NOWADAYS WEB-BASED LEARNING is having a dramatic impact on the development of sales personnel. Geographically spread and often isolated from day-to-day contact with colleagues, sales people are the natural audience for on-line learning and recent research on its effectiveness in the workplace has identified motivated professionals as the most likely people to benefit from this relatively new concept. These people have little interest in the authority and discipline of the classroom. Moreover, they thrive on these kinds of independent learning activities which challenge them with relevant content and help them take charge of their own development. However, like most new initiatives, implementing successful web-based learning depends on a clear understanding of the proper process. This article highlights the critical elements in this process and illustrates how web-based learning can improve the performance of a typical sales force.

There are three key elements in improving sales force productivity and proficiency:

• Defining the organisation’s business needs and expectations
• Understanding the learners needs and readiness
• Establishing an effective tracking system for the learning process

Defining the organisation’s business requirements and expectations
It seems obvious that clearly defined business requirements should drive new business initiatives. Yet, sometimes we have to cajole clients to articulate the business improvement they want to achieve. For example, working with a team of trainers in a media business, we found it difficult to get them to define their business objective beyond having a, ‘better trained sales force’. Only when we asked the sales director to lead the project did they state that growing sales was their prime need and expectation! Perhaps surprisingly, experience in the USA suggests that marketing and sales managers often view training as not integral to the success of their business. However, the introduction of web-based learning frequently requires sales management to handle the course development to ensure their business objectives are achieved and this has led to a change of perspective in some quarters.

Donald Clark, a UK guru of on-line learning, claimed: “We must look beyond the boundaries of traditional training and beyond the boundaries of even the course work. Certainly this will take us into performance- support and knowledge-management but we must go further, bleeding e-learning into corporate communication, workplace learning, marketing recruitment, customer learning, and searches both on the web and in the real world.” The key phrase here is, ‘bleeding e-learning into corporate communication’. The content and tone of the e-learning mantra must be consistent with the overall corporate message because otherwise the sales force will not embrace the e-learning. The company website is a key component with regards e-learning and corporate communication therefore both mediums must promote a consistent message. However, as Gordon Blackwell remarked in his recent Pf article, pharmaceutical companies seem to be having have difficulty in developing solutions-based communications planning. E-learning is one way of helping to change the sales force’s perception of the market but the learning programme and the wider corporate communication must drive the same message to achieve the overall strategic goal.

Understanding the learners needs and readiness
The key to understanding learners is to understand their motivation. For sales people the core motivation is simply increased sales but it is important not to treat the sales force as an undifferentiated mass. As Martin Perry has demonstrated in his Sales Call Reluctance articles in PF, even very experienced sales people need to be helped individually in resolving behaviours that are obstructing their sales calls. Therefore, successful e-learning for motivated professionals not only requires the learning experience to be personalised but it also demands that the learning resources must treat sales people as individuals and respect their personal needs.

We all have experience of focused learning. For example, consider a group of students enrolled in a degree programme in physics. They have all qualified by satisfying a set of entrance requirements, starting from the same point and following a predetermined curriculum. The process is essentially linear. Contrast that with adult learning in the workplace as each learner arrives with different knowledge and experience. One sales person might have been doing a particular job for 15 years but often gets taught product knowledge alongside people who started only a week previously! Both parties have different territories and customer profiles and therefore they have different needs therefore making them all go through the same material in a linear way does not make sense. Offering them personalised routes, depending on their objectives and their preferred style of learning, is essential. We call this diffused learning.

Even the best and most motivated learners need individual encouragement and support. Dr Sam Redfern, a researcher at the National University of Ireland in Galway, commented: “Feelings of isolation, lack of consideration of different learning styles and lack of task co-ordination are frequently cited as the main inhibitors to working and learning remotely.” Although the pharmaceutical industry has a well established practice of individual mentoring and coaching of sales people, there is a physical limit to the amount of individual support a trainer can deliver out in the field. Much more personal support can be provided with a well structured e-learning programme as long as there is an effective tracking system in place.

