Overseas risk

    The paper's authors believe the risk is much greater in other parts of the world. Counterfeit BoNT products have already appeared in Russia and China. The authors don't know if manufacturers leaked something called reagent-grade BoNT, which is only used for research, or if independent counterfeiters brewed the ersatz pharmaceutical. Neither case has been tied to terrorism.

    But even if the toxin hasn't gotten in the wrong hands yet, the potential use of it for nefarious purposes is a real one, says Brad Smith, a senior associate at the Center for Biosecurity of the University of Pittsburgh Medical Center.

    Making weapons-grade BoNT involves growing the bacteria in a fermented liquid, spinning the liquid in a centrifuge to isolate the toxin, then drying the toxic substance into a powder. It isn't baking cookies, but it wouldn't take much more than a Masters Degree in microbiology to handle the science.

    Allergan and other companies could help prepare for a BoNT outbreak by creating a kind of fingerprint for their products. The authors suggest that all seven legitimate companies should put specific molecular markers in their pharmaceuticals. Then scientists could take a survey of the kinds of counterfeit Botox products on the market, and trace where they came from. Such an effort would cost less than $1 million, says Coleman.

    Ingram says Allergan is already keeping an eye on counterfeits. He believes that the company has responded efficiently to incidents in the past, and will continue to do so in the future. "We are the science leader with respect to Botox and botulinum neurotoxin worldwide, and we take that leadership position very seriously," he says. "That leadership comes with an obligation to be a voice for reputable science."