by Kazeem Olalekan MRPharmS

A news article on the BBC Today program (http://news.bbc.co.uk/today/hi/today/newsid_8971000/8971236.stm) came to my attention yesterday about Avandia. It left me concerned for my patients and disappointed in the regulatory framework and in particular at GSK’s response. The concern about Avandia is not new. In July 2007, I posted a blog on Iforg Limited website about Avandia and Heart Disease (http://iforg.com/blog/?p=26) and it related to a youtube video I uncovered. In July 2010, the FDA recommended that Avandia remain on the US market but with stronger restrictions (link).

In the UK we have a regulatory body, MHRA, who I now understand reached a unanimous decision to remove Avandia from the UK market but due to some technical aberrations, cannot. GSK should have quarantined this drug before Europe makes a pronouncement of the drug. That would have been a dignified and right thing to do. That will be acting in the interest of the patients. Failing that the MHRA should have suspended the license temporarily. I am not too happy about this state of affairs and very concerned for my patients. If the powers that be will not act, then I will need to have a discussion with my GPs locally and device a way forward in the interest of our patients.

By the way, the BMJ investigation has also recommended the withdrawal of Avandia (Rosiglitazone) – link.

I am a fan of big pharm but this has been disappointing.

by Kazeem Olalekan

There is something important called the general election happening right now. On May the 6th (3 days from today), the citizens of the United Kingdom will elect one MP for each of the 650 constituencies to the House of Commons(1). There has been a lot of firsts in this election: The first televised series of three political debates, and this: my first honest public assessments of the three political parties. Bookapharmacist.com is apolitical but we believe politics is important: Politics is important in shaping the quality of service we deliver to our patients in my (our) NHS. I am writing this not to influence your vote (hence the short time lag between the election date and publication) but to reflect on what the main political parties have offered and are offering; impact on pharmacy and a glimpse at the future configuration of the NHS.

The Pharmacy vote

A lot might or might not have been made of the pharmacy vote. This is reminiscent of the Motorway Man (2) and the Wheelbarrow Student (sorry…next election!). It assumes, probably, that pharmacists are a homogeneous mix of voters. The actual fact is that my profession is made up of individuals who will vote on the basis of which political party will progress their personal, professional and patients’ interests in a joined up NHS. On this basis, there is no single pharmacy vote. On a personal level, I favour a progressive and fair system of government. Extreme left or extreme right views has almost always tended to be irrational. Arguments are and will be won from the centre. To my colleagues who are still undecided, the folks at Chemist and Druggist has have devoted a page to the election (3). You can assess what each political party will do for you and your profession. I have exercised my right and I hope you would too. I will expand on this later.

Everything but…

Haven analysed what the main political parties are offering on everything but pharmacy interest, I have arrived at a series of conclusions. Let us consider the economy: I have no doubt in my mind that the actions taken by the Labour party to stem the potential disaster of the economic crisis has been well considered and on point. We can thank Gordon Brown and his team for job well done…so far (albeit some minor faux pas). However, the unequivocal winner, in my humble opinion, is Mr Vince Cable of the Liberal democrat, whose knowledge and opinion is standing the test of time. He has guilelessly taken a series of positions which he is standing by. The question on my lips is this: would the politics of power have tempered his frankness on some of the issues? I sincerely hope not. The rise of Nick Clegg, as a direct consequence of the first televised debates, reminds me of an inspiring team, that swept into power more that 10years ago. If I don’t mention the war and some expectations unrealised by the current Labour government, then Nick Clegg/Vince Cable ticket is quite appealing to some extent. There is now the new look and dare I say progressive Conservative party. Under David Cameron, the party is moving from the extreme right to the centre, where arguments are won. When George Osborne mentioned the ‘C’ word earlier this year, he was chastised. It is now clear that he was being honest. There is going to be cuts…big cuts, whoever wins. As someone working within the healthcare service, this will be inevitable. What I ask for is fairness in the way this is done. We recognise this in Pharmacy and that is why in November last year our Pharmacy clinical directors published an article in our professional journal which stated: “Don’t let a good recession go to waste” (4). It was a call to us pharmacists to explore how we can do our bit in this toughest of all times for everyone including our patients. It is also clear from the report by the Institute of Fiscal Studies (IFS) that none of the political parties are coming clean on the scale of tax rises (5). So Labour will ring-fence some vital services but proposes a rise in National Insurance and the Conservatives favours VAT and other tax rises. The actual fact is that a combination of measures will be needed to deal with the scale of the problem. I am no economist and I don’t claim to be one. I am simply a pharmacist within a NHS that I am proud of. The opinion expressed in this week’s leader in The Economist entitled: Who should govern Britain?, states: “But Mr Cameron is much closer to answering the main question facing Britain than either of his rivals is” (6). The leader concluded that “he(Mr Cameron) would get our(The Economist’s) vote”.

