Every letter we have printed
Page 66 of 77 of this archive, newest first.
On “Holding the dose before surgery: for whom, for how long” — Pharmacology, 18 May 2024
Your incidence tables are from the licensed products. I use compounded material at a concentration that does not match any pen. Are the figures transferable at all?
— C. Adeoti, Ibadan
The mechanism transfers; the incidence figures transfer only to the extent that your actual exposure matches the trial exposure, which is unknown unless the content has been measured. That is not evasion. It is the reason we argue for peptide content as a standard reported field rather than purity alone.
On “Why a dead-clean sterile filter can pass pyrogen straight through” — Laboratory Notebook, 17 May 2024
Your endotoxin table gives vial 12 at 112 EU per vial and then declines to say whether that is dangerous. I understand why. It is still frustrating to read a figure of that size next to the sentence "arithmetic, not a safety assessment".
— L. Nyoni, Harare
We understand the frustration and we are going to keep doing it. The figure sits at roughly a third of the hourly systemic allowance for a 70 kg adult if the whole vial were administered at once, which is a comparison a reader can make. What we cannot do is turn a single determination on one vial into a statement about a person, and pretending otherwise would be the more serious failure.
On “Why a dead-clean sterile filter can pass pyrogen straight through” — Laboratory Notebook, 17 May 2024
You write that recombinant factor C is insensitive to the glucan branch of the cascade. It would be worth adding why anybody cares: cellulose filter media and certain paper wrappings shed glucans, and a laboratory that has chased a false positive through three repeat assays will never willingly go back to a reagent that responds to them.
— T. Nkemelu, Port Harcourt
On “The badge economy, and what it is actually certifying” — The Ledger, 16 May 2024
As a buyer I found the section on who chose the vial genuinely clarifying and slightly deflating. I have been treating vendor-published reports as equivalent to my own submissions for two years, and on your account they are not equivalent by an amount that cannot be measured.
— T. Wexford, Louisville, KY
That is the correct reading, and the unmeasurable part is the honest part. We would add only that vendor-published reports are not worthless — a vendor willing to commission testing at all is behaving better than one that will not — they are simply weaker in a specific way.
On “The badge economy, and what it is actually certifying” — The Ledger, 16 May 2024
Your selection-effect model assumes a supplier publishes results above a fixed threshold. Real behaviour is surely more complicated: a supplier might publish a poor result on a batch it has withdrawn, or publish everything for a period to establish credibility and then stop. The arithmetic is fine and the behavioural assumption is a cartoon.
— D. Lockridge, Tulsa, OK
Agreed, and the figure caption now says illustrative arithmetic rather than model. The point survives the simplification, which is that a small amount of selection produces a large apparent effect, but we should not have dressed a demonstration as an estimate.
On “The badge economy, and what it is actually certifying” — The Ledger, 16 May 2024
Your suggestion that laboratories publish the fact of a submission while keeping the result confidential is the first proposal I have read in this area that a laboratory could actually implement without breaching a client obligation. I have raised it internally.
— M. Tsvangirai, Bulawayo
We would be glad to report the outcome either way, including if the answer is no and the reason is commercial. The proposal is only useful if somebody adopts it, and a published refusal is more informative than silence.
On “The badge economy, and what it is actually certifying” — The Ledger, 16 May 2024
You disclose that two of these services advertise with you and then spend four thousand words on structural criticism of the sector they operate in. I cannot decide whether that is admirable independence or an elaborate way of appearing independent. Probably the former. I wanted to say that I noticed the question.
— Y. Sasaki, Sapporo
So do we, every time this department writes about the sector. The only answers we have are procedural: the disclosure, the standards desk edit, the consulting prohibition on the writer, and the practice of printing objections like yours unedited.
On “What a laboratory knows about the material it receives” — Analytics, 15 May 2024
Your selection-effect model assumes a supplier publishes results above a fixed threshold. Real behaviour is surely more complicated: a supplier might publish a poor result on a batch it has withdrawn, or publish everything for a period to establish credibility and then stop. The arithmetic is fine and the behavioural assumption is a cartoon.
