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Logo of oenvmedOccupational and Environmental MedicineVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
 
Occup Environ Med. 2007 August; 64(8): e2.
PMCID: PMC2078485

The pharmacological basis of therapeutics

Reviewed by J E Davies

L L Brunton, J S Lazo, K L Parker. McGraw‐Hill, 2005, £85.00 (hardback), pp 2021. ISBN 0071422803

It is five years since the last edition of this “tour de force” textbook of clinical pharmacology, originally written in the 1940s by Goodman and Gilman. The advances in pharmacology since that time are matched by the sheer size and weight of this volume, and necessarily so. The difficulty in writing a clinical pharmacology textbook is the necessity of including sufficient physiology as the foundation stone to understanding this subject and its clinical relevance. This aspect is indeed addressed by the numerous expert authors contributing to this book, which contains a formidable amount of information. The authors have continued the original concept of this textbook in relating the basic pharmacology to advances in medicine which results in interesting reading for practising physicians.

The format of the chapters has been maintained with the addition of a chapter entitled “The Science of Drug Therapy”. This is a useful outline of drug trials and pharmacokinetics in different age groups and diseases while illustrating the importance of bioavailability of drugs. Refreshingly, reference is also made to the limitation of drug trials including biased selection of patients and the use of surrogate markers rather than clinical outcomes. A useful account of websites containing sources of drug information is also included in this chapter.

As a practising physician I find the deluge of clinical trials overwhelming and at times irritatingly performed. This unfortunately may lead the inexperienced clinician into managing well‐tried drugs inappropriately, as older drugs haven't been incorporated into a modern day trial. This can result in the misuse of a drug, even in the face of a wealth of experience and knowledge. Thus the understanding of pharmacology and the historical use of a drug is an essential tool for the clinician in any field in order to fight their way through the plethora of inadequate trials and to achieve clarity. In the chapters on the cardiovascular system the major trials are quoted, which is helpful.

If there is criticism for such a biblical triumph of a book it is in the repetition of physiological mechanisms of drugs, which sometimes occurs in the introduction to the chapter and then again in the explanation of the mechanism of the drug itself. To a certain extent this is unavoidable in a multi‐author book and not a bad thing for clinicians in general. However, reduction in the size of the book would be an advantage. The other slightly irritating aspect is in the small print explanations within each chapter. The content of the small print seems to me to be quite important and probably better placed in the normal sized font used, which in this book is not so large in any case. This observation may of course be due to natural processes occurring in my lenses but then, as with this book, other things do improve with the passing years!

This is without doubt an excellent book, with improved illustrations in this particular edition. It should be within easy reach of every practising physician and student of medicine, pharmacology and toxicology—preferably within arm's length.


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