Vitamin C: Prevention of Chronic Diseases and Optimal Doses

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Vitenskap Review Vitamin C: Prevention of Chronic Diseases and Optimal Doses

TEXT: Purusotam Basnet, Department of Pharmacy, Faculty of Health Sciences, University of Tromsø, e-mail: [email protected]

INTRODUCTION acid because of its anti-scorbutic property ABSTRACT It has been known for a long time that (Latin word scorbutus = scurvy). In absence of fresh fruit and vegetables in the solution, it releases a proton to give an The role of vitamin C in prevention and human diet leads to scurvy, a fatal disease anion called ascorbate. Ascorbate easily treatment of scurvy is well accepted. In widely described throughout written transfers one electron and one additional spite of having long history as the candidate of alternative therapy for the history (Lind, 1753). Later, it was dis - proton and can remains in the stable prevention and treatment of cancer, still covered that ascorbic acid in fresh fruits radical form as semidehydroascorbate there is no common conclusion on the and vegetables prevents scurvy and that is (SDA), a state in between dehydroa- topic. However, its biochemical reaction why it is a vitamin for humans and must be scorbic acid (DHA) and ascorbate in the as an antioxidant and its immuno- a part of human diet (Mandl et al., 2009). physiological condition (figure 1). stimulating effects drew further Among the long list of people who Because of the unique electron trans- attention towards its health beneficial contributed to the knowledge regarding ferring capability, ascorbate plays a vital effects. Current official recommended vitamin C, three Nobel prize-winners are in role in living cells. Our body synthesizes dietary allowance in most of the the fore front. Albert Szent-Györgyi discov- collagen to strengthen connective tissue. countries is higher than what is needed ered vitamin C as an anti-scorbutic factor For this, prolyl residue must be for the prevention of scurvy, but (Svirbely and Szent-Györgyi, 1932). hydroxylated and the reaction is carried research result suggested that it is far Walter Norman Haworth used the material out by the enzyme prolyl hydroxylase with less to obtain optimum health. from Szent-Györgyi and elucidated the the support of vitamin C (figure 2). The Therefore, especially for the prevention structure and synthesized vitamin C hindrance of this biochemical reaction is of chronic illness such as cancer, (Haworth and Hirst, 1933). For their contri- the cause of scurvy. In spite of having its hypertension, Alzheimer’s diseases etc., it is recommended to consume more butions, Szent-Györgyi and Haworth were vital role in physiology, human is unable to fruits and vegetables together with the rewarded with Nobel prizes in medicine synthesize ascorbate due to the absence of vitamin C supplements. Evaluating the and chemistry in 1937, respectively. The the enzyme, gulonolactone oxidase (GLO) vitamin C efficiency and safety with third person, Linus Pauling is perhaps the as found in most animals and those current literature, up to 1 g/day supple- most renowned advocate of vitamin C. animals including human unable to pro- ment of vitamin C has been suggested to Pauling believed that high doses of vitamin duce GLO, need external supplement of be needed for optimal health. In C can cure or prevent several mental ill- ascorbate as vitamin to carry out normal addition, male population compared to nesses, chronic diseases such as heart dise- physiological functions (Linster and Van female population, older population ases and cancer, including common cold Schaftingen, 2007). compared to younger population, (Pauling, 1970; Cameron and Pauling, Besides acting as a cofactor in several smoking population compared to non- 1973; Cameron and Campbell, 1974; metabolic reactions, it serves primarily as smoking population and stressed Pauling, 1974; Cameron and Pauling, a biologic antioxidant and free radical population compared to non-stressed 1979; Cameron and Pauling, 1993). The scavenger in aqueous environment. Free population need larger amounts of vita- knowledge contributed by these three great radicals produced by enzymatic and non- min C to obtain health beneficial effects. scientists and many others led to the found- enzymatic reactions inside and outside ation for research on vitamin C. cells have been suggested as a major Although the role of vitamin C in the pre- cause of aging process (Harman, 1956; vention and treatment of scurvy is well Harman, 1994). This theory was further accepted, immunomodulatory effect of supported by the discovery of superoxide MAIN MESSAGE vitamin C, its role as an antioxidant to dismutase (SOD) (McCord and Fridovich, Vitamin C (ascorbic acid) is one of the prevent or treat chronic illness and official 1969). Since then, a great deal of essential components in human physio- recommended dietary allowance (RDA) evidences has been accumulated impli- logy working as a water-soluble antioxi- are under critical discussion (Deruelle and cating free radical reactive oxygen and dant and enzyme cofactor. Humans do Baron, 2008; Mandl, 2009). In this review, nitrogen species in the pathology of a not synthesize ascorbate, therefore we need to administer it through diet or the effect of vitamin C on cancer and other number of chronic diseases and age supplements. We must assure a sufficient diseases and optimal doses are discussed. associated functional decline (Knight, intake of vitamin C in order to define its 1998, Ratten 2006; Viña et al., 2007; role for the prevention or treatment of UNIQUE CHEMICAL FEATURE AND Gruber et al., 2008; Ljubunic and Reznick various diseases. BIOLOGICAL FUNCTION OF VITAMIN C 2009). Ascorbate readily scavenges many

