The Blue Vanguard Vol.16

2019 Vol.16

M A I N A R T I C LE S Int e r v ie w s

Le e Ja e Wo o k , K o re a n C o untr y Ma na g e r o f Wo lte rs K luw e r

P ha rm a c e u t ic a ls

S o ft wa re a s a f o rm o f tre a tm e nt

Na t io na l Is s u e s P ha rma c is ts o n Yo uTub e

Lee Eun Chan

Editor's note

Nowadays, various platforms which pharmacists can utilize have grown by leaps and bounds. Accordingly, development in the field of pharmacy undoubtedly requires in-depth understanding of diverse platforms. In this regard, Blue Vanguard focused on covering how pharmacy field takes advantage of various platforms in this 16th edition. Interview with Wolters Kluwer introduces new platforms for medical and pharmaceutical information which help pharmacists’clinical decision making. Moreover, digital therapeutics which is a software grafted treatment will be covered as a new treatment platform in this issue. Lastly, ‘Pharmacist YouTubers’ will be introduced who are broadening pharmacists’ roles, utilizing ‘Youtube’ platform. This issue will be a marvelous opportunity to think over how we can effectively deal with the deluge of new platforms as a pharmacist.

Furthermore, ‘life issues’ are added as a new section in this issue which reflects the close connection between health and our daily lives. Hangover, pet and vegetarianism which are familiar and intriguing topics will be covered in this section. I hope 16th edition to be informative and fascinating for our subscribers.

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CONTEXT 1) Interview

5 min

2) Pharmaceuticals

15 min

3) Column

1 hour

4) Life issues

5 hour

5) National issues

5 hour

- Lee Jae Wook, Korean Country Manager of Wolters Kluwer : 4-5p

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Software as a form of treatment : 6-7p Our nearby future: Printing drugs : 8-9p Embracement of Marijuana on Pharmaceutical Industry : 10-11p Introduction to patch research process : 12-13p

The relation between Microbiome and Brain disease : 14-15p Rare Diseases in Recent Movies: Therapeutic and Pharmaceutical Perspective : 16-17p Will “copy-drugs� be a breakthrough? : 18-19p Medication management for the blind : 20-21p Reasons why microbiome is our second genome : 22-23p

- Hangover: The Price to Pay for an Excessive Drinking : 24-25p - Life with your pet will make you perfect : 26-27p - Common Health Sense for Vegetarians : 28-29p

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Pharmacists on YouTube : 30-31p The truth of reddish water : 32-33p The Pharmaceutical Issues: Time For a Change : 34-35p A nation that forgets its past has no future : 36-37p

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INTERVIEW

Lee Jae Wook, Korean Country Manager of wolters EunChan Lee

Kluwer bihs1@naver.com

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olters Kluwer is a global provider of professional information, software solutions, and services for various professionals including clinicians, pharmacists and other care givers. UpToDate® and Lexicomp® which are clinical decision support resources of Wolters Kluwer are very familiar to pharmacy students. On November 2019, Blue Vanguard visited Korean branch of Wolters Kluwer to interview Mr. Lee, Korean Country Manager of Wolters Kluwer.

Through the interview, we can discover that Wolters Kluwer constantly makes efforts to provide evidence-based clinical solutions in an ever-changing world. Moreover, Mr. Lee gave heartfelt advices to our pharmacy students.

1. UpToDate® is well-known and widely-used clinical decision support resources. For the subscribers of Blue Vanguard, please introduce the advantages of this platform.

UpToDate® is an evidence-based, physician-authored clinical decision support resource which helps clinicians make the right point-of-care decisions. It provides proven recommendations which can lead to effective decision-making and consistent outcomes across the continuum of care, reducing variability in patients’ outcomes. More than 6,900 world-renowned physician authors, editors, and peer reviewers organize the most recent medical information into trusted, evidence-based recommendations that are proven to improve patient care, quality, and outcomes. Currently, about 80 domestic institutions including Severance Hospital and Hyundai Asan Hospital are using UpToDate®. While the other clinical decision supporting systems simply present shortened summaries or libraries consisting of thesis papers and academic journals, UpToDate® provides the latest clinical information in context and evidence-based, graded treatment recommendations.

2. As a future pharmacist, Lexicomp® seems to be a very useful tool for getting clinical drug information.

Please introduce the advantages of this platform.

While UpToDate® helps clinician’s decision making, Lexicomp® is a platform for pharmacists, physicians and nurses. Lexicomp® delivers time sensitive drug information which enables them to make the right point-ofcare decisions. Lexicomp® provides clear, concise, point-of-care drug information including dosing, administration, warnings and precautions.

Moreover, it provides clinical contents such as clinical practice guidelines and IV compatibility, so it contributes to reducing medication errors and variation in quality of care. Because of its usefulness, more than 42 major domestic hospitals and several pharmacy schools are currently using Lexicomp®.

Lexicomp®’s content is also evidence-based, reviewed, and developed from sources generally relied upon in the healthcare community. While it maintains long-standing relationships with pharmaceutical companies to obtain timely information on drug products, Lexicomp®’s content is published by certified pharmacists who are in practices at moment under strict editorial policies and do not accept any sponsorships from any pharmaceutical companies to keep the contents as unbiased as possible.

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INTERVIEW

3. New medicines and treatments have been rapidly developed in the fields of pharmaceuticals and medicine.

Given this, what kinds of efforts has Wolters Kluwer been taking to keep pace with them?

While it took a number of years for the world medical knowledge to increase twofold during the 1950s, nowadays it just takes 80 days for it to be doubled. It is impossible for an individual to acquire all the latest knowledge in this ever changing world.

That is why care givers need the help of CDSS(Clinical Decision Supporting System). Wolters Kluwer tries to timely provide the latest medical information and insights which empower the users to make informed decisions when it matters most. To cope with explosion of information, UpToDate®’s more than 6,900 physician authors, editors, and peer reviewers continually participate in synthesizing the most recent medical information into evidence-based graded recommendations as mentioned above. That’s why our topic contents are always “uptodate”. Surely, all the processes including data acquisition, editing, review are English-based, to provide “up-to-date” information as soon as possible.

Moreover, in response to growth of mobile medical market, more and more clinicians and medical institutions are adopting tablet PCs and smartphones as clinical tools. UpToDate® provides mobile app “UpToDate Anywhere” reflecting this change.

Taking advantage of it, clinicians can use UpToDate® anywhere as a true evidence-based point-of-care tools.

4. Wolters Kluwer established branch offices in many Asian countries. How large is the Korean Branch and how is it constituted?

Like you said, Wolters Kluwer branch offices are established in most of Asian countries including Korea, Taiwan and Japan.

Wolters Kluwer branch offices are managed based on matrix structure. It means most of branch offices consist of core functions for business including sales department and customer service department. On the other hand, human resources, finance department and contract department belong to bases. For example, the financial department located in Dubai covers the Asian and European regions.

Like other Asian branches, Korean branch office also consists of sales department and customer service department. Whole of 6 members provide sales and customers supports to Korean market.

5. I wonder which departments pharmacists can work in Wolters Kluwer.

Basically, working in Lexicomp®’s editorial team is most suitable for pharmacists to utilize and reproduce their pharmaceutical knowledge. As the target of Lexicomp® is pharmacists, its editorial team members are all pharmacists. A pharmacist license is required for not only its editorial team, but also for peer reviewers of it. Number of Lexicomp®’s editorial team is about 50 people including 2-3 Korean pharmacists. As a member of editorial team, you process and update information related to worldwide new medicines. Also, you summarize and recommend medicines based on the latest thesis papers, utilizing your expertise as a pharmacist. Moreover, pharmacists can also work in sales department based on the experience of using this platform.

6. Can you give some advices for pharmacy students?

First of all, do not limit yourself to certain stereotype roles. I believe pharmacy students, soon to become pharmacists, can contribute their knowledges and talents to many different areas of the society. I hope many pharmacy students to harness their potentials. Apart from working in pharmacies and hospitals, there are a lot of areas pharmacists can fulfill their potentials.

Like Lexicomp®, pharmacists can work as provider of professional information. Also, CRO(Contract Research Organization) and labs of many different pharmaceutical companies always look for talented pharmacists. If you broaden your vision, many opportunities will wait for you.

Second, if you want to join foreign companies, understanding their corporate cultures is very important. As I’ve worked in both American companies and European companies, I learned differences of company cultures exist among them. Although decision makers’ opinions are mainly reflected for decision making in many American companies, culture of discussions, sometimes heated, take place before the decision making in many European companies, especially in Dutch companies. Because every culture has its own merits, you should consider your personality to decide which one is more suitable for you. B 2019 VOL.16

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Software as a form of treatment and other recently approved digital therapeutics SuMin Yoon

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jenny.yoon@yonsei.ac.kr

hough the branch of digital healthcare called digital therapeutics (DTx) has been on the market for over ten years, only a few were available. Recently, DTx started gaining more spotlight since its first FDA approval in November 2018. Digital therapeutics has a slightly different definition from digital healthcare. The broader term, digital healthcare, is a field where digital technology and healthcare converge to enhance the efficiency of healthcare delivery. On the other hand, its subset digital therapeutics is a rising field that aims to prevent, manage, and treat a disorder or disease through evidence-based software programs. This relatively new term was first coined in 2015 when Dr. Cameron Sepah of UCSF Medical School said, “digital therapeutic is an evidence-based behavioral treatment delivered online that can increase accessibility and effectiveness of health care.” If approved by the FDA, DTx can be prescribed to patients, either alone or complementary to other treatments. Excitement surrounds digital therapeutics as treatments are being developed for type II diabetes, dementia, asthma, ADHD, anxiety, and more.

The common goal is to help patients check their conditions and progress, personalize treatments, and lower overall cost of healthcare. The expected benefits of this field are objective assessments and better quality of care, as data can be easily collected and monitored by healthcare providers.

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Launched in last November, the first US FDA-cleared prescription digital therapeutic is reSET, which treats patients with substance abuse disorder. Not a month later, its sister product reSET-O was cleared for Opioid Use Disorder. The two digital therapeutics had to submit results of randomized controlled trials (RCT) via the FDA’s de novo approval pathway, which is meant for novel medical devices that ensure safety and effectiveness for the intended use. The FDA approved the software as prescription-only products. According to its developers, Sandoz and Pear Therapeutics, clinical trials showed that reSET-O therapeutic content had an overall retention rate of 82.4 percent by the end of a 12 week-treatment, which was about 14 percent higher than non-users. The software also serves as a training, monitoring, and reminder tool for healthcare providers.

