BMJ  2004;329:31-34 (3 July), doi:10.1136/bmj.329.7456.31

Clinical review

Balancing benefits and harms: the example of non-steroidal anti-inflammatory drugs

¹ Medical Research Council Health Services Research Collaboration, Department of Social Medicine, University of Bristol, Bristol BS8 2PR, ² Medicines Monitoring Unit (MEMO), Divisions of Community Health Sciences and Medicine and Therapeutics, University of Dundee, Dundee, ³ School for Policy Studies, University of Bristol

The first 150 words of the full text of this article appear below.

Introduction

To provide safe and effective interventions for people, reliable and valid evidence is needed. This is most easily produced by undertaking trials in samples of people who are as homogeneous as possible and applying the results to similar, well defined groups of patients. To be equitable, however, appropriate care needs to be provided for everyone in the diverse community using health services. Therefore, there is a tension between obtaining scientific evidence that is reliable but which can be applied only to a small subset of the population, and distributive justice that requires that all in need are treated equally appropriately.

Drugs have potential harms as well as benefits. Doctors would like to be able to balance any risks against benefits to derive a therapeutic ratio for each patient, but this is difficult. Formal trials can tell a lot about the efficacy of a drug in a specific context, but unless . . . [Full text of this article]

Risks and benefits of NSAIDs in treating joint pain

Methods
Results
Community cohort

Validity of trials

-->Adverse event reporting
Risk benefit ratio
Different indications
The need for record linkage

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