Nabilone is an effective oral anti-emetic drug for moderately toxic chemotherapy, but the range and unpredictability of its side-effects warrant caution in its use.

Irritable bowel syndrome, for instance, was recently reported to be largely a manifestation of food intolerance.7 Despite this, and the extravagant claims recently made for food allergy notwithstanding, it is likely that food allergy is an underdiagnosed condition.8 This may, however, be obscured by the exaggerated impression of prevalence gained from studies involving highly selected population samples. Without previous regard to the mechanism involved, we therefore proposed to seek specific food intolerance among patients with unexplained gastrointestinal symptoms.One of the reasons for the scepticism surrounding the subject of food intolerance is the absence of simple and reliable tests for diagnosis. Double blind food challenges are required to establish diagnosis and a number of techniques using this approach are available. In view of the recognition that food induced symptoms may be delayed9 10 and to ensure, therefore, that chronic food intolerance sufferers with late onset of symptoms were not missed, we used food challenges over one week periods, repeated as necessary if more than one food was suspected. The challenges were double blind and placebo controlled.

About 2 per cent of adults have active chronic otitis media, the majority being managed by medical means. Previous controlled studies have been unable to show benefit from any medication, including systemic or topical antibiotics, but the effect of the addition of topical steroids to the latter has never been evaluated.One hundred and sixty three adults with active chronic otitis media were randomly allocated to receive either antibiotic/steroid ear drops or placebo therapy over a 4–6 week period. Fifty-two per cent of ears receiving active therapy, as opposed to 30 per cent on placebo therapy (p<0.05), became otoscopically inactive if compliance to medication was greater than 70 per cent. However, when there was an open mastoid cavity, active therapy was no more successful than placebo. Though gentamicin was the antibiotic used, there was no evidence of ototoxic inner ear damage.Surprisingly, correlation between clinical activity and patient report of a discharge was poor. Forty percent of both treatment groups considered that their ear had become dry following therapy and these were not the same patients whose ears had become otoscopically inactive.

Controlled trial of medical treatment of active chronic otitis media Active chronic otitis media is a common condition affecting 0 6%,' of adults in the United Kingdom. Initial management is usually by general practitioners, who annually prescribe systemic and topical antibiotics on at least 178 000 and 73 000 occasions respectively (unpublished observations). Despite this there have been few studies of the efficacy of antibiotics,'-4 and no study has included a control group of untreated patients or of patients treated solely by aural toilet. We undertook a controlled study comparing appropriate systemic or topical antibiotic treatment with weekly aural toilet and insufflation of boric acid and iodine powder.

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