Can a clinical pharmacologist regain his place in the hospital?

The sub-specialty of clinical pharmacology and the specialty of pharmacology and its practitioners are again at the crossroads. For all practical purposes, a “Pharmacologist” in our country is a “Clinical Pharmacologist” because a primary medical degree (MBBS) is needed to pursue M.D. Pharmacology in our country. Hence, I shall be using these two terms interchangeably in this narrative. WHAT CAN A PHARMACOLOGIST IN INDIA DO? There are two broad avenues for a pharmacologist in India - Industry or Academia.[1] We would be restricting ourselves to Academia as their role in the pharmaceutical industry is well defined. SO WHY IS A PHARMACOLOGIST IN THE ACADEMIA CONFUSED? Till the end of the 20th century, the role of a pharmacologist in academia was to a certain extent well defined. This is because, more than teaching undergraduates, the pharmacologist could take pride in the fact that animal experimentation both in the UG and PG curricula was given paramount importance, and that was a unique skill set that only a pharmacologist possessed. But in the early 21st century and beyond, awareness of animal rights and many more factors have almost eliminated animal experimentation to a great extent.[2] Hence, the only unique skill that sets apart pharmacologist from other disciplines was slowly eroded. As a result, confusion and a sense of diffidence have set in among the pharmacologists, especially in academia. Let us list out a few things which we, as pharmacologists in academia, can do to carve ourselves a niche area that can restore pharmacology to its lost glory. Undergraduate teaching There should be alignment of UG teaching with what should be practiced in the Clinics. Archaichal teaching methods can be replaced with novel methods. Weed out what is not needed for students when they start practicing, and focus only on skills and knowledge required to practice. To this end, right from the curriculum, teaching-learning methods, bedside teaching with actual patients is the key. Ward rounds and clinical cases that are actually in the hospital should be used for teaching rather than case scenarios. Prescription writing and audit should be actual ones picked up from the hospital by the students themselves. Adverse drug reactions (ADRs) should be gathered by the students, and this should be discussed in classes. These can go a long way in building a good teacher–student rapport and instill a sense of belonging for both to the real world rather than a disassociation of pharmacology with the hospital. The pharmacology teacher must be seen as an individual who is seen more in the wards than in the department. The teacher should discuss cases with their clinical colleagues and offer to the student the best mix of both specialties. This will awake an interest in the students to learn more meaningful pharmacology content.[3] Role in a teaching hospital A pharmacologist/clinical pharmacologist plays a vital role in enhancing the quality of patient care within a hospital setting. Their expertise spans a wide range of critical areas, including pharmacovigilance, materiovigilance, therapeutic drug monitoring (TDM), antimicrobial stewardship, and drug utilisation studies. They actively contribute to clinical trials, serve as key members of the drug and therapeutics committee, and provide essential support in routine prescription audits and feedback. In addition, they hold an important position in the ethics committee and offer valuable guidance in pharmacy procurement and inventory management. Clinical pharmacologists are pivotal in enhancing patient safety and therapeutic outcomes within healthcare systems. They are involved in coordinating pharmacovigilance activities, ensuring that ADR reports are meticulously evaluated. Their expertise in biomedical sciences, pharmacology, and training in biostatistics equips them to optimize drug dosing and treatment regimens.[4] In India, the Pharmacovigilance Programme of India (PvPI), under the Indian Pharmacopoeia Commission, has established a robust framework for monitoring drug safety. As of April 2025, PvPI operates through a network of 311 ADR monitoring centers (AMCs) across the country.[5] These centers systematically collect and analyze ADR reports from clinicians and prescribers at the regional and national levels. The evaluated findings are then communicated back to the reporting clinicians and the Drug and Therapeutics Committees (DTCs), fostering a continuous feedback loop aimed at improving prescribing practices. Materiovigilance shares the same core objective as pharmacovigilance, ensuring patient safety, but focuses specifically on monitoring adverse events related to medical devices (MDAEs). All types of MDAEs–whether critical or noncritical, known or unknown, frequent or rare, or those involving incomplete or inadequate device specifications–should be promptly reported and thoroughly evaluated.[6] Clinical pharmacologists help in identifying safety issues, support device recalls, raise awareness about substandard products, and assist regulatory bodies in decision-making, ultimately ensuring safer medical device use and improved patient outcomes. A key pillar of personalized medicine TDM allows treatment to be adjusted according to the unique physiological and clinical profile of each patient. Clinical pharmacologists, with their advanced expertise in pharmacokinetics, drug metabolism, and interactions, are well-equipped to interpret TDM data. They consider critical factors such as age, organ function, and concurrent medications to understand drug behavior in the body and guide precise therapeutic decisions. In the TDM laboratory, clinical pharmacologists design and implement evidence-based protocols, ensuring alignment with current clinical guidelines. They collaborate closely with other healthcare teams to provide informed recommendations on dose adjustments, alternative therapies, or further monitoring, optimizing treatment outcomes while minimizing adverse effects. In addition, they contribute to research and quality improvement initiatives, continuously enhancing the effectiveness and safety of personalized therapeutic strategies.