The Antidote

HEALTH l MEDICINE l RESEARCH l SUCCESS l PHARMING THE FUTURE

THE ANTIDOTE 2012 EDITION 02

GOT ETHICS?

Life after Breast Cancer We focus on Survivors

Worthwhile Publications in Pharmacy

The Multidimensional

Pharmacist: Custodian of

Medicine AND Communication?

Different Heroes: Rx Protagonists

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Unfortunately you tend to miss more than you experience

“It always seems impossible until it is done” - Nelson Mandela If you have never had a dream to publish - whether it be a newsletter, book or magazine, you won’t understand the feeling that I am experiencing now. Well, to make it simple - I’ve ticked off a big item from my Bucket List - along with completing my degree, being an official delegate to represent my country somehow along with seeing one of the Wonders of the World. What do all of these activities have in common? “Pharmacy.” What, except for SAPSF, reminds you of “Pharmacy?” - The very institution where you find your love for pharmacy; where your passion for your profession is nurtured and where an unspoken pride is harvested - your university. Thank you,

North West University - especially Prof Awie van Wyk, for your unconditional support and allowing me to take on fruitful opportunities and obtain irreplaceable experience. I am proud to classify myself as a “PUK Apteker.” Initially I saw The Antidote as a playground for students showing interest in the “written” part of being a pharmacy student. I was soon proved wrong by my brilliant subcommittee. I think it is safe to say that this issue of The Antidote proves that students have power beyond measure, coupled with unlimited talent, which enforces a focus on what the Pharmacists of Tomorrow have to show. I have to mention my right hand, Abednigo Nkosi – my visionary and my reality check. Without him, all of our articles would still be “aligned to the left!” Through the high internet costs and secluded hours with my faithfull laptop, I have to mention my foundation of my support – Marietjie and Peter Hayward. Thank you for your unending understanding, motivation and constant nagging on about “when is this thing done?” This year I’ve come to learn so much about our profession. If you, the reader, don’t find yourself in the profession of Medicine, you certainly have the right to be jealous! Getting to know other enthusiastic pharmacy students from Slovenia to the Netherlands, being involved in structures from university to international level, reading and subscribing to updates on the latest drug developments and following successes of organizations and companies within Pharmacy, all while having a relationship with my Goodman & Gillman’s Pharmacology, has made me excited and proud to share the following with you:

I am your most accessible health care provider; I am a driving force behind discovering new medicines; I am the key that unlocks all you need to know about your medication; I am with you in sickness and in health. I am a pharmacist.

Now I challenge you to go out there and distinguish yourself from the rest – experience and observe. Everyone noticed apples falling from the tree – only Newton questioned it…

Viva la Pharmacie!

Cindy Cindy Hayward – SAPSF Editor 2012/2013

EDITOR’S LETTER

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Sub-Editor Note

The present is the key feature of marrying the past and the future, this very notion accounts for our role not only as pharmacists, but more so as humans in the trajectory that health is set on. Upon exploring the plethora of notions of what the National Health Insurance (NHI) might mean to a mere South African, I found that the pinnacle of a very cohesive, multi-structured, and human-centred health care system begins now, while we are students and fresh graduates. Perhaps I say such with the greatest optimism, but it is that very aura that runs through the Antidote – conceivably a first of many mechanisms we need to support to rejuvenate pharmacy as a field. It is said that the field has too many females. Truth be told, pharmacy has the cream of the crop of women who are well versed in leadership, a smart work ethic, and innovation. I say this with great affirmation after a year of seeing what the queens of this profession can bring to the table; innovation, unity, and a ceaseless cultivation of a dynamic facet of humanity. From student, to intern, to council, women in the field are making a mark that should be acknowledged but us as males. I am part of a team (the Antidote editorial

and writing team) that has made me sway the other direction of a profession that may be seen perhaps as matriarchal. My greatest hope is that this is an Antidote to all Pharmers that will spark debate, new ideas, and breed a new school of thought within academic circles.

For those who assisted in making this issue a predestined success – Thank You| Enkosi| Dankie.

Abednigo Nkosi SAPSF Sub-Editor 2012/2013

SUB-EDITOR’S LETTER

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Meet the Editorial Team

Amoré Orr Elizma du Toit

PUBLISHING EDITOR Cindy Hayward

SUB-EDITOR Abednigo Nkosi

EDITORIAL BOARD

NWU Amoré Orr Lesedi Manyanye Vernice Steenkamp Elizma du Toit Esmari van Jaarsveld Janke Kleynhans Lesedi Manyanye Vernice Steenkamp NMMU Amber Cheng Amber Cheng Lerisha Maharaj UWC Abednigo Nkosi UKZN Lerisha Maharaj TUT/MEDUNSA Sihle Zwane UL Lebogang Nchabeleng Sihle Zwane Lebogang Nchabeleng

THE ANTIDOTE HEALTH l MEDICINE l RESEARCH l SUCCESS l PHARMING THE FUTURE

Esmari van Jaarsveld Janke Kleynahns

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CONTENTS

FOCUS ON SAPSF

PRESIDENTIAL ADDRESS 7 PUBLIC INITIATIVE 9 STUDENT EXCHANGE 12

FOCUS ON PRACTICE

DIFFERENT HEROES 13 THE MULTIDIMENSIONAL PHARMACIST 14 COOKING FROM THE HEART 16 WORTHWHILE PUBLICATIONS 18 GOT ETHICS? 20 STEPPING OUT FROM BEHIND THE COUNTER 22 ONE CAREER, MANY OPPORTUNITIES 25

FOCUS ON DISEASE

SINGLE DRUG AGENT AGAINST MALARIA 27 PHARMACIST’S ROLE IN MANAGEMENT OF DIABETES 30 BREAST CANCER SURVIVORS 32

FOCUS ON TECHNOLOGY

PATIENT CONSULTATION APPLICATION? 34

FOCUS ON ALTERNATIVES

ALTERNATIVE VS. CONVENTIONAL MEDICINE 36 TRADITIONAL AND HOLISTIC MEDICINE 37 VITAMINS 39 BOERERAAT 42

FOCUS ON SOUTH AFRICA RESOLUTION 53 – THE NHI 44 ABSOLUTELY APEX 46

THE ANTIDOTE Page 7

FOCUS ON: SAPSF

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FOCUS ON: SAPSF

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FOCUS ON: SAPSF

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FOCUS ON: SAPSF



What if the possibility of going abroad would be given to you? Going to a place full of opportunities, where you could broaden your pharmaceutical experience while gaining new insights and outlooks?

By Mmakgabo Chokwe

Well it is possible through the IPSF Student Exchange Programme (SEP) which has been one of the longest standing and most popular International Pharmaceutical Student Federation (IPSF) initiative since the formation of the Federation in 1949. SEP is a year-long project that is run by more than 50 IPSF member associations. Majority of exchanges are conducted over the months of May to September for duration of between one to three months. SEP gives you an opportunity of going abroad where you could broaden your pharmaceutical experience while gaining new insights and outlooks. Student Exchange Programme (SEP) is a mobility programme that gives students from all over the world an opportunity to get to know pharmacy in a different country. As a student you can apply for a student grant .The purpose of this grant is to allow some students with no or low finances to participate in the IPSF SEP. The grant will finance partial or full costs of a plane, train, bus or ferry ticket to the destination country, and relieve the exchange student from the payment of the fees imposed to participate in the exchange programme. An application must be completed and all the rules have to be followed! These are the countries participating in SEP and you can only pick three as your desired destination. Apply on line www.sep.ipsf.org and also contact me at [email protected] for more information Closing date for application is 31 December 2012 , so hurry YOUR FUTURE IS WAITING FOR YOU…. Viva la Pharmacie Mmakgabo Chokwe SAPSF SEO 2012/2013

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Thus, almost by default, the responsibility to explain conditions, treatments, side effects and such falls on our shoulders.

The

mulTidimensional

pharmacisT: Custodian of medicine AND communications?

Paul J Meyer said that communication – the human connection - is the key to personal and career success. If you look at the happiness of many pharmacists, you might wonder about their ability to communicate…

By Elizma du Toit

hether you are a little kid in need of

cough syrup, a first year pharmacy student or a veteran – being an expert in the business– everyone knows that pharmacists can be compared to the Medicine Man. Since we are all human, proper custody of medicine is not possible without proper communication. Being able to thoroughly grasp what is being said, to read beyond what isn’t while effectively getting a patient to understand what you need him to understand, (and not what he thinks he should) ultimately to give him the best possible care, is ultimately depended on proper communication. Sadly, in our society today, communication has taken such a different form that it has become a scarce personal skill. Not only do you as pharmacist personally need great communication skills, but you need to be able

to breech your patient’s lack of communication skills as well. Most people can communicate greatly through technology and to meet the need, every pharmacist should be able to reach out to their patients in such a way, yet to successfully do that, skills are needed as well. With technological communication comes the problem of being impersonal and of people portraying a picture far from the real truth.