The Pharmacy Interest

I am always dubious about ‘the pharmacy interest’. The pharmacy interest that is not aligned to the NHS interest or our patient’s interest is no interest at all. So the pharmacy interest is the NHS interest. This election, more than any before, feels like a lot more attention is being paid to the pharmacy interest and role. This is encouraging because as pharmacists, we have an important job to do for our patients. I have been especially impressed with the special interest in Pharmacy by the Conservative party, under Mr David Cameron. ‘It has felt,’ according to my experienced colleague Miall James, that ‘Pharmacy has done best under Labour government’(7). A great measure of how the Conservative party is now responding to the interest of Pharmacy can be gleaned from the response of Pharmacy contractors at the Pharmaceutical Services Negotiating Committee (PSNC) community pharmacy conference in Birmingham in March of this year. On the question of which government will best serve the Pharmacy interest, a Conservative government came out as a clear winner with 111 votes relative to 16 for Liberal Democrats and 32 for Labour (8). I also know that the Liberal Democrats has a Pharmacist MP, Sandra Gidley, for the Romsey constituency(9) – the only pharmacist MP I am aware of (I stand corrected). That said, my profession has experienced giant strides forward under the Labour government.

Where does that leave me?

Firstly, I have exercised my vote. I did that by post after watching the final of the series of three debates. I am reasonably satisfied with my choice. If you haven’t, I think you should. Apart from the three main parties, there is always the minority parties. I cannot tell you who I have voted for but I can assure you it wasn’t the BNP. It is the healthcare of my patients that I care passionately about and I employ whoever is elected not to squander some of the real positive progress that has been happening in the NHS over the past few years. There is still a lot to do to improve the system but change has to have a purpose: A clear purpose. Change for change’s sake is not enough. We need to build on what works for the sake of my patients. There is a rocky road ahead. And if the parliament is hung, like some commentators are predicting, then the different parties must work together on most issues. All parties working together on healthcare is not negotiable!

References

(1) http://en.wikipedia.org/wiki/United_Kingdom_general_election,_2010
(2) http://www.guardian.co.uk/politics/2010/feb/07/motorway-man-election-winner
(3) http://www.chemistanddruggist.co.uk/election2010
(4) http://www.pjonline.com/content/interview_martin_stephens_jonathan_mason
(5) http://www.guardian.co.uk/politics/2010/apr/27/general-election-spending-cuts-ifs
(6) http://www.economist.com/opinion/displaystory.cfm?story_id=16007299
(7) http://www.pjonline.com/news/conservative_government_has_best_pharmacy_proposals_according_to_conference_vote?page=#comment-2975
(8) http://www.pjonline.com/news/conservative_government_has_best_pharmacy_proposals_according_to_conference_vote
(9) http://www.sandragidley.org.uk/

by Kazeem Olalekan


With glowing hearts, United States of America bagged 9 Gold medals, 15 silver medals and 13 bronze medals in the recent winter Olympics in Vancouver. A total medal haul of 37, seven more than their closest rival, Germany. Great Britain, on the other hand, came joint last with Estonia and Kazakhstan (is that not Borat’s country? – Jagshemash!). Amy Williams, now a legend in the women’s skeleton, bagged the only medal for team GB. I sure hope Amy, who honed her skills in Bath, is displaying a glimpse of great things to come from team GB in the London 2012 Olympics. As the Olympic flames pass from Vancouver to London, it is the Olympic sport of synchronised swimming that is exercising my curiosity. And this is relevant to pharmacy in the UK today!


