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

The Association of Industrial Pharmacists of Nigeria (NAIP) has reiterated its commitment to charting the way forward for the pharmaceutical sector by helping pharmacists manage the impacts of government’s macroeconomic policies on the pharmaceutical industry.

The national chairman of the association Pharm. (Prince) ’Gbenga Falabi, disclosed this while making his opening remarks at the first 2015 NAIP bimonthly general meeting/lecture, held at the Lagos Chamber of Commerce & Industry (LCCI), Alausa, Ikeja, Lagos, recently.

According to the NAIP helmsman, the quest of the association to help surmount the numerous challenges facing the pharmaceutical sector prompted the decision of NAIP to bring Dr Akin Ogunbiyi, a distinguished business coach, to speak to members at the event.

In his presentation, Dr Ogunbiyi, who is the group managing director of Mutual Benefit Assurance Plc, observed that the pharmaceutical industry is faced with a number of challenges, including drug counterfeiting, unfavourable macroeconomic policies, unlicensed/unqualified pharmaceutical practitioners and limited spending power of citizens.

The guest speaker also listed poor infrastructure, inadequate and inefficient financing, high registration fees for imports, as well as the absence of meaningful patent legislation, as part of the challenges.

Ogunbiyi, however, noted that despite the challenges, opportunities still abound in the industry due to the growing demography, export opportunities in the ECOWAS region, efforts of NAFDAC to reduce counterfeiting and the renewed interest of the government in the healthcare system.

The Mutual Benefit Assurance helmsman lamented that despite the importance of the pharmaceutical sector to healthcare and general development of the country, the sector had not been well positioned.

He flayed the inability of operators in the industry to be entrepreneurial, their aversion for risk and their inability to attract private investors to the sector.

Preferring the way forward, Ogunbiyi urged operators to improve entrepreneurship, arguing that the current training in pharmaceutical sciences does not adequately prepare registered pharmacists for the business of pharmacy, adding that there was need for re-training of pharmacists as business managers.

He further advocated the development of the local chemical industry to reduce dependency on imported Active Pharmaceutical Ingredients (APIs), while also suggesting active participation of pharmacists in politics to shape the policies affecting the industry.

The guest speaker also urged pharmacists to invest in research and development, as well as getting the WHO GMP certification. He equally urged all pharmacists to work together in cooperation and be creative in initiating innovative strategies to make the system better.

Pharm. Okey Akpa, the chairman of the occasion, while making his remarks, said the guest speaker had challenged pharmacists to strive to continue to make a difference. He however, noted that the current environment is a challenge, noting that everywhere an industry had grown, policies must be improved.

While noting that there was enterprise in the industry, he argued that political will was critical to getting things right, lamenting that there was no enabling environment for Pharmacy to thrive.

He further urged pharmacists to begin to look into partnership. “We must begin to come together. We cannot run singularly and expect to make progress,” he said.

Also speaking at the event, Pharm. (Sir) Nnamdi Obi, managing director/CEO, Embassy Pharmaceuticals& Chemicals Limited, equally lamented the environmental problem.

He noted that pharmacists were not bereft of ideas nor incompetent on how to get things done but were operating in a very difficult environment.

Hehowever urged pharmacists not to relent on their efforts to get things right in spite of the environmental challenges, adding that pharmacists couldmake a huge difference in the industry. “We are the ones that will be the architect of our fortune and/or misfortune,” he said.

The Pharmacists Council of Nigeria (PCN) has admonished young pharmacists in the country to avoid practice that could tarnish the image of the pharmaceutical profession.

 Shun unethical practices, PCN urges graduating  pharmacists – As UNILAG Pharmacy Faculty inducts 138.

Speaking at the induction and oath-taking ceremony for 138 graduands of the Faculty of Pharmacy, University of Lagos, Akoka, on 5 March 2015, PCN registrar, Pharm. N.A.E Mohammed, charged the newly robed pharmacists to distinguish themselves from those who had gate-crashed their way into the profession.

Stressing that the intruders’ primary concern is making money at all cost, Mohammed noted that this was the bedrock of fake drugs in Nigeria.

“As young professionals, please ensure you do the right thing,” he urged the graduands.“If you are caught in a desperate attempt to use your licence in unethical practice, you will be in trouble.”

While explaining the danger of compromising one’s integrity in the profession, the PCN registrar spontaneously asked how many of the graduands understood the meaning of ‘Register and Go’. Scores of hands went up in response, to the admiration of the registrar.

Mohammed also congratulated the parents of the graduands for encouraging them to complete the first phase of pharmacy training, saying that the second phase is the mandatory one-year internship training programme under the supervision of a registered pharmacist in an accredited internship training facility.

