Use Of Ineffective Drugs Research Articles

Epidemiological update of cystic echinococcosis in livestock and assessment of practices related to its control in the Mediterranean area

Cystic echinococcosis (CE), caused by the tapeworm Echinococcus granulosus, is a zoonotic parasitic disease that still represents a serious threat to human and animal health worldwide. The Mediterranean basin is recognized as one of the major hotspots of CE due to several factors, including the presence of diverse intermediate host species as well as socio-economic and cultural conditions of local communities. This study aims to take a closer look at epidemiological data on CE in the Mediterranean area and assess the knowledge attitudes and practices of shepherds towards this disease in four countries (Algeria, Greece, Italy and Tunisia), highly endemic for CE, with the final goal of identifying highly endemic risk areas and practices in use which might potentially allow the persistence of E. granulosus infection in these areas. To update the epidemiological scenario of CE in Mediterranean areas, a comprehensive review of peer-reviewed literature on CE prevalence data published during the 2017–2023 period was carried out and, through a geographical information system (GIS), a map displaying the current CE distribution in the Mediterranean area was generated. In addition, a questionnaire survey was conducted through in-depth interviews of the farmers to collect information on their management system as well as knowledge attitudes and practices towards CE. From the farmer-participatory survey some risky practices emerged including the non-regular deworming of dogs or the use of ineffective drugs or dosing, as well as the provision of uncooked animal viscera to dogs. Finally, lower levels of knowledge and awareness of the disease was observed among farmers from North Africa compared with those of European countries. In conclusion, the results obtained highlight that CE is still a very serious problem in Mediterranean areas and increased efforts are needed to promote awareness among farmers and to turn research results into policy in order to reduce the spread of this disease, according to the One Health perspective.

Blepharospasm: an analysis of typical medical practice and the effectiveness of therapy

Introduction. Blepharospasm (BS) is a form of focal dystonia in which botulinum therapy (BT) has been used successfully, however, data on typical practice of patient management and the effectiveness of long-term BT in BS in our country are insufficient.Aim. To analyse the typical medical practice of management of patients with BS and the effectiveness of long-term BT.Materials and methods. A total of 50 patients with idiopathic BS, mean age 58 years (of which 37 were women) were included in the study. All patients were treated with botulinum toxin type A. Typical medical practice, erroneous diagnosis, time required to reach a correct diagnosis, severity of dystonia, and quality of life before BT and during a three-year prospective observation were analysed. The severity of dystonia was determined using the BS Disability Index (BSDI), and the quality of life was measured using the EQ-5D questionnaire.Results. The correct diagnosis was reached, on average, in 3 years. Upon onset of symptoms the majority of patients (84%) visited an ophthalmologist. Eye diseases and myasthenia gravis were the most common primary erroneous diagnosis in BS, which were treated with inadequate symptomatic therapy. After one-month BT, it was noted that the disability index decreased from an average of 13.6 ± 5.1 to 2.7 ± 2.3 scores (p < 0.001) according to BSDI and the quality of life increased from 59.9 ± 8.2 to 82.6 ± 6.4 scores (p < 0.001) according to the results of EQ-5D. Repeated BT injections (2–6 times a year) conducted for 3 years also resulted in essentially positive effect without significant adverse events. At the end of three years, the disability index decreased to 10.7 ± 4.7 scores, and the improvement in the quality of life reached 81.8 ± 5.9 scores according to the results of EQ-5D (p < 0.001).Conclusion. The low awareness of doctors, especially ophthalmologists, about the symptoms of BS and the widespread use of ineffective drugs was noted. The long-term regular (2–6 times a year) use of BT reduces the symptoms of the disease, improves the quality of life of patients and has no significant side effects.

An unethical trial and the politicization of the COVID-19 pandemic in Brazil: The case of Prevent Senior.

The Brazilian Federal Senate created a Parliamentary Inquiry Commission (CPI) to investigate the Bolsonaro government's irregularities in the management of the COVID‐19 pandemic. One of the cases that drew attention was the research conducted by Prevent Senior, a private health insurance company, on the early treatment of COVID‐19. The article analyzes the scientific validity of the research and the ethical problems related to its implementation. It is based on analysis of Prevent Senior's report of the clinical study, the Brazilian and USA clinical trial registries, the Senate's CPI report, and on the information reported by the media. This case of scientific fraud and political‐ideological bias exemplifies how Prevent Senior, using a questionable protocol to enhance its reputation and gain government support, was instrumental in building the “early treatment” narrative for COVID‐19, and shows how it served as a basis for a government public policy that promoted the use of ineffective drugs.

