Download - Estimating Drug Harms - a risky business?
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8/14/2019 Estimating Drug Harms - a risky business?
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Fvlailen 32Jhtjfav 622' tma njyavekaet gcqehmad c hjexqgtctlje
je c ea~ dvqn xtvctan| tmct lehgqdad sqaxtljex
je hceecflx tj ffied jqt ~mct tma rqfglh tmjqnmt%
T~j sqaxtljex ~ava cx`ad? Dj |jq tmle` hceecflx
xmjqgd fa vahgcxxlffiad: ced ^mct cva |jqv yla~x
je tjqnmav raecgtlax: Vaxrjexax ivjk 98< rajrga
~ava jftclead% Xjka vaxrjedad je famcgi ji
jvncelxctljex ced jtmavx vaxrjedad ledlyldqcgg|%
Tma vaxrjexax cva xmj~e le Tcfga 6' fvj`ae dj~eletj rvjiaxxljecg nvjqrx ced ravxjecg vaxrjexax%
Le tma ravxjecg vaxrjexax' tma ycxt kcojvlt|
~cetad hceecflx tj xtc| cx hgcxx H' c xlnelilhcet
eqkfav ~cetad lt gancglxad' xkcggav eqkfavx
~cetad lt tj nj fch` qr tma hgcxxlilhctlje xhcga
ced c vacxjecfga eqkfav ~ava qedahldad% Macgtm
rvjiaxxljecgx ~ava kjva qedahldad% Xtctqtjv|
rcvteavxmlrx ~ava asqcgg| fcgcehad fat~aae
F ced H' ~ltm tma rjglha xtvjeng| le icyjqv ji F%
L xmjqgd akrmcxlxa mava tmct tmava lx ej dlvaht
faeailt tj tma rjglha le mcylen hceecflx hgcxxlilad
cx hgcxx F le tavkx ji xaetaehlen cx fjtm hgcxxax
lehqv tma xcka raecgtlax% Tma kcojvlt| ji gjhcg
cqtmjvltlax' dvqn xavylha rvjyldavx ced hmcvltlax
~cetad lt tj vakcle hgcxx H% Kjxt vaxrjedaetx dld
ejt ~cet tj vahgcxxli| lt tj F%
Tma CHKD dld ejt ffied tma sqaxtljex rjxad f|
tma njyavekaet hjexqgtctlje rcvtlhqgcvg| magriqg%
^a tmavaijva hcvvlad jqt jqv j~e KJVL xqvya| jic varvaxaetctlya naeavcg rjrqgctlje xckrga cx ~a
~ava rqttlen tjnatmav tmlx tmlvd varjvt -Vc~glex
at cg%' 622=,' ced cx`ad c hjqrga ji sqaxtljex
cfjqt hceecflx% Tma ffivxt ~cx ~mct hgcxx xmjqgd
hceecflx fa: Letavaxtleng|' ~mct ~a ijqed mava
~cx tmct oqxt jyav mcgi ~cetad lt tj fa le c mlnmav
hgcxx -xj c vctmav dliiavaet vaxrjexa ivjk tmct
ji tma vaxrjedavx tj tma ivaa sqaxtlje tmct tma
njyavekaet rqt jqt, ced cfjqt mcgi ~cetad lt tj
xtc| c H -xaa Tcfga 8,% Tmlx xqvrvlxad qx' cx dld tma
icht tmct 86 rav haet ~cetad hceecflx hgcxxlffiad
cx hgcxx C% Fqt tma xahjed sqaxtlje ~cx tma vacgg|letavaxtlen jea? ~mct xmjqgd tma raecgtlax ijv
rjxxaxxlje fa: Jyav t~j+tmlvdx ~cetad tmak tj
altmav vakcle ct hqvvaet gayagx -hgcxx H, jv tj fa
gj~av -Tcfga 4,# Xj' cgtmjqnm c gjt ji rajrga ~cetad
hceecflx hgcxx C' tma| dldet ~cet hgcxx C raecgtlax%
^mct |jq xaa mava lx ce letavaxtlen ckflycgaeha le
tma rqfglh kled? tma| ~cet hceecflx tj fa lggancg
-rvaxqkcfg| fahcqxa tma| tmle` lt lx mcvkiqg'
tma| ~cet lt hgcxx C jv F, fqt tma| djet ~cet tma
raecgtlax tj fa lehvacxad% Li ce|tmlen' kce| ji
tmak ~cet tma raecgtlax cfjglxmad% Lt xaakad tj qx
tmct ~mct tma rqfglh crracv tj ~cet lx datavvaeha
tma| djet ~cet rqelxmkaet0 tma| ~cet tj xhcva
rajrga jii hceecflx qxa fqt tma| djet ~cet tj
rqelxm tmak ijv qxlen lt% \jq kc| tmle` tmct lt lx
sqlta jfyljqx tmct tmlx lx ~mct tma rqfglh ~cetx fqt
tmlx lx tma ffivxt tlka ~a mcya mcd x|xtakctlh dctc
xqrrjvtlen tmlx%
Hctanjv| ji vaxrjedaet Ejx%Vaxrjedlen
\ax+Vahgcxxli|tj F
Ej+Gacya cx H Gancglxa Qedahldad
Macgtm rvjiaxxljecgx 3< 8 > 2 > 1 6> 2 61
Rjglhlen Cnaehlax 6> 3< 4 2 4
Gjhcg Cqtmjvltlax 12 38 66 2 31
Dvqn Xavylha Rvjyldavx 6< > 34 6 9
H cvlt| ) Yj qetcv|Nvjqrx
68 4 < 3 8 8
Ravxjecg Vaxrjexax 8= 364 339
TCFGA 6% RQFGLH JRLELJE JE HCEECFLX+ NJYAVEKAET RJGG
S8% Tma Njyavekaet lx hjexqgtlen je ~matmav tj kc`a hceecflx c Hgcxx F dvqn -lt lx hqvvaetg| Hgcxx H, ~mlhmhjqgd kace tjqnmav raecgtlax% mct cva |jqv yla~x:
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8/14/2019 Estimating Drug Harms - a risky business?
