Cosmetic physicians warn that Botox linked to birth defects

The evidence for this has got more holes than a colander but the caution is not unreasonable. Botulinum toxin is one of the most toxic substances known

WOMEN contemplating injections of the anti-wrinkle treatment Botox have been warned it can cause birth defects in babies - including blindness and deafness. The Cosmetic Physicians Society of Australasia yesterday urged members to stick to national guidelines for the use of Botox. It follows reports last month of a case in 2005 in which a link was made between a child born deaf and blind and its mother's use of an anti-wrinkle treatment during pregnancy.

"Botulinum toxin should not be prescribed to pregnant women and we advise members to strictly follow these guidelines," said the CPSA's Dr Gabrielle Caswell. "Botulinum toxin has a long history of efficacy and a robust safety profile, however there are some circumstances, such as during pregnancy, breastfeeding, glaucoma and neuromuscular disease where it is not an appropriate medication."

The 2005 case did not involve Botox but a rival botulinum type A toxin drug called Dysport. In 2007, Australians spent about $300 million on non-invasive cosmetic treatments including Botox.

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Diet pill side-effects

For years I've been searching for the next quick fix - the miracle diet, the revolutionary gym class or the ultimate fat-busting pill. In fact, I'll do anything to lose weight. Anything, that is, except eat less and exercise more. That's why I was so excited when I first heard about the fat-busting pill Alli, which has just been licensed to be sold over-the-counter in Britain.

A year ago the Daily Mail told how this medically proven obesity drug was already on sale in the US. I couldn't wait to try it. It seemed like the answer to my prayers - finally a little pill to take with every meal that would help me lose weight without any effort. But there was one problem - it was then available only in America. So when a friend suggested a long weekend in New York, the tickets were booked before you could say 'obesity epidemic'.

Arriving in Manhattan, Alli tablets weren't hard to find. The first pharmacy I went into had them. I chose the 90-capsule pack - enough for a month - which, with the exchange rate being so good at the time, cost around 25 pounds. The pack was full of little booklets offering advice on diet, exercise, how to take the pills and their side-effects. They explained that Alli is produced from the drug orlistat, which prevents your body absorbing some of the fat in the food you eat. The undigested fat is then flushed out of your body in your bowel movements. It's a half-strength version of the weight-loss drug Xenical, which is available both in the US and Britain and works in the same way but is only available with a doctor's prescription.

Alli, medical tests had proved, helped increase weight loss by about 50 per cent. So if I went on a diet and lost 2lb in a week, it could be increased to 3lb with the drug. Fantastic! Or so I thought until I read about the side-effects both in the leaflets and in all the testimonies online. Flatulence, diarrhoea and stomach pain were quite common. But I was desperate. I've been 2st overweight for as long as I can remember. I've done every diet known to man, from the Cabbage Soup Diet (great for a week but impossible to sustain any longer) to the Atkins (incredibly difficult for a strict vegetarian like myself). And I'm an emotional eater - if I'm feeling a bit low, I use crisps and biscuits to cheer myself up. So nothing short of risk of death was going to stop me taking Alli tablets.

I'm (unsurprisingly) no stranger to diet pills. I've tried lots of natural ones like Hoodia, a plant which claims to suppress your appetite, and LIPObind which, like Alli, reduces the amount of fat your body absorbs, but with no success. Around four years ago I was even so desperate that I bought appetite suppressant, Reductil, a prescription-only drug, online. I filled in a form and a doctor who didn't know my medical history happily prescribed it for me.

I lost 4lb in the first week - and certainly didn't feel as hungry as normal but the side-effects put me off. At first I felt a raging thirst and had a dry mouth. After a few days, I felt tense, ratty and was unable to sleep. I lost a stone but, even so, I didn't want to repeat the experience.

But Alli seemed different. Most of the side-effects seemed tolerable and there was a chance I might not even suffer them. Most importantly, it had been passed by America's Food And Drug Administration as safe to sell over the counter. Plus I'd read countless testimonies on line of women allegedly `achieving the impossible' with this drug. I dared to hope that I too may be one of them and swallowed my first little blue pill - one to be taken with each meal that contained fat.

The 90-capsule tub lasted about five weeks and the pills seemed to work well. Side-effects were minimal - a few stomach cramps, a little flatulence but nothing I couldn't cope with - and I lost 6lb, more than I'd normally expect to lose without going on a really hard-core diet. It seemed I'd finally found the solution to my weight problems. But Alli still wasn't available in Britain and although by now it could be bought off the internet, I couldn't stretch to 100 pounds for 60 tablets. It wasn't until last summer that I managed to get back to America to buy some more. Again I had only mild side-effects to begin with but, as the first month ended, I realised the weight wasn't coming off.

Even though I was eating about the same as last time - typically non-sugary cereal with low-fat milk for breakfast, a sandwich for lunch and Quorn and vegetables for supper, with fruit snacks - I lost only a pound or two in four weeks. I would have expected to lose that amount anyway, given the amount I was eating. Yes, I'd have bad days when I'd give in and scoff a muffin, but to be honest, I expected better results.

Towards the end of October the drug's side-effects really began to kick in. Every morning I suffered from diarrhoea and agonising stomach cramps. The advice from Alli is that such problems can be controlled if you reduce the amount of fat you eat to around 15g per meal. I genuinely think I did this most of the time, but I still suffered. It got to the stage that I was so afraid of the side-effects, if I was going to eat something that I knew had a bit too much fat in, I wouldn't take the tablet. But still I was suffering from the side-effects.

By December the diarrhoea had cleared up but by then, I'm mortified to say, flatulence had become a real problem. If it wasn't for the fact I work from home and have no colleagues to worry about, I think I would have thrown the Alli in the bin. Plus there was the chronic discomfort. Each night, my stomach was incredibly bloated, like it was pumped full of gas. And each week it got worse. But last week I got on the scales and finally had to face facts. Since November, I've lost only 4lb. In the meantime I've suffered horrible side-effects and my social life has been totally disrupted. I've been in denial, but the truth is, for me, with Alli the problems far outweigh the benefits. So I've stopped taking them and am waiting for my body to get back to normal. Three days on I'm still getting cramps and wind.

Upset at why Alli didn't work for me I did a bit more research. What I discovered made me wish I'd never taken it in the first place. Judy More, a registered dietician, struggled to mask her exasperation when she told me: `If you're prepared to stick rigidly to a low-fat diet, then Alli (or orlistat as it is also known) might help you. `But if you're not, you have to be prepared for some very disagreeable side-effects. `Now it is going to be available over the counter, I have to assume the company has done the necessary research into the potential long-term health implications. 'I can see how it might help some people, but if someone really wants to lose weight, you need to motivate them to change their habits, giving them a pill isn't going to be the magic bullet that I have no doubt this will be marketed as.'

Dr Sidney Wolfe was even more direct. He says: `The drug works by inhibiting absorption of fats, and as a result the absorption of critical fat-soluble vitamins, such as vitamins A and E. Unless these are replaced, a patient could become vitamin deficient. `And, aside from the really unpleasant side-effects, which mean the company itself advises you to wear dark clothing and carry a change of clothes, we have many concerns about the long-term health implications.

`Not least is the fact that Roche's own data showed a correlation between the drug and the formation of pre-cancerous lesions in the colon. Furthermore, randomised control trials on orlistat also suggested there was a link with breast cancer, something that has still not been resolved.

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