Adverse drug reactions – no farewell to harms

Abstract

This issue of the Journal is devoted to papers on adverse drug reactions. That these papers have all been spontaneously submitted to the Journal for peer review, rather than being commissioned or called for, testifies to the importance of the problem. The commonly used term “adverse drug reaction” (ADR) excludes contaminants (such as are sometimes found in herbal medicines) or supposedly inactive excipients (bulking ingredients) in a formulation. Recognizing, therefore, that medicinal products contain ingredients other than active principles, we probably should talk about adverse reactions to medicines or medicaments, ARMs rather than ADRs. And we all surely want a farewell to ARMs. Or at least a farewell to harms. Especially since they are so common. In a widely cited paper Pirmohamed et al. have shown that the prevalence of adverse reactions among 18 820 patients aged over 16 years admitted to hospital over 6 months was 6.5%; adverse drug reactions directly led to admission in 80% of cases; and deaths occurred in over 2%, giving an overall death rate of 0.15% [1]. The projected annual cost of such admissions to the UK's National Health Service was calculated at £466m. To those who are familiar with the literature on this subject, these figures are not surprising. Many adverse drug reactions are preventable, and in this issue of the Journal Howard et al., in a systematic review of 17 papers, identify the drugs that most commonly cause preventable admissions to hospital [2]. Four drug groups accounted for about 50% of drug-related admissions and 12 drug groups accounted for about 80%. The top four were antiplatelet drugs (including aspirin), diuretics, nonsteroidal anti-inflammatory drugs, and anticoagulants, all drugs that doctors perceive as being among the most risky [3]. Other papers in this issue cover a wide range of topics, calling for comment on the classification and detection of adverse drug reactions.