Minimising harm: human variation and adverse drug reactions (ADRs).

摘要

'First, do no harm' - great advice to aspiring physicians throughout most of human history, but with the discovery of effective drugs in the twentieth century, no longer tenable as it stands. We could not get to first base in treating leukaemias, infections, cardiovascular disease, diabetes and so on if we were not prepared to accept an element of risk. It is the balance between benefit and harm that is key, rather than an unachievable ideal of absolute safety. But quantifying the probability of harm is problematic - at least for Rumsfeld's 'unknown unknowns'.The slogan 'Dis-taval - the safe hypnotic' adorned the drug company calendar in my father's consulting room: 'safe' in the sense that when taken in overdose it was less likely to prove fatal than barbiturates, which were the market-leading hypnotics in the nineteen fifties.