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November 2009 | Issue 1
ISSN 2042-4493
Pharmacy
Professional
e x c l u s i v e l y f o r m e m b e r s o f t h e R o y a l P h a r m a c e u t i c a l S o c i e t y
Society
updates
The president and country
chairmen report
The health
editor’s column
Sam Lister of The Times
on pharmacists’ roles
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UNI
Pharmacist on
the front line
The Lt Col dons her uniform and goes to war
Learning & Development
CPD latest
Smiling for success
Top tips from body-language gurus
Singapore revisited
An insider’s guide to the island state
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e d i t o r ’ s w o r d
Celebrating...
Professionalism in pharmacy
Welcome to the first edition of Pharmacy Professional, the
new quality monthly magazine, exclusively for members of
the Royal Pharmaceutical Society of Great Britain.
As the magazine’s name suggests, this publication is a celebration
of the professionalism of pharmacists, both in their working lives
and during those precious few hours when they have time for a little
relaxation or recreation.
Each issue of the magazine includes a
potent mixture of professional and business
articles, profiles of pharmacists, as well as
political comment and columns by experts
in their fields, such as Richard Northedge,
one of the best known business journalists
writing in national newspapers and
magazines today and Sam Lister, Health
Editor of The Times.
The Society’s President, Steve Churton, and Chief Executive Jeremy
Holmes give us an update of the profession from their vantage points, as
do the chairmen of each of the Pharmacy Boards in England, Scotland
and Wales.
Other main features this month include a profile of Lt Col Ellie
Williams, one of the most senior pharmacists in the armed forces, whose
job has taken her to Iraq and Afghanistan amongst other places, and we
look at how body language can be used to help pharmacists feel even
more at ease when dealing with members of the public.
There are pages of news from around the pharmacy profession,
picture spreads featuring some of the major events and, of course,
the Learning and Development section, produced for us by the
Pharmaceutical Journal.
And you will find a rich selection of lifestyle features including travel,
motoring, food, the arts and other subjects. There are even special reader
offers and a prize crossword.
I hope you will enjoy reading Pharmacy Professional.
RPSGB is working with the profession to build a new professional
leadership body for pharmacy www.pharmacyplb.com
Pharmacy Professional ISSN 2042-4493
© The Royal Pharmaceutical Society 2009. While every effort has been made
to ensure that the information is correct, the neither the editor nor publisher
can be held responsible for any inadvertent inaccuracies or omissions.
Pharmacy Professional is protected by copyright and nothing may be reprinted
without written permission. Manuscripts, transparencies and illustrations are
submitted on the understanding that no liability is incurred for safe custody.
Jeffrey Mills, Editor
November 2009 | Pharmacy Professional
1

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04 News Round-up Fake medicines and more
07 Media view Sam Lister, Health Editor of The Times
08 Comment The President and CEO speak out
10 A view from... The English, Scottish & Welsh Boards
16 Body Language Gesturing for success
21 Business Practice Richard Northedge on Pharmacy
22 A Pharmacist’s Life Ellie on the front line
26 The Big Read Is there a future for OTC slimming aids?
30 Politicians’ view Pharmacy in the spotlight
learning&development
lifestyle
41 Travel Singapore, City
breaks, Jetlag and more
49 Health Food This month
top chef Tom Aikens
50 Transport Something
different in car country
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heads off to the opera
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56 Prize crossword Win a
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33 Continuing Professional Development
The Pharmaceutical Journal brings you the latest
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The Internet may have a lot in
its favour but providing the public
with easy access to counterfeit
medicines is one of its features we could all
do without. This is becoming an increasing
issue for patients, pharmacists and
manufacturers alike.
The problem, highlighted at a recent FIP
(International Pharmaceutical Federation)
meeting in Istanbul, has been the focus of
a “Faking It” campaign, a joint initiative
of the RPSGB and the MHRA earlier this
year. It was also highlighted in a series
of hard-hitting cinema advertisements
developed by a partnership of interested
organisations and screened in February.
Look for the internet
pharmacy logo as a
matter of course
These activities are now coming together
in a second-wave UK- wide campaign “Get
Real – Get a Prescription”, which has at its
core the twin objectives of underlining the
need for people who purchase medicines
to do so from a reputable source and at
the same time underscoring the unrivalled
expertise of pharmacists when it comes to
knowledge about medicines.
The new campaign, which has five
sponsors – The MHRA, the RPSGB, The
Patients’ Association, Heart UK and Pfizer
– will feature more hard-hitting ads – this
time on billboards, TV and in other public
places. It will also highlight the dangers
of taking counterfeit medicines through a
dedicated website www.realdanger.co.uk,
in editorial features and road shows in
major cities.
The campaign will emphasise the
dangers of counterfeit drugs, which
can range from the use of substandard
ingredients, to those related to ingredients
which may in themselves be toxic or
inappropriate for the condition they are
supposed to be treating.
Richard Daniszewski, a community
pharmacist working for Doncaster-based
pharmacy H I Weldrick and Vice Chair
of the RPSGB’s English Pharmacy Board,
has no doubt that the campaign is needed.
“The internet is a wonderful invention It
has given people much needed information
about illness and medicine. Every day in
the pharmacy we talk to people who are
much better informed than they would
have been even five years ago. But we are
paying a price for this new technology.
“As we all become used to on-line
shopping we are seeing an increase in the
online purchase of medicines, which has
given counterfeiters the opportunity to step
in,” he says.
“The reason the RPSGB has lent its
support to this new initiative is because
it is concerned that people should know
where their medicine is coming from. They
should also understand the possibility of
fraud. At the very least, we want people
to check with the internet site that there is
pharmacist involvement in the sale and that
the pharmacist is UK registered.
“People should look for the internet
pharmacy logo as a matter of course
before beginning the other checks and
everyone should seek advice either from
their pharmacist or their GP about any
health conditions and medication,” Richard
concludes.
Otherwise, as the campaign strapline
says – someone is making a killing. n
S T U D I E S B E D R O O M S L O U N G E S L I B R A R I E S C I N E M A D I N I N G
November 2009 | Pharmacy Professional
5

n e w s r o u n d u p
m e d i a v i e w
Last call for National Pharmacy
Board election candidates
Members who are passionate about
the future of the pharmacy profession
are being called on to stand for the National
Pharmacy Board elections next month.
Just days remain for candidates to get their
nominations in to the Royal Pharmaceutical
Society by the November 23 closing date.
National Boards for England, Scotland and
Wales will form the backbone of the new
Professional Body and for the first time since
the 1840’s there will be no Council next year.
The increased role of the boards recognises
that health policy is different in each country.
Members of the boards will be directly
elected with some seats allocated by sector
of practice. Each Board has a different
composition in line with devolution and the
needs of each country. England and Wales
will each have 11 places and there will be 12
places on the Scottish Board.
“These elections are particularly significant
as the National Boards will be crucial to
ensuring that the support and decisions of
the professional leadership body are what
the profession wants,” says the Society’s
Chief Executive and Registrar, Jeremy
Holmes.
“All the elected places for each Pharmacy
Board are vacant in this first election, so
this really is your chance to shape your
profession. I’d like to encourage those who
are enthusiastic and committed to creating
our new body to stand. Just as importantly,
we would like a strong voter turnout so that
the elected candidates represent our diverse
membership.”
Voting can be by post or online from
December 12 to January 22, 2010. The
elections are being held earlier than in
previous years to allow the new board
members time to be inducted before the
Society’s scheduled separation in April next
year. All current Society members in England,
Scotland and Wales are eligible to vote.
Although there will not be a Council
election next year, there will be an Assembly.
It will meet less often than the boards and
will look after overall strategic direction
as well as maintaining responsibility for
the financial and governance aspects of
the organisation. The Assembly will be
made up of members from the English,
Scottish and Welsh Pharmacy Boards plus
a pharmaceutical scientist, an academic
and a lay member to provide an external
perspective.
More information on how to stand for the
election can be found at www.rpsgb.org by
clicking ‘Board Elections’ on the right hand
side. n
Pharmacy Support strikes new
partners with action on addiction
The UK’s leading independent welfare
charity for pharmacists and their
families, Pharmacy Support, has agreed a
new partnership with Action on Addiction,
the only UK charity working across the
addiction field in research, prevention,
treatment, professional education and
family support.
The pharmacists’ welfare charity is
building on its existing Health Support
Programme, a confidential specialist service
which exists to help those who experience
problems with alcohol, drug, or other
types of dependency. The charity made an
informed decision to join forces with Action
on Addiction whose specialist services will
enhance the support it is able to provide to
those in need.
The dedicated Health Support
Programme freephone number, 0808 168
5132, will be managed 24 hours a day,
seven days a week by Action on Addiction,
where a team of experts will be on hand
to assist those experiencing addiction and
dependency issues.
“This specialist service is critical to our
clients who have issues with dependency.
Confidential assistance through the
Health Support Programme in the past has
prevented marriage breakdown, fitness to
practice proceedings and has led to a return
to full-time work for the people involved.
“To ensure that the Charity can fully meet
our clients’ needs, we feel the time is right
to join forces with Action on Addiction, a
specialist support provider whose holistic
approach mirrors that of Pharmacist
Support. We look forward to this being
a long and fruitful relationship for both
parties,” says Pharmacist Support charity
manager, Diane Leicester.
Meanwhile Nick Barton, chief executive
of Action on Addiction says: “Action on
Addiction is delighted to have been chosen
to provide a specialist service to the nation’s
pharmacists and their families. It is only
sensible to provide support to those who
play such an important part in the nation’s
healthcare. Professionals are not immune to
the problems that affect society as a whole.
The charity looks forward to a productive
relationship with Pharmacist Support that
results in pharmacists and their families
receiving the help they need.”
The volatile economic climate has seen
demand for Pharmacist Support’s services rise
across the board during the past year. Funded
entirely by donations from pharmacists, the
charity relies on their generosity to continue to
help people in need.
Pharmacist Support provides a range of
other confidential services including a stress
helpline, financial assistance, debt, benefits
and employment advice to any member
or former member of the profession and
their dependents, as well as to pharmacy
students.
To find out more about the services
Pharmacist Support provides and to donate
online please visit www.pharmacistsupport.
org. For further details regarding
Action on Addiction please visit www.
actiononaddiction.org.uk n
Healthcare in the community
Pharmacists are at the forefront
Are you stressed and
overweight? A smoker
prone to days off
sick? An unhealthy eater who
rarely manages much physical
exercise? Chances are you
might be a health professional.
Several audits of health and
habits in the NHS workforce
have been conducted in recent
months, and the conclusions
have an alarming irony: the
people tasked with guarding the
nation’s physical wellbeing are
not quite fit for purpose.
The Boorman review
reported that a third of health
workers had poor or moderate
mental health, smoking rates
were no different from the
general public (despite firsthand
experience of its effects),
many did little or no exercise,
and sickness absenteeism
was unacceptably high. The
problems compromised care,
with bad habits setting a poor
example to the public at large.
Earlier this year, the
Department of Health carried
out its own assessment of
obesity in the health service.
The eye-popping finding was
that 300,000 of the 1.4million
workforce are obese, and
a slightly larger number
overweight.
And when Lord Darzi of
Denham stepped down as
health minister in July, we
discussed what he had achieved
with his strategy plans for
primary and secondary care,
and if he had any unfinished
business. His response to the
latter point was immediate:
health workers need far greater
support to ensure they lead
Sam Lister, Health Editor, The Times
healthy lives, and can act as
ambassadors to the rest of the
country. Get the workforce on
track, and the public health
message will be conveyed far
more effectively.
Pharmacists’ role
expanded
It is no understatement to say
that the country’s 40,000-plus
working pharmacists – both
hospital-based and in the
community – should be central
to this mission. As the role of
pharmacists is expanded in
the push for more healthcare
in the community, so their
responsibilities as dispensers of
lifestyle advice will grow.
Advanced services such as
smoking cessation and Health
Checks for cardiovascular
disease risk underline the
pharmacist’s position on the
Responsibilities
as dispensers
of lifestyle
advice will grow
public health frontline, and the
shift in services traditionally
tied to the GP’s surgery.
In his analysis of primary
care collaboration, Better
Practices, Better Health,
Professor David Taylor of
University of London’s School
of Pharmacy underlines
how the different working
approaches of GPs and
pharmacists can, with closer
alignment, further enhance
health. He concludes that while
pharmacists need to understand
the holistic, relationshipbased
work of family doctors,
“the benefits of community
pharmacy’s more customer
service oriented approach to
meeting public’s health related
demands deserves recognition”.
This has its advantages in
terms of changing people’s
behaviour and curbing selfinflicted
health problems.
The pharmacist can be a good
bridge between a person’s
medical records and the health
peccadilloes of their private
lives. People who come to
the pharmacist do so because
they must — they need
medication — but also because
they are conscientious about
their health. As Prof Taylor
puts it: “The strength of the
pharmacists’ position is they are
used to dealing with consumers
— people who are motivated
come to you.”
A significant number of these
consumers are open to health
advice beyond “must-have”
medicines, and positively seek
it. So should the pharmacists
be taking on a more proactive,
ambassadorial role – and be
an exemplar of the lifestyle
recommendations they set out?
The customer relationship
makes it tricky, both because
of the GP’s historic position
as health arbiter, and because
choosing to go into a shop does
not mean you are necessarily
seeking a sermon.
Take my pharmacist in
East London. Chris dispenses
medicine with great expertise:
he is meticulous with his
instructions, which are the key
message for his customers,
many of whom do not have
English as a first language.
Does he tell people to lose
weight or quit the cigarettes?
Not that I have seen. There are
enough who qualify for such
advice, but it would likely
irritate, confuse and undermine
the relationship he has built
with them.
It is a delicate line to tread,
and one best negotiated by
preaching through what you
practise. The pharmacist who
appears healthy in body and
mind will be the better advocate
of healthy living, and what
applies to the GP should apply
to the pharmacist too. That is
why all pharmacy employers
— be it the NHS, private chains
or independent chemists —
should be particularly alert
to the health and wellbeing
of their staff. The Boorman
Report for all its admirable
recommendations, had no
mention of pharmacies in its
100-plus pages. NHS or not,
it should be centre stage. The
sector is key to expanded
“healthy lifestyle” support
services of the future, and fat
and flagging pharmacists will
struggle to carry that torch. n
l Sam Lister is Health Editor of
The Times. A former news editor
and health correspondent, he
has covered the health service
in times of feast and famine,
the medical community through
reformation and revolt, and some
of the extraordinary advances
in clinical practice and disease
control in recent years.
6 Pharmacy Professional | November 2009
November 2009 | Pharmacy Professional
7

