s FSM Strategy Has no Middle Ground | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists

Editorial

From the desk of the editor

Welcome to the July 2014 homepage edition of i2P (Information to Pharmacists) E-Magazine.
At the commencement of 2014 i2P focused on the need for the entire profession of pharmacy and its associated industry supports to undergo a renewal and regeneration.
We are now half-way through this year and it is quite apparent that pharmacy leaders do not yet have a cohesive and clear sense of direction.
Maybe the new initiative by Woolworths to deliver clinical service through young pharmacists and nurses may sharpen their focus.
If not, community pharmacy can look forward to losing a substantial and profitable market share of the clinical services market.
Who would you blame when that happens?
But I have to admit there is some effort, even though the results are but meagre.
In this edition of i2P we focus on the need for research about community pharmacy, the lack of activity from practicing pharmacists and when some research is delivered, a disconnect appears in its interpretation and implementation.

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Newsflash Updates for July 2014

Newsflash Updates

Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
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Feature Contribution

Woolworths Pharmacy - Getting One Stage Closer

Neil Johnston

It started with “tablet” computers deployed on shelves inside the retailer Coles, specifically to provide information to consumers relating to pain management and the sale of strong analgesics.
This development was reported in i2P under the title Coles Pharmacy Expansion and the Arid PGA Landscape”
In that article we reported that qualified information was a missing link that had come out of Coles market research as the reason to why it had not succeeded in dominating the pain market.
Of course, Woolworths was working on the same problem at the same time and had come up with a better solution - real people with good information.

Comments: 5

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Intensive Exposition without crossing over with a supermarket

Fiona Sartoretto Verna AIAPP

Editor's Note: The understanding of a pharmacy's presentation through the research that goes into the design of fixtures and fittings that highlight displays, is a never-ending component of pharmacy marketing.
Over the past decade, Australian pharmacy shop presentations have fallen behind in standards of excellence.
It does not take rocket science - you just have to open your eyes.
Recently, our two major supermarkets, Woolworths and Coles, have entered into the field of drug and condition information provision - right into the heartland of Australian Pharmacy.

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The sure way to drive business away

Gerald Quigley

I attended the Pregnancy, Baby and Children’s Expo in Brisbane recently.
What an eye and ear opening event that was!
Young Mums, mature Mums, partners of all ages, grandparents and friends……...many asking about health issues and seeking reassurances that they were doing the right thing.

Comments: 1

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‘Marketing Based Medicine’ – how bad is it?

Baz Bardoe

It should be the scandal of the century.
It potentially affects the health of almost everyone.
Healthcare providers and consumers alike should be up in arms. But apart from coverage in a few credible news sources the problem of ‘Marketing Based Medicine,’ as psychiatrist Dr Peter Parry terms it, hasn’t as yet generated the kind of universal outrage one might expect.

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Community Pharmacy Research - Are You Involved?

Mark Coleman

Government funding is always scarce and restricted.
If you are ever going to be a recipient of government funds you will need to fortify any application with evidence.
From a government perspective, this minimises risk.
I must admit that while I see evidence of research projects being managed by the PGA, I rarely see community pharmacists individually and actively engaged in the type of research that would further their own aims and objectives (and survival).

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Organisational Amnesia and the Lack of a Curator Inhibits Cultural Progress

Neil Johnston

Most of us leave a tremendous impact on pharmacies we work for (as proprietors, managers, contractors or employees)—in ways we’re not even aware of.
But organisational memories are often all too short, and without a central way to record that impact and capture the knowledge and individual contributions, they become lost to time.
It is ironic that technology has provided us with phenomenal tools for communication and connection, but much of it has also sped up our work lives and made knowledge and memory at work much more ephemeral.

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Academics on the payroll: the advertising you don't see

Staff Writer

This article was first published in The Conversation and was written by Wendy Lipworth, University of Sydney and Ian Kerridge, University of Sydney
In the endless drive to get people’s attention, advertising is going ‘native’, creeping in to places formerly reserved for editorial content. In this Native Advertising series we find out what it looks like, if readers can tell the difference, and more importantly, whether they care.
i2P has republished the article as it supports our own independent and ongoing investigations on how drug companies are involved in marketing-based medicine rather than evidence-based medicine.

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I’ve been thinking about admitting wrong.

Mark Neuenschwander

Editor's Note: This is an early article by Mark Neuenschwander we have republished after the soul-searching surrounding a recent Australian dispensing error involving methotrexate.
Hmm. There’s more than one way you could take that, huh? Like Someday when I get around to it (I’m not sure) I may admit that I was wrong about something. Actually, I’ve been thinking about the concept of admitting wrong. So don’t get your hopes up. No juicy confessions this month except that I wish it were easier for me to admit when I have been wrong or made a mistake.
Brian Goldman, an ER physician from Toronto, is host of the award-winning White Coat, Black Art on CBC Radio and slated to deliver the keynote at The unSUMMIT for Bedside Barcoding in Anaheim this May. His TED lecture, entitled, “Doctors make mistakes. Can we talk about it?” had already been viewed by 386,072 others before I watched it last week.

