CHILD’S TEETHING PROBLEMS, MY PIKIN TEETHING MIXTURE AND WHERE MOTHERS GOT IT WRONG

Dateline 1990, locations, University of Jos Teaching Hospital and the University College Hospital, Ibadan; 109 Children died after administration of Paracetamol Syrup. This was 57 years after the infamous 1937 Elixir Sulphanilamide disaster in the United States of America in which 107 people died after taking sulphanilamide dissolved in diethylene glycol.

Eighteen years after, My Pikin Teething Mixture, a product registered by NAFDAC may have been fingered as the ‘killer‘ drug that has claimed the lives of not less than 25 children. The drug is manufactured by Barewa Pharmaceuticals Limited, a certified manufacturer by NAFDAC. The national drug law enforcer has, however, shut down the company in the wake of the death allegedly in consequence of the administration of the drug.

Barewa, has, since then, spiritedly defended the contents of My Pikin Teething Mixture as a Paracetamol based drug containing Paracetamol B.P. 120 mg and Diphenhydramine HCL B.P. 6.25 mg per 5mls. But a preliminary test carried out by the National Agency for Food and Drug Administration and Control, has revealed that besides Paracetamol, the drug contains Diethylene glycol as against propylene glycol which is the commonly used excipient. Incidentally, Diethelyne glycol was also implicated in the 1990 deaths in Jos and Ibadan

What is more worrisome with this type of poisoning is the fact that the original chemical entity, Paracetamol is naturally poisonous to the kidneys and liver in high doses. Marry this with the toxicity of Diethylene glycol, what do you have? Bomb!! Instant death.

These, however, are 25 deaths too many. While we await the report of more detailed investigations from the appropriate authorities, so many questions are begging for answers;

Is the drug registered by NAFDAC?

Is the factory currently certified by NAFDAC?

When was the last audit of the factory carried out by NAFDAC?

When was the last time NAFDAC independently surveyed this particular drug in the market?

Has NAFDAC a structured process/procedure to routinely carry on surveillance on ALL products in the market or does the agency randomly pick products?

What do all the agencies, LUTH, UCH, NAFDAC want to achieve by ‘issuing alert’? What in specific terms have they done? What have they put in place to ensure positive outcome? What has been the distribution route of all products from this factory in the last Three months?

Does this ‘alert’ consider the chaotic nature of our drug distribution channels which the Pharmaceutical Society of Nigeria has been talking about over the last several years?

Over the years, regulatory bodies have scaled up their regulatory oversight on pharmaceutical excipients. Pharmaceutical excipients – are inactive ingredients used to formulate active ingredients into finished dosage forms

“…For example, excipients can:

• aid in the processing of the drug delivery system during its

manufacture,

• protect, support or enhance stability, bioavailability or patient

acceptability,

• assist in product identification, or

• enhance any other attribute of the overall safety, effectiveness

or delivery of the drug during storage or use…”

It may interest the Nigerian public to know that since 2007, European regulatory agencies have initiated steps to improve the quality and regulatory aspects of all excipients used in pharmaceutical products all over Europe because of the risks associated with pharmaceutical excipients. Some of the documented evidence of risk includes:

• Fraudulent product obtained from broken supply chain and distribution routes leading to contamination cases and tragedies as outlined below:

1990 Nigeria: Cough syrup contaminated with solvents (47 reported deaths)

1986-1998 India and Bangladesh: Paracetamol syrup contaminated with diethylene glycol from propylene glycol origins (236 reported deaths)

1996 Haiti: Glycerine contaminated with diethylene glycol (88 reported deaths)

Potential exposure:

• Use of inappropriate grade of materials for critical route of administration (e.g. pyrogene-free requirements)

• Excipient variability between suppliers

It is a known general requirement of Good Pharmaceutical Manufacturing Practise to analyse ALL inputs to the production process. We need to know what is contained in the production process submitted by the company while registering My Pikin Mixture as submitted by the company and approved by NAFDAC. Is this process complied with by the manufacturer?

Some pharmacists have long questioned the rational for our regulatory body to continue to register teething formulations. Teething is a well known non specific condition that is common with children and the usual practise is to symptomatically manage the child.

