Health promotion

From Wikipedia, the free encyclopedia

Health promotion is, as stated in the 1986 World Health Organization (WHO) Ottawa Charter for Health Promotion, "the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy life-styles to well-being".

Scope

The WHO's 2005 Bangkok Charter for Health Promotion in a Globalized World defines health promotion as "the process of enabling people to increase control over their health and its determinants, and thereby improve their health".

Health promotion involves public policy that addresses health determinants such as income, housing, food security, employment, and quality working conditions. More recent work has used the term Health in All Policies to refer to the actions that incorporate health into all public policies. Health promotion is aligned with health equity and can be a focus of non-governmental organizations (NGOs) dedicated to social justice or human rights. Health literacy can be developed in schools, while aspects of health promotion such as breastfeeding promotion can depend on laws and rules of public spaces. One of the Ottawa Charter Health Promotion Action items is infusing prevention into all sectors of society, to that end, it is seen in preventative healthcare rather than a treatment and curative care focused medical model. 

There is a tendency among some public health officials, governments, and the medical industrial complex to reduce health promotion to just developing personal skill also known as health education and social marketing focused on changing behavioral risk factors.

History

This first publication of health promotion is from the 1974 Lalonde report from the Government of Canada, which contained a health promotion strategy "aimed at informing, influencing and assisting both individuals and organizations so that they will accept more responsibility and be more active in matters affecting mental and physical health". Another predecessor of the definition was the 1979 Healthy People report of the Surgeon General of the United States, which noted that health promotion "seeks the development of community and individual measures which can help... [people] to develop lifestyles that can maintain and enhance the state of well-being".

At least two publications led to a "broad empowerment/environmental" definition of health promotion in the mid-1980s:

• In year 1984 the WHO Regional Office for Europe defined health promotion as "the process of enabling people to increase control over, and to improve, their health". In addition to methods to change lifestyles, the WHO Regional Office advocated "legislation, fiscal measures, organisational change, community development and spontaneous local activities against health hazards" as health promotion methods.
• In 1986, Jake Epp, Canadian Minister of National Health and Welfare, released Achieving health for all: a framework for health promotion which also came to be known as the "Epp report". This report defined the three "mechanisms" of health promotion as "self-care"; "mutual aid, or the actions people take to help each other cope"; and "healthy environments".
• 1st International Conference on Health Promotion, Ottawa, 1986, which resulted in the "Ottawa Charter for Health Promotion". According to the Ottawa Charter, health promotion:
  • "is not just the responsibility of the health sector, but goes beyond healthy life-styles to well-being"
  • "aims at making... [political, economic, social, cultural, environmental, behavioural and biological factors] favourable through advocacy for health"
  • "focuses on achieving equity in health"
  • "demands coordinated action by all concerned: by governments, by health and other social organizations."

The "American" definition of health promotion, first promulgated by the American Journal of Health Promotion in the late 1980s, focuses more on the delivery of services with a bio-behavioral approach rather than environmental support using a settings approach. Later the power on the environment over behavior was incorporated. 

The WHO, in collaboration with other organizations, has subsequently co-sponsored international conferences including the 2015 Okanagan Charter on Health Promotion Universities and Colleges.

Workplace Setting

The process of health promotion works in all settings and sectors where people live, work, play and love. A common setting is the workplace. The focus of health on the work site is that of prevention and the intervention that reduces the health risks of the employee. The U.S. Public Health Service recently issued a report titled "Physical Activity and Health: A Report of the Surgeon General" which provides a comprehensive review of the available scientific evidence about the relationship between physical activity and an individual's health status. The report shows that over 60% of Americans are not regularly active and that 25% are not active at all. There is very strong evidence linking physical activity to numerous health improvements. Health promotion can be performed in various locations. Among the settings that have received special attention are the community, health care facilities, schools, and worksites. Worksite health promotion, also known by terms such as "workplace health promotion," has been defined as "the combined efforts of employers, employees and society to improve the health and well-being of people at work". WHO states that the workplace "has been established as one of the priority settings for health promotion into the 21st century" because it influences "physical, mental, economic and social well-being" and "offers an ideal setting and infrastructure to support the promotion of health of a large audience".

Worksite health promotion programs (also called "workplace health promotion programs," "worksite wellness programs," or "workplace wellness programs") include exercise, nutrition, smoking cessation and stress management. 

According to the Centers for Disease Control and Prevention (CDC), "Regular physical activity is one of the most effective disease prevention behaviors." Physical activity programs reduce feelings of anxiety and depression, reduce obesity (especially when combined with an improved diet), reduce risk of chronic diseases including cardiovascular disease, high blood pressure, and type 2 diabetes; and finally improve stamina, strength, and energy.

Reviews and meta-analyses published between 2005 and 2008 that examined the scientific literature on worksite health promotion programs include the following:

• A review of 13 studies published through January 2004 showed "strong evidence... for an effect on dietary intake, inconclusive evidence for an effect on physical activity, and no evidence for an effect on health risk indicators".
• In the most recent of a series of updates to a review of "comprehensive health promotion and disease management programs at the worksite," Pelletier (2005) noted "positive clinical and cost outcomes" but also found declines in the number of relevant studies and their quality.
• A "meta-evaluation" of 56 studies published 1982–2005 found that worksite health promotion produced on average a decrease of 26.8% in sick leave absenteeism, a decrease of 26.1% in health costs, a decrease of 32% in workers’ compensation costs and disability management claims costs, and a cost-benefit ratio of 5.81.
• A meta-analysis of 46 studies published in 1970–2005 found moderate, statistically significant effects of work health promotion, especially exercise, on "work ability" and "overall well-being"; furthermore, "sickness absences seem to be reduced by activities promoting healthy lifestyle".
• A meta-analysis of 22 studies published 1997–2007 determined that workplace health promotion interventions led to "small" reductions in depression and anxiety.
• A review of 119 studies suggested that successful work site health-promotion programs have attributes such as: assessing employees' health needs and tailoring programs to meet those needs; attaining high participation rates; promoting self care; targeting several health issues simultaneously; and offering different types of activities (e.g., group sessions as well as printed materials).

