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

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Le tma ravxjecg vaxrjexax' tma ycxt kcojvlt|

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~cetad lt tj nj fch` qr tma hgcxxlilhctlje xhcga

ced c vacxjecfga eqkfav ~ava qedahldad% Macgtm

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rcvteavxmlrx ~ava asqcgg| fcgcehad fat~aae

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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

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ejt ~cet tj vahgcxxli| lt tj F%

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tma njyavekaet hjexqgtctlje rcvtlhqgcvg| magriqg%

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at cg%' 622=,' ced cx`ad c hjqrga ji sqaxtljex

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ji tma vaxrjedavx tj tma ivaa sqaxtlje tmct tma

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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

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|jq klnmt hcgg c rahqglcv kadlc lkfcgceha le vagctlje

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Ej raecgt| >!

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S% ct x jq t a raect| jv rjxxaxxlje a:

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%

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xjka ji tma xj+hcggad tjr xhlaetlffih ojqvecgx mcya

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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

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vctmav tmce ahxtcx| ~cx nlyae f| klxtc`a lx kqhm

gaxx ylxlfga' li rqfglxmad ct cgg#

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varjvt le vahaet |acvx tj njyavekaet ced

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varjvt le rcvglckaet?

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chhjqet tma yla~x ji jtmavx' rcvtlhqgcvg| tmjxa

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ravhartlje ced tma eaadx ced hjexasqaehax ijv

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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

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hgcxx fqt kjva ~cetad tma raecgtlax vadqhad' ejt

ayae xtc| tma xcka% ^a cva rvjdqhlen varjvtx fcxad

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tma kjxt datclgad cxxaxxkaetx ji hceecflx mcvkx

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tma njyavekaet%

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TCFGA 1% KADLC FLCX

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%%%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

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

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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

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ct xjka rjlet le tma iqtqva' c dvqn klnmt gacd tj jv

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le datavvaeha' ced tmlx lx jea ji tma a| lxxqax ijv

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tmce jea klnmt cxxqka% Djax datavvaeha lkrcht je

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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

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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

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L ~lgg qxa KKV cx ce a}ckrga ji tmlx rvjhaxx

ced tma rvahcqtljecv| rvlehlrga% Rajrga ~ava

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tma tvlrga ychhlea klnmt hcqxa fvcle dckcna%

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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

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Cejtmav yav| xcd a}ckrga lx tmct ji c |jqen ~jkce

ivjk tma Xmatgced Lxgcedx ~mj dlad ji c mavjle

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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

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ji dvqnx ji rjtaetlcg klxqxa' rqfglxmad le Tma Gcehat

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ltx ejyagt| ced vaklt' lt ~cx yav| mcvd tj nat tma

rcrav rqfglxmad fahcqxa lt hmcggaenad xjka ji tma

hqvvaet -klx,ravhartljex cfjqt dvqnx%

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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'

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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

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 +

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Fcvfltqvctax F +

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NMF H Nckkc 4+ | vj}| qt|vlh chl

Cec j lh xtavjl x H

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@ ct Ejt hjetvj a

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Ejta? Cghjmjg ced tjfchhj cva lehgqdad mava tj nlya cehmjv rjletx

TCFGA >% TMA DVQNX CX XAXXAD

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

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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%

8/14/2019 Estimating Drug Harms - a risky business?

11/13

~~~%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

8/14/2019 Estimating Drug Harms - a risky business?

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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

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