[Fwd: PRO> ProMED Digest V2004 #458]

From: Liz Brown (bfeab@uaf.edu)
Date: Fri Dec 03 2004 - 09:30:31 PST

  • Next message: DEJry2525@aol.com: "GAA magazine"

    Any bets on when this will show up as a plot for a "Law and Order" episode?
    =================================================================

    Subject: PRO/EDR> Botulism, human, botox related - USA (FL): susp. (02)

    BOTULISM, HUMAN, BOTOX RELATED - USA (FLORIDA): SUSPECTED (02)
    ***************************************************
    A ProMED-mail post
    ProMED-mail is a program of the
    International Society for Infectious Diseases
    Date: Fri, 3 Dec 2004
    From: ProMED-mail
    Source: Newsday NY from the South Florida Sun-Sentinal FL [edited]

    Botox inquiry focuses on possible bootleg drug
    - ---------------------------------------------
    Investigators are looking at an unapproved wrinkle treatment as the culprit
    that hospitalized 4 people with suspected botulism poisoning after they
    received injections at an Oakland Park, FL clinic, 3 officials close to the
    investigation said Thu, 2 Dec 2004.

    "The theory is that [the shots] were not real Botox that was contaminated,
    that they were bogus Botox," an official said. "We don't know for sure
    yet." The officials also said they were focusing on a suspended physician
    who worked at the clinic as the one they think administered the shots to
    the 4, including himself.

    The Florida Department of Health, the lead agency investigating the cases,
    said it still has not reached any conclusions about what happened at
    Advanced Integrated Medical Center, where the 4 people got anti-wrinkle
    injections last week.

    The physician and his girlfriend remain on ventilators but are in stable
    condition at Bayonne Medical Center in NJ. Another couple, of Palm Beach
    Gardens, FL, were listed in stable but critical condition Thu, 2 Dec 2004,
    in Palm Beach Gardens Medical Center, also on ventilators.

    During a half-day search of the clinic, investigators found 3 empty vials
    of a wrinkle treatment and a number of used syringes that are now being
    lab-tested, the officials said. The officials would not identify the
    supplier of the vials or discuss their contents. State and federal agents
    found paperwork in the clinic from an Arizona pharmaceutical wholesaler
    that sells an unlicensed, low-priced Botox-like wrinkle treatment, said the
    officials, who spoke on the condition of anonymity.

    Officials said they found letters from Toxin Research International, a
    Tucson pharmaceutical distributor that sells a product called Botulinum
    Neurotoxin type A. On its Web site, the company says the product is made
    from the A type of the bacteria. Officials would not discuss the content
    of the letters, or whether the company ever supplied any products to the
    clinic. TRI's Web site says a 500-unit vial of the product -- enough to
    treat 5 to 10 people -- sells for USD $1250. Brand-name Botox sells for
    about USA $400 for a 100-unit vial.

    The manufacturer of Botox, Allergan Inc. of Irvine, Calif., has complained
    to the USA that TRI's product is illegal and cannot be sold in this
    country, said company spokeswoman Stephanie Fagan. "We know about them and
    we have turned them over to the FDA," Fagan said. "They sell an unapproved
    version of what they call botulinum toxin type A. It is not legal."

    Allergan is the only company approved by the FDA to make and sell a
    botulinum type A product in this country, an FDA spokeswoman said.

    TRI could not legally obtain Botox to resell because Allergan sells only to
    physicians, Fagan said. Federal law forbids importing prescription drugs
    such as Botox from overseas. Officials said they have not definitively
    determined whether any TRI products are responsible for the illnesses.

    Botox-like products have been a growing problem throughout the country, as
    companies from overseas -- particularly China and Europe -- solicit doctors
    directly by e-mail and faxes offering deep discount prices.

    Health officials fear fake Botox could be harmful because it's not made
    according to FDA standards. Allergan has heard of dozens of cases of fake
    shots, Fagan said, and the FDA has seized some in South Florida, among
    other locales.

    [Byline: Bob LaMendola]

    - --
    ProMED-mail

    [Assuming that the affected individuals indeed have botulism -- very few
    neuromuscular illnesses occur in clusters -- a possible etiology involving
    a nonstandardized product (with higher amounts of toxin) looms large. We
    await the formal results of the CDC/FDA/State of Florida investigation. -
    Mod.LL]



    This archive was generated by hypermail 2b29 : Fri Dec 03 2004 - 09:35:13 PST