While postmarketing surveillance of adverse drug reactions (ADRs) has received
wide attention in recent years, ADR and side effect assessment in clinical trials is an
area which deserves further investigation. Despite the logic of a systematic approach to ADR
detection from preclinical work through postmarketing monitoring, no such system exists.
By increasing sensitivity, reliability and validity of ADR measurement, such a scheme would
more effectively protect patients from dangerous drugs, assist the clinician by providing
comparison data on adverse reactions of psychotropic agents, and improve comparability of
experimental results across testing centers.
We have focussed our inquiry on the assessment of ADRs in clinical trials. Expectations
of such testing should be geared to the statistical realities of practical sample sizes. Within
reason, such sample sizes could be altered in accord with anticipated frequencies of certain
ADRs. In addition, laboratory standards for both low and high frequency reactions would
assist consensus in defining particular ADRs.
Agreement among investigators as to one or two useful ADR rating instruments would
eliminate the large number of non-standard, often inadequate instruments now in use. Such
an assessment instrument could be geared toward completeness, ease of execution and an
effective data analysis. Objective measurement on a limited basis would be of further assistance.
It is of critical importance for changes in adverse drug reaction methodology to truly
assist the clinical researcher, without encumbering him with excessive guidelines and forms.
Such a methodology should complement the clinical observation and rational approach
which are basic elements of clinical observation.