A glamorous drug, an illness, a very public battle

Even before “Mr. Botox” returned from Europe to take the stand and Vanna White showed up, the judge braced the jury for something special. “You’ll remember this for a long time,” he said.

Indeed, history is being made this month in Los Angeles County Superior Court, as Botox goes on trial for the first time in its brief but glamorous life as America’s favorite antiwrinkle treatment.

Hollywood socialite Irena Medavoy, wife of film producer Mike Medavoy, is suing celebrity dermatologist Arnold Klein and Botox’s manufacturer, Allergan Inc., claiming the drug caused myriad illnesses, including a four-month migraine so severe it left her bedridden, barely able to lift her head from the pillow.

The medical malpractice lawsuit, which began Sept. 3 and is expected to last through next month, threatens more than $560 million in annual Botox sales and the reputation of one the drug’s leading experts. And perhaps that’s why defense attorneys kept the first two weeks of testimony focused on the lifestyles of the rich and famous -- instead of the troubling questions about Botox raised by Medavoy’s ordeal.

Not that the audience (and yes, there is one) is complaining. It has already heard witnesses either married to celebrities or employed by them testify on in-home eyebrow dyeing, John Travolta’s birthday party, summers in St. Tropez, winters in Aspen and, naturally, Bill Clinton. And then there’s the melodrama inherent in the bitter breakup between an ex-model and her longtime dermatologist. For 25 years -- through all the swimsuit photo shoots, the recurring role on “Dallas,” the infomercials, the charity galas and four marriages -- Klein helped keep Medavoy looking young and beautiful. “I trusted him with my life,” she said.

But then Botox came between them, and everything changed.

The two leads

Irena Medavoy is a striking woman, tall, blond and tan. But in court, she has looked so unlike herself, wearing flat shoes, plain suits, virtually no makeup and a ponytail, that defense attorneys felt compelled to show the jury photos of her bare-shouldered and laughing in France, beaming in a silver gown and posing at a charity luncheon in a lemon-yellow suit.

Today, she sees herself as a sort of Erin Brockovich for the Botox set, a champion of women everywhere who have suffered similar, debilitating side effects but are silenced by disbelieving doctors. She says her lawsuit has “raised the flag,” showing that the drug isn’t safe for everyone and that Allergan is conspiring with doctors to keep this from the public. “I’m going to be the voice,” she says. “If I have to be stripped for it, I will.”

Beverly Hills dermatologist Arnold Klein, who shuffles into the courtroom using a cane (a gift from good friend Michael Jackson), arrived a week and a half into the trial wearing a black silk suit and a half-smile. He was late, he said, because he’d been lecturing on Botox and other “injectibles” in Portugal, Spain and England.

As Klein watched testimony from the gallery, he was chatty and charming. Out in the hall, he said the whole scene reminded him of a Shakespearean tragedy. “I hope I never have to do this again,” he said. “But it’s actually very amusing.”

A little later, one of his attorneys introduced him to the jury, and Klein stumbled and nearly fell. It seemed the dermatologist to the stars, whom Elizabeth Taylor calls “a saint” and South Korea knows as “Mr. Botox,” who has built his career on Hollywood’s vanity, was a very humble, very fragile man.

When he took the stand, however, a different Klein emerged. He was petulant and condescending, often arguing with the attorneys and Los Angeles Superior Court Judge Victor Chavez. At one point he provoked even the amiable Chavez to shout him down. At another he refused to take his seat, saying, “I prefer to stand when I lecture.”

High life

It’s hard to imagine this jury of working folks -- a janitor, a bank clerk, several county employees -- empathizing with anyone in this case.

The Medavoys live in a 14,000-square-foot Mediterranean manse in Beverly Park. Their son goes to Disneyland with Sylvester Stallone’s kids. And Irena’s girlfriends are married to movie stars and the powerful executives who helped make them.

Klein, meanwhile, earns a considerable fortune as an Allergan consultant and media spokesman -- $25,000 each quarter for consulting, as much as $10,000 a day for meetings, plus travel expenses and as much as $4,000 per appearance. That’s on top of his lucrative Roxbury Drive practice and his position as a UCLA professor.

For Irvine-based Allergan, Botox is a miracle drug that has transformed a modest eyedrop and acne-treatment company into a real player in the aesthetic sciences. And it has fought mightily to quell the controversy that Medavoy’s case has prompted, launching national newspaper ads headlined “The Truth About Botox” and dispatching sales reps to doctor’s offices to help ease anxiety about the drug. After the lawsuit was filed in January 2003, the company vowed to fight it until Botox received “complete vindication.”

‘Like being tortured’

In early 2002, the Medavoys were trying to sell their Beverly Park mansion and Irena was pitching a talk show titled “Behind the Gates” with friend Cynthia Sikes Yorkin, an actress and former Miss Kansas, now the wife of TV producer Bud Yorkin. The show was “ ‘Ab Fab’ come to life,” recalled an executive producer at NBC Universal Television, Stuart Krasnow. “Lucy and Ethel meets ‘Hollywood Wives.’ ” (The two women had also considered producing a TV series titled “Trophy Wives,” but the plot lines turned them off. One featured the wife of a major Hollywood producer desperate for social position who fakes a disease to create her own charity.)

