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More Information on Botulinum Toxin (Botox, Myobloc)

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Letter Urging the Cancellation of "Botox Night"

July 9, 2002

Edward D. Miller, M.D.
Chief Executive Officer
Dean of the Medical Faculty
Johns Hopkins School of Medicine
720 Rutland Avenue
Room 100
Baltimore, MD 21205

Dear Dr. Miller:

If you wish to ensure that the Johns Hopkins School of Medicine maintains its reputation as one of the world’s leading medical schools, you will immediately cancel the "Botox Night", similar in many respects to a so-called Botox Party, scheduled for Johns Hopkins’ Outpatient Center this Thursday, July 11. This event is unseemly, unprofessional and undermines the core educational mission of the university.

Botox Parties have sprung up in the aftermath of the April 15, 2002, Food and Drug Administration approval of botulinum toxin for the treatment of "glabellar lines" (otherwise known as the frown lines between the eyebrows). Such events may occur in spas or in upscale private homes and often feature alcohol and on-the-spot injections with Botox. The average cost of a Botox injection (Allergan; Irvine, CA) is $497, according to a survey by the American Academy of Facial Plastic and Reconstructive Surgery conducted between January and April 2002. Although we do not believe that alcohol will be served at the Johns Hopkins event, one purpose of the party setting is to capitalize on the fact that people in large groups with persuasive speakers are easily swayed. Another purpose is that a vial of the very expensive Botox typically contains enough toxin for five injections; because the contents are intended to be discarded within four hours of the vial being opened, there is an incentive to use all the contents rapidly. The procedure must be repeated every three to six months, potentially providing a steady stream of patients (and income).

Shortly after Botox was approved for cosmetic uses, the American Academy of Dermatology went on record criticizing Botox parties. In an April 29, 2002, letter to all Academy members, Dr. Fred F. Castrow II, the Academy’s president, stated that "Social gatherings of this kind in combination with botulinum toxin treatments are inappropriate and potentially dangerous settings for patients. As such, I strongly discourage you from participating in these kinds of medical/social activities." The adverse effects of Botox include drooping of the eyelids and reactions around the injection site.

It appears that everyone with an email account through the Johns Hopkins School of Medicine (including students, faculty, residents and fellows) received an email on or before July 2 with a series of announcements of upcoming events at the medical school. Among these was the announcement for the Botox event with the title "It’s Botox Night at Hopkins", printed on Johns Hopkins stationary (see attachment). The "host" of the event is Patrick J. Byrne, MD, who is an assistant professor and director of the Division of Facial and Plastic Reconstructive Surgery in the Department of Otolaryngology at Johns Hopkins.

The announcement promises an event in the Outpatient Center for which "Attendance is free." We have since learned that those who elect to receive an injection will pay $5 per unit of Botox, or about $100 per treatment, a sharply reduced rate (Dr. Byrne’s receptionist, personal communication, July 9, 2002). The following information is provided under the "Details" section of the announcement:

Do you have fine lines and wrinkles that make you look older than you really are? Do you want to look younger without the cost and inconvenience of surgery? Curious what all the fuss is about Botox? (sic) Come join us after work for an infomation (sic) seminar including live demonstration of the many uses of Botox. Any (sic) interested in receiving Botox treatments may do so on the spot! Refreshments will be served and attendance is free.

We are astonished that a respected institution like Johns Hopkins would permit so inappropriate an activity under its roof. With all the medical problems facing the U.S., and Baltimore in particular, can this be the most productive use of faculty members’, students’ or residents’ time? What social or medical purpose is served by marketing cosmetic procedures to healthy Johns Hopkins employees, particularly those who, based on their age, will have few signs of aging?

Dr. Byrne may wish to characterize his efforts as an "infomation (sic) seminar," but, clearly, the main purpose of the event is to drum up business for Johns Hopkins. This event does not follow the pattern of educational events for either medical schools or patients. Educational events at medical schools and hospitals typically occur at lunchtime seminars or grand rounds, not after hours with promises of drugs for the attendees. Educational seminars for the public typically provide information on diseases and treatment options, not treatment demonstrations. Has anyone heard of a patient education seminar on arthritis with "on-the-spot Enbrel injections" or a seminar on cancer with "on-the-spot chemotherapy"?

Over the years, Johns Hopkins has developed a reputation for addressing the needs of patients by leading the nation in research, clinical services and education. The crass commercialism of this event sends the message to students that cosmetic procedures — with the lure of a Botox injection at a reduced price — are equally meritorious uses of physician time. Botox injections are medical procedures that should be delivered in a calm, private setting — not in the festive atmosphere this announcement appears to contemplate. If you ensure that this event is immediately canceled, it will send a clear message to students that Johns Hopkins emphasizes professionalism over commercialism in medicine.

Yours sincerely,

Peter Lurie, M.D., M.P.H.
Deputy Director
Public Citizen’s Health Research Group

Eileen Ringel, M.D.
Researcher
Public Citizen’s Health Research Group
Practicing Dermatologist
Adjunct Clinical Professor
Dartmouth Medical School

Sidney M. Wolfe, M.D.
Director
Public Citizen’s Health Research Group

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