Turned up to eleven: Fair and Balanced

Wednesday, April 17, 2002

A little media criticism today, on the incredible lack of scientific literacy in the local daily, the LA Times. I know, the horse is well past dead, and I should stop beating it, but what really gets to me is that their science reporters are so frighteningly bad as understanding science. K.C. Cole wrote The Universe and the Teacup, a book that I didn't like, but was well reviewed (in a bit of science snobbery, I thought it seriously dumbed down cosmology and astrophysics unnecessarily). She writes a Science and Society column called Mind over Matter in the LA Times. This may seem pedantic, but I hate it when science writers don't indulge in some (very) basic research before writing. Ms. Cole decided to write about Botox, a relatively new wrinkle treatment using the toxin from Clostridium botulinum, Botulism toxin, to remove wrinkles (its a very small dose that interferes with muscle contraction in the region, by inhibiting the nerves that cause these muscles to fire). Here is the relevant quote from Cole's article;

Here's another: Not so long ago, the deadly microorganism known to biologists as Clostridium botulinum was mostly known as the source of a lethal poison found lurking in bulging soup cans--one of the most poisonous substances known. Today, it's a beauty treatment, injected at some expense into foreheads to make wrinkles go (temporarily) away. This has gotten to be so "normal" that "Botox" parties are what Tupperware was to my mother's generation.

This is not a good thing, to put it mildly. According to the editor of Science magazine, Donald Kennedy, in a recent issue of his journal, C. botulinum ranks right after anthrax on the list of biological weapons terrorists might employ. If the demand for Botox continues to soar, and longer-lasting strains hit the market, as soon seems plausible, "will we be happy to have that many of these hot bugs around?" Kennedy asks

When I first read this, I thought Cole was confused, but as I reread it, I see that she was lead astray by Don Kennedy, former president of Stanford University, and editor of Science. Both are under the misguided impression that Botox contains actual bacteria. There is no bacterium in the Botox injected into people. If there were, they would all die horrible deaths from paralytic botulism!!! A quick look at the Botox information site (the first hit in a Google search for "Botox") would reveal this simple fact. But this, apparently is too much for either of these writers.

As an aside, I used to think that this was a very silly and misguided use of a very dangerous substance, but I am know much less concerned about it, for the following reasons. The first is that it is carefully regulated and monitored, and the people and companies making and delivering it have a very strong vested interest in ensuring its safety. The second, and more important reason, is that many medicines are just low doses of poisons. The entire principle of drug treatment, for that matter, is based on the notion of the therapeutic dose, with the understanding that an ideal dose of a drug will cure the disease (kill the bacterium or virus, or inhibit a degenerative response), with minimal harm to the patient. Higher doses run into a law of diminishing returns on the therapeutic side, and increased toxicity. Many, many substances that we consider innocuous medicines at normal doses can be very toxic at high doses. "Poisons", for the most part, are simply chemicals which are toxic before they are therapeutic, in a dose-response curve (some, of course, would never be therapeutic).

Here is a second, perhaps interesting aside, and one of my favorite "old school" microbiology stories. Because there is a vaccine for Tetanus, very few cases of Tetanus are seen these days. The disease is caused by another neurotoxin, Tetanus toxin, made by a bacterium closely related to C. botulinum, called Clostridium tetani. Both of these toxins cause paralysis and death by interactions with nerve cells, but in opposite manners. Botulism toxin works by interfering with the signal from the neuron to the muscle (it inhibits the release of calcium in the nerve, by a mechanism called endopeptidase activity. It cuts up the proteins in the nerve that allow it to funtion). Tetanus toxin works by a very similar mechanism, to produce the opposite results. It specifically targets the machinery in nerve cells that make them stop firing. Because the two diseases are, in a sense, complementary, the toxins have been used to treat each other. This was, and may still be, a treatment of last resort, but if someone is dying of either of these paralytic diseases, one method to try and save them can be to inject the other toxin! A person with Tetanus, for example, would be suffering severe muscle spasms (Lockjaw), and doses of Botulism toxin, given properly, could alleviate that symptom, giving the body time to eliminate the toxin through the antibody response! I always thought this was a particularly ingenious method of hijacking the deadly toxin and turning it to noble purposes.

DISCLAIMER: I am not an M.D., and am in no way qualified to advocate any methods to treat any diseases whatsoever, let alone serious ones like Botulism and Tetanus. This is merely an anecdote about a historical method of treatment, and should be viewed as such.