On March 4, 2002, Medavoy saw Klein for her quarterly Botox treatment. Klein had been using the drug -- botulinum toxin type A -- to treat her wrinkles for a year and a half before he first injected it into her temples in May 2001 as a way to suppress her migraines. But this time, she said, he seemed to inject far more than usual. Eight days later, she testified, “I had a headache like I had never experienced in my life.” It was “like a thunderclap, as though half your scalp is being pressed up,” “unrelenting pounding,” “like a vice grip,” “like being tortured every day.”

Defense attorneys claim the stress of selling her home and developing the TV show might have caused her illness.

Medavoy postponed plans for the talk show, canceled trips to Europe and Hawaii and her famed Golden Globes party, and skipped the 2002 Oscars. “I’ve never seen her so sick,” said her friend Donna Estes Antebi. “She could not hold her body up,” said another friend, Dagny Dubelko. “She was shuffling ... weak, pale, feverish.” “She could hardly speak,” said Vanna White.

Soon, a team of specialists was supervising Medavoy’s care -- three neurologists, two rheumatologists, an immunologist, a pulmonologist and a family doctor. After a battery of tests, several attributed her symptoms, at least in part, to Klein’s Botox treatment.

The courtroom players

In court, there’s an air of restraint at the plaintiff’s table, as if any levity might corrupt Medavoy’s image as the trusting patient done horribly wrong. Her lawyer, Jeff Benice, who says his name is spelled like “be nice,” is a broad-shouldered guy with jet-black hair whose quiet, earnest presence suggests another life as a superhero. He rarely smiles, and his delivery is so subtle that the judge often asks him to speak up.

On Klein’s side of the defendants’ table, the mood is far more relaxed. Klein’s attorney, Howard Weitzman, is a longtime Hollywood criminal defense attorney whose client list includes some of L.A.’s most famous defendants, from O.J. Simpson (on spousal abuse charges) to Michael Jackson (a 1993 child molestation case) to John DeLorean (drug trafficking charges). He’s also an old friend of the Medavoys whose role now, it seems, is to humiliate them, albeit in a genial, nonthreatening way.

Weitzman’s co-counsel, Stephen Frasier, is tall and blond. One minute he’s sunny and self-deprecating, the next he’s argumentative and relentless. Among the phalanx of attorneys representing Allergan are Ellen Darling, a petite woman with a shaggy blond haircut, and Hoot Gibson, a bearded and bespectacled fellow (not to be confused with the late cowboy movie star) who trembled when he first addressed the jury. They are a very low-key duo, whose all-business demeanor is perhaps meant to present the company as the most clearheaded of the bunch.

Three sides

In a Sept. 17 statement, Allergan attributed Medavoy’s illness to “a host of unrelated medical and psychological symptoms that were present long before her treatment for migraine with our product.”

Indeed, the defense attorneys have portrayed her as an emotionally unstable, overindulged, overmedicated woman consumed by vanity, opportunism and celebrity. They told the jury of her bulimia in 1983, her breast implants and the six years she’s spent in psychotherapy. They drilled her on her previous marriages, her panic attacks, herpes outbreaks and, perhaps worst of all, her financial solvency.

Even Medavoy’s longtime family doctor, Robert Huizenga, testified that she had “anxiety syndrome.” “If she had a pain on her breastbone, she was convinced she was having a heart attack,” he said. “When she had headaches, she’d be convinced she had brain cancer.”

Meanwhile, Klein’s attorneys have portrayed him as a self-made man who is “not only a scientist” but also “a gifted artist.” He’s so exacting, they say, that he prepares a different syringe for each Botox shot and attaches a special device to every needle to determine precisely where he’s injecting.

But Klein’s testimony revealed some unsettling oversights. For example, he said he knew that even small doses of Botox had been reported as causing severe “life-altering headaches,” but he didn’t change his Botox treatment consent form to reflect those risks. And he never mentioned them to Medavoy.

Then there’s the matter of her medical file. After Medavoy called to complain about the pain, Klein’s nurse, Mitzi Shulman, changed the Botox dosages on her chart from 1.5 cubic centimeters to 0.15 cc. Shulman testified that she “had a habit” of putting the decimal point in the wrong place, and “if there were issues about something that was done, I wanted it to be as clear as possible.”

A couple weeks later, Klein added a note to the file saying that Medavoy’s UCLA neurologist had eliminated Botox as the cause of her illness. Yet the neurologist, Andrew Charles, testified that he believed Botox was potentially to blame and that he had “no recollection” of telling Klein anything different.

A strained friendship

The strained Medavoy-Weitzman friendship has made for some awkward moments on the stand. Irena Medavoy told Weitzman that she took her story to “Dateline NBC” only after “you started to smear me.”

Then there was the back-and-forth about her appearance. Had she gained weight recently? Had the wrinkles around her mouth returned since she stopped receiving collagen injections? And what about those frown lines?

“As you sit there now, do you have those lines in your forehead?” Weitzman asked.

“After what happened to me,” Medavoy said, “I’m not concerned about my appearance.”

When Mike Medavoy took the stand, he refused to look at Weitzman, addressing the jury instead. He answered questions dismissively, with sarcasm. He said he didn’t know his wife got Botox shots and he didn’t know Klein “from a hole in the wall.” But there was something strangely collegial about their exchange, as if they were both holding back laughter.

Later, out in the hallway, Mike Medavoy was asked what it was like to be cross-examined by Weitzman, considering they’d been friends. “Friends?” he quipped. “In Hollywood? Is there such a thing?”