If you have to choose between killing one person to save the lives of 5 others, and doing nothing even though you knew that 5 people would die as a result of you doing nothing – what would you do? What would be the right thing to do? That is the hypothetical scenario that is becoming more relevant in today’s society and is a moral & ethical dilemma that most nations are facing when deciding on what policies to implement in the COVID world.

Side-line observation tells me that the pandemic strategies our government has been employing since our first lockdown a year ago were a mixture of Utilitarian and non-utilitarian approaches. In the case of a pandemic, utilitarian policies focus on looking after younger, healthy people as it’s most likely to produce the best outcomes. Non-utilitarian approaches focus on protecting everyone equally, it’s not just about the consequences but rights, duties and obligations. Now, the reason that I’m exploring this is so that I can make some sense of the decisions that the government is making and why there is an ever-increasing division within the society. It is not intending to criticise the government’s approach to pandemic management, however, what I’m trying to achieve is to figure out which option will do the best overall not just for individuals but also for society as a whole.

As much as we would like to believe we are living in a society, where all people are equal and deserve equal rights and opportunities, there seem to be no egalitarians in a pandemic. The scale of the challenge the pandemic created for our healthcare system means that there is an ineluctable need to prioritise the needs of many due to the lack of resources.  Take the capacity of our ICUs and the availability of ventilators for an example of a moral dilemma that the frontline staff in the hospital are facing. What if, knowing that there are only 10 ventilators available but there are 11 patients admitted who require its use. How would you decide who should get the treatment?

In a situation where money and resources are abundantly available, the argument is simple – everyone has an equal right to access ventilators, and therefore it is wrong to prioritise some over others. We cannot simply abandon our most vulnerable to save more lives, right? Yes, that is very true and should always be our goal to strive towards. However, does the ‘non-utilitarian approach still apply when resources are scarce? At some point, people will have to think about how they can do the best with the limited resources they have, and that means prioritising those people who have the best chance of recovering and living a long and healthy life. Although we are lucky enough to not need to make such dire decisions of who gets a ventilator or not, our government is very well aware that we do not have the necessary resource to cope if a widespread pandemic occurs. This explains the adaptation of a more or less ‘utilitarian’ approach when distributing medical resources like medicines and PPE. However, when it comes to deploying the lockdown strategy, a non-utilitarian approach was at the forefront. The logic to this approach is rather easy to understand: The decision of going into lockdown was purely based on the fact that not only do we need to prevent the number of infection cases and mortality rates from rising but also our healthcare system cannot cope if a widespread community transmission is present. At the initial phase of the pandemic, such strategy makes a lot of sense and it did serve its purpose in controlling the transmission rate within the community while preventing our already stretched healthcare system from overloading.

Some of you might ask, considering that the case-fatality rates of COVID-19 are sitting globally at around 2% (in comparison to 1% of the influenza virus), and the hospitalisation rate and death rates heavily skewed towards those 85 years and older  Then why do policymakers still believe reducing and suppressing the number of cases and case-fatality rates should be the end game we all strive towards? Even at the expense of 5 million people’s freedom and putting the economy on the line for a virus that can be detrimental to a smaller group of the population? Not to mention the repercussions of the lockdown on our mental health and wellbeing. One of the reasons being is that we do not have enough information to know how the virus behaves over time. And time has proven that virus mutation does exist and hence a more contagious delta strain emerged earlier this year. The second reason is that we did not have the vaccination available to us for protection. We all know that there is nothing utilitarian in the lockdown approach at all. However, it is the best strategy available at the time to cope with the pandemic. Hence, the need to sacrifice the many to protect the minority.

So how should countries decide when to implement stringent social restrictions, balancing preventing deaths from COVID-19 with causing deaths and reductions in well-being from the cause of lockdowns? I have to reiterate that I’m not trying to argue that utilitarianism is the only relevant ethical theory, or in favour of a non-utilitarian approach. What I do believe in is that each approach has its place in time and the government should be fluid enough about the approaches they use depending on the given situation.

One of the determinant factors on deciding on the type of approach that policymakers consider when making decisions that affect the nation is a cost-effective analysis. It is extremely likely the government has run their numbers in terms of the cost of letting the virus spread freely in the community versus the cost of implementing strict lockdowns hoping to stomp out the virus. At the initial phase of the pandemic, it makes so much sense that a short burst of lockdown may be the answer that we are looking for before a mass vaccination to protect the population becomes available. It does not cause a significant impact on our economy while at the same time stamping out the virus to reduce the burden on our already stretched healthcare system and reducing the ongoing cost involved with managing and treating patients with COVID. The strategy did prove its success where we did enjoy a fair bit of time in level 1 last year after the success of the initial level 4 lockdown.  However, is this still relevant when the virus can no longer be contained or stomped out?

Unfortunately, the amount of money spent on maintaining our economy during the lockdowns, while not forward-thinking to revamp our healthcare system with the necessary resources to cope with the pandemic– really, this leaves us with not much of an option but to carry on lockdown until the majority of us are vaccinated.

Ever since the government announced the rollout of the COVID-19 vaccination program, I’ve been pondering this question – could we have done this more efficiently? Have we missed the crucial window to vaccinate that would have allowed us to avoid the lockdown we are in at the moment?  Being a front-line healthcare professional, seeing first-hand how our healthcare system operated during the pandemic, and the kind of resistance and bureaucracy that I’m seeing in action, yes, we could have done a lot better. However, in hindsight, being a small country at the bottom of the world and with limited financial capability in comparison to mega countries, maybe that is the reason why we are still in lockdown, maybe we have already done the best we can. Who knows?

