In a "round table" discussion chaired by Miss Christine Clark (Bury, UK), a panel of three European experts discussed the future of therapeutics over the next five to 10 years
Dr Cecilia Bernsten (national board of health and welfare, Sweden) said that it was important to remember that the use of drugs in the community was affected by a number of social factors.
Dr Bernsten emphasised that it was important, especially with the marketing of new drugs, to use appropriate definitions. She said that a new product was sometimes defined as a drug simply because of who had produced it.
It was important to establish whether new drugs were really indicated for serious disease and whether they were really effective, she added.
Pharmacists need to understand the science and technology behind advanced delivery systems, advised Professor Thordis Kristmundsdottir (professor of pharmaceutics, University of Iceland).
Conventional dosage forms were not adequate for newer therapeutic agents, such as proteins and oligonucleotides, and their use was often limited because of poor solubility or intracellular penetration, she said. Recent research in transdermal therapy used iontophoresis to drive ionised substances across the skin and could offer a true biofeedback mechanism. Patients would need to be advised about using such advanced delivery systems and pharmacists must "be up to the challenge", Professor Kristmundsdottir said.
Drug innovation was not just about new chemical entities, said Dr Hubert Leufkens (University of Utrecht, The Netherlands). Better drug delivery systems, improvement in drug usage and prescribing and individualisation of therapy were all important. The major challenge of the future would be the successful integration between pharmacogenetic, pharmacodynamic and pharmacoepidemiological standpoints, Dr Leufkens concluded.
In the discussion that followed, the panel were asked to comment on the profession's fixation with the need for new therapies to reach good clinical outcomes.
Dr Bernsten agreed that it was possible to produce the same clinical improvements by using older drugs correctly but pointed out that this was unpopular as it was "difficult, hard work and does not generate publications". She added that the most important role of the pharmacist was to manage medications properly and to avoid human and financial costs due to errors.
Commenting on the use of pharmacogenetics to reduce the time taken on clinical studies, Dr Leufkens said that everyone could benefit from good compounds reaching the market as quickly as possible. He added that the system of approval for new compounds must be comprehensive and although he recognised the benefit of selecting populations for trials, this would leave the problem of populations that were not covered.
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