It's Botox Night at Hopkins

For the 12th consecutive year, Johns Hopkins Hospital has come in first in the U.S. News & World Report ranking of American hospitals. Ironically, one day before receiving this honor, Hopkins came within a hair’s breadth of disgracing itself by sponsoring a “Botox Night”, in which healthy people would have received on-the-spot treatments at reduced prices in a social setting.

Botox, also known as botulinum toxin A, is a chemical that, injected in small concentrations, reduces the ability of muscles to contract, thereby causing improvement in the appearance of “glabellar lines” (frown lines between the eyebrows). Since (and even before) the approval of Botox Cosmetic by the Food and Drug Administration (FDA) on April 12, 2002, Botox parties have sprung up all over the United States, typically in spas or upscale private homes, often featuring alcohol and on-the-spot injections with Botox. The procedure must be repeated, usually every three to five months, potentially providing a steady stream of patients (and income). The average cost of a Botox injection is $497, according to a survey by the American Academy of Facial Plastic and Reconstructive Surgery conducted between January and April 2002.

Although alcohol was not served at the Johns Hopkins event, one purpose of the party setting is to capitalize on the fact that people in large, casual settings get caught up in the moment and are easily influenced by persuasive speakers. Another is that since a vial of the very expensive Botox typically contains enough toxin for five injections and the contents must be discarded within four hours of the vial’s being opened, there is an incentive to gather enough people to use all the contents in one session.

Just two weeks after Botox was approved for cosmetic uses, the American Academy of Dermatology went on record criticizing Botox parties. In an April 29, 2002, letter to all Academy members, Dr. Fred F. Castrow II, the Academy’s president, cautioned dermatologists that “Social gatherings of this kind in combination with botulinum toxin treatments are inappropriate and potentially dangerous settings for patients. As such, I strongly discourage you from participating in these kinds of medical/social activities.”

Thus, we were astounded when we heard that everyone with an email account through the Johns Hopkins School of Medicine (including students, faculty, residents and staff) had received an announcement on Johns Hopkins stationary for the Botox event with the title “It’s Botox Night at Hopkins.” Here was the pitch:

Do you have fine lines and wrinkles that make you look older
than you really are? Do you want to look younger without the cost and inconvenience of surgery? Curious what all the fuss is about Botox? Come join us after work
for an infomation (sic) seminar including live demonstration of the many uses of Botox. Any
interested in receiving Botox treatments may do so on the spot! Refreshments will be served and attendance is free. (Emphasis in original)

The wording of the ad did not suggest an educational seminar so much as a sales pitch dressed up to look like an educational event. Real educational events at hospitals typically occur at lunchtime seminars or as grand rounds, not after hours with promises of drugs for the attendees. A truly educational seminar would have been entitled “The Safety and Efficacy of Botulinum Toxin A in the Treatment of Glabellar Lines,” rather than the blatant pitch “It’s Botox Night at Hopkins.” It is hard to imagine a patient education seminar on arthritis with “on-the-spot Enbrel injections” or a seminar on cancer with “on-the-spot chemotherapy.”

Whereas the refreshments and attendance at the session were indeed free-of-charge, as advertised, injections were to be offered to prospective clients at a special rate
of about $100 per treatment. Presumably, this “introductory offer” would entice them to return to Hopkins for injections in a few months when the initial treatment inevitably wears off. The full price, typically five times that of the initial treatment, most likely would be charged for subsequent visits.

Dismayed that a respected institution like Johns Hopkins would permit so inappropriate an activity under its roof, Public Citizen sent a letter to Edward D. Miller, M.D., Chief Executive Officer and Dean of the Medical Faculty at Johns Hopkins School of Medicine, strongly urging that “Botox Night” be cancelled. “With all the medical problems facing the U.S., and Baltimore in particular, can this be the most productive use of faculty members,’ students,’ or residents’ time?” Public Citizen asked. “What social or medical purpose is served by marketing cosmetic procedures to healthy Johns Hopkins employees, particularly those who, based on their age, will have few signs of aging? Botox injections are medical procedures that should be delivered in a calm, private setting—not in the festive atmosphere this announcement appeared to contemplate.”

The Public Citizen letter had immediate results. Although Botox Night was not cancelled, the University did call off its plan to administer Botox at the event. It also informed us that the university is drafting an institutional policy which will preclude similar events in the future.

Such gatherings, which market products under the guise of education, undermine the core educational mission of the university, debase the profession, and misdirect precious health resources that would be better spent treating disease than pandering to vanity. For this reason, Public Citizen has written to the Association of American Medical Colleges asking that it develop a national policy banning such blatant commercialism. As for Johns Hopkins, in instituting its planned policy prohibiting future Botox Nights, it may yet lead the nation, not only in medical science, but also in the fight to preserve integrity in medicine.