Tablets engraved with history

Human Drug Metabolism - Life Saving Drugs
February 24, 2006

Human Drug Metabolism is an introductory text that deals with the metabolic aspect of drug pharmacokinetics only. It would thus not be useful as the sole course textbook for medical and biological students since a general text about pharmacokinetics at a more fundamental level would be preferred. It is, however, likely to be of interest to specialist staff, research postgraduate students or undergraduates studying specific areas such as toxicology.

Chapters include detailed information on the human body's drug metabolising processes (processes I-III). Many factors that can affect these metabolic processes are then covered including genetic polymorphisms, drug interactions, age and so on. Attention is given to the important ways that these interfering factors can cause diverse unwanted clinical consequences by making a drug either less available or more toxic. Another chapter addresses specifically the metabolism of illicit drugs. There is also a chapter referring to examination techniques for undergraduate students, which in this book appears out of place.

The scientific content of this book has merit; it gathers together information from different sources that could be dipped into for pieces of information that may not be easily available elsewhere. However, there are certain drawbacks in the delivery of the material, notably the clinical aspects of the book. The chapter "Induction of Phase 1 systems" begins with six brief case histories, which are then repeatedly referred to. Some lack sufficient information to be useful and are not easy to interpret.

There are many spelling errors in the text, including in the contents page and some drug names, and the clarity of the explanations in some areas is not as clear as it could have been; it is not helped by the poor quality of some of the diagrams. Unfortunately, the author mixes US drug terminology (for example, meperidine rather than pethidine) with European drug terminology, and not all of his latter terminology is widely accepted.

Life Saving Drugs could not be a more different book. Although written in the popular science genre, it is essentially a history book of pharmacology - replete with dates, people and places involved in key events - and has three chapters covering pharmacological treatments of bacteria, viruses and cancer. It explores how close we have come to finding the elusive magic bullet, a drug that cures ills without unwanted effects. The preface states that the book is an expansion of an earlier book to include molecular structures and explanations of the modes of actions for most of the drugs included.

Reading afresh the apocryphal stories of Alexander Fleming's discovery of penicillin and cephalosporins isolated from a sewage outfall in Cagliari, as covered in the first chapter, evoked pleasant fantasies of a perhaps more simple scientific world. Here the author captures the pharmacological romance of an earlier era and the sense of medical breakthroughs that really made a difference.

But as he moves to describe discoveries of recent times - for example, the drugs used to treat HIV and cancer - the sepia photographs of our pharmacological forebears in old laboratories disappear and the text becomes more commonplace. Nevertheless, there are still engaging stories to capture the excitement of continuing pharmacological progress.

I remain ambivalent about whether the introduction of drug structures will add to the understanding of readers who do not have a pharmacological background. Where these structures are carefully linked to the mode of action of drugs (for example, with sulphonamides and antiretroviral drugs) they work, but otherwise they are not particularly helpful. Some diagrams about the modes of actions of drugs would have benefited from more detailed explanatory notes. However, Life Saving Drugs will be beneficial to undergraduates, not as a core text but to broaden their perspective and to show them that pharmacology and history are never dull.

Keith Hillier is senior lecturer in pharmacology and medical education, Southampton University.

Human Drug Metabolism: An Introduction. First Edition

Author - Michael D. Coleman
Publisher - Wiley
Pages - 4
Price - £70.00 and £.50
ISBN - 0 470 86352 8 and 86353 6

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