Establishing an effective tracking system for the learning
In the workplace ‘classroom’ it is difficult to determine what has been learned and by whom. Formal tests may be useful if the learning objective is increased comprehension but these concepts are often inappropriate in workplace learning and indeed it is often more difficult to identify evidence-based competence in the classroom because it requires a change in behaviour. However, a tracking system that records the learner’s inter-actions with every activity provides an early indication of how the ‘student’ is developing. As Donald Clark stated: “E-learning has come from the learning world where the focus is on the mind of the learners and the ability to learn and apply knowledge”.

A number of sales managers amongst our clients have found the tracking system the most valuable part of the e-learning project, particularly when improved new product knowledge has been the prime learning objective. Measuring ROI on web-based learning is notoriously complex and is frequently reduced to calculating savings in travel costs and trainer fees. Ara Ohanian, CEO of Vuepoint, is a New York software developer who concentrates on delivering new product knowledge to sales channels and he said: “Speed-to-knowledge may be a soft measurement but the impact is greater than any travel reduction would ever be.”

Increasingly more e-learning is being used to disseminate product knowledge across the organisation to sales forces, distribution channels and even end-users. One major US provider of medical marketing has been particularly successful in creating product-specific learning for pharmaceutical sales training and product-specific educational programmes and marketing messages aimed at medical professionals and consumers. By tracking the learning process in both communities, pharmaceutical managers can gauge the knowledge and skills levels of their sales force and evaluate the impact of the learning programme on end-users.

Conclusion
Clearly, web-based learning has much to contribute to the professional development of sales forces. The process of defining business needs and expectations is not a new idea and indeed has been around for years. However, when this simple business concept is applied to web-based learning, it has been shown that performance improvement can be achieved more quickly and more effectively. It behoves everyone in the industry to take this on board if they are to grow their businesses whilst keeping a highly-motivated workforce content and satisfied.

SO FIRST LINE MANAGEMENT is no easy task, as Jacky so eloquently outlines. This feature on first line management in the pharmaceutical industry will look at the role of a first line manager today and in the future. It will examine on a day-to-day basis what a first line manager typically does in order to make sure the business and the people at the sharp end are as productive as possible. The upsides and down sides in terms of hours and pay of being a first line manager will also be reviewed.

The job itself
First line management is about managing a team of people to produce a set of business outcomes, which are at least, acceptable to the employing company. Essentially there are two types of sets of skills and competencies that are needed to produce the requisite results. The first sets of skills are those that involve being able to understand and act on, from a commercial perspective, the business and the environment you are working in. Skills and competencies like planning and organisation, negotiation, decision-making and judgement; customer focus and commercial awareness will all fall into this first category. The second set of skills and competencies are around being able to manage a team to produce the required results. These tend to be skills and competencies such as motivation, interpersonal skills, communication skills, and leadership, developing others, working with people and performance management.

These two skill sets are very different and not everyone manages to combine successfully both sets of skills. Some people hate the management aspects of a manager’s job. The sheer effort and sometimes patience needed to manage people, ends up just not being some peoples cup of tea. Others hate the commercial analysis and administration angle of a line management role. Pouring over spreadsheets, writing reports, and looking after up to 10 peoples administration does not push the right buttons for everyone. Due to the variances of the skill sets necessary to be a first line manager it also follows that not everyone will have the appropriate skills or indeed can develop the appropriate skills. The best representatives in the industry may be excellent communicators, who have a strong eye for a commercial opportunity, but put them in a line managers position where their success is not dependent on predominately their own efforts, and indeed where they for the most part cannot do the thing they love most, ”sell to customers” and they may well falter.

Being a first line manager is demanding and stretching, often physically and mentally and as the filling in the sandwich between head office and the field it can often be an uncomfortable place- as you can get squeezed from both sides.

Activity Benchmarking Ltd, who supply the pharmaceutical industry with benchmarking data gathered from their member companies, have some interesting statistics about what first line managers actually do on a day to day basis.

Probably not surprisingly, the data shows that in 2002, the biggest proportion of first line management time was spent on field visits, at 39 %. Working on a 228-day working year (sickness is included in the data given) it is interesting to convert this data into how many days per month are spent on each activity

The number of days per month spent on field visits is 7.4 with the second and third biggest slugs of RBM time being taken up by administration at 4 days a months and meetings and conferences at just over 3 days a month.