‘We are confronted with cases of mothers using various teething formulations at once usually resulting in a child taking about 4X the dose of paracetamol’ says a colleague during our brain storming section on Teething mixtures some Six months ago. Cases abound where mothers administer these teething formulations (which usually contain Paracetamol 120mg/5ml) with standard Paracetamol syrup. This health risk is further compounded as they are both Over The Counter (OTC) medicines without regulatory restriction/control of use. While this school of thought has spoken against the outright ban of Paracetamol, some have advocated more stringent packaging alert and warning to parents

This should not be the time for agencies and institutions to trade blames or to start defending themselves. The Federal government should consider these deaths a national tragedy. The loss of defenceless innocent children is not taken lightly in countries where citizens are considered supreme

One thing is clear, the way NAFDAC is currently constituted underscores the fact the agency is a reactionary agency. The agency should be reformed to anticipate problems and prevent them from happening. Life is too precious to be treated the way we currently do, particularly that of Innocent Children

It is the responsibility of the Federal Government to protect the health of the Nigerian Population and I believe that this is one of the reasons NAFDAC was set up. Parents should not just take this as another case of an ‘act of God.’ They should consider this as another case of the carelessness of the state through her agencies against the citizen. This may just be an opportunity for the victims to challenge this callous act through our judicial process. This may just be the wake up call we need to usher in a new healthcare system that really cares for the Nigerian citizens

The dry weather is back again. This is usually the period for high prescription of chloramphenicol eye drop. Has this been prescribed for you. Below is the prescribed way to administer it for maximum benefit.

ADVICE TO PATIENTS

(1) Chloramphenicol Eye Drop;

1. Chlopramphenicol is an antibiotic used to treat eye infection.

2. It is important to use this eye drop as frequently and for as long as the doctor has prescribed and advised by your pharmacist.

3. Do not wear contact lenses while using this drug.

4. If using two drops, for each dose wait for a minute or two between applying the first and second drop. Using more than two drops will not help because the excess will run out of your eye.

5. Pressing your finger against the inner corner of the eye (by the nose) for about a minute after using the drops can help to stop the drops draining into your nose and throat.

6. Discard any unused and left over content three (3) weeks after opening.

7. You may feel a brief stinging after using this eye drop. If this is prolonged for more than three days or your eyes do not get better please see your doctor or pharmacist.

NIGERIAN COMPANIES AND THE HERD MENTALITY

Philip Kotler, in his book, Marketing Management, posited that “all companies must look beyond their present situation and develop a long-term strategy to meet changing conditions in their industry. They must develop a game plan for achieving their long-run objectives.” He further opined that there is no one strategy that is optimal for all companies. Each company must determine what makes the most sense in the light of its position in the industry and its objectives, opportunities, and resources”.

This principle was applied by some notable companies in the United States and Japan in varying degrees to strengthen their operations as well as markets and hence improved revenue base. Companies like Goodyear Tire and Rubber Co., Uniroyal and Armstrong Rubber Co. in the US and Toyota in Japan applied this strategy to perfect their operations and products.

In the tire industry where all the major players adopted it, it was so used efficiently that each of the company got something and was, in a way, content retaining its distinct character and having to run to the other for assistance at any given time.

Here in our dear country, Nigeria, any thing and every thing runs on the herd mentality, This is why any strategy employed by company A to shore up its operations is automatically copied by company B irrespective of the differences in objective, resources and opportunities available to the two companies and to some extent, experience in their respective fields?

It is for the same reason that our telecom providers are all in the race to promote one event or the other usually in the entertainment sector that in a way alter and pollute our culture. No thought is given to the education sector by way of empowering the youths through scholarships as the oil companies do nor assisting with social projects that benefit the majority across economic strata.

During the re-capitalization efforts by banks, the stock market became the centre of attraction to all the banks. And they are yet to leave that market till date, not even the crisis in that pot of confusion is discouraging them, no. When it was the turn of the insurance sector to shore up their capital base; they too turned to the capital market for succor. The irony in this as it concerns the insurance companies is that the sector that is supposed to invest more in the capital market and in such other critical areas of our economy because of its potential to raise more money than other financial institutions, is the one begging for money. A direct opposite of what obtains in other climes is what our insurance sector represents here in Nigeria. Too bad.

By some slips arising from misconceptions or miss-application of strategy, our banks are increasingly finding it difficult to match reality with expectations. Rather than attempt a review of business plans and carry out some radical changes, marketing plans are being updated and probably are now made to replace business plans the result of which are the various panic measures being put in place to hunt for deposits even from school children as if that is what will give value and stability to their business.

While all these comedies are playing out, some of the banks are declaring mind boggling figures and mouth watering figures as profits, some as high as 98% over the previous year. And if we are to believe these fantastic performances it then becomes very difficult to reconcile the crazy hunt for deposits that now bothers on desperation. Worst still is the fact that daily, our highly performing banks are being accused of cheating their customers maybe to make up for the big profits declared.