c o m m e n t
A record to be proud of
Steve Churton, President talks to Jeff Mills
Pride in the profession
Jeremy Holmes, CEO
Need even more reasons to
be proud to be part of the great
pharmacy profession? Look no
further than the words of RPSGB president
Steve Churton when he addressed delegates
at the 145th annual British Pharmaceutical
conference in Manchester.
“It’s right to remember the great
record of our Society during its long and
distinguished history,” he said, in a rousing
upbeat keynote address.
“Since its inception at the height of
Victorian Britain, we have witnessed
significant milestones in modern healthcare
– the discovery of penicillin, the creation
of the National Health Service and the
mapping of the human genome. Over this
long period the Society has consistently
carried the banner for pharmacists and for
pharmacy”.
Fit to lead
But while it is right that tribute be paid to
the founding fathers and their successors,
it is also right that we learn from their
experiences. “I genuinely believe that
we have the responsibility to leave as
our legacy a body fit to lead a modern,
progressive and respected profession, which
future generations will thanks us for,” said
the president.
It is an undisputed fact pharmacy is
regarded by millions of people, patients and
otherwise, as a fundamental component of
effective healthcare delivery, he said. “It
is also undisputed that we are now on the
brink of achieving something very special
– arguably the most significant change
in our profession and to our professional
body in particular – in nearly 170 years,
he told delegates in a clear reference to the
forthcoming demerger of the Society.
But make no mistake, there are plenty of
examples of initiatives undertaken during
the past year that make it crystal clear
the Society has an important purpose, far
beyond the regulatory role which many see
as the overriding purpose.
“When I was elected president last year, I
knew that the issue of workplace pressures
Stressed Tackle workplace pressure
The changes you
voted for mean that
we now have the
prospect of a very
different organisation
was one I wanted to tackle – and in January
I launched our campaign,” Steve Churton
told delegates.
“The campaign has been successful
in raising the profile of what many of us
experience but perhaps don’t have the
confidence or opportunity to speak out
about.
“You have told us that the increasing
number of prescriptions, the lack of
rest breaks, not being able to delegate
effectively, feeling unsupported to deliver
extended services, unrealistic targets, long
working hours and burdensome paperwork
all contribute to a more stressful working
environment,” he noted.
The RPSGB is not only leading the
debate, pointing out the risks to personal
wellbeing and patient safety, but has
explicitly called on all employers to make
sure they do not compel or encourage
pharmacists, or members of their support
teams, to work for long periods without
adequate rest breaks.
“There simply cannot be any excuse
for poor employment practices that place
unwelcome pressure on you as health
professionals – and put patient safety at
risk,” Steve Churton said. “In 2007 the
Society stated its ambition to establish
Britain as ‘the safest place in the world to
receive medicines’ and in February this year
we launched a seminal report intended as a
first step in realising this vision.”
The report’s recommendations have the
potential to bring about very significant
improvements in patient safety and the new
professional leadership body will be in a
powerful position to set the agenda and
drive the changes needed, he said.
“Standing here last year it didn’t cross
my mind that we would see the prosecution
of a pharmacist for making a human error,”
Steve Churton told delegates. The Society
had campaigned hard and engaged with then
profession to engage MPs and other senior
political figures and “we won the debate in
Parliament and in Whitehall”.
“In time the law will be amended – and
as we continue to work to deliver this
permanent change, we will strive to raise
the profile of this in the mind of every
pharmacist, to ensure they don’t fall foul
of current legislation,” he continued.
Active discussions are underway with the
Department of Health, MHRA and the
Crown Prosecution Service.
Constructive dialogue
Increasingly the Society is providing
information to empower pharmacists to
deliver new or specialised services. This
year alone more than a dozen resources
have been published in support of these
professionals. Examples include advice
to ensure the wellbeing of patients using
weight-management drugs; guidance on
diagnostic testing and screening; support in
promoting good sexual health and support
to help pharmacists step into the new
clinical roles expected of them. “Roles for
which we are increasingly and rightly being
recognised as well qualified to fulfil”.
The encouraging vote in favour to the
proposed changes in the Society’s Charter
was a major milestone for the profession
during the year, Steve Churton said. “The
changes you voted for mean that we now
have the prospect of a very different
organisation from the one you have been
used to.”
The work of the new body will be largely
devolved to the National Pharmacy Boards
in the three countries, with policy making,
representation and professional leadership
all taking place where they should be –
closer to members, to those who can be
influenced to shape the pharmacy agenda
and those who are better placed to provide
the local support needed.
Crucial role
The central Assembly will play an important
role as well, said Steve Churton, providing
the necessary strategic direction, financial
management and appropriate degree
of overarching governance for the new
organisation.
The new professional leadership body
will play a crucial role in advising and
influencing the General Pharmaceutical
Council when it takes on the regulatory
role next year, as well as in supporting
and inspiring PLB members to achieve the
standards laid down.
Speaking straight from the heart, the
president shared his view of what it means
to be professional. “I believe that being
a professional is about focusing on our
patients, putting their safety, health and
wellbeing first and foremost. It means
using our professional judgement to deliver
excellent care; and working within a relevant
and modern code of ethics and a shared
value system.”
Being professional also means not shirking
tough decisions when they are needed, being
brave, standing up for what you know is right
in the interests of patients and knowing when
it is right to make a stand.
And few would deny that sentiment! n
The Society is
transforming itself
This magazine is all about
professionalism. What it’s like being
a professional, and what you need in
order to be the best pharmacy professional
you can.
The Society recently sponsored the
“Pharmas”. These are awards given at the
Pharmacy Show to individuals and teams
who have shown exceptional commitment
to their patients and to the profession. There
were some truly impressive achievements,
in ten categories, with an overall winner –
Tony Schofield from South Shields – being
announced as “Pharmacist of the Year”.
Tony has developed an innovative drug
addiction service, including detoxification as
well as maintenance. This involves pharmacists
working closely with GPs, but using their own
skills and premises to maximise accessibility
for patients and cost-efficiency for the Nhs,
including managing patients in primary rather
than secondary care. It’s a model that has
enormous potential for wider roll-out and for
application in other clinical areas.
I was very proud to be able to announce
all the award winners at a gala dinner. But
it was also an opportunity for those at the
dinner, and across the profession, to show
pride in their peers. The advent of a new,
dedicated professional body is a once-in-alifetime
opportunity for us to bring pharmacy
together with a renewed sense of pride, and
for us to take stock of what professionalism in
pharmacy really means.
I suggest it means putting patients first. It
means working with colleagues to develop
and provide the highest quality services,
whether in a directly patient-facing role or in
another part of the healthcare, pharmaceutical
or educational system. And it means having a
clear sense of what is expected of a dedicated
professional in an increasingly clinical
profession, including continuous development
of one’s own knowledge and skills.
That is true right across Great Britain, even
though pharmacy is evolving in different ways
in England, Scotland and Wales. With the
help of a wide range of other organisations,
and especially with the 300-plus “PLB
Pioneers”, the Society is transforming itself
into the new professional leadership body for
pharmacy. That will have as its backbone the
three national boards – for which elections
will be held in December – but its strength
and cohesion comes from the shared sense of
professionalism.
That sense of professionalism was strikingly
evident at the stakeholder meeting we held
in October, the engagement event we held
in York earlier that month, the accelerating
Local Practice Forums, and in the numerous
reference group and other meetings which are
fulfilling the promise of the prospectus for the
new body.
Common interest
It’s also evident in the relationship we’re
establishing with the new regulator-in-waiting,
the General Pharmaceutical Council (GPhC).
The GPhC Chair, Council and Chief Executive
have now all been appointed, and it’s clear
they will be looking to the professional body
to provide the right input to their development
and application of regulatory standards. The
two organisations need to act as counterpoints
to each other, but with the common interest of
professionalism in pharmacy.
Internally, we have established the Professional
Leadership Group, a senior management team
which includes the three country directors, the
Director of Professional Development & Support
and the Head of Marketing & Membership,
as well as myself. They will be responsible for
working with the Boards to drive the professional
agenda – the policy influence and the services to
support members in realising their professional
ambitions.
That team is committed to delivering
a leadership body of which we can all
be proud. As part of that team, I am not
letting up in my intention of launching
it successfully. To get directly involved or
just to keep up to date please go to www.
pharmacyplb.com. n
8 Pharmacy Professional | November 2009 November 2009 | Pharmacy Professional 9

T h e V i e w f r o m e n g l a n d
Opportunities – but threats too
Brian Curwain, Chairman English Pharmacy Board
As we approach the demerger,
early in 2010, of the Royal
Pharmaceutical Society’s
regulatory functions, we are clearly in a
situation containing great opportunities, but
also uncertainties and threats. Will the new
professional body (the much re-developed
and re-focussed Royal Pharmaceutical
Society) attract sufficient members to
remain viable?
Clearly, I believe that it will, and my
involvement as a member of Council (2006-
9) and of the English Pharmacy Board
since its inception has given me ample
information upon which to base that view.
When I first went on to the Register
of ‘Pharmaceutical Chemists’ in 1969,
things were very different. It seemed like
a lifetime licence to practice, so long as
one did not fall foul of the Society. We
had not yet heard of CPD (or was it just
me?), or the concept of lifelong learning
and development which we now all take
for granted. Of course medicines were very
different then, they were, in the main, not
all that effective and, apart from some of
the ‘poisons’ (legally defined in the Poisons
Act), not very dangerous.
Pharmacy degrees were clearly structured
as science degrees with plenty of chemistry,
pharmacology, pharmaceutics and
phamacognosy, with no attention paid to how
we would deal with patients, other healthcare
workers, or interact with the NHS.
The ‘new’ Society
will support
pharmacists in all
areas of practice
We now have medicines which are
effective, expensive, and dangerous. They
interact with one another. Very many people
now take three or four different medicines
on a long-term basis. The number of
prescription items rises inexorably year
on year, and everyone, in whatever sector,
is working much harder. To put it bluntly,
some aspects of pharmacy practice have
become more hazardous to pharmacists.
As we take more clinical responsibility for
patients’ care (POM to P switches, MURs, the
use of patient group directions, prescribing,
advising medics and others about therapy),
it becomes more likely that we will be in the
frame when patients suffer bad outcomes. It
is more important than ever to keep up to date
with developments in medicines, therapeutics
and pharmacy practice.
A number of organisations exist, mostly
developed to assist pharmacists in specific
areas of practice. We are now required to
keep and submit records of our CPD to the
regulatory body when asked, and our needs
for support, advice and opportunities to plan
and record or CPD activities, have never been
greater. CPD is not about going on courses,
it’s about identifying our professional needs
and getting those needs met.
The ‘new’ Society will support
pharmacists in all areas of practice. Firstly
the CPD recording website in its new, more
user-friendly state will provide a readymade
home for our records, which can then
be submitted to the General Pharmaceutical
Council when required. It will provide, for
those who join, a service which will review
our CPD and advise if any remedial action
is needed before submission.
Secondly members will have access to a
local network, a local practice forum (LPF),
to provide a range of CPD and networking
opportunities. This does not mean that we
are simply chucking away our branches all
over Great Britain. On the contrary, Board
members have been getting out and about
extensively to work with members, many of
whom have been branch activists, who want
to be involved in setting up LPFs in their
locality.
Supportive activities
More recently, the Society has paid more
attention to its supportive activities, and it
has also become a far more sophisticated
influencer of health policy. We have
traditionally had a network of branches
throughout the country and as we move
forward to the next phase in the Society’s
life, this structure has come under scrutiny.
Is it what we need now? Is it working well?
How do we measure its performance?
A couple of unpalatable truths: A number
of our branches are classed as ‘inactive’;
in any one year only one pharmacist in 10
actually attends a branch meeting. When I
was Chairman of the Dorset branch in the
1990s, normally 20-50 members came to our
meetings. It felt like the branch was working
well but in reality we never saw over 400 of
our members.
The development of LPFs is intended to
make local support available to all, whether
members choose to access it by going to
meetings or by using the virtual, web-based
resources and networks that will be in place.
This will be very helpful in parts of England
where we are thinly spread and travelling
to meetings after work is a problem. It will
also enable us to be in contact with not only
local, but distant experts and to create our
own supportive networks. LPFs are intended
to be a tool for members to develop what
they want!
Unique selling points
Finally, what makes pharmacists different?
A number of unique selling points have
been suggested. For me it is about having
an understanding of how medicines actually
work and how we measure their benefits. Our
training gives us that in spades compared
to doctors or nurses who do little formal
pharmacology or critical appraisal of evidence.
What this means for us is that we can
explain to patients not just what the drugs
are for, but how they work and provide
benefit. For patients this can be a great aid
to beneficial medicines taking. We can truly
be the scientist on the high street, in the
hospital, the PCT, the MHRA, the university
and of course in the pharmaceutical industry.
One of the important roles of a scientist is
to communicate the science they understand
to those who need to know. For many of us
it is our patients. Don’t think it’s difficult. So
long as you understand something clearly,
you will be able to find the right way to
express it.
Of course, this brings us back to the need
to keep up to date with developments in
medicines and therapeutics. So make use of
the developing local structure of the Royal
Pharmaceutical Society and, better still,
help your colleagues locally to set it up and
develop it. n
Engaging times at
English Board roadshows
Active engagement with the
pharmacists it represents has been
top of the agenda for the English Pharmacy
Board during the past few months with
a series of roadshows, which started in
Birmingham in June and took the stage
in London in September, during which
members had the opportunity to quiz
board members face to face about new
developments, both within the Society and
beyond.
There are few surprises that the Society’s
reorganisation and the planned demerger of
the regulator and the professional leadership
body were among the top subjects of
discussion, prompting some lively exchanges,
illustrating how keen members are to be
involved in the development process.
Questions during a round-table session at
the Society’s London headquarters, hosted
by EPB chairman Brian Curwain, ranged
from the name of the new organisation
to the practical management of virtual
professional leadership forums.
Highlights of the debates were around
the role of the new professional body with
a consensus emerging that, if it is to be
an effective representative of the interests
of professional pharmacy, it must be
positioned in the minds of members as a
first port of call during any storm.
Brian Curwain, endorsed that
sentiment and responded by reiterating
the commitment of the body to being
driven by its members through their active
participation in the Local Practice Forums.
These new entities gave rise to discussion
about their management and to a sense
of excitement and challenge as delegates
talked through possible approaches to the
running of a virtual meeting place.
Topics not related to the Society’s
restructuring not surprisingly featured
discussions about the Responsible
Pharmacist. Many present expressed
the view that a new professional body
would be much better placed to represent
members’ interests than the “old” RPSGB
which to an extent had its hands tied.
At the same time there was a
strong feeling that much more robust
representations would be needed in future
to ensure that pharmacists’ positions were
accurately reflected in any new proposed
legislation – a new Medicines Act being a
case in point. n
10 Pharmacy Professional | November 2009 November 2009 | Pharmacy Professional 11

T h e V i e w f r o m s c o t l a n d
The future’s bright
Sandra Melville, Chairman Scottish Pharmacy Board
The view from Scotland could
hardly be brighter. As we move
towards 2010 the Scottish
Pharmacy Board is busy preparing for
the launch of our new professional body
and its members have been out and about
talking to pharmacists and seeking views
about what they would like to see happen
on the ground.
How often do we get an opportunity like
this? Just think how refreshing it will be
to finally have a professional body which
will not only be free from the role of
regulator, but will be set up in a way which
recognises devolution and the differences
in healthcare in each of our countries. Next
April, when the Council ceases to exist,
the National Pharmacy Boards will form
the core of our new professional body and
will focus on the priorities for pharmacy
in each of their countries whilst still
retaining the advantage of collaborative
working for GB wide issues, such as the
decriminalisation of dispensing errors.
I am sure that the General
Pharmaceutical Council will be an
We recognise that
there is still more to be
done and, in the brave
new world of 2010,
more we shall do!
excellent regulator. Our profession
deserves (and is used to) nothing less.
But in order to ensure that our profession
continues to flourish, this must be balanced
by a strong leadership body which
encourages innovation and supports its
members in achieving their aspirations,
and which speaks out for pharmacy
and ensures that we have our say at the
negotiating table. For, as we all know,
there lies the way to better patient care.
I don’t think I’m giving away any
secrets when I say that in many ways we
in Scotland have been leading the way
for some time now (and I don’t mean
the invention of penicillin, chloroform
and Dolly the Sheep!). Pharmacists in
Scotland are empowered to utilise their
clinical skills more fully through the
Minor Ailment Service and Public Health
Service components of the community
pharmacy contract and we have a high
proportion of pharmacist prescribers
working in hospitals and primary care,
running clinics and already playing a fuller
part in delivering healthcare within our
communities. But we recognise that there
is still more to be done and, in the brave
new world of 2010, more we shall do!
Providing local access to the services we
will offer our members is absolutely key to
the success of the new body, and to this end
we are setting up Local Practice Forums,
which will be whatever members tell us
they want them to be. The road shows we
have been running throughout October and
November were designed to encourage as
many pharmacists as possible to come along
and get involved sharing their views, ideas
and suggestions.
Historic journey
We have a real chance to shape the future –
so come and be a part of it and stand for the
Scottish Pharmacy Board at the forthcoming
elections. All nominations are encouraged
before November 23 with voting closing on
January 22, 2010. This newly elected Board
of 12 pharmacists will first meet in February
next year and will to lead the pharmacy
profession through the split and onto the
next chapter. It is a time to be part of this
historic journey from an organisation that
was once bound by regulation to one that
will fully serve the needs of its members.
Change is the only constant in our future
and this will be further evident with the
Scottish Directorate moving office. We are
now at the end of a lengthy and arduous
process which will see the professional
body being rehoused to a new and modern
building with all the facilities that members
will need in the future. It is indeed with a
heavy heart that we will leave our Scottish
Office here at York Place in Edinburgh,
which has been our Society home since
1884 but Holyrood Park House is better
equipped to take the profession forward.
We will be the new professional leadership
body serving the needs of pharmacists in
Scotland in our new home! n
More information
For further details on the elections please visit
our website www.scottishpharmacynetwork.org
To keep in touch please email reception.
scotland@rpsgb.org or telephone 0131
5564386, or why not join our discussion forums
on www.scottishpharmacynetwork.org
New HQ for Scottish board
The decision to move to prestigious
new offices in central Edinburgh, which
will provide better facilities for members
in Scotland as well as opportunities to
showcase the profession to politicians and
the media, has been confirmed by the
Scottish Pharmacy Board.
“I truly believe that this is the right move
for us and the profession. Located in central
Edinburgh, close to the Scottish Parliament,
it is ideally placed to engage with MSPs
and other key stakeholders,” says Sandra
Melville, chairman of the Scottish Pharmacy
Board.
“The city centre location is easily
accessible to members, close to local
amenities and has good public transport
links, including train and bus stations, with
car parking nearby. The modern office has
full disabled access, is finished to a high
Congratulations
standard and has room for expansion if
required in the future.
“There will be flexible meeting room
facilities for the Board, Local Practice Forums,
and for professional groups. An information
centre will be open to members throughout
the working day with access to a wide
range of electronic and printed information
sources,” she says.
“The Board has given very careful and
considered thought to the future options
for our premises and the decision has
been reached by a clear, transparent and
democratic process. I believe that the new
office will provide a strong foundation for
the future of the new professional leadership
body in Scotland and the timing is fitting as
we prepare to embrace this role in 2010,
with premises in Scotland that offer the best
facilities for our members and staff.” n
All smiles for some of the most recent entrants to the profession at a special ceremony at the
Society’s Scottish HQ in Edinburgh, during which they received their registration certificates. Back
row (from left) Lisa Ferguson, Rhone Jack, Kirstin McIntosh, Fiona Romanes, Lisa Davidson and
Maria Vaert; middle row (from left) Kirstin Delaney, Jane Walsh, Emma Jayne Gallagher, Roslyn
Chambers and Emma Flaherty. Front row (left to right) RPSGB Director for Scotland, Lyndon
Braddick; Scottish Board Chairman Sandra Melville; President Steve Churton and Rose Marie Parr,
Director of Pharmacy at NHS Education for Scotland
12 Pharmacy Professional | November 2009
November 2009 | Pharmacy Professional
13

