Progress in Drug Research / Fortschritte der Arzneimittelforschung / Progrès des recherches pharmaceutiques PDF
Preview Progress in Drug Research / Fortschritte der Arzneimittelforschung / Progrès des recherches pharmaceutiques
PROGRESS IN DRUG RESEARCH FORTSCHRITTE DER ARZNEIMITTELFORSCHUNG PROGRES DES RECHERCHES PHARMACEUTIQUES Vol. 22 Progress in Drug Research Fortschritte der Arzneimittelforschung Progres des recherches pharmaceutiques Vol. 22 Edited by. Herausgegeben von· Redige par ERNST JUCKER, Basel Authors· Autoren . Auteurs A.F. eASY, P.F. D'ARcy and E.M. SCOTT, H.P. KUEMMERLE, I. OSWALD, O. SCHIER and A. MARxER, L.H. STERNBACH, D.L. SWALLOW, J. VENULET 1978 Birkhauser Verlag Basel und Stuttgart All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronical, mechanical, photocopying, recording or otherwise, without the prior permission of the copyright owner. © Birkhlluser Verlag Basel, 1978 Softcover reprint of the hardcover 1st edition 1978 ISBN-13:978-3-0348-7104-4 e-ISBN-13:978-3-0348-7102-O DOl: 10.1007/978-3-0348-7102-0 Foreword Volume 22 of 'Progress in Drug Research' contains 8 contributions from vari- ous areas of drug research and therapy. As in previous volumes, in the present volume the authors have also tried not only to summarize the current status of particular fields of drug research, but also to provide leads for future research activity. The various contributions in this volume will be of especial value not only to those actively concerned in resolving the diverse problems in drug research, but also to those who wish to keep abreast of the latest developments influencing modem therapy. In addition, it is believed that volume 22 and the previous 21 volumes of 'Progress in Drug Research' so far published represent a useful reference work of an encyclopaedic character. The editor would also like to take this opportunity of expressing his gratitude to those who reviewed the previous volumes of this series of monographs and, by doing so gave useful advice for the future volumes. At the same time, thanks are expressed to Dr. A. Naf for carefully working over the manuscripts and correcting proofs. Thanks are also due to the publishers and the printers, Druckerei Birkhauser, especially to Messrs. Th. Birkhauser and C. Einsele. Unfortunately, this is the last volume which went into ptess during Dr. A. Birkhauser's lifetime; he passed away on March 4, 1978 and the editor would like to stress the fact'tl;tat.this series of monographs would not have been founded, had Dr. Birldiauser not given his strong support 20 years ago. April 1978 Dr. E. JUCKER Sandoz AG, Basel Vorwort Der 22. Band der «Fortschritte der Arzneimittelforschung» umfaBt 8 Beitriige aus verschiedenen Gebieten der Arzneimittelforschung und der Therapie. Dieser Band lehnt sich wiederum insofem an seine Vorgiinger an, als die Au- toren versucht haben, nicht nur den gegenwiirtigen Stand des betreffenden Forschungsgebietes darzustellen, sondem dariiber hinaus auch in die Zukunft weisende Betrachtungen anzustellen. Die verschiedenen Beitriige in diesem Band werden sowohl fur jene, die sich mit den mannigfaltigen Problemen der Arzneimittelforschung auseinandersetzen, als auch fUr jene, die sich uber neueste, die modeme Therapie beeinfiussende Entwicklungen auf dem lau- fenden halten wollen, von besonderem Nutzen sein. Es darf angenommen werden, daB die bisher erschienenen 22 Biinde der «Fortschritte der Arznei- mittelforschung» ein wertvolles Nachschlagewerk mit enzyklopiidischem Charakter darstellen. Der Herausgeber mochte diese Gelegenheit auch wahmehmen, um all jenen seine Dankbarkeit auszudriicken, die friihere Biinde der Monographienreihe rezensiert und damit wertvolle Hinweise fUr zukunftige Biinde gegeben haben. Fur die sorgfaltige Dberarbeitung der Manuskripte und die Korrektur der Fahnenabzuge sei Herm Dr. A. Niif der beste Dank ausgesprochen. Dank gebUhrt auch dem Vedag und der Druckerei Birkhiiuser, besonders den Herren Th. Birkhiiuser und C. Einsele. Leider ist dies der letzte Band, der noch zu Lebzeiten von Herm Dr. A.Birkhiiuser in Druck ging; er starb am 4. Miirz 1978, und der Herausgeber mochte hier betonen, daB diese Monographien- reihe ohne die ausdriickllche Unterstutzung durch Herm Dr. Birkhiiuser vor 20 Jahren nicht gegriindet worden wiire. April 1978 Dr. E. JUCKER Sandoz AG, Basel Contents· Inhalt· Sommaire· Vol. 22 Aspects of social pharmacology ................................... 9 By Prof. Dr. J. VENULET Fundamental structures in drug research II . . . . . . . . . . . . . . . . . . . . . . . . .. 27 By Dr. O. SCHIER and Prof. Dr. A. MARXER Antifungal agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 93 By Prof. Dr. P.F. D'ARcy and Dr. E.M. SCOTT Analgesics and their antagonists: Recent developments ............... 149 By Dr. A. F. eASY The benzodiazepine story .................................. . . . . . . 229 By Dr. L. H. STERNBACH Antiviral agents ................................................ 267 By Dr. D.L. SWALLOW Klinisch-pharmakologische Kriterien in der Bewertung eines neuen Anti- biotikums. Grundlagen und methodische Gesichtspunkte ............ 327 Von Prof. Dr. H.P. KUEMMERLE Drug research and human sleep. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 355 By Prof. Dr. I. OSWALD Index Vol. 22 .................................................. 373 Subject Index· Sachverzeichnis· Table des matieres, Vol. 1-22 .......... 