By Adebayo Folorunsho-Francis

Against all odds, representatives of the Obafemi Awolowo University (OAU), Ile Ife, have won the grand prize at the 2015 edition of the Sir Ifeanyi Atueyi Debate Competition.

The contest which took place at the Banquet Hall of the University of Benin (UNIBEN) on 8 July, 2015 was part of activities lined up by the Pharmaceutical Association of Nigeria Students (PANS) to celebrate the Annual Pharmacy Health Week.

Debating on two topical issues – “Should Nigeria Practice Free Education?” and “Should Euthanasia be Legalised in Nigeria?” academic gladiators from both OAU and UNIBEN metaphorically went for each other’s jugular in a bid to garner maximum points through their arguments.

While representatives of UNIBEN claimed that education could not be completely free, citing the huge budget earmarked annually for the educational sector, the OAU team maintained that it was indeed possible, considering the near-100 per cent literacy model of countries like Korea and Sweden.

Team UNIBEN however countered the argument with the claim that the countries cited succeeded simply because of their moderate population figures.

“Now imagine Nigeria with a huge population of approximately 177 million to contemplate the idea of offering free education. Where is that done?” the team asked rhetorically.

On legalisation of euthanasia in Nigeria, Team OAU canvassed that Nigeria was not ripe for such “obnoxious act of ‘mercy killing.’” One of the contestants cited the remarkable case of Karen Quinlan of the United States who survived after she had been removed from mechanical ventilation and even went on to live nine more years in vegetative state before her eventual death in 1985.

Team UNIBEN however countered the notion, pointing out that their opponent (OAU) was not putting peculiar cases, such as those suffering from cerebral cancer, into consideration.

“When dying patients cry out for euthanasia, they know the reason for it. After all, don’t we humans clamour for analgesics and opium in the face of excruciating pains? How then can you justify the need for patients with terminal diseases to go through a lifetime pain? It is totally uncalled for!” the team argued.

At the end of the debate. Team OAU was announced winner.

Announcing the result, the panel of judges, comprising Dr Patrick Osarenmwinda Igbinaduwa, head of department, Pharmaceutical Chemistry, Faculty of Pharmacy, UNIBEN; Barrister Theodora Ewah, administrative assistant, UNIBEN; and Barrister Omoduwa Osaduwa, administrative assistant, UNIBEN, said that they considered a number of factors, which included number of points garnered, manner of presentation, dress code and composure, to arrive at their final decision.

In the same debate category, Ojelabi Jesujoba, who led the OAU delegation, was declared the best speaker.

In the essay writing category, Ezekiel Efeobhokhan, a 400 level pharmacy student in UNIBEN emerged winner, with his article, “Performance Enhancing Drugs: Is it Justifiable In Sports & Academics?”

Praising the contestants and the organisers for their outstanding contributions, Pharm (Sir) Ifeanyi Atueyi, managing director of Pharmanews Limited, said he was particularly impressed with the institution that won the debate contest, given the fact that OAU was his alma mater.

Remarking on the essence of the annual event, which is hosted in his honour, the Pharmanews boss said it was necessary to understand that great men and women do not become successful or prominent overnight, noting that so many hurdles and challenges must have been surmounted along the way.

“There will always be obstruction and challenges. It will get to a point where you might start wondering why those things are happening to you. But know that God is with you even with those challenges.

“I am where I am today because God has destined it. Pharmanews might look like an accident, but I assure you that it is not,” he remarked.

Reminiscing on how the journal was birthed in May 1979, Atueyi narrated the story of how he was compelled to abandon employment to pursue his dream.

“As you go on with your programme, some of you are finishing; let nobody tell you that you cannot be the person you hope to be. Let God decide that for you,” he counselled.

The quest to have a well-ordered drug distribution system in Nigeria through the implementation of the new National Drug Distribution Guidelines (NDDGs) has received a big boost as Pharm. Olumide Akintayo, president of Pharmaceutical Society of Nigeria (PSN) and other eminent pharmacists have backed the 30 June implementation commencement date.

The pharmacists spoke at the official launch of Ultra Logistics Company (ULCO), a Mega Drug Distribution Centre (MDDC), promoted by the PSN, held recently at MAN Centre, Ikeja, Lagos.
Speaking with Pharmanews in an interview at the event, Pharm. Akintayo noted that the MDDC was a product of direct consultation between the federal government, through the Federal Ministry of Health, and the PSN, alongside its various appendages, including the technical groups and the strategic platforms like PMG-MAN, APIN and NIROPHARM.
He disclosed that the PSN had urged the FG to keep to the implementation date,adding that there would be a ministerial press briefing in June to announce the commencement of the policy.
The PSN president, who was the chief host at the event, in his opening remarks, noted that one of the underlying principles behind PSN promoting ULCO is to have pharmacy solution to pharmaceutical problems, especially that of drug distribution.
He noted that ULCO was set up to protect the interest of pharmacy practice and the general public in the implementation of the NDDGs, adding that, in recognition of the value-based principle of the pharmacy profession, the company would operate as a commercial organisation with social enterprise ethos, while growing the investment of shareholders.
The PSN helmsman explained that ULCO will aim to achieve three main objectives, namely, effective and efficient pharma supply management; distribution of safe, efficacious, effective and affordable drugs of good quality; and access to affordable pharma products to the public.
Pharm. Akintayo noted that the Nigerian pharmaceutical market is presently confronted with key challenges which include: fragmented and chaotic nature of drug distribution network; limited advancement in regulatory reforms; poor healthcare infrastructure; limited spending power of citizen; policy inconsistency; poor storage of drugs, leading to deterioration of active ingredients; reliance on imported pharmaceuticals; as well as limited market data, asoperators do not have real time data on quantities of drugs sold, where, when, by who and to whom.
He stated further that if the industry gets drug distribution right, the role of pharmacists will be clearer and there will be better professionalised detailing and less of selling, adding that the desire to see this come to fruition prompted the PSN to play a fundamental role in putting together the 2011 NDDGs.
Pharmacists, he said, must be in charge of ensuring that there is a model of practice in drug distribution, which other players must follow, stressing that, it is part of the responsibility of pharmacists to create confidence in the drug distribution system and ensure the safety and efficacy of drugs.

ULCO, Akintayo said, would be part of providing solution that will ensure an elimination of the current unprofessional practice in drug distribution, as the centre will provide an opportunity to change how drugs are distributed, while also serving as a platform for wealth creation for the pharmacy profession.
While urging pharmacists and pharmacy institutions to see the company as an initiative for financial empowerment, the PSN helmsman hinted that ULCO’s aspiration is to be the market leader in ensuring the Nigerian public get good and quality drugs at reasonable prices.
In his presentation at the occasion, the managing director of ULCO, Dr Lolu Ojo, said that the company was established to provide an opportunity for practitioners to be part of the positive changes that would reposition and boost the Nigerian pharmaceutical industry.
ULCO, Lolu Ojo said, has a mission to emerge as the preferred MDDC and ensure that drugs that are available are affordable and of good quality.
He added that ULCO will establish physical presence in Lagos with zonal hubs in each of the geopolitical zones, so as to meet up with its operational and regulatory requirements.
The ULCO MD stated that the company will focus on densely populated urban areas with large scale wholesalers to maximise business cost of distribution.
He also noted that ULCO will seek competitive advantage by offering highly diverse products at competitive pricing, noting that pricing remains the strongest key buyer value in the Nigerian market.
Chairman of the occasion, Dr Dere Awosika, in her closing remarks, urged all pharmacists to support the ULCO and the new NDDGs, stating that with the support of everybody, the company would succeed and the NDDGs would be effective.

Managing Director of the HealthPlus Group, Pharm. Bukky George, has charged community pharmacists to regularly evaluate their business success to ensure better performance and profitability.

She gave the charge at the 2nd Annual Alumni Lecture of the Faculty of Pharmacy, University of Lagos (UNILAG), which took place at the main auditorium of the institution in Akoka, on 3 March, 2015.

Speaking at the event, which also coincided with the institution’s 30th anniversary of pharmacy education, Pharm. George said she had observed over the years that most pharmacists were laid-back and not willing to take risk in their businesses.

“As an entrepreneur, pharmacists must ever be willing to take risk,” she urged.

While advisingthe 2013/2014 graduating students present at the lecture, the HealthPlus boss recalled that from the inception of her business, her mission was to be Nigeria’s first integrated pharmacy, a dream that eventually materialised.

