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Death to Beauty: The Transformative History of Botox
In the 1970s, Dr. Alan Scott sought to selectively weaken eye muscles to treat strabismus (when one or both eyes are misaligned) without surgery. After failed attempts with other agents, Scott developed a method to stabilize the bacteria that causes botulism, culminating in a drug that eventually became known as Botox .
In Death to Beauty, Eugene M. Helveston, MD, follows the unlikely story of botulism's 1817 discovery in contaminated German sausages, to its use in military and research facilities, to Scott, an ophthalmologist who aimed to safely use the drug in humans. Scott struggled alone as an unknown in the pharmaceutical industry, searching for clinical trial financing and FDA approval, which he achieved at a fraction of the billions big pharma usually spends to bring a drug to market. Eventually, the company Allergan bought him out, capitalizing on the possibilities for cosmetic uses. Scott's formula was renamed "Botox" and reached annual sales in the billions. After the sale, Scott received no further compensation from Botox sales and remained the same unassuming man.
A fascinating walk through the intricate history of how the world's deadliest toxin starting as a treatment for crossed eyes became a routine tool for the cosmetic industry, Death to Beauty will make you rethink success, beauty, and deadly bacteria.
In Death to Beauty, Eugene M. Helveston, MD, follows the unlikely story of botulism's 1817 discovery in contaminated German sausages, to its use in military and research facilities, to Scott, an ophthalmologist who aimed to safely use the drug in humans. Scott struggled alone as an unknown in the pharmaceutical industry, searching for clinical trial financing and FDA approval, which he achieved at a fraction of the billions big pharma usually spends to bring a drug to market. Eventually, the company Allergan bought him out, capitalizing on the possibilities for cosmetic uses. Scott's formula was renamed "Botox" and reached annual sales in the billions. After the sale, Scott received no further compensation from Botox sales and remained the same unassuming man.
A fascinating walk through the intricate history of how the world's deadliest toxin starting as a treatment for crossed eyes became a routine tool for the cosmetic industry, Death to Beauty will make you rethink success, beauty, and deadly bacteria.
- GenresNonfiction
216 pages, Hardcover
Published January 30, 2024
2 people are currently reading
137 people want to read
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Displaying 1 - 9 of 9 reviews
January 14, 2024
Death to Beauty is a fascinating look at the dedication and science behind one man's journey, along with those who helped along the way, to creating a multiuse drug that's safe for humans out of a bacteria that killed many. His success came from diligence, hard work, and little funding. This book is beautifully written and I found myself intrigued by Dr. Alan Scott and his mission despite not having ever been interested in Botox. This is a story of one man's quest that can be appreciated by everyone and his story deserved to be told.
I received a gifted copy in exchange for an honest review.
I received a gifted copy in exchange for an honest review.
January 30, 2025
When I was a neurologist, there was a small, unremarkable refrigerator in the corner of our department’s office. It had a lock and required two senior doctors present to open it. Inside was something called botulinum toxin type A, more commonly known by its brand name “Botox,” a go-to for those seeking to erase wrinkles. However, this substance carries another identity, one of the most toxic substances known to nature—theoretically, just 8 grams could kill all persons on Earth.
The story of botulinum toxin is chronicled in a book titled Death to Beauty by American ophthalmologist Eugene Helveston. True to its title, the book explores how this deadly toxin transformed into a remedy for beauty and medicine—a truly extreme example in the history of science. One reason for writing the book lies in this fascinating transformation; another motivation was to introduce readers to a tenacious ophthalmologist, Dr. Alan Scott, whose contributions might otherwise fade from medical history. Dr. Scott dedicated his life to researching treatments for strabismus (misalignment of the eyes). After discovering botulinum toxin’s potential, he self-funded clinical trials. To meet drug approval requirements, he mortgaged his home and founded a company. He succeeded in getting approval for the product’s use in late 1989, almost 30 years after starting his research. He estimated that the total development cost for botulinum toxin was around $4 million—an astonishingly modest investment compared to today’s average of over $1 billion per new drug.
