Professor Bozidar Darko Vrhovac (1936–2009)


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Professor Darko Vrhovac was born in 1936 in Zagreb where he lived all his life and he died in his home on 4 December 2009. He was born and raised in a highly intellectual family; his father Vuk was the founder of endocrinology in Croatia and this has had a crucial influence throughout his professional career.

He attended Medical School in Zagreb. During his studies, he was student-assistant at the Department of Physiology and within the exchange programme of the Medical School, he spent 5 months in hospitals in Munich and Zurich. At that time, this was a unique chance for early exposure to high-quality medicine. He graduated in 1961, did his internship in 1961–1962 and then did army service as a physician in 1963.

From 1963 to 1965, he worked in the Emergency Department in Zagreb and this is where he first realized the importance of rational drug therapy. He was puzzled by the fact that his colleagues used so many different medicines for the same diseases or conditions. In 1965, he started residency in internal medicine in the Department of Medicine, at the University Hospital Centre in Zagreb where he spent the rest of his extraordinary professional career.

His academic career started in 1971 after he finished residency training and he became assistant professor in Clinical Pharmacology, the first one in any of the medical schools at that time in Yugoslavia. The same year, he became head of the intensive care unit in the department of medicine and that was the moment when he started to promote and fight for rational drug therapy in the hospital. The same year, he became a vice-director of Drug Center, at that time a very important unit of the Hospital Association of Croatia. Professor Vrhovac took advantage of the position and very successfully started to spread the idea and principles of rational drug therapy, at first throughout Croatia and soon thereafter in the whole of Yugoslavia.

In 1972, he was awarded a scholarship from the National Ministry for Sciences and spent a year as a Fellow in Clinical Pharmacology at the Department of Clinical Pharmacology, University College Hospital Medical School in London where his mentor was Professor Desmond Laurence.

On his return to Zagreb in a very short time, he became the undisputed authority in the field of rational drug therapy in the whole of Yugoslavia and soon after he started activities which eventually resulted in the organization of a postgraduate course in clinical pharmacology. In addition, clinical pharmacology was recognized as a separate clinical specialty first in Croatia and then in the other Republics of Yugoslavia. The first resident in clinical pharmacology was appointed in 1975 and the postgraduate course in clinical pharmacology at the Medical School of Zagreb started in 1976.

From 1972, he was a representative of Yugoslavia in several different bodies of the World Health Organisation (WHO), and he was especially proud of being a lecturer at the meetings and symposia organized by WHO on the Role of Clinical Pharmacology in drug evaluation and control. Besides this, he was Head of the National Adverse Drug Reaction Monitoring Center within the WHO programme from the very beginning (1974).

The Center was responsible for the whole Yugoslavia, at that time one of the few not posted in Yugoslavia’s capital Belgrade.

In 1973, Professor Vrhovac organized, and became Head of, the first clinical pharmacology unit in the country. The same year, he was one of the founders of the Section for Pharmacotherapy of the Croatian Medical Association. After a few years, the Section was renamed and became the Society for Clinical Pharmacology, and Therapeutics with Professor Vrhovac as the first President of the Society until 1997.

In 1976, he wrote the first PhD thesis in the field of clinical pharmacology in the region. Also in 1976, he became Associate Professor, and in 1980 Full Professor at the Medical School of Zagreb.

His reputation grew by the years and he was highly respected among colleagues in Croatia and the surrounding countries both for his publishing and organization skills. On two separate occasions, he was President and Chairman in Internal Medicine at the Medical School of Zagreb.

During this time, he edited the first edition of the Textbook of Internal Medicine and he edited three subsequent editions, the last one being published in 2008.

The crucial role Professor Vrhovac had in promoting clinical pharmacology, besides organizing the network in the hospitals, the medical school, the healthcare system and the health insurance authorities in the whole country, was his recognition of the importance of publishing. He recognized very early the importance of the written word for spreading the principles of the newly installed discipline of clinical pharmacology. He started editing bulletins, journals, textbooks, handbooks and wrote altogether some 600 papers related to the rational use of drugs.

