What's in a name?

Abstract

As non-medically qualified individuals with long-standing chairs in clinical pharmacology, we would like to comment on Doctor Aronson's recent manifesto [1] implying that our titles are inappropriate. According to the manifesto, a clinical pharmacologist is a multi-skilled practitioner who conducts research, teaches, makes policy, provides information and advice about the actions and proper use of medicines in humans and implements that knowledge in clinical care. Given the last stipulation, we agree that only the medically qualified can aspire to perform all of these functions to a significant degree. However, the reality is different in that not all ‘clinical’ pharmacologists carry out research, especially related to the scientific basis of the discipline, and, in some cases, their clinical apprenticeship and patient contact is very limited. So, whether medically qualified or not, we believe that 80% compliance with the stipulations is not to be dismissed. Furthermore, we would argue that Doctor Aronson's (and, indeed IUPHAR's [2]) definition of a clinical pharmacologist, as interpreted in a narrow professional sense to refer to those physicians who specialize in clinical pharmacology, is divisive, fails to recognize the major contribution of non-medically qualified individuals to the discipline, and is to the detriment of the future of clinical pharmacology. The latter is an especially important consideration given the decline in the number of medically qualified clinical pharmacologists in the UK [3] and in Australia, the likely increasing dependence of the discipline on professionals who are not medically trained and an increasing responsibility of pharmacists and nurses for prescribing. It may be that exclusivity in the definition of a clinical pharmacologist is a price to pay for increased support for specialist medical training in the discipline, but we object that it is at the expense of highly qualified non-medically trained professionals. In Australia non-medically qualified clinical pharmacologists continue to have a pivotal role in driving clinical pharmacological research. Furthermore, they contribute to the development and implementation of clinical guidelines and the development of health policy, and do much of the undergraduate and graduate-entry teaching of pharmacology and therapeutics. In the UK resuscitation of the discipline and the input to it of non-medically qualified individuals will be difficult given the demise of many departments and units of clinical pharmacology and associated teaching, a development that has been presided over by some clinical pharmacologists who became Deans of medical schools or Directors of Medical Education. The contribution of the non-medically qualified to the research role of clinical pharmacology and its direct involvement with drug development has also been compromised in the UK as our medical colleagues have watched a significant segment of ‘translational medicine’ disappear overseas, strangled by excessive bureaucracy. If there are young, non-medically qualified scientists who would want to help carry the flag for ‘clinical pharmacology’ in the future, we hope that they are not too put off by old-fashioned, closed-shop attitudes. We are encouraged to note that Doctor Aronson's views on non-medically qualified individuals and the definition of a clinical pharmacologist are not endorsed by the senior editors of the Journal [4]. There are no competing interests to declare.