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Dr Munir Pirmohamed
Department of Pharmacology & Therapeutics
University of Liverpool, Box 147
LIVERPOOL L69 3BX 17 July 1998

Dear Dr Pirmohamed,


You may remember I wrote to you and Professor Breckenridge shortly after publication of your paper on drug-induced iatrogenic illness (BMJ 25 April 1998, 316, 1295-1298). I have not heard from Professor Breckenridge: I expect he is very busy and perhaps he was reluctant to discuss issues relating to the CSM. I would therefore be grateful if you could give me some further information about the evidence you and your colleagues relied on. As you will have had some time to consider the points I raised, and because I have abbreviated the original list of questions, I hope it will possible to let me have the information I need in the near future. The questions are as follows:

1. The main estimate in the paper - that ADRs account for about 5% of all hospital admissions - is cited to four US studies. Did you find any data about experience in the UK, and/or any data to indicate that the nature and extent of drug-induced iatrogenic illness was comparable in the US and UK?

2. The paper estimates the incidence of ADRs as a percentage of an unspecified number of "all hospital admissions". Could you please tell the number of hospital admissions/year you had in mind when you calculated this?

3. What is the basis of the estimate that ADRs affect 10-20% of all in-patients? No citation is given.

4. What is the evidence for the estimates in the paper that ADRs cause deaths in 0.1% of medical and 0.01% of surgical inpatients?

5. The major US studies suggest that perhaps half of all ADRs might have been avoided. Did you and your colleagues find any evidence to suggest that the position might be different or similar in the UK?

I hope you will be able to let me have this information, to clarify the significance of your research in this important field. Many thanks and I look forward to hearing from you.

Yours sincerely,


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