LETTERS TO THE EDITORS
Br. J. clin. Pharmac. (1979), 8
183
THE ROLE OF THE CLINICAL PHARMACOLOGIST IN DISTRICT GENERAL HOSPITALS At the risk of continuing the debate on the role of the clinical pharmacologist in district general hospitals I feel I must reply to the letter of Professor M.D. Rawlins (1979). I am a hospital pharmacist who has worked closely with a local clinical pharmacology unit and I take exception to some of Rawlins (1979) comments. Rawlins (1979) has obviously not compared the present contents of pharmacy and medical courses at University. When I did my training several years ago the pharmacy course involved a great deal of physiology, a lot of chemistry and when I specialized in pharmacology, a series of clinical lectures by consultants at a local hospital and training in pathology was provided. Perhaps I am naive, but I believe that I gained slightly more than 'familiarity with medical terminology'. The present pharmacy courses include a detailed training in pharmacokinetics, something quite a few clinical pharmacologists leave to others better qualified. I agree that the clinical pharmacologist has a long detailed training but he is not the only person capable of running a unit. In Rawlins (1979) letter there is no account of highly qualified technicians who develop drug assays, or the biochemists and pharmacists I know who help interpret assay data and present the final result to the clinical phannacologist who instigates appropriate clinical action. I disagree with the comment of Fullerton & Noyce (1978) that clinical pharmacology is a research based discipline. From my experience at the clinical pharmacology unit at Harrogate, drug-related clini-
cal problems have been posed and solved by combined effort within the unit and some of these problems could not have been solved elsewhere within the hospital. As a person with experience of both pharmacy and clinical pharmacology, may I say that there is a place for both in the District General Hospital. The views of Rawlins (1979) and Fullerton & Noyce (1978) have been extreme but I feel both sides would concede certain points to the other and perhaps this would relieve some of the antagonism. Finally, I would like to envisage both departments being amalgamated so that all drug related problems and drugs issued were dealt with under one roof. I realise that this is probably not feasible but it is
certainly a point to ponder. K.D.BALL District Pharmaceutical Officer, West Cwnberland Hospital, Whitehaven, Cumbria CA28 8JG Received April 5, 1979
Referems FULLERTON, S.E. & NOYCE, P.R. (1978). The role of the clinical pharmacologist in District General Hospitals. Br. J. clin. Pharmac, 6, 180-181. RAWLINS, M.D. (1979). The role of clinical pharmacologist in District General Hospitals. Br. J. clin. Pharmac., 7, 123.
OVERNIGHT URINE SPECIMENS FOR THE DETERMINATION OF D-GLUCARIC ACID EXCRETION IN MAN A wide range of drugs, dietary constituents and environmental contaminants are capable of inducing the activity of hepatic microsomal enzymes (Conney, 1967) and this can have important toxicological consequences on long-term exposure to the inducing agent (Richens & Woodford, 1976). The most satisfactory way of assessing induction is by measuring the activity of the mixed function oxidase system in liver biopsies, but this can seldom be justified clinically. Of the indirect indices which are commonly used, each has its own particular
disadvantage. Plasma antipyrine half-lives normally require multiple venepunctures, serum gammaglutamyltranspeptidase activity may be elevated by hepatocellular damage (Whitfield, Pounder, Neale & Moss, 1972; Lum & Gambino, 1972), and urinary 6,Bhydroxycortisol is difficult to measure and must be related to 17-hydroxycorticosteroid excretion. The urinary excretion of D-glucaric acid has been shown to correlate with the total intake of enzymeinducing drugs (Hunter, Carrella, Maxwell, Stewart & Williams, 1971; Latham, Millbank, Richens &
Br. J. clin. Pharmac. (1979), 8
183
THE ROLE OF THE CLINICAL PHARMACOLOGIST IN DISTRICT GENERAL HOSPITALS At the risk of continuing the debate on the role of the clinical pharmacologist in district general hospitals I feel I must reply to the letter of Professor M.D. Rawlins (1979). I am a hospital pharmacist who has worked closely with a local clinical pharmacology unit and I take exception to some of Rawlins (1979) comments. Rawlins (1979) has obviously not compared the present contents of pharmacy and medical courses at University. When I did my training several years ago the pharmacy course involved a great deal of physiology, a lot of chemistry and when I specialized in pharmacology, a series of clinical lectures by consultants at a local hospital and training in pathology was provided. Perhaps I am naive, but I believe that I gained slightly more than 'familiarity with medical terminology'. The present pharmacy courses include a detailed training in pharmacokinetics, something quite a few clinical pharmacologists leave to others better qualified. I agree that the clinical pharmacologist has a long detailed training but he is not the only person capable of running a unit. In Rawlins (1979) letter there is no account of highly qualified technicians who develop drug assays, or the biochemists and pharmacists I know who help interpret assay data and present the final result to the clinical phannacologist who instigates appropriate clinical action. I disagree with the comment of Fullerton & Noyce (1978) that clinical pharmacology is a research based discipline. From my experience at the clinical pharmacology unit at Harrogate, drug-related clini-
cal problems have been posed and solved by combined effort within the unit and some of these problems could not have been solved elsewhere within the hospital. As a person with experience of both pharmacy and clinical pharmacology, may I say that there is a place for both in the District General Hospital. The views of Rawlins (1979) and Fullerton & Noyce (1978) have been extreme but I feel both sides would concede certain points to the other and perhaps this would relieve some of the antagonism. Finally, I would like to envisage both departments being amalgamated so that all drug related problems and drugs issued were dealt with under one roof. I realise that this is probably not feasible but it is
certainly a point to ponder. K.D.BALL District Pharmaceutical Officer, West Cwnberland Hospital, Whitehaven, Cumbria CA28 8JG Received April 5, 1979
Referems FULLERTON, S.E. & NOYCE, P.R. (1978). The role of the clinical pharmacologist in District General Hospitals. Br. J. clin. Pharmac, 6, 180-181. RAWLINS, M.D. (1979). The role of clinical pharmacologist in District General Hospitals. Br. J. clin. Pharmac., 7, 123.
OVERNIGHT URINE SPECIMENS FOR THE DETERMINATION OF D-GLUCARIC ACID EXCRETION IN MAN A wide range of drugs, dietary constituents and environmental contaminants are capable of inducing the activity of hepatic microsomal enzymes (Conney, 1967) and this can have important toxicological consequences on long-term exposure to the inducing agent (Richens & Woodford, 1976). The most satisfactory way of assessing induction is by measuring the activity of the mixed function oxidase system in liver biopsies, but this can seldom be justified clinically. Of the indirect indices which are commonly used, each has its own particular
disadvantage. Plasma antipyrine half-lives normally require multiple venepunctures, serum gammaglutamyltranspeptidase activity may be elevated by hepatocellular damage (Whitfield, Pounder, Neale & Moss, 1972; Lum & Gambino, 1972), and urinary 6,Bhydroxycortisol is difficult to measure and must be related to 17-hydroxycorticosteroid excretion. The urinary excretion of D-glucaric acid has been shown to correlate with the total intake of enzymeinducing drugs (Hunter, Carrella, Maxwell, Stewart & Williams, 1971; Latham, Millbank, Richens &
