The Pharmaceutical Journal Vol 268 No 7192 p480
6 April 2002

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Promoting health [more]
Poison in the sugar [more]
Fatter, not fitter [more]

Promoting health

Two generations ago community pharmacists in Britain carried out an important function in advising their customers on many matters concerning their health. For a variety of reasons this lapsed over the next generation, until in the 1980s it began to undergo a revival.

How these changes occurred is the subject of a paper by Stuart Anderson of the London School of Hygiene and Tropical Medicine published in Pharmaceutical Historian (the journal of the British Society for the History of Pharmacy) for March. In less than a century public concern with environmental health issues has made way for emphasis on personal health promotion, and studies on the relation between poverty and sickness have shifted to the risks associated with certain lifestyles.

Community pharmacists before 1948 played a traditional role. Thereafter the pharmacist was relegated to dispensing prescriptions in the rear of the premises, until in the mid-1980s he or she came out to face the patient in an advisory capacity. This reflects a reversion to the traditional role, in which pharmacists were accepted as important members of the community, were looked upon with respect, and whose advice was regarded as authoritative and sound.

It was the arrival of the National Health Service that prompted the changing role. At that time the interest felt by most pharmacists in preparing medicines extempore in response to prescribers’ wishes was sharpened by the awareness that in that way they were fulfilling the function enjoined by their professional training.

At the same time this notion tended to disguise the real presence of the pharmacist in the eyes of the public. Counter-prescribing was relegated to a minor function and the counter assistant became the main contact with the public, the pharmacist being merely on hand if the customer asked for advice. Naturally, pharmacy responded by promoting an advertising campaign designed to bring pharmacists back into prominence as health advisers.

An important part of the restoration process was co-operation with other bodies concerned with health promotion, initially carried out by a few committed pharmacists, but subsequently spreading. It was speedily found that training patterns would need to be overhauled, and official recognition would have to be sought. The growing demand for information about health and medicines became a powerful consumer force, and pharmacists became better recognised as sources of sound information and advice.

Nevertheless, there remains a gulf between public perception and
professional awareness over health issues. Pharmaceutical advice is readily given but consumers complain that it has to be firmly requested rather than offered willingly.

For future development, it is suggested that there needs to be a strong professional commitment to discuss issues with external agencies at an early stage. The Government has to be persuaded to recognise the role of pharmacy more fully and face the need for payment for services. The health-minded public has to be assured that a pharmacy is the place where they are encouraged to obtain advice and may be confident that whatever advice is offered will be accurate and appropriate.

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Poison in the sugar

A curious situation has been described from Toronto in The Lancet for 23 February. Two men, a 63-year-old father and his 29-year-old son, came to hospital with flank pain, conjunctivitis, anorexia, fever, chills, thirst and vomiting. Both showed acute renal failure. Biochemical testing showed severe vitamin D intoxication. The patients were treated with prednisone and made some improvement. The younger man later suffered from extreme pain, nausea and dehydration, and was treated with hydrocortisone, sodium phosphate and pamidronic acid.

Chromatography revealed a huge excess of vitamin D3. Both patients denied taking nutritional supplements.

Tests of various foods taken from the household were undertaken, and a sample of white table sugar which the son used to sweeten tea was found to contain 21.4mg of vitamin D3 per gram. A second sample contained 3.2mg of the vitamin per gram, on investigation a month later.

It was calculated that each patient had consumed more than 1.3g of vitamin D3 per month in the sugar, for seven months. Whether this resulted from intentional or accidental contamination was unknown. After prolonged treatment with prednisolone both men recovered.

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Fatter, not fitter

The growing problem of obesity was under discussion at the meeting of the American Association for the Advancement of Science in Boston in February. Strangely enough, although we generally attribute obesity to those living in countries with high income and plentiful food, the epidemic is spreading to developing countries where these factors are not applicable.

It is pointed out that from China to Siberia people today are eating diets richer in fat, while at the same time they are growing more sedentary in their habits. The result is that the risk of heart disease, type 2 diabetes and other diseases shows an increase in the most unlikely places.

Among the factors held responsible for this phenomenon are urbanisation, shifts in technology and increasing access to processed food items, things which are altering the lifestyle of individuals in many developing countries. Choice of food has a cultural as well as a physical aspect, and food fads are as likely to take hold in primitive as in overcivilised societies.

In order to reduce the impact of obesity-related diseases in countries where facilities for dealing with them are in short supply, prevention of the condition is an urgent problem. In the United States it is estimated that 61 per cent of adults are overweight, with a body-mass index of 25 to 30, while 26 per cent are obese, with a BMI exceeding 30. And in Asia, Latin America, the Middle East, North Africa and urban sub-Saharan Africa, figures are fast catching up with those of the US.

It is believed that more consumption of fats and sugars is primarily responsible. The mere ability to purchase healthier diets does not accompany a wiser choice. In addition, the change in economies in the developing world means that labour intensive pursuits such as farming and mining are making way for the service sector where less energy is expended. Leisure is also becoming less exacting, with a massive increase in television watching leading to what is called the “couch potato” syndrome. This effect is particularly striking in China today.

Changes in lifestyle have led to a more sedentary habit in women, assisted by access to more processed foods such as sugar and canned meats, which partly explains their increased liability to become obese.
This dual impact of undernutrition or faulty nutrition and lack of physical activity has alarming effects, leading to obese and undernourished individuals within the same community or even the same family. Some experts consider that faulty nutrition in childhood may set the stage for dangerous obesity later in life, so that tackling nutrition of young children in developing countries presents a pressing challenge if the associated diseases are to be contained.

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