Dr. Jon Hallberg: Botox, weight loss and antibiotics

MPR's medical analyst Dr. Jon Hallberg discussed alternative uses for botox, approval of new weight-loss pills and antibiotics with Tom Crann of All Things Considered. Hallberg is a physician in family medicine at the University of Minnesota and medical director of the Mill City Clinic.

An edited transcript of that interview is below.

Tom Crann: When will antibiotics be available over the counter?

Dr. Jon Hallberg: I really don't see that happening anytime soon. Where antibiotics are more freely available we have huge problems with things like multidrug-resistant tuberculosis, other infections. We have a hard enough problem with that in our own country in hospitals with infections that are resistant to antibiotics. I just don't see that happening.

Crann: In the clinic, there's been a push to not prescribe them as often, right?

Hallberg: Exactly. I think we're trying so hard to limit them in the clinic setting that allowing the public to choose when to take them would be a very tough sell.

Crann: The FDA has actually approved a new weight loss drug.... What is this drug?

Hallberg: It's called Belviq, and [it's] the first one in 13 years. The generic name is lorcaserin. The idea is, like a lot of the other ones, that it sort of decreases your appetite, makes you feel full a little quicker and therefore lose weight.

Crann: There have been problems with previous ones, I'm thinking Fen-Phen and others.

Hallberg: All of these have been taken off the market for one reason or another. We need a lot of caution with a medication like this for these very reasons.

Crann: It's not surprising it's the first time in a long time.

Hallberg: Apparently there are three other drugs in the pipeline, and two of them are doing more research, and one of them has already dropped out. The FDA is being very cautious about giving approval for these.

Crann: One thing that I read is they said doctors were actually clamoring for this. Did you read that as well?

Hallberg: I'm not one of those doctors, and I really don't know too many of my colleagues who are either. I think we're just very cautious.

Unfortunately, there's nothing fancier than decreasing calories and increasing activity. The medications sound great. We want medication but it just never seems like it's the right solution.

Crann: When we think of botox we think of it used as cosmetic treatments, to hide wrinkles around the eyes, at least that's a common conception of it. But there's news that it's being used to treat MS. How does that work?

Hallberg: There was a small study that came out in the journal "Neurology," that found that people with MS who had arm tremors, that their tremors decreased with the use of botox.

But this is just the latest in a long line of things that goes way beyond the treatment of wrinkles using botox.

Crann: How would it work to calm tremors?

Hallberg: It basically blocks nerve transmission. A nerve impulse going to a muscle is blocked: Muscles relax, wrinkles disappear and arm tremors may diminish. And other musculoskeletal things benefit from it as well.

Crann: Give us an idea what else it is being used for.

Hallberg: Some ophthalmology groups have used it for the treatment of migraine headaches. It's been used in excessive sweating, and we're not talking just a little sweating, but excessive to the point of just soaking clothing.

And other things like focal dystonia, which is a painful cramping of muscles in the hand for example. This concert pianist was basically prevented from doing his craft, from playing at this high level because of this condition. He had tried everything, and finally they tried botox and it worked.

Interview transcribed and edited by Jon Collins, MPR reporter.

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