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~~~%hvlkacedoqxtlha%jvn%q`
9
Kadlc flcxL ~cet tj kjya je ej~ tj gjj` ct mj~ rajrga nctmav
leijvkctlje cfjqt dvqnx ced tma hmcggaenax ji
hjkkqelhctlen tma faxt ayldaeha vagctlen tj dvqn
mcvkx tj tma rqfglh% Tmlx lx dliffihqgt le tma icha ji ~mct
|jq klnmt hcgg c rahqglcv kadlc lkfcgceha le vagctlje
tj dvqnx% Tma dctc le Tcfga 1 lggqxtvcta c vakcv`cfga
ffiedlen% Lt davlyax ivjk tma RmD ji c Xhjttlxm nvcdqcta'
Cgcxdclv O K Ijvx|tm' ~mj gjj`ad ct ayav| xlenga
ea~xrcrav varjvt ji dvqn dactmx le Xhjtgced ivjk
3|vx +33!
H cxx F 1|vx +38!H cxx H |vx + 43!
Ej raecgt| >!
Djet `ej~ !
TCFGA 4% RQFGLH JRLELJE JE HCEECFLX CHKD
Lrxjx+ KJVL rj hje qhta je a c j t a CHKD jv t a 622= vayla~ j hceec lx+ 3228 vaxrje aetx vjk t a naeavc rq lh
S% ct x jq t a raect| jv rjxxaxxlje a:
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8/14/2019 Estimating Drug Harms - a risky business?
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~~~%hvlkacedoqxtlha%jvn%q`
tma xhlaetlffih varjvtlen cfjqt dvqnx lx flcxad% Ltx c
fln hmcggaena ijv xhlaetlxtx tj kc`a xqva tmct tmalv
hjggacnqax cva rvjdqhlen dctc tmct cva chhqvcta%
Tmava mcya faae xjka mjvvlffih a}ckrgax ~mava
xjka ji tma xj+hcggad tjr xhlaetlffih ojqvecgx mcya
rqfglxmad rjjv sqcglt| vaxacvhm cfjqt tma mcvkx
ji dvqnx xqhm cx hceecflx jv ahxtcx|' xjkatlkax
mcylen tj vatvcht tma cvtlhgax% Tma rvjfgak lx' |jq
eayav xaa tma vatvchtljex' |jq oqxt xaa tma ivjet
rcna ji ea~xrcravx xc|len ahxtcx| ivlax |jqv fvcle%
Tma vatvchtlje a}rgclelen tmct katmckrmatcklea
vctmav tmce ahxtcx| ~cx nlyae f| klxtc`a lx kqhm
gaxx ylxlfga' li rqfglxmad ct cgg#
Dvqnx ced rjgltlhxLe 622= tma CHKD rvaxaetad ltx tmlvd hceecflx
varjvt le vahaet |acvx tj njyavekaet ced
vahjkkaedad tmct hceecflx xmjqgd vakcle c hgcxx
H dvqn% Tma Mjka Xahvatcv| ~aet je tj dlxhqxx tma
varjvt le rcvglckaet?
Le vachmlen k| dahlxlje' L mcya cgxj tc`ae letj
chhjqet tma yla~x ji jtmavx' rcvtlhqgcvg| tmjxa
vaxrjexlfga ijv aeijvhlen tma gc~' ced tma rqfglh L
mcya nlyae tma hjqehlgx varjvt hcvaiqg hjexldavctlje%
Ji ltx 63 vahjkkaedctljex' L chhart cgg fcv tmjxa
vagctlen tj hgcxxlffihctlje
Xj ~m| ~cx tmct: Tma ijvkav Mjka Xahvatcv|hjetleqad?
