Preface

For your own satisfaction and for mine, please read this preface!1

Professor D. R. Laurence was either author or coauthor of this textbook from its 1st edition in 1960 to its 8th in 1997. This is a long life for any textbook. Its achievement bears testimony to a style of presentation that strives to be clear and readable, and to retain the reader's interest whilst imparting information about a subject that can be at times both complex and confusing. As he withdraws from active involvement in the book it is opportune to pay tribute in this 9th edition to an achievement in authorship sustained over four decades, during which 'Laurence's pharmacology' became the aid, advisor and companion to generations of students and doctors seeking guidance in the vital field of medicinal therapeutics.

This book is about 'he scientific basis and practice of drug therapy. It is particularly intended for medical students and doctors, and indeed for anyone concerned with evidcnce-based drug therapy and prescribing.

The scope and rate of drug innovation increases.

Doctors are now faced with a professional lifetime handling drugs that are new to themselves — drugs that do new things as well as drugs that do old things better; drugs that become familiar during training will be superseded.

We do not write only for readers who, like us, have a special interest in pharmacology. We try to make pharmacology understandable for those whose primary interests lie elsewhere but who recognise that they need some knowledge of pharmacology if they are to meet their moral and legal 'duty of care' to their patients. We try to tell them what they need to know without burdening them with irrelevant information and we try to make the subject interesting. We are very serious, but seriousness

1 St Francis of Sales: Preface to Introduction to the devout life (1609)

does not always demand wearying solemnity. An author, poet and critic said that he judged fiction thus: 'Could I read it? If I could read it, did I believe it? If I believed it, did I care about it, what was the quality of my caring, and did it last?'2 It would be presumptuous for us to aspire to satisfy the criteria for fiction but we have been mindful of them in producing this book.

All who prescribe drugs would be wise to keep in mind that the expectations of patients and of society in general are becoming ever more exacting and that doctors who prescribe casually or ignorantly now face not only increasing criticism but also civil (or even criminal) legal charges. The ability to handle new developments depends, now more than ever, on comprehension of the principles of pharmacology. These principles are not difficult to grasp and are not so many as to defeat even the busiest doctors who take on themselves the responsibility of introducing manufactured medicines into the bodies of their patients.

The principles of pharmacology and drug therapy will be found in chapters 1-8 and they are applied in the subsequent specialist chapters which are offered as a reasonably brief solution to the problem of combining practical clinical utility with some account of the principles on which clinical practice rests.

How much practical technical detail to include is difficult to decide. In general, where therapeutic practices that are complex, potentially dangerous and commonly up-dated, e.g. anaphylactic shock, we provide more detail together with web-sites that list the latest advice; less, or even no detail is given on therapy that is generally conducted only by specialists, e.g. anticancer drugs and i.v. oxytocin. But always, especially with modern drugs with which the prescriber may not be familiar, formularies, approved guidelines, or the manufacturer's current literature should be consulted.

Use of the book. Students are, or should be, concerned to understand and to develop a rational, critical attitude to drug therapy and they should therefore chiefly concern themselves with how drugs act and interact in disease and with how evidence of therapeutic effect is obtained and evaluated. To this end they should read selectively and should not impede themselves by attempts to memorise lists of alternative drugs and doses and minor differences between them, which should never be required of them in examinations. Thus the text has not been encumbered with exhaustive lists of preparations which properly belong in a formulary, although it is hoped that enough have been mentioned to cover much routine prescribing, and many drugs have been included solely for identification.

The role and status of a textbook. If a book is to be a useful guide to drug use it must offer clear conclusions and advice. If it is to be of reasonable size, alternative acceptable courses of action will often have to be omitted. What is recommended should be based on sound evidence where this exists, and on an assessment of the opinions of the experienced where it does not.

Increasingly, the selection of drugs is influenced by guidelines produced by specialist societies and national bodies. We have provided or made reference to these as representing a consensus of best practice in particular situations. Similarly, it is assumed that the reader possesses a formulary, local or national, which will provide guidance on the availability, including doses, of a broad range of drugs. But the practice of therapeutics by properly educated and conscientious doctors working in settings complicated by intercurrent disease, metabolic differences or personality, involves challenges beyond the rigid adherence to published recommendations. The role of a textbook is to provide the satisfaction of understanding the basis for a recommended course of action so that an optimal result may be achieved by informed selection and use of drugs.

The guide to further reading at the end of each chapter generally comprises a few references to original papers, to referenced editorials and review articles from a small range of English language journals that are likely to be available in most hospital libraries in order to enable anyone, anywhere, to gain access to the original literature and to informed opinion, and also to provide interest and sometimes amusement. We urge readers to select a title that looks interesting and to read the article. We do not attempt to document all the statements we make, which would be impossible in a book of this size.

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