PQ+2 December 2015 by PQ PlusTwo

DEC 2015

PQ PLUS 2 Pill-enty of wonderful procrastinating tools and stress-busters in this issue - read on!

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SLC Winning Entries Three UofA Pharmacy students present their insightful views on our profession today

PRESENTED BY OUR TITLE SPONSOR:

PHARMACARE SPECIALTY PHARMACIES

IN THIS ISSUE SAMPLE

PQ COVER DESIGN BY MARCOS ZERENE

06 04

Mr. Pharmacy

A quick snapshot of one of the hottest events in Pharmacy, and the moments we all swooned and cheered our amazing contestants on!

My Finals Routine

Just as you are “productively” reading PQ, Victoria shows her “productive” studying style

CSHP Meeting Novel Anticoagulants, anyone?

Editors' notes

2 PHARMACY QUARTERLY

This year’s top Student Literacy Competition winners touch on important issues in Pharmacy

A new addition - find out what kind of pharmacist you are!

SLC

Workout Gurus

What do the wise workout gurus of Pharmacy offer to us plebians? Find out!

PQ Quiz

Detox Dangers

Eating on a detox diet - the appeal and the dangers of hyperclean eating.

FLICKR IMAGES: BALA SIVAKUMAR, SPARKY, PAT GUINEY, PETER MACDONALD Disclaimer: Any opinions or viewpoints published are directly from the contributing authors and do not represent the philosophy or viewpoints of the Faculty of Pharmacy or the University of Alberta.

quick jog or study breaks with friends. Good luck to everyone on your exams, and remember that your GPA does not define you: you are not a number on a scale. You Is Smart, You Is Kind, You Is Important. Happy holidays! Just a couple of weeks left until freedom! Try to make time to relax and take care of your body during this exam season-- don’t underestimate the power of a

GHASAK HUSSAIN

We are in the home stretch!!! For some reason, it doesn’t feel like it’s been an entire semester already! And in less than a month - we will experience FREEDOM (and the horror of receiving exam grades Christmas morning... right, I didn’t say that). The PQ Committee has been working hard to stuff this issue full of fun and distracting articles to accompany you while you study - if you find yourself early to exams, why not try to find our

contest locations? Or for a hilarious laugh, read how Victoria studies for her finals. Good luck everyone! And happy holidays! WINNIE LO

CALENDAR

APSA CALENDAR After three long months of all nighters and more Tim Hortons than the average human body should consume, we are a month from the finish line! Here are some events to look

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PQ DESIGN AND LAYOUT BY WINNIE LO

You can find us on Facebook at PQ PlusTwo or Instagram @pqplustwo

PHARMACY QUARTERLY 3

MR PHARMACY

MR PHARMACY 2015

PHOTO CREDITS: HUMIRAH SULTANI, MORGAN MOFFAT, SHERRY ZHU

PHARMACY SUPERHEROES

PHARMACY SUPERHEROES Who is extra-super-amazing in our faculty? Here are this month’s heroes - both big and small.

Kevin Huie! You seem like such

a great guy! You’re soft spoken but I can tell you have a big heart. I think you’re a really nice classmate to have and I hope to get to know you better!

“Dylan - the tall blonde guy from 2018 who plays Wii all the time Thank you, thank you for lending me your white coat. Legit saved me a panic attack (and my life) If you ever need a white coat, you know I got you. However I feel my lab coat may be too short.”

Amanda L from the Class of

2017 is amazing! She shares notes and very helpful study summaries with her classmates. If profs present extra slides, she uses her super fast typing skills to jot it down for us. She’s beautiful, caring, and I couldn’t ask for a better friend.

Zeke Hartwig - thank you so

much for all the comments you post on Facebook on your studying status! You many not think so, but it’s one of the best parts of my studying day when I see a hilarious comment that sums up my studying experience. Good luck with your exams!

Submit a hero you know for our next issue at: tinyurl.com/pq2-questions

PHARMACY QUARTERLY 05

FINALS ROUTINE

MY FINALS ROUTINE BY VICTORIA PRICE With finals season upon us, studying is as much of a challenge for me as it is for anyone else (um, three months into Infectious Diseases and I still don’t know the difference between cefotaxime and ceftriaxone), but lately I’ve found that a strict and structured regimen is all I need to succeed. I’d like to share my daily routine during finals in the hopes that your studying can be as effective as mine. Enjoy! 7:00am: My phone’s alarm—an EDM remix of Hotline Bling—goes off and it’s time to start the day! Unfortunately my body disagrees, and I end up pressing the snooze button a few (okay, several dozen) times. Did you know a lack of sleep can lead to an increased risk of hypertension and dementia? I’m just utilizing those preventive non-pharmacological measures. 9:30am: I roll out of bed and get to work on my hair and makeup. While everyone else is sporting Ugg boots, sweatpants and hair they haven’t washed since the last day of classes, I’ll be fresh-faced and ready to mingle with those cute med students in the Tim’s line. Everyone needs a backup plan if they don’t pass the PEBCs, right?

11:00am: Arriving at school, I stop to get a nutritious breakfast. (Bonus tip #1: The mint in a peppermint mocha counts as a vegetable!) While I don’t usually run into any cute med students (I guess the 20 minutes it took to perfect my eyeliner was in vain), I do run into a couple pharmacy friends! We chat about how rough our lives are for a good while (if you think it gets better by third year, sorry, it doesn’t). Bonus tip #2: Take some selfies with your BFF. When those letter grades roll in, at least you can be sure your Facebook profile will get an A+ for cuteness! 11:45am: I check all the PBL rooms and go to 5 different libraries trying to find an empty seat before finally settling down in the MedSci stairwell. Ah, so quiet, drafty, cold and relaxing! I open my laptop, organize my highlighters, select a note-taking pen, open my notebook, create an elaborate title page for that day’s set of notes, finish my peppermint mocha and candy cane donut, tie my hair up out of my face, clean the fingerprints off my computer screen, fire off a few emails to Rae asking for her interpretation of my latest Justin Bieber dream, and put my phone away so I won’t have any distractions. Okay, now it’s time to get to work!

06 PHARMACY QUARTERLY

11:50am: Check Facebook for the hundreds of updates on the class page. 12:00pm: Check eClass for last-minute exam information postings.

Bonus tip #3: Don’t forget to update your Instagram so people know you’re studying real hard.

12:10pm: Check the University Calendar for other programs I could switch into. Hmm, a major in Human Geography would be way easier to wrap my head around than PK… 12:25pm: Count the days until my next exam and the number of lectures I have to review until then. Get overwhelmed and panic. 12:30pm: Need to go for a walk to calm down. Go to Tim Horton’s and get another caffeinated beverage. (Bonus tip #4: If you get the light cream cheese, that means it’s healthy so you can get 2 bagels instead of one!) 12:50pm: Settle back down and study. Check Facebook again to see if anyone has posted any summary notes. Get distracted by a video of a dog playing in snow. 1:10pm: Okay, I’m getting serious now. I pull up one of the lectures and get to work. 1:12pm: There’s a picture of carbuncles on the slide set so now I start googling carbuncles and sending gross pictures to all of my friends. 1:20pm: Wow, it’s already past lunchtime! How time flies when you’re working hard. I head to Tim’s for another break. 1:30pm: The person at Tim’s pretends like this isn’t my fourth donut of the day. I appreciate their tactfulness. 1:45pm: Alright, back to work. 2:00pm: All this pharmacy talk has got me watching old Mr Pharmacy videos on YouTube. Maybe if I had that kind of talent I wouldn’t have to waste my time studying. I could be a star. 2:20pm: Research beauty pageants. Decide that female beauty pageants are dumb and probably not the best career choice. Also I’m too old to appear on Toddlers & Tiaras, so what’s the point. 2:40pm: Okay, maybe I need a change of scenery so that I can focus better. I gather up my stuff and head in search of a new study spot. 3:00pm: Ah, the SUB basement is perfect. And they even have couches for maximum study comfort!

Sometimes the hardest part is finding a comfortable study position!