During our years of study, lots of emphasis is being placed on the need of knowledge about medicine, in contrast to the skill of communication which is greatly neglected. Afterwards, in practice when the need arises, we fear changing our methods and stick to the widely accepted “cashing in the most the quickest” – at cost of the patient and ultimately ourselves.

“THE SINGLE BIGGEST PROBLEM IN COMMUNICATION IS THE ILLUSION THAT IT HAS TAKEN PLACE” – GEORGE BERNARD SHAW.

We easily fall into this trap by assuming that the patient understands what we are trying to explain, and not wanting to waste time, we hardly make sure that they do understand. Pharmacists are the link between other health professionals like doctors and patients and are perceived as more approachable to the patient as well. Thus, almost by default, the responsibility to explain conditions,

treatments, side effects and such falls on our shoulders. “COMMUNICATION IS ABOUT BEING EFFECTIVE - NOT ALWAYS ABOUT BEING PROPER” – BO BENNET.

There is a need to educate people about uncomfortable topics, to ask hard questions and face hard answers; there’s a need to call people to responsibility for their own health and there is a need

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to call health professionals back to minding patients’ health first and bank accounts later.

The responsibility is there, the situations are there, will we rise to challenge of multidimensional service or will we hover in fear next to that we know?

Knowledge can be conveyed in many ways. With the expansion of technology, the need of our knowledge may soon be unnecessary. But technological communication has its limits. Personal attention and relations can’t be replaced. In a fast changing world, we as pharmacists will need to adapt communication skills to make us irreplaceable. The power lies within YOU!

Editor’s Note

At the 58th Annual IPSF Congress in Egypt, Sanofi did ‘n

presentation on the importance of Communication. Dr

Ahmed Arabi said that Yesterday’s Pharmacist

dispensed medicine and counseled the patient,

whereas as the Future Pharmacist uses social media,

alternative medicines and focuses on drug safety and

communication down the line. He said that we should

remember that patients are ill people – they feel

anxious and afraid, and if you want to know whether

they are satisfied with your service and

communication, the only way is to ask them. See

patients as individuals with individual personalities,

needs and preferences and focus on what they are

NOT saying as well as synchronisation between verbal

and non-verbal communication.






Got Ethics?

Ethics focuses on the disciplines that study standards of conduct, such as philosophy, theology, law, psychology, or sociology. Another way to define ethics is as a method, procedure, or perspective for deciding how to act and for analyzing complex problems and issues. (Resnik: 2011)

By Esmari van Jaarsveld

thics can consist of codes, policies, and principals which are very important and useful. Like any set of rules, they do not

cover every situation, they often conflict, and they require considerable interpretation. It is therefore important for researchers to learn how to interpret, assess, and apply various research rules and how to make decisions and to act in various situations. Ethics should be applied on all stages of research, such as planning, conducting and evaluating a research project. (Explaramble.com: 2008).

Ethics: a two syllabled word contains so much power- in everyday live ethics comes forward in one or more ways. Pharmacists are in positions where ethics plays a very important role. The code of ethics of pharmacist's states that these ethics must help the development of the profession by sharing their knowledge and experience with other pharmacists and students, through participation in courses and training courses and the work and scientific research in the field of pharmacy.

“Research ethics provides guidelines for the responsible conduct of biomedical research. In addition, research ethics educates and monitors scientists conducting research to ensure a high ethical standard.” (University of

Minnesota Centre for Bioethics: 2003). Research ethics involves - the application of fundamental ethical principles to a variety of topics involving scientific research. These topics include the design and implementation of research projects involving human experimentation, animal experimentation, various aspects of academic scandal, including scientific misconduct (such as fraud, fabrication of data and plagiarism), regulation of research, etc. Research ethics is most developed as a concept in medical research. (National Academy of Sciences: 2009)

Many different disciplines, institutions, and professions have norms for behavior that suit their particular aims and goals. These norms also help members of the discipline to coordinate their actions or activities and to establish the public's trust of

the discipline Ethical norms also serve the aims or goals of research and apply to people who conduct scientific research or other scholarly or creative activities.

The question still stands why ethics is important in research. Well there are several reasons why it is important to adhere to ethical norms in research. Firstly, ethical norms help to promote the research’s aims,

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such as knowledge, truth, and avoidance of error. This helps to ensure that fabrication, falsifying and the misrepresentation of information is eliminated in the research progress. Secondly, since research often involves working with many different people and is greatly dependent on the cooperation and coordination of these different people in different disciplines and institutions, ethical standards and norms can help to promote the values that are essential for collaborative work. Some of these values include trust, accountability, mutual respect, and fairness. Many ethical norms in research, such as guidelines for authorship, copyright and patenting policies, data sharing policies, are designed to protect intellectual property interests, while encouraging collaboration. Most researchers want to receive credit for their contributions and do not want to have their ideas stolen or disclosed prematurely. Thirdly, some of these ethical norms help to ensure that researchers can be held accountable for the public. Federal policies on research misconduct, conflicts of interest, the human subjects’ protections, and animal care are some of the factors that are necessary to make sure that researchers who are funded by public money can be held accountable to the public. Fourthly, public support can also be helped build by ethical norms in research. People are more likely to fund a research project if they can trust the quality and integrity of research. Finally, many of the norms of research promote a variety of other

important moral and social values, such as social responsibility, human rights, animal welfare, compliance with the law, and health and safety.

Here are ten basis ethical principles regarding research:

Research participants must voluntarily consent to research participation, the research aims should contribute to the good of society, research must be based on sound theory and prior animal testing, research must avoid unnecessary physical and mental suffering, no research projects can go forward where serious injury and/or death are potential outcomes, the degree of risk taken with research participants cannot exceed anticipated benefits of results, proper environment and protection for participants is necessary, experiments can be conducted only by scientifically qualified people, human subjects must be allowed to discontinue their participation at any time and the researchers and scientists must be prepared to terminate the experiment if there is cause to believe that continuation will be harmful or result in injury or death. (University of Minnesota Center for Bioetics: 2003).

Ethics is important, not only to ensure our own safety as pharmacist, but also to ensure that the patient’s life goes unharmed whilst treatment. Ethics sets the guidelines between what is right and what is wrong.

References 1. EXPLORABLE.COM. 2008. Ethics in research.

http://explorable.com/ethics-in-research.html#ixzz2B15K7uwV Date of Access: 1 Nov. 2012.

2. NATIONAL ACADEMY OF SCIENCES. 2009. On Being a Scientist: Third Edition. Washington, DC: The national Academies Press. http://www.nap.edu/catalog.php?record_id=12192 Date of Access: 1 Nov. 2012.

3. RESNIK, D.B. 2011. What is Ethics in Research & Why is it Important? http://www.niehs.nih.gov/research/resources/bioethics/whatis/ Date of Access: 1 Nov. 2011.

4. UNIVERSITY OF MINNESOTA CENTER FOR BIOETHICS. 2003. A Guide to Research Ethics. http://www.ahc.umn.edu/img/assets/26104/Research_Ethics.pdf Date of Access: 1 Nov. 2012.





One career, many roads to a brighter future The first decision was made when we were in matric and decided our calling was pharmacy, however the decision making didn’t end there, in a few years time (sooner than later) we will find ourselves deciding on which aspect of pharmacy to follow, will it be a future in community, retail or an industrial pharmacy? There will also be that famous question of whether to stay in South Africa or move abroad, sigh! Decisions decisions, they never end do they? Today I aim to please in guiding you in your decision to a better future...

By Lerisha Maharaj

any think of pharmacists as the person behind the counter when we go to fill a prescription at the

pharmacy, contrary to outdated beliefs, being a pharmacist means endless opportunities, there’s never a dead end or dull moment but many pathways leading from our degree to brighter, better futures.

First up for dissection is retail pharmacy, think Clicks and Dis-Chem. The duties of Retail Pharmacists range from the supplying and sale of medication and related products to the general public. Retail pharmacists when compared to the other categories of pharmacists, have a greater interaction with the public, advising and re-assuring patients as well as prescribing over the counter medications that can be used to treat minor illnesses. These days retail pharmacists are guided by upgraded pc’s with programmes such as “unisolve’’ that record both medication history and personal particulars of a patient, allowing pharmacists to be better equipped in advising on adverse reactions, dosing etc. Most retail pharmacists are locums i.e. they are not permanent and choose when/where to work, negotiating salary as well as hours. This is the option for you if you like challenges and like to meet different people, however the Hours are

generally long and the benefits minimal if you are not permanent staff. The advantage is that Retail Pharmacists are more in demand now than ever before.