K| dahlxlje tc`ax letj chhjqet lxxqax xqhm cxrqfglh
ravhartlje ced tma eaadx ced hjexasqaehax ijv
rjglhlen rvljvltlax% Tmava lx c hjkragglen hcxa ijv qx tj
cht ej~ vctmav tmce vlx` tma iqtqva macgtm ji |jqen
rajrga% mava tmava lx c hgacv ced xavljqx rvjfgak'
fqt djqft cfjqt tma rjtaetlcg mcvk tmct ~lgg fa
hcqxad' ~a kqxtavv je tma xlda ji hcqtlje ced
rvjtaht tma rqfglh% L kc`a ej crjgjn| ijv tmct% L ck
ejt rvarcvad tj ~clt ced xaa%
Tmlx lxxqa ji rqfglh ravhartlje lx yav| lkrjvtcet
ced mj~ faxt tj mcya c xaexlfga rqfglh dafcta
ced dlxhqxxlje cfjqt dvqn mcvkx% Cx dlxhqxxad
cfjya ced le jqv varjvt xjka kakfavx ji tma
rqfglh klnmt mcya ~cetad hceecflx tj kjya qr c
hgcxx fqt kjva ~cetad tma raecgtlax vadqhad' ejt
ayae xtc| tma xcka% ^a cva rvjdqhlen varjvtx fcxad
je datclgad' a}taexlya vaxacvhm' ced tma 622= CHKD
hceecflx varjvt -Vc~glex at cg%' 622=, ~cx jea ji
tma kjxt datclgad cxxaxxkaetx ji hceecflx mcvkx
ayav| djea% ^a tmavaijva vacgg| mcya c nvact dacg ji
hjeffidaeha le jqv cecg|xlx' cx xmjqgd tma rqfglh ced
tma njyavekaet%
Dvqn Tj}lhjgjnlhcg xtctlxtlhx e Ea~xrcrav varjvtx e j}lhjgjn| tj ea~xrcrav vctlj
Cgg hcxax 6611 149 4?3
Cxrvle*Xcglh|gcta 36 +
Rcvchatckjg 691 3 691?3
Dlczarck 4=3 32 4=?3
Takczarck 89< 1 31?3
Kjvrmlea 483 >6?3
Ckrmatckleax 89 38 8?3
Hjhclea 82 4 =?3
Mavjle*Dlckjvrmlea
846 >1 ?3
Kat c jea 492 < 39?3
Ahxtcx|*KDKC 6= 9 ?
TCFGA 1% KADLC FLCX
Dlxtjvtad: c sqcetltctlya a}rgjvctlje ji dvqn ictcglt| varjvtx le tma rjrqgcv rvaxx
Cgcxdclv O%K% Ijvx|tm Letavectljecg Ojqvecg ji Dvqn Rjglh| 36 -6223, 481+418
%%%hjkrcvlen jiffihlcg tj}lhjgjnlhcg xtctlxtlhx ijv c xlenga hjqetv| -Xhjtgced, ~ltm tma varjvtlen ji dvqn dactmx le tmct hjqetv|x
kjxt rjrq cv ea~xrcravx jyav c nlyae tlka ravlj t a 3
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8/14/2019 Estimating Drug Harms - a risky business?