Entities and projects by country

Worldwide, government agencies (such as health departments) and non-governmental organizations have substantial efforts in the area of health promotion. Some of these entities and projects are:

International and multinational

The WHO and its Regional Offices such as the Pan American Health Organization are influential in health promotion around the world. The main eight health promotion campaigns marked by WHO are World Health Day, World Tuberculosis Day, World Blood Donor Day, World Immunization Week, World Malaria Day, World No Tobacco Day, World Hepatitis Day and World AIDS Day.

The International Union for Health Promotion and Education, based in France, holds international, regional, and national conferences.

The European Union is co-funding a Joint Action on Chronic Diseases and Healthy Ageing across the Life Cycle (JA-CHRODIS) with a strong focus on health promotion.

Australia

The Australian Health Promotion Association, a professional body, was incorporated in year 1988. In November 2008, the National Health and Hospitals Reform Commission released a paper recommending a national health promotion agency. ACT Health of the Australian Capital Territory supports health promotion with funding and information dissemination. The Victorian Health Promotion Foundation (VicHealth) from the state of Victoria is "the world’s first health promotion foundation to be funded by a tax on tobacco." The Australian Government has come up with some initiatives to help Australians achieve a healthy lifestyle. These initiatives are:

• Get Set 4 Life - Habits for Healthy Kids
• The Stephanie Alexander Kitchen Garden National Program
• Healthy Spaces and Places
• Learning from Successful Community Obesity Initiative
• Healthy Weight information and resources.

Health Promotion is strong and well-established in Australia. Since 2008 there has been a number of graduate courses people can take to be involved within Health Promotion in Australia. The government since 2008 has included an initiative that involves the Aboriginal and Torres Strait Island citizens in the preventive health sector.

Health Promotion In Australian Schools

School programs are based on curriculum documents from state and territorial councils. Schools mainly focus on health issues that are being supported by funding and special events. Funding for many health issues are the main basis for the school curriculum's subject of health.

Health Promotion for Aboriginal and Torres Strait Islander Citizens

Aboriginal and Torres Strait Island citizens in Australia in the last couple of centuries have had poor health. The reason behind the poor health conditions is due to major events in the history of Australia. There is an increasing advancement in the promotion of health for Torres Strait Islander and Aboriginal citizens, but this cannot be achieved without the co-operation of non-indigenous Australians. For this health promotion to be a success, the citizens of Australia need to put the history between non-indigenous and indigenous citizens behind them and co-operate as equals.

Canada

The province of Ontario appointed a health promotion minister to lead its Ministry of Health Promotion in the year of 2005.

The Ministry’s vision is to enable Ontarians to lead healthy, active lives and make the province a healthy, prosperous place to live, work, play, learn and visit. Ministry of Health Promotion sees that its fundamental goals are to promote and encourage Ontarians to make healthier choices at all ages and stages of life, to create healthy and supportive environments, lead the development of healthy public policy, and assist with embedding behaviours that promote health.

The Canadian Health Network was a "reliable, non-commercial source of online information about how to stay healthy and prevent disease" that was discontinued in 2007.

The BC Coalition for Health Promotion is "a grassroots, voluntary non-profit society dedicated to the advancement of health promotion in British Columbia".

Ireland

Health Promotion Research in Ireland

The Health Promotion Research Centre (HPRC) at the National University of Ireland Galway was established in 1990 with support from the Department of Health to conduct health promotion related research on issues relevant to health promotion in an Irish context. The Centre is unique in that it is the only designated research centre in Ireland dedicated to health promotion. It produces high quality research of national and international significance that supports the development of best practice and policy in the promotion of health. The Centre is a World Health Organization (WHO) Collaborating Centre for Health Promotion Research, has an active multidisciplinary research programme, and collaborates with regional, national and international agencies on the development and evaluation of health promotion interventions and strategies.

Objectives of the HPRC include:

• The generation and dissemination of health promotion research that is of national and international relevance.
• The translation of research that will lead to the development of healthy public policy and evidence-informed practice.

New Zealand

The Health Promotion Forum (HPF) of New Zealand is the national umbrella organization of over 150 organisations committed to improving health. HPF has worked with The Cancer Society in order to produce a personal development plan for health promoters, which may be helpful to perform personal development reviews, to identify the competencies of individuals and to provide ideas for future development.

The Health Promotion Agency (HPA), formed July 1, 2012, is a Crown institution that has been established under the New Zealand Public Health and Disability Amendment Act 2012. Its board has been appointed by the Minister of Health. The work of HPA is divided into three main areas:

• Promoting the wellbeing and health of the community
• Enabling health promoting initiatives and environments
• Informing the public on health promoting policies and practices

HPA has a variety of programs based around many areas of work, including alcohol, immunisation, mental health, and skin cancer prevention. The agency aims to promote the wellbeing of individuals and encourage healthy lifestyles, prevent disease, illness and injury, enable environments that support health and wellbeing, and to reduce personal, economic and social harm.

Health Workforce New Zealand (HWNZ) is an organisation that is part of the National Health Board which provides national leadership on the development of the health workforce. Some health promotional programs supported by HWNZ include education and training initiatives, and the Voluntary Bonding Scheme, which rewards medical, midwifery and nursing graduates who agree to work in hard-to-staff communities, and sonography, medical physicist and radiation therapy graduates who stay in New Zealand.

