{"id":43126,"date":"2018-09-28T14:16:32","date_gmt":"2018-09-28T13:16:32","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=43126"},"modified":"2018-10-05T16:37:42","modified_gmt":"2018-10-05T15:37:42","slug":"jeffrey-aronson-when-i-use-a-word-medicine-medicines-and-the-medicines-act-1968","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2018\/09\/28\/jeffrey-aronson-when-i-use-a-word-medicine-medicines-and-the-medicines-act-1968\/","title":{"rendered":"Jeffrey Aronson: When I use a word . . . Medicine, medicines, and the Medicines Act 1968"},"content":{"rendered":"<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/12\/jeffrey_aronson.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-32935\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/12\/jeffrey_aronson-223x300.jpg\" alt=\"jeffrey_aronson\" width=\"122\" height=\"146\" \/><\/a><span style=\"font-weight: 400\">As I pointed out <\/span><a href=\"https:\/\/blogs.bmj.com\/bmj\/2018\/09\/21\/jeffrey-aronson-when-i-use-a-word-must-and-should\"><span style=\"font-weight: 400\">last week<\/span><\/a><span style=\"font-weight: 400\">, the IndoEuropean root MED, to measure or take appropriate measures, has given rise to a large number of English words, among them \u201cmedicine\u201d and related words, such as medicinal, medication, and remedy. The corresponding Latin word, med\u0113r\u012b, meant to look after, heal, or cure. Metheglin (Welsh meddyglyn) came from meddyg, a healer or doctor and llyn, liquor. It contained water, spices, sweet herbs, and also honey, \u201cMeddyg\u201d may have been confused with \u201cmedd\u201d, mead. The IndoEuropean root MEDHU meant honey, which was considered medicinal, as were mead and metheglin.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The <\/span><a href=\"https:\/\/www.goodreads.com\/book\/show\/21322625-the-physicians-of-myddfai\"><span style=\"font-weight: 400\">Physicians of Myddfai<\/span><\/a><span style=\"font-weight: 400\"> (Meddygon Myddfai) were herbalists who lived in the Welsh village of Myddfai in Carmarthenshire, and were descended from the sons of the legendary Lady of the Lake. Their remedies were first published in Welsh in a vellum manuscript known as the <\/span><a href=\"https:\/\/www.vanhamel.nl\/codecs\/Oxford,_Jesus_College,_MS_111\"><i><span style=\"font-weight: 400\">Red Book of Hergest<\/span><\/i><\/a><span style=\"font-weight: 400\"> in around 1382. Honey was used in many of their recipes, and metheglin is mentioned in a second book of remedies, of the physician Hywel, as an expectorant (<\/span><a href=\"https:\/\/books.google.co.uk\/books?id=_NY_AAAAcAAJ&amp;printsec=frontcover&amp;dq=the+physicians+of+myddvai&amp;hl=en&amp;sa=X&amp;ved=0ahUKEwiw5Lf6t93dAhWMzYUKHdLSDIcQ6AEIMDAB#v=onepage&amp;q=meddyglyn&amp;f=false\"><span style=\"font-weight: 400\">\u00a7113<\/span><\/a><span style=\"font-weight: 400\">).<\/span><\/p>\n<p><span style=\"font-weight: 400\">The word \u201cmedicine\u201d is ambiguous. The Latin word \u201cmedicina\u201d implied \u201cars medicina\u201d, the art or practice of healing, and more specifically the administration of a drug; hence medicine. However, \u201cmedicina\u201d could also imply \u201cres medicina\u201d, a medicinal thing or a medicament, in short a medicine. The latter meaning was first recorded in English in the early 13<\/span><span style=\"font-weight: 400\">th<\/span><span style=\"font-weight: 400\"> century, the former not until about 100 years later.<\/span><\/p>\n<p><span style=\"font-weight: 400\">So the phrase \u201ctoo much medicine\u201d could refer to too much practice of medicine, such as too many tests, too many guidelines, too many diagnoses. Or it could refer to too much of an individual medicament or too many different ones, resulting in too many adverse drug reactions and drug interactions. I prefer the term \u201ctoo much healthcare\u201d, which has the twin advantages of being unambiguous and encompassing aspects of care other than purely doctor-driven ones.<\/span><\/p>\n<figure id=\"attachment_43128\" aria-describedby=\"caption-attachment-43128\" style=\"width: 224px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" class=\" wp-image-43128\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/09\/aronson_medicines_act.png\" alt=\"\" width=\"224\" height=\"349\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/09\/aronson_medicines_act.png 392w, https:\/\/blogs.bmj.com\/bmj\/files\/2018\/09\/aronson_medicines_act-193x300.png 193w\" sizes=\"auto, (max-width: 224px) 100vw, 224px\" \/><figcaption id=\"caption-attachment-43128\" class=\"wp-caption-text\">Figure 1. The front cover of my copy of the Medicines Act 1968, in the reprinted version of 1986<\/figcaption><\/figure>\n<p><span style=\"font-weight: 400\">This year is the 50<\/span><span style=\"font-weight: 400\">th<\/span><span style=\"font-weight: 400\"> anniversary of the <\/span><a href=\"http:\/\/www.legislation.gov.uk\/ukpga\/1968\/67\/pdfs\/ukpga_19680067_en.pdf\"><span