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~~~%hvlkacedoqxtlha%jvn%q`
=
Tma rvahcqtljecv| rvlehlrgaXj' jea ji tma `a| cvnqkaetx le kjylen hceecflx
ivjk hgcxx H tj F ~cx tma hjehave tmct x`qe` ~jqgd
hcqxa kjva rx|hmjxlx% ^mct lx yav| vanqgcvg| leyj`ad
le tmlx dafcta lx tma rvahcqtljecv| rvlehlrga' ~mlhm
lx tmct' li |jqva ejt xqva cfjqt c dvqn mcvk' vce`
lt mlnm' kc`a cgg dvqnx hgcxx C ced nat vld ji tma
rvjfgak% Tj varact ~mct tma ijvkav Mjka Xahvatcv|
xcld' ^a kqxtavv je tma xlda ji hcqtlje ced rvjtaht
tma rqfglh%Cx tmlx lx rvjtahtlje ivjk tma ej~e
qe`ej~ex' ct ffivxt xlnmt lt klnmt xaak tma jfyljqx
dahlxlje ~m| ~jqgdet |jq tc`a tma rvahcqtljecv|
rvlehlrga: a ej~ tmct dvqnx cva mcvkiqg ced tmct|jq hce eayav aycgqcta c dvqn jyav tma gliatlka ji c
~mjga rjrqgctlje' xj ~a hce eayav `ej~ ~matmav'
ct xjka rjlet le tma iqtqva' c dvqn klnmt gacd tj jv
hcqxa kjva mcvk tmce lt dld acvg| le ltx qxa%
Tma rvahcqtljecv| rvlehlrga lx cgxj ce cht ji icltm
le datavvaeha' ced tmlx lx jea ji tma a| lxxqax ijv
gc~|avx% Mj~ayav' lt kc| aed qr djlen kjva mcvk
tmce jea klnmt cxxqka% Djax datavvaeha lkrcht je
dvqn qxa: ^a djet `ej~% Le icht' tma jqthjka kc|
fa tma jrrjxlta ji tmct rvadlhtad% Lt kc| fa tmct li
|jq kjya c dvqn qr c hgcxx lt mcx c nvactav hchmat%
Rajrga tmle ' Jm' ltx letavaxtlen' kc|fa ~a xmjqgd fa
tv|len lt fahcqxa ltx c hgcxx F jv c hgcxx C vctmav tmce
c hgcxx H% ^a djet `ej~% ^a cgxj djet `ej~ ~mct
dvlyax tma qxa ji dvqnx le vagctlje tj hgcxxlffihctlje%
Kjva lkrjvtcet' L tmle`' tma rvahcqtljecv| rvlehlrga
klxgacdx% Lt xtcvtx tj dlxtjvt tma ycgqa ji ayldaeha ced
tmavaijva L tmle` lt hjqgd' ced rvjfcfg| djax' daycgqa
ayldaeha% Tmlx gacdx qx tj c rjxltlje ~mava rajrga
vacgg| djet ej~ ~mct tma ayldaeha lx% Tma| xaa tma
hgcxxlffihctlje' tma| macv cfjqt ayldaeha ced tma|
nat kl}ad kaxxcnax% Tmavax sqlta c gjt ji ceahdjtcg
ayldaeha tmct rqfglh hjeffidaeha le tma xhlaetlffih
rvjflt| ji njyavekaet mcx faae qedavklead le tmlx`led ji ~c|%
L ~lgg qxa KKV cx ce a}ckrga ji tmlx rvjhaxx
ced tma rvahcqtljecv| rvlehlrga% Rajrga ~ava
hjehavead' je tma fcxlx ji icgxa xhlaeha' tmct
tma tvlrga ychhlea klnmt hcqxa fvcle dckcna%
Tmlx gad tj c vadqhtlje le ychhlectlje qrtc`a
ced ej~ hmlgdvae cva nattlen gqen ced fvcle
dckcna ivjk kacxgax% Le xjka hlvhqkxtcehax'
rajrga chhaxxad xlenga ychhlectljex' ~mlhm ~cx
kjva a}raexlya' rvjfcfg| ej xciav' ced le aiiaht
vadqhad tma fvacdtm ji macgtm rvjtahtlje chvjxxtma hjkkqelt|% Tma rvahcqtljecv| rvlehlrga ~ltm
KKV mcx faae hgacvg| xmj~e tj fa ~vjen lt mcx
mcvkad kjva rajrga tmce lt mcx magrad% Xj ~a
eaad tj fa yav| hcqtljqx cfjqt xlkrg| leyj`lentma rvahcqtljecv| rvlehlrga le vagctlje tj dvqnx%
Cejtmav yav| xcd a}ckrga lx tmct ji c |jqen ~jkce
ivjk tma Xmatgced Lxgcedx ~mj dlad ji c mavjle
jyavdjxa% m| ~cx xma tc`len mavjle: Tma rvjfgak
chhjvdlen tj mav ivlaedx ~cx tmct xma ~cetad' gl`a mav
ivlaedx ced jtmav taaecnavx tj tv| hceecflx% Le tmlx
lxjgctad hjkkqelt| lt ~cx' mj~ayav' kqhm acxlav tj
nat mavjle' rvaxqkcfg| fahcqxa lt mcx c mlnmav qelt
rvlha ced lx acxlav ced kjva rvjffitcfga tj lkrjvt tmce
hceecflx% Tmlx lx xjkatmlen ~a xmjqgd facv le kled%
^a djet ej~ mj~ kce| dactmx cva hcqxad f| ciclgqva ji rajrga tj chhaxx dvqnx tmct cva vagctlyag| gaxx
dcenavjqx fahcqxa kjva dcenavjqx dvqnx cva falen
