Case threatens frown lines over Botox use

By DAVID USBORNE


When they hear of the goings-on in the Los Angeles County Superior Court, the pampered and the precious of Beverly Hills are not sure whether to wince or smile.

Many of them are incapable of doing either, of course, thanks to their affection for the wrinkle-erasing drug called Botox, the enemy of all facial expression.

Pay attention they will, however, because this is precisely about Botox; its wonder-drug reputation may be on the line.

True, the trial under way inside the courtroom of Judge Victor Chavez is just another fine example of justice-turned-entertainment in Tinseltown. Day after day, it offers spectators and members of the jury titillating glimpses of Hollywood at its most vain, narcissistic and back-stabbing.

The John Travolta birthday bash sounded fun. And didn't Vanna White, America's most famous game-show glamour girl, look great on the stand? But more serious themes are in play. Most importantly: Is Botox a gift from the angels or a curse from the devil?

About half a million Americans are paying US$300 ($450) a session to have their dermatologists inject tiny doses of the modified toxin into their brows to smudge away those pesky crow's-feet and frown lines.

A good number of others are taking the drug for other more dubious reasons, such as combating crippling migraines.

This drama comes to us courtesy of Irena Medavoy, 45, a former actress (Dallas) and model and the wife of Mike Medavoy, the mogul movie-producer behind films such as Annie Hall and Rocky.

She was a long-time fan of Botox and, by extension, the company who makes it, Allergan Inc. She was even more devoted to the dermatologist who, for years, kept stabbing her with it, Dr Arnold Klein.

Now, Medavoy, who has arrived in court daily without makeup, in sensible shoes and looking nothing like her glittering professional persona, loves neither the drug nor the doctor who prescribed it to her.

She is alleging that after Klein injected Botox into her temples in March 2002 to help to reduce migraines, the headaches grew worse and her health declined to the point where husband was deprived of "companionship, intimacy and services".

By launching a lawsuit against Allergan and Klein, with a claim for unspecified damages, she has taken on a new role. She wants to be the Erin Brokovich of the Botox brigade, sending out an alert to all devotees of the drug that the miracle it promises them can just as easily turn into misery.

"I'm going to be the voice," she declared at the start of the trial, expected to last into next month. "If I have to be stripped for it, I will."

This is no paltry challenge. Botox is on trial here for the first time since it received government approval in America as a treatment for wrinkles two years ago.

Last year, the Society for Aesthetic Plastic Surgery said Botox injections had become America's fastest-growing cosmetic procedure. But if Medavoy wins her case, it would put the Botox gold rush in immediate peril.

Patients across America and in countries beyond who have embraced the drug as the next best thing to an elixir for youth may become shy of it.

No wonder that California-based Allergan, which sold doses worth more than half a billion US dollars last year, accounting for about a third of the company's entire profits, is taking it very gravely indeed, even launching a series of newspaper advertisements this month under the headline, "The Truth about Botox".

Beneath the headline of the trial - is Botox less safe than we thought? - there lies another important and tangled issue: the relationship between drug manufacturers and the doctors that must prescribe their products. When is it proper and when does it become unethical?

Enter Klein, 59, whose fame extends around the globe. South Korea gave him the sobriquet "Doctor Botox" and it has stuck. The British magazine Harpers & Queen crowned him Hollywood's top Botox doctor.

Indeed, his list of celebrity patients runs to the likes of Elizabeth Taylor, Michael Jackson, Dolly Parton, Madonna and Cher. He told Los Angeles Magazine that he had probably injected the stuff into no fewer than 90,000 people.

Over time, Klein also became important to Allergan. Like every other drug manufacturer, the company dedicates plenty of energy and money to recruiting physicians to spread the word about their products.

Klein, who carries a cane and cuts a rather fragile figure in court, became its favourite cheerleader for Botox. So important, in fact, that Allergan, say court documents, has been paying him US$25,000 a quarter-year as a consultant on Botox.

If he attends meetings to champion the drugs, he is paid another US$10,000 a day plus travel expenses. Between September 2000 and December 2003, Allergan paid him and his company, Minimally Invasive Aesthetics, almost US$500,000 for his services.

If Klein is intimidated by his place at the heart of this trial, he doesn't show it. "I hope I never have to do this again," he said. "But it's actually very amusing." But on the stand he does not show much humour. Invited to take a seat, he tartly demurred. "I prefer to stand when I lecture."

Just how much sympathy this jury of ordinary, non-Botoxed folk - not a mogul or film star among them - will feel for Medavoy is hard to gauge. Some may see in this trial a parable of what happens when human vanity and ego get the better of common sense. But Medavoy is doing her best.

Already, we have heard plenty of what happened - or did not happen in the marital bed and elsewhere - after the Botox shots were administered in her temples and neck for her headaches. She returned to Dr Klein on a March day two years ago for her quarterly Botox boost. She had already been receiving extra injections in the temples for her migraines, but this time, she alleges, the doses were much higher.

By her account, she fell into a tailspin of ill health about eight days later. Almost worse, her plans at the time for a summer season of high-life fun and travel, to St Tropez and beyond, fell apart, as did a proposal to launch a TV talk show to be called Behind the Gates - conceived as "Ab Fab come to life", she said. The show never got developed. She cancelled her travel schedules. She even missed the annual Vanity Fair party for the Oscars.

"I couldn't hold my head up," she said before the trial. "My neck muscle, where it was injected in my neck, could not support my head. It was like a bowling ball on a pin. I couldn't sleep. When I lay down, it was as if someone was torturing me."

And friends, including Vanna White, have come to back her up. "She could hardly speak," White assured the jury. Another pal, Donna Estes Antebi, said she had "never seen her so sick. She could not hold her body up".

Not all the testimony has been so helpful, however, especially from her other doctor, Robert Huizenga, who painted a picture of a patient obsessed with demons of self-imagined illness.

Saying that in his opinion she suffered from "anxiety syndrome", he recalled that, "if she had a pain on her breastbone, she was convinced she was having a heart attack".

Juicing up the proceedings is the presence of Howard Weitzman as Klein's lead lawyer. Weitzman is well-known on the Hollywood legal scene, having represented clients such as O.J. Simpson and Michael Jackson. It happens also that the lawyer was once a family friend of the plaintiff and her husband. His role today is not to be chummy with Medavoy, but instead to make her look small and silly.

Mike Medavoy avoided all eye contact with Weitzman from the stand, apparently feeling the awkward irony of the turning of the tables of old acquaintance.

When asked by reporters what it was like to be cross-examined by someone who was once a friend, he replied, "Friends? In Hollywood? Is there such a thing?"

The nub of the defence is that Medavoy suffered sudden illness for reasons not associated with the injections. Allergan has also defended the widespread practice of injecting its drug for headaches, rather than for the smoothing out of age lines. It argued that the "scientific and medical facts demonstrate that Botox is safe and effective therapy that has improved the health and quality of life for millions of patients with serious and debilitating neurological disorders, which account for 60 per cent of all Botox use."

Nonetheless, the picture is not so clear when it comes to the exact scope of Botox's approved uses. The drug is a distilled form of the botulism food-poison toxin and is injected into nerves to block the release of acetylcholine, a naturally occurring chemical that activates muscle movement.

For years, doctors used the drug to treat abnormalities like eye squints and unwanted spasms in the neck or eyelids.

Some might say there is a separate problem with Botox - the relationship between patient and their bathroom mirrors. Vanity is not limited to the mansions of Hollywood and nor is the popularity of Botox. The future of the drug could be less than wrinkle-free.

- INDEPENDENT