“What I see in many of you are personalities that are looking for unforgettable adventures. The Nigerian health care delivery arena is full of untapped opportunities that are wrapped in countless but surmountable challenges,” Mohammed told the young graduates.

The PCN chief executive officer further observed that brain drain had orchestrated shortage of pharmacists, as many had migrated to other countries in search of better remunerations, state-of-the-art facilities and conducive working environment.

He added that even within the country, pharmacists were walking away from the health sector to other more attractive sectors such as telecommunication and petroleum.

“I am happy to note that most of them are coming back to their first love – Pharmacy. As you can see, Pharmacy is not boring because you will forever be learning about new people, organisations, places and methods of doing things…the PCN is aware of the challenges posed to pharmacists by the dynamics of the practice, tech advancement, increasing disease burdens, adverse drug reactions, drug interactions, drug resistance among others,” he said.

Congratulating the graduands, Prof. Olukemi Odukoya, dean of the faculty, explained that the occasion was not only meant to reflect on the past, but to prepare for the future.

“You will be faced with so many obstacles but with these challenges come opportunities for leadership and innovation. As pharmacy profession continues to evolve, remember the oath and commitment to patient care,” she said.

The dean also charged the newly inducted pharmacists to remember that their strength as pharmacists lay in their being experts in the safe and effective use of medicines and their potential contribution and integration into health and social care teams.

According to her, the profession of pharmacy is currently in a dynamic era, as it attempts to transform the role of the pharmacist from a product-oriented practitioner, concerned only with medication distribution, to a patient-centred practitioner able to meet the complex drug therapy needs of individuals and society.

“No matter where your career takes you, don’t forget that as University of Lagos-trained pharmacists, you must proudly represent the royal purple and remember that what starts here changes the world,” she stressed.

The induction ceremony saw the emergence of five first class graduates – Odunayo Abdulai, Innocent Ijeoma, Chinwe Obiakor, Omoshola Kehinde and Isilamiyat Rufia. Of the five, Odunayo Abdulai was announced the best graduating student. Not only was the young brain given a cash reward but she equally claimed every available prize in sight –the PCN, HealthPlus, Dean and Pfizer Science awards.

The colourful ceremony equally witnessed a massive turnout of participants, including professors, faculty members, pharmacists in academia, pharmacy students, parents, as well as top officials of the PCN and the PSN.

In view of the unending strike actions in the health sector, the Association of Community Pharmacists of Nigeria (ACPN) has urged members of the public not to resort to self-medication and arbitrary consumption of local herbs.

Speaking exclusively with Pharmanews, ACPN chairman, Pharm. (Alhaji) Ismail Adebayo, explained that the association was fully aware of the sufferings experienced by patients and their loved ones during industrial actions such as the recently suspended strikes by the Joint Health Sector Union (JOHESU) and the Nigerian Medical Association (NMA).

“Whenever we have issues like this, you discover that patients will always seek alternatives. Some are forced to visit hospitals and that can be very expensive. Secondly, the quality of the service, especially when it comes to pharmaceutical care, will be poor”, Adebayo said.

“Besides we know that most private hospitals don’t even have pharmacists. And by virtue of that, it is going to affect the quality of health care delivery that will be given to the citizens,” he added.

The ACPN chairman however noted that the most worrisome fallout of health workers’ strikes is the number of people who resort to self-medication, which could be dangerous for them.

“As the national chairman of ACPN, what we preach when we see patients is proper enlightenment and education on what to do. But how many of them can afford even the consultation fees that private hospitals charge? Consequently, they may resort to self-medication. What can we do? One thing is for pharmacists to give advice, another thing is for people to take to it,” he remarked.

According to Adebayo, self-medication is not limited to those who use local herbs, but also those using cheap and substandard medicines because they cannot afford to visit private hospitals or pharmacies during strikes.

“Of course, we know how much it takes to treat ordinary malaria in this country. By virtue of this, I will implore the government to look at this matter holistically,” Adebayo urged.

It would be recalled that the Nigerian Medical Association (NMA), after several dialogues with the federal government, was compelled to call off its 55 days strike on 25 August, 2014. According to a communiqué released to announce the Call-off, the decision was based on current challenges in the country.

Similarly, the Joint Health Sector Union (JOHESU), embarked on strike on 12 November, 2014 over non-implementation of the agreement entered into by the government, which bordered mainly on issues of improved welfare for health workers. The strike was eventually suspended on 2 February 2015. This was sequel to a meeting between President Goodluck Jonathan and JOHESU during which salient issues regarding the grievances of the union were discussed.

