Healthy Skepticism Library item: 14950

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Publication type: news

Singer N.
Love the Long Eyelashes. Who’s Your Doctor?
The New York Times 2009 Jan 13
http://www.nytimes.com/2009/01/14/health/research/14lash.html?_r=1&emc=eta1

Full text:

First it was frozen foreheads. Now it’s Betty Boop eyelashes.

Allergan, the company that turned an obscure muscle paralyzer for eyelid spasms, Botox, into a blockbuster wrinkle smoother, hopes to perform cosmetic alchemy yet again. At the end of the month, the company plans to introduce Latisse, the first federally approved prescription drug for growing longer, lusher lashes.

The product has the same formula as Allergan’s eye drops for glaucoma, called Lumigan. It is one of several drugs in a category known as prostaglandin analogs, which are meant to reduce dangerous pressure in the eyeball. But as a side effect, the treatment tends to make the eyelashes of many patients longer and fuller.

Some medical experts say they worry that cosmetic customers may occasionally experience some of the glaucoma drug’s other side effects, which can include red, itchy eyes and changes in eyelid pigmentation. Some financial analysts, meanwhile, wonder how many people will want to spend $120 for a monthly dose of lash-lengthening Latisse.

But other analysts predict that in a world where people spend about $5 billion a year on mascara, Latisse could be the biggest thing to hit cosmetic medicine since, well, Botox. Sales for the cosmetic use of Botox were $600 million in 2007.

“I think this is a fairly big deal,” said Ronny Gal, a senior research analyst in specialty pharmaceuticals at Sanford C. Bernstein, an equity research company. “It is a new idea in a market that loves new ideas and, frankly, it works.”

David E. I. Pyott, Allergan’s chief executive, predicted that in the long term, worldwide sales of Latisse would exceed $5o0 million. And he suggested that many women would not blink at spending $120 for a one-month, three-milliliter supply of the drug. He compared the cost of longer lashes to a daily cup of coffee.

“If you think about it in terms of luxury, it’s four dollars a day,” he said. “We think this is fairly acceptable to a large segment of people even in these times.”

But one analyst, Gary Nachman, director of specialty pharmaceuticals at the investment bank Leerink Swann, said the expense of Latisse and the inconvenience of obtaining a doctor’s prescription might deter many women from trying it. Health insurance does not typically cover such cosmetic treatments.

Mr. Nachman said Latisse might have more value to Allergan as a gateway drug that brings new patients to cosmetic medicine and leads them to try Botox. He predicted Latisse would have sales of only $80 million by 2012. “I don’t think this is going to be a huge game changer,” Mr. Nachman said.

Indeed, Jennifer Nobriga, one of a pair of stay-at-home mothers behind the Web site beautyinreallife.blogspot.com, said she intends to stick with plain old mascara rather than splurge on the eyelash drug.

“It would not be at the top of my list,” said Ms. Nobriga of Woodbridge, Va. “I would rather spend the money on a good under-eye cream.”

Some doctors said that while Lumigan had a track record as a safe glaucoma drug, they were nonetheless concerned that the cosmetic version could have some of the same minor side effects.

Dr. Harry A. Quigley, a professor of ophthalmology at Johns Hopkins School of Medicine, said that frequent complaints of glaucoma patients included temporarily red eyes, itching and darker eyelid skin. But in a few glaucoma patients who used eyedrops containing a prostaglandin, he said, green or hazel irises permanently turned darker after 6 to 12 months of treatment.

“It’s like the country-western song “Don’t It Make My Brown Eyes Blue,” but in this case it’s ‘Don’t it make your blue eyes brown,’ ” Dr. Quigley said.

Allergan held a clinical trial with about 280 volunteers, half of whom used Latisse daily for 16 weeks. The study results were reviewed by the Food and Drug Administration, which approved the drug in late December. In that study, eyelashes typically grew 25 percent longer, 106 percent thicker and 18 percent darker. While 3.6 percent of patients experienced eye itching and red eyes, none had a change of eye color, Allergan said.

But the Latisse data, Dr. Quigley said, was short-term and involved too few patients to draw conclusions about side effects. “I would bow to data that says ‘we have 100,000 patients in F.D.A. studies and no one’s eye color changed.’ ”

Mr. Pyott of Allergan says that darker iris color is extremely unlikely with Latisse because each daily application to the lashes involves 5 percent of the amount prescribed to glaucoma patients. “We can assume that that kind of scale must lead to a drastically lower risk,” Mr. Pyott said.

In the application for F.D.A. approval of Latisse, Allergan established the basic safety of the drug with data from multiple studies of Lumigan. Allergan has sold 65 million bottles of Lumigan since its approval in 2002, Mr. Pyott said, with worldwide sales last year of about $430 million.

Latisse will cost slightly more than Lumigan, which is $73 to $84 for a 2.5 milliliter bottle for patients who pay for it themselves. But analysts do not expect many eye doctors to write prescriptions for people to use Lumigan only cosmetically.

Allergan plans to introduce Latisse this month, primarily to cosmetic doctors like dermatologists. Some women who have already tried Latisse are fans.

“People would say to me ‘Are you wearing false eyelashes?’ – even my own mother asked,” said Cindy Ross, vice president for sales at Young Pharmaceuticals in Wethersfield, Conn., who participated in the Latisse clinical trial.

Ms. Ross said she liked the effect so much that she had a doctor prescribe the glaucoma drug to use on her lashes until Latisse becomes commercially available. “I wouldn’t stop,” Ms. Ross said. “I found a way to get it.”

Some doctors, meanwhile, are wondering whether Latisse could be used on hair elsewhere.

“Someone will call to say ‘I am Dr. Jones in wherever, and I would like to conduct a study on eyebrows,’ ” Mr. Pyott said. “For a lot of women, the eyebrow is every bit as important as the eyelash.”