Overcoming Resistance to Tumor-Targeted and Immune-Targeted Therapies.

Resistance to anticancer therapies includes primary resistance, usually related to lack of target dependency or presence of additional targets, and secondary resistance, mostly driven by adaptation of the cancer cell to the selection pressure of treatment. Resistance to targeted therapy is frequently acquired, driven by on-target, bypass alterations, or cellular plasticity. Resistance to immunotherapy is often primary, orchestrated by sophisticated tumor-host-microenvironment interactions, but could also occur after initial efficacy, mostly when only partial responses are obtained. Here, we provide an overview of resistance to tumor and immune-targeted therapies and discuss challenges of overcoming resistance, and current and future directions of development. SIGNIFICANCE: A better and earlier identification of cancer-resistance mechanisms could avoid the use of ineffective drugs in patients not responding to therapy and provide the rationale for the administration of personalized drug associations. A clear description of the molecular interplayers is a prerequisite to the development of novel and dedicated anticancer drugs. Finally, the implementation of such cancer molecular and immunologic explorations in prospective clinical trials could de-risk the demonstration of more effective anticancer strategies in randomized registration trials, and bring us closer to the promise of cure.

Diffusion kurtosis imaging in predicting the chemotherapeutic response of colorectal liver metastases: The result of the FDZL-MRinCLM study.

e16034 Background: Colorectal liver metastatic (CLM) patients are a special population who have potential of cure with effective conversion treatment. The conventional radiological imaging commonly evaluates the response 6-8 weeks after the medication. A response marker for earlier prediction could avoid further use of ineffective drugs and guide the medical change for optimal regimen. This study is to evaluate the feasibility of early parameter change assessed by functional MR in predicting clinical response to chemotherapy and investigate its prognostic value in CLM patients. Methods: From August 2016, CLM patients were consecutively enrolled and examined by functional MRI with diffusion kurtosis imaging (DKI) sequence of liver at baseline and one cycle after the initiation of chemotherapy. The whole-lesion histogram and texture analyses of DKI was analyzed and features were extracted from the inline-generated parametric maps included K and D. The primary endpoint of the study was the DKI-predicted ORR of liver metastases, and the secondary endpoint were the DKI-predicted PFS and OS. The efficacy response was assessed by the RECIST Version 1.1 every two cycles of treatment. The association between the baseline DKI parameters, value change ratio (delta-DKI parameters = (Valuebaseline-Valuecycle1)/ Valuebaseline) and ORR and survival were examined. Results: Up to Dec 2019, one-hundred consecutively enrolled patients (65 Male, 35 Female, Age from 30-75 years old) received the treatment (FOLFOX 13, XELOX 53, FOLFIRI 34) and complete the liver functional MRI scanning. A total of 42 responding (CR+PR) and 58 nonresponding (SD+PD) patients were evaluated. Lower baseline D values (D-mean, D-std and D-median, P < 0.005), higher baseline K values (K-mean, K-median, P < 0.005), lower delta-D values (delta-D-DiffEntropy, P = 0.000) and higher delta-K value (delta-K-median, P = 0.022) were significantly associated with a higher ORR, and the combination of all the significant parameters yielded an AUC of 0.834 (sensitivity 76.19%, specificity 77.59%) in predicting the early efficacy of CLMs. Patients with higher delta-D-diffEntropy value showed a longer PFS (9.0 vs 5 mons, P = 0.002) and OS (30.5 vs 14.8 mons, P = 0.032). Conclusions: The baseline value and early parameter change in DKI might be a good predictive marker for the chemotherapeutic response of CLMs, and the early increase of D value in liver metastases could be a promising factor for survival of patients undergoing standard chemotherapy. Clinical trial information: NCT03088163 .

