CLINICAL PHARMACOLOGY IN THE UK,
c. 1950-2000: INFLUENCES AND INSTITUTIONS
The transcript of a Witness Seminar held by the Wellcome Trust Centre
for the History of Medicine at UCL, London, on 6 February 2007
Edited by LA Reynolds and E MTansey
Volume 33 2008
©The Trustee of the Wellcome Trust, London, 2008
First published by the Wellcome Trust Centre
for the History of Medicine at UCL, 2008
The Wellcome Trust Centre for the History of Medicine
at UCL is funded by the Wellcome Trust, which is
a registered charity, no. 210183.
ISBN 978 085484 117 2
All volumes are freely available online at: www.history.qmul.ac.uk/researchlmodbiomedlwellcome_witnesses/
Please cite as : Reynolds L A, Tansey E M. (eds) (2008) Clinical Pharmacology in the UK c.1 950-2000: Influences and Institutions.
Wellcome Witnesses to Twentieth Century Medicine, vol. 33. London: Wellcome Trust Centre for the
History of Medicine at UCL.
CONTENTS
Illustrations and credits v
Witness Seminars: Meetings and publications; Acknowledgements
E MTansey and LA Reynolds vii
Introduction
MarkWalport xxi
Transcript
Edited by LA Reynolds and E MTansey 1
Appendix 1
Clinical pharmacology: dates of key publications and events
by Jeffrey Aronson 77
References 81
Biographical notes 101
Glossary 121
Index 127
ILLUSTRATIONS AND CREDITS
Figure 1 A woodcut of Ge Hong engraved c. 15th century.
Reproduced by permission of the Wellcome Library,
London. 5
Figure 2 Dose— response curve on the effect of propranolol.
Adapted from Prichard and Gillam (1971). 23
Figure 3 Sir Thomas Lauder Brunton, oil on canvas by
Sir Hubert von Herkomer, 1913. Reproduced by
permission of St Bartholomew's Hospital Archives
and Museum. 25
Figure 4 Aberdeen Prescription Sheet, 1967. Reproduced
by permission of the Royal College of Physicians
of London. 31
Figure 5 WHO Technical Report no. 446, Clinical
Pharmacology: Scope, organization, training, 1970.
Reproduced by permission of the World Health
Organization. 41
Figure 6 Cover of the second edition of the National War
Formulary, 1943. Crown Copyright; reproduced
under licence from the Office of Public Sector
Information. 54
Figure 7 Per Lunde, Barbro Westerholm and Owen Wade,
1971. Provided by and reproduced with permission of
Professor Owen Wade. 59
WITNESS SEMINARS:
MEETINGS AND PUBLICATIONS 1
In 1990 the Wellcome Trust created a History of Twentieth Century Medicine
Group, associated with the Academic Unit of the Wellcome Institute for the
History of Medicine, to bring together clinicians, scientists, historians and others
interested in contemporary medical history. Among a number of other initiatives
the format of Witness Seminars, used by the Institute of Contemporary British
History to address issues of recent political history, was adopted, to promote
interaction between these different groups, to emphasize the potential benefits
of working jointly, and to encourage the creation and deposit of archival sources
for present and future use. In June 1999 the Governors of the Wellcome Trust
decided that it would be appropriate for the Academic Unit to enjoy a more
formal academic affiliation and turned the Unit into the Wellcome Trust Centre
for the History of Medicine at UCL from 1 October 2000. The Wellcome
Trust continues to fund the Witness Seminar programme via its support for
the Centre.
The Witness Seminar is a particularly specialized form of oral history, where
several people associated with a particular set of circumstances or events are
invited to come together to discuss, debate, and agree or disagree about their
memories. To date, the History of Twentieth Century Medicine Group has held
more than 50 such meetings, most of which have been published, as listed on
pages xi— xix.
Subjects are usually proposed by, or through, members of the Programme
Committee of the Group, which includes professional historians of medicine,
practising scientists and clinicians, and once an appropriate topic has been
agreed, suitable participants are identified and invited. This inevitably leads to
further contacts, and more suggestions of people to invite. As the organization
of the meeting progresses, a flexible outline plan for the meeting is devised,
usually with assistance from the meeting's chairman, and some participants are
invited to 'set the ball rolling' on particular themes, by speaking for a short
period to initiate and stimulate further discussion.
The following text also appears in the 'Introduction' to recent volumes of Wellcome Witnesses to Twentieth
Century Medicine published by the Wellcome Trust and the Wellcome Trust Centre for the History of
Medicine at UCL.
Each meeting is fully recorded, the tapes are transcribed and the unedited transcript
is sent to every participant. Each is asked to check his or her own contributions and
to provide brief biographical details. The editors turn the transcript into readable
text, and participants' minor corrections and comments are incorporated into that
text, while biographical and bibliographical details are added as footnotes, as are
more substantial comments and additional material provided by participants. The
final scripts are then sent to every contributor, accompanied by forms assigning
copyright to the Wellcome Trust. Copies of all additional correspondence received
during the editorial process are deposited with the records of each meeting in
archives and manuscripts, Wellcome Library, London.
As with all our meetings, we hope that even if the precise details of some of the
technical sections are not clear to the non-specialist, the sense and significance
of the events will be understandable. Our aim is for the volumes that emerge
from these meetings to inform those with a general interest in the history of
modern medicine and medical science; to provide historians with new insights,
fresh material for study, and further themes for research; and to emphasize to
the participants that events of the recent past, of their own working lives, are of
proper and necessary concern to historians.
Members of the Programme Committee of the
History of Twentieth Century Medicine Group, 2008-09
Professor TilliTansey - Professor of the History of Modern Medical Sciences, Wellcome
Trust Centre for the History of Medicine at UCL (VVTCHM) and Chair
Sir Christopher Booth -WTCHM, former Director; Clinical Research Centre,
Northwick Park Hospital, London
Mrs Lois Reynolds - Senior Research Assistant, WTCHM, and Organizing Secretary
Dr John Ford - Retired General Practitioner, Tonbridge
Professor Richard Himsworth - former Director of the Institute of Health,
University of Cambridge
Professor Mark Jackson - Centre for Medical History, Exeter
Professor John Pickstone -Wellcome Research Professor; University of Manchester
Dr Helga Satzinger - Reader in History ofTwentieth Century Biomedicine, WTCHM
Professor Lawrence Weaver - Professor of Child Health, University of Glasgow, and
Consultant Paediatrician in the Royal Hospital for Sick Children, Glasgow
Sir Iain Chalmers authorizes the Wellcome Trust to publish his work and to report or reproduce it in any
form or media, including offprints, provided that it is understood that the Wellcome Trust's right to do so
is nonexclusive.
ACKNOWLEDGEMENTS
'Clinical pharmacology in the UK, c. 1950—2000' was suggested as a suitable
topic for a Witness Seminar by Dr Jeffrey Aronson, who assisted us in planning
the meeting. We are very grateful to him for his input and to Professor Rod
Flower for his excellent chairing of the occasion. We are particularly grateful
to Dr Mark Walport for writing such a helpful Introduction to these published
proceedings. Our additional thanks go to Professor Desmond Laurence and
Dr John Mucklow, who read through earlier drafts of the transcript, and
offered helpful comments and advice. We thank Dr Jeffrey Aronson, Dr
Arthur Fowle, Dr Tony Peck and Professor Brian Prichard for their help with
the Glossary and Professor Desmond Laurence, Professor Brian Prichard and
Professor Owen Wade for the photographs. For permission to reproduce images
included here, we thank the Office of Public Sector Information, the Royal
College of Physicians of London, St Bartholomew's Hospital Archives and
Museum, the Wellcome Library and the WHO. Sir James Black cooperated
through the editorial process, but did not assign copyright for the use of his
contribution, although he gave permission to include his contribution as
recorded speech.
As with all our meetings, we depend a great deal on our colleagues at the Wellcome
Trust to ensure their smooth running: the Audiovisual Department, and the
Medical Photographic Library; Mr Akio Morishima, who has supervised the
design and production of this volume; our indexer, Ms Liza Furnival; and our
readers, Ms Fiona Plowman, Mrs Sarah Beanland and Mr Simon Reynolds; and
Ms Stefania Crowther for editorial and marketing assistance. Mrs Jaqui Carter
is our transcriber, and Mrs Wendy Kutner and Dr Daphne Christie assisted us
in running this meeting. Finally we thank the Wellcome Trust for supporting
this programme.
Tilli Tansey
Lois Reynolds
WellcomeTrust Centre for the History of Medicine at UCL
HISTORY OF TWENTIETH CENTURY MEDICINE
WITNESS SEMINARS, 1993-2008
1 993 Monoclonal antibodies
1 994 The early history of renal transplantation
Pneumoconiosis of coal workers
1 995 Self and non-self: A history of autoimmunity
Ashes to ashes: The history of smoking and health
Oral contraceptives
Endogenous opiates
1 996 Committee on Safety of Drugs
Making the body more transparent: The impact of nuclear
magnetic resonance and magnetic resonance imaging
1 997 Research in general practice
Drugs in psychiatric practice
The MRC Common Cold Unit
The first heart transplant in the UK
1 998 Haemophilia: Recent history of clinical management
Obstetric ultrasound: Historical perspectives
Post penicillin antibiotics
Clinical research in Britain, 1950-1980
1 999 Intestinal absorption
The MRC Epidemiology Unit (South Wales)
Neonatal intensive care
British contributions to medicine in Africa after the Second
World War
2000 Childhood asthma, and beyond
Peptic ulcer: Rise and fall
Maternal care
2001 Leukaemia
The MRC Applied Psychology Unit
Genetic testing
Foot and mouth disease: The 1967 outbreak and its aftermath
2002 Environmental toxicology: The legacy of Silent Spring
Cystic fibrosis
Innovation in pain management
2003 Thrombolysis
Beyond the asylum: Anti-psychiatry and care in the community
The Rhesus factor and disease prevention
The recent history of platelets: Measurements,
functions and applications in medicine
2004 Short-course chemotherapy for tuberculosis
Prenatal corticosteroids for reducing morbidity and mortality
associated with preterm birth
Public health in the 1980s and 1990s: Decline and rise?
2005 The history of cholesterol, atherosclerosis and coronary disease
Development of physics applied to medicine in the UK,
1945-90
2006 Early development of total hip replacement
The discovery, use and impact of platinum salts as chemotherapy
agents for cancer
Medical ethics education in Britain, 1963-93
Superbugs and superdrugs: The history of MRSA
2007 The rise and fall of clinical pharmacology
in the UK, c. 1950-2000
The resurgence of breast-feeding, 1975-2000
DNA fingerprinting
The development of sports medicine in
twentieth-century Britain
2008 History of dialysis, c. 1950-2000
History of cervical cancer and the role of the human
papillomavirus over the last 25 years
Clinical genetics in Britain: Origins and development
PUBLISHED MEETINGS
'. . .Few books are so intellectually stimulating or uplifting.
journal of the Royal Society of Medicine (1999) 92: 206-8,
review of vols 1 and 2
'. . . This is oral history at its best. . . all the volumes make compulsive reading. . . they
are, primarily, important historical records'.
British Medical Journal (2002) 325: 1 119, review of the series
Technology transfer in Britain: The case of monoclonal antibodies
Self and non-self: A history of autoimmunity
Endogenous opiates
The Committee on Safety of Drugs
Tansey E M, Catterall P P, Christie D A, Willhoft S V, Reynolds L A. (eds)
(1997) Wellcome Witnesses to Twentieth Century Medicine. Volume 1. London:
The Wellcome Trust, 135pp. ISBN 1 869835 79 4
Making the human body transparent: The impact of NMR and MRI
Research in general practice
Drugs in psychiatric practice
The MRC Common Cold Unit
Tansey E M, Christie D A, Reynolds LA. (eds) (1998) Wellcome
Witnesses to Twentieth Century Medicine. Volume 2. London: The Wellcome
Trust, 282pp. ISBN 1 869835 39 5
Early heart transplant surgery in the UK
Tansey E M, Reynolds LA. (eds) (1999) Wellcome Witnesses to
Twentieth Century Medicine. Volume 3. London: The Wellcome Trust, 72pp.
ISBN 1 841290 07 6
Haemophilia: Recent history of clinical management
Tansey E M, Christie D A. (eds) (1999) Wellcome Witnesses to
Twentieth Century Medicine. Volume 4. London: The Wellcome Trust, 90pp.
ISBN 1 841290 08 4
Looking at the unborn: Historical aspects of obstetric ultrasound
Tansey E M, Christie D A. (eds) (2000) Wellcome Witnesses to
Twentieth Century Medicine. Volume 5. London: The Wellcome Trust, 80pp.
ISBN 1 841290 11 4
Post penicillin antibiotics: From acceptance to resistance?
Tansey E M, Reynolds LA. (eds) (2000) Wellcome Witnesses to Twentieth
Century Medicine. Volume 6. London: The Wellcome Trust, 71pp.
ISBN 1 841290 12 2
Clinical research in Britain, 1950-1980
Reynolds L A, Tansey E M. (eds) (2000) Wellcome Witnesses to Twentieth
Century Medicine. Volume 7. London: The Wellcome Trust, 74pp.
ISBN 1 841290 16 5
Intestinal absorption
Christie D A, Tansey E M. (eds) (2000) Wellcome Witnesses to Twentieth
Century Medicine. Volume 8. London: The Wellcome Trust, 81pp.
ISBN 1 841290 17 3
Neonatal intensive care
Christie D A, Tansey E M. (eds) (2001) Wellcome Witnesses to Twentieth
Century Medicine. Volume 9. London: The Wellcome Trust Centre for the
History of Medicine at UCL, 84pp. ISBN 854840 76 1
British contributions to medical research and education in Africa after the
Second World War
Reynolds L A, Tansey E M. (eds) (2001) Wellcome Witnesses to Twentieth
Century Medicine. Volume 10. London: The Wellcome Trust Centre for the
History of Medicine at UCL, 93pp. ISBN 854840 77 X
Childhood asthma and beyond
Reynolds L A, Tansey E M. (eds) (2001) Wellcome Witnesses to Twentieth
Century Medicine. Volume 11. London: The Wellcome Trust Centre for the
History of Medicine at UCL, 74pp. ISBN 854840 78 8
Maternal care
Christie D A, Tansey E M. (eds) (2001) Wellcome Witnesses to Twentieth
Century Medicine. Volume 12. London: The Wellcome Trust Centre for the
History of Medicine at UCL, 88pp. ISBN 854840 79 6
Population-based research in south Wales: The MRC Pneumoconiosis
Research Unit and the MRC Epidemiology Unit
Ness A R, Reynolds L A, Tansey E M. (eds) (2002) Wellcome Witnesses to
Twentieth Century Medicine. Volume 13. London: The Wellcome Trust Centre
for the History of Medicine at UCL, 74pp. ISBN 854840 81 8
Peptic ulcer: Rise and fall
Christie D A, Tansey E M. (eds) (2002) Wellcome Witnesses to Twentieth
Century Medicine. Volume 14. London: The Wellcome Trust Centre for the
History of Medicine at UCL, 143pp. ISBN 854840 84 2
Leukaemia
Christie D A, Tansey E M. (eds) (2003) Wellcome Witnesses to Twentieth
Century Medicine. Volume 15. London: The Wellcome Trust Centre for the
History of Medicine at UCL, 86pp. ISBN 85484 087 7
The MRC Applied Psychology Unit
Reynolds L A, Tansey E M. (eds) (2003) Wellcome Witnesses to Twentieth
Century Medicine. Volume 16. London: The Wellcome Trust Centre for the
History of Medicine at UCL, 94pp. ISBN 85484 088 5
Genetic testing
Christie D A, Tansey E M. (eds) (2003) Wellcome Witnesses to Twentieth
Century Medicine. Volume 17. London: The Wellcome Trust Centre for the
History of Medicine at UCL, 130pp. ISBN 85484 094 X
Foot and mouth disease: The 1967 outbreak and its aftermath
Reynolds L A, Tansey E M. (eds) (2003) Wellcome Witnesses to Twentieth
Century Medicine. Volume 18. London: The Wellcome Trust Centre for the
History of Medicine at UCL, 1 14pp. ISBN 85484 096 6
Environmental toxicology: The legacy of Silent Spring
Christie D A, Tansey E M. (eds) (2004) Wellcome Witnesses to Twentieth
Century Medicine. Volume 19. London: The Wellcome Trust Centre for the
History of Medicine at UCL, 132pp. ISBN 85484 091 5
Cystic fibrosis
Christie D A, Tansey E M. (eds) (2004) Wellcome Witnesses to Twentieth
Century Medicine. Volume 20. London: The Wellcome Trust Centre for the
History of Medicine at UCL, 120pp. ISBN 85484 086 9
Innovation in pain management
Reynolds L A, Tansey E M. (eds) (2004) Wellcome Witnesses to Twentieth
Century Medicine. Volume 21. London: The Wellcome Trust Centre for the
History of Medicine at UCL, 125pp. ISBN 85484 097 4
The Rhesus factor and disease prevention
Zallen D T, Christie D A, Tansey E M. (eds) (2004) Wellcome Witnesses to
Twentieth Century Medicine. Volume 22. London: The Wellcome Trust Centre
for the History of Medicine at UCL, 98pp. ISBN 85484 099
The recent history of platelets in thrombosis and other disorders
Reynolds L A, Tansey E M. (eds) (2005) Wellcome Witnesses to Twentieth
Century Medicine. Volume 23. London: The Wellcome Trust Centre for the
History of Medicine at UCL, 186pp. ISBN 85484 103 2
Short-course chemotherapy for tuberculosis
Christie D A, Tansey E M. (eds) (2005) Wellcome Witnesses to Twentieth
Century Medicine. Volume 24. London: The Wellcome Trust Centre for the
History of Medicine at UCL, 120pp. ISBN 85484 104
Prenatal corticosteroids for reducing morbidity and mortality after
preterm birth
Reynolds L A, Tansey E M. (eds) (2005) Wellcome Witnesses to Twentieth
Century Medicine. Volume 25. London: The Wellcome Trust Centre for the
History of Medicine at UCL, 154pp. ISBN 85484 102 4
Public health in the 1980s and 1990s: Decline and rise?
Berridge V, Christie D A, Tansey E M. (eds) (2006) Wellcome Witnesses to
Twentieth Century Medicine. Volume 26. London: The Wellcome Trust Centre
for the History of Medicine at UCL, 101pp. ISBN 85484 106 7
Cholesterol, atherosclerosis and coronary disease in the UK, 1950—2000
Reynolds L A, Tansey E M. (eds) (2006) Wellcome Witnesses to Twentieth
Century Medicine. Volume 27. London: The Wellcome Trust Centre for the
History of Medicine at UCL, 164pp. ISBN 85484 107 5
Development of physics applied to medicine in the UK, 1945-90
Christie D A, Tansey E M. (eds) (2006) Wellcome Witnesses to Twentieth
Century Medicine. Volume 28. The Wellcome Trust Centre for the History of
Medicine at UCL, 141pp. ISBN 85484 108 3
Early development of total hip replacement
Reynolds L A, Tansey E M. (eds) (2007) Wellcome Witnesses to Twentieth
Century Medicine. Volume 29. London: The Wellcome Trust Centre for the
History of Medicine at UCL, 198pp. ISBN 978 085484 1110
The discovery, use and impact of platinum salts as chemotherapy agents
for cancer
Christie D A, Tansey E M. (eds) (2007) Wellcome Witnesses to Twentieth
Century Medicine. Volume 30. London: The Wellcome Trust Centre for the
History of Medicine at UCL, 142pp. ISBN 978 085484 112 7
Medical Ethics Education in Britain, 1963-93
Reynolds L A, Tansey E M. (eds) (2007) Wellcome Witnesses to Twentieth
Century Medicine. Volume 31. London: The Wellcome Trust Centre for the
History of Medicine at UCL, 24lpp. ISBN 978 085484 113 4
Superbugs and superdrugs: A history of MRSA
Reynolds L A, Tansey E M. (eds) (2008) Wellcome Witnesses to Twentieth
Century Medicine. Volume 32. London: The Wellcome Trust Centre for the
History of Medicine at UCL, 167pp. ISBN 978 085484 114 1
Clinical pharmacology in the UK, c. 1950-2000: Influences
and institutions
Reynolds L A, Tansey E M. (eds) (2008) Wellcome Witnesses to Twentieth
Century Medicine. Volume 33. London: The Wellcome Trust Centre for the
History of Medicine at UCL (this volume). ISBN 978 085484 117 2
Clinical pharmacology in the UK, c. 1950-2000: Industry and regulation
Reynolds L A, Tansey E M. (eds) (2008) Wellcome Witnesses to Twentieth
Century Medicine. Volume 34. London: The Wellcome Trust Centre for the
History of Medicine at UCL (in press). ISBN 978 085484 118 9
The resurgence of breastfeeding, 1975-2000
Reynolds L A, Tansey E M. (eds) (2009) Wellcome Witnesses to Twentieth
Century Medicine. Volume 35. London: The Wellcome Trust Centre for the
History of Medicine at UCL (in press). ISBN 978 085484 119 6
The development of sports medicine in twentieth century Britain
Reynolds L A, Tansey E M. (eds) (2009) Wellcome Witnesses to Twentieth
Century Medicine. Volume 36. London: The Wellcome Trust Centre for the
History of Medicine at UCL (in press). ISBN 978 085484 121 9
History of dialysis in the UK: c. 1950-2000
Reynolds L A, Tansey E M. (eds) (2009) Wellcome Witnesses to Twentieth
Century Medicine. Volume 37. London: The Wellcome Trust Centre for the
History of Medicine at UCL (in press). ISBN 978 085484 122 6
History of cervical cancer and the role of the human papillomavirus over
the last 25 years
Reynolds L A, Tansey E M. (eds) (2009) Wellcome Witnesses to Twentieth
Century Medicine. Volume 38. London: The Wellcome Trust Centre for the
History of Medicine at UCL (in press). ISBN 978 085484 123 3
Hard copies of volumes 1-20 are now available for free, while stocks
last. We would be happy to send complete sets to libraries in developing
or restructuring countries.Available from Dr Carole Reeves at:
c.reeves@ucl.ac.uk
All volumes are freely available online at www.ucl.ac.uk/histmed/
publications/wellcome-witnesses/index.html or by following the links to
Publications/Wellcome Witnesses at www.ucl.ac.uk/histmed
A hard copy of volumes 21-33 can be ordered from www.amazon.co.uk;
www.amazon.com; and all good booksellers for £6/$10 plus postage, using
the ISBN.
Other publications
Technology transfer in Britain: The case of monoclonal antibodies
In: Tansey E M, Catterall P P. (1993) Contemporary Record9: A09-AA.
Monoclonal antibodies: A witness seminar on contemporary
medical history
In: Tansey E M, Catterall P P. (1994) Medical History 38: 322-7.
Chronic pulmonary disease in South Wales coalmines: An eye-witness
account of the MRC surveys (1937-42)
In: D'Arcy Hart P, edited and annotated by E M Tansey. (1998) Social
History of Medicine 11: 459—68.
Ashes to Ashes — The history of smoking and health
In: Lock S P, Reynolds LA, Tansey E M. (eds) (1998) Amsterdam: Rodopi
BV, 228pp. ISBN 90420 0396 (Hfl 125) (hardback). Reprinted 2003.
Witnessing medical history. An interview with Dr Rosemary Biggs
Professor Christine Lee and Dr Charles Rizza (interviewers). (1998)
Haemophilia 4: 769-77.
Witnessing the Witnesses: Pitfalls and potentials of the Witness Seminar
in twentieth century medicine
By E M Tansey. In: Doel R, Soderqvist T (eds) (2006) Writing Recent Science:
The historiography of contemporary science, technology and medicine. London:
Routledge, 260-78.
INTRODUCTION
This Witness Seminar comes at a timely moment for clinical pharmacology, which,
as a clinical subspecialty, finds itself in intensive care. The best use of medicines in
clinical practice, new drug development and proper regulation of drugs each require
medical practitioners with skills in clinical pharmacology. But in contrast, there is
litde demand for clinical pharmacologists in every day clinical practice — and it is
the demand and opportunities for clinical practitioners that are the main drivers of
specialty choice amongst young doctors. Clinical pharmacology must evolve and I
will return to this at the end of this introduction.
My first contact with clinical pharmacology was at the interview for senior house
officers at Hammersmith Hospital in 1978. Dr John Nabarro, my consultant
at the Middlesex Hospital, knowing of my passion for research, advised me to
apply for senior house officer (SHO) jobs at the Royal Postgraduate Medical
School, Hammersmith Hospital and my senior registrar, Dr David Morris,
suggested that rheumatology would be a good career choice within medicine for
a young doctor interested in immunology. So I duly turned up to the interview,
hoping to be appointed SHO to the rheumatology firm. The interviews were a
formidable and curious affair, approximately 25 candidates milling around, with
rapid fire interviews of about four or five minutes. The successful candidates
were duly marched into the boardroom, lined up against the portraits of retired
deans on the wall facing the interview panel and told which job they were being
offered, with little doubt that each would accept. I found myself appointed
SHO in clinical pharmacology and, without second thought, or any thought
at all under the pressure of circumstances, accepted immediately. Indeed after
many years on the other side of the interviewing table, I can only recall one
candidate who ever did decline the offered post.
After my appointment as a senior lecturer in rheumatology in 1985, 1 discovered
that the SHO interviews were almost as stressful for the interviewers as the
interviewees, since the members of the interview panel had no idea in advance
whether they would be asked to ask questions of any given candidate and Keith
Peters, then the professor of medicine, would deliberately pick as an interviewer
anyone who gave the appearance of dozing off or of complacency. This led to
some quite curious and challenging questions — one professor would regularly
jerk to life and ask some hapless candidate: 'What price a life?' I confess to
using the same technique as Keith Peters when eventually I became professor of
medicine and chaired the panel myself.
Back in 1978, as a newly appointed SHO, I had very little idea what to expect
from clinical pharmacology. In particular, what patients would be referred to a
clinical pharmacologist? And therein lies the paradox of clinical pharmacology.
The skills of clinical pharmacology are essential for the practice of the best
medicine - but the specialty 'owns' no diseases per se — it is the purest form of
general medicine. In the late 1970s the department of clinical pharmacology
at Hammersmith was the hub of the specialty in the UK. The department was
led by Colin Dollery, supported by John Reid, Peter Lewis and Donald Davies;
recently graduated senior academics from the department included Alasdair
Breckenridge and Charles George, the junior staff included an array of 'later
to be' professors and leaders including Morris Brown, John MacDermot, Mike
Rawlins and Garret Fitzgerald. The clinical pharmacology firm in those days
looked after patients with diseases requiring drugs that were difficult to manage.
These included hypertension, Parkinson's disease and epilepsy — but then as
now the majority of the clinical practice was general medicine.
The combination of working for John Nabarro, a meticulous and rigorous
diabetologist, followed by an equally meticulous and rigorous clinical
pharmacologist, Colin Dollery, taught me things that medical school had not.
The first was that taking a history and clinical examination were not activities that
were 'plucked from memory' on each and every occasion — the model instilled
in medical school. Assessing a hypertensive at Hammersmith involved filling in
a form — no question of forgetting some aspect of the history or examination
— the results were collected rigorously and ultimately entered in to a computer
database. The second was the quantitative aspects of drug treatment, whether in
the prescription of insulin or the titration of the blood pressure of a patient with
hypertension. I will never forget the patience of Colin Dollery, who personally
titrated the blood pressure of a patient undergoing the dangerous procedure of
surgical removal of a phaeochromocytoma, a catecholamine-secreting tumour
of the adrenal gland. This was not a matter that he would delegate to either one
of his juniors or to the anaesthetic team. These lessons remain important today
in an era when properly implemented electronic records, recording clinical
information in a systematic fashion and supported by expert systems could
transform the practice of medicine.
Clinical pharmacology is a very small specialty — but one that is disproportionately
important in relation to its size. One of the notable features of the specialty has been
the success of its practitioners in the national structures of medicine. Although the
ranks of district hospital physicians include few clinical pharmacologists, this could
not be said of the ranks of medical Knights. This reflects the crucial importance
of clinical pharmacology in the regulation and assessment of drug effects and side
effects. Bodies such as the Medicines and Healthcare products Regulatory Agency
(MHRA), the Medicines Commission and the National Institute for Health and
Clinical Excellence (NICE) have each had prominent leadership by members of
the small community of clinical pharmacologists. The pharmaceutical industry is
similarly critically dependent on the skills of pharmacologists in the laboratory and
the clinic for the development of new medicines.
Six months of SHO experience is a somewhat debatable qualification for writing
the introduction to this Witness Seminar. Directorship of the Wellcome Trust
is a more plausible explanation for the invitation to contribute, but could be
seen also as an equally doubtful qualification! However, I have had the pleasure
of long-standing professional association and friendship of many of those who
participated in this Witness Seminar, edited and presented as ably as ever, by
Tilli Tansey and her colleagues. I have also participated in the debate about the
future of the specialty 3 And that future probably depends on changing clinical
pharmacology from a subspecialty of medicine in its own right to a skill set that
is key to the future of all of the major subspecialties of medicine. For example,
gastroenterology can only proceed if there are some gastroenterologists who can
use the tools of clinical pharmacology to advance the specialty. This is the model
that has worked for a discipline such as immunology, in which immunologists
are embedded in every subspecialty of medicine. Clinical pharmacology is in
need of rebranding and Garret Fitzgerald has suggested 'clinical therapeutics
and translational medicine' as the banner for the next generation of clinical
pharmacologists. 4 Is this simply spin? I think not. The new title recognizes that
the skill set needed to advance medicines research in the twenty-first century is
broad and, in addition to pharmacological skills, requires skills in imaging, the
physiology and pathology of health and disease, trial design and bioethics. This
should be an attractive area for budding clinical scientists. But the brand alone
will not be sufficient, first class marketing will be required as well.
Moreover, writing this introduction provides me with the opportunity to signal
my admiration for the Witness Seminar series as a whole. One of the important
issues for those that are responsible for the funding of scientific research is
how to evaluate the outcomes of the research. Witness Seminars provide an
invaluable tool, because they illustrate the complexity of scientific discovery
Breckenridge et al. (2006).
4 Fitzgerald (2005).
and the human side of the research endeavour. It is over-simplistic to think that
the pathways of scientific discovery can be unravelled by simple bibliographic
analysis of the research literature. As an example, no amount of citation analysis
could capture the development of medical ultrasound, described in Volume 5
of the Wellcome Witnesses to Twentieth Century Medicine, a journey from Second
World War sonar research, through the Glasgow shipyards to the obstetric clinic.
The present volume is not an account of specific scientific discovery. Instead it
documents the development of an important small specialty which has been key
to the practice of modern medicine.
Mark Wal port
The Wellcome Trust
CLINICAL PHARMACOLOGY IN THE UK,
c. 1950-2000: INFLUENCES AND INSTITUTIONS
The transcript of a Witness Seminar held by the Wellcome Trust Centre
for the History of Medicine at UCL, London, on 6 February 2007
Edited by LA Reynolds and E MTansey
CLINICAL PHARMACOLOGY IN THE UK,
c. 1950-2000: INFLUENCES AND INSTITUTIONS
Participants
Dr Stuart Anderson
Dr Jeffrey Aronson
Professor David Barnett
Dr Linda Beeley
Professor Sir James Black
Professor Morris Brown
Professor Mark Caulfield
Sir lain Chalmers
Professor Donald Davies
Professor Robin Ferner
Professor Rod Flower (chair)
Dr Arthur Fowle
Professor Sir Charles George
Professor David Gordon
Professor David Grahame-Smith
Dr Andrew Herxheimer
Dr Kenneth Hunter
ProfessorTrevor Jones
Professor Desmond Laurence
Professor Denis McDevitt
Professor Walter Nimmo
Professor Michael Orme
DrTony Peck
Professor Laurie Prescott
Professor Brian Prichard
Professor John Reid
Professor Jim Ritter
Professor Phil Routledge
DrTilliTansey
Professor Geoffrey Tucker
Professor Patrick Vallance
Professor Duncan Vere
Professor Owen Wade
Professor David Webb
Professor Frank Woods
Among those attending the meeting: Professor Ray Hill, Mr Alan Hunter,
Professor Sir Stanley Peart
Apologies include: Professor SirWilliam Asscher, Professor Nigel Baber,
Professor Peter Barnes, Professor Nicholas Bateman, Professor Nigel Benjamin,
Dr Peter Bennett, Professor Sir Alasdair Breckenridge, Professor Joe Collier;
Professor Hal Cook, Professor Sir Colin Dollery Professor Sir Liam Donaldson,
Professor Sir Michael Drury Professor Sir Abraham Goldberg/ Professor John
Griffin, Ms Rachel Hillman, Professor Leslie Iversen, Dr Peter Jackson, Professor
David Lawson, Professor Michael Radcliffe Lee, Professor Salvador Moncada,
Drjohn Mucklow, Professor Munir Pirmohamed, Professor Lawrence Ramsay,
Professor Sir Michael Rawlins, Professor Alan Richens, Professor Peter Rubin,
Professor Peter Sever; Professor Stephen Smith, ProfessorThomas Walley
Professor Kent Woods
t Died 1 September 2007
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
Dr Tilli Tansey: Good afternoon ladies and gentlemen. My name is Tilli Tansey
and I am the convenor of the Wellcome Trust's History of Twentieth Century
Medicine Group. This was established some years ago by the Wellcome Trust, to
bring together historians, scientists and clinicians interested in recent medical
history, and also to provide material resources for present and future historians.
One of the ways we have been most successful in doing this is this idea of a
Witness Seminar, where we gather together people who have been involved in
particular debates or discoveries, and ask them to talk among themselves about
their own personal reminiscences, about what happened, when, why and who
were the main drivers of various discoveries, or non-discoveries in some cases. 1
An important part of any meeting is of course the selection of the chairman,
and we are delighted that when Jeff Aronson suggested that we had a meeting
on clinical pharmacology, Rod Flower — who has been to some of our meetings
before — was not only available but willing to take on this onerous duty, so we
are very grateful that Rod is here to do so, and without further ado I will hand
over to him.
