In early 2006 a self-styled “naturopathic” doctor, Chad Livdahl, pleaded guilty in Arizona to mail fraud and conspiracy to engage in mail and wire fraud, to misbrand a drug and to defraud the U.S. He was sentenced to nine years in prison. His wife and business partner in Toxin Research International, Inc., in Tucson, Zarah Karim, pleaded guilty to the same charges and received a six-year sentence. Both also paid heavy fines and restitution because, according to prosecutors, the couple had made at least $1.5 million in just more than a year by peddling tiny vials of fake Botox to doctors across the U.S. 

Botox, which is injected in minute amounts to smooth frown lines or relax muscle spasms, is far from the only medical product that inspires illicit manufacture and trade. The world market in counterfeit pharmaceuticals is estimated to be worth some $75 billion annually. But the active ingredient in Botox and related products differs from the constituents of other pharmaceuticals in a profound way: in its pure form, it is the deadliest substance known to science. In fact, botulinum neurotoxin (BoNT) is grouped with the world’s most lethal potential biological weapons agents, sharing “Select Agent” status with the pathogens that cause smallpox, anthrax and plague. This biowarfare potential puts the existence of illicit laboratories churning out the toxin and of shady distributors selling it worldwide through the Internet into a more disturbing light than most pharmaceutical fraud.

This article was originally published with the title Fake Botox, Real Threat.

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