T h e V i e w f r o m wa l e s
Groundbreaking opportunities
Marc Donovan, Chairman Welsh Pharmacy Board
This IS an exciting time for the
pharmacy profession in Wales.
As we move ever closer to the
establishment of the new Professional
Leadership Body (PLB) for pharmacy I am
confident that the unprecedented changes
ahead will offer significant and ground
breaking opportunities for pharmacist
members and for the pharmacy profession
as a whole.
The Welsh Pharmacy Board remains fully
immersed in the transitional activities for the
Society, working alongside our colleagues
in England and Scotland and, ensuring
at the same time, our core business is not
disrupted. This is a tough challenge but we
are making progress and taking the steps
needed to ensure the new PLB supports all
its members in Wales and plays a significant
role in supporting you, advancing your
career, raising the profile of pharmacy, and
developing the profession as a whole.
‘Change always comes bearing
gifts 1 ’
I strongly believe that we should all embrace
the change ahead and the opportunities that
will inevitably arise from the transfer of the
Society’s current regulatory functions to the
General Pharmaceutical Council and in the
formation of the new PLB.
So what’s in it for pharmacist members
in Wales? This is, of course, the crucial
question that I regularly hear from colleagues
across Wales, but before I touch on this
and outline some of the key challenges for
the Welsh Pharmacy Board, I think it is
important to contemplate how the pharmacy
profession could develop if there were no
professional body to represent and advocate
on its behalf.
Who would stand alongside you
throughout your career, helping you develop
your skills, offering you advice to help you
in your daily work, and providing practical
guidance for those who wish to return to
practice?
Who would develop the practice guidance
to support you in delivering services with
confidence? Who would represent the
profession as a whole in government and
policy circles and influence longer term
issues and sustainable change?
Who would protect the profession
when professional values and practice are
threatened? As these questions are raised, I
believe it becomes increasingly clear that as
a new body, free of its regulatory functions,
the PLB will be the one body that can
provide all of these important benefits and
will put your interests at the heart of its role.
We have set out our commitments to our
members for the immediate future and I can
provide assurances that the Welsh Pharmacy
Board is taking action to fulfil our promises
to you.
A One-Stop-Shop for Pharmacist
members in Wales
Developing a one-stop-shop for all your
professional support needs in Wales is
one of the key challenges for the Welsh
Pharmacy Board but will inevitably be one
of its key benefits for you.
Over the next 12 months we will be
working hard to improve upon and tailor
our services to your particular needs.
Whether this is supporting your professional
and personal development needs, helping
you achieve advanced and specialist levels
of practice, or campaigning for change to
improve your daily practice, the Welsh
Pharmacy Board will be listening to you
and positioning itself in Wales to take action
on your behalf.
Localising support
I believe that, for Wales, one of the key
benefits of the new professional leadership
body will be the increased localisation
of support and close contact with the
profession that will develop as a result
of strengthening the role of the Welsh
Pharmacy Board. As we move forward,
the Welsh Pharmacy Board will have more
responsibility for delivering the change and
improvements for pharmacists that members
in Wales wish to see.
The Board will also have more
opportunities to listen to you, work with
you and for you. The development of
Local Practice Forums (LPFs) will be an
important vehicle for making this happen
and will offer significant opportunities for
meaningful engagement between the new
PLB and pharmacist members from all
sectors across Wales.
In Wales we are already making good
progress to ensure all of our members will
have access to an active or virtual LPF by
April 2010. We are working with several of
the existing branches, such as Gwynnedd
and Clwyd in North Wales, which are
taking an active interest in building upon
their current strengths and developing new
professional networks.
We have been sharing our vision with
branches across Wales and outlining the
support we can provide in helping our
members to establish LPFs and I am
personally encouraged by the positive
response to this across Wales. While there
is a great deal of work ahead to establish
seven LPFs, coterminous with the new Local
Health Board boundaries, I am confident we
will develop a strong professional network
across Wales, capable of and empowered
to improve and advance your professional
practice.
Taking a pioneering approach
It is a privilege to lead the Welsh Board and
represent the pharmacy profession in Wales
through this important time of change but I
believe it is equally important for us all, as
pharmacists, to take a proactive approach
to influence the future shape of our new
professional leadership body.
Signing up as a pioneer for change, via
the RPSGB website, offers this unique
opportunity and it is encouraging to see that
members in Wales are taking action and
getting involved. I would still encourage
more pharmacists to get involved, however,
to ensure the new professional body is
built around the needs and aspirations of
pharmacists and is truly representative of the
pharmacy profession in Wales.
‘Be the change you want to see 2 ’
The current process we are going through to
establish your new professional leadership
body offers all pharmacists the unique
opportunity to get involved. There is no
doubt that the months ahead will be a
challenging time for establishing a modern
and dependable PLB for pharmacy but we are
committed to getting it right for our members.
The Welsh Pharmacy Board and the
Society staff based in Cardiff have a
daunting task ahead but they cannot make
the changes alone. I cannot emphasise
enough the need for pharmacists in Wales
to grab this opportunity and be a part of
developing the new PLB. You can influence
the change you wish to see and, as Chair of
the Welsh Pharmacy Board, I look forward
to working with you to tackle the challenges
ahead for Wales. n
1 Price Pritchard; 2 Mahatma Gandhi
Pharmacist Prescribing
in Wales strides on
FuRTher steps are being taken by
the Welsh Pharmacy Board to work
in partnership with the Royal College of
Nursing to help strengthen the infrastructure
for non medical prescribing in Wales. An
agreement was recently made to
hold a joint conference early
in the New Year to ensure
engagement with Nhs
senior managers in order
to raise the profile of non
medical prescribing and
outline the benefits for
patients, health professionals
and Nhs service delivery. This
follows a successful symposium
on non medical prescribing held in April
this year.
As the first collaborative venture between
RPsgB and RCN in Wales, the symposium
successfully captured the views of both
pharmacist and nurse prescribers on the
positive aspects of prescribing and the
existing barriers to practice. The event also
provided a useful forum to explore how non
medical prescribing can be further developed
and strengthened in Wales. The outcomes
of the day clearly pointed to the need
for engagement with key decision
makers in Wales and holding a
conference with Nhs senior
managers forming a key
part of that work.
The conference will
be fully endorsed by the
National Leadership and
Innovation Agency for
Healthcare (NLiah) which
has indicated its support for
non medical prescribing in delivering
multidisciplinary models of care. The
conference will be held at an important time
in Wales, following Nhs reorganisation, and
will provide the opportunity to explore the
ways in which non medical prescribing can
be fully integrated into key Nhs plans. n
Respiratory medicine expert in the spotlight
An interactive CPD seminar providing
clinical training on the day to day
management of respiratory disease was
enthusiastically received by pharmacist
prescribers in September. Led by Professor
Dennis Shale, a leading figure in the field of
respiratory medicine, the seminar provided
an opportunity for prescribers to look at
a range of real clinical case scenarios and
discuss appropriate courses of action.
The evening seminar, held on September
22, was organised following the success
of a pathfinder CPD event for pharmacist
prescribers initiated by the Welsh Pharmacy
Board earlier this year. The event, which
benefited from a non restrictive educational
grant from Astrazeneca, was well attended
and created a real buzz of enthusiasm
among the prescribers in attendance.
Plans to hold further events to meet the
learning needs of pharmacist prescribers are
currently being discussed. n
Responsible Pharmacists’ roles clarified
The Welsh Pharmacy Board in partnership with the WCPPE staged no fewer than 10 events in
September to outline the key aspects of the Responsible Pharmacist regulations. The events were
well attended by pharmacists eager to understand the full implications of the new regulations,
issued by the Department of Health and which came into force on October 1 this year. n
14 Pharmacy Professional | November 2009
November 2009 | Pharmacy Professional
15

f e at u r e b o d y l a n g u a g e
Gesturing
for success
Matt Guarente asks two leading
experts a simple question – how do
you use non-verbal communication
to really engage with customers?
There are many, many clichés surrounding the whole issue of
what we communicate without even opening our mouths. And there
are many, many misconceptions too. But right at the core of our
behaviour when we meet another person is a whole world of signs, ‘tells’
and cues that help us, whether we know it or not, engage with them.
As a pharmacist, you have a special set of issues to deal with –
sensitivity to potentially delicate medical matters, differences in how
personal information is revealed among different cultures, and also the
simple – and possibly broader issue – of increasing sales.
We all understand, and react to, non-verbal communication probably
without realising it. We know when someone is embarrassed when they
go red, or that they will gesticulate more under stress. But how do you
counteract those reactions and even defuse them? And how do you
encourage people to align themselves with you – so they communicate
better in return.
Our body language experts highlighted four key areas below that might
help pharmacists to communicate more meaningfully with their customers.
They also put to rest some myths about the subject. For example, looking
down isn’t necessarily lying – it is more likely to be a visual ‘tell’ of
brain activity, in this instance accessing dialogue-based memory – and
looking upwards tends to be visual memory. But even here, there is some
complexity. “Ask someone how they feel about something and their eyes
will likely go down and to the right,” says Martin Phipps, one of our body
language experts. “Ask them to make a choice, and it will be down and
left.”
Body language can be complex, but it can also be simple – both to
decode, and also to use to your advantage.
How do you do it? Well, it will require a little thought, and some work.
It might help if you first look critically at how you typically encounter
a customer. Even some basics, like having to address someone across a
counter-top, can create barriers. And in consulting rooms or booths, what
is your body attitude like – is it defensive and closed, or is it open and
welcoming, helping the customer to therefore open up to you?
It’s essential you read body language in context with the situation and
in a sequence or pattern - not just seeing one instance on its own and
thinking, ‘that must mean X’. And if you only take away one thing from
this article, it will be to hold eye contact with people, and smile.
Æ
16 Pharmacy Professional | November 2009 November 2009 | Pharmacy Professional 17

f e at u r e b o d y l a n g u a g e
The eyes have it
Counter culture
Closed out?
You need hands
We all know that eye contact is essential – but
that there is the right time and place, and the
right length of time to gaze into a stranger’s
eyes without feeling a bit odd about it.
Jonathan Pope, who is in charge of the
delivery of presentation and training courses
at consultancy Bladonmore, says the big issue
with eye contact is about timing.
“The key is to have eye contact at the end
of what you are saying – drifting off at the end
is bad and looks like you’re not bothered. Also,
check to see what reactions what you’re saying
has – stopping and looking at a person has a big
impact.”
Eye contact is held longest by the listener.
A UK study showed as much as 75% of the
time a person is really listening will be using
eye contact, but it’s changing because of the
cultural melting pot says body language expert
Robert Phipps. “This makes body language
a very specific thing which is a minefield to
generalise in – a young woman might come
into the pharmacy and not engage in any eye
contact for no other reason than because it is
not culturally appropriate.”
Bladonmore Europe: www.bladonmore.com
For more on Robert Phipps, see www.robertphipps.com
The environment you work in is often not
terribly conducive to really engaging with
people. At times, of course, the actual physical
barrier can be a useful reinforcement of the
notion that there is a ‘specialist’ and a ‘civilian’
in the exchange and the separation of the
counter can help in keeping the exchange
professional and efficient.
But the counter can also be a prop – to be
more casual, you can lean on it with one hand,
which will tend to incline your head which
is an excellent non-verbal communication
which says ‘I am listening, and empathetic.’
Of course, people often put their prescriptions
down on it too – and you also have the ability
to use ‘props’ like the scrip or even product
packages and literature to help you. But don’t
let them be a distraction.
“Just as in a presentation, where people
will use the PowerPoint projection as a way
of avoiding contact with others, some people
will use props – in this case, diving into notes
or packaging, as an excuse to look away or cut
engagement,” says Bladonmore’s Pope. “Don’t
do it – use them to help you.”
It’s a comedy show cliché of bad service to
see a shop assistant, waiter or barman standing
with their arms folded and one shoulder
slouched. And while you would probably never
do it when facing customers – what if they do
it back? “People faced with anything difficult
close off their own body posture,” says Phipps.
“They put their hands on top of each other, or
they close their arms up or cross their arms.”
People do things naturally with the things
around them, like clicking pens or playing with
glasses. But these are all useful – for example,
putting glasses on gives an authoritative look,
while removing them says that you are now
making a conscious effort to be more open
and empathetic. It’s the same with a pen – use
it for gesture when you are speaking, but put
it to your mouth when you want the person to
respond – you are not expected to talk if the
pen is in front of your mouth.
“Use active listening points,” says
Bladonmore’s Pope. “Demonstrating back that
you hear what is being said, repeating some
of the words and phrases in your response,
nodding, and giving encouragement like ‘uhhuh’
all give good signals that you are engaged
and listening. It’s important for me, as the
speaker, to see you’re getting it.
No, not just for holding a little baby, but for
really engaging with people and helping sales,
too.
When you are giving out information about
products, for example, “use your right hand for
these gestures,” says Phipps. “When you want
feedback, encourage it with left-hand gestures,
it’s to do with how the left and right side of
the brain functions. For example, you assess
and filter with the left side, so it’s important to
help out the brain (of the recipient) to present
information in the right format.”
There are behavioural patterns, called
anchors, and everyone has thousands in them
already – for example, if you ask a child about
ice cream, their eyes will get bigger. If you can
recognise some of these then you are on the
way to better communication.
Using touch and feel can even help the
bottom line, by going for what sales gurus call
the ‘puppydog close’. “If you get a puppy in
your hands, it’s hard to say no,” says Phipps.
So encourage people to “try it, feel it, hold it in
your hands, and if you don’t like it I can take
it away – but the more they can see, feel and
touch something the more happy they will feel
with it,” says Phipps. “It makes people much
more intimate with what they’re buying.”
18 Pharmacy Professional | November 2009
November 2009 | Pharmacy Professional
19

