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Clinical Pharmacology 400
2014Jim Wright
Clinical Pharmacologist7 lectures
Outline of seriesClinical Pharmacology as a career.
Therapeutics Initiative, Therapeutics Letter.
Cochrane Collaboration, Principles of Evidence Based Medicine.
How do drugs get approved for prescription.
Clinical trials, what do the numbers mean?
Approach to prescribing a drug.
Discussion of a clinical trial.
Clinical Pharmacology 400
2014Clinical Pharmacology as a Career
OutlineWhat is Clinical Pharmacology?
Determinants of drug choice.
Benefits and harms of drugs.
What is the problem?
My training and journey at the university.
Ways to become a Clinical Pharmacologist.
Types of work.
What is a Clinical Pharmacologist?
A Medical Specialist who has the training to deal with complex problems associated with drugs in patients.
Minimum amount of information needed before prescribing or
taking a drug?Patient problem and goal of therapy.
Therapeutic options.
Choice of therapy and evidence to justify choice.
Prescription (dose and regimen).
Method of assessing drug effect.
Mechanism of action.
Major route of inactivation.
Important contraindications and adverse effects.
Determinants of drug choice.What is the optimal order?
Diagnostic condition
Drug industry marketing
Expert opinion
Past experience
Best available evidence
Clinical pharmacology knowledge.
Actual order of determinants of choice of drug today
Diagnostic condition
Drug industry marketing
Expert opinion
Past experience
Best available evidence
Clinical pharmacology knowledge.
Optimal order of determinants of choice of
drugDiagnostic condition
Best available evidence
Clinical pharmacology knowledge
Past experience
Expert opinion
Drug industry marketing
Optimizing use of prescription drugs:The Elephant in the
Room
What is the elephant that nobody wants to talk about?
Definition of Advertising
“The science of arresting the human
intelligence long enough to get money from it.”
Stephen Leacock
Our Daily Medsby Melody Petersen
How the Pharmaceutical Companies Transformed themselves into Slick
Marketing Machines and Hooked the Nation on Prescription Drugs
The Magnitude of the Prescription Drugs
Problem
Why do we need Clinical
Pharmacologists?To solve this problem
What is the problem in a bigger context?
For most of the DAILY drugs that people take, we do not know whether the
benefits outweigh the harms.
How I became a Clinical Pharmacologist
2 years undergrad in Science (Experimental Psychology)
4 years medical school (University of Alberta) including summer research in Pharmacology lab.
1 year rotating internship Montreal General Hospital (MGH).
1 year Internal Medicine resident at MGH
1 year Teaching Fellow in Nairobi, Kenya.
My training (cont)4 years combined Doctoral research and Internal
medicine residency training (Dept of Pharmacology and MGH, McGill University).
1975-76, one year Post doctoral training in Clinical Pharmacology at Hammersmith Hospital, London, UK
My degrees MD, University of Alberta 1968
PhD, McGill University, 1976
FRCP(C), Internal Medicine, 1975
My journey at UBCFirst Phase
1977 Assistant professor in Pharmacology & Therapeutics and Medicine.
Clinical Pharmacologist – Clinical practice, (in hospital consultations and outpatient clinic).
1977-1983, MRC funded basic research into mechanisms of adverse drug effects and drug interactions.
Teaching – Pharmacology to Medical students, Graduate students.
My journey at UBC Second Phase
In 1983 I began doing clinical trials (mostly drug industry funded on new antihypertensive drugs).
Between 1983 and 1994, I was principal investigator for 15 trials with >10 different drug companies.
Examples of drugs studied: fosinopril, irbesartan, terazosin, lemakalim, etc.
My journey at UBCThird Phase
In 1994 the Therapeutics Initiative was formed and I was appointed the Clinical Managing Director.
I stopped all drug industry funded research.
1994 to present -- main activity, Managing Director of TI and Editor-in-Chief of Therapeutics Letter.
2001, I was appointed Coordinating Editor of the Cochrane Hypertension Review Group.
My journey (cont)3 sabbaticals, Stockholm, Sweden (85-86);
Wellington, New Zealand (96-97); Lyon, France (2005-6).
Many changes and variety of work during my career.
Understanding drug effects is extremely complex, interesting and challenging.
I enjoy the fact that I do different things almost every day.
Ways to become a Clinical Pharmacologist today.
Pre-med. Opportunities to get involved with TI or Cochrane during summer.
Medical training. Electives in Clinical Pharmacology.
Residency in Internal Medicine; 3 core years.
Residency in Clinical Pharmacology; 2 years.
Fellowship in Internal Medicine end of first year of Clinical Pharmacology training.
Certification exam in Clinical Pharmacology with Royal College of Physicians end of second year.
Alternate ways to become a Clinical Pharmacologist today.
Residency in Pediatrics, Psychiatry, Emergency Medicine, Anesthesiology; 3 core years.
Fellowship in Clinical Pharmacology for 2 years.
Career PathsMostly Clinical
Consultations in hospital and outpatient clinic.
Chair, Pharmacy and Therapeutics Committee in hospital.
Presentations at rounds.
Career Paths (cont)Mostly research.
Conduct Clinical trials
Some clinical practice
Some teaching.
Career Paths (cont)Academic
Research doing clinical trials or lab based research
Major teaching responsibility, undergraduate and graduate students.
Some clinical practice.
Career Paths (cont)Government
Evaluating drugs for Federal or Provincial governments.
Teaching and training responsibility.
Career Paths (cont)Industry
PhD or MD or MD, PhD
Research
Drug development basic or clinical
Administration
ConclusionsYou already have a good background training in
Pharmacology.
Clinical Pharmacology is interesting, highly challenging and greatly needed.
Prescription drugs are not used optimally and are a major cause of unnecessary death.
Conclusions (cont)Physicians both family practitioners and
specialists are not adequately trained in Clinical Pharmacology.
Physicians are highly vulnerable and unknowingly influenced by Big Pharma.
Because number and complexity of drugs is expanding Clinical Pharmacologists are badly needed.
