Keeping the Identity of Pharmacology Strong for the Future
Palmer Taylor began his professorial career in the Department of Medicine at the University of California at San Diego in 1971. Within a decade, he became the Head of the Division of Pharmacology within the Department, and UCSD emerged as a model of pharmacology as a discipline at the hub of diverse fields of biomedicine—so much so, that Pharmacology became its own full-fledged Department within just a few years. The Department of Pharmacology at UCSD continues to expand, and so does Taylor’s leadership role in research science at the institution. Just this year, a new School of Pharmacy and Pharmaceutical Sciences was founded at UCSD with Taylor as founding Dean; he was also named Associate Vice Chancellor for Health Sciences at the University. Taylor speaks proudly of the contributions and challenges that await future “practitioners” of pharmacology, and he is intent that the new School at UCSD will prepare its trainees to realize the promises that modern biomedicine has been articulating over the past couple of decades. In particular, he views the vocabularies of genomics and bioinformatics as indispensable to today’s trainees. His vision of the future of pharmacology entails practitioners who use these vocabularies not only to deliver increasingly complex therapies more efficiently, but also to facilitate biomedical communication among an increasingly diversified range of specialties.
MI: The Pharmacology Department at UCSD is consistently ranked as one of the nation’s best. What makes the program here at UCSD so distinctive?
PT: When the School of Medicine at UCSD started in the late 1960s, the idea was not to have any basic science departments, but rather to have the basic science served by departments of the main campus, as opposed to the medical school. But the first Chair of Medicine at UCSD, Gene Braunwald, didn’t think that such an arrangement would work for disciplines, like pharmacology and physiology, that are more closely aligned with medicine. So up until about twelve years ago, pharmacology was represented as a division in the Department of Medicine, even though the founder of the division, Steve Mayer, was interested in having Pharmacology emerge as a separate department and developed a faculty anxious to expand their identity. Not until the Department of Medicine grew sufficiently, under Helen Ranney as Chair fourteen years ago, did Pharmacology split out of Medicine to become its own department. So, whereas many pharmacology departments elsewhere have ended up amalgamated with other departments, here at UCSD, we went the other way. And it still makes great sense to me academically that pharmacology departments should have a separate identity, because pharmacology is one of the few bridging disciplines in the health sciences whose academic endeavors span between basic and clinical interests, as well as between professional practices.
MI: So this independence explains the success of this department?
PT: Well, I think our success relates more to the diverse and creative people that were recruited and assembled here at the most productive stages of their careers. In other words, we became a separate department at a time when our faculty members were developing innovative research and training programs and acquiring the requisite support.
MI: And that just started the momentum for the success here?
PT: That’s right. A successful group agitates for more resources and space, in addition to participating in a larger fraction of institutional academic functions, and then success becomes autocatalytic. Now we are in the process of becoming an even larger department, serving two professional schools. The prominence of pharmacology at UCSD was an important factor in starting a pharmacy school in La Jolla. Within the University of California system, there had been only one pharmacy school, at UCSF. A need for more sophisticated pharmaceutical care was a second argument for establishing a new pharmacy school. Here we were, a state of thirty-five million people, and only one state-supported school of pharmacy. At the other extreme, the state of Washington has maybe five million people, and the state of South Carolina has four million, and both states have two state-supported schools of pharmacy. It just didn’t make sense that the most populous southern part of the state lacked a state-supported school. Now, the School of Pharmacy and Pharmaceutical Sciences is in its second quarter with our very first class of students.
MI: How has this first year gone?
PT: We’ve put together an interesting curriculum for our students. The first year of the pharmacy curriculum will be pharmacy-specific: pharmaceutics, pharmaceutical chemistry, medicinal chemistry, and introduction to professional practice. But the unique part of it is that the pharmacy students in their second year will take the same courses as first-year medical students. So they’ll take cell biology and biochemistry, physiology, pharmacology, and neuroscience and endocrinology.
MI: How did you go about getting students?
PT: Oh, there’s great demand for student positions. We had nearly 500 applications for twenty-five positions in the first-year class, and this year we’ve had even more applicants. We’re limited to twenty-five because we’ve decided to place our pharmacy students in common courses with the medical students.
MI: How long did it take to make the new school a reality?
