Only in Hollywood: Botox goes on trial

By Gina Piccalo
Los Angeles Times

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Even before "Mr. Botox" returned from Europe to take the stand and Vanna White showed up, the judge braced the jury for something special. "You'll remember this for a long time," he said.

Indeed, history is being made this month in Los Angeles County Superior Court, as Botox goes on trial for the first time in its brief but glamorous life as America's favorite antiwrinkle treatment.

Hollywood socialite Irena Medavoy, wife of film producer Mike Medavoy, is suing celebrity dermatologist Arnold Klein and Botox's manufacturer, Allergan, claiming the drug caused illnesses, including a four-month migraine so severe it left her bedridden.

The medical malpractice lawsuit, which began Sept. 3, threatens more than $560 million in annual Botox sales and the reputation of one the drug's leading experts.

The two leads

Irena Medavoy is a striking woman. But in court, she has looked so unlike herself, wearing flat shoes, plain suits, virtually no makeup and a ponytail, that defense attorneys felt compelled to show the jury photos of her bare-shouldered and laughing in France.

Beverly Hills dermatologist Arnold Klein, who shuffles into the courtroom using a cane (a gift from good friend Michael Jackson), arrived a week and a half into the trial wearing a black silk suit and a half-smile.

It's hard to imagine this jury of working folks — a janitor, a bank clerk, several county employees — empathizing with anyone in this case.

The Medavoys live in a 14,000-square-foot Mediterranean manse in Beverly Park.
 
Klein, meanwhile, earns a considerable fortune as an Allergan consultant and media spokesman on top of his Roxbury Drive practice and his position as a UCLA professor.

For Irvine-based Allergan, Botox is a miracle drug that has transformed an eyedrop and acne-treatment company into a real player in the aesthetic sciences. And it has fought to quell the controversy that Medavoy's case has prompted, launching national newspaper ads headlined "The Truth About Botox" and dispatching sales reps to doctor's offices to ease anxiety about the drug. After the lawsuit was filed in January 2003, the company vowed to fight it until Botox received "complete vindication."

"Like being tortured"

On March 4, 2002, Medavoy saw Klein for her quarterly Botox treatment. Klein had been using the drug — botulinum toxin type A — to treat her wrinkles for a year and a half before he first injected it into her temples in May 2001 as a way to suppress her migraines. But this time, she said, he seemed to inject far more than usual. Eight days later, she testified, "I had a headache like I had never experienced in my life." It was "like being tortured every day."

Medavoy canceled trips to Europe and Hawaii and her famed Golden Globes party. "She could hardly speak," said Vanna White.

After a battery of tests, several specialists attributed her symptoms, at least in part, to Klein's Botox treatment.

In a Sept. 17 statement, Allergan attributed Medavoy's illness to "a host of unrelated medical and psychological symptoms that were present long before her treatment for migraine with our product."

But Klein's testimony revealed some oversights. For example, he said he knew that even small doses of Botox had been reported as causing "life-altering headaches," but he didn't change his consent form to reflect those risks. And he never mentioned them to Medavoy.

Then there's the matter of her medical file. After Medavoy called about the pain, Klein's nurse, Mitzi Shulman, changed the Botox dosages on her chart from 1.5 cubic centimeters to 0.15 cc. Shulman testified that she "had a habit" of putting the decimal point in the wrong place, and "if there were issues about something that was done, I wanted it to be as clear as possible."

Weeks later, Klein added a note to the file saying that Medavoy's UCLA neurologist had eliminated Botox as the cause of her illness. Yet the neurologist, Andrew Charles, testified that he believed Botox was potentially to blame and that he had "no recollection" of telling Klein anything different.

Klein's attorney, Howard Weitzman, is an old friend of the Medavoys. His role now, it seems, is to humiliate them. The strained friendship has made for some awkward moments on the stand. Irena Medavoy told Weitzman that she took her story to "Dateline NBC" only after "you started to smear me."

When Mike Medavoy took the stand, he refused to look at Weitzman.

Later, he was asked what it was like to be cross-examined by Weitzman, considering they'd been friends. "Friends?" he quipped. "In Hollywood? Is there such a thing?"