Ahead of the 2015 World Tuberculosis Day which is usually mark on March 24 of every year, the World Health Organisation (WHO) has called on all countries to support a new 20-year strategy which aims to end the global tuberculosis epidemic by 2035.

This decision was reached at a World Health Assembly conference convened by WHO in Geneva, in May 2014 to adopt a post-2015 strategy with an ambitious target of ending the disease by 2035.It will be recalled that the eradication of TB was one of the MDGs which was not achieved in 2015.Thus, the emergence of the new strategy.

According to a press release from WHO, the strategy aims to end the global TB epidemic, with targets to reduce TB deaths by 95% and to cut new cases by 90% between 2015 and 2035, and to ensure that no family is burdened with catastrophic expenses due to TB. It sets interim milestones for 2020, 2025, and 2030.

Worried by the prevalence of the disease, the WHO Director-General, Dr Margaret Chan, said the ailment has devastating economic consequences for affected families, reducing their annual income by an average of 50%, and aggravating existing inequalities.

“This is a matter of social justice, fundamental to our goal of universal health coverage. Each and every man, woman or child with TB should have equal, unhindered access to the innovative tools and services they need for rapid diagnosis, treatment and care”.

Hence, the call for new commitments and new action in the global fight against tuberculosis – one of the world’s top infectious killers.

Go into the fields and country lanes in the spring-time, and you will see farmers and gardeners busy sowing seeds in the newly prepared soil. If you were to ask any one of those gardeners or famers what kind of produce he expected from the seed he was sowing, he would doubtless regard you as foolish, and would tell you that he does not “expect” at all; that it is a matter of common knowledge that his produce will be of the kind which he is sowing, and that he is sowing wheat, or barley, or turnips, as the case may be, in order to reproduce that particular kind.

Every fact and process in Nature contains a moral lesson for the wise man. There is no law in the world of Nature around us which is not to be found operating with the same mathematical certainty in the mind of man and in human life. All the parables of Jesus are illustrative of this truth, and are drawn from the simple facts of Nature. There is a process of seed-sowing in the mind and life – a spiritual sowing which leads to a harvest according to the kind of seed sown. Thoughts, words and acts are seeds sown, and, by the inviolable law of things, they produce after their kind.

The man who thinks hateful thoughts brings hatred upon himself. The man who thinks loving thoughts is loved. The manuscriptwhose thoughts, words and acts are sincere, is surrounded by sincere friends; the insincere man is surrounded by insincere friends. The man who sows wrong thoughts and deeds, and prays that God will bless him, is in the position of a farmer who, having sown tares, asks God to bring forth for him a harvest of wheat.

He who would be blessed, let him scatter blessings. He who would be happy, let him consider the happiness of others.

Then there is another side to this seed-sowing. The farmer must scatter all his seed upon the land, and then leave it to the elements. Were he to covetously hoard his seed, he would lose both it and his produce, for his seed would perish. It perishes when he sows it, but in perishing it brings forth a great abundance. So in life, we get by giving; we grow rich by scattering. The man who says he is in possession of knowledge which he cannot give out because the world is incapable of receiving it, either does not possess such knowledge, or, if he does, will soon be deprived of it – if he is not already so deprived. To hoard is to lose; to exclusively retain is to be dispossessed.

Even the man who would increase his material wealth must be willing to part with (invest) what little capital he has, and then wait for the increase. So long as he retains his hold on his precious money, he will not only remain poor, but will be growing poorer everyday. He will, after all, lose the thing he loves, and will lose it without increase. But if he wisely lets it go; if, like the farmer, he scatters his seeds of gold, then he can faithfully wait for, and reasonably expect, the increase.

Men are asking God to give them peace and purity, and righteousness and blessedness, but are not obtaining these things; and why not? Because they are not practising them, not sowing them. I once heard a preacher pray very earnestly for forgiveness, and shortly afterwards, in the course of his sermon, he called upon his congregation to “show no mercy to the enemies of the church.” Such self-delusion is pitiful, and men have yet to learn that the way to obtain peace and blessedness is to scatter peaceful and blessed thoughts, words, and deeds.

Men believe that they can sow the seeds of strife, impurity and unbrotherliness, and then gather in a rich harvest of peace, purity and concord by merely asking for it. What more pathetic sight than to see an irritable and quarrelsome man praying for peace. Men reap that which they sow, and any man can reap all blessedness now and at once, if he will put aside selfishness, and broadcast the seeds of kindness, gentleness, and love.

Culled from MIND IS THE MASTER by JAMES ALLEN