Immunosuppressants, mortality, and risk of cancer

doi:10.1136/bmj.b1645

Published 3 July 2009, doi:10.1136/bmj.b1645
Cite this as: BMJ 2009;339:b1645

Editorials

Immunosuppressants, mortality, and risk of cancer

New data raise concerns, but don’t yet warrant a substantialchange in practice

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

The retrospective cohort study by Kempen and colleagues (doi:)forces us to take a hard look at two of the most pressing questionsin drug treatment today.¹ The first is what are the longer termrisks of the increasingly powerful drugs we now prescribe routinely?The second relates to "pharmacoepistemology"—the questionof "how we know what we know" about the risks and benefits ofdrugs.²

On the first topic, clinicians, patients, and policymakers mustlive with the fact that drugs are generally approved on thebasis of tests that may last just a few weeks or months, evenif the drug is designed to be taken for years. Once short termefficacy is shown—even if it is in comparison with placebo,or by the achievement of a surrogate outcome, such as a laboratorytest—subsequent drug effects cannot be systematicallytracked. A report by the US Institute of Medicine argued strongly. . . [Full text of this article]

Jerry Avorn, professor of medicine, Sebastian Schneeweiss, associate professor of medicine

¹ Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA 02120, USA

javorn@medsoc.harvard.edu

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