Next up is the sector of industrial pharmacy. Pharmacists in this specialty oversee all aspects of drug production for pharmaceutical companies, such as Adcock-ingram, Pfizer, cipla etc. These pharmacists Undertake research, testing and analysis related to the development, production, storage, quality control and distribution of drugs and related supplies. Industrial Pharmacists are generally secluded and do not encounter interactions

with patients as such. So if you’re the reserved / shy or more of the design and research type, then this is the perfect career for you! Industrial pharmacists are

generally very well paid, however this is dependent on experience. This choice entails benefits, as well as flexible hours if need be.

Are you the type of person that loves working in a hospital environment? Doing ward rounds and interacting with patients? Preparing TPN’s and being on call? If you’ve answered yes to any of the above questions, than you would be an excellent Hospital Pharmacist.

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… contrary to outdated beliefs, being a

pharmacist means endless opportunities…


1 $ = R8.73

1 £ = R14.04

Hospital Pharmacists are responsible for compiling and dispensing medication to patients, going on ward rounds and monitoring patients medications, they also prepare TPN’s and cytotoxic preparations if need be. Working in a Hospital Pharmacy encompasses a bit of each of the different aspects of pharmacy, the communicating with patients, preparation and dispensing of medication and even counselling. Being a hospital Pharmacist has many benefits, namely standard working hours, maximum benefits such as medical aid, pension, housing subsidy and guaranteed employment.

Ultimately, the type of path you choose represents your personality. The salary

shouldn’t be the advantage but rather a benefit, because as health care providers we will be taking an oath to safeguard and adequately satisfy the health needs of the people. It may seem as if though going abroad would yield much more income, but think again, why would you want to forsake sunny skies, amazing beaches and awesome people for a few more rand!

Below is a table comparing the different categories as well as the salary range in South Africa, USA and UK, so whip out those calculators and start converting ‘em dollars and pounds to Rand’s, (with the currency’s provided below) yes, you also have some work to do!

Type Advantages Disadvantages RSA Highest salary by city

US Highest salary by city

UK Highest salary by city

Retail The pay and benefits (if permanent staff) are excellent

Long Hours

R207,803 - R472,711

Durban JHB Pretoria

$81,239 - $128,367

Dallas , Texas

£28,637 - £51,832

London

Industrial Flexible hours + Benefits

Lots of paperwork and chemistry procedure involved

R180,991 - R479,198

JHB

$35,000 - $130,998

Dallas , Texas

£14,544 - £50,491

London

Hospital Regular hours + benefits

Being on call Salary is not exceptional

R85,788 - R449,744

Cape Town

$83,643 - $127,032

Houston, Texas

£23,489 - £52,346

London

References: 1. ‘Payscale’ viewed 07 October 2012

http://www.payscale.com/research/ZA/Job=Industrial_Pharmacist/Salary

2. Santiago, A 2011, ‘Types of Pharmacist’s Careers viewed 09 October 2012 http://healthcareers.about.com/b/2011/07/27/types-of-pharmacists-careers.html

3. LeClaire, J, ‘Retail or Hospital Pharmacy?’ viewed 09 October 2012 http://allhealthcare.monster.com/training/articles/132-retail-or-hospital-pharmacy

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The Role of the Pharmacist in the Management of Diabetes Mellitus

Diabetes Mellitus can be defined as a condition where there are insufficient amounts of insulin produced by the pancreas, resulting in increased levels of glucose in the blood. People might argue and say that the pharmacist does not play any role or doesn’t have a position in the management of Diabetes Mellitus - but I beg to differ.

By Esmari van Jaarsveld

iabetes has been named as one of the most potent killers of the South African nation. But the real question

presents itself as how can pharmacists alleviate the insecurity and lack of management of this silent killer? A pharmacist plays an important role in the management, not only of Diabetes, but in everyday illnesses and diseases. Pharmacist are health care professionals that are the most accessible of all the health care professional, which places us in the spotlight - which should drive us as pharmacist to do everything we can to help these patients. The pharmacist is responsible to provide pharmaceutical care, and drug therapy to achieve the maximum outcomes and most importantly to improve the patient’s quality of life. Monitoring, documenting, reporting of patient adherence and the outcomes of the particular drug therapy are only some of the most important things that

fall under pharmaceutical care and the role of the pharmacist.

According to Wubben, on average patients are seven times more likely to see and speak to a pharmacist rather than to their primary health care provider and/or physician.1 The combination of a pharmacist’s knowledge about medication and the increased contact that pharmacists have with patients plays an important role in achieving optimal results in Diabetes treatment and management. Studies have also proven that patient outcomes have improved through education, consultation and the management of drug therapy.2

Pharmacists can even help prevent the development of Diabetes by just giving attention to patients that come into the pharmacy. The identified position of a pharmacist in the health care system, and most importantly, is to identify patients with Diabetes through, for example, screening and

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also by targeting patients with a family history of Diabetes, therefore aiding in the identification of patients whom are at high risk of developing Diabetes.1 Furthermore; patient education plays a very important role and should it be given or made accessible to patients right after a diagnosis is made and then again at a second stage when the patient’s progress is being assessed. Referring to more specialized health care providers and/or medication that specialises in Diabetes is also very important. Lack of knowledge about Diabetes, the symptoms thereof and how to prevent it, are problems that can be overcome by educating and validating patients about their health.

The pharmacist is in the greatest position to identify Diabetes Mellitus, educate the patient about the symptoms, possible treatments, referring the patient to other health care providers and lastly the pharmacist is in the position to monitor the patients progress and to assess the outcomes of the treatment - to identify if the treatment should be altered or adjusted or if the treatment will be successful in the end. The role of the pharmacist is very important, we as pharmacists have the responsibility towards each patient we come in contact with. “Pharmacists are in a unique position to provide the services necessary to optimize treatment, facilitate education, and improve outcomes.”2

Physicians, nurses, dieticians and pharmacists all together form an important multidisciplinary health care team that is necessary in the management of Diabetes Mellitus. The efforts of this team are focused on developing and implementing an individual

management plan, wherein each plan is designed to fit and to promote the health of each individual patient.1 The pharmacist role in this team is very important but also short-termed as the pharmacist will mainly give the medication to the patient, to give instructions regarding the taking of medication and to assess the patient progress in the end. Diabetes education gives knowledge to patients with or who are at risk to developing Diabetes, skills are also promoted so that there can be successful self-management of this disease.

A pharmacist can use his or her expertise and knowledge about medication and drug therapy in the monitoring and management of diabetes, to impact the outcomes more positively. Patient empowerment is also very important during the management of their health and when it comes to the prescription or the medication – therefore education reaches beyond just giving information about Diabetes and how to live with it, but also to educate the patients about the right way to take the prescribed medication to attain optimal results. The most important role is that pharmacists can serve as a resource in addition to other health care providers about medication, drug therapy and Diabetes, to ensure safe, appropriate and most importantly cost effective medication.4

In retrospect the pharmacist can most definitely be seen as more than just a person in a lab-coat or someone behind a counter counting tablets - the pharmacist can be seen as a health care provider that can have a positive result in the treatment and management of Diabetes Mellitus.

References: 1 CAMPBELL, R.K. Role of the pharmacist in diabetes management. Am J Health Syst Pharm. 2002;59 (suppl 9):S18-S21. 2 Michael Bartholow. 2011. Diabetes Management: The Role of the Pharmacist. https://secure.pharmacytimes.com/lessons/200910- 01.asp Date of Access: 30 Oct. 2012. 3 WUBBEN, D.P., VIVIAN E.M. Effects of pharmacist outpatient interventions of adults with diabetes mellitus: a systematic review. Pharmacotherapy. 2008;28(4):421-436. 4 SMITH, M. 2009. Pharmacissts’ Role in Improving Diabetes Medication Management. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769842/ Date of access: 30 Oct. 2012.


BREAST CANCER SURVIVORS Breast cancer Is a type of cancer originating from the inner lining of milk ducts or the lobules that supply the ducts with milk. There are two main types of breast cancer, the ductal carcinoma which originates from ducts and the lobular carcinoma which originates from lobules. Women are often

warned about Breast Cancer and are advised to regularly do self check ups regularly, but is enough emphasis being placed on the survivors?