Wikipedia (link) describes synchronised swimming as “a hybrid form of swimming, dance and gymnastics, consisting of swimmers (either solos, duets, or teams) performing a synchronized routine of elaborate moves in the water, accompanied by music. Synchronized swimming demands advanced water skills, and requires great strength, endurance, flexibility, grace, artistry and precise timing, as well as exceptional breath control when upside down underwater.”



What is the relevance of this to pharmacy? It is simple. The Royal Pharmaceutical Society of Great Britain (RPSGB) as we know it is changing for good. Later this year, the regulatory arm will separate from the leadership arm. If one of the factors underpinning the change relates to attempts to give clear and better leadership to the professional pharmacist, then the fact that the change is going ahead is a tacit acceptance that this is necessary. I couldn’t agree more. It is also an attempt to put behind us the problems that had dogged us in the past. A way forward has clearly been mapped.


In the recent election to the Assembly, only 21% of eligible voters, exercised that choice in the English Board. Whilst this was a better turn out than in previous elections, it was still unacceptably low. The ’stop remote supervision’ camp got their voters out. That is encouraging. What happened to the silent 80%? The “million dollar” question is how does the profession engage with the silent majority? I have a suggestion and it can be found in the Olympic sport of synchronised swimming:


The argument goes thus: If the steps being taken by the society to separate the leadership and regulatory arm is the right thing to do (I certainly think so); then organisations which employ pharmacists (notably multiples) must review their management structure. Their structure must now mirror what is happening at the new RPSGB. A pharmacy leadership champion must be appointed at a reasonably high organisational level who will have specific remit: Build a motivated, independent and professional pharmacist workforce which is confident to engage with the profession at large and quite comfortable to defend the company’s positions. That will of course differ from the disenfranchised workforce which we are currently seeing in some instances. It will be a position of leadership for a suitably qualified candidate who can gain the confidence of his/her professional colleagues.


The society, our society is moving ahead. To continue to play an important part in pharmacy, organisations that employ pharmacists must adapt to the changing landscape and embrace a new type of strategy. A strategy that will instil confidence in their pharmacy workforce. Appointing a suitably qualified person with relevant track record is a start. So swim with us and let us win loads of gold medals together.


Note: There is a rating embedded within this post, please visit this post to rate it.

The issue surrounding the suspended sentence handed out to our colleague, Elizabeth Lee, has exercise a lot of passion amongst practising pharmacists. It moved myself to write this article.


The latest update in this sorry episode is the report by the coroner on the 4th of March 2010. Peter Bedford, Berkshire coroner, said that the effects of the mistaken overdose of propranolol “were likely to have been so minimal at the time of [Mrs Sheller’s] death as to be able to be discounted as having any material effect”. (link)


Comments:
Mrs Sheller’s son: “We are pleased that the coroner is going to report to relevant authorities for the pharmaceutical industry and hope it will help to prevent the public from the harm of human error.”


Mark Koziol, chairman of the Pharmacists’ Defence Association: “There is nothing in the outcome which causes Elizabeth any problems with her appeal, nor anything which causes problems for the profession.”


This has been a sorry case all round and I hope the legislative changes being proposed will be implemented and as professionals we can keep the number of human errors to the minimum.