According to her, Healthplus commenced operation 15 years ago in a modest18-square-metre room in Ikeja GRA, with just three staff, adding that, since then, the business had progressively grown to include40 branches nationwide.

“This is why I said that you need to evaluate the success of your business from time-to-time. Being a leader is beyond just opening a store and sitting there. We all have entrepreneurial spirit and skills within us,” she said.

George, who was once a staff of GlaxoSmithKline, equally encouraged young community pharmacists to seek mentoring.

“As young pharmacists, you must learn to look at the big picture. Everything you need to know about life, you don’t know yet. Graduating from school is just a step into preparing you for the journey ahead,” she stressed.

The pharmacist-turned-entrepreneur also called for professionalism on the part of the graduating students, adding that a professional pharmacist is mature, dresses appropriately, comes to work with a good attitude, is always willing to learn, gives appropriate feedback and is a team player.

Quoting the FIP description of a professional pharmacist, George said that such pharmacist is a 7-star pharmacist who is a communicator, manager, leader and teacher.

“I believe that is what you all are. If there is anything I learnt from my role models (Aliko Dangote and Richard Branson), it is to do big things at all time. That has always been my mantra,” she said.

While emphasising the need for careful thinking and planning before venturing into the world of entrepreneurship, the retail mogul also charged the students to be confident and inquisitive.

“You need to be bold and speak as you would like to be remembered. One of your lecturers, Pharm Tosin Adeyemi, once interned with HealthPlus after his graduation. He was bold, brash and quite inquisitive, always asking questions.That is the hallmark of a good pharmacist. I encourage you to do the same wherever you find yourself,” she admonished.

Sharing Pharm. George’s optimism, Pharm. Remi Adeseun, chairman of Rodot Nigeria Limited charged the graduating students to be emboldened and empowered by their history,rather being than being enslaved by it.

“The skill-set you have acquired in the course of your training can also be deployed to create and share value in other fields such as telecommunication, sales and marketing, retail banking and management education services,” he said.

Adeseun urged the young scholars to hold on to their dreams as there would be challenges on their way to becoming outstanding pharmacists.

Sharing his personal experience, the Rodot chairman said, “Competition is in my nature. That is why it was easy for me to seek a career in pharmaceutical sales and marketing. After my internship in community pharmacy and national youth service in the hospital, I knew my future professional happiness lay in deploying the clinical pharmacy knowledge I had acquired from the university to help healthcare workers give their patients the best treatment choices using my products from my Sandoz to Novartis to Janssen-Cilag days.”

Dignitaries at the event included Prof. Olukemi Odukoya, dean, Faculty of Pharmacy, University of Lagos; Pharm. Wale Oyenuga, managing director, Evans Therapeutics and Prof. Fola Tayo, pro-chancellor and chairman of council, Caleb University.

Others were Dr Ayodele Ogunleye, chairman, UNILAG Alumni Association, Dr Arinola Joda, PSN assistant secretary, Pharm. Ike Onyechi, managing director of Alpha Pharmacy and Prof. Cecilia Igwilo, Director, Foundation Programme Unilag

According to Dr Odukoya, the lecture was intended to bring prominent and successful alumni to the campus to share their wisdom and experience with the faculty.

“Lecturers are also chosen amongst the alumni who have repeatedly proven themselves with tremendous achievements at the highest levels in their respective fields. In this way, both the students and faculty benefits in terms of alumni support and overall exposure,” she said.

Chairman of the Pharmacists Council of Nigeria (PCN) Pharm. Bruno Nwankwo has said that, to consistently meet the drug needs of Nigerians, patent medicine stores are indispensable .

Speaking at the three-day education summit organised by the Nigeria Academy of Pharmacy (NAPharm.) in collaboration with the Pharmaceutical Society of Nigeria and the PCN which held at the University of Lagos Guest House and Conference Centre, Akoka on 22 April, Nwankwo explained that such sub-cadre was essential to support pharmacists in the onerous task of meeting their obligations to the community.

He added that his stance was “not so much out of love for the vendors but out of concern for the council’s responsibility to the nation.”

The PCN boss further remarked that while he was aware that many pharmacists would be repulsed by his seeming endorsement, especially considering his office as the chairman of the PCN, there was no denying that patent medicine dealers were indispensable in the present circumstances.

“Current statistics show that only about 25 per cent of our 774 local government areas have a pharmacist; yet their residents need basic medicines,” Nwankwo noted.

He said rather than denounce patent medicine dealers, pharmacists must “come up with an appropriate training model for them and then go on to recruit, train, relocate and regulate them to provide the intended limited services in the rural and remote places where pharmacists cannot presently serve.”

He also added that “our profession has a responsibility to provide medicines and medical supplies to the entire population of Nigeria. Unfortunately, we are not doing so. WHO guidelines in this area require countries to have a pharmacist to population of 1 to 2,300 persons. In Nigeria, we presently have about 19,000 pharmacists for a population of 168 million people – a far cry from the ideal.”

Pharm. Nwankwo’s pronouncement echoes a similar call made by Dr Moyosore Adejumo, Director of Pharmaceutical Services in Lagos State Ministry of Health, recently.

Speaking at The Panel, an annual entrepreneurial summit for young pharmacists organised by Shyne and Cloe Consulting, Adejumo had declared that it was wrong for people, especially pharmacists, to victimise patent medicine dealers over their role in the health sector.

“Let me categorically say that patent medicine dealers equally have their right. We register them especially to in areas where pharmacists are in short supply or don’t exist at all. For instance, we need them in remote places like Badagry, Ikorodu and environs,” Adejumo said.

To justify her statement, the Lagos DPS explained that a team of inspectors once visited a community called “Cele Village” in Ikeja and was shocked to discover there was no single pharmacy in sight.

“Should we leave such areas to suffer? I don’t think so. What’s fair is fair! If you (pharmacists) don’t want them, we admonish you to move to those areas and cover up the lapses. Because one thing I can tell you is that they are recognised by the Pharmacists Council of Nigeria (PCN) and the DPS in Lagos State for as long as they comply within the ambiance of the law,” she noted.

Dr Adejumo, however, conceded that only the PCN had a final say on the issue. Accordingly, with the present thumbs-up coming from the PCN chairman, the contentious issue appears to have been laid to rest.

In a similar vein, Pharm. Azubike Okwor, immediate past president of the PSN, has also called for the incorporation of pharmacy technicians into the society, saying that the world was facing a chronic shortage of trained health workers.

During his presentation at the academy summit, he remarked that the WHO statistics had shown that there was a global health workforce deficit of more than four million, adding that countries with lower economic indicators such as those in Africa tend to have relatively fewer pharmacists and pharmacy technicians.

As a way out, he recommended to the summit that task-shifting, the process of delegating assignments to less-specialised health workers should be implemented alongside other strategies that had been designed to increase the total number of health workers in all cadres.

“Pharmacy technicians are a vital part of the pharmacy team working under the direct supervision of pharmacists. However, a relatively small percentage of graduating technicians are registered with the PCN,” he observed.

Okwor further canvassed protection and fairer treatment of technicians by pharmacists.

“With sufficient supervision and support, technicians can be assigned more roles to enable pharmacists concentrate on more patient-centred roles. I also urge the PCN to ensure that there is ‘One Register, One Entry Point and One Standard for Technicians,” he proffered.

The distinguished pharmacist who has been officially recognised as the first African Fellow of the International Pharmaceutical Federation (FIP) charged community pharmacies to engage the services of pharmacy technicians to relieve them of the daily stress, stressing that task-shifting could provide a platform for the incorporation of the technicians’ services into the pharmacy team efforts in health care delivery.

“The PSN should understudy other professional associations and how they relate with their technicians with a view to incorporating pharmacy technicians into our society,” he suggested.

For the record, the summit organised by NAPharm. marked its first formal programme since inauguration at a ceremony chaired by former Head of State, General Yakubu Gowon (rtd.) GCFR, in June 2014.

The summit was created to provide the necessary window for the pharmacy profession to look outwards with a duty to society, with the purpose of working with other members of the health professional team in order to create a larger health system that would deliver on quality health for Nigerians including diagnostic, preventive, curative and rehabilitative health care.

In attendance at the summit were Prince Julius Adelusi-Adeluyi, former minister of health and president of NAPharm; Prof. Rahamon Bello, vice chancellor, University of Lagos; Prof. (Mrs) Cecilia Igwilo, chairman of the NAPharm.’s Education Committee; Prof. Fola Tayo, NAPharm’s general secretary; Pharm. Olumide Akintayo, PSN president and Pharm. N.A.E. Mohammed, PCN registrar.