Another FDA approved digital therapeutics is owned by the Israeli pharmaceutical company Teva Pharmaceutical. Teva’s digital therapeutic system is essentially an inhaler with built-in sensors that send the inhaler usage data to a mobile application, providing patients and doctors with information that allows prevention and better treatment of chronic obstructive pulmonary disease (COPD) and asthma. Benefits of this technology are reduction in unnecessary hospital readmissions as well as costs in treatment.

THE BLUE VANGUARD

PHARMACEUTICALS

Recently, another form of digital therapeutics is rising to challenge the status quo of medicine, which is none other than games. Akili Interactive Labs, Inc., a company based in Boston, Massachusetts, has been developing a game to treat Attention Deficit Hyperactivity Disorder (ADHD) in pediatric patients. Akili’s investigational digital therapeutic, AKL-T01, aims to deliver sensory and motor stimuli in order to improve cognitive function.

One of their core technologies is Selective Stimulus Management (SSME™) engine, which enhances prefrontal cortex based cognitive control, attention, and working memory. Moreover, it improves executive function and response to competing stimuli. Multi-center, randomized, controlled double-blind trials have been completed and the status of FDA clearance of AKL-T01 is currently pending. Once launched, AKL-T01 will be the first video game-based treatment for pediatric ADHD patients, and doctors will be able to prescribe the digital therapeutic as done with conventional drugs.

Cognoa is another company that is developing digital therapeutics. In February, it received FDA Breakthrough Designation for one of its ongoing projects. The product in development aims to treat autism spectrum disorder (ASD) and targets identification of behavioral conditions that allow early diagnosis essential to a successful treatment. The company attempts to combine diagnostics and therapeutics into a single platform to provide accurate diagnosis and modify treatments in more informed ways.

Currently, the average age of ASD diagnosis at four years old falls past the window of active brain plasticity, which is critical to maximizing treatment outcomes. Cognoa’s ASD Diagnostic Device is designed to help healthcare professionals diagnose children between 18-72 months who are at risk of developmental delays. Additionally, the ASD Therapeutic Device will be focused on improving social skills and responsiveness in these patients. Once approved, it will supplement existing therapies and give patients convenient access to care.

Concerns and Future aspects Concerns surrounding digital therapeutics are rising as the field blooms. Industries and medical regulators scramble to make sure that standards of clinical evidence are met. One of them is Digital Therapeutics Alliance (DTA), a global non-profit trade association that aims to “set standards and promote integration into health care.”

As wonderful as prescribed software sounds, it is undeniable that games and mobile software contain risks, including hacking of personal medical information as well as eye fatigue and improper posture. Nonetheless, the benefits may outweigh the risks. Unlike patients who take chemical and biological drugs, those who receive digital therapeutics are not subjected to drug toxicity and other alarming side effects. Moreover, software as a treatment is much more accessible for patients in terms of time, distance, and cost. Especially since the field can help treat common chronic illnesses, the US market has witnessed digital therapeutics continue to grow consistently since 2014 Likewise, new pipelines and startups springing up across the globe demonstrate that the market will continue to grow well into the next decade.

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Our Nearby Future: Printing Drugs

Jiyoun Son

kikijenny1203@gmail.com

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hese days, 3D printing has been used everywhere. Because of its innovative technology, it caught the eyes of specialists from various fields. It is often cheaper definitely faster than most modern manufacturing technologies, which makes it easier and favorable to use. Most people think that 3D printing is only used to manufacture architectural metal or plastic products. However, you might be shocked by the fact that 3D printing has already been applied and is anticipated to lead a whole new territory in the pharmaceutical and medical field. 3D printing in the medical field is primarily concerned with plastics and metals, such as surgical planning, reconstructing surgery, prosthetics, and so on. Surgeons can conduct treatment with greater confidence since they can print accurate 3-dimensional models of organs and body structures of their patients. 3D printing for pharmaceuticals is not as advanced as medical applications, but offers high hopes for the possibility to print organic materials for biomedicine and advanced personalized treatment.

What is 3D Printing?

Before we discuss this promising new technology, what is 3D printing exactly? How does it work? 3D printing is a process of making three dimensional solid object from a digital file. It is not exactly the “printing” technology we used to know. In order to “print” a product, you need to create a 3D blueprint. It could be made by using a 3D scanner or a 3D modeling software. After creating a 3D model, we need to slice it into thousands of horizontal layers. A slicing software controls this process, which then sends the “sliced” file to the 3D printer. The printer deposits thin layers of materials, which is called the additive process. Various materials are available for 3D printing. The most common material is plastic, due to its cheap price. Other materials include nylon, metal and wood and industrial 3D printers can additionally use wax, paper, resins and other unfamiliar materials. This whole 3D printing process recreates the original design in exquisite detail and you can have your personalized product just like that!

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3D printing was already applied in manufacturing drugs by these exact processes as any other plastic products. In 2015, the U.S. Food and Drug Administration (FDA) approved the first 3D printed drug, Spritam.

This epilepsy medication is surprisingly easy to take and administer thanks to 3D printing. The 3D printing technology used to design this drug is called ‘ZipDose® Technology.’ It produces a highly porous structure that rapidly sucks in liquid, collapsing to form a suspension.

This can be useful for children, the elderly and other patients who struggle with swallowing pills. It also allows very large doses of Levetiracetam to be contained in a single, small tablet.

PHARMACEUTICALS

The Benefits of 3D Printed Medicine 1. Cost-effectiveness Spritam’s approval by the FDA was viewed as the start of a 3D printing revolution in medicine manufacturing.

Some welcomed this news, thinking this technology would bring greater benefits than drawbacks. One of the merits of 3D printed pills is their cost-effective process.

Today, pharmaceutical companies maintain expensive and professional infrastructures. Compared to that, 3D printing requires lower initial and maintenance cost. This enables developing countries to manufacture drugs and helps people buy medicine at affordable prices. This will eventually contribute to health promotion and revitalize the pharmaceutical market.

2. The commercialization of personalized medicine 3D printing also makes it possible to manufacture various kinds of drugs. Providing a product line for unpopular drugs or personalized medicine is a burden for pharmaceutical companies these days. With 3D printing technology, it is theoretically possible to print many different types of tablets with only a few product lines. This could solve the matter regarding production of medicine with weak demand (e.g. rare disease drugs) and open up the possibility of commercializing personalized medicine since we can customize the details of drugs for each individual patients at no extra cost.

3. Greater accuracy Finally, it would be more accurate to use 3D printing in the pharmaceutical manufacturing process. 3D printers will make fewer mistakes and save more manpower than the existing system. Many experts who had to carry out repetitive tasks in the product line could either be relocated to advanced jobs or create new research areas by linking the pharmacology and technology sectors, which could benefit society as a whole.

The Concerns Related to 3D Printed Medicine However, some people are worried about the introduction of new technology to medicine. Researchers believe we will be able to develop and commercialize printed tablets in the next five to 10 years. Just as all technological developments face a variety of problems in their early stage, problems can follow. Technologically, there are still some drawbacks when using each available drug printing techniques. Also, the type of polymer that is available does not always have the optimum characteristics for all drugs.

Socially, the commercialization of manufacturing drugs might lead to adverse effects and drug abuse. Pharmacies will be less and less needed since patients will be able to print their own medicines. AI or Watson supercomputers will diagnose patients and print prescribed medicine. Pharmacists would have no work to do. For pharmaceutical companies, due to the massive fall of drug price, they could go bankrupt.

3D printing definitely has its benefits and drawbacks. But the real question is how we should deal with these inevitable changes. The advantages of 3D printing would be useless if the introduction of the technology could threaten the maintenance of national health. Specialists from various fields should review the side effects printed drugs could have. Additionally, health administrations of each country should supervise the whole industrial revolution carefully. What should we, pharmacists, do? The future role of pharmacists is going to change for sure.

Some might even say our jobs would disappear. However, the expertise in pharmaceuticals would still be needed even when printers might replace manufacturing medicine, just in different ways from now. To prepare for this change. we should widen our knowledge and seek for new possibilities in other academic fields. Then, 3D printing in pharmaceutics would be an opportunity, rather than a replacement. B

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Embracement of Marijuana on Pharamaceutical Industry Kyungeun Lee

kyungeun0217@gmail.com

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arijuana is budding its potential towards the medical industry. The U.S. Food and Drug Administration (FDA) approved the first cannabidiol medication, Epidiolex in June 2018. Epidiolex is an oral solution for the treatment of seizures of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome, in patients over two years old. The legalization of medical marijuana is a step towards the transformation of pharmaceutical industry. According to the projections from the Global Market Insights, the revenue of the medical cannabis market is expected to exceed $55 billion by 2024.

Thus, an increasing number of pharma companies are funding and hopping aboard on the medical marijuana money train.

Marijuana that was historically demonized as a leading source of social afflictions is now the major player in the medical industry. However, marijuana plant itself has not been approved by the FDA as a medicine. It is currently classified as Schedule I controlled substance by the U.S. Drug Enforcement Administration (DEA) under Controlled Substances Act(CSA) because it has high potential for abuse with no currently accepted medical treatment in the U.S. and lack of accepted safety for use under medical supervision. In fact, cannabis is the most commonly cultivated, trafficked and abused illicit drug worldwide. According to the World Health Organization (WHO), marijuana consumption has an annual prevalence rate of approximately 147 million people or nearly 2.5% of the world population.

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Then why did FDA grant approval on CBD medical drug? The proportion of the primary active ingredients in medical marijuana is different from that in recreational marijuana. Marijuana contains more than 100 active components, called cannabinoids. Among them, THC (delta-tetrahydrocannabinol) and CBD are mainly used as purified drug substance. THC is responsible for wide range of psychoactive effect, including euphoria, so it is the main component for recreational marijuana. However, CBD is a non-psychoactive compound with little, if any, intoxicating properties. CBD seems to reduce the mind-bending effect and anxiety caused by THC. The psychoactive difference between two components of cannabis comes from interaction with endocannabinoid receptors. While THC activates CB1 receptor in the central nervous system, CBD elicits its pharmacological effects without exerting any significant intrinsic activity on CB1 and CB2 receptors.

Therefore, the combination of THC and CBD is crucial in manufacturing medical marijuana products.

