Clinical Pharmacology – A thorough knowledge of pharmacological and therapeutic principles
A preface should tell the prospective reader about the subject of a book, its purpose, and its plan. Clinical Pharmacology is about the scientific basis and practice of drug therapy. It addresses medical students and doctors in particular, but also anyone concerned with evidence-based drug therapy and prescribing.
The scope and rate of drug innovation increase. Doctors now face a professional lifetime of handling drugs that are new to themselves – drugs that do new things as well as drugs that do old things better; and drugs that were familiar during medical training become redundant.
We write not only for readers who, like us, have a special interest in pharmacology. We try to make pharmacology understandable for those whose primary interests lie elsewhere but who recognise that they need some knowledge of pharmacology if they are to meet their moral and legal ‘duty of care’ to their patients. We are aware too, of medical curricular pressures that would reduce the time devoted to teaching clinical pharmacology and therapeutics, and such diminution is surely a misguided policy for a subject that is so integral to the successful practice of medicine. Thus, we try to tell readers what they need to know without burdening them with irrelevant information, and we try to make the subject interesting. We are very serious, but seriousness does not always demand wearying solemnity.
All who prescribe drugs would be wise to keep in mind the changing and ever more exacting expectations of patients and of society in general. Doctors who prescribe casually or ignorantly now face not only increasing criticism but also civil (or even criminal) legal charges. The ability to handle new developments depends, now more than ever, on comprehension of the principles of pharmacology.These principles are not difficult to grasp and are not so many as to defeat even the busiest doctors who take upon themselves the responsibility of introducing manufactured medicines into the bodies of their patients.
The principles of pharmacology and drug therapy appear in Chapters 1–11 and their application in the subsequent specialist chapters where we draw on the knowledge and authority of a range of experts in these fields. The current edition includes new contributions from Sir Michael Rawlins, Sir Peter Rubin, Professor Munir Pirmohamed and Professor Patrick Vallance. We seek to offer a reasonably brief solution to the problem of combining practical clinical utility with an account of the principles on which clinical practice rests.
The quantity of practical technical detail to include is a matter of judgment. In general, where therapeutic practices are complex, potentially dangerous, and commonly updated, e.g. anaphylactic shock, we provide more detail, together with websites for the latest advice; we give less or even no detail on therapy that specialists undertake, e.g. anticancer drugs. Nevertheless, especially with modern drugs that are unfamiliar, the prescriber should consult formularies, approved guidelines, or the manufacturer’s current literature.
Use of the book. Francis Bacon2 wrote that ‘Some books are to be tasted, others to be swallowed, and some few to be chewed and digested.’ Perhaps elements of each activity can apply to parts of our text. Students and doctors are, or should be, concerned to understand and to develop a rational, critical attitude to drug therapy and they should therefore chiefly address issues of how drugs act and interact in disease and how evidence of therapeutic effect is obtained and evaluated.
To this end, they should read selectively and should not impede themselves by attempts to memorise lists of alternative drugs and doses and minor differences between them, which should never be required of them in examinations. Thus, we do not encumber the text with exhaustive lists of preparations, which properly belong in a formulary, although we hope that enough has been mentioned to cover much routine prescribing, and many drugs have been included solely for identification.
The role and status of a textbook. A useful guide to drug use must offer clear conclusions and advice. If it is to be of reasonable size, it may often omit alternative acceptable courses of action. What it recommends should rest on sound evidence, where this exists, and on an assessment of the opinions of the experienced where it does not.