking treatment, I'm disappointed my doctor wasn't aware of that option."

This is really surprising. If you Google 'blepharospasm treatment' and read a few articles, it's impossible not to come across Botox. And this isn't even recent... About 20 years ago, I did a project related to commercializing an innovative treatment of blepharospasm, and I recall contrasting this new treatment against the alternatives available at the time. Botox was one of them.

The biggest problem was being taken seriously. Everyone gets an eye-twitch from time-to-time. I made a special appointment with my PCP and was told "get more sleep", reduce stress and eat more things containing potassium... I have since found a new doctor. :)

This was the early 00's but considering your project 20 years ago, that lands in at about the right time-frame.

I think people see the pictures and it looks like it might be an improvement but it's the motion of expressions that really makes it look weird/uncanny. A human face is always moving and it reads very wrong to see it move wrong.

Digitalis/Digoxin/Lanoxin is a life-saving drug that is derived from the toxic Foxglove plant and can still poison someone in sufficient quantities according to Agatha Christie and the internet. (I guess lots of drugs can harm you in sufficient quantities lol.)

Hey I grow foxglove in my garden. Lovely.

Here's another one : CASTOR OIL PLANT. Pretty common. Has these beans.

Take some of the beans. Soak em in water for a couple days and you have a fabulous poison : ricin.

Excruciating tummy ache and bloody diarrhea. Then you die.

https://en.m.wikipedia.org/wiki/Ricinus

I wasn’t aware of the castor oil plant’s beans.

My good old friend Calabar Bean came to visit last week though (Cain’s Jawbone reference).

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