style=\"font-weight: 400\">Medicines Act 1968<\/span><\/a><span style=\"font-weight: 400\"> (Figure 1), which dealt specifically with the use of medicines, not the practice of medicine. The use of the plural, medicines, makes it clear that it is the <\/span><a href=\"http:\/\/blogs.bmj.com\/bmj\/2017\/09\/29\/jeffrey-aronson-when-i-use-a-word-language-that-counts\"><span style=\"font-weight: 400\">count noun<\/span><\/a><span style=\"font-weight: 400\"> we are talking about\u2014a medicine, a medicament, or a medicinal product, <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16180936\"><span style=\"font-weight: 400\">defined<\/span><\/a><span style=\"font-weight: 400\"> as \u201ca manufactured article, intended to be taken by or administered to a person or animal, which contains a compound or compounds with proven biological effects, plus excipients, or excipients only, and may also contain contaminants.\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400\">The first concern of the act was to establish a Medicines Commission. After defining \u201cMinisters\u201d (\u00a71), the act states (\u00a72) that \u00a0\u201cThere shall be established a body to be called the Medicines Commission (in this Act referred to as \u201cthe Commission\u201d) to perform the functions assigned to the Commission by or under this Act.\u201d Two sections later the act lays down the procedures whereby committees, so-called \u201csection 4 committees\u201d may be established. The Committee on Safety of Medicines (the erstwhile CSM), established in 1970, was one such committee. I was vice-chairman of the Medicines Commission immediately before the Commission and the CSM were conjoined in 2005 as the Commission on Human Medicines (CHM), which was formed primarily in order to harmonize with European procedures. Several other clinical pharmacologists were and are members of all these bodies, and have been prominent in many other relevant committees, such as the National Institute for Health and Care Excellence (NICE), the NIHR Health Technology Assessment (HTA) Programme, the British Pharmacopoeia Commission, and the Advisory Council on the Misuse of Drugs.<\/span><\/p>\n<p><span style=\"font-weight: 400\">All of these and other aspects of clinical pharmacology will be in focus during <\/span><a href=\"https:\/\/www.bps.ac.uk\/education-engagement\/clinical-pharmacology-skills\/clinical-pharmacology-month\"><span style=\"font-weight: 400\">Clinical Pharmacology Month<\/span><\/a><span style=\"font-weight: 400\"> in October, with a range of activities, including case presentations at grand rounds and prize competitions for medical students. We hope that the patron saint of pharmacology and clinical pharmacology will look favourably on all of this.<\/span><\/p>\n<p><span style=\"font-weight: 400\">As I have <\/span><a href=\"https:\/\/blogs.bmj.com\/bmj\/2018\/07\/06\/jeffrey-aronson-use-word-saintly-medical-specialties\"><span style=\"font-weight: 400\">previously pointed out<\/span><\/a><span style=\"font-weight: 400\">, drug actions are mediated by chemical signalling, and chemical recognition is the function of <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16402126\"><span style=\"font-weight: 400\">receptors<\/span><\/a><span style=\"font-weight: 400\">, which are major targets of many important medicines. The mechanism whereby drug\u2013receptor interactions are translated into therapeutic outcomes involves chemical transmission by substances generally known as <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/27481708\"><span style=\"font-weight: 400\">second messengers<\/span><\/a><span style=\"font-weight: 400\">. So, no saint is better qualified to be the sought after patron saint than God\u2019s great messenger himself, the archangel Gabriel. And Gabriel\u2019s saint\u2019s day falls tomorrow, on 29 September.<\/span><\/p>\n<p><em><strong>Jeffrey Aronson<\/strong>\u00a0is a clinical pharmacologist, working in the Centre for Evidence Based Medicine in Oxford&#8217;s Nuffield Department of Primary Care Health Sciences. He is also president emeritus of the British Pharmacological Society.<\/em><\/p>\n<p><strong>Competing interests:<\/strong>\u00a0None declared.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>As I pointed out last week, the IndoEuropean root MED, to measure or take appropriate measures, has given rise to a large number of English words, among them \u201cmedicine\u201d and [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2018\/09\/28\/jeffrey-aronson-when-i-use-a-word-medicine-medicines-and-the-medicines-act-1968\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":38359,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5762],"tags":[],"class_list":["post-43126","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-jeff-aronsons-words"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Jeffrey Aronson: When I use a word . . . 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