Today bookapharmacist.com showcase how it is building effective professional pharmacist networks by interviewing Katerina Mesmer (author of “Complacency did not build the Tower of Babylon“), Hospital Pharmacist and Project Facilitator at Iforg Limited. The interview explores her role at the Local Pharmacy Forum and at bookapharmacist.com. Most importantly, how she is working with bookapharmacist to build effective professional pharmacist networks.

Please click here to listen to the interview.

Some of you may be aware of the Babylon Tower debacle. The story goes that at one point in the history the world had one common language as they all descended from one man. A part of the world’s people moved eastward and some settled on the plain of Shinar also called Babylonia. That is were the name Babylon comes from.

Babylonians had a goal in preventing any further scattering of the people over the earth to create a city where the achievements of a united and integrated people would be concentrated. Did you notice any similarities with the dreaded globalisation? With eyes on this big prize it was an invitation to come together to work on this great project.

It is a very important ‘come’ of the story. ‘Come, let us build ourselves a city, with a tower that reaches to the heavens, so that we may make a name for ourselves and not be scattered over the face of the whole earth’.

Three incredible things are involved in this invitation: a vision for the city, a desire for a name and reputation, and a plan for a new movement. Being involved in the transition into the new Pharmacy Professional Leadership Body through the Local Practice Forum, I entertained the idea that we, pharmacists, are also a community of one common language and we are indeed trying to create a place where the achievements of a united and integrated people would be centralized. We have a vision of strong professional body that will support its members through strong network, we have the desire for our name and reputation to become well known to the public and to other healthcare professions and we have a plan how to build a great community with a voice and reason that influences the decision-makers at the very core of our democratic set-up.

Since the Babylon Tower was never built it begs to ask, what happened to it? And more importantly, what happened to the people? Well, people started to speak in different tongues, never managed to agree on the process, battled over obscurities and eventually abandon the idea all together. Sorry, no divine intervention can be blamed on this one. It was people them self, so sure and confident in their abilities to ‘reach the heavens’ that got them down to their knees. Complacency, my fellow pharmacists, is the barrier to achieving great things.

In these exciting times when the society is reforming and the many ideas are being implemented it is the right time to reflect on the mistakes of others and learn from it. Shall we have another big ‘come’ for the historians to write about in the distant future? ‘Come, let us build ourselves a professional body with a profession that reaches to the heavens.’

Reference:
Notes by James Montgomery Boice on Nimrod and Babel. The Tower of Babel and the confusion of languages by Lambert Dolphin http://ldolphin.org/babel.html (accessed 07/11/09)

Genesis. 3,4


Editorial Comment
(Kazeem Olalekan)

Important contribution Kat, thank you. The sentiments raised in this article is very relevant to the changes going on in the way we practice pharmacy in the UK. The split between the regulatory and leadership arm is the case in point. I was very surprised (shocked, perhaps) when at a meeting held by the Southampton Branch of the RPSGB in November 2009, a straw poll of the attendees was taken as to how many members will join the new leadership body. Less than 30% of those attending said they would. I guess that informed the candidacy of Jaggy (link) in the recent Election to the English National Pharmacy Board. The important task ahead of those elected is to find ways of engaging with members with the desire to want to join the new professional body. Else it will be Babylon, mark 2.

Gaviscon Advance Peppermint Flavour

Oral suspension containing sodium alginate 500mg and potassium bicarbonate 100mg in 5ml
PL 0063/0103

Reckitt Benckiser Healthcare (UK) Ltd are recalling the above lots due to a low -evel microbial contamination detected in one of the batches. The contamination causes spoilage of the product and a phenolic or antiseptic smell. The product should smell of peppermint.


The microbial contamination is not likely to be harmful to normally healthy consumers. However, if this product is being used by patients with suppressed immune systems, such as patients on chemotherapy, the risk of infection and other adverse reactions cannot be ruled out. General Practitioners or Pharmacists receiving enquiries from such patients are requested to give professional advice and refer to the responsible treatment centre where necessary.

