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. 1981;11(Suppl 1):105S–110S. doi: 10.1111/j.1365-2125.1981.tb01845.x

Difficulties in assessing the adverse effects of drugs

M S Kramer
PMCID: PMC1401635  PMID: 7052788

Abstract

1 In recent years the phenomenon of the adverse drug reaction (ADR) has become a focus of increased attention and research, and we have become aware of the clinical complexity of the phenomenon and some of the difficulties inherent in assessing adverse effects. Evidence for such difficulties includes the discrepancies in figures for ADR incidence in epidemiological studies, the non-specificity and suggestibility of ADR symptoms, and the substantial disagreements, even among experts, in the diagnosis of ADRs.

2 An observed clinical manifestation heavily depends on the clinical setting and on the intent of the clinician, and the large number of factors that may confound the link between a given manifestation and an administered drug. A diagnostic algorithm, or branched logic decision format, has recently been developed. It comprises six axes of decision strategy and provides standardized, operational rules for rating the probability of an ADR.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Avery C. W., Ibelle B. P., Allison B., Mandell N. Systematic errors in the evaluation of side effects. Am J Psychiatry. 1967 Jan;123(7):875–878. doi: 10.1176/ajp.123.7.875. [DOI] [PubMed] [Google Scholar]
  2. Caranasos G. J., Stewart R. B., Cluff L. E. Drug-induced illness leading to hospitalization. JAMA. 1974 May 6;228(6):713–717. [PubMed] [Google Scholar]
  3. Downing R. W., Rickels K., Meyers F. Side reactions in neurotics. I. A comparison of two methods of assessment. J Clin Pharmacol J New Drugs. 1970 Sep-Oct;10(5):289–297. doi: 10.1177/009127007001000501. [DOI] [PubMed] [Google Scholar]
  4. Feinstein A. R. Clinical biostatistics. 28. The biostatistical problems of pharmaceutical surveillance. Clin Pharmacol Ther. 1974 Jul;16(1):110–123. doi: 10.1002/cpt1974161part1110. [DOI] [PubMed] [Google Scholar]
  5. GREEN D. M. PRE-EXISTING CONDITIONS, PLACEBO REACTIONS, AND "SIDE EFFECTS". Ann Intern Med. 1964 Feb;60:255–265. doi: 10.7326/0003-4819-60-2-255. [DOI] [PubMed] [Google Scholar]
  6. Hurwitz N., Wade O. L. Intensive hospital monitoring of adverse reactions to drugs. Br Med J. 1969 Mar 1;1(5643):531–536. doi: 10.1136/bmj.1.5643.531. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Hutchinson T. A., Leventhal J. M., Kramer M. S., Karch F. E., Lipman A. G., Feinstein A. R. An algorithm for the operational assessment of adverse drug reactions. II. Demonstration of reproducibility and validity. JAMA. 1979 Aug 17;242(7):633–638. [PubMed] [Google Scholar]
  8. Karch F. E., Lasagna L. Toward the operational identification of adverse drug reactions. Clin Pharmacol Ther. 1977 Mar;21(3):247–254. doi: 10.1002/cpt1977213247. [DOI] [PubMed] [Google Scholar]
  9. Karch F. E., Smith C. L., Kerzner B., Mazzullo J. M., Weintraub M., Lasagna L. Adverse drug reactions-a matter of opinion. Clin Pharmacol Ther. 1976 May;19(5 Pt 1):489–492. doi: 10.1002/cpt1976195part1489. [DOI] [PubMed] [Google Scholar]
  10. Kellaway G. S., McCrae E. Intensive monitoring for adverse drug effects in patients discharged from acute medical wards. N Z Med J. 1973 Dec 26;78(505):525–528. [PubMed] [Google Scholar]
  11. Koch-Weser J., Sellers E. M., Zacest R. The ambiguity of adverse drug reactions. Eur J Clin Pharmacol. 1977 Jan 3;11(2):75–78. doi: 10.1007/BF00562895. [DOI] [PubMed] [Google Scholar]
  12. Kramer M. S., Hutchinson T. A., Rudnick S. A., Leventhal J. M., Feinstein A. R. Operational criteria for adverse drug reactions in evaluating suspected toxicity of a popular scabicide. Clin Pharmacol Ther. 1980 Feb;27(2):149–155. doi: 10.1038/clpt.1980.23. [DOI] [PubMed] [Google Scholar]
  13. Kramer M. S., Leventhal J. M., Hutchinson T. A., Feinstein A. R. An algorithm for the operational assessment of adverse drug reactions. I. Background, description, and instructions for use. JAMA. 1979 Aug 17;242(7):623–632. [PubMed] [Google Scholar]
  14. Leventhal J. M., Hutchinson T. A., Kramer M. S., Feinstein A. R. An algorithm for the operational assessment of adverse drug reactions. III. Results of tests among clinicians. JAMA. 1979 Nov 2;242(18):1991–1994. [PubMed] [Google Scholar]
  15. Miller R. R. Hospital admissions due to adverse drug reactions. A report from the Boston Collaborative Drug Surveillance Program. Arch Intern Med. 1974 Aug;134(2):219–223. [PubMed] [Google Scholar]
  16. Ogilvie R. I., Ruedy J. Adverse drug reactions during hospitalization. Can Med Assoc J. 1967 Dec 9;97(24):1450–1457. [PMC free article] [PubMed] [Google Scholar]
  17. Porter J., Jick H. Drug-related deaths among medical inpatients. JAMA. 1977 Feb 28;237(9):879–881. [PubMed] [Google Scholar]
  18. Reidenberg M. M., Lowenthal D. T. Adverse nondrug reactions. N Engl J Med. 1968 Sep 26;279(13):678–679. doi: 10.1056/NEJM196809262791304. [DOI] [PubMed] [Google Scholar]
  19. SCHIMMEL E. M. THE HAZARDS OF HOSPITALIZATION. Ann Intern Med. 1964 Jan;60:100–110. doi: 10.7326/0003-4819-60-1-100. [DOI] [PubMed] [Google Scholar]
  20. Smidt N. A., McQueen E. G. Adverse reactions to drugs: a comprehensive hospital inpatient survey. N Z Med J. 1972 Dec;76(487):397–401. [PubMed] [Google Scholar]
  21. Spriet A., Spriet C., Larousse C., Chigot D., Roux M., Simon P. Methodology and results of a survey of adverse reactons to a drug in private practice. Eur J Clin Pharmacol. 1977 Mar 11;11(3):181–192. doi: 10.1007/BF00606408. [DOI] [PubMed] [Google Scholar]
  22. Vakil B. J., Kulkarni R. D., Chabria N. L., Chadha D. R., Deshpande V. A. Intense surveillance of adverse drug reactions. An analysis of 338 patients. J Clin Pharmacol. 1975 May-Jun;15(5-6):435–441. doi: 10.1002/j.1552-4604.1975.tb02365.x. [DOI] [PubMed] [Google Scholar]
  23. Wang R. I., Terry L. C. Adverse drug reactions in a veterans administration hospital. J Clin Pharmacol New Drugs. 1971 Jan-Feb;11(1):14–18. doi: 10.1177/009127007101100102. [DOI] [PubMed] [Google Scholar]

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