The "Generic" Myth Finally Debunked!

To substitute or not to substitute! That is the question!

It's not as clear-cut as we'd like it to be. Many drugs on the market are generics to originator (branded) drugs. Do they differ? Can they be substituted? To simplify it, the answer is two fold.

Yes, because they are (bio) equivalent but no because sometimes they are metabolized differently and therefore the experience is that: they're not the "same"?!

Some pharmacists will tell you 'it's the same'! And quite rightly so, often when addressing patient fears, uncertainties and issues of treatment accuracy. It's a quick answer to calm the patient down. A generic drug contains the same active ingredient, at the same dose than it's original counterpart. Therefore in this light, they ARE the same!

However, when it comes to efficacy and side effect profile, generic drugs might differ. This is because formulations (processes of manufacturing the drug and excipients or other additives) can differ.
Potency may also differ, as drug concentrations, release rates and absorption into plasma rates also differ. The regulated ranges for plasma concentrations (AUC) usually fluctuate between 85-110% match. Meaning a generic drug can be less or more potent than the original drug even at the same dose. Generic drug bio-equivalence have to be the same by law, but bio-equivalence doesn't necessarily mean tolerance equivalence either.
Patients may often complain that one generic doesn't work for them, or that the generic "feels" different. Besides a strong possibility of them just being picky or playing mind games, there is a real rationale behind it. It might actually be that they metabolize the generic differently and hence experience (effect and side-effect of) the generic drug more or less than with the originator.

The other common patient phobia is with pricing. Many patients feel cheated if a drug is too cheap. They actually want to pay more as they think it will "work better". Again it often is a mind game associated with perceived value. But the truth is, big price difference are  because of research setbacks.

The originator drug took time (including clinical trials) and lots money to develop, and so once it reaches the market for the first time, it benefits from patent exclusivity in sales. Usually 15-20 years. This is to recuperate the heavy research costs incurred and make profit for that manufacturing company.
After this period, the originator drug patent expires and is then made available to other manufacturers who can simply "copy" the 'recipe' for much less monetary investment and no research time. They therefore can slash the prices radically - hence cheaper generics.

At the end of the day, a generic drug will act in the same way as an original drug in effecting it's desired pharmacological effect. It may however feel different to a patient  who experiences it differently due to a difference in overall metabolism.

Next time a patient asks you if "they're the same", what will you say?


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10 Things Outstanding Pharmacists Do Differently

Here are ten ways (in no particular order) to identify someone who does an outstanding job and provides the best possible service to patients:

1. They do their homework: Continuous education is key in keeping up to date with treatment guidelines and procedures. An excellent pharmacist reads up and stays afloat on the newest trends ideas and regimens. They read up and are clued up. "I don't know" is rarely on their tongues.

2. They ask insightful questions: this requires deeper understanding of the problems patients can pose and it is strategically set out to reach an optimal desirable therapeutic end. Patient history to gain basic insight is crucial for diagnosis and treatment selection (basics) but building patient trust with thought provoking, meaningful specifics & information (deeper) is essential to adherence and ultimately therapy outcomes. Insightful questions reveal experience, knowledge and flexibility in tailoring treatments.

3. They are empathetic: They put themselves in the patients shoes to understand challenges arising. When you tell a patient to take medication six times a day, practically what does it entail? Have they tried it for themselves? Having to wake up at night to take a dose? An excellent pharmacist would add tips on how to achieve the task at hand. Setting alarms on your phone, asking a relative to remind you, and keeping a small pill container in your purse or pocket are a few examples.

4. They are open to dialogue: this might seem obvious, however when routine kicks in and pharmacists develop a comfortable road map to executing a counselling task for example, the dialogue tends to go one way and is more of a lecture to the patient. However to include them in treatment regimen, dialogue must flow in both directions. Questions and answers from both parties reveal a mutual, cooperative partnership and intentionally engages commitment To achieve therapy goals.

5. They know their value: most pharmacists add tremendous value to their patients therapies and health care in general. However an outstanding pharmacist will let it transpire. A lot goes unnoticed behind the counter and an unsuspecting patient won't know half of it. With effective communication (verbal and nonverbal) an outstanding pharmacist will demonstrate the value they add. This may be in the form of gestures/ postures and mannerisms, or statements, suggestions and questions, confirming and reassuring patients; all wrapped up into a pleasant, & superior experience.

