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This issue of Bandolier may look a little different. The reason for that is that after 10 years of setting the print version on a programme called PageMaker, we have moved to the latest system called InDesign. As with many enormously complex programmes we only use a fraction of its capability. The problem is knowing what parts and where to find them. And then there is the blind trust that they will work, and the confusion and disappointment when the one thing one wants to work doesn't.

Pause for thought

Evidence can be the same. We can go on happily doing something for years and be brought up short by evidence that makes us wonder. This month Bandolier spends a bit of time looking at the evidence around paracetamol (acetaminophen for US readers) in osteoarthritis. Two systematic reviews and several recently-published RCTs question whether there is any difference between paracetamol and placebo. Larger, longer, and better trials consistently say no.

We need to stop and think here. We know that paracetamol is an analgesic in acute pain, and in some shorter but smaller and less good studies in osteoarthritis. Is this a paracetamol problem, or a trial sensitivity problem? Either way it suggests we put on our thinking caps.

Keeping taking the medicine

Bandolier continues to be intrigued by the large proportion of patients who do not take prescribed medicines. This issue of compliance has large repercussions, for individual patients and for health services. There are big costs involved. And we know that compliance is not the 'in' word, and that using compliance, concordance, or adherence as synonyms will get us into trouble with someone. Whatever, evidence and insight are more important than labels here.

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