Professor Rod Flower: 2 Thanks very much, Tilli, and I would like to add my
welcome to all of you to what we hope will be a great session. It's appropriate
that I start by thanking Tilli, Daphne, Wendy and Lois and the team here for
hosting this meeting, and also Jeff for putting in a lot of groundwork in setting
out agendas and ideas for what I hope will be a really stunning afternoon. I think
that when we first sat down to consider this entire area, we quickly realized that
there was far too much to cover in an afternoon meeting and so we made a
decision to cut the subject matter in half. We are going to have a second meeting
later in the year, which will deal specifically with clinical pharmacologists and
the regulatory bodies. That will be on 25 September 2007 and you will all get an
invitation to that event. We do hope that you will be able to come and complete
the circle. It is just impossible to get everything covered in one afternoon.
Quite why I was selected as chairman for this meeting, I don't know, except
that I am quite probably the only person in the room without a clinical
qualification. With that in mind, I would just like to say that whether scientists
or clinicians, we all have this subject very close to our hearts. When I first
For the background to the Witness Seminar as an historical tool, see pages vii— viii.
Biographical notes appear on pages 101—20.
3 The Witness Seminar, 'Clinical pharmacology in the UK, c. 1950-2000: Industry and regulation', was held
on Tuesday, 25 September 2007, and is published as volume 34 in the series Wellcome Witnesses to Twentieth
Century Medicine (Reynolds and Tansey (2008)).
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
began in pharmacology, the very title 'clinical pharmacology' always struck me
as a little counter-intuitive, because, after all, all physicians give their patients
drugs, so why shouldn't pharmacology be clinical? Why do you have to make
a special case for it? It was only later I came to appreciate the rather turbulent
history of the subject which, in conversation with a student once, I likened
to that of a young person growing up in the 1940s and 1950s, full of self-
confidence and new ideas, becoming increasingly embarrassed by their elderly
father 'therapeutics'. I don't know whether that is a close approximation to what
actually happened, but I guess we are going to find out. We also, hopefully, are
going to discover why it wasn't called 'human pharmacology'; the relationship
between clinical pharmacology and pharmaceutical medicine; and the answer
to lots of other important questions as well.
I will just say a few words about how we are going to operate. This is very much
a forum for you to speak, and to share your recollections. I only have two jobs
to do today: one is to finish at four o'clock for tea, and the other is to ensure we
finish at 6 o'clock in time for drinks, so in between I will just attempt to guide
the discussion, if I think it is flagging, or if I want to move into a different area.
But other than that, it is up to you to talk, and we will endeavour to capture
everything faithfully and transcribe it for your later attention. So in order to set
the ball rolling, I am going to ask Jeff Aronson from the Radcliffe Infirmary in
Oxford to kick off with a few remarks.
Dr Jeffrey Aronson: Thank you. First of all I would like to add my thanks to
Tilli and her colleagues for all the hard work they have done in organizing this,
and to Rod for being so willing to chair it. We didpick him because we wanted
somebody who wasn't a clinical pharmacologist, but who knew his way around,
and I think we have found the perfect man. Tilli and Rod have asked me if I
would give a kind of brief historical introduction and I tried to tackle that by
producing a sheet of paper that's in your pack on which I have included some
key publications and events. I have started with the British National Formulary
in 1946, which replaced the National War Formulary? and I have gone on
right up to the 75th anniversary of the British Pharmacological Society (BPS)
last year.
For some key publications and events in clinical pharmacology, see Appendix 1 on pages 77-79, provided
by Dr Jeffrey Aronson.
For further details, see the Glossary, page 121. See also Wade (1993).
6 Cuthbert (2006); Aronson (2006); Dollery (2006).
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
\
1
Figure 1:A woodcut of Ge Hong, c. 15th century.
I am conscious that I will have picked publications and events that some of you
might think ought not to be there, or there may be some that I have missed that
you think ought to be there. So, I encourage you to annotate this sheet of paper
with any additional information you think might be valuable — publications
I don't know about, events I have forgotten — and at some time in the future
let us have it back, so that we can increase the amount of information in this
chronology. On the other side of the paper you will find something I have
called 'Towards a map of the history of academic departments'. If at some time
— perhaps today, but it doesn't have to be — you could try, particularly those of
you who were professors of clinical pharmacology or lecturers or whatever, in
different institutions, to answer those questions, it would be very helpful in
building up a map of the history of the subject, to see where people came from,
where they were at particular times, and so on. I hope that you will be able to
add your bits of information to those two sheets of paper.
The returned forms (although insufficient for the proposed analysis) will be deposited, along with
the other records of this meeting, in GC/253 in archives and manuscripts, Wellcome Library, London.
See also Aronson (2004).
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
I guess we think about clinical pharmacology as being largely a twentieth-century
subject, but actually for hundreds of years, as we all know, physicians have been
developing drugs in one way or another, using tools that we would now recognize
as being those of a clinical pharmacologist. A good example that I know of, and
one that we illustrated on one of the issues of the British Journal of Clinical
Pharmacology last year — well known for its green cover — is Ge Hong.
He was a fourth-century Chinese physician, who took some qinghaosu — what
we nowadays call Artemisia annua— dunked it in water and squeezed it out. And
that was the first demonstration that you could make an extract from a plant to
treat malaria, intermittent fevers actually. He described all this in a text called
Emergency Prescriptions Kept up One's Sleeve. Because the substances that are
in this plant are so unstable, it is now believed that this squeezing-out process
somehow creates an emulsion that allows you to extract the active ingredient.
You wouldn't be able to do it other than by traditional methods. Whether that's
true or not, I have no idea, though it makes a good story. But I think that Ge
Hong was a clinical pharmacologist, at least a pharmacognosist. Then there
were the Peruvians who used cinchona bark to treat ague (malaria). There was
also William Withering, a favourite of mine, and his meticulous description
of the use of foxglove in dropsy. And the Reverend Edward Stone, observing
the efficacy of willow bark as a febrifuge. All of these people, I think, could be
called clinical pharmacologists in one way or another. And we are just taking
it up to date with modern techniques, and that's often what I think defines
a subject.
Being interested in words, I thought I would look at the words that describe
our discipline, and so I have done a little bit of very, very sketchy research
on the terms: 'therapeutics', 'materia medica' and 'clinical pharmacology'.
The image of Ge Hong was featured on the cover of the issue of the British Journal of Clinical Pharmacology
[(2006) 61: 647-790] to celebrate the 75th anniversary of the British Pharmacological Society and the 1 5th
International Union of Pharmacology [IUPHAR] congress in Beijing.
9 Hsu (2006).
Containing quinine. See Collier (1984); Bruce-Chwatt (1988).
Digitalis was first prescribed by the English physician and botanist William Withering (1741—99), who
used it to treat oedema (dropsy). See Withering (1785); Aronson (1985); Sheldon (2004).
Stone (1763); see also Hedner and Everts (1998).
See, for example, Dr Jeffrey Aronson's series of articles on medical linguistics, published under the general
heading 'When I use a word. . .', which has appeared in the British Medical Journal since 1994.
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
'Therapeutics', in its original singular form, 'therapeutic', as a noun, first appears
in the Oxford English Dictionary in a citation from the sixteenth century. But its
modern form, the plural form 'therapeutics', first occurs in 1671, as long ago as
that, in a book by William Salmon called Synopsis Medicinae, or a Compendium
ofPhysick. He wrote that 'the Therapeuticks, or active part of Physick, is either
Material, or Relative'. And that's a very old term, to which Rod alluded.
I have traced the term 'materia medica' back to the beginning of the nineteenth
century. It was originally used specifically to describe medicines, rather than the
art of using them, which, I think, is how we would now think of it. And in the
early days the definition given was 'the remedial substances used in the practice
of medicine'. But William Cullen in 1789 used it in this latter sense in his
Treatise of the Materia Medica, and the Materia Medica Americana [Potissimum
regni vegetabilis], of 1787, which I translate as 'the materia medica of America,
especially plants', where 'plants' implies members of the vegetable kingdom ('regni
vegetabilis'). 1 ' So the term materia medica is very old. But the first textbook to
my knowledge to use the term was Elements of Materia Medica and American
Therapeutics by Edward Ballard and Alfred Baring Garrod, which was published
in 1845. 16 The Bodleian Library's catalogue lists a rather impressive 790 titles
containing the words materia medica, and I haven't surveyed all of them.
When I grew up in Glasgow the subject that I studied was materia medica, not
clinical pharmacology. Materia medica was what was on the syllabus, although
the textbook that we used was Dillings Clinical Pharmacology. It's an interesting
textbook, because it was first published in 1884 by a man called John Mitchell
Bruce, who wrote it, and he called it Materia Medica and Therapeutics. When
Dilling came on board it was called Bruce and Dillings Materia Medica and
Therapeutics, but when the twentieth edition appeared in I960, it was called
Dillings Clinical Pharmacology." That's the first time that the term clinical
pharmacology appears in a textbook to my knowledge, and in the same year
of course Desmond Laurence published the first edition of his now famous
textbook Clinical Pharmacology. So, 1960 is the first time that we see this term
in the title of a textbook.
14 Salmon (1671).
15 Cullen (1789); Schoepf (1787).
16 Ballard and Garrod (1845).
17 Bruce (1884); Dilling (1960).
Laurence (1960).
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
I found a translation of a German book in the Bodleian Library, Oxford, by
two pharmacologists, Hans Horst Meier and Rudolph Gottlieb. The original
German title translates into something like Experimental Pharmacology and the
Basis ofTherapeutics. It was translated from the German by John Taylor Halsey
— I don't know who he was — with the English title, Pharmacology, Clinical and
Experimental, in 1914. It's not quite there, but already by 1914 it sounds as if
people are thinking about clinical pharmacology.
The first use of the precise term 'clinical pharmacology' and by whom is not
clear. It has been attributed to Harry Gold, a US physician of Russian ancestry,
who did some fantastic work on cardiac glycosides in the late 1920s and early
1930s, delineating the pharmacokinetics of digoxin, purely by measuring the
stuff in the urine. 20 Incredible, and, I think, amazing clinical pharmacology,
given the limitations of the technique. He certainly used the term 'clinical
pharmacology'. We have evidence of this in John Gaddum's Dixon Memorial
Lecture of 1954, entitled 'Clinical pharmacology', who said he used the term
because Gold had. And again, at a symposium that Desmond Laurence edited
in 1958 (he kindly sent me a copy), in which Gold again, in a lecture entitled
'Human pharmacology', used the term 'clinical pharmacology'. In that lecture,
Gold says that he thinks that human pharmacology is a much better term for
the subject than clinical pharmacology, and he argues the case. Some of you
may have views about that and may be able to throw some light on it.
Finally, I want to contribute a personal reminiscence, since this is a Witness
Seminar. On the list of publications that I have given you, I particularly included
some from around the late 1 960s— early 1 970s, because these were the publications
that actually influenced me to come into clinical pharmacology. There was
a 1967 British Medical Journal editorial, 'Future of clinical pharmacology'; a
1969 British Medical Journal editorial, 'Clinical pharmacology as a specialty';
the Royal College of Physicians' Report of 1969; and a Lancet editorial in 1970,
'The image of clinical pharmacology'.
19 Meyer and Gottlieb (1914).
20 See Hutcheon (1972); Millet (1981); see also Atonson (2007).
21 Gaddum (1954).
22 See Gold (1959): 47; see also Gold (1968).
See list of publications and key events in Appendix 1, page 77 .
24 Ware (1969); Royal College of Physicians of London (1969); Anon. (1970).
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
In July 1970, I had just passed the final exams, MBChB, in Glasgow and a
neighbour of ours, Jake Davidson, a radiologist at the Western Infirmary in
Glasgow, came across the road — he lived across from us — to congratulate me on
passing. He asked, 'What are you going to specialize in?' Well, I hadn't a clue,
I hadn't thought about it; you didn't have to in those days, not the way they do
nowadays. He said, 'Well, what was your best subject in medical school?' I said,
materia medica, because I had got a distinction; it was the only thing I had a
distinction in at all. I was absolutely fascinated by it. He said, 'Well, you have
got to be a clinical pharmacologist.' I said, 'What's that?' He said, 'Go and read
about it'. And I did, and these are the papers that I read: the BMJ editorial, the
Report of the Royal College, the WHO Report of 1970, the Lancet editorial;
and I thought, 'That's for me'. I was hooked. So that's why I became a clinical
pharmacologist. I wonder if anybody else was influenced by those publications
at that time, either to continue their studies or to take them up, and I would be
interested to hear that. But that's all I have to say.
FlowenThanks very much, Jeff. Does anyone want to comment on the question
of the nomenclature and how clinical pharmacology got its name? Concerning
early influences on career choice, I should say that you are not the only person
who got into pharmacology by accident, without knowing what it was. I am
sure there is a long list of us who had to go and look it up in the dictionary
before we applied for posts. Would anyone like to come in on this point?
Dr Andrew Herxheimer: I got interested because I was almost the only person
in my year at medical school at St Thomas' Hospital Medical School, London
who enjoyed the therapeutics lectures, and when I had done my house job I
asked Dr R S (Sam) Stacey, who was the reader, whether there was a job in his
department. I started to do some experiments of conventional pharmacology,
animal work, and I got really stuck and didn't like working with animals and
made a mess of it. But I also started doing human experiments, which worked,
and I thought for that reason what interested me was human pharmacology.
I was as interested in healthy human beings as in patients at that point, and I
thought that 'human' pharmacology included healthy and unhealthy people.
So, I preferred the expression human pharmacology.
Professor Michael Orme: Just to say, Jeff, that I predate you by only a few years,
I think. But my particular seminal influence was Colin Dollery's article in 1966. 2
25 WHO (1970). See Figure 5, page 41.
26 Dollery(1966).
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
At that stage I was doing a house job at the Hammersmith, and I think that,
combined with the presence of many august bodies, persons that are here at this
meeting as well, influenced me to specialize in clinical pharmacology. It was a
combination of the clinical work with the pharmacology and therapeutics that
was my stimulation.
Professor Denis McDevitt: I got in by serendipity and I suspect that I am
not the only one. I hadn't read anybody's article. When I had qualified and
was starting training in medicine, the department from which it was known
that people were most likely to pass the Membership of the Royal College of
Physicians was the one that Owen Wade ran at the department of therapeutics
and pharmacology at Queen's University, Belfast. I went to work there, not
because I was attracted to clinical pharmacology; it was more because I wanted
to pass the Membership and then make a decision about my career. Once
I got there I got hooked, particularly because of working with Robin Shanks,
who had come from ICI, where he had worked with Sir James Black. 28 We
started to do work with propranolol in thyroid disease, some of the early work.
It turned out to be a really fascinating thing to do, and I never wanted to do
anything else.
Professor Owen Wade: I used the words 'clinical pharmacology' because when
I was appointed at Belfast, most of the other pharmacologists were 'preclinical
pharmacologists'. British pharmacology was very much dominated in the 1930s
by an influx of Germans: Wilhelm Feldberg, Hugh Blaschko and others.
27 This is a recurring theme in other Witness Seminars. See, for example, Zallen et al. (eds) (2004): 30.
See also the special issue, 'Creativity and discovery in biomedical sciences' of Creativity Research Journal
(1994) 7. For a further perspective see Booth (1990) and Pepys (2007).
28 Propranolol [Inderal (ICI 45520)] was launched in 1964 by ICI. See Black etal. (1964). See also Reynolds
and Tansey (eds) (2008).
29 McDevitt etal. (1968); McDevitt (1976).
Professor Owen Wade wrote: 'The best description of Feldberg, Blaschko and Chain is in Medawar and
Pyke (2000). Feldberg and Blaschko were much older than me. Indeed, Feldberg taught me in my first year
as a student in Cambridge University Medical School, department of physiology, in 1939. Many years later
when Feldberg was in retirement and still working in the NIMR, his department was infiltrated by an anti-
vivisectionist who criticized Feldberg's anaesthesia of the animals he was working on. This got enormous
publicity in the press that was quite unjustified and I was upset that no senior member of the Physiological
Society came forward to defend this great scientist, who had found out so much about the transmission of
nerve signals by acetylcholine, which is immediately destroyed by anticholinesterase.' Part of a note on draft
transcript, 1 1 July 2008. See also, for example, Bisset and Bliss (1997).
10
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
They were using drugs, not to treat patients, but in order to explore human
physiology. I was amazed how little they knew about the use of drugs like
penicillin, streptomycin and cortisone, which had come on the scene by the
time I went to Belfast in 1957. 31
Professor Desmond Laurence: I fell into the subject completely by accident
when I was an ex-service registrar at St Thomas' Hospital, London, in 1948
and I associated myself with the department of medicine, because there were
two very attractive people there, Peter Sharpey-Schafer, professor of medicine,
and Tony Dornhorst, a reader and consultant. 32 They showed me what clinical
science was, which I had never even heard of. One day I was summoned by
the dean and the professor of medicine and they said, 'What are you going to
do with yourself?' I said, 'I suppose I am going to be one of the 50 people now
applying for each hospital registrar post.' They said, 'Would you like to be a
lecturer in therapeutics? We are going to provide the reader in therapeutics with
a lecturer; he wants a non-medical lecturer, but we are not going to let him have
one. And, if you will accept the job, we will force you on him.' And not long
after that Andrew Herxheimer and I shared a room in the same department. So,
that's how it started for me, no intentions at all; it just grew on me.
Flower: A bit like taking the 'King's shilling'. 33
Professor Jim Ritter: I was first exposed to pharmacology within Bill Paton's
department and several of the pharmacologists there: Hugh Blaschko (in whose
house in Park Town, Oxford, I rented a flat), Edith Biilbring and a number
of other distinguished pharmacologists. 3 But a lot of pharmacologists were
actually clinicians: Blaschko was a clinician — having done clinical medicine
before he did pharmacology — and Bill Paton had done clinical medicine, but
I don't think Edith Biilbring had. 3 ' But Bill Paton, in particular, even though
he was a scientist par excellence, was very proud of his background in clinical
medicine and not only proud of it, but felt that it contributed very substantially
See Tansey and Reynolds (eds) (1997).
32 See also Reynolds and Tansey (eds) (2000): 59, 63.
Accepting the 'King's shilling 1 from a recruiting sergeant was formal acceptance of the conditions of Her/
His Majesty's Army as an enlisted man.
Medawar and Pyke (2000). See also note 30. For details of the department of pharmacology in Oxford
during Paton's tenure, see Rang and Perry (1996): 299—301.
35 See Born and Banks (1996).
11
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
to the way that he thought about scientific problems. ' I can remember him
arguing the toss with Humphrey Rang, who was another great influence in my
life, and who also had done clinical medicine at the time. Humphrey and Bill
Paton used to debate the relative merits of having done clinical medicine before
one did one's basic pharmacology.
Professor David Grahame-Smith: The great influence on me was the man who
is sitting next to me on my left, Sir Stanley Peart. At some point in about 1960,
I went to see him and said I wanted to do some research, not knowing at all
what research was all about. At the time I was a registrar in medicine at St
Mary's Hospital, London, where he was professor of medicine. He said, 'What
do you want to do?' I said, 'I don't know, I want to do research, and you are
the professor of medicine.' So he said, 'Well, there's a patient on the ward with
something called the carcinoid syndrome', which had only fairly recently been
described. He said, 'This tumour makes something called serotonin (5HT) and
it seems nobody knows really how it is made. Why don't you find out?' So I
did, although my approach was a bit messy. I was placed in Albert Neuberger's
department of chemical pathology, and he was very kind to me, as were the
people in that department. I knew no biochemistry at all, but learned it as I
went along, kitchen sink stuff then. And having done that, and Hugh Blaschko
having examined my PhD, I went to the US to become an endocrinologist, and
did some work on ACTH, and cyclic AMP, and steroidogenesis. 39
So, I was very thoroughly a clinical biochemical pharmacologist, not a
pharmacologist. And while I was in the US, Stan Peart wrote to me and said
that there was a senior lectureship in clinical pharmacology coming up at St
Mary's: 'What about it?' Well, as a young married man with two young children,
what was I going to do? So, I came back to be a senior lecturer in clinical
pharmacology. But my career progress was not structured and one of the things
3 See, for example, Paton (1982); Paton and Rang (1965). See also Colquhoun (2006). Professor Edith
Biilbring's papers (PP/BUL) are held in archives and manuscripts, Wellcome Library, London, as are those
of the British Pharmacological Society (SA/BPS). See Bolton and Brading (1992).
37 See Rang and Dale (1987).
38 Page (1954); Grahame-Smith (1964); Twarog (1988). The Serotonin Club, an international association
for scientists interested in serotonin (5-hydroxytryptamine), was founded in 1987 and sponsors a satellite
meeting at the International Congress of Pharmacology (IUPHAR) every four years and hosts annual
lectures and dinners, including one meeting annually of the British Pharmacological Society. See also
Green (2008).
39 See, for example, Grahame-Smith et al. (1967).
12
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
that worries me now is the terribly rigid structure of medical academic careers.
It worries me that people can't move from one thing to another in the way that
they used to be able to do. It takes the fun out of career development.
Professor Sir Charles George: Like Denis McDevitt, I went in by serendipity. I
was doing cardiology in Birmingham and Brian Pentecost said, 'You must go and
work for John Goodwin and Celia Oakley'. But, that job came up two or three
months later, and I had just done a trial of ICI 50172 or practolol in angina, and
so I applied for Colin Dollery's registrar post in 1969 and got that, and the rest
is history. °
Professor DuncanVere:I think I got into clinical pharmacology and therapeutics
for entirely negative reasons. I was on the house, and very interested in medicines
and drugs, but my recollection is of the extraordinary primitivity of the work that
was going on. I remember a patient with malignant hypertension who did not
have long to live and there were no real treatments then, apart from Kempner's
rice diet or a total sympathectomy, or whatever. ' And Clifford Wilson turned up
one day, having just been to Oxford, and fished in his waistcoat pocket and said,
'I have got something here which Bill Paton gave me, called hexamethonium.
Would you like to try it on Mr So and So?' I said, 'What is the dose?' And he
said, 'Well, we have no idea.' [Flower: He gave you a form of consent then,
obviously] I gave the patient a very small amount and he went out like a light.
He did recover and lived for about three more days, but that's another story. 2
I was supposed to be becoming a nephrologist, but I was doing research on the
then fairly new metabolic ward and discovered that all the experiments went
wrong and produced results that I would not have expected. So I tried to find
out why and discovered that the patients were getting the wrong drugs and the
wrong electrolytes. And the atmosphere was unbelievable. If I could just say that
in those days the nurses had to add up the amounts of dietary constituents to six
places of decimals, from wartime tables by McCance and Widdowson, which
Briant et al. (1973). Practolol was withdrawn in 1975 following yellow card reports to the Committee on
Safety of Medicines of unforeseen side effects concerning serious skin, eye and abdominal problems. See,
for example, the debate in the House of Commons on 'Drugs (Adverse Effects)', 16 March 1977, Hansard
928: cols 583-94. For further details of the practolol problem, see Reynolds and Tansey (2008): 4-5, 30;
Abraham and Davis (2006).
See Glossary, page 123.
42 Paton (1982).
13
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
were totally irrelevant. I remember remonstrating with an assistant matron
about this, and she said: 'But it does them good, Dr Vere.' That sort of thing.
We investigated. There were errors of complex prescribing (some 22 per cent of
drug administrations), which we wrote up. One day Jim Crooks came into the
lab and said, 'Look, we have published something about complex prescribing.
We have found exactly the same things in Ireland and so on, and in Dundee.'
And so my interest was kindled.
We also worked on the reaction of patients to subcutaneous drainage and to
the thromboembolic effects of acid intravenous fluids and found, of course,
thrombosis and so on. ' So the final straw was that Clifford Wilson came and
saw me one day and said, 'Look here, don't you think you ought to be a clinical
pharmacologist?' Then he gave me the very references that Jeff Aronson has
referred to. ' So, that was how I came into it.
Professor David Barnett: It's interesting that the influences that people have
described on the way that they have chosen a career vary. My choice was also
somewhat serendipitous in that I had just finished my Membership of the RCP
and Robert Kilpatrick said there was some money for a research fellowship,
funded, I think, by Roche at the time, and then I became involved in the
possibility of a Merck fellowship. That, I think, was the transition zone for
me, because I spent two years in San Francisco with Ken Melmon and the
Cardiovascular Research Institute and it did two things. 7 One is that it helped
me to fall in love with biology and to understand the science ethic. But also
the alternative pathway of clinical pharmacology, that is of understanding how
drugs affect physiology, and that kick-started my interest. So I didn't read the
background material, it just happened by accident, but it was a joyous experience
and I never really looked back.
Professor Laurie Prescott: I am interested to hear how everybody fell into
clinical pharmacology almost by accident. In my case it was quite different. I
had always been interested in chemistry and pharmacology and from an early
3 See, for example, McCance and Widdowson (1946).
44 Crooks (1975); Wier etal. (1976).
45 Vere (1965).
' The list of articles circulated at the meeting can be found in Appendix 1, page 77. See also notes 24
and 25.
7 See, for example, Barnett et a I. (1978).
14
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
stage after qualifying in medicine I seriously intended to become involved in
some way with the clinical use of drugs. I happened to see an editorial entitled
'Clinical pharmacology' by Louis Lasagna at the Johns Hopkins Hospital,
Baltimore, Maryland. I wrote to him saying that I was interested in becoming
a clinical pharmacologist and did he have any suggestions? He invited me to
apply for a research fellowship, and a very pleasant pub lunch with him in
London turned out to be my interview for the position. This was 1963 and
I was probably one of the first to hold a formal research fellowship in clinical
pharmacology. I was at the Johns Hopkins Hospital for two years, during which
time I gained much experience, and I learnt to start work early and to really
work hard. I came back to a lectureship in therapeutics in the department of
materia medica and therapeutics in Aberdeen with Professor Alastair Macgregor.
At that time, Jim Crooks was a senior lecturer in the department. So, I started
with a very purposeful intention of specializing in clinical pharmacology.
Aronson: I ought to say that Laurie's mention of Lou Lasagna reminds me
that all but one of the papers I listed here are UK papers. I concentrated on
the UK story because that's what we are here for. There's one US report and
one interesting Anglo— American report, when British and US pharmacologists
got together and had a meeting. It was published in the journal Clinical
Pharmacology and Therapeutics and is absolutely fascinating.' But Laurie is
right — Lou Lasagna was writing about clinical pharmacology in the 1960s and
publishing editorials.
Perhaps I may add a reminiscence. Hearing David Grahame-Smith saying
how much Stan Peart had influenced him, I ought to say how much David
influenced me. Although I had decided to become a clinical pharmacologist
before I met him, he was a huge influence on me throughout the time he was
Rhodes professor of clinical pharmacology in Oxford. I had been working in
Abe Goldberg's department in the Stobhill Hospital, Glasgow - John Reid's
stamping ground — and Abe had been Stanley Alstead's successor as Regius
professor, and I worked there for a few years before I decided to leave Glasgow
and look for clinical pharmacology jobs elsewhere. There was a man called
Brian Whiting there who was measuring plasma digoxin concentrations, and I
48 Lasagna (1959, 1966).
9 See, for example, Prescott (1964).
50 Melmon and Turner (1986). See also Appendix 1.
51 See, for example, Goldberg (1983).
15
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
thought, 'What a waste of time'. Bloody fool — me, I mean, not Brian. 'Why is
he measuring plasma concentrations? This stuff is distributed all over the place.
How does he know that the plasma concentration has got anything to do with
cardiac concentrations? It's a drop in the ocean, surely. It can't tell you anything.'
I wanted to find a way, or to think of a way, of measuring the effects of the
material, but I hadn't a clue, I really didn't know anything about it. And when
I came down to Oxford, looking for a job, David told me about the sodium-
potassium pump.' I had never heard of it. I didn't know what it was. But my
eyes just lit up when I heard him talk about it, because here was a method for
measuring the effect of a drug.' The fact that it was in a red cell miles from the
heart actually didn't strike me, and that I should have been thinking exactly the
same thing as plasma concentrations and cardiac concentrations when it came
to ATPase in red cells and the heart. But that's what really turned me on to
working with David, and, as I say, I was hugely influenced by everything he did
scientifically while he was professor.
Professor Patrick Vallance:I guess I just drifted into clinical pharmacology. What
I was thinking about as people have been talking was how I ended up having
the substrate to even think about drifting into it. The answer is undergraduate
teaching, and there were three people who taught me and who influenced a large
number of individuals and they were Humphrey Rang,' Joe Collier and Brian
Robinson. 5 ' There were two things about undergraduate pharmacology that led
me into clinical pharmacology. The first was that it was an integrating science, it
wasn't just about looking at the biochemistry or physiology, something actually
changed when you intervened, you could see biology in action. The second
point was that this was clearly demonstrated. In those days (c. 1978—80) at St
George's Hospital Medical School, London (St George's, University of London
since 2005), there was an integrated pharmacology and clinical pharmacology
52 See Eisner and Smith (1991).
53 See, for example, Aronson etal. (1977); Boon etal. (1984).
Professor Humphrey Rang worked on the binding of radiolabeled atropine to smooth muscle of the gut
for his PhD in Oxford. See Paton and Rang (1965).
Professor Joe Collier wrote: 'Brian (Fyfe) Robinson retired from his chair in cardiovascular medicine at
St George's Hospital Medical School around 1985 (as I recall). He had been a student at St George's and
after his obligatory stint in the armed services (call-up) he came back to St George's where, barring a research
stint in the US, he gradually rose through the ranks both as a clinician and as an academic to get his personal
chair.' E-mail to Mrs Lois Reynolds, 3 August 2008. See Collier et al. (1970).
5 See, for example, Benjamin et al. (1995).
16
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
course and there were a couple of practicals where (3-blockers or atropine were
given to what was called a volunteer — somebody encouraged out of the audience
by Joe Collier and injected with a (3-blocker. We saw physiological parameters
changing, and I think that was incredibly important for a large number of
students. It inspired them to go on to try to understand what they had seen. I
think rather few of them ended up as clinical pharmacologists, but many took
away a basic understanding and some inspiration.
Professor Brian Prichard: I suppose the reason I went into clinical pharmacology
is possibly almost unique. I started at King's College, London, aged 17, and I
thought, 'Well, I don't want to complete preclinical studies too quickly and start
clinical studies'. (I should also add in parentheses that my favourite pastime was
spending the long vacation cycling across Europe to the Alps and back with a
couple of friends.) So, I did a BSc in physiology, which meant two extra-long
vacations, besides just one for the ordinary preclinical course. The part of the
BSc that I enjoyed particularly was pharmacology with George Brownlee and
Peter Quilliam. Having done the BSc and wanting another long vacation, I
thought I would spend one more year and do a Master's degree by examination
in pharmacology. After qualifying in medicine at St George's, I spent four
years doing various clinical posts there when Desmond Laurence advertised
his research assistantship in clinical pharmacology. It was due to the MSc that
I was appointed on 1 December 1961, at University College Hospital Medical
School (UCHMS). My entry into clinical pharmacology could be put down to
a passion for transcontinental cycling.
Flower: What about industrial clinical pharmacology? We have several people
from industry here: Arthur Fowle, Tony Peck and Trevor Jones. OK, Arthur is
going to say a few words about how he became a clinical pharmacologist.
Dr Arthur Fowle: I am afraid it is entirely unglamorous. I had a long suit in
cardiovascular research, which seemed to be the best-funded way of studying
clinical science, which I always thought I was in. I went to the Wellcome
Foundation by accident and thought that I was there to solve problems for them,
such as finding out why British drivers weren't welcome in Europe because of
the number of accidents they had, which I thought was probably due to very
cheap alcohol on the boat, but French authorities thought was due to Marzine,
For a description of Paton's UCH preclinical practical classes and students' self-administration of drugs to
observe their effects, see Rang and Perry (1996): 297.
17
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
which most travellers used to take at that time. And, I solved those kind of
problems from 1965 and thought of myself as a clinical scientist, until I read
Colin Dollery's article. Colin and I had been housemen together and good
friends, and I suddenly realized that perhaps I was a clinical pharmacologist and
so it really had nothing to do with training, but just copying.
Dr Tony Peck: Yes, I had a fellow feeling with David Grahame-Smith that I
needed a living, and Eric Neil, professor of physiology, and Franz Hobbiger,
reader in pharmacology at the Middlesex, had a job going and I went into
clinical pharmacology for that reason.' Of course, the Middlesex Hospital,
which will come out later I am sure, was the one medical school in London
that never had a department of clinical pharmacology. It had a pharmacology
department, which C A Keele headed for a long time, with Desiree Armstrong,
and their work on substances causing pain and itch was quite seminal.' But
the Middlesex was not a place to do clinical pharmacology, because, as I said,
it never had a department. Its medicine was regarded as an extension of Harley
Street, London. Anyway, it provided me with a living and a lot of fun teaching,
but it was only when I joined the dear old Wellcome Foundation down at
Beckenham in 1969 that I really had the opportunity to start doing human
research and had a great deal of fun for 25 years.
Flower: But when you joined the Wellcome Foundation in those days there was
no department of clinical pharmacology, was there? I mean, did they call it that
in those days?
Peck: May I pass that to Arthur?
Fowle: Yes, we did. We changed the name from medical department to clinical
pharmacology in 1966, and Tony came to join us when he said he did.
Professor Donald Davies: First of all to correct you, chairman. I am a
biochemical pharmacologist who went into a clinical pharmacology
department, so there are at least two of us here. ' 3 I had studied for my PhD
Cyclizine hydrochloride, a Hi-receptor antagonist.
59 Dollery(1966).
60 See, for example, Anon. (1957, 1959).
See, for example, Armstrong et al. (1957).
See, for example, Peck (2004).
Professors Donald Davies and Geoff Tucker.
18
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
with Professor Tecwyn (Tec) Williams at St Mary's Medical School, London,
on drug metabolism. I then joined Bernard Brodie's laboratory at the National
Institutes of Health (NIH, Bethesda, Maryland) in the US, where the research
was directed to relationships between kinetics and metabolism and drug action
in man. 6 While I was at Brodie's laboratory, Colin Dollery applied to the
MRC for a grant to set up the MRC Clinical Pharmacology Research Group
at the Hammersmith Hospital.' Fortunately for me, Tecwyn Williams was
one of the reviewers and it is alleged that he suggested that Dollery appoint
a biochemical pharmacologist and put my name forward. I came back to the
Royal Postgraduate Medical School (RPMS) at the Hammersmith Hospital,
London, in 1967 and brought with me analytical techniques and knowledge of
kinetics and metabolism, reactive metabolites and drug interactions, and that's
how I got started in clinical pharmacology.