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Makes a
great gift
Retail pharmacies
provide high-price items
for nothing to customers
who thus do not value them
and sell low-price items that
consequently look comparatively
costly. If the cost to the Nhs of
dispensed items was printed on
prescriptions customers might
better appreciate their medicines
and understand where their
taxes have been going. The price
would probably shock that vast
majority of patients who do
not have to pay even £7.20 for
their prescriptions but it would
suddenly make everything else in
the shop look better value.
The £10bn a year pharmacists
receive for Nhs work dwarfs the
£3bn revenues from Otc and
other medical products, but for
the paying public, it is the price
of the non-prescription items that
hits their pockets and which they
purchase carefully.
Of the many reforms suggested
for the health service, telling
customers the cost of their
medicines is not one, but the
more the price of healthcare is
discussed – not only in Britain,
but in the United States, where
the argument is so loud it is being
heard in the UK – the more the
public will value items that they
have no idea whether they are
worth a few pennies or many
pounds. Nhs users not only have
no inkling of the cost of what
they consume, few even wonder.
To many, pharmacies are like a
sweet shop without prices, and
while the customers keep coming,
they fail to appreciate the wares.
When the pharmacist looks
out at the rest of the high street
he sees outlets that have to slash
prices to counter the recession. At
least pharmacies have weathered
the slump better than many of
those neighbours. Prescriptions
that are free are not price
sensitive. If anything, recession
makes more people ill and brings
more people into the free service.
Exceeds inflation
The revenues received by retail
pharmacists from the Nhs
have doubled over the past
decade, according to Verdict, the
retail analysts, compared with
a one-third increase in Otc
and other medicines. That well
exceeds general inflation, even
if price cuts have tempered the
recent growth. Big-ticket items
like furniture and white-goods
that have been hit hard by the
recession but small items are still
selling – indeed pharmacies offer
many substitutes for the luxuries
shoppers can no longer afford.
Health and beauty products
will be second only to food and
groceries in growth this year,
says Verdict, which is forecasting
a 2.7 per cent rise in sales when
the whole retail sector will fall
0.6 per cent.
“Historically, health and
beauty has proved resilient in
a recession,” say the analysts,
citing the 1990-92 slump. “It
offers customers the opportunity
to indulge in luxury products at
relatively low prices, providing
them with a sense of wellbeing in
difficult times.”
That’s no grounds for
complacency though, especially
for pharmacies squeezed on other
fronts, not least by supermarkets.
But it provides a relatively strong
base for exploiting opportunities
created by recession including,
for the brave, expansion.
The pharmacist who surveys
the neighbouring shops on his
parade probably sees units where
the Sale signs on the windows
have been covered by Closing
Down signs. The more shops
that close, the more highstreets
risk becoming deserts.
Each closure threatens to cut
footfall, but each closure is also
a potential opening: pharmacy
owners should ask which
items previously sold in those
shut-down units could be sold
from their own premises. Much
of what Woolworth sold, for
instance, could sit comfortably on
a chemists’ shop’s shelves.
Wise owners will decide which
wares fit their image or can
benefit from the premium value
of being bought from an outlet
associated with health, quality
and specialist sales staff.
Indeed that should be the
criterion for adding new stock.
Does it capitalise on the goodwill
associated with pharmacies?
Does it get customers in to buy
other things? Items from cleaning
materials to toiletries – where
there is a perceived premium for
a product associated with hygiene
or health – are potential additions
to the range on offer, for instance.
Ageing population
Wise owners will also look at
both local and national markets.
They know who their customers
are but need to think which
people are not visiting their
shop – and why. But while
independent pharmacies may be
losing market share, the market
is expanding to compensate.
The demographic of an aging
population adds 5 per cent a
year to dispensing volumes, says
Verdict, but those people are
becoming wealthier as well as
older. It makes sense to target
that group with, say, skincare
products, whose sales grew 6.6
per cent last year and account for
one pound in eight of health and
beauty spending. More working
women means more people with
the money and the wish to buy
high-value skincare, but other
trends work in pharmacists’
favour too, with men’s toiletries
the fastest growing sector of
health and beauty for the past two
years.
And the independent
pharmacist has a flexibility
impossible for bigger chains. So
increase the sun cream displays
during heatwaves or take the
flu packs off the back shelf
during winter to catch impulse
purchases. The independents
cannot mount marketing
campaigns like the chains, but
they can piggyback on their
promotions, putting out the
products the bigger rivals have
expensively advertised. Firms
with big budgets can enlarge the
market but small retailers can
take their share.
If customers knew the value
of the prescriptions they pick up
at pharmacies they might realise
they are better off than they think
and have the confidence to spend
more. Running a retail outlet is not
easy but other high-street traders
have been hit harder and have
neither resources nor inclination
to grow. The opportunities are
there for those pharmacists ready
to take them. n
l Richard Northedge writes
for the Spectator, Wall Street
Journal, Independent on Sunday
and other publications. He was
Deputy City Editor of the Daily
Telegraph for 12 years and
Editor of Sunday Business.
November 2009 | Pharmacy Professional
21

a p h a r m a c i s t ’ s l i f e i n a WA r z o n e
Pharmacist on
the front line
Work clothes are khaki fatigues and
transport’s often a helicopter, Jeff Mills
meets the Army’s senior pharmacist
An anonymous-looking Ministry of Defence building in
central London and I am being escorted through the high-security
doors and up in a lift to an open-plan office, much like any other
to be found in this part of the capital.
There are few uniforms to be seen here, deep in the headquarters of the
Surgeon General’s empire. But many of the personnel are no strangers to
military attire, whether it be the formal clothing of a grand dinner in the
officers’ mess or the fatigues of the battlefield.
Certainly that is true of the woman I am here to meet, Lt Col Ellie
Williams, not only a very senior officer but also one of the top pharmacists
in the Army.
Today she may well be wearing civilian clothes, giving her the look of
maybe a corporate lawyer or one of the more successful bankers, but make
no mistake; Ellie Williams is no stranger to the various theatres of conflict
around the world where UK troops find themselves.
Originally from Wigan in Lancashire, Ellie trained at Brighton
Polytechnic before registering as a pharmacist in 1990 after a preregistration
year at the Royal Albert Edward Infirmary back in Wigan. She
then took a job as Resident Pharmacist at the Derby City Hospital, where
she also gained a University of Wales College, Cardiff (UWCC) Diploma
in Clinical Pharmacy.
Æ
Hot spot
Lt Col Ellie Williams
on duty overseas
22 Pharmacy Professional | November 2009 November 2009 | Pharmacy Professional 23

a p h a r m a c i s t ’ s l i f e i n a WA r z o n e
High flyer Ellie Williams tries a Hercules for size
After this she moved to the John
Radcliffe Hospital in a clinical
pharmacy role, with a special
interest in healthcare of the elderly.
It was while she was here that
Ellie converted her diploma into
an MSc, with a dissertation on
“A Multidisciplinary Approach to
Discharge Planning”, graduating in
1995.
Clearly already a high flyer, Ellie
became Deputy Chief Pharmacist
at the Radcliffe Infirmary,
where she was responsible for
training the diploma students in
such specialities as neurology,
ophthalmology and endocrinology.
But exciting as this work clearly
was, an even bigger adventure was
obviously calling, so off went Ellie,
to join the Army.
February to June 1997 saw Ellie
on the Officer Entry Course at the
Royal Military Academy, Sandhurst
which included the Professionally
Qualified Officer Course, which is
a bit shorter than that mainstream
officers have to endure. And then
she was well and truly on the
promotion fast track.
After Sandhurst it was off to the
Medical Supplies Agency, but not
before she had risen to the rank of
Captain. Then the following year
she was off to Split in Croatia as
Officer in Charge (OIC) of the
Medical Provisioning Point.
“This was the central medical
logistic point providing all
medicines and medical equipment
to the troops in Bosnia as part of
Operation PALATINE,” she says. A
peacekeeping mission and therefore
less risky than it may otherwise
have been.
Ably supported by
‘Victor’, a blunt-nosed
viper who lived in the
bushes outside my office
“I had opportunities to
accompany medical equipment,
flying in Chinook and Sea King
helicopters and I saw field medical
treatment facilities, including the
British Hospital, for the first time.”
A job in Cyprus followed, where
Ellie found herself posted to RAF
Akrotiri, as Officer in Charge of
the Medical Distribution Centre for
British troops in Cyprus. “It was
the same sort of job as in Bosnia
but with much more sun and with
plenty of different opportunities,”
she says. One of the challenges was
turning around the warehouse so
that it was awarded a Wholesale
Dealers Licence (WDL).
“Part of WDL requires a
warehouse to have a pest control
programme,” Ellie relates. “Ours
was ably supported by ‘Victor’, a
blunt-nosed viper who lived in the
bushes outside my office. Sadly the
local gardeners did not appreciate
his usefulness and he came to an
untimely end”.
Dealing with snakes aside,
the real job here also involved
providing medical supplies for
four army medical centres, not to
mention the odd passing Royal
Navy ship.
But how many pharmacists can
boast their job also involved flying
in a Red Arrows jet, a Tornado and
a Sea Harrier, as well as going to
sea on board a Type 42 Destroyer
and taking part in a three-week
adventure training exercise which
included diving off Ascension
Island? Ellie Williams can!
It wasn’t all sunshine and diving
though. During this time Ellie also
found herself deployed for three
months to Operation AGRICOLA in
Kosovo as Officer in Charge of 84
Medical Supply Section. “The base
was in a large warehouse where we
had to sweep the snow out in the
mornings,” she says.
“We were there for the
Millennium celebrations and,
knowing we had links to medical
gas providers, we were asked
by colleagues if we could obtain
helium cylinders for balloons at
the troops’ party at Horseshoe
Lines. We could and it arrived on
December 31, just in time for the
celebrations”.
Drug testing
Yet more promotion, this time to
Major and a posting to 5 General
Support Medical Regiment
came next, followed by various
deployments in Kenya (vaccinating
locals in the Masai Mara amongst
other things) and Sierra Leone
(including a spell training that
country’s military police in drug
testing techniques).
Operation TELIC, otherwise
known as the conflict in Iraq,
brought its own set5 of challenges
for Ellie Williams when she was
posted there to provide medical
support for 1 (UK) Armoured
Division.
“My original wartime role had
been taken over by the Royal
Logistic Corps but in order to assist
with expert advice I was detached
to the Logistics Headquarters of 1
(UK) Armoured Division, where I
worked closely with medical and
logistic branches to help ensure
medical supplies were delivered in
time.
“This included two morphine
autojets per serviceman and
antimalarials. Temperatures reached
over 50 degrees celsius, which
makes storing and transporting
pharmaceuticals much more
complicated,” she says.
The action of Iraq was
eventually replaced by another
spell in the UK with a number
of postings including the
Army Primary Healthcare
Services, as Regional
Pharmacist for the
Wessex Regions, based in
Tidworth, where she was
responsible for overseeing
pharmacy services
for around 14 primary
healthcare medical centres. There
was an Intermediate Command and
Staff Course and a staff post at HQ
Northern Ireland, overseeing the
provision of medical services to
troops deployed there.
Another spell of duty in Iraq saw
Ellie involved in the massive task of
relocating the military hospital from
Shaibah to the airport, made even
more difficult as she and her team
were mortared on a regular basis.
And it was over Christmas, too!
Promotion to Lt Col came in
March 2007 and with it a role
overseeing pharmaceutical services
right across UK-based public
healthcare facilities.
But let’s not forget the small
matter of a deployment to
Operation HERRICK, better known
as the conflict in Afghanistan, over
Christmas once again, and a spell
at the new trauma hospital in Camp
Bastion.
“This wasn’t like the old tours,
I never left camp, for very good
reasons,” Ellie recalls. Though,
understandably perhaps, she
chooses not to go into too much
detail of what was clearly a taxing
posting, not least working with
RAF medical staff to try and
improve medication for troops
being evacuated by air back to the
UK.
It wasn’t without the odd smile,
however. Such as the time Ellie
was asked for her advice on a
particular medicine. “I had a call
from a vet asking if it was true
that Doxycycline can cause loss of
smell?”
It was just as well he asked. The
animal he wanted to prescribe it for
was an explosives sniffer dog! n
Congratulations
Ellie Williams presents
Staff Sergeant
Richard Chapple
with the Pharmacy
Technician of the Year
“Professional” award
at an Army pharmacy
conference
How to join
the Army as a
Pharmacy Officer
Pharmacists can apply to
join the Royal Army Medical
Corps (ramc) after either their preregistration
training year or a period
of work as a civilian pharmacist. You
must be registered with the Royal
Pharmaceutical Society of Great
Britain.
The first three months of service
are spent attending the Entry Officers
Course, which includes a programme
of training in military skills at the
prestigious Royal Military Academy
Sandhurst. The course has a large
practical element in preparation for
your career and you will also learn
about the behaviour and self-discipline
of an officer, and will be expected to
act with integrity at all times.
Officers are expected to master the
same basic military skills and tactics
as soldiers. This will include drill, basic
fieldcraft, map reading, first aid and
how and when to fire your personal
weapon, although the ramc is not
a fighting arm, and its officers and
soldiers may only use their weapons
in self-defence.
In addition to soldiering skills you
will also learn the skills required
to become an officer, and how to
exercise command. As well as all the
skills you would learn as a civilian
pharmacist, you will gain a wide
range of military-specific experience,
particularly in medical logistics.
You will then learn about the
operational role of the ramc at the
Defence Services Training Centre in
Ash Vale, Hampshire, and undertake
a short attachment to the Medical
Supplies Agency to learn about
specialist pharmacy and medical
logistics skills. n
For more information go to
www.armyjobs.mod.uk
24 Pharmacy Professional | November 2009
November 2009 | Pharmacy Professional
25

f e at u r e t h e b i g r e a d
Fat chance?
In April 2009 Alli, the over-the-counter dosage of
orlistat, was launched in a huge push to consumers
who might benefit from its fat uptake-limiting
properties. Six months on, Pharmacy Professional
writers ask – what has been the impact?
YOU can probably blame
the Press. In the same way
that papers will add ‘-gate’ to
any scandal in a vain attempt
to imbue their story with the impact and
importance of Watergate, so the ‘War
on…’ headline has been reliably rolled
out – especially with reference to any of
society’s many ills.
Indeed, “war on obesity” was used
more than 220 times in UK national
newspapers in the last three years. But
the shouty headline could, this time,
be justified. Figures out just before
Pharmacy Professional went to press
indicated that primary care trusts might
have to allocate as much as £6.3bn a
year to battle obesity by 2015, while a
government Foresight report in 2007 put
the broader economic impact of 50% of
the population being obese in less than a
decade at a further £38.5bn a year.
It’s not surprising that the big
pharmaceutical companies have been
targeting weight-loss drugs. First,
consumers want science, as opposed to
the dubious merits of wonder-berries
and crushed shell fat absorbers. Æ
26 Pharmacy Professional | November 2009 November 2009 | Pharmacy Professional 27