Like all scientific and technological breakthroughs, the development of botulinum toxin was not the result of a single scientist’s eureka moment but rather a collective effort spanning generations. Helveston highlights three key figures in this journey: Justinus Kerner, a German public health official who first hypothesized the existence of botulinum toxin while investigating blood sausage poisoning cases in 1822, even predicting its potential for medical use; Dr. Edward Schantz, who safeguarded botulinum toxin cultures for decades and generously shared them for research with scientists like Dr. Scott; and Dr. Scott himself, who carried the baton to convert the toxin into a viable pharmaceutical product. By modern standards, Dr. Scott’s clinical trials were disorganized and inefficient—there were no patient recruitment goals, and researchers weren’t restricted in how they used the drug. Yet, this loose framework inadvertently uncovered many of the toxin’s applications, including its popular wrinkle-erasing effect. Due to financial constraints, patients were even asked to pay nominal fees during the later stages of the trials.
In 1991, Dr. Scott sold his company to Allergan for $9 million. The toxin, rebranded as “Botox,” expanded its uses far beyond ophthalmology to dermatology (cosmetic purposes), neurology, urology, psychiatry, and more, with annual sales climbing into the billions of dollars. The Time magazine once called it the “Drug Treating Everything.” After the sale, Dr. Scott returned to clinical work and teaching, continuing his research on strabismus until his death in December 2021. Despite Botox’s commercial success, he did not personally benefit much from it.
Helveston’s book ends around the time of Allergan’s acquisition, briefly mentioning the toxin’s growing applications in dermatology and neurology but without delving deeply into them. This may stem from either the author’s professional focus or his initial intent for the book. However, the story of botulinum toxin remains far from finished. Its development trajectory reflects broader societal phenomena that deserve deeper reflection, leaving readers with much to ponder.
Allergan’s continued expansion of Botox’s indications heavily relied on the efforts of independent researchers, many of whom were clinicians. These doctors encountered patients with conditions beyond the approved uses for the drug and, based on their professional judgment, tried administering Botox off-label. When successful, word of mouth among physicians would attract others to join in. Over time, as enough cases were collected, findings were presented at academic conferences or published in journals, catching the attention of the company. If the commercial potential seemed viable, Allergan would initiate confirmatory clinical trials. This reliance on independent researchers echoes the open, collaborative spirit of Dr. Scott’s early work and stands in stark contrast to the typical pharmaceutical development model.
Pharmaceutical companies are undoubtedly the driving force behind modern drug development. With vast resources and personnel, they conduct clinical trials and market drugs with efficiency, quickly bringing benefits to both doctors and patients. However, their profit-driven nature often leads them to overlook rare conditions with low commercial appeal. Independent researchers, on the other hand, pursue science with passion, devoting resources to these neglected areas. Yet, they face limitations such as less accurate efficacy evaluations, smaller research scales, and weaker promotion capabilities. Botox’s rapid rise underscores how combining the strengths of both groups can yield remarkable results. Still, off-label drug use relies heavily on a physician’s ethics and expertise, which can sometimes lead to misuse or errors, posing risks to patients. Many countries and regions permit such practices out of trust in doctors and to provide hope for patients with no alternatives. Regulatory agencies can guide resource allocation responsibly and strike a balance between innovation and safety.
Looking beyond the realm of drug development, botulinum toxin has become a household name among the general public. People outside the medical field eagerly share personal experiences about its cosmetic applications. Botox is not only available in hospitals but is also widely used in countless beauty clinics. Despite measures to ensure safety, its inherently toxic nature means improper use carries risks. Shockingly, the public discourse around Botox often downplays these risks, whether intentionally or not.
In recent years, the weight-loss drug semaglutide has sparked similar societal reactions but on a larger scale. Comparing these two cases reveals common traits. First, there is a shift in demand—from treating diseases to enhancing appearance. Consumers’ definitions of “beauty” are shaped by social pressures, cultural trends, and marketing, leading individuals to prioritize emotional and immediate gratification while underestimating risks. Second, commercial narratives driven by profit tend to emphasize effectiveness and efficiency while minimizing risks—even when risks are mentioned, they are usually framed as rare or manageable. Lastly, the influence of social figures—such as Elon Musk reportedly using semaglutide—or celebrities and relatable success stories creates a strong demonstration effect, encouraging the public to ignore risks and follow suit. Even the strictest regulatory systems struggle to counteract the societal momentum that follows a drug’s widespread adoption.