Vitamin C (C6H8O6) is named as ascorbic physiologically relevant reactive oxygen

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CH OH 2 CH2OH CH2OH CH2OH CH2OH H C OH H C OH H C OH H C OH H C OH O O O O O O O O O O H e, H e H H H H H H e, H e HO OH O OH O OH O O O O

Ascorbic acid Semidehydroascorbate Dehydroascorbic Ascorbate (ASC) radical (SDA) acid (DHA)

Figure 1. Structure of ascorbic acid and its fates during physiological reactions.

and nitrogen species and is the most effective endogenous aqueous phase COO H O antioxidant in human plasma under many different oxidizing conditions (Frei et al., NCC CH2 1989). Although other endogenous CH2 antioxidants are able to decrease the rate + O2 + of lipid and protein oxidation in plasma, C O only ascorbate is reactive enough to H H intercept oxidants before they can cause COO Prolyl residue Prolyl hydroxylase detectable oxidative damage. Due to its +Ascorbate α−Ketoglutarate role as an antioxidant and by having +Fe+++/Fe++ immunomodulatory functions, vitamin C is H O COO one of the most promising molecules of NCC health beneficial effects. For this purpose, CH2 more than 86,000 metric tons of vitamin C + CO2 + was consumed only in 2003 which is more CH2 than 50 % of all the other vitamins. In C O addition, consumption rate is expected to H OH increase by more than 2000 metric tons 4-Hydroxyprolyl residue O per year (Asard et al., 2004). Succinate

RECOMMENDED DIETARY ALLOWANCE FOR VITAMIN C Figure 2. Hydroxylation of a prolyl residue with the enzyme prolyl hydroxylase. In this The US Food and Nutrition Board has pre- reaction, vitamin C acts as an antioxidant by reducing ferric ion which activates prolyl pared RDAs for vitamin C since 1941. hydroxylase. Hydroxyprolyl residue stabilizes the collagen triple helix by forming interstrand hydrogen bonds. Initially, the RDA was based on the amount needed to prevent people from getting scurvy with a safety margin but numerous research results suggested that lactating period. Pauling suggested the for chronic diseases such as heart disease this may not be sufficient for optimal daily intake of vitamin C of 250–4000 mg and certain types of cancer (Hathcock, health (Pauling 1974; Levine et al., 1996; (Pauling, 1970; Pauling 1974). Challem 1997; Ames 2004; Ames 2005; Ames Food and Nutrition Board, 2000). concluded that the RDAs might be 2006). In this connection, two studies Moreover, the RDA for vitamin C is based seriously inadequate guidelines for health demonstrated that current RDA for vitamin on estimates of rates of absorption, (Challem, 1999). However, high doses of C should be re-evaluated and increased to depletion, turnover and catabolism (Levine vitamin C, as proposed by previous aut- 200 mg daily (Levine, 1996; Graumlich et et al., 1999; Food and Nutrition Board, hors, are not supported by all literature. A al., 1997). 2000). For vitamin C, however, the meta-analysis on a potential effect of information is unavailable, incomplete, or vitamin C on the common cold showed ROLE OF VITAMIN C IN CANCER flawed. Currently, RDA requirements for that there seems no justification for routine THERAPY vitamin C differ among countries, with the mega dose vitamin C supplementation, For the prevention of cancer, the US highest value being 110 mg/day (Food 1–3 g/day, in the normal population department of Agriculture and the and Nutrition Board 2000; Levine et al., (Hemilä et al., 2007a). Moreover, without National Cancer Institute has recom- 2001). According to Norwegian Social reaching the mega doses of vitamin C mended five servings of fruits and and Health Affair, the RDA for vitamin C consumption, numerous reviews suggest vegetables daily. Further analyses have are 75 mg per day for the adult and 100 that intakes of vitamin C much higher than suggested that this consumption should be mg per day for the women during the RDA may reduce the risk or risk factors even higher (Lachance and Langseth,

