Dear fellow Pharmers,

As this academic year comes to an end, we are proud to present you the 49th MRT’s last issue of Elixir.
In this issue, read all about past events that have been organized by the various committees of NUSPS. We bring you plenty of coverage on:
- Late 2009’s YEP and Xperience Pharmacy Camp
- Patient Counselling Event and Brown Bagging
- The newly initiated Sports Carnivals
- and our very own Health Bazaar, held in conjunction with World Tuberculosis Day

Since final exams are looming ahead, we’re sure most of you must be feeling the stress.?In this issue, we meet up with two of our professors who are NUS Pharmacy alumni for some golden advice on how to survive the course, as well as some anecdotes of what life as a student was like for them. We’ve also included some tips of how to destress–will you take our quiz to check your stress levels?

So do take a short break from your studying and look through Elixir to unwind. This time round, we have taken much effort to print Elixir out in a glossy new MAGAZINE FORMAT for keeping in the PS room! So if you’re in school by any chance, do drop by to take a look.

Don’t forget, all work and no play makes one a dull person!

Click on the image to access the download link of the newsletter!

Happy reading, and we wish you all the best in your end-of-year exams!

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With much love,
Belinda & the 49th Media Resource Team
NUS Pharmaceutical Society

(Study not just hard, but smart. Plan your time well, stick to your goals, and be as efficient as you can!
Don’t end up like studying at the rate of the construction of the Kent Ridge MRT station)

Savvy Singaporeans are self-medicating. There are many people who prefer to self-medicate for common and small ailments rather than consult a doctor as buying medications straight from a pharmacy is cheaper than consulting a doctor. Moreover, many feel that doctors generally provide the same kinds of medicine for common cold and cough. Hence, there is no need to pay extra money to see a doctor when those medicines are readily available at the pharmacy. However, people are not able to buy more drugs which used to be prescription-only drugs, over the counter. As quoted from Ms Quek Zhi Yuan, a pharmacist at the National University Hospital, “down-regulation is strictly regulated by the Health Sciences Authority”.

Self-medication may be part of a trend as people are more educated and drugs are more accessible. However, doctors warn of possible risks in doing so. Medical professions noted that there are pros and cons to people taking matters into their own hands. Although responsible self-medication helps to move patients towards greater independence in making decisions about management of minor conditions and symptoms, misdiagnosis and taking wrong medication can cause possible dangers. Sometimes, patient take the right medication, but at the wrong dosage and timing. They may also mix medications in dangerous combinations unknowingly.

For example, mixing paracetamol with muscle relaxants, which already has paracetamol, can cause the risk of overdose. Cardiac patients who are on blood thinners should be careful about taking aspirin or anti-inflammatory drugs, as it can increase the risk of bleeding. One should also take caution when mixing medicine, especially when taking western medicine together with complementary medicine as it may cause potentially dangerous side effects. In addition, self-medication might also mask a more serious illness by treating the symptoms but not the underlying cause. Very often, persistent symptoms may be a signal for something more serious, which may go undetected when people self-medicate.

They can prevent this by asking reliable healthcare professions, such as pharmacist or doctor about the drugs they are consuming. This is to confirm that self-medication is suitable for the particular condition, and helps to ensure that they have adequate knowledge regarding the drug’s dosing and administration.

In this aspect, pharmacists can play an important role. They are a link between patients and their doctors. They help patients to understand the role of medications in treating their conditions, and ensure that the patients are having effective treatment plans. Pharmacy Practice in Singapore has evolved from being drug-oriented to patient-oriented. Equipped with their immense drug knowledge, many pharmacists are reaching out to the communities and taking up the role to counsel patients on their drug treatment. For people who would like to self-medicate but are unsure of what type of medications to take, consulting a pharmacist is very convenient, as pharmacists are found in at retail pharmacies which are highly accessible. Some pharmacies even have webcam services to talk to a pharmacist from another outlet if the pharmacist is not available in a particular outlet. In this way, pharmacies are providing a more effective way to serve patients.

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Review by Tan Yu Quan (Year 1)

Article Source: The Sunday Times, Tuesday, Mar 02, 2010.
(An online copy of the article can be found here)

Picture Credits:
Neel’s Corner
Unity Pharmacy

The newly opened Skin Pharmacy at City Square mall in Kitchener Road has been brought to attention due to its provision of products that are specially formulated to cater to individual customers? needs. What makes this pharmacy stand out from other existing pharmacies is that the pharmacists do not only dispense medication but are also involved in the blending and concoction of skin and hair care products specially tailored for individual customers.

