Bulletin Number Five 1986

adviser to the World Health Organization's International Drug Monitoring Project, and in 1973 he was awarded a World Health Organization Fellowship to visit drug monitoring organizations in the USA and Canada. He has also served on a number of other national and local committees, concerned with the use of drugs in hospitals. He has been a Regional Adviser to the Royal College of Physicians and a member of its Clinical Pharmacology Committee, a member of the Specialist Advisory Subcommittee on Clinical Pharmacology of the Joint Committee on Higher Medical Training, and an examiner in Medicine and Clinical Pharmacology to the Universities of London, Newcastle-upon-Tyne, and Dundee. He is a Fellow of two of the Royal Colleges of Physicians — London and Edinburgh. Tasks Ahead 一 DM. Davies Perhaps the most worrying thing about modern medicine is that the capability of the pharmaceutical industry to produce new and potent drugs has outpaced the efficiency of clinicians in handling these powerful therapeutic agents. Most clinical pharmacologists believe that drug therapy is still not taken seriously enough, and that if therapeutics were studied as closely as applied anatomy and prescribing performed as carefully as surgical operations then this might cease to be the era of ‘safe surgery and dangerous medicine'. This is why I consider that the first priority of a new Department of Clinical Pharmacology is to remind doctors, students, and nurses of the cardinal importance of the rational and safe use of drugs. And drugs can be used rationally and safely only if doctors make themselves aware of the potential dangers of drugs as well as their claimed benefits (such claims requiring very careful scrutiny), and write prescriptions that are legible and unambiguous; and if nurses take great pains to ensure that the right drug in the right dose is given at the right time to the right patient. Assessment of the risk:benefit equation of drug therapy is a continuous process, since the nature and incidence of adverse reactions to a drug may not become apparent until it has been used for longer periods and in many more patients than is possible during premarketing trials in strictly limited numbers of volunteers and patients. Every doctor has a duty to contribute to the assessment of risk by recording and reporting all suspected reactions to new drugs and serious reactions to established drugs. The medical staff of teaching hospitals have a special responsibility in this respect, and I hope that the adverse reaction reporting scheme recently introduced in the Prince of Wales Hospital will be a success, both for purposes of teaching and improving drug safety. Doctors cannot practise therapeutics efficiently unless they know exactly what they are prescribing, and this is difficult when drugs are habitually identified by the usually meaningless (though slick and euphonious) proprietary names given to them by their manufacturers, so an important part of the teaching programme of a clinical pharmacology unit is to emphasize and reemphasize the importance of prescribing by generic name, which usually indicates the class to which the drug belongs, thus ensuring that the patient is not given two different preparations of the same drug or two drugs with almost identical actions at the same time. Another essential function of a modern clinical pharmacology unit is to provide, in collaboration with the hospital pharmacy, a clinical drug information service to answer questions from doctors, pharmacists, nurses, and students; and such a service should deal with drug composition and dosage, and with actions, reactions (including acute poisoning) and interactions. Members of a clinical pharmacology unit cannot seriously hope to influence their colleagues unless the unit is itself involved in the day-to-day care of patients. Consequently, the new unit, when fully staffed, will become responsible for its own outpatient clinics and hospital beds; and as the clinical pharmacologist concerns himself with all types of disease treated with drugs, he is possibly the only remaining truly ‘general' physician, and his outpatient and inpatient practice will reflect this broad interest. Since medical practice becomes fossilized without research, members of the clinical pharmacological unit will be encouraged to investigate problems within any of the diverse range of interests of the unit: pharmacokinetics and pharmacodynamics, therapeutics and clinical trials, therapeutic drug monitoring, clinical toxicology, drug information technology, and systems for prescribing and administering drugs in hospitals and in the community. Other fruitful areas of research will be the special therapeutic problems of Hong Kong, which arise because patients 'shop around' for doctors, use traditional herbal remedies, sometimes of obscure composition and action, and treat themselves with 'over-the-counter' remedies; and because medicine containers are often not labelled with the name of the drugs they contain. 16 RECENT DEVELOPMENTS