[7] Another area which contributes to personalized medicine is pharmacogenomics, and many pharmacologists have taken up research and translational activities in this domain. Clinical pharmacologists are integral to antimicrobial stewardship programs (ASPs) in hospitals, where they play a pivotal role in combating antimicrobial resistance (AMR). Their responsibilities encompass evaluating antibiotic prescriptions, managing formularies, guiding de-escalation strategies, developing treatment guidelines, and educating healthcare teams. By leveraging their expertise in pharmacokinetics and pharmacodynamics, clinical pharmacologists ensure the appropriate selection, dosing, and duration of antimicrobial therapies. These help in optimizing patient outcomes and minimizing the emergence of resistance. In India, the involvement of clinical pharmacologists in ASPs is gaining momentum. A study by the Indian Council of Medical Research across 20 tertiary care hospitals revealed that 85% had integrated clinical pharmacologists into their ASP teams, leading to significant improvements in antimicrobial use and patient care.[8] Clinical pharmacologists also lead prescription audit services to monitor the quality of prescribing practices, a key requirement in hospitals. These audits focus on various prescribing indicators such as average number of drugs prescribed per encounter, percentage of drugs by generic name, percentage of encounters with antibiotics and injections, and percentage of drugs from the essential medicine list.[9] Medication errors often arise not from negligence but from the complexity of the medication use cycle. Clinical pharmacologists, with their specialized knowledge, understand the root causes of prescribing errors and are instrumental in preventing these errors, fostering safety, and promoting effective reporting and investigation of medication-related errors. Once an audit is conducted, clinical pharmacologists provide corrective and preventive actions to improve prescribing practices. They assess the effectiveness of these actions through ongoing audits. In addition, these contribute to drug utilization studies to optimize therapy and improve patient outcomes. Clinical pharmacologists are vitally involved in DTCs. They act as a bridge between medical, pharmacy, and other healthcare staff. A DTC should be in place and ideally include clinical pharmacologists, medical specialists, pharmacists, and other relevant personnel. Clinical pharmacologists often provide leadership within DTCs, guiding the development of evidence-based recommendations for medication use tailored to local healthcare needs.[10] They contribute to the creation of local formularies in alignment with the WHO Essential Medicines. In addition, they are also central to drug information services, offering both descriptive and problem-focused guidance for clinicians. Their involvement enhances rational prescribing, improves adherence to guidelines, and strengthens the overall quality of care delivered through DTC initiatives. The formulary list helps in finding out the need and the requirement of various drugs in the hospital setting. Clinical pharmacologists also play a leadership role here in overseeing the procurement, stocking and also regular surveys conducted in various wards in hospital in terms of proper storage and disposal of different categories of drug, such as double locking, LASA drugs, crash cart, biomedical waste management, disposal route of expiry drugs to name a few. Clinical pharmacologists play a key role in supporting and advancing clinical trial activities within hospitals. They assist in evaluating the feasibility of proposed studies, act as liaisons between sponsors and clinical teams, and often serve as the central coordinators for establishing clinical research units. These units provide the necessary technical and logistical infrastructure for smooth trial execution. In addition, clinical pharmacologists are instrumental in ethics committee functions. In India, ethics committees require a basic medical scientist, preferably a pharmacologist, as part of their quorum.[11,12] In this capacity, clinical pharmacologists offer valuable insights into trial design, ensuring scientific rigor, ethical standards, and patient safety are upheld throughout the research process. THE WAY FORWARD The future of clinical pharmacology lies in establishing it as an independent, integral discipline within hospitals. Given the growing complexity of therapeutics, clinical pharmacologists are essential in guiding the rational, cost-effective use of medicines across diverse disease areas. Their expertise is crucial in minimizing prescribing errors, managing adverse drug effects, and supporting clinicians in personalized patient care. They are also positioned to educate both healthcare providers and patients about safe and effective medication use, contributing to better therapeutic outcomes. As medicine evolves and patient safety becomes increasingly important, clinical pharmacologists will play a pivotal role in shaping evidence-based practices and advancing healthcare quality in India. Hence, it is time for us, pharmacologists, to leave the comfort zone of our department and head to the hospital, where the actual practice of clinical pharmacology lies.