INTERNSHIP IN INDRAPRASTHA APOLLO HOSPITAL, NEW DELHI

INTERNSHIP IN INDRAPRASTHA APOLLO HOSPITAL, NEW DELHI

Mary Raju Mathew, Sharanya Nair

In our final year of Pharm.D, it was a valuable experience to have  been able to do our internship in Indraprastha Apollo Hospital, New Delhi and get to know how clinical pharmacists in India work about.  IAH is the first hospital, in India, to be accredited by the JCI (Joint Commission International). As medicine management is mandatory for JCI accredited hospitals, they have a clinical pharmacy practice depatment which carries out activities that includes prescription audit, where a pharmacist goes daily and checks the patient file in their assigned floor. A pharmacist gets to audit around 30 patients at the minimum in a day.  The pharmacist verifies whether the drug, its dosage form, dose, frequency, route of administration, administration time and counter signs the medication chart. Any errors identified are informed to the physician and changes are made. They also verify the medicine indents, before they are dispensed to the patient from the pharmacy.  During our three month internship time, we were posted in the oncology, paediatrics and orthopaedics department and were allowed to shadow the clinical pharmacists during their rounds.  The hospital has been enlisted as an ADR monitoring centre under the PvPI (Pharmacovigilance Programme of India) by the IPC (Indian Pharmacopeia Commission), hence the reported ADR reports are send to IPC through software called VigiFlow®. They have a 24/7 Drug Information Centre, where they receive around 500 telephone queries in a day. Mostly physicians call to query about the drugs before prescribing and even nurses call to enquire about a medicine during indenting.  The Out Patient counselling service they provide is quite notable. A large number of patients are benefited from the OP counselling desk, located in a space next to the OP pharmacy. The patients are also allowed to buy their medicines from outside the hospital, and the medicines they bring from outside is again approved and managed by the clinical pharmacist. During our internship in Delhi, we also visited the IPC in Gaziabad, the centre of ADR monitoring and reporting in India.

 It was an incredible experience and we could really get an insight into how pharmacists of our nation can prove serviceable in the clinical scenario. 

CLINICAL PHARMACIST BECOMES AN INTEGRAL PART IN HEALTH CARE: AN INSPIRING EXPERIENCE FROM FORTIS HOSPITAL,BANGLORE

CLINICAL PHARMACIST BECOMES AN INTEGRAL PART IN HEALTH CARE: AN INSPIRING EXPERIENCE FROM FORTIS HOSPITAL,BANGLORE

Athira.B.M, Nayana.S.A, Anusree.S

       Being clinical pharmacists getting ready to run through, we were always curious to learn how a clinical pharmacist is fulfilling his/her responsibilities. We decided to exploit the opportunity PCI is providing to the Pharm D interns, that three months of the internship period can be done inside a different hospital setting. The goal was to choose a hospital with a well established clinical pharmacy department. Fortis hospital, being one of the very few JCI accredited hospitals in India is undoubtedly the first name coming up to the mind. With the great support of our college management and teachers we got an opportunity to carry out a 45 days internship programme there.    

       Fortis is a 250 bedded, JCI accredited hospital with 29 departments, 111 well qualified doctors, sufficient nurses and a clinical pharmacy division with well experienced clinical pharmacists. During the 45 day period we were posted in every important department, including all the Intensive Care Units(ICUs), Oncology, Gastro enterology, Neurology and Urology, for one week each. The ICU posting was an outstanding experience. Every patient getting admitted in Medical ICU will be taken care by a special team of intensivists along with a clinical pharmacist. Clinical pharmacist has the responsibility to ensure that the prescribed doses and dilutions are correct and are timely administered to the patient. Based on the patients’ age, co morbidities and other complications, appropriate dosage adjustments are made. In such a way clinical pharmacist prove to be an unavoidable part of critical care team. Another exciting experience was the posting in department of oncology. The chemotherapy is carried out only under the supervision of a clinical pharmacist who has to make sure that the chemotherapeutic agent, its dose, the diluents are all accurate, the dilution is carried out in strictly aseptic conditions and the medication is properly administered.       Being a JCI accredited hospital, it has to maintain cupboards with specified medications and locking systems in each critical care unit, which are audited regularly by the clinical pharmacist. Any inappropriateness in the maintenance of such cupboards, including variations in stocks, nonstandard storage conditions etc are to be recorded and reported.        In addition to the above activities, clinical pharmacist has to do his daily monitoring of each and every patient admitted in the hospital to make certain the efficacy and safety of drug therapy provided to the patient. We also had case presentations in the department, on the challenging cases we found during our posting.        We were proud to be part of a health care team providing high quality treatment and patient care. In such a set up every health care professional has to play a well defined role in which the duties of clinical pharmacist are undoubtedly vital. The way the physicians and other members of the team valuing and accepting the views and suggestions of clinical pharmacist on drug therapy really made us understand the importance of our profession. The experience was impeccable and we were lucky enough to have trained in such a great environment.