Uses of medical marijuana are broad in spectrum, from alleviating anxiety, spasticity and insomnia to treating potentially life-threatening disorders, such as epilepsy. Dravet syndrome, a childhood epilepsy, is almost impossible to control, but patients respond dramatically to CBD-dominant strain of marijuana called Charlotte’s Web, making Epidolex the best available treatment. In addition, Dronabinol and Nabilone are two FDA-approved drug with THC. These drugs treat nausea caused by chemotherapy and boost appetite in patients with extreme weight loss by AIDS. The most common use for medical marijuana in the U.S. is for pain control. It is not strong enough to treat severe pain, but it is quite effective for chronic pain, particularly for multiple sclerosis and nerve pain. Furthermore, researches by National Institutes of Health (NIH) reported possible use of medical marijuana in treatment of cancer, HIV, Parkinson’s diseases, irritable bowel syndrome and Crohn’s disease.

Although cannabis can be applied to various medical conditions, little is known about its safety in long term use.

Much of what is known about the adverse effects of medical cannabis comes from studies of recreational marijuana.

Marijuana has low to moderate dependence potential and its active dose is far below the lethal dose, but it exhibits various adverse effects. Short-term use of marijuana triggers impaired short-term memory, damaged motor coordination, altered judgment and even paranoia or psychosis at high doses. Long-term or heavy use of marijuana may lead to deficits in prospective memory and executive function as well as severe cardiovascular disease, such as tachycardia, orthostatic hypotension, angina and myocardial infarction.

Moreover, there is a voice of concern over the public safety.

Some people link the increase traffic fatalities with the legalization of medical marijuana as THC alters perception and psychomotor performance, decreasing ability to drive safe. However, the casual relationship remains controversial and others argue that, in fact, the number of people killed in the traffic accidents dropped after medical marijuana laws were enacted.

It is still too early to determine the competitive displacement effect the marijuana-based treatments might have on drugs used to treat health issues. The only guarantee is that the growth of the market for medical marijuana products will continue to accelerate. Thus, there is more pressing need for follow-up studies about the adverse effects and introduction of international riskbased regulations or guidelines for medical marijuana.

The approval of FDA serves as a reminder that advanced technology in extracting active ingredients from marijuana and controlling the safety of manufactured medical cannabis products can mark a new era in medical therapies B

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Introduction to Patch Research Process Junseo Oh

ojoojo1194@naver.com

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ummary: During my summer vacation in July of 2019, I did a summer internship at the Handok Central Research Institute. Handok Central Research Institute not only conducts research and development assignments in over-the-counter(OTC) drugs and ethical-the-counter(ETC) drugs, but also develops transdermal drug delivery system(TDS) which its product Ketotop is famous for. I have also conducted a variety of experiments on the development of patch formulations as well as oral formulations, which included processes such as granulation, tableting, and coating. However, I worked mostly in the TDS department, so in this column I would like to introduce you to the definition, classification, and experiments in the development stage of TDS.

Definition of TDS Transdermal drug delivery system(TDS), also known as “patches”, are dosage forms designed to deliver a therapeutically effective amount of drug across patients’ skin. Several TDS containing drugs such as clonidine, estradiol, fentanyl, nicotine, nitroglycerin, oxybutynin and scopolamine are available in the United States. Hot action patches are mainly used in chronic inflammation. On the contrary, cold action patches are usually used in acute inflammation.

Formulation classification of TDS In Korean Pharmacopoeia(KP), formulation of transdermal drug delivery system is classified by patch, cataplasma and plaster. First, patch shows systemic action throughout the body. Organic solvents are used as solvents when producing patches, but water is rarely used as a solvent. In the Japanese Pharmacopoeia(JP), patch is called a “system patch” because of its systemic effect. The second type of formulation known as cataplasma shows local action at the place of attachment. Water is used as a solvent when making cataplasma. These usually feel slightly thicker and contain more moisture than plasters. That is why cataplasma has a poultice effect. In the Japanese Pharmacopoeia, cataplasma is called a “gel patch”. A popular cataplasma is the “lidocaine cataplasma”, which is a local anesthetic. Finally, plaster also shows local action near the site of application. Unlike cataplasma, water is not used when making plaster. In the Japanese Pharmacopoeia, plaster is called a “topical patch”.

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TDS property evaluation In the Drug Quality Reporting System(DQRS), the United States Food and Drug Administration(FDA) has received numerous reports of “adhesion lacking” for transdermal drug delivery systems. For example, there are reports about environmental condition use failure, falling off during the patch usage, and appearance of adverse events. Therefore, the adhesive of the transdermal drug delivery system is critical to the safety, efficacy and quality of the product. So how do we measure the “adhesion” of TDS? The adhesive performance of TDS is a critical factor that determines its drug delivery, therapeutic effect and patient compliance. Several in vitro techniques have been used to monitor adhesive performance such as peel adhesion, tack and shear strength.

Peel adhesion measures the force required to peel away an adhesive once it has been attached to a surface. Most recent test methods for TDS peel adhesion are based on methods developed for industrial tapes. These typically call for the use of a stainless steel test panel. The peel adhesion measurement is greatly influenced by the experimental parameters such as dwell time at a stainless steel panel, peel angle, peel speed, and etc.

The tack of an adhesive was initially evaluated by a probe tack. For a probe tack test, a probe touches the adhesive surface with a light pressure, and the force required to break the bond after a short period of contact is measured.

Shear adhesion is thought of as a measure of cohesive strength. This is a viscoelastic measurement that can be related to performance and processing. There are two categories of shear testing-dynamic and static. In the dynamic test, the TDS is pulled from the test panel at a constant speed. In the static test, the TDS sample is vertically applied to a test panel, and the sample is subjected to a shearing force by a means of a given weight (1000g) suspended from the sample. When the sample is pulled from stainless steel, considerable stretching and deformation of the sample may be seen. These results call for reinforcements to the TDS through the application of tape to the patch backing.

Conclusion Good adhesion over several hours or days is necessary to ensure proper drug delivery. Skin adhesion is one of the most important functional properties for TDS. Poor adhesion results in improper dosing in patients and potential accidental dosing in children when they pick up fallen patches. Therefore, it is essential to process a proper in vitro adhesion testing. The outcome of an in vitro adhesion test is desirable when it correlates with that of an in vivo skin adhesion. B

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The r e l at ion ship between Micr obiome and Brain disease

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Donghwan Lee

donglee1009@naver.com

arkinson’s disease (PD) is one of the most common degenerative neuronal diseases. About 1% of people over the age of 60 have PD and they suffer from physical and psychological problems such as tremor, rigid muscles, and depression. PD is caused by the death of neurons in the substantia nigra, which is the main region of dopamine secretion. Many studies showed that the death of neurons is mainly caused by the accumulation of α -Synuclein, which is a presynaptic neuronal protein that neurons make. However, the specific causes of PD are unclear yet. These days, some scientists are focusing on the gut and microbiota to find the answer.

The gut is sometimes called ‘the second brain’. The enteric neuronal system (ENS) consists of 500 million neurons, which is five times larger than a mouse’s brain. Also, ENS contains afferent neurons, efferent neurons, and interneurons like a brain, which allows the intestines to work even without input from the CNS. Michael D. Gershon, a professor of Columbia University, found out that the gut secretes lots of neurotransmitters such as serotonin and dopamine.

Especially, serotonin in the gut is made from enterochromaffin cells (EC) of the gastrointestinal epithelium, which makes up 95% of all serotonin made in the body. Furthermore, if excess serotonin is secreted from EC, it stimulates the extrinsic nerve, leading to nausea and vomiting. It is called gut-brain axis (GBA), which the gastrointestinal tract and the CNS signal to each other through. Likewise, the gut not only receives signals from the CNS, but also makes its own signals and even affects the brain.

However, it is not only the gut cells that communicate with the CNS, but also the gut microbiota. The gut microbiota is a group of bacteria residing in the gastrointestinal tract. It can weigh about 1~3kg if all bacteria are collected and has genomes(microbiome) five times the amount human cells have. It is well known that they help digestion and make nutrition that animals need. Some studies show that the portion of the different microbe species can affect the balance of metabolism. For example, while healthy people have a higher ratio of Bacteroidetes than Firmicutes, people with obesity have a higher ratio of Firmicutes. Furthermore, the gut microbiota have influences on the development of the brain, neurogenesis, and even various CNS diseases. In 2004, a study showed that germ free mice responded more intensely than normal group to stress. However, when germ free mice got normal microbiota by stool transplant or Bifidobacterium infantis, they showed normal responses to stress. This means that gut microbiota somehow influenced the stress associated hypothalamic-pituitary-adrenal (HPA) axis, which is one example of gut-brain axis.

The microbiota also can contribute to immune systems. In 2013, a study revealed that the microbiota influences the regulation and maturation of Peyer’s patch, which is an organized lymphoid follicle of the gut. Moreover, they can control the number of antibodies producing cells such as plasma cells that makes IgA, gut Tγδ cells, and CD4+ T lymphocytes. The regulatory T cells(Treg), especially, need the microbiota to function properly. Bacteroides fragilis is one of these microbiota. T cell stimulated by polysaccharide A (PSA) releases Interleukin-10(IL-10), which is an important cytokine that controls inflammation. To sum up, the microbiota can somehow control our immune systems.

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Now, let’s go back to Parkinson’s disease. How does the gut and microbiota relate to this disease? Some studies show that PD patients have different compositions of the microbiota. For example, a research led by Scheperjans found out that patients with PD have more Enterobacteriaceae than normal people, and this might be related to a postural instability. Also, they detected the reduction of Prevotellaceae in PD patients’ feces. The diminishment of Prevotellaceae causes the reduction of health-promoting neuroactive short chain fatty acids, thiamine and folate, which decreases the vitamin level that can be detected from PD patients.

Other studies claim that the inflammation from the gut might cause PD. As we’ve seen from the above, α-Synuclein is the main protein that cause PD. However, this protein also plays an important role in gut inflammation. Michael Zasloff, professor of Georgetown University, found out that the nerves around the gut inflammation have α-Synuclein, and the more severe the inflammation is, the more α-Synuclein is found. He hypothesized that chronic microbial inflammation might increase the level of α-Synuclein, which eventually move to the brain, causing PD. Also, other researchers revealed that α-Synuclein can be transported from the intestinal wall to the CNS and move to other neurons by endocytosis.