Thanks to Dr. Helveston’s efforts to capture Dr. Scott’s final interview, we now have a record of how botulinum toxin transformed from a deadly poison into a “miracle drug.” The book is thoroughly researched, rigorously documented, and written in a straightforward style. As drug development becomes increasingly stringent and complex, such a story is unlikely to repeat itself. Fortunately, the perseverance, focus, and dedication of past researchers continue to inspire generations. Revisiting the botulinum toxin story today offers us not only lessons from their innovations but also an opportunity to reflect on the complex relationships between science, humanity, and risk—and how scientific advancements can sometimes threaten the very society they aim to serve.
This review is originally written in Chinese and translated into English with the help of ChatGPT.
The story of botulinum toxin is chronicled in a book titled Death to Beauty by American ophthalmologist Eugene Helveston. True to its title, the book explores how this deadly toxin transformed into a remedy for beauty and medicine—a truly extreme example in the history of science. One reason for writing the book lies in this fascinating transformation; another motivation was to introduce readers to a tenacious ophthalmologist, Dr. Alan Scott, whose contributions might otherwise fade from medical history. Dr. Scott dedicated his life to researching treatments for strabismus (misalignment of the eyes). After discovering botulinum toxin’s potential, he self-funded clinical trials. To meet drug approval requirements, he mortgaged his home and founded a company. He succeeded in getting approval for the product’s use in late 1989, almost 30 years after starting his research. He estimated that the total development cost for botulinum toxin was around $4 million—an astonishingly modest investment compared to today’s average of over $1 billion per new drug.
Like all scientific and technological breakthroughs, the development of botulinum toxin was not the result of a single scientist’s eureka moment but rather a collective effort spanning generations. Helveston highlights three key figures in this journey: Justinus Kerner, a German public health official who first hypothesized the existence of botulinum toxin while investigating blood sausage poisoning cases in 1822, even predicting its potential for medical use; Dr. Edward Schantz, who safeguarded botulinum toxin cultures for decades and generously shared them for research with scientists like Dr. Scott; and Dr. Scott himself, who carried the baton to convert the toxin into a viable pharmaceutical product. By modern standards, Dr. Scott’s clinical trials were disorganized and inefficient—there were no patient recruitment goals, and researchers weren’t restricted in how they used the drug. Yet, this loose framework inadvertently uncovered many of the toxin’s applications, including its popular wrinkle-erasing effect. Due to financial constraints, patients were even asked to pay nominal fees during the later stages of the trials.
In 1991, Dr. Scott sold his company to Allergan for $9 million. The toxin, rebranded as “Botox,” expanded its uses far beyond ophthalmology to dermatology (cosmetic purposes), neurology, urology, psychiatry, and more, with annual sales climbing into the billions of dollars. The Time magazine once called it the “Drug Treating Everything.” After the sale, Dr. Scott returned to clinical work and teaching, continuing his research on strabismus until his death in December 2021. Despite Botox’s commercial success, he did not personally benefit much from it.
Helveston’s book ends around the time of Allergan’s acquisition, briefly mentioning the toxin’s growing applications in dermatology and neurology but without delving deeply into them. This may stem from either the author’s professional focus or his initial intent for the book. However, the story of botulinum toxin remains far from finished. Its development trajectory reflects broader societal phenomena that deserve deeper reflection, leaving readers with much to ponder.
Allergan’s continued expansion of Botox’s indications heavily relied on the efforts of independent researchers, many of whom were clinicians. These doctors encountered patients with conditions beyond the approved uses for the drug and, based on their professional judgment, tried administering Botox off-label. When successful, word of mouth among physicians would attract others to join in. Over time, as enough cases were collected, findings were presented at academic conferences or published in journals, catching the attention of the company. If the commercial potential seemed viable, Allergan would initiate confirmatory clinical trials. This reliance on independent researchers echoes the open, collaborative spirit of Dr. Scott’s early work and stands in stark contrast to the typical pharmaceutical development model.
Pharmaceutical companies are undoubtedly the driving force behind modern drug development. With vast resources and personnel, they conduct clinical trials and market drugs with efficiency, quickly bringing benefits to both doctors and patients. However, their profit-driven nature often leads them to overlook rare conditions with low commercial appeal. Independent researchers, on the other hand, pursue science with passion, devoting resources to these neglected areas. Yet, they face limitations such as less accurate efficacy evaluations, smaller research scales, and weaker promotion capabilities. Botox’s rapid rise underscores how combining the strengths of both groups can yield remarkable results. Still, off-label drug use relies heavily on a physician’s ethics and expertise, which can sometimes lead to misuse or errors, posing risks to patients. Many countries and regions permit such practices out of trust in doctors and to provide hope for patients with no alternatives. Regulatory agencies can guide resource allocation responsibly and strike a balance between innovation and safety.
