TS: What is your background?
“I am a pharmacist by profession. I believe that this vocation initially sprouted at home, since my mother is a nurse and my sister is a pharmacist (although, truth be told, in hindsight, I wonder whether it would have been a wiser option to follow the steps of other cousins, since I would have ended up as deputy prime minister or judge!). Following graduation as a pharmacist, I furthered my studies by taking up doctorate studies on a parttime level. I considered a PhD with the Faculty of Medicine and Surgery to be a better option to any other 3-year part-time Masters-equivalent course. The study period lasted nine years and successfully ended two years ago.”
TS: What was your PhD research area?
“The studies were conducted within the department of Paediatrics, under the supervision of Prof. Victor Grech. The main research related to off-label and unlicensed use of paediatric medicine in the community setting in Malta and Gozo. This research was requested by the European Commission. So my studies effectively bridged this knowledge gap for Malta. In view of the fact that I started my studies a couple of months before the scholarship scheme was introduced by the previous government, I ended up paying every last cent of the research. At this stage I also need to thank Prof. Simon Attard-Montalto, Dr Paul Vassallo-Agius, Dr Herbert Lenicker and Prof. Liberato Camilleri [brilliant statistician] for their invaluable help.”
TS: What were your main findings?
“We found that almost one in two prescriptions were being prescribed in an off-label or unlicensed manner. It is however, important to bear in mind that such prescribing [within the principle of therapeutic freedom] does not mean that these medicines were being prescribed in an unsafe manner. Rather, the two main contributing factors were a lack of appropriately licensed paediatric medicines and lack of harmonisation between the product literatures of medicines containing the same composition of active ingredients. In fact, against this backdrop, the main concern by participants related to medicolegal issues.
The highest incidence of off-label or unlicensed prescribing was found in the 1 month – 2 years age range. More paediatricians, rather than family doctors, prescribed in an off-label or unlicensed manner for age. Conversely, more family doctors, rather than paediatricians, prescribed in an off-label manner for dose.
During the course of the research I was privileged to be invited at conferences in various European cities as speaker, including Genoa, Rome, Marseille, Brussels, Liege, Warsaw, Dublin, Prague and London. I was also lucky to receive one of five travel scholarships awarded by the Drug Information Association. Our research was also published in various peer-reviewed European and US journals. The last publication is Can Registration Procedures of pharmaceuticals inadvertently Contribute to OffLabel Prescribing in Children?, published earlier this year in the official journal of the Drug Information Association.”
TS: Your work has not been solely academic. In fact for somebody so interested in academia, you have really moved around. Can you explain more about your journey within your field?
“I started as a director of pharmacy services with the St James Group. Afterwards I took a job at the Medicines Authority for eight years in the licensing directorate. During that time, I was appointed national coordinator for clinical trials. This involved setting up from scratch the framework for the regulation of clinical research in Malta; I personally transposed and translated the relevant EU legislation. After that experience I became a partner in a private business. In the meantime I was also approached to be a second-line responsible person, as well as conduct local literature surveillance of adverse events, for a couple of pharmaceutical companies. In 2013 I was also asked to head the regulatory affairs office of a major institution, however I declined in view of my studies. Presently I work as technical evaluator at the Central Procurement and Supplies Unit, evaluating tenders relating to medicinal products, foods and medical devices within the Ministry of Health. Since 2004 I have been on the board of the Health Ethics Committee whose remit includes the evaluation of proposals for research being conducted in the health sector, including ethical and data protection aspects. Most surprisingly, our appointment expired in August 2014 and the new committee has never been appointed. Maybe the reason is that we do not get paid, so there aren’t a lot of people interested in replacing us! Recently, I was also privileged to be invited by the British Medical Journal to be a peer reviewer.”
TS: What do you do in your free time?
“For quite a number of years I was involved on a voluntary basis within the Kummissjoni Djoċesana Żgħażagħ. This is where I met my wife. So the Kummissjoni holds a special place in my heart. Another key initiative I was involved in was the setting up of a youth centre in Luqa in 2003. I remember that at the time I was nursing a broken ankle and it dawned on me that young people in Luqa did not have any social meeting place. I started the ball rolling together with a couple of good friends, also from Luqa. I am proud to say that the group is still going strong.”
TS: So voluntary work was important on several counts. You mentioned meeting your wife …
“Yes we have been married for two and a half years and are the proud parents of a 1 year old girl … fatherhood is a remarkable thing …”
TS: And of course you are the managing editor of The Synapse Medical Journal.
“I remember when I started to be involved with the production of the journal, over 11 years ago, when the publication was a two-colour eight-pager. Over the years it has definitely evolved. Today it carries between 28 - 32 pages in fourcolour (full colour). The Synapse Journal is basically unrivalled within the Maltese medical field since we print a yearly average of 180 pages over 6 issues which are printed, then mailed, to practically each and every doctor, pharmacist and dentist in Malta. Each print run is 3500 copies.
We try to collaborate closely with various key stakeholders, namely the Malta Medical Students Association, Malta Pharmaceutical Students Association, Malta Association of Dental Students, German Maltese Medical Society, Health Promotion Department, University of Malta, Department of Health Information, Chamber of Pharmacy and many others besides. Recently we also had the pleasure of including articles by various lawyers including Dr Yana Micallef Stafrace [Percentage disability reports in the medical field], Drs Sonia Vancell & Franco Vassallo [Negligence and Civil Liability in the Medical Profession] and Judge Giovanni Bonello [The Decline and Fall of the Sacra Infermeria]. Apart from articles, each issue includes an interview [like this one] with a key professional which is a great way to getting to know peers. We also place a great effort in featuring fronts which are somewhat related to medicine, be it medicinal plants, paintings by medics or pharmacists or historical medical buildings.
Sixty-seventy hours of my time goes into each publication. Responsibilities include the development, acquisition and management of content, as well as overseeing the overall layout of articles. The core tasks include copywriting and content writing. Considering that each issue is posted to 3,500 subscribers, including several foreigners, it must be carefully and meticulously compiled.”