There are two professionals I love and want them always to succeed: The pharmacist and the physician, while the earlier would be the objective of my write up today but the latter I love and have worked with all my career, I also have one for a brother. In the Nigeria health sector, there is so much tension and in-fights between the various health professionals, and this is sad. When people squabble, the open-mindedness needed to achieve a collaborative greater purpose is lost, and this means less than ideal service to the end users of these services, the patients. In Canada, I and the physicians that I get their prescriptions work together in the best interest of the patients no one is the master or servant. There is such mutual respect that when I raise a query about a drug or prescription the physician knows that that is my turf and may make me see reasons for the clinical decision made, at the end of the day the most suitable and best safety option is chosen usually based on extensive references.

 

Pharmacy is an exciting profession and quite diverse in field and expectation. As a pharmacist, you can choose where you want to practice. It is why I do ask people to chose one that their passion lies. There is research, administration, teaching, clinical or industrial. Other aspects such as sales and marketing do also exist, but in all these the utilization of the essential skills of drug use, man and safety is the foundation. In my experience based on some great observations, many pharmacists initially get confused on where to lay their career nest and the first few years is filled with career move changes and trying to fit in. But were the passion may not be evident many lose hope and feel they have studied the wrong course or are in the wrong profession. My advice to all young pharmacists is to choose a career in pharmacy where they have a reasonable amount of passion, and this could make a huge difference in job satisfaction and productivity.

 

Assertiveness is a good thing to any professional if practiced with the best modesty and finesses. But just as the name may sound uncomfortable for some it is the right of any professional to be assertive. The lawyers do this in the courtrooms, the engineers do this in designs and constructions, and the physicians do this in the care and diagnosis of their patients. To be assertive is a fair thing and it is needed for anyone to bring their professional relevance to the fore. Assertiveness is a great responsibility when it comes to public safety, and as a custodian of drugs if a pharmacist is none assertive it could mean that their patients that have full trust in the professional judgment could be put in harm’s way. It is the responsibility of a pharmacist to make sure his of her patients gets the best medication under the clinical circumstances as diagnosed by the physician and that the choice is rational and safe. It should produce the best results under the circumstances under consideration. You may take into account the financial might of the patient, but the final decision is not yours, this is the standard ethical approach remember your role could be sometimes advisory.

 

Some pharmacist hide under the coat of cost to perpetuate (serve the interest of the chains) self or others. Just this afternoon I filled a prescription for our little daughter for Clarithromycin suspension (BIAXIN) in a chain pharmacy near my physicians’ clinic. It is not my usual pharmacy, and the pharmacist I met took a clinical decision on my behalf FOUND not in the best interest of the young girl that would take the prescription. He filled the generic suspension; please note I have nothing against generics but they must have a face and must have the needed formulation equivalence to the originator. They (pharmacist and his technician on duty) did not know I am also a pharmacist. I did request it changed, because of this appeal they may have kept me for another thirty minutes. This pharmacy is not busy only one patient came in in the forty-five minutes we spent there, and the young child had a low-grade fever. At the end of the day the brand was produced, and my co-pay was ONLY three ($3.00) dollars, and I am sure that would have been the co-pay of the generic too. This pharmacist acted to make money for his chain and took NOT into consideration that Clarithromycin is a very bitter medication and the brand is formulated as a suspension in a suspension as granules for a masked taste. His decision could eventually cost me more since NON-COMPLIANCE or NON-ADHERENCE was a significant risk. The formulation technology is available to the generic companies too, but some have refused to use it, many chains are looking for cheap drug deals and would not take this paramount factors into consideration when looking for medicines, they just want the cheapest that brings in the most profit. It is a sad development in pharmacy these days, and it is even worse in Africa.

 

Let me let you in on a secret, when we launched our psychiatry franchise in Nigeria in 2011 we approached one of the best and busiest psychiatric hospitals in Nigeria to stock our brands, and they requested a clinical trial, and we obliged. We did two at that center, One for ZEPIDONE (Risperidone) and another for OZACE (Olanzapine Oral Dissolving Tablets). In the ZEPIDONE trial, it was mandated by the pharmacists and the psychiatrists that patients on the originator brand of Risperidone in the clinical wards be switched from the originator brand to the same dose of ZEPIDONE and they were observed for eight weeks. At the end of the eight weeks, many of the patients were discharged into the community doing very well. The negative and positive symptoms have mainly resolved, and the patients have passed the acute phase of the illness and needed just maintenance medications. In some of the cases, the psychiatrists did observe some had early discharge and the symptoms resolved as expected comparable to what the over five years’ experience with the originator brand. Our brand was approved by the ethical and clinical committee to be added to the hospital formulary. We also did a clinical trial on OZACE in same hospital and DEBIXA (Aripiprazole) in another facility. The OZACE trial cost about five million Naira and about ten million Naira for the DEBIXA trial including the cost of medications and the double-blind medications. In our professional organization, we do not cut corners. Some of our partners have their production facilities approved by the United States FDA and Western European regulators.

 

There is a trend by many pharmacists to go for the least expensive medication and sometimes this is not in the best interest of the patients, but I know cost is important for compliance. Many a time some community and hospitals pharmacists in Nigeria take medications from reputable companies, get them sold and NOT pay for them and start looking for the cheap generics in the market with these unpaid monies to buy as a replacement just for optimal profit (ethical issues) just as the Canadian pharmacist gave me a generic that would not ensure compliance. The new crazy in Nigeria is the unregistered TEVA products that are assumed faceless since they are not registered in Nigeria by NAFDAC, and NONE knows those that bring them into the country, how they even get in. They abound as medications in the different specialties and chronic illness. Stories abound of some merchants going to Asia to clone these products, making it worse. It is a grave danger to the patients and the public. They want more money, more profit and we all know that faceless products have no organization behind them, many are fake, and no one can be held responsible for providing information in case of a recall or any other safety problems. When you tell these pharmacists the dangers in their actions, they get defensive. “You just want to sell your products” or ” everyone is doing it,” “people are using it,” “we have had no problems yet.” But they forget that Pharmacy is a public safety professional not just a trader.

 

How many pharmacists in Nigeria spends just two extra hours every day to read more and attempt to seek higher knowledge. Pharmacy is more than a trade; it is a healthcare profession, life and dead in your hands. As a pharmacist, you should know so much about all the diseases prevalent in your community of practice, know the healthcare trends, disease outbreak, diet information. Seek knowledge on all new drugs entry, generic or originator product. Explore to find out the organizations behind these products. Request for clinical data and information to act as a guide for use, recommendation or prescriptions of these medications. As a supervising pharmacist, you need to read more about human resources. When did your graduate, and have you done any other diploma, degree or certification after your initial degree. To be assertive, you must be professionally competent, and this is the only way to make sound and better clinical decisions or impact. Physicians and clinicians even other pharmacists gravitate toward the sound and clinically competent pharmacist. Do not be that pharmacist that people refer to “where did this person train” or “are you sure this person is a pharmacist.” A professional means someone that can get results with minimal or no supervision and bring a lot to the table. Please be that pharmacist. The purpose of life is a life of a purpose. Shalom.