Others were Sir Ifeanyi Atueyi, vice president of the Academy; Dr Teresa Pounds, assistant dean for Clinical Pharmacy Education of Mercer University College of Pharmacy & Health Sciences, USA; Dr Bugewa Apampa, director of pharmacy, University of Sussex, United Kingdom; Prof. Chinedu Babalola, FPSN, FAS (dean, Faculty of Pharmacy, University of Ibadan) and Prof. Augustine Okhamafe, FPSN (Former dean, Faculty of Pharmacy, University of Benin).

Atrial fibrillation (Afib) is a disorder of heart rhythm, also known as an arrhythmia. It is now an increasingly common disease, particularly in elderly persons of over 60 years of age. There are approximately 160,000 new incidences of Afib annually in the United States alone, each patient requiring proper care and management to prevent the occurrence of a stroke due to circulating blood clots.
People with Afib may be on medication treatments to stabilise/normalise their heart’s electrical conduction; or they may be surgically treated by the placement of a pacemaker device.
Among those that may suffer an Afib are people suffering from hyperactive thyroid glands, those with diseases of the heart’s mitral valve, and those with genetically induced malformations of the heart’s musculature. These patients will require a well co-ordinated counselling and treatment programme for better understanding of their ailment and for survival.
Some symptoms of an atrial fibrillation are: chest pain, palpitations, syncope and or fainting spells due to an heart failure. The irregular heartbeats and misfiring of electrical impulses seen in Afib may lead to pooling of blood, stasis and clot formation in the upper chamber of the heart. The clots formed may dislodge and travel through the blood vessels into the brain causing an occlusion and stroke.
Prevention of a stroke, management of Afib and treatment compliance, especially for oral anticoagulants is critical to the management of patients living with atrial fibrillation. Warfarin is an important oral anticoagulant that is commonly used in Afib, and its role as an anticoagulant is discussed comprehensively in this action plan. Aspirin, an antiplatelet is also used for its efficacy in preventing clot formation.

What drugs are used in Afib?
Your prescriber may recommended different kinds of medications in the management of your condition, depending on the diagnosis and perceived origin of the atrial fibrillation. Examples of these medications are listed below:
• Anticoagulants: Warfarin, Enoxaparin, Heparin.
• Antiplatelets: Aspirin, Clopidrogel, Cilostazol, and Dabigatran.
• Beta-blockers: Sotalol.
• Antiarrhythmics: Quinidine, Procainamide, Flecainide, Propafenone, Disopyramide, and others, Amiodarone, Dronaderone, Dofetilide ,Ibutilide.
• Calcium channel blockers: Verapamil and Diltiazem.
• Digoxin.

Warfarin as an oral anticoagulant in atrial fibrillation
The use of warfarin in the management and prevention of complications of Afib is discussed here in detail because it is the most widely used oral anticoagulant agent for the prevention of strokes in Afib patients. Other than the need for monitoring of its effectiveness with an INR or PT Time test, warfarin is efficacious, cheap and tolerable in most patients with Afib.
Warfarin is superior to aspirin or clopidrogel, whether both agents are used singly or combined. It is preferred over dabigatran because it’s hepatically metabolised and can be used in patients with renal failure. The starting doses of warfarin in most cases are: 5MG in the elderly, 7.5MG in obese patients or 2.5MG in patients with very lean body mass.
Warfarin’s effect may take up to seven days to manifest, therefore most patients are first given heparin or low-molecular weight heparins (LMWH) together with oral warfarin if patient can be orally dosed. Most hospitals in the US do have standard warfarin dosing protocols for initiation therapy and for maintenance based on the patient’s Lab values of the INR and comorbid conditions.
Warfarin education and treatment counselling is an essential component of pharmaceutical care for patients who require continuous anticoagulant therapy in atrial fibrillation management. Following admission for an acute episode of Afib, and subsequent patient stabilisation and effective resolution of blood clots (if any) with LMWH or heparin infusion, the patient is initiated on warfarin for a continuous anticoagulation therapy.
Warfarin doses have to be taken daily and continuously for a life time in most Afib patients. The patient, if active, and family members or care-givers are educated appropriately by the clinical pharmacists on duty on the anticipated side-effects, adverse drug reactions, precautions, food-drug interactions and herb-drug interactions of warfarin.

How warfarin works in preventing complications of Afib
Warfarin works by inhibiting a liver enzyme known as vitamin K epoxide reductase(VKOR) which converts natural vitamin K to the active form for the production of clotting factors (II, VII, IX and X). In this way, warfarin helps reduce the chances of blood clot formation, reducing the risks of a stroke in atrial fibrillation. It also slows the production of certain proteins: Proteins C, S and Z which are called anticoagulant proteins.
Warfarin doses must be taken daily to be effective in the prevention of clots in Afib. If doses are missed or skipped, the effectiveness is compromised. If warfarin doses are doubled, the risks of bleeds from the nose, gums, skin cuts and other body cavities are increased. Warfarin’s effect may be reduced or increased by some other drugs that a physician or dentist prescribes. The effect of warfarin is increased by drugs such as: Aspirin, Clopidrogel, Dabigatran, Cilostazol.
Some pain relief drugs used in arthritis may increase your risks of bleeding with warfarin, examples are: Naproxen, Ibuprofen, Nabumetone, Ketorolac, Diclofenac, Sulindac and Indomethacin. Inform your dentist appropriately that you are a warfarin patient. Use of certain steroids, orally or topically, may also increase your chances of skin bruises and bleeds with warfarin. Drugs or medications that interfere with warfarin metabolism or elimination from the body may equally prolong its effects and adverse reactions. These include: metronidazole, co-trimoxazole such as Batrim or Septra brands and their generic equivalents, as well as some medications used for high lipids- rosuvastatin, atorvastatin and simvastatin.

What’s the duration of warfarin treatment?
Oral doses of warfarin prescribed by a doctor or clinical pharmacist must be taken regularly and consistently as instructed, to prevent unfavourable circumstances and complications of Afib. Clinic visits need to be adhered to, so the doctor’s office may check the effectiveness of warfarin through the INR (International Normalised Ratio) Test, or by the PT (Prothrombin Time) Test.

Side-effects of warfarin use
These include skin bruises, purple-toes syndrome, gum bleeds, stomach upsets, nausea, taste alterations, chills, numbness, muscle weakness, dizziness etc. Inform your physician or pharmacist immediately if you notice or experience any of the following:
*Bruises, Gum bleeds, or Bright-red colour stools.
*Head injuries from falls
*Unusual dizzy-spells, fainting, light-headedness or extreme weakness.
*Pregnancy, excessive period bleeds or blood in urine.
*Bright-Red or coffee-brown coloured stools.

Monitoring of warfarin effects
The effectiveness of warfarin is measured at clinic visits by the test known as the International Normalised Ratio (INR). The INR is a standardised test used in monitoring whether warfarin levels in the blood are maintained and normal for the prevention of blood clots.
In Afib patients, an INR goal of 2.0–3.0 is the target. INR values of less than 1.8 has been shown to double the risk of a stroke.

General goals of treatment in atrial fibrillation
(a) To reduce rapid heart rate
(b) To effect a control of irregular heartbeat or tachycardia
(c) To use an anticoagulant for stroke prevention
(d) To get the patient into normal heart rhythm.

References
1. Lopes RD, Crowley MJ, Shah BR et al, Stroke Prevention In Atrial Fibrillation(Internet); Agency For Healthcare Research and Quality(US); 2013 Aug. Report No. 13-EHC113-EF
2. Stuart J et al; Dabigatran versus Warfarin in Patients with Atrial Fibrillation. N Engl J Med 2009, 361: 1139 – 1151, September 17, 2009.
3. Mant J, Hobbs FD, Fletcher K, Roalfe A, Fitzmaurice D; Warfarin versus aspirin for Stroke Prevention in an elderly population with atrial fibrillation – The Lancet vol. 370, Issue 9586; 11 – 17, August 2007.

“Things may come to those who wait, but only the things left by those who hustle” – Abraham Lincoln

The world doesn’t pay you for what you know; it pays you for what you do. There’s an enduring axiom of success that says, “The universe rewards action.” Yet, as simple and as true as this principle is, it’s surprising how many people get bogged down in analysing, planning, and organising when what they really need to do is take action.