PHARMACY QUARTERLY 07

FINALS ROUTINE

3:45pm: Wake up and realize I fell asleep on the SUB couch. (Bonus tip #5: Sleep is very important for the consolidation of memory and retaining learning! Of course, it helps if you’ve actually learned something first…) 4:00pm: Move to the Rutherford library reading room. The silence is so tranquil! Finally, I can get so much done! Bonus tip #6: Spend any leftover student loan money from the end of the term on coffee. Your heart may not thank you, but your GPA will! 5:00pm: It’s three slides and a quarter page of notes later. The person in front of me watching Friends is a little distracting, but I swear I’ll get back to work right after Ross and Rachel get back together. (Bonus tip #7: Finishing an entire series on Netflix in one day gives you equal if not greater satisfaction than studying! 10/10 would recommend.) 6:30pm: Okay, this isn’t really working out. I’ll just go to ECHA. I stop at 4 different bake sales on my way through the building because they’re unavoidable. 6:45pm: I ate too many donuts. I think I’ll just go on Facebook for a little bit until I’m less full and can focus again. Oh, look, someone did post summary notes. I’ll look at those the morning of the test, if I have time. 7:00pm: Well, it’s been a long and productive day! I’m quite tired from all that I’ve accomplished, so now it’s time to head home and watch some Christmas movies because I’ve earned it. It’ll be back to the grind tomorrow!

It’s that easy! By implementing the same strategies that I use, you too can have a productive finals week and great adherence to study habits. Good luck everyone!

08 PHARMACY QUARTERLY

PHOTO CREDITS VICTORIA PRICE

CSHP MEETING

CSHP ANNUAL GENERAL MEETING 2015 – ALBERTA BRANCH UPDATE ON ORAL ANTICOAGULANTS PRESENTED BY DR. TAMMY BUNGARD, BSP, PHARMD, ACPR BY JAY MUTCH Novel/Direct Agents and their use with Mechanical Valves RE-ALIGN Trial – Dabigatran Etexilate in Patients with Mechanical Heart Valves - Dabigatran – 150mg, 220mg or 300mg BID vs. warfarin - Excellent study design - Stopped early with increased rates of thromboembolism in the dabigatran groups

Antiplatelet Agents and their use with newer “4th generation” Mechanical Valves -The On-X valve, bi-leaflet, made with a smooth carbon surface is designed to function with less anticoagulation Risk 3 Months Post Op Randomization at 3 months Status

Status of Reversal Agents for Direct Anticoagulants Idarucizumab – Reversal Agent for Direct Thrombin Inhibitors (dabigatran) RE-VERSE AD Trial – published with positive results as a reversal agent – does reversal improve overall mortality outcomes?? – we still do not know

TAKEHOME: Dabigatran is still contraindicated in Mechanical Heart Valves and this will likely never change. CATHAR Trial – Comparison of Antithrombotic Treatments After Aortic Valve Replacement Rivaroxaban: A New Antithrombotic Treatment for Patients With Mechanical Prosthetic Aortic Heart Valve - rivaroxaban 20mg daily vs phenprocoumon (VKA – similar to warfarin) for 6 months - prospective, open label, phase 2 trial (N=30) - 2 groups of patients studied – those right out of the OR (80%) and those 3 months out (20%) - primary endpoint – to determine if rivaroxaban 20mg is feasible and safe for prevention of major complications in patients undergoing a mechanical aortic (bileaflet) heart valve replacement - estimated completion in Jan 2017 (pushed from December 2015) TAKEHOME: Still waiting for evidence to see if rivaroxaban can be used in mechanical heart valves efficaciously and safely.

Interim Results for “high risk” patients – Really aren’t high risk as they are high flow aortic valves - Similar mortality between both groups RR=0.86 (0.41-1.82; P=0.7) - More events in the test group although NSS – Valve thrombosis: 0.23 vs 0.25%/pt year; P=0.9 - Less major bleeding 1.6 vs 3.9%/pt year; P=0.007 TAKEHOME: DAPT therapy alone is insufficient for 4th generation mechanical heart valves, warfarin therapy with lower INR targets MAY be used after 3 months (time for endothelization of sewing cuff of valve to heal) which may influence future guidelines as the rate of major bleeding was lower and statistically significant in the high risk AVR group. Waiting for results for MVR.

Andexanet Alpha – Reversal Agent for Anti-10a Inhibitors (apixaban, rivaroxaban), Currently in Phase 3 trials in healthy volunteers, bleeding trials expected to publish in 2022 Aripazine – Broad reversal agent for apixaban, rivaroxaban, dabigatran, heparin, LMWH, still in early prelimary stages, does not require refrigeration like idarucizumab and andexanet alpha (wider marker, increased applications?)

PHARMACY QUARTERLY 09

SLC COMPETITION

WHEN QUANTITY EXCEEDS QUALITY: ADDRESSING THE ELEPHANT IN COMMUNITY PHARMACY BY GHASAK HUSSAIN pharmacy as a profession and as a business.

You are presented with two patients dropping off a prescription: a hypertensive senior openly non-adherent with several of his medications; a young adult compliant with her three schedule 1 drugs. Both qualify for a medication assessment, but given your tight schedule, you only have time to spend with one. Who do you choose? For the majority of pharmacists, the answer is discretely evident: choose the simplest patient that would take up the least amount of time. This leads to a predicament where medication reviews are not being offered to patients that would benefit most. The recent CBC marketplace investigations have cast the public eye on the provision of these services. Hidden cameras have documented drive-thru medication reviews, pharmacists have come forward with claims of quotas set by their employers, and internal challenges for most billable services have been exposed1. The profession’s reputation is on the line. It is critical that federal and provincial regulatory bodies collaborate with pharmacists to implement a new model: one that supports effective and ethical delivery of clinical services, and establishes a balance between

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The expanded scope of practice has demonstrated it’s value for pharmacists, patients, and the healthcare system. During a period of drug rebate slashing and stagnant dispensing fees, remunerable clinical services became a powerful incentive for pharmacists to maintain a viable business model. Pharmacists also began filling their niche as medication management experts and proved to be integral to primary care. The public perceive expanded services positively; following a medication review, patients report a better understanding of potential drug interactions, side effects, and dosing frequency2. Pharmacist intervention eases the burden on the healthcare system as well3,4. Adverse drug events results in $10-23 million in costs per 100,000 admissions; over half of these events could be prevented through pharmacist intervention5. The Shoppers Drug Mart Sustainable Solutions Report further demonstrated that expanded services hold the potential to slash healthcare expenses by $1.4 to $1.9 billion dollars over a period of three years6. Provincial governments and third party payers have recognized these benefits; for example, Alberta Pharmacists’ Association, Alberta Blue Cross and the Government of Alberta collectively reached an agreement in 2014 to provide stable funding for expanded services over the next four years7. However, the quality of expanded services— notably medication reviews, smoking cessation,

and comprehensive annual care plans— can be compromised by external pressures and environmental barriers. A revision of the present system is highly necessary to preserve the professional, clinical, and economic value of these services. The scope of practice continues to progressively widen. However, the pace and extent of implementation has been variable among colleges. Not surprisingly, it is the provinces with widest scope and most comprehensive compensation models that report the greatest challenges; these challenges include lack of resources and time, increased workload, and increased corporate pressures2. Furthermore, the per-capita use of prescription medications and the incidence of chronic disease continues to steadily rise; more than half of the Canadian population now has one or more chronic disease2. In order for jurisdictions to continue to demonstrate the value of professional services to provincial health ministries, these challenges must be addressed. The biggest hurdle that pharmacists report as a barrier to providing expanded services is an increased workload. Pharmacists are still spending the same amount of time dispensing—40% of their day, relatively unchanged from three years prior— yet now have additional clinical responsibilities to add to an already overburdened load. Whereas pharmacists do indeed express a desire to provide expanded services, the actual time