Flower: We have talked about how we got into the subject, but maybe now is
a good time to start talking about the way in which the subject developed in
different centres around the country, and Don [Davies], I don't know whether
you would like to say a few words about the Hammersmith, when you first
began there and so on?
Davies: There are others here who might correct me, but we began applying a
knowledge of kinetics, drug metabolism, analytical techniques to solving drug
problems in patients at the Hammersmith, particularly work on drug interactions
with Alasdair Breckenridge and Michael Orme, and on cardiovascular drugs,
differences in dose— response, with Charles George and John Reid. ' That led to
a great output of research, and perhaps those were the low-hanging fruits that
were easily gathered. Where it became more difficult — we will see what others
think— is when clinical pharmacologists moved into mechanisms of drug action,
but possibly more importantly, mechanisms of disease processes, without the
firm foundation of drug metabolism and kinetics to back up the research. That
was more complex and it became more difficult to obtain research funds.
Flower: What we are trying to get now is a sense of what was happening at the
beginning when academic departments began to call themselves 'departments
of clinical pharmacology' and how the subject gathered momentum.
64 See, for example, Neffetal. (1965); Vesell (ed.) (1971).
MRC grants for 'research groups' were introduced in 1961. See Thomson (1973): 153.
" See, for example, Breckenridge et al. (1971).
19
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
Laurence: It really happened for me when Tony Dornhorst at St Thomas' asked,
'Are you going to apply for the readership at UCH/UCL made vacant by Bill
Paton [in 1956]?' I said, 'No, because I am not yet qualified to be a reader.'
He said, 'Go and see Max Rosenheim, professor of medicine (that's Sir Max
Rosenheim after 1967), and tell him I told you to.' 67 So I did and, briefly,
the job was demoted for me, and it was, interestingly, a joint appointment
between University College London and UCH Medical School, which were
then separate, later to come together. At the interview I was supported by Max
Rosenheim and for many years after; he was a great man for supporting people. I
attended the interview committee and this was in the days when the title 'senior
physician' was bandied about and meant something, and the 'senior physician'
at UCH said to me, 'Tell me, Dr Laurence, what is this chemical pathology
that you are so interested in?' 8 I got the post and it was titled Pharmacology
and Therapeutics, joint with UCL, and I believe it originated when Harry
Himsworth, later secretary of the Medical Research Council (MRC), was
professor of medicine (1939—49). He and the then professor of pharmacology
at UCL got together — I am afraid I don't know who it was at UCL at that
time. ' They perceptively saw this was a coming scientific and clinical subject,
and that there should be clinicians integrated with basic sciences. Anyway, I got
the job. My background was clinical, so my work in UCL was limited; I simply
did clinical pharmacology at the medical school, and we developed from there.
Flower: How many people were there when you first began?
Professor Desmond Laurence wrote: 'When Max Rosenheim was president of the Royal College of
Physicians (PRCP), the College ran Advanced Medicine Conferences. I was told I must contribute, so
I put my best foot forward and showed Max my text. He said it was too complex. I replied: "This is an
Advanced Medicine Conference". He said, "Exactly, so keep it simple." He was a marvellous man, also what
is known as a "doctor's doctor", ie sick doctors sought him out.' Note on draft transcript, 21 June 2008.
Professor Desmond Laurence wrote: 'Rosenheim, although not a clinical pharmacologist, was the first editor
of the Department of Health's Prescribers' Journal. It was then entirely more appropriate that a physician
should have edited this.' Note on draft transcript, 4 July 2008. See also note 117. See Biographical note
on page 114.
Professor Desmond Laurence wrote: 'Many senior doctors thought clinical pharmacology was a rash term
for mindless prescribing. The senior physician once chased me round the medical school as he thought I
had criticized his treatment of a patient. Max Rosenheim told me not to let it bother me.' Note on draft
transcript, 21 June 2008.
Frank Winton was professor of pharmacology at UCL from 1938 to 1961. For the history of the
department, see www.ucl.ac.uk/Pharmacology/history.html (visited 7 May 2008). See also Black (1994).
20
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
Laurence: One in UCH Medical School: there was just me and it gradually
developed. It was always a fairly modest enterprise. I went to the joint post in
1954 from St Thomas' Hospital Medical School.
McDevitt: I think there are a number of different models that operated in
the 1960s, during that transition phase. For example, there were places like
Belfast, where they had had a department of pharmacology, and it certainly
wasn't a research department as far as I was able to find out historically, and
they really moved right over to appoint a professor of clinical pharmacology
— Owen [Wade] will correct me — and effectively abandoned pharmacology as
a subject. So, that was one model, I think, but what they did critically was to
make it a clinical department and they gave the department its own beds. Now,
another model, I think, was the one that existed in Scotland, where they always
had chairs of materia medica in most of the medical schools, and there were
clinical departments, but, I think, they also had departments of pharmacology,
or certainly pharmacologists present. Then there were other places where a
clinical pharmacologist was added on to a department of pharmacology, and
that was often extremely difficult, because they often didn't have very much in
the way of clinical access. So, I don't think there is a model that applies to all,
and sometimes I think it critically influenced what happened beyond that, as to
how the thing was set up.
Prichard: When I joined Desmond as his research assistant at the end of
1961, we had very little clinical base, though we were located in the clinical
faculty. Our clinical activity at that time was a matter of performing a couple
of outpatient sessions, mainly in the care of hypertension patients. This was in
Max Rosenheim's hypertension clinic and attending his ward rounds. However,
over a number of years the clinical commitment developed, and in 1966 I was
given charge of beds and in due time ran a full clinical service. Of course, such
commitment is very heavy in terms of time, the total number of sessions one has
to perform, and I guess until Patrick Vallance came to UCH we were understaffed.
A seven-tenths clinical commitment and teaching obligation didn't leave so
much time for research. In spite of the commitment and pressure on research,
I think it is very important that one has a clinical base, though the roots of the
subject of course, scientifically, are in pharmacology. In the late 1960s and early
1970, Robin Shanks, the late Paul Turner and myself with others, including
Colin Dollery, Duncan Vere and Desmond Laurence, set about establishing the
Clinical Section of the British Pharmacological Society (BPS). 70 As our scientific
See, for example, Aronson (2006).
21
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
roots were in pharmacology, the British Pharmacological Society was where we
felt the forum for clinical pharmacology in the UK should be. I guess it also had
a fair amount to do with the fact that most of us were members of the BPS in
any case. I think that's a very important point that deserves emphasis — if you
are going to practise clinical pharmacology you do need your feet in the clinical
area, but not forgetting one's scientific roots.
[Professor Sir James Black commented that Brian Prichard was being
too modest. They first met in I960, when Prichard was working with
surrogate markers and in 1962 Black took him pronethalol, which
Prichard gave to patients, gradually adjusting the dose until all the
patients had pulse rates at rest at 60/minute before the trial monitoring
their blood pressure. This was a trial of equal effects, not equal doses and
their blood pressure slowly came down. When propranolol came along
in 1964, Prichard again tried to achieve a 60/minute heart rate, which
was the first study of (3-blockers in hypertension. The range from the
smallest to the highest dose of propranolol was about ten-fold, which
got Prichard into bad odour with his colleagues. ]
Flower: Brian, you have been severely censured for being too modest, but do
you want to deny or confirm the fact that you got into bad odour with your
colleagues?
Prichard: I thank Sir James Black, the pioneer of (3-blockers, for his comments. I
had a little trouble with ICI, who I had to cajole into making stronger tablets. At
first they only produced lOmg tablets of propranolol. Some of my patients were
taking 40 tablets a day, at least they told me they were. I persuaded ICI to make
40mg and 80mg, and then 1 OOmg for patients with angina and hypertension, and
250mg tablets of propranolol for hypertension patients. I think the important
Prichard et al. (1963). Professor Brian Prichard wrote: 'We started patients suffering from angina pectoris
on a small dose of pronethalol and gradually increased the dose up to the maximum tolerated. Patients
entered the double blind phase of the trail at the highest dose that was free of side effects. Pronethalol
was found to produce tumours in mice and was withdrawn for that reason and was not well tolerated.
Propanolol became available in January 1964 and was devoid of sympathomimetic activity. The reduction
of blood pressure seen in normotensive angina patients with pronethalol was reported and described in
hypertensive patients, as was the use of propranolol in 1964. Several papers followed with a series of 109
patients described in 1969. ' Note on draft transcript, 20 September 2008.
72 Prichard (1964).
73 Prichard and Gillam (1969).
22
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
70
(L)
£ 60
00
Z
50
40
30
1
8
(52)
(104) (208)
Dose propranolol (Av mg)
FULL
(417)
Figure 2: Dose-response curve to propranolol on the number of attacks of anginal pain.
Adapted from Prichard and Gillam (1971).
principle of what Sir James has just referred to is that I always felt you should
apply dose— response principles evaluating new drugs in patients, having been
trained by performing dose— response curves to various agonists in the guinea-pig
ileum for about three solid months. This means once you have the principle of
dose— response hammered into your brain, it never leaves you. We applied this
to attacks of angina, and we did a 4-log incremental dose— response curve of
propranolol plus placebo in angina pectoris, and obtained a beautiful straight-
line dose— response relationship over the doses used: as shown in Figure 2. 7 '
Laurence: I think I heard Brian Prichard say that he was my assistant. Well, it
didn't seem like that to me. He always did exactly what he wanted.
Professor John Reid: Can we go back to the origins of clinical pharmacology
and some of its most successful groups? I am struck, having been chairman of
a large academic division of medicine for the last 10-15 years, by the relatively
The relationship between the dose of a drug administered during a trial to measure direct drug effects and
the response of the organism to the drug over time (mg/minute) as illustrated in a graph. See, for example,
Aellig (1981).
75 Prichard and Gillam (1971); Gillam and Prichard (1971).
23
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
small scale of some of these influential early groups. I went from Oxford to
the Hammersmith Hospital in 1969. When Donald Davies joined him, Colin
Dollery was the only clinical academic. Alasdair Breckenridge was a senior
registrar and Jim Paterson and Michael Orme were registrars. Alasdair later
joined the staff, but when he went to Liverpool I was recruited back from
NIH on a Wellcome Trust senior clinical fellowship. What was an enormously
influential group in drug metabolism and cardiovascular pharmacology was a
very small team. I am sure the same is true at UCH and Bart's.
Flower: Brian, you mentioned Paul Turner a minute ago, so I am going to ask
Mark Caulfield, who was present in Paul's department for many years and a very
close colleague, to say a few words about him, and then I would like maybe to
ask Duncan Vere to talk about things at the Royal London and how they got
going, if that is appropriate, Duncan.
Professor Mark Caulfield: Thanks very much. It's a pleasure to talk about
Paul. I wasn't there, obviously, when the department was formulated, because
I was still at primary school, but I think that Paul was an incredibly kind and
influential man in clinical pharmacology. ' He was passionate about the subject,
and believed that he really should put his entire endeavour into making sure
that as many people got as enthusiastic as he was about the subject. And his
influence was Sir Thomas Lauder Brunton, who is probably an early example
of the medical transfer market that we now enjoy in medical schools, because
we poached him from his lectureship in materia medica at the Middlesex
in about 1897 to be the first lecturer in materia medica at Bart's. 7 And his
principles were observation, measurements and experiment. There's a picture of
him in the north wing of the medical school, and on his arm there is a Marey
sphygmograph used to record changes in arterial tension, similar to one that
you used to use, Patrick, and others, in measuring hand vein changes in vessel
dilatation. He was very much an inspiration to Paul Turner.
Paul was influenced by him, but also by some of the people he came across
earlier in his career. For example, Sheila Sherlock wouldn't let him have a day
off, and even when he wanted a day off to plan his wedding, she said, 'Well,
Turner, if you have finished all the ward work, off you go and draw graphs'. 78
7 ' See, for example, Turner (1993).
See Brunton (1897, 1906); note vase of foxgloves (from which digitalis is derived) in Figure 3. See also
Medvei and Thornton (1974).
78 Turner et al. (1962).
24
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
Figure 3:SirThomas Lauder Brunton, 1913. Oil on canvas portrait by
Sir Hubert von Herkomer, presented to St Bartholomew's Hospital in 1960.
Basically, he got this fundamental training in observation, measurements
and experiment from his early career. Turner went to work with Professor
Quilliam (also known as Q) at Bart's where he and Mike Besser — whom
some of you may have heard of vaguely — were contemporaries in Q's lab.
And it looked like Mike Besser — you probably don't know this — was being
earmarked for the first lectureship in clinical pharmacology, but he went off to
the US for a while, and in that time Sir Eric Scowen appointed Paul Turner to
the lectureship in clinical pharmacology. So, as a result of that, Mike became
an endocrinologist. 7 '
But Paul's enthusiasm for the subject was really manifest in his teaching. I
trained at the London with Duncan Vere, Tony D'Mello and Ziggy Kruk,
79 See, for example, Delitala et al. (1983).
25
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
and the foundation in basic pharmacology there was fantastic. One of the
things that was incredible was to watch Paul Turner teaching medical students,
because he always taught them as if they were standing at the end of a bed with
somebody that they had to treat and save. And so, in his teaching, he always
had a strong connection with the students. When I came in 1989 — because
I had applied for a job with Denis McDevitt - but Paul didn't shortlist me,
probably very wisely, as he was ill at the time having had coronary grafts, and so
what happened was that I got appointed in his absence. So, at my first meeting
with him, he said: 'Your responsibility, Mark, is to make sure that with all the
medical students, the teaching is really well organized; we pride ourselves here
in making everyone a rational and safe prescriber when they get to the point of
exit from this medical school, it is really important.' And, as Charles George
will attest, because he inspected my post — unfortunately one of the drawbacks
of my post was that you spent most of your time doing clinical work or teaching
as a result. But Paul also recognized the value of developing countries and the
wealth of talent that was hidden there that needed to be drawn out and he had
a long history of people coming from all over the world.
The other thing is that he wanted to create clinical pharmacology across
multiple specialties, and so he always had fellows, and this may be one thing
that in the modern day we would criticize him for, and that's perhaps the lack
of a focused research strategy in one disease area. But he believed that one of the
great things about clinical pharmacology was you could go where you wanted
to, and so if you found something in one area that took you somewhere else,
there was no physical barrier to your forming collaborations to go there. So he
had cardiologists, oncologists, palliative care doctors, all training with him in
the time that I was there. And although it was multiple disciplines, we all learnt
something from each other. But the fundamental core principles that make
an excellent clinical pharmacologist were there in every one of those people,
and although they went on to do other things they took those with them. So
although unfortunately, as the editorial in the 1969 BMJ says, we never quite
managed to have a clinical pharmacologist in every district general hospital, he
was hoping that he had put some clinical pharmacology into other specialties,
and that's the way he worked. 81 He was a very Christian person in his outlook
and he would always try to look after his colleagues and make sure that they
were well served in their time with him. But I think his contribution to clinical
See, for example, Gorog et al. (1993).
81 Anon. (1969).
26
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
pharmacology probably was in trying to spread it as broadly and widely around
the world through the many people he trained, many of whom have gone on to
industry as well as to academia.
Flower: We are going to come back and talk about the journals in a minute, as I
think that is a very important topic. First, Duncan, do you want to say anything
about the development of the subject at the Royal London?
Vere: Very briefly, it was a series of U-bends. What happened at the London
was that I was seconded across to the department of pharmacology under Miles
Weatherall; Andrew Herxheimer, Tony D'Mello and so on were there. And I
spent some time there in pharmacology. But then I was elected to the staff as a
physician, so with that went beds and outpatient sessions. It was a tremendous
load of work, particularly as the clinic was on a Saturday morning in the East
End of London. And then, of course, with that went registrar posts, and so John
Dunne and Maurice Cuthbert came into those posts, in SHO and registrar
posts, but as clinical pharmacologists in the making. And, of course, they have
since gone on to much else in clinical pharmacology. But that was how it began,
by a series of growths round U-bends. It was very difficult to find the time
to teach clinical pharmacology, therapeutics and so on. We had 130 hours of
teaching time in those days. Now this has all evaporated, gone. But that was
what happened near the start.
Prichard: I would like to make two points about Paul Turner. Paul was a devout
Christian, and, in fact, when I went to India as the BPS (British Pharmacological
Society) visitor, he suggested to Professor Molly Thomas in Vellore that I should
take a service in one of the churches of South India. While I had not preached
in very many churches, it was as a result of Paul Turner that I had the privilege
in India. But, another point to make about Paul is that early on in the Clinical
Section of the BPS when I was secretary, I was doing preliminary work for
setting up the British Journal of Clinical Pharmacology, and I was delighted when
he agreed to be volunteered, press-ganged, into becoming our first editor of that
journal. He certainly made a great success of that task, setting the journal on
a successful course.
82 See Vere (1987).
Dr Jeffrey Aronson wrote: 'Universally known in India as "Doctor Molly".' Note on draft transcript,
14 July 2008.
84 See Aronson (2004).
27
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
Dr Kenneth Hunter: May I take up John Reid's point about how clinical
pharmacologists, even though few in number — in his case he was mentioning the
Hammersmith — cooperated together and, in a sense, were more than the sum
total of their individual parts. Because I think the same was true at UCH, where
I was a student. I became aware of clinical pharmacology as a house physician in
the medical unit there, and I think one of the things that hasn't been emphasized
enough by Desmond Laurence and Brian Prichard, was the tremendous influence
of the professor of medicine, Max Rosenheim, at the time. He was the one that
encouraged clinical pharmacology. I am sure Desmond would say that he was
given a very free rein and was able to do it, but it was very much helped by
Max Rosenheim's stature and his tremendous influence. I remember as a house
physician we used to have a weekly business meeting, where we went through
all the patients that had been discharged and talked about them, and Desmond
Laurence would come along to the meeting, and to other teaching meetings and
so on, and gave a different input to the discussion as a clinical pharmacologist.
I think it was the influence of clinical pharmacology that permeated through
the medical unit certainly, and probably, in a sense, through the whole hospital,
which was very important. And then I went back as a registrar, and registrars in
medicine at that time could rotate through all sorts of firms, like neurology, and I
was working in neurology and a post came up which was between neurology and
clinical pharmacology, because levodopa was a new drug and the MRC wanted
people to study that. That was a tremendous experience, working jointly, half
in clinical pharmacology and half in clinical neurology, for a couple of years. I
think it was the influence of clinical pharmacology going out into all the other
departments that was terribly important.
Flower: Thanks very much, Ken. I don't want to be too 'London-centric' here,
because obviously things were happening in other parts of the country. Phil, do
you have any reminiscences about the development of the subject in Wales or
in Cardiff in particular.
Professor Philip Routledge: I suppose my entree into clinical pharmacology
was in Newcastle, and I don't think there's anyone else here from Newcastle,
so just to say a few words about that. Sorry, Robin [Ferner] is here. I think
Mike Rawlins had an enormous impact when he came in 1974 to Newcastle.
There was a department of pharmacology but no department of clinical
pharmacology, and Dai Davies, the late Dai Davies, was ploughing a lone furrow
in adverse reactions; and I think Mike's appearance crystallized those interests
5 See biographical note, page 1 14.
28
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
around the department of pharmacology and it became a joint department
of pharmacology and clinical pharmacology. ' I think the strength of it, as we
have heard earlier, was the beds. There hadn't been beds attached to clinical
pharmacology, and as soon as there was a clinical base, clinical pharmacology
became attractive to junior doctors like myself, because they could see the
relevance of it. So I owe my interest in pharmacology to Desmond Laurence's
book as a medical student, which was a delightful book to read as one of
those of the Hammersmith diaspora who came to clinical pharmacology in
Newcastle.
Professor Walter Nimmo: I came to clinical pharmacology from anaesthesia
to work with Laurie Prescott. I had trained clinically in anaesthesia before
moving into clinical pharmacology and then went back and forward once or
twice. Training in clinical pharmacology was useful in anaesthesia practice and
vice versa.
Professor Robin Ferner: Perhaps I can draw one or two threads together in fact,
because I had gone back to UCL and then to UCH to study medicine, whereas
I had started off as a chemist. And at UCL there were inspirational teachers of
pharmacology. There was Heinz Schild, who was revered; I wouldn't say his
lectures perhaps were as riveting as other members of staff. There was a young
chap called Jim Black, in an interregnum I guess. Then there was the thrill of
going to Desmond Laurence's lectures, which were fantastic and marked by
newspaper clippings related to awful adverse effects, a habit which I have got into
and, I gather, he has still got a drawer of newspaper clippings somewhere, which
one might have access to. Brian Prichard — my memory is having rows with him
— sorry, having an academic discussion with him — about the value of measuring
blood pressure to 2mm of mercury, which varied from one reading to another
by 10mm of mercury, and maybe today I will learn the answer. After house
jobs at UCH, I then went to Newcastle, not with the clinical pharmacologists,
but with Bob Souhami, and there were a number of dramatic and important
teachers in Newcastle, of whom George Alberti and Mike Rawlins were two.
As you have heard, although Mike may not have lectured a great deal, he got
his staff to teach in small groups. So the threads I would draw together are:
relatively small departments, as John Reid has said; very influential teachers, as
Patrick Vallance and Mark Caulfield have said, and an exciting time.
' See biographical note, page 113.
Laurence (1966).
29
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
Orme: One or two things to draw together. First, following, I think, Denis
[McDevitt] and others, about the importance of the clinical input. Certainly, as
we are now moving into the 1970s, when I moved with Alasdair Breckenridge
to Liverpool in the mid-1970s, the clinical experience for the first time was
allowed. In contrast, in Manchester George Mawer was working at the time, but
he was only allowed access to outpatient facilities, and perhaps as a result clinical
pharmacology never took on there. So I would stress again the importance of
inpatient facilities and beds. The other striking thing in Liverpool at that time,
and Andrew Wilson's name has already been mentioned, but he was working
and trying to work clinically, following Dilling, who has also been mentioned. 88
The problem was that he was really kept out of the clinical work by a variety of
rather parochial clinicians in Liverpool, and the only clinician at that time who
was active and helpful was David Price-Evans, whose name might have come up
— another Welshman, Don, who was very productive. He wouldn't call himself a
clinical pharmacologist, but I think that's what he was and in some ways still is,
ploughing away in Riyadh, Saudi Arabia. I think the importance of the clinical
input was significant.
The only other topic I would like to cover is the combination of pharmacology
and clinical pharmacology. When Alasdair and I moved to Liverpool the
pharmacology department was there, and we were placed in the pharmacology
department, which gradually changed its name to pharmacology and
therapeutics. The strengths of anything that we have achieved in the research
side, I think, are based heavily on having a very strong pharmacology department
with the basic sciences always there, and that allowed us, I think, to emphasize
teaching. I guess we could talk all afternoon about teaching and maybe one
of the things that might come up at the future meeting is the role of deans
in this. There's something about clinical pharmacologists that seems to be a
disease, that they would go on and become deans — there are several of us here
in this room; obviously the influence there is on teaching. I don't want to side-
track us into teaching at the moment, but maybe if you are thinking of a topic
for the September meeting, the teaching side could be touched on. But just
to stress, I think, the importance of working with pharmacology and clinical
pharmacology together cannot be over-emphasized. 89
88 Cohen (1972).
For the transcript of the second Witness Seminar held on 25 September 2007, see Reynolds and Tansey
(eds) (2008).
30
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
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Wade: What is in my mind is to make a comment about prescribing. And, I
want to pay a tribute to Jim Crooks. He, I and Dr William Wallace, a youngster
in my department, looked at errors in prescribing in the hospitals where we
were working in the early 1960s. It was really after that that Jim produced
the 'Aberdeen' prescribing form which is now so widely used in hospitals. In
the old days, doctors used to write a prescription in the patient's notes, and the
ward sister would make a list for nurses to administer the medicines — it was all
very casual, and accuracy was becoming much more important with the arrival
of antibiotics and corticosteroids, etc., in the postwar period. More precision
was needed, and I think Jim Crooks played a very big part in this important
development.
50 Crooks etal. (1965); Wallace (1965); Crooks (1975); Wade (1966). See also note 44 and page 79.
91 Crooks etal. (1967). See also Hamley etal. (1981); Wade (1996): 98-9.
31
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
McDevitt:Just to give an illustration of the basis of clinical pharmacology being
in clinical medicine, and the importance of having not just access to beds,
but preferably a ward unit that the department actually was responsible for.
Something like 20-odd years ago, there was a meeting, not quite like this, but it
was in America, and it was to review the first 20 years of clinical pharmacology
in, principally, the UK and the US. One of the things I was asked to do was
to survey the senior registrars in training, and one of the questions that I asked
them was to prioritize what their ideal career post would be. And the things that
they put at the very bottom of the list were the things where they would not
have direct responsibility for patient care. I think that the success of clinical
pharmacology in this country for a long time was the expectation that you would
get a job where you would have your own patients to treat, and where you could
encompass all the excitement of clinical pharmacology in your research career.
Barnett: Just to extend the concept of the importance of the clinical input of
clinical pharmacologists. Because of the wide spectrum of medicine that clinical
pharmacology covers, clinical pharmacologists became general physicians, and
have continued to be that way, taking a holistic approach to the whole of medicine
and therapeutics. This has continued for many years, but is now gradually
fading. General medicine was retained in clinical pharmacologists who had
clinical practice, simply because they didn't have another specialty, and because
therapeutics covered all of medicine. I echo what Mike Orme was saying, that
the issue about teaching and expressing what clinical pharmacology is across
the general medicine horizon is still very, very important, and unfortunately it's
failing so badly 9
Flower: I want to encourage anyone who wants to say anything about the
development of clinical pharmacology in centres other than London to say their
bit if they would like to do so, before we move on to the next topic.
Grahame-Smith: I would just like to say a word or two about what happened
in Oxford, and Stan Peart can give the background of the views of the
MRC at that time better than I can. But to cut the story short, after a fairly
frightening interview and at least two post-interview interviews in Oxford, I
was appointed to the chair of clinical pharmacology in Oxford and director
of the MRC Unit of Clinical Pharmacology in 1972. Now, those of you who
For a discussion of the Anglo— American meeting, see page 15. See also Melmon and Turner (1986).
93 McDevitt (1986).
See page 30.
32
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
know about these things will know that you are not just appointed; you have
to go through a long process of producing a full programme of research until
you are 60, which takes quite a bit of doing. This was not easy because I
was not in the mainstream of clinical pharmacology; I was still a clinical
biochemical pharmacologist. And I was interested in the brain, because some
of you may know that serotonin is in the brain, and it became a popular area
of research for the next two decades. I really wanted to develop basic and
clinical psychopharmacology in Oxford, and Professor Michael Gelder, who
was professor of psychiatry, was very interested in clinical psychopharmacology
and he too was attempting to get it going, and it was clear that there would
be a place for collaboration between the department of psychiatry and the
department of clinical pharmacology. So in fact, all the time that I was there,
one of my main thrusts was basic and clinical psychopharmacology, doing
basic experiments to elucidate mostly the effects of drugs upon the serotonin
system and translate that into the clinical sphere and also at the same time
training people in neuropharmacology, which they could then apply to their
work in clinical psychopharmacology. That has been very successful, and
Phil Cowen, professor of psychopharmacology in Oxford, Guy Goodwin,
professor of psychiatry in Oxford, Dave Nutt, professor of psychiatry in
Bristol and Professor Paul Grasby, professor of psychiatry at Imperial College,
London, all went through the MRC Unit of Clinical Pharmacology, learning
both basic neuropharmacology and clinical psychopharmacology. That was, I
think, quite successful training for them and produced a lot of papers of one
sort or another.
The other area that I was very interested in, in terms of biochemical pharmacology,
was finding surrogate biochemical pharmacological markers for drug effects,
and Jeff Aronson has spoken about sodium— potassium ATPase in red cells,
which is a good example." It never quite came to anything clinically useful in
an everyday sense, except — and to me, this was a big surprise — we showed an
adaptive response of red blood cells to long-term treatment with digoxin in
humans. In other words, the red cell develops more sodium— potassium ATPase
sites. For me, this triggered a great interest in neuroadaptive responses in the
brain to chronic treatment with antidepressants, neuroleptics and almost every
CNS drug that you can think of, because the brain is one of the greatest adaptive
organs, par excellence. So those were the main themes of the unit's work over
the years. However, I found it very difficult to establish an accepted and strong
55 See page 16; Eisner and Smith (1991).
33
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
identity for clinical pharmacology in Oxford. I remember treating a very well-
known and distinguished professor of philosophy in Oxford after a mild stroke,
who asked me: 'What's your specialty?' in the way that they do in Oxford. I
replied, 'I am professor of clinical pharmacology'. 'What's that?' So I said, 'Well,
studying how medicines work, what they do to the body, how the body deals
with them, their effects and their side effects'. 'Oh, you are the professor of
pills'. Straight in, 'professor of pills.'
When I first went to Oxford, I went to an induction party by the Rhodes Trust.
I was introduced all round by the secretary of the Rhodes Trust as the professor
of criminal psychology, which, of course, is very much more interesting at a
cocktail party than the professor of clinical pharmacology. [From the floor: I
shall use the line myself] And then finally, just to give the flavour of Oxford and
how difficult it can be, going to a private dinner and sitting opposite a very nice,
very distinguished lady of the upper classes, who said, 'How did you get here,
young man?' (because I was a young man). I went through the whole rigmarole
and she said, 'How did they know that you would be socially acceptable?' So,
these are some of the things that I came across in Oxford that are relevant to the
teething troubles of clinical pharmacology.
But I have to say I had a row at the interview for the professorship, not a big
row, but subsequently at the post-interview it was quite a row, because I insisted
that I wanted to continue to do clinical medicine and this was contrary to some
opinions in Oxford at the time. My reason was that I very much liked doing
clinical medicine, and I don't think that a clinical pharmacologist could hold
his head up unless he knows, in fact, about the prescribing of drugs to people
who are ill. Also, the clinical students will soon find you out if you are just
a theoretician. You have got to know what you are talking about on a ward
round or whenever you are teaching clinical students, you really must know the
practical implications. I think it is extremely important to maintain this contact
with ordinary, grubby, day-to-day medicine. Our problem is — and it hasn't been
said yet — that we are not organ-based. That's why the subject finds its position
difficult, because we are not organ-based. Those who fund the National Health
Service would rather pay the pharmacists (cheaper) to look after the drugs,
not the clinical pharmacologists. So there is still a serious problem, I think,
in identity of the subject of clinical pharmacology and I don't know how you
overcome that.
Flower: I think it is best if we stick to criminal psychology.
34
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
Aronson: David didn't tell you, but he told me that when he was accused of
being a criminal psychologist, someone asked him what did he specialize in?
What would you say? Drugs.
I wanted to add something to what David said about Oxford. When we arrived
we rapidly learned that there were two groups of individuals in the hospital, those
who thought that we were rubbish and those who were keen to collaborate — it
was quite a divide. And you knew which ones steered clear of us, and you knew
which ones were keen. And we also realized that there weren't going to be jobs
in clinical pharmacology, so we did what Mark described Paul Turner doing,
which was to bring other specialists into the department to train them somehow
in the use of drugs, and send them out to their disciplines, such as Nick Boon,
for example, who is now a cardiologist in Edinburgh, and Chris Hawkey, now
a gastroenterologist in Nottingham. We had nephrologists, psychiatrists and,
as David has described, a whole host of people across the spectrum of different
medical disciplines and we hope we seeded our discipline into those specialties.
And, in turn, we were then asked to collaborate with others outside of the
department: I published with gastroenterologists, cardiologists, nephrologists,
psychiatrists, and so on, which has enriched my career enormously by those kinds
of collaborations that do come if you bring others into your department and try
to seed as we did and, as Mark Caulfield described, as did Paul Turner.
Reid: I want to add something to David Grahame-Smith's comment before saying
something about the Scottish medical schools and Glasgow in particular. I can
confirm, as a student at Oxford in the preclinical and clinical school through the
1960s, that there was absolutely no clinical pharmacology. Most students would
not have known what it was. There was no teaching on prescribing and no
teaching of therapeutics. In spite of this, I managed to follow a career in clinical
pharmacology via the Hammersmith. In Scotland it was very different. I do
not know about Dundee, because it is the newest Scottish medical school, but
I am certain that in Aberdeen, Edinburgh and Glasgow, clinical pharmacology
grew out of materia medica and therapeutics as an undergraduate teaching
responsibility. The universities funded clinical academic teaching posts: lecturers
in materia medica and therapeutics for over 200 years in Glasgow. One of the
early ones was professor of botany as well as professor of materia medica. The
name changed to therapeutics in Edinburgh and Aberdeen in the 1960s because
of local interest in drug regulation and safety, led by Alastair Macgregor and
96 See, for example, Willoughby et al. (1982); Williams et al. (1978); Brearley et al. (1993); Antia
etal. (1995).
35
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
Derrick Dunlop. Clinical pharmacology was late in coming on the scene, as
it was more of an experimental and research discipline in the early days. The
merger of undergraduate teaching, drug regulation and experimental medicine
emerged as clinical pharmacology in the 1970s. However, it was firmly based
in clinical practice with the professor of materia medica (and later clinical
pharmacology) always having responsibility for beds in a main teaching hospital
through the nineteenth and twentieth centuries.
Professor Morris Brown: I was going to follow on from David [Grahame-
Smithj's account of Oxford with an account of the whipper-snapper university's
[Cambridge] rise of clinical pharmacology, but John [Reid] got in the way. But
that's appropriate in a way, I suppose, because my first subconscious introduction
to clinical pharmacology — although I have lost the accent — was getting a school
prize awarded by [Derrick] Dunlop in Edinburgh Academy, and, of course, John
[Reid] was my first supervisor at the Hammersmith when I came there. But
Cambridge was very much a sort of new boy on the block, not just in clinical
pharmacology, but in clinical medicine, in a weird sort of way. There's been a
clinical school in Cambridge for a long time, and I think that one of the final
spurs to setting up clinical pharmacology in Cambridge was that there was a final
MB in which clinical pharmacology had long featured as quite a major part, and
the only teaching which went on in Cambridge for that was by an undergraduate
pharmacologist with a lovely Lancastrian accent called Bill Grundy, who made
sure that everyone passed, by telling them the questions before they got the
paper. But the university in particular — one can't call it a preclinical school,
because there still isn't a preclinical school in Cambridge, they can't get the
departments to agree on that — but the university was rather against giving much
money to a clinical school for clinical activities. So, clinical pharmacology came
about after the retirement of one of the physicians at Addenbrooke's, and it was
one of the NHS physicians, David Rubenstein, who persuaded Addenbrooke's
that they should fund a chair in clinical pharmacology. And we have still never
had any university funding for clinical pharmacology in Cambridge. So my
own philosophy, having come out of the department at Hammersmith, as John
described, I suppose, has been more in the way of using drugs to investigate
disease and physiological processes and that as I am sure you would say yourself,
David, is challenging. But I very much also followed the Oxford philosophy
97 See, for example, Macgregor (1965, 1969).
98 See, for example, Grundy (1968).
99 Rubenstein and Wayne (1976).
36
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
that if we are not going to create many pure clinical pharmacologists, we have
to influence people going into other specialties, and many of our training posts
have been formally in clinical pharmacology and an organ-based specialty.