NANOPARTICLES TO TREAT ATHEROSCLEROTIC PLAQUES

Pharma pulse by linu mohan

NANOPARTICLES TO TREAT ATHEROSCLEROTIC PLAQUES

 Hardening and narrowing of the arteries  is known as atherosclerosis. This is progressive process which silently and slowly blocks arteries, results blood flow at risk. It leads to cardiovascular diseases like heart attack, strokes and peripheral vascular disease, which are the leading cause of death.

Plaque is a jumble of cholesterol, cells, and debris that creates a bump on the artery wall. As atherosclerosis progresses, that bump gets bigger and may create a blockage. The plaques of atherosclerosis cause the three main kinds ofcardiovascular disease

1. Coronary artery disease: Stable plaques in the artery of heart cause angina.  Sudden plaque rupture and clotting causes heart muscle to die and thereby myocardial infarction.

2. Cerebrovascular disease: Ruptured plaques in the arteries of brain causes strokes which may cause permanent brain damage.

3. Peripheral artery disease: Narrowing in the arteries of the legs caused by plaque causes poor circulation and its complications.

As atherosclerotic plaque is an invisible killer, the scientists have recently developed a nanoparticle, that can simultaneously light up and treat atherosclerotic plaques which clog arteries. This nanoparticle that functionally mimics natural high-density lipoprotein (HDL) and the treatment with this may help to prevent  heart attacks and strokes.

The existing detection methods, often fail to identify dangerous plaques, which can clog arteries orcan detach from arterial walls to block blood flow, causing a heart attack or stroke. Magnetic resonance imaging (MRI) is a good detection method for plaque visualization, but requires the use of a contrast agent to show the atherosclerotic plaques clearly.

So the principle of this new method is by making a synthetic nanoparticle which can functionally mimic HDL widely known as "good" cholesterol because of its ability to pull low-density lipoprotein, out of plaque. Since it is synthetic HDL the chances of immune reactions are totally avoided. The MRI-active HDL mimic, with encapsulated iron oxide as contrast agent, can use for both detection and treatment of plaque developed as result of atherosclerosis.

                   (Plaque formation)

HEPATITIS B VIRUS; QUANTITATIVE TEST

Hepatitis B is a potentially life-threatening liver infection caused by the hepatitis B virus. It is a major global health problem. The virus attacks the liver and can cause both acute and chronic disease and it is transmitted through contact with the blood or other body fluids of an infected person.

An estimated 240 million people are chronically infected with hepatitis. More than seven lakh people die every year due to complications of hepatitis B, including cirrhosis and liver cancer.

It is not possible, on clinical grounds, to differentiate hepatitis B from hepatitis caused by other viral agents and, hence, laboratory confirmation of the diagnosis is essential. Recently FDA had given approval for a laboratory test used to measure the amount of hepatitis B virus (HBV) DNA in patient’s blood, where viral DNA is genetic material from HBV.

In this technique using patient’s blood sample, DNA is separated from serum .Separated DNA is mixed with the assay reagents and calculates the amount of HBV DNA in the patient’s blood based on the fluorescent signal measured by the analyser

This test is used together with other laboratory results and clinical information to determine whether a person has active HBV infection and also to evaluate the patient’s response to treatment.

FDA recommended that this test should not be used to screen blood or blood products for transfusion. The assay should not be used to determine if a person is infected with the hepatitis B virus or to determine the stage of HBV infection.

DPP-4 inhibitors for type 2 diabetes may cause severe joint pain

Adr bulletein

by shinu.c

DPP-4 inhibitors for type 2 diabetes may cause severe joint pain

DPP-4 inhibitors are a class of prescription medicines that are used with diet and exercise to control high blood sugar in adults with type 2 diabetes.When untreated, type 2 diabetes can lead to serious problems, including blindness, nerve and kidney damage, and heart disease.