— N. Halvorsen, Trondheim
Agreed, and the figure caption now says illustrative arithmetic rather than model. The point survives the simplification, which is that a small amount of selection produces a large apparent effect, but we should not have dressed a demonstration as an estimate.
On “What a laboratory knows about the material it receives” — Analytics, 15 May 2024
As a buyer I found the section on who chose the vial genuinely clarifying and slightly deflating. I have been treating vendor-published reports as equivalent to my own submissions for two years, and on your account they are not equivalent by an amount that cannot be measured.
— T. Elorriaga, San Sebastián
That is the correct reading, and the unmeasurable part is the honest part. We would add only that vendor-published reports are not worthless — a vendor willing to commission testing at all is behaving better than one that will not — they are simply weaker in a specific way.
On “What a laboratory knows about the material it receives” — Analytics, 15 May 2024
On the archive point: a public record of submissions by vendor would be gamed within a month. Vendors would submit under the names of resellers, or through intermediaries, and the archive would show a distribution as selected as the current one but with a veneer of completeness.
— R. Hollenbeck, Spokane, WA
Probably true in part, and it is the strongest argument against our proposal. Our answer is that gaming requires effort and leaves traces, which the present arrangement does not, and that a partially gamed record is more informative than no record. We would not claim more than that.
On “What a laboratory knows about the material it receives” — Analytics, 15 May 2024
VendorInvestigate does not measure anything and you have grouped it with three laboratories under the heading independent testing. That is exactly the conflation your article says the market makes.
— H. Baptiste, Fort-de-France
A fair hit. The tag under which this coverage sits predates the distinction we now draw, and we have added the distinction to the second paragraph and to the table. The department name will follow at the next reorganisation of the site.
On “What twenty companies say about storage, and what they have measured” — The Supply Chain, 14 May 2024
I have shipped temperature-sensitive material commercially for eleven years and your coolant arithmetic is right but generous. You assume the pack starts fully frozen. In practice packs are pulled from a freezer that is opened forty times a day, and a pack that starts at minus four with a soft core has lost a fair share of its budget before the box is closed.
— J. Delahunty, Waterford
A good point and one we had not considered properly. The latent heat calculation assumes a fully solid pack at its melting point, and a partially thawed pack is exactly as much worse as the missing solid fraction. We have added a sentence and would welcome any data you can share on pack condition at packing.
On “What twenty companies say about storage, and what they have measured” — The Supply Chain, 14 May 2024
You say no company reports residual moisture. I obtained a figure from a supplier last year without difficulty, on request, so the data exists in at least some cases. The problem may be less that it is not measured than that it is not printed.
— P. Sarkissian, Beirut
On “Side effects, cost, supply, target: four reasons with four trajectories” — Clinical Trials, 14 May 2024
I lost access for eleven weeks during the shortage, restarted at the dose I had been on because nobody told me otherwise, and spent a fortnight unable to keep food down. I had been on that dose for seven months without difficulty. Reading your resumption section was the first time anybody explained it.
— B. Achterberg, Utrecht
It is entirely predictable from the label and the pharmacokinetics, and the failure to communicate it during the shortage period was systemic rather than individual. We are sorry it reached you this way and we are glad it reached you.
On “Side effects, cost, supply, target: four reasons with four trajectories” — Clinical Trials, 14 May 2024
Your piece describes tapering as pharmacologically pointless and then spends three paragraphs making a case for it. Pick one.
— P. Havlíček, Brno
Both, we think, and deliberately. There is no pharmacological rationale, because there is no withdrawal syndrome and a week-long half-life produces its own decline. There is a behavioural rationale, which is different in kind and untested. Our objection is to tapers advocated in pharmacological language, not to the practice.