By Lebogang Nchabeleng

LILLIAN DUBE

he is known for her appearance on our television screens, in films and theatres. You might remember her from Cry the Beloved Country, Sweet & Short, Shucks! I’m Gatvol, Zulu on my Stoep

and African skies. Lillian Dube is just like any other women in the world - she is one of the breast cancer survivors. Lillian is part of the new Cancervive campaign that educates and creates awareness about the shy-cancers. She is also a member of Bosom Buddies, which is another Breast Health Foundation in Lesotho.

Background information about Lillian Dube Lillian Dube was diagnosed with breast cancer in December 2007 during her routine check up, whereafter she had a successful surgical procedure where the cancerous growth was removed from her breast on the 11th January 2008.

Treatment The surgery involved the removal of the tumour and breast reconstruction, which was then followed by chemotherapy treatment every three days for four months and radiotherapy for 30 days this helps to make sure that remaining microscopic cancer are totally destroyed.

Advice Although not all cancers can be prevented, healthy lifestyle choices and early detection in lowering the risk. And truth is early detection of cancer can be treatment. Most cancer survivors have regular check-ups (mammogram).

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GIULIANA RANCIC

She is a 37 year old international celebrity who like any other girl’s dream got married to Bill Rancic. In any marriage the first thing that comes to mind after knowing each other is to be parents. When Giuliana found out that she had failed to fall pregnant it was the most devastating time of her life. While dealing with and accepting the fact that she had failed to become pregnant, she found out that she had cancer. When Giuliana found out she had cancer she was on IVF treatment trying to fall pregnant. Apparently Giuliana had been trying to have a baby for four years. The couple decided on having a gestation mother whereby Giuliana’s egg and Bill’s sperm where placed inside the gestation mother where the baby would grow. Treatment Giuliana went through a lumpectomy followed by radiation before undergoing a double mastectomy. I will briefly elaborate on the treatment options for breast cancer:

1. Lumpectomy which is a form of breast surgery and apparently a good option for patients who have a tumor that is less than five centimetres in diameter. Radiation then follows which helps if the patient is reasonably fit and healthy.

2. Chemotherapy, whereby drugs are used to either directly kill the cells or by preventing the cells from dividing.

3. Hormone therapy which removes the hormones and stops cancer cells from growing and often given with Tamoxifen (a risk lowering drug prescribed to women diagnosed with cancer).

4. Mastectomy - total also known as simple mastectomy which involves the removal of the entire breast that has cancer, another is modified radical mastectomy where some part of the breast that has cancer is removed, some lymph nodes, the lining over the chest muscle and sometimes part of the chest wall muscles as well.

Despite of all the bad news of not falling pregnant and diagnosed with breast cancer Giuliana and Bill welcomed their son Edward Duke Rancic on the 29th of August 2012.


“Patient Consultation?”

Can’t I download an App for that?”

If you have a smart phone, raise your hand. If not, raise your standards! Of course I am only joking, but the truth is that many of us plead guilty on offence of being in an intimate relationship with our mobile phones, tablets or similar electronic devices.

By Cindy Hayward

Interestingly…

In 2011, Africa became the world’s second most connected region after Asia, with 616 million mobile subscribers. This number is projected to rise to almost 1 billion mobile connections by 2016 at a compounded annual growth rate of more than 30%.1 About 4.59-million (10.5 % of all South Africans) have internet access – a lot of them aged between 18 and 29. Up to 11% of the total population (around 5.3 million people) use personal computers, where the online market comprises mostly of social networking usage, as well as informative browsing, according to web information company, Alexa, which ranks Google.co.za as the top site, followed by Facebook. News24 is South Africa’s top web brand, followed by MSN. South African blogs total around 26 000 and is read by more than 600 000 people.

Continent Percentage of mobile traffic as a share of internet traffic Africa 14.85% Asia 17.84% Europe 5.13% Latin America 2.86% North America 7.96% Oceanic Region 7.55% World-wide 10.01% Source: Pingdom, 2012

Mobile Consumption driving Social Media “The high and growing amount of traffic generated from mobile phones in Africa highlights an important trend going forward: namely, that throughout Africa there is a vast interest and uptake in social media platforms.”2 For example, 44.9 million people on the African continent use the world’s largest social network, Facebook. 80% of logins in South Africa are from mobile devices.

We all know that “Knowledge is Power,” but we tend to forget that “Ignorance is Bliss…” “Technodiction” is surrounding us and evidence points to drivers typing away on the steering wheel. Or those walking with heads bowed down over an ever-so-important Instant Messaging conversation. Party Invitations state that you bring your own drinks AND chargers…

In the case of a fire, some tweet about the event before evacuating the building! Google is being used more than ever and applications are available to calculate anything from ovulation dates to calorie consumption. People are getting more connected with each other via networking, and less dependent of professionals through services offered by their electronic devices. The easiest way to become terminally ill is type your symptoms into a search engine online.

As a pharmacist, you may feel that all social and technological business should be handled by the IT Department. You are wrong. A mobile revolution has opened the floodgates of technology, and if pharmacists don’t stay updated and surf the waves of new software, social media platforms and technological developments, we may soon be replaced by an application.


References 1Deloitte Rise and Rise - Newsweek, “How Africa is Becoming the New Asia” Feb 18, 2010 2http://www.semantica.co.za/online-marketing/social-media-marketing/south-africa-social-media-landscape-2012/v 3World Health Organisation, The World Health Report 2006 – Working together for Health. www./who.int/whr/2006/en/ 4United Nations Department of Economic and Social Affairs, Division for Public Administration and Development Management, Compendium ICT Applications on Electronic Government – Volume 1. Mobile Applications on Health and Learning. http://unpan1.un.org/intradoc/groups/public/documents/un/unpan030003.pdf.2007 5Vital Wave Consulting. mHealth for Development: The Opportunity of Mobile Technology for Healthcare in the Developing World. Washington, D.C. and Berkshire, UK: UN Foundation-Vodafone Foundation Partnership. www.vitalwaveconsulting.com/pdf/mHealth.pdf.2009. 6http://www.mediaclubsouthafrica.com/index.php?option=com_content&view=article&id=101:south-africa-online&catid=36:media_bg

MOBILE HEALTH You get the notifications regularly – “An updated version of your application is now available,” prompting you towards a download page where you will see hundreds of other applications for your mobile phone. Medical Health applications, or now referred to as “Apps” can diagnose illness, describe drug pharmacology, pharmacokinetics, side effects, cautions etc. with the click of a button, or should I say, by flick of your stylis pen? Useful applications, like these, are becoming more and more popular amongst both doctors and patients. You need to distinguish yourself from the application as patients tend to want to “replace” their pharmacists with the latest Rx App, as a pharmacist is more prone to forget the mentioning of useful information by assumption. But these Apps aren’t all evil, as pharmacists can benefit from using ones like Medscape, RxDrugs etc. for quick reference and regular updates.

POCKET EDUCATOR Applications come in all shapes and sizes. I have seen ones to calculate your ovulation dates, BMI and even the time you take to fall asleep. How accurate they are, I can unfortunately not tell you. Consumers tend to be more interested in Health Apps and may even look for applications to help them manage chronic illness. A simple example would be the previously mentioned “Cooking from the Heart” initiative. Healthy recipes can easily be accessed from your mobile phone. As seen from statistics, it is obvious that South Africans are quite active on their mobile

Imagine making an App available to South Africans, calculating their alcohol intake, processing graphs to view blood glucose, heart rate or weight in order to calculate and identify risk factors or behaviour. Apps could inform patients whether their medicines are in stock at the pharmacy or even remind them to take their ARV’s or TB medicine. According to the World Health Organisation (WHO), a serious shortage of health care workers threatens overall health in especially the developing world.3 Yet, 64% of mobile phone users are found in developing countries, showing that, by the end of 2012, half of all individuals living in remote areas will own a mobile phone.4 This equates to mobile communication offering an effective means of making healthcare service more accessible to patients in developing countries.5

IRREPLACABLE Although Apps have infinite potential and possibilities, they can never replace actual health care personel. Using this form of education and awareness should merely encourage patients to take control of their health issues, schedule regular visits to professionals and monitor their own progress. By distinguishing yourself from an electronic device by means of patient care, effective communication and building a trusting relationship with the patient, I firmly believe that there doesn’t have to be a “War against the Machines.”


