Hugh H Tilson

Department of Public Health University of North Carolina USA

The specialty practice of preventive medicine extends into the realm of pharmaceutical medicine just as deeply as better-recognized disciplines such as clinical pharmacology or toxicology. Pharmaceutical physicians may often be found practicing preventive medicine under the guise of clinical research or regulatory affairs, or in separate departments of pharmacoepidemiology, health economics or outcomes research, as well as the perhaps more predictable aegis of drug safety and pharmacovigi-lance.

Preventive Medicine/Public Health physicians, alias pharmacoeconomists and pharmacoepide-miologists, are trained in the core sciences of public health—epidemiology and statistics along with their non-physician pharmacoepidemiology colleagues. But, being physicians, they are also steeped in pathophysiology, diagnostics, therapeutics, and behavioral sciences. Additionally, specialization in preventive medicine requires detailed education in environmental health and general management and logistic skills. Many of these areas of expertise are shared with other types of pharmaceutical physicians, e.g. clinical trialists. It is not uncommon to find professionals moving (or oscillating) between pharmacoepidemiology and other departments within the same company.

Public health physicians use all these tools to identify, and control, public health hazards. In the pharmaceutical sector, these skills extend to such hazards associated with pharmacotherapy. Pharmacoepidemiologists have an additional dimension to their work, in that they may study drugs not only as a potential hazard to the public health (perhaps through drug surveillance programs) but also as a potential benefit to the public health (e.g. in large-scale interventional, clinical outcomes or economics studies). Identifying the types of patients who are most likely to benefit (or be harmed) by a therapeutic intervention is merely an extension of the orthodox world in which the public health physician practices. Thus, preventive medicine physicians may be found in pharmaceutical companies, CROs, academic, governmental, and international political environments.

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