Dear Sir,Clinical pharmacology scope has been significantly expanded in the past four decades. Many clinical application-based tools in the form of pharmacogenomics, pharmacokinetic-based dosing, various hospital-based stewardship, and vigilance programs are being considered in clinical practice.[1] The primary idea of starting Doctor of Medicine (DM) clinical Pharmacology superspecialization course was to rationalize the medicine use, for patients, caregivers and patient populations including special populations such as pediatric and geriatric. The fundamental nectar for the reasonable and efficient use of medications is the information. The drug information needs to be available in a suitable visual aspect to the patients and healthcare practitioners, in accordance to current clinical need and practice.[2] The drug information center concept given by University of Kentucky in 1960s grew into evidence-based medicine on-call service in later years. It has much strengthened potential and wider application in clinical pharmacology services.[3] A regional clinical pharmacology unit in European countries should flock with new medicine registrations, clinical trial co-ordination, medication-related adverse event watch, and medication information catering to the healthcare providers and patient population. Till 2013, in 22 European countries, the clinical pharmacologists provide different drug problems-related counseling as a clinical pharmacology service.[4] During the time of opioid crisis in the USA, over two million of stakeholders formed an “opioid response network”. It is a kind of drug information network including regional clinical pharmacology consultants and organizations to take a control of the misuse and abuse related to opioids and create awareness among public and health care practitioners.[5] Many developed nations have country specific opioid stewardship programs based on this event. The situation is little different with the developing countries. The problems with regard to delivering clinical pharmacology services are multiple, such as, policy implementation, scarcity of trainers, lack of awareness, and funding limitations etc.[3] While talking about India, a prototype resource constrained setting, the clinical pharmacology discipline came into existence in India 50 years back. Few of these services are routinely taken up as a part of the DM clinical pharmacology curriculum in India to train resident doctors. DM clinical pharmacology residents are the ones who have finished their basic medical education with subject specialization, i.e., MBBS and MD Pharmacology. The current curricula of DM clinical pharmacology in India are not uniform throughout the country and varies as per the resources available.[2]In the Western side of the globe, the hospital pharmacists and clinical pharmacists are actively helping patients with drug therapy related counseling over and above clinicians offering an ample amount of time for a thorough discussion over disease prognosis and treatment courses. Indian scenario is almost opposite to that of the western one due to several reasons. Disproportionate doctor-patient ratio, daily wages lost in waiting for consultation in public hospitals, scanty amount of time spent per patient consultation, absence of dedicated clinical pharmacist designation, are some of the major hurdles in providing quality pharmacotherapy with proper counseling in the country.[3] Thus, here is a call for the novel clinical pharmacology service via which one can bridge this gap and help the local population with relevant counseling related to the treatment plan and tailor it toward patient-specific concerns. Patient counseling service run by clinical pharmacology departments with or without the drug information center can revolutionize the evidence based medicine practice of developing nations. To start with, common pharmacogenetically important disorders like G6PD (glucose-6-phosphate dehydrogenase) deficiency, long QT syndrome, mastocytosis, myasthenia gravis, and porphyria may be considered for patient education and counseling [Figure 1] with standard textbook or web based resources like Harrison principles of internal medicine, Lexicomp, or UpToDate website.[3]
Figure 1
Pilot run Pharmacotherapy counselling service from Clinical Pharmacology discipline of developing world
Pilot run Pharmacotherapy counselling service from Clinical Pharmacology discipline of developing world
Figure 1