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 Clinical pharmacology -

A key to the science and economic efficiency in the health service


Hans-Robert Böhme


The clinical pharmacology is as key to a scientifical and to look at with it economical pharmacotherapy, whose instruments and knowledge cause important health-political, scientifical and lead economical consequences of strategical quality.

The subject need no one vindication from his position, but the fortified use from his knowledge, particularly by the optimization of the co-operation between industry and universities.The consideration of the clinical pharmacology as medical key-discipline bears the decision of the responsible governmental members to the development of this branch calculation.

The concept, ´key-discipline ´ should be used on branches, whose interdisciplinary emplacement, whose instruments (also algorithms are tools!) and possibilities to an improvement of the efficiency of labor lead in the furthest sense, whose right influence not only impulses gives for a qualitative high grade research, but at the same time the transference whose results in the practice speeded or optimized (also meaning ' main projects '; RÜTTGERS/ll9.Vers. GDNÄ).

That from various parties for the health service formulated jobs have the further qualification of the pharmacotherapy to the warranty of a well-founded scientific, effective drug use as target.This wanted target get however, how has the recently time tought, chases with unsuitable wherewithals.

The existing thoughts aren't in the sense to understand fundamental declarations, the often in the course the question of the competence more as a by contents discussion promote.With this collection shall rather a contribution to the discussion of problem, particularly also to the possibilities of the inclusion of non-medical scientists in get delivered the applied research.

With the statement of problems of efficacy at example of the clinical pharmacology shall the implication alonges other disciplines not will deminuted.But earns in the medical range the clinical pharmacology about of the perimeter and the meaning from a rational pharmacotherapy for each doctor a certain exceptional position.

To the meaning of the pharmacotherapy for patients, doctors, health service and society Until to 90% of of all medical performances get today with the application of medicines and you equated products brought in connection. The frequency of the prescribing of drugs and the through them procured costs are for the whole society meaningful.

It gives cause to the acceptance, that beside the introduction new compounds and price increases also other factors to the high disbursements for medicine responsible.With this heard for example the age structure of the population .With rising number of post-working people are disbursements for medicine in this age group especially high.

In the legal health insurance it gives no-one functioning market. The most employee haven't the choice between various insurances with differential outputs (with the possibility to the modular liquidation of the contractor).He can not choose, which risk they save they want.There is only an insurance, this expensively all-risk-insurance.A sick person is as a result also no courted client, but each behaves instead whose so, that he its benefit enlarged and with it harms the system.

The problems, the with a scientifical and also economical drugs use connecting are, put the working field of the branch clinical pharmacology, the also the instruments for the interdisciplinary possible generalization his results possible to the disposition used.So therapeutical directions are possible for all clinical branches.

The compliance to different drugs and the fetish medicine for the patients lead by increasing number relation drugs also to a considerable increase of the every medicine-means inclosed side effects.

The uncritical cessation to the drug`s use through the patients generates by one row of medicines a abusus, the maybe for his part medical treatment get.

Over the counter or over the Internet drawee pain reliever, laxatives, appetite suppressants and tranquilizers are in in this view particularly charged. On sides of the doctor's leads a by teach- and further training courses clear growing increasing unsureness in pharmacotherapeutic questions partly. Also out timewise overloading out to an often pronounced polypragmasy, in whose retinue drug interactions tread up, this can lead to an iatrogenic disease.

The number the to expecting side effects rises exponential with the number of the prescribed drugs.This represents in various sense a charge of the Public Health and the society.

Responsible for the pharmacotherapeutic unsureness of the doctors are e.g. the specialist field electronics comparable short half-lifes of the as saved respected knowledge in the clinical pharmacology.

For the health service is particularly the high portion ambulant ordered medicaments out the group the antibiotics and heart-cardiovascular agent significant.On this occasion are important interdisciplinary differences in the habit to prescribe drugs phrasing differential quantity clinical-pharmacological knowledge, but also restricted diagnostical possibilities in the ambulant or family doctor`s practice.

A system small, handy, battery-operated electronical utensils (for example to the temperature`s measurement, to the judgement the heart-circulation parameters and to the drug- or Compliance-diagnostics could with test-stripes, postulated a sufficient production deposable utensils, as starting point serve to the clinico-pharmacological controlled use of drugs.

