Nov.22, 2006 -- A Florida doctor injected himself and three others with an unlicensed botulinum toxin mixture, otherwise sold as Botox, in 2004. It was a cosmetic procedure that could have been deadly -- and a new report confirms that those patients are lucky to be alive.
The illegal preparation contained the same botulinum bacteria as the popular cosmetic Botox, but at concentrations 40 times higher than a lethal dose.
The Florida doctor was sent to jail in January 2006, but the accident was not entirely his mistake.
This week's Journal of the American Medical Association examines the four life-threatening cases of botulism for the first time since they were originally reported to the Centers for Disease Control and Prevention in November 2004.
Patients Showed Signs of Known Illness
Before these four cases were reported, the medical community had not seen cosmetic or therapeutic procedures lead to botulism.
According the report, all the patients in the case had been injected with a highly concentrated, unlicensed preparation of botulinum toxin. The preparation had been intended and labeled for laboratory use but not human use.
The patients and the physician who self-administered an injection eventually reported symptoms of weakness and problems swallowing or controlling facial muscles after receiving four to six injections of the unlicensed drug. Two patients became short of breath.
Researchers report that the patients had blood toxin levels equivalent to 21 to 43 times the estimated human lethal dose of botulinum. A full vial of the same toxin that was taken contained enough toxin to kill approximately 14,286 adults by injection.
The doctor and his patients were lucky to survive.
Botulism is a rare and paralyzing illness caused by strains of botulinum bacteria. If untreated, the infection slowly paralyzes the arms, legs, chest and respiratory muscles.
The doctor involved was sentenced in January to three years in jail for using an unapproved drug.
Licensed Botox Generally Safe
The Florida cases were not related to the Food and Drug Administration-approved Botox, which is generally considered a safe substance.
"Properly administered, Botox is far safer than some of the normal day-to-day, over-the-counter medications we take," said Dr. Suzan Obagi, director of the Cosmetic Surgery and Skin Health Center at the University of Pittsburgh Medical Center.
In the hands of a well-trained professional, approved treatments and procedures pose no more danger to patients than other medical procedures. So what happened in Florida?
"The simple reason that people risk doing [unlicensed cosmetic procedures] is greed," said Dr. Richard Glogau, a clinical professor of dermatology at the University of California at San Francisco.
Greed Conquers Reason, Endangers Patients
"Greedy patients agree to let unlicensed persons or completely untrained persons inject them because they have been promised they will save a few dollars. Greedy physicians attempt to bypass the expense of using something approved and reliable in an attempt to widen their profit margin," Glogau said.
But it isn't entirely a patient's mistake. Patients seeking cosmetic procedures may not realize the potential dangers of a cheap fix, because the media glamorizes cosmetic procedures, Obagi said.
"I am a firm believer that we have cheapened the art and science of medicine with our current barrage of stories in the tabloids and the plethora of reality TV shows," Obagi said.
"This has allowed patients to develop a very cavalier attitude toward cosmetic surgery without really perceiving it as surgery," she said.
Are fraudulent doctors therefore not to blame for deceiving their patients?
Well, yes, Glogau said. Such deception from phsyicians and medical professionals is illegal at worst and unethical at best, he said.
"But oftentimes [patients] have only themselves to blame for failing to seek out and pay for professional licensed and experienced physicians," Glogau said.
If there is a lesson to be learned from the Florida cases, it may be a simple one. "Cosmetic injection is a very safe and effective tool, but know your injector and the product they use," said Dr. Julius Few, professor of surgery at Northwestern University medical school.
In other words, caveat emptor -- let the buyer beware.
For tips on how to find a plastic surgeon, check out tips from the American Society of Plastic Surgeons.