Miracle Cures or Marketing Myths?

Beyond Botox: 7 Strategies for Sexy, Ageless Skin Without Needles or Surgery
by Ben Kaminsky, Howard Kaminsky

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The FDA cautions that the recent rise in the popularity of Botox has much to do with the manner in which it is marketed. For instance, some practitioners buy the toxin in bulk and arrange get-togethers (called Botox parties) for people who want to receive treatments. As in business, volume discounts are available in medicine. Not only has the FDA voiced great concern that Botox has the potential for misuse and abuse, the American Society for Aesthetic Plastic Surgery (ASAPS) recently reported that unqualified people are dispensing Botox in salons, gyms, hotel rooms, home-based offices, and other retail venues. In such cases, consumers run the risk of improper technique, inappropriate dosage, and unsanitary conditions.

Maintaining the smooth "Botoxed" face is also an expensive proposition. Most print and television ads do not tell consumers that to maintain the anti-wrinkle effect, Botox shots are necessary approximately every three to four months, costing from $350 to $500 for a single injection, $400 to $900 for areas requiring more than one injection, and $600 to $1,300 for larger surfaces such as forehead wrinkles. On an added note, contrary to what some experts claim, there are now those who advise that Botox injections may result in the development of new wrinkles as nearby muscles "overcompensate," creating new facial expressions in the area where the muscles are paralyzed.

For dermatological purposes, Botox is only approved by the FDA to reduce the severity of frown lines (for up to 120 days). Yet hundreds of dermatology and medical Web sites found on Google widely advertise the use of Botox for treating myriad cosmetic conditions such as brow furrow, crow's-feet, forehead creases, and neck bands. When the botulinum toxin was improperly used, there have been cases of paralysis and even deaths after an injection. You might remember the widely publicized story in late 2004 about the Palm Beach County, Florida, osteopath, his girlfriend, and another couple who were paralyzed and put on ventilators after being injected with a "cheap alternative to Botox." It was revealed that the ill people had contracted botulism, a rare disease that is fatal in 10 percent of cases. In another case in 2003, a Florida woman went into cardiac arrest after receiving a Botox injection, dying shortly thereafter. The cause of death was listed as anaphylactic shock associated with Botox injection.

Don't get me wrong. Along with Botox injections and cosmetic procedures, many physicians prescribe numerous topical therapies. We all know the big names in this skin care field - celebrity dermatologists with pricey products and quick-fix plans to make you look younger yesterday. Some of them have good things to say and good products to promote. In fact, not a week goes by that I don't get a call from a dermatologist or his or her agent asking me if I would be interested in formulating a line of topical skin-treatment products for use under the physician's name. When I ask the good doctor if he or she wants to build upon his or her clinical studies or revolutionary findings acquired in years of medical practice, the answer is usually no. It then becomes apparent that these medical doctors realize that there is a significant financial benefit to combining business and medicine, and they are looking for a way to get into the retail skin game. My response to them is always "Thank you for thinking of me, but no, thanks."

The reality of skin care today is that many of these self-promoting physicians are successful as both marketing executives and doctors. Their use of the media is brilliant; it is easy to use ostentatious terminology when addressing a captive nonprofessional audience. The talk is impressive, the promises are grandiose, and people think that the flamboyant health care professionals surely know what they are talking about ... or do they?

One such popular dermatologist turned entrepreneur and anti-aging author has extensively touted the use of alpha lipoic acid as "a quintessential antioxidant, anti-aging ingredient." Yet new findings on alpha lipoic acid by Dr. Jing-Yi Lin with the Department of Dermatology at Chang Gung Memorial Hospital in Taipei, Taiwan, contradict these claims. In extensive research published in the November 2004 issue of the Journal of Investigative Dermatology, Dr. Lin concludes that this nutrient is completely ineffective as a topical antioxidant, contradicting the previous "hyped" benefits of alpha lipoic. The aforementioned anti-aging author also recommends megadoses (400 to 800 International Units [IU] daily) of vitamin E in all of his anti-aging books, when in fact this is contrary to the latest scientific findings. Reports from the American Heart Association at their Scientific Sessions in 2004 state that high doses of vitamin E supplements "do more harm than good, can increase the risk of death, and should be avoided." By the way, the American Heart Association defines a high dose as over 400 IUs daily (the lowest starting dose in the doctor's prescriptive program).