Salary and Hours
Most representatives will acknowledge, that when they think about their manager’s job, the job seems to entail working long hours, especially if managers have large geographical territories.

Data from the PF company perception and remuneration survey provides an insight into the typical hours of a working day of a first line manager compared with other jobs in the industry. It also allows us to look at the comparative rates of pay versus the number of hours worked for a variety of jobs. The survey data shows that first line managers do earn more than representatives (this was one of the most important factors sited by our representatives in last months feature as why they wanted to become a first line manager). However they do work longer hours for their pay. The table below shows the average salaries as disclosed in the last PF survey. The average representative length of service in this data was 4 years.

The range of salaries in field based jobs increases as representatives reach managerial level positions. With the average first line manager’s salary being £16000 higher than the average and £8000 higher than the average representative with greater than 8 years experience.

However it is worth taking a look at the hours worked each week in order to reach these higher salaries and therefore in reality the rates of pay per hour.

First line managers work more hours a week than any other job surveyed, they on average reported working typically 54.5 hours a week versus a representative working on average 41 hours, i.e. a 12 hour days versus 8 hour days. So on a pay per hour basis the average first line manager with less than 8 years experience achieves the same pay per hour worked as a representative with eight or more year’s experience. It could be argued therefore that from a quality of life perspective first line managers get a tough deal working an extremely long working day. Even as managers get more experienced whilst they do manage to cut down their working week, managers with over 8 years experience still report working a 50+-hour week.

The Future First Line Manager
So first line management is no easy option as a career step, it is a long hours job with many demands. The evolving NHS will also cause the job role to become more critical in the pharmaceutical sales chain and as each locality works up its individual local delivery plan. Jackie Williams, National Business Manager, Baxter Healthcare Ltd says, “ Already Managers are becoming more involved in developing local and creative value added strategies. They will also need to enhance their coaching skills because sales calls have and will continue to change from the walking, talking brochure to a consultative problem solving partnership with customers.”

Mike Stowe, Ethical Sales Manager of Amdipharm, a new UK ethical pharmaceutical company, also feels the new structures of the NHS will drive further the importance of the first line manager’s role, “The NHS is anything but unified. A good regional overview is required to allow appropriate direction to be given to representatives or account managers so that the buying chain is fully covered. Regional Managers need to be able to understand the micro market within their regions to adequately tackle local issues.”

Despite the challenges of first line management, is a job that often gives great job satisfaction and can be immensely enjoyable. The variety of the tasks undertaken in the role makes it continually interesting and challenging. The people and leadership aspects make it demanding but very rewarding when it is done well. It is also a role that is critical to the pharmaceutical industry from a sales and marketing perspective and often a “must do” job on the CV of anyone who wants to climb to senior pharmaceutical positions. A succinct summary of what is necessary to be a successful manager came from Steve Tarpey of Boehringer- Ingelheim. Steve said, “ The role of the RBM today is to juggle lots of balls, but you do have to make sure that they are the right balls you are juggling”. Never was truer word spoken.

Although they may not realise it, management and representatives in the pharmaceutical industry have a definite personal and company spending power with regards to where they buy their petrol, which airlines they use, the hotels they stay in or even which food and drinks they purchase. We look at how, with just a little thought and planning, that spending power can be harnessed and utilised to maximum advantage.

Prizes for petrol
As pharmaceutical managers and representatives will gladly tell you, they are far from the top of the tree as far as perks in the job are concerned but during the course of their daily business there are opportunities for some legitimate ‘little earners’ that could and should be maximised. Daily fuel consumption is one such area of potential benefit. In this industry, as we know, travelling anything between 100-1000 miles per week is not unusual - it’s simply the nature of the beast.

However, the consequent petrol consumption this sort of mileage demands can be a source of benefit in kind from the petrol companies. Times have moved on since the ’free glass’ initiatives which were used to encourage motorists to use the same garage to fill up. These ‘gifts’ were often treated as a bit of an embarrassing joke and some motorists would sneak out from the petrol station shop with their freebie hidden under a copy of Caravan Weekly! But with the recent explosion in car journeys, oil companies are desperate to encourage loyalty from customers and all the big petrol outlets now offer their own peculiar ‘reward’ schemes.