Health promotion in New Zealand has become an established approach in addressing public problems since the 1980s, through increasing use of intersectoral action, the use of public policy and mass media as promotional strategies, and the increasing control Maori have taken over the provision and purchase of health promotion services. An example of health promotional initiatives is the action put in place to reduce childhood obesity in primary schools. Research was completed to identify the barriers to improving school food environments and promoting healthy nutrition in primary schools in New Zealand.

Considerable progress has also been made in the health impact assessment (HIA) research on the impact of policies on health in New Zealand. The approach has an important contribution to make in the strengthening of health and wellbeing in policymaking in New Zealand.

Sri Lanka

In 2015, the life expectancy of Sri Lankan people was 72 for male and 78 for female. The disease burden has started to shift towards non-communicable diseases related to lifestyle and environmental factors. The 2012 estimated “healthy life expectancy” at birth of all Sri Lanka's population is 68 for females, 63 for males, and 65 overall. 

The development of the Sri Lankan National Health Promotion Policy is related to the State Policy and Strategy for Health and the Health Master Plan 2007–2016. It emphasises advocacy and empowerment to enable individuals and communities to take control of their own health, as well as improving the management of health promotion interventions across sectors.

Sweden

In Sweden, on a national level, health promotion is primarily the responsibility of the Public Health Agency of Sweden. However, many regional initiatives exist, for example, within clinical health promotion programs in certain geographical areas . Health promotion is also highlighted by the Swedish National Board of Health and Welfare as the agency suggests this to be a component in health professionals' curriculum and training, which concerns, for example, Registered Nurses and Physicians.

Many health promotion initiatives in Sweden focus on health equity and thus focus on groups in society that have seen to be experiencing poorer health status. For example, a Swedish study suggest that health promotion interventions aiming at empowering adolescents in disadvantaged communities, should enable active learning activities, use visualizing tools to facilitate self-reflection, and allow the adolescents to influence the intervention activities.

United Kingdom

The Royal Society for Public Health was formed in October 2008 by the merger of the Royal Society for the Promotion of Health (also known as the Royal Society of Health or RSH) and the Royal Institute of Public Health (RIPH). Earlier, July 2005 saw the publication by the Department of Health and Welsh Assembly Government of Shaping the Future of Public Health: Promoting Health in the NHS. Following discussions with the Department of Health and Welsh Assembly Government officials, the Royal Society for Public Health and three national public health bodies agreed, in 2006, to work together to take forward the report's recommendations, working in partnership with other organisations. Accordingly:

1. The Royal Society for Public Health (RSPH) leads and hosts the collaboration, and focuses on advocacy for health promotion and its workforce;
2. The Institute of Health Promotion and Education (IHPE) works with the RSPH Royal Society for Public Health to give a voice to the workforce;
3. The Faculty of Public Health (FPH) focuses on professional standards, education and training; and
4. The UK Public Health Register (UKPHR) is responsible for regulation of the workforce.

In Northern Ireland, the government's Health Promotion Agency for Northern Ireland was set up to "provide leadership, strategic direction and support, where possible, to all those involved in promoting health in Northern Ireland". The Health Promotion Agency for Northern Ireland was incorporated into the Public Health Agency for Northern Ireland in April 2009.

Recent work in the UK (Delphi consultation exercise due to be published late 2009 by Royal Society of Public Health and the National Social Marketing Centre) on the relationship between health promotion and social marketing has highlighted and reinforced the potential integrative nature of the approaches. While an independent review (NCC 'It's Our Health!' 2006) identified that some social marketing has in the past adopted a narrow or limited approach, the UK has increasingly taken a lead in the discussion and developed a much more integrative and strategic approach. This development adopts a holistic approach, integrating the learning from effective health promotion approaches with relevant learning from social marketing and other disciplines. A key finding from the Delphi consultation was the need to avoid unnecessary and arbitrary 'methods wars' and instead focus on the issue of 'utility' and harnessing the potential of learning from multiple disciplines and sources. Such an approach is arguably how health promotion has developed over the years pulling in learning from different sectors and disciplines to enhance and develop.

United States

Government agencies in the U.S. concerned with health promotion include the following:

• The Centers for Disease Control and Prevention has a Coordinating Center for Health Promotion whose mission is to "Prevent disease, improve health, and enhance human potential through evidence based interventions and research in maternal and child health, chronic disease, disabilities, genomics, and hereditary disorders".
• The National Institute for Occupational Safety and Health has developed Total Worker Health, a strategy incorporating elements of occupational safety and health and health promotion, to advance the health and well-being of employees.
• The United States Army Center for Health Promotion and Preventive Medicine "provide[s] worldwide technical support for implementing preventive medicine, public health, and health promotion/wellness services into all aspects of America's Army and the Army Community".

Nongovernmental organizations in the U.S. concerned with health promotion include:

• The Public Health Education and Health Promotion Section is an active component of the American Public Health Association.
• The National Commission for Health Education Credentialing offers the NCHEC, a competency-based tool used to measure possession, application and interpretation of knowledge in the Seven Areas of Responsibility for Health Education Specialists. The exam reflects the entry-level sub-competencies of these areas of responsibility.
• The Wellness Council of America is an industry trade group that supports workplace health promotion programs.
• URAC (Utilization Review Accreditation Commission) accredits comprehensive wellness programs "that focus on health promotion, chronic disease prevention and health risk reduction".

Pharmacopoeia

From Wikipedia, the free encyclopedia

Back cover of the Chinese Pharmacopoeia (first edition; published in 1930)

 

A pharmacopoeia, pharmacopeia, or pharmacopoea (literally, “drug-making”), in its modern technical sense, is a book containing directions for the identification of compound medicines, and published by the authority of a government or a medical or pharmaceutical society.

Descriptions of preparations are called monographs. In a broader sense it is a reference work for pharmaceutical drug specifications.