kcda cyclgcfga% Kc`len cgg dvqnx hgcxx C ~jqgd fa c
gjnlhcg hjehgqxlje ji tma rvahcqtljecv| rvlehlrga' fqt
~jqgd fa c xqrvaka klxtc`a%
Cxxaxxlen mcvk^aya tvlad yav| mcvd ijv ct gacxt tma gcxt tae |acvx
tj rqt tjnatmav c xtvqhtqva ijv cxxaxxlen dvqn
mcvkx% Tmlx fance ~ltm tma Vqehlkce varjvt
-6222, ced ayjgyad letj c kjva datclgad cecg|xlx'
~mlhm ayaetqcgg| tqvead letj c vaxacvhm rcrav'
Dayagjrkaet ji c vctljecg xhcga tj cxxaxx tma mcvkx
ji dvqnx ji rjtaetlcg klxqxa' rqfglxmad le Tma Gcehat
-Eqtt at cg%' 622>,% Daxrlta jv ravmcrx fahcqxa ji
ltx ejyagt| ced vaklt' lt ~cx yav| mcvd tj nat tma
rcrav rqfglxmad fahcqxa lt hmcggaenad xjka ji tma
hqvvaet -klx,ravhartljex cfjqt dvqnx%
Le rvlehlrga' ~a fvj`a dj~e dvqn mcvkx letj elea
dliiavaet rcvckatavx -Tcfga 9,% Tmlx x|xtak ~cx
cvfltvcv| fqt ~a tmjqnmt lt ~cx c xaexlfga ~c| ji
hctanjvlxlen cgg tma rjxxlfga mcvkx ivjk dvqnx'
hjyavlen rm|xlhcg mcvkx' daraedaeha ced xjhlcgmcvkx%
^a cgxj gjj`ad ct cgg tma dvqnx le tma KDC ced
cddad xjka jtmavx tmct ~avaet cgvacd| hjyavad f|
tma Cht -Tcfga >,% Ijv a}ckrga' ~a lehgqdad `atcklea'
~mlhm ~cxet hjyavad f| tma Cht ct tma tlka' xjgyaetx'
~mlhm cva ejt lehgqdad' ced tjfchhj ced cghjmjg'
fahcqxa ~a tmjqnmt lt ~cx yav| lkrjvtcet tmct
mcvkx ji lgglhlt dvqnx ~ava cxxaxxad cnclext tma
mcvkx ji dvqnx tmct rajrga ej~ ced qxa' jtmav~lxa
lt lx ejt rjxxlfga tj mcya c tvqg| mcvk+fcxad
cxxaxxkaet% Tma xhjvax ji tmaxa jtmav dvqnx cgxj rgc|ce lkrjvtcet rcvt cx cehmjv rjletx cnclext ~mlhm
jtmavx hce fa xhcgad% ^ltmjqt xqhm vaiavaeha rjletx'
tma dafcta cfjqt vagctlya dvqn mcvkx fahjkax
lxjgctad ced cvfltvcv|' kjva c`le tj c vaglnljqx
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8/14/2019 Estimating Drug Harms - a risky business?
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~~~%hvlkacedoqxtlha%jvn%q`
R |xlhc Mcvk ea Chqta
T~j H vjelh
Tmvaa Letvcyaejqx mcvk
Daraedaeha Ijqv Letaexlt| ji rgacxqva
Ilya Rx|h j jnlhc arae aeha
Xl} R |xlhc arae aeha
Xjhlcg Mcvkx Xayae Letj}lhctlje
Alnmt Jtmav xjhlcg mcvkx
Elea Macgtm+hcva hjxtx
TCFGA 9% TMA ELEA RCVCKATAVX JI MCVK
Rcvckatav
Ivjk Eqtt at cg' 622>% Tcfga 3 Cxxaxxkaet rcvckatavx
gcxx le Klxqxa ji Dvqnx Cht Hjkkaetx
Ahxtcx| C Axxaetlc | 8'4+kat | aea lj}|+E+kat | ckr atcklea
-KDKC
4+KTC C 4+katm|gtmljckrmatcklea
GXD C G|xavnlh chl lat | ckl
Hjhclea C Leh q ax hvch hjhclea
Mavjle C Hvqda dlckjvrmlea
Xtvaat katmcdjea C Dlyavtad rvaxhvlfad katmcdjea
Ckr atcklea F +
Kat | r ael cta F an' Vltc le kat | r ael cta
Fcvfltqvctax F +
Fqrvaejvrmlea H an' Taknaxlh' Xqfqta}
Faezjdlczarleax H an' Ycglqk -dlczarck,' Glfvlqk -hmgjvdlczarj}lda,
NMF H Nckkc 4+ | vj}| qt|vlh chl
Cec j lh xtavjl x H
Hceecflx H +
Cghjmjg Ejt hjetvjggad li jyav 3= |acvx le Q@
Cg`|geltvltax Ejt hjetvjggad
@atcklea Ejt hjetvj a ct t a tlka j cxxaxxkaet0 hjetvj a cx h cxxH xleha
Oceqcv|' 622>
@ ct Ejt hjetvj a
Xjgyaetx Ejt hjetvjggad0 xcgax vaxtvlhtad
Tjfchhj Ejt hjetvjggad li jyav 39 |acvx le Q@
Ivjk Eqtt at cg' 622>% Tcfga 6? Tma 62 xqfxtcehax cxxaxxad' xmj~len tmalv hqvvaet xtctqx qedav tma Klxqxa ji Dv qnx Cht
Ejta? Cghjmjg ced tjfchhj cva lehgqdad mava tj nlya cehmjv rjletx
TCFGA >% TMA DVQNX CX XAXXAD
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8/14/2019 Estimating Drug Harms - a risky business?
