Children have returned to school and are bringing home stories about the things they learned and the friends they made. But some parents are concerned they could also be bringing home a tiny nuisance — lice.
Though schools are not the only place transmission occurs, the Centers for Disease Control and Prevention says head lice infestations in the U.S. are most common among preschool and elementary-age children.
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Jacob Anthon demonstrates the use of an FDA-cleared device that uses a combination of airflow temperature, speed, and direction to kill lice and eggs at Lice Clinics of America in Sugar Land, Texas, on Monday, Sept. 22, 2025. (AP Photo/Lekan Oyekanmi)
Jacob Anthon demonstrates the use of an FDA-cleared device that uses a combination of airflow temperature, speed, and direction to kill lice and eggs at Lice Clinics of America in Sugar Land, Texas, Monday, Sept. 22, 2025. (AP Photo/Lekan Oyekanmi)
Jacob Anthon demonstrates the use of an FDA-cleared device that uses a combination of airflow temperature, speed, and direction to kill lice and eggs at Lice Clinics of America in Sugar Land, Texas, Monday, Sept. 22, 2025. (AP Photo/Lekan Oyekanmi)
Jacob Anthon demonstrates the use of an FDA-cleared device that uses a combination of airflow temperature, speed, and direction to kill lice and eggs at Lice Clinics of America in Sugar Land, Texas, Monday, Sept. 22, 2025. (AP Photo/Lekan Oyekanmi)
Jacob Anthon demonstrates the use of an FDA-cleared device that uses a combination of airflow temperature, speed, and direction to kill lice and eggs at Lice Clinics of America in Sugar Land, Texas, Monday, Sept. 22, 2025. (AP Photo/Lekan Oyekanmi)
Since the middle of August when students began returning to school, more people have searched Google for information about the blood-sucking parasites and are seeking answers to common questions about how to prevent and treat infestations, according to Google Trends. The CDC estimates there are up to 12 million head lice infestations annually in the U.S. infecting children between 3 to 11 years old.
Experts say there is a lot of misinformation about lice. Here are the experts' answers to commonly asked questions:
Head lice are parasitic insects that feed on human blood, but they are difficult to find because they are very small, move quickly and avoid light. The hallmark symptom that indicates there might be an infestation is new and onset itching of the scalp, said Dr. Danilo C. Del Campo, a dermatologist in Chicago and a fellow of the American Academy of Dermatology.
The eggs, commonly called nits, can be yellow, brown or tan and look like tiny seeds, but when hatched will appear clear, experts say. An infestation can often be confused with dandruff or seborrheic dermatitis.
Becky Boudreau, a head lice technician in New Hampshire, says because lice are most active at night, parents may notice their children scratching more then or not sleeping well. She said it may take longer to recognize a lice infestation in children who have a high pain tolerance or are less reactive to insect bites.
There is no set number of lice that would classify as an infestation, either you have lice, or you don't, experts say.
Treatments to get rid of the insects include medication and specialists who use different methods to manually remove the eggs and adult lice. Depending on the age and temperament of the child, access to clinics or technicians, the cost and the severity of the infestation, including any sensitivities, will determine the most appropriate treatment option.
Many people hire nit pickers or visit clinics because they don't want to handle the insects, Boudreau said.
“It is still successful, but it is time consuming,” said Boudreau, who became a head lice technician about six years ago after her child had an infestation.
Dr. Krista Lauer, national medical director for Lice Clinics of America, says their clinics have become another option. They use an FDA-cleared medical device that uses a combination of airflow temperature, speed and direction to kill lice and their eggs. Technicians consider children's heat sensitivity or restlessness, but for the treatment to be successful, they must use the device in a specific pattern before combing out the dead debris and using a washable topical substance, she said.
Boudreau, who uses shampoo, olive oil and a special comb to assist in combing out the insects, says many of the over-the-counter kits “are designed to fail" and often require multiple uses for this reason. Guidelines from the American Academy of Dermatology Association recommend retreating for any product that can be bought without a prescription, and that no approved method can kill lice and their eggs during the first treatment.
As long as people are using products, like shampoos, as indicated on their labels they should be OK, said Del Campo, who is board certified by the American Board of Dermatology. He emphasized that many of these products have been tested and approved by the Food and Drug Administration. Some of those products include benzyl alcohol lotion which only kills lice and not the eggs, ivermectin lotion, malathion lotion, and lindane shampoo which can be toxic if used incorrectly.
But he said many dermatologists don’t jump to using the lice combs or other procedure-based treatments because it often takes a lot of time and energy for parents, requires multiple applications and is not consistent across hair types. Instead, he said there are “effective over-the-counter medications that require no prescription, require no doctor guidance and are a wonderful first step for parents.”
There is no scientific evidence that home remedies like smothering hair with oil, mayonnaise or something occlusive can kill lice or their eggs, experts say.
Adult lice can live for about 30 days on their hosts' heads. However, experts say they will die within two days if they fall off a person and cannot feed. Their eggs can take up to nine days to hatch and from there another seven days to mature into adult lice.
Lice cannot hop, jump or fly and are mostly spread through head-to-head contact where the parasites can crawl from one host to another, experts say.
