This is a thoroughly reported story on a medical therapy that merits skepticism but which has also earned a reasonable amount of scientific respect in recent years. It does a nice job of explaining the myriad uses of Botox in medicine today and issues some needed cautions about potential harms, nonapproved uses, and misuse. The story’s sources are plentiful and appear to be balanced. But is this enough? How good is the evidence to support the various uses of Botox? Are there reasonable alternatives to Botox for some of the conditions it treats? Is it okay to tease a national audience with a headline that shouts one thing, but place deeper in the story the caveats that suggest another? There is extraordinary variability in the quality of the research on Botox from one medical condition to another—missing information important for a national audience that inevitably includes people searching desperately for solutions to intractable problems. For example, our quick literature search turned up more than a score of randomized, controlled trials and systematic reviews on the use of Botox for the involuntary muscle contortions that cause the painful neck disorder known as cervical dystonia–and just one, very small, inadequate trial on Botox treatments for low back pain. The story fails to quantify side effects, most of which seem to be dismissed as transient. And readers might be better served if the story put more meat on the bones of alternative approaches (including no treatment) to some of the conditions Botox treats. Indeed, one could argue that the story’s ultimate effect is that of treatment mongering—simply because it shines so much (mostly flattering) light on Botox. The admonition from one source—“Don’t demand a certain treatment just because you saw a headline”—can’t compete with the magazine cover’s actual headline: “The Botox Boom” followed inside by, “You thought Botox was all about looks? It's also a salve for everything from cerebral palsy to writer's cramp”. In spite of the story’s multiple caveats about Botox, the headline hypes a therapy that may be a boon for some, but a bust for others.
The cover story points out that Botox is big business—accounting for some $830 million in annual sales. It explains that insurance companies will reimburse treatments for FDA-approved uses and in some cases nonapproved uses. It mentions cost of wrinkle treatments in a sidebar, but it doesn’t compare the costs of Botox with the costs of the alternatives–for wrinkles, neck pain, or other problems—nor does it attempt to account for the expense of office visits and other associated costs.
The story provides no quantitative estimates of the benefits of using Botox.
The story mentions several of the major side effects of Botox, points out that the long-term effects of multiple injections over many years are unknown, and cautions readers about the potential dangers of using Botox for off-label uses. A sidebar in the story warns readers about the dangers of highly concentrated injections derived from bootlegged Botox. But the article could have added more about the frequency of side effects that are listed in the package insert. About a fifth of patients treated for spasmodic eye-blinking develop drooping lid; about a fifth of those treated for cervical muscle spasms have difficulty swallowing; and recipients of wrinkle treatments frequently suffer bruising or swelling.
Though the news article hints that there are good studies and bad (“Where the science is sound…”), urges caution for unapproved uses, and notes that rigorous trials are underway for several conditions, it provides no true description of the quality of evidence to support the use of Botox for the painful neck condition known as cervical dystonia or any other condition. In fact, there is extraordinary variability in the quality of the literature on Botox from one condition to another–important information for a national audience that inevitably includes people searching desperately for solutions to intractable problems. High-quality research to support many of its unapproved uses has yet to be published.
The news article suggests that some of the conditions Botox treats are legitimate medical problems. But it also seems to medicalize other conditions such as facial wrinkles and sweating that are simply the normal consequence of life, and details how off-label uses are considered "quality-of-life saving." One could argue that the story’s ultimate effect is that of treatment mongering–because it shines so much (mostly flattering) light on Botox. The admonition from one source—“Don’t demand a certain treatment just because you saw a headline”—can’t compete with the U.S. News cover headline itself: “The Botox Boom” followed inside by, “You thought Botox was all about looks? It's also a salve for everything from cerebral palsy to writer's cramp”.
This story cites 8 sources who represent a range of views and interests. Where appropriate, the article lists potential conflicts of interest; several have received funding from pharmaceutical companies and others appear to be unbiased professionals.
This story mentions treatments other than Botox (deep brain stimulation for cervical dystonia, drugs for headaches, and drugs or surgery for urological problems). But these are light sketches against a bold tapestry of information on Botox. There is no discussion of surgical or topical alternatives for wrinkles, medical alternatives for dystonias, or non-treatment for several conditions, including sweating. Readers would benefit from more subtle comparisons to see how Botox measures up against other therapies.
The US News story explains that botulinum toxin (brand name Botox) is FDA-approved for some medical conditions and not approved for many others, and rightly suggests that Botox is widely available.
The news story explains that the use of Botox has expanded rapidly since it was first rolled out a decade ago as a fix for wrinkled brows.
No obvious use of text from a press release.