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November 25, 1998

Adverse Drug Reactions in Hospitalized Patients

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;280(20):1741. doi:10-1001/pubs.JAMA-ISSN-0098-7484-280-20-jac80013

To the Editor.—The article by Dr Lazarou and colleagues1 and the accompanying Editorial by Dr Bates2 are welcome additions in putting the major health care problem of safe therapeutic approaches in focus. While drugs are often life-saving and help improve the quality of life and functional status of patients, clinicians should be worried that so many patients die from their drug treatments despite appropriate indications for use for the disease. The situation will get worse with the increasing use of drugs as the numbers of elderly patients increase.3 Are these fatalities unavoidable? While the development of safer and more effective drugs will decrease the risk of drug therapy, I believe that much more can be done beyond the product level. Some of the more important factors include (1) the current fragmented approach to drug therapeutics based on a disease model in patients with multiple diseases, (2) the reliance on drugs as quick fixes for health problems that have become chronic, (3) the propensity to accentuate the positive effects and to downplay the negative effects of drugs in promotional materials, (4) inadequate preparation of health professionals in clinical pharmacology and therapeutics required for the safe and effective use of drugs, and (5) the inadequate contribution from government and industry to foster educational and research efforts to minimize the occurrence of ADRs and adverse drug interactions.