The CDC suggests machine wash and dry clothing, don't use infected hair products, furniture or toys, and clean where infested people were. But their guidance also says it is less likely that lice could be spread through used products.
“Most of the jobs I get called to are in my families’ homes and I can’t get these bugs home quick enough from a job to take their pictures or study them because they die so quickly without the heat and blood from their hosts,” Boudreau said.
Students with head lice infestation do not need to be sent home early from school, the CDC says. Students can go home at the end of the day and return to class once beginning treatment. Experts say successful treatments will kill crawling lice but that nits might still be present.
Del Campo said parents need to be advocates for their children because there are many outdated school policies forcing them to miss more school than they need to, including requiring all eggs to be removed before returning to class, which he says is not necessary.
“Lice are not dangerous. They don’t spread disease. There’s no medical reason to remove a child immediately from a classroom,” he said. “By the time lice are noticed, they've often been present for weeks — not days or even hours."
He says it is likely that adults have some level of trauma from dealing with lice when they were children and when there were fewer effective treatments, and misconceptions about the parasites often add to the stigma and accompanying embarrassment affected people might feel.
“What people went through and are carrying with them is understandably miserable, but it is very different today,” he said, adding that lice are not associated with hygiene, disease or economic status.
Jacob Anthon demonstrates the use of an FDA-cleared device that uses a combination of airflow temperature, speed, and direction to kill lice and eggs at Lice Clinics of America in Sugar Land, Texas, on Monday, Sept. 22, 2025. (AP Photo/Lekan Oyekanmi)
Jacob Anthon demonstrates the use of an FDA-cleared device that uses a combination of airflow temperature, speed, and direction to kill lice and eggs at Lice Clinics of America in Sugar Land, Texas, Monday, Sept. 22, 2025. (AP Photo/Lekan Oyekanmi)
Jacob Anthon demonstrates the use of an FDA-cleared device that uses a combination of airflow temperature, speed, and direction to kill lice and eggs at Lice Clinics of America in Sugar Land, Texas, Monday, Sept. 22, 2025. (AP Photo/Lekan Oyekanmi)
Jacob Anthon demonstrates the use of an FDA-cleared device that uses a combination of airflow temperature, speed, and direction to kill lice and eggs at Lice Clinics of America in Sugar Land, Texas, Monday, Sept. 22, 2025. (AP Photo/Lekan Oyekanmi)
Jacob Anthon demonstrates the use of an FDA-cleared device that uses a combination of airflow temperature, speed, and direction to kill lice and eggs at Lice Clinics of America in Sugar Land, Texas, Monday, Sept. 22, 2025. (AP Photo/Lekan Oyekanmi)
WASHINGTON (AP) — The Food and Drug Administration commissioner's effort to drastically shorten the review of drugs favored by President Donald Trump's administration is causing alarm across the agency, stoking worries that the plan may run afoul of legal, ethical and scientific standards long used to vet the safety and effectiveness of new medicines.
Marty Makary's program is causing new anxiety and confusion among staff already rocked by layoffs, buyouts and leadership upheavals, according to seven current or recently departed staffers. The people spoke to The Associated Press on the condition of anonymity because they were not authorized to discuss confidential agency matters.
At the highest levels of the FDA, questions remain about which officials have the legal authority to sign off on drugs cleared under the Commissioner’s National Priority Voucher program, which promises approval in as little as one month for medicines that support “U.S. national interests.”
Traditionally, approval decisions have nearly always been handled by FDA review scientists and their immediate supervisors, not the agency’s political appointees and senior leaders.
But drug reviewers say they've received little information about the new program's workings. And some staffers working on a highly anticipated anti-obesity pill were recently told they can skip certain regulatory steps to meet top officials' aggressive deadlines.
Outside experts point out that FDA drug reviews — which range from six to 10 months — are already the fastest in the world.
“The concept of doing a review in one to two months just does not have scientific precedent,” said Dr. Aaron Kesselheim, a professor at Harvard Medical School. “FDA cannot do the same detailed review that it does of a regular application in one to two months, and it doesn’t have the resources to do it.”
On Thursday Reuters reported that FDA officials have delayed the review of two drugs in the program, in part due to safety concerns, including the death of a patient taking one of the medications.
Health and Human Services spokesman Andrew Nixon said the voucher program prioritizes “gold standard scientific review” and aims to deliver “meaningful and effective treatments and cures."
The program remains popular at the White House, where pricing concessions announced by the Republican president have repeatedly been accompanied by FDA vouchers for drugmakers that agree to cut their prices.
For instance, when the White House announced that Eli Lilly and Novo Nordisk would reduce prices on their popular obesity drugs, FDA staffers had to scramble to vet new vouchers for both companies in time for Trump's news conference, according to multiple people involved in the process.
That’s sparked widespread concern that FDA drug reviews — long pegged to objective standards and procedures — have become open to political interference.
“It’s extraordinary to have such an opaque application process, one that is obviously susceptible to politicization,” said Paul Kim, a former FDA attorney who now works with pharmaceutical clients.
