Co-lumbo, and co-nstipation

When Kojak walked out of the surgery sporting a magnificent mullet, word of my semi-miraculous skills soon got around to the other great detectives. Most of the cases were straightforward: Cannon was underweight (the camera is fattening), Batman had a rubber allergy, and Porfiry Petrovich had diarrhoea after a bad bowl of borscht.

But Columbo? It seemed an uncomplicated tension headache, so I gave him some general advice on lifestyle changes and a prescription for co-codamol. “That’s great, wonderful,” he said, “thank you, Doctor, you’ve been very helpful.”

Then, at the door, he turned, with a swirl of his shabby raincoat.

“Just one more thing, Doctor,” he said, “A small thing; but it’s been annoying me. Co-codamol: that’s a combination of paracetamol and codeine isn’t it?”

“Exactly, Lieutenant,” I said, in the patronising “pride before a fall” manner demanded by cinematic tradition. “Just to give it that extra punch; like the adverts, you know: zap! Kapow!”

“Yes, of course, you’re right,” he said. “But there are a couple of loose ends I’d like to tie up; nothing important, you understand. I was checking out codeine as an analgesic, and it seems the dose is 30 to 60 mg every 4 to 6 hours.”

“Yes,” I said uncomfortably, beginning to see where this was heading.

“Yet,” he continued, “The dose of codeine in my prescription and in the adverts is only 8 mg.”

“Indeed,” I said weakly. “For that extra punch, you know.”

“But 8 mg of codeine has marginal analgesic value.”

“Indeed,” I said, like a rat in a corner.

“Indeed yes or indeed no,” he asked, more sharply.

“Yes,” I said wretchedly, breaking down at last and blurting out my confession (because some conventions must be observed). “Okay, it’s a fair cop, we use co-codamol because it sounds better than just paracetamol, which though undoubtedly effective, has suffered due to its ubiquity. It adds a bit of mystique and helps the placebo effect. Drug companies, I’m sure, share the same selfless motivation, and it’s purely incidental that it makes them loads of money.”

“So, to conclude,” said Columbo, “There are no advantages to co-codamol over paracetamol” (MeReC Bulletin2000;11:1-4R).

“Not exactly, Lieutenant,” I protested. “Not if you enjoy being constipated.”


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