10/13
~~~%hvlkacedoqxtlha%jvn%q`
32
dlxhqxxlje% Tmlx cecg|xlx ayaetqcgg| axtcfglxmad cvce`len jvdav rvaxaetad le Ilnqva 8%
C eqkfav ji lkrjvtcet rjletx akavnad% Tma vce`len
xqnnaxtad tmct tmava cva hgacvg| xjka yav| mcvkiqg
dvqnx -|jq klnmt xc| tmaxa ~jqgd fa hgcxx C dvqnx,
ced tmava cva xjka dvqnx tmct cvaet yav| mcvkiqg'
xqhm cx mct jv cg`|geltvltax' ~mlhm cvaet hjetvjggad
f| tma Cht ct cgg% Tma dcv` fcvx cva tma hgcxx C dvqnx%
Letavaxtleng|' xjka hgcxx C dvqnx xhjvad kqhm gj~av
tmce jtmav hgcxx C dvqnx' xqnnaxtlen tmct tmava lx
xjka cejkcg| le tavkx ji tmct rcvt ji tma hqvvaet
xtctqtjv| hgcxxlffihctlje x|xtak%
Tma vce`len cgxj xqnnaxtx tmct c tvlrcvtlta
hgcxxlffihctlje x|xtak klnmt kc`a xaexa' ~ltm dvqnx
vce`len cx kjva mcvkiqg tmce cghjmjg falen hgcxx C
ced tmjxa vce`len gj~av tmce tjfchhj cx hgcxx H% Tma
a}avhlxa cgxj mlnmglnmtad mj~ dcenavjqx cghjmjg lx% L
faglaya tmct tma hmcggaenax ji dacglen ~ltm tma mcvkx
ji cghjmjg lx rvjfcfg| tma flnnaxt hmcggaena tmct ~a
mcya le vagctlje tj dvqn mcvkx tjdc|%
Xj' ~a qxad jtmav dvqnx ijv c hjkrcvlxje ji mcvkx%
Fqt tmava cva c gjt ji dcenavjqx chtlyltlax ~mlhm
xjhlat| djaxet eahaxxcvlg| dlxhjqvcna fqt djax tv|tj hjetvjg% L faglaya tmct qxlen cecgjnlax ~ltm jtmav
mcvkiqg chtlyltlax magrx qx aencna le crrvjrvlcta
dafcta cfjqt vagctlya mcvkx ji dvqnx% Jea rvjfgak
lx tmct xjkatlkax |jq nat letj ~mct L tmle` ji cx
ce lggancglt|gjnlh gjjr% Tmlx lx ce a}ckrga ji c
hjeyavxctlje tmct Lya mcd kce| tlkax ~ltm kce|
rajrga' xjka ji tmak rjgltlhlcex?
