2 Pharmaceutical Medicine

as a Medical Specialty

Michael D. YoungandPeter D. Stonier

Medicine is an art that has been practiced since
time immemorial. The use of herbs and natural
medicaments to relieve pain or to aid the sick in
coping with their afflictions has been a part of all
societies. In the Western world, medicine has
developed at least since the time of the Greeks
and Romans – the Hippocratic oath reminds us of
this nearly 2500-year history. However, the pro-
gress of medicine has been very different from that
ofmany other arts withinsociety. It hascome of age
after an incredibly long maturation period. As a
function capable of offering a successful treatment
for a human ailment, medicine is very much a
development of the last 100–150 years. Indeed,
the major advances have come in the last 50–75
years.
The role of physicians in society has changed
over the centuries. It may have reached its nadir
during the early renaissance, when the general
attitude was, as Shakespeare said, ‘Trust not the
physician; his antidotes are poison’. From nine-
teenth century onwards, with their growing diag-
nostic understanding and their therapeutic agents
becoming increasingly effective, physicians have
come to be increasingly valued. Today, much of the
practice of medicine in all of its subspecialities is
based on a physician’s diagnosis and treatment
with drugs, devices or surgery. This radical change

to an era of focused treatments, after aeons of using

homespun remedies and then watching hopefully

for the crisis or the fever to pass, has accompanied

the recent revolutions in the understanding of bio-

logical processes and in technical and biotechnical

capabilities. These developments have allowed us

to produce pure therapeutic agents and establish

their safe and effective use.

The exponential growth in scientific knowledge,

particularly over the last 100 years, has brought

about a paradigm shift in our approach to pharma-

ceuticals. Until the twentieth century, the sale and

use of medicines and medical devices was almost

entirely unregulated by governments. It was a case

ofcaveat emptor, with only the drug taker’s com-

mon sense to protect against the dangers of the so-

called patent medicines and ‘snake oils’. The

obvious abuses in these situations eventually led

to government intervention, professional regula-

tion and requirements that drugs be pure and una-

dulterated. With advances in science and in the

ability to define and establish drug efficacy came

a requirement to demonstrate that drugs were also

safe. Finally, as late as the second half of the

twentieth century, came the legal requirement to

establish that pharmaceuticals were effective

before they were marketed. These legal require-

ments reflected changes in social attitudes and

Principles and Practice of Pharmaceutical Medicine, 2nd Edition Edited by L. D. Edwards, A. J. Fletcher, A. W. Fox and P. D. Stonier
#2007 John Wiley & Sons, Ltd ISBN: 978-0-470-09313-9