When you take action, you trigger all kinds of things that will inevitably carry you to success. You let those around you know that you are serious in your intention. People wake up and start paying attention. People with similar goals become aligned with you. You begin to learn things from your experience that cannot be learnt from listening to others or from reading books. You begin to get feedback about how to do it better, more efficiently, and more quickly. Things that once seemed confusing begin to become clear. Things that once appeared difficult begin to be easier. You begin to attract others who will support and encourage you. All manner of good things begin to flow in your direction once you begin to take action.

Talk is cheap

Over the years of teaching and coaching people in my company and in my seminars, I have found that the one thing that seems to separate winners from losers more than anything else is that winners take action. They simply get up and do what has to be done. Once they have developed a plan, they start. They get into motion. Even if they don’t start perfectly, they learn from their mistakes, make the necessary corrections, and keep taking action, all the time building momentum, until they finally produce the result they set out to produce…or something even better than they conceived of when they started.

To demonstrate the power of taking action in my seminars, I hold up a $100 bill and ask, “Who wants this $100 bill?” Invariably, most of the people in the audience will raise their hands. Some will wave their hands vigorously back and forth; some will even shout out “I want it” or “I’ll take it” or “give it to me.” But I just stand there calmly holding out the bill until they get it. Eventually, someone jumps out of her seat, rushes to the font of the room, and takes the bill from my hand.

After the person sits down – now $100 richer for his efforts – I ask the audience, “What did this person do that no one else in the room did? She got off her butt and took action. She did what was necessary to get the money. And that is exactly what you must do if you want to succeed in life. You must take action, and, in most cases, the sooner the better.”

I then ask, “How many of you thought about getting up and just coming and taking the money but stopped yourselves?” I then ask them to remember what they told themselves that stopped them from getting up.The usual answers are

“I didn’t want to look like I wanted or needed it that badly.”

“I wasn’t sure if you would really give it to me.”

“I was too far back in the room.”

“Other people need it more than I do.”

“I didn’t want to look greedy.”

“I was afraid I might be doing something wrong and then people would judge me or laugh at me.”

“I was waiting for further instructions.”

I then point out that whatever things they said to stop themselves are the same things that they say to stop themselves in the rest of their lives.

One of the universal truths in life is “How you do anything is how you do everything.” If you are cautions here, you are probably cautious everywhere. If you hold yourself back for fear of looking foolish here, you probably hold yourself back for fear of looking foolish elsewhere. You have to identify those patterns and break through them. It’s time to stop holding yourself back and just go for the gold.

Culled from How to Get from Where You Are to Where You Want to Be by Jack Canfield

Man’s essential being is inward, invisible, spiritual, and as such it derives its life, its strength, from within, not from without. Outward things are channels through which its energies are expended, but for renewal it must fall back on the inward silence.
As the body cannot thrive on empty husks, neither can the spirit be sustained on empty pleasures. If not regularly fed, the body loses its vitality, and, pained with hunger and thirst, cries out for food and drink. It is the same with the spirit: it must be regularly nourished in solitude on pure and holy thoughts or it will lose its freshness and strength, and will at last cry out in its painful and utter starvation.
The pure life of the spirit cannot be found, but is lost, in the life of the senses. The lower desires are ever clamorous for more, and they afford no rest. The outward world of pleasure, personal contact, and noisy activities is a sphere of wear and tear which necessitates the counterbalancing effect of solitude. Just as the body requires rest for the recuperation of its forces, so the spirit requires solitude for the renewal of its energies.
Solitude is as indispensable to man’s spiritual welfare as sleep is to his bodily well-being; and pure thought, or meditation, which is evoked in solitude, is to the spirit what activity is to the body. As the body breaks down when deprived of the needful rest and sleep, so do the spirits of men break down, being deprived of the necessary silence and solitude.
Man, as a spiritual being, cannot be maintained in strength, uprightness, and peace except he periodically withdraws himself from the outer world of perishable things and reach inwardly toward the abiding and imperishable realities. The consolations of the creeds are derived from the solitude which those creeds enforce. The regular observance of the ceremonies of formal religion, attended, as they are, with concentrated silence and freedom from worldly distractions, compels men to do unconsciously that which they have not yet learnt to do consciously – namely to concentrate the mind periodically on the inward silence, and meditate, though very briefly, on high and holy things.
In solitude a man gathers strength to meet the difficulties and temptations of life, knowledge to understand and conquer them, and wisdom to transcend them. As a building is preserved and sustained by virtue of the foundation which is hidden and unobserved, so a man is maintained perpetually in strength and peace by virtue of his lonely hour of intense thought which no eye beholds.
It is in solitude only that a man can be truly revealed to himself, that he can come to understand his real nature, with all its powers and possibilities. The voice of the spirit is not heard in the hubbub of the world and amid the clamours of conflicting desires. There can be no spiritual growth without solitude.

Culled from MIND IS THE MASTER by JAMES ALLEN

Man’s essential being is inward, invisible, spiritual, and as such it derives its life, its strength, from within, not from without. Outward things are channels through which its energies are expended, but for renewal it must fall back on the inward silence.
As the body cannot thrive on empty husks, neither can the spirit be sustained on empty pleasures. If not regularly fed, the body loses its vitality, and, pained with hunger and thirst, cries out for food and drink. It is the same with the spirit: it must be regularly nourished in solitude on pure and holy thoughts or it will lose its freshness and strength, and will at last cry out in its painful and utter starvation.
The pure life of the spirit cannot be found, but is lost, in the life of the senses. The lower desires are ever clamorous for more, and they afford no rest. The outward world of pleasure, personal contact, and noisy activities is a sphere of wear and tear which necessitates the counterbalancing effect of solitude. Just as the body requires rest for the recuperation of its forces, so the spirit requires solitude for the renewal of its energies.
Solitude is as indispensable to man’s spiritual welfare as sleep is to his bodily well-being; and pure thought, or meditation, which is evoked in solitude, is to the spirit what activity is to the body. As the body breaks down when deprived of the needful rest and sleep, so do the spirits of men break down, being deprived of the necessary silence and solitude.
Man, as a spiritual being, cannot be maintained in strength, uprightness, and peace except he periodically withdraws himself from the outer world of perishable things and reach inwardly toward the abiding and imperishable realities. The consolations of the creeds are derived from the solitude which those creeds enforce. The regular observance of the ceremonies of formal religion, attended, as they are, with concentrated silence and freedom from worldly distractions, compels men to do unconsciously that which they have not yet learnt to do consciously – namely to concentrate the mind periodically on the inward silence, and meditate, though very briefly, on high and holy things.
In solitude a man gathers strength to meet the difficulties and temptations of life, knowledge to understand and conquer them, and wisdom to transcend them. As a building is preserved and sustained by virtue of the foundation which is hidden and unobserved, so a man is maintained perpetually in strength and peace by virtue of his lonely hour of intense thought which no eye beholds.
It is in solitude only that a man can be truly revealed to himself, that he can come to understand his real nature, with all its powers and possibilities. The voice of the spirit is not heard in the hubbub of the world and amid the clamours of conflicting desires. There can be no spiritual growth without solitude.

Culled from MIND IS THE MASTER by JAMES ALLEN

African Pharmaceutical Forum (APF), a subgroup of the International Pharmaceutical Federation (FIP), has officially unveiled its website for the use of all pharmacists across the globe.

The event which was held at the Pharmacy House in Anthony, Lagos, was graced by dignitaries like Sir Anthony Akhimien, APF president; Pharm. Azubike Okwor, former president of the Pharmaceutical Society of Nigeria (PSN); Pharm. Olumide Akintayo, PSN president, represented by the PSN secretary, Pharm. Gbolagade Iyiola; Ms Margaret O. Olele, corporate affairs/health & value director, Pfizer; and representatives of the various arms of the PSN.

While addressing the audience, the APF president, who revealed that the launch of the website was a dream comes true, noted that the project was made possible by the sponsorship of Pfizer Global.

Sir Akhimien disclosed that since the APF was established ten years ago, it had been difficult to create such a platform due to logistical and financial challenges.

“Since I became the president two years ago, it had been one of my goals to get a website for the region and I’m happy because it’s a dream come true,” said Akhimien.

The APF helmsman, who described the website as a robust, multilingual and professional site, said the establishment of the platform would bring an end to the language and payment barriers the Forum had encountered in the past, as members can now easily pay their dues without difficulty.

He further expressed optimism in APF members’ utilisation of the website, as each country would be expected to regularly update information on its activities, which should spur up a sort of competition among all member states.