Many of the concerns around the program stem from the fact that it hasn't been laid out in federal rules and regulations.
The FDA already has more than a half-dozen programs intended to speed up or streamline reviews for promising drugs — all approved by Congress, with regulations written by agency staff.
In contrast, information about the voucher program is mostly confined to an agency website. Drugmakers can apply by submitting a 350-word “statement of interest.”
Increasingly, agency leaders such as Dr. Vinay Prasad, the FDA’s top medical officer and vaccine center director, have been contacting drugmakers directly about awarding vouchers. That’s created quandaries for FDA staffers on even basic questions, such as how to formally award a voucher to a company that didn’t request one.
Nixon, the HHS spokesman, said that voucher submissions are evaluated by “a senior, multidisciplinary review committee,” led by Prasad.
Questions about the legality of the program led the FDA’s then-drug director, Dr. George Tidmarsh, to decline to sign off on approvals under the pathway, according to several people with direct knowledge of the matter. Tidmarsh resigned from the agency in November after a lawsuit challenging his conduct on issues unrelated to the voucher program.
After his departure, Sara Brenner, the FDA’s principal deputy commissioner, was set to have the power to decide, but she also declined the role after looking further into the legal implications, according to the people. Currently the agency’s deputy chief medical officer, Dr. Mallika Mundkur, who works under Prasad, is taking on the responsibility.
Giving final approval to a drug carries significant legal risks, essentially certifying that the medicine meets FDA standards for safety and effectiveness. If unexpected safety problems later emerge, both the agency and individual staffers could be pulled into investigations or lawsuits.
Traditionally, approval comes from FDA drug office directors, made in consultation with a team of reviewers. Under the voucher program, approval comes through a committee vote by senior agency leaders led by Prasad, according to multiple people familiar with the process. Staff reviewers don't get a vote.
“It is a complete reversal from the normal review process, which is traditionally led by the scientists who are the ones immersed in the data,” said Kesselheim, who is a lawyer and a medical researcher.
Not everyone sees problems with the program. Dan Troy, the FDA’s top lawyer under President George W. Bush, a Republican, says federal law gives the commissioner broad discretion to reorganize the handling of drug reviews.
Still, he says, the voucher program, like many of Makary’s initiatives, may be short-lived because it isn't codified.
“If you live by the press release then you die by the press release,” Troy said. “Anything that they’re doing now could be wiped out in a moment by the next administration.”
Initially framed as a pilot program of no more than five drugs, it has expanded to 18 vouchers awarded, with more under consideration. That puts extra pressure on the agency’s drug center, where 20% of the staff has left through retirements, buyouts or resignations over the past year.
When Makary unveiled the program in October there were immediate concerns about the unprecedented power he would have in deciding which companies benefit.
Makary then said that nominations for drugs would come from career staffers. Indeed, some of the early drugs were recommended by FDA reviewers, according to two people familiar with the process. They said FDA staffers deliberately selected drugs that could be vetted quickly.
But, increasingly, selection decisions are led by Prasad or other senior officials, sometimes unbeknownst to FDA staff, according to three people. In one case, FDA reviewers learned from GlaxoSmithKline representatives that Prasad had contacted the company about a voucher.
Access to Makary is limited because he does not use a government email account to do business, according to people familiar with the matter, breaking with longstanding precedent.
Once a voucher is awarded, some drugmakers have their own interpretation of the review timeline — creating further confusion and anxiety among staff.
Two people involved in the ongoing review of Eli Lilly's anti-obesity pill said company executives initially told the FDA they expected the drug approved within two months.
The timeline alarmed FDA reviewers because it did not include the agency's standard 60-day prefiling period, when staffers check the application to ensure it isn’t missing essential information. That 60-day window has been in place for more than 30 years.
Lilly pushed for a quicker filing turnaround, demanding one week. Eventually the agency and the company agreed to a two-week period.
Nixon declined to comment on the specifics of Lilly's review but said FDA reviewers can “adjust timelines as needed.”
Staffers were pushed to keep the application moving forward, even though key pieces of data about the drug's chemistry appeared to be missing, according to one person involved in the process. When reviewers raised concerns about some of the gaps during an internal meeting, the person said, they were told by a senior official: “If the science is sound then you can overlook the regulations.”
Former reviewers and outside experts say that approach is the opposite of how FDA reviews should work: By following the regulations, staffers scientifically confirm the safety and effectiveness of drugs.
Skipping review steps could also carry risks for drugmakers if future FDA leaders decide a drug wasn’t properly vetted. Like other experts, Kesselheim says the program may not last beyond the current administration.
“They are fundamentally changing the application of the standards, but the underlying law remains what it is,” he said. “The hope is that one day we will return to these scientifically sound, legally sound principles.”
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.
FILE - The Food and Drug Administration seal is seen at the Hubert Humphrey Building Auditorium in Washington, April 22, 2025. (AP Photo/Jose Luis Magana, File)
Dr. Marty Makary, commissioner of the Food and Drug Administration, speaks during a press briefing at the White House, Wednesday, Jan. 7, 2026, in Washington. (AP Photo/Jacquelyn Martin)