Etymology

The term derives from Ancient Greek: φαρμακοποιΐα pharmakopoiia "making of (healing) medicine, drug-making", a compound of φάρμακον pharmakon "healing medicine, drug, poison", the verb ποιεῖν poiein "to make" and the abstract noun suffix -ία -ia.

In early modern editions of Latin texts, the Greek diphthong οι (oi) is latinized to its Latin equivalent oe which is in turn written with the ligature œ, giving the spelling pharmacopœia; in modern UK English, œ is written as oe, giving the spelling pharmacopoeia, while in American English oe becomes e, giving us pharmacopeia.

History

Although older writings exist which deal with herbal medicine, the major initial works in the field are considered to be the Edwin Smith Papyrus in Egypt, Pliny’s pharmacopoeia and De Materia Medica (Περὶ ὕλης ἰατρικῆς), a five-volume book originally written in Greek by Pedanius Dioscorides. The latter is considered to be precursor to all modern pharmacopoeias, and is one of the most influential herbal books in history. In fact it remained in use until about CE 1600.

A number of early pharmacopoeia books were written by Persian and Arab physicians. These included The Canon of Medicine of Avicenna in 1025, and works by Ibn Zuhr (Avenzoar) in the 12th century (and printed in 1491), and Ibn Baytar in the 14th century. The Shen-nung pen ts'ao ching (Divine Husbandman's Materia Medica) is the earliest known Chinese pharmacopia. The text describes 365 medicines derived from plants, animals, and minerals; according to legend it was written by the Chinese god Shennong.

City pharmacopoeia origins

The first known work of this kind published under civic authority appears to have been that of Tang Dynasty in China. The treatise was written by several officials of Emperor Gaozong of Tang. The pharmacopoeia contained 850 sorts of crude medicine, revising the treatises written by ancient Chinese pharmacists. 

However, the first dated work appeared in Nuremberg in 1542; a passing student Valerius Cordus showed a collection of medical prescriptions, which he had selected from the writings of the most eminent medical authorities, to the physicians of the town, who urged him to print it for the benefit of the apothecaries, and obtained for his work the sanction of the senatus. A work known as the Antidotarium Florentinum, was published under the authority of the college of medicine of Florence in the 16th century. In 1511, the Concordie Apothecariorum Barchinone was published by the Society of Apothecaries of Barcelona and kept in the School of Pharmacy of the University of Barcelona.

The term Pharmacopoeia first appears as a distinct title in a work published at Basel, Switzerland, in 1561 by A. Foes, but does not appear to have come into general use until the beginning of the 17th century.

Before 1542 the works principally used by apothecaries were the treatises on simples by Avicenna and Serapion; the De synonymis and Quid pro quo of Simon Januensis; the Liber servitoris of Bulchasim Ben Aberazerim, which described the preparations made from plants, animals, and minerals, and was the type of the chemical portion of modern pharmacopoeias; and the Antidotarium of Nicolaus de Salerno, containing Galenic formulations arranged alphabetically. Of this last work, there were two editions in use — Nicolaus magnus and Nicolaus parvus: in the latter, several of the compounds described in the large edition were omitted and the formulae given on a smaller scale.

Also Vesalius claimed he had written some "dispensariums" and "manuals" on the works of Galenus. Apparently he burnt them. According to recent research communicated at the congresses of the International Society for the History of Medicine by the scholar Francisco Javier González Echeverría, Michel De Villeneuve(Michael Servetus) also published a pharmacopeia. Michel De Villeneuve, fellow student of Vesalius and the best galenist of Paris according to Johann Winter von Andernach, published the anonymous " ''Dispensarium or Enquiridion" in 1543, at Lyon, France, with Jean Frellon as editor. This work contains 224 original recipes by Michel De Villeneuve(Michael Servetus) and others by Lespleigney and Chappuis. As usual when it comes to pharmacopeias, this work was complementary to a previous Materia Medica that Michel De Villeneuve published that same year. This finding was communicated by the same scholar in the International Society for the History of Medicine, with agreement of John M. Riddle, one of the foremost experts on Materia Medica-Dioscorides works. 

Nicolaes Tulp, mayor of Amsterdam and respected surgeon general, gathered all of his doctor and chemist friends together and they wrote the first pharmacopoeia of Amsterdam in 1636 Pharmacopoea Amstelredamensis. This was a combined effort to improve public health after an outbreak of the plague, and also limit the number of quack apothecary shops in Amsterdam.

London

Until 1617 such drugs and medicines as were in common use were sold in England by the apothecaries and grocers. In that year the apothecaries obtained a separate charter, and it was enacted that no grocer should keep an apothecary’s shop. The preparation of physicians’ prescriptions was thus confined to the apothecaries, upon whom pressure was brought to bear to make them dispense accurately, by the issue of a pharmacopoeia in May 1618 by the College of Physicians, and by the power which the wardens of the apothecaries received in common with the censors of the College of Physicians of examining the shops of apothecaries within 7 m. of London and destroying all the compounds which they found unfaithfully prepared. This, the first authorized London Pharmacopoeia, was selected chiefly from the works of Mezue and Nicolaus de Salerno, but it was found to be so full of errors that the whole edition was cancelled, and a fresh edition was published in the following December.

At this period the compounds employed in medicine were often heterogeneous mixtures, some of which contained from 20 to 70, or more, ingredients, while a large number of simples were used in consequence of the same substance being supposed to possess different qualities according to the source from which it was derived. Thus crabs’ eyes (i.e., gastroliths), pearls, oyster shells, and coral were supposed to have different properties. Among other ingredients entering into some of these formulae were the excrements of human beings, dogs, mice, geese, and other animals, calculi, human skull, and moss growing on it, blind puppies, earthworms, etc.