Also speaking at the event, Pfizer’s corporate affairs/health & value director, Ms Olele, said Pfizer chose to sponsor the website because it was important to have a platform to galvanise groups of professionals together towards a common goal.

“The world is becoming a global village, and people need to know about best practices in their country, and neighbouring countries, in order to utilise available opportunities,” Olele said.

She explained that the existence of a viable platform that pulled different groups of pharmacists from different countries together to speak with one voice, learn and improve themselves, was indispensable at such a time as this, adding that the website could also serve as an educational educational platform for pharmacists to be updated on recent developments in the profession.

The Pfizer’s spokesperson also noted that the website would enable members leverage on social media networking, where they could share information on the website on social media, whereby creating global connection with other pharmacists .

While assuring that Pfizer would continue to support the APF, Olele added that it was part of the company’s obligations to teach the Forum’s executives how to sustain the website through generation of revenues.

“Pfizer delights in CSR because it is our belief that when society is getting better, it will definitely impact positively on the people. That’s why we are also on the vanguard to see how we can assist the communities and people enjoy good life. We look at different areas to help drive people, knowing that if we create a better world, life becomes sweet to the people”, Olele stated.

Also speaking, Pharm. (Mrs) Amaka Okafor, who represented the PCN registrar at the occasion, expressed the Council’s willingness to support APF on both institutional and individual levels.

She also appreciated the Forum’s president for the laudable initiative, adding that the website would facilitate easy payment, through the e-payment channel thereby ameliorating the challenges of the past.

A consultant physician and endocrinologist in the College of Medicine, University of Lagos, has revealed that contrary to the widespread belief that diabetes mellitus affects only adults, the condition also affects children but is often misdiagnosed.
Speaking with Pharmanews in an exclusive interview, Dr Ifedayo Adeola Odeniyi, a Fellow of the American College of Endocrinology and honorary consultant endocrinologist for the Lagos University Teaching Hospital, Idi Araba, noted that while Type 2 diabetes sometimes occurs, the Type 1 variant is the commonest type seen in children.
According to him, the onset of diabetes can be noticed at any stage after the neonatal period, but it is most common in childhood and adolescence. He added that the usual cause of the ailment is absolute deficiency of insulin.
On the symptoms of the condition, Odeniyi said the major ones are weight loss, excessive passage of urine, bedwetting, excessive thirst and tiredness (not wanting to work or play). He stated also that children could suffer from a severe complication of diabetes mellitus, called diabetic ketoacidosis, which may lead to shock, coma and eventually death.
“Diabetes in children is often misdiagnosed as some other condition,” says Odeniyi.“For example, it is often misdiagnosed as pneumonia or asthma, which manifests through laboured breathing; as appendicitis or gastroenteritis, which manifests through abdominal pain and vomiting; and as a serious infection as malaria, typhoid, HIV/AIDS, tuberculosis, meningitis etc. It could also manifest as urinary tract infection or as malnutrition, through weight loss and tiredness.”
While blaming the recent upsurge in the number of people living with diabetes on lifestyle and environmental factors, the diabetetologist however disclosed that those with a family history of diabetes mellitus are more vulnerable to the condition.
“The International Diabetes Federation (IDF) puts the prevalence of diabetes in Nigeria at 4.64 per cent as at 2014 and this is projected to increased to 5.47 per cent by 2035. There is also increase awareness of diabetes mellitus by the populace and the health care practitioners. This has led to more people being diagnosed as having diabetes mellitus. However, according to statistics from the IDF, 50 per cent of people with diabetes mellitus are still not diagnosed,”Odeniyi said.
The specialist also listed factors that lead to complications in diabetes to include poor education about the disease, non-compliance with medications, lack of finance to get right medications, lack of motivation on the part of the patients and lack of knowledge in managing the patient on the part of the medical practitioner.
The don however advised the government to further assist in enhancing diabetes care and management in the country by improving on the education, training and support of health professionals He said such initiative will boost their capacity to identify diabetes early and treat it cost-effectively, while also developing innovative ways of extending the geographical reach of health services to improve access to care and education for people with diabetes, especially those in low and middle-income classes.
“Government should also ensure that essential care (which includes risk assessment and early diagnosis), essential low-cost medicines, treatments and self-care education appropriate to people’s needs are made available. They must ensure that the safest and most proven medicines are purchased at the lowest possible prices, while they strive to improve drug distribution systems to ensure continuity in the availability of essential diabetes medicines”, Odeniyi said.

Mr Emmanuel Tarfa addressing a section of participants at the workshop

A business consultant, Mr Emmanuel Tarfa, has stated that for there to be a meaningful boost in health care financing in Nigeria, there is need to re-orientate health entrepreneurs on new and progressive methods of business management.

Tarfa, who was addressing a group of health practitioners on the topic, “Health care Entrepreneurship: Business Financing and Cash Management”, in a recent workshop organised by Pharmanews Limited in Lagos, highlighted some reasons health-related businesses encounter difficulties in accessing loans. These, according to him, include: too many bad examples, poor communication of business pitches, key-man risk, lack of business traction, among several others.
Explaining business financing, the business expert said it is a means of sourcing capital to fund a business start-up, operation or expansion, which could be done through debt or equity, depending on which seems handier at the specific time.
To achieve the goal of funding their businesses, the consultant counselled practitioners to build a team of people who have faith in their visions and who can lend support at any time to the business. He equally advised them to acquire knowledge and skills in their area of concentration, as well as get professional assistance in drawing up clear-cut business plans.
“Raising money is a difficult task and sometimes a very long process. You must be patient with your prospects and display that calmness always”, Tarfa explained.
The workshop facilitator also urged health entrepreneurs to always resolve a fundamental issue of whether a loan is needed or not before embarking on the acquisition of such fund. This, he said would help to forestall future challenges.
“Cogent indications that a business needs funding include: one, when you have identified a clear opportunity and have the business case to back it up, especially for start-ups; and two, when an existing business cannot meet demands and when a business is undercapitalised and could acquire more market share, if given more money”, Tarfa stated.
On the necessity of a solid business plan, Tarfa noted that the idea, concept or actual business must have a clear value proposition, a target audience and a clear connection between the entity and audience.
According to the expert, other prerequisites in establishing and managing an enterprise effectively include: “knowing the difference between the market and industry and determining intricacies of both; identification of size, growth, structure, consumer trends; having a detailed list of risks and plans on how to deal with such threats; as well as knowledge of capital requirement (the projection of financial statement – income, cash flow and balance sheet).”
Tarfa equally dwelt on the issue of cash management, defining it as a broad area of finance involving the collection, handling, and usage of cash. He explained that businesses could keep cash for speculative or compensation motives.
Clarifying further, he said that by speculative motive, an enterprise may want to take advantage of an opportunity, outside the normal course of business; while compensation motive involves compensating banks for providing certain services or loans.
He added that whatever may be the reason for a business to be in possession of cash, it must maintain a minimum balance of cash at the bank which it cannot readily use.

Lifeline Chemicals Limited has just moved to its new corporate office in Victoria Island, Lagos. Bose, a younger sister of the Managing Director, is invited to serve meals at the office cafeteria daily. She is issued a letter, requesting for her services for one year, starting from October 2009. The letter contains an “honour clause” stating that the arrangement “shall not be attended by any legal relationship or the subject of litigation, but all such transactions are binding in honour only.” The desired menu for each month, from October to December, is sent to Bose and she provides the meals according to the order.

In the month of November, plans are made for an End-of-Year & Christmas Party. It is suggested that professional caterers should be hired for this event. The Managing Director accepts the suggestion. He informs his sister that she will not be needed to cater for the End-of-Year event. He also lets her know that her services to the company may not be required subsequently.

Bose is saddened by this development. She has already invested in foodstuff towards fulfilling the orders. She intends to make a case to protect her interests. However, she is told by a friend that her rights are not enforceable because she is doing business with her brother. What is the legal position of Bose with the company?

A valid contract, which is enforceable in a court of law, must have an offer, an acceptance and some form of consideration from each party. It is however agreed that there is a fourth element required to be present in any contract. This is the intention of both parties to enter into legal relations. For a contract to be enforceable, it must be clear that the parties consented to enter into legal obligations and accepted to be bound by them.

The present case covers the following legal issues:

1. The place of domestic and social engagements.
2. The effect of the “honour clause” in contracts.
3. The nature of divisible contracts.

