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

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Abstract
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 they are huge and pragmatic they tell less about a drug's toxicity. Post-marketing surveillance may uncover more information on toxicity, but the data usually lack sufficient detail to lead to an understanding of the determinants of adverse reactions. Furthermore, extrapolation of the efficacy or toxicity of a drug in one disease or group of patients to those associated with different diseases or groups can be difficult and misleading.

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