The pharmacists are able to create an individualized formula for customers, from pharmacy stocks containing mostly ingredients that are not commercially available; including amino acids, essential oils and whitening agents. This formula is devised in accordance to individual customer?s skin type and needs, before mixing the product on the spot. Fragrance and colour can then be included to improve the presentation and appeal of the product. There are also machines available to perform skin analysis of the customers. In my opinion, these machines will definitely be of benefit especially to customers who are not fully aware of their skin types and conditions. Therefore these skin analyses can help to ascertain individual skin conditions; aiding in the identification of effective treatment methods to deal with existing skin problems.

The Skin Pharmacy is managed by a local husband-and-wife team who are both Australian-trained pharmacists and is believed to the first boutique pharmacy in Singapore. Besides offering custom-made products and its own skin and hair care line, it also functions as a regular pharmacy containing medicines for treatment of dermatological ailments such as fungal growth and hair loss.

Their main focus on establishing a boutique pharmacy was mainly driven by their knowledge that compounding work in a retail setting is not so common in Singapore, especially with technological advancements resulting in pharmacists taking on more patient-centered roles of solely recommending or dispensing medication instead of blending and making products. This is especially evident in retail pharmacies such as Guardian and Watsons; whereby pharmacists are mostly involved in dispensing over-the-counter medications.

Prices start from about $30 for a 230g tub of moisturizing cream which then ranges for customized products depending on the nature and amount of ingredients required by the customers. Service charges are also included as the pharmacists will provide professional advice on the compatibility and stability of the ingredients to ensure the best welfare of the customers.

Personally, I find that these personalized services are quite worthwhile especially since the effectiveness of skin-care or hair-care products may vary among individuals depending on their skin types. Therefore, by seeking professional pharmacist opinions, customers can feel more reassured rather than simply purchasing off-the-counter medications and products which may contain ingredients that may evoke allergic reactions among certain individuals.

Review by Chong Hui Ping (Year 1)

The holidays are here, but while we’re taking a well-deserved break let’s not forget that there’s still plenty of pharmacy-related issues out there in the world for us to think about.

Happy holidays everyone!
The 49th Media Resource Team

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Article on the Bayer HIV Tainted Drug Scandal

For centuries, clear and simple principles shaped the relationship between physicians and their patients: work for the good of the patient; do no harm; keep the patient’s medical information confidential. The medical profession’s respect for patient privacy is rooted in the foundation of medical practice, as evidenced by provisions included in the earliest versions of the Hippocratic Oath.

These principles can be seen between a physician-patient relationship, but what happens in the relationship between a pharmaceutical company and her patients? Should these companies be bound by their respective code of ethics?

Pharmaceutical company Bayer sold large amounts of blood-clotting medicine for hemophiliacs in Asia and Latin America in the 1980s. However, the medicine sold carried a high risk of transmitting AIDS.

Hemophiliacs are people who are unable to stop bleeding or prevent bleeds from starting. The medicine, called Factor VIII concentrate, basically provides the crucial ingredient for clotting which hemophiliacs lack.

However, in the early years, the medicine used pools of plasma from 10,000 or more donors. Since there was still no screening test for AIDS, it carried a high risk of passing along the disease; even a tiny number of HIV-positive donors would contaminate an entire pool of plasma.

In response, Cutter Biological (division of Bayer) introduced a safer medicine in 1984 and sold it in the West. Yet for more than a year, the old medicine was sold overseas – an attempt to avoid being struck with large stocks of a product that was increasingly unmarketable in the West.

There were other reasons as to why the old medicine was still marketed: the company (Cutter) had several fixed-price contracts and believed the old version would be cheaper to produce. Later, when the whole incident was revealed, Cutter claimed that some patients believe that the older version worked better than the newer one.

Nearly 20 years later, the precise human toll of these marketing decisions is difficult, if not impossible, to document.

But in Hong Kong and Taiwan alone, more than 100 hemophiliacs contracted HIV after using Cutter’s old medicine, records and interviews show. Many have since died. Cutter also continued to sell the older product after February 1984 in Malaysia, Singapore, Indonesia, Japan and Argentina, records show.