Many researchers are still trying to find the answer to the cause of the Parkinson’s disease from the gut and gut microbiota. Pharmaceutical companies such as Enterin are trying to develop drugs that ‘repair the dysfunctional gut-brain axis in patients with neurodegenerative disease’. Also, there is an effort to lessen the symptoms of PD by changing the composition of gut microbiota by prebiotics, probiotics, and dietary control. Although a clear treatment has not been found yet, the area of gut-brain-axis and gut microbiota can make us one step closer to the treatment of PD. B

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Rare Diseases in Recent Movies: Therapeutic and pharmaceutical persepective Seo Woo Park

pinkwoo97@naver.com

“We need that touch from the one who loved almost as much as we need air to breathe, who never understood that until I couldn’t have it”

“My life was an unending, unchanging midnight. I must, by necessity, always be midnight for me.

So how was it possible that the sun was rising now, in the middle of my midnight?”

-Five Feet Apart(2019)

-Midnight Sun(2018)

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uotes above are famous lines from two recent movies, Five Feet Apart(2019) and Midnight Sun(2018). Both movies are romantic, and love stories always have a reason to keep the couple apart. In this case, the dis eases which the characters are suffering keep them apart. The diseases introduced in the movies are “rare,” which arouses interest from the audience. The former movie covers Cystic Fibrosis(CF) and the latter covers Xeroderma Pigmentosum(XP).

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What are rare diseases?

Cystic fibrosis: Five Feet Apart

The mysterious nature of rare diseases has fascinated many scientists and pharmaceutic professionals for centuries. They have struggled to make a significant breakthrough in understanding the diseases and developing the treatment.

The definition of “rare” diseases varies from country to country. The U.S Food and Drug Administration states a disease “rare” if it has a prevalence of less than 200,000 people in the United States. In Korea, the Ministry of Food and Drug Safety defines rare diseases if the prevalence is less than 20,000 people. Also, if there is no treatment or medicine developed for patients less than 42.5 people per 100,000 people, the diseases is classified as rare. The awareness of rare diseases by the general public has grown nowadays, and the media is using the subject widely.

Recent movies also feature rare disease as a main theme in their stories.

In the movie “Five Feet Apart,” the teenage couples suffer CF and they have to be literally six feet apart in order to prevent vulnerabe infection. Then, what is Cystic fibrosis that hinders their love?

Cystic fibrosis is a complex inherited disorder that is critical to children and young adults. Patients diagnosed with cystic fibrosis have a gene mutation in a gene named CFTR. CFTR encodes a protein which transports chloride to the surface of cells. The clinical features of cystic fibrosis involve respiratory tract. As the mutation in CFTR disturbs chloride attracting water, sticky mucus is formed.

The mucus obstructs the airways and leads to subsequent infection.

The frequency of the disease varies among ethnic groups and is ethnic groups: highest in Northern Europe and lowest in Asian areas. Anderson brought the rare diseases to light in 1938 by pointing out the destruction of

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pancreatic exocrine function. The cause of the disease is straightforward.

However, there is no cure for cystic fibrosis yet.

Treatment can ease the symptoms and reduce further aggravation, but it does not completely cure the disease.

Followings are medications for cystic fibrosis. Antibiotics are used to treat and prevent lung infections. Antiflammatory medications lessen swelling in the airways of lungs. Mucus thinning drugs help to cough up the mucus which improves lung function. Bronchodilators keep the airways open and relax the muscles around the bronchial tubes. Oral pancreatic enzymes help the digestive tract to absorb nutrients.

Although treatments are improving, the average life expectancy of a cystic fibrosis patient is approximately 40 years. Then, what anticipated treatments are now being studied? Gene therapies for cystic fibrosis are being developed to obstruct the fatal consequence of the disease when treated to children and young adults. If the therapy can modify enough lung cells, it will substitute other medications for lung function. Furthermore, there are additional approaches to improve efficacy of the existing drugs. One representative method is a combined therapy.

For example, a drug named Ensifentrine not only reduces the amount and thickness of the mucus, but also decreases inflammation.

Xeroderma Pigmentosum : Midnight Sun

The other couple in the movie “Midnight Sun(2018)� spend time together only after dark because the woman is afflicted with Xeroderma Pigmentosum(XP). XP is a rare disease which makes the patients extremely sensitive to the sun.

XP is an inherited, autosomal recessive skin disorder which leads to the increase of sensitivity to the DNA damaging effects. These effects are caused by ultraviolet radiation in the sunlight. The effects mainly target on skin and contribute to higher risk of skin cancer after the exposure to sunlight. In addition, approximately 25% of the patients have nervous system disorder. The disorder is thought to arise due to the loss of nerve cells in the brain.

Other than cutaneous effects, the symptoms of XP include ocular effects, photophobia, and skin neoplasia.

Nine XP complementation groups each corresponds to nine different genes, and results in XP if defected. The proteins resulting from normal expression are involved in DNA repair by recognizing damaged DNA, removing the damage, and filling in the gap. Exposure to the sun greatly elevates the induction of mutations in the genes, accounting for symptoms mentioned above.

There is no drug treatment for XP yet. Thus, it can only be managed by preventative techniques. Radiation is contraindicated such as using sunscreen, wearing protective clothes and avoiding sun like how the woman in the movie tried not to leave her house in order to keep herself safe from sunlight. Scientists and pharmaceutical professionals are trying to correct the DNA defect, and have found genes which cause the most types of XP, but some genes remain unidentified.

Conclusion There is still a long way to set a standard care with rare diseases. However, many researchers are consistently putting effort in order to learn more about these complex diseases. Also, the media including movies arouse interest and encourage conversation of the diseases, bringing the rare diseases to the public. With constant research and increased awareness, there sure is the potential to revolutionize the lives. B

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Will “copy-drugs� be a breakthrough?

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SangSoo Na

sangsoo66@yonsei.ac.kr

he human race has constantly striven to control numerous diseases, beginning from the medical use of opium in the earliest recordings in the 9th century. This effort has given birth to drugs that have raised quality of life or saved patients from pain and death. However, most of naturally formulated chemicals have already been investigated and various standards of new drug approval have been reinforced, contributing to the difficulty –or almost impossibility- of new drug development in the pharmaceutical field.

Inventing new drugs has some shortcomings. First, it requires an astronomical amount of development expense.

Drug development process necessitates time and patience, which takes around 15 years, including three stages of clinical demonstrations. Not only is it enduring but also needs monetary investment to make a brand new drug.

Average cost per drug developed and approved was reported to be 350 million US dollars in 2013. Furthermore, it is much more risk-taking. On average, 100 million chemicals become possible candidates for new drugs, but only 10 to 250 pass the screening and undergo preclinical trials.

After all three phases of clinical trials, two candidates are assessed for New Drug Application (NDA) by the US Food and Drug Administration (FDA), and only one of them becomes approved. This, however, is an ideal example, and the whole process merely has a success rate of 9.6%.

In other words, 350 million dollars may go down the drain by 90.4% while inventing a new drug.

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On the other hand, copying an already-existing drug is cost-efficient and guaranteed. According to the Korean Food and Drug Administration (KFDA), screening, preclinical trials, and clinical trials are skipped and only requires a bioequivalence test, allowing companies to cut down the budget. Additionally, the effectiveness and reliability of the chemical have been certified during the patent period of the original drug. This aspect provides a safety net for the companies in case of unexpected side effects that are followed lawsuits.

This reality led the chemists to turn their eyes to generic drugs and biosimilar. Developing generic drugs or biosimilars is anticipated to be the breakthrough, as much of the drug market has been saturated. Prior to diving into the importance of these drugs, clarification is needed for the distinction between two concepts. Both have the same commercial basis, meaning that they are marketed after the patents of original drugs are expired, but they have a notable difference. Generic drugs refer to small and simple molecules with distinct molecular structures that are 180 daltons on average, whereas biosimilars are complex molecules that vary greatly in size and usually undergo post-translational modifications. Some biosimilars, such as monoclonal antibodies, can exceed 150,000 daltons, making it difficult to mimic.

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Task at Stake

Generic Drug at Present State This year is a pivoting point for the generic drug industry due to the scheduled patent expiration of countless drugs. Companies that develop new drugs are guaranteed exclusive right to monopolize the item for 5 to 7 years.

After this period, the drug is open to rival companies and is modified by them for production. As stated by Generic and Biosimilars Initiatives (GaBI), up to 50 items will meet their expiration date which is the greatest of all-time.

Many of these are ‘blockbuster drugs’ with annual sales over 800 million US dollars, making even some major pharmaceutical companies anxiously waiting for the starter pistol to win the generic drug race. Over 300 generic drugs are anticipated, and the market has grown from 6 billion dollars in 2016 to 24 billion dollars in just three years.

Avastin® is a great example. It is the product name of anti-cancer drug from Rosche which made more than 6 billion dollars annual sale in 2017. It met its patent expiration in the US early this year and will also be expired in Europe in January 2020, making a room for other companies to occupy in the chemotherapeutic field.

Allergan got its biosimilar of Avastin® approved in Europe and is in queue for production. Pfizer has also jumped into the generic drug market of Avastin® and got its approval from the US FDA. Domestic companies, such as Celltrion, also begun phase 3 clinical study of its biosimilar in the United States.

Concerns arise along with the heated competition. First is whether generic drugs and biosimilars are safe. New drugs undergo exhaustive research and are monitored even after their release to the market. On the other hand, generic drugs are subjected to abbreviated clinical trials and do not have mandatory monitoring process. Indeed, the effects of the therapeutic chemical have already been approved by the original drug, but generic drugs come in various combinations of additives or in different forms.

For instance, an improved generic drug may enable noninvasive oral doses instead of injections. In this case, the first-pass effect of the liver may chemically alter the drug and show unintended side effects.

In addition, generic drugs may not be as economical as expected. Copying does not require as much seed capital to develop as mentioned, but this does not mean that it requires no money. In order to occupy a pioneering position in the generic market, laboratory researches must be done before the patent expiration so that the item can be released immediately after the patent is over. Despite this burden, generic drugs are only given three-year patent.

The companies are compelled to lower the prices after this period and share their pie with others.