Hindsight is 20/20. What makes it powerful is that it allows us to make better decisions for the future. There is no doubt that minimising the loss of lives due to COVID-19 is important. Equally, if not, more important, is the well-being of all people – both with and without COVID-19 – which must be balanced and should not be dismissed. There is huge attention to quantifying the number of cases of COVID-19 infection and the number of consequent deaths. However, our government should also place more attention to the possible consequences of lockdown measures for everyone. There is no doubt that lockdown measures themselves will have a direct effect on morbidity and mortality due to the denial and delay of medical treatments. The tremendous amount of pressure and stress generated by the lockdown will have a long-term effect on people’s mental health the many years to come. Besides the direct implication on our health and wellbeing, lockdown measures also have indirect effects through an economic recession. We simply do not know the number of job losses with associated loss of well-being and death.

Policy is often driven by politics or popular options, not ethics. Choosing an appropriate approach is not an easy task regardless of whether it is utilitarian or non-utilitarian. It requires that we choose the best course of action that will benefit the majority of the population to the greatest degree. There is no doubt that there will be a minority of people who would rather bear the consequences of their own decisions than to comply. However, those in the minority must be safeguarded by the policy that protects them as much as possible with full transparency so that they can be as autonomous as possible. I agree that no matter what approach the government takes, there is no win in the court of public opinion. However, what the pandemic has taught us in the last 20 months is that successive governments have neglected our healthcare and hospital systems for decades, sequentially explaining why our health system cannot cope with the burden that the pandemic has created. We have also observed significant mismanagement, injustice, and infringements of rights over the past 12 months which resulted in a divided nation.  Sometimes is easy to put our own agenda forward while neglecting people’s wellbeing and their right to autonomy. That is why it is more important than ever that our government must fill the gap of effective management that was missing throughout the pandemic and start making decisions by not only taking into consideration the pandemic itself but also the wellbeing and livelihood of its people.

The post What is the right thing to do? [Weekly Dose Of Wisdom] appeared first on Eastmed Pharmacy.

Being a parent has in some way shaped my perspective in trying to understand such human behaviour and help me to find an answer to the perplexing question of why people don’t take their damn pills. Ever since the birth of my son, whenever he feels sick, my wife and I would take him to see the doctor. The doctor gives him a prescription and we religiously follow the instructions, even to a point of setting up the alarm clock to remind ourselves when the next dose should be. My wife and I realised that we are no longer that important compared to our little guy. He is much more important than us and we care more about his wellbeing than our own. On one hand, I understand why people could treat their pets like family members, but on the other, it still makes no sense to me as to why people would prefer their pets to themselves when it comes to their own health.

I’ve read a book written by Jordan Petersen a few years ago and I remember one of the chapters was about “treating yourself like someone you are responsible for helping”. The more I think about what he wrote, the more I understand that solving the adherence issue requires more than just a blister pack or proper medication counseling. In the chapter, he made a compelling case explaining why people don’t take good care of themselves – it’s related to how we perceive ourselves. He referred to the biblical story involving Adam & Eve.

According to the creation story, God places Adam in Paradise and created Eve as a partner for Adam. Within the Garden, there was the Tree of Life which had the fruit they could freely eat while the fruit on the Tree of Knowledge of Good and Evil was forbidden to touch. Despite the warning, both Adam and Eve ate the forbidden fruit. Hence, they both awoke with their eyes wide open, which gave them the ability to see the good and the bad, right and wrong. For the first time, they both became conscious, or perhaps self-conscious as the first thing they noticed was their naked body. I would imagine that becoming conscious that you are naked is a big deal for both of them as it was the first time, they saw each other’s flaws. Nakedness can have a negative connotation and is usually associated with vulnerability and weakness, exposed and unprotected. That is why Adam and Eve felt ashamed after their eyes opened because their flaws stood out.

This is particularly true when patients are diagnosed with a long-term clinical illness, they are finally coming to terms with how “naked” they are. Immediately they become defensive and frightened of being ill and this eventually progresses to a resentful stage where they feel ashamed and unworthy of medical attention and intervention. The reason they have such thoughts is that they believe they are the “flaws” of their life and are unworthy of “help”. These are the very same thoughts that Adam had about being afraid to walk with God because he was conscious of his nakedness and that God would judge him based on his high standards. Because of this, I really think that medication adherence is not just a simple matter of forgetting to take the medicine. It lies deeper into our human psyche where our transgressions, insufficiencies, and inadequacies are the fuel that leads us into thinking that our innocent pet is more deserving of our attention.

Sooner or later, we all need to ask ourselves an important question, “What will my health be like when I care for myself properly and start taking the medicine that I should?” Well, for a start, don’t expect your health will ever revert to 100% efficiency. However, knowing that it will not progress in a downward spiral is both relieving, and reassuring.

Ultimately, to reduce the cost of medication non-adherence, we need to get people to take their damn pills. The health system and healthcare professionals like us must shift our strategy slightly. We must make efforts to understand the human psyche and help individuals to remove the veil of unworthiness and resentfulness to reveal the self-confidence lurking behind so that people can finally stand up tall with their shoulders back and start moving forward without shame once again.

To taking your medicines regularly, as prescribed,

The post Why people don’t just take their damn pills! (Part 2) appeared first on Eastmed Pharmacy.

If I were to summarise the role of a pharmacist in two bullet points, it would be:

• To ensure safe and effective use of medicines
• To improve health outcomes through education and compliance promotion.

