Fundamentals of Clinical Pharmacokinetics by John J. Wagner (review)

BOOK REVIEWS Fundamentals of Clinical Pharmacokinetics. By John J. Wagner. Hamilton, 111.: Drug Intelligence Publications, 1975. Pp. xvi+461. $37.50. Publication of this collection of courses in pharmacokinetics directed primarily at sixth-year Pharm. D. students highlights a new perspective in pharmacy of great concern to practicing physicians. In particular, detailed understanding of the pharmacokinetics of drugs given by any route has become fundamental to modern anesthesia and antibiotic therapy. Lively correspondence on the need of better communication between physicians and pharmacists has made its appearance in the correspondence columns of medicaljournals such as theNew England fournal ofMedicine, and Dr. Wagner's topic has recently received rigorous attention as review articles in both the New England fournal and the Journal of the American Medical Association. The leading textbooks of pharmacology, Principles of Drug Action by A. Goldstein, L. Aranow, and S. M. Kaiman (2d ed. [New York: John Wiley & Sons, 1974]) and The Pharmacological Basii ofTherapeutics, edited by L. S. Goodman and A. Gilman (5th ed. [New York: Macmillan Publishing Co., 1975]) can no longer be understood without an in-depth knowledge of pharmacokinetics . And yet, few practicing physicians are equipped with or anxious to apply this powerful mathematical tool of the pharmacist. Much of the controversy can be resolved by a study of this astonishingly comprehensive book, organized to trace the course of drugs from their administration to their ultimate effect, with admirable emphasis on human data and application rather than derivation. Each chapter includes review questions and problems. It contains 122 figures, 98 tables, and 1,190 equations as well as numerous mathematical models suitable to interpret time-course data. It is the most rigorous book on pharmacokinetics published so far, and it is certain to become established as a classic. It marks recognition of pharmacokinetics as a cornerstone of modern medical therapy, after its originators, Professor F. H. Dost (a pediatrician) and Torsten Teorell (a physiologist), laid its foundation barely 30 years ago. Formulation of pharmacokinetic concepts and the derivation of its formulas require higher mathematics, as Dr. Wagner well shows. However, his book dispels a commonly encountered misconception in that it also shows, beautifully and convincingly, that understanding and ability to apply these principles by no means demand mathematical prowess which is beyond the grasp of the average physician. In fact no physician today can be regarded as safe without understanding the pharmacokinetics of the drugs he uses. If the subject is now adorned with its most definitive and elegant exposition (along with Wagner's previous major book, Bwpharmaceutics and Relevant Pharmacokinetics [Hamilton, 111.: Drug Intelligence Publications, 1971]), does that 310 Book Reviews mean that practicing physicians should buy the book and expend the effort necessary to master its contents? I think not, simply because we can no longer be "an island sufficient to ourselves." We have to improve professional communication with the pharmacists who are the real experts in pharmacokinetics, just as we have to lean heavily on their assistance in providing the products of the pharmaceutical industry, and just as we have always relied on so many other paramedical personnel who are not themselves corporate members of the professional body of physicians. Jacobus W. Mostert, M.D. University of Chicago Life or Death—Who Controls'? Edited by Nancy C. Ostheimer and John M. Ostheimer. New York: Springer Publishing Co., 1976. Pp. 308. $7.95. Who controls what? This book is an exploration of phenomena and problems which have recently received a great deal of attention and verbiage. It deals with certain questions related to life—genetics, abortion, euthanasia, and compulsory sterilization. (Organ transplantation, closely related, is not taken up here.) In fact, the keynote is in the preface—that Western societies stress the dignity and preservation of human life. But that is true in words only, and these words are in constant dissonance with practices. Examples are all around us. Even in the exploration of the questions pertaining to preservation of life, I submit that commonly we do not use the appropriate methods for our investigations. For example, we attempt to show the proper persona by speaking of compassion and ethics and giving courses in the latter. I believe that one cannot teach compassion...