Desk method: Open → Annotate → Countersign → Seal

The names are bench shorthand. They stuck, so they are printed here.

1. Open

A first draft is pulled from primary sources - pivotal trials, regulator documents, the live label. The prose is written for this desk. If a claim cannot be traced, it does not survive the opening pass.

2. Annotate

The draft is checked against the current FDA prescribing information, line by line. Doses, half-lives, contraindications, interaction lists - each number must match the label or carry a plain explanation of why it differs. When literature and label disagree, the letter says so out loud.

3. Countersign

Dr. Nora Lindqvist, MD reads the page the way she read charts on rounds: would this counselling survive a real Tuesday? Sections that are technically correct but practically useless get rewritten. This pass also sets the sealed date under every title.

4. Seal

The letter is released and dated. It is not finished. Labels get revised, and when one does, the page returns to annotate. The date on the snapshot tells you how fresh the last full review is.

What this method cannot do: know your kidneys, your other medicines, your chart. Use the letters to ask sharper questions, then take those questions to your prescriber or pharmacist.