They certainly sound very PC, but we strive to do this every day behind the scenes. And trust me – they are very hard to attain.

The way we measure success is not very scientific but it mostly involves seeing my patients at three-monthly intervals for their regular medications. Three-monthly is a sweet spot, where people are not sick enough to see me every couple of weeks but also it’s not too long to be suspicious that they are not taking their pills regularly.  Striving to revert damaged health is often unrealistic and unattainable. However, we’ve always pleased to find out that our interventions have contributed in some way to not let their health slip to a stage of absolute hell.

After accumulating a few more wrinkles on my forehead, it’s made me realise that what appears on the surface may only be skin deep.  Seeing my patients regularly every three months does not mean that they are doing all they can to maintain their health. Medication adherence is a major problem that I see every day on the job. According to the American Heart Association, 12% of people that are prescribed a drug won’t fill the prescription. Approximately 50% of the remaining 88% will fill it, but won’t take the medication or they’ll cease taking it before they should.

Take this as an example, a regular patient of mine passed away recently, her daughter asked if we would help her discard her mother’s medication safely. Certainly, is always the answer as I’m a strong advocate of safe medicine disposal. However, I didn’t realise what I got myself into until I saw the two large boxes of medications that could easily equate to more than a year’s worth of medicines – untouched medications.

A scene like this is not foreign to me and happens more often than you think. What’s interesting is that many of our patients which we once thought were relatively compliant, based on the consistency of their prescription collection, were in fact the complete opposite. What’s worse is to imagine someone having a stroke and have undergoing procedures to bring him back to life. To keep them from having another stroke, they must take heart medications and blood thinners for the rest of their life. Most people are happy to accept the trade-off.

Despite the utility of these drugs, many people will eventually experience another stroke. It’s not because the drug is not effective, but rather not taking the drugs as prescribed. To allow yourself to have another episode of stroke and deteriorate your health further because you don’t want to take your medication? How could people possibly do this to themselves?  You would assume that being given another go in life would change someone’s perspective and be more proactive. But in reality, it doesn’t.

As a pharmacist, I tend to blame myself for my patient’s non-compliance. I have the tendency to assume that the failure of patients to follow my professional advice is the fault of mine, not the patient. Have I not explained properly the importance of taking the medication regularly? Have I not spent enough time with my patients?

I believe my job is ensuring my advice will be followed, my intervention will be respected and my follow-up may promote the correct use and assist my patients to achieve desirable health outcomes. Unfortunately, this can sometimes be wishful thinking.

In reality, most pharmacists are time-poor, we don’t have the luxury of time with our patients to the level we would like to be spending with them. That explains why sometimes I’m lacking the understanding as to why won’t they just take their damn pills? Don’t they want to get better? The truth is often fairly complicated. There are multiple variables to explain someone’s non-compliance. It could be psychological factors. It could be miscommunication between doctors/pharmacists and patients. It could also be a matter of affordability of the medicines.

The health system has continued trying to tackle the medication adherence issue. There is a lot of research and discussion on how to improve adherence. The discussion put forward often focuses on more engagement, better information and patient education about medication, and also potential changes to the medication supply chain and delivery leading to greater adherence. Despite that, compliance issues still at an all-time high. It is estimated the cost of non-adherence is $700m, mostly relating to unplanned and avoidable hospitalisation due to people not taking medication as prescribed. This makes me wonder if a different approach is needed and whether we need to dig deeper as to why non-adherence even exists.

Next week I will dive deeper into medication non-adherence and what we can do to help solve this problem.

To taking your medicines regularly, as prescribed,

The post Why people don’t just take their damn pills! (Part 1) appeared first on Eastmed Pharmacy.

This is fantastic news, right? Of course, it is. Who would have thought that we would have a promising COVID-19 vaccine in just under a year of discovering the virus? Plus, developing and manufacturing the vaccine is one thing, but getting our hands on a vaccine is itself a process that alone is difficult enough since every country wants it. Credit has to be given to our government, as we now have an adequate buffer for our fight against COVID-19.

So, we’ve got the vaccine, now what? Indeed, that’s the million-dollar question and is one that should not be taken lightly. The next hurdle that the government must overcome is how to vaccinate the whole population within a short period of time. Vaccinating the population is a key priority of the government because it could end the pandemic and give us the power to open our borders and steer our economy back on the trajectory of economic recovery. It is an exercise that needs to be done as swiftly as possible. Not to mention that new variants of the virus are emerging, potentially making the vaccine ineffective. We are definitely in a race against time for sure.

Let’s put this into perspective: if the government’s goal is to vaccinate everyone within a year, this means that we would need to perform approximately 14,000 vaccinations each day for us to achieve that goal. This is the minimum speed the country needs to reach to achieve herd immunity before next winter approaches.  It is possible but it’s not an easy task. Let’s say if we have the manpower, facilities and resources to do all this, how can we guarantee that every one of the population would be willing to get vaccinated. In the second half of 2021, we could reach a point when we have more COVID-19 vaccines than people to vaccinate, and getting them to take it will be the primary issue.

This is a very valid question and is one that’s going to affect our pandemic strategy and possibly the one that could give our government significant headaches.

