Botox - from Medical Procedure to Household Word

Objective

• Determining the factors driving the adoption of invasive medical procedures for consumer application
• To determine a measure of 'buzz' required to drive consumer adoption that can be used to model adoption for new invasive therapies

Problem Statement

• To derive the time to market for invasive procedures for consumer applications like

1. Nanotechnology for skincare or hair care
2. Stem-cell therapy

Methodology

• We decided to follow the 'analogy' method for determining the time it takes for consumer adoption of invasive medical procedures.
• For the purpose of this study, we decided to study the consumer adoption of Botox and apply the learning from Botox story to determine the timescale for consumer adoption of other new invasive procedures.
• Botox was considered appropriate since it is an invasive procedure for skin treatment.
• Botox is similar in that it's adoption is driven by 'expert opinion' which will also be the case for Invasive Nanotechnology therapy and Stem-cell therapy.

Study Goals for Botox

• To determine/measure the 'expert buzz' and 'consumer buzz' required for 'wide scale' adoption of an invasive procedure among experts.
• To determine the market drivers that create the 'expert buzz'

Study Method to determine 'Expert buzz' required for consumer adoption

• Study the number of expert articles published discovering and eulogizing Botox miracle
• Determine the number of experts and the voice required to reach out to them

Study Method to determine 'Consumer buzz' for Botox as a market driver

• Study the number of articles published in consumer media space eulogizing/talking about Botox
• Study the media vehicles in which these articles are published
• Determine from the articles published, the number of media vehicles required and the number of 'voices' (Journalists) required to create a 'consumer buzz'
• Analogy to the internet world will be the number of powerful 'voices' required at the minimum to create a strong 'online buzz' (with a multiplier for the number of powerful voices thrown in to account for media fragmentation)

Data collection and data sources

• We used secondary research for data collection
• Botox procedure data has been taken from ASAPS (American Society of Aesthetic Plastic Surgeons)
• Databases used to search articles are Factiva and Google scholar
• Search query used is:

• botox, botulinum toxin: to find the total number of articles published on botox
• botox and wrinkles, botox and frown, botox and lines: to find skin care articles using botox

• Determined the correlation between the number of articles published and number of botox procedures
• Analyzed the articles published to determine the market drivers

Technical overview

Botox injection is a diluted form of botulinum toxin type A which is injected into facial muscles to paralyze or weaken the muscles that form wrinkles. Botulinum toxin is a medication and a neurotoxic protein produced by the bacterium Clostridium botulinum. It is the most toxic protein known with an LD50 of roughly 0.005-0.05 µg/kg.

It is sold commercially under the brand names:

• BTXA, Dysport, Myobloc, Neurobloc and Xeomin which are used in the treatment of muscle spasms.
• Botox Cosmetic and Vistabel are available for cosmetic treatment.

How botox procedure is performed

• Botox procedure usually takes 5-15 minutes and there is no need for any anesthesia.
• The procedure is not entirely painless and the small needle does sting. Some physicians may numb the area with a topical anesthetic prior to the injection.
• Before the injections, all the sites are premarked and cleaned with an antiseptic solution.
• The Botox is then injected.
• It generally takes three to seven days to take full effect and it is best to avoid alcohol at least one week prior to treatment.
• Aspirin and anti-inflammatory medications should be stopped two weeks before treatment as well in order to reduce bruising.
• Once the procedure is performed results last anywhere from 4 to 6 months.

Botox Is commonly used to treat

• Forehead lines
• Crow's feet (lines around the eye)
• Frown lines

Side effects of botox

Botox is not without side effects. However, the side effects are minor and resolve rapidly. The most common side effects include:

• Mild nausea

• Flu like symptoms

• Headache

• Redness

• Pain at injection site

No severe side effects have been reported, but the dermatologist or medical practitioner administering botox injection should be experienced.

Source: articles.directorym

Market overview

Initially botox was marketed for its medical applications in treating various muscle-related conditions but later its marketing was broadened to include its cosmetic application—smoothing out frown lines between the eyebrows.

Y-o-Y sale of botox procedures

Source: ASAPS

Conclusions:-

• Safety of botox was proven through invasive muscular and neurological procedures very well till 1992.
• In 1990, a serendipitous discovery showed Botox effect on 'smoothing wrinkles'
• Consumer adoption happened through off label use (6 years before FDA approval for cosmetic use) due to 'Expert Buzz' and an existing demand for a 'wrinkle smoothing' product (as shown from number of Collagen procedures that numbered 400,000 in 1997)
• Experts were willing to recommend/try Botox on their patients due to two factors: (A) Safety of Botox (in higher doses for invasive muscular and other disorders) and (B) It's proven discovery to smooth wrinkles
• Suddenly experts got a substitute for collagen procedures that took more a few months to show perceptible results (as shown below)

Procedures of Botox Vs Collagen

Botox and collagen are both invasive procedures used for smoothing of wrinkles and facial lines. With the increase in off-label use and popularity of botox the market share of collagen has decreased.

