organ toxicity

Adverse effects on reproduction

Nature is neutral, i.e. it has no 'intentions' towards humans, though it is often unfavourable to them. It is mankind, in its desire to avoid suffering and death, that decides that some of the biological effects of drugs are desirable (therapeutic) and others are undesirable (adverse). In addition to this arbitrary division, which has no fundamental biological basis,

1 From, The remedy worse than the disease. Matthew Prior (1664-1721).

unwanted effects of drugs are promoted, or even caused, by numerous nondrug factors. Because of the variety of these factors, attempts to make a simple account of the unwanted effects of drugs must be imperfect.

There is general agreement that drugs prescribed for disease are themselves the cause of a serious amount of disease (adverse reactions), ranging from mere inconvenience to permanent disability and death.

Since drugs are intended to relieve suffering, patients find it peculiarly offensive that they can also cause disease (especially if they are not forewarned). Therefore it is important to know how much disease they do cause and why they cause it, so that preventive measures can be taken.

It is not enough to measure the incidence of adverse reactions to drugs, their nature and their severity, though accurate data are obviously useful. It is necessary to take, or to try to take, into account which effects are avoidable (by skilled choice and use) and which are unavoidable (inherent in drug or patient). Also, different adverse effects can matter to a different degree to different people.

Since there can be no hope of eliminating all adverse effects of drugs it is necessary to evaluate patterns of adverse reaction against each other. One drug may frequently cause minor ill-effects but pose no threat to life, though patients do not like it and may take it irregularly, to their own detriment. Another drug may be pleasant to take, so that patients take it consistently, with benefit, but it may

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