f e at u r e t h e b i g r e a d
Second, the market is growing.
A July 2009 report by Datamonitor
estimates that in the seven most
developed consumer markets there
are 125m obese adults, and the
prospect of serving those adults with
a regular or repeated treatment opens
up the possibility of blockbuster
drugs that will dramatically affect
corporates’ bottom lines. Datamonitor
puts the annual market value for
an effective anti-obesity drug, in
these key markets, at $10bn and
extrapolating to the overweight (as
opposed to clinically obese) as well as
moving the geographical limits would
easily double, and could quadruple,
this estimate.
But prescription anti-obesity
drugs have had a chequered history
at best, with a series of highly
publicised scares followed by product
withdrawals. Alli is the first OTC
medication but is itself a smaller dose
of a prescription medication, orlistat,
that has been available for years.
Orlistat was developed by Roche
but when prescription sales failed to
set the world on fire GlaxoSmithKline
stepped in and acquired the rights to
market the OTC version, which was
launched in the US in the summer of
2007. It was one of the first ‘switch’
drugs to be allowed by the US Food
& Drug Administration, and the basis
of their approval was that orlistat acts
At the time,
market analysts
forecast annual
sales of as much
as $500m in the
US market
in the intestine, inhibiting the uptake
of dietary fats, rather than in more
complex organs where side-effects
might occur. At the time, market
analysts forecast annual sales of as
much as $500m in the US market.
Fast forward to August, 2009.
Alli has been launched in the UK,
with a massive education and
marketing push that saw thousands
of pharmacists receive briefings from
GSK, not to mention flashy display
stands and heavy support from print
and TV advertising. It should have
been a significant money earner for
pharmacists, who had all the tools and
support to help clients understand and
use the drug appropriately.
However, damage from the
bulletin board rumour mills, which
had always focused on the side
effects of Alli, including wind and
rather more embarrassing issues,
were compounded by an FDA
announcement that it was reviewing
complaints that orlistat had caused
liver damage in patients, citing 32
cases between 1999 and 2008.
GSK says Alli has been rigorously
tested and is safe. And, it has always
been completely open and honest
about the effects that social media
sites, bloggers and board posters were
commenting on – if you ‘bust’ the
diet by eating a fatty meal, there is the
possibility of diarrhoea. The solution is
– don’t bust the diet. If you’re having
a celebration meal or just have to have
that tub of ice-cream, lay off the Alli.
But whatever the problems,
it looks like Alli, as with its
prescription precursor, is not going
to sell anywhere near the analyst
predictions. US sales according to
trade magazine Ad Age in 2008
were $131m, while the company
spent $96m on ads. Revenues from
WeightWatchers Inc. in the same year
were $1.54bn. European sales have
kicked in now, however, and GSK
reported £82m worth of global sales
n the second quarter of 2009 with
more than half attributable to Europe.
Again – to put it in perspective, they
sold £109m worth of Lucozade…
Pharmacy Professional has
surveyed a range of pharmacists
and other healthcare
professionals for their views.
There was a rush of interest
at first…
Richard Evans
Locum pharmacist, West Wales
“From what I’m seeing, it’s just not
hitting targets.
“Alli is not the answer on its own,
you have to do the full package. It’s
not the be all and end all – it’s part of
a lifestyle change and it won’t do the
job all on its own. It’s like nicotine
patches – if you’re not willing or
ready to give up the fags, don’t bother
to start
“People are asking for the pill who
don’t hit the criteria, who have a BMI
of much lower than 28, in many cases
you simply have to look at them to
know that they’re nowhere near the
criteria BMI.”
Another issue, said Evans, is price.
Although GSK is at pains to point out
that there is a network of support, a
booklet and other material that comes
with the medication to help with
weight loss above and beyond the drug
itself, the practical cost of a course of
Alli is £2 per day. “There was a rush
of interest at first, but a lot of people
did say ‘oh, that’s expensive’.”
You really have to see what
makes people tick
Shahrad Taheri, consultant
endocrinologist at Birmingham
Heartlands Hospital and clinical
director of its obesity clinic
“Anything a patient does is positive.
If they can independently access a
medication, and follow the lifestyle
changes, that’s positive. But if they
don’t, and it’s yet another thing that
doesn’t work, then that can be a big
disappointment.
“There really is no silver bullet
and the problem is that patients have
very big expectations, but you’ve got
to be up for it. Expectations are too
high, people look at celebrities who
have been successful but they HAVE
changed their mentality and the tablet
is a springboard.
“Pharmacists have a really
important role to play but the problem
is that weight management is very
time-intensive and you really have
to see what makes people tick before
you can help them.
“A lot of people have not got the
message that it’s the same drug –
orlistat – and when you tell them
what it is, they say ‘oh, no, I tried that
and didn’t like it’.
“The message that drug companies
have to learn is that this isn’t a
treatment you can get into the water
system – you have to have the right
treatment for the right patient at the
right time. The issue with orlistat
is that it’s not like a blood pressure
tablet, which you take and blood
pressure goes down, simple: there’s
more to it.”
Alli is a real opportunity –
not a magic bullet
James Hallatt, General Manager
GSK Consumer Healthcare UK:
“Obesity and overweight are a major
concern of our society and people
need help. Alli offers a clinically
proven way to help people lose
weight. It is not a magic bullet – users
must be committed to weight loss;
Alli, when added to a reduced calorie,
lower-fat diet, can help people lose
50% more weight than dieting alone.
“Alli represents a real
opportunity for overweight
and obese people to benefit
significantly from
professional pharmacy
intervention. GSK is
committed to ensuring
pharmacy staff not
only feel comfortable
and confident helping
people lose weight with Alli, but also
that pharmacists can make the most
of the exciting business opportunity
the launch of Alli presents.”
Alli allows you to build the
relationship
Marc Donovan, pharmacist at
Boots in Cardiff
“We see it as a great opportunity
to provide enhanced advice around
weight loss. As a pharmacist I’ve
been involved in weight management
advice for years, and I have noticed
a whole lot of improvement and
engagement within the profession,
With Alli, I’ve undergone training,
but it’s not just the medication itself
– it’s around weight loss and an awful
lot of people who have tried to access
the drug, and not been eligible for
whatever reason, we’ve been able to
counsel them about other ideas, such
as healthy eating.
“My advice has been to suggest
people adopt a low-fat diet, then start
on the product, I think it’s significant
to give lifestyle advice, rather than
here’s the product, go away.
“It’s difficult because people
do have the right to self-diagnose
and ask for certain products off
the back shelf but, especially with
Alli, we have to ask ourselves is
it suitable for them? If you don’t
have engagement on the possible
side effects, it’s likely they won’t
continue, and the side effects get
the better of them. You need to
build a relationship and Alli allows
that – there’s not many products that
do. But it allows us to help patients
make the choice – pharmacists need
to meet the challenge, and patients
appreciate that pharmacists have a
role to play.”
People were intrigued, but
things have levelled out
Mitesh Soma, founder, Chemist-
Direct.co.uk
“We sell a range of products targeted
at weight management, most of which
are supplements, and Alli is the most
popular. At launch we did see a surge
in sales, when it was marketed heavily,
I think people were intrigued to try it,
but things have levelled out and now
it’s a small percentage of our sales.
What about those who use internet
pharmacies to bypass pharmacistchecked
criteria?
“RPS registered pharmacists look
at every order. We ask the right
questions, we look at things like
previous purchases, and if we have
any reason to suspect someone is
buying who shouldn’t be, we can and
do decline the sale. We contact them
to say why and suggest that they see
their doctor to get further help.
The only real issue is the
BMI confusion
Locum pharmacist, West
London (name withheld by
request)
“When it first came out, and I talked
to customers about it, the only issue
was urgent rushes to the loo – but
then after a week, maybe they got
used to the routine, and they were
fine, no problems and there were lots
of repeat sales.
“The only real issue was a
confusion over the BMI required to
be eligible for the drug. Many said
‘Look, 25 is overweight,’ but I was
always very strict that the minimum
BMI had to be 28 – and that’s the
RPS guideline, and that’s the limit
that was set under the licence. But
customers said ‘Oh, other pharmacies
give it to me.’ I think that this has
been an issue – if the BMI hurdle was
25, an awful lot more would be sold.
“When it first was made available
as an OTC drug, I was working in
Kensington and the first week was
amazing. People queued out the door,
buying three or four big packs at a
time and the price was not an issue.
“But I really don’t see many people
buying it now – I think the last time
I did a consultation and someone
bought it was two weeks ago.” n
More information
The Royal Pharmaceutical Society of
Great Britain provides clear guidance
to pharmacists for the OTC orlistat
treatment on
http://www.rpsgb.org/pdfs/
otcorlistatguid.pdf. The issues
surrounding a change of diet,
managing weightloss expectations,
side effects and how to limit them, and
also guidance on who is included in the
marketing authorisation are all covered.
28 Pharmacy Professional | November 2009
November 2009 | Pharmacy Professional
29

p h a r m a c y t H E p o l i t i c i a n s ’ v i e w
Building on strengths
Prime Minister Gordon Brown used his letter to delegates
at the British Pharmaceutical Conference to reinforce the
Government’s vision for the “essential profession” of pharmacy
High standards
Shadow Health Minister Mark Simmonds, Conservative MP for
Boston and Skegness, shares his view of the pharmacy profession
The pharmacy profession
is currently undergoing a
period of change. After years
of stability, over the next few months
we will see dramatic changes to
the regulatory and representative
structure of the profession, as well as
the introduction of the Responsible
Pharmacist Regulations.
I am supportive of the separation of
the General Pharmaceutical Council
from the Royal Pharmaceutical
Society and believe that it is right
that pharmacy, like other healthcare
professions, has a separate regulator
from representative body. This
separation should strengthen
the profession in the long run,
by ensuring a high standard of
practicing professionals and good
quality representation. However,
like many, I am concerned over the
restrictions of the use of the title
‘pharmacist’. I would like to see the
General Pharmaceutical Council
maintain a retired and non-practicing
register. Not only would this bring
pharmacists into line with other
healthcare professionals, it could also
be beneficial during outbreaks of
disease, such as swine flu, as former
or non-practicing pharmacists could
be easily identified and contacted,
should their skills and expertise be
required.
Adequate training
I am more concerned about the
Responsible Pharmacists regulations.
These oblige every pharmacy to
have a designated ‘Responsible
Pharmacist’ to ensure the safe and
effective running of the business.
Many pharmacists do not believe
they have had adequate training
prior to these regulations being
implemented, and I am concerned
that the designated ‘Responsible
Pharmacist’ may not be able to have
adequate rest breaks or could be held
responsible for issues that are largely
Ensure that
guidance to
pharmacists
is clear and
universally
understood
out of their control. I have called
for the Government to reassess and
reconsider these regulations to ensure
that guidance to pharmacists is clear
and universally understood.
Despite these ongoing changes,
I have no doubt that the pharmacy
profession is robust, and will respond
sensibly and professionally to these
reforms. It is therefore important
that all those involved in pharmacy
begin to turn their attention to how
the profession will look in 10 years
time. Increased technology, both in
terms of improved interaction with
other healthcare professions, as well
as increased automation of dispensing
may result in changes to the role of a
pharmacist.
Personally, I would like to see
a significantly expanded role for
pharmacies in providing additional
services, particularly in the field of
public health. As I travel around
the country I am often impressed
by the variety of services offered
by pharmacists, including vascular
checks, stop smoking clinics and
screening for sexually transmitted
diseases. In addition, pharmacists
are well placed to provide
healthcare information to their local
populations, both through faceto-face
conversations and use of
information technology, which allows
patients to print information relevant
to their own condition. Currently,
the majority of these services are
provided by enthusiastic pharmacists
taking the initiative; however I
would like to see more pharmacists
commissioned to provide these
services by the Primary Care Trust.
Services from pharmacists
Under a Conservative Government,
GPs would be responsible for
commissioning services, and I would
like to see them commissioning
further services from pharmacists,
where this would benefit patients. Not
only would this be cost effective for
the NHS, it would also be extremely
beneficial to the patients, particularly
hard to reach groups such as young
men who are more likely to visit
a pharmacy than a GP. I believe
that currently pharmacies are an
underutilised resource, yet they are
close to the communities they serve
and are well placed to help improve
the public health of the nation. n
30 Pharmacy Professional | November 2009 November 2009 | Pharmacy Professional 31

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Offer of free resource to overcome
language barriers in the pharmacy
T
hat
poor health literacy is a
subject that needs to be
tackled was raised in a recent
issue of The Pharmaceutical
Journal (26 September 2009).An
article (pp333–6) in that issue
discussed the evolving theory
on the topic and described several
types of health literacy. But,
in some cases, the most fundamental
hurdle to ensuring optimal
medicines use is
overcoming language barriers.
According to the National
Research and Development
Centre for Adult Literacy and
Numeracy, learners of English
Aconite
Recent news at a glance
Reports of a patient with kidney
problems and another with
paraesthesia after taking aconite
(monkshood) has led to the Medicines
and Healthcare products Regulatory
Agency warning against unlicensed
herbal aconite products.
COPD
Patients with chronic obstructive
pulmonary disease and given “triple
therapy” (tiotropium plus a long-acting
beta-agonist and an inhaled steroid)
attain an 11 per cent increase in FEV 1 ,
compared with tiotropium alone,
according to a study published in the
Robert J Erwin/SPL
The software can be used to construct simple images
explaining how and why a medicine should be taken
American Journal of Respiratory and
Critical Care Medicine (n=660). These
patients also report better ability to
carry out activities, improved symptoms
and fewer severe exacerbations.
Diabetes
Recommendations for adding insulin to
oral antidiabetic therapy have been
supported by a three-year open label
trial (n=708; New England Journal of
Medicine). Also in the field of diabetes,
a new add-on therapy for people with
type 2 diabetes is now available.
Saxagliptin (Onglyza) tablets are
licensed for use with metformin, a
sulphonurea or a thiazolidinedione. A
5mg daily dose inhibits dipeptidyl
peptidase enzyme 4 activity, resulting
in higher insulin and C-peptide
concentrations after a glucose load.
Emergency contraception
A new emergency hormonal
contraceptive is now available on
prescription. EllaOne (ulipristal) is
licensed for use up to 120 hours after
unprotected sexual intercourse. Side
effects are similar to those
experienced with levonorgestrel but
ulipristal may reduce the effectiveness
of regular hormonal contraception.
Multiple sclerosis
Administration of 20mg glatiramer
daily in patients with isolated
syndromes and brain lesions is
associated with a 45 per cent
reduction in the risk of developing
clinically definite multiple sclerosis
compared with placebo, according to
a study in The Lancet.
Rheumatoid arthritis
A new interleukin-6 receptor
antagonist infusion (tocilizumab,
RoActemra) has been launched for
patients with rheumatoid arthritis
who have not responded adequately
to or are intolerant of diseasemodifying
antirheumatic drugs or
tumour necrosis factor antagonists.
Prescribers in rheumatoid arthritis
now also have the option of a new
for Speakers of Other Languages
find it a challenge not only to navigate
the British health system but
also to understand medical instructions.
The NHS spends millions of
pounds each year translating its information
and employing interpreters
in an attempt to ensure
effective healthcare but such services
are not always available in
pharmacies and, no doubt, many
readers — not only those in inner
cities — have found themselves up
against a language barrier when
supplying medicines. However,
support is now available in a set of
antitumour necrosis factor injection,
certolizumab (Cimzia).
Vaccinations
Paracetamol to prevent vaccinationrelated
pyrexia in babies can reduce
antibody responses to several
vaccine antigens so should not be
recommended, according to a study
in The Lancet. However, the
researchers expect this effect to be
reduced if paracetamol is used to
treat established fever.
learning&development
These Learning & Development
pages are produced by The
Pharmaceutical Journal as an
exclusive benefit for members of
the Royal Pharmaceutical Society
Editor Lin-Nam Wang, MRPharmS
■ tel 020 7572 2413
■ e-mail LandD@pharmj.org.uk
November 2009 | Pharmacy Professional 33

L E A R N I N G & D E V E L O P M E N T
Produced by The Pharmaceutical Journal
COURSES AND RESOURCES
tools that can be used to convey, graphically,
instructions to patients where
needed.
For a number of years, the military and
emergency pharmacy section (MEPS)
of the International Pharmaceutical
Federation has been working on a project
to develop pictograms for pharmacists to
use to communicate medication instructions
to people with whom they have no
language in common or who are illiterate.
The project began in Gabon in 2005 and
after field tests culminated in the launch of
the free software this autumn.
Early work indicated that the best way to
communicate medication instructions was
to use a series of pictures to depict quantity,
dosage form, route, frequency, alcohol restriction,
food requirements (eg, dosing relationship
to meals) and child protection.
The software,World Health Pictograms, can
be used to generate pictographic instructions
to use for counselling patients when
supplying them with a medicine.
The researchers was also found that the
elements listed above fell into two broad
categories — those that are understood by
people of any culture or background (eg,
two tablets) and those requiring a culturally
specific content in order to be understood
(eg, the type of food that is eaten).
The software allows the user to select a
world region most suitable for a patient
and the pictograms available will be specific
to his or her culture.The user can also
select the language preferred by the patient.
The pictogram can then be printed
for use. On the printed sheet is an outline
of a human body so that the pharmacist
can make a mark to indicate what a medicine
is for.
“Language, education, age and even
culture may impact how people interpret
medical instructions. With something this
critical, it is important to help reduce the
possibility of mistakes,” said the project
lead Régis Vaillancourt, director of pharmacy
at the Children’s Hospital of Eastern
Ontario, Canada.
An introduction to the MEPS project,
the software and instructions for use
are available on the International
Pharmaceutical Federation website
(www.fip.org). — Lin-Nam Wang
CONTINUING PROFESSIONAL DEVELOPMENT
Understanding treatment of prostate cancer
Prostate cancer is the second most common cancer in men worldwide after lung cancer. In 2006, more than 35,000 men in the UK were
diagnosed with this cancer. Netty Wood explores its diagnosis and management and highlights the role of screening and treatments
Asking the pharmacist — questions from practice
Statins and coenzyme Q10
QI’ve been put on simvastatin and a friend
told me I should be taking coenzyme Q10
to help prevent muscle pain. Do I need it?
AMyalgia is considered to affect around 10 per
cent of people taking statins. Given that some
patients may have a tendency to overestimate the
risk of adverse effects, being able to provide
reassurance that nine out of 10 patients do not
experience muscle pain with statins can lay a
useful foundation for a discussion about coenzyme
Q10.
A number of factors are recognised as
increasing the risk of myopathy above baseline
levels and these need to be considered. Patientrelated
factors include: age over 80 years,
diseases affecting renal or hepatic function,
female gender, genetics (eg, polymorphisms of
cytochrome P450 or defects of muscle
metabolism), grapefruit juice consumption, high
alcohol intake, high levels of physical activity,
history of myopathy, untreated hypothyroidism,
low body mass index and recent surgery or
trauma. Treatment-related factors include highdose
What statin is therapy QRISK? and drug interactions (eg,
amiodarone, azole antifungals, ciclosporin,
diltiazem, fibrates [especially gemfibrozil],
macrolide antibiotics, protease inhibitors and
verapamil).
Inhibition of HMG-CoA reductase by statins
reduces the production of mevalonate, a
precursor of coenzyme Q10. On the basis that
coenzyme Q10 has numerous effects in
mitochondria, depletion by statins has been
suggested as a possible cause of myopathy.
Although some studies have shown statins lower
plasma levels of coenzyme Q10, others have
failed to show consistently that statins have the
same effect on Q10 in muscles.
A number of studies have assessed the
potential role of coenzyme Q10 on statin-induced
myopathy:
■ Patients with myopathy and taking statins
(n=32) were randomised to either coenzyme
Q10 (100mg/day) or vitamin E. After 30
days, those given coenzyme Q10 had
improvements of around 40 per cent in pain
severity and interference with daily activities,
compared with no change in those given
vitamin E.
■ Patients with previous statin myalgia
(n=44) were randomised to coenzyme Q10
(200mg/day) or placebo and followed for 12
weeks, during which time simvastatin doses
were increased from 10mg to 40mg.
Coenzyme Q10 had no significant effect on
either statin tolerance or myalgia.
■ Patients taking atorvastatin 10mg/day
(n=49) were given coenzyme Q10
(100mg/day) or placebo and the effect on
Robert Lerich/iStockPhoto.com
creatine kinase (the level of which may be
raised in some patients with myopathy) was
studied. Assessment at 16 weeks showed no
significant difference in creatine kinase
levels between the two groups.
It should also be recognised that patients
usually need to self-fund coenzyme Q10. At the
doses studied, supplements would typically cost
at least £15 per month; which may be a
disincentive for some patients to continue with
statin therapy. This would be unfortunate when
the evidence base for Q10 is suboptimal and
other approaches to managing statin-related
myopathy may be more appropriate. With a robust
evidence base for statin therapy, efforts should be
made to facilitate patients staying on a statin
where it is clinically appropriate. Preferable
options may include reviewing co-existing
medication that could be implicated in myopathy
or switching to a different statin (possibly one
with a different route of metabolism) and aiming
to achieve an equivalent effect on the lipid profile.
Other approaches, such as reducing the potency
of statin therapy or changing to a different class
of dyslipidaemia therapy with a less well
established evidence base, may be less
desirable.
Reviews have concluded that the evidence
available does not support routine use of
coenzyme Q10 for statin-related myopathy or that
it is tried in patients who cannot be managed with
other approaches, recognising that it may only
have a placebo effect. — Angus Thompson,
lecturer in therapeutics and pharmacy practice,
School of Pharmacy, University of Tasmania,
Australia.
Referenced article available at www.pjonline.com.
The prostate is an accessory male sex gland,
which is wrapped around the urethra and secretes
fluid to form semen. In the UK, prostate
cancer is the most common cancer in men, accounting
for 24 per cent of all new male cancer diagnoses.
1 However, mortality rates are relatively low,
with 70 per cent of patients alive at five years. 1 In
fact, many men die with, rather than from, prostate
cancer. It is estimated that 215,000 men are living
in the UK with a diagnosis of prostate cancer. 1
Although the incidence is increasing, there is no increase
in mortality rates.This may be influenced by
the introduction of transurethral prostatectomy
(TURP), a minimally invasive surgical procedure
for removing prostate tissue, and prostate specific
antigen (PSA) testing, which have led to the detection
of more latent, earlier, slow growing tumours.
Bearing all this in mind,it is likely that pharmacists
will encounter increasing numbers of patients with a
diagnosis of prostate cancer, so a basic understanding
of the disease, the patient’s journey and treatments is
important. In addition, prostate cancer is not a topic
only for those working in secondary care. Sometimes
therapies are initiated in primary care, particularly
where GPs write the first prescription following a letter
from the consultant, and pharmacists can play a
useful role in supporting these patients.
Risk factors
Age is the strongest known risk factor and the condition
is rare in men under 50 years. 1 The older the
man, the higher the risk, with three-quarters of
prostate cancer diagnosis occurring in men over 65
years.Another strong risk factor is family history —
men who have a first-degree relative affected with
Check your
learning...
available online
until 16 December
2009
Zephyr/Science Photo Library
Identify knowledge gaps
1. What are the common presenting symptoms of
prostate cancer?
2. What is the rationale behind the use of gonadorelin
analogues?
3. Where do bicalutamide and cyproterone fit in the
treatment strategy for prostate cancer?
Before reading on, think about how this article may help
you to do your job better. The Royal Pharmaceutical
Society’s areas of competence for pharmacists are listed in
“Plan and record”, (available at: www.uptodate. org.uk).
This article relates to “common disease states and their
drug therapies” (see appendix 4 of “Plan and record”).
early prostate cancer, have twice the risk of developing
prostate cancer and those with two or more
first-degree relatives affected with early prostate
cancer, have approximately a seven- to eightfold increased
risk of developing prostate cancer compared
with the general population. 2
The variation of incidence rates globally has led
to the suggestion that prostate cancer risk is affected
by ethnicity. For example,African American
men are 61 per cent more likely to develop prostate
cancer than Caucasian men and are nearly 2.5
times as likely to die from it, whereas Asian men
generally have a lower risk than the national average.
It is uncertain whether this difference is due to
genetic susceptibility or exposure to causative
environmental factors.
Molecular biology studies have suggested that
genetic changes directly related to androgen
metabolism can affect the risk of prostate cancer.
Furthermore, androgen levels in some populations
reflect the risk of prostate cancer — African
American men have relatively high androgen levels
and Asian men have relatively low androgen levels.
Observational studies have suggested that diets
high in saturated fats and red meats, and low in
34
Pharmacy Professional | November 2009
November 2009 | Pharmacy Professional 35