SLC COMPETITION spent on them collectively is a mere 6% of the day, which works out to 30 minutes for a given eight hour shift2. On the other hand, provincial regulatory bodies advise that a single medication review should take approximately twenty to forty-five minutes to conduct. Given pharmacists’ current workload and staffing allocation, this is clearly not feasible. Pharmacy technicians, who have yet to be fully regulated across Canada, have been a positive development and have the potential to ease the dispensatory burden from pharmacists2. In addition, pharmacy physical setups need to be more conductive for medication reviews. Adequate training also needs to be made available, given that 80% of pharmacists claim that they require more training on expanded services2. If pharmacists are to continue to exercise their expanded powers, significant improvements in staffing and environmental resources is urgently required. Media investigations have been a pivotal force in drawing attention to external pressures in the form of quotas. Various chain pharmacies have denied setting unreasonable targets for billable services and taking punitive measures if these targets are not met, yet 80% of pharmacists have reported that their employers do indeed have expectations, with those working in franchise and chain settings the most likely to claim so2. Pressure from employers can cloud profes-

sional and ethical judgement and place value in volume and speed over patient safety. Pharmacists recognize this dilemma: 82% of respondents in a 2014 poll felt that colleges should ban the practice of quotas8. Developments have already taken place. For example, the College of Pharmacists of British Columbia became the first regulatory body in Canada to propose new regulations against quotas. Theoretically, making medication reviews accessible through provincial health databases, such as Netcare in Alberta and PharmaNet in British Columbia, can help ensure their completeness as well as establish a comprehensive auditing process. With Canadians’ positive impression of pharmacists still on the high, it is vital that federal and provincial pharmacy associations and colleges address these threats before the media wavers patients’ trust in pharmacists, and the value of these services to payers.

practice, one that can make significant advancements to the profession, the healthcare system, and above all, the health of Canadians.

The road towards passing legislation in support of pharmacists’ expanded scope of practice has certainly not been an effortless one; it is critical that provincial governments and third party payers are shown that their return of investment is worthwhile. To ensure sustainability and continuity of expanded services, quality must surpass quantity. Change begins with transparency and addressing the setbacks of the current model. The outlined mitigation strategies can work in harmony to pave the way for a more balanced and feasible

References 1. Burgess, L. (n.d.). Rexall managers pushed for medication reviews at drive-thrus, insiders say. The Canadian Broadcasting Corporation (CBC). Retrieved September 2, 2015, from http://www.cbc.ca/news/health/rexall-managers-pushed-for-medication-reviews-at-drive-thrus-insiderssay-1.3095248. 2. Canadian Pharmacists Association. (2015). Community Pharmacy Trends & Insights 2015 (pp. 1-20). Vancouver: Pharmacy Practice+. 3. Hakkarainen KM, Hedna K, Petzold M, H€agg S. Percentage of patients with preventable adverse drug reactions and preventability of adverse drug reactions – a meta-analysis. PLoS ONE 2012;7:e33236. 4. Gurwitz JH, Field TS, Harrold LR, Rothschild J, Debellis K, Seger AC et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA 2003;289:1107–16. 5. Beijer HJM, de Blaey CJ. Hospitalisations caused by adverse drug reactions (ADR): a metaanalysis of observational studies. Pharm World Sci 2002;24:46–54. 6. Sustainable Solutions Report - A Focus on Managing Complex Chronic Diseases. (2013). Retrieved September 2, 2015, from http://cdn.agilitycms. com/shoppers-drug-mart-corporate/Sustainable-Solutions-Report-A-Focus-on-Managing-Complex-Chronic-Diseases-September-5-2013.pdf. 7. Alberta Blue Cross. Changes coming to prescription drug pricing in Alberta. (2014). Connection Bulletin, 1-2. 8. Ruffell, B. (2015, January 23). Video: Pharmacists speak out about quotas. Canadian Healthcare Network. Retrieved September 2, 2015, from http:// www.canadianhealthcarenetwork.ca/pharmacists/news/professional/video-pharmacistsspeak-out-about-quotas-29371. PHARMACY QUARTERLY

SLC COMPETITION

MEDICATION ADHERENCE: OVERVIEW OF CURRENT KNOWLEDGE AND INTEGRATIVE STRATEGY PROPOSITION BY ABANOUB GRAISS Medication adherence represents the crucial link between prescription of effective medications and disease management. Low adherence is thus a significant concern that negatively impacts patient health and poses an appreciable economic burden. The therapeutic importance of adherence is captured in the words of former U.S. Surgeon General C. Everett Koop: “Drugs don’t work in patients who don’t take them.” (1) This paper presents an overview of factors that affect adherence, characteristics of effective models for improving adherence, and some strategies whose effectiveness in improving adherence has been investigated. The paper ultimately concludes with a proposed integrative model for improving adherence within today’s increasingly patient-focused healthcare system. Factors Affecting Medication Adherence A 2006 review by Delamater enumerated various factors related to low adherence.(2) Psychological factors, such as anxiety, depression, and eating disorders have been associated with adverse effects on regimen adherence.(3) On the other hand, appropriate health beliefs, such as perceived seriousness of condition, vulnerability to complications, and the efficacy of treatment, can also predict better adherence. (4) Likewise, healthcare providers and the medical system act as

12 PHARMACY QUARTERLY

factors affecting adherence.(2) For instance, having regular, frequent contact with patients by telephone promotes adherence.(5) Furthermore, patients who are satisfied with their healthcare providers have better adherence.(6) Diseaseand treatment-related factors have also been implicated in affecting adherence.(7) More specifically, lower regimen adherence can be expected when a health condition is chronic, when the course of symptoms varies or when symptoms are not apparent, when a regimen is more complex, and when a treatment regimen requires lifestyle changes.(7) Characteristics of Effective Models for Improving Medication Adherence Many chronic illnesses, including diabetes and coronary heart disease, are essentially self-managed diseases and therefore require a degree of patient autonomy and motivation to successfully perform optimal self-management. (2) This collaborative care model emphasizes providers setting goals with their patients and providing ongoing support for optimal patient self-management behaviors over time.(9,10) This is generally preferable to the traditional approach which involves advice-giving as the main technique for the delivery of knowledge from the healthcare provider, seen as the expert who knows what is best for the patient, to the patient.(2, 11) This is because the traditional approach assumes that patients should change their

behaviour, want to change, and that their health and their prescribed regimen are major priorities for them.(2) However, the traditional approach can potentially undermine patients’ sense of autonomy, generate resistance, may fail to consider patients’ priorities, and does not work in the majority of cases.(2) It is thus important to avoid several pitfalls, including failing to establish rapport with patients, telling patients what to do, taking control away from patients, misjudging patients’ sense of the importance of behaviour change and their confidence in achieving change, overestimating patients’ readiness to change, arguing with patients, blaming patients for not taking better care of themselves, and using scare tactics.(2) Healthcare providers should instead have a patient-centred approach, cultivate collaborative relationships, communicate clearly, and provide directive advice when patients are ready to learn more about the new recommendations.(11, 12) For effective behavioural consultation, providers should encourage patients to express their concerns and use active listening techniques, such as open-ended questions, clarifications, reflective statements, and summary statements.(2) Healthcare providers should also help their patients to brainstorm options and consider the advantages and disadvantages of various therapeutic approaches. Collaborating is integral to these encounters, but patients assume control over decision making.(2) Several specific