New Zealand has a hesitancy problem

To clarify, herd immunity is when enough people are protected against the virus to stop its spread. To achieve herd immunity and end this pandemic, experts estimate that we’ll need to vaccinate at least 70% to 80% of the population. Yet according to a recent survey by global company Ipsos, 51% of New Zealanders say they are likely to get the jab once it’s available to them. While 18% say they are not likely and a further 24% are sitting on the fence.  If that holds true and the herd immunity estimates are correct, it would make ending this pandemic impossible. Compounding that is the uncertainty of whether the vaccine is safe for children as currently it is not approved for use in children. Although several clinical trials are going on at the moment, sufficient data might not be available until the end of this year or early 2022. Given that 20% of the population is under 16, it might further hammer our goal of reaching herd immunity when such a large part of the population is excluded.

I believe the government has a huge task ahead of them when they roll out the COIVID-19 vaccination campaign. In order to launch a successful vaccination programme, the government should be completely transparent with the information they obtain with regards to monitoring the safety of the vaccine; but also, they need to understand why there is a hesitancy in getting the jab in the first place and strategically address the issues. Other than individuals with a strong anti-vaccine view, which tend to make up a very small minority of the public, hesitancy is often brewed by miscommunication and misinformation.

Misinformation about the short & long term safety of the vaccine

Those I know that are sceptical about the vaccine are mainly concerned about the short term and long-term safety of the vaccine being compromised due to the fast-tracked development process. A lot of these concerns are valid but are misinformed. This is because even though the vaccine development was fast-tracked, it still went through the three-phase clinical trial process required by the FDA, testing for safety and efficacy. Furthermore, the vaccines have already been tested in the real world since the mid-2020, meaning most of the short-term side effects would have been identified by now. Millions of people have already been vaccinated in the northern hemisphere with no major safety concerns detected for serious side effects. Not to mention that by the time a wider spread vaccination rollout happens here, there will be more than a year’s worth of safety data available, meaning that we would have a high level of confidence about the safety of the vaccine by then.

In terms of the long-term side effects, concerns are being raised on the internet that the mRNA technology used in the development of the Pfizer/BioNTech vaccine can affect our DNA or change our genetic code. This information is misleading. First of all, as discussed in my previous article, mRNA (messenger RNA) is found in all living cells and it sends signals to the cell and teaches them how to produce certain proteins that trigger the immune response inside the body. It is not the same as DNA (your genes), and it does not affect or in any way interact with your DNA. Hence, we can be assured that it will not cause DNA damage or alteration in both the short or long term.

In my opinion, the way COVID-19 played out in New Zealand has contributed to creating vaccination hesitation. On one side, a well-handled pandemic with minimal transmission and death rates was praised around the world. However, on the flip side, our success can hinder the government’s effort when it comes to encouraging people to get vaccinated to reach herd immunity. This is because there was never a widespread community transmission compared to the rest of the world. Hence, people simply don’t see the urgency to get vaccinated because there isn’t a threatening problem in the first place. But if the pandemic should have taught us anything in 2020, it’s that it’s better to be proactive and be on the offence than reactive and be on the defence. We must understand that it is important to get ahead of the pandemic before it becomes out of control.

Annual vaccination might eventually become the norm in our post COVID world. Of course, getting vaccinated is a personal choice and is one that everyone must consider with all the available evidence and information. What makes the vaccination decision so unique and important is that the decision we make could potentially affect the lives of everyone surrounding us.

To a successful vaccination rollout.

The post COVID-19 vaccination hurdle: How to convince Kiwis to get vaccinated? appeared first on Eastmed Pharmacy.

The NZ government has secured 4 different COVID-19 vaccines. They all use different vaccine technology and have different strengths and weaknesses. One of the stand-out candidates which has gained significant media coverage is the Pfizer/BioNTech vaccine. It was put in the spotlight partly because it was the first COVID-19 vaccine granted emergency use authorisation in the US. Also, it shattered previous records for vaccine development going from the development phase to clinical trials and being granted approval for use in less than a year. I have talked about how development speed can be made possible in my previous article (you can access it here). In summary, besides the global effort and billions of dollars that were pumped into speeding the developmental process up, another reason that we can achieve so much in such a short period of time is because of a ground-breaking vaccine technology that allows the long development timeline to be shrunk significantly. This technology is called mRNA and many more vaccines will be developed in the future using this method.

Let me explain why. Traditionally, there are 4 ways to develop a vaccine. The 2 most common methods are by exposing you to either a weakened (measles vaccine) or a dead (flu vaccine) virus or bacteria so that your body can develop the necessary antibodies to fight off the pathogens if you ever come across it in the future. The third way is by introducing a toxin (tetanus shot) of a virus rather than the virus itself. The fourth type is developed by exposing a small fragment (hepatitis B vaccine) of the virus instead of the entire virus.

Some of the COVID-19 vaccines use the more traditional method such as Novavax which uses a part of the SARs_CoV2 virus known as the spike protein. When injecting the spike protein into your body, it will not result in an infection. However, it’s enough to trigger your immune system to produce antigens that can recognise and launch an assault on the virus if it ever comes across it again.

The problem with such technology is that the production and isolation of the spike protein in a lab environment takes a tremendous amount of time and resources. It requires a large amount of live virus which is practically impossible to achieve in a short timeline, especially when mass vaccination of the population is required. As mentioned in my previous article, one of the reasons the COVID-19 vaccine can be created in such a short period of time is due to overlapping different phases during the development process and initiating the manufacturing process early, before approval of use has been granted.

The scientists are also able to speed up the development timeline by focusing on a different technology for the vaccine – the mRNA method. We all heard of the phrase “give a man a fish and it’ll feed him for a day. But teach a man how to fish and it will feed him a lifetime”. This is exactly what the mRNA method is about. It is to shift some of the work that is traditionally performed in a lab to your body.