Shell introduced their ‘Shell pluspoints’ scheme which also ties in with other major companies like Woolworth, JJB, Next, WH Smith and B&Q. For every one litre of petrol a cardholder buys, they are rewarded with one ‘pluspoint’ and when saved up, points can be exchanged for e.g. shopping vouchers and charities can also benefit.

Jet’s successful ‘Smile’ scheme is installed at most of the company’s 550 service stations and currently has a membership of over one million. The rewards format is similar. The account holder is given 1p back for every litre of fuel bought and 2p back for every pound spent in Jet shops. In addition, 15p is redeemed against any top car wash purchased. Once £15 is saved, the consumer can make a withdrawal, either in the form of a cheque or through vouchers redeemable at many high street stores.

BP are involved in the Nectar scheme, probably the best known of all these types of initiatives, although it would perhaps be more accurate to describe the petrol company as a partner rather than the driving force in this particular idea. Membership entitles you to benefits from four big companies - Sainsburys, Barclaycard, Debenhams and of course, BP themselves.

The Nectar system is similarly straightforward. For every litre of fuel you buy from a BP garage you get one point. For very £1 you spend in Sainsbury’s you get two points. For very £1 you spend in Debenhams you get two points. For every £2 you spend on your Barclaycard you get one point. And in a special ‘Brucie Bonus’, if you use your Barclaycard at BP, Debenhams and Sainsburys, you get double points. And what do points make?…

But is there real merit in registering for these schemes? The average motorist might not think it’s worth it because they don’t use their car that much, but the average representative or manager, with their heavy fuel consumption, is perfectly placed to cash in. Registering to become a member/account holder takes only minutes and the easiest way is to simply pick up the relevant form at your garage (and scheme) of choice. It will take five minutes of your time and even the hardest working manager or representative can spare that!

Additional points
As noted above, there is also the ability to add to your points/benefits through the other companies involved with the petrol firms. For instance, BP’s partners in the Nectar scheme are Sainsburys, Debenhams and Barclaycard and whilst these outlets obviously don’t offer the same potential for rewards as the petrol stations do, there are possibilities that shouldn‘t be ignored. For instance, many surgeries require to provide food and drink for important practice meetings so if it’s possible, and convenient, why not use Sainsbury’s - and pay by Barclaycard - and make sure the points continue to get racked up. And don’t worry, you’re unlikely to bump into Jamie Oliver!

Making the most of hotel visits
Of course travelling often results in overnight stays for managers and representatives and most hotel groups also operate ‘reward’ schemes. An example of this is the ‘Priority Club’ scheme operated by the Six Continents Hotel group which includes in its portfolio hotels such as Holiday Inn, Inter Continental and Crown Plaza. Membership offers several benefits including single rates for double occupancy, extended check out times and points accrued can be used for free night stays, airline miles, select wines and even Hot air balloon trips.

Again, joining these particular schemes takes only minutes. The next time you’re sitting alone in a hotel dining room guessing which of the middle-aged couples around you are married (the ones sitting in silence reading their menu like it’s a best selling novel) or who are having an affair (the ones holding hands and talking to each other) why don’t you ask for one of the forms and leisurely fill it in. Then return to your fun!

The ability for most managers and representatives to maximise their spending power is probably at its peak in the areas of petrol consumption and hotel visits but there is also a smaller section of the industry, those who regularly travel by plane, who can gain further benefits.

Air miles
The concept of gaining air miles is simple to understand and easy to use. The basic idea is that for every mile you fly with an airlines they will give you ‘free air miles’ which you save up and use for free travel.

British Airways is one high profile airline who have their own ’Frequent flyer programme’ available to those who sign up for their thriving Executive Club scheme. Earning BA miles is easily calculable. You’ll earn one mile for every mile flown in Economy. You’ll earn one and a half times the miles flown in Premium Economy and you’ll earn double the miles flown in Upper Class. In addition - and by now you‘ll recognise an underlying theme of these reward schemes - there are other benefits available. You can ‘spend’ your BA miles on various things from Red Letter Day experiences to discounts on British Airways holidays. Worth a few minutes of your time to sign up, I’m sure you’ll agree.