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1994; Guenther et al., 2006). If these i.v. doses up to 1.5 g/kg in patients According to Frei and Lawson, ascor- recommendations are based on vitamin C (Riordan et al., 2005; Hoffer et al., 2008). bate (ASC–), which is regarded as anti- and followed, daily intake will be 210 to Additionally, a series of case reports oxidant in general, can act as a pro- 280 mg, depending on food type (Levine, indicated that high-dose i.v. vitamin C was oxidant by donating an electron to redox- 1999). Reports suggest that fresh produce associated with long-term tumor regress- active transition metal ions, such as ferric or juice may loose 50–100 % of its vitamin ion in three patients with advanced renal (Fe3+) or cupric (Cu2+) ions, reducing them C content due to handling and processing cell carcinoma, bladder carcinoma, or B- to ferrous (Fe2+) or cuprous (Cu+) ions, (Severi et al., 1998; Gil et al., 1999; cell lymphoma (Hoffer et al., 2008). respectively (Eq. 1) (Frei and Lawson, Johnston and Bowling, 2002). Further - Vitamin C can be taken i.v. or orally. 2008). In fact, reduction of iron or copper more, more than 500 mg/day of vitamin Oral absorption of vitamin C can not in the catalytic site of certain enzymes C would be difficult to obtain from dietary achieve plasma concentrations com- underlies ascorbate’s well known sources alone and therefore would require parable to those obtained by i.v. biological function as a co-substrate in supplements especially for the prevention administration (Padayatty et al., 2004). procollagen, carnitine, and catecholamine of cancer (Levine et al., 1995). In spite of Intravenous doses were used as an biosynthesis (Englard and Seifter, 1986). wide use of vitamin C as an alternative alternative therapy to treat patients with Reduced transition metal ions, in contrast

therapy for the prevention and treatment advanced cancer (Cameron and Pauling, to ascorbate, readily react with O 2, of cancer, the potential cancer-therapeutic 1993; Padayatty et al., 2004; Riordan et reducing it to superoxide radicals (Eq. 2),

activity of vitamin C has a long and al., 2005; Hoffer et al., 2008). This can be which in turn dismutate to form H2O2 and controversial history (Verrax and explained by the fact that i.v. doses raise O2 (Eq. 3) (figure 3). Calderon, 2008). plasma concentrations as high as 14,000 In addition, the reaction of ascorbate

In 1973, Pauling and Cameron µmol/L, with doses of 50–100 g/day and with iron and H2O2 produces the postulated that vitamin C inhibits tumor concentrations of 1000–5000 µmol/L extremely reactive pro-oxidant hydroxyl growth with the treatment of high doses were found selectively cytotoxic to tumor radical (Halliwell 1987). Although (Cameron and Pauling, 1973). Cameron cells but not to normal cells in vitro scientific rationale for the production of

and Campbell reported beneficial effect of (Benade et al., 1969; Bram et al., 1980; H2O2 and radicals in initiation with vitamin C based on the response of 50 Leung et al., 1993; Riordan et al., 1995; ascorbate as shown in figure 3 might be a consecutive patients with advanced cancer Casciari et al., 2001; Padayatty et al., matter of discussion, it is evident that to continuous i.v. infusions (5–45 g/day) 2006). ascorbate causes cancer cells to undergo and/or oral doses (5–20 g/day) A rosy picture came forward with the apoptosis, pyknosis, and necrosis by