To understand this concept, we need to be aware that our body cells are like mini-factories that are constantly producing proteins for our body to function properly. Our cells do this by producing a single strand of DNA (also called mRNA). Each strand of mRNA in a way acts like an instruction manual where it holds the information on how to make one type of protein. The cell then follows the instructions provided by the mRNA and makes the protein. If our body already has the hardware to produce proteins in a more efficient manner, why not teach our body to produce spike proteins of the SARs_CoV2 virus and sequentially allow our body to develop the necessary antibodies to combat the virus?

This is how the Pfizer vaccine is being produced – by identifying the genetic sequence in a COVID-9 virus that is responsible for producing the spike protein. By identifying the specific DNA sequence, a scientist can synthesise an instruction manual (mRNA) to teach our cells to produce the harmless spike proteins, allowing our body’s immune system to recognise the threat and produce the necessary antibodies to combat it.
Doesn’t this sound like the perfect vaccine that can speed up the development and production process? Yes, it does. However, it is not without drawbacks. The problem with isolating mRNA material is that it is relatively unstable and can be broken down easily. In order to main the vaccine in a stabilised state, it needs to be encapsulated inside a fatty layer and kept in sub-zero temperature. This has created some challenges logistically because it cannot simply be transported across the globe without a super-freezer and it is relatively costly to do.

The pandemic has created an opportunity for all the brains and resources in the world to come together to use ground-breaking technology to create a vaccine in an extremely short timeframe. We are all hoping this is the key turning point in the pandemic. However, what many of us don’t realise is that the COVID-19 pandemic gave vaccine development a whole new chapter and a perfect vantage point that we needed in shaping how we prepare, manage and contain any future virus outbreaks of any kind.

To a successful vaccination rollout.

The post The Pfizer/BioNTech vaccine explained appeared first on Eastmed Pharmacy.

There is something powerful about the new year, about the opportunities we have with a fresh start to the year. To be perfectly honest, as one of the most devastating years in our lives has come to an end, we need exciting things to look forward to in 2021! Bill Gates thinks we should be optimistic about 2021 because of three vaccines (Moderna, Pfizer-BioNTech & AstraZeneca) gaining approval for use at various quarters in 2021 in the fight against COVID-19.

The breakthrough of a vaccine and the pace of its development in 2020 has stunned us – governments, companies, and scientists around the world were able to cut through the “BS” and get along to handle a global pandemic crisis swiftly. Such collaborative achievement and effort are not just something that could only happen in a Hollywood movie. This has definitely restored our faith in humanity in some sense. But the truth of the matter is while the calendar might be turning a new page, much of our reality will still be the same in 2021. The detrimental effect from 2020 will definitely resonate for the years ahead. Sadly, many who struggled in 2020 will continue to face serious problems – personally, financially, and professionally. In a way 2021 feels like an extension of 2020 and January became the 13^th month of 2020 for most parts of the world particularly the UK and the US.

It’s interesting how the experience I get from each previous year has positioned me differently and shaped the way I place my focus for the year. After the year we just had, I felt the desire to go back to the basics. I want to be as optimistic as I can be with a clear path forward. What 2020 has taught me is that the key to gaining clarity and optimism is not through complexity but rather through simplicity. Sometimes we tend to overcomplicate things, this can do more harm than good psychologically and can shroud us from the truth.  I have made myself a small list of three points that I’ll be focusing on this New Year:

The first is the idea of de-cluttering my life.  What I mean by that is to de-clutter our thoughts, stop overthinking the consequences, shrink down the list of friends to those who are supportive and genuinely interested in your well-being and place your focus on the long-term goals. Work microscopically on a daily basis to move closer to where you want to be. It certainly sounds simple to do but I can tell you that it is extremely hard and is something I’m actively working on to improve myself.

The second point is don’t wait and start doing. I think one of the consequences of spending so much time in lockdown this year is the realisation of how much time we have. Many of us have lost the appreciation of what I would consider the most valuable resource everyone has. Before COVID-19, many of us would complain about how little time we had in a day to get things done. However, during the lockdown, we realised how much of our precious time is wasted aimlessly browsing Facebook feeds and watching Netflix. This is something I’ve been thinking about a lot for the past year. There have been moments where I was playing the waiting game to wait for the storm to pass, however, I do not want my whole life to be dictated by unforeseeable circumstances. I’m not going to wait to try to bring to life the things I dream about even if it means I need to be resourceful and find creative ways to turn it into a reality.

The third thing is to figure out how you want to spend your time. Allocating your time to things that matter is probably the most important point when it comes to living a less exhausting and more productive life. Just before the new year, I found out on average I’ve spent 2.5 hours on my phone checking and replying to emails, browsing the news and social media, and listening to podcasts.

This newfound information really opened my eyes to my media consumption. This concerns me because when I look back at my life, such a level of media consumption is not something that I would think of as mattering. Don’t get me wrong, I’m not against social media or any form of media consumption. However, I also consider it a waste of my time which I could better invest elsewhere such as spending more time with my family and working on the business direction I want to go.

Despite our greatest hope for an easy year, 2021 will no doubt be a year just like other years, where it will take its own course. There will be multiple obstacles, bumps, and windy corners. But to gain clarity and optimism, we must adopt a simple mindset, de-clutter our thoughts, embrace what life throws at us and allocate our time effectively. This will allow us to navigate the year ahead with a little more ease.

