A response to: ‘A manifesto for clinical pharmacology from principles to practice’ by Jeff Aronson

Abstract

I read with interest the recent provocative article entitled ‘A manifesto for clinical pharmacology from principles to practice’ from Jeffrey Aronson that appeared in the Journal [1]. Dr Aronson defines a clinical pharmacologist as ‘a medically qualified practitioner who teaches, does research, frames policy and gives information and advice about the actions and proper use of medicines in humans and implements that knowledge in clinical practice’. Dr Aronson goes on in his article to say he prefers ‘to refer to those who contribute to the discipline, but are not medically qualified as applied pharmacologists’. He further states that ‘without medical training there are many areas in which such individuals cannot fulfil all the aspects of the discipline of clinical pharmacology and are therefore not clinical pharmacologists’. Laudable as Dr Aronson's attempts to provide a ‘manifesto for clinical pharmacology’ may be, and certainly he has done much to highlight the poor prescribing behaviour of physicians in the UK, his article fails to address the ‘Elephant in the Room’ which is the erosion of the discipline of pharmacology over the last 25 years in both the UK and elsewhere in the world [2]. Pharmacology is defined as the ‘Science that deals with the actions, mechanisms of action, uses, adverse effects and fate of drugs in animals and humans’[3]. I would argue that the distinction between clinical and basic (or applied) pharmacology used by Dr Aronson and that is used by a number of societies throughout the world (including the British Pharmacological Society of which Dr Aronson is a Past President), is both artificial and divisive and such divisions have contributed to the dilution of the discipline of pharmacology at a time when there is increasingly a call for a more integrated approach to understanding diseases and treatments. This dilution is continuing with the increasing use of the term ‘translational medicine’. Surely pharmacology in its widest sense, from identifying new targets for drugs through the development of such drugs into safe and effective medicines, and ultimately ensuring their appropriate clinical use is the best example of translational medicine we have. It is also worth noting that the very Journal Dr Aronson chooses to publish his manifesto for Clinical Pharmacology actually states under the ‘General Information’ section at the front of the Journal that ‘the British Journal of Clinical Pharmacology is published monthly by Blackwell Publishing Ltd for the British Pharmacological Society. Papers on all aspects of drug action in man will be considered’. There is certainly no clarification that one has to be medically qualified or clinically trained to submit work of relevance to drug action in man. Surely pharmacologists of all persuasions should be working hard to restore the importance of our discipline which has done so much for medical science and mankind over the last two centuries, rather than arguing about terminology of one set of pharmacologists over another based on what degrees they have. After all most pharmacologists by definition have the common interest of drugs and how they work and their appropriate use as the core reason for getting out of bed in the morning (irrespective of whether they have a medical degree or not). There are many of my clinical colleagues who would surely satisfy point 2 in the summary on page 3 of Aronson's article as they are specialists in their chosen therapeutic and disease areas, but who certainly would not label themselves as clinical pharmacologists. Surely any manifesto should be for pharmacology and encourage basic scientists to work more closely with relevant clinical colleagues (whether they call themselves clinical pharmacologists or not) in order to expedite the discovery of new medicines, which sadly is in decline, and to ensure that such medicines are then used appropriately. Maybe the time has come to ditch the term clinical pharmacology (and indeed other such divisive terms such as molecular pharmacology) and we should return to the use of the term pharmacology to cover our subject area. After all whether you work to understand the interaction of a drug with its receptor at a molecular level or the use of such a drug in patients, the common interest between us is the drug and surely it is also drugs that distinguish pharmacologists from physiologists or many other branches of medical science.