EDITORIAL

Clinical T

Pharmacology: Pharmacology

he last year has seen an encouraging trend in the formation ofnew divisions ofclinical pharmacology and fellowship programs. Some of this support has come through the Food and Drug Administration, a new and to be encouraged participant in supporting the discipline ofclinical pharmacology. Certainly the heart of the discipline lies in medical school divisions and services they perform. Clinical pharmacology serves many purposes, but the roles it serves in a medical school are some of the most critical. An effective division bridges the gap between basic pharmacology and clinical practice. With pharmacology becoming ever more basic, a clinical pharmacology program must fill the void of aiding the student to be able to employ basic pharmacology in formatting ‘herapeutic plan. The overly excessive emphasis ot curriculum on pathophysiology and diagnostics has been a frequent point of emphasis in the therapeutic community. It is a sad medical school curriculum that has only a medical pharmacology course to provide future physicians exposure to therapeutics. Certainly clinical pharmacology plays a critical role in therapeutic education. But this should not be limited to a medical pharmacology course. Ideally a series oflectures in the third or fourth year of medical school codifyingbasic pharmacology knowledge obtained during the clinical clerkship and supplementing this information with clinically relevant principles of clinical pharmacodynamics and pharmacokinetics is essential. Additionally, a clinical pharmacology division needs to provide a service to the department of medicine. A consultative service is essential in this complex world of therapeutics. An important component is to update the practicing community on new therapeutic advances and to make rational decisions in an

J COn

Pharmacol

1992;32:773

Medicine

or

age of multiple therapies within a therapeutic group. Examples are the eight new converting enzyme inhibitors or the four new nicotine transdermal delivery systems. Education combined with a consultative service and advice on drug monitoring combine to place clinical pharmacology as a critical link in the effective teaching and practice components of a medicine department. In addition, clinical pharmacology research often involves patients, patient care situations, and clinical research that is hospital based. In fact, more and more “core” research in clinical research centers is pharmacologically based and these centers are often managed by clinical pharmacologists. Clearly clinical pharmacology provides a useful supplement to medical pharmacology departments. Basic research interest may be shared and the clinical/basic science interactions are to be encouraged. However, clinical pharmacology is not an extension of pharmacology. It’s true service lies in medicine. The teaching in the later medical school years, the hospital-based clinical research, the continuing medical education role, and the physician-based clinical pharmacology consultation service clearly places clinical pharmacology in a clinical department. There are important intentions with surgery, OB/ GYN, and pediatrics as well as shared critical components with psychiatry and anesthesia. Perhaps this is why in England clinical pharmacology is often a department. But right now with funding constraints and the predominant role clinical pharmacology should play in medical therapeutic education, clinical pharmacology should develop through Medicine. John

C. Somberg,

MD Editor

773

Clinical pharmacology: medicine or pharmacology.

EDITORIAL Clinical T Pharmacology: Pharmacology he last year has seen an encouraging trend in the formation ofnew divisions ofclinical pharmacology...
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