To all the highs and lows that 2021 brings,

The post What does 2021 mean to you? appeared first on Eastmed Pharmacy.

I’m not sure if you feel the same, but as we are approaching closer to the silly season, the presence of alcohol becomes more and more noticeable. It doesn’t help when there are so many opportunities and temptations which lie ahead in the next week or so – that having an affair with alcohol seems inevitable. If you were unfortunate enough to have been cursed with a prescribed course of antibiotics for you during Christmas and New Year, you must be wondering whether you had to abolish your intensive wine list?

Staying off alcohol when taking antibiotics has been consecrated advice from pharmacists and GPs for as long as I can remember. The negative connotation between alcohol and antibiotics closely resembles a pair of lovers that are destined to be apart despite many efforts to be together. Unless you are a woman who is looking for an excess to turn down an alcoholic drink because you are trying or in the early stages of pregnancy, and are not willing to give away the happy news so quickly; telling friends and colleagues that you are on antibiotics can be a bit off-putting and an anti-social thing to do.

So, is it true that you need to abstain from alcohol whenever you are on a course of antibiotics? The answer to this isn’t quite that simple.

It is difficult to work out exactly where the advice of avoiding alcohol with antibiotics came from. However, such advice can date back as far as the 1950s where penicillin was developed and first used to treat sexually transmitted infections such as gonorrhoea and syphilis. At the time, the advice came about not because alcohol makes penicillin less effective, but rather it was due to the fact that doctors worried that the risky sexual behaviour under the influence of alcohol could potentially undo the reputation of it as a miracle drug at the time.

Such observant remarks, although not backed by science at the time, there is now emerging evidence to suggest that people are generally more likely to engage in risky sexual activity when they are intoxicated.

There are a lot of myths out there where people would assume that alcohol can stop antibiotics from working effectively or cause serious side effects. From a pharmacological standpoint, alcohol does not post any detrimental effect when used in combination with most antibiotics. However, from a clinical standpoint, there are several compelling reasons to believe that all antibiotics should not be mixed with alcohol.

One is that if the patient assumes alcohol is contradictory to their treatment, then it would encourage them to skip their antibiotics over a glass of wine at dinner time. Doctors and pharmacists want to prevent this because such behaviour could potentially lead to the serious problem of antibiotic resistance.

Secondly, drinking alcohol while your body is trying to fight off infection may not be ideal because alcohol can promote dehydration by forcing your kidneys to lose more fluid, interrupt your circadian rhythm and affect sleep patterns. This can prevent your body from absorbing vital nutrients which can result in a slower recovery when you are ill.

Although most antibiotics are compatible with alcohol, there are a few exceptions. Metronidazole and Co-trimoxazole (sulfamethoxazole/trimethoprim) are the two examples of incompatibility. These antibiotics block one of the pathways where alcohol is metabolised, leading to a rapid build-up of a nasty substance called acetaldehydes. Such substance generally results in a host of unpleasant hangover symptoms such as nausea, vomiting, facial flushing, headache and rapid heart rate.

The interaction of this kind between alcohol and antibiotics is generally more unpleasant than serious. I usually advise avoiding alcohol completely for the duration of the course and for at least 72 hours after finishing your course of antibiotics before considering having a sip.

Although mixing alcohol with most antibiotics is not contraindicated. Both alcohol and antibiotics can individually and collectively cause unpleasant side effects. Such an experience will only get worse if you are ill or physically unwell. I always advise my patients to avoid the combination as much as possible regardless of whether you’re on one of the problematic antibiotics or not. Bear in mind that antibiotic treatment is often prescribed for short term use. So, put a halt on your heels and consider resuming alcohol consumption until after your treatment. This could only do more good than harm by reducing the potential side effects brought on by the antibiotic and also a greater chance of a speedy recovery.

So next time when you have prescribed a course of antibiotics, make sure you talk to your pharmacist to find out if you need to abstinence from alcohol and for how long.

To a joyful festive season,

The post Will antibiotics ruin your Christmas & New Year? appeared first on Eastmed Pharmacy.

Many serious health problems seem to develop unexpectedly, upsetting your life out of the blue. You may feel overwhelmed by waves of difficult emotions. There is bound to be a certain element of fear, profound sadness, anguish, and grief. Or you’ll just enter a phase frozen by the shock and simply do not know how to react and cope. The emotional turmoil can prevent you from functioning or thinking straight and what’s worse is that it can lead to depression and anxiety problems further down the track if you don’t handle it properly in the first instance. What I’ve learned as a pharmacist after dealing with multiple patients with newly diagnosed medical conditions is not to let it get the best of you. It is very easy to blur the line between your illness and your character. Over the years, I’ve seen many people with different values and outlooks on life, all handle their diagnosis differently – some for the better and some for the worse.

The first thing to do to preserve your character is to allow yourself a period to absorb the news and to not ignore your feelings. It is always the best approach to talk to someone you trust and not to bottle up your feelings and emotions which often is the easiest thing to do. By acknowledging your feelings and emotions, you are allowing yourself to grieve through proper means; hence preventing yourself from internalising fear and anger which is a dangerous fuel for bitterness and resentment.

The reason some people may never seem to look past the grieving phase could very well because of the fact that they are frustrated the diagnosis may hugely affect their normal life and plans for the future. You’re now no longer able to travel because of the treatment plan (not that we can travel overseas now anyway due to COIVD) or you’re no longer able to live the same lifestyle as before. Either way, we need to come to terms that life is unpredictable and even the best-laid plans may go astray and that is part of being alive. Even though you know where you’re heading, you might have a flat tire along the way and that might affect the expected time of arrival to your destination. The point is to realise that life can be punctuated by unexpected catastrophe and the responsibility lies with us on how to handle it and to make it no worse than it has to be. The best time for such realisation is after acknowledging your feelings and emotions and not before.

