Br. J. clin. Pharmac. (1979), 7
References DUGGER, H.A., COOMBS, R.A., SCHWARTZ, H.J.,
MIGDALOF, B.H. & ORWIG, B.A. (1976). Biotransformation of Mazindol: I. Isolation and identification of some metabolites from rat urine. Drug Metab. Dispos., 4, 262-268.
LETTERS TO THE EDITORS
123
SWAISLAND, A.J., FRANKLIN, R.A., SOUTHGATE, P.J. & COLEMAN, A.J. (1977). The pharmacokinetics of ciclazindol (Wy 23409) in human volunteers. Br. J. cin. Pharmac., 4,61-65.
THE ROLE OF THE CLINICAL PHARMACOLOGIST IN DISTRICT GENERAL HOSPITALS
The criticism made by Fullerton & Noyce (1978) of your excellent statement (British Journal of Clinical Pharmacology, 1978) on this subject highlights two major issues: first, it rehearses most of the prejudices and misconceptions surrounding clinical pharmacology; and secondly, it shows with abundant clarity the direction from which the discipline can expect least support. The basis of Fullerton & Noyce's (1978) attack comes from their assertion that clinical pharmacology ', . . is a research-based discipline rather than practisebased'. They obviously do not know that undergraduate medical students are expected to pass examinations in this subject before they can practise medicine; that it is a recognized specialty within the National Health Service; that it has its own Specialty Advisory Committee within the Joint Committee on Higher Medical Training; and that many consultants, senior registrars and registrars are in post throughout the country. Your correspondents are obviously unaware that there are patients whose clinical problems are pharmacological in nature, and who benefit from the services of a specialist clinical pharmacologist. He parallels, precisely, the physician with an organ-based specialty such as cardiology, nephrology or gastroenterology (Rawlins, 1978). The suggestion that most of the functions of a District General Hospital clinical pharmacologist can be undertaken by pharmacists is laughable. The training of a pharmacist includes little physiology, pathology or clinical medicine, and it is naive to believe that experience in hospital pharmacies provides anything more than familiarity with medical terminology. Without the clinical training which a clinical pharmacologist obtains as an undergraduate (3 years), pre-registration house officer (1 year), during general professional training (3 years), and higher medical training (4 years), the successful application of modern pharmacology to the treatment of disease is impossible. The notion that clinical pharmacology should be
subjected to 'careful appraisal' is one which several of us have considered. Although it would be simple to analyse a clinical pharmacologist's working pattern, it would be much more difficult to assess 'benefit' (either positive or negative). Really useful information-such as his influence on the incidence of adverse drug reactions in his hospital and his community-would be so expensive to gather as to negate the exercise completely. Perhaps this is why Drug Information Services, of which Fullerton & Noyce (1978) speak so highly, have not been subjected to detailed cost-benefit analysis. Finally, Fullerton & Noyce (1978) are possibly unaware that the concept of DGH clinical pharmacologists originated-from the Royal College of Physicians (1974). Their suggestion that clinical pharmacologists have supported the scheme merely to expand their discipline is as insulting as it is inaccurate. M.D. RAWLINS Department of Pharmacological Sciences, Wolfson Unit of Clinical Pharmacology, University of Newcastle upon Tyne, Newcastle upon Tyne Received September 19, 1978
References BRITISH JOURNAL OF CLINICAL PHARMACOLOGY
(1978). The role of the clinical pharmacologist in district general hospitals. Br. J. clin. Pharmac., 5, 3-5. FULLERTON, S.E. & NOYCE, P.R. (1978). The role of the clinical pharmacologist in district general hospitals. Br. J. clin. Pharmac., 6, 180-181. RAWLINS, M.D. (1978). Clinical Pharmacology in the National Health Service. J. Roy. Soc. Med., 71, 556-557. ROYAL COLLEGE OF PHYSICIANS (1974). Report of the Committee on Clinical Pharmacology. London: Royal College of Physicians.