Conventional Medicine v.s. Alternative Medicine A normal day at the pharmacy will definitely involve at least one confused but very determined patient insisting that you supply them with a new product seen on television promising to solve all of this patient’s problems…

By Janke Kleynhans

lternative medicine is defined as any practice deemed as effective as conventional therapy but is not scientifically proved.1 This includes the categories homeopathy, herbal and dietary supplements, acupuncture and treatments performed by therapists not authorized by

healthcare professionals. In the definition of alternative medicines lies this problem - no scientific evidence is collected to show adverse effects or lack of effect, nor does it rule out the possibility thereof. Conventional medicine is mistrusted because of the myriad of side-effects plain to see on every package insert, but every possible negative aspect has been established and can therefore be monitored. Natural products on the other hand have no side-effects proven and therefore the patient is more trusting.

I was privileged to have the opportunity to attend a very informative presentation by Prof. Roy Jobson (Rhodes University) at the annual APSSA conference. The presentation covered the distortion of pharmacology used by unregistered complementary medicine companies during their advertising campaigns. He gave many examples where products have been tested and has shown to have none of the mentioned active ingredients, or no conclusive evidence for efficacy and even no effect what so ever. There were even outrageous claims by some products to “reverse the course of AIDS”. Prof. Roy Jobson is an activist for the strict regulation of alternative medicine advertising to protect the public.2

The Scientific community is avidly asking regulators to change legislation so that medicine should be classified solely on valid scientific evidence and that public awareness should be increased on which products are effective.3 Dangers of alternative therapies are interactions with conventional medicine,

unknown side-effects and treatment delay (due to ineffective alternative medicine).It is therefore my opinion that if a company would like to market a product as medicine, it must take the responsibility to get it properly scientifically tested and registered. I am convinced that some natural remedies indeed does have power (opium and digoxin are but two examples of dangerous but powerful remedies that are registered), but science must prevail in the end. As a pharmacist it is your responsibility to make sure that any natural product that you sell is scientifically at least viable and that no side-effects are known. Educate patients about the danger of substitution of conventional medicine with unproven alternative therapy. In the end there are only two categories of medicine, those that are proven and those that are not. For those who would like further reading on this topic feel free to visit “What’s the harm?”

A


Are we ignoring the benefits that medicinal plants have to offer?

By Janke Kleynhans

Okay, so you have just read the article where I was ranting on about the danger of alternative medicines and now I want to convince you that medicinal plants are an option? Yes, I really do think medicinal plants have been overlooked by the scientific community as potential treatments. Just think of all the life saving products that were isolated out of medicinal plants. Examples are Artemisia Annua known as artemisin for malaria, Papaver Somniferum that yields morphine as painkiller, Digoxin (a cardiac glycoside) extracted from Digitalis Lanata and salicylic acid that was first isolated from the willow tree.

The main idea here is to screen medicinal plants for possible candidates to employ in their purified form with scientific evidence to substantiate their activity. Indeed many universities across South-Africa is doing just that. South Africa itself has a large collection of indigenous plants that offer interesting possibilities for further research. Research must in the end prevail and separate fact from fiction and it is our responsibility as pharmacists to monitor new research about plant medicine so that we can give accurate information to our clients.

Traditional Conventional Medicine v.s. Complimentary Alternative Medicine

By Lesedi Manyanye

Traditional, conventional medicine refers to the medicine, therapy or treatment that is delivered by practitioners of medicine like M.D’s, nurses, pharmacists, physiotherapists and their allied partners.

raditional conventional medicine is often seen as a therapy plan that aims to treat the symptoms of a particular medical condition,

disease or ailment. This form of therapy is very beneficial in treating acute and chronic conditions like infections caused by microorganisms, that can only be cleared or effectively treated by drugs aimed to inhibit or kill the growth of such microorganisms. Infections like HIV and the progression of the infection to AIDS has shown susceptibility only to ART and any other form of treatment has failed dismally at trying to cure the infection resulting in multitudes of deaths of patients who could have otherwise been saved by ART. Cancer is one of the diseases that can only be handled with traditional conventional treatment plans that include chemotherapy, radiation and sometimes surgery. Many other chronic conditions are a result of organ or system function failure that cannot be reversed or altered. For such conditions conventional medicine remains the cornerstone of treatment as the condition can only be treated by restoring the functions of the implicated organ or system.

The downside of conventional medicine is that treatment can be very expensive especially if it includes surgery or is long term, the adverse effects of drugs as well as drug-drug interactions may also interfere with treatment compliance and therefore reduce adherence. If reduced adherence to conventional therapy is noted the caregivers may consider introducing a holistic approach to treating

T


the condition by suggesting integrative medicine (holistic medicine). The American Holistic Health Association defines holistic medicine as the art and science of healing that addresses care of the whole person-body mind and spirit. The philosophy of holistic medicine integrates allopathic osteopathic, naturopathic, energy and ethno medicine as well as complementary therapies. Health promotion is advocated as a tool to create optimal health for the patient by prioritising lifestyle changes to ensure that the patient takes responsibility for their health, this approach requires that the patient be informed about the impact and benefit of physical activity and prudent dietary practices; smoking avoidance or cessation and the mitigation of stress.

Integrative medicine thus offers, in theory at least, the opportunity to combine the “best” of both conventional medicine and complimentary alternative medicine (CAM), and thereby produce better patient outcomes measured in terms of symptom relief, functional status, patient satisfaction, and perhaps cost-effectiveness and that chronic illness can be prevented where possible. Enlightened practice of integrative medicine should only be on the basis of both clinical and financial grounds. Complimentary Alternative Medicine is defined as any form of treatment that does not use traditional conventional medicines, that includes but is not limited to the use of herbal remedies, dietary supplements, probiotics, mind and body practices-using the mind to achieve optimal physical functioning

i.e. yoga-postures, breathing, meditation and relaxation, acupuncture, hypnotherapy, progressive relaxation and tai chi. Other forms of alternative medicine that are practiced include manipulative and body based practices- structures and systems of the body, bones and joints and lymphatic systems. Alternative medicines aim to assist the body to heal itself by asserting that unconditional love is a powerful healer and that perceived loss of life is the greatest health risk. The World Health Organization recognizes traditional medicine as a vital health-care resource in developing countries and has encouraged governments to adopt policies to officially acknowledge and regulate the practice of traditional medicine.

Problems with alternative medicine

Many advocates of conventional medicine will argue that traditional medicine is fraught with problems which put their patients’ health and lives at risk. Lack of standardization often seen with herbal medicines and supplements has been detrimental to the handling of diseases like HIV/AIDS and other communicable diseases by promising people a dosage form that treats all diseases. Unclear dosage regimens lead to inaccurate doses being administered either by the practitioner or patients themselves resulting in very toxic doses being given. Lax licensing and lack of regulation makes it difficult to track the fatalities that result treatment with these medicaments. Not enough information is available with regard to adverse effects and contraindications of these medications and that is a problem as most patients taking such remedies may also be taking conventional medicines and the level of literacy of the patients may be significantly low. Patients taking traditional herbal medicines may delay to seek professional care when the side effects of the medication present or when the disease progresses because they may think that the medication is working or may not feel comfortable disclosing that they have been to a traditional healer or taken anything.


Even though CAM in the South African health care system is known to be widely popular among the public (about 70% of the population) and recognised by the constitution, resistance to the proliferation of CAM among conventionally trained practitioners persists and medical aid schemes still do not cover the visits to traditional healers and traditional remedies (a law is being tabled to enable traditional healers to register and claim from medical aid schemes)(www.aidsbuzz.org). These tensions and incompatibilities constitute a challenge and a threat to patient centred, holistic approaches to care, and to the goals and objectives of preventive medicine.

Patient empowerment coupled with evidence based benefits of integrative medicine call for a greater consideration of the approaches indicating how well CAM and conventional medicine must coexist. Integrative medicine broadens the array of treatment options available to fulfil the objectives of preventive medicine and increasing emphasis on prevention as a cornerstone of health policy merely adds to the urgency and promise of reconciling these trends, and to the costs of failure to do so. To achieve integrative care the boundaries between conventional care and CAM should be the removed and both disciplines be subjected to rigorous scientific inquiry so that interventions that work are systematically distinguished from those that do not (Vickers, 2001). Safety should not be assumed in either case but should similarly be derived from rigorous evaluation of the practices.

References 1. Angell, M., and J. P. Kassirer. 1998. Alternative medicine--the risks of untested and unregulated remedies. N Engl J Med 339 (12):839-41. 2. Vickers, A. J. 2001. Message to complementary and alternative medicine: Evidence is a better friend than power. BMC Complement Altern Med 1:1. 3. http:// www.aidsbuzz.org./index .php. (accessed on the 27th November 2012.)

Vitamins? I skipped that part in my preparation for oral examinations…

We all know that nutritious meals, exercise and enough sleep keeps us quite healthy, but when the body experiences certain states of stress, like illness, late nights or pregnancy, taking supplements may benefit your health.