SLC COMPETITION behavioral strategies and psychosocial interventions can improve patient self-care behaviors once it is established that patients want to work on particular goals.(3, 11, 13, 14) Self-monitoring is integral to behavior change, serving to heighten awareness of the behavior and its determinants, and track progress over time. It is helpful to gradually implement new regimen-related behaviors over time, especially for more complex regimens.(2) Goal setting is also important for achieving success at behavior change, provided that goals are specific and easily measured.(2) Investigated Strategies for Improving Medication Adherence A 2002 review by McDonald et al. concluded that current methods of improving adherence for chronic health problems are complex, labour-intensive, and not predictably effective.(15) A 2009 review by Ho et al stated that unimodal interventions are generally less successful than multimodal interventions since the reasons for non-adherence are often multifactorial.(16) Murray et al randomized clinically stable outpatients with heart failure diagnosis to an intensive pharma-

cist-led intervention versus usual care, finding 10.9% improvement in adherence.(17) In contrast, Lee et al randomized patients to an intervention composed of patient education, medication reminder packaging, and frequent clinic visits versus usual care and showed improvements in adherence (â&#x2030;&#x2C6;30%).(18) Across these studies, one of the consistent features of successful interventions has been regular follow-up with the healthcare system.(16) Although multimodal interventions are more likely to be successful than unimodal interventions, some of the study findings remain mixed with regard to outcomes, and the complexity of the interventions makes it difficult to implement them in routine clinical care.(16) Suggested Tailored Strategy for Improving Medication Adherence As such, it is possible to conclude that multimodal interventions are essential for addressing low adherence. With increasingly autonomous and well-informed patients acting as integral decision makers in their healthcare, the following framework is thus suggested so as to practically allow for individualized strategies that suit the needs of different patients. This strategy entails classifying patients according

to their self-identified reasons for low adherence. It is then suggested that patients be assigned to one of two interventions, blister packs or brief educational sessions, based on the main reason for their low adherence (cognitive or lack of education, respectively). Furthermore, it is suggested that patients receive adherence follow-up phone calls and more frequent follow-up clinic or pharmacy visits. These multimodal tailored strategies, which emphasize already-existing pharmacy practice strategies, can be further supported by the development of policies that facilitate pharmacistsâ&#x20AC;&#x2122; efforts to improve medication adherence, whether it be through providing incentives or minimalizing financial and/or bureaucratic hindrances. These synchronized tailored strategies would ultimately improve medication adherence, contributing to the resolution of an increasingly concerning issue in the Canadian healthcare system.

References 1. Blaschke TF, Osterberg L, Vrijens B, Urquhart J. Adherence to medications: insights arising from studies on the unreliable link between prescribed and actual drug dosing histories. Annual review of pharmacology and toxicology 2012;52:275-301. 2. Delamater AM. Improving patient adherence. Clinical diabetes 2006;24(2):71-77. 3. Delamater AM, Jacobson AM, Anderson B, Cox D, Fisher L, Lustman P, et al. Psychosocial Therapies in Diabetes Report of the Psychosocial Therapies Working Group. Diabetes Care 2001;24(7):1286-1292. 4. Kravitz RL, Hays RD, Sherbourne CD, DiMatteo MR, Rogers WH, Ordway L, et al. Recall of recommendations and adherence to advice among patients with chronic medical conditions. Archives of internal medicine 1993;153(16):1869-1878. 5. Aubert RE, Herman WH, Waters J, Moore W, Sutton D, Peterson BL, et al. Nurse case management to improve glycemic control in diabetic patients in a health maintenance organizationA randomized, controlled trial. Annals of internal medicine 1998;129(8):605-612. 6. Von Korff M, Gruman J, Schaefer J, Curry SJ, Wagner EH. Collaborative management of chronic illness. Annals of internal medicine 1997;127(12):1097-1102. 7. Haynes RB, Sackett DL. Compliance in health care. Baltimore: Johns Hopkins University Press; 1979. 8. Williams GC, Freedman ZR, Deci EL. Supporting autonomy to motivate patients with diabetes for glucose control. Diabetes care 1998;21(10):1644-1651. 9. Wagner EH. Population-based management of diabetes care. Patient education and counseling 1995;26(1):225-230. 10. Glasgow RE, Wagner EH, Kaplan RM, Vinicor F, Smith L, Norman J. If diabetes is a public health problem, why not treat it as one? A population-based approach to chronic illness. Annals of Behavioral Medicine 1999;21(2):159-170. 11. Rollnick S, Mason P, Butler C. Health behavior change: a guide for practitioners. Elsevier Health Sciences; 1999. 12. Funnell MM, Anderson RM. Empowerment and self-management of diabetes. Clinical diabetes 2004;22(3):123-127. 13. Meichenbaum D, Turk DC. Facilitating treatment adherence: A practitionerâ&#x20AC;&#x2122;s guidebook. Plenum Press; 1987. 14. Anderson BJ, Rubin RR. Practical psychology for diabetes clinicians: Effective Techniques for Key Behavioural Issues. American Diabetes Association 2002. 15. McDonald HP, Garg AX, Haynes RB. Interventions to enhance patient adherence to medication prescriptions: scientific review. Jama 2002;288(22):2868-2879. 16. Ho PM, Bryson CL, Rumsfeld JS. Medication adherence its importance in cardiovascular outcomes. Circulation 2009;119(23):3028-3035. 17. Murray MD, Young J, Hoke S, Tu W, Weiner M, Morrow D, et al. Pharmacist Intervention to Improve Medication Adherence in Heart FailureA Randomized Trial. Annals of Internal Medicine 2007;146(10):714-725. PHARMACY QUARTERLY 18. Lee JK, Grace KA, Taylor AJ. Effect of a pharmacy care program on medication adherence and persistence, blood pressure, and low-density lipoprotein cholesterol: a randomized controlled trial. Jama 2006;296(21):2563-2571.

SLC COMPETITION

DISCUSSING THE IMPACT OF RURAL COMMUNITY PHARMACISTS AND THE ROLE THEY CAN PLAY IN CHRONIC CONDITIONS BY LINDSAY MAZUR I facilitate an Alberta Health Services program in rural northern Alberta called Better Choices, Better Health. The program educates participants by providing tools to help support them with their chronic condition(s). One of our topics, which always becomes a very interactive discussion, is that of communicating with health care providers. This topic always sparks the interest of even the quietest participants as it can be a serious issue for people with chronic conditions. Why is communication at the heart of frustration for our patients? Because a lack of accessibility leads to health care gaps and limited collaboration with other health care professionals and with the patient, which so often decreas-

14 PHARMACY QUARTERLY

es the trust of the patient in their own health care team. Pharmacists can have an impact on this aspect of rural health care. By becoming a leader in primary health care, pharmacists can work to fill the void in patient care, thereby increasing positive outcomes for patients with chronic conditions. Pharmacists have expanded their scope of practice to be competent in managing many different chronic conditions; this helps alleviate some of the stress of a health system that is currently overworked and overloaded. Having access to laboratory results, medication profiles, and the ability to assess and prescribe treatments for patients is advantageous when practicing in primary care. Hyper-

tension, diabetes, cardiovascular disease, hypothyroidism, gout, anxiety, depression are just some of the chronic conditions that a pharmacist can help to manage. With the increased scope, pharmacists have the ability to be the most accessible health care professional in primary care, which in turn, helps close the gaps in the health care system. For example, rather than waiting two weeks, or more to get into the only clinic in town orwaiting in the emergency room for six or more hours, a patient can utilize the expertise of a community pharmacy. Here, the patient can speak to the pharmacist about side effects, medication refills, laboratory results, and almost any other concerns they are having about their condition. This helps patients to feel like care is more accessible, especially in rural areas where time and staffing constraints are very real barriers that may prevent patients from seeking help in the first place. The increased scope holds a pharmacist responsible to other health care professionals, as a collaborative member of the patient care team. It also helps to build care relationships and strengthen a patientâ&#x20AC;&#x2122;s care network. It is important to know the members within a patient care team and also the roles and skillset each member brings to the team. If a family physician has treated a patient with cardiovascular disease to the point of stable medication management, the physician should feel confident in the pharmacist to continue that management, therein freeing up

SLC COMPETITION the family physician to treat other patients in need. There is also another viewpoint of collaboration that health care professionals often overlook; the patient is just as important of a member to the patient care team, if not the most important member. A necessary part of managing a chronic condition is setting goals and problem solving, both of which require the patient to be an engaged member of the team. As the most accessible health care provider, the pharmacist can help to maintain a familiar face of patient contact, especially in places where the only physicians accessible are often locums or emergency only. By collaborating with the patient, health care professionals build a professional relationship with the patient. This is where the pharmacist again has the opportunity to step in and fill the void. In general, rural community pharmacists have more opportunity and time to build patient relationships due to lower populations and having repeat visits. A good relationship can serve as the foundation to providing an excellent medication experience that in the end will keep the patient engaged in their own care plan. A care plan has a greater chance of success if it is patient centered, which leads to overall improvement of health and wellness in the patient, the ultimate goal of every care plan. In addition, patients will return to the pharmacy far more than they will to the clinic. This gives the pharmacist repeat opportunities to strengthen the re-

lationship, and earn the trust of the patient. Ultimately, pharmacists have the ability to tailor their career to their own desires and to their community. If the pharmacist makes the choice to use their scope of practice to fill the gaps within the health care system, they are taking on a responsibility to their patients and peers to be a leader in primary care. This puts the pharmacist in a position to help improve communication across the health care system by being accessible, increasing collaboration and helping to build trusting patient relationships. In rural areas, where there is often a shortage of family physicians, having an alternate health care provider that can fulfill the needs of the population is ideal, especially for patients with chronic conditions. The fact is that this void can be filled by pharmacists in rural Alberta. Pharmacists are accessible health care professionals that have the time to build trusting relationships with a patient for the sole purpose of developing a patient-centered care plan.