Information for consumers

Reckitt Benckiser is carrying out a precautionary medicine recall at wholesale and pharmacy level, on two batches of 500ml bottles of Gaviscon Advance Peppermint Flavour; batch numbers 924471 and 925071.

The reason for this is that low-level bacterial contamination has been found in one of the batches. The recall of the other batch is purely a precautionary measure. The contamination could cause the product to spoil and alter the product’s smell from peppermint to antiseptic.

Healthy consumers who have consumed or have this product at home do not need to worry, as the contamination is unlikely to be harmful. For consumers with suppressed immune systems, such as patients on chemotherapy, the risk of infection from this contamination cannot be ruled out.

If consumers have any worries or suspected side effects, they should contact their doctor.

A series of very useful information on how to prevent Hospital Associated Infection. Very relevant to the UK as well and chimes with the work done by Dr Kieran Hand at Southampton University Hospitals Trust.

Campaign supported by Kimberly-Clark Corporation.
Links:
http://www.haiwatch.com
http://www.haiwatchnews.com/

by Kazeem Olalekan MRPharmS



On Tuesday the 20th of October 2009, the Southampton Branch of the Royal Pharmaceutical Society hosted a presentation by Dr Kieran Hand, Consultant Pharmacist– Anti-infectives at Southampton University Hospitals Trust. It was a remarkably successful evening on a number of fronts and I will highlight these here:


The Speaker


Dr Kieran Hand is a BSc Pharmacy graduate of Strathclyde University and began his career in hospital pharmacy as a resident pharmacist at the Chelsea and Westminster Hospital in London. He earned his PhD in pharmacology from the University of London and continued his research as a postdoctoral fellow before a brief career in the pharmaceutical industry in clinical trials pharmacovigilance. In 2002, Dr Hand returned to Chelsea and Westminster, appointed to a position of specialist microbiology pharmacist, and graduated from the first cohort of the MSc in Infection Management for Pharmacists at Imperial College. In January 2007, Kieran was appointed to the first consultant microbiology/Infectious Diseases pharmacist post in the UK, at Southampton University Hospitals NHS Trust. Kieran led a team in SUHT that won the 2009 UK Clinical Pharmacy Associations (UKCPA) Novatis Award for Antimicrobial Management for the design and implementation of an electronic referral system for microbiology ward rounds. He is a committee member former chair of the UKCPA’s infectious management group and he sits on the Health Protection Agency programme board for healthcare-associated infection and antimicrobial resistance and the antibiotics prescribing sub-committee of the Department of Health Advisory committee on Antimicrobial Resistance and Healthcare Associated Infection (ARHAI). Dr Hand is a council member of the British Society for Antimicrobial Chemotherapy and an editor at the Journal of Antimicrobial Chemotherapy.


So here we have an eminent speaker and a pioneer pharmacist.



The Audience


The Royal Pharmaceutical Society of Great Britain (RPSGB) has around 130 local branches which provide a local focus for professional and educational matters and hold regular meetings on a wide range of scientific and current affairs topics. Southampton Branch (http://www.rpsgb.org/branches/Southampton/) is a very dynamic branch consisting of pharmacists from community and hospital practises within the area. This meeting was to my knowledge, one of the best attended with over 60 members setting aside their evening to listen to Dr Hand deliver his talk. I guess we all wanted to know what the storm was all about. A cross section of the audience revealed a diverse audience from final year student of pharmacy at the University of Portsmouth and Pre-registration Pharmacy students to Practising Pharmacists (hospital and community) and Pharmacy Technicians.


The Presentation


The first thing that was remarkable about the presentation was its sheer comprehensiveness. There was something in it for the Final year Pharmacy students, something in it for the pre-registration pharmacist and certainly a lot in it for the hospital and community pharmacists. There were practical tips which pharmacy technicians found very interesting. On a personal note, I needed this presentation to help dust down my knowledge of infectious disease and management. So Dr Hand kindly made his presentation available to attendees and we have a copy on our server for registered users of our service to view. Just click here. Otherwise contact Katerina Mesmer (kat@bookapharmacist.com) for a copy of the presentation.