L E A R N I N G & D E V E L O P M E N T
Produced by The Pharmaceutical Journal
CONTINUING PROFESSIONAL DEVELOPMENT
CONTINUING PROFESSIONAL DEVELOPMENT
Panel 1: Non-pharmaceutical treatment options
Watchful waiting/active surveillance The option of watchful waiting involves an active
plan to monitor the patient closely for disease progression without invasive treatment. It is
used when an early stage, slow-growing prostate cancer is suspected or when the risks of
invasive treatment outweigh the possible benefits.
Surgery There are a number of surgical options for prostate cancer treatment, involving
removal of the prostate gland (used for tumours that have not spread beyond the prostate) or
the testicles (to decrease circulating androgens). Radical prostatectomy is the removal of the
prostate gland through an incision in the abdomen wall (retropubic prostatectomy) or the
perineum (perineal prostatectomy). Laparosopic prostatectomy (removal of the gland via
small incisions) may be used in an attempt to reduce nerve damage. Side effects of these
procedures include loss of urinary control, impotence, infertility and impaired erection and
ejaculation.
Radiotherapy Radiotherapy can be used instead of or after surgery in early stage prostate
cancer. It is also used to treat painful bone metastases in advanced, metastatic prostate
cancer (ie, it is used for palliative as well as radical treatment). Radiation treatment can be
combined with hormonal therapy for intermediate risk patients. Side effects include diarrhoea,
mild rectal bleeding, urinary incontinence and impotence but these tend to improve over time.
There are three types of radiotherapy: external beam radiotherapy (EBRT), intensity modulated
radiation therapy (IMRT) — both given daily via a linear accelerator (linac) machine over
several weeks — and brachytherapy (the permanent implant of 100 small rods containing
radioactive material through the skin of the perineum directly into the tumour).
Panel 2: Risk stratification for localised prostate
cancer according to risk of recurrence
Risk PSA level Gleason score Clinical stage
Low 20ng/ml or 8–10 or T3–T4
Panel 3: Localised prostate cancer treatment options
Risk
Low
Intermediate
High
Options
Watchful waiting
Watchful waiting, radical prostatectomy, brachytherapy or
radical radiotherapy
If there is a prospect of long-term disease control then
prostatectomy or radical radiotherapy (with a minimum of two
years’ adjuvant hormonal therapy)
The recommendation for high risk cancer that has spread to the tissues surrounding the
prostate (ie, locally advanced cancer), radiotherapy with neoadjuvant and concurrent
hormonal therapy for three to six months.
fruits, vegetables, tomato products and fish can
increase the risk of prostate cancer. Obesity has
also been suggested as a risk factor for prostate
cancer.
More frequent ejaculation may reduce the risk
of prostate cancer, but this has not been confirmed
in larger controlled studies. 3 Infection with the sexually
transmitted infections chlamydia, gonorrhea
or syphilis is also suggested to increase the risk.
It has been suggested that the daily use of nonsteroidal
anti-inflammatory drugs or statins may reduce
the risk of prostate cancer. 4,5
Author Netty Wood
will be available to
answer questions
online on the topic
of this CPD article
until 28 November
2009
Screening
Prostate cancer is incurable when diagnosed at a late
stage so there is potential benefit in detecting early
stage disease. Two tests used to detect the presence
of cancer at an early, curable stage are:
■ Digital rectal examination Internal examination
of the rectum by a clinician
■ Prostate specific antigen measurement The level
of PSA, an enzyme produced by the prostate, is
measured in the blood
In the US, all men over 50 years (or 45 years if
considered at high risk) are offered routine PSA
testing but in the UK there is no current screening
programme for asymptomatic men.Although this is
controversial, the decision is evidence-based. First,
there is lack of sensitivity (men with prostate cancer
may not have a raised PSA) and lack of specificity
(two thirds of men with an elevated PSA level do
not have prostate cancer, and this would subject
men to unnecessary further investigations).
Secondly, there is a lack of consensus about the best
treatment for early stage prostate cancer. There is
also no evidence that screening reduces mortality,
although two large international trials are currently
looking into screening.
Presentation, diagnosis and staging
Local symptoms from prostate cancer do not usually
manifest until the tissue surrounding the prostate
gland is invaded. These include urinary hesitancy,
nocturia, incomplete emptying and a diminished
urinary stream, which are also signs of benign prostatic
hypertrophy. It is less common for men to
present for the first time with symptoms of metastatic
disease, such as bone pain and anaemia.
Diagnosis is via a transrectal ultrasound (TRUS)
biopsy, following a positive DRE or high PSA test,
or both.This is the use of sound waves produced by
a probe inserted into the rectum to create an image
of the prostate to allow biopsy.The aim is to detect
prostate cancers with the potential to cause morbidity
or mortality. Computer tomography or magnetic
resonance imaging scans are only
recommended for patients who have high risk cancer
and are considering radical treatment.
Staging comprises the Gleason score, a PSA test
and the tumour, node, metastases (TNM) system.
The Gleason score The Gleason score is based on
the microscopic appearance of biopsy tissue, and
ranges from 2 to 10, with 10 representing the most
abnormal appearance. Cancers with a higher Gleason
score are more aggressive and have a worse prognosis.
The PSA test Normal PSA levels are considered
to be:
■

L E A R N I N G & D E V E L O P M E N T
Produced by The Pharmaceutical Journal
CONTINUING PROFESSIONAL DEVELOPMENT
Panel 5: Chemotherapy
Chemotherapy is only used in advanced hormonal refractory disease. The aim is to improve
symptoms, prolong life and slow progression of the disease. Chemotherapy regimens that
have been used to treat prostate cancer include those based on mitoxantrone, estramustine
and docetaxel. Docetaxel has become the gold standard.
The TAX 327 clinical trial compared two docetaxel schedules with mitoxantrone and
prednisone (the previous standard chemotherapy regimen). The median survival for the
three weekly docetaxel was 18.9 months compared with 16.5 months in the mitoxantrone
arm and 17.4 months in the weekly docetaxel. Progression free survival was not reported. 6
The SWOG 9916 clinical trial compared docetaxel plus estramustine with mitoxantrone
plus prednisone. Median survival for the docetaxel arm was 17.5 months compared with
15.6 months in the mitoxantrone arm. The median time to progression was 6.3 months in the
docetaxel and estramustine arm and 3.2 months in the mitoxantrone and prednisone arm. 7
In 2006 NICE recommended docetaxel, within its licensed indications, as a treatment
option for men with hormone-refractory prostate cancer within specified restrictions. 8
Hypersensitivity can occur as a response to docetaxel itself or, more commonly, its polysorbate
80 vehicle. Premedication with steroids to prevent a reaction is, therefore, important.
Other chemotherapy regimens are not recommended by NICE for prostate cancer but
mitoxantrone is used for patients who cannot tolerate docetaxel or who fall outside NICE
guidance and is also used as the standard arm in many trials. Mitoxantrone with prednisone
improves quality of life in men with advanced, hormone-refractory prostate cancer, but it
does not improve survival. 9
Chemotherapy regimens used in practice include:
■ Mitoxantrone 12mg/m2 iv on day 1 and oral prednisone 5mg twice daily continuously
(21-day cycle)
■ Docetaxel 60mg/m2 iv on day 2 plus estramustine 280mg orally three times a day on
days 1 to 5, with dexamethasone 60mg in three divided doses before docetaxel (21-day
cycle)
■ Docetaxel 75mg/m2 iv on day1, in combination with prednisone or prednisone 5mg
orally twice daily continuously (21-day cycle)
Side effects of chemotherapy include a potential loss of ejaculation and fertility so sperm
storage should be offered. For erectile dysfunction, the patient should be offered
phosphodiesterase type 5 (PDE5) inhibitors. If these fail or are contraindicated, the patient
can be offered vacuum devices, intraurethral inserts or penile injections, or penile
prostheses. If urinary function is compromised, then access to specialist continence
services should be arranged.
All patients with advanced prostate cancer should be encouraged to participate in local
clinical trials if these are available.
Action: practice points
Reading is only one way to undertake CPD and the Society
will expect to see various approaches in a pharmacist’s
CPD portfolio.
1. Check that patients given a gonadorelin analogue for
the first time or after a break have also been given an
anti-androgen to prevent tumour flare.
2. Should men with prostate cancer and hypogonadism be
given supplemental testosterone? Research this.
3. Ensure men buying herbal products sold for benign
prostatic hyperplasia have consulted their GP.
Evaluate
For your work to be presented as CPD, you need to evaluate
your reading and any other activities. Answer the following
questions: What have you learnt? How has it added value
to your practice? (Have you applied this learning or had any
feedback?) What will you do now and how will this be
achieved?
Resources
■ Clinical guidance on prostate
cancer diagnosis and
treatment is available from
from the National Institute of
Clinical Excellence website.
Signposting
■ Patients can be directed to
the following websites for
support and information:
www.prostatecancer
foundation.org, www.
prostate-cancer.org.uk,
www.cancerbackup.org.uk
and www.cancer
screening.nhs.uk
CPD articles are
commissioned by The
Journal and are not peer
reviewed.
ical cancer multidisciplinary team with a view to
seeking an oncologist or specialist palliative care
opinion, or both, as appropriate.
Treatment options to be considered, according
to NICE, are:
■ Dexamethasone 0.5 mg daily for palliation of
symptoms
■ Radiotherapy for painful bone metastases
■ Bisphosphonates for painful bone metastases
when other treatments have failed
■ Strontium-89 for painful bone metastases (This
a beta-emitting radioactive isotope which is
given intravenously and is taken up preferentially
in bone metastases.)
■ Chemotherapy (see Panel 5)
Bone metastasis affects more than 80 per cent of
patients with advanced prostate cancer.
Bisphosphonates (infusions of zolendronic acid or
disodium pamidronate are often used) can be used
for the palliation of symptoms such as pain and
skeletal events. However they do not influence disease
progression or patient survival.
Future strategies More research comparing the
different treatment options in each stage of the disease
is required to determine a more defined treatment
strategy.With the increased understanding of
the mechanisms responsible for prostate cancer and
the development of hormone resistant prostate cancer.
I imagine that the development of targeted
therapies will soon follow, leading to a change of
focus for the treatment of prostate cancer.
References
1. Cancer Research UK. Prostate cancer incidence statistics. Available
at http://info.cancerresearchuk.org (accessed on 9 February 2009).
2. Steinberg GD, Carter BS, Beaty TH, Childs B, Walsh PC. Family history
and the risk of prostate cancer. Prostate 1990;17: 337–47.
3. Leitzmann MF. April 2004. Ejaculation frequency and subsequent risk
of prostate cancer. JAMA 2004;291:1578–86.
4. Jacobs EJ, Rodriguez C, Mondul AM, Connell CJ, Henley SJ, Calle EE et
al. A large cohort study of aspirin and other nonsteroidal antiinflammatory
drugs and prostate cancer incidence. Journal of the
National Cancer Institute 2005:97:975–80.
5. Shannon J, Tewoderos S, Garzotto M, Beer TM, Derenick R, Palma A,
et al. Statins and prostate cancer risk: a case-control study.
American Journal of Epidemiology 2005;162:318–25.
6. Tannock IF, de Wit R, Berry WR, Horti J, Pluzanska A, Chi KN et al.
Docetaxel plus prednisone or mitoxantrone plus prednisone for
advanced prostate cancer. New England Journal of Medicine 2004;
351:1502–12.
7. Petrylak DP, Tangen CM, Hussain MH, Lara PN Jr, Jones JA, Taplin ME
et al. 2004. Docetaxel and estramustine compared with mitoxantrone
and prednisone for advanced refractory prostate cancer. New England
Journal of Medicine 2004;351:1513–20.
8. National Institute of Clinical Excellence. Docetaxel for the treatment of
hormone refractory metastatic prostate cancer 2006. Available at
www.nice.org (accessed on 16 October 2009).
9. Ernst DS, Tannock IF, Winquist EW, Venner PM, Reyno L, Moore MJ et
al. Randomized, double-blind, controlled trial of
mitoxantrone/prednisone and clodronate versus
mitoxantrone/prednisone and placebo in patients with hormone
refractory prostate cancer and pain. Journal of Clinical Oncology
2003;21:3335–42.
38
Pharmacy Professional | November 2009

lifestyle
contents
41 Travel
Singapore, City breaks,
Jetlag and more
49 Health Food
Chef Tom Aikens
50 Transport
Stylish affordable cars
52 The Arts
Pharmacy at the opera
54 In the picture
Pharmacists at work and play
56 Offers
For members only
56 Prize crossword
Clues just for Pharmacists
Singapore scene
It may be viewed as the bland ultra-modern
and squeaky clean face of Asia but get to know
it, uncover its charms and you will be pleasantly
surprised. Jeff Mills revisits the island state
When you first arrive in Singapore
you could be forgiven for wondering
whether or not you are in Asia at all.
The city is so clean and so well regulated that,
climate aside, it would fit in seamlessly if it
were to be transported to somewhere in Europe
or perhaps North America.
The island state did suffer from a bit of an
image problem for a few years following the
tough controls put in place under the former
regime, during which the city went through
a period when it was about as exciting to
visit as one of the UK’s less appealing New
Towns. But much of that has changed. Æ
November 2009 | Pharmacy Professional
41