KR? \jq hcet hjkrcva mcvkx ivjk c gancg chtlylt|
~ltm ce lggancg jea%
Rvjiaxxjv Eqtt? ^m| ejt:
KR? Fahcqxa jeax lggancg%
Rvjiaxxjv Eqtt? ^m| lx lt lggancg:
KR? Fahcqxa ltx mcvkiqg%
Rvjiaxxjv Eqtt? Djet ~a eaad tj hjkrcva mcvkx tj
datavklea li lt xmjqgd fa lggancg:
KR? \jq hcet hjkrcva mcvkx ivjk c gancg chtlylt|
~ltm ce lggancg jea%
varactx
L mcya faae xqvrvlxad mj~ dliffihqgt tmlx hjehart
lx tj nat chvjxx tj xjka rajrga' ~matmav tma| cva
ILNQVA 8% DVQN MCVK VCE@LEN
Ilnqva 3? Kace mcvk xhjvax ijv 62 xqfxtcehax%
Tma vaxrahtlya hgcxxlffihctlje qedav tma klxqxa ji Dvqnx Cht' ~mava crrvjrvlcta' lx xmj~e cfjya achm fcv% Hgcxx C dvqnx cva ledlhctad f|
fgch` fcvx' F f| dcv` nva|' ced H f| glnmt nva|% Qehgcxxlffiad xqfxtcehax cva xmj~e cx qeffiggad fcvx%
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~~~%hvlkacedoqxtlha%jvn%q`
rjgltlhlcex' iaggj~ xhlaetlxtx jv kakfavx ji tmanaeavcg rqfglh% Tma xqrrjxltlje tmct li xjkatmlen lx
lggancg ltx mcvkx hcet fa cxxaxxad le tma xcka ~c| cx
li lt ~ava gancg lx jea tmct lx sqlta dliffihqgt tj fvac`% C
hjkkje hjvjggcv| ji tmlx lx tmct dvqn mcvkx cva xaae
cx gaxx chhartcfga tmce jtmav mcvkiqg chtlyltlax tj
eje+qxavx tmjqnm jfyljqxg| c dliiavaet cttltqda lx
tc`ae f| qxavx% Xj ~mj lx vlnmt:
Ea~ dvqnx^m| lx ce| ji tmlx lkrjvtcet: ^agg ~a mcya jtmav
hmcggaenax% ^a mcya jtmav dvqnx tj vayla~% L mcyakaetljead NFG cgvacd|' ced |jq kc| ej~ tmct tmava
mcya faae c hjqrga ji dactmx vahaetg| ivjk tmlx xtvjen
xadctlya' ~mlhm lx hmaklhcgg| yav| xlklgcv tj NMF
fqt ejt hqvvaetg| hjetvjggad% Tmae tmava lx xrlha ced
vagctad xkj`len kl}tqvax% a dldet ej~ ~mct tmaxa
~ava qetlg cfjqt xl} kjetmx cnj' ~mae tmava ~ava
xjka hcxa varjvtx ji kcv`ad mcggqhlectjv| vachtljex
tj tmaxa kl}tqvax% Navkce hmaklxtx ~ava cfga tj
cecg|xa xjka ji tma mavfcg kl}tqvax tmct rvjdqhad
tmaxa aiiahtx ced dlxhjyavad tmct tma fqg` hjkrvlxad
c rvatt| leavt mavf% Mj~ayav' lt mcd faae xrvc|ad
~ltm x|etmatlh hceecflx cnjelxtx% Tmaxa cnjelxtx cva
jitae kjva rj~aviqg tmce hceecflx ltxagi' xj xrlha hce
fa gl`a xkj`len c rjtaet ijvk ji hceecflx% Fqt ltx
ejt hjetvjggad qedav tma Cht fahcqxa' qetlg ej~' tma
x|etmatlh hceeecflejldx mcya ejt faae klxqxad xj
tma| mcya eayav faae hjetvjggad% Tmlx lx xjkatmlen ~a
cva ~jv`len je yav| mcvd ct rvaxaet tj tv| tj xaa li ltx
rjxxlfga tj vanqgcta jv hjetvjg tmak le tma xcka ~c|
~a hjetvjg hceecflx%
Tmae tmava lx tma ~mjga sqaxtlje ji hjneltlje
aemcehlen dvqnx xj hcggad xkcvt dvqnx% Tmaxa cva
dvqnx' gl`a kjdcicelg -Rvjylnlg, ced katm|grmaeldcta
-Vltcgle,' ~mlhm cva qxad f| xtqdaetx tj magr tmak~jv` mcvdav' xtc| qr gctav tj ~jv`' ced xjkatlkax tj
`aar tmak c~c`a ~mae tma| ~cet tj nj jqt rcvt|len
cgg elnmt% Xmjqgd tma| fa hjetvjggad: Dj tma| hcqxa
mcvk: Cva tma| gl`ag| tj hcqxa mcvk le tma gjen tavk:
Tmaxa cva tma sqaxtljex ~a cva gjj`len ct%
Hgcxxlffihctlje ji dvqnx le tma Cht^a cgxj mcya tj ~jv` je tma hgcxxlffihctlje
hjeqedvqk? ~mct cva tma fjqedcvlax fat~aae
C' F ced H: Hce ~a hjka qr ~ltm xjka cfxjgqta
kacxqvax tmct ~jqgd' le iqtqva' cggj~ qx tj xc| tmlxdvqn lx C fahcqxa ji tmlx jv F fahcqxa ji tmlx% Jea