DESIGN BY FREEPIK

PHARMACY QUARTERLY 15

WORKOUT

PHARMILY WORKOUT GURUS BY JASMINE HAN & PAWAN GILL For this month’s edition, we took some time to interview some of pharmacy’s most well-known workout gurus to have some insights to their gains. Starting with the fresh first year is Jason Youn. Jason is a dedicated lifter who is working towards becoming a competitive lifter in the future. Jason admits that in no shape or form is he an “expert” when it comes to gym. However, he believes that he has some credentials to say a thing or two about the gym since he trains regularly, sometimes with experienced powerlifters, to compete next year. Poor workout habits are one of Jason’s greatest workout pet peeves. He commented, “I see a lot of people doing incomplete sets by half-repping with improper forms so that they can hit huge weights – giving them the right to brag. Let’s take benchpress as an example. People need to realize that the bar needs to touch the chest, and lock out your arms before you count the lift. Do NOT tell me that you only need to go 90 degrees with your arms. The ONLY exception to this would be if you were doing a “spoto press” which is a form of bench press where you pause the bar one or two inches above the chest for a couple seconds before you go up. I am sure some people may argue that that’s what they were doing but I HIGHLY doubt that that’s the case since many of them do not do that pause required for this exercise.” Giant Egos in the Gym “In addition to incomplete and improper forms, most guys have

16 PHARMACY QUARTERLY

giant egos. They think they can hit certain numbers, when in reality, they cannot. With increasing numbers, their egos get bigger, when in reality I am snickering and laughing at the back”, commented Jason. Sharing the Goal Jason ended with a note saying that, “when I ask someone if I can share certain gym equipment during busy hours, they bluntly say no. I believe that we all have the same goals – getting fit – and at such a busy gym, it’s only polite to share the equipment. So let me tell you this - I hope those who do not workout properly, AND do not share their equipment lose their gains.”

James Tao who is in his second year of pharmacy, took a different focus on working out. He identified cardio as the “ability to lose gains, and expressed his belief in “Gains before Brains”. James believes this to be true because “we live in a society where we place disproportional emphasis on desensitizing our nervous system by sitting in a chair all day, hunched over in a desk. We spend so much time “learning” with our “brain” that we forget our whole body is innervated by our central, peripheral, autonomic, and somatic nervous system, all extensions of our brain. Intelligence, and our ability to interpret, adapt, understand, and learn deals with so much more than just our brain; it is a dynamic process involving the whole body. Your mind is your body and your body is your mind. So when we put so much effort in at the gym, it’s not that we are placing more emphasis on “making gains”, we are simply trying to counteract the heavy pressure

WORKOUT

Will Chan - our charming Social VP and previous Mr. Pharmacy participant - is next on the list! Will wanted to give us his insightful thoughts on why he wants to gain until he can’t fit through doors unless he walks sideways. “My motto is “Gain until you cannot fit through doors - unless you walk sideways”. Fellow bros and brosettes, listen up, there are reasons to my madness. One, you will be less prone to diseases. Let me explain. When you are big, naturally, there are more layers for pathogenic organisms like parasites, fungi, bacteria, and viruses to penetrate. As a result, your physical barrier, part of your innate immunity, will be stronger and tougher. Consequently, these organisms will not stand a chance in causing any sort of problems. that the system has put on us in an effort to deaden our liveliness, our nervous system, and our ability to be truly intelligent” Most Important Exercise in the Gym Change to: “My training strategy typically revolves around the big 3+1: squats, deadlifts, bench press, and the overhead press. Don’t get me wrong, you’ll still catch me in the gym sometimes hitting 4 sets of 15 bicep curls with a triple drop set at the end just to chase that pump”, commented James.

Moreover, being big means having a big adaptive immunity, it only makes sense. The bigger you are the bigger your leukocytes will be, and the more leukocytes your body will produce. Thus, you will

have greater and more effective response to any pathogens that somehow managed to penetrate your body. Finally, getting big will not only benefit you physically but also mentally, because when you walk sideways you inevitably force your brain to work harder. If you walk like how everyone else walks, you won’t be thinking about where you are going because you are so used to it. But, if you walk sideways, you will develop and grow a different part of your brain and become more cognitively aware of your surroundings. Sometimes on a good day, I challenge myself by walking sideways with my eyes closed. This increases adrenaline in the body allowing for increased memory capacity. Now that I have shared my insightful thoughts I hope all you bros and brosettes will incorporate this into your training. #eyesclosed #broscience”

PHOTO CREDITS: JASMINE HAN

Weakest body part? “My feelings” Final Words When I asked what he would recommend as a personal trainer, he commented, “Dont’t be scared to lift some heavy ass weight”, and as a last note he left his instagram account, @jamesbrah66 if anyone wanted fitness inspiration.

PHARMACY QUARTERLY 17

PQ POLLS

Finally, Ibrahim Mourad who is in his third year of his pharmacy degree believes that “lifting isn’t just a thing, it’s a lifestyle”. He wanted to give his opinion on how to eat properly for gains. “At the moment, I work out regularly, and am not on a super strict diet in a sense that I eat fat, protein, and carbs without discrimination to any specific type of nutrient. Basically, I just follow the Canada’s Food Guide and eat clean to stay fit and for gains. If anything, I stay away from food with high sugar content. Occasionally, I eat fast food as well - not very often though, just once or twice a month. I think moderation is the key when it comes to eating healthy for gains. Obviously, I am talking on behalf of myself and personal experience, however, one of my greatest pet peeves is seeing people go on strict diets like no carb diet, protein shake diet, or other fad diet plans. As a pharmacy student I have years of education, and I can say confidently that it’s not all about protein but about other nutrients like fat and carbs along with protein. People have the misconception that protein is will give them all. It’s not true. In fact, if you just take those protein shakes, your body won’t

18 PHARMACY QUARTERLY

be able to absorb them properly anyways.

naturally or don’t do much good to you. I think it’s all about marketing.

Moreover, I don’t believe in supplements either. I drink coffee before I workout as a stimulant but nothing else. I mean I don’t look down on those who take any but I think those supplements are bogus because they can be taken either

So the message I would like to leave behind is that lifting isn’t just a thing, but it’s a lifestyle. It’s important that you take all the nutrients naturally not via supplements that don’t even work a lot of the times.”

HOLIDAY & FINALS CRUNCH SURVEY BY PAWAN GILL & SPENCER SYDOR With less than a week till finals, we at the PQ+2 wanted to remind everyone Santa will be making his naughty and nice list! What better way to get on his nice list than by helping a friend in need?

PQ QUIZ

WHAT TYPE OF STUDIER ARE YOU? 1

It is 3 pm on a Friday afternoon at Infectious Diseases Seminar. You are: a.) On Reddit. Then Facebook. Oh, did Dr. Mitchell say something important? *checks seatmate’s notes* b.) Focused on Bugs and Drugs and have your notes up. Your speedy fingers type up everything that comes out of Dr. Mitchell’s brain. c.) Paying close attention. To dog videos.