(Cameron and Campbell, 1974). recent series works of Chen et al. which H2O2-dependent pathways (Chen et al., Cameron and Pauling compared survival showed that high doses (pharmacologic 2005). In contrast, normal cells are

time between 100 patients with terminal doses) of vitamin C decreased the growth considerably less vulnerable to H2O2. The cancer treated with i.v. and oral vitamin C, and weight of human, rat, and murine reason for the increased sensitivity of

usually 10 g/day and 1,000 comparable tumor xenografts in athymic nude mice tumor cells to H2O2 is not clear but may be patients not given vitamin C (Cameron (Chen et al., 2005; Chen et al., 2007; due to lower antioxidant defences and Pauling, 1976). Patients treated with Chen et al., 2008). The results suggested (Oberley and Oberley, 1997). Whatever vitamin C survived approximately four that millimolar concentrations of extrac- may be the exact mechanism, the

times longer than controls. A follow-up ellular vitamin C selectively kill cancer cells increased sensitivity of tumor cells to H2O2 study reported that patients given vitamin but not normal cells in a hydrogen may provide the specificity and

C had a mean survival time almost 1 year peroxide (H2O2)-dependent manner. Such «therapeutic window» for the antitumor longer than matched controls (Cameron millimolar concentrations of vitamin C can effect of extracellular millimolar and Pauling, 1978). be achieved in humans by i.v. infusion but concentration (higher doses) of vitamin C. The National Cancer Institute sponsored not by diet or supplements (Padayatty et two randomized, placebo-controlled, al., 2004). Hence, vitamin C is postulated IMMUNE RESPONSE AND OTHER double-blind trials with vitamin C and to exert local pro-oxidant effects in the BIOLOGICAL FUNCTIONS OF VITAMIN C advanced cancer at the Mayo Clinic interstitial fluid surrounding tumor cells, White blood cells store higher quantities of (Creagan et al., 1979; Moertel et al., killing them or inhibiting their growth, vitamin C even when levels in the 1985). In both trials, patients were given while leaving normal cells intact. surrounding plasma are low (Hornig, 10 g/day vitamin C or placebo. Survival rates were essentially the same for all groups. Plasma concentrations of vitamin C were not measured in these studies and vitamin C was given only orally. In ASC– + Fe+++ ¨ SDA•– + Fe++ + H+ (1) ++ ¨ •– +++ retrospect, the Mayo Clinic trials may have Fe + O2 O2 + Fe (2) •– + ¨ failed to properly evaluate the clinical 2O2 + 2H H2O2 + O2 (3) efficacy of vitamin C in cancer because of – ¨ •– insufficient plasma concentrations of 2ASC + O2 2SDA + H2O2 (total reaction) vitamin C attained with oral supplementation (Padayatty et al., 2004). Ascorbate (ASC–); Semidehydroascorbate (SDA•–) In spite of several controversies, two phase I clinical trials with vitamin C have +++ recently been published that demonstrated Figure 3. The possible pathways of vitamin C to generate H2O2 by the reduction of Fe remarkable tolerance and safety for high (Frei and Lawson).