Source: ASAPS

Source: wikipedia, wikipedia, botoxforum

Botox procedures as a percentage of total cosmetic procedures

Source: ASAPS

An Analysis of 'Consumer Buzz'

• The below graph indicates the number of articles published on use of Botox for 'wrinkle smoothening' over time.

Correlation among the no. of articles and procedures

• We have co-related the number of articles published in media with the use of Botox and find a strong co-relation of 0.89.
• Despite a high co-relation, the number of 65,000 procedures of Botox through off-label used is hard to explain with the publication of in-total 58 consumer articles till 1997 (out of which 35 were published in 1997 alone).
• Botox being an invasive procedure requiring expert advice, we thought to understand if 'expert recommendations' was the cause for the high consumer adoption by 1997 (5 years before the FDA approval for cosmetic use of Botox)

Consumer buzz - A qualitative analysis

• Dcotors, Dermatologists, Surgeons, experts and consumers shared their experiences and gave positive reviews about the use of botox leading to initial buzz.
• Approx. 18 medical experts were quoted in media till 1997 (the inflection point) before the Botox Market took off in a big way. The list of experts quoted in media has been given below:

Various distinct experts that gave reviews are:

• Ophthalmologist Jean Carruthers
• Dermatologist Alastair Carruthers
• Dr. Brin
• Dr. William J. Binder
• Dr. Arnold Klein, Hollywood's king of collagen
• Dr. Gerald Imber
• Dr. Alster
• Dr. Davis
• Dr. Kauvar
• Dr. Ian Little
• Dr. Vito Quatela, N.Y.
• Dr. George Brennan, California
• Cosmetic surgeons at the University of Michigan Medical Center
• Dr. Todd Koch, amherst plastic surgeon
• Surgeon Basim Matti
• Dermatologist Rhoda Narins
• Dermatologist Fredric Brandt
• Dermatologist Arsenal

Major media Vehicles used are:

Expert buzz

• In 1990, a serendipitous discovery was made by Mr. and Mrs. Carruthers, both medical practitioners, that Botox smoothed skin wrinkles.
• Alastair Carruthers, a dermatologist, published a seminal article on the cosmetic application of Botox in 1992
• Till 1992, safety of Botox use in invasive procedures was proven. Botox had also won FDA approval for at least 3 invasive procedures by then.
• Between 1992 and 1997, 36 journal articles on the benefits of Botox for cosmetic procedures on skin were published.
• These articles were enough to create buzz in the 15,000 approx. strong community of Dermatologists in the USA.

Expert buzz Vs Consumer buzz

Qualitative analysis of Expert Buzz articles

• The Expert articles were published in various leading journals like:

• American Academy of Neurology
• Journal of Neuroly, Neurosurgery & Psychiatry with practical Neurology
• International Ophthalmology Clinics
• Science and Medicine
• Southern Medical Journal
• Clinical Neuropharmacology
• The Annals of otology, rhinology & laryngology
• Journal of the Royal Society of Medicine
• Journal of the American Medical Association
• Lippincott Williams & Wilkins
• Plastic and Reconstructive Surgery
• Journal of Dermatological Surgery and Oncology
• Aesthetic Plastic Surgery
• Dermatologic Surgery
• Survey of Ophthalmology

Conclusion

• For a procedure like Nanotechnology or Stem cell therapy, the first obstacle will be to prove its safety.
• Once the safety of the procedure is established, then its uptake can be modeled on existing customer base for other invasive procedures like Botox, Collagen etc.
• Modeling on other invasive procedures is possible, since safety and efficacy of treatment are the biggest barriers to consumer adoption.
• The case of Botox classically shows that once safety of a procedure is proven, it is the experts that are driving the consumer adoption for the 'new therapy' (for an existing well articulated need).
• However, for a completely new 'need' that has never been articulated by the consumers (and hence never been met), Expert Buzz and Consumer Buzz will play an equally important role to drive consumer adoption.
• Timescale for building adoption curves will be a function of the 'amount of buzz' created in Expert and Consumer circles over a period of time. Amount of buzz can be measured by the 'number of opinion' leaders who drive the opinions through various media channels. Overall, uptill the inflection point for Botox, 36 unique Journal articles were needed. For the consumer buzz, 58 unique articles published in 58 different vehicles were needed.