Healing With Poison

Surprisingly, Indian physicians, as elsewhere in the world, are finding new therapeutic uses for a dreaded biological weapon

Cleverly camouflaged in our food, sneaking into our guts, throwing our nerves into utter disarray, causing severe vomiting, paralysis and frequently death. For most of human history, the bacterium called Clostridium botulinum has evoked more fear among those who know it than Osama bin Laden. It may even be familiar to bin Laden, the bacterial toxin, called botulinum; is the most poisonous substance known to mankind and has been recognised as a potent biological weapon since World War II.

Now, in a medical twist on the lines of Bollywood's Aks or Rudraksh in reverse, the terrible killer has turned into an impassioned healer. In its modern avatar, called Botox, the botulinum toxin has even acquired a sheen of glamour as it smooths the frowns and wrinkles of the high and mighty. But the benefits of Botox are literally more than just skin deep. In 2003, it was used in India to successfully treat more than 25 stroke victims. In blazing hot summers it has provided relief to people who sweat excessively. At some of Mumbai's cancer wards it is seen as a far more effective painkiller than morphine. From back-aches to headaches, squints to spastics and even writer's cramps, Botox has been used in India for an increasing and diverse range of diseases for the past four years.

This dramatic transformation happened quite by accident. In the 1950s, a Canadian doctor stumbled upon the fact that an extremely small amount of the botulinum toxin induces a temporary paralysis of a hyperactive muscle. He soon established that the toxin blocked a specific receptor at the ends of nerves. These receptors are the "nozzles" of nerves which, like guns, fire "bullets" of a certain type of chemical called acetylcholine. These chemical "bullets" spark movements in the muscles they target. Usually the nerve "shoot-outs" are tightly controlled and synchronised according to the body's needs. Sometimes some of these nerves mutiny and misfire causing headache and spasms.

Enter Botox. A tiny amount of it, when injected locally and precisely, blocks the "nozzle", i.e. the receptor, and prevents the chemical from being fired at that spot, thereby providing relief. Botox used in very small doses is harmless. In the right hands, that is. It can only be administered by trained doctors. One wrong move and the pounding headache could be compounded by a sour face, thanks to the wrong facial muscles being "frozen".

It took the medical community another 20 years to fully appreciate the therapeutic value of this discovery. Botox was first used clinically by a doctor in San Francisco to treat squint in the 1970s. In the late '80s, two Canadian doctors discovered that Botox could temporarily reduce facial wrinkles, and the once dreaded poison leaped to fame. In 1988, a small pharmaceutical company called Allergan began developing it as a drug. But only after 2000 has the role of Botox the healer grown rapidly. In 2000, the US Food and Drug Administration (FDA) approved it for a condition that many computer whizkids in Bangalore are familiar with-cervical dystonia, a severe cramp of the neck and shoulder muscles.

The same year Botox arrived in India. One of the pioneers of the use of the drug in India is G.P. Dureja, an eminent neurologist at All India Institute of Medical Sciences (AIMS) in Delhi. Since 2000, he has been injecting Botox into children with cerebral palsy to coax them into movement. In the small ward leading to his Pain Clinic, lined with iron beds, the pungent smell of disinfectant is offset by the palpable hope among the row of patients awaiting their turn. Among them is eight-year-old Neha Aggarwal. "After three months of treatment and physiotherapy, she is getting better," says Neha's father Sanjay, a chartered accountant working in Bihar.

When he is not helping little children have the joy of walking independently, Dureja turns his attention to grown ups suffering the acute pain of spondylitis and writer's cramps. His studies show that three fourth of the patients with severe backaches improved noticeably after four weeks of being treated with Botox and the effect lasted 24 weeks. None reported any adverse effect.

At Sir Ganga Ram Hospital, Delhi, neurologist Anshu Rohatgi uses Botox for a common but torturous pain-headache. "It is particularly effective in migraines induced by tension," he says. With Botox, the number of migraine attacks decrease by 60 per cent and the effect lasts six months.

Rohatgi has not stopped at headaches though. In 2003, he pioneered the use of the toxin in victims of stroke-young men and women who had survived the jaws of death, only to face a life of disability as the stroke left them paralysed. With Botox and physio-therapy, 25 such patients have slowly regained the use of their limbs and, along with it, their zest for life. At Indraprastha Apollo Hospital, dermatologist R.K. Joshi ensures with a prick of the drug that many red-faced, sweaty patients come out literally home and dry.

But many of these uses have not yet been approved by the US' FDA and other medical bodies. In fact, the best known use of Botox, smoothing wrinkles, was approved only in April 2002, although cosmetologists have been using it for several years. But the question remains:

How safe is it? It is a nerve toxin, after all. "It is harmless in the very small doses we use," says Rohatgi. Cosmetologist Vandana Chatrath, however, cautions: "The treatment is technique dependant. It is essential you know who you are going to." The use of Botox lies in its precise delivery. An error of even a fraction of an inch can paralyse the wrong muscles. That is probably why Botox is not available at pharmacies. The company, Allergan, sends it directly to approved physicians.

It is no cheap cure either, costing Rs 15,000 a shot. Nonetheless, it is unlikely to deter doctors finding new benefits of the toxin, or patients flocking for the healing touch of a poison.

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