A Rapid Functional Screen for Small Molecule and Monoclonal Antibody Drug Sensitivity in Multiple Myeloma Patients

Background: The oncogenic drivers and progression factors in multiple myeloma (MM) are heterogeneous and difficult to target therapeutically. As a result, personalized medicine approaches have not yet been realized. However, clinical availability of numerous anti-myeloma drugs and readily obtainable bone marrow (BM) aspirates raises the possibility to benefit patients by profiling the drug sensitivity of their MM. Despite newly available drugs, resistance inevitably develops and there is no defined rationale for sequencing therapy. Treatments now consist of >15 agents, including IMiDs, protease inhibitors (PIs), alkylator chemotherapies, steroids, monoclonal antibodies, and options are still expanding. To profile sensitivity to the wide array of options, we developed a rapid functional assay of primary MM cells, distinct from prior assays by forgoing CD138+ cell selection to optimize MM cell viability and allow measurement of monoclonal antibody activity.Methods: Myeloma drug sensitivity testing (My-DST) was performed on patient BM aspirates to measure the MM sensitivity in heterogeneous mononuclear cell (MNC) mixtures. My-DST is performed by culturing samples with a 7-drug panel consisting of bortezomib (Bor), carfilzomib (Car), lenalidomide (Len), pomalidomide (Pom), dexamethasone (Dex), cyclophosphamide (Cy, metabolite 4HC), and daratumumab (Dara) for 48h, followed by multiparameter, high-throughput flow cytometry to measure the surviving MM population. All conditions are performed in triplicate and in parallel, clonality verified by kappa/lambda staining.Results: MM cell viability was substantially better in unselected MNC cultures than CD138-selected cultures (data not shown). Dose-response was evaluated for each agent in MNC cultures to select single active concentrations for high throughput screening (data not shown). Single concentration profiling was completed on 55 patient samples from diagnosis (n = 24), first relapse (n = 11) and after multiple relapses (n = 20) with 2.5 nM PIs, 10 µM IMiDs, 1 µM Dex, 3.75 µM Cy and 20 nM Dara. Each was scored as sensitive or resistant using a cutoff of 80% surviving MM cells normalized to untreated controls (Fig 1A). Mild inherent resistance to varied tested agents was evident at diagnosis and progressively increased with lines of therapy (LOT) until multidrug resistance predominated (Fig 1B). My-DST displayed significant correlation for LOT with increasing resistance to Bor (r = 0.27, P = 0.046), Car (r = 0.27, P = 0.044), Len (r = 0.44, P = 0.0006) and Pom (r = 0.43, P = 0.0009), but not Dara (r = 0.27, P = 0.10), Cy (r = 0.17, P = 0.24) and Dex (r = 0.032, P = 0.82) (Fig 1C). The ex vivo sensitivity for Bor and Car were highly correlated (r = 0.67, P < 0.0001) from sensitive to both to resistant to both, but still differential results favoring Bor or Car were observed (Fig 1D). The ex vivo results for the tested IMiDs were even more highly correlated (r = 0.79, P < 0.0001), with fewer samples showing greater sensitivity differentially to Len or Pom (data not shown). In patients at diagnosis, the ex vivo sensitivity to all drugs given during treatment led to significantly deeper clinical responses than those with resistance to ≥1 drugs received (Fig 1E). As an example of potential clinical utility of My-DST, the test for #847 at diagnosis identified sensitivity to PIs and resistance to IMiDs, which correlated with inadequate response to Len/Dex, followed by complete response (CR) after change to Bor/Dex (Fig 1F). Dara had ex vivo activity in most naïve patients, but patients already exposed showed significant acquired resistance (Fig 1G). We also found that CD38 expression was significantly lower in patients that showed ex vivo Dara resistance (Fig 1H). The ex vivo Dara activity was partially blocked by inhibiting macrophages with clodronate-liposomes (CL) (Fig 1I).Conclusion: My-DST on unselected MM BM aspirates with minimal perturbations ex vivo was clinically predictive of resistance to IMiDs and PIs. For the first time, this approach is able to measure the antibody-mediated cytotoxicity of daratumumab in clinical MM samples. Our data indicate that personalized regimens based on rapidly obtained ex vivo sensitivity may lead to optimized depth of clinical response. We next plan to translate this approach into clinical use in an effort to improve patient outcomes and avoid wasted time, money and complications that may arise from the use of ineffective drugs. [Display omitted] DisclosuresMark:Janssen, Takeda, Celgene, Amgen: Consultancy; BMS, Celgene: Research Funding; Celgene: Honoraria.