t r av e l S I n g A P O r e
Pristine city State-of-the-art architecture along Singapore’s waterfront
Mind you, visitors are still advised to be on
their guard against a number of misdemeanors.
Don’t drop litter or forget to flush a public
lavatory, for example. Not for nothing is
Singapore known as a “Fine City” – because you
can be fined for any number of activities which
are unexceptional in other, less squeaky-clean,
parts of the world.
That said, a trip to Singapore is now a very
attractive proposition, provided you don’t mind
being surrounded by state-of-the-art skyscrapers
and futuristic architecture everywhere you look.
Even the entertainment scene in Singapore,
though still nothing like as vibrant as it was in
the days when the transvestites and other dubious
characters of Bugis Street in the central area
were strutting their stuff, has come on in leaps
and bounds in recent years.
Visit Clarke Quay, one of the many
regenerated areas by the river now awash with
decent bars and restaurants, and you will quickly
see what I mean.
But it’s not all frenetic activity in Singapore.
When you feel like some peace and quiet
head for the Singapore Botanical Gardens and
National Orchid Gardens on Cluny Road at the
western end of Orchard Road, Singapore’s main
up-market shopping street, and you will find
all the seclusion you want, unless, of course,
you count the reputed 12,000 types of orchid,
Singapore’s national flower, growing there.
Top sightseeing
Haw Par Villa
Originally known as the Tiger Balm Gardens,
this villa at 262 Pasir Panjang Road, just to the
west of the main downtown area, is a gaudy
parade of more than 1,000 grotesque statues
inspired by Chinese legends and myths. It’s
named after its original owners, the Aw brothers
Boon Haw and Boon Par, who made their fortune
selling Tiger Balm, the cure-all lotion created by
their father.
Open daily 9am - 6pm.
www.hph.hawpar.com
Tel: +65 63 37 9102
Singapore Zoological Gardens and Night
Safari
These gardens, on Mandai Lake Road, form
what is one of the few open zoos to be found
anywhere in the world, where many of the
2,000 animals, representing about 240 or so
species, are contained in their areas by moats,
rather than cages, though some of the fiercest,
such as the big cats, are kept in cages. The night
safari allows you to view around 100 species of
nocturnal animals.
The Zoological gardens are open daily between
8.30am and 6pm.
www.zoo.com.sg
Tel: +65 6269 3411
Little India
As the name suggests, this is a lively area of
Indian restaurants, music, shops and above all
a major assault on your senses as thousands of
hawkers try to persuade you to but their wares
while fortune tellers seem to lurk on every
corner.
The main part of Little India can be found on
Serangoon Road.
Top hotels
Raffles
To stay in a piece of history opt for Singapore’s
legend, Raffles, one of the few remaining
great 19th century hotels, declared a national
monument by the Singapore Government in
1987, which reopened in 1991 after a S$160m
(about £53m) refurbishment.
www.raffles.com
Tel: +65 6337 1886
The Fullerton
One of the real gems on Singapore’s hotel scene,
The Fullerton, housed in a beautiful 1920s
building, at various times has been home to the
General Post Office, The Chamber of Commerce
and most recently Singapore’s Inland Revenue
Authority. Right by the river, in front of Raffles
Place, it is small wonder that The Fullerton
is firmly one of the in places for movers and
shakers who have done their homework.
1 Fullerton Square,
www.fullertonhotel.com
Tel: + 65 6733 8388
New Majestic Hotel
The building which originally housed the
Majestic hotel, an art deco gem, has been
refurbished into a sleek boutique-style hotel,
perfect for business travellers on the lookout for
something a bit different from the norm. Décor
awes much to a stunning collection of art, mainly
by local artists, belonging to the hotel’s owner.
31-37, Bukit Pasho Road,
www.newmajestichotel.com
Tel: +65 65 11 4700
The Oriental
This stylish hotel at Marina Square, designed
with the familiar atrium by John Portman at its
heart, is a particular favourite with well-heeled
business travellers keen on choosing the “right”
address. All the usual five-star facilities plus
Æ
When you
feel like some
peace and
quiet head for
the Singapore
Botanical
Gardens and
National Orchid
Gardens
42 Pharmacy Professional | November 2009
November 2009 | Pharmacy Professional
43

t r av e l S I n g A P O r e
t r av e l j e t l a g
Fan fair Traditional
Singapore is alive and
well in the local markets
How to beat jetlag
Long-haul flights, lack of sleep and airline food can all lead to you arriving
feeling exhausted. But there are ways to beat jetlag, says Jeff Mills
many rooms with views across the bay.
www.mandarinoriental.com/singapore
Tel: +65 6338 0066
Recommended restaurants
Indochine
One of a number of restaurants in the Indochine
chain this one, the Indochine Wine Bar and
Restaurant, is one of the best. Dark décor, not
unlike that of a gentlemen’s club, bold sculptures
and excellent food from around Indo China, as
the name would suggest.
49, Club Street,
www.indochine.com.sg
Tel: + 65 63 23 0503
Saint Pierre
A Belgian flavour in this top restaurant, where the
chefs are consistently in among the awards. The
food is a fascinating fusion of Belgian and Asian,
an exotic marriage which seems to work well.
Central Mall, 3, Magazine Road,
www.saintpierre.com.sg
Tel: +65 6438 0887
Au Jardin Les Amis
Located in the Botanic Gardens, this restaurant
overlooks lush greenery and provides marvellous
views from its balconies, ideal for wining and
dining business contacts. Fabulous food and a
great wine list.
EJH Corner House
Singapore Botanic Gardens, Cluny Road
www.lesamis.com.sg
Tel: +65 6466 8812
Essentials
Getting there
Singapore’s Changi airport, which prides itself
for the range of duty-free goods on offer, is
served from the UK by a number of airlines
including British Airways (www.ba.com, Tel:
0870 850 9 850), and Qantas (www.qantas.com
Tel: 0845 7 747 767), which code share their
flights, Singapore Airlines (www.singaporeair.
com, Tel: 0844 800 2380) and Virgin Atlantic
(www.virgin-atlantic.com, Tel: 0870 380 2007)
all flying the route.
Getting around
Singapore is one of the easiest places to get
around in the whole of Asia with an underground
train system, the MRT (Mass Rapid Transport)
which puts many in Europe, including London’s,
to shame. Alternatively you can hail one of
Singapore’s plentiful and inexpensive taxis.
Main Tourist Office
The main Singapore Tourism Board (STB)
information centre is at the aptly named Tourism
Court, 1, Orchard Spring Lane
Mon - Fri 8.30am - 5pm, Sun 8.30am - 1pm.
www.stb.com.sg
Tel: +67 36 6622
Of special interest to pharmacists
Pharmaceutical Society of Singapore,
Alumni Medical Centre, Second Level,
2, College Road,
Singapore 169850
www.pss.org.sg
Tel: +65 6221 1136
What else you need to know
• Singapore is seven hours ahead of UK time.
• Take a trishaw ride around the city, it may be
touristy but there aren’t many places where you
can still do it.
• Best shopping is along Orchard Road where you
will find a large selection of malls and stores.
• Best buys are clothes, jewellery, electronic
goods and cameras. n
CoDEG collaborations
with Singapore
Rapid developments in clinical
pharmacy taking place in Singapore
led to Prof Ian Bates and Prof
Graham Davies of the Competency
Development and Evaluation
Group (CoDEG) being invited to
introduce the idea of competency
frameworks for pharmacists, at the
19th congress of the Pharmaceutical
Society of Singapore in 2007.
The Department of Pharmacy
at the Singapore General Hospital
(SGH), began to collaborate with
CoDEG to adapt its general level
framework and advanced and
consultant level framework to the
Singapore setting.
Two years on, a pilot project
is underway at SGH to establish
GLF and ACLF-based competency
development for all 80+ of its
pharmacists. CoDEG is in the midst
of drafting an MOU with SingHealth
(which represents nine public
healthcare institutions in Singapore)
and is due to return to Singapore
this month to conduct “train the
trainer” workshops and perhaps
help spread the project island-wide.
More information from:
Vicky Coleman, MRPharmS
PGDip, Senior Pharmacist,
Singapore General Hospital
Your plane lands at some far
away destination after a 12-hour
flight and no sooner has it taxied
to the gate than all the first and businessclass
passengers, immaculate in their smart
clothes and with happy smiles on their eager
faces, are rushing through the airport ready
to get on with the day’s business.
Travelling in first class or business
class does, of course, provide you with
rather more legroom than that endured by
those towards the back of the plane in the
economy seats – and you certainly get more
attentive service and probably better food
and drinks. But this doesn’t change the fact
that you’ll be sitting still, possibly for hours
on end, and that is not a good thing to do.
Much better to risk looking a bit stupid and
take some in-flight exercise.
Exercise on board
The debate whether or not ailments such
as deep vein thrombosis (DVT) are caused
by travelling by air continues, with many
experts arguing that the sometimes lifethreatening
condition is a result of any kind
of inactivity, whether this is on a plane or
during a long car journey.
But many experts and frequent travellers
alike agree that a certain amount of exercise
within the limited confines of a seat on board
a plane can go a long way towards not only
reducing the risk of DVT but helping you
arrive at your destination in better shape.
If they have been following the advice
handed down by many nutritionists,
high-flying travellers will have
been drinking plenty of water to
counteract the dryness of the air
on board planes, experts reckon
we should all drink at least six
to eight glasses a day, when you
fly, however, your water intake
should leap to around a glass
every hour.
If you have really been taking
your health as seriously as you
should, you would have spent
the days before you travelled
eating a diet made up of fibrerich
foods such as dried figs and
other fruit, raw vegetables and
Consider ordering
one of the so-called
“special” vegetarian
or other meals
oatmeal. And you would have avoided foods
which can provide what some nutritionists
rather coyly call “excess gas”, including,
rather surprisingly, some fruits such as melon,
along with more obvious suspects such as
beans and pulses, carbonated drinks. And, of
course Brussels sprouts.
Though airline food has improved
enormously in recent years you still need
to watch out. Some airline food is
excessively salty, say experts, so you
could counter this by pre-ordering
a low-salt option. Also consider
ordering one of the so-called
“special” vegetarian or other meals
usually offered to those with
particular dietary preferences or
needs. They are often created with
rather more care – and therefore
have more taste -- than the more
mass-produced variety.
Yet another problem with air
travel is that it does not allow
time for passengers’ biological
clocks to adjust to new time zones,
so they can experience a period of maximum
sleepiness when they least expect or want it.
If, for example, you travel London to
Hong Kong, which is eight hours ahead
of the UK, you will hit your maximum
sleepiness between the hours of 11am
and 1pm Hong Kong time. If you plan an
important meeting or other event around
this time it is the equivalent of planning a
meeting between 3am and 5am in the UK.
The equation to use to work out when you
are most at risk of slipping into the maximum
sleepiness zone is: Take your usual wakeup
time, say 7am, minus three hours, plus or
minus the local time difference. This gives
you the time of your mental and physical
trough. You can then avoid scheduling any
important meetings for this time.
And heed the advice of top chefs, many
of whom suggest the way to overcome
jetlag, reduce insomnia and increase your
vitality is to eat foods low in calories and
carbohydrates.
“Keep it light,” seems to be the mantra.
Dishes such as tomato and mozzarella
salad, fruit soup with berries, papaya and
honey sorbet and grilled vegetables, roasted
red pepper soup and chick pea salad are
excellent. When combined with whole grains
such as rice, chick peas provide virtually
fat-free high-quality protein, while providing
steady, slow-burning energy.
And that’s what we all need when wee are
travelling. n
44 Pharmacy Professional | November 2009
November 2009 | Pharmacy Professional
45

t r av e l c i t y b r e a k s
Scene setter The “Neues Rathaus”, or New City Hall, in the Marienplatz square provides the spectacular backdrop for one of Munich’s main festive Markets
Festive markets
Looking for some seasonal cheer to brighten up the dark winter days?
Philippa Taylor goes in search of traditional festive markets on the Continent
With the lead up to Christmas
in the UK marked more by the
jingling of the cash tills than
of Santa’s bells; roasting chestnuts over a
coal-burning brazier replaced by fast-food
wrappers littering the streets and carol singers
round the fir tree shunned in favour of pop
music blaring from every high street, it is
difficult to believe that the romance and
magic of the season is still alive and well but
it is, just across the Channel or the North Sea.
It was Queen Victoria’s consort, Prince
Albert, who first made Christmas trees
and all the other paraphernalia of the
festive season fashionable here. And in his
homeland, Germany, among a number of
other European countries, the mystery and
sheer joy of the festive season is alive and
well, just as it has always been. And you
find it in very condensed form in the many
Christmas markets (or Christkindlmarkets).
The Bavarian city of Munich has one of
the oldest, dating back to the 14th century
and originally specialising in the provision
of “Oberammergau goods, ginger bread
and crib figurines”, according to the early
annals. It takes the stage each year in the
Marienplatz in the very heart of the city
when the Mayor of Munich throws the
switch to light up a huge 30-metre high
Christmas tree, the signal for the 140 stalls,
selling everything from craftwork, candles
and ceramics to traditional wooden toys and
tree decorations to open up for business.
The heady aroma of Gluhwein (hot spiced
wine) is everywhere, the beer stalls do a
image: GNTB, Joachim Messerschmidt
roaring trade, there is traditional festive
food to be bought, as well as the ubiquitous
German sausages, and each evening local
choirs sing Christmas carols from the
balcony of the Town Hall. Sometimes there’s
even some snow to complete the Victorian
Christmas card picture idyll.
In beautiful Hamburg in the northern
part of Germany, too, the Christmas spirit
is alive and well at a number of markets in
and around the centre of this fascinating
city on the River Elbe, one of the original
Hanseatic Ports and with the vast Alster lake
at its heart. The main Christmas markets are
the Rathausmarkt, the Gansemarkt, Gerard
Hauptmann-Platz and Nikolai Kirke but
there are more in the city suburbs, too. This
is one of the cities to head for if you want
to combine your Christmas shopping with
some nightlife, Hamburg’s after-dark scene
is legendary.
But you will find Christmas markets all
over Germany, from the country’s capital
city, Berlin, where the annual market takes
over much of one of the major avenues,
Unter den Linden by the Opern Palais, and
Dresden in the pre-reunification former
East Germany, which has what is said to be
the oldest Christmas market in the country,
where visitors are served “stollen”, the
typically German fruit bread much loved as a
Christmas treat, to small towns and villages
along the Rhine, often with fairy-tale castles
as a backdrop.
The historic city of Brussels, gets into the
Christmas spirit with seasonal markets in no
fewer than five of its main squares, you can
even try out your skill on skates at the ice rink
in the main Grand Place. You may want to
forego the gluhwein here, though, in favour
of a few refreshing glasses of Belgium’s
rightly-renowned beers – there are after all
plenty to choose from – and perhaps a plate of
moules-frites (fried mussels with chips) at one
of the dozens of cafes and restaurants which
line the ancient square.
Prague in the Czech Republic, with its
medieval gothic centre and grand old opera
houses, is another great destination for
Christmas shopping the traditional way.
At this time of year virtually the whole
of famous Wenceslas Square becomes a
magical winter wonderland of decorated
trees, glittering lanterns and welcoming
market stalls. Look out, too, for the Old
Town Square, where daily carol concerts
are performed by children’s’ choirs, and the
goods on offer include straw decorations, cut
glass and what many consider to be the best
wooden toys to be found anywhere.
Austria’s capital, Vienna, romantic at
Historic Vienna’s many palaces enhance the elegant setting for the Austrian capital’s Christmas markets
Great destinations for
Christmas shopping
the traditional way
any time of year, takes on an even more
magical air in the run-up to Christmas,
with markets, fairs, decorated trees and
thousands of lights, all against the backdrop
of grand old buildings dating back to the
Habsburg empire and before. The main
Christmas market here is the Ratshausplatz,
dating back to 1294. Make time, too,
for a visit to Schonbrunn Palace with its
festive concerts, then head for the historic
Spittelberg area to check out the handicrafts
on sale from stalls set up in the granitelined
alleyways.
And another Austrian city, Salzburg,
dominated by its spectacular castle with
the mountains in the distance behind and
best known as the home of Mozart, takes
on a particularly festive mood, with plenty
of the composer’s music on hand for good
measure. There is usually choral singing
to be enjoyed on the cathedral steps, while
“Turmblasen” wind instrument bands
Tasty Christmas pastries and other festive foods
perform in Residenz Square, where there is
also a nativity exhibit to help provide even
more Christmas spirit.
Budapest is worth considering, too, not
only for its annual Christmas market on the
main shopping street, Vaci Utca, and Heroes’
Square, but also for the city’s permanent
enormous covered market, right by the
Danube, where you can buy everything
from clothes and blankets to fresh fruit
and vegetables. Look out in particular for
Russian caviar at hard-to-believe prices. And
throughout Budapest at this time of year you
will come across traditional Hungarian folk
music and dancing at every turn.
Then, provided you don’t mind the cold
weather and more than an outside chance
of some snow, there’s Tallin, capital of
Estonia, where there’s a market every
day outside the Town Hall in the historic
Raekoja Square and the Polish city of
Krakow, which has one of the largest and
possibly best preserved medieval squares
in the whole of Europe. The market here is
particularly well known for the local honey
cake, local handicrafts and embroidery, all at
astonishingly-low prices.
No matter which city you choose for your
break, you can’t fail to return home full of
festive spirit. n
Fact file
Most Festive markets in European cities are
open from early December right up until
Christmas Eve, some operate right over the
New Year period, too. They are typically open
from 10am to 8pm each day. A number of
tour operators specialise in arranging short
breaks including British Airways Holidays
(www.ba.com) and Kirker Holidays (www.
kirkerholidays.com).
46 Pharmacy Professional | November 2009
November 2009 | Pharmacy Professional
47