6. They follow up: after a while working at a pharmacy, pharmacist will recognize patients on a name basis.  They develop a relationship and know more and more about their patients. Outstanding pharmacists follow up on even the non prescription items they had suggested or opted for their patients' ailments not long ago. This contributes to building patient confidence and trust as they feel valued and of importance. They are noticing the intentional care and appreciate the follow ups. Outstanding pharmacists give a phone call or write an email response.

7. They are confident: they do not need anyone to validate their skill. They are not out to please or be liked but to do an excellent job. Sometimes that requires saying no and being firm. Patients, practitioners, or nurses who push their luck and abuse favours will be reprimanded and kindly turned down by outstanding pharmacists who hold their ground. They know their scope, limits and boundaries for better and for worse. They aren't afraid to keep them.

8. They are team conscious: working in health care is NOT an individualistic or selfish job destination. You must and will form part of various teams. Outstanding pharmacists are inclusive. They know to include nurses, specialists and GPs on their wagons and do not self-limit their processes. If a patient requires additional assistance, they refer, call, ask and inquire from their team. Taking decisions alone can be detrimental to patient therapy and they know it.

9. They are resourceful: being part of a team is one thing but being in contact and having the correct resources to refer or inquire about anything is crucial to outstanding pharmacists. Poison control, emergency numbers, specialist practises and the promotional discounts/ cost cutting strategies are things that an outstanding pharmacist should know!

10. They love their job: passion is inextinguishable. When they do what they love and love what they do, it shows. It's appreciated and the positivity of it all is communicable and transferable To others. Patients will feel the energy, see the love and experience superior service emanating from passion. Outstanding pharmacists intuitively bring a 'come back to me' feeling to their patients every time.

There it is. Ten of the things that make this special breed seldom utter the phrase: "I don't know". 

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3 things to prevent a cold or flu this winter!

Colder winter days are upon us and the common cold (milder) and flu (more severe/intense) season as well! You may know that both these similar conditions are caused by viruses ( rhinoviruses and influenza viruses) meaning they are self limiting. Once you get a cold or flu expect 7-10 days of symptoms including a sore throat, fever, runny nose and a dry cough (persistent).

Note: you do not need a doctor to treat an episode as most over the counter medication will suffice. However if an underlying or pre existing condition exist such that your symptoms are exacerbated, do not hesitate. Antibiotics are usually seldom required and unnecessary as they only treat bacterial infections and not viral ones. So to steer clear of these viral bugs here are 3 things you can do:

1. The obvious one is keep warm! "Catching cold" can actually trigger sickness if you have a sensitivity or predisposition. Hypothermia will cause illness. The mucus membrabe in your nose and mouth can dryup or crack therefore compromising the protective layer and inviting the common cold or flu virus in. Also asthma can become exacerbated or flare up leading to dry or productive coughs. Smokers can also further irritate their bronchi with prolonged cold weather exposures.

2. Intentional supplemental intakes. During the colder winter days be proactive to ward of getting sick. Maximise your water intake, this helps flush out parasites and viruses from your system before they cause harm. Eat more citrus fruits packed with vitamin c to boost your immune system.  You can also take a daily vitamin c & zinc supplement. You should also eat balanced meals that give you essential amino acids and minerals to build a stronger body... and don't forget to exercise!

3. Prevention is better than cure. You've surely heard that saying many times before and it couldn't be truer regarding colds and flu. Avoid crowd, and busy enclosures. Since the weather is cold, people tend to stay indoor more and thus recycle each other's air, airborne germs and viruses. If someone coughs or sneezes openly, those particles travel to everyone else. Same with shaking hands with someone who just sneezed, coughed or held a used tissue. Wash hands more regularly throughout the day to prevent direct contamination. Lastly, check with your pharmacist if you qualify and get a flu injection.

Also note that through the hundreds of various "colds & flu" preparations that promise to cure you, many have similar active ingredients which can cause serious harm when taken concurrently. Especially with anti pain/inflammation substances like paracetamol / codeine / ibuprofen.