The storm gathering


The metaphor of antibiotic resistance being a perfect storm is apt. Dr Hand described a declining trend in number of antibacterial agent approval over the last 25 years. From 16 in 1983-1987 to just 4 in 2003-2007. He showed a powerful slide which illustrated the declining number of new antibiotic classes. The Oxazolidinones being the only new class of antibiotics from 2000 onwards.


An important element of this gathering storm is the proportional correlation between the amount of antibiotics prescribed and antibiotic resistance. Kieran explained why this might be the case using a powerful illustration. He used the opportunity refresh our minds on mechanism of actions of some antimicrobials and their spectrum of activity. The colourful slides are a God-send and will act as a good quick reference source.


Now we know, the question is how do we deal with this gathering storm? Dr Hand’s presentation was explicit. He drew on some of the work he did on Clostridium difficile infections (CDI) at Southampton University Hospital Trust(SUHT). The modifiable risk factors were: (1) Reduce contact with spores and (2) Reduce high-risk antibiotic exposure. The graphs he displayed have started to show a reduction in the cases of CDI at SUHT after the interventions.


Another factor that made this presentation unique is the fact that Dr Hand drew on the work done by Professor Paul Little of the University of Southampton in Primary Healthcare. You can hear professor Little on the BBC Today program in July 2008 describing some of his findings (here). Community pharmacists have an important role to play in modifying that cycle of expectation which Professor Little described.


The result of the Community-acquired pneumonia epidemiology study by Patrick Charles and others in Australia illustrates the ongoing battle of ideologies over broad-spectrum or narrow-spectrum antibiotic therapy. Matthew Drydon, Kieran Hand and Peter Davey concluded that “narrow-spectrum agents are often as effective and result in less collateral damage” (Antibiotics for community-acquired pneumonia – Journal of Antimicrobial Chemotherapy doi:10.1093/jac/dkp359).


So there you have it: We have a gathering storm and we can still do things to mitigate the problem. The overriding messages are: adopt ‘clean’ strategies, delay use of antibiotics in certain primary care situations and use the right medicines for the infection. It is on the back of this that the Hampshire and Isle of Wight developed a Guideline for Antibiotics Prescribing in the Community in 2008. We have a copy for our members to view here. It is now widely used across the area. Many thanks to the Medicines Management Teams, Professor Little and Dr Hand for all their efforts in making this guideline a reality.


Sponsors


This meeting was sponsored by unconditional grant from Pfizer and bookapharmacist.com (that is us!). We hope Pfizer will continue to work intently on antimicrobials in order that we may have new agents to help fight the increasingly resistant microbial infections. Many thanks to Pfizer for the support. As far as we are concerned, we will continue to work to support the efforts of the Branch in particular and the changes in Pharmacy, in general. Today we support a Branch meeting. Tomorrow who knows?


We will continue to work to bring valuable information and support to our members. If you are not yet a member or haven’t yet felt an interest in joining, we hope you will read more about the project here. We will be waiting to welcome you into our fold.


Many thanks

Tonight bookapharmacist.com in conjuction with Pfizer, are supporting an important Branch meeting on Antibiotics Resistance (-Just another example of big Pharma working with Pharmacists). Download the events pdf here. The talk on Antibiotic Resistance will be given by no other than Dr Kieran Hand, Consultant Pharmacist – Anti-infectives at Southampton University Hospitals Trust. This promises to be a great talk and the attendee should really get a great deal out of the day.


Antibiotic pharmacists in the ascendancy – Dr Kieran Hand – Journal of Antimicrobial Chemotherapy (Link). Dr Hand has also done a lot of work around the Antibiotic risks for Clostridium Difficile.


We will be keen to understand how community pharmacists can play important roles in averting the devastating consequence of perfect storm that is antibiotics resistance.