Science and physicianly practice: are they compatible?

1. Science, in the present paper, is defined as the systematic study of humans, based on deduction and inferences from reproducible observation and measurement. Physicianly practice is the art of healing through accurate diagnosis and treatment. 2. The science that is conducted by clinical pharmacologists involves both clinical studies, which is working with patients or normal volunteers, and a variety of in vitro techniques. 3. Studies of patients with exercise-induced asthma (EIA) suggest that inhaled beta-adrenoceptor agonists may afford protection against EIA by inhibiting mast cell mediator release. In vitro experiments with human lung tissue demonstrate dose-dependent inhibition of histamine and leukotriene release by fenoterol, a beta-adrenoceptor agonist. 4. Studies in normal volunteers following the inhalation of corticosteroids (fluticasone and budesonide), which are used for the treatment of asthma, detected the presence of the administered drugs in the plasma. The potency ratio of fluticasone : budesonide for inhibition of the hypothalamic-pituitary-adrenal (HPA) axis in these normal volunteers was similar to the potency ratio determined in animal models of inflammation. 5. Studies in vitro showed that fluticasone and budesonide have effects on alkaline phosphatase release from human osteoblasts, with a potency ratio of similar rank order to that observed in vivo on the HPA axis. 6. These studies have shown that in vivo and in vitro techniques can be used in a complementary fashion to address questions of clinical relevance.