Abstract TMEM-035: GLYCOMARKERS FOR PREDICTING PLATINUM–DRUG RESPONSE IN OVARIAN CANCER

Abstract Platinum-based drugs (pt-drugs) continue to be the mainstay of first-line therapy for a wide range of cancers including ovarian carcinoma. Despite common applications, resistance to pt-drugs is an ongoing dilemma in cancer treatments, because tumor cells have different molecular characteristics that affect their responses to drugs. A molecular test that can accurately identify pt-drug resistance would provide invaluable guidance for chemotherapy strategy and reduce the random use of ineffective drugs. This would be a significant advancement in treatment management. Our studies address this unmet need in cancer care by introducing an innovative method to predict pt-drug resistance, before administrating the drug. Our method is based on a new concept linking glycan cell surface expression with drug reactivity. We have identified a glycan structure, namely Glycomarker 1, whose expression level on the cancer cell surface is associated with a response to first-line chemotherapy. A patent for this discovery has been issued by the US patent office in 2009(1). Flow cytometry with a series of fluorescent lectins was initially used to profile the cell surface glycans on three isogenic pairs of ovarian carcinoma cell lines, each pair consisting of parental chemosensitive cell lines, 2008, A2780, IGROV-1, and their corresponding resistant cell lines 2008/C13*5.25, A2780/CP and IGROV-1/CP, respectively. The cell surface glycan comparison revealed that the expression levels of Glycomarker 1 on resistant phenotypes were at least ten times lower than that of sensitive parental cells, on all three pairs of cell lines. Further experiments by various methods of fluorescent confocal microscopy (with fluorescently labeled cisplatin), colony forming assay, glycan modifications, and mass spectrometry confirmed the association of Glycomarker 1 with drug uptake by ovarian carcinoma cell lines(1). Lectin histochemistry (LHC) was adopted as a clinical method to test the Glycomarker 1 on human ovarian tissue samples. The LHC was optimized and validated for reproducibility, specificity, and sensitivity by colorimetric and fluorescent staining systems. The feasibility of LHC as a clinical test was evaluated on a training panel of 64 ovarian tissue sections. In retrospective studies, LHC correctly predicted drug-response in 22 out of 27 (81.4%) cancer specimens from patients with a known history of response to first-line chemotherapy. In the course of testing the clinical samples for Glycomarker 1, we identified another glycan structure, namely Glycomarker 2, whose expression pattern was strongly similar to that of the Glycomarker 1, suggesting the association of two glycan motifs with drug response. A patent for this discovery is pending in the US, Canada and European patent office(2). The ultimate objective of this work is to translate the assays to clinical tests used to predict platinum response in ovarian cancer. This is a novel direct predictive method, truly different from existing procedures, which will provide molecular information for treatment strategy. Thus far, our experiments have focused on ovarian cancer. However, evidence indicates that this method may also apply to other cancers that are treated with pt-drugs. 1) US patent #7585503 2) PCT patent # 20150024409, 01/22/2015 pending in the US, Canada &amp; Europe. Citation Format: Nahid Razi, Afshin Bahador, Nathalie Scholler and Nissi Varki. GLYCOMARKERS FOR PREDICTING PLATINUM–DRUG RESPONSE IN OVARIAN CANCER [abstract]. In: Proceedings of the 11th Biennial Ovarian Cancer Research Symposium; Sep 12-13, 2016; Seattle, WA. Philadelphia (PA): AACR; Clin Cancer Res 2017;23(11 Suppl):Abstract nr TMEM-035.

Initial assessment of the benefits of implementing pharmacogenetics into the medical management of patients in a long-term care facility.

The health care costs associated with prescription drugs are enormous, particularly in patients with polypharmacy (taking more than five prescription medications), and they continue to grow annually. The evolution of pharmacogenetics has provided clinicians with a valuable tool that allows for a smarter, more fine-tuned approach to treating patients for a number of clinical conditions. Applying a pharmacogenetics approach to the medical management of patients can provide a significant improvement to their care, result in cost savings by reducing the use of ineffective drugs, and decrease overall health care utilization. AltheaDx has begun a study to look at the benefits associated with incorporating pharmacogenetics into the medical management of patients who are on five or more medications. Applying pharmacogenetic guided PharmD recommendations across this patient population resulted in the elimination and/or replacement of one to three drugs, for 50% of the polypharmacy patient population tested, and an estimated US$621 in annual savings per patient. The initial assessment of this study shows that there is a clear opportunity for concrete health care savings solely from prescription drug management when incorporating pharmacogenetic testing.