h e a lt h f o o d
Win
Healthy food for busy people
Welcome to the first in a series of Pharmacy Professional features in which
we ask top chefs to come up with a healthy yet easy to prepare recipe
a riser
recliner
in luxury leather
Following a period working in the
private sector, for both Lord Lloyd Webber
and the Bamford family, where he helped
Lady Bamford develop a range of organic
products for Daylesford Farm Organic
Shop and Wootton Organic, he opened
Tom Aikens Restaurant in Chelsea in 2003
and a second restaurant, Tom’s Kitchen, an
informal all day dining restaurant serving
home-style brasserie food, in 2006. n
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send a stamped self-addressed envelope to the address in the coupon. All entries received
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“ My aches and pains have lessened and the stress
has gone out of my life, I feel so restful.”
E N, London – Willowbrook customer
Rise to your feet effortlessly in this
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Post to: Willowbrook Recliners FREEPOST SWC2458, Droitwich WR9 0BR
Please tick if you would prefer NOT to receive product/service information
This month the spotlight is on Tom
Aikens, one of the most exciting
chefs working in the UK today.
Although he has been cooking since the
age of 16, it was when he launched his own
eponymous restaurant in London in April
2003 that Tom Aikens sealed his culinary
reputation.
Born in 1970 in Norwich, Tom’s early
exposure to food and wine came from his
father and grandfather who were both wine
merchants, and the family regularly travelled
throughout France and sampled fine regional
French cuisine.
Aged just 22, Tom worked as Chef de
Partie with Pierre Koffman at the famous
London restaurant La Tante Claire during the
period when it earned its third Michelin star.
In 1993 he was appointed Sous Chef at
another top London restaurant, Pied à Terre.
He then took a year off to work in France to
gain more Michelin experience at the threestar
level with Joël Robuchon in Paris and
Gérard Boyer in Les Crayères in Reims.
l Tom Aikens lives in London with his wife,
Amber. His first cookbook “Tom Aikens:
Cooking” – was published by Ebury in
October 2006. His second cookbook FISH was
published in November 2008, again by Ebury.
Butternut Squash and
Polenta Gratin
Serves 4
For the polenta
3 cups chicken stock
3.5 cups milk
1.5 cups polenta
3oz butter
1.5 tbsp truffle oil
1 cup Parmesan cheese
2 tbsp thyme and sage
2 cloves minced garlic
1 tsp nutmeg
Salt and pepper
For the Squash
1 large butternut squash peeled, de-seeded
and cut in half at the bulb
• Cut the bottom half of the squash in half,
sprinkle with honey, salt and pepper. Bake
in the oven at 180ºc for 30 minutes until
slightly tender. Once cooked, coarsely purée
the squash with a fork, or in a food processor
and leave to one side.
• Slice the top half of the squash into 1/2 cm
slices and season with salt, pepper, nutmeg,
brush with butter and bake in the oven for
15-20 minutes at 180ºc until tender.
• Mix together the polenta, chicken stock,
milk, squash purée and other remaining
ingredients and pour into a ceramic dish.
Arrange the squash slices over the top,
sprinkle with Parmesan cheese and drizzle
with butter. Bake at 170ºc for 40 minutes.
November 2009 | Pharmacy Professional
49

t r A N s p o r t c a r s
1
2
Alternative therapy
Matt Guarente picks five new cars that offer something a little different
from the same old front-runners – and they’re still good economic options
NO-ONE, the old adage goes, ever got fired for buying
an IBM. Nor for wearing a grey suit or sensible
shoes, either. And when it comes to buying a new car,
most of the advice you’ll get will be based on the tried, trusted
– and frankly boring.
Some of the most iconic, and sought-after, cars of recent
years have been those which set out to be a bit different from the
mass market offerings. Nissan’s Figaro is one example, a retrochic
anomaly that still turns heads. The Smart (two-door that
is, not the pointless ForFour) is still a one-of-a-kind, arguably
the ultimate city car with a reinvent-the-rulebook design. Fiat’s
Multipla launched with decidedly odd looks, but anyone who
drove one raved about its flexibility and three-up-front seating.
It was restyled in 2004 and its appeal is even wider.
Of course, some would say there are some solid reasons
for sticking to the big companies and their most popular cars.
Availability of replacement parts, cheaper servicing and a
wide network of dealers is one. But consider that you service
your car once a year (and even on the most idiosyncratic car
listed here, the engine is based on the proven and widelyused
block used in the Peugeot 206 GTi) and you’ll see these
issues are not much of a problem. If you are concerned about
the financial futures of any of these smaller companies, bear
in mind that the biggest – GM, which owns Vauxhall, and
Ford – have been near collapse themselves in recent months.
However, in the European markets these two giants have
produced some very fine cars indeed. Ford’s new Fiesta is
3
excellent, and its Kuga is worth a look for anyone who wants
a compact, relatively environment-friendly SUV – itself a
good alternative to a larger hatchback. Vauxhall’s smaller
hatches are also very good and its new workhorse saloon, the
Insignia, wins plaudits on style and value.
Overall, carmakers are still going through a torrid time
and buyers are able to strike some effective deals. It’s worth
having a look at some of the car publications’ ‘target prices’
because the dealers will be aware of them and expect buyers
to pitch at, or below, those levels.
Green goddess
1 Mercifully, Toyota has unveiled a new Prius (called the
Pious by come uncharitable souls) which goes some way to
improving the slab-sided dullness of the original eco-chariot
of celebrities. But dig a little deeper and you’ll find that new
technologies do as much, if not more, to make your motoring
green. First, why have two engines, which hybrids do? How is
that ‘green’? Stop-start technologies and super-efficient turbodiesels
on new cars mean some of the emissions and MPG
numbers from the hybrids look a bit high. The Volvo V50 1.6
DRIVe has 104g/km emissions and does 72 mpg, for example,
in a far better overall car than the Prius; What Car? called it
‘hugely impressive’.
In a couple of months Mini will launch its electric version,
and in a couple of years hybrids will be overtaken by both
battery and conventional technology.
Not a Golf
2 The Golf almost deserves to have a category in its
own right, and it’s a fine car (you can feel the ‘but’ coming
up, can’t you?). But… we feel that there’s so much more
excitement to be had than plumping for another conservative,
tick-the-boxes model in the long line from Wolfsburg.
Car makers are working to break down the classic car
‘styles’ and offer variations, and a good example is the Nissan
Quashqai. Leaving aside its rather annoying name, not to
mention the TV ads where the city appears to totally have it
in for the car, the point of this Nissan is to use some of the
best ideas of a 4x4, like a high driving position and rugged
looks, and apply them to a medium-sized car from a more
enjoyable drive. The cabin is very roomy, and build quality is
great. Also, even on the base models target price from around
£13,500, the level of kit is very impressive – all-round electric
windows, aircon, and satnav.
City car
3 In August this year, Hyundai became Britain’s favourite
car, selling more than any other manufacturer. And star of
that performance is the little i10, which outsold nearest rivals
two-to-one. It’s a belting alternative to the rather stodgy, and
pricey, Ford Ka, even in its newest guise. It’s nippy, incredibly
good value and cheap to run, The i10 is a great city car but
with a list price of £7,200, you can’t expect it to do everything
well – and in this model’s case the problem is that it doesn’t
excel in racking up motorway miles.
Our ‘alternative alternative’ is the Toyota iQ. Funky looks,
packed with technology, and a city car that WILL cruise on
the motorway without complaining too much (it’s still only
a one litre engine, so don’t expect too much), this does a lot
more that the i10 but at a £2,000 premium.
4
Something for the weekend
4 While Audi makes a fine car, in some parts of the country
its TT roadsters are more common than speed cameras. And
don’t start us on Porsche Boxsters. We’ve long liked the retrostyled
PGO, based on the beautiful Porsche 356 Speedster
of the 1950s, and were rather surprised to see one pop up
on Coronation Street. Don’t let that put you off; this highly
individual, classically beautiful car with all mod cons is made
by hand in France and its drivetrain is based on readilyavailable
parts. Performance is similar to mid-range TT
models even though it’s a fraction more pricey at £31,000.
Bored with Beemers?
5 No-one would say no to a nice new 3 Series, arguably
the prettiest of the long-lived line of executive saloons. But
therein is one of the problems; it’s had so many facelifts
that it has somewhat lost direction, even if it does still win
awards. Not unlike Mickey Rourke. Our preference would
be the sleek, muscular and very attractive indeed Audi A5,
which comes in a number of guises each one matching BMW
for style and performance, right up to the frankly terrifying
S5 version. To make the range even more complete there’s
the new four-door Sportback, which makes the decision even
harder to make. n
5
50 Pharmacy Professional | November 2009
November 2009 | Pharmacy Professional
51

t h e a r t s o p e r a
EST. 14 YEARS • OVER 25,000 MEMBERS • FREE HOTEL ROOMS... YOU ONLY PAY FOR YOUR MEALS
On stage chemistry
Alasdair Steven looks at the, often sinister but crucial, role of potions in opera
Operas often rely on
magic potions to change
the plot thus allowing
the tenor and soprano to fall into
each other’s arms as the curtain
falls at the end of the evening.
‘Lozenge operas’ are everywhere.
Some are serious and have dire
consequences (Wagner) others
are a purely a vehicle to inject
some comedy and move the plot
along (Bitten and Donizetti).
All, however, use chemical
subterfuge to change
the action dramatically.
It may be a sort of
dramatic cheat – the
potions certainly are – but
this is opera not real life. And
there is always the music to add
glory to the cheating.
Elixir of Love
Donizetti’s glorious comic opera
‘L’elisir d’Amore’ (The Elixir of
Love) hinges on the selling of a
decidedly questionable elixir by
a well-meaning but unqualified
quack (Dr Dulcamara) to the
hero Nemorino (‘little nobody’).
He presumes one swig of the
relabelled Bordeaux will make
the heroine and village belle,
Adina, fall for him. It is a simple
and fantastic plot (this is Italian
opera, remember!) which, thanks
to the music, is accepted as a sort
of pantomime/comedy with a hint
of personal inner turmoil.
As the curtain rises Adina
mocks Nemorino’s advances
and reads the fable of ‘Tristan
and Isolde’ (on which Wagner’s
opera is based) which tells that
when Tristan has drunk the magic
elixir Isolde will love him for
ever. Adina teases Nemorino that
there are now no elixirs to soften
the heart of a young girl into
“slavish dependence on a young
man.” Nemorino, nonetheless,
approaches Dr Dulcamara and
begs him to solve his amorous
problems with a love potion of
Queen Iseult as in the Tristan
story: the “marvellous elixir that
awakens love”.
Adina does, of course, fall in
Potent performance L’elisir d’Amore, 2009 Simone Alaimo as Dulcamara & The Royal Opera Chorus
love with Nemorino but that is
nothing to do with a potion and
more to do with the fact that he
has inherited a fortune. Dulcamara
thinks his little bottles do have
magic qualities after all but Adina
tells him she has a more potent
potion of her own: her female
guile. All ends happily.
L’elisir is a classic ‘lozengeopera’.
But its potion is, of
course, a hoax: it has no magic
qualities and is indeed totally
harmless. The charm of L’elisir
is mainly in the music and the
comic situations. The story has
its roots in legends, myths and
magic and finally the moral is
clear. Love is the most potent
aphrodisiac of them all.
Nemorino sings ‘Una furtiva
lagrima’ (A furtive tear) which
is a show piece aria for the tenor
and the likes of Luciano Pavarotti
and Jose Carreras have both sung
the role to acclaim in London.
Both have made memorable
recordings of the opera (as has
Placido Domingo) which is a
reflection on the work’s enduring
popularity. n
l Alasdair Steven is a freelance
writer on the arts. He has covered
opera and ballet in the UK as well
as writing television scripts; most
notably for the first relay of The
Three Tenors from Rome in 1990.
He also writes obituaries for The
Times and The Scotsman.
PHOTOGraphs ©JOHAN PERSSON, MAY 2009
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52 Pharmacy Professional | November 2009
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e v e n t s i n t h e p i C T u r e
Stylish dining
The dramatic backdrop of Manchester Cathedral provided the stylish
setting for the annual dinner during this year’s British Pharmacy Conference
Down to business
Pharmacists from all parts of England, Scotland and Wales made the
journey to Manchester for this year’s British Pharmaceutical Conference
Look and learn Students spend time at the British
Pharmaceutical Students Association stand at the
BPC. From left Lynda Bennett, Rumana Choudury,
James Davis, Gemma Donovan and Matthew Crum
Meet and greet Plenty of interest in the RPSGB
stand at the conference
Shake on it RPSGB President Steve Churton (left)
greets Shadow Health Minister Andrew Lansley
In the chair Fergus Walsh of the BBC
takes centre stage
Candlelight and silver service set the scene for the BPC dinner in Manchester
Council meeting
The Hospitium (pictured right) in the beautiful
Roman city of York provided the dramatic
backdrop for the October meeting of the Royal
Pharmaceutical Society’s Council
images: jason king
Line-up All smiles for the camera from (left to right) Yvonne Hunter and Pauline Appleby of Health Links; consultant
pharmacists Adrian Ward and Mark Tomlin of Southampton University Hospital; Martin Stevens, national clinical
director for hospital pharmacy at the Department of Health; Jean Trainor and Chris Hanney of Health Links
Time for a catch-up during a coffee break for council members
Catherine Duggan (left) who is soon to join the Society as Director
of Professional Development and Support and West Yorkshire Local
Practice Forum lead Gill Hawksworth
Honorary membership of the RPSGB for Martin Kendall (right) emeritus
professor at Birmingham Medical School, seen receiving his certificate from
the Society’s Vice-President, Martin Astbury
54 Pharmacy Professional | November 2009
November 2009 | Pharmacy Professional
55

o f f e r s e x c l u s i v e ly f o r m e m b e r s
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Pharmacy Professional’s Prize Crossword 1
Compiled by www.puzzle-house.co.uk
After solving the crossword, take each letter from the shaded squares (in order) to spell out the Prize Word.
Email your Prize Word answer and your contact details to ppcompetitions@rpsgb.org by November 23 2009
November answers will be published here next issue
Clues Across
1&18 across A common concern that’s for
everyone’s own good (6,6)
6 A link to the supply between
pharmaceutical manufacturers, wholesalers
and stockists (5)
7 It offers growth potential that can go to
one’s head (7)
8&10 across Warn footballers about the
medicine scheme (6,4)
9 A form of medicine favoured by skiers? (6)
10 See 8 across
11 Therapy for pampered individuals? (3)
12 Muscle quality is sound (4)
14 Like a quiet little village affected by
antihistamines, perhaps (6)
15 For the record, it’s a dispensing error (6)
16 A little bit of this and a little bit of that (7)
17 Fall victim to hypotension – often quite
literally (5)
18 See 1 across
Clues Down
1 Antiepileptic dating back to 1912 (13)
2 Medicines that have made a name for
themselves (7)
3 It connects city, self and ear (5)
4 Popular products fly off it! (5)
5 Calling it quits? Here’s something worth
sticking with (8,5)
8 It counts as both exercise and relaxation (4)
11 A made-to-measure pack specification? (4)
12 A common take on pregnancy prevention
(3,4)
13 Chemical representative? (5)
14 Achieve that razor-sharp look (5)
This month’s prize is
a copy of Martindale,
worth £375,
produced by RPSGB
Publishing, which
provides unbiased,
evaluated information
on drugs and
medicines in clinical
use around the world.
56 Pharmacy Professional | November 2009