Prescott: I would like to follow up on what John Reid said about the Scottish
medical schools, where there was a long tradition of departments of materia
medica and therapeutics. These departments were often on an equal footing
with the departments of medicine, in terms of clinical commitments and
teaching responsibilities. This was perhaps even more so in the time of Sir
Derrick Dunlop in Edinburgh, where the department of therapeutics probably
eclipsed the department of medicine. The strong academic tradition of materia
medica and therapeutics was a great advantage and it certainly facilitated the
introduction of clinical pharmacology as a specialty. I was appointed as senior
lecturer in clinical pharmacology in the department of therapeutics in Edinburgh
in 1969 with Professor Ronnie Girdwood, who was very supportive.
Professor Frank Woods: Strangely enough, Sheffield is rather like the
Scottish universities. The first professor of pharmacology and therapeutics in
Sheffield was William T Cocking (1897-1911), who was appointed in 1890,
and thereafter you had a succession of Sir Edward Mellanby (1920-33), Sir
Edward Wayne (1934-53), Grahame Wilson (1954-67) and Robert Kilpatrick
(1966-75, Baron Kilpatrick of Kincraig from 1996), all of whom had a very
strong endocrine specialty, and, indeed, towards the end of the 1960s, the
period we are talking about — the transition if you like — and the emergence of
clinical pharmacology, the department of therapeutics had more beds than the
department of medicine. Indeed, whereas I accept what colleagues say that it is
important, as David Grahame-Smith has emphasized, for respectability, but also
in relation to the quality and power of your teaching, to be seen to be delivering
medicine at the bedside and in the clinic, also we found some difficulty because
Professor David Webb wrote: 'Going back to earlier records [the Edinburgh University Calendar} it seems
that the Christison chair, which I currently hold, and which was held by Sir Derrick Dunlop, was the first
chair of therapeutics in the UK, instituted in 1919. The descriptor "therapeutics and clinical pharmacology"
was only introduced much later, as indicated by Professor Laurie Prescott.' E-mail to Dr Daphne Christie,
12 February 2007. See also Blackden (1968).
Professor Laurie Prescott wrote: 'In addition to general medicine, I also had a clinical base in the Regional
Poisoning Treatment Centre where there were wonderful opportunities for research and teaching in high-
dose human pharmacology. In the course of time, Ronnie Girdwood changed the name to the department
of therapeutics and clinical pharmacology. I think it is important to remember that the long-established
departments of materia medica and therapeutics in the Scottish schools laid the foundations for modern
clinical pharmacology' Letter to Dr Daphne Christie, 12 July 2007.
37
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
we had too much clinical responsibility. And once it became clear that we were
able to recruit high-quality non-clinical scientists, if I may call them that, as
our equal colleagues, our opportunities for research, so far as I am concerned
anyway initially, were hampered because of the weight of clinical work. I don't
think it did us any harm in relation to teaching and respectability, but I think it
did hamper some of the research development.
McDevitt: It's just to complete the Scottish picture, because of course Dundee
was for a long time the clinical base of St Andrews University, and so it, like the
other Scottish medical schools, had a chair of materia medica from the nineteenth
century onwards. When Dundee University split away from St Andrews, in
1967, it changed the name of the chair to therapeutics. But, in fact, similar to
what's just been said by Laurie, there was tremendous power both in the chair
of medicine and the chair of materia medica. It was actually alleged — and I can't
confirm this — that Sir Robert Brockie Hunter, professor of materia medica, and
Sir Ian Hill, professor of medicine, kept their names on every clinical bed in the
Tayside region and made a point of going round the beds at least once a month
and changing some of the treatments, just to make sure that their empire was
preserved. Now, in fact, when Brockie Hunter went to be vice-chancellor of
Birmingham in 1968, James Crooks was appointed to Dundee as professor of
therapeutics, and he was a very influential figure, not just within Scotland, but
also within the development of clinical pharmacology in the UK. 103
Now, the other important aspect of the teaching responsibilities, which John
Reid and Laurie Prescott have spoken about, is that very often in the Scottish
medical schools, departments of materia medica or therapeutics had access to
final exams, as well as teaching. One of the other difficulties encountered by some
of these new chairs of clinical pharmacology was in getting into the examination
system and certainly getting into the examination system after about the third
year; whereas in Scotland, traditionally, clinical pharmacologists examined right
up until the final MB. And I think that gave them great influence.
Routledge: You asked me earlier to comment on Wales and I think this is an
appropriate time, because Wales is a very new player on the block. I think it was
when Alan Richens went to Cardiff in 1981 that clinical pharmacology started.
He negotiated the beds, which was, I think, crucial. I think he did one other
See www.archiveshub.ac.uk/news/02112106.html; www.dundee.ac.uk/main/about.htm (visited 24
October 2007).
For example, see note 90.
38
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
astute thing, which was to get an exam in therapeutics mandatory for the very
first time, so that the students couldn't become doctors if they failed. Prior to that,
they could scrape through on the medicine, but Richens developed the objective-
structured clinical exam, based on the Dundee model, which seems now to be the
model for most of the exams in Cardiff. But I think that he recognized that if
you want a subject to have prominence, it has to be examined and students will
work at it. He's left that legacy, for which we in Wales are very grateful.
Aronson: I wanted to ask Phil a question about Cardiff, because I am not sure
if Alan Richens set it up, but when I first visited Cardiff at that time, you had a
contract unit for doing studies for pharmaceutical companies. This is something
we haven't discussed, and I wondered how the presence of such a unit in your
department, and perhaps Charterhouse [at Bart's] — I don't know if it was
through Paul Turner's involvement — how did that influence the development
of clinical pharmacology?
Routledge: I think it helped in many ways and I think people like John Posner
and Tony Peck will have worked with Alan Richens in that unit. It did really give
opportunities first of all for income generation for other research, but secondly,
to develop strong links with the pharmaceutical industry. I think Dave Barnett
mentioned earlier the importance of the Merck fellows. I was a Merck fellow
and several others were and they did a marvellous priming job in getting those
of us who were new to clinical pharmacology in the 1970s to broaden our
horizons and come back with renewed interest in clinical pharmacology.
Laurence: A word about Sir Derrick Dunlop. I am not sure whether he was
professor of materia medica or therapeutics at Edinburgh, I think it was
therapeutics. Anyway, I was involved in setting up, for the World Health
Organization (WHO), the Technical Group on Clinical Pharmacology in the
early 1970s and we produced a number of reports [see e.g. Figure 5]. ' They
got in touch with me, particularly about the choice of chairman. So I decided to
104 Harden etal. (1975); Lowry (1993).
105 See Baber (1991); Posner (1992).
' Professor Desmond Laurence wrote: 'The first WHO Technical Report on clinical pharmacology, chaired
by Sir Derrick Dunlop, is a truly seminal document. Years later, for the first World Conference of Clinical
Pharmacology at Wembley, organized by Colin Dollery, he had it reprinted for all the delegates, so good
was it. Over the years, there have been numerous relevant WHO Reports, and also the famous Essential
Drugs/Medicines Programme for developing countries.' E-mail to Mrs Lois Reynolds, 20 August 2008. See
also note 152.
39
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
suggest somebody who was professionally allied to, but not actively professionally
concerned with, the development of clinical pharmacology (which might lead
to friction). I thought hard and my thoughts turned to Scotland. Of course,
I had met Derrick Dunlop. I had heard him lecture: a man of extraordinary
presence, charisma is certainly the right word for him. So I suggested him and
gave my reasons. And of course, I knew that in an international meeting it was
pretty certain that almost nobody would ever have met a character like that
before. And the WHO got on to Dunlop and asked: 'Would you consider this?'
And so he phoned me and said, 'What's all this about?' And so I told him and
I said I thought he could be a successful figure for bringing everybody together
on this relatively new subject, and he said, 'Well, you'll keep me informed won't
you.' And he did it, and it worked out as expected. On the first evening, Lou
Lasagna, who I think was the vice-chairman, escorted us to the usual WHO
buffet at the beginning of a Technical Group, and Lou Lasagna took Dunlop
along and he said, 'Sir Derrick, what would you like?' and Dunlop pointed to a
bottle of Scotch whisky, 'The wine of my country' 107
Vere: Very briefly on Mark Caulfield's remarks. Paul Turner was a remarkable
colleague and friend indeed, and we agreed very strongly about joint training
programmes. It was very difficult in the enactment. I found quite quickly,
when I was chairing the committee of the Joint Committee on Higher Medical
Training (now Joint Royal Colleges of Physicians Training Board) on clinical
pharmacology, that other specialties regarded clinical pharmacology much as
one might think of bird flu virus nowadays. A couple of brief examples of this:
it seemed to me that the cardiologists were the people who really would be
most likely to accept a joint training programme. This was obvious, but no.
There was no response at all. The worst, though, was to come, because there
was a dentist who was a very good clinical pharmacologist and I rang up the
chairman of the surgical committee, and he turned out rather surprisingly to be
a pathologist. And he said, 'No, no, no.' I said, 'How about setting a precedent?'
And his reply was, 'We have no precedent for setting precedents.' And that was
it; end of conversation. I still think that Paul was right.
Flower: We have 15 minutes before tea, and Desmond mentioned the WHO
report; and somebody, I think it was David, mentioned the MRC's involvement,
so I wondered whether anyone might like to say a few words about the impact
Professor Desmond Laurence wrore: 'He was a great success, and drank my "duty free" bottle of whisky
in the evening when we planned the next day's business (he said his wife required him to come home with
his bottle unopened).' Note on draft transcript, 21 June 2007. See Figure 5.
40
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
Figure 5: WHO Technical Report no. 446, 1970.
of the MRC in clinical pharmacology or that of the WHO report or the Royal
College of Physician's report of 1969? What influence did these have on the
subject? Does anyone feel able to speak to that for a minute or two?
Laurence: I think the WHO Technical Report has exerted an immense
influence. I well remember when the International Conference on Clinical
Pharmacology came to London at Wembley. Colin Dollery was the moving
spirit and he had, I forget the year of that conference [From the floor: 1980],
he had the WHO Technical Report reproduced as a conference paper, which I
think is a sufficient testimonial for it. 10
Orme:Just a brief comment following on from Desmond on the WHO. I don't
know whether we would like to go beyond 2000 in our terms of reference, but
one of the worries that I have had about WHO is that since that report there
See notes 24 and 25.
109 World Health Organization, Study Group (1970). See also Gross (1986); note 152.
110 Dollery (1978); Turner (ed.) (1980).
41
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
has been an almost total silence from the WHO, in spite of attempts in the late
1980s to get it brought up to date. But if there is some good news, I gather
that the new WHO Director [Dr Margaret Chan, from 2006] is having a new
broom and one of the things that they seem to be more interested in is not
neglected diseases, but clinical pharmacology. So whether anything will come of
this — the trouble is the WHO is a rather strange organization, but maybe things
are a little bit more positive than they were during the last 25 years.
George: I think those were incredibly important reports and they did outline
the training programme and the potential career contributions you could
make following a training programme. It also meant that there would be a
certain number of physicians who carried senior registrar status; and then the
fly in the ointment came along, which was the Department of Health's Joint
Planning Advisory Committee (JPAC), which had obtained some figures from
Paul Turner that suggested that rather than there being 24 posts in clinical
pharmacology, there should only be 12 for the whole of the UK. I managed
to draw on Denis McDevitt's article, which had been printed in Clinical
Pharmacology and Therapeutics, and then to do a rapid survey round the UK
departments of clinical pharmacology and went to JPAC with a proposal that
we should actually have 24 posts." And everybody accepted my figures, and the
late John Swales at the tail-end of the meeting said: 'Why don't we be generous
and give them 25?' And everybody went away happy, except the man from the
Department of Health.
McDevitt:Just an example against Charles's background of 25 posts in England.
When JPAC came out, and when they were starting to approve senior registrar
training posts, we managed to ask them to approve our department for two
posts in clinical pharmacology, but also because general medicine was part of
the system, we had it approved for two posts in general medicine as well, and
we managed to persuade the powers that be in Northern Ireland that we should
have four posts. So, for a period of quite some years, we actually had four
senior registrar posts within our department, and we used them basically to
bring people through to do MDs. Dennis Johnston, who's now the head of
clinical pharmacology in Belfast, trained under that system. But a lot of them
did what other people have been doing; they did, say, two or three years with
us, and developed a particular interest and went off to become consultants in
111 See McDevitt (1986); Reid (1997).
See Glossary, page 123.
42
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
a different specialty. But we were particularly fortunate at that stage that we
managed to buck the system.
Herxheimer: I would like to make a slightly different comment, which concerns
the start of clinical pharmacology. Clinical pharmacology is the offspring of
a union between pharmacology and medicine and these have not been equal
partners. The initiative, as we have heard, the power, has always lain with
medicine, and so pharmacology has played a hugely important maternal role,
but the father has really determined the career of the offspring. I think that
if we look at all the stories that we have heard from different places, we can
see that is how that interaction has played out in its different variations. For
example, the JPAC posts are entirely from medicine; pharmacologists played
no part in that. 13 Pharmacology was nothing to do with it; it's like once you
have recognized the importance of clinical pharmacology in a medical context,
then the child has left home and the career is determined by the male ancestry. I
think that's very impressive, and I think it's self-perpetuating, because medicine
has the power everywhere, both in education and in health services and other
places where clinical pharmacology is needed. So, we are left with that structure
and we have to make it work.
Flower: That's a good point; would anyone like to talk to that?
Fowle: I'm ex-Wellcome Foundation. When I joined Wellcome I became a
consultant physician at the same time, and I have listened to the conversations
from dedicated clinical pharmacologists who ran departments, and I wonder
what they thought they were running them for, because if you have to turn
out clinical pharmacologists, you have got to find a place to put them; not just
teach other clinical pharmacologists. And at the time that I became a consultant
the burning question from the other physicians interested whether you were
going to join them or not, was: 'Are you going to help me with my load of
peptic ulcers?' Have we forgotten just what a huge lot of medical outpatient
work was considered very dull by physicians? And, they weren't very welcoming
to somebody who was going to be a clinical pharmacologist, who would, they
thought, just tell them how to use digoxin. I can remember that from when
I was a senior registrar working for Walter Somerville. 11 I could not imagine
Walter Somerville accepting advice from a clinical pharmacologist on how to
use digoxin on his patients, and I suspect the same thing applied to physicians
113 See, for example, Hurst (1990).
See Tansey and Reynolds (eds) (1999).
43
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
in other specialties. And when I toured Australia and saw how many universities
had departments of clinical pharmacology, dedicated to turning out graduates
of clinical pharmacology, I wonder where they thought they were going to get
a job.
Flower: Any Australian graduates here?
Laurence: Let us not forget the considerable role of clinical pharmacologists
from this country in developing the Essential Medicines Programme of the
WHO, particularly in getting it off the ground. 1 " And just a tip for somebody
who wants to flatter a physician who's doubtful about clinical pharmacology, is
to say, 'Well, when I am ill I want a physician to come through the door, not a
clinical pharmacologist', and that cheers them up.
Flower: We are now going to discuss various matters, but I would like to kick off
by asking Charles George to talk a little bit about the significance of specialized
societies dealing with clinical pharmacology, and clinical pharmacology meetings
which have stimulated the area, publications which have had an important
influence, and so on.
George: Perhaps I should declare an interest; I am a non-executive director of
the BMJ Publishing Group, which is not only concerned with the BMJ but
also has a stable of 19 specialist journals, and of course they are very important
to learned societies for obvious reasons. The first is that they enable people
who presented at the meetings of the Society to tidy up their manuscripts and
submit them to a journal which is ethical and which actually will publish some
of their papers, either soon afterwards or subject to modification. In the case of
the Clinical Section of the British Pharmacological Society that came into being
in 1970, and Paul Turner was the first secretary of the editorial board of the
journal in 1974, and did a sterling job, with assistance from other members of
his group, Alan Richens and Anne-Marie Hedges, who acted as sub-editor and
did a phenomenal job over many years. The proximity of the editorial offices in
John Street to St Bartholomew's Hospital, of course, aided and abetted the way
that they ran the journal for many years and even though Alan subsequently
moved to Cardiff, in 1974, he paid at least a weekly visit to John Street to run it
the same way. I inherited the journal in 1985 and ran it from 1985-87, and if
I made any contributions at all, it was to make it demonstrably possible to run
it outwith London, and Elizabeth Whelan kept me busy with a liberal supply
See WHO, Expert Committee (2007). See also Glossaty, page 122.
44
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
of manuscripts. ' These I farmed out to other members of the editorial team
and it seemed to go reasonably well. Looking back on the journal in its early
days, the methods section seemed to me to be a very successful thing among
the profession.
We clearly made substantial profits, not only for the publisher, but also for
the British Pharmacological Society; not only from the journal itself, but also
from the various reprints, which were popular among some pharmaceutical
companies. And in particular, I think the journal supplement, which we started
— and we had a very good mechanism in those days to make sure that it wasn't
just the organ of the pharmaceutical company, but there was a member of
the editorial board who was responsible for editing the proceedings of those
meetings held by or sponsored by pharmaceutical companies - I think that
was a model that was used by other societies in due course. It was very good in
terms of producing revenue for the society and there's no doubt that when the
contract with Wiley— Blackwell comes to an end in due course, others will no
doubt be courting you for the British Journal of Pharmacology.
In addition to that, I have had the privilege of working on a number of other
bodies. I worked on Prescribers 'Journal, which was a very cosy thing. I think we
can be a little critical of Prescribers Journal, in that it was a bit late in producing
guidance, but it was very readable, despite the fact that it was largely written in
committee, by committee, which was rather a strange way of operating. But I
enjoyed my time there and on the advisory board.
My other activity was to work on the British National Formulary (BNF) as
chairman of the Joint Formulary Committee. Owen Wade, of course, has
written the history of this in the British Medical Journal in 1993, but he and
I were co-chairs of edition 12 of the new-style British National Formulary and
I continued until the year 2000 edition, number 39. " 8 This was a fantastic
time. Quite how I became chairman is an interesting story, but I think I was
a nuisance, as is my wont. I particularly remember writing that I thought the
advice on management of snakebite was inappropriate, and Owen Wade wrote
back to me saying, 'No, you have got it wrong'. So I wrote back and said, 'No,
Dr Jeffrey Aronson wrote: 'The publisher Elizabeth Whelan has been associated with the BJCP since 1983,
when the journal was transferred from Macmillan to Blackwell.' Note on draft transcript, 14 July 2008.
See Glossary, page 125.
118 Wade (1993, 2003).
45
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
you have got it wrong', and the advice was subsequently modified in the light
of experience, particularly of the late H Alistair Reid, who worked in Liverpool
and Malaysia. So during my time, I suppose the circulation increased to
over 200 000 copies twice a year of the paper version. It did grow in girth,
but it also grew in stature and we managed to get it so that medical students
received it twice during their training, although there were some problems
when there were new medical schools coming along and expansion of student
numbers, but Liam Donaldson, the CMO, with some reluctance, agreed to
put some pressure to ensure that they got the requisite number of copies. So, a
great organ.
The Monthly Index of Medical Specialities (MIMS) of course is in my brief, but
I only touch it to mention the fact that it's not an organ that I have found
helpful. It encourages A— Z prescribing, by which you start with the prescribing
of a product which begins with the letter A and you work through B, C and
eventually you get through to Y, which stands for 'why not try this'. But it's not
very logical therapy. And finally, of course, I should declare that in November
last year BMJ Publishing bought the excellent publication Drug and Therapeutics
Bulletin, because they thought it was very important to preserve, despite the fact
that the Department of Health no longer wished to sponsor it in England. 120
Flower:Thanks, Charles. We are going to come back to the DrugandTherapeutics
Bulletin in a minute, but Jeff has a question for you.
Aronson: Thanks for that advert for the BMJ, Charles. Can you remember
when it was that you persuaded the Department of Health to send copies of the
BNF to the medical students, because as you know last year, or very recently,
the Department of Health has said they will no longer do that?
George: I met Sir Liam Donaldson, on 24 May 1999.
Professor Trevor Jones: There are three other publications that I think are
worthy of record. The Merck Manual, which I know is very American, but
terrifically good, is almost small enough to go in your white coat pocket. Unlike
the other two: Martindale's Extra Pharmacopoeia, which I think as a quick guide
is a super place to start, and, if I may say from my days at the Association of
the British Pharmaceutical Industry (ABPI), the Medicines Compendium. It is
now available on the Web to everybody, lay as well as professional. I think these
119 Reid (1976).
For further details, see discussion on pages 51—2.
46
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
publications are good places to start. They are not research-based publications
but essentially canonical records of the drugs that we use.
George: Yes, I think Martindaleis an excellent publication. They use exactly the
same evidence base, but the way they present the information is very different.
I still think it's slightly unfortunate that Martindale starts with adverse effects,
which doesn't seem to me quite the right way round. 122 I am dissatisfied with
the interactive section of the BNF, but there are a limited number of times you
can bang your head against a brick wall. I agree with you that the Merck Manual
is also extremely useful, and the ABPI Compendium is much better now that
people have tightened up their sections on poisoning, which were pretty awful
at one stage.
Flower: It didn't include polonium in those days as far as I remember; a
grave omission. I would like to come to you, Andrew, in a minute about
the Drug and Therapeutics Bulletin, but I wonder, since we are talking about
the British Journal of Clinical Pharmacology, whether Geoff Tucker would like
to say something about the journal, which obviously contributed a lot to the
cohesion of the clinical side of the society, if I can call it that. Do you have any
recollections you would like to share, Geoff?
Professor Geoffrey Tucker: I would just like to add the fact that there is more
than one non-clinical pharmacologist here today. Although I am not a clinician,
I had stewardship of the BJCP from the late 1980s through the 1990s, which I
think was a particularly difficult time for clinical pharmacology. It coincided with
the inexorable rise of the DNA stamp collectors, in almost inverse proportion
to the demise of clinical pharmacology, I think, so it was a particularly difficult
time to get things funded in our area and to get them published. But one of the
saving graces, I think - and I want to bang the drum here for the non-clinical
contributors to the clinical section - is the tremendous input we had from
people interested in drug metabolism and pharmacokinetic— pharmacodynamic
modelling through that period, because that was when we really began to
understand the enzymology of drug metabolism, with implications for
See, for example, Berkow (ed.) (1982). For a brief history of the British Pharmacopoeia, see Dunlop and
Denston (1958); Wills (1986). See also http://emc.medicines.org.uk/ (visited 19 October 2007).
Professor Desmond Laurence wrote: 'Yes, indeed. I tried to change this, but they would not listen.' Note
on draft transcript, 2 1 June 2007.
This is a reference to the poisoning of Aleksander Litvinenko, the former KGB agent, in London with
polonium in November 2006. See Anon. (2007); Singh (2007).
47
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
understanding drug interacdons and the beginnings of understanding genetic
variability in things. 124
And, to emphasize what Don [Davies] was saying earlier, I would like to make
a plug for the non-clinicians out in the provinces who have made significant
contributions to British clinical pharmacology. For example, Kevin Park and
Dave Back in Liverpool, Andy Renwick in Southampton, a few of us in Sheffield
and others in Glasgow. If it wasn't for these individuals and their scientific input,
the Journal would have been pretty thin in the 1980s and 1990s. 125
Reid: On the subject of the BJCP, I don't want to spoil what is such a congenial
afternoon, but I have distinct memories at the Hammersmith in the early 1970s
of people being less than enthusiastic about the setting up of a new British
Journal of Clinical Pharmacology. I wonder if anyone else has any recollections.
I do not think it was quite as cosy as we are saying today. There were a number
of influential people who wished to keep clinical pharmacology in the BJP and
to avoid setting up another journal. 12 '
Prichard: It was during my time as secretary of the Clinical Section of the BPS
that I was responsible for the negotiations setting up the journal, as I remarked
earlier. The opposition came from the main body of the Society. I was unaware
of any of it from the clinicians or from Colin Dollery at the Hammersmith
Hospital. 128 He seemed to me to be supportive at the time. There was some
opposition from the committee of the BPS and the Society as a whole. They
were worried it would be a financial drain on the Society; we managed in the
end to reassure the sceptics. The other source of opposition was from Professor
Franz Gross, who was the editor of the European Journal of Clinical Pharmacology
and felt we didn't additionally need a British Journal. I dealt with that by a bit
See, for example, Lennard et al. (1984).
125 Back etal. (1984); Renwick et al. (1988); Lewis et al. (1991); Donnelly et al. (1989).
Professor John Reid wrote: 'There were a number of opponents to the founding of the BJCP, who
expressed their views at the annual general meeting of the British Pharmacological Society. As far as I know,
the minutes of the annual general meeting were not formally published!'. E-mail to Mrs Lois Reynolds, 7
July 2008.
See page 27.
See note 126.
Professor Franz Gross (1913—84) was a founder editor of the European Journal of Clinical Pharmacology.
See Gross (1978); see also Glossary, page 122.
48
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
of masterly inactivity, not being over-diligent in replying to the correspondence
from Germany, because I didn't want any ammunition to get into the hands
of the Society at large. I was quite convinced it was very important for the
development of British clinical pharmacology to have our own journal. As I
said earlier, I was delighted that Paul Turner agreed to become the first editor,
the first secretary of the board. In response to a question from Paul at that time,
I remarked that I had no ambitions in that direction, and I was convinced he
would do the task well, as he did.
Aronson: Two things I wanted to say. The first was to say that Mark Caulfield
talked about Paul Turner, and everybody knows Paul Turner was the first
secretary, as the post of editor-in-chief was then called. If you look at the first
issue or two, maybe even more, a lot of the papers came from Bart's, and it was
quite clear that Paul worked very hard to try to get high-quality material into
the journal to kick it off, and I think he did a brilliant job, and of course it did
eventually attract work from other institutions. But a lot of the early stuff came
from Bart's.
The other thing is to say that I think Geoff Tucker has understated his role here.
He put into my hands in 2003 a really thriving journal, despite all the problems
that he describes, making a large amount of income for the Society, which we
use to fund all our worthwhile activities. We now have two European editors
and an Australasian editor, who were all in place, and, of course, a reviews
editor, when Geoff was in post, and now we have a North American editor.
It really is thriving, and I think he has understated his contribution to that; it
really is a credit to the Society and a credit to the previous editors, chairmen of
the editorial board, that it is now thriving the way that it is.
Flower: If I could make a general remark about your behaviour, you are all
being far too modest — that is coming through very strongly to me as chairman.
Andrew, I think it is time for you to talk about the Drug and Therapeutics
Bulletin, without being modest.
Herxheimer: When I was at the London Hospital I was still doing research,
looking at the effects of this drug or that drug on whatever function. And then
I came to the conclusion that it was really a bit of a waste of time to spend six
months or longer doing that, while there was so much that was known that
nobody was using, that was just going to be published, sit there and gather
dust. And what was really needed was for the information to be got to every
prescriber. I had been in the US and seen the Medical Letter, which was new in
49
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
1959, and Owen Wade had imported the Medical Letter to Northern Ireland
with British names at right- angles in the margin, and distributed it in Northern
Ireland. I felt we ought to have this for the whole of the UK. How could that
be done? So I persuaded the Consumers' Association to try it. And I translated
a couple of issues from American (i.e. drug names and spelling) into English
and that seemed to be not very difficult and so we started the British edition of
the Medical Letterby subscription, and gradually got a small circulation started.
The Americans were very interested in checking that no commas or anything
else were different and they wanted to see everything before it was published
and that became rather difficult, before e-mail and so on. We also needed
articles about things that didn't exist in America, so we had articles of our own,
and then eventually we became separate. The subtitle of the Medical Letter was
'Medical Letter on Drugs and Therapeutics', and so we called it the Drug and
Therapeutics Bulletin. In 1962 we had started from the US edition of Medical
Letter and became independent in the UK in 1963. We had a small circulation,
a few thousand people, and then at one point we persuaded the Department of
Health that junior doctors should get it, and so that was the bulk subscription.
The bulk subscription in Northern Ireland was there all the time, it was an
extremely important and welcome support for the whole activity. And as this
went on for many more years, there were more and more medical students
and junior doctors, but the Department of Health decided that it didn't want
to take anybody off the list. So eventually, in the 1970s, when David Owen
was Health Minister and Jennifer Jenkins (Roy Jenkins' wife) was the chair of
the Consumers' Association, she asked him at a dinner at the Jenkins': 'How
about sending it to all the doctors in the country?' He thought that was a good
idea and it happened. That arrangement continued until the middle of last
year (2006). Throughout, the Bulletins assessment was impartial, with many
referees; the drafts were sent to the drug companies and drafts sent to people
in the Medicines Control Agency, and so on, for comment. We considered all
the arguments, but we had the final word. There was no need to engage in long
arguments and correspondence. And the motto of the Bulletin was that you had
to be able to read the whole issue without having to sit down, so it was kept as
short as practicable. I am afraid it's no longer possible to read the whole thing
standing up, but it's still desirable. We had an advisory council who were very
distinguished and did a lot of work, but what was unique, I think, was that the
Consumers' Association would publish something which was only for a small
section of the public, not for consumers at large, and that was pretty odd. The
See Glossary, page 1 24.
50
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
argument was, of course, that if doctors prescribed well, then all consumers
would benefit. But sadly this attitude did not survive the most recent changes
in management in the Consumers' Association.
Wade: My only comment is that one of the people who helped a great deal
with Presenters' Journal and certainly with the BNF was Dr Ed Harris. He was
Deputy Chief Medical Officer (DCMO, Department of Health, 1977-89) at
that time, and, you know, it's nice to pay tribute to him for the help that he
131
gave us.
Jones: Just a reflection on the Drug and Therapeutics Bulletin. I think over the
years it has been a tremendously valuable point of reference for prescribers, to
the benefit of patients. But I have to say, during my tenure at ABPI in the latter
years, a rather large number of folks in the industry thought it was a gift to the
politicians to promote rather old 'generic' drugs, rather than an objective review
of all available medicines. Of course, one has to recognize that the research-
based companies needed to defend their own products, but I think it is a pity
that the reputation of the Bulletin, in my opinion, has not been maintained,
and doesn't look, in my opinion, as objective as it used to.
HerxheimenThe relationship with pharmaceutical companies was always a bit
tense: companies didn't like their own products to be criticized. They were quite
enthusiastic when other companies' products were being criticized, and that's
just a fact of life. We were sued only once, which was very early on, when we
concluded: 'No preparation for softening ear wax [including Cerumol drops]
had been shown to be better than a simple vegetable oil'. 132 That action was very
troublesome, but was settled on the steps of the court, with each side paying its
own costs. So a softening occurred in that direction.
Flower: I thought you were going to say that you were sued by the olive oil
manufacturers.
Herxheimer: But we did have rather legalistic letters threatening to sue us. I
remember another occasion when the company insisted on having a meeting,
which we hardly ever did; but they came and they talked about their side of
the issue. We realized that their claims were even weaker than we had said they
were, and so we made that point in the revised version of the article.
131 See Griffin (2006); Wade (2003).
132 Anon. (1968). For a recent review, see Burton and Doree (2003).
133 Anon. (1983). See also Anon. (2002).
51
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
Barnett: As one whose current occupation is well aware of the tensions between
independent advisors and the drug industry, may I say that I found as a young
man, which seems like a hell of a long time ago, growing up and understanding
clinical pharmacology and therapeutics, the Drug and Therapeutics Bulletin to
be an incredibly useful reference base, and it still remains that way. There have
been some differences of opinion between the Drug and Therapeutics Bulletin
and the way in which the National Institute for Health and Clinical Excellence
(NICE) now carries out its business, but in principle it's the same concept, an
independent review of the real evidence and independent advice on what's the
best to do. I think that's the way it remains and I think NICE has taken on that
banner now. But it also means that it is actually where clinical pharmacologists
can make their point to everybody else, in a well-respected publication in the
medical community, and long may it continue in whatever guise it takes on.
Ferner: I am going to take the opportunity, since the temperature is rising
slightly, to attract the attention of both David Barnett and Iain Chalmers to
the demise of Presenters' 'Journal Although Owen Wade and then Linda Beeley
and Jeff Aronson were very influential and expert chairs of the committee of
management of Presenters' 'Journal, I was the last chair of that committee. In the
way that the Department of Health have withdrawn funding from the Drug and
Therapeutics Bulletin and also from the Adverse Drug Reactions Bulletin, which I
think Phil Routledge may talk about, the Department of Health also withdrew
funding from Presenters' Journal, but in rather a circuitous way 13 They gave the
money that they had spent on Presenters' Journal to NICE, and NICE, enthused
by or inflamed by ideas of evidence-based medicine and systematic reviews, that
can only have come from Oxford, criticized Presenters' Journal. I think unfairly,
because as you have heard from Charles George, although Presenters' Journal
hid behind named individuals, it was really a carefully researched, evidence-
based, and readable guide to therapeutics, in his time at any rate. So for the
excuse that there was no evidence behind it, and that the evidence that might
have been behind it hadn't been reviewed, it was demolished. This is a small
requiem for Presenters' Journal.
Sir lain Chalmers: One of the nice things about the transcripts of these Witness
Seminars is that people have an opportunity to reconsider what they have said
and to provide references to the evidence supporting them. I had absolutely
nothing to do with decisions about Presenters' Journal. Furthermore, I have
never spoken or written about evidence-based medicine, because I haven't been
134 See Boseley and Hall (2006).
52
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
a prescriber since 1973 and I didn't feel I had any authority to speak about the
topic. By contrast, I have views about evidence-based patient choice, because I
am a patient.
Flower: I don't know whether Owen would like to say a few words about BNF;
would you like to add anything to the discussion we have already had, Owen,
since we are just talking about these publications?