From as far back as 1919, the case of Balfour v. Balfour, established the position that contractual intention is absent in domestic and social engagements. Parties to such an agreement cannot sue each other on it. This rule has been applied especially in family relationships like that of a husband and wife or between a parent and child. In Jones v. Padavatton, a mother promised to make monthly payments to her daughter and provide accommodation in return for the daughter’s promise to study Law. After a bitter quarrel between the two, the mother revoked her promise and evicted the daughter. It was held by the Court of Appeal that the agreements to pay the daughter a monthly allowance and permit her possession of the house were not binding because they were not meant to create legal relations.

However, this rule may not apply in certain situations. For example, where family members are not living in harmony and their relationship has degenerated to the level of mutual hostility, an agreement between them would be binding. Also, where the performance of a domestic or social engagement involves great sacrifices on the part of one or both parties, the absence of contractual intention may be rebutted. In the case of Parker v. Clark, a man and his wife sold their house to move in and share expenses with his uncle. The agreement was held to be binding because of the drastic and irrevocable steps they had taken.

The case of Bose catering for Lifeline Chemicals involves a commercial agreement to provide services over a period of time. The fact that the business is done with the company classifies it as a commercial transaction. In law, there is a presumption of contractual intention in commercial agreements. However, a party may plead the absence of contractual intention where the agreement itself contains a clause expressly excluding the intention to enter into legal relations.

Indeed, it is not uncommon for provisions in a contract, as in the letter from Lifeline Chemicals, to absolve the parties of any legal liabilities arising from the business. In Buko v. Nigerian Pools Company, the Supreme Court expressed its views on the “honour clause” as follows: “the intention was to ensure that the relationship between the parties was to be that of honour, in other words, a gentleman’s agreement rather than to create a legal relationship.”

Thus, it would seem that the provision of catering services is a commercial transaction, which should be binding on the parties. Nevertheless, provisions have been made to exclude legal liabilities by the insertion of an “honour clause” in the original letter of offer. This means that, even though the services of Bose have been engaged for a period of one year, Lifeline Chemicals is at liberty to disengage without any liability.

It must be noted that this transaction involves what is known as a divisible contract. This is a situation with a major contract clearly divisible into smaller units. For example, a contract may be entered into for the supply of goods over a period of time. Every time a specific order is placed, it is a smaller contract in the major one. In Bose’s case, she had a major contract to provide meals for a period of one year. Subsequently, specific menus were given for October to December. Each order placed was a contract by itself. From the judicial decision in Rose & Frank’s Case, we see that the parties in a divisible contract are legally obligated to orders made before the termination of the contract.

In conclusion, Lifeline Chemicals is liable for the orders made to Bose for the months of October to December, before her services were disengaged.

Principles and cases are drawn from Sagay: Nigerian Law of Contract

Worried by the dismal health conditions of the poor in Nigeria, Pharm (Mrs) Bisi Bright, CEO of LiveWell Initiative (LWI), has called for immediate intervention from all stakeholders to prevent escalation of morbidity and mortality rates in the country.

Pharm. Bright made the call while speaking at a workshop organised by Pharmanews Limited, with the theme, “Health Care Entrepreneurship Workshop.”
The consultant clinical pharmacist and public health manager highlighted the poor health indices observed in the country to include 608 maternal mortality in every 100,000 births, compared to Ghana’s 409 and South Africa’s 237; high under-five and infants mortality; low life expectancy at birth; low adult literacy; low birth weight; non-conformity of many nursing mothers to exclusive breastfeeding, malnutrition and stunted growth among many others.
She attributed the disturbing statistics to inadequate health education, arguing that if majority of Nigerians were adequately furnished with health information, there would be drastic reduction in mortality rates in the country.
“Health literacy can be achieved through the informal sector, where it can be well organised with its own structure and hierarchies, which can be realised by reaching out in harmony to the community leaders, health care practitioners within the community, government officials, and government at all levels’’, Pharm. Bright pointed out.
Addressing the participants on the topic, “Elements of the emerging wellness industry”, Pharm. Bright explained the concept of wellness as being not merely the absence of disease but a complete state of physical, mental, social, emotional and psychological fitness.
While admitting that not all deaths are preceded by disease, the LWI boss emphasised that wellness promotion activities are designed to maximise the health of the community dwellers, while disease prevention is utilised to minimise the risk of disease and premature death.
Analysing the current state of the Nigerian health care system, she recommended better options of health care management for best outcomes. She noted that instead of exhibiting a nonchalant attitude towards health until there is an emergency or a life-changing diagnosis, there should informed choices, as well as informed decision-making.
She equally noted that in place of peer referral system and self-medication, there should be pharmaceutical care, promotive health care and public health care. She suggested that out of pocket health care spending be replaced with effective ‘pooling’ of health care services through microfinancing or health insurance, while individual is health responsibility must shift to collective responsibility, where individuals, communities, governments, employers and policy makers are all stakeholders.
Citing Burnside and Dollar (2000)’s submission as stated in The American Economic Review, Pharm. Bright stated the need for officials in the health sector to utilise internal and external funds judiciously for the benefit of the masses, as well as establish functional institutions and policies, adding that anything short of this would keep up the status quo.
“Not all aid is intended to generate economic growth,” she said. “Some aid is intended for humanitarian purposes; some may simply improve the standard of living of people in developing countries. The impact of aid on GDP growth is positive and significant in developing countries with sound institutions and economic policies, while aid has less or no significant impact in countries with “poor” institutions and policies.”

Medicinal plants and drugs of biological origin have a place in the treatment of chronic diseases. Drugs of biological origin, such as penicillin, morphine and senna, have been used consistently and are still in use globally in medical and pharmaceutical practices. A significant number of antimicrobial agents, such as vancomycin, griseofulvin, streptomycin, erythromycin, and gentamycin, were originally obtained from natural origin.

Stevia is a medicinal plant belonging to the botanical family Asteraceae. The leaf extracts of Stevia rebaudiana (Bertoni) contain eight potent diterpene glycosides: Stevioside, Rebaudosides A to E, Steviolbioside and Dulcoside A, which have been studied elaborately for use as sweeteners.

Three of the stevia glycosides listed above (Stevioside, Rebaudoside A, and Rebaudoside D) are well studied and recognised to be 250–300 times sweeter than sucrose. Animal studies in mammalian species, using rats, dogs and mice by researchers, have examined the pharmacological and toxicological properties of stevia glycosides. Ulbricht C, Isaac R et al, in an evidence-based systematic review, courtesy of the Natural Standard Research Collaboration, assessed the effects of stevia on two indications – hypertension and hyperglycaemia – from two long-term studies. The result showed stevia possesses hypoglycaemic and blood pressure lowering effects in mammals.

Shibata et al, have postulated that the anti-diabetic effects of stevioside may be from a suppression of glucagon secretion from the alpha cells of the pancreas. Wheeler et al (2008), have conducted human studies showing a similar but different metabolic and elimination pathways for Rebaudoside A and Stevioside. The insulin-like effects of stevia extracts in stimulating glucose uptake were demonstrated by Stone et al, using two cell types, HL-60 human leukaemia and SH-SY5Y human neuroblastoma cells. Stevia extract was found to enhance glucose uptake in both cellular lines.

In the United States, purified forms of Rebaudoside A were granted GRAS (Generally Recognised As Safe) status by the FDA and are available under low-calorie sweetener brand names as natural sugar substitutes for people living with diabetes, and for obese patients on strict diets/exercise regimen. They are also available for patients diagnosed with pre-diabetes and or metabolic syndrome.

Natural stevia leaf extracts are obtainable as diet supplements and may not be added to commercial beverages as a food additive, though current research is evaluating its potency in diabetes, obesity and hypertension. In regard to diabetes, some studies identified stevia’s trophic effects on pancreatic beta cells, insulin secretion and insulin sensitivity in rats.

Stevia is not recommended in pregnant patients, and its effect is not yet evaluated in juveniles. It is inapplicable in Type 1 diabetes since its potential effects appear connected to functional pancreatic cells. In one case report of adverse reactions, four patients who were given 500mg of stevia powder experienced symptoms of abdominal fullness, nausea, asthenia, and myalgia; but their symptoms disappeared after one week of treatment.

In vitro studies shows marked anti-inflammatory and antibacterial properties of stevia glycosides; though there have been warnings of weak mutagenic activity in laboratory animals given high doses. According to The JECFA (Joint FAO/WHO Expert Committee on Food Additives), brand name products labelled as a stevia sweetener must contain at least 95 per cent of the stevia glycoside Rebaudoside A, and the suggested acceptable daily intake(ADI) per JECFA is 0–2mg/kgbw/day of a steviol content that is equivalent to 0-6mg/kgbw/day of Rebaudoside A.