On “Side effects, cost, supply, target: four reasons with four trajectories” — Clinical Trials, 14 May 2024
I stopped eight months ago after reaching a weight I was happy with, and I have regained four of the twenty-two kilograms I lost. Every article I read told me to expect two-thirds back. I am not complaining, but I would like to know whether I am unusual or whether the two-thirds figure was always a mean concealing an enormous range.
— N. Zangwill, Manchester
The second. The published interquartile ranges around those means are wide, and outcomes like yours are well within them. The trials were not designed to explain why some people hold weight after cessation and others do not, and nothing measured at randomisation predicts it usefully. You are not an anomaly; you are part of a distribution nobody quotes.
On “Side effects, cost, supply, target: four reasons with four trajectories” — Clinical Trials, 14 May 2024
You describe the maintenance strategy of stepping down one dose and holding for eight to twelve weeks as something clinicians report doing, and then say it is not a recommendation. That distinction will be lost on most readers, and printing the protocol makes you a source for it whether you intend to be or not.
— N. Villaseñor, Guadalajara
This is the hardest editorial question this department faces and we do not think you are wrong. Our position is that a practice this widespread is better described accurately, with its evidentiary status stated, than left to circulate in fragments. We accept that the distinction does work that a reader may not do.
On “Who signed this, and what did they undertake by signing it” — The Supply Chain, 13 May 2024
The composite test table you print as a model is unrealistic. No research supplier is going to run headspace GC and ion chromatography on every lot at these price points, and publishing an aspirational document as a benchmark just makes real certificates look worse than they are.
— R. Ekwueme, Awka
The table note says explicitly that no supplier in our programme issues a document containing every row, and it is offered as a reference rather than as a demand. But you have a point about framing, and we have moved the caveat from the note into the caption.
On “Who signed this, and what did they undertake by signing it” — The Supply Chain, 13 May 2024
Nine years buying research chemicals and I had never once looked at the date of manufacture. I checked eleven certificates in my drawer this evening. Four do not carry one.
— A. Kirkbride, Leeds
On “Who signed this, and what did they undertake by signing it” — The Supply Chain, 13 May 2024
A technical query on your identity row: you specify 4111.1 Da monoisotopic with a tolerance of ±10 ppm, which is 0.04 daltons. Is that not tighter than most contract laboratories will commit to on a peptide of that size?
— C. Bąkowski, Łódź
It is achievable on an orbital trap with internal calibration and is tight for a quadrupole time-of-flight on external calibration. The row is drawn from a real certificate issued by a laboratory running the former. We should have said so, and the note now does.
On “Who signed this, and what did they undertake by signing it” — The Supply Chain, 13 May 2024
You put every documentary finding to the company before publication, which is admirable and also means you are letting companies that do not reply escape coverage entirely. Silence should have a cost.
— D. Sakamoto, Kobe
It does, and we should make it more visible. Non-response is recorded in the dossier register and published there. What we will not do is publish an inference we cannot support merely because nobody objected to it, and that constraint does protect the unresponsive. We accept the trade knowingly.
On “Who signed this, and what did they undertake by signing it” — The Supply Chain, 13 May 2024
You describe reused chromatogram images as a tell. I work in a contract laboratory and I would note that some data systems export a representative overlay rather than the individual injection, so identical-looking traces can occur legitimately across a batch series. It is still worth asking about; it is not the smoking gun your article implies.
— M. Bogdanović, Podgorica
A useful qualification and the text has been softened. The observation remains worth making; the inference we drew from it was stronger than the practice supports.
On “How to audit an identity claim in five minutes” — Laboratory Notebook, 12 May 2024
The claim that a reproduced spectrum is worth more than any number in the document seems overstated. Most buyers cannot read a spectrum, and a printed image invites false confidence rather than scrutiny.
— E. Marchetti, Bologna
Partly conceded. A spectrum is worth more to a reader who can read one, and this department exists partly to increase that number. But it is also an artefact that can be checked by a third party later, which a bare verdict is not, and that alone justifies printing it.