By Cindy Hayward

It makes sense to take Calcium and Magnesium in the evening to prevent inhibition of multivitamin absorption. You know that B-complex and vitamin C are water-soluble vitamins, so taking them in divided doses where deficiency occurs, would be logic. Of course it would be safer to take vitamins and minerals in a multivitamin/multimineral complex as they work better together. Iron overload can have similar effects to a deficiency. Anaemic patients should be advised to take their iron together with vitamin C as it increases absorption.1 But did you tell your patient this?

Always A

Retinol, or Vitamin A, is known for its important role in eye care and eye sight. It also helps the base layer of skin cells to keep the mucous membranes healthy

http://www.aidsbuzz.org./index%20.php.%20(accessed%20on�


and is also an antioxidant, which protects the cell membranes and tissue linigs from irritation from free radicals. Sources: Liver, sweet potatoes, spinach and Beta-carotene-rich foods, such as carrots, apricots and butternut. Excess: Think retinoid drugs. Dry eyes, scaling and peeling off of the skin, you may suffer from hair loss as well. Shortage: Visual disturbances like visual impairment, leading to blindness and night blindness. RDA: 900 mcg males >14 years 700 mcg females > 14 years

Interesting: During pregnancy, vitamin A intake exceeding 3 000 mcg/day should be avoided. Rather recommend Beta-carotene supplement. Absorption of this fat soluble vitamin is reduced by alcohol, vitamin E deficiency, cortisone medication and excessive iron intake.1

B is Better

Since there are a lot of B vitamins and this article is not aimed at replacing your pharmacology lesson, we will only cover the interesting topics. Vitamin B can be sub divided into B1, B2, B3, B5, B6 and B12, all of which are found in the same foods. Since they aren’t found in isolation and have similar functions, they need each other to function optimally. The B-complex is water soluble, and thus not stored well in the body.

B1 Thiamine is needed for energy release from glucose and transforms carbohydrates into fat. It supports neurological processes as well. An excess may cause irregular heartbeats, convulsionas and muscular weakness, while a deficiency may present with fatigue and confusion. Thiamine needs increase with pregnancy, high stress levels, during and after surgery.2

B2 Riboflavin is important in the metabolism of protein, fats and carbohydrates. It also assists in the maintenance of mucous membranes, the formation of red blood cells and production of antibodies. Too much Vitamin B may colour your urine bright yellow, while a deficiency presents with chapped lips and a

purplish tongue. Stress and excessive exercising can deplete Riboflavin stores.

B3

Niacin or Nicotinic Acid is needed for cell respiration and aids energy release. It is an important component of sex hormone production. Too much may cause skin flushing and itching, while a deficiency presents with skin irritations, loss of apetite, nausea and fatigue. Pellagra is the common deficiency disease. People suffering from peptic ulcers, liver disease or diabetes, should be careful of niacin supplementation.3

B5

Pantothenic Acid, or “Anti-stress vitamin” is used in relief of stress and fatigue as it supports the adrenal gland.4 Too much may cause diarrhoea, while getting too little may cause depression, fatigue, tingling in the hands and “burning feet”. When exposed to acids like vinegar, or alkali such as baking soda, Vitamin B5 can become lost in cooking.6

B6

When I hear pyridoxine, I think “Isoniazid” or “Peripheral Neuropathy.” Vitamin B6 is especially important for women, as it balances hormonal changes, assists the immune system in the growth of new cells and helps control your mood.

B12

“Energy vitamin,” or Cobalamin, is needed in the manufacture and maintenance of red blood cells; it stimulates appetite, promotes growth and releases energy. No toxic effectes from overdoses have been reported, but a deficiency may cause peripheral numbness, muscle weakness, memory loss or anaemia. Vegans should take Vitamin B12 supplementation.7


C is for Citrus

Ascorbic acid, known for its scourge of scurvy, is a water soluble, antioxidant vitamin that helps fight infection. It is important in the formation and maintenance of collagen – needed to support and shape the body. Vitamin C is what helps you heal when you get cut. You also need vitamin C to help with the absorption of iron from food.

Sources Citrus fruits like oranges, grapefruit and lemon, tomatoes, peppers, kiwi fruit, strawberries.

Excess: Gastrointestinal disturbance.

Shortage: Bleeding gums, poor healing of bruises and wounds, skin lesions, rheumatic pain in legs.

RDA: 45 milligrams per day 300 milligrams per week.8

Interesting When having taken excessive amounts of alcohol, normal amounts of anti-inflammatory drugs, corticosteroids, oral contraceptives, HRT, medication for hypertension or pain killers, you may need more vitamin C. Smokers require twice the amount of vitamin C.9

D is for D-termination

Calciferol is crucial for strong bones. Fat-soluble vitamin D assists in Calcium absorption and is necessary for strong bones and teeth. Even adequate Calcium intake may prove useless in a state of vitamin D deficiency. Sunlight activates inactive vitamin D in our bodies, but it can also be found in food sources.

Sources Oily fish, milk, chicken liver

Excess: Constipation, appetite loss and nausea.

Shortage: Children: Rickets. Adults: Loss of bone density resulting in an increased risk for osteoporosis.

RDA:

E is for Excellent

Basicly, vitamin E’s function is to modify and stabilise blood fats ao that the blood vessels, heart and entire body are better protected from free radical-induced-injury.

Sources Whole grains, leafy greens, avocado, sardines and nuts.

Excess: Impaired liver storage, impaired bone mineralisation. Shortage: Increased risk for neuromuscular or vascular damage.

K is for Koagulationsvitamin (German origin)

We all know that this fat soluble vitamin is responsible for blood clotting and is often used in toxicity of anti-coaggulants such as Warfarin.

Sources Broccoli, meat, eggs, dairy products.

Excess: Can cause haemolytic anaemia. Shortage: Increased bruising and poor blood clotting.

Resources:

1,2Every Vitamin Page All Vitamins and Pseudo-Vitamins. Compiled by David Bennett. 3The Merck Manual: Nutritional Disorders: Vitamin Introduction Please select specific vitamins from the list at the top of the page. 4,5,6,7 Shape’s A-Z guid to vitamins & minerals. Weider Publications.2011. 8 "Vitamin and mineral requirements in human nutrition, 2nd edition" (PDF). World Health Organization. 2004. Retrieved 2007-02-20.

http://www.lifeinyouryears.net/everyvitamin.pdf�

http://www.merck.com/mmhe/sec12/ch154/ch154a.html�

http://www.merck.com/mmhe/sec12/ch154/ch154a.html�

http://whqlibdoc.who.int/publications/2004/9241546123_chap7.pdf�

http://whqlibdoc.who.int/publications/2004/9241546123_chap7.pdf�


Boererate:

Feit of

fiksie? Hetsy jy naeltjie-olie vir

tandpyn aanwend of

koljander sade kou vir

goeie spysvertering, elke skeet en pyn het ‘n

boereraat om op die proef

te stel wat dateer uit

oertye uit. Alhoewel honderde boererate

bestaan is die uiteindelik

vraag, hoe effektief en

veilig is boererate?

Deur Vernice Steenkamp

In die verlede was goeie

dokters, aptekers en

geneesmiddels so skaars

soos hoendertande. Die

afwesigheid van mediese

kennis het mense

magteloos gelaat teen

siekte, pyn en lyding.

Gemeenskappe moes dus

self met moontlike genesing

vir verskeie simptome

vorendag kom.

Kultuurgedrewe kennis en -

lewenswyses het oorsprong

gegee aan

volksgeneeskuns.1

Volksgeneeskuns hou nou

verband met boererate wat

steeds vandag bekend is

omdat die meeste boererate

ontstaan het uit verskillende

volke se geneeskuns wat

toegepas en as effektief

beskou is. Hedendaagse

kenners beskou sommige

volksgeneeskuns as

ondeurdenk en ‘n gevaar vir

die mensdom. Voorbeelde

sluit in die aanwending van

emetikums teen appendisitis

om “van alle kwaad ontslae

te raak.” Verwys ook na

sommige landelike gebiede

waar dieremis op babas se

naelstringe geplaas word,

infeksie ontstaan en dikwels

onomkeerbare nagevolge

het.1 Volksgeneeshere is

deur die eeue heen getrou

gevolg; al wat verander het

is die gehoor, die produkte

en die media, terwyl die

basiese idee steeds

onveranderd bly.2

Boererate bestaan nie net

uit die gebruik van

natuurlike kruieplant nie -

bygelowe speel ook ‘n

noemenswaardige rol.