A contribution to the dismantling scientific not founded mode of therapy, as she for example in the branches dermatology, psychiatry and stomatology became registered from us, are neutral informations for physicians,which with the corresponding medical societies tuned and periodical updated from us more than 20 years in the field of the last GDR all doctors in personal copies to the disposition became placed.

In this connection will be clinical pharmacologists (also in therapy-commissions) still very much different effective, so that self on university-clinics today as saved to regarding knowledge not adequate is known (for example using of digitalis glycosides).Herzglykoside belong to the medicines with lower therapeutic tolerance.Their misuse is of great consequence.Because of the epidemiological high meaning of heart-circulation-disorders is an optimization of the pharmacotherapy (for example use of calcium-channel-blockers, nitrates) here urgent and the scientifical explanatory statement of the handling of new drugs for instance hemorheologicals of special meaning.

Out clinical-pharmacological view can also a delimitation to the jobs of the pharmacists in this connection not cease. To eximining that from the pharmacists e x t r a biological factors of the drug design,-fabrication and - application under inlay of the the notion biological availability assigned problems can be don't confound with it (also if for example in the USA

and scandinavia with other structure of the Public Health and other course of education `clinical pharmacists' (!) act), that for the fact-finding of the drug`s action at humans and the optimization of the pharmacotherapy in the practice alone the clinico-pharmacological trained or consulting doctor responsible must be.

Before overemphasized recommendations (`positive-,negative lists´, price-limited drug using), the at last equal to a reinforced dirigism, is very to warn, there uncritical generalizations not provided security individual aspects the individual disease`s course and whose complexicity, don't carry calculation and can lead to considerable misjudgements.

Textural helps get the doctors of politics and exchequers thereto hardly are given.By the fact, that year for year physicians working for health insurances get critics, milliards of euros to give out for unscientifical medicine, is it necessary now at last this medicine of one assured (and not with the incompetent stochastics of the federal commision BGA doctors (!) and health insurance practised) sure theoretical concept out to nominate and their prescription to the burden of to rule out the legal health insurance.

To an unscientifical drug`s using heard while not only the too much, but also the too little.

Examples, how uncritical generalizations to the insecurity can contribute of the convenient transact doctor's, are of BÖHME and LUDEWIG analyzed (impact of the laboratory diagnostics under pharmacotherapy, inefficient vitamine B12-therapy, unscientifical therapy of migraine a.o.).

The enforcement of a scientifical and also economical drug therapy must as laggard job without each form of the financial giving in advance on the single patient, an indication and without uncritical application so called alternative therapies get seen (see in this connection the results of that from Novartis inaugurated IGES-study) a number of compounds with high effectiveness and virility for a individualized therapy get after our experiences (clinical- pharmacological board) regarding to their possibility of interactions and dosages in the ambulant practice often scientific unfounded used.this concern for instance betablockers, calcium channel blockers and also hemorheological active agents. Tests, the relations between costs in the health service and the pharmacotherapy at a single patient estimate through the isolated to consideration individual nominal values (for instance costs`average, number of patients per time, costs for drugs per prescription and so on,also uncritical prescription`analysis, drug recommendation lists in every form. Tests of non-professionals are by reason of the complexicity of the influences possible for failing a right conclusion.The prospective determination of the use properties of medicines is only possible by sensible combined application of the instruments of the clinical pharmacology.

The socially meaning of the branch clinical pharmacology, the from the preceding executions already is to size up, must through a accentuation of the training in this area also in the frame of of the study so also the advance training stronger as until now calculation get borne, in which interdisciplinary organizings of the preference should be given.An this place is also the cooperation with philosophers, theologians, economists and possible other scientists possible and necessary. To emplacement, jobs, possibilities and ' tools' of the clinical pharmacology

Medicine have a complete extraordinary economical efficiency effect.

Under efficienca effect get in this connection the ethic and economically higher to estimating `healing value` from a scientific well-founded pharmacotherapy on the one hand and the by development, production, application and selection accessible effciency in reference on the medicine self understood.