PT: Well, it’s been in the works a long time. For over two decades we’ve run a pilot program with UCSF, in which eighteen senior UCSF pharmacy students spend their fourth year in San Diego to complete clinical experiences. So we had a substantive base to start a pharmacy school. We might have started sooner, but state budgetary limitations in the mid nineties slowed things down, and there were some faculty at UCSF that may have looked at a new UC pharmacy school too provincially and saw us as competition. The current Dean of the Pharmacy School at USCF, Mary Anne Koda-Kimble, I think, has taken a more forward-looking view and is looking at our new program as important to pharmacy education nationally. Several UCSF faculty have been of considerable help in getting our program off the ground. Two UCSF faculty, David Adler and Tony Manoguerra, now also serving as Associate Deans here, have been key players in launching our school.
MI: How is pharmacy education changing, and what sort of impact are you hoping to make?
PT: Just this year, all the pharmacy schools in the nation are offering the four-year PharmD degree. In California, the PharmD has been the entry-level degree for over ten years. Competition to get into pharmacy school has been increasingly intense, and so we here at UCSD, and at UCSF, we could count on all our entering students already having a baccalaureate degree. As prerequisites, you have to complete organic chemistry and quantitative analysis, calculus, a speech course, biology courses, and economics courses. It really takes three years to get these courses out of the way, so students are willing to go an additional, fourth year to get their bachelor’s degree from a premier institution. We expect that the new faculty that will staff the pharmacy school will expand our health sciences. The incentive for me as well as for many other basic and clinical investigators here relates to the faculty adding more diversity in research, and creativity into scientific and instructional endeavors at UCSD.
MI: You were also here at UCSD to see the start of Pharmacology, weren’t you?
PT: Almost. I’ve been here a long time, over thirty years. So, we’re sort of repeating the academic exercise we did with the School of Medicine. When I came here, we only had forty medical students per class, and Steve Mayer and I were the only two with a pharmacology identity. Over the years, we’ve expanded into this large department. In a way, then, we’re repeating the act with pharmacy. And we’re not going to have a separate pharmacology faculty or other distinct departments for the pharmacy school. Our basic science departments and clinical departments will be serving two professional schools. I think if you look at it nationally, it’s never made sense research-wise or in terms of university distinction to divide pharmacology between separate professional schools. It may have soothed the ego of a dean to say, “These are my faculty, and I can control their teaching and activity.” But typically, you get a situation where the critical mass of active investigators is absent, and the University has one strong and one weak department.
MI: So, you don’t think that this type of separation has necessarily hurt pharmacology as opposed to pharmacy, but where the separation occurs, it seems to hurt one department as opposed to the other.
PT: Yes. If we think of ourselves as a discipline—you have to have diversity in the discipline and a certain amount of synergism to run a graduate program, for example. Pharmacology has to be taught within both pharmacy and medical curricula, but research and the intellectual drive of a pharmacology department come out of interactions, that is, the research endeavors and the creative agenda that those faculty have. If you take half of your faculty and say, “You’re responsible to this dean,” and assign the other half to a separate dean and agenda, then I don’t think you get the kind of synergism and diversity optimal for research and teaching.
MI: And yet you said that pharmacology is disappearing altogether from some medical schools, being absorbed into other disciplines. Do you regard that as general problem for the discipline of pharmacology?
PT: Yes, indeed. If pharmacology gets amalgamated with other disciplines, then it begins to lose its identifying characteristics, simply through dilution. And I think the importance of pharmacology in the professional and graduate curricula is sufficiently strong that it has to be well defined as a discipline. An increasingly aging population requiring more therapeutic modalities, coupled with the complexity of evolving drugs, places great demands on instruction in pharmacology. The Institute of Medicine report “To Err is Human” placed therapeutic errors at the top of the list. Moreover, that report addresses overt errors, but not whether increasingly sophisticated training will lead to more prudent therapeutic decisions. So, there is plenty about therapeutics that ought to be taught to practitioners, and it doesn’t make sense that academic institutions are hiding or diluting the discipline, pharmacology, that addresses the major tool for a positive outcome of a diagnosis: therapeutics. Pharmacology should be front and center in the training of practitioners.
MI: Then it’s the organization of science, or organization of therapeutics, and the communication of the science that suffers when pharmacology is not independently preserved?
PT: Perhaps it is the collapsing of perspective. Another way to look at the problem would be that if you ask cell or molecular biologists to teach pharmacology, they may say, “I could teach some basic mechanisms because there are lots of kinases in the yeast (or Drosophila) that I’m studying, but it would be a stretch to extend this to an integrated human system, let alone the proper therapy.” But that’s precisely where the therapeutic side of medicine and pharmacy is—in the study of the human!