Recently, a group of HIV-hemophiliac patients from Taiwan are appealing a US court ruling barring them from suing pharmaceutical giant Bayer. The group’s first appeal was in 2003.

Dr Sidney Wolfe, who as director of the Public Citizen Health Research Group has been investigating industry practices for 30 years, said “these are the most incriminating internal pharmaceutical industry documents I have ever seen.”

This incident have led many to wonder about pharmaceutical companies and their aims:
- Are they out to heal us or just out to earn money?
- Should we place our full trust in the medications we take? Are they any safeguards we should take and how?

Although this incident questions the goals of pharmaceutical companies, there are companies which strives to help others in need. Take Merck for example. Being one of the first to develop the HIV medication, they are now ’selling’ their HIV medication at a very low cost to needy patients in Africa, where HIV infection rates are high.

As we have learnt in Pharmacy Practice I, resolving the goals of a commercial business and professional ethics of pharmacy is of utmost importance. As some of you are already aware, “Commerce with Conscience” is the direction some companies have taken. The most famous example would be The Body Shop, were founder Mrs Anita Roddick reconciled profits with her ideals of returning what she have gained to the society. The Merck example above is a prime example of a pharmaceutical giant providing social change.

Perhaps it is time for health-care related industries to change their goals.

Review by Chua Jia Ni  (Year 1)

Read one of the articles that our NUS Pharmacy faculty, Dr Joyce Lee, wrote in the Ministry of Health’s blog recently. It is about the changing roles of pharmacists today.

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Not Yesterday’s Pharmacist Any More

By Joyce Lee, Pharm.D., BCPS
NUS Assistant Professor, Department of Pharmacy
Primary Care Clinical Pharmacist, NHG Polyclinics/Pharmacy

A few months ago, I saw Mrs. Tan for her uncontrolled diabetes. She was referred to my clinic by her doctor. When I reviewed her medical history and lab results, it showed that her condition had been long-standing with hint of complication. Mrs. Tan had been using five insulin injections religiously every day for years, yet she could not keep her blood sugar under control. She was losing faith in the medical treatment.

After spending some time talking with her and performing a few simple physical assessments, I recommended that her insulin therapy to be converted from five injections to two injections. Mrs. Tan looked at me in amazement and asked, “Are you sure?” A few months later, I was happy to congratulate Mrs. Tan for achieving a dramatic improvement in her blood sugar control, something which she once thought impossible. Although she thanked me for helping her, I really should be the one to thank her for making my job as a clinical pharmacist so rewarding.

Dr Joyce Lee seeing a patient.

The role of pharmacists is rapidly changing from the traditional pill dispenser to an integral member of a patient?s healthcare team. Although the evolvement has started decades ago mainly in the United States, the change is only beginning to happen in Asia with Singapore among the Asian pioneers.

Two years ago, I came from the US to join the NUS ‘pharmily’ and National Healthcare Group Polyclinics/Pharmacy with a dream to help advance the pharmacy profession and to set up clinical pharmacist services in Singapore. During my site visit for the job, I was impressed by the contributions of Singaporean pharmacists in the hospital settings. More improvement, however, was still needed in the primary care setting.

HDL-C Clinical Pharmacists. From left: Ms. Lim Mui Eng, Ms. Anna Liew, Ms. Evonne Lee, Ms. Ng Sock Mui, myself (Dr. Joyce Lee), and Ms. Esther Bek. Not in the picture: Ms. Ong Soo Im.

In October 2007, I piloted the first pharmacist-managed multi-disease clinic, also known as the?hypertension, diabetes and lipids clinic (HDL-C) in Singapore. The clinic targets the top chronic diseases in the country. It aims to work collaboratively with doctors, nurses, and other allied healthcare professionals as a team in the primary care setting to manage uncontrolled chronic conditions and to minimize complications and unnecessary hospital admissions. HDL-C was first piloted in Bukit Batok Polyclinic and the service has since expanded to Clementi and Choa Chu Kang polyclinics. I am grateful to the doctors at NHG Polyclinics, especially Dr. Sabrina Wong, Dr. Elaine Tan and Dr. Keith Tsou for supporting an idea that is new to Singapore and for giving me the guidance and resources to train primary care pharmacists and provide the HDL-C service.