Such an is for the diseases poliomyelitis, tuberculosis, measles, the Parkinson` disease, ulcus-disease, acutely leukaemia in the infancy, morbus Hodgkin, seminoms, hemophilia, one time malignant hyperthermia, glaucoma, morbus Werlhof, pemphigus vulgaris, porphyria, hypertension, influenza and much others are proved. Particularly vaccinations have a high, good proved economical effect. Costs-benefit-relation will until to 1: 90 given, with it are ethical and social points of view not yet take into consideration.This must get weighted against the costs.

A number of recommendations, also in textbooks and information materials, bears the at the moment assured knowledge in the clinical pharmacology only insufficient calculation.

The increased requirements of security, the necessity from a differential therapy as pendant of a differential diagnostics, the considerable costs for the finding and developing effectual new therapeutics, new scientific findings to pharmacokinetic (for example first pass effect, biological availability) and pharmacodynamics, the gone up toxicological relevance the medicine also in the frame of interactions with ecologic meaningful factors, the knowledge of the chronoparmacology a.o. require a technology and instruments to the judgement of the effectiveness, safety and the indication of the medicine as well as to the economic meaningful `clearing of lumber` of the pharmacotherapeutical reservoir (examples for judgements thereto deliver BÖHME and LUDEWIG for vitamin B12, secale alkaloids, yohimbine a.o..

Useless medicine can be putted in also not as a placebo. In the opposite to the at non-biological material working scientist must the clinical pharmacologist a n d physician considering an important inter- and intraindividual variability, the neither through hearings of experts still with the methods of the statistics alone is to deal with, but for whose judgement always the scientific checked clinical relevance must be decisive.

Instruments resp. methods, the today in the frame of a scientifical pharmacotherapy through the clinical get pharmacology used, are for instance randomization, crossover-technique, blind design technology, use of placebos, comparison to reference populations, the differentiation of the application potential of drugs according nation's and european legal givings in advance and thereto existing international valid interpretations.

To the derivation of the meaning, the jobs and the possibilities of the clinical pharmacology

After ABSHAGEN is the clinical pharmacology a well-defined academical area, that in research and teachings the substructure for the most important activity of the doctor's (helping and curing is predominant pharmacotherapy), namely the treatment of sicknesses represents with medicines.

Essential target is therefore the conception, proving and scientifical underpinning new pharmacotherapeutic principles after the criterias efficacy and safety as well as the continuously critical revision and further development of the therapeutic principles.

The fortified inclusion of the knowledge and methods of the clinical pharmacology leads through the optimization of the pharmacotherapy to a benefit on quality of life, to the consideration disease-caused changes of the pharmacokinetic and - dynamics and to scientific well-founded cost analysis on the basis from a scientific funded value of therapy in a complex view, the at the moment while about their economical accentuation in the interdisciplinary cooperation still considerable further must be developed. The co-operation between searching and clinical transact doctors gains also by the moral responsibility for the aims of investigations particular meaning.

As main area of the clinical pharmacology (also in the sense of a key or basic science) be valid the deployment new medicine and the optimization of the inset of medicines in the integrated total conception from a rational based pharmacotherapy.

By the judgement, obviation and early diagnosis of side effects.Especially through polypragmasy causes side effects in the frame of drug interactions must between side effects differentiated in the sense of the WHO - definition and mistakes of using, a selectively perception of the risk, the neglect of the comparison to the risk other harmful effects and get avoided an incoherent and complete communication (ABSHAGEN). Out the ignoring of the knowledge and the instruments of the clinical pharmacology results the peril of for the singles patients difficult-weighing and for the society prejudicial misjudgements. Thereto belong dirigism and economism (mostly out professional incompetence) and other forms of the unilateral judgement of the clinical-pharmacological tasks.Typical example are here the legal regulations in the frame of the so-called Health Reform Act of the Federal Republic of Germany (ignoring economical prevailing conditions, problems of using generics, problem of the homogeneity of groups for comparisons, jurisdictional inconsistencies for the contract surgeon a.o.), generate the summarized social costs, extract social therapeutical differences, favour unscientifical therapeutical methods and the contract surgeon a rational therapy next to impossible make. 



Thank you for interest!