The Pharmaceutical Journal
Vol 277 No 7418 p348
16 September 2006

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Need for better prescribing emphasised more
Why childhood’s imaginary friends may lie at the root of civilisation more
Would rebranding chemistry as molecular science improve its image? more

Need for better prescribing emphasised

An editorial in the 2 September issue of the BMJ by a group of clinical pharmacologists discusses the need for medical students to be given better instruction in the gentle art of prescribing for their patients.

The authors ask whether, with the arrival of new junior doctors in the community, they have been properly trained in practical aspects of drug therapy and the art of prescribing, and believe that they may not have been.

Such concern has been expressed both in the US and in the UK. Effective treatments such as the use of angiotension-converting enzyme inhibitors for heart failure and statins for hyperlipidaemia, have been underprescribed. Prescription errors, especially among new doctors starting work in hospitals, are common and some 6.5 per cent of admissions to hospital, with a mortality rate of 0.15 per cent, are related to adverse drug reactions due to faulty prescribing.

Some errors relate to system failures and it is asked why every NHS hospital has to have its own inpatient-prescribing sheet, when a single national form would suffice.

A fundamental problem is that medical students are not adequately instructed. In 1994 in the UK, they received a median of 61 hours of teaching related to pharmacology, and since then teachers of pharmacology, clinical pharmacology and therapeutics have decreased in numbers. Meanwhile, prescribing is becoming increasingly difficult, with an increased risk of adverse reactions and interactions. Modern drugs are pharmacologically complex, the use of polypharmacy is increasing, and the population treated is ageing.

The root cause of prescribing errors among final year medical students is the lack of integrated scientific and clinical knowledge background. A broader basis is called for. There are too few teachers expert in all the fields. Medical students have expressed the desire for more teaching in practical drug therapy and prescribing.

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Why childhood’s imaginary friends may lie at the root of civilisation

A comment in the 12 August issue of New Scientist throws light upon a facet of childhood which has, I think, an important bearing on civilised behaviour, a quality sadly lacking in the greedy world of today.

Children often converse with mysterious companions who are invisible to observers. It has been estimated that as many as 65 per cent of children up to the age of seven have had at some time an imaginary friend with whom they play, and that these children develop faster psychologically and linguistically than others of the same age who lack such imaginary companions. The friend may be a dog, another child, an adult or some creature of sheer fantasy.

Psychologists suggest that children who entertain such companions learn more quickly that other individuals have beliefs, desires and intentions that differ from their own. They become able to view life from the standpoint of someone else, in other words develop a constructive sympathy and empathy, which better enable them to enter into society without the distrust and envy that do so much to disturb human communities. In most instances, it is believed, imaginary friends fade when a child finds that they are not recognised at school or because real companions arrive to displace them.

In the last resort it all comes down to imagination — the power to consider things that are not evident to the senses. The ability of an individual to understand the reaction of another to any situation and to see someone else’s point of view when it differs from one’s own is vastly underrated as a concept that makes living together in societies possible and reduces to a minimum the friction that gives rise to wars and violence of all kinds. To pretend that taking a tough line towards any person is a sign of strength is nonsense — that it demonstrates a personal sense of inadequacy is much nearer the truth.

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Would rebranding chemistry as molecular science improve its image?

An editorial in the 3 August issue of Science raises the intriguing possibility that getting rid of the title “chemistry” in our curricula might offer a way of rendering it more popular for those who must fund and those who must study it. Six important questions are being asked and, elsewhere in the same issue, attempts are made to answer them. The discipline itself is teeming with fresh ideas and challenges.

The current poor image of chemistry is due in great part to an aura of industrial pollution of the planet and the fact that when we use the word “synthetic” to describe a new product it suggests to some a kind of inferiority to something natural and not thought up in a laboratory. Hence the idea has been mooted that chemistry might better be regarded as molecular science.

Precedents are not lacking. Geologists have come to regard themselves as earth scientists and metallurgists as materials scientists, while biologists have a wide range of titles at their disposal. Changes are not always fashionable but represent a genuine shift of emphasis.

The argument for the term “chemistry” to describe the various sciences of matter and its transformations remain powerful. It is not an endangered subject and may rather be in some respects the victim of its own success. It has opened to us means of probing problems in the life sciences, which without it have proved impenetrable. The label “biochemistry” often is limited to a study of the kinetics of enzyme processes. “Chemical biology” merely shows chemistry as an adjunct to a separate discipline. In academia such moves might only serve to displace chemistry into other departments of science.

Chemistry needs to reassert itself as a core scientific discipline in its own right.

The traditional divisions into organic and inorganic chemistry are now irrelevant in many respects and more effort is needed to associate them with the phenomenon of life in general where the general public is unaware of the basic functioning of chemistry pure and simple.

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