Stevia glycosides are metabolised initially in the gut to steviol (the aglycone moiety) and are excreted in the urine as steviol glucuronide. Stevia was shown to have additive antihypertensive effects with verapamil, and blood sugar lowering effects with antidiabetic drugs; therefore caution must be exercised in its use and recommendation in patients taking prescription drugs for chronic ailments.

Section 201(ff){1} of the Federal Food, Drug & Cosmetic Act permits the sale of stevia leaf extracts in the US as a diet supplement only, and not for the treatment of any manner of disease. Stevia shows promise as a potential source of important phytochemical ingredients that may serve as precursors of new drugs for diabetes in just the same way as a derivative of guanidine extracts from Galega officinalis (Goat’s rue or French lilac), Galegine, became the precursor of metformin.

Oluwole Williams wrote from Glenside, Pennsylvania, USA

REFERENCES

• Ulbritch, C; Isaac, R; Milkin, T; Poole, EA; Rusie, E. et al.(April 2010). “An evidenced-based systematic review of stevia by the Natural Standard Research Collaboration”. Cardiovascular Hematol Agents Med Chem 8(2): 113 – 127. PMID 20370653.
• Joint FAO/WHO Expert Committee on food additives, sixty-ninth Meeting. World Health Organisation 4 July 2008.
• FDA GRAS notification database; Stevia search in FDA GRAS Database.
• Misra, H; Soni M; Silawat, N; Mehta, D; Mehta, B.K; “Antidiabetic activity of medium-polar extract from the leaves of stevia rebaudiana Bet(Bertoni) on alloxan-induced diabetic rats” Pharm Bioallied Sci. 3(2): 242 – 8.
• “Diabetic Supplement Health and Education Act of 1994”. FDA.gov. 2011.
• Koyama, E.et al. “In vitro metabolism of the glycosidic sweeteners in stevia mixture and enzymatically modified stevia in human intestinal microflora. “Food and Chemical Toxicology 41”.3(2003) 359 – 374.
• Kujur, R.S; Singh, V; Ram, M; Yadava, N.H; Singh, K.K; Kumari, S; and Roy, B.K. Antidiabetic activity and phytochemical screening of crude extract of stevia rebaudiana in alloxan-induced diabetic rats. Pharmacognosy Res. 2010 Jul – Aug; 2(4): 258 – 263 PMC3141138.
• Shibata H, Sawa Y, Oka T, Sonoke S, Kim, K.K, Yoshioka M. Steviol and steviol glycosides: glucosyl tranferase activities in stevia rebadiana Bertoni – purification and partial characterization. Arch Biochem Biophys. 1995; 321(2): 390 – 396.
• Chen TH, Chen SC, Chan P et al. Mechanism of the hypoglycemic effect of stevioside, a glycoside of stevia rebaudiana. Planta Med.2005; 71(2): 108 – 113.
• Wheeler A, Bioleau AC, Winkler PC, Compton JC, Prakash I et al. Pharmacokinetics of rebaudoside A and stevioside after single dose in healthy men. Food Chem Toxicology, 2008:04.041.
• Gregersen S, Jeppensen PB, Holst JJ, Hermansen K. Antihyperglycemic effects of stevioside in type 2 diabetic subjects. Metabolism.2004; 53:73-6.
• Melis, M.S. et al. “Effect of calcium and verapamil on renal function of rats during treatment with stevioside” : J. Etnopharmacol. 1991; 33(3): 257-62.

In this insightful article, the International Pharmaceutical Federation (FIP) gives hospital pharmacists a preview of what to expect at this year’s World Congress of Pharmacy and Pharmaceutical Sciences.

The World Health Organisation estimates that each year some 16 million people die prematurely —before the age of 70 —from non-communicable diseases (NCDs). These include heart and lung diseases, stroke, cancer and diabetes. The effective use of medicines figures prominently among the “best-buy” options to reduce the death toll. This is a thread that links many of the sessions at the International Pharmaceutical Federation’s 75th world pharmacy congress and is a topic of particular interest to hospital pharmacists.

Building blocks

Evidence-based practice and medication review are two of the building blocks of effective medicines use and a number of speakers will address different aspects of these topics. One session is devoted to reviewing the definition and relevance of evidence-based practice, the gaps between current practice and evidence-based use of medicines, and the limits. Medication reviews are undertaken in all areas of clinical practice and, in recent years, guidelines and algorithms have been developed to help pharmacists deliver consistent, high-quality reviews.

Best practice examples from all over the world will demonstrate different methods for medication review, software solutions and documentation together with the evidence for effectiveness. A related session will show how “information mastery” is essential for the delivery of evidence-based practice. Speakers will explain how this differs from critical appraisal skills and provide a hands-on demonstration of the use of high quality information mastery resources.

Revolutionary developments

Another aspect of effective medicines use is personalised dosing—something that is critical for high-potency drugs and vulnerable groups, such as paediatric or geriatric patients. Speakers will describe how, for some drugs, doses can be matched to the patient’s unique genetic make-up —an approach that is predicted to increase the safety and efficacy of drug treatment.

But this is not the only revolutionary development in drug treatment. The way we give medicines is advancing far beyond the tablet and the injection and participants will hear about new formulation concepts. Experts will describe how individualised oral therapy can be given using a solid dosage pen and how printing technology can be used to produce personalised dosage forms.

Integrated safety

Safety is now seen as an integral aspect of medicines use. In a session devoted to pharmacy in Germany, Dr Torsten Hoppe-Tichy, chief pharmacist, University Hospital of Heidelberg, will describe how pharmacists are playing a key role in the development of the medication safety system in German hospitals. “There are many good examples where pharmacists have taken the lead, for example, in tackling vincristine and methotrexate dosing errors and look-alike, sound-alike drug names. As a result there is now a national plan for patient safety,” he says.

Human impacts

In what promises to be a thought-provoking session on human impacts on medicines use, speakers will explore a variety of important issues. Yolanda Robles, executive vice president of the Philippine Pharmacy Association, explains: “It is in the hospital setting where admissions and negative consequences related to non-adherence by patients to medication regimens are encountered.In addressing this problem, more focus has been given by healthprofessionals to motivating patients through standard patient education and counselling (based on disease and drug information), and the use of compliance aids. While these methods have their documented benefits, there is less knowledge and understanding of medication adherence relating to human beliefs, including religiosity and spirituality.”

Professor Robles has studied the relationship between medication and the depth of belief in Christian religious doctrines in the Philippines, for example. “The data from the study may be helpful in designing counselling interventions for patients with religious belief-related health adherence problems,” she says. Participants will also hear how the study has provided data on religious and spiritual beliefs that patients may not openly discuss with health professionals during their hospital stay.

In the same session,Dr PernilleDam, an R&D consultant at Pharmakon, Denmark, will talk about new technologies for tracking compliance and administration. The impact of pharmacogenomics and the balance between patient autonomy and acting in the patient’s best interests will also be discussed during the session.

Workforce evolution

The changing role of the hospital pharmacist and rapid developments in pharmaceutical technology raise many issues for workforce training and development. How the FIP Global Competency Framework supports the FIP Basel statements —a set of 75 consensus statements developed by an international group, which describe the preferred vision for hospital pharmacy— is also on the agenda. Speakers will use practical examples and case studies to show a variety of approaches that are being used to develop competency and advanced practice.

For instance, Catherine Duggan, director of professional development and support, Royal Pharmaceutical Society, will describe how the UK is developing a “royal college” approach to professional recognition, following the medical model.“Healthcare providers now need to provide evidence that their staff have the qualifications, competence, skills and experience to safely provide patient care,” Dr Duggan explains.

Participants can also hear about an e-learning project for French-speaking, low-income countries. Started in 2013, it aims to foster the development of local experts in hospital pharmacy. Pascal Bonnabry, chief pharmacist at the University Hospital of Geneva,explains: “In many low-income countries, access to affordable high-quality drugs is a problem and so is [ensuring] safe and appropriate use of drugs. There are significant gaps both in the training of professionals in this specialised area and in the organisation of hospital pharmaceutical services — and patient care suffers as a result.” His hospital has had a long-standing collaboration with the Faculty of Medicine, Pharmacy and Dentistry at the University of Bamako, Mali, providing valuable insights into the problems and possible solutions.