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1975; Omaye et al., 1986; Moser, 1987; 1–3 g daily, may be required to reduce vitamin C above 1.5 g in fact reduced the Jacob, 1990). In fact, vitamin C has been risk of chronic diseases such as cardio- risk of kidney stones (Curhan et al., 1996; defined as a stimulant of leukocyte vascular disease, cancer, or cataract (Carr Curhan et al., 1999; Gerster, 1997). function, especially of neutrophil and and Frei, 1999a; Frei and Traber, 2001; Li Evidence indicates that high intakes of monocyte movement (Maggini et al., and Schellhorn, 2007). Furthermore, the vitamin C do not increase oxalate 2007). Vitamin C supplementation was oxidative stress associated with many excretion or induce the potential formation shown to improve many indices of human diseases may increase ascorbate of kidney stones (Hathcock, 1997; immune responses, such as antimicrobial requirements (Harman, 1994; Mezzetti et Hathcock, 2005). and natural killer cell activities, al., 1996). Large doses of ascorbate have Gastrointestinal distress seems to be the lymphocyte proliferation, chemotaxis, and been found to reduce cardiovascular most common adverse effect of higher delayed-type hypersensitivity response, disease risk, lengthen the lifespan of doses of vitamin C intake (Miller and and the concentration of vitamin C is patients with cancer (Cameron and Hayes, 1982). When these symptoms found to be higher in activated neutrophils Pauling, 1979; Enstrom et al., 1992, occur, the vitamin C dosage is usually and macrophages (Wolf, 1993; Jacob et Myint et al., 2008). Supporting this fact, more than 2 g/day. The symptoms al., 1991; Washko et al., 1991; May et the epidemiological studies have con- generally disappear within a week or 2 al., 2005). Moreover, in older people firmed an inverse relationship between with no further consequences, and may (over 70 years), known to have reduced serum ascorbate level and blood pressure. have been produced by other components vitamin C plasma and leukocyte A decrease in plasma vitamin C level has such as sorbitol (Hill and Kamath, 1982). concentrations, vitamin C supplementation been observed in both type 1 and type 2 Other studies and recent phase I clinical (500 mg/day for 1 month) enhanced the diabetes (Asard et al., 2004). Moreover, trials showed that large doses of vitamin C proliferative response of T lymphocytes the literature has demonstrated that men are safe (Hemilä, 1999; Hanck, 1982; (Kennes et al., 1983). Furthermore, in might require more vitamin C than women Johnston, 1999; Garewal and Diplock, healthy people and neutrophil motility (Jacob, 1990; VanderJagt et al., 1989) 1995; Riordan et al., 2005; Hoffer et al., defective patients, with higher and that the elderly might require more 2008). A recent review demonstrated that concentrations of ascorbate (supple- ascorbate than younger people vitamin C supplements of 2 g/day are mentation of 1 g/day), white blood cells (Blanchard et al., 1990; Blanchard, 1991; safe for most adults (Hathcock et al., became more active and could move Heseker and Schneider, 1994). 2005). These authors also supported the toward infection or inflammation more claim that intakes of up to 4 g/day are quickly (Anderson, 1981; Anderson, SAFETY OF VITAMIN C well tolerated in the general population. 1981a; Anderson, 1982). SUPPLEMENTATION No consistent and compelling data Lenton et al. demonstrated that 13 It has been suggested that vitamin C alone demonstrating serious adverse effects of weeks with vitamin C supplementation or mixed with N-acetyl-cysteine could be vitamin C in humans have been (500 or 1000 mg/day) promoted an toxic, acting as a pro-oxidant (Podmore et established (Frei and Traber, 2001), increase in lymphocyte glutathione level, al., 1998; Childs et al., 2001). However, although the tolerable upper limit intake suggesting that vitamin C may also be of the literature shows that ascorbic acid is has been estimated to 2 g/day (Food and value in the treatment of glutathione not a pro-oxidant in vivo, even with iron Nutrition Board, 2000). deficiency (Lenton et al., 2003). For co-supplementation (Carr and Frei, example, during aging, ascorbate and 1999a; Gomez-Cabrera et al., 2008). CONCLUSIONS glutathione in lymphocytes were found to The literature has also evoked the pot- Vitamin C is an essential component of be decreased, and low concentrations ential adverse effects of high doses of human physiology and should be supplied caused a higher risk of cancer, parti cular- vitamin C, especially as regards the either through fresh fruits and vegetables ly lung cancer, and chronic illnesses such increase in oxalate and kidney stone or through supplements. The clinical as ischemic heart disease, diabetes, formation (Levine et al., 1996; Levine et benefit of vitamin C known so far is the cataract, chronic renal failure, and al., 1999). Indeed, Auer et al. demon- prevention of scurvy. Intake of as little as eukaemial (Kharb et al., 2000; Loria et strated that 8 g/day, for 8 consecutive 10 mg/day is sufficient for this purpose. In al., 2000). days, can cause harmful calcium oxalate order to potentiate immune function or Men with low serum ascorbate crystalluria secondary to relative prevent chronic illnesses such as cancer, concentrations may have an increased risk hyperoxaluria in persons who have a hypertension etc., higher doses of vitamin of mortality (Loria et al., 2000). Fletcher et predisposition for increased crystal aggre- C are needed. Recent clinical updates on al. have measured that men (mean age 80 gation (Auer et al., 1998; Auer et al., the role of vitamin C in tetanus (Hemilä years) with 100 mg/day vitamin C intake 1998a). Wandzilak et al. observed a and Koivula 2008) pneumonia (Hemilä presented a mortality risk nearly half that modest increase in urinary oxalate after and Louhiala 2007), asthma (Kaur et al., compared to men with a consumption of administration of high doses of vitamin C 2009), diabetic retinopathy (Lopes de 50 mg/day (Fletcher et al., 2003). A large (5 and 10 g/day for 5 days) (Wandzilak Jesus et al., 2008) and pregnancy body of evidence demonstrates that et al., 1994). Moreover, other work by (Rumbold and Crowther 2005) are increased dietary vitamin C intake can Auer et al. using 4 g/day of ascorbic acid available as Cochrane reviews. Most of enhance resistance to and improve for 5 days, concluded that ingestion of these reviews conclude that present recovery from infectious, degenerative these doses did not affect the principal risk knowledge does not allow a strong diseases, and certain types of cancer factors associated with calcium oxalate conclusions on the role of vitamin C, (Hemilä, 1992; Hoffer and Pauling, 1993; kidney stone formation (Auer et al., 1998; however the weakness of research met- Carr and Frei, 1999). Many biological, Auer et al., 1998a). Furthermore, large hodology in vitamin C clinical trial has to clinical, and epidemiological studies have doses of vitamin C (1.5 g or more) did not be considered before further conclusion indicated that higher intakes of vitamin C, produce kidney stones and the doses of (Lykkesfeldt and Poulsen, 2009). ¨