Although other editions of the London Pharmacopoeia were issued in 1621, 1632, 1639, and 1677, it was not until the edition of 1721, published under the auspices of Sir Hans Sloane, that any important alterations were made. In this issue many of the remedies previously in use were omitted, although a good number were still retained, such as dogs’ excrement, earthworms, and moss from the human skull; the botanical names of herbal remedies were for the first time added to the official ones; the simple distilled waters were ordered of a uniform strength; sweetened spirits, cordials and ratafias were omitted as well as several compounds no longer used in London, although still in vogue elsewhere. A great improvement was effected in the edition published in 1746, in which only those preparations were retained which had received the approval of the majority of the pharmacopoeia committee; to these was added a list of those drugs only which were supposed to be the most efficacious. An attempt was made to simplify further the older formulae by the rejection of superfluous ingredients.

In the edition published in 1788 the tendency to simplify was carried out to a much greater extent, and the extremely compound medicines which had formed the principal remedies of physicians for 2,000 years were discarded, while a few powerful drugs which had been considered too dangerous to be included in the Pharmacopoeia of 1765 were restored to their previous position. In 1809 the French chemical nomenclature was adopted, and in 1815 a corrected impression of the same was issued. Subsequent editions were published in 1824, 1836, and 1851.

The first Edinburgh Pharmacopoeia was published in 1699 and the last in 1841; the first Dublin Pharmacopoeia in 1807 and the last in 1850.

National pharmacopoeia origins

The preparations contained in these three pharmacopoeias were not all uniform in strength, a source of much inconvenience and danger to the public, when powerful preparations such as dilute hydrocyanic acid were ordered in the one country and dispensed according to the national pharmacopoeia in another. As a result, the Medical Act of 1858 ordained that the General Medical Council should publish a book containing a list of medicines and compounds, to be called the British Pharmacopoeia, which would be a substitute throughout Great Britain and Ireland for the separate pharmacopoeias. Hitherto these had been published in Latin. The first British Pharmacopoeia was published in the English language in 1864, but gave such general dissatisfaction both to the medical profession and to chemists and druggists that the General Medical Council brought out a new and amended edition in 1867. This dissatisfaction was probably owing partly to the fact that the majority of the compilers of the work were not engaged in the practice of pharmacy, and therefore competent rather to decide upon the kind of preparations required than upon the method of their manufacture. The necessity for this element in the construction of a pharmacopoeia is now fully recognized in other countries, in most of which pharmaceutical chemists are represented on the committee for the preparation of the legally recognized manuals.

There are national and international pharmacopoeias, like the EU and the U.S. pharmacopoeias. The pharmacopeia in the EU is prepared by a governmental organization, and has a specified role in law in the EU. In the U.S., the USP-NF (United States Pharmacopeia – National Formulary) has been issued by a private non-profit organization since 1820 under the authority of a Convention that meets periodically that is largely constituted by physicians, pharmacists, and other public health professionals, setting standards published in the compendia through various Expert Committees. In the U.S. when there is an applicable USP-NF quality monograph, drugs and drug ingredients must conform to the compendial requirements (such as for strength, quality or purity) or be deemed adulterated or misbranded under the Federal food and drug laws.

Supranational and international harmonization

The Soviet Union had a nominally supranational pharmacopoeia, the State Pharmacopoeia of the Union of Soviet Socialist Republics (USSRP), although the de facto nature of the nationality of republics within that state differed from the de jure nature. The European Union has a supranational pharmacopoeia, the European Pharmacopoeia; it has not replaced the national pharmacopoeias of EU member states but rather helps to harmonize them. Attempts have been made by international pharmaceutical and medical conferences to settle a basis on which a globally international pharmacopoeia could be prepared, but regulatory complexity and locoregional variation in conditions of pharmacy are hurdles to fully harmonizing across all countries (that is, defining thousands of details that can all be known to work successfully in all places). Nonetheless, some progress has been made under the banner of the International Council on Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH), a tri-regional organisation that represents the drug regulatory authorities of the European Union, Japan, and the United States. Representatives from the Pharmacopoeias of these three regions have met twice yearly since 1990 in the Pharmacopoeial Discussion Group to try to work towards "compendial harmonisation". Specific monographs are proposed, and if accepted, proceed through stages of review and consultation leading to adoption of a common monograph that provides a common set of tests and specifications for a specific material. Not surprisingly, this is a slow process. The World Health Organization has produced the International Pharmacopoeia (Ph.Int.), which does not replace a national pharmacopoeia but rather provides a model or template for one and also can be invoked by legislation within a country to serve as that country's regulation.

Medical preparations, uses, and dosages

A bottle of glycerin purchased at a pharmacy with the abbreviation I.P. appearing after the product name.

 

Though formerly printed there has been a transition to a situation where pharmaceutical information is available as printed volumes and on the internet. The rapid increase in knowledge renders necessary frequent new editions, to furnish definite formulae for preparations that have already come into extensive use in medical practice, so as to ensure uniformity of strength, and to give the characters and tests by which their purity and potency may be determined. However each new edition requires several years to carry out numerous experiments for devising suitable formulae, so that current pharmacopoeia are never quite up to date.

This difficulty has hitherto been met by the publication of such non-official formularies as Squire's Companion to the Pharmacopoeia and Martindale: The complete drug reference (formerly Martindale's: the extra pharmacopoeia), in which all new remedies and their preparations, uses and doses are recorded, and in the former the varying strengths of the same preparations in the different pharmacopoeias are also compared (Squire's was incorporated into Martindale in 1952). The need of such works to supplement the Pharmacopoeia is shown by the fact that they are even more largely used than the Pharmacopoeia itself, the first issued in 18 editions and the second in 13 editions at comparatively short intervals. In the UK, the task of elaborating a new Pharmacopoeia is entrusted to a body of a purely medical character, and legally the pharmacist does not, contrary to the practice in other countries, have a voice in the matter. This is notwithstanding the fact that, although the medical practitioner is naturally the best judge of the drug or preparations that will afford the best therapeutic result, they are not as competent as the pharmacist to say how that preparation can be produced in the most effective and satisfactory manner, nor how the purity of drugs can be tested.