Most importantly, investing capitals to copying already-effective drugs can seem like a loss to the humanity. There still are innumerable diseases that need remedy, but companies are either reluctant to invest as it is not economically valuable or incapable of treating the conditions. If it is the latter, the fund for generic drugs can be expended to invent revolutionary drugs to save another day – or even years – for patients suffering from incurable diseases. We cannot blame the companies for not taking the risk, but copying drugs is not the only way out. Inventing a new drug not only brings material success but also leads to honor and respect. In short, it all boils down to how innovative or expeditious you are in the heated market of pharmaceutical industry. B

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NATIONAL ISSUES

medication management for blind patientspatients : How to Improve Medication Adherence Among Visually Impaired Patients JiHye Seo

sjh0216ann@gmail.com

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s highly accessible health care providers, pharmacists must pursue increasing medication adherence and improve health outcomes among patients. However, people with a sight disability have suffered with taking medicine properly by themselves. The various efforts to make low-vision-patients able to understand their medical information have been devised, yet the patients are still experiencing significant discomfort. Community pharmacists are now looking for more effective ways to improve legibility and usability of drug classification.

Current Status of Medical Rights for disabled patients Visual impairment is associated with people’s ability to self-medical-management. Medication adherence plays a significant role in optimising patients’ health care.

Unfortunately, those with low vision may be at particular risk of medication non-adherence. Professor Han Eun-ah of Yonsei University School of Pharmacy said, “Medicine is the most commonly used health and medical data in everyday life, and proper use of medicine for treatment and prevention can improve the quality of life”. Therefore it is an essential right to take medicine with understanding diverse safety information.

According to a 2019 survey by Korean Pharmaceutical Association(KPA) on registered blind and partially sighted adults in South Korea, the nine out of ten blind and partially sighted people said they haven’t been provided appropriate education on how to use and take medicine safely. Also they claimed information on medication, such as dispensing labels and storage instructions, was quite illegible and difficult to understand. To solve sustained problems, KPA is planning to carry out a total of 10 pilot projects for the visually impaired patients. In the future ,

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the pilot project is scheduled to provide two training sessions for the blind people and other two for the disabled care trainers. Moreover KPA issued and distributed guidance for safe drug use transcribed into braille during the training. Most trainees were satisfied with the training and replied it was so helpful that they are willing to participate in further retraining. “We are providing pilot training for people with vision and hearing disabilities this year, but we need to gradually expand the education for safe use of medicines for each type of disabilities.” said Kim Yi-hang, head of the pharmaceutical division of KPA.

The efforts audio devices and braile stickers The Seoul Metropolitan Government’s project supporting the information access rights for the blind will start in September to establish an automatic conversion system between audio and braille. The project will be carried out through a cooperation between the Korea Federation of Disabled Consumers and Pharmacology Information Service. “We provided data regarding to medicines to establish a system for transcribing text information into voice information.” said the representative for the

NATIONAL ISSUES

Pharmacology Information Service. “The service that reads medical information through voice will help us a lot from the point of view of medication guidance.” The Korea Federation of Disabled Consumers said it will complete the establishment of the system in August. It announced that voice services for the blind will be available starting in September as soon as the system development is completed, and that 5,000 to 10,000 of the 60,000 medicines information will be accessible by the end of this year. Seoul Metropolitan Government announced the system will be developed into a smart phone application version, PC version and telephone ARS that are available on mobile devices.

The government of Busan City is planning to conduct a project to improve the effectiveness of treatment and prevent misuse of drugs by using braille. The pharmacists participating in the project will attach braille stickers to envelopes of prescribed drugs to make it easier for blind people to take medicines by themselves. Moreover they will give the patients a guidance of the drugstores involved in the pilot project. In addition to signifying the release time -pre-morning, morning, lunch, evening, and prenight- the braille will give information of dosage order and method. The envelopes are intended to help more people with visual impairments by displaying related signals.

“We will make efforts to prevent blind people from drug misuse and improve the effectiveness of treating diseases by providing braille stickers in thecomplex guide,” a Busan city government official said.

conclusions The right time for change It has been 12 years since <The Act on the Prevention of Discrimination Against Disability and the Relief of Rights> enacted to fundamentally protect human rights and improve discrimination against the disabled, but unresolved contradictions still exist.

Difficulties remain in the specific classification of, such as, packaging containers and dosage forms which should be improved in the future. Plus, technically improved auditory aids should be widely available in diverse forms like watches, blood pressure meters, thermometers, and liquid-measuring devices so that patients rely less on reading. It is right time to support both disabled and non disabled to be able to enjoy their everyday lives indeed. B

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Reasons why microbiome is our second genome Ji Eun Ryoo

S

ginaryoo21@gmail.com

imply put, microbiome (microbe+biome) refers to total genome of all microorganisms found in humans, plants, and other animals. What is so fascinating about human microbiome is that there are about 100 trillion microbes living in a single individual, most of which are in our guts. Human microbiomes range from bacteria, viruses to single-celled eukaryotes. Although their sizes are almost 100 times smaller than those of other ordinary human cells, they are accountable for up to 2.5 kgs of adult weight.

Why Is Microbiome So Important?

The human microbe is composed of not only bacteria but also viruses and fungi, leading to a formation of quite complex community. Since there are only about 23,000 protein encoding genes in human genome, 3.3 million number of protein encoding genes in microbiome is breathtaking. It was confirmed that healthy individuals carry 10 times more microbes than cells and 200 times more microbes than genes. The number of microbes to human cells in healthy individual is about 10 to 1 while the number of microbes to human genes is 200 to 1. Such ample number of microbiomes found in our bodies represents their significance. Since there are so many protein encoding genes in microbiome, it is not surprising that various microbiomes have some impact on diseases. Researchers confirmed that there are mainly four areas in which microbiome plays a big role: nutrition, immunity, behavior, and disease. Helpful microbiome aids in digestion of otherwise indigestible food. Deleterious microbiome is responsible for gastrointestinal diseases. On the other hand, microbiome in our intestine plays a great role in maintaining immune cellsâ&#x20AC;&#x2122; homeostasis. For instance, signaling from microbes kicks off systemic immune responses and anti-inflammatory host immune responses. While human genomes differ from one individual to another by only 0.1%, microbiomes differ among individuals for about 10-20%. Even within an individual, great variation in microbiome makeup can be observed. Due to huge diversity of microbiome makeup in individuals, researchers are expecting that microbiota transplantation from healthy individuals to some suffering patients would help in curing diseases.

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Efforts Into Learning About Our Microbiome 1) Human Microbiome Project (HMP) phase 1 The Human Microbiome Project, HMP, was first conducted in 2008 by the National Institute of Health, NIH. It further expanded what we already knew about our genetic makeup from the previous Human Genome Project. Researchers were surprised to find that there are only 20,000-25,000 genes in human genome. They expected for such complexity of human beings, far more genes were needed. Therefore, they soon relaunched a research project to learn about human microbiome. The first phase HMP (HMP 1) was conducted with 160 million dollars for the first 5 years. The research mainly focused on microbiome living in five body sites: skin, nose, mouth, gut and vagina of human. In 2013, the HMP1 ended with over 14 terabytes of data from 300 healthy individuals.

2) Integrative Human Microbiome Project The second stage of HMP which is also known as integrative HMP (iHMP) first started in 2014. Using data from the previous HMP, iHMP further focuses on three main health issues: pregnancy and preterm birth, onset of inflammatory bowel disease (IBD), onset of type 2 diabetes.

Pregnancy & Preterm Birth: Researchers in Vaginal Microbiome Consortium team at Virginia Commonwealth University are conducting multi-omics microbiome research on how microbiome ecology changes as pregnancy progresses in mothers and development of nascent microbiome in newborns.

Onset of Inflammatory Bowel Disease: The Inflammatory Bowel Disease, IBD, refers to chronic inflammation condition in digestive tracts including diseases like ulcerative colitis and Crohn’s disease.

Since IBD is primarily related to chronic inflammation in digestive tracts, it has been theorized for some time that IBD is related to diversity and ecology of human gut microbial ecosystem.

Onset of Type 2 Diabetes: According to WHO, the number of diabetes patients has risen from 108 million in 1980 to 422 million in 2014. The percentage of people affected by diabetes changed from 4.7% to 8.5% from 1980 to 2014.

It was confirmed that people in middle to low income countries are more predisposed to suffer from diabetes.

Since there are so many people affected with Type 2 diabetes mellitus (T2D), researchers are working together to understand more about diabetes. In hopes of finding mechanisms of onset and progression of T2D disease, groups of researchers are now pulling a longitudinal profiling on microbiome of T2D predisposed patients.

Its Current Pharmaceutical Applications People are expecting that if we gain a better understanding of individual’s microbiome, we could use such knowledge into developing personalized medicine based on his or her microbiome. Since most of the microbiome in human is mainly located in gut, current research mostly focuses on gastrointestinal microbiome.

Currently, researchers studying microbiome are trying to define normal microbiome in humans. They are expecting that once they successfully define what normal microbiome individuals should carry in order to be healthy, they will be able to elucidate microbiome’s roles in human bodies. Yet defining normal microbiome is difficult because human microbiome varies greatly depending on geographic location, age, and race. By correctly identifying which microbiome is altered and shifted in patients, they will know which microbiome could be transferred from healthy individuals to other patients. Hopefully, such a better understanding of microbiome will be of great help in treating diseases that have not been conquered by current therapy. B

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Hangover The Price to Pay for an Excessive Drinking SoYeon Choi choisoyeun@yonsei.ac.kr

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rinking culture in Korea is quite different from other countries. Almost 80% of Koreans regard drinking as one of their cultural life, and some people still think that an adequate amount of alcohol is sometimes necessary for their social life. As you guess, many Koreans are tolerant toward alcohol even in excessive drinking.

According to the 2013 research data, NHIS(National Health Insurance Service) evaluated the total social economic cost of alcohol to be about 9.5 trillion wons. Its cost is much higher than the sum of social cost regarding smoking and obesity.

What makes the matter worse, Korea has one of the highest binge drinking rates as 30.5% in the world in accordance with social chaos and instability of economic. Was that the reason? Nowadays, people are buying hangover supplements or drugs that relieve speicific unpleasant symptoms after heavy drinking at a pace that we never expected.

Definition and Mechanism After excessive drinking, some people complain of a severe headache or other after effects, called â&#x20AC;&#x2DC;hangoverâ&#x20AC;&#x2122;. In other words, hangover includes all physical or psychological displeasure and concomitant decrement in work which lasts for hours to days. Other symptoms include not only muscle pain, nausea, vomiting, mannerism and thirst, but also change of sleeping pattern and gastrointestinal displeasure. The sense of lassitude and decrease of cognitive ability might be typical symptoms after drinking an excess of alcohol. Usually, various symptoms of hangover occur when the BAC(blood alcohol concentration) decreases to nearly zero.

