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Essentials of clinical pharmacology for education and research in developing countries.

Most academic departments of clinical pharmacology in the U.K. have at some time or another accepted overseas postgraduate students for training purposes and will therefore be acquainted with the problems that can arise in trying to design and organize a suitable training programme. But few attempts have been made to review systematically these difficulties and to try to lay out guide lines for future training. Therefore a Workshop involving clinical pharmacologists from developed and developing countries which took place at the Ciba Foundation, London, in January 1984, under the auspices of the International Union of Pharmacology and the Clinical Section of the British Pharmacological Society is of some note. Laurence & Bennett (1980) have argued that 'no medical school can be considered complete without a department or subdepartment of clinical pharmacology'. Regrettably, a few medical schools in the U.K. are still incomplete, but what of the schools in developing countries? There are few clinical pharmacologists and very few departments of clinical pharmacology (WHO, 1970; Fraser 1981), yet the importance of constructing national drug policies, of promoting rational drug use through effective undergraduate and continuing education, and of initiating relevant basic and clinical research is particularly great in developing countries. In much of the developing world, medical schools have been established comparatively recently, and their lack of clinical pharmacology departments leads to a deficiency of teaching both at an undergraduate and postgraduate level. This state of affairs will continue until positive efforts are made to correct the deficiency. The first priority is to define a realistic clinical pharmacology component in the undergraduate teaching programme for developing countries, and the second is to identify and train physicians to provide such teaching and to fulfil the other duties already mentioned. The undergraduate teaching of clinical pharmacology should not be identical to the teaching in the developed countries. On qualifying, the physician may have access to a limited formulary of drugs and drug costs become of even greater importance. Emphasis should therefore be placed upon these factors throughout the medical course as well as in Finals examinations. In this respect, the presently available textbooks of clinical pharmacology are not ideal for the developing world. Consideration should be given to making available teaching materials which reflect these differences. Such materials might most usefully be organized on a modular basis to make them more flexible and therefore applicable to regional variations in prescribing and disease patterns and availability of drugs. The relevance of clinical pharmacology to clinical medicine can best be transmitted to students by practising physicians who have had a well rounded training in clinical pharmacology, and such individuals would also benefit from specific training in medical teaching and communication skills. The lack of such trained clinical pharmacologists is likely to lead to a continuing dependence on the developed countries for at least the next decade while trainees acquire the skills that they require and return to their own countries to set up departments and develop postgraduate courses of their own. But this present dependence upon Western medical schools means that there must be a clear understanding both on the part of-the sponsoring body and the host institution about the purpose and limitations of the training programme. Too often the postgraduate student arrives to find not only cultural and educational differences which he has to adjust to, but also that the requirements of the higher degree, which his government has indicated that he must acquire, demands that most of his next three years is spent in a very narrow area of research, perhaps involving the use of sophisticated research equipment which is not available in his own country. He may therefore return with none of the broad and simple skills that are essential if he is to persuade his other colleagues, administrators and governmental bodies that clinical pharmacology must in the future play an important part in medical education and health care development. There must be a dialogue between the sponsor and host on exactly what components are necessary. The sponsor may need to have it explained to him that studying for a Ph.D. in drug metabolism in the U.K. may not be the best way of training a doctor to develop local drug formularies or