A lot of people don’t realise that allowing a diagnosis to bring you down is a poor strategy to position yourself on the road to recovery. Also, what’s worse is to allow your behaviour to take its toll on the people around you. You have a moral obligation to not destroy your family or loved ones by letting them see your illness tear you down in the first place. You have to be strong, not just for you, but also for them. Now I’m not saying you cannot show your vulnerability, in fact, you should embrace it but there is a delicate balance in doing so and not letting your vulnerability break you or your loved ones.

A difficult situation that I have been in is with my mum. She had a problem with her lower back and it bothered her for a few years before it reached a stage where she needed to have surgery to fix it. She experienced excruciating pain daily and the hardest thing was watching someone you love so dearly suffer from so much pain. The level of pain is malevolent beyond belief. However, she always conducted herself admirably, not showing us the level of pain that she was in because she didn’t want us to get worried. My mother has taught me not to let your illness be an excuse to be a victim. Once you start feeling sorry for yourself, you automatically won’t be able to distinguish the difference between your illness and your vulnerability. Once you start to blur that line, you’ll be in a murky place, where it’s more difficult for you to bounce back, leading to a path of resentment.

So how can you remain positive and emotionally intact when you are faced with a significant diagnosis or health issue? Well, as mentioned in my previous paragraphs, acknowledging your emotions and the ability to comes to terms with reality is important. However, it is equally, if not more important to realise that the alternative is worse if you insist on not accepting the reality. Many times, we deceive ourselves into thinking that escaping reality and constant denial is the best strategy. I mean, it makes perfect sense to find a corner of the room, hide away from the problem and not deal with it. But doing so will not make your illness go away, it will probably make it worse. Being diagnosed with a significant illness is one thing but doing something about it, staying positive, and making your life less miserable is another. The last thing you want to be doing is to let your illness not only conquer you physiologically but also psychologically as well.

If you know someone is going through a difficult time accepting their illness, you owe it to yourself to do something to help them. Sometimes all you need to do is to be there to support them and let them know that they are not a victim. Steer them back on the path of recovery by letting them know that they are still strong and their life is still as bright as before the diagnosis.

To overcoming adversity,

The post How to deal with a significant medical diagnosis? appeared first on Eastmed Pharmacy.

One of the questions that many of us might be pondering ever since our first lockdown is how can we plan and prepare for something that cannot be seen. Well, it turns out there is a way to see coronavirus indirectly, to see its transmitting behaviour, to see how fast it spreads. It is the method used by many data journalists or epidemiologists to collect as much relevant data as possible.

Mapping an invisible killer like the coronavirus is just the same as catching a serial killer. You always need to be ahead of the killer, understanding their behaviour, studying their every move so that you can catch them before they strike again. It also requires both patience and dedication and a robust data collection and reporting system. It is considered both a science and an art form.

The birth of virus mapping has its root in London in the mid-1800s. Back then, people genuinely lived a hard life where medical knowledge and interventions were not as advanced as today’s world. Multiple new diseases were emerging where people had no idea of their whereabouts, let alone how to treat and eradicate them. Many people were contracting and dying from diseases that they had no knowledge of despite the fact that those diseases and viruses are not considered deadly in modern-day terms. One of them is cholera. As a result, people came up with a bunch of weird theories and potential remedies for the disease that lead to inaccurate health advice from wrapping up in hot blankets to taking a teaspoonful of hot water. The advice was not evidence-based and people were generally ill-informed, hence they continued to get sick and die.

The situation took a drastic change when an English physician, John Snow showed up. (By the way, he’s not the Jon Snow from the Game of Thrones). His proposition was simple: tracking every single sick person by talking to them, asking them where they’ve been, what they did, what they touched, and who they came in contact with.

The data he collected all clustered and pointed to a water pump in Broad Street. It turned out that from this data collection exercise, they found out the water supply from the pump was polluted by sewage from a nearby cesspit where a baby’s nappy contaminated with cholera had been dumped. This was a huge revelation because people at the time believed that cholera was transmitted through the air rather than through bodily fluid.

What John produced was not just a simple map of a killer disease, but a detailed statistical analysis. Medicines back then were predicated on each doctor’s knowledge and experience rather than incorporating data science in their daily practice. His work changed the way we practice medicine and also the way we see, visualise and analyse data.

Now fast track to 2020, we are in the midst of a global pandemic. Although, the coronavirus today is very different from the cholera outbreak in the 1850s. (For starters, it is a virus and not a bacteria like cholera). However, what is common between the two is that they both were fast-spreading and infectious. The technique and method required to map coronavirus is virtually the same but on a much greater scale. Rather than trying to map out the virus in a small city, we now need to extend the mapping to countries and even the entire world.

What’s different in today’s world is that people move a lot faster and can travel further compare to back in the 1850s. With that being said, technology these days enables us to track and trace coronavirus in ways we could never imagine and to an extent that can be quite disturbing to comprehend. However, it comes at a cost.