Although hangover is prevalent, this condition is not well understood pathophysiologically. As far as known, ingested ethanol undergoes three steps of degradation mechanism, that converts from ethyl alcohol to acetaldehyde to acetate each by alcohol dehydrogenase and aldehyde dehydrogenase. At the end, acetate can be converted to carbon dioxide and water subsequently.

During the detoxicification and metabolism of active aldehyde, alcohol and acetaldehyde cause damage to brain and hepatic cells and major hangover symptoms including headache, vomiting, and so on. In particular, people with lack of alcohol dehydrogenase can be disturbed more than normal people by alcohol, and heavy drinking puts more pressure on their liver function. Surprisingly, the IARC(International Agency for Research on Cancer) designated endogenous acetaldehyde as a Group 1 carcinogen.

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Market of Hangover Drug

Many are easy to access to hangover supplements and related drugs in the pharmacy and convenience store. For instance, hangover supplements and drugs are one of the most thriving products in pharmacies in Yeouido, a popular place for dining with alcohol. In fact, data of growth rate, sales, patent granted, and accessibility reflect market growth.

According to Nielsen Koreaâ&#x20AC;&#x2122;s 2017 FMCG trend report, growth rate of hangover chaser was the fourth highest as 14.9% among the food groups. Sales data definitely shows the rapid growth of hangover chaser market in Korea. Nowadays, its sales has increased constantly and is now approaching 200 billion won. As its demand increases, hangover supplement comes in wide variety of types in terms of formulation, flavor, and so on.

Drug & Supplement and its Mechanism Experts say that there is no particular remedy to relieve hangover symptoms promptly, and â&#x20AC;&#x2DC;timeâ&#x20AC;&#x2122; is the most effective component of treatment. Nonetheless, cholagogues and hepatic protectors still have been permitted to be used as hangover supplements. There are several drink and pill types of complex herbal medication which reduce BAC on the market as well, and most supplements have quite high sugar content because the lack of blood glucose can also cause hangover. Major medicinal herbs of hangover supplement are oriental raisin tree, daikon, spindle tree, kudzu, acanthopanax, etc. These components inhibit absorption of alcohol and decrease BAC by accelerating biological alcohol metabolism. Furthermore, they are effective in not only protection of hepatic cells and mucous membrane of stomach from aldehyde, but also deodorizing and maintenance of intestinal flora. Unexpectedly, these drinks and pills are not applicable to health functional food. Only three extracts of oriental raisin tree, lentinus edode hypha, and thistle are admitted as health functional food related to liver function by the Food and Drug Administration.

Conclusion

Many treatments and supplements are described to reduce the severity of hangover symptoms and shorten its duration. Nevertheless, people should not have blind faith in the efficacy of hangover drugs. Some who especially enjoy heavy drinking must realize the seriousness of hangover and its related symptoms with taking good care of their health.

Especially people with diabetes, metabolic syndrome and obesity should take an extra care when they take hangover supplements with high sugar content. As the public encounter more and more hangover supplements easily, industry has to provide correct information and pharmacists must instruct and advise on medicines based on its effectiveness and precautions such as sugar contents. B 2019 VOL.16

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LIFE ISSUES

Life with your pet will make you perfect Heeyoun Yang

aimjwwife101@naver.com

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t was since the Paleolithic Age, 12,000 B.C., that humans have been living with dogs, the first types of pets. It seems like the dogs were used to protect people’s homes from wild animals by hunting them down. Cats, on the other hand, have been the owners of living rooms since around 5,000 years ago. Back then, They were good warehouse keepers that protect grains from the attack of the rats. Over time, they became a pet for royal family and novel society because of their elegance, and perhaps cuteness. Aside from these two famous species, there are countless other species living with humans as pets. Just by looking at pets makes us happy, and they are also good friends and family to spend time together. They give us faith and trust which provide emotional stability, leading us to improve of our social relationship with other people. Not only are pets good for our mental health, but also for our physical health. Here are some amazing effects of pets on human health and the reasons behind them, from the basic physical strength improvement to the prevention of diseases.

Pets Enhance Your Cardiovascular Health American Centers for Disease Control and a study of Dr. Well’s team of Queen’s university in England both proved that living with pets reduces blood pressure, cholesterol, and triglyceride levels, which reduces risk of heart disease. Dr. Wells said that “Dogs help improve people’s cardiovascular health directly by relieving stress, and providing the regular activities.”, and there are a number of studies supporting her words. Friedman research team’s study on myocardial infarction showed that people with pets recovered much faster than those without,

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and the mortality rate of people with pets were 67% lower than people without pets. These studies show that hugging and kissing tender and furry pets everyday do not give us just happy feeling to our hearts. They give us literally the practical benefits to our hearts.

Pets Keep Dementia Away Living with pets is known to show effects of the mental aerobic. The mental aerobic is an activity to relive brain’s fatigue and stimulate the brain to work efficiently, usually concerned with solving quizzes, meditation, and counseling. It is known as the number of dorsal spins of brain nerve cells that are increased by the stimulation of the mental aerobic. There are many studies showing that stimuli caused by contact with pets’ warm body temperatures and soft fur help improve cognitive function. These effects are expected to be directly linked to the prevention of dementia. In addition, living with pets shows the effects of reducing the depression of middle-aged people who have independent children as well. ‘The Forbes’ has included ‘living with pets’ in its list of 10 secrets to enjoy longevity.

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Pets Boost The Amount Of Your Physical Activity

Pets Can Help Improve Children’s Immune System

There are some studies showing that playing with pets contribute a lot to improving your health. Dr. Evan Paul Cherniack of the University of Miami said that people with dogs should go outside ‘by force’ to walk with their dogs.

Hyuik Cho, the director of the central animal hospital saidsaid, “a dog is as accurate as a clock, so it will help you work out the same distance, at the same speed, at the same time.” According to the study on ‘International Journal of Behavioral Nutrition and Physical activity’, the walking patterns of 45,514 adults in California show that people with dogs walk about 20 minutes a week more than people without pets. It stated that considering the appropriate intensity of physical activity recommended by the US centers for Disease Control and Prevention is ‘over at least two and a half hours a week’, that difference provides a significant result. All these studies focus on the activities needed to be provided for the pets’ happy life.

It is well-known that dogs need to walk outside everyday, often more than once a day. Also, cats need to play actively with people everyday, at least an hour. These activities are helpful not only to make pets’ life better, but people’s lives as well, by increasing their amount of exercise.

According to the results of a study published in the October issue of ‘Infectious Diseases’ of the University of Cambridge by Dr. Jane Heyworth of the University of Western Atustralia, children who grew up with their pets have a healthier immune system and suffer less gastrointestinal infections. Dr. Jane said “The general view is that dogs and cats cause gastrointestinal infections, but the result is the opposite: Close contact with pets enhances a child’s immunity.” The results of a study by Dr. John McNicholas of the University of Coventry and Warwick, England also showed that children with dogs and cats are exposed to more infections in childhood, which strengthens the immune system in the long term. Also, despite the fact that animal hair is known to cause allergic reactions, there is a study that proves children who have been in close contact with animals since childhood show less allergic reactions. It is a very controversial and complex matter to say whether raising children with pets from a young age is good or bad, and how dangerous it can be. However, with careful study and control of parental behavior, it seems like there are some clear advantages we can get from living with pets from a certain young age.

Some researchers say that not all people living with pets can experience all of these effects. Also living with pets is not fit for everyone as pets require a lot of money and time. It is also undeniable that sometimes pets can be a danger to your health. However, we know there are so many advantages we can get from living with pets, including all those benefits on health mentioned in this article. Above all, it is an irrefutable fact that pets make us feel an infinite amount of unconditional love that we never ever had before. Wouldn’t that be enough of a reason to spend the rest of our live with them? B

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Common health sense for vegetarians What is the disease most suffered by vegetarians?

JungWon Kim

wjddnjs521@naver.com

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he number of vegetarians, including semi-vegetarians, estimated in 2019 is over 11% of the worldâ&#x20AC;&#x2122;s population and tends to be steadily increasing. People adopt vegetarianism for various reasons. While some people are motivated by advocating animal rights, others are for their own health, economic, or environmental conditions.

However, all vegetarians have different perceptions of health commonalities that are prevalent in society. That is because most health common sense are still focused on meat-eaters, so vegetarians have to take care of their health in different ways. If you decide to be a vegetarian for any reason, here is some knowledge that you should be aware of.

Common health sense

Common health sense for vegans

Sodium and potassium are the two main cations in human body that regulate ionic constancy and blood pressure; both of which must be kept at proper levels to ensure that cells remain stable. Since the total cation level in a healthy body is fixed to some extent, if one cation deviates from the appropriate level, other is being adjusted in complementary phase, just like the form of seesaw. As the sodium level in the body is high, the potassium level decreases, and if the potassium level is high the sodium level becomes low.

Negative perceptions of sodium are rampant in modern society, so â&#x20AC;&#x153;low-salt dietsâ&#x20AC;? are regarded as beneficial. This is because salt is always used for meat-based foods in the process of cooking and seasoning, so meat-eaters constantly get sodium at an appropriate lever or even higher in their daily lives which leads to several diseases. In fact, the cause of most severe heart and cardiovascular diseases is high internal sodium levels.

However, in the case of vegetarians, it is more common to find this sodium-potassium seesaw tilted in the opposite direction. This phenomenon is based on the condition that vegetarians eat raw fruits and vegetables on a daily basis, so there is already a slight tendency for potassium levels to be high and sodium levels to be low in the body. The problem is that even for these vegetarians, there are many who believe without doubt that sodium, or salt, is their health enemy and thus try to eat a low-salt diet. As a result, more than 28 percent of vegetarians across the U.S have been diagnosed with hyperkalemia, which causes severe arrhythmia in the heart. Vegetarians should keep in mind to eat vegetables steamed enough in water or to blanch them to lower their potassium content, and to eat foods or sauces containing salt.

: Salt intake should be minimized, because high-salt diet causes a variety of cardiovascular diseases.

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: You should be aware of taking enough sodium to prevent hyperkalemia.

LIFE ISSUES

Common Health Sense For Vegetarians

Common health sense

: You should cut back on the intake of meat, dairy products, or soda for kidney health.