The Pulmonary midterm is tomorrow at 9 am and you have no started studying. You have work tonight from 4 pm - 9 pm. What do you do? a.) I will call in and ask if it’s possible to not work tonight and beg until they say yes. b.) Pfft. I started 2 weeks ago and I’m ready to write that test in my sleep.

BY ALYSSA ACO

c.) Call in sick. Oh man, is that a fever coming on?

Your laptop breaks down a week before finals (b/c upgrading to Windows 10 failed). Your first instinct is to: a.) Ask your friends for their notes. That’s what friends are for hey? b.) Have a panic attack and run to the store and cry to the technicians. “MY NOTES ARE ALL IN HERE HAAALP MEEE.” c.) Dont’ worry, you’ve got 7 days to get it fixed. It’s not like you look at your notes until the night before anyways.

The Law & Ethics group project is due in 2 hours, and yet one of your group mates has not started their part. You:

the Google doc yet? b.) Start the part yourself. Ain’t nobody got time to wait on anybody - you would do a better job anyways - and make a mental note never to trust anyone. c.) Go back to watching dog videos. I’m sure it’ll turn up in an hour or so.

You are falling asleep in Pharmaceutics because you had a late night the previous evening (not because the material is dry, come on) your strategy to stay awake is: a.) Take 5 minute naps at 30 minute intervals. Lucky you sit close to the back so that nobody notices... b.)Caffeine. Caffeine. Caffeine. That’s my drug of choice. c.) Watch dog videos.

a.) Call him and ask what’s up. Maybe its done and he hasn’t put it on

Mostly A’s you are a: Casual Procrastinator Most students will get this result! You’ve got a good understanding of when to pay closer attention and when to be able to relax and take it easy. You know it is important to study but sometimes give in to the temptations of Facebook, Youtube and Reddit. Your study patterns can go from “incredibly focused (like Limitless level)” to “I have zero motivation to study” - but don’t worry, you are not alone. Everyone has those moments and school can get overwhelming with information-overload. Study tip would be to try and avoid these external distractors by shutting off your internet while you’re studying so you can’t access these social media sites, perhaps? Mostly’s B’s: Keener Level Congratulations, you are officially a keener! You are on constant over-drive and chances are you sit somewhere in the front row and have answered (or asked) one question to the professor at least once each class. You’ve got your study schedule down to every last minute, extensive notes, and color-coded study cue cards. You’re the type who is very passionate about what you’re learning. Keep up what you’re doing, star student! But also remember to relax once in a while. Take a break, watch a movie, talk to friends and remember grades are not everything. Mostly C’s: Last Minute Crammer A good proportion of students will get this result. We can most likely find you at the back of the room, not paying attention at all or taking notes off your friend. You are relaxed, chill, and people love you because you calm them down. You are much needed source of serenity when everyone goes in a frenzy during exam time. You don’t mind if things are done to the 11th hour (literally) and that’s just how you work. You work best at the last minute. Study tip? Try organizing your time so that you do not leave the important* things to the last minute. (You don’t want to fail your PEBC’s do you?)

A DAY IN THE LIFE

A DAY IN THE LIFE OF

CHRIS MCREE

PSYCHIATRIC PHARMACIST

QUESTIONS BY GHASAK HUSSAIN Hi Chris! Can you tell me a little bit about your career path and how you got to be where you are today? Hi Ghasak. It’s been a fun and interesting trip. I suppose my road into psych pharmacy all started the summer after finishing my second year. At his point I didn’t really even recognize that hospital pharmacy was really “a thing”... haha. My good friend and classmate got a summer internship position at the UofA and started telling me about some of the interesting things he was doing there. I was working in a community pharmacy at this time and got to thinking that I really owed it to myself to check out this whole hospital pharmacy track. The next summer I applied and was accepted to be an intern at The Grey Nuns. The staff there was all amazing and the 2 psych pharmacists (Bill Chernezky and Jeff Whissell) really took interest in showing me the ropes. It stuck with me. After graduation, I worked casual for a bit less than a year at the Nuns and floated in community. In Dec. I moved to Washington State and practiced at Rite Aid for a bit less than 4 years. When it was time to move home, I knew there was nowhere I’d rather be and was lucky enough to get a position back where it all started at the Grey Nuns. Psych was the only thing I really wanted to

20 PHARMACY QUARTERLY

do at that point so I ran with that and haven’t looked back. I did take a Leave of Absence a few years ago and worked for BMS as a Scientific Advisor supporting Neurosciences and Immunology so that was a cool diversion for a year. Why psychiatry over other units? Good question. It’s not one thing— it’s a number of things. Again, I was lucky enough to get two very good preceptors very early in my training. After that, I think it was important to work in a number of other areas to truly conclude that my passion was in psych. Every day is different. Just when I think I’ve seen it all and heard it all, along comes something new to deal with and work on. I never considered myself “artsy”, but as far as medicine goes there is a bit of an artistic side to psychiatry. There are guidelines....but that’s all they are: guidelines. Every patient is unique and every treatment differs. You just really need to be creative sometimes. Work off-label. Just because a drug isn’t “indicated” doesn’t mean there’s no evidence or that it doesn’t work. Finally, I really just think I’m lucky enough to work with some of the best people in the country in psychiatry. Our physicians, nurses, social workers, and occupational therapy staff are the best in the business. We’re very team based at the Grey Nuns and I work within an

absolutely amazing group of people. How are pharmacists integral to the psychiatric unit? We are trained as “the” drug experts within the medical system. I consider my job on the team as primarily the medication consultant. It’s not complex—just simple pharmacy. Are we using the right drug at the right dose to treat our patients to achieve the best efficacy with the least adverse effects? Every time I pick up a patient’s chart or speak with a patient, that is my goal. If it’s not right, I fix it. If it can be better, I make it better. Constant assessment, feedback, monitoring, change. I always ask: Is this the best we can do?” If not, we try something different. What is the most rewarding, and on the flip side, demanding aspect of your job? Most rewarding is when you see a patient get better and start achieving their personal goals. It’s always important to ask the patient what they want out of their treatment. Sometimes complete symptom resolution may be the goal of the physician, but not necessarily the patient. You need to consider what’s most important to your patients. Most demanding for me is when despite best efforts, treatment is unsuccessful and a life is lost tragically far too soon. It’s an inevitable reality....but it never gets any easier.

A DAY IN THE LIFE

Can you give us an example of a typical day for you on the unit? Depends on the day of course, but in a nutshell: • Prepare for interdisciplinary conference and then go to conference to review patient progress. • Respond to some pages and answer some questions. • Review medication profiles, labs, flowsheets. Do some TDM. • Do a few consults with patients. • Interventions. Chat with the physicians (a typical day I’ll have 7-15 psychiatrists and 35-72 inpatients to follow). • Do some research. Reading. Try to figure out some answers to the weird questions the docs come up with... haha • It really depends on the day. There’s a lot of other things that come up to throw a wrench into my “planned” day.

PHOTO CREDITS: GHASAK HUSSAIN

How often do you interact with

patients? Every day. Sometimes lots, sometimes not so much, but every day there’s something to do directly with the patient. What advice do you have for students interested in psychiatric pharmacy? Be yourself when you’re interacting with patients. While stigma related to mental health is improving, it still exists and impacts the care of people. When talking with patients or families, I’ll often compare mental health disorders to other chronic diseases such as asthma, diabetes, etc. Same concepts apply to patient care and treatment. Patients with psychiatric illness aren’t stupid and aren’t dangerous. Talk to your patients. Be comfortable. Build a therapeutic alliance. The rewards are significant for you and your patients if you can do this. If you think you might be interested

in specializing in mental health, I’d encourage you to become a well rounded practitioner first then specialize. The reality is that patients with mental health disorders are at higher risk of morbidity and mortality from comorbidities such as diabetes, hypercholesterolemia, heart disease, etc. You need to be comfortable with treating these conditions in addition to treating the primary mental health disorder as well. At that point, learn. Educate yourself. Find a preceptor. Read. Go to conferences. I still learn something every single day I go to work. It’s a never ending process. Where do you see the future of psychiatric pharmacy headed? Psychiatry must find a way to better support patients in the community. The system simply will not be able to continue to accommodate the amount of patients presenting for admission to hospital. Hospital beds are always full and many patients are in ERs far too long. Community pharmacists will be essential in helping keep patients better, for longer and helping to decrease the need for hospitalization. And finally, just for fun! What do you do outside of pharmacy? When I’m not working I’m often on the road. I go to the States lots, usually to watch football. I’m a huge sports fan so I’m in Seattle, Buffalo, Montana lots. I’m a loyal Oilers fan as well so many evenings in the winter are spent at the rink watching them play. Otherwise, music, Citadel, skiing and pretty much anything else you can do outside.

