Clinical Pharmacology 400 2014 Jim Wright Clinical Pharmacologist

Clinical Pharmacology 400 2014 Jim Wright Clinical Pharmacologist 7 lectures

Outline of series Clinical 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 2014 Clinical Pharmacology as a Career

Outline What 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 drug Diagnostic 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 Meds by 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, Mc. Gill University). 1975 -76, one year Post doctoral training in Clinical Pharmacology at Hammersmith Hospital, London, UK

My degrees MD, University of Alberta 1968 Ph. D, Mc. Gill University, 1976 FRCP(C), Internal Medicine, 1975

My journey at UBC First 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 UBC Third 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 Paths Mostly 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 Ph. D or MD, Ph. D Research Drug development basic or clinical Administration

Conclusions You 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.

Questions? ? Websites www. ti. ubc. ca/cochrane/ jim. wright@ti. ubc. ca