Welcome to the December homepage edition of i2P- Information to Pharmacists E-Magazine.
This homepage will be utilised for both December 2012 and January 2013 with irregular updates to get us through the holiday period.
This enables all i2P writers to relax before what appears to be a challenging year in 2013.
It is estimated that the pharmacy business/professional cycle (45 years) will be bottoming out over 2013 with more disturbance to pharmacy profitability and its ability to provide regular levels of employment.
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With a researcher's perspective and a pair of fresh eyes, Joseph Conway has mapped out his version of the trends and future directions for pharmacy, community pharmacy in particular.
In presenting his logic he argues from two opposite points of view - a model comprising supermarket majority ownership compared to a more traditional model of pharmacist ownership.
His article is presented in four parts, with supermarket ownership looked at first.
2013 will be an extraordinarily difficult year as the 45 year pharmacy business and professional cycle bottoms out with no soft landing.
The hiatus in pharmacy leadership that is apparent in the lack of a cohesive forward plan leaves all pharmacists (pharmacy owners and non-owners) with no sense of direction, a mix of disjointed "bits and pieces" that is the substitute for a clear and definitive plan
While Joseph has outlined some options, it will be up to individuals to complete the puzzle and fill in all the gaps.
Editor's Note: Joe Conway continues with Part Two of his four-part series on Australian pharmacy and its direction.
Please post comments at the foot of his article to help expand the debate.
Pharmacy has to change quite drastically to drag itself into the 21st century.
It has hesitated for too long a period of time.
In New Zealand, the launch of Countdown pharmacy seems to have gone down with little fuss. However, from an Australian pharmacy perspective, the issue of concern is that Countdown Pharmacies are at least in part owned by Woolworths.
In part 1, I outlined what I thought were the potential advantages of Supermarket pharmacies in Australia. In part 2, I would like to give my opinion as to the disadvantages of allowing Supermarkets to run pharmacies in store.
Editor's Note:Joe Conway Introduces Part three of his four-part series on the potential impacts of supermarket pharmacies in Australia (if introduced). Part three discusses impacts for patients.
Countdown Pharmacies are at least in part owned by Woolworths. This raises the possibility that Woolworths is using this Kiwi venture to hone its skills in the area of pharmacy before a possible bid to be allowed to provide such services here in Australia.
People aren’t marching the streets in Australia wanting pharmacies in Supermarkets and the Discount model of pharmacy is already providing Australians with access to cheaper medicines that is the catch-cry of the Supermarkets when extolling their virtues as potential custodians of prescription medicines.
An example of this was Chemist Warehouse supplying the Lipitor® generic Atorvastatin Sandoz® for $0 for a limited time on a valid prescription.
You can’t get any cheaper than that? In part 1, I outlined what I thought were the potential advantages of Supermarket pharmacies in Australia.
In part 2, I gave my opinion as to the disadvantages of allowing Supermarkets to run pharmacies in store.
In part 3 I would like to explore potential patient attitudes in this debate.
Editor's Note: This is the fourth article in a series by Joseph Conway.
He has made a number of assumptions and predictions within the article series, floating the proposal that if Australia adopts the New Zealand model of Countdown Pharmacy, there are a range of advantages and disadvantages.
In this final article Joe blows apart the notion that supermarkets are cheaper than pharmacies by completing a survey of products held by pharmacies and supermarkets in common.
To his surprise, he found that pharmacy is currently more than competitive with supermarkets, taking away the supermarket trumpet call that they would provide cheaper prices than pharmacies.
It would seem that pharmacy can still remain in the race to be competitive, with the point of difference being provision of patient information. The latter service may need to be tidied up, even charged for if there is value for money.
The Guild’s least favourite combatant at the moment is the Consumer's Health Forum.
I’ve been a member of this organization for a few years now, and I’ve come to acknowledge their expectations that they, as a representative body for the Australian consumer, should have a say in health.
And I’m beginning to understand now that this organization might, in fact, reshape our role in health.
I can’t get over the wide variety of contacts they have, the panels in which they are involved and more especially, their positioning as the voice of the consumer.
Perhaps we can take a leaf out of their book?