Medicines in the DPP-4 inhibitor class include sitagliptin, saxagliptin, linagliptin, and alogliptin. They are available as single-ingredient products and in combination with other diabetes medicines such as metformin.DPP-4 inhibitors lower blood sugar by helping the body increase the level of the hormone insulin after meals. Insulin helps move sugar from the blood into the tissues so the body can use the sugar to produce energy and keep blood sugar levels stable.

In addition to severe joint pain, other possible side effects of DPP-4 inhibitors include inflammation of the pancreas, low blood sugar when this class of medicines is combined with other prescription medicines used to treat diabetes, and allergic reactions.

FDA Adverse Event Reporting System  identified  33 cases of severe arthralgia reported with the use of dipeptidyl peptidase-4 (DPP-4) inhibitors. Each case involved the use of one or more DPP-4 inhibitor. Sitagliptin was the most frequently reported, followed by saxagliptin, linagliptin , alogliptin, and vildagliptin . All 33 patients experienced arthralgia that resulted in a substantial reduction in their prior level of activity, including 10 patients who were hospitalized due to disabling joint pain.

In 22 cases, symptoms appeared within 1 month of initiation of treatment with a DPP-4 inhibitor. In 20  cases, the DPP-4 inhibitor was suspected as a possible cause of arthralgia and was discontinued within a month following the onset of symptoms. However, 8 cases reported a period of 44 days to 1 year between the onset of symptoms and discontinuation of the DPP-4 inhibitor. In 23 cases, symptoms resolved less than 1 month after discontinuation of the drug.

Reports of eight cases documented a positive rechallenge. In these eight cases, individuals discontinued treatment, experienced a resolution of symptoms, restarted therapy with a DPP-4 inhibitor (a different member of the class in six of the eight cases), experienced the reappearance of the arthralgia, and subsequently, experienced resolution of the symptoms when DPP-4 inhibitor therapy was again discontinued. Twenty-one of the 33 patients were treated for arthritis with drug therapies that included corticosteroids, nonsteroidal anti-inflammatory drugs, methotrexate, and immune-modulating drugs

Additional Information for Patients

·      Some patients who take the type 2 diabetes medicines called dipeptidyl peptidase-4 (DPP-4) inhibitors can develop joint pain that can be severe.

·      Contact your health care professional right away if you develop severe and persistent joint pain while taking one of these medicines. Do not stop taking your DPP-4 inhibitor medicine without first talking to your health care professional.

·      Talk to your health care professional if you have questions or concerns about your diabetes medicines.

·      Report side effects from DPP-4 inhibitors

Additional Information for Health Care Professionals

·      Severe and disabling joint pain has been reported with the use of dipeptidyl peptidase-4 (DPP-4 inhibitors). The time to onset of symptoms following initiation of drug therapy varied from 1 day to years. Patients experienced relief of symptoms upon discontinuation of the medication. Some patients had a recurrence of severe joint pain when restarted on either their original DPP-4 inhibitor medication or another DPP-4 inhibitor.

·      Consider DPP-4 inhibitors as a possible cause for any patient who presents with severe and persistent joint pain, and consider discontinuation of therapy with this class of drugs.

·      Report adverse events involving DPP-4 inhibitors

Pharmacy education, Post Graduate Programs and Specialization at University of Southern California (United States)

Pharmacy education, Post Graduate Programs and Specialization at University of Southern California (United States)

by Dr Dilip.C

(Written based on author’s one month Pharma bridge experience at USC school of pharmacy, California)

ABOUS USC,

Pharmacy education and practice is almost similar in all cities across Unites States though not identical. Founded in 1905, USC School of Pharmacy is the oldest and foremost pharmacy school in Southern California and is a national leader for its progressive curriculum and research excellence. The very first Doctor of Pharmacy program- Pharm D was started in 1950. In 1968, the School of Pharmacy launched the nations First Clinical Pharmacy training program and some of the facilities for training included: Los Angels country USC medical centre; USC keck medical center; USC Norris Cancer Center and in addition to that, USC have four campus Pharmacies owned and operated by the School of Pharmacy.

Being the pioneers to start the nations first Pharm D program, USC School of Pharmacy has around 740 Pharm.D students (180 per year), 220 graduate students and 75 full time faculties. In addition, 440 part time and volunteer faculty work for USC, since everyone is dedicated to build the profession. These graduates account for 50 percent of practicing pharmacists in southern California and are graduated from USC. 220 graduates comprise of Ph.D./regulatory/ Masters/drug development/post marketing surveillance etc that mainly focuses on research work as USC ranks among one of the top 10 institutions for research.

