“If I have seen further, it is by standing on the shoulders of giants.” – Sir Isaac Newton
By Prof Ray I. Ozolua
Although other systems of medicine exist with some over millennia, Western (orthodox, allopathic, conventional) medicine is evidence-based with drugs as the tools. Despite rigorous pre-approval evaluations for safety and efficacy, a system of continuous monitoring is always in place. Safety entails continuous monitoring (pharmacovigilance) for the unintended outcomes of drug use (adverse effects), through multidisciplinary and multi-institutional mechanisms. Teaching and institutionalization of drug safety protocols seem like assignments given by the Almighty to Prof. Ambrose Isah who has turned 70. Being the age of retirement from active services in the Nigerian federal university ecosystem, it is worth celebrating and offers an opportunity for me to reflect on his contributions to drug safety and mentorship.
Great mentors desire that their mentees run with greater grace and glory than themselves. He taught my class topics in clinical pharmacy with zeal and zest despite the prevailing economic situation which had led to the exodus of healthcare experts to Saudi Arabia and other Gulf states. His lectures were delightful and impactful, and we unlearned and learned. Perhaps, one thing that struck us was that we could see a consultant medical doctor who neither discriminated against us nor sat on a knowledge high horse. Sir Francis Bacon’s statement that “I hold every man a debtor to his profession”, resonated well with Prof Isah’s loyalty to medicine, but it did not affect his excellent relationship with other healthcare professionals.
I was employed as a Graduate Assistant within a few days of completing the mandatory national youth service and I immediately began postgraduate studies. I was rattled academically when Drs Eric Omogbai and Ambrose Isah (as they then were), came to me in my laboratory office to suggest a topic for my MSc thesis that would be jointly supervised by them. We were to unravel the circumstances behind the prevailing use of indomethacin, a non-steroidal anti-inflammatory drug (NSAID), as a rodenticide. Was something missed before its approval for clinical use? Phenylbutazone, another NSAID, had been withdrawn due to a post-marketing surveillance-discovered adverse effect and this tilted prescriptions towards indomethacin. Adherence to prescribed indomethacin became a problem because patients were afraid of taking what had become a rodenticide. We ligated the bile duct of rats and found that enterohepatic recycling accounted largely for the rodenticidal action that presented as fatal peritonitis, gastrointestinal ulceration, renal tubular necrosis, and hepatocellular degeneration. Rats often ingested far more than the oral LD50 when indomethacin was applied to bait. An aspect of the study (Omogbai EKI, Ozolua RI, Idaewor PE, Isah AO, 1999, Some studies on the rodenticidal action of indomethacin, Drug and Chemical Toxicology 22: 629–642) elicited further evaluation of the drug in USA. Prof. Isah, therefore, joined in cutting my teeth in experimental toxicology.
I recall how he and Prof. Eric Omogbai got me involved in external examinership. They recommended me to many schools immediately I was promoted to the rank of Senior Lecturer and in some cases, took me along as a co-examiner. They trained me and sharpened my skills in writing examiner’s report. Together, Prof. Isah and I supervised theses that interrogated drug safety. He has personally supervised several postgraduate dissertations and theses, and many of his former mentees are now professors. It is therefore appropriate to say that his academic trajectory has been one of profundity and fecundity.
Prof Isah and I rendered consultancy services to healthcare development partners and the Federal Ministry of Health. With him as my leader, we wrote the first ever national policy on pharmacovigilance. This was despite the obstacles, financial and otherwise, that could have stalled the process, but he importunately finally got the Federal Executive Council to approve the policy. He got Medical Sciences for Health (MSH), a USA-based agency, to hire me as a consultant for a pharmacovigilance-related national survey, when he was away in Uppsala. This also accentuates his strong mentorship.
Chairing the National Drug Safety Advisory Committee (NDSAC) epitomized his contributions to the Nigerian health system. It is to his credit that drugs which had become thoroughly misused especially by quacks, and had posed serious safety risks, were either withdrawn or had their formulation strengths changed. For example, dipyrone (metamizole), a once popular analgesic and antipyretic injection sold as Novalgin® and Analgin®, was withdrawn, and 280 mg gentamicin injection was discontinued, based on safety evaluation by NDSAC. Through his efforts, Nigeria featured prominently at the Uppsala Monitoring Centre, the global hub for adverse drug reaction signal detection and monitoring. He was not only enthusiastic about drug safety in Nigeria, but he also extended it to the whole of Africa and beyond.
Beyond drug safety and clinical pharmacology, Prof Isah represented the humblest and self-effacing persons within the University of Benin community. He was miscible with the poor as with the rich, with the ignoramus as with the cerebral, with the foolish as with the wise, with the timid as with the sociable. But he repudiated the evil, the cunning, and the sharp practitioners. He had a short fuse for nepotism and lack of due process. Every mentee imbibes some of the idiosyncrasies of their mentor. As he took me along with him round the country, delivering lectures and holding meetings that promoted drug safety, his attitudes, knack for diligence, quest for excellence, love for fellow human beings, altruism, and an unparalleled patriotism, should have rubbed off on me, I suppose.
This academic colossus has bestridden the landscape of University of Benin, of Nigeria, Africa, and indeed the world with remarkable excellence. I wish him sweet longevity with a brain that remains academically interrogative, a mind that is sharp, and a body that is quick. May the years ahead of him be very many and glorious. May the curative properties and safety of drugs be better advanced by his mentees.
Ray I. Ozolua, B.Pharm., M.Sc., PhD, FWASP, FPSN, FNAPharm
Professor of Pharmacology & Toxicology/ Former Deputy Vice Chancellor (Academic) at the University of Benin.