Always check with your pharmacist the total daily allowed dose for any particular active ingredients to avoid overdose, contraindications and side effects.

Happy Winter!

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What is Pharmacy? Who is a Pharmacist?

Over the years most professions change and pharmacy is no exception.

It is still represented by a mortar and pestle as that once was the major function of crushing and mixing leaves, seeds, and various strange things. But today the profession has stretched out far and wide...

The age of scientific evidence has demystified and surely transformed the perceptions of this noble career. Pharmacists are not wizards who compound nauseating concoctions for you to mystically cure you anymore. Now they are (for the most part) highly scientific, professionally trained drug dealers!

The South African Pharmaceutical Council, responsible body for controlling and  registering all pharmacies and their personnel;  states that pharmacy is the science of dealing with collection, preparation, standardization, dispensing and storage of drugs.
Did you know that pharmacy has over 8 specialty fields ?
From laboratory, research, academia, retail, hospital/clinical, industrial/production, to regulatory/ quality control, warehousing/distribution, consultant/specialist, and a few others! There are a lot of options to explore throughout ones career as a pharmacist! With all these sub sectors come just as many diversified services they offer!

Think of it this way, when you're sick, a general practitioner could diagnose you with a condition X. But if it weren't for all those pharmacists who research the medicine in the labs, those who manufacture the medicine in industry, those who package it and make sure it is safe, and the one who hands it over at the counter or in the hospital wards; you couldn't get treatment!

If you know a pharmacist in your friends or family circles, ask them what they do at work! You may be surprised.

Never think again of Pharmacy only as a shop where you can buy medicine. That's only the last carriage on the pharmacy-types train!


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What Your Pharmacist Wishes You Knew!

Every Pharmacist's Wish

Here's a quick run down of the top 5 things your pharmacist secretly wishes you knew:

1. That you can trust them. They went to school for several years and are not just tellers or cashiers. They actually studied pharmaceutical sciences including pharmacology and kinda know what they're doing. Whether for over-the-counter products or prescription items they are in a better position to give you accurate sound professional advice. Trust them.

2. They are more than pill counters. Of course counting pills is part of dispensing your medication but that's really the last steps towards issuing your treatment. From the minute your prescription is handed in, pharmacists begin the art of multitasking. They do a quick but thorough scan through first of all to"assess" the correctness of the prescription including if it's valid by law and secondly look at the correctness of the treatment prescribed vs the condition being treated.
All this happens under your unsuspecting nose and so just because they don't mention what they're doing doesn't mean it's not happening.

3. That you can speed up the process and cut down your waiting time by being ready with all relevant cards, prescriptions and information required (by law) before hand. (Also, don't take phone calls while next in line. They need your full attention and must ask important questions.) Its no use staring at the pharmacist while standing in line just to get to the counter and start shuffling through your bag or briefcase. Either way they usually do their best with regards to time. They're not standing there being slow on purpose or delaying the line for fun. Each patient needs is different and waiting times will fluctuate.
Be ready and patient.

4. The pharmacy is not a fast food store. Pharmacists don't appreciate your impatience. In general its rude to rush someone doing their job. When a service is rendered for your benefit, you must realize that it's to your advantage that all the safety precautions are taken to ensure a quality. Don't come in expecting to be out in 5mins. Make allowance for prescription mistakes to be caught and changed Which may involve phone calls to your prescriber or even medical aid provider. Again, it's medicine not pizza. An allergy, a wrong dosage or label could send you to the ER or worse.

5. They are there to help you. Pharmacists are the last member of your health care team. The last professionals you interact with before commencing treatment. Don't rush in to grab something for a runny nose without asking your pharmacist if it will interfere with any other medicine your taking. Advice from family and friends are well meaning but sometimes misguided. There's nothing worse to a pharmacist than giving you advice on a pain pill and you dismissing it because so and so suggested you take something else instead. They are professionals. Trained to help you. Ask them about the correct approach to relieving all your ailments.

There are a lot more things on their list apparently, but if you start with these 5, you'll be sure to get much appreciation from your pharmacist next time you visit the pharmacy.

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