383 Author and Paper Index· Autoren- und Artikelindex· Index des auteurs et des articles, Vol. 1-22 ............................................ 389 9 Aspects of social pharmacology By Jan Venulet Division of Clinical Pharmacology, Department of Medicine, H6pital Cantonal and University of Geneva, Geneva, Switzerland 1 Development and definitions .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 2 Parties involved in social pharmacology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 2.1 Drug manufacturer ...................................................... 18 2.2 Drug-regulatory agency. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 2.3 Retailer ................................................................ 19 2.4 Prescriber (doctor) ....................................................... 20 2.5 Consumer (patient) ...................................................... 21 3 Non-medical uses of drugs ................................................ 23 4 Chernicalization of daily life . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 10 J. Venulet: Social Pllarmacology Development and definitions As is the case with terms composed of more than one word, an explanation of what the term means can start with the first or last word. As a pharmacologist I see social pharmacology as the ultimate step in the natural history of pharmacology, in which the properties of a drug, its availability, doctors' prescribing patterns, patients' compliance, etc. combine and interact in a manner which determines the final effects of the therapeutic efforts. Needless to say, for various reasons and quite independent of the correctness of medical thinking, diagnosis, etc. the final outcome often falls short of that intended. Pharmacology is a vast science. Over the years it has been the subject of considerable evolution. Several major phases can be distinguished, as depicted in figure 1 which will be frequently referred to in this section. On the left-hand side of the figure facts and factors relevant to the evolution of pharmacology are listed. On the right-hand side their effects on the discipline itself are set out. The development of physiology and experimental methods has significantly contributed to the evolution of pharmacology into an independent and experimental science. The study of the effects of various substances under experimental conditions made possible a departure from the approach of classical materia medica that is mainly descriptive and relies upon empirical observation, and thus the provision of a more rational basis for pharmaco- therapy was set. In this way experimental pharmacology was born (fig. l, sect. I and II). The development of biochemistry and the introduction of new techniques have provided new insights into intimate biological processes. Pharmacologists immediately started using these techniques to study bio- chemical mechanisms of drug actions which led to the development of biochemical pharmacology (fig. l, sect. III) besides making a considerable contribution to the development of biochemistry itself. In spite of the seemingly better knowledge of the effects of various drugs, it became more and more evident that the results of animal studies quite often differ from the effects observed in man. Additionally, professors of clinical disciplines in medical schools sometimes expressed their dissatisfaction with the practical value, as applied to patients, of the pharmacological background acquired by medical students during their preclinical years. This situation has been probably aggravated more recently because of the steadily increasing number of pharmacologists without full medical training. Thus, it is the domain of clinical pharmacology (fig. l, sect. IV), which is now recognized as a medical speciality in its own right, to study drugs in man and to advise the doctor on the rational use of them. Although clinical trials of new drugs are carried out according to strict scientific criteria, with proper controls, and using single- or double-blind procedures, and sophisticated statistical analysis, the medical community, health authorities and pharmaceutical manufacturers are sometimes bitterly J. Venulet: Social Pharmacology 11 From experimental to social pharmacology I. Empirical observations --- .. ·1 Materia medica_I , Experimental pharmacology II. Development of physiology .. (animals, tissular level, and of experimental methods functional exploration) t Biochemical pharmacology III. Development of biochemistry (subcellular level, drug and of biochemical methods .. metabolism and pharmaco- kinetics) IVa. Differences between man and animal in etiology and Clinical pharmacology pathogenesis of disease _____. ....;.~ (objective: rational b. Differences in response pharmacotherapy) between man and animal J c. Role of pathological condition Va. Research and interpretation of rare drug reactions b. large scale retrospective and prospective studies ----.~IEpidemiological pharmacolog~ c. Non-medical use of medicines and drugs d. Role of the environment Vl.i. Social implications following the use of drugs ii. Role of "derationalising" factors a. Social environment b. Economic situation c. Relationships: Doctor. • Patient I I l >< ~ ----...~. Social pharmacology Industry • • Government iii. Social aspects of the use of medicines and drugs for non-medical reasons Figure 1 From experimental to social pharmacology.
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