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The ivory towers are as resilient as ever

BMJ 2005; 331 doi: (Published 28 July 2005) Cite this as: BMJ 2005;331:299
  1. Martin Vaughan, general practitioner (
  1. Measham, Leicestershire

    I have a patient called Betty. Betty is 75 and is weighed down by more than her share of troubles. She has had severe rheumatoid arthritis for as long as I have known her—which is approaching 30 years. Her pains, which are still severe despite hip and knee replacements, have been augmented by the recent death of her husband. Now she faces a further hurdle: the painkiller that is most effective for her is about to be withdrawn.

    The profits on co-proxamol are tiny, so which drug company is going to do serious studies to promote it?

    Over the years Betty has tried all the second line agents, as well as most of the non-steroidal anti-inflammatory drugs and every combination of analgesics from paracetamol up to morphine. However, every time we have a change of painkillers she always comes back to co-proxamol as being the one that helps her most.

    I know this flies in the face of all the “evidence,” but …

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