Take South Korea and Singapore for an example. If you were to tested positive for coronavirus, you’ll be interviewed by the police and health officials, and your phone’s GPS signal and credit card transactions will be accessed cross-referenced to retrace your every step. This is to reconstruct a trail of everyone that you have close contact or interaction. Even any objects that you’ve touched will be traced and isolated. Once you are in isolation, all your movements will be monitored and tracked to ensure you do not breach the isolation period. This is the way these countries map out coronavirus to stay ahead of the game. Despite the meticulous, labour, and resource-intensive work involved with this method of mapping, it is possibly the only possible way to truly track the virus and stay ahead of it.

Now a plausible question to ask is why aren’t all countries in the western civilisation utilising this strategy to stamp out the coronavirus?  There are several reasons for this. One of the important reasons is that many people in the western world are not comfortable with the idea that their every move is being tracked. We are more sensitive in regards to our privacy being breached compared to some parts of the world. Secondly, this level of tracking requires the government to pour in a large amount of money and funding for it to be possible, and to be frank, many countries do not have the necessary financial resource to do so. Lastly, and is probably the real reason, is that some countries like the United States are simply too late to implement any tracking and mapping of the virus. Many countries did not act or respond quickly enough when there were only a few hundred cases. When it gets over thousands of cases and without a responsive government plan and strategy, it is virtually impossible to map the virus accurately for us to stay ahead of it.

In a way, we all should be extremely grateful for how responsive our government was when handling the pandemic. Obviously, there are things we could have done a lot better but overall, I believe the government has done a tremendous job in preventing NZ from following the footsteps of some other less responsive governments.

Even though we are at alert level 1, there is still a risk of COVID-19 returning to the community. So it is crucial to continue good habits with a face covering, maintaining good hygiene, maintaining social distancing, staying at home if you are sick, and getting a COVID-19 test if you present with COVID-19 symptoms. I also encourage everyone to continue tracking where they’ve been and who they’ve seen to help with the contact tracing app.

It is possible for NZ to continue on level 1 for the long term but it requires all of our input – don’t be complacent!

To a COVID-19 free NZ,

The post Mapping our way to COVID-19 free appeared first on Eastmed Pharmacy.

Our priority at eastMED Pharmacy during the COVID-19 pandemic response is to ensure all members of our community in St Heliers, Glendowie, Kohimarama and Mission Bay continue to have access to medicines, health information and advice. A big thank you and appreciation to my colleagues (Amy, Annie, Hana, Jan, Jess, Jo, Karen, Moree, Radha, Tracy) who have put in the tremendous time, effort, and worked long hours into making this priority theirs. I am extremely grateful and proud of what they have accomplished and I’m honoured to be part of this incredible team and work alongside these amazing people.

World Pharmacist Day is today, each year it gives me a time to reflect on the changes that have occurred during the last year. This year the list is endless! From building a perspex glass barrier in the pharmacy, wearing masks every day to restricting the customers in the pharmacy in level 3 and 4. I would have never imagined that we would be doing these things. The future of pharmacy has changed forever, the way we operate as a country – even the world has changed forever.

In New Zealand, there are 4000 pharmacists who work in a variety of areas – in your local community pharmacy, in hospitals, at drug companies, medical publishers, clinical trials and more!

As a pharmacist, I think that what we can offer the community is poorly understood by the public and our knowledge and expertise are grossly undervalued. This makes me really sad. Pharmacists need to go through four years of University study, a one-year internship and some even go beyond and further their study to obtain a masters degree like myself. Not to mention many pharmacists deployed in the community have years of clinical experience up their sleeves.  I left pharmacy school with enthusiasm and immense knowledge, however, most people think of pharmacists as merely pill counters or a shop keeper and we are extremely underutilised. Don’t get me wrong – I love my job and make it my goal to help others and educate them about what pharmacists can offer. That’s why I want to cover 5 things that you may not know about how your local pharmacist can help you:

1. We make sure that what you’re prescribed is safe – if it’s not we talk to your doctor. You may wonder why it’s taking so long to get your medicine but behind the scenes were calling the doctor, getting them to resend the prescription, checking it again – your safety is paramount.
2. We can let you know if you need to see the doctor. Ever wonder if there is something you can do for a minor ailment without seeing the doctor – we can help with that, saving you time and money.
3. We provide medicines for information. If you take regular medicines you should always check if it’s compatible with any other tablets or supplements that you take. Just ask us and we can review it for you.
4. We offer free advice with no reimbursement numerous times throughout the day. This is on the spot health care advice – no appointments. We don’t get government funding for this. We’re the only healthcare professionals to do so.
5. We are always available for you – whether it’s an ear to listen to or a shoulder to cry on – we’re here for you and the community. Part of why I love being a pharmacist so much is getting to know my patients and customers – listening to their stories and accomplishments makes my day.

I could keep going on about all of the things that we do on a regular basis which most of you aren’t aware of but instead, I’ll finish this week’s Dose of Wisdom with this:

Pharmacists are the healthcare professionals in which you can depend on and trust because we have absolute confidence and clarity in what we do. Our recommendations and suggestions for you are with keeping your best interests in mind – we get no financial gains or reimbursement from this free advice that we give. This is a rarity in this day and age! As the saying goes – there’s no such thing as a free lunch in this world…except when it comes to pharmacist’s expert advice!!

Next time when you see your pharmacist, give them a pat on their back. I’m sure it will make their day or even week because they are the people who work silently behind the scenes safeguarding our health system, usually with little or no recognition for the non – glamorous but important work that they do. They are the people who give so much to their community and do not expect anything in return.

Happy World Pharmacist Day!

The post 5 things you don’t know about pharmacists appeared first on Eastmed Pharmacy.