Wade: The .STVFhad been in existence since it took over from the National War
Formulary after the war, and it was produced every three years then. ' It was Dr
Edmund (Ed) Harris, deputy CMO, who enabled us to completely change the
BNF, so that instead of being 'a selection of drugs' as it then was, it included
every medicine on the market that could be prescribed. I think the people I
worked with and those who have succeeded me, like Charles George and Martin
Kendall, have made it a tremendous success: it is widely used and well thought
of. I never dreamt it was going to be as successful as it has been.
McDevitt: I think the thing that transformed the BNF was the decision to
publish it twice a year. Until that time it was largely irrelevant, because the
things that you were wanting information about, which were usually the new
drugs that you could find in MIMS, just weren't in it. Now every houseman and
most other doctors, carry their copy of the BNF around with them. I think it
has had an absolutely huge influence on prescribing. The only caveat I would
make is that some medical students, because this was given to them free, felt
that this was all they needed to learn clinical pharmacology and I would have to
say that I totally disagree with that.
George: Could I just add that Ed Harris asked for the revised format of the
BNF, because general practitioners, 80 per cent of them said that they used
other sources of information and that the old small blue-style hardback thing
was not meeting their needs. So whereas 80 per cent of general practitioners
used to use other sources as their prime source of information, now 71 per cent
say that the BNF is their main source of information about prescribing matters.
And actually, it does profoundly influence the way in which they prescribe.
Aronson: I think those last two comments sum it up. The fact that it was six-
monthly rather than three-yearly And the fact also that it gave so much more
See Figure 6, page 54.
136 Wade (1993).
137 Watkins etal. (2003).
53
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
NATIONAL
WAR FORMULARY
For general use in war time by medical
practitioners, pharmacists, hospitals and
others concerned with the prescribing
and dispensing of medicines
Compiled by a Committee
appointed by the
Minister of
Health
Second Edition
*943
Cntatt Copyright Relented
LONDON
PRINTED AND PUBLISHED BY HIS MAJESTY'S STATIONERY OFFICE
To be purchased directly from H.M. STATIONERY OFFICE
at the following addresses:
York House, Kingsway, London, W.C.a ; r3a. Castle Street, Edinburgh a;
30-41 King Street, Manchester 2; 1 SI. Andrew's Crescent, Cardiff;
80 Chichester Street, Belfast;
or through any bookseller
1944
Figure 6: Cover of the second edition of the
NationalWar Formulary, 1943.
information that was also important. This [holding up a copy] is the National
War Formulary, second edition dated 1943, 1 got it in a special issue - 76 pages.
The titles are in Latin. The measures are apothecaries'. Then 1946 — a huge
change when the new BNF came out. But the change in 1981 was even more
striking; it really was a huge change in the kind of information that was being
given to doctors.
Flower: Does the War Formulary contain any useful advice about ear wax?
Wade: I think we owe a lot to Ed Harris. He and I discussed the business of
getting it out six-monthly. We were fed up with doctors using MIMS all the
time, and it was partly to compete with MIMS that we initially produced it
six-monthly.
Flower: Does anybody else want to say anything about publications, formularies
and pharmacopoeias, or journals, because if not I think we could move on.
Herxheimer: I would just like to add a footnote or postscript that at the
Clinical Pharmacology Congress, the first one in London, we had an informal
54
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
meeting among about half a dozen people who were publishing independent
drug bulletins in other countries. And that led to the start of the International
Society of Drug Bulletins, which was then founded in 1986. I think, in a way,
that completes the story of the independent drug bulletins.
Flower: That's probably a good point at which to leave the topic of publications.
I would like to move on and talk a little bit about the way in which clinical
pharmacology, the academic departments, the enterprise, if you like, expanded
its scope and about the different directions everyone took; cardiovascular,
neuropharmacology, drug metabolism, psychopharmacology, and so on.
Perhaps I will begin by asking if anyone has any views or ideas about the way in
which developments in UK pharmacology impacted on the growth of clinical
pharmacology overseas in the sense that lots of overseas fellows were trained in
our medical schools, our hospitals, academic departments, and so on.
Jones: During my time with the Wellcome Foundation, I served on the US
Burroughs Wellcome Fund, which is like the Wellcome Trust here but much
smaller. George Hitchings and Trudy Elion and others were members of
that Board as well. It was a way of giving cash to bright young people to
do their research in different areas, tropical diseases, etc. One of the areas was
experimental pharmacology and nobody knew what that was, so very few people
actually started to apply for grants. But, based upon what was going on here in
the UK, we changed that to clinical-based pharmacology and I think that did
stimulate a huge amount of further effort in the US in this discipline. I have to
say that was at a time here when also, it seemed to me, that fewer people wanted
to become clinical pharmacologists. When I got to the ABPI, several companies
had put money into a pot to give to registrars in this discipline, and very few
took up the cash. Now, that could have been due to something else. In the UK,
postgraduates followed an MD route, then went back to their specialty, whereas
in the US the MD PhD was allowing people to be experimental and do their
Dr Andrew Herxheimer wrote: 'The International Society of Drug Bulletins has grown to embrace
72 independent bulletins in 36 countries throughout the world and has gained international
influence.' Note on draft transcript, 4 August 2007. See www.isdbweb.org (visited 11 October 2007);
Anon. (2002): 25.
139 Dr George Hitchings was director of the Burroughs Wellcome Fund from 1971 to 1994 and president
from 1971 to 1990; Professor Gertrude Elion worked for Burroughs Wellcome as a research scientist from
1944 until her retirement in 1983 and a research professor at Duke University, Durham, North Carolina
until her death in 1999. Sir James Black, Gertrude Elion and George Hitchings shared the Nobel Prize in
Physiology or Medicine 1988 for their discoveries of important principles for drug treatment. See http://
nobelprize.org/nobel_prizes/medicine/laureates/1988/index.html (visited 9 November 2007).
55
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
clinical work at the same time. Here, unless you were on the clinical special path,
two or three years out to do a PhD was probably going to disadvantage your
career. But, I think that the US Burroughs Wellcome fund certainly increased
clinical pharmacology activity in the US.
Orme: The question you raised was really about the influence of the British
clinical pharmacology body on people coming here. I think other people are
probably better qualified than me to talk about that, but just an anecdote which
may give the wrong flavour, but certainly in the early days in Liverpool we had
a German research fellow who came from Heidelberg to work with us for a year
and a half, and unfortunately we totally changed his life, because we were Dr
Herr, Dr Professor for the first two weeks and after that it was Christian names.
And then when he went back to Germany he could not cope with the German
hierarchical system and left to go to the US, where he has been doing very well.
I can't mention names.
I would just like to say a word the other way round — in fact, the influence that
the UK generally, in clinical pharmacology, has had in Europe. As background,
I helped to set up the European Association of Clinical Pharmacology and
Therapeutics in the early 1990s and I am currently, at least for the next six
months, chairman. And it's been quite striking the influence that the UK and
Sweden have had in the way that the French societies have come together to
produce a single clinical section. The same is happening now in Germany; the
way in which the Spanish society has used some of the UK things, particularly
around teaching; we have seen improvements in Italy and in some of the eastern
European countries; and they all cite what is going on or what had been going
on in the UK. And at times we have had to say to them, 'I am terribly sorry the
UK isn't actually doing all that well in clinical pharmacology', for the reasons we
have been discussing earlier on. But nevertheless they look to the UK in their
professional work as to how to develop clinical pharmacology. We keep learning
new things, not good things. Only a month ago, in discussion with a Spanish
colleague, I discovered that the Spaniards had passed a law that says that all
research ethics committees in Spain must be chaired by a clinical pharmacist,
which doesn't seem to me quite the right way of going about things. But,
Orme and Sjoqvist (1991).
Directive 2001/20/EC of the European Parliament and of the Council of 4 April 2001 set the target
for the implementation of good clinical practice in the conduct of clinical trials on medicinal products
for human use by 2004. Official Journal of the European Communities, 2001;1;L 121/34. For Spanish
committees, seewww.privireal.org/content/rec/spain.php (visited 5 June 2008).
56
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
you know, we are not winning all the battles. However, certainly Europe is still
looking to the UK in terms of matters of clinical pharmacology.
Flower: I can support your point of view, because funnily enough when wind
of this Witness Seminar got around, I was approached personally by two Italian
clinical pharmacologists, asking me if they could come, and they both said exactly
what you have said — that they had always looked to the UK as the fountainhead
of clinical pharmacology. When I pointed out that this seminar was meant to be
about UK clinical pharmacology, they were quite disappointed.
McDevitt: To bring the process earlier than that, I can't exactly date it, but it
was when I was secretary of the Clinical Section of the British Pharmacological
Society - probably in the late 1970s - and it was really at the time when clinical
pharmacology had got itself positioned within the clinical training programme
in the UK as a clinical sub-specialty - we had a meeting in the Ciba Foundation
in Portland Place, London, to which we invited representatives of clinical
pharmacology from many European countries. 1 3 At that stage we were really
the envy of all that was going on in Europe and the reason was because clinical
pharmacology was being muscled out, on the one hand by medicine and on the
other by pharmacologists, in most of Europe, with the possible exception of
Sweden. When it came to trying to get the thing harmonized within a European
scene, which I think was the basis of the meeting, the groups that sponsored
the specialists to go to the European meetings were groups like the BMA, etc.
So the clinical pharmacologists weren't getting a look in. And certainly at that
stage what had happened within the UK was very much the envy of the other
European clinical pharmacologists. In many ways, I think, a number of the other
countries have moved on now, but at that stage they were largely in despair.
Herxheimer: One thing that happened in the 1960s - Brian [Prichard]
thinks it is 1966 — was that there was a British Council meeting, a seminar
on clinical pharmacology for people from other countries. And then there was
another one, and that was very important, because there were people from
Italy, Croatia, Tunisia with great enthusiasm, and that was very successful.
Professor Desmond Laurence's account of 'The initiation of research ethics committees in the UK' will
be deposited along with other records of the meeting in GC/253 in archives and manuscripts, Wellcome
Library, London. See also the Report of the Ad Hoc Advisory Group on the Operation of NHS Research Ethics
Committees ax www.dh.gov.uk/assetRoot/04/ 1 1/24/17/041 124l7.pdf (visited 14 April 2006). For an earlier
assessment, see Wise and Drury (1996).
See Lee and Spufford (1993). See also www.novartisfound.org.uk/hist.htm (visited 16 November
2007).
57
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
And a lot of those were very much influenced by that. I know especially
about Croatia, because Professor Bozidar Vrhovac from Zagreb really started
r l 144
rrom there.
The other thing I want to mention is that in 1956, at the XXth International
Congress of Physiology in Brussels, clinical pharmacology didn't exist. ' I had
met Wim Lammers, a young pharmacologist who then became professor of
pharmacology in Groningen, and while he was there, he persuaded the professor
of medicine that Groningen needed a clinical pharmacologist. Because all
the Dutch universities are state universities, and, to be employed by a state
university, you had to have a nationally agreed description of who was qualified
to apply for a chair. So, by definition, no qualified Dutchman existed, and they
asked me if I would be part-time professor of clinical pharmacology and start to
introduce it. I said yes, and they created a chair of clinical pharmacology on one
day, and the next day they split it into two twin chairs of clinical pharmacology.
The senior one was Professor Meyler of Meyler's Side Effects of Drugs; he was
running the place, he lived there, and I went there for a few weeks several times
a year and that's how it started. ' That was a very direct kind of descendant.
Then later on, other Dutch universities started to have clinical pharmacologists
and we trained a successor who then ran the department in Groningen. That's
another bit of the European dimension.
Chalmers: I am encouraged to ask a question, because of this extension of the
discussion into Europe. I am puzzled why the name Paul Martini hasn't been
mentioned up until now.
Orme: To respond to Iain as one of the erstwhile winners of the Paul Martini
Prize, I did do a little bit of homework before I went to Germany and certainly
his influence was very considerable. But I have to say I can't give you chapter
and verse at the moment, but I will just vouch for what Iain is saying, he did
have a major impact in Germany at that time.
See, for example, Orme etal. (2002). Dr Jeffrey Aronson wrore: 'Known to his friends as "Darko".' Note
on draft transcript, 18 June 2008.
^ International Congress of Physiologists (1956).
Professor Leopold Meyler published his first edition of Side Effects of Drugs in 1952. Dr Andrew
Herxheimer has been co-editor since the 6th edn (Meyler and Herxheimer (eds) (1968)). For a
publishing history, see www.elsevier.com/framework_products/promis_misc/meylerhistorynew2005.doc
(visited 3 June 2008).
147 Shelley and Baur (1999); Grosse-Brockhoff (1964); Wiedemann (1994).
58
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
Figure 7: L to R: Per Lunde, Barbro Westerholm and Owen Wade, 1 971 .
Vere: Like many other departments, we had a continual trickle of people from
overseas coming through London, doing various different kinds of attachment
studies. They came from China, from India, from Nigeria, Kenya, and so
on. And I know some who went back had a considerable influence in their
own countries. The Essential Drugs List in Sri Lanka, for example, was carried
through by one of them.
The other thing which I think is worth mentioning is the BSc in London,
where there were course units; one of the course units in many places was a
unit in clinical pharmacology. Having the BSc students go through human
experimentation in clinical pharmacology has, I know, had a considerable
influence on the subsequent interests and training of those people. I certainly
know of some surgeons who went through that and who clearly benefited from
the exposure.
Wade: There was a WHO meeting in 1969, in Copenhagen, after which there
was a lot of cooperation between me in Northern Ireland, Barbro Westerholm,
who later became chief medical officer in Sweden, and Per Knut Lunde in Oslo,
comparing the use of drugs in our three countries. This spread to some other
countries in Europe. The Drug Utilization Research Group (DURG) started
The Essential Drugs List was first published in 1977 and the 15th edn became available in 2007. See
www. who. int/medicines/events/fs/en/index. html (visited 16 November 2007).
59
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
then, and it is has grown a lot since those days in Europe, Israel, Australia and
even Russia.
Aronson: I have an anecdote to match Mike Orme's and then a serious aspect to
the same story. We have had many foreign students over the years in Oxford, from
Russia, China, Australia, Brazil, I could go on and on, like Duncan [Vere] said.
I am sure we have all done that. We had one student from Sri Lanka who went
back after getting his DPhil and when I next saw him he said, 'You have made
my life a misery'. I said, 'Why's that?' He said, 'You taught me to say no.' And,
of course, over there you don't say 'no'. Somebody asks you to do something and
you say 'yes', and then you don't do it. But, I expected him to say 'no' if 'no' was
what he meant, and I would do the same with him, and that was very difficult
for him to adapt back at home. The serious side of that story is when I went
to visit him and discovered that there was an epidemic of self-poisoning with
oleander seeds, mostly by young farmers, young men not doing well. Oleander
seeds grow on a big yellow ornamental shrub. I said, 'The pharmacology of what
these seeds contain suggests to me that repeated doses of activated charcoal may
be beneficial.' So they did what may be, if not the largest, certainly one of the
largest prospective randomized controlled trials of self-poisoning in any form.
Within eight months they randomized 400 patients and reduced mortality from
8 per cent to 2.5 per cent and that has changed practice in Sri Lanka. We are
now doing another study in snakebite. I think this collaboration abroad has been
very fruitful and very influential. I could tell other stories, but that's just one.
Prichard: I thank Andrew for mentioning the British Council courses. Professor
Desmond Laurence was the director of studies and I had the privilege of assisting
him. In fact, they were not just seminars but two-week courses in 1966 and
1981, where we took actual and potential clinical pharmacologists from overseas
around various centres in the UK, both in London and, indeed, out of London,
and we certainly penetrated Scotland on at least one, if not both, occasions.
Speaking of overseas fellows who have come here, I think one individual we
should mention is Walter Aellig of Sandoz, Basel. He was a research fellow
Shortly after the photograph in Figure 7 was taken, Per Lunde became responsible for the WHO Essential
Drugs Policy for Developing Countries and Barbro Westerholm became the Chief Medical Officer of Sweden.
See Bergman (2006). See also Wade (2006); www.rcgp.org.uk/pdf/TNG_06Winter_DURG.pdf (visited
23 May 2008).
150 de Silvan al. (2003).
151 See, for example, Aellig (1981, 1994).
60
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
at UCH in 1968/9 and has been a tower of strength in supporting the BPS.
The Sandoz Prize (renamed the Novartis Prize in 1997) was first presented
by Professor Botand Berde; Dr Aellig took over in the late 1970s. He is also
distinguished in that he gave the first communication of the inaugural session
of the Clinical Section of the British Pharmacological Society in January 1970
at UCL. He was recently honoured by being elected to Honorary Fellowship of
the British Pharmacological Society in 1998.
Aronson:I could add to that that Walter Aellig, a huge supporter of the Society,
was also for many years a member of the editorial board of the British Journal
of Clinical Pharmacology, and was very sad when he had to give it up at the end
of 2003.
Davies: The chairman said we have been too modest. I should mention a two-
week workshop in clinical pharmacology that we ran at the Hammersmith for
about 12 years from 1969, I think, which not only trained leaders in academia
but also many people who took senior posts in the pharmaceutical industry.
The other event that immensely increased the UK's international reputation in
clinical pharmacology was the first clinical pharmacology congress at Wembley
[International Union of Pharmacology (IUPHAR) in 1980], which Colin
Dollery took on, I think, when plans to hold it in the US fell through, and, we
can say — modestly — that it was a very great success and a great shop window
for British pharmacology.
Herxheimer: I want to add to what Duncan [Vere] said, which reminded me that
at the London Hospital we had student projects in the normal course for all
students. They each had to do a litde project, and lots of those were clinical
pharmacology projects. And they were really very exciting and enjoyable. They were
long before ethics committees were thought of. Some of them were actually published
as little papers. I remember two being published in the Lancet and I thought that
was extraordinary for student projects. And that sensitized the students to clinical
pharmacology thinking. Anybody else have that kind of experience?
Flower: I think that is a very important point. When I was a student of
physiology, we did all the experiments on ourselves, in the way that students
just can't do these days in most undergraduate centres, for various reasons. I
think it's an enormous detriment to our educational system actually.
152 The World Conference on Clinical Pharmacology and Therapeutics, London, Wembley Conference
Centre, 9 August 1980, see Turner (ed.) (1980); See also Breckenridge (1991, 1993). See also note 1 10.
153 Benson etal. (1966); Herxheimer et al. (1967).
61
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
Aronson: The 1967 Lancet medical education paper by Quilliam and Turner
describes a large number of experiments that they expected their students to
do on themselves. For example, mydriasis and miosis in the eye, and using
agonists and antagonists; you are right, we can't do that any more.
George: You can, but you have to structure your curriculum to it, and one
of the special study modules in Southampton is a fourth-year study in depth,
and quite a number of students each year opt to go for clinical pharmacology.
Provided you get your organization right, you can actually make sure that it's
properly ethically approved, etc.
Reid: The BPS clinical pharmacology section is currently awarding prizes
each year to medical schools for students doing research projects in clinical
pharmacology. These become poster presentations at the December meeting of
the BPS. There is some very high-quality work presented. At least two of our
Glasgow students have won prizes in the last few years. '
Aronson: You are right, John, but these students are not doing the kind of
research project that Quilliam and Turner described — demonstrating the actions
of drugs on themselves — they are actually doing research projects in patients
and so on. But you are absolutely right, they are of high quality.
Prescott: Alas, times have changed. I remember the days when we gave our
students single doses of amphetamine and barbiturates in their practical classes
so that they could experience the drug effects and identify which agent they had
been given. To conduct such experiments now would be unthinkable. I have vivid
memories of another practical class, which was supposed to show the effect of prior
induction by phenobarbitone on the hexobarbitone sleeping time in mice. The
whole class ended up chasing mice all over the laboratory and it was hilarious.
Flower: Before we leave this debate, does anybody else want to chip in a
last comment? One thing I mentioned earlier concerned the relationship
1 ' Quilliam and Turner (1967).
Dr Jeffrey Aronson wrote: 'A prize is awarded each year to the best student research project at each
university that enters.' Note on draft transcript, 18 June 2008.
Professor Laurie Prescott wrote: 'The students had another very valuable learning experience when they
inhaled amyl nitrite after breaking the little glass "pearls" in which it was formulated at the time. Pearl drops
apart, this produced an immediate and very dramatic cardiovascular response, which they measured on each
other and that they would never forget. Sadly, these days are gone forever thanks to the health and safety
regulations.' Letter to Dr Daphne Christie, 12 July 2007.
62
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
between clinical pharmacology, as it became known, and 'clinical
pharmacy'. I was talking with Stuart in the tea break and he had a couple
of comments about this, so I thought it would be a good point to bring
him in.
Dr Stuart Anderson: I think I could describe myself as a very early clinical
pharmacist. I was a student of pharmacy at Manchester in the 1960s, when it was a
four-year degree course, and I spent my vacations working in a hospital pharmacy.
That experience convinced me that the proper place for the hospital pharmacist was
much more on the ward than it was in the pharmacy counting tablets: that clearly
all this new knowledge I was acquiring was of far greater benefit perhaps to these
new medical students and junior doctors, who were struggling with prescribing
on the ward. And I was supported in that view, if you like, by a number of things
that were being published. They included various reports on prescribing errors
and the design of prescription charts, and these were very often collaborations
between clinical pharmacologists and senior pharmacists. And they came from
hospitals like the London with Chris Barrett, the Westminster with John Baker
and Aberdeen with Graham Calder, working with clinical pharmacologists. At the
same time, I was conscious of other reports, the editorials in the Lancet and so on,
which appeared to be claiming a broader advisory role for clinical pharmacology,
staking out the ground, if you like. ' What I saw as the area that clinical pharmacy
might evolve into was very much this same kind of territory. Anyway, when I
graduated, obviously as a very junior hospital pharmacist, it was one of my first jobs
to see if we could do something along these lines. And there were many obstacles.
I have to say the biggest obstacle was usually chief pharmacists themselves, who
were often resistant, but also there was in those places considerable hostility, I
would say, from some clinical pharmacologists. For me the atmosphere changed
completely when I moved to Alder Hey Children's Hospital, Liverpool, when I
was appointed principal pharmacist there in 1974 and clearly there were a lot
of problems around paediatric therapeutics, not least children's doses and so on.
The group of people I worked with there was the senior registrars, who had the
clinical pharmacology role, if you like, which resulted, of course, in the Alder Hey
Book of Children's Doses (ABCD), which carried on for quite a number of years.
I don't recall any involvement from the clinical pharmacology unit; Mike [Orme]
might know otherwise. I would be interested to know whether paediatric clinical
pharmacology had emerged at that stage.
See Appendix 1, page 77.
158 See Anderson et al. (1976). First edition published 1973.
63
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
I moved to the Westminster Hospital in 1978, where I was chief pharmacist for a
while, and things there were different again. The professor of clinical pharmacology
and therapeutics then was Ariel Lant, who had been working very closely with the
very dynamic district pharmaceutical officer, John Baker, and they were already
developing the district drugs guide, which became quite a substantial book. And
my understanding is that the Westminster District Drugs Guide became very
influential in the design of the re-launched BNF'm 1981. 15? By the time I had
moved to St George's in 1983, the relationship between clinical pharmacology
and clinical pharmacy had become one of complete collaboration. In fact, Joe
Collier was on my appointment panel at that stage, and the two professionals —
the hospital pharmacist on the one hand and the clinical pharmacologist on the
other — were essentially a team, working together on the drug and therapeutics
committee, on the design content of the St George's Pharmacopoeia!™ So, there
was a gradual transition really. ' I am interested to hear that in certain areas clinical
pharmacists appear almost to have the upper hand.
Barnett: I think the interface between clinical pharmacy and clinical
pharmacology is a very important one. When I was appointed as a senior lecturer
I went into the doctor's dining room and met a rather senior obstetrician/
gynaecologist who asked me what I did, and as I was new, I said I was a clinical
pharmacologist and he said, 'My God, they are letting the pharmacists in here
now'. I didn't know whether that was a compliment or not. The point is I
do remember the important interface between clinical pharmacist, clinical
pharmacy, and research pharmacy in San Francisco and clinical pharmacology.
People like Malcolm Rowland, who came to San Francisco, subsequently went
to Manchester, championed the pharmacokinetic approach within pharmacy
departments then, as opposed to the UK, where this development was confined
to departments of clinical pharmacology. I think this interface is very important,
and is extended now to ward pharmacy. Certainly in my university, my clinical
work, the interface between clinical pharmacy and clinical pharmacology is
absolutely essential at all levels.
159 Westminster and Associated Teaching Hospitals Kensington, District Drugs Committee (1981). For
details of the Guide, see Sutters et al. (1993).
Dr Stuart Anderson wrote: 'The 13th edition was in 1995, by which time it had been re-named as
a formulary.' Note on draft transcript, 11 July 2008. See Wandsworth Health Authority, Drugs and
Therapeutics Subcommittee (1985).
Dr Stuart Anderson wrote: 'The relationship progressed from initial suspicion and hostility, through
cooperation and collaboration, to one of equal partnership.' Note on draft transcript, 20 June 2007.
64
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
Wade: I want to comment on the cooperation with pharmacists, which has
been so important as far as the BNF is concerned. It is produced by the staff
of the Royal Pharmaceutical Society and that's one of the reasons it is such a
good production.
Tucker: With regard to British pharmaceutical scientists, Malcolm Rowland,
Grant Wilkinson and (not to be modest) I have helped to underpin quantitative
clinical pharmacology coming from the direction of pharmacokinetics.
Orme: First, to respond to Stuart. He's right that at this time the department
at Liverpool did not have very much input into Alder Hey; I guess we were
finding our feet. His successor at Alderley, Tony Nunn, worked with us in our
department very closely and indeed we have actually trained a paediatric clinical
pharmacologist, Imti Choonara, who is currently professor at the University of
Nottingham in Derby. ' So we do have some input, but it was a bit late, Stuart.
To respond to the general theme of the clinical pharmacist, I certainly totally
agree with those people who said it must be a collaboration. Unfortunately,
there are one or two of my colleagues in Europe who have got a real bee in their
bonnet about the role of clinical pharmacists, and you only have to mention
the word and they go ballistic, which is totally unhelpful, because collaboration
works. But to revert to the Dutch problem. The title clinical pharmacologist is
not protected there, so in fact most clinical pharmacists have the title clinical
pharmacologist — it is not a medical title in the Netherlands, it's a general title,
so you have to define what you are talking about. In practice, if you talk to
the Dutch — in fact, they do collaborate pretty well — but it's when looked at
from outside, you might say, 'Well, clinical pharmacists have taken over clinical
pharmacology' — they haven't as we understand it, but it's easy to see why people
think that is happening.
Grahame-SmithTn Oxford, over the years that I was there, the tension between
pharmacists, clinical pharmacists and clinical pharmacologists was diffused
very, very effectively, by the Drug and Therapeutics Committee. Pharmacists
sat on the Drug and Therapeutics Committee, clinical pharmacologists sat
on the Drug and Therapeutics Committee, and physicians and surgeons,
and people who had got the time to do it, sat on the Drug and Therapeutics
Committee [laughter] . There was a wide representation of medicine, pharmacy
and clinical pharmacology. And frankly, once it was established and running, all
See Glossary, page 125.
163 Choonara et al. (2004).
65
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
the tensions disappeared, and the pharmacists and the clinical pharmacologists
got on well together and they mapped out their own areas of influence and so
on, without it being written down or discussed. It just happened naturally, that
they saw that there was different expertise in each group. I don't know whether
the Oxford Drugs and Therapeutics Committee still goes on, whether the
pharmacists play their part in it, and whether interprofessional relationships
are still good. 1 '
Aronson: Yes, it's still the same in Oxford, David. 16 '
McDevitt: I start with an anecdote. I once went to Saudi Arabia and came
face to face with a clinical pharmacist who had trained in America and
he represented the extreme end of US clinical pharmacy, whose view was
doctors should diagnose and pharmacists should prescribe — doctors don't
know anything about drugs. But I think there is another dimension to clinical
pharmacy, beyond the ones that have already been mentioned. In most hospital
setups there are a lot of pharmacists and very few clinical pharmacologists, so
they can't afford to be in competition. Certainly in Dundee we had ward
pharmacists who didn't just go to the ward and count up the pills, but as
a generality they went on the ward rounds with the doctors and they were
there to provide information about drugs, which a lot of doctors, clinical
pharmacologists excepted perhaps, wouldn't have known. And it greatly
enhanced the quality of prescribing.
Flower: As an ex-head of a school of pharmacy, I am glad to hear that.
George: Really to emphasize again the importance of information pharmacists,
not only because they actually have access to the information and have the time
to do it, but I have to say from my standpoint, when I got to Southampton
one of the most arduous things was people asking me questions about things
which were much more to do with pharmacy than clinical pharmacology, and
the arrival of information pharmacists took a huge burden off my back so that
I could get on with some research.
Professor David Grahame-Smith wrote: 'Drug and Therapeutics Committees go back a long way. In
Oxford, a Standing Committee on Medicines was first established on 10 July 1975, became the Drug and
Therapeutics Committee in 1994 and finally the Medicines Advisory Committee in 1997. I suspect this
mirrors generally the history of these local groups throughout the country.' Note on draft transcript, 7 July
2008. See, for example, Jenkings and Barber (2004).
Dr Jeff Aronson wrote: 'It is now called the Medicines Advisory Committee and has executive powers.'
Note on draft transcript, 18 June 2008.
66
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
Caulfield: We have had a very profitable interaction with both the School of
Pharmacy and the pre-registration pharmacists in North-East Thames region
for a number of years; Paul Turner started that and we continued it after he
retired. At the School of Pharmacy, we taught a module, and in fact actually on
that module on clinical pharmacology, which was very popular, there were about
20—30 students from the School of Pharmacy who used to come over every year.
And we used to do the type of human pharmacology experiments that Laurie
was talking about, which we used to do with the second-year medical students as
well. For some curious reason that I never really understood, in the mid-1990s
the School of Pharmacy went in a different direction with a new curriculum and
decided that that module, which coincided with reduced clinical pharmacology
staff numbers, so it was stopped. " Recently we have been asked whether we
could reinstate it, or a variation on the theme.
The pharmacy ward rounds were very good. All the pre-registration pharmacists
came in from all over the North-East Thames and we used to do drug ward
rounds, and we used to do the same for medical students. And the other
interface that we have, which we preserve with the pharmacy, is a very strong
relationship on an initiative about safe prescribing. This is in addition to the
drugs and therapeutics committees, where not only do our senior people sit,
but also our trainees. In the safe prescribing initiative, there's a multidisciplinary
team of pharmacists, senior nurses and specialist registrars (SpR), who look at
'near misses' and critical incidents in prescribing to see whether any educational
needs should be met there, as this is quite a serious issue for us now. We have a
very strong interaction still with pharmacy, and it has been a long tradition both
at Bart's and the London for that to occur.
Dr Linda Beeley: I was an NHS clinical pharmacologist in Birmingham and ran
the West Midlands Centre for Monitoring Adverse Reactions to Drugs, where
I employed three pharmacists, to do all the work basically. But, I think it was
very useful training. I used to have quite junior pharmacists who would come
through for about six months and work with me doing various things connected
with drug monitoring, producing information and bulletins, which we sent
round the West Midlands. And then they would move on to other jobs, but I
think it provided a useful training experience for quite a few pharmacists.
' See, for example, Florence (2002).
Dr Jeff Aronson wrote: 'Now run by Robin Ferner.' Note on draft transcript, 14 July 2008.
67
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
Flower: I would like to stop the discussion on that subject now, because I am
aware of the fact that we are heading towards the finishing line, and during
the coffee break David Gordon told me he wanted to make a comment about
clinical pharmacologists.
Professor David Gordon: This relates to one or two of the things we have
talked about in the last hour or so. I wonder whether the specialty — I cannot
claim to be a clinical pharmacologist — is in a state of concern about what it is
doing? It goes back about five years ago when I was invited to a debate at the
Royal College of Physicians, about the nature of the undergraduate medical
curriculum. Defending the GMC Education Committee were, of course, Sir
Graeme Catto, the president of the GMC since 2002, and Roger Green, a
member at the time. When I arrived I discovered that the entire opposition was
made up of clinical pharmacologists, a kind of horde of clinical pharmacologists,
who had come to descend on the undergraduate medical course and to tell us —
deans of medical faculties, deans of medical schools - that we had got it wrong,
because we weren't teaching enough clinical pharmacology. 168 Now that was a
very good debate, and a good discussion, but deans of medical schools do get a
kind of sense of deja vu when they hear that, because it goes back to anatomists
saying we don't teach enough anatomy, and surgeons saying we don't teach
enough surgery or anatomy, and so on. Every subject can say that we don't teach
enough of it, and yet this keeps recurring. The latest instance I can think of was
an article in the BMJ, I think, where the same point was made, rebutted pretty
firmly, I have to say, in the correspondence column by the dean of the East
Anglia Medical School, and I think we have to await real evidence of whether
or not students are being taught enough clinical pharmacology. ' But are you
all feeling a bit defensive? I am just wondering.
Flower: I didn't know what question you were going to ask, David, but you
did say you were going to be provocative. As it happens, this was the topic that
I wanted to wind up with and I wanted to ask a fairly generic question about
where we are all going. I can see David Webb attracting my attention - unless
it is an isometric stretch.
Dr Aronson wrote: 'I wrote about this in an article (Aronson (1998)), I preferred the term "interaction".'
E-mail to Mrs Lois Reynolds, 19 August 2008.
9 Aronson et al. (2006) . For the rapid response e-letter from Professor Sam Leinster, dean of the University
of East Anglia School of Medicine, Health Policy and Practice, and Dr Yoon Loke, senior lecturer in clinical
pharmacology there, see www.bmj.com/cgi/eletters/333/7566/459 (visited 22 September 2008).
68
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
Professor David Webb: I am not feeling defensive, but I was one of the authors
of the piece that you refer to, and I have to say that some of us were in the process
of putting together evidence at the time. Without this evidence it will be difficult
to pursue the case for clinical pharmacology, but I think the argument we have
actually been launching recently is not so much about clinical pharmacology, but
more about the ability of junior doctors to prescribe. I think prescribing is the
key. Interestingly, there has been a widespread recognition, unofficially, by every
colleague that I talk to, that junior doctors have a problem with prescribing, and
that's fairly obviously in part because medicine has got so much more complex
over the last ten or 20 years. I think we, as clinical pharmacologists, are probably
concerned that the inability for us to teach a strand of training in pharmacology
and therapeutics has also contributed to that problem. Now, I believe we do
have some evidence, and I am not sure whether I am allowed to talk about it, but
we had a meeting recently with the GMC and that was chaired by Peter Rubin
and we have agreed to put together a working party to look at prescribing issues
and how they might be addressed. 170 I think there is a concern not just about
doctors' abilities to prescribe, but also that their attitude has moved to a position
where they don't actually think it matters if they get it right or not because there
are pharmacists who can pick up on this, and I believe that we will have a very
worrying loss of professional strength if we reach that position. So I think there
is a concern that may well now have to be met.