On “Background rates, and why they matter for attribution” — Pharmacology, 11 May 2024
The gallbladder section says some of the excess is attributable to weight loss rather than the drug. If the drug causes the weight loss, is that not a distinction without a difference for the person who ends up in theatre?
— Q. Delacroix, Montréal, QC
For the individual, largely yes. For the question of whether one molecule is safer than another, or whether the risk would fall on slower loss, the distinction is the whole question. We should have made clear that it is a mechanistic distinction rather than a consoling one.
On “Background rates, and why they matter for attribution” — Pharmacology, 11 May 2024
As an anaesthetist I read the perioperative section with interest and one objection. You frame disclosure as the patient obligation. In my experience the failure is more often ours: the pre-assessment questionnaire in my own institution did not include these drugs until eighteen months after the first guidance appeared.
— P. Sandoval, Albuquerque, NM
A fair correction and we have amended the text. If the question is not on the form, the absence of an answer is not a patient failure. We would be interested to hear from readers in other institutions about whether their pre-assessment documentation has caught up.
On “The dose that got you here and the dose that keeps you here” — The Ledger, 11 May 2024
I take this for kidney disease, not for weight. Every piece of writing I encounter about stopping is about the weight coming back. It has taken me a year to find anybody willing to say plainly that the renal benefit accrued over years of treatment and nobody has tested what happens if I stop.
— A. Nazarian, Glendale, CA
On “Endotoxin is not a microorganism, and killing the bacteria does not remove it” — Analytics, 10 May 2024
Your endotoxin table gives vial 12 at 112 EU per vial and then declines to say whether that is dangerous. I understand why. It is still frustrating to read a figure of that size next to the sentence "arithmetic, not a safety assessment".
— H. Nakagawa, Fukuoka
We understand the frustration and we are going to keep doing it. The figure sits at roughly a third of the hourly systemic allowance for a 70 kg adult if the whole vial were administered at once, which is a comparison a reader can make. What we cannot do is turn a single determination on one vial into a statement about a person, and pretending otherwise would be the more serious failure.
On “The fourteen-day problem, and what it does to a commercial testing model” — The Supply Chain, 9 May 2024
On multiple-dose closures: the puncture budget you refer to is generally in single figures for a standard lyophilisation stopper, and the qualification uses a new needle each time. Anybody reusing a needle through the same entry point is outside the data entirely.
— F. Okonjo, Asaba
On “The fourteen-day problem, and what it does to a commercial testing model” — The Supply Chain, 9 May 2024
Why did you submit only two vials for sterility testing when the whole article argues that the sample size is the problem? Two is worse than twenty by exactly the argument you make.
— P. Hollingsworth, Norwich
Because we could not afford twenty, and because the two results are reported as what they are: two vials, each destroyed, telling us nothing about their batches. The purpose was to establish that the test is commercially available to a private purchaser and what it costs, not to characterise anything. We should have said that in the article rather than in this reply.
On “The fourteen-day problem, and what it does to a commercial testing model” — The Supply Chain, 9 May 2024
I photograph every cake now because of an earlier piece of yours, and last month it paid for itself. Two vials from the same box, one a proper matte plug and one a collapsed glassy disc. The supplier replaced both without argument when I sent the photographs.
— A. Chowdhury, Dhaka
On “The fourteen-day problem, and what it does to a commercial testing model” — The Supply Chain, 9 May 2024
You keep saying you are criticising documentation and not honesty. I think that distinction is doing more work than it can bear. If a company knows buyers read a purity certificate as a safety document and issues one anyway, the omission is doing something.
— M. Bogdanović, Podgorica
It is a fair challenge and we have thought about it. Our answer is that the convention long predates any individual company’s decision to follow it, that four of our correspondents told us plainly the products are not represented as sterile injectables, and that we have no evidence of anybody intending the inference readers draw. We will report intent when we can demonstrate it and not before.
On “The fourteen-day problem, and what it does to a commercial testing model” — The Supply Chain, 9 May 2024
The statistics section is the part of this I will be sending to people. I had assumed a passed sterility test meant something about the batch. It had not occurred to me that a batch with one contaminated vial in a hundred passes four times out of five.