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We need more research to explain some suffering from acute and chronic diseases doses during the day, in order to ensure of the facts associated with vitamin C such remains to be determined. Many studies an optimal health. Moreover, male as: lack of vitamin C supply causes have demonstrated that higher doses than population compared to female decrease number of leukocytes, tobacco the RDA for vitamin C can potentiate the population, older population compared to smoking lowers the plasma and leukocyte immune system and prevent as well as younger population, smoking population vitamin C level, refined carbohydrate treat a wide range of pathologies. compared to non-smoking population and seems to be accelerated the process of The need of vitamin C is higher to those stressed population compared to non- depleting vitamin C, women’s vitamin C who are in continuous oxidative stress. stressed population may need higher plasma levels are approximately 20 % Oxidative stress is the focal point for consumption of vitamin C to obtain health higher than men’s for any given dietary chronic illnesses in human. The direct beneficial effects. intake, vitamin C plasma level decreases evidence and mechanism of action for the by aging, etc. in order to get a clearer role of vitamin C in treating chronic Conflict of interest: None picture of the biological functions of illnesses could not be correlated yet, but vitamin C. results of epidemiologic and indirect For references, see A recommendation of five servings of studies are in strong support (Myint et al., www.farmatid.no/id/4002 fruits and vegetables daily for the cancer 2008). prevention is not sufficient to obtain Consequently, even if vitamin C Manuscript received October 7, 2009 optimal benefit based on the current requirements vary greatly among and accepted April 30, 2010. reviews. In addition, because of modern ndividuals,i it is suggested that vitamin C farming, handling and processing, more supplementation is not only safe but also than 500 mg/day vitamin C would be necessary to achieve optimal health. difficult to obtain from dietary sources Therefore, in agreement with the current alone. It should be noted that pharmaco - literature, it can be suggested, especially kinetics and physiologic responses to vita- to the older population to consume more min C are known to vary considerably than five servings of fruits and vegetables between individuals and optimal intakes daily, added to 1 g of vitamin C for children, older adults and those supplementation divided in two or three

