Evaluating botulinum toxin products for clinical use requires accurate, complete, and unbiased data

Modern clinical use of botulinum toxin (BoNT) by doctors requires evidence-based facts and data to support their work. In particular, these need to be unbiased and complete. Too often in the past, speculative statements have been used and repeated until injectors have come to believe they are solid facts. 1 Yet no supporting data exist. Consequently, doctors have often been reluctant to change to or even try other products because of what they have been told. This has not been a good situation for either clinicians or patients. We have published about these " urban legends " 1 and tried, on many occasions, to correct these inaccuracies (see, for example, 2,3). Therefore the recent paper by Park and colleagues, claiming to be a review of a relatively new BoNT product used in blepharospasm, was disappointing at best. 4 Many of the old and outdated claims about the properties of BoNT products have again been repeated. In 2011, this is an incorrect approach and borders on a marketing activity. For example, the product data contained in their Table 1 4 has no references cited as to the sources of information, is inaccurate, and does not even take into consideration previous publications which have highlighted errors in such tabular data. 1 We published last year a definitive work on the formulation composition of BoNT products in clinical use 5 specifically to stop these errors. We have previously suggested that authors contact manufacturers of BoNT products before they publish such data, to ensure complete accuracy; 1 all of this has apparently been ignored by Park and colleagues. Data in error in their Table 1 include the manufacturer of Myobloc ® /Neurobloc ® (this should be US WorldMeds, who acquired Solstice in August 2010), " stabilization " of Xeomin ® (also a freeze-dried product and not as cited), the vial size of Dysport ® (also available as 300 units per vial in many countries, including the United States), the vial sizes of Botox ® (also available as a 50 and 200 units per vial product in many countries), the so-called " complex sizes " for each product (none of which exist for the BoNT-A products in the actual vial) 6 and storage after reconstitution of Myobloc ® (this is already liquid product and not stable " for a few hours " after reconstitution – which simply does not happen!) More important clinically, Park and …