— D. Sakamoto, Kobe
On “Tapering: a word borrowed from drugs with withdrawal syndromes” — Clinical Trials, 9 May 2024
I stopped eight months ago after reaching a weight I was happy with, and I have regained four of the twenty-two kilograms I lost. Every article I read told me to expect two-thirds back. I am not complaining, but I would like to know whether I am unusual or whether the two-thirds figure was always a mean concealing an enormous range.
— R. Cadogan, Bridgetown
The second. The published interquartile ranges around those means are wide, and outcomes like yours are well within them. The trials were not designed to explain why some people hold weight after cessation and others do not, and nothing measured at randomisation predicts it usefully. You are not an anomaly; you are part of a distribution nobody quotes.
On “Tapering: a word borrowed from drugs with withdrawal syndromes” — Clinical Trials, 9 May 2024
You describe the maintenance strategy of stepping down one dose and holding for eight to twelve weeks as something clinicians report doing, and then say it is not a recommendation. That distinction will be lost on most readers, and printing the protocol makes you a source for it whether you intend to be or not.
— S. Ó Ceallaigh, Limerick
This is the hardest editorial question this department faces and we do not think you are wrong. Our position is that a practice this widespread is better described accurately, with its evidentiary status stated, than left to circulate in fragments. We accept that the distinction does work that a reader may not do.
On “Tapering: a word borrowed from drugs with withdrawal syndromes” — Clinical Trials, 9 May 2024
I lost access for eleven weeks during the shortage, restarted at the dose I had been on because nobody told me otherwise, and spent a fortnight unable to keep food down. I had been on that dose for seven months without difficulty. Reading your resumption section was the first time anybody explained it.
— D. Ó Súilleabháin, Killarney
It is entirely predictable from the label and the pharmacokinetics, and the failure to communicate it during the shortage period was systemic rather than individual. We are sorry it reached you this way and we are glad it reached you.
On “Tapering: a word borrowed from drugs with withdrawal syndromes” — Clinical Trials, 9 May 2024
Your piece describes tapering as pharmacologically pointless and then spends three paragraphs making a case for it. Pick one.
— K. Mwangi, Nakuru
Both, we think, and deliberately. There is no pharmacological rationale, because there is no withdrawal syndrome and a week-long half-life produces its own decline. There is a behavioural rationale, which is different in kind and untested. Our objection is to tapers advocated in pharmacological language, not to the practice.
On “Tapering: a word borrowed from drugs with withdrawal syndromes” — Clinical Trials, 9 May 2024
I take this for kidney disease, not for weight. Every piece of writing I encounter about stopping is about the weight coming back. It has taken me a year to find anybody willing to say plainly that the renal benefit accrued over years of treatment and nobody has tested what happens if I stop.
— Y. Sasaki, Sapporo
On “What a mass spectrometer does to a peptide before it measures anything” — Explainers, 8 May 2024
Sixteen years in a peptide plant and I have never once been asked by a customer which ionisation source we used. I have been asked hundreds of times for a purity figure to one more decimal place.
— P. Havlíček, Brno
On “What a mass spectrometer does to a peptide before it measures anything” — Explainers, 8 May 2024
The claim that a reproduced spectrum is worth more than any number in the document seems overstated. Most buyers cannot read a spectrum, and a printed image invites false confidence rather than scrutiny.
— B. Achterberg, Utrecht
Partly conceded. A spectrum is worth more to a reader who can read one, and this department exists partly to increase that number. But it is also an artefact that can be checked by a third party later, which a bare verdict is not, and that alone justifies printing it.
On “Target dose, effective dose, and the distance between them” — Pharmacology, 8 May 2024
Thank you for saying plainly that the maximum dose is not the goal. I stopped at 10 mg fourteen months ago because it was working and I was tired of arguing about it. Every article I read before yours implied I had given up early.
— C. Nightingale, Plymouth