In India, Pharm D (short form for Doctor of Pharmacy) was first started in 2008, introduced as a 6-year program, which includes 5-year academic study and 1 year of internship. Anyone interested can take the exam after high school and join the Pharm D and start their journey towards becoming a Pharmacist. In USA, it is slightly different. A student who wishes to join Pharm.D has to meet certain prerequisites. They have to undergo 3-4 years of undergraduate studies. It can be mathematics, physical science, biological sciences (biology, physiology, microbiology etc) English, communications, psychology, Sociology, economics, social and behavioral sciences, humanities etc. Once all prerequisites are met, the student is eligible to enroll in Pharm D program. In USA, Pharm.D is a 4 year Program that is broadly divided into non clinical and clinical, also known as IPPE and APPE. IPPE stands for Introductory Pharmacy Practice and APPE stands for Advance Pharmacy Practice (externship).  During initial years of study, students focus on learning basic skills required for pharmacy practice, like taking B.P, doing Pulse check, giving injections and exposure to the community setting. As the course progresses, there will be less and less of basic sciences and more of clinical pharmacy practice.

Pharmacy Education (Clerkship -APPE)

As the program advances, the student has to undergo clerkship (APPE) where they will be put on six rotations, 6 weeks each.

Mandatory requirements are:

·       Acute care/Medicine; where the students get an opportunity to work with sick patients in hospital

·       Ambulatory care (outpatient clinics)

·       Community Pharmacy

·       Health systems (broader issues)

·       PTC Medication, Therapy, Antimicrobial Stewardship etc.

·       Elective- HIV, DIC, international, AIDs clinic etc

Before completion of the program, student has to accumulate 900 hours of experience in clerkship (APPE) and 600 hours in voluntary work/internship in any pharmacy related area.  Clerkship is more like patient care/clinical activity, but internship is a paid position where the higher proportion of distribution of drugs and preparation of prescription. By the time of completion of the graduation, a student has to accumulate 1500 hours total.

CASE CONFERENCES

Case conference is another interesting part of the Pharm D academic curriculum, where the students get an opportunity to present their clinical findings. Case conferences provide a good platform for aspiring pharmacy students as they get an opportunity to discuss their clinical findings, share any new medical procedures which they come across, conduct drug reviews and participate in journal clubs. I have been part of many brainstorming discussion about various diseases and drugs in these conferences, which keeps everybody abreast with the latest information's and helps to hone the clinical skills of the emerging clinical Pharmacist. We had attended four such clinical conferences, which falls on Tuesdays. First day, the discussion was on anticoagulants followed by two journal clubs on the same topic. Two students presented latest medical procedures like watchman procedure and lariat procedure with video demonstrations, which turned out to be an awesome experience. All sessions were from 8am to 1pm.

 A study on anticoagulants was presented in one of the journal club. Students take up a recent, relevant literature and present the background with objectives, study design, inclusion/exclusion criteria, discussion, statistical analysis, outcomes and conclusion to the detail. Every body understands the strength and weakness of the study and gets to know more about anticoagulants.

Case conference on diabetes was really interesting. Minute details about the disease have been put up for discussion, including the drugs used, dosing, patient counseling, life style modifications etc. Less importance is given to theory and is more focused on improving the practice skills and team building exercises, which are truly constructive that makes a student pharmacist confident enough to work in any clinical setting. It was more or less like a comprehensive review on diabetes where the preceptor discusses about diabetes, different type of medications, included dosage and side effect and patient counselling. Two to three cases were also discussed with students.

Pharm D education- Post Pharm D

Every student has to pass the licensing exam, if they want to get into pharmacy profession, provided they must have graduation and internship. The licensing exam and the rules associated to it vary by each state and the state law. So depending upon the state the exam may differ. The student must also clear national licensing exam in order to cross the final hurdle.  If anybody wants to go for higher studies after pharm. D, can opt for residency, which is a one year program of two category, General (PG Y1) and Specialty (PG Y1). It s an extension of internship which is more or like an advanced training. Student has the option to do continuing Pharmacy education certificate programs as well as board certification (BCCP etc in oncology, psychiatry etc.)

Pharmacy practice history in USA

 In pre 1950, it was caring (patient caring) in USA, after 1950, pharmacist started dispensing the medicine, later in 1970, hospital clinical pharmacist, consultant pharmacist etc came into picture including pharmaco-kinetics, DI, monitoring etc. In 1980, pharmacist started focusing on patient education, cost control, pharmaco-economics etc and in 1990 again pharmacist returned to care (pharmaceutical care, manage, ambulatory care). Currently there are plenty of career opportunities in USA in the areas like community, ambulatory care hospital, specialist, Govt, industry consultant, academia and Pharmacy benefits management.