No matter where you appear within the “food chain” of pharmacy, uncertainty is the common background theme.
Students are wondering if they will succeed in getting an internship.
Interns are worried about continuing employment and becoming registered.
Newly registered pharmacists are wondering if they are in over-supply with the prospect of reduced (or no hours) of employment at hourly rates not much above pharmacy technicians.
Career pharmacists are wondering about their prospects in a rapidly changing and stressful environment.
Clinical pharmacists are wondering when community pharmacy is going to embrace them as part of a solution.
Senior pharmacists (those that do not want to retire) are wondering if the workplace will ever become friendly to the extent that some of their working day can be in a seated position, to take stress off aching joints. Also to be valued in a mentoring role to other pharmacists.
Owner pharmacists, in varying degrees, are wondering whether they will have sufficient capital to sustain their businesses into the future.
Businesses tend to focus on profits with no consideration as to whether these profits are good profits or bad profits.
Good profits would be defined as those profits earned from customers who are delighted with the products or services provided – so much so that they will voluntarily refer your business to their friends and associates - in other words, become an advocate for your business
A funny thing didn’t happen recently.
I rang our (Global Pharmaceutical Company) territory manager and she didn’t answer.
In fact, her mailbox was so full I couldn’t leave a message.
Several days later, her manager rang to inform me that she had been made redundant as a part of a company-wide restructure.
Then, a couple of days ago I had a meeting with the State Manager of another Global Pharmaceutical Company.
He told me that 300 jobs had been made redundant in the pharmaceutical industry in the previous five weeks.
A growing number of medical leaders are calling for “Slow Medicine.”
They are calling for a similar rationale which evolved as the “Slow Food Movement” that originated in Italy as a reaction against fast food and industrialised agriculture.
Slow Food links the pleasure of growing and consuming good food with a commitment to community and the environment.
The movement exists in Australia and information about it can be found here
i2P first wrote about slow food here.
Omni-channel and multi-channel are in-vogue phrases and concepts.
They reflect the presence and need for parallel and compatible avenues to reach out, connect with and to engage existing and prospective clients and customers.
What level of Individual Responsibility do we each have in managing our Health and Well-Being, given that 40% of "total health" is due to lifestyle choices and behaviour and only 10% Healthcare Delivery? 
How much "free" healthcare, taxpayer funded, are we prepared to give individuals?
Should we limit it?
Unlimited Free Goods guarantee unlimited demand for them.
Education is a stepping stone to success, but some of the most important lessons aren't taught in class. There are plenty of life lessons that we need to know, and the textbooks often do not have chapters on them.
Here are some lessons you should learn in order to grow both in your career and in your personal life.
Wednesday 21 November 2012 was National Go Home On Time Day in Australia (www.gohomeontimeday.org.au/).
This event is an initiative of the Australia Institute (www.tai.org.au), an independent public policy think tank based in Canberra.
Other supporters are beyondblue (www.beyondblue.org.au) and the ACTU.
On Wednesday 21 November the address at the National Press Club in Canberra was given by beyondblue CEO and pharmacist, Kate Carnell and ACTU President, Ged Kearney.
A recording of the address, which I recommend, can be viewed at:http://www.abc.net.au/news/2012-11-21/national-press-club-ged-kearney-and-kate-carnell/4384590.
Despite differing political backgrounds both presenters were united in their view that life-work balance is essential to a healthy and productive workforce.
This is something which, I believe, many pharmacists need to consider and apply to their lives.
Well before Starbucks began roasting exotic blends, Yuban took a swing at it. Not sure they hit the ball out of the park, but they were getting more for a pound of coffee than number-one Folgers at checkout stands across America. Do you remember Yuban commercials during the 1960s? They concluded with that deep trained-for-television voice saying, “As John Arbuckle says, ‘You get what you pay for.’”
The philosophy behind 'fundamentalist' chiropractic is that spinal 'blockages' cause most illnesses and that removing them will restore health.
A range of chiropractic 'medical devices' are claimed to locate and remove these 'blockages'.
So what types of devices do chiropractors use, are they registered with the federal government, and do they work?
I2P has already commented that unless pharmacy leaders become united, the profession will continue a decline that has been building for over a decade.
