Speech by Director of Medical Services, Professor K. Satku at the 20th Singapore Pharmacy Congress

25 Jul 2009

By Professor K. Satku

Opening Address 

1. It gives me great pleasure to join you at the opening of the 20th Singapore Pharmacy Congress. Let me begin by extending a warm welcome to all and a special welcome to our overseas delegates and speakers.

2. I am encouraged by the continued growth and development of the Singapore Pharmaceutical Society. Founded in 1905, more than a century ago, as the then Straits Pharmaceutical Society, the Singapore Pharmaceutical Society has served its members and the Singapore public well.

3. You have been actively involved in many public education efforts and have made significant contributions among others, to making medications safe for our public. You have also through many continuing professional development programmes constantly upgraded yourself for service to the public.

4. An annual Congress such as this is no mean feat and this is your twentieth. Importantly, this annual congress provides a platform for the meeting of minds of pharmacy professionals, to share experience and review latest developments and trends in practice.

5. Despite your diverse backgrounds - as community pharmacists, hospital pharmacists, marketing, sales and distribution, manufacturing, regulatory and academic pharmacists, you recognize the commonality that binds you all; you recognize the strengths that each one of you bring and you continue to work together for both the public’s and the profession’s good.

6. There is every reason to celebrate such an achievement and therefore I believe the theme for this year : “Celebrating 20 years of Singapore Pharmacy Congress – Unity in Diversity” is most appropriate.

7. However, with rapid growth and development, you will face new challenges to stay united. I see this as a happy problem. Let me elaborate.

Setting up of Pharmacist Specialists Board

8. One of the major changes that took place just last year and one that would affect your profession significantly were the amendments to the Pharmacists Registration Act. These changes were aimed at preparing the pharmacy profession for new developments in pharmacy and medicine and at equipping the profession to manage them.

9. The key amendments introduced included converting the old Singapore Pharmacy Board to the present Singapore Pharmacy Council, giving it statutory status; introducing compulsory continuing professional education for pharmacists; developing a more rigorous disciplinary proceedings framework for the profession; and of course, the setting up of a Pharmacist Specialists Accreditation Board that will oversee the development of specialties and training of specialists in pharmacy and  allow for the development of a specialist register and registration of specialist pharmacists.

10. The setting up of a Specialist Accreditation Board and Specialist Register for pharmacists is a landmark measure. It will result in yet greater diversity and the challenge ahead to stay united will be significant. 

11.  The increase in the number of novel and potent medications over the years, has made it possible to obtain better therapeutic outcomes in many fields of medicine but the process has become quite complex and there is an urgent need for specialization in pharmacy.

12 There are many examples. One important area is in the field of oncology, where drugs typically have a narrow therapeutic index, and combination chemotherapy is often used.

13 An in depth knowledge of the pharmacokinetics, and pharmacodynamics of the various cytotoxic drugs, the type of cancer and the  physiological status of the patient are critical to minimize adverse effects, and to achieve optimal therapeutic outcomes.

14 Another area of growing concern, as our population continues to age, is polypharmacy in the elderly. The limited functional reserves of these individuals changes their ability to absorb, metabolise, distribute and excrete drugs, and puts these elderly patients at greater risk of adverse drug reactions and interactions.

15 Pharmacists specialising in geriatrics with in-depth knowledge of issues related to aging will be well placed to optimize drug therapy while mitigating the risks of medication-related problems in this population. 

16 In short, specialization is an inevitable journey. The interventions by specialist pharmacists can result in fewer complications; reduction in unnecessary medications and improved outcomes. Pharmacists in turn will derive greater job satisfaction as their professional roles and responsibilities expand to bring the profession closer to its mandate of achieving safe and effective use of medication for patients.

A Privilege for the Profession

17 Internationally, while the establishment of specialty boards and specialists has been a long-standing practice for doctors and dentists, it is a new milestone for the pharmacy profession, even in developed countries. Pharmacists in Singapore are hence among the few in the world to enjoy this privilege.

18 I choose these words carefully, because it is indeed a privilege, and not a right. And because it is a privilege, it is our responsibility to ensure that this is developed in a manner that will serve the needs of our patients in the best possible way. 

19 Establishing the Pharmacist Specialists Register is not a development primarily to benefit individuals in the profession, nor even the profession itself, but for the better service of the public. It may well benefit the profession in the longer run, but this outcome must only be secondary to the primary purpose of serving the population.