Looking beyond the realm of drug development, botulinum toxin has become a household name among the general public. People outside the medical field eagerly share personal experiences about its cosmetic applications. Botox is not only available in hospitals but is also widely used in countless beauty clinics. Despite measures to ensure safety, its inherently toxic nature means improper use carries risks. Shockingly, the public discourse around Botox often downplays these risks, whether intentionally or not.
In recent years, the weight-loss drug semaglutide has sparked similar societal reactions but on a larger scale. Comparing these two cases reveals common traits. First, there is a shift in demand—from treating diseases to enhancing appearance. Consumers’ definitions of “beauty” are shaped by social pressures, cultural trends, and marketing, leading individuals to prioritize emotional and immediate gratification while underestimating risks. Second, commercial narratives driven by profit tend to emphasize effectiveness and efficiency while minimizing risks—even when risks are mentioned, they are usually framed as rare or manageable. Lastly, the influence of social figures—such as Elon Musk reportedly using semaglutide—or celebrities and relatable success stories creates a strong demonstration effect, encouraging the public to ignore risks and follow suit. Even the strictest regulatory systems struggle to counteract the societal momentum that follows a drug’s widespread adoption.
Thanks to Dr. Helveston’s efforts to capture Dr. Scott’s final interview, we now have a record of how botulinum toxin transformed from a deadly poison into a “miracle drug.” The book is thoroughly researched, rigorously documented, and written in a straightforward style. As drug development becomes increasingly stringent and complex, such a story is unlikely to repeat itself. Fortunately, the perseverance, focus, and dedication of past researchers continue to inspire generations. Revisiting the botulinum toxin story today offers us not only lessons from their innovations but also an opportunity to reflect on the complex relationships between science, humanity, and risk—and how scientific advancements can sometimes threaten the very society they aim to serve.
This review is originally written in Chinese and translated into English with the help of ChatGPT.
This entire review has been hidden because of spoilers.
February 9, 2024
This is my favorite type of nonfiction read..I’ll tell you why. I’m fascinated with the history behind things. I remember reading SALT: A WORLD HISTORY and my kids were like, “Isn’t that the most boring subject?”
Well, No..any book that tells me how something came to be I absolutely love.
So for this nonfiction read, I’ve learned about the layers of how what we now know as Botox (botulinum toxin) came to be. The book does a great job of sharing the past, the present, and the future of this toxin.
The book talks about Alan Scott who was an ophthalmologist looking for a way to correct the misalignment of eyes without surgery. From that process, Botox as we know it came to be.
Some of the history of the botulinum toxin is shared including the first recorded outbreak of botulism from blood sausage. There was also an outbreak from olives at the turn of the 20th century in the US. Even the government got involved with testing to see if this drug could be used in biological warfare. All of this lead to Dr. Scott and his FDA trial.
I could go on with facts and information, but if you like this type read or have ever used Botox for either cosmetic or medical issues you should read this.
I’m not great with science and medicine, but everything was written so that I didn’t feel like I needed a PhD or be an MD in order to enjoy this.
Well, No..any book that tells me how something came to be I absolutely love.
So for this nonfiction read, I’ve learned about the layers of how what we now know as Botox (botulinum toxin) came to be. The book does a great job of sharing the past, the present, and the future of this toxin.
The book talks about Alan Scott who was an ophthalmologist looking for a way to correct the misalignment of eyes without surgery. From that process, Botox as we know it came to be.
Some of the history of the botulinum toxin is shared including the first recorded outbreak of botulism from blood sausage. There was also an outbreak from olives at the turn of the 20th century in the US. Even the government got involved with testing to see if this drug could be used in biological warfare. All of this lead to Dr. Scott and his FDA trial.
I could go on with facts and information, but if you like this type read or have ever used Botox for either cosmetic or medical issues you should read this.
I’m not great with science and medicine, but everything was written so that I didn’t feel like I needed a PhD or be an MD in order to enjoy this.