The above is not an exhaustive list of schemes and benefits but it does give an idea of what can be found if you take just a little time to look around and register for the schemes which are suitable for you. But of course, these blue-chip companies don’t just give things away. No matter what reward scheme or initiative you register for, you will have to save up a considerable amount of points in order to reap the benefits. For example, it will take 500 Nectar points to get a £5 discount on the total cost of two Brewster Fayre main meals. And it will take 1500 Shell pluspoints to allow you to donate £10 to charity. So it isn’t exactly money for nothing. But the point remains that of all the people in Britain at whom these various schemes are targeted, it is those within the pharmaceutical industry who are the ideally placed to take advantage. At most, there would be minimal disruption to your routine and at the end of every year, or every summer, you can cash those points in and give your spouse or partner a nice little treat.

Paul Midgley of the Healthcare Partnership examines the new and expanded role of the Practice Manager within primary care under the proposed new GMS GP contract and explains how these customers are becoming vital calling targets for representatives who wish to work in close partnership with key target practices. If your company is not crediting you with Practice Manager calls then it may be time to review this policy!

Background
Most GP practices, regardless of size, have a nominated Practice Manager (PM). However, the remit of the PM role varies - from glorified administrator/receptionist in some practices, to strategic business manager/leader in others. The extent to which each particular role is played out in individual practices depends upon a variety of factors:

1. Practice size and income.
2. GPs’ attitude to their business and staff (and each other).
3. Career history and experience of the PM.
4. PM’s aspirations for self and practice.
5. Development support offered to PM and practice by the PCT, etc.

A key role for any PM is to ensure the practice maximises income. This means that once the GP(s) have agreed which services they wish to offer and to what level (for example, in the annual business plan), it is then the PM’s responsibility to organise the practice and staff to make sure that this plan is delivered effectively. Many GPs delegate a great deal of the ‘business’ side of General Practice to their PM (and professional advisors), so they can concentrate on the aspects of the job they enjoy most/are most competent at i.e. organising and delivering patient care.

So what’s changing for Practice Managers?
The proposed new GMS contract for GPs recognises the central role of quality (and data to support this) in improving delivery of healthcare services and aims to reward excellence in quality services with additional income. A typical 3-GP partner practice could theoretically earn an additional £75,000 if all quality indicator targets are met. This figure is on top of the guaranteed ‘global sum’ payment based around either (1) notional list size (using the Car-Hill formula) or (2) a minimum practice income guarantee (MPIG). Additional income is available for providing ‘enhanced services’ over and above the normal range expected by practices.

These changes will increase the complexity of the management structures required to provide back-up information required to ensure ‘plan delivery’. GPs are unlikely to suddenly develop an interest in business management (or find the free time to do it), hence the onus will rest with the PM to develop the necessary systems to move from the old GMS ‘Red Book’ basis of activity-based payments to the ‘quality service’ based system which will consequently maximise practice income.

So, what will the range of responsibilities of a Practice Manager encompass under the new GMS Contract?

Practice Management Competency Framework
As a representative, you are probably familiar with the ‘key competencies’ required to do your job and typically these number between 5 -10 key job areas in Pharma sales. Similarly, the new GMS GP contract outlines the competencies required for Practice Management in the modern world of General Practice and this is broken into 9 key areas:

1. Practice Operation and Development
2. Risk Management
3. Partnership Issues
4. Patient and Community Services
5. Finance
6. Human Resources
7. Premises and Equipment
8. Information Management and Technology
9. Population Care

The importance to you of understanding the Practice Manager’s role can be illustrated by examining the detailed sub-headings within each competency area. Let’s look at ‘Practice Operation and Development’ as an example(see below).