The change occurred with the fourth edition of the British Pharmacopoeia in 1898. A committee of the Royal Pharmaceutical Society of Great Britain was appointed at the request of the General Medical Council to advise on pharmaceutical matters. A census of prescriptions was taken to ascertain the relative frequency with which different preparations and drugs were used in prescriptions, and suggestions and criticisms were sought from various medical and pharmaceutical bodies across the British Empire. As regards the purely pharmaceutical part of the work a committee of reference in pharmacy, nominated by the pharmaceutical societies of Great Britain and Ireland (as they were then), was appointed to report to the Pharmacopoeia Committee of the Medical Council.

Some difficulty has arisen since the passing of the Adulteration of Food and Drugs Act concerning the use of the Pharmacopoeia as a legal standard for the drugs and preparations contained in it. The Pharmacopoeia is defined in the preface as only "intended to afford to the members of the medical profession and those engaged in the preparation of medicines throughout the British Empire one uniform standard and guide whereby the nature and composition of, substances to be used in medicine may be ascertained and determined". It cannot be an encyclopaedia of substances used in medicine, and can be used only as a standard for the substances and preparations contained in it, and for no others. It has been held in the Divisional Courts (Dickins v. Randerson) that the Pharmacopoeia is a standard for official preparations asked for under their pharmacopoeial name. But there are many substances in the Pharmacopoeia which are not only employed in medicine, but have other uses, such as sulphur, gum benzoin, tragacanth, gum arabic, ammonium carbonate, beeswax, oil of turpentine, linseed oil, and for these a commercial standard of purity as distinct from a medicinal one is needed, since the preparations used in medicine should be of the highest possible degree of purity obtainable, and this standard would be too high and too expensive for ordinary purposes. The use of trade synonyms in the Pharmacopoeia, such as saltpetre for purified potassium nitrate, and milk of sulphur for precipitated sulphur, is partly answerable for this difficulty, and has proved to be a mistake, since it affords ground for legal prosecution if a chemist sells a drug of ordinary commercial purity for trade purposes, instead of the purified preparation which is official in the Pharmacopoeia for medicinal use. This would not be the case if the trade synonym were omitted. For many drugs and chemicals not in the Pharmacopoeia there is no standard of purity that can be used under the Adulteration of Food and Drugs Act, and for these, as well as for the commercial quality of those drugs and essential oils which are also in the Pharmacopoeia, a legal standard of commercial purity is much needed. This subject formed the basis of discussion at several meetings of the Pharmaceutical Society, and the results have been embodied in a work called Suggested Standards for Foods and Drugs by C. G. Moor, which indicates the average degree of purity of many drugs and chemicals used in the arts, as well as the highest degree of purity obtainable in commerce of those used in medicine.

An important step has also been taken in this direction by the publication under the authority of the Council of the Pharmaceutical Society of Great Britain of the British Pharmaceutical Codex (BPC), in which the characters of and tests for the purity of many unofficial drugs and preparations are given as well as the character of many glandular preparations and antitoxins that have come into use in medicine, but have not yet been introduced into the Pharmacopoeia. This work may also possibly serve as a standard under the Adulteration of Food and Drugs Act for the purity and strength of drugs not included in the Pharmacopoeia and as a standard for the commercial grade of purity of those in the Pharmacopoeia which are used for non-medical purposes.

Another legal difficulty connected with modern pharmacopoeias is the inclusion in some of them of synthetic chemical remedies, the processes for preparing which have been patented, whilst the substances are sold under trade-mark names. The scientific chemical name is often long and unwieldy, and the physician prefers when writing a prescription to use the shorter name under which it is sold by the patentees. In this case the pharmacist is compelled to use the more expensive patented article, which may lead to complaints from the patient. If the physician were to use the same article under its pharmacopoeial name when the patented article is prescribed, they would become open to prosecution by the patentee for infringement of patent rights. Hence the only solution is for the physician to use the chemical name (which cannot be patented) as given in the Pharmacopoeia, or, for those synthetic remedies not included in the Pharmacopoeia, the scientific and chemical name given in the British Pharmaceutical Codex.

Pharmacology (updated)

From Wikipedia, the free encyclopedia

Pharmacology
Diagrammatic representation of organ bath used for studying the effect of isolated tissues
MeSH Unique ID	D010600

A variety of topics involved with pharmacology, including neuropharmacology, renal pharmacology, human metabolism, intracellular metabolism, and intracellular regulation

Pharmacology is the branch of biology concerned with the study of drug action, where a drug can be broadly defined as any man-made, natural, or endogenous (from within the body) molecule which exerts a biochemical or physiological effect on the cell, tissue, organ, or organism (sometimes the word pharmacon is used as a term to encompass these endogenous and exogenous bioactive species). More specifically, it is the study of the interactions that occur between a living organism and chemicals that affect normal or abnormal biochemical function. If substances have medicinal properties, they are considered pharmaceuticals. 

The field encompasses drug composition and properties, synthesis and drug design, molecular and cellular mechanisms, organ/systems mechanisms, signal transduction/cellular communication, molecular diagnostics, interactions, toxicology, chemical biology, therapy, and medical applications and antipathogenic capabilities. The two main areas of pharmacology are pharmacodynamics and pharmacokinetics. Pharmacodynamics studies the effects of a drug on biological systems, and Pharmacokinetics studies the effects of biological systems on a drug. In broad terms, pharmacodynamics discusses the chemicals with biological receptors, and pharmacokinetics discusses the absorption, distribution, metabolism, and excretion (ADME) of chemicals from the biological systems. Pharmacology is not synonymous with pharmacy and the two terms are frequently confused. Pharmacology, a biomedical science, deals with the research, discovery, and characterization of chemicals which show biological effects and the elucidation of cellular and organismal function in relation to these chemicals. In contrast, pharmacy, a health services profession, is concerned with application of the principles learned from pharmacology in its clinical settings; whether it be in a dispensing or clinical care role. In either field, the primary contrast between the two are their distinctions between direct-patient care, for pharmacy practice, and the science-oriented research field, driven by pharmacology.

