The Poison That Heals. Botox, a lethal neurotoxin that doubles as a miracle cure, is a medical paradox. This two-part series dives into the history, science, and dark side of Botox.
Part: 1
“Alle Dinge sind Gift, und nichts ist ohne Gift; allein die Dosis macht, dass ein Ding kein Gift ist.” — Paracelsus, the Father of Toxicology¹
The Latin proverb—”All things are poison, and nothing is without poison; the dosage alone makes it so a thing is not a poison”—perfectly captures the duality of one of the world’s most famous substances. On November 5th, 2025, the FDA issued warnings to 18 website owners for selling misbranded and unapproved botulinum toxin, highlighting a growing tension between medical utility and public safety.
What is Botox?
Botox, or botulinum toxin, is a highly potent metalloprotease produced by the bacterium Clostridium botulinum. This protein is internalized by nerve cells, where it targets SNARE proteins to prevent the release of acetylcholine (ACh). Since ACh is the neurotransmitter responsible for muscle contraction, Botox acts as a neurotoxin that induces localized paralysis.
A Lethal History
The journey from a lethal toxin to a therapeutic medicine is a fascinating historical narrative. In the 1820s, physician Justinus Kerner investigated a fatal illness in Germany where patients suffered from muscle weakness and paralysis; he attributed these symptoms to contaminated sausages.² The bacterium was formally discovered in 1897 by Belgian bacteriologist Émile van Ermengem following a botulism outbreak.³ He isolated Clostridium botulinum and confirmed that the illness was caused by the toxin produced by the bacteria, rather than the bacteria themselves. With an extremely low lethal dose, one gram of this toxin is sufficient to kill one million people.
The Transformation into Medicine
The toxin’s transition into medicine began in the 1970s with Dr. Alan B. Scott. Seeking a non-surgical way to treat strabismus (crossed eyes), he theorized that a micro-dose could induce localized paralysis in overactive eye muscles. This therapeutic use gained FDA approval in 1989 under the brand name Oculinum.⁴
In the late 1980s, Canadian doctors Drs. Jean and Alastair Carruthers observed that patients treated for eyelid spasms experienced a side effect: their frown lines were disappearing.⁵ Their research confirmed the toxin’s ability to smooth facial wrinkles. The drug received FDA approval for cosmetic use in 2002 and was renamed Botox. From Nicole Kidman to Dolly Parton, celebrities have since encouraged millions to opt for this treatment. In 2023, approximately 8.8 million procedures were performed globally.⁶
Next week, we look at the other side of the story: what happens when this powerful toxin is misused, and how the rise of the counterfeit market is changing the stakes.
Further Reads
- “Die dritte Defension wegen des Schreibens der neuen Rezepte,” Septem Defensiones 1538. Werke Bd. 2, Darmstadt 1965, p. 510.
- F Erbguth (2000) On the first systematic descriptions of botulism and botulinum toxin by Justinus Kerner (1786–1862) J Hist Neurosci 9 218–220.
- Van Ermengem EP. Über einen neuen anaeroben Bacillus und seine Beziehung zum Botulismus. Z Hyg Infektionskrankh 1897: 26: 1–56.
- Monash, A., Tam, J., Rosen, O., & Soreq, H. (2025). Botulinum Neurotoxins: History, Mechanism, and Applications. A Narrative Review. Journal of neurochemistry, 169(8), e70187.
- Carruthers, J., Carruthers, A., Blitzer, A., Eadie, N., & Brin, M. F. (2023). Treatment of glabellar lines with Botox (onabotulinumtoxinA): Development, insights, and impact. Medicine, 102(S1), e32375.
- Triana L, Palacios Huatuco RM, Campilgio G, Liscano E. Trends in Surgical and Nonsurgical Aesthetic Procedures: A 14-Year Analysis of the International Society of Aesthetic Plastic Surgery-ISAPS. Aesthetic Plast Surg. 2024;48(20):4217-4227.
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