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How should we react to adverse drug reactions?
  1. R E Ferner,
  2. K Beard
  1. West Midlands Centre for Adverse Drug Reactions, City Hospital, Birmingham, UK
  1. Correspondence to Professor R E Ferner, West Midlands Centre for Adverse Drug Reactions, City Hospital, Birmingham B18 7QH, UK; r.e.ferner{at}bham.ac.uk

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Introduction

Terry Herbert was sweeping a field in Staffordshire with his metal detector in July 2009 when he stumbled on a horde of hundreds of Anglo-Saxon gold and silver ornaments, richer than any discovered since the Second World War. He said it ‘was what metal detectorists dream of.’ Detectorist is a useful neologism. It might be applied to the scientists who scan the fields of spontaneous reports of suspected adverse drug reactions, such as the UK Yellow Card reports, in the search for signs of possibly unknown reactions.

Regulation of medicines

These detectorists are responsible for an important aspect of post-marketing surveillance of safety of medicines. They supplement the system of licensing of medicines. To obtain a licence for a medicine, the applicant has to satisfy the regulator as to its quality, efficacy and reasonable safety in the indication proposed for it. A drug with even modest benefits can be identified in relatively small placebo-controlled clinical trials. Often the ‘benefits’ are changes in a biochemical measure, such as serum cholesterol concentration, which is a surrogate measure of the clinically important effect. It is much harder to know about potentially important adverse effects. This is important, since rational therapeutics demands that both the potential benefit and the possible harm that could result from treatment are weighed in the balance. By contrast, common adverse effects of treatment occur even with placebo (the ‘nocebo’ effect) and confuse the picture. A rare adverse drug reaction can be difficult to detect, but serious enough to alter the balance between benefit and harm. How can the prescriber make proper decisions or give proper advice if the possible harm is undefined, and serious adverse drug reactions remain to be discovered?

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