RECOGNISED PHARMACY SPECIALITES

 Nuclear pharmacy in 1978 was the first specialty recognized in USA, This stream does not exist in many countries followed by nutrition support pharmacy in 1988, pharmacotherapy in 1988, psychiatry pharmacy in 1992(BCCPP) Oncology pharmacy in 1996, ambulatory care pharmacy 2010, Critical care pharmacy in 2013, pediatric pharmacy in 2013.

Recertification

Every seven years, recertification has to be done. Recertification is a procedure that documents the specialist’s current knowledge and skills. There are 100 questions in recertification examination and the specialist has to pass the recertification programme. Continuing education option is also available in some specialties.

Opportunities in Community Pharmacy practice, a Perspective for Indian Pharmacist

Opportunities in Community Pharmacy practice, a Perspective for Indian Pharmacist

Prof Anantha Naik Nagappa, Senior Faculty, SCS College of Pharmacy, Harapanahalli 583131, Karnataka India

anantha1232000@gmail.com

Community pharmacy is hidden treasure for Public health, when it comes out in action, it can lead to a big revolution in healthcare delivery. The present system of product centric market is going to be washed away and patient centric care shall take the place. The pharmacist in India mainly depends upon the sales margin and over focus on increasing the turn over so that profits remain always green. However in its attempt, a serious negative health care delivery affecting the health consumers and patients who are sponsors for pharmacy are affected. This is what happening resulting in poor quality of services. The Pharmacy industry, Prescribers, Regulators and Government are not showing interest due to conflict of interest, and only the patients and health consumers are only adversaries in present health care delivery system.

The patients and health consumers are tolerating the current system of delivery as they were ignorant and do not have proper advocates to represent their point of view and demand fair transparent health care delivery, which they are missing all these years. The pharmacist especially the Doctor of Pharmacy practiceioners are going to emerge as advocates for patients and healthcare consumers.  Keeping and updating the patient records by community pharmacist and consulting of Doctor of pharmacy is going to be one of the professional practices, giving lots of opportunity to the public .Currently, the maintenance of   individual patient profile and medication history is not done in India at all. If is offered as a service, it can bring the transparency and openness which automatically gives an opportunity to correct the prescriptions and avoid irrational prescribing to a standing halt.

The pharmacy practice guidelines 2015, defines that all registered pharmacist as drug information specialists    who are entitled to provide the services of clinical pharmacist as fallowing

1. “Drug Information Pharmacist” means an individual currently registered who works in a community pharmacy/hospital Pharmacy/teaching hospital/ other health care settings and provides information and advice regarding drug interactions, side effects, dosage and proper medication storage to patients/physicians/dentists/other health care professionals.
2. “Clinical Pharmacist” means an individual currently registered and who provides patient care that optimizes the use of medication and promotes health, wellness and disease prevention. Clinical pharmacists care for patients in all health care settings. Clinical pharmacists often collaborate with physicians and other healthcare professionals.

As for the patient records a registered pharmacist has to mandatory maintain the  patient records are concerned.

•       Every registered pharmacist shall maintain the medical / prescription records pertaining to his / her patients for a period of 5 years from the date of commencement of the treatment as laid down by the Pharmacy Council of India in Appendix II Pharmacy Practice Guidelines 2015

•       If any request is made for medical records either by the patients/authorized attendant or legal authorities involved, the same may be duly acknowledged and documents shall be issued within the period of 72 hours.

•       Efforts shall be made to computerize medical/prescription records for quick retrieval.

These provisions and guidelines in the law is going to be the game changer in health care delivery. It shall empower the patients with much required data, regarding how they were given treatments.  They shall be asking the pharmacist to provide services. Hence there can be huge job openings not only for Doctor of Pharmacy but also to B.Pharm and D.Pharm   holders. Every patient and health consumer are ready to provide a fee for maintaining their health and medication profiles. 