tmlenx ijv xqva? ct rvaxaet' a}ravtx ced rjgltlhlcex
djet cnvaa' ~mlhm lx ~m| L tmle` tma rqfglh dafcta
eaadx tj fanle% ^mj dj tma rqfglh tvqxt kjva tma
a}ravtx jv tma rjgltlhlcex: mae ~a gjj` ct tmadlxhqxxlje tmct ~a mcd cfjqt ahxtcx| -~mava tma
CHKD vahjkkaedad hgcxx F -Eqtt at cg%' 622
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~~~%hvlkacedoqxtlha%jvn%q`
36
xjhlcg xhlaetlxtx ced rajrga letavaxtad le tmlx cxrahtji gancg xhlaeha%
L tmle` ~a mcya tj chhart |jqen rajrga gl`a tj
a}ravlkaet ~ltm dvqnx ced jtmav rjtaetlcgg|
mcvkiqg chtlyltlax ced ~mct ~a xmjqgd fa djlen
le cgg ji tmlx lx tj rvjtaht tmak ivjk mcvk ct tmlx
xtcna ji tmalv glyax% ^a tmavaijva mcya tj rvjylda
kjva chhqvcta ced hvadlfga leijvkctlje% Li |jq
tmle` tmct xhcvlen `ldx ~lgg xtjr tmak qxlen' |jqva
rvjfcfg| ~vjen% Tma| cva jitae sqlta `ej~gadnacfga
cfjqt dvqnx ced tma letaveat mcx kcda chhaxx tj
leijvkctlje a}tvakag| xlkrga% ^a mcya tj tagg tmaktma tvqtm' xj tmct tma| qxa qx cx tmalv rvaiavvad
xjqvha ji leijvkctlje% C iqgg| xhlaetlffihcgg|+fcxad
Klxqxa ji Dvqnx Cht ~mava dvqn hgcxxlffihctlje
chhqvctag| vastahtx mcvkx ~jqgd fa c rj~aviqg
adqhctljecg tjjg% Qxlen tma Cht le c rjgltlhcg ~c| tj
nlya kaxxcnax jtmav tmce tmjxa vagctlen tj vagctlya
mcvkx qedavkleax tma Cht ced djax nvact dckcna
tj tma adqhctljecg kaxxcna%
^a cgxj mcya tj iqgg| aedjvxa mcvk vadqhtlje
crrvjchmax ct cgg gayagx ced axrahlcgg| xtjr tma
cvtlffihlcg xarcvctlje ji cghjmjg ced tjfchhj cx
eje+dvqnx% Le xjka rcvtx ji tma Q@ tmlx mcx cgvacd|mcrraead% Le ^cgax tma rvjnvckka ji letavyaetlje
le vagctlje tj dvqn mcvkx ej~ lehjvrjvctax
xkj`len ced dvle`len fahcqxa tmjxa cva xaae cx
le xjka hcxax falen flnnav rvjfgakx tmce jtmav
dvqnx% Tmava cva jtmav kavltx le crrvjchmlen tmak
xlkqgtceajqxg|? ijv a}ckrga' kce| ji tmaxa dvqnx cva
falen qxad ct tma xcka tlka f| tma xcka rajrga%
Cejtmav a| sqaxtlje ~a mcya tj cddvaxx cx c xjhlat|
lx ~matmav jqv cttltqda tj dvqnx lx dvlyae fahcqxa ji
tmalv mcvkx jv cva ~a aencnlen le c kjvcg dafcta:
Jea tmlen tmlx njyavekaet mcx djea a}tvakag|~agg le tma gcxt tae |acvx lx tj hqt c~c| kqhm ji tma
kjvcg cvnqkaet cfjqt dvqn tvactkaetx% Tma| mcya
kjyad le tma dlvahtlje ji lkrvjylen chhaxx tj mcvk
vadqhtlje tvactkaetx' ce crrvjchm tmct' L tmle`' lx
~mjgg| aedjvxad f| tma xhlaetlffih hjkkqelt| ced f|
tma kadlhcg rvjiaxxlje% Ijv vacxjex tmct cva ejt hgacv'
tma xcka ayldaeha+fcxad hmcena mcx ejt mcrraead
le vagctlje tj tma hgcxxlffihctlje ji dvqnx ji klxqxa%
L tmle` lt xmjqgd mcrrae fahcqxa' ~mlga Lk ejt c
kjvcg rmlgjxjrmav' lt xaakx tj ka dliffihqgt tj daiaed
c kjvcg cvnqkaet le vagctlje tj dvqnx li |jq djet
crrg| lt tj jtmav asqcgg| mcvkiqg chtlyltlax%
Rvjiaxxjv Dcyld Eqtt' Lkravlcg Hjggana Gjedje
Aya Xcylgga Gahtqva' Oqg| 622
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8/14/2019 Estimating Drug Harms - a risky business?
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~~~%hvlkacedoqxtlha%jvn%q`
VaiavaehaxCdylxjv| Hjqehlg je tma Klxqxa ji Dvqnx -CHKD,-6226,' Tma Hgcxxlffihctlje ji Hceecflx qedav tma Klxqxaji Dvqnx Cht 33' Gjedje? Mjka Jiffiha%
Eqtt' D% O% -622