Magiese aspekte kom voor

in verskeie boererate soos

om “vratte te blaas na die

volmaan.”1 Dierlike en

magiese aspekte van

boererate het oor die jare

heen trefkrag verloor omdat

dit as vuil en gevaarlik

beskou word vanuit ‘n

farmakologiese oogpunt,

terwyl die gebruik van

kruieplante teen sekere

siektes, verder nagevors

word om te dien as

simptoomverligting vir

pasiënte.1

Omdat boererate in

hedendaagse tye

hoofsaaklik bestaan uit

natuurlike middels, word dit

dikwels as onskadelik

beskou. Wat die mensdom

nie besef nie is dat ons

voorouers alle middels op

die proef moes stel en baie

fatale nagevolge moes

deurstaan voordat

effektiewe geneesmiddels

gevind is. Mense verloor

steeds hul lewens aan

natuurlike geneesmiddels

wat in foutiewe dosis

aangewend word of

verkeerd geïdentifiseer

word.2 Alhoewel talle gevare

skuil in die gebruik van

natuurlike boererate, bly dit

gewild as

genesingsvoorkeur in die

hoop op volkome genesing.

Wetenskaplike navorsing in

natuurlike middels het

drasties toegeneem oor die

jare en tradisionele

medisyne is al hoe meer in

aanvraag. Hierdie toename

in gewildheid dwing ook

apteke om meer


belangstelling in natuurlike

middels te toon en dit meer

beskikbaar te stel vir die

publiek.2

Verskeie kruieplante wat in

die verlede aangewend is vir

sekere kwale is

wetenskaplik getoets met

drastiese resultate. Die

perikarp van graan word

dikwels ingeneem om

bloedcholesterol vlakke te

verlaag en om kolonkanker

te voorkom. Wetenskaplike

navorsers debateer steeds

oor die kanker

voorkomende- en

cholesterolverlagende

eienskappe, terwyl die

navorsing getuig dat die

inname van groot

hoeveelhede van dié produk

mineraalabsorpsie kan

verlaag, wat uiteindelik tot

intestinale blokkering kan

lei. Lesitien word beskou as

aanvulling wat vetneerslae

in bloedvate verminder en ‘n

positiewe uitwerking toon by

mense wat ly aan artritis,

droë vel en geheueverlies.

Wetenskaplike navorsing

kon geen bewyse vind

hiervan nie, inteendeel, kan

groot hoeveelhede lesitien

speekselafskeiding

vermeerder, anoreksia

nervosa veroorsaak en

glukemiese indeksvlakke

oplewer wat afwyk van die

normale.3

Baie boererate is steeds nie

wetenskaplik getoets nie en

kan dus nie as veilig en

effektief bestempel word

nie. Die gebruik daarvan is

opsioneel, alhoewel beter

resultate bereik word met

konvensionele, nagevorsde

geneesmiddels. Dit is dus

raadsaam om deeglik

nagevorsde middels te

gebruik eerder as

tradisionele middels

waarvan die effektiwiteit en

veiligheid nooit vasgestel is

nie.

Bronnelys 1. Van der Walt, E. 2011.

Koers 76 (2).

Volksgeneeskuns in

Suid-Afrika. Pretoria:

Protea Boekhuis. P397-

407. 2. Frost, J. 2008. Is

“natural” good for you?

Myths, perceptions and

science in advertising,

marketing and the

media. 76 p. 3. Der Marderosian, Ara H.

& Liberti, Lawrence E.

1988. Natural Product

Medicine: A Scientific

Guide to Foods, Drugs,

Cosmetics.Philadelphia,

Pa.: George F. Stickley

Company. P.116-123.


Resolution 53: An APharmation of the Future of Health Care in South Africa

By Abednigo B. Nkosi

The power of any society is deep within the furrows of its policies and the diversely collective intellectual capacity. Health is perhaps one of the pivotal rights at the apex of humanity, and a health system upholds that right in erecting dignified and socio-economical accessible institutions. South Africa is at the global centre of gradually rolling out the biggest blanket for health insurance to its people – the National Health Insurance (NHI) scheme. The NHI is a true affirmation of a future for health care in South Africa, and it is this very future we have to explore. What is the NHI? What does the NHI mean to the people of this country? And more importantly within the perspective of pharmacy, what fundamental part, if any, does pharmacy play in NHI and the future of health care in South Africa?

In the words Dr Margaret Chan; “Fairness, I believe, is at the heart of our ambitions in global health. We see this in your support for global health initiatives and funding mechanisms that redistribute some of the world’s riches towards health needs of the poor. A health system is a social institution. It does not just deliver pills and babies the way a post office delivers letters. Properly managed and financed, a health system that strives for universal coverage contributes to social cohesion and stability. I further believe that a failure to make fairness an explicit objective, in policies, in the systems that govern the way nations and their populations interact is one reason why the world is in such a great big mess”. A statement that was made three years ago, but is today, one key statement

that resonates with the common South African as to what the NHI is, its aims, and perceived implications for the country. To the converted, the NHI is a scheme that will ensure that each South African has access to suitable, efficient, affordable and quality health care services despite ones socio-economic status.1 This is a radical transformation and conceivably a paradigm shift in terms of health in the country.

In its pilot phase, many questions have risen, both from critics and champions of the policy about key elements of the policy. Where will the money come from? With the shortage in human resources, where will the work force come from? And what is their role in this re-engineering of primary health care? KPMG calculated that the rollout of the NHI will cost an average of R10.4 billion annually, over what is currently spent on public healthcare.2 But it is the human resource requirements that one needs to dwell upon to see the pragmatic of the NHI’s future. The backbone of every health system is its health workers, and the country’s health system has been hindered by inadequate numbers and discriminatory distribution of health worker.3 To bring it home, and make more practical, it is the key role that pharmacy will play in seeing the success of the NHI.

As it stands there are 2.33 pharmacist per 10 000 population (NDOH, 2011), a ratio that speaks to the availability, skills and motivation to fellow health workers (Lloyd, 2010). NHI focuses on a preventative approach to health care, preventative health which can be achieved


through rational drug use, patient education, and compliance management4, all of which are specialty tools of pharmacists. In countries where NHI-type of schemes have been established, pharmacists have maintained their identity when contributing to the innovative self-sustenance of NHI-like schemes. A perfect example would be the United Kingdom, where pharmacist pioneered the shift from paper prescriptions to electron prescriptions, a move that was well embraced by doctors and nurses, and a key historically collaborative endeavor that the UK health system has seen. If we are to contribute to the success of the NHI, we need to act as a collective, with a firm and distinct identity in shaping the NHI, because if we fail in that, the question from the public will be; where were pharmacists when this was decided for us?

Thus, we need to affirm ourselves in contributing to the success and firm

establishment of the NHI through being part of collaborative health teams, task-shifting and embracing the idea of cross-over collaborative scopes of practice. It was DG of Health Malebona Matsoso that once said, “We need to be bold and affirmative and provide solutions with an emphasis on strengthening human resources (to meet service demand) for the immediate future, and medium term. The NHI will demand strong human resource capacity for the health sector”. Subsequently, the country’s financial ministry has its share to worry about the financial structure of the NHI, buts it is us who need to immerse ourselves in a culture of advocating for pharmacy as a profession with a unique identity and contribution towards the future of health care in South Africa. The question we ought to ask ourselves moving forward is, if not us – who?

References 1 NATIONAL HEALTH INSURANCE IN SOUTH AFRICA - POLICY PAPER (2011) 2 KPMG NHI Report, Sven Byl (2011) – Funding NHI: A spoonful of sugar? – An Economic analysis of the NHI 3 Lloyd .B, Sanders. D, and Lehmann, U (2010) - Human resource requirements for National Health Insurance. School of Public Health, University of the Western Cape; People’s Health Movement Steering Council 4 Tlala TM. SAPC. (2009). Providing affordable healthcare in an NHI environment – Pharmacy Perspective - Health in SA a new dimension..


Absolutely APEX

The APEX product range made its debut on the broader commercial scene about 5 years ago, after only exclusively being available to the top drug tested athletes in South Africa and abroad, for 10 years, through direct consultation with the brains behind the operation, Prof Du Toit Loots. APEX has an extensive product range, with products to build lean body mass, increased athletic performance, lose excess winter w eight, or general health maintenance. Considering this, APEX has the perfect product to fulfil all of your sporting needs. APEX is also considered an affordable premium supplement, and contains no harmful or banned substances. It was founded and formulated by Prof. Du Toit Loots, who has a Ph.D. in Metabolic

Biochemistry and has written over 50 publications on the topic. He is also an expert on sport consultation and practice. By Amoré Orr

The Apex Nutrition and Supplementation range includes:

• "LipoBurn X-treme" (for men) and "Thermolean" (for women) can be used to aid fat burning, lower the appetite and increase metabolic processes and energy levels.