We are now in the “bottoming-out” phase of the pharmacy business/professional cycle that will become extended if there is no sign of cohesiveness emerging over the next twelve months.
Pharmacy leaders must sort out their various differences and support each other where strengths exist and need to be nurtured.
The last thing pharmacists want to see is a prolonged battle for power, wasteful in resources and energy and depressing for individual pharmacists struggling to find an identity and build their professional roles.
i2P will support any progress towards unity because we can see how close pharmacy is to major destruction, caused by weaknesses created over the last decade through in-fighting and power broking.
When I was cutting my teeth in the sales game right after college, I made sure to read or listen to everything I could get my hands on from a handful of sales and motivational legends - Napoleon Hill, Earl Nightingale, Dale Carnegie, Norman Vincent Peale, Jim Rohn and Zig Ziglar.
I, like many people around the world, was saddened to hear about the recent death of my friend Zig. He was one of a kind. I was fortunate to share the stage with him several times - and I will be forever grateful for those opportunities.
Recently, whilst I waited to be interviewed on a regional Victorian afternoon radio program, I was put “on hold”, so I was able to listen to the messages going out to the radio public.
I was staggered however, to listen to a Pharmacy Guild sponsored message, outlining the best option to help the obesity issue………..bariatric surgery!
Everybody has the right to good health.
Governments spend $’s billions ensuring that their constituents have access to:
* Good Food
* Clean air
* Clean water
These are the basic elements of self care that are all components of human rights
However, industrialisation has caused contamination and adverse effect on health as pollutants have made their way into these basic elements of food, air and water, often being unwittingly ingested in micro-amounts over long periods of time.
According to recent reports in Bloomberg, Eli Lilly has been consistently bribing officials for a period of up to 20 years, in countries such as China, Russia and Brazil.
The mechanism employed is through the use of “offshore marketing agreements” that established bank accounts that could be accessed by employees based in those countries.
Little, or no checks were performed on these offshore accounts as to how the money was spent – just as long as business flowed from that type of investment.
The American Securities and Exchange Commission has fined Lilly an amount of $29.4 million under the Foreign Corrupt Practices Act.
Sometimes the columns that get the biggest reaction are those that offer the simplest advice.
A couple weeks ago I wrote about street-smart ideas and was inundated with requests for more.
A few readers shared their ideas too.
Because I truly believe in the importance of street smarts for success, I'm continuing the list.
In 1975 I began life as a marketing and management consultant.
I specialised in two primary services:
* Inventory management- because every pharmacy was overstocked due to manufacturer pressure and poor pharmacist management expertise.
* Income tax management-because pharmacists were unable to pay their income tax, because the overstocks had soaked up their liquidity.
Pharmacy in 1975 was characterised by successful looking pharmacies, profitable on paper, but choking to death because of a lack of liquidity and management controls.
I am wondering whether that may sound familiar today.
I read a recent article written by Harold Mitchell, the media mogul, philanthropist, and all round great bloke.
If you want a great read, try his autobiography.
I was lucky enough to sit beside him at a function years ago, and he left a lasting impression on me.
Harold explains in his article that he had spoken at a function attended by Australian former business icons, like the chairman of Qantas, managing director of Ford, managing director of the ANZ Bank, CEO of the NAB and a number of top-end medicos.
They all had the feeling that they could do more, but society had pushed them aside because of their age.
Do you believe in Santa Claus?
Whether you ever did - or still do - there's something about the jolly old elf that wise businesses should consider emulating if they want to establish a year-round aura of good will.
Santa has a number of attributes that easily translate beyond the holidays.
Here are some that I think are worth noting:
Being a senior pharmacist and also being very conscious of the limited roles that pharmacists in a senior age bracket are afforded, I was pleased to read Gerald Quigley’s comments on the subject in this edition of an i2P update for December 2012.
A quick search of the Internet revealed there was no association in Australia to represent senior pharmacists (but there were doctor groups).
The UK seemed to be the only country where a formal group has been established for retired pharmacists under the umbrella of the Royal Pharmaceutical Society.
It is known simply as the Retired Pharmacists’ Group.