February 24, 2024
Botox has become a common name in the cosmetic / beauty industry. But I would be interested to see how many people know its origins and history.
In 𝐃𝐞𝐚𝐭𝐡 𝐭𝐨 𝐁𝐞𝐚𝐮𝐭𝐲, Dr. Helveston breaks down the science of bacteria, toxins, and poisons for us, and he does so in a manner that makes these things understandable and fascinating.
Botox, actually a deadly bacteria called botulism, was discovered in some bad sausages in 1817. Eventually, the toxin was used by an ophthalmologist looking to treat the misalignment of the eyes. After he struggled with stabilizing the bacteria and worked exhaustively on clinical trials to get FDA approval, a large company took note of its use in the beauty industry -and thus, Botox was born.
I can’t say I would never get Botox for my wrinkles, but it’s expensive, and putting a deadly bacteria into my skin kind of freaks me out! I was interested when there was talk about Botox injections helping migraine sufferers like myself, but my doctors did not recommend them.
This is an excellent read if you’ve ever been curious about the facts and myths behind Botox or if you just enjoy very well-written nonfiction.
Thank you @suzyapprovedbooktours and @iu.press for a spot on tour and a gifted book.
In 𝐃𝐞𝐚𝐭𝐡 𝐭𝐨 𝐁𝐞𝐚𝐮𝐭𝐲, Dr. Helveston breaks down the science of bacteria, toxins, and poisons for us, and he does so in a manner that makes these things understandable and fascinating.
Botox, actually a deadly bacteria called botulism, was discovered in some bad sausages in 1817. Eventually, the toxin was used by an ophthalmologist looking to treat the misalignment of the eyes. After he struggled with stabilizing the bacteria and worked exhaustively on clinical trials to get FDA approval, a large company took note of its use in the beauty industry -and thus, Botox was born.
I can’t say I would never get Botox for my wrinkles, but it’s expensive, and putting a deadly bacteria into my skin kind of freaks me out! I was interested when there was talk about Botox injections helping migraine sufferers like myself, but my doctors did not recommend them.
This is an excellent read if you’ve ever been curious about the facts and myths behind Botox or if you just enjoy very well-written nonfiction.
Thank you @suzyapprovedbooktours and @iu.press for a spot on tour and a gifted book.
January 25, 2024
“All things are poison. Only the dose determines a thing is not a poison.”
What a fascinating read! I learned a little bit about botulism in school, but it really only covered the basics and made me afraid of swollen cans of food. And then in my Lamaze class I learned that you don't give honey to babies because it could be contaminated by the botulinum spores. This book gave me a whole different outlook on the facts and myths about botulism/botox.
What a fascinating read! I learned a little bit about botulism in school, but it really only covered the basics and made me afraid of swollen cans of food. And then in my Lamaze class I learned that you don't give honey to babies because it could be contaminated by the botulinum spores. This book gave me a whole different outlook on the facts and myths about botulism/botox.
February 5, 2024
I’ve been a fan of Botox for quite some time but didn’t know much about the history. I found this book to be really interesting. It’s incredible that something so deadly has been turned into such a powerful drug that is used by so many people successfully. I think this book would be fascinating for anyone who has considered Botox.
February 22, 2024
This is a very interesting story of Dr Alan Scott, an ophthalmologist looking for a treatment to correct misalignment of eyes and what became the role of botulinum toxin through the years.
I learned a lot about the history of this toxin and outbreaks, deadly and yet used successfully on many.
I learned a lot about the history of this toxin and outbreaks, deadly and yet used successfully on many.
February 25, 2024
What an interesting and riveting story.
I had no idea of the origins of Botox and it was fascinating to learn about it. A well reserached story full with really interesting facts. A great read.
I had no idea of the origins of Botox and it was fascinating to learn about it. A well reserached story full with really interesting facts. A great read.
March 11, 2024
This nonfiction read tells the story of Alan Scott and the science behind, what we now know as, Botox. I found the book to be easy to read and had diagrams explaining the original uses for Botox, including food safety, biological warfare and overall health for humans. I found myself enjoying reading about how Alan Scott’s research and testing showed how the muscles would react once given Botox. It was something I had never thought about. Would highly recommended for anyone who has gotten or is thinking about getting Botox.
Displaying 1 - 9 of 9 reviews