“The e-learning platform that we have developed provides free, internet-based training at undergraduate and postgraduate levels”, Professor Bonnabry says.

Remuneration

Remuneration is a critical element of any job and can be an important incentive. Around the world, there is a wide diversity of models for the payment of hospital and community pharmacy services, some based on margins, while others are fees for services or capitation. FIP has conducted an international survey on remuneration in both community and hospital pharmacy and Dr Jacqueline Surugue, immediate past president of FIP’s Hospital Pharmacy Section, will describe the findings related to hospital pharmacy.

When and where?

The World Congress of Pharmacy and Pharmaceutical Sciences will take place from 29 September to 3 October in Düsseldorf, Germany.It offers 230 hours of sessions given by 220 experts from 40 different countries and includes many leading hospital pharmacists, clearly demonstrating the breadth and depth of innovative hospital pharmacy services worldwide. Make this a date in your diary.

Source:www.fip.org/dusseldorf2015/media

There is no striking a cheap bargain with prosperity. It must be purchased, not only with intelligent labour, but with moral force. As the bubble cannot endure, so the fraud cannot prosper. He makes a feverish spurt in the acquirement of money, and then collapses. Nothing is ever gained, ever can be gained, by fraud. It is but wrested for a time, to be again returned with heavy interest. But fraud is not confined to the unscrupulous swindler. All who are getting, or trying to get, money without giving an equivalent are practicing fraud, whether they know it or not. Men who are anxiously scheming how to get money without working for it, are frauds, and mentally they are closely allied to the thief and swindler under whose influence they come, sooner or later, and who deprives them of their capital. What is a thief but a man who carries to its logical extreme the desire to possess without giving a just return – that is, unlawfully? The man that courts prosperity must, in all his transactions, whether material or mental, study how to give a just return for that which he receives. This is the great fundamental principle in all sound commerce, while in spiritual things it becomes the doing to others that which we would have them do to us, and applied to the forces of the universe, it is scientifically stated in the formula, “Action and reaction are equal.”

Human life is reciprocal, not rapacious, and the man who regards all others as his legitimate prey will soon find himself stranded in the desert of ruin, far away from the path of prosperity. He is too far behind in the process of evolution to cope successfully with honest men. The fittest, the best, always survive, and he, being the worst, cannot therefore continue. His end, unless he change in time, is sure – it is the jail, the filthy hovel, or the place of the deserted outcast. His efforts are destructive, and not constructive, and he thereby destroys himself.

It was Carlyle who, referring to Mohammed being then universally regarded by Christians as an impostor, exclaimed, “An imposter found a religion! An imposter couldn’t build a brick house!” An imposter, a liar, a cheat – the man of dishonesty – cannot build, as he had neither tools nor material with which to build. He can no more build up a business, a character, a career, a success, than he can found a religion or build a brick house. He not only does not build, but all his energies are bent on undermining what others have built, but this being impossible, he undermines himself.

Without integrity, energy and economy will at last fail, but aided by integrity, their strength will be greatly augmented. There is not an occasion in life which the moral factor does not play an important part. Sterling integrity tells wherever it is, and stamps its hall-mark on all transactions; and it does this because of its wonderful coherence and consistency, and its invincible strength. For the man of integrity is in line with the fixed laws of things – not only with the fundamental principles on which human society rests, but with the laws which hold the vast universe together. Who shall set these at naught? Who then shall undermine the man of unblemished integrity? He is like a strong tree whose roots are fed by perennial springs, and which no tempest can lay low.

To be complete and strong, integrity must embrace the whole man, and extend to all the details of his life; and it must be so thorough and permanent as to withstand all temptations to swerve into compromise. To fail in one point is to fail in all, and to admit, under stress, a compromise with falsehood, howsoever necessary and insignificant it may appear, is to throw down the shield of integrity, and to stand exposed to the onslaughts of evil.

The man who works as carefully and conscientiously when his employer is away as when his eye is upon him, will not long remain in an inferior position. Such integrity in duty, in performing the details of his work, will quickly lead him into the fertile regions of prosperity.

The shirker, on the other hand, he who does not scruple to neglect his work when his employer is not about – thereby robbing his employer of the time and labour for which he is paid – will quickly come to the barren region of unemployment, and will look in vain for needful labour.

Culled from MIND IS THE MASTER by JAMES ALLEN

It should be 755 to 760 words

With a view to increasing the participation of students in the publication, the National Health Magazine creates a new column for letters and contributions from university students. As an incentive, writers of any article published will receive the sum of N20,000.

Oliver, a pharmacy student in Benin, has a school assignment which is required to be published in a health journal. He sends his write-up to the National Health Magazine. Fortunately, his contribution is selected and published along with articles of some other students. Oliver proceeds to the offices of the magazine to receive his remuneration. On meeting with the editor, he is informed that the magazine has accepted more entries than was budgeted for. He is offered N10,000, instead, as compensation. Oliver accepts the sum of money and signs with the accounts department for the collection.

After one week, the money from the magazine is exhausted. Oliver wants more. He writes a letter to the editor of the National Health Magazine, demanding for the payment of N10,000, being the balance of his remuneration. The editor replies him stating that: (1) Oliver’s write-up was of no real value to the magazine in the first place; (2) He already had a duty to publish his school assignment and so his contribution was merely in fulfillment of that duty; and (3) He accepted the sum of N10,000 offered and was paid in good faith.

In view of this, what are the legal rights of Oliver and the liabilities of the National Health Magazine?

It has been established that a contract between two parties requires an exchange. This may involve money, a product, a service or a promise to perform a certain action. The term ‘consideration’ refers to that which is exchanged. For a party to be able to enforce a contract, he or she must have furnished some consideration in support of it. This consideration must have some value in the eye of the law.

The legal issues to be considered in this case are:

1. The determination of something of value.
2. The performance of an existing duty.
3. The variation of a contract.
4. Composition with creditors.

The sufficiency of consideration means that what is provided by a party in a contract must be ascertainable, useful or meaningful; otherwise it will be regarded as insufficient. Judicial declarations support the notion that consideration does not have to be something of economic benefit. In the view of the legal scholar, J. C. Smith, “all that is necessary is that the defendant should, expressly or impliedly, ask for something in return for his promise, an act or promise by the offeree. If he gets what he asks for, then the promise is given for a consideration.”

With regard to Oliver’s contribution to the magazine, it is the view of the editor that his write-up added no value to the publication. However, in the case of De la Bere v. Pearson, the question arose whether a letter from a reader was sufficient consideration to a newspaper. It was held that there was consideration, as such publications had a tendency to increase the circulation of the newspaper. Considering that the National Health Magazine created the coloumn to reach more students, it is apparent that the involvement of a student, like Oliver, constituted something of value.

Subsequently, there is the question of the performance of a duty that one is already bound to fulfil. From the case of Collins v. Godefroy, it is established that a party cannot enforce a promise made to him in return for his performance of a public duty. On the other hand, Oliver’s commitment was to a school assignment, which he was not bound by law to fulfil. Rather, this was a duty to a third party (his lecturer).   In the New Zealand Shipping Case, it was declared that “an agreement to do an act which the promisor is under an existing obligation to a third party to do, may well amount to valid consideration.”

A major point of contention is the variation of the magazine contract to pay a student writer N10,000 in lieu of the advertised sum of N20,000. It is the position of the editor that since Oliver accepted the arrangement, the magazine is no longer liable to pay the balance. On the contrary, the authourity for this is Pinnel’s Case, where a creditor accepted to be paid a lower sum and later sued for the outstanding amount. The court held that the payment of a lesser sum could not discharge a debtor from the obligation to pay the full amount of debt.

The basis of this judgement is clear. For this new arrangement to be tenable, there must be some new form of consideration from the debtor. The magazine should have given something in compensation for the difference, otherwise the promise by the creditor to accept less money would not be enforceable.

Finally, in the settlement of debts, there is a concept known as composition with creditors. This is a situation where one debtor has multiple creditors and an arrangement is jointly made with all the parties to accept a lower sum in order to offset the debts simultaneously. In Wood v. Roberts, it was held that such an agreement is binding on all of them and none can subsequently sue for the balance of his debt. If the magazine had made a joint agreement with all the student writers, the arrangement would have been binding.

In conclusion, Oliver is entitled to the outstanding sum of N10,000. The National Health Magazine is liable for the full sum advertised.

Principles and cases are drawn from Sagay: Nigerian Law of Contract