• "Endurox" is a general stimulant free energiser, also increasing memory and concentration, and additionally aid in fat loss.

• "Nutrilean" is a meal replacement shake, aiding weight loss, and lowers cravings.

• "Hyper X-cell" is a very advanced energiser dramatically increasing energy and endurance, and is safe for use by adults and children.

• "NitroxHGH" contains naturally occurring amino acids, known to optimise natural growth hormone secretion, and increases lean muscle mass, and performance, though elevated oxygen uptake by the muscles.

• "Nitrox Creatine CRT" stimulates natural creatine synthesis, oxygen uptake by the muscle and growth hormone levels, increasing strength, performance, lean muscle mass.

• "Testovone" contains ingredients shown to increased natural testosterone synthesis, and additionally helps to protect the prostate, by preventing the synthesis of harmful testosterone metabolites. It also increases overall metabolic rate and libido.

• "Nitro Whey" is a high protein, low carbohydtrate supplement, used to build lean muscle mass and promote fat loss. It also increases post training recovery and general immunity.

Omega 3 is an essential fatty acid, required by most individuals consuming a westernised diet, which is already rich in Omega 6 and 9, but poor in omega 3.


Q and A with Prof Loots

Q: What time do you usually get up in the morning? I usually get up at 6 am when my 2 year old daughter Gemma ,wakes up the household with "Pappa!...........Mamma! .......Wake up!"

Q: What do you eat for breakfast? At this point I should say that breakfast is the most important meal of the day, and that a good breakfast consists of two poached eggs, yoghurt, fruits, a slice of toast, tomatoes and fresh orange juice. However, due to time constraints, I merely eat two muesli rusks, a cup of coffee and half an Apex Nitro Whey protein shake. I however make up for this at 10h00, with a portion of fat free meat and a portion of cooked vegetables, prepared the evening before, with another Apex Whey shake.

Q: What do you enjoy doing in your free time? Prof Loots really enjoys gym during the week, Enduro motorbike riding on weekends, and surfing at J-Bay when he is on vacation. He enjoys various TV sitcoms and action movies.

Q: What did you want to be when you grow-up? I wanted to become a fireman (when he was 5 of course), but things worked out quite differently...

Q: What was the inspiration behind Apex? A: I had a keen interest in sport, and being a Professor in human metabolism (PhD), I knew of the benefits of sports supplementation, when used in combination to a healthy eating and exercise plan, and the edge it could give in sport, if taken correctly. Unfortunately, at the time, very few, if any supplements commercially available, had what I was looking for, and were generally lacking regarding: synergistic ingredient combinations, dosage volumes, many of ingredients used having insufficient clinical data for efficacy and safety and the risk for causing positive drug tests. I subsequently started making my own formulations, based on clinical evidence, and after winning the Mr Drug Free Universe title in Los Angeles in 2002, and supplying these mixtures to a number of my

friends, realized that the need for such a product range exists in the broader commercial environment, and Apex Nutrition and Supplementation was born.

Q: What makes Apex supplements unique? A: What distinguishes Apex from other products, is that we use only ingredients with sufficient clinical evidence for safety and efficacy, and abide by the world anti-doping regulations. These are combined in such a manner to act synergistically, considering their modes of action. Additionally, we have a number of manufacturing practices in place for preventing cross contamination of our products, and for these reasons, in the 10 years we have been involved in world class top drug tested athletes from a variety of sporting disciplines, no athlete using our supplements has ever tested positive, or suffered any adverse effects. Additionally, apart from striving to produce the best supplements available, we also consider pricing, and strive to make these top class supplements affordable to the everyday man on the street.

Q: What was the duration of the research? A: Well, that is a difficult question, as the research is an on-going process, and as new research findings are published and investigated by ourselves and others, we adapt our products in order to make sure they are up to date with the latest research findings. I studied 9 years to attain my PhD, and did an addition 3 years of post doctoral studies, one of which was a drug development for a pharmaceutical company in The Netherlands, and the other 2 years at one of South Africa's leading medical facilities in Stellenbosch. I subsequently worked as a researcher at one of South Africa's leading Nutrition facilities for 4 years, researching the use of various plant extracts and nutraceuticals / supplements on human health, and am currently still employed as an academic researcher at one of South Africa's Leading Metabolomics Institutes. So if we tally all of that up, I would say 19 years of research to date.


Q: Where does the name Apex come from? A: As per definition, "Apex" is the "tip, the summit, the vertex, the climax, the peak or highest point" and hence, is highly appropriate considering Apex Nutrition and Supplementation aims at doing exactly this. Q: Why didn’t you study B.Pharm? A: Well, to be honest with you, after completing an MSc in human biochemistry, investigating the effects of acetyl-l-carnitine on human metabolism, and treating Parkinson's and Alzheimer's disease, I did consider a PhD in Pharmaceutical Chemistry, as I had a keen interest in drug development. I however decided to continue in my research direction, due to my even bigger interest in nutraceuticals and human metabolism. These research approaches and degrees are synonymous at our institution, as the methods used for research and the topics investigated are similar, as we collaborate extensively. Subsequently, after completing my PhD, I was offered a number of positions at various pharmaceutical companies in their Research and Development Laboratories, which I turned down at the time for a drug discovery research position abroad. Q: What is your life motto? A: "Always do the right thing, work hard, and you will be rewarded". I also believe that if you want to leave a legacy, you should keep in mind: "that people don't remember you for your achievements, but for the difference you made to their lives. So work hard, achieve big, but make a difference to others’ lives, while walking the path to success". Q: Any health tips? A: General health tips which I use on a daily basis: 1. 6 small meals a day. What I do is prepare a double portion of dinner in the evenings, which I take with me to work in the mornings. For breakfast I would typically have 2 whole wheat or muesli rusks and a cup of coffee, half the prepared dinner I eat at 10H00, and the other half at 13h00, a fruit at 15h00, and then dinner again at 19h00. My dinner typically consists of a portion of meat, a portion of starch, and a portion of vegetables or salad. 2. With every meal I would take half a serving a Nitro whey protein shake, and subsequently take half my required protein in as a shake, and the other from whole foods, which limits my fat intake, and allows me to stay lean all season. 3. Apex Omega 3: 2 to 4 caps a day


4. Apex Lipoburn X-treme, 3 tabs, once daily prior to a gym session, 4 days a week. I found that this product gives me the needed energy to get in a good training session after a hard day's work, in addition to lifting my mood, and aiding in maintaining a low fat percentage. Furthermore, at this dosage, I never develop tolerance to the product, and can use this indefinitely. It really makes my life so much easier, and weight maintenance a breeze. 5. I also get in at least 2L of water per day. This wasn't always easy for me, what I do now is always have a bottle of water at hand, and every time I see it standing on my desk, I take a sip. Before I know it, the bottle is empty and I fill her up again. 6. A general multivitamin in the mornings with breakfast. Q: What is your favourite Apex product and why? A: One of my favourite Apex products is the Hyper-X-Cell. What makes it great is that it is an energiser, free of banned stimulants, safe for use by children and adults, and can also be used for those individuals suffering from chronic fatigue. The science behind the product is amazing, and the resultant effects are astounding. Q: What is your favourite food? (Healthy and UNhealthy) A: Healthy foods: Biltong, biltong and more biltong. I also enjoy fresh garden salad, with tomato, lettuce, rocket, feta, olives, gherkins and sweat peppers. Unhealthy foods: Ice cream....definitely ice cream! Q: What are your plans for next year? A: There are really big things in the pipeline for Apex Nutrition and Supplementation for next year, most of which I am not at liberty to discuss at present. One thing I can however mention, is due to our spotless drug free record, and quality of supplements, there are a number of major local and international sporting bodies and rugby unions, whom have approached Apex recently, and are seriously considering us as their official sports performance supplement. Q: What is the administration route of the future? A: The most convenient and least intrusive of course, being oral or intra dermal. Q: Are you aware of nanotechnology and how does your product relate to this? A: Nanotechnology in nutritional supplements is currently poorly understood, controversial, and considered by many as unsafe. Until more substantial clinical proof is available for efficacy and safety, Apex will not manufacture supplements using this type of technology. Q: Tell me more about the Mr Universe chapter of your life. A: This was an amazing chapter in my life, winning the Drug Free Mr Universe Title in Los Angeles in 2002, the ultimate reward for many years of hard work. You can read all about this at the following link: http://www.apexnutrition.co.za.

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