This is still the beginning. Whether in the hospital setting or the primary care setting, the role of pharmacists continues to evolve. I believe Singapore will remain the trend setter in this field in Asia not only because Singapore has supportive public health managers but also because of its bright students, and high quality faculty at the NUS Department of Pharmacy who are uniquely qualified to educate pharmacists of the future. To prepare for the coming changes in pharmacy practice, the Department of Pharmacy at NUS has modernized its pharmacy curriculum, and the first post-graduate Doctor of Pharmacy (Pharm.D.) class was launched this year in order to cultivate pharmacists with a high level of clinical skills.

Mrs. Tan’s story is only one of many success stories that take place every day in Singapore due to the changing role of today’s pharmacists. With more pharmacists stepping out from their traditional place behind the pharmacy counter and applying their knowledge and skills to direct patient care, Singaporeans can look forward to a new important improvement in their healthcare service.

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If you’re interested, you may also read the articles by our other 2 faculty members from here:
By Adjunct Assoc Prof Chan Cheng Leng and
By Adjunct Assoc Prof Lam Pin Woon.

Credits to The Ministry of Health blog for the articles.

Feel free to discuss your own opinions about the posts!

Review on the Straits Time Article:
Tame doctors’ greed and protect patients (30 Sept 2009)

There has been much buzz on the newspapers recently about doctors who have been negligent in their prescriptions. Although stiff penalties have been imposed by the Health Ministry, there are still a good number of doctors who fall into the web of greed. These unethical acts pose threats not only to the reputation of the doctors, but also to the lives of their patients.

In the past five years, 23 doctors have been hauled before the Singapore Medical Council (SMC) and penalized for dispensing sleeping pills indiscriminately. Subutex drugs, meant for curbing heroin abuse, were also freely dispensed to patients?however the drugs ended up being abused.

Several people such as Madam Halimah Yacob (Jurong GRC) and Salma Khalik (Straits Times Health Correspondent) have suggested the separation of prescription from sale. Pharmacists, trained to check doctors? prescription, would help maintain patient safety by ensuring that the appropriate drugs are dispensed to the patients.

It has been agreed that it would be highly inconvenient for patients to go down to a pharmacy after consulting a doctor to get their medication, compared to the one-stop service patients are exposed to locally. However, this may not be applicable to drugs such as sleeping pills or obesity drugs. These drugs are not needed urgently by patients, but still can be easily abused if doctors are lax in prescribing them.
The Straits Time report also suggests that there could be an identifying of pharmacy-only drugs or the registering of patients who are prescribed such drugs, to prevent doctor-hopping.

The current dispensing system has been kept by the Health Ministry in order to ensure the convenience of patients. However, Health Minister Khaw Boon Wan has suggested that doctors provide patients with a clearly written prescription, and then leave the patient to decide where to obtain his medication.

Another good way of preventing greed by doctors while keeping the current system of practice would be to enforce transparency in bills from private clinics that itemize the costs of consultation, tests and drugs.

Review by: Selina Lim & Belinda Tan (Year 1)

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What do you think? Discuss your views here.
Time to apply what we have learnt in PR1103!

If you have been following the news closely, the issue of Means Testing has dominated the local front page for several days.  

The Context

Means Testing is a scheme introduced by the Ministry of Health (MOH), its purpose being to appropriately allocate limited healthcare resources in Singapore. Means testing will be based on salaries declared in tax or CPF returns [for salaried workers] and housing type [for the retirees, children and unemployed]. 

Why the need for Means Testing?

Patients going to the hospitals routinely ask for the senior consultants in the mistaken belief that their chances of recovery is guaranteed; however, they fail to recognise that the minor ailments that they are suffering from can be treated just as effectively by the other [albeit less, junior] doctors.  This has resulted in long queue-lines for all patients and MOH is looking towards improving this aspect of patient care.

Economists normally have 2 solutions for this phenomenon – either raise the price until supply equals demand, or let the queue mechanism sort itself out. Those who can afford to pay but cannot afford to wait will naturally leave the queue.

However, to apply this principle, ceteris paribus, to healthcare might result in some unpleasantness. Means Testing is the proposed solution: by allowing people who can afford to take up the better-class wards, we’ll be able to free up the remaining wards. This would also mean that we will be able treat more people, thus freeing up queue-lines. At least, this is the ideal case scenario.