Dose Discrepancies Between the Physicians' Desk Reference and the Medical Literature, and Their Possible Role in the High Incidence of Dose-Related Adverse Drug Events

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Abstract
OPINIONS DIFFER regarding the extent of iatrogenic illness secondary to medication reactions, but there is general agreement that this is an important problem. The most recent meta-analysis determined that in 1994 an estimated 106 000 hospital patients had fatal adverse drug events (ADEs), "making these events between the fourth and sixth leading cause of death" in the United States annually.1(p1200) The study also estimated that 2 216 000 hospitalized patients had ADEs that were considered serious, which the study defined as requiring hospitalization, being permanently disabling, or resulting in death. Clearly, even more ADEs occur that do not reach these levels of severity. In a recent editorial, Bates addressed questions about these statistics by stating, "Even if the true incidence of ADEs is somewhat lower than reported by Lazarou et al, it is still high, and much higher than generally recognized."2(p1216) This statement probably represents the general viewpoint.