Similar Posts

  • LYMEPOLICYWONK: Expired Drugs—Are they Effective, Safe?

    This is a little off topic for my blog, but something that is of high interest to patients. Patients ask all the time about the effectiveness and safety of “expired” drugs. A recent article that appeared in the Medical Letter examines the issue in detail. The article notes that generally manufacture expiration dates merely reflect the fact that the drug is “stable” at that point, they do not reflect when the drug becomes unstable. The conclusion of the article indicates that outdated drugs may be effective and safe for at least 5 years after the expiration. Notable exceptions include liquid suspensions and epinephrine in Epipen, which are not stable over time. The article also notes the following: " There are no published reports of human toxicity due to ingestion, injection or topical application of current drug formulations after their expiration date. Renal tubular damage has been reported after use of degraded tetracycline in a formulation that is no longer available (REF 2)." Other sources contain warnings about expired doxycycline, which may (or may not) be based on this outdated tetracycline warning, but patients may want to check with their doctors when using expired doxycycline to be on the safe side.

  • LYMEPOLICYWONK: A Question of Ethical Reporting–Chicago Tribune/Los Angeles Times.

    Biased reporting harms the credibility of journalism, harms patients, and misleads the public. The recent Tribune piece, which is now being republished in other Tribune outlets (including the Los Angeles Times) distorts and manipulates reality and makes a ‘good story’ at the expense of professional journalism. It does this by ignoring science, and by characterizing patients as hapless victims and their physicians as frauds. It was called to task for its profound lack of professionalism by Knight Science Journalism Tracker. Articles on science that do not present both sides of a legitimate controversy in science do a serious injustice and may violate the canons of journalist ethics established by the Society of Professional Journalism. Today, I look at some of those canons and point out how the Tribune article fell short. More after the jump. . .

  • LYMEPOLICYWONK: Embers Monkey Trials Part 4. Lab Tests Fail to Detect Lyme Disease.

    This is Part 4 of a series on the Embers study of Lyme disease in non-human primates. As described in Part 1 of the series, the Embers monkey research study posed three questions: one regarding treatment of early disseminated Lyme disease, one regarding treatment of late disseminated Lyme disease, and one regarding the ability of the C6 to accurately detect infection. This part of the blog series focuses on the last question, the accuracy of lab tests. Embers evaluated the C6 antibody test to see if its results accurately reflected active infection. It was believed that the C6 might permit researchers to determine whether treatment cleared infection. However, the study concludes: “Reliable procedures to determine that infection has been cleared from Lyme disease patients have not been established.” Moreover, the study demonstrated that the ability of the C6 to detect active infection generally was poor. Although the test detected infection in 100% of the inoculated monkeys at 4 months, after this period it failed to detect active infection in 60% of untreated monkeys in the study and in 100% of infected monkeys that received treatment.

  • LYMEPOLICYWONK: IDSA Lyme Hearing Panel–What to do when opinion is strong, but evidence is weak?

    Now that two studies have shown that IDSA guidelines are generally long on opinion and short on evidence, what should the IDSA guideline panel do? The study by Lee, discussed in yesterday's blog, found that IDSA frequently makes strong recommendations, but that these strong recommendations are supported by strong evidence only 15% of the time. Dr. Maloney found that the majority of recommendations in the IDSA Lyme guidelines were based on the weakest level of evidence–expert opinion. Shouldn't clinical judgment only be suppressed when there is strong evidence? That's what the American Academy of Pediatrics says in its guidelines on making guidelines.

  • LYMEPOLICYWONK: IOM Conference calls: A Phone to Nowhere?

    I have to say, I have not heard encouraging things about the IOM process. Most folks think the IDSA simply plucked a friendly forum to reaffirm its beleaguered Lyme guidelines and the tainted Lyme review panel process. The big question is: Does this process have any substance or is it just a matter of going through the motions? Is anybody listening on these "listening" phone calls? Is the IOM offering to listen to anyone who cares?

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    LYMEPOLICYWONK: Dr. Fallon Sets the Record Straight—Part 1. Size Matters.

    Dr. Fallon, director of the Columbia Lyme Center, and colleagues have recently published an open access article (I’ll post the link below): “A reappraisal of the U.S. Clinical Trials of Post-Treatment Lyme Disease Syndrome.” The article reviews the findings of the four clinical trials and accurately lays out the state of the science in chronic Lyme research. This is important because future research needs and policy decisions are determined by the state of the science.