References DUGGER, H.A., COOMBS, R.A., SCHWARTZ, H.J.,
MIGDALOF, B.H. & ORWIG, B.A. (1976). Biotransformation of Mazindol: I. Isolation and identification of some metabolites from rat urine. Drug Metab. Dispos., 4, 262-268.
LETTERS TO THE EDITORS
123
SWAISLAND, A.J., FRANKLIN, R.A., SOUTHGATE, P.J. & COLEMAN, A.J. (1977). The pharmacokinetics of ciclazindol (Wy 23409) in human volunteers. Br. J. cin. Pharmac., 4,61-65.
THE ROLE OF THE CLINICAL PHARMACOLOGIST IN DISTRICT GENERAL HOSPITALS
The criticism made by Fullerton & Noyce (1978) of your excellent statement (British Journal of Clinical Pharmacology, 1978) on this subject highlights two major issues: first, it rehearses most of the prejudices and misconceptions surrounding clinical pharmacology; and secondly, it shows with abundant clarity the direction from which the discipline can expect least support. The basis of Fullerton & Noyce's (1978) attack comes from their assertion that clinical pharmacology ', . . is a research-based discipline rather than practisebased'. They obviously do not know that undergraduate medical students are expected to pass examinations in this subject before they can practise medicine; that it is a recognized specialty within the National Health Service; that it has its own Specialty Advisory Committee within the Joint Committee on Higher Medical Training; and that many consultants, senior registrars and registrars are in post throughout the country. Your correspondents are obviously unaware that there are patients whose clinical problems are pharmacological in nature, and who benefit from the services of a specialist clinical pharmacologist. He parallels, precisely, the physician with an organ-based specialty such as cardiology, nephrology or gastroenterology (Rawlins, 1978). The suggestion that most of the functions of a District General Hospital clinical pharmacologist can be undertaken by pharmacists is laughable. The training of a pharmacist includes little physiology, pathology or clinical medicine, and it is naive to believe that experience in hospital pharmacies provides anything more than familiarity with medical terminology. Without the clinical training which a clinical pharmacologist obtains as an undergraduate (3 years), pre-registration house officer (1 year), during general professional training (3 years), and higher medical training (4 years), the successful application of modern pharmacology to the treatment of disease is impossible. The notion that clinical pharmacology should be
subjected to 'careful appraisal' is one which several of us have considered. Although it would be simple to analyse a clinical pharmacologist's working pattern, it would be much more difficult to assess 'benefit' (either positive or negative). Really useful information-such as his influence on the incidence of adverse drug reactions in his hospital and his community-would be so expensive to gather as to negate the exercise completely. Perhaps this is why Drug Information Services, of which Fullerton & Noyce (1978) speak so highly, have not been subjected to detailed cost-benefit analysis. Finally, Fullerton & Noyce (1978) are possibly unaware that the concept of DGH clinical pharmacologists originated-from the Royal College of Physicians (1974). Their suggestion that clinical pharmacologists have supported the scheme merely to expand their discipline is as insulting as it is inaccurate. M.D. RAWLINS Department of Pharmacological Sciences, Wolfson Unit of Clinical Pharmacology, University of Newcastle upon Tyne, Newcastle upon Tyne Received September 19, 1978
References BRITISH JOURNAL OF CLINICAL PHARMACOLOGY
(1978). The role of the clinical pharmacologist in district general hospitals. Br. J. clin. Pharmac., 5, 3-5. FULLERTON, S.E. & NOYCE, P.R. (1978). The role of the clinical pharmacologist in district general hospitals. Br. J. clin. Pharmac., 6, 180-181. RAWLINS, M.D. (1978). Clinical Pharmacology in the National Health Service. J. Roy. Soc. Med., 71, 556-557. ROYAL COLLEGE OF PHYSICIANS (1974). Report of the Committee on Clinical Pharmacology. London: Royal College of Physicians.