20 In my years growing as a healthcare professional, and yes, I am still growing, I have come across many definitions of what ‘a professional’ means and what ‘self-regulation’ entails.

21 One of the best definitions, I believe, came from a renowned judge – Judge Brandeis, who worked as a Supreme Court Justice in the United States about the time your society was founded. Among other elaborations, he defined a profession as an occupation that one pursues primarily for the benefit of others.

22 I strongly believe that we must uphold this principle.

23 The opportunity that is now before individuals in the pharmacy profession will create greater diversity within the profession. Our homegrown pool of pharmacists will eventually comprise both basic and specialized pharmacists: specialists with interest in fields like Oncology, Geriatrics, Paediatrics, Infectious Diseases, Psychiatry, Clinical Nutrition Support and possibly more.

“Unity  in Diversity”

24 These developments will lead to interest groups that will threaten to fragment your society. If however the pharmacy professionals continue to engage each other and remain united because you see virtue in the diversity each of your colleague brings to the profession, it would be an achievement and you should, maybe in another 20 years once again celebrate the “Unity in Diversity” to remind all that…….

25 ..“Unity in diversity” is a motto celebrating co-operation between different groups of people in a single society. It is a socio-ecological philosophy that describes a sense of oneness despite diversity in physical, psychological or cultural attributes and has the power to influence developments positively.

26 The origin of this motto, can be traced back to Nehru and the Indian Independence movement. India – a nation of diverse races, the birthplace of many religions, and the home of many cultures, united to oppose the British who had ruled India for four centuries.

27 Men and women of diverse cultural, religious and regional backgrounds came together in support of this massive freedom movement. Millions of people of different backgrounds worked together to decide joint actions. They went to jail together, and they found various ways to oppose the British.

28 Incidentally, the European Union has also adopted the term “United in Diversity” as its motto. Established after the Maastricht Treaty came into force in 1993, moves towards European integration were viewed by many as an escape from extreme nationalism which had devastated the continent during the Second World War.

29 The European Union is presently an economic and political union of 27 member states, with a population of 500 million incorporating diverse cultural and regional backgrounds. A single market has been developed to ensure the free movement of people, goods, services and capital, with 16 of its member states adopting the euro as a common currency. In 2008, the European Union generated an estimated 30% share of the nominal gross world product, an impressive tally undoubtedly contributed by member integration.

30 The world today is filled with a spectrum of experiences, opinions, physical appearances, cultures and opportunities. The challenge we face is not just to simply find a way to live in harmony with people who differ from us, but more importantly, to celebrate this diversity and enrich ourselves with it. If we choose to and open our minds to it, we will realize that there is a fortune of new knowledge to be gained from those who have an alternative perspective to our own.

The Challenge Ahead

31 Today, at least in the way I see it, there is a fundamental difference between how the term “Unity in Diversity” applies to the history of India, or for that matter to the European Union, and how it will apply to the pharmacy profession.

32 India and the European Union had a spectrum of diverse variation to begin with, and this diversity came together, united for a common cause.

33 The pharmacy profession is currently at a point in your history where you want to create more diversity in order to serve the population better and strengthen yourselves. As this diversity evolves, we must constantly remind ourselves of our common purpose and not let diversity become divisive or fragment the profession. Unity without uniformity is the essence.

34 How do we then manage this fine balance between nurturing the need to diversify and yet preserving the integrity of the pharmacy profession? 

35 Take small steps especially in the initial stages. Evaluate your actions and contemplate if you are in danger of losing your fundamental purpose to serve society.

36 It is only then that we can be  sure that we will continue to reap the fruits of diversity without compromising the solidarity of our very institution.

Conclusion

37 However if diversity eventually leads us to inevitable fragmentation, we must be courageous enough to accept it, as long as this fragmentation is necessary for us to further improve upon the standard of healthcare for the public.

38 Look around and see for yourselves. How far has India progressed since its independence? Has the country become stronger in the face of diversity?

39 Has the formation of the European Union brought about greater good for the region than if member states had otherwise stayed fragmented?

40 What about the medical profession? Has diversity served the medical fraternity well? Have healthcare standards for our population become better as a result of this diversity?  I leave you to ponder these issues.

41 You have an opportunity today to shape the progress of your profession through managing its diversity. On that note, I wish you well in your endeavours and a successful and meaningful congress. Thank you.