BMJ 1999; 318 doi: (Published 19 June 1999) Cite this as: BMJ 1999;318:1706
  1. Christopher Martyn (cmartyn{at}
  1. BMJ
    • Non-steroidal anti-inflammatory drugs work their magic by inhibiting cyclo-oxygenase, an enzyme vital to the synthesis of prostaglandins. Actually, there are two isoforms of the enzyme:cyclo-oxygenase-1, which has a physiological role in many tissues, including protection of the gastric mucosa, and cyclo-oxygenase-2, which is induced by proinflammatory stimuli. The older generations of non-steroidal anti-inflammatory drugs inhibited both isoforms, so it is not surprising that adverse effects are common. Selective cyclo-oxygenase-2 inhibitors promise anti-inflammatory activity without gastrointestinal and renal toxicity. The Clinical Significance and Potential of Selective COX-2 Inhibitors (ed J Vane, R Botting, William Harvey Press, £50, ISBN 0 9534039 0 4) reviews current knowledge of these agents. Most interesting are their potential applications in treating preterm labour and Alzheimer's disease.

    • Here's a tough assignment. Write a handbook advising mariners on how to deal with medicalemergencies that might arise among their crew. Remember that they might have to cope for many days before the casualty can be hospitalised, that the problem might occur anywhere in the world, and that they will have had little or no medical training. The Ship Captain's Medical Guide (The Stationery Office, £33, ISBN 0 11 551658 1) is now inits 22nd edition and covers everything from the acute abdomen to zinc oxide ointment, with burial at sea, jellyfish stings, and trigeminal neuralgia somewhere in between.

    • Clinical Effectiveness Made Easy (R Chambers, Radcliffe Medical Press, £17.95, ISBN 1 85775 316 X) is based on the author's experience of running workshops for primary and community care practitioners. Its intention is to guide and encourage general practitioners who are taking their first steps into critical appraisal and evidence based medicine.

    • According to the publisher's blurb, a second edition of Rehabilitation of the Physically Disabled Adult (C J Goodwill, M A Chamberlain, and C Evans, Stanley Thornes,£42.50, ISBN 0 7487 3183 0) was needed to reflect rapidly changing treatment and legislation over the past 10 years in the context of social, technological, and political change. Well, perhaps. But what stands out by omission is how few of the recommended treatments are evidence based.

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