Individualized therapeutic medicine

This chapter is the first chapter in this book and serves as an introduction The first section of this chapter starts with a discussion of what is a medicinal chemist In this chapter the reader will notice far more attention to the people aspect of the discipline of medicinal chemistry than will be found in later chapters. This is by design. When expert practitioners in the field discuss success in medicinal chemistry the focus is usually very much on the person rather than on the technology. We admire the persistent drug hunters. We remember the individuals who do not give up easily. We appreciate those individuals with the interpersonal skills that facilitate an effective therapeutic project team. We admire those medicinal chemists who think out of the box and come up with the insights that transform a program. In this introduction I have tried to give some credit to this people factor. 

In human medicine, metallic copper is used in some intrauterine devices, and various copper compounds are used as emetics and to treat rheumatoid arthritis (USEPA 1980 Aaseth and Norseth 1986). Some individuals wear copper bracelets as treatment for arthritis although its therapeutic value has little support (USEPA 1980). 

In this rapidly evolving field, the detection of PDE enzymes in the central nervous system (CNS) has stimulated interest in exploring potential applications of PDE inhibitors for treating CNS disorders such as Alzheimer s disease and other cognitive malfunctions, depression, anxiety, and schizophrenia. This review will focus on these therapeutic opportunities as well as new developments in the medicinal chemistry and biology associated with selected members of the PDE family, in particular PDEs 2, 4, 9, and 10. There have been a number of other reviews in this field in the past year that have covered selected individual PDE enzymes and potential pharmacologic applications of PDE inhibitors in CNS disorders [3,7,8]. 

Most of the assessment of toxicology and safety of therapeutics is focused on the patients who are to benefit from the new medicine. However, there are two other groups of individuals (each of which has different exposure profiles) that one must be concerned about the healthcare providers (nurses, pharmacists and physicians) who provide and/or administer the drugs and the individuals involved in manufacturing them. The concerns here are in the realm of occupational toxicology. 

Once the viral RNA has been translated and the large polyprotein has been processed to form individual viral proteins, new viral particles begin to form. Packaged in each virion are two copies of fully unspliced viral RNA. To be packaged into the virion, the RNA dimerizes in a highly orchestrated process involving a self-complementary stem-loop interaction. Such HIV-specific RNA events may prove useful for fumre therapeutic intervention, although they have so far received relatively little attention by medicinal chemists. 

The therapeutic benefits and risks of a medicine, and therefore the choice of treatment for an individual patient, stem from evidence from a series of clinical trials. Taken together, these trials should reflect all likely therapeutic situations. From time to time, a particular problem arises that generates a new hypothesis. In order to obtain an answer to the specific question, we sometimes restrict the population sample to study subjects who do not possess a number of variables that may confound the outcome. In this manner, we move away from the realities of everyday clinical practice to an idealised, but artificial, environment. This is justifiable if the restriction is logical and if, with it, the hypothesis testing can be successfully completed. Otherwise, the issue may never be settled. 

By the flrst century a.d. it was clear to both physician and protopharmacologist alike that there was much variation to be found from one biological extract to another, even when these were prepared by the same individual. It was reasoned that to fashion a rational and reproducible system of therapeutics and to study pharmacological activity one had to obtain standardized and uniform medicinal agents. 

This chapter intends to briefly overview, for each of the major areas of uses of per-fluorochemicals (PFCs) in medicine, biology, and biochemistry, the medical needs and therapeutic objectives the challenges facing product definition and development the solutions and products that are or could be provided by PFC-based materials as well as some present research trends and perspectives. The increasing number of pharmaceuticals and agrochemicals that contain individual fluorine atoms or trifluoromethyl groups is out of the scope of this chapter [1,2]. 

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