Practice Operation and Development This competency area includes the following responsibilities:

1. Primary Health Care Team Meetings (Doctors, nurses, district nurses, midwives, other allied professionals, admin staff)
2. Development plans/reports (e.g. Practice Professional Development Plans)
3. Clinical services (will include any enhanced services offered)
4. Care pathways (e.g. protocols)
5. Liaison with secondary/tertiary care providers
6. Innovation
7. Clinical audit
8. Organisational audit
9. Clinical effectiveness/evidence-based practice
10. Resource allocation
11. Professional development (helping with PDPs, GP appraisal, Protected Learning Time activities, Revalidation)
12. Research

Under each competency heading a range of activities are included, with three ‘levels of competence’ described for each activity:

1. ‘Administrative’
2. ‘Managerial’
3. ‘Strategic’

Let’s take one example from this list - the clinical audit - to illustrate the important role that PMs can have in helping you work in partnership with key practices to deliver key clinical (e.g. NSF) targets.

Practice Manager Competency
Clinical audit

Administrative level
Provides data for audit and may participate in planning audit and organisation of data.

Managerial level
Will coordinate process directed by Clinical Governance (CG) lead and may collaborate on CG, review and disseminate audit results.

Strategic level
Leads audit process, taking responsibility for cycle completion. May advise others on audit structure/ format.

If your company offers help with clinical audits, you should be speaking with the Practice Manager regardless of whether their role in this area is administrative, managerial or strategic. It will be their job to make sure the audit gets done!

Within this wide range of practice management activities, it is clear that only a superman/woman could fulfil all these roles on their own. Therefore, the job of Practice Manager is to ensure all of these functions are achieved through the effective teamwork of the various members of the PHCT - including your key target prescribers.

It may well be that you and/or your company have the skills and resources to provide relevant support to help develop either the Practice Manager, or staff, to develop competence in key areas which moves them and the practice from ‘administrative’ towards ‘strategic’ competence. By doing so, you will help the practice to deliver the highest quality services possible whilst helping maximise its income.

Many PCTs now provide ‘Protected Learning Time’ on a monthly basis, where every practice closes on a specified afternoon to engage in planned learning and development. Clearly, the advent of the new GMS contract will require major developments of Practice Management competence in most practices. Identifying their needs through the Practice Manager could provide you with an ideal opportunity to spend quality time with target practices in return for providing them with relevant training.

1. Contact HCP for the full GMS Practice Management Competency Framework.
2. Identify the PCTs on your patch that provide Protected Learning Time.
3. Identify key target practices within these PCTs which you are happy to invest your time and extra budget.
4. Identify which of these competency areas that you/your company are able to provide development training or support for.
5. Make an appointment to speak to the PM in these key practices.
6. At the meeting, review with the PM which areas the practice are prioritising for development and where and how you can support them.
7. If possible, arrange the relevant development activity - ideally also involving the doctors/nurses - during Protected Learning Time. Contact the trainer required if this is not you (consider an independent training provider -see footnote).
8. Contact colleagues to share the cost if necessary.
9. During the development session, get fully involved with your customers to develop a closer relationship, prove your interest in their business and identify follow-ups to maintain the momentum (and opportunities to discuss where your products can be used). Ensure you use the refreshment breaks as a promotional opportunity.
10. Arrange follow-up meetings/appointments with key target customers in the practice.
11. Keep your promises - if information or call-back items were requested then deliver them promptly!

TODAY’S MODERN LIFESTYLE encourages quick meals such as fries, bagels, burgers, pizzas, pastries, ice-creams, chocolate bars, etc that are derived from single or few food sources. Additionally, they not only lack antioxidants but are also loaded with oxidants. This does not allow someone to have a balanced platter of small portions of assorted foods sourced from vegetables, fruits, cereals, nuts and lentils, lean meats and / or fish. The good-old “food pyramid” and “balanced diet” dictums are all but extinct.

Chemistry of Oxidants
Exogenous and endogenous oxidants or free radicals are the major cause of over a hundred human diseases. The process of ageing is also hastened by the onslaught of oxidants in the body. Oxidants are normally produced during healthy cellular metabolism, wherein 98 per cent of the oxygen consumed by a cell is converted to water. The remaining one to two per cent of the unutilised oxygen is free to escape as free radicals. Free radicals or oxidants are molecules containing single unpaired electrons, and are on the lookout for electrons to pair up. Examples of oxidants are superoxide anion, hydroxy one radical, reactive oxygen species like peroxides, hydroxides and singlet oxygen. Even this one to two per cent of oxidants may be associated with useful activities like modulation of inflammation, killing bacteria, detoxifying toxins and maintaining vascular tone.

