Be bold and be sensible

doi:10.1136/bmj.327.7414.0-g

BMJ 2003;327 (6 September), doi:10.1136/bmj.327.7414.0-g

Editor's choice

Be bold and be sensible

The first 150 words of the full text of this article appear below.

"Fortune assists the bold," wrote Virgil, thinking of the Trojanwars not of medicine. But there is room for boldness in medicine,and I see examples in this BMJ.

The Global Initiative on Chronic Obstructive Lung Disease—apretentiously named outfit that must have slavered over itsacronym GOLD and which is backed by the National Institutesof Health and the World Health Organization—warns againstusing opioids in managing patients with dyspnoea and chronicobstructive pulmonary disease (p 523). We all know that opioidsare respiratory depressants and that such patients have almostno respiratory reserve. Yet some experienced doctors believethat morphine can help patients with refractory dyspnoea. Abold group from Australia has now conducted an adequately poweredcrossover trial of oral morphine against placebo in patientswith refractory dyspnoea in whom the underlying aetiology ismaximally treated (p 523). The morphine produced important . . . [Full text of this article]

Richard Smith, editor

rsmith@bmj.com

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