The origins of clinical pharmacology date back to the Middle Ages in Avicenna's The Canon of Medicine, Peter of Spain's Commentary on Isaac, and John of St Amand's Commentary on the Antedotary of Nicholas. Clinical pharmacology owes much of its foundation to the work of William Withering. Pharmacology as a scientific discipline did not further advance until the mid-19th century amid the great biomedical resurgence of that period. Before the second half of the nineteenth century, the remarkable potency and specificity of the actions of drugs such as morphine, quinine and digitalis were explained vaguely and with reference to extraordinary chemical powers and affinities to certain organs or tissues. The first pharmacology department was set up by Rudolf Buchheim in 1847, in recognition of the need to understand how therapeutic drugs and poisons produced their effects.

Early pharmacologists focused on natural substances, mainly plant extracts. Pharmacology developed in the 19th century as a biomedical science that applied the principles of scientific experimentation to therapeutic contexts. Today pharmacologists use genetics, molecular biology, biochemistry, and other advanced tools to transform information about molecular mechanisms and targets into therapies directed against disease, defects or pathogens, and create methods for preventative care, diagnostics, and ultimately personalized medicine.

Etymology

The word "pharmacology" is derived from Greek φάρμακον, pharmakon, "drug, poison, spell" and -λογία, -logia "study of", "knowledge of" (cf. the etymology of pharmacy).

Divisions

The discipline of pharmacology can be divided into many sub disciplines each with a specific focus.

Clinical pharmacology

Clinical pharmacology is the basic science of pharmacology with an added focus on the application of pharmacological principles and methods in the medical clinic and towards patient care and outcomes.

Neuropharmacology

Neuropharmacology is the study of the effects of medication on central and peripheral nervous system functioning.

Psychopharmacology

Psychopharmacology, also known as behavioral pharmacology, is the study of the effects of medication on the psyche (psychology), observing changed behaviors of the body and mind, and how molecular events are manifest in a measurable behavioral form. Psychopharmacology is an interdisciplinary field which studies behavioral effects of psychoactive drugs. It incorporates approaches and techniques from neuropharmacology, animal behavior and behavioral neuroscience, and is interested in the behavioral and neurobiological mechanisms of action of psychoactive drugs. Another goal of behavioral pharmacology is to develop animal behavioral models to screen chemical compounds with therapeutic potentials. People in this field (called behavioral pharmacologists) typically use small animals (e.g. rodents) to study psychotherapeutic drugs such as antipsychotics, antidepressants and anxiolytics, and drugs of abuse such as nicotine, cocaine and methamphetamine.  Ethopharmacology (not to be confused with ethnopharmacology) is a term which has been in use since the 1960s and derives from the Greek word ἦθος ethos meaning character and "pharmacology" the study of drug actions and mechanism.

Cardiovascular pharmacology

Cardiovascular pharmacology is the study of the effects of drugs on the entire cardiovascular system, including the heart and blood vessels.

Pharmacogenetics

Pharmacogenetics is clinical testing of genetic variation that gives rise to differing response to drugs.

Pharmacogenomics

Pharmacogenomics is the application of genomic technologies to drug discovery and further characterization of older drugs.

Pharmacoepidemiology

Pharmacoepidemiology is the study of the effects of drugs in large numbers of people.

Safety pharmacology

Safety pharmacology specialises in detecting and investigating potential undesirable pharmacodynamic effects of new chemical entities (NCEs) on physiological functions in relation to exposure in the therapeutic range and above.

Systems pharmacology

Systems pharmacology is the application of systems biology principles in the field of pharmacology.

Toxicology

Toxicology is the study of the adverse effects, molecular targets, and characterization of drugs or any chemical substance in excess (including those beneficial in lower doses).

Theoretical pharmacology

Theoretical pharmacology is a relatively new and rapidly expanding field of research activity in which many of the techniques of computational chemistry, in particular computational quantum chemistry and the method of molecular mechanics, are proving to be of great value. Theoretical pharmacologists aim at rationalizing the relation between the activity of a particular drug, as observed experimentally, and its structural features as derived from computer experiments. They aim to find structure—activity relations. Furthermore, on the basis of the structure of a given organic molecule, the theoretical pharmacologist aims at predicting the biological activity of new drugs that are of the same general type as existing drugs. More ambitiously, it aims to predict entirely new classes of drugs, tailor-made for specific purposes.

Posology

Posology is the study of how medicines are dosed. This depends upon various factors including age, climate, weight, sex, elimination rate of drug, genetic polymorphism and time of administration. It is derived from the Greek words πόσος posos meaning "how much?" and -λογία -logia "study of".

Environmental pharmacology

Environmental pharmacology is a new discipline. Focus is being given to understand gene–environment interaction, drug-environment interaction and toxin-environment interaction. There is a close collaboration between environmental science and medicine in addressing these issues, as healthcare itself can be a cause of environmental damage or remediation. Human health and ecology are intimately related. Demand for more pharmaceutical products may place the public at risk through the destruction of species. The entry of chemicals and drugs into the aquatic ecosystem is a more serious concern today. In addition, the production of some illegal drugs pollutes drinking water supply by releasing carcinogens. This field is intimately linked with Public Health fields.

Experimental pharmacology

Experimental pharmacology involves the study of pharmacology through bioassay, to test the efficacy and potency of a drug.