I had the privilege of attending a recent symposium called by the Consumers Health Forum of Australia, to assess the Community Use of Medicines from the Perspectives of Carers.
The key objectives of this project included:
* Providing strategic advice regarding consumer perspectives on QUM issues
* Supporting consumers to contribute to, and participate in, NPS advisory groups
* Developing and building diversity around key topical health areas
There are approximately 2.6 million carers in Australia.
They are recognized by the Carer Recognition Act 2010, which defines carers as people who provide unpaid personal care, support and assistance to other individuals who are in need of support due to disability, medical condition, terminal or chronic illness, mental illness, or who are frail and aged.
For many of us in the workforce (including me) there was at one stage, a vision we could retire around age 55.
However, with the many shifts and vagaries that have occurred within the Australian economy, most have abandoned that dream as their savings depleted.
In fact those depletions have contributed to the thought that it might be more prudent to work for as long as possible. This thought has also been fuelled by the knowledge that lifespans are increasing and that it is difficult to sustain a social structure outside of a workplace because most of us have been defined by our work and it is difficult to embrace major or abrupt changes as we age.
Professional isolation is a fact of life in community pharmacy.
Gone are the days where an average pharmacy could support around four pharmacy job skill levels (apprentice, unregistered pharmacist, registered pharmacist and master pharmacist). Also gone is the collegiate and mentoring environment with the sharing of information and various techniques including the skill of patient interviewing, and the identification of various conditions and how to treat them with remedies compounded and formulated by a clinical pharmacist.
While nobody expects professional development to stand still, what has replaced these skills has not been for the better, with patient personal interest and care becoming the primary casualty.
The four-wall syndrome, a phenomenon that developed in the mid-1960's has slowly strangled job satisfaction parallel with government control through the PBS system.
With the advent of modern communication systems it is now possible to recreate a model of information and technique sharing that could well revive what was previously a vital and viable clinical experience. Like an expanded version of information sharing in a social media format-something like a secure medical Facebook.
Editor's Note: Pharmacy has always been at the forefront of primary care and self-care.
Politically, these activities seem to have been hijacked through unusual and unacceptable drug scheduling decisions (children's cough mixtures etc) and the bureaucratic and unnecessary trans -Tasman harmonisation operation.
Decisions in both the above areas have had nothing to do with patient safety or patient care and they are both examples of bureaucratic insults against the pharmacy profession, as there was no problem that needed fixing in the first place.
The proposal by ASMI as part of a Federal Budget Submission is an interesting one for pharmacists and unless there is proper pharmacy representation to ensure that another carving up of the community pharmacy market does not occur, we may yet lose a further opportunity - because of poor pharmacy leadership.
At least we should demand that both PSA and PGA have a major role here and that they should agree the boundaries of their responsibilities.
We can no longer afford nor tolerate continuing disunity.
The use of antidepressants doubled in Australia between 2000 and 2011 and they now account for two out of every three psychotropic medications prescribed, a new study by the University of Sydney reveals.
It also shows that over the last decade there has been a dramatic 58 percent increase in the use of psychotropic medications by the Australian population, which has only increased by 13 percent over that time.
An electronic nose, used to detect the presence of molecules in the breath of a patient, could be used to diagnose obstructive sleep apnoea.
A new study, published online in the European Respiratory Journal, could make the diagnosis of the condition quick and inexpensive compared to current methods.
Taking the “ouch” out of injections is a worthy endeavor, but what if they could be avoided entirely?
New research conducted at Royal Holloway, University of London offers the hope of achieving just this, by using a bacterium to deliver a vaccine which can be administered via nasal spray, oral liquid, capsule, or small soluble film placed under the tongue, thus reducing the risk of spreading infectious diseases like HIV.
Melbourne researchers have developed cows’ milk that protects human cells from HIV.
The milk contains antibodies which defend against human immunodeficiency virus (HIV).
The next step will be to develop it into a cream which women can apply to protect themselves from contracting HIV from sexual partners.
Adelaide scientists have found that mice with gum disease develop worse arthritis.
The scientists are using this knowledge to investigate whether treating mouth conditions could help relieve arthritis.
