Therapeutic practice rarely changes greatly as a result of a single investigation or trial. Traditionally, experiments carried out in the laboratory lead to small scale studies in humans, some of which may be translated into larger controlled clinical trials, which, if successful, may begin to influence patient management. The time scale of this process varies greatly. At one end of the spectrum a new biotechnology product may be developed with great rapidity, tested in a small cohort of patients, and be used by specialists within seven to eight years of its initial design. On the other hand valuable information on drugs of proved therapeutic value may languish in the literature for some 10 to 15 years before being widely accepted into clinical practice (for example, thrombolytic drugs after myocardial infarction). Dissemination of the results of research is as important as the original research itself, and implementation may represent an even bigger hurdle.

It is not an easy task to describe the advances in clinical pharmacology and therapeutics over the past year. I will start with the general issue of cost effective prescribing, which has moved up the political agenda in Britain after the publication of two influential reports. I will then cover four specialist therapeutic areas (AIDS, post myocardial infarction management, neurodegenerative disease, and diabetes), where treatment has become clearer because of positive or negative trial results. Finally, I will discuss the clinical exploitation of experimental findings on nitric oxide, which will have important roles in many diseases.