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When I use a word . . .“Well tolerated” is intolerable

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g5385 (Published 05 September 2014) Cite this as: BMJ 2014;349:g5385

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Re: When I use a word . . .“Well tolerated” is intolerable

I agree with Prof Aronson completely. The way well-tolerated is used can be the scientific equivalent of political spin. Whether or not a patient has tolerated a drug is dependent of how tolerant the patient is (to adverse effects) as well as the adverse effects themselves, and is likely to be a function of the perceived benefits. A drug that prevents imminent death is likely to be tolerated even if it does cause your hair to fall out. On the other hand the same adverse event would not be tolerated for drug treatment of a mild headache. Toleration is an individual value judgement, and so the extent to which a patient has "tolerated" a drug can only be established by asking the patient. If a drug is described as well-tolerated the editors should expect some evidence that the patients have been asked appropriate questions about their experience of taking the drug. In the absence of such evidence the term should not be used.

Competing interests: No competing interests

11 September 2014
Paul D P Pharoah
Professor of Cancer Epidemiology
University of Cambridge
Strangeways Research Laboratory, Worts Causeway, Cambridge, CB1 8RN
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