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They Could Have Been Billionaires: Jean and Alastair Carruthers


Not ones to frown, the cosmetic Botox originators say a lawyer's mistake kept them from patenting their eyebrow-raising discovery.

It's the only lethal neurotoxin that's said to boost self-esteem.

Depending whom you ask, it's either the great equalizer, leveling glabellar lines in a world rigged to respond to youth and beauty, or just another grim indicator of how our priorities have been corrupted. (Or at least numbed.)

Either way, with its reported 2.9 billion treatments last year alone, cosmetic Botox is arguably the biggest thing in anti-aging since cold cream, a contribution made by the Greeks back in the second century.

The use of Botox as a skin enhancer, however, can be traced to more modern times, to a day in 1987. That was when an opthamalogist in Vancouver, Canada, named Jean Carruthers was injecting botulinum toxin near the brow of a patient who suffered from uncontrollable blinking, or blepharospasm, when her client requested another shot of the poison and pointed at a spot on her forehead. But you're not having problems there, the doctor responded. True, said the client, a woman in her late 30s, but when you inject me there, my wrinkles go away.

That night Jean had dinner with her husband, Alastair, a dermatologist, and the couple's three young sons. Jean told her husband the story of the patient's odd request. At the time, treating spastic facial muscles or a case of crossed eyes with small amounts of Botox was becoming common practice, but using it to "soften" deep wrinkles was unheard of. In the chaos of a typical family dinner, however, Alastair, whose clinic then offered both surgery for skin cancer and some cosmetic work, didn't think much of the anecdote. "It went right over my head," he told Vancouver magazine in a recent interview.

Jean didn't forget. She went to work the next day and convinced her receptionist, Cathy Bickerton, to try what would become the first Botox treatment for frown lines. According to the couple's telling of the story, as reported in Vancouver: "Once Alastair saw the frownless Bickerton, he needed no persuasion. 'I had the patients,' he says, summing up what would become one of the most successful symbioses in late-20th-century cosmetic medicine, 'and Jean had the toxin.' "

If you're singing along at home, this is the part in the famous Pet Shop Boys song that goes, "Let's make lots of money," and rather triumphantly. (The song's lyrics use "brains" and "looks" where Alastair Carruthers uses "patients" and "toxin".) But the Carruthers never got to cash in on their discovery. Sure, they became consultants and investigators for Allergan (AGN), the $18 billion market cap company that eventually launched the Botox Cosmetic product, and they bought stock in the company, which already owned the formula for medical treatment, but the pioneering doctors never patented their own discovery.

"We took advice from a lawyer in Toronto who was supposed to be an expert and said that he did not think this was a patentable idea. We have since learned that it was indeed," Alastair tells Minyanville. "Are there any regrets? I guess so, but not major."

Of course, Botox went on to become a major blockbuster of a drug. It's estimated to make $1.3 billion in annual sales for Allergan.

That sales figure could soon rise if Botox is approved for migraine treatment, already a popular off-label use. In fact, the assortment of off-label applications for Botox is growing, and in foreign countries, the drug is officially approved for several usages not yet approved in the US. Last year, the New York Times created a body chart to graph the many points of entry by which the poison is now entering the body.

The poison is even being investigated as a solution to help ward off the blues. As the theory goes, your expressions are influenced by your thoughts, and the stress in an angry, clenched face only feeds into unhappy, stressful rumination. Freezing a muscle and making it impossible to frown could break this cycle. A new study out of Barnard College appears to support this idea, suggesting that Botox deadens emotional feelings and affects the way emotions are formed.

It's taken several years for Botox to reach this stage of global ubiquity. Not surprisingly, it also took years for the Carruthers to get others warmed up to idea of embracing the toxin for facial use as a vanity treatment.

After their initial discovery, the Vancouver doctors began recruiting volunteers. Finding few women willing to step forward, Jean began injecting herself with Botox and documenting the results. In 1991, when the Carruthers presented their findings at the American Society for Dermatologic Surgery, they were told the idea was simply "crazy."

Nevertheless, they kept up clinical trials and published their results, doggedly searching for validation. Eventually other doctors started to catch on. Along the way, the Carruthers learned that Alan Scott, the San Francisco doctor who first started using Botox for medical purposes, had also tested the formulation for cosmetic use two years before the Carruthers made it their mission to pursue the cause. "[He] told us that he had used it cosmetically in 1985 in conjunction with the plastic surgeon, realized that it worked, and promptly lost interest so that nothing further came of this," says Alastair.

In the late '80s, a group of researchers from Columbia University in New York recognized that there was cosmetic potential in Botox, he adds, but "they did not proceed until after the publication of our work in the early '90s. It was not until 1993 that there were a significant number of people who were using Botox Cosmetic in New York and Los Angeles."

The FDA approved Allergan's Cosmetic Botox in 2002.

Since then, the use of Botox has exploded, despite the rare but serious side effects -- such as swallowing problems, blurred vision, muscle weakness, and lack of bladder control -- that can occur if the toxin leaks to other parts of the body.

The newest worry is connected to the manufacturing of fake batches, as reported this month in Scientific American and the Washington Post. If cloned or real botox falls into the wrong hands, it could be used as a biological weapon. And as the Washington Post points out, a speck of the toxin smaller than a grain of sand can kill a 150-pound adult.

(Indeed, America's initial interest in the toxic substance had nothing to do with preserving youthful good looks. According to historical accounts, during World War II, the Office of Strategic Services came up with a plan to arm Chinese prostitutes with capsules encasing the poison. The deadly pill was to be slipped into the drinks of their trusting clients: high-ranking Japanese army officials.)

Botox has survived other instances of negative press over the years, including news of a backlash from casting agents tired of seeing starlets unable to hit the mark in a script calling for an expression depicting something other than happiness or surprise; the fear that botox treatments could become addictive; and now a focus on the tell-tale secondary "bunny lines" above the nostrils on either side of the nose, seen as the consequence of having only some muscles strapped in place while others are free to move and mark out new boundaries. "Botox Gives You Wrinkles" went the inevitable headline following publication of a damning report in the Journal of Cosmetic Dermatology last month.

And now Botox faces fresh competition from Dysport, another purified form of the toxin made by Medicis (MRX).

Nevertheless, Botox advocates, including the Carruthers, who are in their sixties and look much younger, stand by their original poison. Alastair's practice is now only cosmetic, and he says he sees it as good work. They may not have made billions, but both can claim clients who say that regular injections have helped their careers (especially in sales) and "psychological wellness." As Jean has phrased it, "We're helping people be the best they can be."
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