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

doi:10.1136/bmj.329.7456.31

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

Paul Dieppe, professor¹, Christopher Bartlett, research assistant¹, Peter Davey, professor², Lesley Doyal, professor³, Shah Ebrahim, professor¹

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

Correspondence to: P Dieppe p.dieppe@bristol.ac.uk

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

Introduction

To provide safe and effective interventions for people, reliableand valid evidence is needed. This is most easily produced byundertaking trials in samples of people who are as homogeneousas possible and applying the results to similar, well definedgroups of patients. To be equitable, however, appropriate careneeds to be provided for everyone in the diverse community usinghealth services. Therefore, there is a tension between obtainingscientific evidence that is reliable but which can be appliedonly to a small subset of the population, and distributive justicethat requires that all in need are treated equally appropriately.

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

Risks and benefits of NSAIDs in treating joint pain

Validity of trials

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