The companies proclaimed that with nearly total certainty all the things was the result of bias and confounding. Even for a sceptic at the time, that was an unreasonable position: all four research had been reasonably executed and had withstood criticism in the Committee on Safety of Medicines and reviewers of leading journals. Hence, the companies’ position ran the high danger ofMorphine induced allodynia in youngster with brain tumourSigns are a lot more most likely to possess been as a consequence of underlying medical situation Editor–Heger et al remind readers that high doses of morphine may have paradoxical effects.1 We’re surprised, having said that, in the choice of patient they use to illustrate this lesson. The diagnosis of discomfort in an infant depends solely on the observation of his or her behaviour.two It’s especially hard to diagnose discomfort, let alone characterise it as allodynia, within a 9 month old infant with considerable neurological deficit and raised intracranial pressure. The authors try to justify the diagnosis of allodynia in just such a patient. Furthermore, higher dose morphine is properly reported as a cause of rigidity, catalepsy, akathisia, and myoclonus, which need to add towards the difficulty of interpreting pain around the basis of observation alone.3 Two inconsistencies within the case history undermine the speculative diagnosis. Firstly, the signs of distress provoked by routine nursing that have been interpreted as allodynia induced by morphine-3glucuronide have been also recorded just before morphine was provided. Secondly, when the morphine dose was reduced the patient received methotrimeprazine, dexamethasone, and dypirone, each of which could have eased the signs of distress. The patient’s distress had resolved inside per week with this new remedy regimen, but the raised ratioBMJ VOLUME 320 five FEBRUARY 2000 http://www.bmj.comLettersdamaging both their item and their credibility. Their behaviour is reminiscent of that described by Barbara Tuchman in 1984 within the March of Folly: from Troy to Vietnam, in which rulers turn out to be removed from reality and continuously act against their own finest interests in spite of clear warnings. Considering the fact that 1995 3 multinational businesses have employed huge marketing sources to sow confusion. An avalanche of particular symposia and paid supplements convinced outsiders that something had to become incorrect with the research obtaining the larger risks. Several basic practitioners, gynaecologists, and family planners were swayed into accepting methodological arguments that sounded logical for the reason that of their legitimate concern with fantastic contraception. Nevertheless, couple of are really educated inside the intricacies of epidemiological arguments. The corporations exerted strong legal stress on governments. Irresponsible scientists were accused of obtaining caused a pill scare by Z-VAD-FMK juxtaposing selected figures without showing longer time trends in undesirable pregnancies. Irrelevant comparisons abounded, as together with the risk of thrombosis in pregnancy. The industry’s view on bias and confounding was disproved by the World Well being Organisation’s scientific committee of major epidemiologists who weren’t involved in the controversy.5 Provided the pervasiveness of the competing interest brought on by market funding, BMJ readers must know whose words they study.Jan P Vandenbroucke professor, division of clinical epidemiology [email protected] Frans M Helmerhorst lecturer, division of obstetrics, gynaecology, and reproductive medicine F.