Chemical Alley How easy was it to buy an eye-popping 3,081 vials of research botulinum toxin, the deadly neurotoxin produced by Clostridium botulinum, always found on jihadist terror wish lists? Very easy in 2003 - unlike so many other things alleged to be simple to do by designated evil-doers in the war on terror. Two Arizona scammers in pursuit of profit in the anti-aging industry found it elementary to order the most poisonous substance known fresh from List Labs in Campbell, CA, a purifier of biochemicals and toxins used in counter-terror research.
Chad Livdahl and Zahra Karim had set up a series of shell companies in Tucson with the aim of acquiring botulinum toxin cheaply and repackaging it as "Mimic Botox." The "Mimic Botox" would be shilled to cosmetic surgeons, fraudulently misrepresented as Botox, undercutting Allergan's product, the only company that can sell it as a trademarked and licensed drug.
The scam worked. Using the front company Toxins Research International, Livdahl and Karim ordered thousands of 5 nanogram vials of botulinum toxin ( order form, and intro page) from List Labs sight unseen and promptly diverted it for resale on a collection of websites, as well as through anti-aging seminars.
According to the US government's indictment (full text here), Livdahl and Karim paid List Labs about $30,000 for the botulinum toxin shipment, subsequently making about one and a half million dollars in profit through the operation. It unraveled when one of their primary customers, Bach McComb, a doctor in Florida whose license to practice medicine was suspended for overprescription of painkillers, accidentally mistreated - or overprescribed, if you will, himself and three others with purified toxin.
Which brings us to a report in the Journal of the American Medical Association's November 22 edition entitled, "Botulism in 4 Adults Following Cosmetic Injections With an Unlicensed, Highly Concentrated Botulinum Preparation." (Subscription only.) Although the paper does not name them, it describes the poisoning of McComb and three patients, one of whom was his girlfriend. The onset of paralysis required hospitalization for all which, in turn, led to investigation and jail terms on intent to defraud for him (three years) - as well as Livdahl (nine years) and Karim (six years). NB: For the curious, McComb is referred to as "case-patient 2;" his girlfriend, "case-patient 1," in the medical journal study.
In late November of 2004, McComb received a 100 microgram vial of highly purified botulinum toxin from List Labs. He injected himself and three others with aliquots taken from it in treatment for wrinkles. Three to four days later McComb and his patients were on hospital ventilators to keep them alive. McComb's girlfriend took the worst of it, requiring about six months on a machine, saying in a videotaped statement for the criminal trial that her body wasted away until it was unrecognizable.
The JAMA paper describes the poisonings as equivalent to "21 to 43 times the estimated human lethal dose by injection." The vial from which McComb took his injections was thought to contain enough material for 14,286 fatal doses.
At first look this seems to make the 100 micrograms of botulinum toxin as sold by List Labs a potential weapon of mass destruction. The JAMA paper informs that federal regulations allow for transfer, possession and use of up to 500 micrograms, or half a milligram, of the poison "without registration or notification of the Select Agent Program," a US operation administered by the Centers for Disease Control to control and monitor the use of toxins and microorganisms with potential applications in biochemical terrorism.
As a consequence, the authors of the paper recommend that the current weight limit for botulinum toxin be revised downward for individual shipments, a task that's performed by a national interagency working group of researchers and medical doctors, which includes the authors of the paper, all plugged into the science of botox. More stringent examination of credentials is also called for, they say.
For additional perspective the CDC was contacted. This resulted in being put in touch with with Charles Millard at the Walter Reed Army Institute of Research, which supports the CDC in this matter. Millard is a botulinum toxin expert and also part of the interagency working group on the poison.
While over fourteen thousand lethal doses sounds like an awful number, and one imagines the toxin reconstituted from the delivery vial and deposited with great malice into a vat of dressing at a serve-yourself bar, the feat is perhaps not that cut and dried or obviously practical. One hundred micrograms of the toxin is a vanishingly small amount, the high number of lethal doses being a theoretical number. (The method of reconstitution and toxicity of the toxin sold to McComb and Livdahl is described here and here.)
However, as Millard explained, the actual amount for lethality in humans is not an exact science and extremely small amounts of highly purified protein complexes, which is what botulinum toxin is, tend to be unstable when put into much larger volumes. In other words, they denature, degrade and disappear. Millard indicated the vial contained much less practical material than the stated number of theoretical lethal doses.
Millard suggested this uncertainty was perhaps seen in the variance of the severity of the disease suffered by McComb and his girlfriend. The levels of botulism toxin seen in blood samples from McComb's girlfriend and another patient appeared identical, yet the former was gripped by a deadly paralysis much greater than the others. The reasons for it remain unclear.
What is clear from a reading of the court files and the JAMA paper is that diligence was absent everywhere in the case. No eyebrows were raised when over three thousand vials of botulinum toxin - about 0.7 of a theoretical lethal dose/vial - were ordered by people with no legitimate research connections, persons the Department of Justice described as wishing to "enrich themselves unjustly" by selling the material. Nary a peep was heard when List Labs sold the 100 microgram vial of purified toxin to a physician who'd had his license suspended, described in court by one of the case-patients tracked by JAMA as one "who practiced medicine like Dr. Frankenstein would have practiced medicine," according to The Palm Beach Post. In the hospital the man laid, his body wooden, saying at McComb's sentencing last January, "At first I thought I was at my own funeral... I thought I was dead."
The same newspaper reported that a federal investigator in the McComb/Livdahl case, "[posed] as an employee of a company that sells the toxin to researchers" and was offered a few vials of it by List Labs. "He was asked only for his name, address and credit card number," added the newspaper.
It is certain that more scrutiny is now being directed at those who purify and sell botulinum toxin in the US. The CDC, however, does not release the names of companies and researchers being regulated through its select agent program out of security concerns, paradoxically, over revealing information on where potential terrorists could get dangerous biochemicals and microorganisms.
Thus the dilemmas posed by the McComb case become fairly obvious.
One, this misuse of man-prepared botulinum toxin came not from al Qaeda terrorists, said repeatedly by terrorism experts and the mainstream media to be wishing for it, but fresh from a California lab which delivered it into the hands of people motivated by the pursuit of illegal profits. It underscores the dichotomy that while Islamists have shown no scientific know-how in the manufacture of poisons like botulinum toxin or ricin, an American purifier and three bad people unexpectedly collided in the delivery and employment of it through no more effort than a few telephone calls.
More nettlesome, the problems in regulation exploited in the case appeared to come not so much from the weight regulation of toxin not being low enough as from the absence of common sense and appropriate scrutiny in the checking of who could obtain it. The good news, which is not widely publicized but which was emphasized repeatedly by the scientist interviewed for this story, is that, generally speaking, it still appears to be very difficult to poison large numbers of people with such things. ® George Smith is a Senior Fellow at GlobalSecurity.org, a defense affairs think tank and public information group. At Dick Destiny, he blogs his way through chemical, biological and nuclear terror hysteria, often by way of the contents of neighborhood hardware stores.