PHARMACY QUARTERLY 21

DETOX REGIMENS

DETOX REGIMENS: PURIFY, CLEANSE, AND. . . DELUDE? BY GHASAK HUSSAIN When I was a teenager, I become a fruitarian. Naive, gullible and thirsty for change, I was convinced that a strict diet of fruits and vegetables would lead me to a vibrant life. It wasn’t a decision that happened overnight; it was a year-long journey of reading countless of blogs and books that lead me to believe that fruitarianism was the healthiest diet one could follow. Just look at all the raw food benefits touted over the web: permanent weight management, beautiful skin and hair, mental clarity, increased energy, and healing of acne, asthma, cancer, diabetes, and other ailments. Now before you jump on the bandwagon yourself— after all, these are some very tempting claims— keep reading on. It took a tremendous amount of willpower and resilience, but I finally committed to the diet fully, eating only raw and unprocessed fruit. During the first month, I had an abundance of energy. The effect didn’t last long, as by the third month, acne swarmed my face. By the sixth month, I had lost half of my hair and was fatigued constantly. Instead of becoming a picture of health, I ended up looking like an emaciated Donald Trump with chickenpox. Confused and frustrated, I posted help on a fruitarian forum. The response was unanimous : you’re going through detox. By the time I finally came to my senses and saw a doctor— and

22 PHARMACY QUARTERLY

was subsequently diagnosed with anemia—‘detox’ had become my least favourite word. To the public, the word is illusive; purity is tempting. Detox regimens are incorporated into the majority of weight loss regimens, advertised in health magazines, and displayed in health food stores and some pharmacies. But what does the term ‘detox’ actually mean? According to the Centers for Disease Control and Prevention, detoxification is the “care provided to a dependent person during the period of reduction or stoppage of a dependence-producing substance with the aim of withdrawing the substance safely and effectively1.” The pathophysiology of detox as it used in everyday terms of cleansing is non-existent. However, there is indeed a legitimate medical definition for detox as a means to minimize withdrawal symptoms in those who have overdosed on alcohol and drugs. Within the sphere of naturopathic medicine, the term has been uprooted to fit the following philosophy: Typical American clients have been exposed to toxic chemicals in hundreds of ways throughout their lifetimes... Beginning in infancy, our bodies have been given toxic vaccinations, over-the-counter and prescription toxic chemical medications, and over-processed, factory farmed “foods” full of toxic chemicals….Detoxifying the body is the basis for curing all chronic disease. Detoxification allows the body’s cells to release waste

products and absorb nutrients properly2. In a 2011 survey of licensed naturopathic doctors in the USA, 92% of respondents claimed to use detoxification regimens to treat patients for various ailments, everything from autoimmune disease to cancer3. With the widespread popularity of detox diets, it’s vital for us as future healthcare professionals to deconstruct the fallacies behind these claims. Delusion #1: Our bodies easily accumulate toxins As we know, our bodies are already equipped with a sophisticated detoxification system: the liver. The kidneys, gastrointestinal system, lungs, and skin also play a role in excreting toxic substances. It is true that some chemicals, like metals and persistent organic pollutants (POPs), take longer to be removed by our bodies. Because POPs like DDT are lipophilic, they accumulate in adipose tissue and take a number of years to break down. DDT for example, is suggested to be linked to various endocrine abnormalities like diabetes and infertility. In 2012, the World Health Organization (WHO) and the United Nations Environment Programme (UNEP) concluded that “although it is clear that certain environmental chemicals can interfere with normal hormonal processes, there is weak evidence that human health has been adversely affected by exposure

DETOX REGIMENS

PHOTO CREDITS: AGRICULTURE RESEARCH SERVICES

to endocrine-active chemicals4.” For the average consumer, it is unlikely that one has had longterm exposure to heavy metals, phthalates, POPs, and other chemicals in high doses. Exposure to everyday toxins can be safely eliminated by our bodies without the need for detoxifying agents. Delusion #2: Detox regimens can ‘detoxify’ you Consumers definitely seem to think so— 83% of people who had undergone a detox protocol rated their results as ‘good’ or ‘great’3. But what about objective measures? Theoretically, this should be the easiest to prove: take a sample of blood and record a level of toxin X, administer a detoxifying agent, and then resample the blood. Unfortunately, there have been very few peerreviewed and randomized studies on this subject with sufficient

sample sizes. It is likely that people report feeling great because of the initial rapid weight loss, of which is mostly water weight. Just look at the sample menu of one popular detox regimen, in addition to a concoction of supplements taken throughout the day: Breakfast: green smoothie Lunch: quinoa salad with roasted vegetables Dinner: kale and bean salad With an energy-deprived diet such as this, any weight loss experienced during a cleanse is inevitable. It is therefore what these detox regimens eliminate rather than include that promotes weight loss, as the majority of people who embark on these cleanses are coming off the standard american diet. The problem is that the majority of people return to their former eating vices following the cleanse, and subsequently gain all the weight back.

There is no compelling evidence as of yet to support detox diets for weight loss, toxin elimination, and disease treatment. However, we do have multiple studies that have have investigated the role of nutrition on the prevention and treatment of disease, in addition to protecting against environmental toxins5. A 7-day cleanse will not fix a life-time of poor eating habits, as it will fail to make the consumer’s wallet any bigger. As the new year draws in and the frantic hunt for a regimen to undo the misgivings and indulgences over the holidays commences, it is important that we educate our patients on the benefits of adhering to a well-balanced diet that is sustainable in the long run.

PHARMACY QUARTERLY 23

YOU’VE GOT TO TRY THIS

BY WINNIE LO

YOU’VE GOT TO TRY THIS:

STEEPS TEA LOUNGE

And you’ve got to read this too! Each issue, the PQ will be visiting one of the many restaurants on our APSA membership card to give YOU an inside look at the food you’re missing out on! On the menu today - teas and warm drinks to soothe a frazzled student’s soul in the midst of our wild exam season. Winnie – I love my food tasting side job - is this career-switch time? #theonetheonly Iced Tea of Lemon Mango [Fruit Infusion] I decided to get an iced tea for something sweet and refreshing, so I went with something the owner recommended. It’s a bright ruby tea - mildly sweet paired with a citrus tang from the lemon. Super delicious - I thoroughly enjoyed my drink! I love the cafe for it’s mismatched arrangement of chairs, soft music, and comforting sounds of tea-making and low conversation. Definitely an ideal study spot - this wasn’t my first time here, and it definitely won’t be my last! 5/5 Monica - everything for the food! #theoracle Iced Tea of Paradise Peach [Fruit Infusion] I was super thirsty after an intense hematology lecture, and I enjoy cold drinks when it’s snowing so... I decided to get a cold tea. The paradise peach iced tea was surprisingly dark red but could have been more fruity. I also liked how calm it is in the café, and how you can smell all the different tea samples before ordering! My favourite part was the Spirited Away music playing in the background. Definitely was a satisfying experience overall - I can’t wait to come here again :) 5/5 24 PHARMACY QUARTERLY

YOU’VE GOT TO TRY THIS

Sherry - yearbook editor, photographer, and food critic all rolled into one #becomingaregular Matcha Latte Matcha Latte I loved the atmosphere and decor of the tea lounge - cozy and warm, perfect for relaxing or studying! My drink was very milky but the matcha flavor was not as strong as I had wanted, so if you are looking for a more flavorful drink, I wouldn’t recommend this one. The service is great, close to campus and and would definitely come again! 5/5

