On a State level, the struggle continues. One State Health Department's document, 'Olive Oil Treatment for Headlice' widely circulated by schools, recommends olive oil on 7 days in a 21 day period, to kill headlice. (The oil is applied generously to the hair, left on for 8 hours or overnight.) Schools claim that the treatment is a safe and effective, and issue the Health Department document to support their claim. The Health Department says, without qualification, that olive oil is a "safe and effective way to kill head lice" and quotes Harvard University to support their claim. Harvard University (School of Public Health) says "...we do not recommend the use of olive oil...as a treatment for headlice". In the words of the National Pediculosis Association (USA) "There is no Harvard study on this method. We raise this issue not because we oppose the use of olive oil per se, but because we need to keep the record straight." We agree! Dermatologists have expressed worry about the amount of detergent needed to wash olive oil out of the hair. 

Health care workers should realise that apart from product efficacy, patient acceptability is vital, and a treatment that is both practical and comfortable is more likely to be used correctly than an alternative that is neither. There are a number of approved essential-oils treatments which are safe, and effective to varying degrees. 

In the USA there is a bold and rational approach by government agencies. The USA Government's Division of Parasitic Diseases provides consumers with timely updates on what works & what does not. For example, about pyrethrins and permethrin, it states that "Treatment failures are common." 

The USA Bureau of Consumer Protection (BCP) is very active on false and unsubstantiated claims on products, particularly those which claim to kill lice and eggs in a single treatment. Of interest to Australians, is that a multinational company, forced to change its misleading labelling in the USA, has not bothered to extend its legal or moral obligation on the same product for Australian consumers. The BCP also took action against a manufacturer whose lice and nit combs were laboratory tested by specially trained people to get 100% results. The BCP forced the manufacturer to issue a consumer notice that ordinary mums and dads using the comb would probably not get the advertised results. 

In the United Kingdom, a high level of resistance of headlice to both permethrin and malathion was officially reported in 1999 in the British Journal of Dermatology. This double-resistance confirms what many people have claimed for a long time - that some well established and widely recommended pesticides do not always work effectively. Headlice have adapted to resist the effects of pesticides and poisons that used to kill them. 

Recently, the Australian Therapeutic Goods Administration (TGA) commenced a project to establish evidence-based guidelines for the regulation of headlice products. The review will include appropriate packaging and labelling to ensure safe and effective use in the community. The project was prompted by reports of headlice products being ineffective, giving harmful reactions, and perhaps encouraging resistance to develop.