Understandably, and in line with the bandwagon behavior, the new craze has shifted to the micro finance sector with virtually all the major banks falling over themselves to take vantage (?) position in that area. The obvious fact that that sector is also banking at the low level makes no meaning to the extent ‘deposit money’ will be sourced there.

While commending our banks for their innovation and ingenuity in what is gradually becoming a phenomenon in the way we do business in this country, it is better some good thought is given to carry out a review of operations based on reality. It will be a better strategy for each bank to look inward and turn its distinctive competence into its competitive advantage as IBTC used to be. Cutting an edge for your business will be a better strategy to this uniformity approach. Harassing people on the streets for deposits sends a signal that all is not well with our banks.

Can we be more creative in doing these things? Enough of these pretensions.

DEMAND FOR NEW CARS HITS THE HIGH…INTENDING CAR OWNERS NOW ON WAITING LIST

Nigerians now seem to prefer new cars to used ones a FORTUNE&CLASS Weekly survey has shown. A snap survey conducted by the magazine’s correspondents across new cars dealers shows that there is a strong demand for new cars, especially, the Japanese and Korean brands.

Most intending buyers are now placed on waiting list. FORTUNE&CLASS correspondents explained that demand is now high that customers can’t just walk into a dealers shop to pay and drive off with a car. “It takes an average one month or more to get a car after a commitment to buy is made to the dealers.” One of our correspondents that conducted the survey said.

Three brand names are reported to be in high demand; Toyota, Kia and Hyundai. Giving reason for the demand pile up for these brands, a marketing manager with a popular Toyota sales outlet said the desire by Nigerians to acquire new vehicle may not be unconnected with the long term financing provided by banks.

“The five years vehicle repayment plan on a 10 per cent down payment being spearheaded by First Bank Plc has created a new demand push for new cars.” An official of a car dealership said.

The emerging preference for new cars is in sharp contrast to the choices of Nigerian car owners until three years ago when most intending vehicle buyers would rather buy second hand vehicles, this, in fact, gave impetus to the thriving ports in Benin Republic, Nigeria’s neighbouring country, from where the second hand cars known as Tokunbo are smuggled into Nigeria through bush paths and unmanned border points.

INVESTMENT EXPERT SAYS BANKS EXPANSION TO OTHER AFRICAN COUNTRIES IS ANOTHER RAT-RACE

An investment expert, Mr. Jide Ogunleye, has questioned the rationale of Nigerian banks newly found fervor for expanding their operations into African countries with low economic generation capacity. Ogunleye, who is the Chief Executive Officer of Denaro Capitals, said the acquisition and establishment of Nigerian banking brands in countries in West and East Africa lacks appropriate investment judgment.

“I believe that the establishment or acquisition of Nigerian bank brands in these countries is simply an ego tripping by most of Nigerian banks that want to join in the feel of internationalizing their operations. It’s like another rat race to determine which of the banks can boast of establishing its brand outside the country.” Ogunleye said.

“But sincerely, I don’t think it makes investment sense to spend so much money to construct a bank branch in a country where the Gross Domestic Product is not up to that of Lagos State. This is beside the fact that most of the citizens of these countries have been shown by reports to prefer their own banks. I can tell you that a new branch in any urban centre in Nigeria will yield better returns for the banking brand than those outposts they are establishing in the other countries.”

“I am not saying that there is something generically wrong with establishing branches in other countries, but in the case of most Nigerian banks, I feel the choice of those countries do not make a good investment decision. I do not know how the Nigerian bank brands want to take on the indigenous financial institutions in those countries with their solitary single branch. This is beside the regulatory hurdles and fees they have to pay to get the branches established.

“Now, if the argument is to serve the needs of Nigerians resident in those countries, we would need to know the population of Nigerians in the countries, and I can tell you that with the exception of neighbouring Benin Republic and to a little extent, Ghana, the population of Nigerian residents in these countries does not provide for a flourishing bank branch.

“If a Nigerian bank opens a branch in London, South Africa or in the United States of America I think that would be understandable because of the obvious dynamics available in these countries. The population of resident Nigerians are not only appreciable but given the natural inclination for Nigerians to identify with their home brands when they are in the diaspora one can easily conclude that such branches in these countries would be beneficial to shareholders of the banks and Nigerians in those countries.” Ogunleye argued.