Publication Bias Perpetuates Use of Ineffective Drugs in Stroke

Drugs approved and used for treatment of stroke vary from country to country. This is, at least, partly because of variation in the standards of evidence that is required for approval of drugs across countries. For example, some countries, usually low and middle income ones, approve a drug on the basis of a small positive study or post hoc subgroup analysis in a overall negative study, while others, usually high income countries, require confirmatory or replication studies before approving the same drug. Needless to say that such confirmatory or replication studies need to be published and adequately disseminated as soon as possible so that approval decisions can be revised in the light of additional evidence. However, this does not always happen. The new evidence often remains hidden in the form of nonpublication or abbreviated publication. Sometimes, it is published but with undue delay. What is worrisome is that these problems occur more often when the new evidence does not favor the new drugs than when it favors them, a manifestation of what is called 'publication bias.' This bias is well documented in the stroke research literature (1, 2).

Malaria Epidemics and Interventions, Kenya, Burundi, Southern Sudan, and Ethiopia, 1999–2004

Quantitative data on the onset and evolution of malaria epidemics are scarce. We review case studies from recent African Plasmodium falciparum epidemics (Kisii and Gucha Districts, Kenya, 1999; Kayanza Province, Burundi, 2000-2001; Aweil East, southern Sudan, 2003; Gutten and Damot Gale, Ethiopia, 2003-2004). We highlight possible epidemic risk factors and review delays in epidemic detection and response (up to 20 weeks), essentially due to poor case reporting and analysis or low use of public facilities. Epidemics lasted 15-36 weeks, and patients' age profiles suggested departures from classical notions of epidemic malaria everywhere but Burundi. Although emergency interventions were mounted to expand inpatient and outpatient treatment access, we believe their effects were lessened because of delays, insufficient evaluation of disease burden, lack of evidence on how to increase treatment coverage in emergencies, and use of ineffective drugs.

Postmortem Confirmation of Human Rabies Source

Postmortem Confirmation of Human Rabies Source

CONQUERING THE INTOLERABLE BURDEN OF MALARIA: WHAT’S NEW, WHAT’S NEEDED: A SUMMARY

Each year, up to three million deaths due to malaria and close to five billion episodes of clinical illness possibly meriting antimalarial therapy occur throughout the world, with Africa having more than 90% of this burden. Almost 3% of disability adjusted life years are due to malaria mortality globally, 10% in Africa. New information is presented in this supplement on malaria-related perinatal mortality, occurrence of human immunodeficiency virus in pregnancy, undernutrition, and neurologic, cognitive, and developmental sequelae. The entomologic determinants of transmission and uses of modeling for program planning and disease prediction and prevention are discussed. New data are presented from the Democratic Republic of the Congo, Tanzania, Ethiopia, and Zimbabwe on the increasing urban malaria problem and on epidemic malaria. Between 6% and 28% of the malaria burden may occur in cities, which comprise less than 2% of the African surface. Macroeconomic projections show that the costs are far greater than the costs of individual cases, with a substantial deleterious impact of malaria on schooling of patients, external investments into endemic countries, and tourism. Poor populations are at greatest risk; 58% of the cases occur in the poorest 20% of the world's population and these patients receive the worst care and have catastrophic economic consequences from their illness. This social vulnerability requires better understanding for improving deployment, access, quality, and use of effective interventions. Studies from Ghana and elsewhere indicate that for every patient with febrile illness assumed to be malaria seen in health facilities, 4-5 episodes occur in the community. Effective actions for malaria control mandate rational public policies; market forces, which often drive sales and use of drugs and other interventions, are unlikely to guarantee their use. Artemisinin-based combination therapy (ACT) for malaria is rapidly gaining acceptance as an effective approach for countering the spread and intensity of Plasmodium falciparum resistance to chloroquine, sulfadoxine/pyrimethamine, and other antimalarial drugs. Although costly, ACT ($1.20-2.50 per adult treatment) becomes more cost-effective as resistance to alternative drugs increases; early use of ACT may delay development of resistance to these drugs and prevent the medical toll associated with use of ineffective drugs. The burden of malaria in one district in Tanzania has not decreased since the primary health care approach replaced the vertical malaria control efforts of the 1960s. Despite decentralization, this situation resulted, in part, from weak district management capacity, poor coordination, inadequate monitoring, and lack of training of key staff. Experience in the Solomon Islands showed that spraying with DDT, use of insecticide-treated bed nets (ITNs), and health education were all associated with disease reduction. The use of nets permitted a reduction in DDT spraying, but could not replace it without an increased malaria incidence. Baseline data and reliable monitoring of key outcome indicators are needed to measure whether the ambitious goals for the control of malaria and other diseases has occurred. Such systems are being used for evidence-based decision making in Tanzania and several other countries. Baseline cluster sampling surveys in several countries across Africa indicate that only 53% of the children with febrile illness in malarious areas are being treated; chloroquine (CQ) is used 84% of the time, even where the drug may be ineffective. Insecticide-treated bed nets were used only 2% of the time by children less than five years of age. Progress in malaria vaccine research has been substantial over the past five years; 35 candidate malaria vaccines are in development, many of which are in clinical trials. Development of new vaccines and drugs has been the result of increased investments and formation of public-private partnerships. Before malaria vaccine becomes deployed, consideration must be given to disease burden, cost-effectiveness, financing, delivery systems, and approval by regulatory agencies. Key to evaluation of vaccine effectiveness will be collection and prompt analysis of epidemiologic information. Training of persons in every aspect of malaria research and control is essential for programs to succeed. The Multilateral Initiative on Malaria (MIM) is actively promoting research capacity strengthening and has established networks of institutions and scientists throughout the African continent, most of whom are now linked by modern information-sharing networks. Evidence over the past century is that successful control malaria programs have been linked to strong research activities. To ensure effective coordination and cooperation between the growing number of research and control coalitions forming in support of malaria activities, an umbrella group is needed. With continued support for scientists and control workers globally, particularly in low-income malarious countries, the long-deferred dream of malaria elimination can become a reality.