Kidney is an organ closely related to the body pH regulated maneuvers. The pH level of food people eat varies from about 3 to 11. Despite of this pH variation, our body maintains pH homeostasis so that it does not deviate significantly from 7.4. It is ruled by the excretory function of the kidneys and the buffer effect of blood. Nevertheless, depending on the dietary tendency, each person has slightly different internal pHs. For instance, people who frequently eat meat with acid pHs and vegetarians with alkaline pHs. Thus, the kidney also has the opposite tendency to regulate the pH through the emission action in the two different diets.

People with weak kidney function may get blood dialysis, and doctors advise them to cut back on their meat intake. Through these experiences, many people have a perception that meat has negative effects on their kidney health. In fact, there are patients who stop eating meat for kidney health and start to eat vegetables, but still suffer blood dialysis for a long period of time after diet change due to the increased pH imbalance in the body.

Common health sense for vegans

: Dairy products and soda intake may be helpful in health maintenance.

This is not because meat or vegetables themselves have an adverse effect on the patient, but because a diet that only continuously consists of meat or unprocessed vegetables puts a strain on the kidney function. Therefore, patients getting blood dialysis should understand their diets, and intake some dairy products, acidic oranges, or nutritional supplements in order to put less strain on their kidneys.

Whether vegetarianism or meat-eating is beneficial for peopleâ&#x20AC;&#x2122;s health is a constant debate among nutritionists.

However, both meat eaters and vegetarians are required to recognize and control their own physiological deficiencies or excesses by adjusting their diets. In particular, vegetarians can maintain a healthy life by creating and checking their own common sense of health, as well as selectively applying appropriate health information among tremendous resources. B

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NATIONAL ISSUES

YakTube

Pharmacists on YouTube Yeji Jeon yejijeon97@naver.com

Y

ou all might have once seen a 3-year-old little baby using smartphone on his own to watch YouTube. It is quite a striking scene that a baby who cannot even write knows how to use IT products to watch videos. Not only babies, but also everyone else including students and adults, might have YouTube-app on their smartphones. People use it for various purposes such as entertainment, studying or catching up with latest news. Like this, along with the development of IT, YouTube is seeping deeply into our daily lives and videos are replacing letters as the tool for delivering information.

Since YouTube has become a bridge among people, numerous people try to communicate through YouTube. Pharmacists is a notable example of a group of people who are trying to approach people through YouTube. Now the most popular pharmacist YouTuber has approximately 1.85 million subscribers, which demonstrates the influence of pharmacist on YouTube. So, who are they?

Who are pharmacist YouTubers?

To simply define â&#x20AC;&#x153;pharmacist YouTubersâ&#x20AC;?, they are pharmacists who communicate with patients and people who are interested in healthy life through YouTube by making and editing video clips by themselves as the words literally say. Each has their own style when it comes to communicating with subscribers, by creating contents related to K-Pop, their daily lives such as traveling, or interviews of other people. Despite of their various styles, they all have the same purpose: to deliver correct information about drugs to patients in a more familiar way. They expect patients to feel more comfortable about asking questions online and satisfy their curiosity. Pharmacist YouTubers also act as entertainers, helping people to develop an interest in drugs and acquire basic, essential information. They are pharmacists who people can meet whenever we want.

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NATIONAL ISSUES

Light and Shadow of pharmacist YouTubers Pharmacists often feel helpless when they face people at pharmacy, because there are lots of people who rely more on false information from internet and television than pharmacists. Therefore, pharmacist YouTubers are trying to correct wrong information and upload contents about drug abuse or misuse in an easier way to understand. They also make effort to be a friend-like pharmacist to patients and deliver beneficial information about drugs. The special thing is that they help people get to know who pharmacists are by explaining their roles. There are lots of positive feedback that praise how pharmacist YouTubers are widening the role of pharmacists.

However, there are some critics who worry about pharmacist YouTubers’ activities. Since people rely on them in the name of “experts” of medicine, there would be tremendous consequences if pharmacist YouTubers deliver wrong information to people.

Suppose that a particular pharmacist YouTuber has about a million subscribers. This means that if one false information is delivered, those million subscribers would get that information and if that video is shared, the number of could double.

A representative example is the event related to “aronamin gold”. One of the popular pharmacist YouTubers who has about 11 million subscribers had been surrounded by controversy for causing a misunderstanding regarding the product. On his video, he told people the reason why he doesn’t consume ‘aronamin gold’ is that it is less cost-effective than other products with similar effects. However, people seemed to be misinformed that ‘aronamin gold must not be taken’ and the company of the product had to make an explanation. The YouTuber made an apology to people and had to delete the video. People voiced genuine concerns about this incident and also about pharmacist YouTubers. Critics feel anxious about some making wrong use of YouTube, for example advertising or defaming particular product while pretending they are delivering information.

Suggestions It is obvious that pharmacist YouTubers are giving positive effects on broadening pharmacist’s role and helping people to get various beneficial information about drugs. However, it is a double-edged sword as well. To avoid problems introduced previously, prevention policies related to the use of social media of pharmacists are needed. Also, strict systems regulating delivery of false information throughout YouTube should be prepared. More importantly, pharmacist YouTubers themselves should be aware of how they are being shown to people. Though it definitely has positive aspects such as becoming familiar figures to patients, pharmacists should emphasize their expertise rather than a certain internet presence. It is important for pharmacists YouTubers not to forget their duty as a “pharmacist”. B

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NATIONAL ISSUES

the truth of reddish water Sang Hee Lee

idshannon@yonsei.ac.kr

L

ast summer, Incheon Metropolitan citizens suffered from ‘reddish tap water’. Reddish tap water was first reported on May 30 in western Incheon, and in Yeongiong island, Ganghwa-gun few days later. Tap water of these places was reddish with unknown black particles. Since the cause of reddish tap water was unclear for few days, people had to undergo inconvenience : restaurants faced great loss of customers and a school hour was shortened. Furthermore, government announced everything is fine even though reddish water was still releasing which stimulated the distrust for citizens of the water supply . Not only Incheon citizens, but also whole nations wondered: what was the fundamental cause of the reddish tap water?

Background and Causes Before looking into the cause, we have to understand the background and policies related to this incident. Every filtration plant needs a periodic inspection. Gongchon filteration plant, which supplies water to the affected area, was scheduled for this inspection. During the inspection, Gongchon filteration plant could not supply water. To prevent suspension of water supply, Waterworks Headquaters Incheon Metropolitan City decided to use water from Namdong filtration plant. However, to use water from Namdong, switching the waterway was inevitable.

In order to switch the waterway, there is a guideline that workers have to follow. It starts with controlling a water gate valve. By unwinding the vlave, new waterway opens.

To make water pass through the pipe in new direction, high water pressure is needed. High pressure causes rust of the pipe to fall into water more easily than usual. This can lead to poor water quality, so Korea Construction Standards states that workers should be extra careful about the water quailty when controling the gate valve during water supply switch. Also, to prevent rusts from releasing, workers should switch the gate valve stage by stage to dilute the

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rust. Waterworks headquaters Incheon Metropolitan City didin’t follow two of the standards.

First, Waterworks headquaters Incheon Metropoitan City didn’t control the gate valve stage by stage. The valve was unwined at once, resulting in releasing lots of water abruptly with high pressure. Consequently, amounts of rusts dropped out and released without diluting. Second, paying extra careful attention to water quality was not met.

When Waterworks headquaters scheduled the switch of waterway, they planned some factors such as the direction, but omitted to track the water quality. Therefore Waterworks headquaters did not know the rusts were releasing, letting them arrive to households.

Health Effect How does this scary reddish water affect the human body? It is yet hard to know the actual health impact of the water. Incheon Metropolitan did not disclose the specific composition of the red water. Therefore, risk assessment of the reddish water couldn’t be conducted . However, we can infer the health impact from a research paper and data released by Waterworks Headquaters Incheon Metropolitan City.

NATIONAL ISSUES

According to the water quality test standards unveiled

by Waterworks Headquaters Incheon Metropolitan City, the Incheon City Water Quality Inspection examines a total of 61 substances in five categories: categories about microorganisms, health-harmful minerals, health-harmful organic materials, disinfectants together with disinfection by-products, and aesthetic effects. Waterworks Headquaters announced that in both Yeongjongdo and western Incheon, turbidity, one of the substances of aesthetic category, exceeded the national standard of that ; 0.5 NTU. No information on the causative materials of turbidity was disclosed, and all the remaining substances were in the normal range. According to a ‘Manual on drinking water quality’ released by the Ministry of Environment, turbidity causes psychological repulsion but is harmless to human health. However, the Ministry of Environment added that diarrhea can be caused when turbidity is very high.

It is because the water with high turbidity can be exposed to disinfection disorder, which increases the chances of diarrhea-causing bacteria proliferating.

‘Impact assessment for water pressure and turbidity by changes in water flow rate in large water distribution networks’ provides information of the causes of turbidity.

According to the research, when flow rate increases, slime and biofilm deposited inside the pipe floats in water as particulate matter. In addition, microflux-sized iron and aluminum oxide also floats in water as particulate matter, causing turbidity problem. Iron oxides may be the main cause of turbidity of this disaster, considering that the main feature of the water was reddish color. If the concentration of iron exceeds the water quality standard, it can cause hemochromatosis. However, considering that the water quality test was in normal range, even if used as drinking water, there would be little haemorrhosis.

Conclusion Combining the data of the Waterworks Headquaters Incheon Metropolitan city, Environment Ministry, and the research paper, conclustions are as follows - Reddish water is mainly harmless but can cause diarrhea if used as drinking water in areas with very high turbidity. However, the red color and the psychological repulsion given by the floatting particles is so great that restaurants and schools should not use the water as drinking water.

Although there was no fatal effect on the human health, it doesn’t mean everything is okay. The workplaces including restaurants, swimming pool, and schools were not able to do business, resulting in financial damage. Also, pregnant women and parents with young children were worried about their children’s health, which has caused serious mental damage. This disaster should not happen again. The Ministry of Environment and the metropolitan waterworks headquarters should once again emphasize compliance with the rules and necessity for enhanced monitoring. B

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NATIONAL ISSUES

The Pharmaceutical issues: Time For A Change ChiHo Jeon

I

chiho2275@yonsei.ac.kr

What is ‘Valsartan inccident?’

n July 2018, a shocking accident called ‘Valsartan Incident’ hit Korea. ‘Ministry of Food and Safety (MFDS)’ claimed that the carcinogen called ‘N-nitrosodimethylamine (NDMA)’ was detected from Valsartan. Valsartan is one of the raw materials of medicines for treating high blood pressure (HBP). The medicine regulates blood pressure(BP) by inhibiting angiotensin converting enzyme (ACE). By binding to a AT-1 receptor instead of angiotensin Ⅱ, Valsartan inhibits several processes including secretion of aldosterone, catecholamine and vasopressin, and water resorption which causes drop in blood pressure. Valsartan itself is not the problem, but the NDMA which is one of the side products produced while materializing Valsartan causes a trouble.

