The Deadliest Botox Has Arrived

You know the stuff you inject in your face? It’s a sanitized version of the most lethal substance on earth—and science has just found a scary new strain. Kent Sepkowitz reports.

10.18.13 9:45 AM ET

Botox is surely science’s best example of Grandma’s twinkling advice: turn lemons into lemonade, make a silk purse from a sow’s ear, turn your frown upside down. After all, it started out as a disease—botulism, both the cause of occasional severe, even lethal food poisoning and a biologic weapon of mass destruction, the most potent and lethal one out there by far due to its ability to paralyze. It is said (PDF) that a single gram dispersed correctly could kill more than a million people.

But a few decades ago this same ability to disrupt nerve conduction led to a medical use: deliberate, targeted paralysis. This was used for types of pathologic muscle spasm at first—neck and bladder and elsewhere—but soon slid right on over into the glam business, where little injections began to smooth the foreheads of now forever un-startle-able actresses from West Hollywood all the way to East Hollywood.

There’s news on the Jekyll-Hyde, botox-botulism front: scientists have found an even more potent form of the toxin—i.e., an even deadlier form of one of the deadliest substances on earth—labeled strain H to distinguish it from the 7 (A though G) that have come before it. Furthermore, this strain, collected from the stool of an infant with a rare form of botulism, seems impervious to the classic treatment of botulism, the use of antibodies directed at the toxin itself.

It is clear that potency matters, as Eric and Bonnie Kaplan discovered. A decade ago, they decided for a holiday botox spruce-up mit smooth-out. They chose a doctor who had, perhaps unknown to all, used a cheaper, much too potent and not-approved-for human-use brand—and the Kaplans ended up totally paralyzed on ventilators for months, due to overwhelming botulism. ‎ They survived and have chased the American dream since then—they have sued, written a book, and now lecture on their ordeal. Their experience, though, demonstrates just how cautious one must be when playing with powerful chemicals, especially in the post-Walter White era.

Botulism is caused by the bacterium Clostridium botulinum, a hardy anaerobe. Not needing oxygen, it thrives in dark forgotten places such as poorly canned foods (witness the famous Bon Vivant vichyssoise soup outbreak) and Inuit delicacies such as whale blubber. Indeed, Alaska has the highest number of cases in the US. The botulism bacterium is in the same genus (but different species) of bacteria that cause gas gangrene, tetanus, and hospital-acquired diarrhea. Quite a rough family.

The disease became evident in Germany 150 years ago when people eating sausage became ill with progressive paralysis. The word derives from “botulus,” the Latin word for “sausage”—itself a bit of a surprise:  who ever thought of Romans eating sausages? Perhaps this, not lead poisoning, is the reason for the fall of the Roman Empire. It was a small-time public health problem, striking unlucky families here and there, until World War II sparked speculation about its use as a bioterror agent. Indeed, more than a million doses of botulism antiserum were prepared (PDF) for D-Day soldiers invading Normandy Beach.

It has been used with varying success as a bioweapon. The Japanese used it on Manchurian prisoners in the 1930s; in the 1990s, the Japanese cult and terror group Aum Shinrikyo, famous for its lethal use of sarin gas in the Tokyo subways, tried to disperse botulism repeatedly in Tokyo without success (PDF). And one of the “weapons of mass destruction” connected to Saddam Hussein was a series of canisters said to contain botulism toxin (PDF).

As a disease, botulism is everyone’s worst nightmare—a rapidly progressive paralysis with maintenance of the total awareness. The paralysis starts with the facial nerves and eventually can affect breathing muscles. which means that a person can remain awake and alert but unable to move a single muscle. And the toxin, which sits in the synapses between neurons, can take weeks to wash out. The only good news is that the disease is not contagious person-to-person.

This double jeopardy of the new H strain having more potency and poor response to current therapies led the medical journal publishing the findings, the venerable Journal of Infectious Diseases (JID), to not publish the genetic sequence of the recovered strain. This is customary, if not mandatory, in reputable journals such as JID. The editors expressed their concern that the information could fall into the wrong hands and make it too easy for a bad guy somewhere to mix up a batch of botulism toxin H to spread around. This conundrum is referred to with the awful acronym of DURC, for “dual use research of concern.”

The same issue was raised earlier this year around publication of two studies examining transmission of a worrisome influenza strain. Most cite the so-called “Corson Report” of 1982 entitled “Scientific Communication and National Security” for guidance. In this Reagan-era document, scientific autonomy is favored: they call for scientific research to remain as unrestricted as possible. Secrecy was seen as a deterrent to the two essentials of superior investigation: intellectual audacity and talking to colleagues ceaselessly and maniacally.

It’s a tricky issue for sure. But it is further complicated when doctors start to play national security experts and national security experts begin to snoop into scientific research. As the ridiculous decision to try to vaccinate the U.S. against smallpox a decade ago demonstrated, good people can make bad decisions when they leave their area of expertise.