Barnett: I want to echo that, because I think it's really important. At one extreme,
it would be impossible to believe that we would train surgeons without the skills to
use a scalpel, and it seems unbelievable to me that we would train doctors who do
not have the skills to use their pen properly and prescribe appropriately. However,
I believe that there is a concern that this collaboration with clinical pharmacists,
particularly with ward pharmacists, may potentially de-skill junior doctors. I think
we may be reaching a point where doctors diagnose and pharmacists prescribe,
and that is totally inappropriate for the twenty-first century.
Reid: Can I come in again. I don't disagree with anything that's been said by
David [Webb] and David [Barnett], nor David Gordon either, but I think
this is not a matter for evidence. We have heard already about the pioneering
work 30 or 40 years ago, about how diabolical prescriptions were. Pioneering
In January 2007 the General Medical Council (GMC) convened the Safe Prescribing Working Group.
See the recommendations and outcomes of the Safe Prescribing Working Group at www.chms.ac.uk/
publications.htm (visited 8 July 2008). See also Glossary, page 125-6.
69
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
work could be done again now to show that it's pretty awful, but what really is
important is the perception here. Most of our final year medical students have a
very low feeling of comfort in prescribing. Almost all the senior nursing staff on
the wards have no confidence in the junior doctors' prescribing; the pharmacists
have no confidence in junior doctors' prescribing. And the junior doctors don't
have any confidence either. So, whatever the evidence base, there's a perception
here which is undermining therapeutics and is a risk to patients, because - again
echoing what David Barnett was saying — there's no way someone straight after
passing MB ChB should be allowed to go out and operate in any unsupervised
way. They are prescribing potentially very dangerous drugs with drug interaction
potential. I think we are not giving them enough formal grounding, as a result
of some of the changes in the curriculum over the past 10 or 15 years.
Webb: I think it's pretty clear that assessment drives learning. And I believe one
of the problems we have at the moment is that if medical students realized that
they had to be good prescribers, and they were put to a test in prescribing, they
would become good prescribers, in the same way that they meet any test that
they are put to. So I think that assessment clearly has to be a major part of the
way forward.
Caulfleld: I think learning is driven absolutely by assessment. We purged a lot
of things in the revision of the curriculum and its integration into teaching.
Some of those needed to go from the curriculum because the knowledge base
we required of medical students was not entirely germane to the practice of
medicine. There is one thing that you can do on day one as a doctor and that
is kill someone with a pen if you are not a safe prescriber or you haven't got
a BNF. You probably won't be able to kill them with your lack of knowledge
of anatomy, although that's possible if you are a surgeon. It's much easier to
kill people with drugs, and I think the whole prescribing arena has become so
complex now that it is impossible to be safe without a very strong foundation
in clinical pharmacology. If students are not exposed to an assessment that they
can see is palpably in a specific area, geared to make them safe prescribers, they
will often not learn the last component or a bit of a question, which, if they
don't quite answer it, nothing bad happens, because they will pass on knowing
the physical signs and how to take a history from the patient. I shared the
concern of Aronson et al. when they wrote that article, and I do believe that
there is a way forward on that. In London we have put together a group, initially
171 Mucklow (2001).
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Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
under the chairmanship of Mike Farthing, to look at integrating the way in
which medical schools that are still part of the University of London assess safe
prescribing. Hopefully we can come to a common route to assess students
using a mixture of a driving- test based Foundation Year 1 computer exam that
has been developed by pharmacists at King's, though it is not yet perfect. There
are other computer-based learning and safe prescribing assessments which we
have just been piloting at Bart's and the London. Now all of our finalists have
to do an assessment in safe prescribing using a computer-marked exam, which
produces multiple scenarios for the same question, so you can have batches of
30 or 40 students turn up for a session, do it, yet will never be able to tell the
others anything other than the subject area of the exam. We are moving back
to assessing the subject directly in a way that is meaningful and which will act
as a hurdle prior to exit from the medical school, and we think that this is the
only way forward. We have structured it so that it is not an impediment to
exit, by actually holding the assessment away from the qualification date, and
repeating it many times with support for learning along the way. I understand
that the heads of medical schools' reactions to these sorts of things (eg the
BMJ) is an inward groan, but I think this is a serious problem and they should
actively take it on board now.
Prescott: Things have changed in other ways. In the olden days young doctors
used to learn by the clinical apprenticeship system. Initially they had six- or
12-month junior appointments where they were an integral part of the ward
'firm'. During this time they learnt how to prescribe from the senior medical staff,
who by this time had usually worked out how to use drugs safely. Their example
greatly influenced the way in which trainee doctors prescribed drugs. Now, the
training of junior medical staff is horribly fragmented and there is no longer any
recognizable apprentice system. Young doctors rotate dizzily from one specialty
to another throughout their appointments and no one seems to have continuing
Professor Michael Farthing chaired the Research Board of the General Medical Council's Education
Committee from 2004 to develop and supervise all their research initiatives. From August 2007, the Education
Committee became responsibile for the content and standards for medical education from Foundation Year 1
up to the point of full registration, an outcomes-based framework for programmes for provisionally registered
doctors. Further details at www.gmc-uk.org/about/council/papers/2007_12/9%20-%20Work%20of%20
the%20Education%20Committee%202006-2007.pdf (visited 9 June 2008).
Professor Mark Caulfield wrote: 'At Bart's and the London, this has developed as a formative assessment
where 120 students simultaneously sit the computer-based exam containing extended matching questions
on safe prescribing. It is highly regarded by final year students and we hope it will shortly be adopted as a
summative assessment.' Note on draft transcript, 6 October 2008. See Aronson et at. (2006).
71
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
responsibility for them any more. In such circumstances it is impossible for them
to learn good prescribing by example. This makes it all the more important for us
as clinical pharmacologists to ensure that they receive proper training.
Aronson: David Gordon made his point from the point of view of a dean of a
medical school, and so it's worth saying that when we met the GMC a couple
of weeks ago at the meeting which David Webb referred to, the representative
of the deans of all the London medical schools expressed her concern about the
problem in prescribing, and agreed that something needed to be done. So this is
the perception of deans as well. It was also the perception of John Tooke when
we met the Council for the Heads of Medical Schools, to take Mark Caulfield's
point. They were initially critical, but they agreed that there is a problem,
and that something needs to be done about it. Incidentally, as David [Webb]
hinted, we regard this as being different from the manpower problem in clinical
pharmacology, which is a separate problem. David Webb and Simon Maxwell
highlighted it in their very good leader in the Lancet last year, but it is a separate
problem from delivering the teaching; whether we can or whether others can,
pharmacists, nurses, and others, we have got to find ways of doing it. It's the
prescribing that's the problem. And I draw your attention to the last line of the key
events which were initiated in 2006, as part of the 75th anniversary of the BPS:
one of the initiatives that I hope the Society will do is a prescribing initiative,
and we have various ideas about changing the way we teach prescribing and the
way we assess it, and we are going to be making some suggestions and doing
something about that. But we hope to be able to improve that.
Ferner: I agree entirely with what David Webb said about examination being
crucial. I am impressed by the fact that Mark Caulfield has a computer to
examine his students. Maybe that will be appropriate when computerized
prescribing comes. We still retain in Birmingham a therapeutics exam, which
I guess Owen Wade might recognize, which owes a lot to Professor Martin
Kendall, and which involves actual real people, not patients — fortunately — as
17 Some time after this meeting Professor Sir John Tooke's report on Modernising Medical Careers (MMC),
Aspiring to Excellence, was published, which suggested a reworking of many aspects of postgraduate medical
education (PGME). See Glossary, page 124.
175 Maxwell and Webb (2006). Breckenridge etal. (2006).
' See Glossary, page 125.
See note 6. See also the 75th Anniversary Supplement of the BPS [British Journal of Pharmacology (2006)
147: S 1-307]; Cuthbert (2006); Aronson (2006).
72
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
many of the prescriptions would kill them. But there's a glut of junior medical
staff, as you know. The anger that David Gordon is worried about is not
anger; I think it is sadness that somehow a discipline which is very different
from, let us say, anatomy or physiology and is a crucial practical skill for people
to learn, but which is not organ-based, should have been lost to a generation
of doctors.
Orme: As an erstwhile dean, perhaps I should respond to some of these particular
issues; David Gordon and I have discussed this on a number of occasions, also
with David's predecessor (Professor Steve To mlinson) in Manchester. In Liverpool
we had a very didactic course where everything was measured in hours, and you
had to have 300 hours of anatomy, and so many hours of this, and so many
of that. The first two years was a total disaster. Students got browned off, they
didn't remember anything, and it took them probably six months to recover.
In my view, the course which we introduced was a considerable improvement.
Now, not everyone would agree with that. Indeed, my senior colleague Alasdair
Breckenridge and I debated this, and I know he is not entirely wedded to the
idea of problem-based learning; but nevertheless, in terms of objectivity there is
one particular study, which Andrew Herxheimer will probably know, because it
was done by one of his colleagues in Amsterdam, comparing about 20 different
European medical schools, those that had problem-based learning and those that
did not. There wasn't much in the way of definite results. But the one definite
result, in statistical terms, was that students from medical schools with problem-
based learning produced better prescribers than those from schools which did
not, or had, if you like, the old didactic system. 179 However, I will be the first to
admit that not everything in the course was perfect. One of the things I regret is
that, although I think students got a good exposure to pharmacology and clinical
pharmacology in the various sessions in the course, they did not get adequate
training in prescribing, much as it pains me to say so. I fully accept that assessment
drives learning, and unless you have got a proper assessment system, then the
students are not going to learn how to prescribe. So I think that is fundamental,
but it can be built into problem-based systems. You don't necessarily have to have
a factual multiple-choice question (MCQ) to test whether students can prescribe
or not. So, I would hold my hand up and say, 'Yes, things are not perfect. We do
need to have medical students taught how to prescribe throughout the course,
78 Hall (2008). See www.telegraph.co.uk/news/uknews/1544307/Doctors'-training-system-'a-shambles'.
html (visited 3 June 2008).
179 Bruijnen et al. (2000). See, for example, deVries (1993); Queneau et al. (1993).
73
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
but particularly in their final year and there needs to be some form of assessment
of their skills'. 180
Flower: OK, David, the last comment is going to be yours, because I don't want
to finish in the midst of an education debate.
Grahame-Smith: One of the things that I have pondered is the tension that
I think now exists between prescribing led by evidence-based medicine and
prescribing, as it were, de novo from a clinical pharmacologist's mind. Let me
just explain this. Take the 'polypih": aspirin, a statin, maybe a bit of (3-blocker,
put it all together and anybody over the age of 55 gets it. Now the young
student, I think, will look at that and ask: 'Why the hell do we need to know
any clinical pharmacology, we can give this thing to everybody', a little bit like
the situation with statins. Now, I see the oral contraceptive, and several other
potent drugs, possibly coming off medical prescription and being bought over
the counter at the pharmacy. Now, the young mind-in-training in medicine
must look at this and say, 'What are these people called clinical pharmacologists
going on about pharmacokinetics, pharmacodynamics, drug metabolism
and benefit-risk ratios, when you can go and buy a lot of this stuff from the
chemist's shop and do what you like with it?' Does anybody else perceive a
tension there? Or has anybody experience of the youngsters saying, 'Why do we
need to know all this if you can give this combination?' We are not there yet,
but it's being mooted pretty strongly that a 'polypih" will stop everybody from
having a vascular event.
Prescott: What David has just said is very true and very familiar. It seems that
today you no longer need specialist knowledge to use drugs properly and anyone
can do it. What we are seeing is surely the dumbing down of therapeutics.
Flower: Colleagues, it is six o'clock, and as I told you I had two jobs today, one
was to get to tea at four o'clock and the other is to finish by six o'clock in time
for a glass of wine. I think we have got there. I have really enjoyed this afternoon;
you have been a wonderful, if somewhat over-modest, collection of witnesses,
and I have enjoyed listening to what you had to say. Hopefully, everything will
See, for example, the UCL document on Medical School Examination Boards, including assessment
requirements, compiled and edited by Professor Jane Dacre and Ms Gaynor Jones, at www.ucl.ac.uk/
medicalschool/about-medicalschool/mgt-structure/MBBS_3_Examination_Boards_0708.pdf (visited 15
July 2008).
181 Wald and Law (2003). See also Collier (1984).
182 See Reynolds andTansey (eds) (2006): 7, 36, 47, 53-4, 74-86.
74
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions
be captured faithfully on tape. Tilli, are there housekeeping announcements
that you would like to make?
Tansey: I would like to thank you all very much for coming. It's been a very
interesting afternoon, with some fascinating and amusing anecdotes, but also
clearly some thoughtful reflections on serious issues. What happens now is that
the tape recording of the entire meeting is transcribed, which will take between
four and six months before the transcript comes through your letterbox. At that
point we would ask for your help in translating the verbatim record into written
text. We will add footnotes, bibliographies, biographies, appendices, glossaries,
and hopefully that transcript will also help form the agenda for the second
meeting, which we are going to hold on 25 September 2007. We will keep
you informed. May I say once again, thank you all for coming to this meeting.
And thank you to Jeff for suggesting it, and particularly to Rod for chairing
it so ably.
75
Clinical Pharmacology in the UK, c. 1 950-2000: Influences and institutions - Appendix 1
Appendix 1
Clinical pharmacology: dates of key publications and events
Jeffrey Aronson
1 946 British National Formulary
1 954 Gaddum J H. (1954) Clinical pharmacology. Proceedings of the Royal
Society of 'Medicine 47: 195-204.
1960 Dilling W J. (1960) Clinical Pharmacology, 20th edn, revised by
Alstead S with Macarthur J G, Thomson T J, Anderson W F.
London: Bailliere, Tindall & Cassell, 1960.
Laurence D R. (1960) Clinical Pharmacology. London: Churchill.
1 961 Presenters' Journal
1 962 Drug and Therapeutics Bulletin
1963 Committee on Safety of Drugs (Dunlop Committee) established
1 966 Dollery C T. (1966) Clinical pharmacology. Lancet'v. 359-60.
1967 Quilliam J P, Turner P. (1967) Clinical pharmacology. Its role and
its integration into the education of the medical student. Lancet
ii: 1081-3.
Anon. (1967) Future of clinical pharmacology. British Medical
Journal v. 125.
1 968 Medicines Act, which created the Medicines Commission and led
to the Committee on Safety of Medicines (1971); the DHSS
Medicines Division (later Medicines Control Agency) administers
the Act.
1969 Anon. (1969) Clinical pharmacology as a specialty. British Medical
Journal ii: 331—2.
Royal College of Physicians of London, Committee on Clinical
Pharmacology. (1969) Report of the Committee on Clinical
Pharmacology. London: Royal College of Physicians.
77
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions -Appendix 1
1 970 Establishment of the Clinical Section of the British Pharmacological
Society
Anon. (1970) Editorial: the image of clinical pharmacology. Lancet
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WHO. (1970) Clinical Pharmacology. Scope, organization, training.
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1972 Establishment of the Unit of Clinical Pharmacology, Oxford
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1 974 First issue of the British Journal of Clinical Pharmacology
1981 New version of the British National Formulary
1 986 Anglo— American Workshop on Clinical Pharmacology held at Airlie,
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1 989 Establishment of the Medicines Control Agency
1999 Royal College of Physicians, Working Party. (1999) Clinical
Pharmacology and Therapeutics in a Changing World: Report of a
working party. London: Royal College of Physicians.
Establishment of the National Institute of Clinical Excellence
2003 Medicines and Healthcare products Regulatory Agency created from
the merger of the Medicines Control Agency and the Medical
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2005 Medicines Commission and Committee on Safety of Medicines
disbanded; Commission on Human Medicines established
2006 75th anniversary of the British Pharmacological Society
BPS Prescribing Initiative 183
78
Clinical Pharmacology in the UK, c. 1 950-2000: Influences and institutions - Appendix 1
Professor Owen Wade suggested that two further publications be added to the list:
*Goodman L, Gilman A. (1941) The Pharmacological Basis of Therapeutics: A textbook of pharmacology,
toxicology and therapeutics for physicians and medical students. New York, NY: Macmillan Company.
'I first read the book in 1947 when I was a house surgeon at Addenbrooke's Hospital, Cambridge. It was
a copy owned by Mr Hopkins, the chief pharmacist of the hospital and I used to read it at night in the
pharmacy when I lived in the hospital as a resident house officer for six months. This book was an enormous
influence in my life. Like so many books, the first edition, all of which was written by the two authors, was a
much better read than its many further editions, which had a number of contributors. By an extraordinary
coincidence, when Mr Hopkins retired and moved to live near his son, my eldest brother, David Wade, who
had just retired as a cardiac surgeon in Edinburgh, bought his home in Kingston, just outside Cambridge,
and David and his wife Agnes, lived there for many years.'
* Crooks J, Calder G, Weir R D. (1967) Drugs in hospitals. Journal of "the Royal College of ^Physicians 1: 233^4.
'Jim Crooks was a great friend and colleague of mine and after discussions with him, he and Dr William
Wallace in my department (Belfast) made a detailed study of the prescribing of drugs; he in the Aberdeen
General Hospitals, Wallace in the Belfast City Hospital. They both found 'casual and inefficient handling
of drugs 1 which resulted in many errors of drug administration to patients. This was the basis of the
development of the Aberdeen Prescription Sheet, which in one form or another is now used in all NHS
hospitals in the UK. It was a very important development.
When this paper was published, some astute journalist working for the Belfast Telegraph commented on
"all the erroneous drug prescribing in the Royal Victoria Hospital (RVH)", which was where my university
department was based. I had not seen the Journal and was taken by surprise to have a visitation from the
senior physician of the RVH and two infuriated colleagues demanding that I must immediately deny than
any such errors occurred in the RVH. Unwillingly, I agreed to the publication of a statement that the
newspaper's report was mistaken and there was no evidence of errors of drug administration at the RVH.
Unwilling — and with my tongue in my cheek — because I knew that if Dr Wallace had done the study in the
RVH, I was sure he would have found identical errors to those he had found in the Belfast City Hospital.'
Note on questionnaire 'Toward a map of the history of academic departments of clinical pharmacology in
the UK', n.d.
79
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - References
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Biographical notes'
Dr Stuart Anderson
FRPharmS FHEA (b. 1946)
graduated in pharmacy from
the University of Manchester in
1969. After experience in north
Wales, he was appointed principal
pharmacist in 1974 at Alder Hey
Children's Hospital, Liverpool;
chief pharmacist in 1978 at
Westminster Hospital, London,
and director of pharmacy in 1983
at St George's Hospital, London;
moved to the School of Pharmacy,
University of London, in 1993,
and is now associate dean of studies
at the London School of Hygiene
and Tropical Medicine, London.
He is a former president of the
British Society for the History of
Pharmacy and a former chair of the
Society for the Social History of
Medicine; currently vice-president
of the International Academy for
the History of Pharmacy.
Dr Jeffrey Aronson
FRCP FBPharmacolS FFPM
(b. 1947) trained in the University
of Glasgow (1964-73) and
the MRC Unit of Clinical
Pharmacology, Oxford, under
Professor David Grahame-Smith.
He is currently reader in clinical
pharmacology at the University of
Oxford and honorary consultant
physician in the Oxford Radcliffe
Hospitals Trust. He was president of
the British Pharmacological Society
(2008/9); vice-chairman of the
Medicines Commission (2002—05);
and editor-in-chief of the British
Journal of Clinical Pharmacology
(2003-07). He has been chairman
of the British Pharmacopoeia
Commission's Expert Advisory
Group on Nomenclature since
2006; a member of the Formulary
Committees of the British National
Formulary since 2006 and the
British National Formulary for
Children since 2003.
For full curriculum vitae and
list of publications, see
www.clinpharm.ox.ac.uk/JKA
(visited 22 July 2008).
Professor David Barnett
CBE FRCP (b. 1944) trained
at Sheffield University. He was
a Merck international fellow in
clinical pharmacology in San
Francisco, California, (1975-77);
chair of the Specialist Advisory
Committee for the Royal College
of Physicians (1966-2000) and
vice-chair of the Leicester Royal
* Contributors are asked to supply details; other entries are compiled from conventional
biographical sources.
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Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Biographical Notes
Infirmary NHS Trust (1994-99).
He is currently chairman of the
Appraisal Committee for the
National Institute for Health and
Clinical Excellence and has been
professor of clinical pharmacology
at the University of Leicester
Medical School and honorary
consultant physician with a special
interest in cardiovascular medicine
at the University Hospitals of
Leicester NHS Trust since 1984.
Dr Linda Beeley
FRCP (b. 1939) trained at the
University of Oxford and then at
the Radcliffe Hospital, Oxford. She
held registrar posts at the Queen
Elizabeth Hospital, Birmingham,
and a lectureship in the department
of clinical pharmacology, University
of Birmingham. She was appointed
consultant clinical pharmacologist
at the Queen Elizabeth Hospital in
1980 and set up and directed the
West Midlands Monitoring Centre
for the Committee on Safety of
Medicines (1980-93); a member
of the Subcommittee on Safety,
Efficacy and Adverse Reactions
of the Committee on Safety of
Medicines (1986-92); chairman of
Presenters' Journal ( 1 984— 89) ; and
consultant to the British National
Formulary (1980-97). She retired
from the NHS in 1993. See Wade
and Beeley (1976); Beeley (1992).
Professor Sir James Black
Kt OM FRCP FRS (b. 1924)
was professor and head of the
department of pharmacology,
University College London, (1973—
77), director of therapeutic research
at Wellcome Research Laboratories
(1978-84); and professor of
analytical pharmacology at King's
College Hospital Medical School,
London (1984-93). He was
chancellor of Dundee University
(1992-96). He shared the 1988
Nobel Prize for Physiology or
Medicine for 'discoveries of
important principles for drug
treatment' with George Hitchings
(1905-98) and Gertrude Elion
(1918-99).
Dr Nicolas Boon
FRCP FESC (b. 1950) was clinical
lecturer and senior registrar at
the John Radcliffe Hospital in
Oxford (1983-86); consultant
cardiologist at the Royal Infirmary
of Edinburgh from 1986; honorary
reader at the University of
Edinburgh from 2005; honorary
senior lecturer (1986-2005);
and president-elect of the British
Cardiac Society from 2005.
Sir Alasdair Breckenridge
Kt CBE RCP FRCPE FRSE
FMedSci (b. 1937) following house
jobs was lecturer and senior lecturer
at the Hammersmith Hospital,
London and the Royal Postgraduate
102
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Biographical Notes
Medical School (1964-74);
professor of clinical pharmacology,
University of Liverpool (1974—
2002); and has been chairman of
the MHRA since 2003. He was a
member of the CSM (1982-2003),
serving as vice— chairman (1996—
98) and chairman (1999-2003).
He was also a member of the
Medical Research Council
(1992-96).
Professor Bernard Brodie
PhD (1907-89) British born,
educated at McGill University,
Toronto, gained his PhD in
organic chemistry from New
York University (NYU) in 1935
and joined the pharmacology
department there. He moved to
NYU's Goldwater Research Service
in 1941, working on antimalarial
therapy for war use. He became
head of the laboratory of Chemical
Pharmacy in the National Heart
Institute, Bethesda, MD (1950-
70). His work included the fields
of anti-malarials, analgesics, anti-
arthritic and anti-arrhythmic agents
and the control of CNS function.
See Costa etal. (1989).
Professor Morris Brown
FAHAFMedSci (b. 1951) trained
at Trinity College Cambridge
and University College Hospital,
London. He was a MRC senior
fellow, Royal Postgraduate Medical
School (1982-85) and has been
professor of clinical pharmacology,
Cambridge and fellow of Gonville
and Caius College, Cambridge,
since 1985. He was president of
the British Hypertension Society
(2005-07) and winner of the Lilly
Gold Medal 2002; the British
Pharmacological Society; Walter
Somerville Medal of the British
Cardiovascular Society 2006.
Professor George Brownlee
DSc (b. 1911), pharmacologist,
joined the Biological
Standardization Labs of
Pharmaceutical Society, London,
and then the Wellcome Research
Labs, Beckenham, from
c. 1940, and later was head of the
chemotherapeutic division. He was
appointed reader in pharmacology
at King's College, University of
London in 1949; and professor
of pharmacology (1958-78),
later emeritus. He was editor
of the Journal of Pharmacy and
Pharmacology (195 5—72) .
Sir Thomas Lauder Brunton
FRCP FRS (1844-1916) qualified
at Edinburgh University. His MD
thesis demonstrated that amyl
nitrite would relieve the pain of
angina pectoris and temporarily
lower blood pressure. He returned
to the Middlesex Hospital,
London, in 1870 as a lecturer on
materia medica and pharmacology.
The following year he moved to a
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Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Biographical Notes
similar post at St Bartholomew's
Hospital, London, was elected
assistant physician in 1875 and
physician (1895-1904).
Professor Edith Bulbring
FRS (1903-90) German-born
pharmacologist and physiologist,
was educated at the universities
of Bonn, Munich and Freiburg,
and worked as a research assistant
in pharmacology to Professor
Paul Trendelenburg in Berlin
(1929-32). She was dismissed
in 1933 because of her Jewish
background, and offered a post in
J H Burn's new Pharmacological
Laboratory of the Pharmaceutical
Society of Great Britain, University
of London (1933-38), then in the
University of Oxford from 1938
as demonstrator, lecturer and later
reader and professor (1967-71)
in the pharmacology department.
She became a naturalized citizen in
1948. See Brading (1993).
Professor Mark Caulfield
FRCP FMedSci (b. I960) graduated
in medicine in 1984 from the
London Hospital Medical College
and trained in clinical pharmacology
at St Bartholomew's Hospital
where he developed a research
programme in molecular genetics
of hypertension. He is currently
director of the William Harvey
Research Institute and the London
Genome Centre at Bart's and the
London (since 2002); national
co-ordinator of the MRC British
Genetics of Hypertension Study
(since 1996); principal investigator
of the Genetics of Pre-eclampsia
Consortium; and deputy chair
of the London Biobank Regional
Collaborating Centre (since 2002).
Sir lain Chalmers
FRCPE FFPH FMedSci (b. 1943)
has been editor of the award-
winning James Lind Library since
2003. He was director of the UK
Cochrane Centre in Oxford from
1992 to 2002, and director of the
National Perinatal Epidemiology
Unit, Oxford (1978-92). See
www.jameslindlibrary.org/ (visited
4 June 2008).
Professor Joe Collier
FRCP (b. 1942) was professor of
medicines policy and a clinical
pharmacologist at St George's
Hospital and Medical School,
London, where he has worked
continuously since 1964 as student
and teacher until his retirement in
2007. He is the editor of Drug and
Therapeutics Bulletin, president of
the International Society of Drug
Bulletins, a member of the UK
Medicines Commission, and a
writer and broadcaster.
Professor James Crooks
CBE FRCP MFCM (1920-83)
was professor of pharmacology and
therapeutics at the University of
104
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Biographical Notes
Dundee and was made a member
of the Faculty of Community
Medicine in 1978.
Professor David (Dai)
Margerison Davies
(1923-2002) qualified at the
London Hospital in 1949 and after
house jobs, took a junior registrar
post at a sector psychiatric hospital,
flirted with medical journalism,
and spent three years as medical
registrar at the Bolingbroke
Hospital, south London, before
returning to the London Hospital
as senior registrar to Lord (Horace)
Evans and then receiving room
physician and, at the same time,
medical correspondent of the News
Chronicle. He was a consultant
physician at Shotley Bridge General
Hospital, Co. Durham (1962-86).
When Michael Rawlins was
appointed to the Ruth and Lionel
Jacobson Professor of Clinical
Pharmacology at the University
of Newcastle uponTyne (1973—
2006), he joined him as honorary
senior lecturer until appointed to
the foundation chair of clinical
pharmacology at the Chinese
University of Hong Kong (1986-88).
He served on the Committee on
Safety of Drugs and Committee on
Safety of Medicines (1968-86), and
on the Prescription-Only Medicines
Subcommittee of the Medicines
Commission (1970-72). He started
the Adverse Drug Reaction Bulletin
in 1966 and co-founded the
Adverse Drug Reactions and Acute
Poisoning Reviews (now Toxicological
Reviews) in 1982. See de Glanville
and Ferner (2003).
Professor Donald S Davies
FRSC FRCPath HonFRCP
(b. 1940) completed his PhD at
St Mary's Hospital Medical School
in 1965 and following a two year
post-doctoral fellowship at the
National Institutes of Health,
US, joined the MRC Clinical
Pharmacology Research Group at
the Royal Postgraduate Medical
School (RPMS), Hammersmith
Hospital, London. In 1980 he was
appointed professor of biochemical
pharmacology at RPMS and in
1987 became director of the clinical
pharmacology department as well
as director of the department of
health toxicology unit at Imperial
College London.
Professor Sir Colin Dollery
Kt FRCP FMedSci (b. 1931)
qualified at Birmingham and
trained at the Hammersmith
Hospital, London, where he
has been a consultant physician
since 1962. He was a lecturer in
medicine (1962-65); professor of
clinical pharmacology (1965-87);
professor of medicine (1987-91);
and dean (1991-96) at the Royal
Postgraduate Medical School,
Hammersmith Hospital until
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Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Biographical Notes
his retirement. He was pro-vice-
chancellor for medicine (formerly
medicine and dentistry), University
of London (1992-6). He has been
a senior consultant in research and
development, at GlaxoSmithKline
(formerly Smithkline Beecham)
since 1996.
Professor Anthony Dornhorst
CBE FRCP (1915-2003) joined
St Thomas' Hospital Medical
School, London, as a house officer
in 1938 and served in the Royal
Army Medical Corps in Palestine,
North Africa, Italy and Berlin.
He returned to St Thomas' and
was appointed reader in 1949 and
consultant in 1951. He held the
foundation chair of medicine at St
George's Hospital Medical School,
London, (1959-80); was a member
of the advisory council of the Drug
and Therapeutics Bulletin (1962—
67) and a member of the Medical
Research Council (1973-77). See
Collier (2003).
Professor Robin Ferner
FRCP (b. 1949) trained in
chemistry and then in medicine,
qualifying at University College
Hospital, London, in 1978. He
was senior registrar in the National
Institute of Health and Clinical
Excellence in Newcastle upon
Tyne (1984-90) and has been
a consultant physician at City
Hospital, Birmingham, formerly
Dudley Road Hospital since
1990. In 1993 he was appointed
director of the West Midlands
Centre for Adverse Drug Reactions,
and honorary senior lecturer in
Medicine at the University of
Birmingham. In 2006 he was
made honorary professor of clinical
pharmacology at the University of
Birmingham.
Professor Roderick Flower
FMedSci FRS (b. 1945) trained
as a physiologist at Sheffield
University, subsequently receiving a
PhD in experimental pharmacology
from the University of London
andaDScin 1985. After 12
years working in industry at the
Wellcome Foundation, he left to
take the chair of pharmacology at
the University of Bath in 1985. In
1990 he returned to London to
establish a new unit at the William
Harvey Research Institute, Bart's
and the London. During this
time he was head, on a part-time
basis, of the clinical pharmacology
department, and was president of
the British Pharmacological Society
(2000-03).
Dr Arthur Fowle
FRCP (b. 1929) trained at King's
College Hospital, London,
intending to practise cardiology.
He joined Wellcome Research
Laboratories, Beckenham, in 1965
as a clinical physiologist. Security of
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Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Biographical Notes
tenure was promised if he became
a part-time consultant physician in
the NHS. In the interval, clinical
pharmacology was recognized as
the discipline which he practised.
He became head of the clinical
pharmacology department in 1968
and part-time consultant general
physician in the same year. He
retired from Wellcome in 1992.
Professor Sir Charles George
Kt FRCP FFPM FMedSci
(b. 1941) studied medicine at the
University of Birmingham and after
junior posts in the West Midlands
and Manchester trained in clinical
pharmacology with Professor
Colin Dollery and Dr Alasdair
Breckenridge. He moved to the
University of Southampton as a
senior lecturer in 1974 and a year
later became professor of clinical
pharmacology there. He served two
terms as dean of medicine (1986—
90; 1993-8) and was chairman
of the General Medical Council's
Education Committee before he
became medical director of the
British Heart Foundation (1999-
2004); president of the British
Medical Association (2004/5) and
has been chair of their Board of
Science and Education since 2005.
Professor Sir Abraham Goldberg
Kt DSc FRCPGlas FRCPE FRCP
FFPM FRSE (1923-2007) held
posts at the University of Glasgow
(1956-99); was chairman of the
Committee on Safety of Medicines
(1980-86); foundation president
of the Royal College of Medicine's
Faculty of Pharmaceutical Medicine
(1989-91); and editor of the
Scottish Medical Journal ( 1 962/3) .
Professor David Gordon
FRCP FMedSci (b. 1947) is a
general physician. He began his
academic career in the medical
unit at St Mary's Hospital Medical
School. In a prolonged break from
his conventional academic medical
career he was a member of the staff
of the Wellcome Trust, London,
responsible for support of
biological and medical research
across a wide range of subjects,
and for the career development
of clinical and basic biomedical
scientists. He worked at the
University of Manchester (1999-
2007), most of that time as dean of
the medical faculty. He was chair
of the Council of Heads of Medical
Schools and also the president of
the Association of Medical Schools
in Europe. He has been visiting
professor at the University of
Copenhagen since 2007.
Professor David Grahame-Smith
CBE FRCP (b. 1933) was Rhodes
professor of clinical pharmacology,
University of Oxford (1972-
2000), honorary director of the
Medical Research Council Unit
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Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Biographical Notes
of Clinical Pharmacology, Oxford
(1972-92), honorary director of
the Oxford University SmithKline
Beecham Centre for Applied
Neuropsychobiology (1989-99)
and honorary consultant in clinical
pharmacology and general internal
medicine to the Oxford Radcliffe
Hospitals (1972-2000).