So where does the truth lie? How can a consumer know what is truth and what is marketing hype? Many marketing-savvy executives use cosmetics studies to hype claims for anti-aging skin products, promoting them as magic potions for young-looking skin. The fact is, many of these cosmetics studies do not mimic the hard scientific work required for approval by the FDA, and the result is a shelf full of cosmeceutical products that are of questionable value to you, the consumer.

Confidence in a Chemist's Perspective

I am not a dermatologist. For more than three decades, I've worked as a pharmaceutical chemist - on the front lines of the skin care industry, making and testing and perfecting the products that your dermatologist prescribes. During this time, I have become increasingly distressed to see the hype that many cosmetic dermatologists and skin care companies use in advertisements simply to sell products. And the products they sell are not cheap. In the United States alone, more than $45 billion is spent annually on cosmetics and toiletries. This amount does not include the billions spent on doctor-prescribed therapies for the skin. With highly scientific words such as retinoids, hyaluronic acid, nonosomes, and liposomes appearing in product ingredient lists, is it any wonder that most women are confused and even overwhelmed when it comes to making responsible choices for their skin?

From the time I started my pharmaceutical company, I have observed specialists touting many topical products they claim to have formulated but which they have actually purchased from private-label contractors - not pharmaceutical labs. Consumers do not realize that many of these dermatologists and other physicians who claim to have found the "magical treatment" for aging skin are actually selling the exact same topical product as their counterparts but with their own brand names stamped on the packaging! The problem arises because dermatologists and physicians are specifically trained in medical school as diagnosticians - professionals who identify skin conditions such as aging or wrinkling skin, sun-damaged skin, acne, eczema, rosacea, and skin cancers - and not as chemists - scientists who understand the composition, structure, and properties of substances and the transformations they undergo when formulated into medications and dermatological treatments.

Many in the health care profession believe there is a potential conflict of interest when cosmetic dermatologists practice medicine along with selling their own brand of topical "formulations." I firmly believe, as do many clinical dermatologists, that these doctors compromise their reputation as medical professionals when they add marketing their cosmetic wares to the practice of medicine. When I see doctors marketing their topical products, it also leads me to the disturbing conclusion that much of the popularity of topical products has to do with the marketing rather than the therapeutic formulation.

Devising a cosmeceutical to alleviate acne, reduce scars, diminish under-eye puffiness, or reverse the obvious signs of aging is both an art and a science. The chemist fully understands atoms and molecules and how matter interacts with matter in the classic chemical reaction. The pharmaceutical chemist comprehends how chemical substances interact with living systems and which compounds have medicinal value, including the composition, properties, interactions, toxicology, and desirable effects.

Once the chemist has researched and developed a new product over a period of years, the pharmaceutical companies further study this compound in clinical trials before marketing it to doctors, who then prescribe the product for consumers (patients). During every stage of scientific research and development, the chemist and pharmaceutical company work side by side to perfect the formulation before marketing it to doctors and consumers, making sure they fully understand how it is used, including the dose, the side effects, and the contraindications, among other factors.

Does everyone in the skin care industry give consumers an honest appraisal of a product's benefits and risks? As a scientist and chemist, I think the answer is no, and this causes me great distress. I remember attending a skin care convention in the late 1990s and being appalled at the faulty or blatantly misleading information leaders in the cosmeceutical industry were giving consumers. They were cleverly deceiving both media and customers, with, I imagine, the intent of profiting from their cosmetics and the skin care products they had formulated. Not only did the exaggerated claims indicate a cynical, irresponsible marketing ploy, but they also made the skin care field appear to be solely a business rather than a medical profession where trained professionals are passionate about the health and well-being of consumers.

Copyright © 2006 by Ben Kaminsky and Howard Kaminsky

About the Author

Ben Kaminsky, a graduate of the Faculte de Pharmacie de Universite de Montreal, is a preeminent pharmaceutical and dermatological chemist who has developed medicines for physicians and dermatologists all across North America for more than 30 years. He is a member of numerous professional pharmaceutical societies. He resides in Montreal.

Howard Kaminsky was the president and publisher of three major publishing houses: Warner Books, Random House, and William Morrow/Avon. Also the author of several screenplays, four novels (cowritten with his wife, Susan), and numerous magazine articles, he lives in New York City and Connecticut.