Scientific background

The study of chemicals requires intimate knowledge of the biological system affected. With the knowledge of cell biology and biochemistry increasing, the field of pharmacology has also changed substantially. It has become possible, through molecular analysis of receptors, to design chemicals that act on specific cellular signaling or metabolic pathways by affecting sites directly on cell-surface receptors (which modulate and mediate cellular signaling pathways controlling cellular function). 

A chemical has, from the pharmacological point-of-view, various properties. Pharmacokinetics describes the effect of the body on the chemical (e.g. half-life and volume of distribution), and pharmacodynamics describes the chemical's effect on the body (desired or toxic).

When describing the pharmacokinetic properties of the chemical that is the active ingredient or active pharmaceutical ingredient (API), pharmacologists are often interested in L-ADME:

• Liberation – How is the API disintegrated (for solid oral forms (breaking down into smaller particles)), dispersed, or dissolved from the medication?
• Absorption – How is the API absorbed (through the skin, the intestine, the oral mucosa)?
• Distribution – How does the API spread through the organism?
• Metabolism – Is the API converted chemically inside the body, and into which substances. Are these active (as well)? Could they be toxic?
• Excretion – How is the API excreted (through the bile, urine, breath, skin)?

Medication is said to have a narrow or wide therapeutic index or therapeutic window. This describes the ratio of desired effect to toxic effect. A compound with a narrow therapeutic index (close to one) exerts its desired effect at a dose close to its toxic dose. A compound with a wide therapeutic index (greater than five) exerts its desired effect at a dose substantially below its toxic dose. Those with a narrow margin are more difficult to dose and administer, and may require therapeutic drug monitoring (examples are warfarin, some antiepileptics, aminoglycoside antibiotics). Most anti-cancer drugs have a narrow therapeutic margin: toxic side-effects are almost always encountered at doses used to kill tumors.

Medicine development and safety testing

Development of medication is a vital concern to medicine, but also has strong economical and political implications. To protect the consumer and prevent abuse, many governments regulate the manufacture, sale, and administration of medication. In the United States, the main body that regulates pharmaceuticals is the Food and Drug Administration and they enforce standards set by the United States Pharmacopoeia. In the European Union, the main body that regulates pharmaceuticals is the EMA and they enforce standards set by the European Pharmacopoeia.

The metabolic stability and the reactivity of a library of candidate drug compounds have to be assessed for drug metabolism and toxicological studies. Many methods have been proposed for quantitative predictions in drug metabolism; one example of a recent computational method is SPORCalc. If the chemical structure of a medicinal compound is altered slightly, this could slightly or dramatically alter the medicinal properties of the compound depending on the level of alteration as it relates to the structural composition of the substrate or receptor site on which it exerts its medicinal effect, a concept referred to as the structural activity relationship (SAR). This means that when a useful activity has been identified, chemists will make many similar compounds called analogues, in an attempt to maximize the desired medicinal effect(s) of the compound. This development phase can take anywhere from a few years to a decade or more and is very expensive.

These new analogues need to be developed. It needs to be determined how safe the medicine is for human consumption, its stability in the human body and the best form for delivery to the desired organ system, like tablet or aerosol. After extensive testing, which can take up to 6 years, the new medicine is ready for marketing and selling.

As a result of the long time required to develop analogues and test a new medicine and the fact that of every 5000 potential new medicines typically only one will ever reach the open market, this is an expensive way of doing things, often costing over 1 billion dollars. To recoup this outlay pharmaceutical companies may do a number of things:

• Carefully research the demand for their potential new product before spending an outlay of company funds.
• Obtain a patent on the new medicine preventing other companies from producing that medicine for a certain allocation of time.

Drug legislation and safety

In the United States, the Food and Drug Administration (FDA) is responsible for creating guidelines for the approval and use of drugs. The FDA requires that all approved drugs fulfill two requirements:

1. The drug must be found to be effective against the disease for which it is seeking approval (where 'effective' means only that the drug performed better than placebo or competitors in at least two trials).
2. The drug must meet safety criteria by being subject to animal and controlled human testing.

Gaining FDA approval usually takes several years. Testing done on animals must be extensive and must include several species to help in the evaluation of both the effectiveness and toxicity of the drug. The dosage of any drug approved for use is intended to fall within a range in which the drug produces a therapeutic effect or desired outcome.

The safety and effectiveness of prescription drugs in the U.S. is regulated by the federal Prescription Drug Marketing Act of 1987. 

The Medicines and Healthcare products Regulatory Agency (MHRA) has a similar role in the UK.

Education

Students of pharmacology are trained as biomedical scientists, studying the effects of drugs on living organisms. This can lead to new drug discoveries, as well as a better understanding of the way in which the human body works.

Students of pharmacology must have detailed working knowledge of aspects in physiology, pathology and chemistry. During a typical degree they will cover areas such as (but not limited to) biochemistry, cell biology, basic physiology, genetics and the Central Dogma, medical microbiology, neuroscience, and depending on the department's interests, bio-organic chemistry, or chemical biology. 

Modern Pharmacology is highly interdisciplinary. Graduate programs accept students from most biological and chemical backgrounds. With the increasing drive towards biophysical and computational research to describe systems, pharmacologists may even consider themselves mainly physical scientists. In many instances, Analytical Chemistry is closely related to the studies and needs of pharmacological research. Therefore, many institutions will include pharmacology under a Chemistry or Biochemistry Department, especially if a separate Pharmacology Dept. does not exist. What makes an institutional department independent of another, or exist in the first place, is usually an artifact of historical times.

Whereas a pharmacy student will eventually work in a pharmacy dispensing medications, a pharmacologist will typically work within a laboratory setting. Careers for a pharmacologist include academic positions (medical and non-medical), governmental positions, private industrial positions, science writing, scientific patents and law, consultation, biotech and pharmaceutical employment, the alcohol industry, food industry, forensics/law enforcement, public health, and environmental/ecological sciences.