Dr Andrew Herxheimer
FRCP (b. 1925) worked
in preclinical and clinical
pharmacology at St Thomas'
Hospital Medical School, the
London Hospital Medical
College and at Charing Cross and
Westminster Medical School until
1991. He was founding editor
of the Drug and Therapeutics
Bulletin (1962-92), while
simultaneously working with
Consumers International. In 1986
he became the first chairman
of the International Society of
Drug Bulletins. He was also
extraordinary professor of clinical
pharmacology at the University of
Groningen (1968-77). He is part-
time consultant at the Cochrane
Centre in Oxford (since 1992),
and has been its emeritus fellow
since 1995. In 1996 he and Dr
Ann McPherson started the DIPEx
project. See www.dipex.org, www.
adverseeffectsmethods, and
cochrane.org; (sites visited 1 1
October 2007).
Sir Harold Himsworth
KCB FRCP FRS (1905-93) was
appointed professor of medicine
and director of the medical unit
at University College Hospital,
London, in 1939 and was secretary
of the Medical Research Council
(1949-68). See Gray and Booth
(1994).
Professor John Hope
(1725-86) held the chairs of
materia medica and of botany at
the University of Edinburgh from
1761 to 1768, giving lectures on
materia medica in the winter and
on botany starting in May. He
resigned as professor of materia
medica in 1768 on appointment
to the Regius chair of botany at
Edinburgh. See Hope (1770).
Dr Kenneth Hunter
FRCP (b. 1939) graduated in 1963,
having trained at Cambridge and
University College Hospital (UCH)
Medical School. His postgraduate
training included experience in
clinical pharmacology at UCH
and the Hammersmith Hospital,
London. He became a consultant
physician with a special interest in
diabetes in Plymouth in 1977, was
a councillor at the Royal College of
Physicians (1994-97) and gave the
Fitzpatrick Lecture in the history of
medicine there in 2001.
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Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Biographical Notes
Professor Sir Robert Brockie
Hunter (Baron Hunter of
Newington)
Kt MBE DL FRCP FRCPE FACP
FIBiolFFCM (1915-94) qualified
at Edinburgh University; was a
founder member of the Committee
on Safety of Drugs in 1963. He
became professor of therapeutics,
university administrator, principal
and vice-chancellor of Birmingham
University (1968-81).
Professor Trevor Jones
CBE (b. 1942) was research
and development director of the
Wellcome Foundation (1987-94).
He is a founder member of
the public-private partnership,
Medicines for Malaria Venture
(MMV) and a member of the World
Health Organization Commission
on Intellectual Property Rights,
Innovation and Public Health. He
was a member of the Medicines
Commission (1982-94); director
general of the Association of the
British Pharmaceutical Industry
(1994-2004); a member of council
of the International Federation of
Pharmaceutical Manufacturers &
Associations (1994-2004) and the
board of the European Federation
of Pharmaceutical Industries and
Associations (1994-2004). He is
also deputy chairman of council
and a visiting professor at King's
College London; a director of
Allergan Inc. US, ReNeuron Ltd,
BAC, BC, People in Health Ltd,
VeronaPharma pic and NextPharma
Technologies Ltd.
Professor Martin Kendall
OBE FRCP FFPM was professor
of clinical pharmacology at
the University of Birmingham
Medical School, a member of the
Commission on Human Medicines;
chairman of the Formulary
Development Committee;
and clinical examiner for the
Membership Exam of the Royal
College of Physicians.
Professor Louis Lasagna
MD (1923-2003) qualified at
Columbia University and joined
the Johns Hopkins University
in 1954 and later established
a department of clinical
pharmacology there. In 1970
he moved to the University of
Rochester School of Medicine
and Dentistry as chairman of the
department of pharmacology and
toxicology and in 1976 founded
the Center for the Study of Drug
Development, until he and the
Center moved to Tufts University,
Boston, MA, in 1984, where he
was dean of the Sackler School of
Graduate Biomedical Sciences until
his retirement in 2002.
Professor Desmond Laurence
FRCP(b. 1922) qualified in
medicine from St Thomas' Hospital
Medical School, London, in 1944
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Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Biographical Notes
and was appointed lecturer in
therapeutics there in 1950. He was
senior lecturer in pharmacology
and therapeutics at University
College Hospital Medical School
jointly with University College
London (1954-61) and professor
there (1961-89). He served on the
Committee on Safety of Drugs,
Committee on Safety of Medicines
and the Medicines Commission
(1963-88). In 1967 he was a
member of the Royal College
of Physicians committee on the
supervision of the ethics of clinical
investigations and institutions, and
subsequently served on the college's
Committee on Ethical Issues in
Medicine. For 26 years he served
on research ethics committees as
chairman or member.
Professor Alastair Macgregor
FRCP FRCPE FRCPGlas (1919-
72) qualified at the University
of Glasgow; served as surgeon
lieutenant in the Royal Navy
Volunteer Reserve ( 1 944-46) ; was
clinical assistant at the Western
Infirmary, Glasgow (1946-48);
lecturer in therapeutics at the
University of Sheffield (1948-52);
senior lecturer in therapeutics
at the University of Edinburgh
(1952-59); and Regius professor of
materia medica in the department
of therapeutics and pharmacology
at the University of Aberdeen
(1959-72).
Professor Paul Martini
(1889-1964) was chief physician
and director of St Hedwig
Hospital, Berlin (1927-31)
and was professor for internal
medicine at the University of
Bonn (1931-59). He published
Methods ofTherapeutic Examination
in 1932. His textbook Principles
and Practice of Physical Diagnosis
appeared in English in 1935.
He was president of the German
Society for Internal Medicine
in 1948. The Paul Martini
Foundation was established by
the Medizinisch-Pharmazeutische
Studiengesellschaft in 1966 to
promote pharmaceutical research
in Germany through the support of
students of clinical pharmacology.
Professor Denis McDevitt
DSc MD FRCP FRSEd
(b. 1937) trained at Queen's
University, Belfast, and later at
Vanderbilt University, Nashville,
Tennessee. He was professor of
clinical pharmacology at Queen's
University, Belfast (1978-83);
professor of clinical pharmacology
at the University of Dundee (1984-
2002); and dean of medicine,
dentistry and nursing in Dundee
(1994-97). He was secretary
(1978-82) and subsequently
chairman (1985-88) of the
Clinical Section of the British
Pharmacological Society, of which
he is now an honorary fellow. He
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Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Biographical Notes
was president of the Association
of Physicians of Great Britain and
Ireland (1987/8), a member of the
Medicines Commission (1986-95;
vice-chairman, 1992-95) and a
member of the General Medical
Council (1996-2003; treasurer,
2001-03).
Professor Walter Nimmo
(b. 1 947) was educated at Bathgate
Academy and qualified at the
University of Edinburgh. His
early medical career included the
Sir Stanley Davidson lectureship
in clinical pharmacology and a
lectureship in anaesthesia at the
University of Edinburgh. In 1979
he was appointed senior lecturer
in anaesthesia at the University
of Sheffield. In 1988 he was the
founding managing director of
Inveresk Clinical Research and chief
executive of the Inveresk Research
group of companies in 1996.
Professor Michael Orme
FRCP FMedSci (b. 1940) trained
as a clinical pharmacologist in the
UK and Sweden and worked for
most of his career in Liverpool. He
was dean of the faculty of medicine
in Liverpool (1991-96) and has
taken a particular interest in
education. He helped to found the
European Association for Clinical
Pharmacology and Therapeutics
in the early 1990s and was its
chairman (2003-07).
Professor Sir William Paton
Kt CBE FRCP FRS (1917-93)
was on the scientific staff of the
National Institute for Medical
Research (1944-52); reader in
applied pharmacology at University
College Hospital, London (1952-
54); held the Vandervell chair of
pharmacology at the Royal College
of Surgeons, London, (1956-59);
and was professor of pharmacology
at the University of Oxford and
fellow of Balliol College (1959-
83). He was a member of the
MRC (1963-67), a trustee of the
Wellcome Trust (1978-87) and
honorary director of the Wellcome
Institute for History of Medicine
(1983-87). His papers are held
in archives and manuscripts,
Wellcome Library, London, as
PP/WDP, with further papers in
GC/68/ and GC/ 1 54/A/ 1 1 . See
Rang and Perry (1996).
Professor Sir Stanley Peart
Kt FRCP FMedSci FRS
(b. 1922) was professor of medicine
at St Mary's Hospital Medical
School, University of London,
(1957-87), later emeritus. He was
master of the Hunterian Institute,
Royal College of Surgeons of
England (1988-92); trustee of
the Wellcome Trust (1975-94),
deputy chairman (1991-94) and
consultant (1994-98); and a Beit
trustee (1986-2003). He delivered
the Goulstonian lecture in 1959,
111
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Biographical Notes
the Croonian lecture in 1979,
and was a founder member of
the Academy of Medical Sciences
in 1998.
Dr Anthony Peck
FRCP FFPM (b. 1933) qualified at
the Middlesex Hospital, London,
and gained his PhD in 1967 from
the University of London. In
1968 he was appointed assistant
professor at the San Francisco
Medical Center; was a clinical
pharmacologist at the Wellcome
Foundation (1969-94); part-time
senior lecturer at the Middlesex
Hospital (1969-98), later
University College Hospital. He
was also part-time senior medical
assessor to the Medicines Control
Agency (1994-2000).
Professor Brian Pentecost
OBE FRCP (b. 1934) qualified at
St Mary's Medical School, London,
in 1957, was consultant physician
and cardiologist at the United
Birmingham Hospitals (1965-93);
dean of postgraduate medicine and
dental education there (1987-91);
and honorary professor of medicine
(1991-98). He has been advisor
in cardiology to the Department
of Health's chief medical officer
(1986-93), a member of the
Committee on Safety of Medicines
(1984-89; 1996-98), the Royal
College of Physician's Linacre
fellow (director of training,
1991-94) and medical director
of the British Heart Foundation
(1993-99).
Professor Laurie Prescott
FRCPE FRCP FFPM DCPSA
FRSE (b. 1934) trained at
Cambridge and the Middlesex
Hospital, London. After junior
hospital appointments in London,
he was medical resident at the
Boston City Hospital, Boston,
Massachusetts, and then research
fellow with Professor Lou
Lasagna in the division of clinical
pharmacology at the Johns Hopkins
Hospital, Baltimore, Maryland.
He returned to the UK as lecturer
in therapeutics at the Aberdeen
Royal Infirmary, Foresterhill
(1965-69), and was senior
lecturer, reader, and then professor
of clinical pharmacology in the
department of therapeutics and
clinical pharmacology, University
of Edinburgh (1969-97). He was
honorary consultant physician to
the Edinburgh Royal Infirmary and
the Edinburgh Regional Poisoning
Treatment Centre.
Professor Brian Prichard
CBE FRCP FFPM FESC FACC
FBPharmacolS (b. 1932) started
preclinical studies at King's College
London in 1950 and qualified
at St George's Hospital Medical
School, London, in 1957. He was
appointed research assistant in
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Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Biographical Notes
clinical pharmacology to Professor
D R Laurence at University College
Hospital Medical School, London,
in 1961, and became professor
in clinical pharmacology at
University College London (UCL)
in 1980. He is past president
of the International Society for
Cardiovascular Pharmacotherapy,
past vice-dean of the faculty of
clinical sciences at UCL, and
was foundation secretary of the
Clinical Section of the British
Pharmacological Society (1970-75)
and has been chairman of the
Institute on Alcohol Studies since
1993, a councillor in the London
Borough of Wandsworth for over
40 years and a medical officer to
Boys' Brigade camps.
Professor Peter Quilliam
OBE FRCP (1915-2003) was
professor of pharmacology at St
Bartholomew's Hospital, London,
from 1962 until his retirement,
later emeritus, and was a co-
founder of the charity, Help the
Hospices. See Quilliam and
Brown (2004).
Professor Humphrey Rang
FRS FMedSci (b. 1936) was
director of the Sandoz (later
Novartis) Institute for Medical
Research (1983-97); and professor
of pharmacology at University
College London (1979-83; 1995-
2001), now emeritus.
Professor Sir Michael Rawlins
Kt DL FRCP FRCPE FFPM
FBPharmacolS FMedSci
(b. 1941) qualified at St Thomas's
Hospital, London, where he
was later lecturer in medicine
(1967-71); moving to the
Hammersmith Hospital, London,
as senior registrar (1971/2), a
visiting research fellow at the
Karolinska Institute, Stockholm,
Sweden (1972/3) and was Ruth
and Lionel Jacobson professor
of clinical pharmacology at the
University of Newcastle upon Tyne
(1973-2006). He was a member
of the National Committee
on Pharmacology (1977-83);
the CSM (1980-98; chairman
1993-98); Committee on Toxicity,
(1989-92), the Standing Group
on Health Technology Assessment
(1993-5). He has been chairman
of the National Institute for Health
and Clinical Excellence since 1999.
Professor John Reid
OBE FRCP FRCP(Glas) FRS(E)
FMedSci (b. 1943) graduated in
medicine from Oxford and trained
in clinical pharmacology at the
Royal Postgraduate Medical School
(RPMS), Hammersmith Hospital,
London. After a Medical Research
Council travelling fellowship to
the National Institutes of Health,
Bethesda, Maryland, he returned
to the RPMS as senior lecturer
and later reader. In 1978 he was
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Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Biographical Notes
appointed Regius professor of
materia medica and therapeutics
at the University of Glasgow and
in 1989 translated to the Regius
chair of medicine and head of
the department of medicine and
therapeutics. He is past president
of the Association of Physicians
of Great Britain and Ireland and
of both the British and European
Societies of Hypertension.
Professor Alan Richens
PhD FRCP FFPM FBPharmacol, a
clinical pharmacologist in the area
of antiepileptic drugs.
Professor James Ritter
DPhil (b. 1944) gained his first
degree in animal physiology and
a DPhil in pharmacology before
completing clinical medicine at
the Radcliffe Infirmary (Oxford)
and training in Oxford, London
and the Johns Hopkins Hospital
Baltimore, Maryland, with
specialist training in clinical
pharmacology at Hammersmith
Hospital, London. He has been
head of the department of clinical
pharmacology at Guy's, King's and
St Thomas' School of Medicine
(King's College, London); an
honorary consultant physician
at Guy's Hospital, then at Guy's
and St Thomas' NHS Trust since
1988. He sat on the Subcommittee
on Safety and Efficacy of the
Committee on Safety of Medicines,
has chaired local and multicentre
research ethics committees and
chaired the Thames Specialty
Training Committee in Clinical
Pharmacology. He is editor-in-chief
of the British Journal of Clinical
Pharmacology (2008— ) and has co-
authored the third and subsequent
editions of Rang and Dale (1987).
Professor Sir Max Rosenheim
(Baron Rosenheim of Camden)
Kt FRCP FRS (1908-72) qualified
at Cambridge and did house jobs
at University College Hospital
(UCH) and Westminster Hospital,
London. He became first assistant
to the medical unit at UCH under
Sir Harold Himsworth in 1940 and
served in the Royal Army Medical
Corps (RAMC) from 1941,
reaching the rank of brigadier in
the Allied Land Forces South East
Asia. He returned to the UCH
medical unit as deputy director
and was appointed professor there
in 1954. He was a member of the
Medical Research Council and
the Tropical Medicine Research
Board (1961-64) and president of
the Royal College of Physicians,
London, (1966-72). See Robson
(1982).
Professor Phil Routledge
MBE has been professor of clinical
pharmacology at the School of
Medicine, Cardiff University and
consultant general physician at
114
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Biographical Notes
the Llandough Hospital, Cardiff.
He has been chair of the All Wales
Medicines Strategy Group, head
of Yellow Card Centre Wales; and
chair of the All Wales Medicines
Strategy Group.
Professor Heinz Schild
FRS (1906-84), pharmacologist,
qualified at the Munich Medical
School. He worked in Sir Henry
Dale's lab (1932/3) and stayed in
Britain working with Professor
I de Burgh Daly at Edinburgh,
and with S H Gaddum in Egypt;
returning in 1937. He was interned
in 1939 and on his release returned
to the evacuated University
College London department of
pharmacology in Leatherhead,
Surrey, from 1941. He became a
British citizen in 1948. His method
for obtaining the real equilibrium
constant for antagonist binding
contributed to the understanding
of ligand receptor binding.
Professor Sir Eric Scowen
Kt FRCP FRCS FRCPE FRCPath
FRPharmS FRCGP (1910-2002)
qualified at St Bartholomew's
Hospital Medical School, London,
and was house physician to Professor
Francis Fraser, the first professor of
medicine at Bart's, leaving in 1937
for Columbia University, New York,
as a Rockefeller fellow. He returned
in 1938 as a reader in medicine at
Bart's, where he remained throughout
the war, serving as one of the
Prime Minister's physicians. He
was physician there from 1946 and
helped plan the rebuilding of the
Medical College in Charterhouse
Square, appointed as its warden in
1951. In 1955 he became director
of the medical professorial unit at
Bart's, and professor of medicine,
University of London (1961-75).
He was chairman of the British
Pharmacopoeia Commission
(1963-69); member of the
Committee on Safety of Drugs
(CSD) (1963-71); chairman of the
CSD's Subcommittee on Toxicity;
twice chairman of the Committee on
Safety of Medicines (1971-76; 1977-
80); member of the Committee on
the Review of Medicines (1975-78)
and chairman of the Council of the
School of Pharmacy (1970-80).
Professor Robin Shanks
CBE FRCP FACP (b. 1934)
was senior pro-vice chancellor,
Queen's University, Belfast,
(1995-98). He was professor of
clinical pharmacology at Queen's
University, Belfast, (1972-77),
Whitla professor of therapeutics and
pharmacology, Queen's University,
Belfast, (1977-98), and dean of the
faculty of medicine (1986-91).
Professor Reginald Stephen
(Sam) Stacey
(d. 1974) qualified at St Thomas'
Hospital Medical School, then
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Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Biographical Notes
joined the medical unit there
until appointed as professor of
pharmacology and therapeutics at
the College of Medicine, Baghdad,
Iraq. He returned to St Thomas'
as reader in 1948 and professor
(1958-70) where he was known for
his work on blood-platelet function
and 5-hydroxytryptamine (5HT).
After retirement he joined the
Wellcome Research Laboratories,
Beckenham. See Anon. [S.E.S.]
(1974). His papers, including
descriptions of the development of
courses of study in pharmacology
and therapeutics, cover the period
1931-74 and are held as MS826 at
Senate House Library, University
of London.
Professor E M (Tilli)Tansey
HonFRCP FMedSci (b. 1953)
is convenor of the History of
Twentieth Century Medicine
Group and professor of the history
of modern medical sciences at the
Wellcome Trust Centre for the
History of Medicine at UCL.
Professor Sir John Tooke
Kt FRCP FMedSci (b. 1949) has
been professor of vascular medicine,
University of Exeter, since 1992;
dean of the Peninsula Medical
School since 2000; honorary
consultant physician in diabetes
and vascular medicine, Royal
Devon and Exeter Healthcare NHS
Trust since 2000; executive dean of
the Peninsula College of Medicine
and Dentistry, and chairman of
the Council of Heads of Medical
Schools, since 2006.
Professor Geoffrey Tucker
FRCP(E) FRCA FFPM
FBPharmacolS FBTS FCCP
(b. 1943) trained as a pharmacist
and received his PhD from the
University of London in 1967. He
was research assistant professor
at the Anesthesia Research
Center of the University of
Washington, Seattle (1967-73);
and after various appointments
at the University of Sheffield,
he was professor and head of
the academic unit of clinical
pharmacology, later emeritus.
He has been editor (1988-94)
and chairman of the editorial
board (1995-2002) of the British
Journal of Clinical Pharmacology;
received the Lilly Prize from the
British Pharmacological Society in
2000 for contributions to clinical
pharmacology; and is chairman
and co-founder of Simcyp Ltd, a
University of Sheffield company
specializing in the prediction of
pharmacokinetics in populations
since 2001.
Professor Paul Turner
CBE FRCP FFPM (1933-94)
qualified at the University of
London and trained at Middlesex
Hospital, the Royal Free Hospital,
116
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Biographical Notes
London, and Edgeware General
Hospital. He joined the staff
of St Bartholomew's Hospital,
London in 1963 as a lecturer
in clinical pharmacology, later
reader; was professor of clinical
pharmacology at the University of
London; and consultant physician
at St Bartholomew's Hospital
(1972-93). He was chairman of the
Department of Health's Committee
on Toxicity (1976-91) and
president of the Medical Society
of London (1991/2). See Gillam
(2000).
Professor PatrickVallance
FRCP FMedSci (b. 1960) trained
at St George's Hospital Medical
School, London, and qualified
in 1984, where he was appointed
as consultant and senior lecturer
(1990-95). He left to take up the
chair of clinical pharmacology
at Univeristy College London.
In 2002 he became head of the
division of medicine and in 2006
left to join GlaxoSmithKline as
head of drug discovery. He chaired
the Wellcome Trust pharmacology
and physiology grants panel and
was registrar of the Academy of
Medical Sciences.
Professor Duncan Vere
FRCP FFPM (b. 1929) trained in
medicine at the London Hospital
Medical College and completed a
postgraduate research fellowship
there. He was medical officer at
the RAF Institute of Aviation
Medicine; senior lecturer in
medicine and consultant physician
at the London Hospital; reader
and then professor of therapeutics
at the London Hospital Medical
School and was appointed head of
the department of pharmacology
and therapeutics there in 1969. He
was a member of the Committee
on Safety of Medicines, the
Committee on Dental and Surgical
Materials and the Medicines
Commission (1970-90), and a
member of the Nuffield Enquiry
into Pharmacy, St Christopher's
Hospice Research Committee.
Professor Owen Lyndon Wade
CBE FRCP HonFRCPI
(b. 1921) trained at Cambridge and
University College Hospital, and
joined the MRC's Pneumoconiosis
Research Unit, (1948-51) under
Charles Fletcher and Archie
Cochrane. He worked with
K W Donald in the early days of
cardiac catheterization (1951-57)
and spent a year as a Rockefeller
fellow at Columbia University,
New York, with Robert Loeb.
He was appointed to the chair of
pharmacology and therapeutics at
Queen's University, Belfast (1957—
71) and to the chair in clinical
pharmacology at Birmingham
University (1971-86), serving six
years as the dean of the faculty
117
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Biographical Notes
of medicine and dentistry and
three years as pro-vice-chancellor.
He was a member of the Joint
Formulary Committee responsible
for the British National Formulary
(1963-86) and chairman of the
Joint Formulary Committee
(1978-86). He was chairman of
the Subcommittee on Adverse
Reactions of the Committee on
Safety of Drugs. He was also a
founder member of the World
Health Organization Drug
Utilization Research Group. See
Wade (1996): 110; Figure 7.
Dr Mark Walport
FRCP FRCPath FMedSci
(b. 1953) trained at Cambridge and
the Middlesex Hospital Medical
School; after junior appointments
at the Hammersmith, Guy's and
the Brompton Hospitals, he
became an MRC training fellow in
the MRC Mechanisms in Tumour
Immunity Unit, Cambridge,
gaining his PhD in 1986. He was
head of the rheumatology section
in the Royal Postgraduate Medical
School (1985-97); head of the
division of medicine at Imperial
College London (1997-2003); and
has been director of the Wellcome
Trust since 2003. He was awarded
the Roche Rheumatology Prize in
1991 and the Graham Bull Prize
in Clinical Science (Royal College
of Physicians) in 1996; and was a
governor of the Wellcome Trust
(2000-03). He is a co-author of
Immunobiology: the Immune System
in Health and Disease (Janeway
et al. (1997)) and was chairman of
the editorial board of the British
Medical Bulletin (2002-04). A
founder fellow of the Academy
of Medical Sciences (1998),
he was appointed a member of
the Prime Minister's Council
for Science and Technology in
2004 and the Office for Strategic
Coordination of Health Research
(2007- ). He chairs the Academic
Careers Subcommittee of the UK
Clinical Research Collaboration
and Modernising Medical Careers
(2004-) and co-chaired the
independent review on the use and
sharing of personal information in
the public and private sectors for
the Ministry of Justice (2007/8).
Professor Miles Weatherall
FIBiol (1920-2007) qualified
at Oxford in 1 943 followed by
house jobs at the Hammersmith
Hospital, London, and started
pharmacological research in
Edinburgh under Professor
J H Gaddum, later becoming a
lecturer there. He moved to the
London Hospital Medical College,
University of London in 1949 with
the responsibility of introducing
a new department and became
professor of pharmacology there
(1958-66). He moved to the
Wellcome Research Laboratories
118
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Biographical Notes
at Beckenham, Kent, in 1967 as
head of the therapeutics research
division and became director
of establishment (1974/5-79),
and served on the Medicines
Commission (1979-81). See
Hanley etal. (1970); Waters (2007).
Professor David Webb
FRCP FRSE (b. 1953) trained as a
cardiovascular physician and clinical
pharmacologist with Professor Joe
Collier at St George's Hospital and
Medical School, London, before
moving to Edinburgh, where he
was appointed to the Christison
chair of therapeutics and clinical
pharmacology in 1995, and has
subsequently led Edinburgh's
department of medical sciences
(1998-2001), the Wellcome Trust
Cardiovascular Research Initiative
(1998-2001), and the Centre for
Cardiovascular Science (2000-04).
He was clinical vice-president to
the British Pharmacological Society
(BPS) (1996-98), chair of the Royal
College of Physicians Committee
on Clinical Pharmacology (1998/9)
and chair of the BPS committee
of heads and professors of clinical
pharmacology (2004-07). In 2004
he became UK counsellor to the
clinical division of the International
Union for Pharmacology and
chairman of the Scottish Medicines
Consortium. In 2006 he was
appointed vice-president of the Royal
College of Physicians of Edinburgh.
Professor Richard Tecwyn
Williams
FRS (1909-79) was professor
of biochemistry at St Mary's
Hospital Medical School, London
(1949-76), and dean (1970-76).
Following Sir Archibald Garrod's
work on the role of enzymes in
drug metabolism, he developed
detoxication chemistry as a science
in its own right, and established
the two-phase drug metabolism
in animals. In 1931 he published
the structure of gluconuronic acid,
and spent the rest of his career
examining the fate of foreign
compounds in the body. See
Neuberger and Smith (1982).
Professor Andrew Wilson
CBE FRCP FRCPGlas
(1909-74) was Weir assistant in
materia medica, University of
Glasgow, (1933-37); lecturer in
pharmacology and therapeutics,
University of Sheffield and
clinical assistant, Sheffield Royal
Infirmary (1939-46); lecturer in
applied pharmacology, University
College London, and University
College Hospital Medical School
(1946-48), reader in the University
of London (1948-51); professor
of pharmacology, University of
Liverpool (1951-74); and chairman
of the British National Formulary
Committee.
119
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Biographical Notes
Professor FrankWoods
CBE FRCP FRCPE FFPM
(b. 1937) was professor of
pharmacology and therapeutics
at the University of Sheffield
from 1976, becoming Sir George
Franklin professor of medicine in
1989 and director of the division of
clinical sciences (south) , University
of Sheffield, and served as dean of
the faculty of medicine (1988-98).
He was awarded a CBE for his
services to the Committee on
Toxicity of Chemicals in Food,
Consumer Products and the
Environment and was chairman
of the General Medical Council's
Health Committee.
120
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Glossary
Glossary*
British Journal of Clinical
Pharmacology
A 'daughter' journal to the British
Journal of Pharmacology whose
first issue was published bi-monthly
in February 1974 with G M Wilson
as chairman of the editorial board
and Paul Turner as secretary and
first editor. Originally published
by Macmillan, it transferred to
Blackwellin 1983. From 1975, 12
issues were published a year. See
Cuthbert (2006).
British Journal of Pharmacology
The BMJ Publishing Group agreed
to sponsor the new BPS journal
of four issues a year, originally
entitled the British Journal of
Pharmacology and Chemotherapy,
the first published in spring 1946
edited by H R Ing. Macmillan Ltd
became the publisher in 1968 and
the title shortened to the British
Journal of Pharmacology, succeeded
in 1983 by Blackwell, increasing in
size to 24 issues a year in 1995. See
Cuthbert (2006).
British National Formulary (BNF)
A listing of medicines that replaced
the National War Formulary, in
which names of the preparations
were in Latin, the doses in minims
and grains. It was founded in
1948, closed in 1976 and started
again in 1981. Wade (1993). For
details of 50 editions of the British
National Formulary, see www.
bnf.org/bnf/extra/current/popup/
BNFcommemoration.pdf (visited 9
November 2007).
British Pharmacological Society
(BPS)
Established as a 'daughter society'
of the Physiological Society in
1931 by Walter E Dixon FRS
(1871-1931), J A Gunn (1882-
1958) and Sir Henry Hallett Dale
OM FRS (1875-1968). It met
once a year until 1946 when the
launch of the British Journal of
Pharmacology increased its activities
and from 1968 there were four
meetings a year. There had been
some discussion at the BPS AGM
in 1968 about retaining British
in the title. The 50th anniversary
was celebrated by a short history
[Bynum (1981)] and its 75th
with a special supplement [British
Journal of Pharmacology (2006)
147: Sl-307]. See Cuthbert
(2006); Aronson (2006);
Dollery (2006).
* Terms in bold appear in the Glossary as separate entries
121
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Glossary
Clinical Section, BPS
A section of the Society devoted
to clinical pharmacology was
formed at the end of the 1960s,
proposed by C T Dollery, D R
Laurence, B N C Prichard, R
G Shanks, J R Trouce, P Turner
and D W Vere. The section had
two of the four BPS scientific
meetings a year for papers on
clinical pharmacology. For further
details, see www.bps.ac.uk/
site/cms/contentChapterView.
asp?chapter=106 (visited
7 May 2008).
Drug and Therapeutics Bulletin
A Which? publication that began as
the UK edition of the US Medical
Letter on Drugs and Therapeutics
in 1962, changing its name a
year later. It was independent
of the pharmaceutical industry,
Government and regulatory
authorities with no advertising
or commercial sponsorship and
was distributed to all prescribing
doctors in the UK from 1966 to
2006, paid for with a grant from
the Department of Health (DoH).
It held its first conference in 1984
and co-founded the International
Society of Drug Bulletins (ISDB)
in 1989. See Anon. (2002).
essential medicines
The first 'model list' of 208
essential medicines was created in
1977 for developing governments
to select medicines for local public
health needs to be incorporated
into national lists, which preceded
the famous 1978 Alma-Ata
declaration on Health For All. The
list is revised every two years by a
group of experts; the March 2007
list contains 340 medicines. See
WHO, Expert Committee (2007).
See also www.who.int/medicines/
services/essmedicines_def/en/index.
html (visited 26 October 2007).
For a comparative list over the 30
years, see www.who.int/medicines/
publications/essentialmedicines/
compar_table_who_edls.xls (visited
3 June 2008).
European journal of Clinical
Pharmacology
Founded by Hans Dengler, Franz
Gross and Hartmut Dost in 1968
as Pharmacologia Clinica with
Springer Verlag. Two years later it
was renamed the European Journal
of Clinical Pharmacology {EJCP)
with Hans Dengler, Franz Gross
and Luzius Dettli as co-editors.
Imperial Chemical Industries
Ltd (ICI)
Formed in 1926 from the merger of
four chemical companies: Brunner,
Mond; Nobel Industries; United
Alkali; and British Dyestuffs,
selling chemicals, explosives,
fertilizers, insecticides, dyestuffs,
non-ferrous metals and paints.
The 1993 demerger of ICI
122
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Glossary
Pharmaceuticals, created in 1957,
and their agrochemicals businesses
formed Zeneca (merged with Astra
AB to create the pharmaceuticals
company AstraZeneca in 1999;
the agrochemicals business joined
Novartis to form Syngenta in
2000). In 2008, ICI became
part of AkzoNobel, a coatings
manufacturer, selling decorative
paints and performance coatings,
and supplying specialty chemicals.
Notable pharmaceuticals
produced by its research group
were sulfamethazine, the first
sulfonamide antibiotic; Paludrine
in the 1940s when supplies of
the natural quinine treatment
for malaria were threatened by
hostilities; halothane (1951, an
anaesthetic agent); Inderal (1965,
a (3-blocker), brodifacoum (1974,
a rodenticide), Tenormin (1976, a
(3-blocker) and tamoxifen (1978,
frequently used to treat breast
cancer). See Reader (1970, 1975).
International Union of
Pharmacology (IUPHAR)
Founded in 1959 as a section
of the International Union of
Physiological Sciences, it has been
an independent body since 1966,
renamed the International Union
of Basic and Clinical Pharmacology
in 2006. International meetings
are generally held every three
years, the first in Stockholm,
Sweden in 1961; the second
in Prague, Czechoslovakia in
1963. From 1990, the meetings
alternate with the world congresses
of the International Union of
Biochemistry and Molecular
Biology (IUBMB) and
the International Union of
Physiology (IUPS).
Joint Planning Advisory
Committee (JPAC)
A committee established in 1985 to
advise the Department of Health
and Social Security on national
targets for the total number of
senior registrar posts by specialty
group and on regional quotas, with
17 members, and five observers
from the Association of Medical
Research Charities, the Welsh
Joint Consultants Committee,
the Department of Health, the
Welsh Office and the Scottish
Home and Health Department.
The Committee continued until
1990 when it was replaced by the
Specialist Workforce Advisory
Group (SWAG) and later by
the Advisory Group on Medical
Education Training and Staffing
(AGMETS). See Anon. (1985). See,
for example, Salter (1995).
Kempner's rice diet
Dr Walter Kempner from Duke
University, Durham, North
Carolina, investigated the effect
of diet on disease, including
hypertension and diabetes, and
123
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Glossary
found that these conditions were
rare when rice was a staple. Rice,
fruit, juices, sugar, plus vitamin
and iron supplements made up the
regimen. For details, see Dunlop
(1950). See also http://archives.
mc.duke.edu/mcakempnerw_pdf
(visited 26 June 2008).
Medical Letter on Drugs and
Therapeutics
Founded in the US as one of
two newsletters (the other being
Treatment Guidelines from The
Medical Letter) in 1959 by Dr
Harold Aaron and Arthur Kallet,
also co-founder of the Consumers
Union. See http://medlet-best.
securesites.com/html/who.htm
(visited 9 November 2007).
Merck Fellowship in Clinical
Pharmacology
An award from the Merck
Company Foundation to promote
and strengthen the discipline
of clinical pharmacology. Four
fellowships have been awarded
annually since 1965, later renamed
the International Fellowship in
Clinical Pharmacology, supported
by the Merck Foundation. See also
Sjoqvist et al. (2007).