He edited the Hospital Drug Bulletin (University Hospital Center Zagreb), he was chief editor (1981–2007) of Pharmaca– the national journal devoted to drugs. He was editor of the first book on Clinical Trials in the country (1984), and in 1982 he organized the translation of the textbook ‘Clinical Pharmacology’ (by D.R. Laurence and P.N. Bennett) with commentaries for local readers stressing the local attitudes in drug prescribing. In 1980, he co-edited the first National Drug Formulary and since then has been the chief editor for the next four editions, the most recent of which was published in 2007.

Soon he was recognized internationally and continued his publishing activities at the international level. He was one of the co-authors of Meyler’s ‘Side Effects of Drugs’ in the 1984, 1988, 1995 and 2000 editions. He was co-editor of ‘Clinical Pharmacology’ (McGraw Hill, Milan, 2000) and he was one of the authors in The IUPHAR Compendium of Basic Principles for Pharmacological Research in Humans edited by Patrick de Souich, Sergio Erill and Michael Orme, 2000.

He was a member of the Editorial Board of the European Journal of Clinical Pharmacology, the International Journal of Clinical Pharmacology Therapy and Toxicology and the Journal of Chemotherapy.

He was very active at many international conferences and working groups in the field of medicines. He was a Member of the Council of the Uppsala Collaborating Center for Adverse Drug Reactions. In 2000, he was one of the founders of the Vienna School for Clinical Research and lecturer there for many years.

He was an active member of numerous international societies such as the British Pharmacology Society and the Hungarian Society for Pharmacology, and in 2004 he was awarded the honorary membership of the Royal College of Physicians of London.

When the European Association for Clinical Pharmacology and Therapeutics (EACPT) was founded in 1993, Professor Vrhovac was one of the two delegates from Croatia on the EACPT Council and he was quickly elected to the Executive Committee. His extensive experience and sound common sense was of immense help to the new committee on which he served for the maximum term of 8 years. The meetings were often enlightened by his humorous asides.

Listing the numerous achievements of Professor Vrhovac could go on and on but above all he was a warm-hearted friendly person who liked socializing and enjoyed meeting people always ready to help regardless of their status, position or profession. He had a great sense of humour and it is hard to tell whether he preferred listening or telling the jokes.

He was a hard-working person throughout his life, often giving the impression of being in a hurry. On one occasion, we were discussing this attitude of his. He told me that because of his diabetes, he knew that he did not have time to lose. His dealing with diabetes for more than 50 years was impressive in many respects. While many other individuals would consider diabetes as a handicap, with his strict control of the disease he turned it into motivation. Even in that respect, he could serve as a positive example both for the physicians and patients.

He enjoyed life in many aspects. He liked to play tennis and played the game on the day he passed away. He liked to dance and never missed the opportunity to dance and very appropriately his favourite dance was rock and roll.

Working with Professor Vrhovac for 3 decades, I could witness his enormous energy, enthusiasm and passion for medicine or more precisely for clinical pharmacology. What was unique about Professor Vrhovac was that he did not slow down as if he either did not know how to or did not want to slow down. I could not see any sign of fading of any of the aforementioned virtues and qualities. Full of plans and even more with a sense that there are still so many things to be done, he died quietly in his home. Talking with Professor Vrhovac on many occasions about the eternal issue of life and death, he was not afraid of death but he was terrified by the possible manner of his dying. His sudden death was a shock for his family and for all of us but if he had had the chance to choose, he would have chosen this kind of end.

We guess that many of the well-known European clinical pharmacologists have experienced the hospitality that Professor Vrhovac and his charming wife Yvonne offered so gladly to numerous visitors. I had a feeling that he enjoyed more being a host than being a guest.

We will miss Darko, as he was known to many of us; the loss is enormous for European clinical pharmacology and nearly unbearable for Croatian clinical pharmacology.

The best we can do is to continue from where he has stopped and try to finish at least some of the projects he had in mind.

Professor Vrhovac is mourned by his wife Yvonne, Professor at the University of Zagreb, his son Radovan, Associate Professor at the School of Medicine in Zagreb, by his daughter-in-law Jasmina, dipl.iur., by grandchildren Pava and Ivan and by his very many friends and colleagues too numerous to mention.