The NEJM Study was done in the very early 2000's before the Picaradin was approved in 2005 for sale in the US. For me the key takeaway and real learning for me. Is how short the window of time the products and snake oil so many of us have been using for years. For decades I carried the near worthless Skin So Soft so many claims does all these great things.

The data shows DEET will help protect against a broader list of critters. DEET will repel ticks, Picaradin does not show that benefit. Data does show Picaradin does work with mosquitos as long as you use enough and apply the Picaradin often.

Quote

"When it comes to picaridin, recent studies have indicated that a concentration of 7 percent is equivalent to about 10 percent DEET (one to two hours of protection), and a 20 percent concentration offers the same protection (four to five hours) as an equivalent DEET concentration."

If you want protection from bugs. Skip all the gimmicks and marketing. Get something with a high >20% content of Picaradin or DEET. Apply the stuff before you get to the Carribean. Apply the stuff after each time you get wet, apply the stuff when you get up, apply the stuff before you go to bed, most importantly apply the stuff before you go ashore or around other people. If you want the stuff to work, You need a lot, you need it early, you need it often.

I was hoping the NEJM study would get the message across. Throw away all the Skin So Soft and all the "natural" stuff there is no science data that shows they work. In fact the data shows they do not and put the users of those products at risk for insect born disease.