MI: And what about the way that genomics is changing pharmacology?
PT: I think that the strong departments—just as they embraced recombinant DNA techniques as integral to uncovering pharmacological mechanisms—are embracing genomics to explain individual variations in drug responses and improve therapies. An attractive part of genomics is that it will provide a strong scientific base for individualizing therapy. In our new school of pharmacy, genomics and informatics will be accorded the major emphases. As databases combining genetic information, drug interactions, intermediate disease phenotypes, and somatic cell variations expand, the practitioner of the future will have to be conversant with this information and be able to extract data relevant to the individual patient. The true “genomic” challenge for academic institutions in the future will be training these practitioners in informatics skills and packaging and networking pharmacogenomic data in a form friendly to the practitioner making the therapeutic decision.
MI: Are traditional and established pharmacy schools also trying to include those goals in the curriculum?
PT: Yes, but if you carry no legacy, you can appoint a new faculty intent on setting the pace in the field and interested in seeing the findings appropriately applied to human health. Our medical school was successful over decades ago by selecting preeminent investigators from the NIH and elsewhere to come to La Jolla. This may be a good model to follow.
MI: So you are already anticipating practicing pharmacists as dependent on genomics and bioinformatics?
PT: The practitioner of pharmacy in the future has got to be thoroughly computer-skilled. There will be a need to access genomic databases, correlate data with sequence information on the patient, as well as with knowledge about the existing therapy and potential drug interactions or idiosyncratic reactions found in relatives. Patients of the future may find themselves in a pharmacy setting, agitating some mouthwash between their teeth to slough some buccal cells for DNA amplification and sequencing. Profiles of the P-450 genes may dictate dosing and the SNPs in genes of the drug targets or their associated signal transduction pathway may be critical determinants in selection of the therapeutic agent. Such a future requires that we train a new breed of individuals who are skilled in dealing with informatics competently and comfortably.
MI: What of the dangers of depending so heavily on genomics as opposed to actual diagnoses? By virtue of genomics, isn’t every patient fated to have some potential, but not actual, disease that calls for a prescription?
PT: Well, we should first consider that there may be some therapeutic modalities that can be prophylactic but would not be efficacious in combating the full-blown disease. For example, maybe we can’t reverse the plaques and tangles of Alzheimer’s disease, or maybe we can’t reduce the damage to blood vessels from incidents of hypertension, but if you could predict these things and give a drug prophylactically, therapeutic potential is enhanced.
MI: And yet there will be cases where lots of people who don’t require intervention could nevertheless get a drug.
PT: Perhaps, and an intervention may carry a risk of producing a toxicity. But we have great uncertainty in assessing risk–benefit ratios associated with chronic therapies. Correlating responses with genetic information way help us select the responsive populations. A pharmaceutical company that has a corner on the market might find it desirable to treat a large sector of the population, but not all are responders. On the other hand, if you have a drug in the pipeline, identifying the responders through genetics may be what leads to its approval.
MI: So in attempting to place the new School of Pharmacy at UCSD at the vanguard of technology, how do you attract students savvy enough to come to UCSD?
PT: Don’t underestimate the resourcefulness of the student. They have forty to fifty career years ahead of them and the more talented will select the creative and challenging endeavors. At UCSD we developed an undergraduate major called “Pharmacological Chemistry.” Students in the major basically take the same courses as the biochemistry majors, but they also take an undergraduate course in pharmacology and a seminar sequence that deals with the career opportunities in the broad spectrum of biological, chemical, pharmaceutical, and medical sciences. “Pharmacological Chemistry” has become, under Bob Tukey, one of our most popular chemistry majors, second only to Biochemistry. The students were flocking to this major even before “big pharma” companies established permanent bases in La Jolla.
MI: Is economics setting the trend and the flow of funds in science, and is professional practice dictated by business interests?
PT: Well, fortunately we have peer review, the NIH, and other federal agencies for support that isolate the academician from many of these pressures. Even in industry we find remarkable successes with people following their scientific sense and training. When Craig Venter got his PhD in Physiology-Pharmacology at UCSD, economics was not, and still is not, in our training program. In the long run, if one starts future-oriented training programs in contemporary science, we’ll prepare our students within a framework that will further science and the mission of scientific and educational institutions.
- © American Society for Pharmacology and Experimental Theraputics 2003
