Pharmacy

When I was asked to teach pharmacy students in the medical ward this weekend, I took them to see patients and talked about the way we used drugs. So we started looking at the drug chart of one patient after another. It wasn't surprising that the vast majority of us teach in this way.

A medley of case examples, in essence.

The method notwithstanding, seeing a few cases can be misleading. The plural of anecdote, as many scientists can tell us, is not data. An anecdote is something that happened to my current patient, or any patient I could remember. Alas, it's more often an outlier than not.

That's where statistics comes in.

After talking for more than an hour, I moved to stories with more patients. Those are the stories of many many patients, instead of an anecdote. I digressed and talked about how we discovered new drugs or devices that often fall short of the oh-so-wonderful promise: the oral direct renin inhibitor aliskiren and renal denervation (that had once been thought to be a breakthrough for treating people with stubbornly high blood pressure) are two "good" examples that didn't work out.

Now, move on to name those old-fashioned drugs that were dug out of the cobweb closet, but with new purpose. Think spironolactone, thalidomide, colchicine and pentoxifyline. The ideas range from a new indication of treating blood cancer by a banned pill for morning sickness to, as if by magic, using colchicine (an ancient drug known to curb joint inflammation) to damp down inflammation of a sac surrounding a sick heart. And the list goes on. They all work wonder for new indication!

It's a testament to the mantra why we need old friends.