Botox wrinkle: worries over supply, pricing

Since the FDA has approved its cosmetic use, those who rely on it for other applications are concerned the increased popularity will raise the cost with demand.

By Victoria Stagg Elliott, AMNews staff. June 24, 2002.

Nestor Galvez-Jimenez, MD, chief of the movement disorder program at Cleveland Clinic Florida in Fort Lauderdale, remembers the 1997 Botox shortage.

Over a two-month period, he asked patients -- those who depended on periodic injections to function -- to wait a couple of extra weeks between visits. He kept a very close eye on his stock, and just as he was down to his last bottle, the glitch that had caused the problem was resolved.

"Everyone got their injections, but we stretched them out a little bit," he said. "The good thing is that, at the end, we did OK."

But since the Food and Drug Administration's April approval of Botox -- botulinum toxin A -- for the treatment of brow wrinkles and the ensuing media firestorm it caused, he and other physicians who use it for therapeutic indications are concerned about the possibility of another shortage. They also worry about other issues because of the growth in cosmetic use.

Among these: The impact of increased demand on price; the chance that patients could develop resistance to the toxin from cosmetic use but later need it for a medical indication; and the possibility of long-term effects.

"When you deal with the world's most poisonous substance, you must pay respect to it," said Michael Chancellor, MD, professor of urology and gynecology at the University of Pittsburgh School of Medicine.

Most of these concerns, though, are unlikely to bear fruit.

Allergan Inc., the company that makes Botox, has issued statements that the supply will be more than adequate to meet expected needs. "We can produce enough product, and we don't foresee any kind of problems with production that would interrupt supply," said Christine Cassiano, a company spokeswoman. [...]