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FARMASIDAGENE 2010 I tillegg støttet Selskapet, via stipend- enet gjennomgikk rett før, under og etter den arrangeres 28.–30. oktober med hovedtema fondet, deltakelse for Helle Håkonsen og nye apotekloven kom i 2001. «Riktig legemiddelbruk – for hvem?». Stein Lyftingsmo, som begge bidro med Program og påmeldingsskjema finner du innlegg og poster. Se hjemmesiden for mer ETIKKRÅDSMØTE på www.nfs.no. Som NFS-medlem sparer du informasjon om dette. Det nye Etikkrådet hadde sitt andre møte 8. mye på deltakeravgiften, og melder du deg september. Etikkrådet for farmasøyter i på før 26. september blir det enda rimeligere. NYE BØKER INNEN FARMASIEN Norge er det faste organ i spørsmål som Satellittsymposiet 28. oktober omhandler Selskapet har, sammen med flere andre, ytet angår farmasøytisk yrkesetikk. Det gjelder «Bruk og misbruk av rusmidler; legemidlers støttet til to nye «farmasibøker». både i forhold til enkeltsaker og spørsmål av andel av problemet og plass i rehabilitering- I starten av august ble den nye lære boken generell karakter. For mer informasjon om en». Her vil blant annet utvalgs leder Thorvald i samfunnsfarmasi tilgjengelig. Boken heter hvem som sitter i Etikkrådet og arbeidet som Stoltenberg snakke om hva «Utvalg for å «Samfunnsfarmasi – legemiddelbruk og gjøres, kan du gå inn på menyvalget «etikk» utrede de mest hjelpetrengende rusmiddel- farmasøytisk profesjonsutøvelse». Redak - på www.nfs.no. avhengige» har sagt i sin innstilling. tører er Kjersti Bakken og Anne Gerd I disse dager begynner også seksjons - Granås. Den 6. september inviterte Fag bok - DATAKRØLL FOR SELSKAPET foredragene å bli klare. De legges fortløp- forlaget, forfatterne og Selskapet til Release - I løpet av sensommeren har Selskapet skift- ende ut på hjemmesiden vår. Jan Egeland party i Apotekforeningens lokaler på Major- et server og dermed også måttet skifte e- kom mer på Internasjonal seksjon – gjør du? stuen. Etter et kort program med informasjon postsystem. Dette har dessverre resultert i om boken og innholdet kunne redaktørene, en del datakrøll. Dersom du har sendt en e- 70 TH FIP-KONGRESS I LISBOA medforfatterne og andre interesserte feire post med forespørsel til Selskapet i 28. august til 2. september gikk årets FIP- bokutgivelsen med sprudlende drikke og juli/august og ikke fått svar på denne, kan kongress av stabelen. Årets tema var From hyggelig «mingling». dette være årsaken. Fint om du da tar Molecule to Medicines to Maximising Patient I midten av august ble boken «Riktig k ontakt med Selskapet igjen. (Dette gjelder Outcomes. 32 norske farmasøyter hadde medisin? En historie om apotekvesenet» ikke påmeldinger til Farmasidagene, da funnet veien til Portugal. utgitt. Forfatter er Olav Hamran (forfatter av disse går i et annet system.) Styreleder Britt Wolden var offisiell «Farmasøytenes historie i Norge representant fra Selskapet, og reiste sam - 1858–2008», NFFs jubileumsbok), og er Rønnaug Larsen, men med undertegnede. historien om de store endringene apotekves- daglig leder i NFS

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