“Friendly Fire”
However, the ideal level of oxidants is never achieved and a portion of the oxidants go on a rampage damaging cell membranes, lipids, DNA etc. causing significant cell defects or destruction. Natural endogenous free radicals or oxidants are derived not only from metabolic reactions, but also from physiological and psychological stress and immunological reactions to microbial infections and allergens. Much of this damage is repaired by naturally occurring antioxidant systems that scavenge oxidants, but not all of them.

Increasing Risks of External Foes
The body is exposed to many exogenous or external sources of oxidants from the environment like smoking, alcohol, radiation, UV light, heat shock, strong sunlight, domestic chemicals like pesticides and air-fresheners, industrial and vehicular pollutants, certain drugs and deep fried and fatty foods. Modern food processing and preserving techniques produce free radicals and also destroy the antioxidants already present in the food item.

Natural Defences Overwhelmed
If oxidants are not paired with electrons, they start a series of chain reactions leading to damage of living cells and tissues. This may lead to development of various degenerative diseases including artherosclerotic heart disease, diabetes, skin ailments, arthritis, smoking induced lung disease and, neurodegenerative disorders, cataract, retinopathy, macular degeneration, and cancer, and may also increase the rates of mortality associated with some of these diseases.

When the body’s antioxidative defences are inadequate, or when the supply of nutritional antioxidants is unreliable, or when the oxidant attacks are consistently alarming, the state of balance is tilted from a state of health to a state of slow degeneration. Over the years of evolution the human body has developed a whole arsenal of antioxidative enzyme systems and vitamins for its protection. Antioxidant systems of the body are critically dependent upon external dietary sources. What are these exogenous antioxidants and where are they found?

Natural Antioxidants To The Rescue
The vitamins particularly vitamin A in the form of beta-carotene and other carotenoids, vitamin C or ascorbic acid, and vitamin E as tocopherols and tocotrienols function as independently active natural dietary antioxidants. Minerals are the other dietary antioxidants that are critical to the activation of vital antioxidant enzyme systems in the body. Selenium is required for the antioxidant activity of the enzyme glutathione peroxidase. Zinc is essential for the activity of at least 90 enzymes including the antioxidant enzymes catalase and superoxide dismutase. Copper and manganese are also needed for superoxide dismutase activity.

Vitamin A and its polymers are available from brightly coloured vegetables and fruits such as carrots, apricots, dark green leafy vegetables like spinach, red, yellow and green peppers, sweet potatoes, and blue-green algae. Vitamin C is obtained from lemons, limes and other citrus and sour fruits. Vitamin E is found in nuts, whole grains, vegetable oils and to some extent in fruits and vegetables. In general, minerals are available naturally from fruits, nuts and lentils, whole cooked and germinating grains, shell-fish, vegetables and many others. Many other naturally occurringantioxidants that have been studied are pycnogenol from pine bark, grape seeds and red wine, lycopenes from tomatoes and beets, and coenzyme Q10 from red lean meat and blue-green algae. Garlic, tea and blueberries are also rich in natural antioxidants.

Conclusion
Supplementation of these dietary antioxidants in the right concentrations is important for protection against disease and premature ageing. Nutrition, like all sciences is constantly changing. Vitamins, minerals and other nutrients are no more ‘boring’ or old fashioned in the public consciousness. They have now been proven to act as antioxidants and protect against illnesses, repair tissues, and safeguard against the daily stresses of pollution and lifestyle. All of these substances are useful since they act as antioxidants at different levels and with different modes of actions. Consumption of these natural antioxidants through natural foods or commercially available nutraceutical or nutritional supplements will help in retarding the ageing process and increasing life spans, preventing and / or reducing the intensities of diseases like diabetes, artherosclerotic heart disease, cancer, arthritis, skin diseases, eye disorders and many other ailments.