A textbook of clinical pharmacology

Textbooks of clinical pharmacology for medical students face two challenges. They need to provide concise information on the treatment of common diseases to enable the newly qualified doctor to acquire an adequate knowledge base to prescribe. Most textbooks succeed in this with varying ‘cost effectiveness’. The second more difficult task, more relevant to producing long-term professional competency in drug treatment, is to encourage students to think critically about drug use and the principles of clinical pharmacology and to encourage the acquisition of the skills required to practise ‘rational’ or ‘optimal’ therapeutics. Few student textbooks succeed in capturing this intellectual spirit of clinical pharmacology that separates it from the approach of other disciplines to drug treatment. The fourth edition of this textbook takes a traditional approach with the first section covering general principles, and the remaining 13 sections accounting for over 75% of the book, dealing with the treatment of common diseases (therapeutics). The book is attractively laid out, easy to read and has sufficient figures, tables, case histories and key points to hold the reader's attention, although the similarly priced ‘Integrated Pharmacology’ by Page et al. is better on visual presentation and layout. The principles of pharmacokinetics, pharmacodynamics and drug use in special groups (pregnancy, children and the elderly) are well covered at an appropriate level. This section would benefit from chapters on practical aspects of drug administration, particularly intravenous drug administration, writing prescriptions and the procedures and mindset necessary to avoid the ‘drug disasters’ that still too commonly occur in routine clinical practice. The importance of adherence to drug treatment, and its influencing factors, is not covered adequately, with only brief discussion in the chapters on the elderly and children. This approach will perpetuate the incorrect belief that poor adherence is a problem mostly in these patients. Inevitably textbooks are soon out of date and omit recent advances in therapeutics, and these sections should come with a ‘best before’ date. CD or web based updates are probably needed if textbooks are to avoid being completely replaced by electronic media. I was disappointed to see no mention of the use of thrombolysis and aspirin in acute ischaemic stroke, or beta-interferon as a treatment for multiple sclerosis. Although multiple risk factor assessment in cardiovascular risk is discussed, examples of how to use coronary risk prediction charts are not given. However, in general the therapeutics sections provide a lucid comprehensive account for students. This text is less successful in capturing the spirit of clinical pharmacology and outlining the principles and thinking which cultivate a ‘critical approach’ to the optimal use of drugs in clinical care. The North American text ‘Melmon and Morelli’s Clinical Pharmacology' is best in this respect, but it is little read in this country and too large to suit most students. This book is a reasonable recommendation to students as a core text for therapeutics teaching. Departments with integrated teaching of Pharmacology and Clinical Pharmacology and Therapeutics should probably consider other texts, which include more basic pharmacology.