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To the Editor: Dr Gurwitz and colleagues¹ reported that adverse drug events are common among older persons in the ambulatory clinical setting, and that the more serious adverse drug events also were more likely to be preventable. However, I am concerned about their conclusion that most of these events were causally related to drug effects. The authors indicated that this causality was based on "the temporal relation between drug exposure and the event, as well as whether the event reflected a known effect of the drug," and state that this method "has been used in numerous prior studies." Nonetheless, this method is an insufficient basis for determining a drug effect because it does not account for the background rate of the events in patients not taking the drug.

Consider, for instance, the relationship between nonsteroidal anti-inflammatory drugs (NSAIDs) and gastrointestinal bleeding. Although NSAIDs are known to cause gastrointestinal bleeding, episodes . . . [Full Text of this Article]

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