Merck Manual of Diagnosis and
Therapy (Merck Manual or
Merck's)
An alphabetical listing of agents
of therapeutic value based on
the US Pharmacopoeia, along
with symptoms and diseases,
first published in 1899 as Merck's
Manual of Materia Medica, in its
18th edition (2006). Full text is
freely available at www.merck.com/
mmpe/index.html (visited 9
November 2007). See Morowitz
(1976).
Modernising Medical Careers
(MMC)
A policy statement from the UK
Departments of Health in 2003
outlining reforms to postgraduate
medical education, including
a shorter specialist foundation
training period of two years, a
computerized central selection
process for training posts and
revision of the non-consultant
career grade. After the online
Medical Training Application
Service for junior doctors failed
in 2006, Professor Sir John Tooke
was appointed by the Secretary
of State to investigate MMC
procedures. His 2008 report,
Aspiring to Excellence, suggested
further reforms of postgraduate
medical education. The report is at
www. mmcinquiry org. uk/Final_8_
Jan_08_MMC_all.pdf (visited 20
June 2008). See also Delamothe
(2008).
Monthly Index of Medical
Specialities (MIMS)
Established in 1959 by Medical
Publications as a free service to
124
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Glossary
prescribing medical professionals by
cooperating pharmaceutical manu-
facturers, whose editorial team was
independent of pharmaceutical
companies.
Preservers' Journal
Designed to provide the physician
with early and reliable information
about new pharmaceutical products
for use in general practice or in
the hospital setting. It superseded
Preservers' Notes, first introduced
in February 1952, which aimed to
promote economy in prescribing
habits as well as information on
prescribing matters.
Prescribing Initiative
An initiative of the British
Pharmacological Society that began
after a series of events in which
members of the Society highlighted
problems with practical prescribing
and its teaching. The first event
was a press briefing at the Royal
Institution's Science Media Centre
in July 2006, which was followed
by the publication of an editorial
in the British Medical Journal
(Aronson et al. (2006)). This led to
the formation of a working party,
organized by the General Medical
Council, at which the Society had
representation; the problems were
discussed and changes proposed
to the 2008 version of Tomorrow's
Doctors. The Society agreed to fund
a research registrar, for one year
initially, to carry out a systematic
review of the literature on methods
of teaching practical prescribing,
to formulate a curriculum, and
to survey teaching methods
current in the UK. This initiative
began in February 2008. See, for
example, www.newscientist.com/
article/dn9 5 74-experts-warn-on-
dangerous-drugprescribing-errors.
html; www.dailymail.co.uk/news/
article-396399/Hundreds-dying-
doctors-lack-training-prescribing-
drugs.html (visited 16 July 2008).
Royal Pharmaceutical Society of
Great Britain
The professional and regulatory
body for pharmacists in England,
Scotland and Wales. See www.
rpsgb.org.uk/ (visited 16 November
2007).
Safe Prescribing Working Group
The General Medical Council
(GMC) convened a meeting
of interested parties to discuss
prescribing errors in junior doctors.
The Safe Prescribing Working
Group was asked to determine
what a Foundation Year 1 doctor
must know on his or her first
day with regards to prescribing;
to suggest ways to support the
development of this knowledge
through undergraduate education
and foundation training, including
assessment; and to consider ways
to support junior doctors in their
125
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Glossary
prescribing. The recommendations
and outcomes of the Safe Prescribing
Working Group are available on the
Medical Schools Council's website at
www. chms. ac. uk/publications.htm
(visited 8 July 2008)
Wellcome Foundation
The umbrella organization formed
in 1924 by Henry Wellcome to
absorb his libraries, museums,
research laboratories and the
pharmaceutical company of
Burroughs Wellcome & Co. Sir
Henry Wellcome's will created
the medical charity, the Wellcome
Trust, which managed the
Foundation until it was floated on
the stock market and merged with
Glaxo in 1995 (GlaxoSmithKline
from 2001). For the history of
the years to 1940, see Church and
Tansey (2007).
126
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Index
Index: Subject
Aberdeen, 15, 35-6, 63
Aberdeen General Hospital, 79
Aberdeen prescription sheet, 31, 79
ABPI see Association of the British
Pharmaceutical Industry
acetylcholine, 10
Addenbrooke's Hospital, Cambridge,
36
adverse drug reactions, 28-9
newspaper clippings, 29
Adverse Drug Reactions Bulletin, 52
Alder Hey Book of Children's Doses
(ABCD), 63
Alder Hey Children's Hospital,
Liverpool, 63, 65
amphetamine, 62
amyl nitrite, 62
anaesthesia, 29
angina pectoris, 13, 22-3
Anglo-American Workshop on
Clinical Pharmacology, Virginia
(1986), 15,32,78
animals, studies on, 9, 10, 62
antidepressants, 33
antivivisectionists, 1
Artemisia annua, 6
aspirin, 74
assessment see examination/assessment
Association of the British
Pharmaceutical Industry (ABPI),
51,55-6
Medicines Compendium, 46—7
atropine, 16, 17
Australia, 44, 60
Ballard and Garrod, Elements of
Materia Medica and American
Therapeutics (1845), 7
barbiturates, 62
Bart's see St Bartholomew's Hospital,
London
beds, hospital, 21, 27, 30, 32, 36,
37-8
Belfast, 21,42-3, 79
Belfast City Hospital, 79
P-blockers, 17, 22-3, 74
see also practolol; propranolol
biochemical pharmacology, 12, 18-19,
33-4
Birmingham, University of, 13,38,
67, 72-3
BJCP see British Journal of Clinical
Pharmacology
BJP see British Journal ofPharmacoh
blood pressure
high see hypertension
measurement, 29
BMA see British Medical Association
BMJ see British Medical Journal
BMJ Publishing Group, 44, 46
BNFsee British National Formulary
Bodleian Library, Oxford, 7, 8
BPS see British Pharmacological Society
brain, 33
Brazil, 60
British Council meeting, 57-8, 60
British Journal of Clinical Pharmacology
(BJCP), 44-5, 47-9, 61, 121
75th anniversary of BPS, 6
establishment of, 27, 44, 48-9, 78
British Journal of Pharmacology (BJP),
45,48, 121
BPS 75th anniversary issue, 4
British Medical Association (BMA), 57
British Medical Journal (BMJ), 44,
45,46
article on better prescribing
(2006), 68
127
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Index
editorials on clinical pharmacology,
8, 9, 26, 77
British National Formulary (BNF),
45-6, 47, 53-4, 121
Ed Harris and, 51, 53
evaluation of, 53, 70
first issue, 4, 77
Joint Formulary Committee, 45
production, 65
recipients, 46, 53
revised format, 53, 64, 78
British Pharmacological Society (BPS),
61, 121
75th anniversary, 4, 72, 78
Clinical Section see Clinical Section
of the British Pharmacological
Society
Prescribing Initiative, 72, 78, 125
publication of BJCP, 44, 45, 48-9
visiting fellow to India, 27
Bruce, Materia Medica and
Therapeutics, ( 1 8 84) , 7
Bruce and Dilling's Materia Medica and
Therapeutics (Dilling, 1933), 7
Burroughs Wellcome Fund, Research
Triangle Park, NC, US, 55-6
Cambridge, 36
carcinoid syndrome, 12
cardiac glycosides, 8
see also digitalis; digoxin
Cardiff, 28, 38-9, 44
cardiovascular pharmacology, 16, 17,
19,24
Cardiovascular Research Institute, San
Francisco, California, US, 14
Cerumol, 51
Charterhouse Square see Bart's
chemical pathology, 12, 20
Chief Medical Officer (CMO), 46
China, 59, 60
cinchona bark, 6
clinical medicine, 11—12, 32, 34
clinical pharmacologists
clinical practice see clinical practice
in history, 6
influences on career choices, 8-19
roles, 43-4
teaching see teaching
clinical pharmacology
academic departments, 19-22,
23-30, 32-9
chronology of events, 4-5, 77-9
future, xx, 8, 72
industrial, 17-18
international influence on UK,
56-61
need for rebranding, xxiii
nomenclature, 4, 6-8
numbers of posts, 42-3
overseas, 56-61
paediatric, 63, 65
Clinical Pharmacology (Dilling,
1960), 7
Clinical Pharmacology (Laurence,
1960), 7, 77
Clinical Pharmacology and Therapeutics
(journal), 15,42
Clinical Pharmacology: Scope,
organization, training (WHO ,
1970), 39-41
Clinical Pharmacology Research
Group, MRC, Hammersmith
Hospital, London, 19
Clinical Pharmacology Unit, MRC,
Oxford, 32-3, 78
clinical pharmacy, 63-6, 69
clinical practice, 21, 27, 30, 32, 37-8
clinical psychopharmacology, 33
clinical science, 11, 17—18
Clinical Section of the British
Pharmacological Society
(BPS), 122
Ciba Foundation meeting, 57
128
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Index
establishment, 21-2, 61, 78
prizes for medical students, 62
setting up the BJCP, 27, 44, 48
clinical trials, 13, 22, 23, 60
European Directive, 56
CMO see Chief Medical Officer
Committee on Safety of Drugs, 77
Committee on Safety of Medicines,
77,78
Compendium ofPhysick (Salmon,
1671), 7
computer-based assessment and
learning see medical students
Consumers' Association, 50-1
cortisone, 11
Council for the Heads of Medical
Schools, 72
criminal psychology 34-5
Croatia, 57-8
Crooks etal., 'Drugs in hospitals'
(1967), 79
Cullen, Treatise of the Materia Medica
(1789), 7
cyclizine hydrochloride (Marzine),
17-18
DCMO see Deputy Chief Medical
Officer
deans of medical schools, 11, 30, 68,
72,73
Department of Health, 42, 46, 50, 51,
52
departments of clinical pharmacology,
19-22,23-30,32-9
Deputy Chief Medical Officer
(DCMO), 51,53
developing countries, 26, 39
digitalis, 6
digoxin, 8, 15-16,33,43
Dilling's Clinical Pharmacology (I960),
7,77
District Drugs Guide (Westminster,
1981), 64
Dixon Memorial Lecture (1954), 8
dose-response relationships, 19, 22, 23
dropsy, 6
Drug and Therapeutics Bulletin, 46,
49-52, 77, 122
drug and therapeutics committees,
65-6, 67
drug interactions, 19, 48
drug metabolism, 19, 24, 47-8
drug regulation and safety, 35-6
Drug Utilization Research Group
(DURG), 59-60
'Drugs in hospitals' (Crooks et al,
1967), 79
Dundee, University of, 35, 38, 39, 66
ear wax, 51, 54
East Anglia Medical School see
University of East Anglia School
of Medicine, Health Policy and
Practice
Edinburgh, 35-6, 37
Elements of Materia Medica and
American Therapeutics (Ballard
andGarrod, 1845), 7
Emergency Prescriptions Kept up One's
Sleeve (Ge Hong), 6
essential medicines lists/programmes
«WHO
ethics committees, 56-7, 61
Europe, 56-8, 65
European Association of Clinical
Pharmacology and
Therapeutics, 56
European Journal of Clinical
Pharmacology, 48-9, 122
evidence-based medicine, 52-3, 74
examination/assessment, 38, 39, 70-1,
72-4
experimental pharmacology, 9, 55-6
Experimental Pharmacology and the
Basis of Therapeutics (Meyer and
Gottlieb, 1914), 8
129
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Index
foxglove see digitalis
France, 56
funding, evaluation of scientific
research, xxiii— xxiv
Ge Hong, Emergency Prescriptions Kept
up One's Sleeve, 5, 6
General Medical Council (GMC),
Education Committee, 68, 71
Safe Prescribing Working Group,
69, 72, 125-6
general medicine, 32, 42, 43
general practitioners, 53
German pharmacologists, 10-11, 56
Germany, 49, 56, 58
Glasgow, University of, 7, 9, 15, 35-6,
48,62
GMC see General Medical Council
Goodman and Gilman, The
Pharmacological Basis of
Therapeutics (1941), 79
Groningen, Netherlands, 58
Hammersmith Hospital (Imperial
College School of Medicine),
London, xxi, xxii, 10, 19, 24, 29,
36, 48, 61
hand vein measurement see Macey's
sphygmograph
hexamethonium, 13
hexobarbitone, 62
human pharmacology, 4, 8, 9
5-hydroxytryptamine (5HT) see
serotonin
hypertension, xxii, 21, 22
malignant, 13
see also pronethalol; propranolol
ICI, 10,22, 122-3
ICI 50172 (practolol), 13
Imperial Chemical Industries Ltd see
ICI
Imperial College, (Imperial College
School of Medicine) London, 71
see also Hammersmith Hospital,
St Mary's Hospital, Westminster
Hospital
India, 27, 59
industrial clinical pharmacology,
17-18
information pharmacists, 66
International Conference on Clinical
Pharmacology, Wembley (1980),
39,41,61
International Congress of Physiology,
Brussels (1956), 58
international influence on UK clinical
pharmacology, 56-61
International Society of Drug
Bulletins, 55
International Union of Pharmacology
(IUPHAR), 61, 123
Italy, 56, 57
itch, 18
Johns Hopkins Hospital, Baltimore,
Maryland, US, 15
Joint Committee on Higher Medical
Training (Joint Royal Colleges of
Physicians Training Board from
2007), 40
Joint Formulary Committee, 45
Joint Planning Advisory Committee
(JPAC), 42, 43, 123
JPAC see Joint Planning Advisory
Committee
junior doctors, 50, 63, 69, 70, 71-2, 73
see also registrars; senior registrars;
training
Kempner's rice diet, 13, 123-4
Kenya, 59
kinetics see pharmacokinetics
King's College London, 17
130
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Index
Lancet
articles on clinical pharmacology, 8,
9, 62, 63, 72, 77, 78
student projects, 61
levodopa, 28
Liverpool, University of, 30, 48, 63,
65,73
London Hospital and Medical School
see Royal London Hospital
London University, 70-1
Macey's sphygmograph, 24
malaria, 6
Manchester, University of, 30, 63,
64, 73
Martindale's Extra Pharmacopoeia,
46-7
Marzine, 17-18
materia medica
academic departments, 35, 37, 38
academic posts, 15, 21, 24, 38
as academic subject, 7, 9, 35-6, 37
origin of term, 6—7
Materia medica Americana potissimum
regni vegetabilis (Schoepf, 1787), 7
Materia Medica and Therapeutics
(Bruce, 1884), 7
MCQ see multiple choice questions
mechanisms of drug action, 19
medical education
curriculum, undergraduate, 68-71,
72, 73-4
computer-based assessment and
learning, 71, 72
examination/assessment, 38, 39,
70-1,72-4
problem-based learning, 73
see also medical students; teaching
Medical Letter on Drugs and
Therapeutics, 49-50, 124
Medical Research Council (MRC), 20,
28, 40-1
Clinical Pharmacology Research
Group, Hammersmith Hospital,
London, 19
Clinical Pharmacology Unit,
University of Oxford, 32-3, 78
medical students
learning about prescribing, 68-71,
72-4
provision of BNF to, 46, 53
research projects, 61, 62
self-experimentation, 61—2
teaching see teaching
medicine
academic departments, 11, 28, 37
general, 32, 42, 43
Medicines Act, 1968,77
Medicines Advisory Committee,
Oxford Radcliffe Hospitals NHS
Trust, 66
Medicines and Healthcare products
Regulatory Agency, xxiii, 78
Medicines Compendium (ABPI), 46-7
Medicines Commission, xxiii
Medicines Control Agency, 50, 78
Merck fellowship in clinical
pharmacology, 14, 39, 124
Merck Manual of Diagnosis and Therapy
{Merck Manual or Merck's), 46,
A7, 124
Meyer and Gottlieb, Experimental
Pharmacology and the Basis of
Therapeutics (1914), 8
Meyler and Herxheimer, Meyler's Side
Effects of 'Drugs (1968), 58
Meyler's Side Effects of Drugs (Meyler
and Herxheimer, 1968), 58
Middlesex Hospital (UCL Medical
School from 2008), London, xx,
18,24
MLMS see Monthly Index of Medical
Specialities
131
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Index
Modernising Medical Careers (MMC),
72-3, 124
Monthly Index of Medical Specialities
(MIMS), 46, 53, 54, 124-5
MRC see Medical Research Council
multidisciplinary training, 26, 35, 40
multiple choice questions, 73
National Institute for Health and
Clinical Excellence (NICE), xxiii,
52,78
National Institutes of Health (NIH),
Bethesda, Maryland, US 19, 24
National War Formulary, 4, 53, 54
Netherlands, 58, 65
neuroleptics, 33
neurology, 28
neuropharmacology, 33
Newcastle, University of, 28-9
NICE see National Institute for Health
and Clinical Excellence
Nigeria, 59
NIH see National Institutes of Health
nomenclature, clinical pharmacology,
4,6-8
North-East Thames region, 67
Northern Ireland, 21, 42-3, 50,
59-60, 79
Nottingham, University of, 35, 65
objective-structured clinical
examinations, 39
oleander seeds, self-poisoning, 60
oral contraceptives, 7 A
Oslo, Norway, 59
Oxford, 4, 11-12, 13, 15-16, 32-5, 60
Oxford Drug and Therapeutics
Committee, 65-6
paediatric clinical pharmacology see
clinical pharmacology
pain, 18
penicillin, 1 1
pharmaceutical companies
BJCP and, 45
contract studies for, 39
Drug and Therapeutics Bulletin and,
51-2
research fellowships, 14, 39
pharmacists, 34, 63-8, 69
pharmacokinetics, 8, 19, 47-8, 64, 65
The Pharmacological Basis of
Therapeutics (Goodman and
Gilman), 79
pharmacologists, non-clinical, 47-8
pharmacology
academic departments, 11-12, 18,
21,27,28-9,30
undergraduate courses, 16-17
Pharmacology, Clinical and
Experimental (Meier and
Gottlieb), 8
pharmacology and clinical
pharmacology department, joint,
29
pharmacology and therapeutics
joint academic departments, 10, 30,
37-8
joint academic posts, 20
pharmacy, 63-8, 69
phenobarbitone, 62
physicians
clinical pharmacologists as, 27, 32
general, attitudes of, 43-4
senior, 20
Physiological Society, 10
plasma concentrations, 15-16
polonium, 47
'polypill', 7 A
practolol, 13
preclinical pharmacology, 1
pre-registration pharmacists, 67
Prescribers' Journal, 20, 45, 51, 52—3,
77, 125
132
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Index
prescribing
Aberdeen form, 31,79
errors, 13, 31, 79
medical education/training, 69-74
near misses/critical incidents, 67
role of pharmacists, 63, 66, 69
self-experimentation by students,
61-2
Prescribing Initiative see British
Pharmacological Society
problem-based learning, 73
pronethalol, 22
propranolol, 10, 22
psychiatry, 33
psychopharmacology, clinical, 33
publications, 6, 7, 27, 44-55
chronology of key, 4, 8, 77-9
terminology used, 7-8
qinghaosu, 6
Queen's University, Belfast, 10-11
quinine, 6
Radcliffe Infirmary, Oxford, 4
RCP see Royal College of Physicians of
London
red blood cells, 16, 33
Regional Poisoning Treatment Centre,
Royal Infirmary, Edinburgh, 37
registrars, 11, 13, 27, 28
Report of the Committee on Clinical
Pharmacology (RCP, 1969), 8, 9,
41,77
research, 19, 55-6
constraints on, 21, 38
by medical students, 61, 62
research fellows, 26
individual appointments, 14, 15,
17,24
industry-sponsored, 14, 39
from overseas, 55, 56, 59, 60-1
Rhodes Trust, 34
rice diet, Kempner's, 13, 123-4
Roche (F Hoffman-La Roche AG,
Basel; Roche Products Ltd,
Welwyn Garden City), 14
Royal College of Physicians of London
(RCP)
advanced medicine conferences, 20
debate on medical education, 68
Joint Training Board, 40
Membership, 10, 13
Report (1969), 8,9,41,77
Working Party, 78
Royal London Hospital and Medical
School (Barts and the London
School of Medicine and
Dentistry, University of London),
Charterhouse Square, London,
24-7,49,61,63,67
Royal Pharmaceutical Society of Great
Britain, 65, 125
Royal Postgraduate Medical School
(RPMS), Hammersmith Hospital,
London, xx, 19
Royal Victoria Hospital (Royal
Hospitals), Belfast, 79
Russia, 60
Safe Prescribing Working Group see
General Medical Council
Salmon, A Compendium of Astrological,
Galenical and Chymical Physick
(1671), 7
San Francisco, California, US, 14, 64
Sandoz Prize (Novartis Prize), 61
Schoepf, Materia medica Americana
potissimum regni vegetabilis
(1787), 7
School of Pharmacy, University of
London, 66, 67
Scotland, 21,35-6, 37, 38, 40
self-experimentation by students,
61-2, 67
133
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Index
self-poisoning, 60
senior physicians, 20
senior registrars, 32, 42, 63
serotonin, 12, 33
Serotonin Club, 12
Sheffield, University of, 37-8, 48
snakebite, 45-6, 60
sodium-potassium pump (ATPase),
16,33
Southampton, University of, 48, 62, 66
Spain, 56-7
specialty
clinical pharmacology, xxii
multiple, 26, 35, 37, 40, 44
organ-based, 34, 37
sphygmograph, Macey's, 24
Sri Lanka, 59, 60
St Andrew's University see University of
St Andrew's
St Bartholomew's Hospital and Medical
School (Barts and the London
School of Medicine and Dentistry,
University of London), London,
24, 25, 39, 44, 49, 67, 71
St George's Hospital Medical School
(St George's, University of
London), London, 16—17, 64
St George's Hospital Pharmacopoeia
(Wandsworth, 1985), 64
St Mary's Hospital and Medical School
(Imperial College School of
Medicine), London, 12, 19
St Thomas' Hospital Medical School
(King's College London School of
Medicine at Guy's, King's College
and St Thomas' Hospitals),
London, 9, 11,20,21
statins, 74
streptomycin, 11
students
self-experimentation, 61-2, 67
see also medical students; teaching
Study Group on Clinical
Pharmacology «WHO
Sweden, 56, 57, 59
Synopsis Medicinae (Salmon, 1671), 7
teaching, 26, 30, 67
BSc course, 59
debate on, 68
manpower problem, 72
meetings, 28
need for clinical knowledge, 34
preclinical teaching, 36
responsibilities, 27, 35-6, 37, 38
see also medical students; students
Technical Group see WHO
therapeutic, origin of term, 7
therapeutics, 4
academic departments, 35-6, 37
academic posts, 11, 15, 35, 38
dumbing down, 74
origin of term, 6—7
therapeutics and clinical pharmacology,
joint department, 37
thrombosis, 13
thyroid disease, 10
training
courses, 57, 59, 60, 61
junior doctors, 69, 71-2
multidisciplinary 26, 35, 40
pharmacists, 67
posts, numbers, 42-3
WHO reports, 42
see also junior doctors
Treatise of the Materia Medica
(Cullen), 7
UCH see University College Hospital
UCHMS see University College
Hospital Medical School
UCL see University College London
United States (US), 15, 19, 32, 55-6,
66
134
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Index
University College Hospital (UCH),
20,21,28,29,61
University College Hospital Medical
School (UCHMS) (UCL Medical
School from 2008), 17, 20-1, 29
see also Middlesex Hospital
University College London (UCL), 20,
29,61,74
University of East Anglia School of
Medicine, Health Policy and
Practice, Norwich, 68
University of London, 70-1
University of St Andrew's, 38
Vellore, India, 27
Wales, 28, 38-9
Wandsworth, St George's Hospital
Pharmacopoeia (1985), 64
ward pharmacy 63, 64, 66, 69
ward units, dedicated, 32
Wellcome Foundation, Foundation
(Glaxo Wellcome from 1995;
GlaxoSmithKline from 2001),
London, 17-18, 55, 126
Wellcome Trust, London, xxiii, 3, 24,
55
Director, xxiii
fellowship, 24
Wellcome Witnesses to Twentieth Century
Medicine, xxiv
ultrasound, xxiv
West Midlands Centre for Monitoring
Adverse Reactions to Drugs,
(West Midlands Centre for
Adverse Drug Reactions), City
Hospital, Birmingham, 67
Westminster, District Drugs Guide
(1981), 64
Westminster Hospital and Medical
School (Imperial College School
of Medicine), London, 63, 64
WHO see World Health Organization
Wiley-Blackwell, 45
willow bark, 6
Witness Seminar, xxiii
World Health Organization (WHO),
41-2
Essential Medicines programme, 39,
44, 59, 60, 122
meeting in 1969, 59
reports on clinical pharmacology, 9,
39-42, 78
Study Group report (1970), 39-40
135
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Index
Index: Names
Biographical notes appear in bold
Aellig, Walter, 60-1
Alberti, Sir George, 29
Alstead, Stanley, 15
Anderson, Stuart, 63-4, 65, 101
Armstrong, Desiree, 18
Aronson, Jeffrey (Jeff), 3, 4-9, 14, 15-
16, 33, 35, 39, 46, 49, 52, 53-4,
60,61,62,66,72,77, 101
Back, Dave, 48
Baker, John, 63, 64
Ballard, Edward, 7
Barnett, David, 14, 32, 39, 52, 64, 69,
70, 101-2
Barrett, Chris, 63
Beeley, Linda, 52, 67, 102
Berde, Botand, 61
Besser, Mike, 25
Black, Sir James, 10, 22, 23, 29,
55, 102
Blaschko, Hugh, 10-11, 12
Boon, Nick, 35, 102
Breckenridge, Sir Alasdair, xxii, 19, 24,
30, 73, 102-3
Brodie, Bernard, 19, 103
Brown, Morris, xxii, 36—7, 103
Brownlee, George, 17, 103
Bruce, John Mitchell, 7
Brunton, Sir Thomas Lauder, 24, 25,
103-4
Bulbring, Edith, 11, 12, 104
Calder, Graham, 63, 79
Catto, Sir Graeme, 68
Caulfield, Mark, 24-7, 29, 35, 40, 49,
67,70-1,72, 104
Chalmers, Sir Iain, 52-3, 58, 104
Chan, Margaret, 42
Choonara, Imti, 65
Cocking, William T, 37
Collier, Joe, 16, 17,64, 104
Cowen, Phil, 33
Crooks, James (Jim), 14, 15, 31, 38,
79, 104-5
Cullen, William, 7
Cuthbert, Maurice, 27
Dacre, Jane, 74
Davidson, Jake, 9
Davies, David (Dai), 28, 105
Davies, Donald (Don), xxii, 18-19,
24,48,61, 105
Dilling,WJ,7, 30,77
D'Mello, Tony, 25-6, 27
Dollery, Sir Colin, xxii, 9-10, 13, 18,
19, 21-2, 24, 39, 41, 48, 61, 77,
105-6
Donaldson, Sir Liam, 46
Dornhorst, Tony, 11, 20, 106
Dunlop, Sir Derek, 36, 37, 39-40
Dunne, John, 27
Elion, Gertrude (Trudy), 55
Farthing, Mike, 70-1
Feldberg, William, 10-11
Ferner, Robin, 28, 29, 52, 72-3, 106
Fitzgerald, Garret, xxii, xxiii
Flower, Roderick (Rod), 3-4, 9, 11,
13, 17, 19, 20, 22, 24, 27, 28, 32,
34, 40-1, 43, 44, 46, 47, 49, 51,
53,54,55,57,61,62-3,66,68,
74-5, 106
Fowle, Arthur, 17-18, 43-4, 106-7
136
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Index
Gaddum, John, 8, 77
Garrod, Alfred Baring, 7
Ge Hong, 5, 6
Gelder, Michael, 33
George, Sir Charles, xxii, 13, 19, 26,
42, 44-6, A7, 52, 53, 62, 66, 107
Gilman, A, 79
Girdwood, Ronnie, 37
Gold, Harry, 8
Goldberg, Sir Abraham (Abe), 15, 107
Goodman, L, 79
Goodwin, Guy, 33
Goodwin, John, 13
Gordon, David, 68, 69, 72, 73, 107
Gottlieb, Rudolph, 8
Grahame-Smith, David, 12-13, 15,
16, 18,32-4,35,36,37,65-6,
7 'A, 107-8
Grasby, Paul, 33
Green, Roger, 68
Gross, Franz, 48—9
Grundy, Bill, 36
Halsey, John Taylor, 8
Harris, Edmund, 51, 53, 54
Hawkey, Chris, 35
Hedges, Anne-Marie, AA
Herxheimer, Andrew, 9, 1 1, 27, 43,
49-51, 54-5, 57-8, 61, 73, 108
Hill, Sir Ian, 38
Himsworth, Sir Harold (Harry),
20, 108
von Herkomer, Sir Hubert, 26
Hitchings, George, 55
Hobbiger, Franz, 18
Hopkins, Mr, 79
Hunter, Kenneth, 28, 108
Hunter, Sir Robert Brockie (Baron
Hunter of Newington from
1977), 38, 109
Jenkins, Jennifer, 50
Johnston, Dennis, 42
Jones, Gaynor, 74
Jones, Trevor, 17, 46-7, 51, 55-6, 109
Keele, CA, 18
Kempner, Walter, 13, 123-4
Kendall, Martin, 53, 72-3, 109
Kilpatrick, Sir Robert (Baron
Kilpatrick of Kincraig from
1996), 14, 37
Kruk, Ziggy 25-6
Lammers, Will, 58
Lant, Ariel, 64
Lasagna, Louis (Lou), 15, 40, 109
Laurence, Desmond, 7, 8, 11, 17, 20,
21-2, 23, 28, 29, 39-40, 41, AA,
57, 60, 77, 109-10
Leinster, Sam, 68
Lewis, Peter, xxii
Litvinenko, Aleksander, 47
Loke, Yoon, 68
Lunde, Per Knut, 59, 60
MacDermot, John, xxii
Macgregor, Alastair, 15, 35-6, 110
Martini, Paul, 58, 110
Mawer, George, 30
Maxwell, Simon, 72
McCance, RA, 13-14
McDevitt, Denis, 10, 13, 21, 26, 30,
32, 38, 42-3, 53, 57, 66, 110-11
Meyer, Hans Horst, 8
Mellanby, Sir Edward, 37
Melmon, Ken, 14
Meyler, Leopold, 58
Morris, David, xxi
137
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Index
Nabarro, John, xxi, xxii
Neil, Eric, 18
Neuberger, Albert, 12
Nimmo, Walter, 29, 111
Nunn, Tony, 65
Nutt, Dave, 33
Oakley, Celia, 13
Orme, Michael, 9-10, 19, 24, 30, 32,
41-2, 56-7, 58, 63, 65, 73-4,
111
Owen, David (Baron Owen of the
City of Plymouth from 1992), 50
Park, Kevin, 48
Paterson, Jim, 24
Paton, Sir William (Bill), 11-12, 13,
20, 111
Peart, Sir Stanley (Stan), 12, 15, 32,
111-12
Peck, Anthony (Tony), 17, 18, 39, 112
Pentecost, Brian, 13, 112
Peters, Keith, xxi
Posner, John, 39
Prescott, Laurie, 14-15, 29, 37, 38,
62,67,71-2,74, 112
Price-Evans, David, 30
Prichard, Brian, 17, 21, 22-3, 27, 28,
29,48-9, 57,60-1, 112-13
Quilliam, Peter, 17, 62, 77, 113
Rang, Humphrey, 12, 16, 113
Rawlins, Sir Michael (Mike), xxii,
28-9, 113
Reid, H Alistair, 46
Reid, John, xxii, 15, 19, 23-4, 28,
29, 35-6, 37, 38, 48, 62, 69-70,
113-14
Renwick, Andy, 48
Richens, Alan, 38-9, 44, 114
Ritter, James (Jim), 11-12, 114
Robinson, Brian Fyfe, 1 6
Rosenheim, Sir Max (Baron
Rosenheim of Camden from
1972), 20, 21,28, 114
Routledge, Philip (Phil), 28-9, 38-9,
52, 114-15
Rowland, Malcolm, 64, 65
Rubenstein, David, 36
Rubin, Peter, 69
Salmon, William, 7
Schild, Heinz, 29, 115
Scowen, Sir Eric, 25, 115
Shanks, Robin, 10, 21-2, 115
Sharpey-Schafer, Peter, 1 1
Sherlock, Dame Sheila, 24
Somerville, Walter, 43-4
Souhami, Bob, 29
Stacey, Reginald Stephen (Sam), 9,
115-16
Stone, Edward, 6
Swales, John, 42
Tansey, E M (Tilli), 3, 4, 75, 116
Thomas, Molly, 27
Tomlinson, Steve, 73
Tooke, Sir John, 72, 116
Tucker, Geoffrey, 47-8, 49, 65
Turner, Paul, 21-2, 24-7, 35, 39, 40,
42, 44, 49, 62, 67, 77, 116-17
Variance, Patrick, 16-17, 21, 29, 117
Vere, Duncan, 13-14, 21-2, 24, 25-6,
27,40,59,60,61, 117
Vrhovac, Bozidar, 58
Wade, David, 79
Wade, Owen Lyndon, 10-11, 21, 31,
45-6,50,51,52,53,54,59-60,
65, 72-3, 79, 117-18
Wallace, William, 31,79
Walport, Mark, xxi, 118
138
Clinical Pharmacology in the UK, c. 1950-2000: Influences and institutions - Index
Wayne, Sir Edward, 37
Weatherall, Miles, 27, 118-19
Webb, David, 37, 68, 69, 70, 72, 119
Weir, R D, 79
Westerholm, Barbro, 59, 60
Whelan, Elizabeth, 44-5
Whiting, Brian, 15-16
Widdowson, Elsie, 13-14
Wilkinson, Grant, 65
Williams, Hugh, 25
Williams, Richard Tecwyn, 19, 119
Wilson, Andrew, 30, 119-20
Wilson, Clifford, 13, 14
Wilson, Grahame, 37
Winton, Frank, 20
Withering, William, 6
Woods, Frank, 37-8, 120
139
Key to cover photographs
Front cover, top to bottom
Dr Jeffrey Aronson, Professor Sir James Black
Professor Owen Wade
Professor Desmond Laurence
Dr Andrew Herxheimer
Back cover, top to bottom
Professor Donald Davies, Professor Sir Charles George
Professor David Grahame-Smith
Mr Alan Hunter, ProfessorTrevor Jones
Professor Rod Flower (chair)
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