MFDS announced that NDMA is ‘Class 2A’ carcinogen withouth explaining the meaning of ‘Class 2A’. Patients suffering from HBP didn’t exactly know what ‘Class 2A’ meant and they were seized with panic. Meanwhile, MFDS published ‘List of products for temporary suspension of sale and manufacture’ including 175 items without asking companies whether they were using Valsartan as raw material medicine or not. Upon revealing the list, the institute reexamined all the items. After that, it reannounced that 153 items which contain NDMA less than 0.3ppm which is considered as NDMA controlling standard. Inadequate countermeasure conducted by MFDS caused chaos to not onlypharmacists but also pharmaceutical companies.

Followed by the first announcement, pharmacists who already filled a prescription had to exchange the medicines that patients brought back. However, MFDS reversed it after the reinspection. Refilling a prescription was deductible and it was a big blow to pharmacists’ pecuniary affairs. ‘Ministry of Health and Welfare(MOHW)’ came into conflict with pharmaceutical companies that sold the medicines due to pharmacists’ claims for the compensation.

All of the related parties had a difficulty because of this incident. Society and medical industry demanded fundamental reform of pharmaceutical industry. At the same time, MFDS and MOHW were required to reestabilish systems and polices to avoid another unfortunate accident.

Unfortunately, after a year and a half from the incident,

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What is ‘Ranitidine inccident?’ another accident shocked Korea again. It started from reports released from the United States Food and Drug Administration (FDA) and European Medicines Agency (EMA). On september 13, 2019, FDA and EMA published that some ranitidine medicines, including some products commonly known as Zantac of GSK, contain NDMA at low levels. Ranitidine acts as a competitive inhibitor of histamine which binds to histamine-2 acceptor (H2) located on partial cell: histamine participates in allergic reaction by binding to a histamine-1 receptor (H1) causing bronchus

NATIONAL ISSUES

contraction, angiotelectasis, flare and urtication and stimulates gastric acid secreting system by binding to a H2 receptor. Thus, ranitidine is a typical medicine for curing a digestive trouble such as gastric ulcer and reflux esophagitis.

Contrary to the FDA and EMA’s reports, NDMA wasn’t detected from MFDSs’ emergency inspection. Subjects of the inspection were limited to a part of raw material.

However, after the complete enumeration, they found that all the ranitidine contained NDMA over than the controlling standard. This amplified distrust towards MFDS. Having suffured a chaos already, they knew how to handle it. First, MFDS revealed a list of medicines which couldn’t pass the standard. Then, they stopped importing it and ordered doctors to stop to prescribe it. Furthermore, the institute decided to recall all the medicine which were already prescribed and sold. By recalling the medicine, pharamceutical industry could avoid confusion in a measure, differentiating from the last incident. However, there still remained a pecuniary matter. When the companies brought back the medicines, pharmacists asked comanies to repay full charge whether those were used or not.

be done actively by MFDS. They also raise a question regarding the institute’s safety managing ability. The doubt is based on the publishments. Most of all, it shocked people that carcinogen was detected from medicines already assessed to be safe. In addition, reversing former reports in a matter of days lowered confidence.

Because of the two incidents, pharmaceutical industry is being attacked by medical communities. According to interviews, patients said they can no longer take medicine with confidence. Also, they will not take ranitidine even if some of the medicine are judged to be safe later. This will cause companies’ sales to decline. Since Gastrointestinal medicine market is so big, the reduction in sales can make pharmaceutical industry suffur.

Some policies are criticized as well. In Korea, occasionally, some companies operate bioquivalence test hitching a result of another company that manufactured original medicine. Also, MOHW put a much higher selling price on generic medicine than a cost price. Even the selling price is higher than that of a original medicine whose patent has expired. MOHW established these pharmaceutical industry development policies to promote developing a new medicine. However, the situations such as ‘Valsartan incident’ and ‘Ranitidine incident’ show that the policies are being used only as tools to make a profit.

Conclusion As profit making organizations, companies can’t disregard financial aspects. However, most of all, they must set national health as high-priority because what the companies make directly affects people’s lives. Focusing on their mission, they must keep pace with developing techiques and make an effort to establish altruistic policies.

By doing so, they can gain what they want with social honor. B

Government’s treatment Then, what have been changed after the ‘Valsartan inccident’? Actually, it seemed that nothing changed but the way handling the problematic medicines. Both of the incidents were started from foreign government agency’s reports. As a result, people have come to wonder what can 2019 VOL.16

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NATIONAL ISSUES

A nation that forgets its past has no future - Japan boycott and Japan drugs

T

JaYeon Heo

heojayeon@daum.net

his year marks the 100th anniversary of 3·1 movement that occurred on march 1st, 1919. Even though it has been long since independence from Japan, the two nations are colliding once again. With Japan’s unilateral atrocities and Korean’s anger, the slogan “we would boycott even if we had not been part of any independence movements” is chanted throughout the country. The ‘2019 boycott against Japan’ is a boycott on Japanese goods which arose from Korean people’s retaliation against Japanese Prime Minister Shinzo Abe’s decision to impose export controls on South Korea on July 2019.

Differences between the previous and current boycott movement against Japan

There have been several anti-Japanese boycotts before 2019, but the boycott in 2019 has clear differences from the previous ones.

First, previous boycotts were mainly related to the problems pertaining to the distortion of Korea-Japan history or the territorial issue, especially on Dokdo islands.

However, the main reason for the boycott in this year is the backlash from Japan’s restrictions on exports to Korea.

Second, the previous boycotts were mostly limited for ordinary retail consumers to ‘not buying’ Japanese products.

However, the 2019 boycott extended its meaning not only to ‘not buying’ but also to ‘not selling’. This means companies as well as consumers that sell or distribute Japanese products are participating in this movement.

Third, boycotts in the past were often led by certain groups such as civic organizations or communities, but this 2019 boycott is in the form of voluntary participation across the whole nation. Boycott participants and supporters in 2019 are striving to keep the boycott a proactive movement.

They assert that the government should focus on the dispute over international affairs, not interfering in this boycott.

Fourth, previous boycotts were limited to Japanese companies that had controversial stances. In past boycott, when the Japanese firm sells non-replaceable products in Korea, the boycott eventually lose its momentum spontaneously as alternative goods could not be obtained. However ‘2019 boycott’ is a national issue. Though Japan advocated free trade as a chair country of 2019 G20 meeting, just two days later, their government reversed its decisions and enforced export controls which completely damaged the credibility of Japanese goods and products. Once confidence has been broken, it is very difficult to restore.

In short, the previous boycott is “not buying yours,” but ‘2019 boycott’ is “not buying yours never again.”

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NATIONAL ISSUES

2019 boycott in the field of medicine

Every Korean is now joining ‘2019 boycott’ movement in all areas, including tourism, food, electronics, household goods and clothes.

In the area of pharmaceuticals, more than six regional pharmaceutical associations have been taking part in boycott on Japanese medicines and products. Jeon-buk Pharmacist Society first began to boycott in protest of the Japanese export regulations. Meanwhile, Daegu-Gyeongbuk pharmaceutical association announced a statement on Aug. 2nd, 2019, when the Japanese government decided to exclude South Korea from the trade white-list country. The statement is as follows.

“The Japanese government admitted itself that it was an economic reprisal against the Korean Supreme Court’s decision that Japan must compens ate for its forced conscription. If the Japanese government pushes ahead with the economic retaliation, members of the pharmaceutical association will boycott on all Japanese medicines and products.

This is a kind of ways to fulfill the duty as a Korean and to put political and economic pressures on Japanese war-criminal companies and the ultra-rightist regime”.

‘Not buying Japanese medicine’ is not just for patriotism and unity of the nation, but actually for our living health.

Japan’s radioactive contamination reached critical level and sales of its products are allowed if they are produced outside the 50km radius of Fukushima. Although carcinogens such as radioactivity are not immediately apparent, they can be accumulated in the body and result in various cancers or deformed babies.

It is important to be aware of what kinds of Japanese medicines that Koreans take often and what medicines can be replaced. In Korea, there are many famous and popular Japanese medicines. Well known examples are Whituben and Albothyl of Takeda parmaceutical company. Alternative medicines are Powercole-S from Donghwa Pharmaceutical company and Peritouch from Green Cross company.

How to search Japan drugs?

Pharmaceutical association of the future for pharmacists (Yak-Jun-mo in Korean) opened ‘no-no-Japan-drug’ website (https://nonojapan.pharmmaker.com) to the public, which includes information about Japanese medicines and alternative medicines. So far, total 241 of drugs including ETC(Ethical The Counter) drugs, OTC(Over The counter) drugs and other products have been registered.

As a pharmacy student and a future pharmacist, we are responsible for the health of our nation people as well as respect for life. We should not only be familiar with various pharmaceutical fields. but also care about domestic and international issues. Let’s keep in mind that we should actively participate in the boycott, in particular, refraining from using Japanese drugs as much as possible. B

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Comments Eun_Chan_Lee The Blue Vanguard Volume 16 is out!

Address : College of Pharmacy, Yonsei Univ. 85 Songdogwahak-ro, Yeonsu-gu, Incheon 21983, Korea Online Site : https://issuu.com/bluevanguard 20h

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Kyung_Eun_Lee The Blue Vanguard Volume 16 is out!

Enjoy 16 articles in this issue, along with an interview with Lee Jae Wook, Korean Country Manager of Wolters Kluwer!

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Su_Min_Yoon The Blue Vanguard Volume 16 is out!

We worked hard all semester, so we hope you enjoy!

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Seo_Kyung_Kim The Blue Vanguard Volume 16 is out!

There are so many pretty designs! What are you waiting for?

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Jae_Min_Cha Please enjoy!

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Jun_Seo_Oh The Blue Vanguard is the best!

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Ye_Ji_Jeon The Blue Vanguard 2019 winter issue! Please enjoy~ 13h

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