New
York: McGraw-Hill; 2006; ISBN 0-07-142280-3. $135 2021 pages.
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There
are few technical books that remain in a leadership position for
65 years. The Pharmacological Basis of Therapeutics is
one. Physicians, teachers, and medical students have voted for
Goodman & Gilman with their feet and with their pocketbooks
for over six decades. The question is not whether this is an important
and useful text, but why?
A
sentence by the original authors in their 1940 preface still describes
the 11th edition: "This book has also been written for the
practicing physician, to whom it offers an opportunity to keep
abreast of recent advances in therapeutics and to acquire the
basic principles necessary for the rational use of drugs in his/her
daily practice."1:xxiii The book's 65 chapters
are grouped into 15 sections: General Principles, Drugs Acting
at Synaptic and Neuroeffector Junctional Sites, Drugs Acting on
the Central Nervous System, Drug Therapy of Inflammation, Drugs
Affecting Renal and Cardiovascular Function ... Chemotherapy of
Microbial Diseases, Chemotherapy of Neoplastic Diseases ... Hormones
and Hormone Antagonists, Dermatology, Ophthalmology, Toxicology,
plus two appendices on prescription writing and patient compliance,
and on the design of dosage regimens.
Reading
the sections on general principles reminds one that, with the
notable exception of antimicrobial and antiparasitic therapy,
pharmacology is the science of altering human physiology by chemical
means. The well-written chapter on treating hypertension illustrates
this concept nicely; it is a pleasure to read and a vast improvement
over the PDR or drug company ads. So too is the chapter
on principles of antimicrobial therapy. Given the large number
of authors, some chapters are easier to read than others, but
none can be faulted for lack of well-organized and referenced
information. Comparison of the current edition with the fifth
edition of only 30 years ago provides an interesting insight into
changing times. Then, the great Louis Weinstein personally wrote
all the chapters on antimicrobial agents. In the current edition,
five experienced and specialized physicians are required for that
task.
Even
so, a book this size is not the end-all of pharmacology. Some
uncommon drugs or drug uses are not described; fortunately, references
are provided to information in earlier volumes about some once-major
drugs no longer available in the US: eg, emetine, which has uses,
though no market, far beyond its amebicidal activity. Unusual
uses of medications are noted, eg, cimetidine as a treatment for
warts because of its immunostimulant effects. At the other extreme,
one imagines the current avian influenza threat will generate
great interest in the section on anti-influenza agents. Surprisingly,
immunizing agents are barely mentioned in a total of three pages.
The ever-increasing complexities of HIV treatment are covered
in an understandable fashion.
Appendix
1 deals with prescription writing, the potential for errors in
drug orders, and patient compliance. The book closes with nearly
100 pages of tabular pharmacokinetic data providing nicely organized
data on oral bioavailability, excretion, volume of distribution,
half-life, and other information that is occasionally needed but
usually difficult to locate for commonly prescribed medications.
While
Goodman & Gilman is no quick-read, it is surprisingly
clearly written, logical, and interesting. It is also an awesome
realization to see how much one never knew, added to what one
once knew but forgot. Nevertheless, the logical, step-wise organization
of The Pharmacological Basis of Therapeutics provides a
much greater sense of confidence in one's ability for self-development
than do drug company ads or their frequently underwritten large
clinical trials for me-too drugs. I once knew an older physician
in Baltimore who said he read ten pages every night from the then-current
second edition. While this was easier to do with earlier editions,
the task is still not inconceivable.
Reference
1. Brunton LL, Lazo JS, Parker KL. Goodman & Gilman's The
Pharmacological Basis of Therapeutics, 11th edition. New York:
McGraw-Hill: 2006.
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