Letters

As a practice nurse I would add the ten-second hold to your list of things people skip. I watch patients withdraw immediately and then wonder about the wet patch on their skin. It is the most visible underdose there is and almost nobody connects the two.

The section on in-use stability is unhelpfully agnostic. Everyone in this market uses a figure of around thirty days refrigerated. Surely you can say whether that is roughly right rather than declining to comment.

You recommend writing the concentration on the vial. I would add: write it on the box as well. My vial label came off in the fridge and I lost the only record of what diluent volume I had used.

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 Real behaviour is surely more complicated: a supplier might publish a poor result on a batch it has withdrawn, or publish everything for a period to establish credibility and then stop.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.

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.

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.

Your piece describes tapering as pharmacologically pointless and then spends three paragraphs making a case for it. Pick one.

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.