Kasia - Class Rep of 2018 on the outside, wannabe foodie on the inside Tiramisu Tea Latte Veggie Spring Rolls As an avid tiramisu enthusiast, trying this tea latte was quite the experience. The smell was true to the real thing and the taste was smooth, creamy and just enough sweet to satisfy the palette. Randomly paired with veggie spring rolls, I was felt I satisfied my meal and dessert cravings in an exceptional manner. In a life that is currently crammed with therapeutics and PK, the atmosphere of this tea lounge was calm with background music that soothes the mind of a stressed out student. 4/5 Anita - avid lover of caffeine and cats Teapot of Dragonwell Special [Green Tea] The loose leaf tea smelt very good - it reminded me strongly of home. It is what you would like to taste in a Asian green tea - the flavor is comforting with a bitter note to balance, and a pleasant aftertaste. I thought the assortment of teacups were adorable - I couldn’t resist grabbing an extra to share! The atmosphere was soothing with soft music; overall, a great place to study or catch up with friends. 4/5

Steeps Tea Lounge currently has a

Buy One get One latte Offer until December 24th, 2015

PHOTO CREDITS: SHERRY ZHU

[visit their page on Facebook to redeem]

DEAR EDITOR

DEAR EDITOR, I have no idea what i’m doing... I have a major crush on this girl in pharmacy (ya she’s in my year too) but she has a boyfriend... and it’s kinda obvious they’re for real and long term... I can’t stop thinking about her... and I’m kinda excited cos we are going to pdw together I can’t stop thinking what if something happens at PDW or if I should make a move or should I just admire her from afar (cos she’s taken???)

Dear Secret Admirer,

signs that she may be interested in you.

That sounds frus-- I mean, difficult for you. As you just said, there are really only 2 options to handle this situation:

On the flip side, there is a good chance that she sees you as just a friend: someone she can study with and can rant about the struggles of pharmacy school. Now, whereas love certainly has no bounds, it’s important to think about how her boyfriend would feel if you were to choose option 2. How would you feel if you were to be in a relationship with someone you loved, only to find out that her classmate has ‘made a move’ on her at PDW? There are a lot of pharmfish in the sea. I understand that at this point it may be difficult to imagine being in a relationship with anyone but her, but sooner or later you will meet someone who makes you just as giddy as memorizing USP 661’s various containers.

1) Allow yourself to be friend-zoned and keep your feelings cooped up, in the hopes that maybe she will be single one day. 2) Let her know of your feelings. You know that there are a million reasons why you should give her up, but well, the heart wants what it wants. If she is serious about her boyfriend as you claim, there is a good chance that this will not turn out well-- it can possibly destruct your friendship. Keep in mind that you will have to see her everyday in class until you graduate. Are you ready to handle that?

Good luck, Secret Admirer.

The truth is, if she truly wants to be with you, she would have given you hints, however small, throughout your friendship. Does she want to work late at the library on those PK assignments with you? Is she telling about how her relationship is not going so well? Has she suggested that you hang out with her during Blue & Gold or Mr. Pharmacy? Do you find that she uses an excuse to get physically close with you? Those are all

Love,

Ghasak Hussain PQ Editor

FLICKR GRAPHIC: WEBTREATS

Do you have a question you’d like to ask our editors’? Drop us a word at our submissions page: tinyurl.com/pq2-questions

26 PHARMACY QUARTERLY

HOROSCOPES

PHARMACY HOROSCOPES BY MONICA WONG

LIBRA (SEPT 23 - OCT 22)

ARIES (MAR 20 - APR 19)

Counting the days to winter break instead of counting how many pages of notes you still have left to read? Worry not, you are so close! Remember: Work hard, play hard. (+ sleep hard?)

Is the idea of being cooped up in a PBL room for the next month increasing your blood pressure past 140/90 mmHg? Have no fear, find a fellow pharmily member to help you de-stress and provide you with therapeutic friendship.

SCORPIO (OCT 23 - NOV 21)

TAURUS (APR 20 - MAY 20)

After seeing Professor Sanghera’s fiery dance on stage, it has motivated you to to making a new year’s resolution for physical fitness. If it doesn’t work out though we are waiting with boxes of snacks :)

SAGITTARIUS (NOV 22 - DEC 21) Based on the current positions of the stars and a number of RCT trials, it has been said that listening to Italian opera and doing synchronized swimming with a partner will give optimized outcomes for better overall health. Get that swim cap and goggles you have been eyeing for months.

It is time to rock those upcoming finals with the same confidence as a Mr. Pharmacy MOustangel walking down a fashion runway. Don’t look away, make full eye contact with those notes.

GEMINI (MAY 21 - JUN 20) We have stared deeply into a crystal ball, and those of us at PQ can see that you are feeling overwhelmed. Our extraordinary empathizing skills will hopefully pass on to you! Go and ace your lab exam!

CAPRICORN (DEC 22 - JAN 19)

CANCER (JUN 21 - JUL 22)

The aroma of all sorts of baked Christmas goodies suddenly fills your senses – and you find yourself at the nearest Starbucks … how did this happen…Anyway, treat yourself to something nice to celebrate your hard, 110% never-gonna-give-up attitude.

All of that holiday cheer you can’t participate in making you feel nauseous? Before you resort to scopolamine, flip ahead to our “You’ve got to try this” article for ideas about new study locations – with a coupon!

AQUARIUS (JAN 20 - FEB 18) Those who fall under this sign will find that taking coffee q2h PRN will greatly optimize their studying experience over the next 2 weeks. The writer of this article does not ensure your safety of this dosage.

PISCES (FEB 19 - MAR 19) Are you suddenly losing everything? Your pen? Your sanity? Why is your wallet always empty?! This month, take extra effort in keeping track of your belongings, to save yourself from pre & post-exam paranoia.

LEO (JUL 23 - AUG 22) Another exam… *deep yawn* You take a big stretch and your arm suddenly flips the page to the “How to Survive Exam Season” guide. It is full of valuable tips to get you through.

VIRGO (AUG 23 - SEP 22) Stay safe this weekend. Don’t catch that fragilis in your vagilis.

PHARMACY QUARTERLY 27

You’ve walked the halls of your university for years. In that time you’ve found the quietest study spots, you’ve met your professors in the most obscure places, and you’ve probably been lost multiple times. PQ Plus Two puts your knowledge of campus geography to the test in our latest contest! Pharmacy Quarterly presents:

The “Where Exactly is That?” Contest CONTEST RULES (1) The following three photos are places in Katz, Medical Sciences, and Heritage Medical Research. Identify the floor number and building of all three locations. (2) The first three people to identify the locations of all three images in a private message to the Facebook account of PQ Plus Two will get a Holiday Season-themed gift box prepared by our editor, Winnie Lo. Please send the names of all three locations in a single message. Extra: Take a picture of yourself at one of the locations. It’s not required to send a picture to win but it would be nice to attach the photo to the post in which we announce the three winners. Perhaps you think that you already know where one or two of the pictures were taken. Will you now search high and low for that last location? Or will it appear to you on your usual travels in the university? Deadline: Midnight, December 21st, 2015

The Fine Print: Pharmacy Quarterly (henceforth referred to as PQ Plus Two) takes no responsibility for lost work/school time spent searching for these locations. Additionally PQ Plus Two should remind you that taking the stairs is good exercise and is better for the environment than taking the elevator. By the way, did you know that elevators are called ‘lifts’ in the United Kingdom? Anyway, don’t forget to bring your Proxy Card. And if you do get lost, don’t forget that you can probably turn your body 180 degrees and escape by walking towards where you came from. So, did you enjoy the fine print? Was it too small to comfortably read? But you’re used to reading RxFiles, aren’t you? Fine print is here because this is a contest and any contest which is worth your participation has to have fine print. Face it: this contest immediately took on an air of legitimacy once you noticed this small writing. That being said, if you’re still reading this, then must have time to spare and you clearly already know where all three pictures were taken and should be able to send that message to PQ Plus Two on Facebook.