Nosocomial infection of scabies in national hospitals and sanatoria in Japan

The aim of this study was to investigate cases of nosocomial infection of scabies in the national hospitals in Japan. Questionnaires sent to 183 hospitals and sanatoria were returned by 93. Fifty-three cases in 24 institutions of nosocomial infection were reported in the past 5 years. No nosocomial infection was reported from 7 sanatoria for Hansen's diseases where the patients were relatively older and had higher ADL scores. It took 7.5 weeks on the average to eliminate nosocomial infection and more than 8 weeks were required to control them in the hospitals where more than 10 cases had occurred. Benzyl benzoate, gamma benzene hexachloride, and Pyrethroids, which were not approved as drugs for the treatment of scabies in Japan, were used in the all institutions where nosocomial infection occurred except for one institution. Problems to be solved were as follows; (1) delay of diagnosis and treatment, (2) lack of nursing staff, (3) difficulties of complete isolation due to lack of spaces, inability of patients to understand the need for isolation and also the psychological instability of the isolated patients, (4) recurrence due to the use of ineffective drugs, (5) insufficient information about the prevalence of scabies in the previous institutions, (6) misdiagnosis of non-scabies patients with itchy skin rash as the scabies, (7) inconsisitent care due to poor evaluation of skin lesions.

The ESP culture system for drug susceptibilities of Mycobacterium avium complex

To validate the non-radiometric, broth-based ESP system for determining Mycobacterium avium complex (MAC) susceptibilities. MAC isolates from sterile body sites of 20 adult HIV-infected patients who were failing their present MAC regimen were identified. Susceptibilities were determined and comparisons made between the agar proportion method and the ESP system for clarithromycin, ethambutol, sparfloxacin and cycloserine. Ninety-nine percent of the MICS generated by the ESP system user identical to or lower than the MICs determined by the agar proportion In vitro resistance was documented by the ESP system for 86% of the drugs that patients were taking at the time of breakthrough, and no resistance was seen to cycloserine, a drug that no patient was taking. The ESP system, a fast and reliable method for determining MAC susceptibilities, could be used to optimize MAC regimens in a timely fashion, avoid the use of ineffective drugs, minimize emerging resistance and ultimately improve outcome.

Treatment of Unclassified Mycobacteria-Reply

The statement referred to by Dr. Vishnevsky may be misleading, a not infrequent consequence of brevity necessary in editorial remarks. Enlarging upon this statement may dispel any confusion. Chemotherapy has a definite place in management of human infections caused by unclassified mycobacteria. Although this chemotherapy is based on same general principles utilized in treatment of tuberculosis, agents employed may differ. The frequent drug resistance of unclassified mycobacteria often dictates use of a wide variety of agents that are seldom used in therapy of classical pulmonary tuberculosis. Treatment failures can be common, particularly in infections with Group III (Battey strain) organisms. Prolonged use of ineffective drugs can be dangerous and unwarranted. The statement referred to by Dr. Vishnevsky was intended to refute occasionally voiced opinion that the failure to properly identify mycobacterium infecting a patient is of little consequence,