For example, if the patient is prescribed with any medicine, the patient with his record can approach the pharmacist to know is it appropriate to use the medicines. He may also learn about the medication and become aware regarding the importance of medication in the disease management. It is very important as the patient shall be taking medicine as prescribed as because he is aware of his co operation in improving his health.  The opportunity for pharmacist in drug information services are not just confined to patients, but also other  fellow healthcare providers like Doctors, Nurses and Lawyers in regular practice and in medico legal cases. The challenge before the pharmacist is to prove his professional credentials as advocates of patient safety and establish a professional image which is currently at ground 0. The public and peer healthcare practitioner either depend on Pharmaceutical industry or the Internet. Major drawback of Industry provided information is tainted with marketing practices and internet information is not authenticated and hence not reliable. The clinical pharmacist who is trained in the aspects of medicine is competent to provide one to one information, which can be subject verification and scrutiny. This is why the developed country avail the well trained clinical pharmacist for the information needs in therapeutics. The pharmacist has to establish their competence as fit for practice every year or two as they have to get fresh license to practice pharmacy profession and drug information services. Such a development is seen in India, as much drug use related safety issues are reported in media, highlighting the failure of current health care delivery being incompetent to contain and assure patient safety.        

Darker Side of Skin Care Products!

Darker Side of Skin Care Products!

 By Dr Guru prasad Mohanta

“The recent compensation of USD 72 million granted by an US Court to the family of an Alabama woman (USA) who died from ovarian cancer which was linked to well-known baby powder and other products containing talcum” raises serious concern about the safety aspects of cosmetics. She was reported to have used iconic talcum powder as a bathroom staple for decades which caused the cancer, her cause of death.

Indian market is flooded with many skin care or cosmetic products of doubtful efficacy and do have potential to cause damaging effect to health. Here is a case of fairness cream, a cocktail mixture, for the men who are in pursuit of fair skin. Flucinolone is a steroid used to treat the itching, redness, dryness, crusting, scaling, inflammation, and discomfort of various skin conditions; Hydroquinone is a skin bleaching agent; and Tretinoin is a form of Vitamin A helps skin to renew quickly.  This is a steroid based cream and un-necessary and prolong use can cause serious adverse effects. “Facial erythema with skin irritation, aggravation of acne, and steroid addiction” are the main adverse effects reported by many studies. The dermatologists cautioned against the unsupervised use of these creams.

Hydroquinone lightens the areas of darken skin by decreasing the production and increasing the breakdown of melanin in skin. Melanin is responsible for skin pigmentation. It requires at least a month or so to see the effects of topical hydroquinone in lightening the skin. Though topical use of hydroquinone is often well tolerated, some users may experience minor and temporary skin irritations like mild itching and reddening of the skin. Tretinoin is indicated for the treatment of acne. It controls but not cures. It takes about two to three weeks to see a visible change of improvement. However, it may also cause warmth or slight stinging of the skin, scaling of skin, increase in acne sores, blistering or crusting of the skin.  

Another startling finding is the presence of heavy metals in fairness creams. The Centre for Science and Environment, a not for profit organization, recently tested the marketed cosmetics and revealed the presence of mercury in 44 % of fairness creams.  Other cosmetics are no less hazardous. The presence of chromium in 50 % and nickel in 43 % of lipstick samples are also detected.  The present revelation showed that 14 of the 32 tested fairness has the presence of mercury from 0.10 parts per million (ppm) to 1.97 ppm. 15 out of 30 tested lipsticks showed the presence of 0.45 ppm to 17.83 ppm of chromium and 13 out of 30 lipstick products found to have nickel in the range of 0.57 to 9.18 ppm. The content of heavy metals in these cosmetic products are much higher than the permissible limits.

            Mercury in any form is highly toxic and potentially dangerous for pregnant woman, foetus and child. Exposure to mercury, even in fairly small amounts, may cause serious health issues. Mercury may have toxic effects on the nervous, digestive and immune system, and on lungs, kidneys and eyes.  Mercury released to environment is eaten by fishes. The individuals eating such fishes expose themselves to mercurial toxicities. Realising the toxicity of mercury based products and their environmental impact, worldwide it has been advocated to discontinue the use of mercury based health products. The steps are initiated by various authorities even to replace the mercury based clinical thermometers with digital ones. One can just imagine the health impact of use of such fairness products. The other two heavy metals found in lip sticks are equally hazardous too. Chromium is known to be carcinogenic and the acute ingestion of nickel is known to cause nausea, vomiting, diarrhoea and headache.  Nickel too is a known carcinogenic and can cause several harmful effects even deaths. The lipsticks are invariably gets ingested by users. The baby shampoo was also known to contain harmful ingredients.

Someone once said “We make cosmetics in our factory but we sell hopes in the store”. The industry should be conscious enough to selling hopes but not harming the users.