As part of her PhD studies, Melissa Cantley worked with colleagues at the University of Adelaide to develop a new way to study these two diseases and their relationship. She is presenting her research this week as part of Fresh Science — a national program for early-career scientists.
This is the largest edition of Australian Prescriber ever published - 40 pages. There will be something for everyone in the wide variety of topics - ranging from common conditions as in Jo-Ann See's review of acne to the infrequently encountered idiopathic interstitial pneumonias reviewed by Lauren Troy and Tamera Corte. Pneumococcal pneumonia is one of the conditions which may be considered for treatment with intravenous antibiotics in the patient's home . David Looke and David McDougall's article will be of interest to health professionals in hospitals and in the community. The quality use of medicines is important fo! r all health professionals . As it is 20 years since Australia's policy was launched, Tony Smith reflects on what has been achieved. Looking to the future, the conference on national medicines policies in our region reports that there is still work to be done.
Serotonin – often dubbed the happy hormone for its ability to regulate moods – plays a vital and perhaps lesser known role in everything from blood clots to bone density.
Yet despite its significance in the human body, researchers do not fully understand how serotonin is released into the bloodstream.
A landmark discovery about how insulin docks on cells could help in the development of improved types of insulin for treating both type 1 and type 2 diabetes.
For the first time, researchers have captured the intricate way in which insulin uses the insulin receptor to bind to the surface of cells. This binding is necessary for the cells to take up sugar from the blood as energy.
The research team was led by the Walter and Eliza Hall Institute and used the Australian Synchrotron in Melbourne. The study was published today in the journal Nature.
For more than 20 years scientists have been trying to solve the mystery of how insulin binds to the insulin receptor. A research team led by Associate Professor Mike Lawrence, Dr Colin Ward and Dr John Menting have now found the answer.
The development and expansion of the Pharmacists’ Support Service (PSS) has been given a significant boost through support from the Pharmacy Guild of Australia (PGA).
The PGA has now joined the other pharmacy organisation supporting PSS both financially and through participation in the PSS Management Committee.
A STUDY published in the journal of Biochemical Pharmacology suggests major flavonoid quercetin is beneficial in reducing the risk of cardiovascular disease (CVD).
The study highlights the cardioprotective effects certain dietary flavonoids have when consumed as part of a normal diet.
Study supervisors Medical Research Foundation and UWA research fellow Natalie Ward and UWA School of Medicine and Pharmacology professorial fellow Kevin Croft say quercetin is one of the most widely abundant flavonoids in the diet.
UNSW researchers have discovered a new strain of norovirus that they warn could cause a severe epidemic of acute gastroenteritis in Australia this winter.
Known as Sydney 2012, the highly infectious mutant virus has already caused an epidemic of nausea, vomiting and diarrhoea in Europe, with an estimated 1.2 million cases of gastro in the UK during the colder months.
It has led to the closure of dozens of hospital wards there, and affected schools, age-cared facilities, cruise ships and workplaces, resulting in headlines in the British press such as the Chunder from Down Under.
Editor's Note: In a flurry of press releases issued by the pharmacists' trade union, APESMA, it would appear that a challenge has been presented to the PGA to put its house in order.
The challenge appears to have the backing of the Fair Work Ombudsman, who will audit a selection of 400 pharmacies from all states and territories.
The press releases seem to indicate a carefully planned campaign is under way and that pharmacy owners need to be compliant before April 2013.
Electronic Prescription Exchanges in Australia have been sputtering along with little momentum, for quite a few years now.
Not surprisingly, the two main players in the field have been the doctors (in the form of the Royal Australian College of General Practitioners) and the pharmacists (in the form of the Pharmacy Guild of Australia).
The former has endeavoured to comply with all the specifications of NEHTA (the organisation established by government to oversee all e-health developments), which has spectacularly blown its budget on numerous occasions, with little to show.
On the other hand, the PGA developed its exchange outseide of NEHTA Guidelines.
Both the PGA (in the form of the eRx system) and the RACGP (in the form of the Medisecure System) have each tried to become the dominant system, a battle that has considerably drained cash resources on both sides.
We have asked Mark Coleman to comment on a media item describing recent developments that was published in Pulse IT.