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Dispensing errors – a ripple effect of damage

Kay Dunkley - BPharm, Grad Dip Hosp Pharm, Grad Dip Health Admin, MPS, MSHPA

Most readers will be aware of recent publicity relating to dispensing errors and in particular to deaths caused by methotrexate being incorrectly packed in dose administration aids.
The Pharmacy Board of Australia (PBA), in its Communique of 13 June 2014, described a methotrexate packing error leading to the death of a patient and noted “extra vigilance is required to be exercised by pharmacists with these drugs”.
This same case was reported by A Current Affair (ACA) in its program on Friday 20 June
http://aca.ninemsn.com.au/article/8863098/prescription-drug-warning

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Take a vacation from your vocation

Harvey Mackay

Have you ever had one of those days when all you could think was, “Gosh, do I need a vacation.”
Of course you have – because all work and no play aren’t good for anyone.
A vacation doesn’t have to be two weeks on a tropical island, or even a long weekend at the beach. 
A vacation just means taking a break from your everyday activities. 
A change of pace. 
It doesn’t matter where.
Everyone needs a vacation to rejuvenate mentally and physically. 
But did you also know that you can help boost our economy by taking some days off? 
Call it your personal stimulus package.

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Explainer: what is peer review?

Staff Writer

This article was first published in the Conversation. It caught our eye because "peer review" it is one of the standards for evidence-based medicines that has also been corrupted by global pharma.
The article is republished by i2P as part of its ongoing investigation into scientific fraud and was writtenby Andre Spicer, City University London and Thomas Roulet, University of Oxford
We’ve all heard the phrase “peer review” as giving credence to research and scholarly papers, but what does it actually mean?
How does it work?
Peer review is one of the gold standards of science. It’s a process where scientists (“peers”) evaluate the quality of other scientists' work. By doing this, they aim to ensure the work is rigorous, coherent, uses past research and adds to what we already knew.
Most scientific journals, conferences and grant applications have some sort of peer review system. In most cases it is “double blind” peer review. This means evaluators do not know the author(s), and the author(s) do not know the identity of the evaluators.
The intention behind this system is to ensure evaluation is not biased.
The more prestigious the journal, conference, or grant, the more demanding will be the review process, and the more likely the rejection. This prestige is why these papers tend to be more read and more cited.

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Dentists from the dark side?

Loretta Marron OAM BSc

While dining out with an elderly friend, I noticed that he kept his false tooth plate in his shirt pocket. He had recently had seven amalgam-filled teeth removed, because he believed that their toxins were making him sick; but his new plate was uncomfortable. He had been treated by an 'holistic dentist'. Claiming to offer a "safe and healthier alternative" to conventional dentistry, are they committed to our overall health and wellbeing or are they promoting unjustified fear, unnecessarily extracting teeth and wasting our money?

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Planning for Profit in 2015 – Your key to Business Success

Chris Foster

We are now entering a new financial year and it’s a great time to reflect on last year and highlight those things that went well and those that may have impacted negatively in the pursuit of your goals.
It's also a great to spend some time re-evaluating your personal and business short, medium and long term goals in the light of events over the last year.
The achievement of your goals will in many cases be dependent on setting and aspiring to specific financial targets. It's important that recognise that many of your personal goals will require you to generate sufficient business profits to fund those aspirations

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Attracting and Retaining Great People

Barry Urquhart

Welcome to the new financial year in Australia.
For many in business the past year has been described as a challenging period.
Adjectives are a key feature of the English language.  In the business lexicon their use can be, and often is evocative and stimulate creative images.  But they can also contribute to inexact, emotional perceptions.
Throughout the financial pages of newspapers and business magazines adjectives abound.
References to “hot” money draw attention and comment.  The recent wave of funds from Chinese investors, keen to remove their wealth from the jurisdiction and control of government regulations is creating a potential property bubble in Australia.

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Updating Your Values - Extending Your Culture

Neil Johnston

Pharmacy culture is dormant.
Being comprised of values, unless each value is continually addressed, updated or deleted, entire organisations can stagnate (or entire professions such as the pharmacy profession).
Good values offer a strong sense of security, knowing that if you operate within the boundaries of your values, you will succeed in your endeavours.

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Evidence-based medicine is broken. Why we need data and technology to fix it

Staff Writer

The following article is reprinted from The Conversation and forms up part of our library collection on evidence-based medicines.
At i2P we also believe that the current model of evidence is so fractured it will never be able to be repaired.
All that can happen is that health professionals should independently test and verify through their own investigations what evidence exists to prescribe a medicine of any potency.
Health professionals that have patients (such as pharmacists) are ideally placed to observe and record the efficacy for medicines.
All else should confine their criticisms to their evidence of the actual evidence published.
If there are holes in it then share that evidence with the rest of the world.
Otherwise, do not be in such a hurry to criticise professions that have good experience and judgement to make a good choice on behalf of their patients, simply because good evidence has not caught up with reality.

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Laropiprant is the Bad One; Niacin is/was/will always be the Good One

Staff Writer

Orthomolecular Medicine News Service, July 25, 2014
Laropiprant is the Bad One; Niacin is/was/will always be the Good One
by W. Todd Penberthy, PhD

(OMNS July 25, 2014) Niacin has been used for over 60 years in tens of thousands of patients with tremendously favorable therapeutic benefit (Carlson 2005).
In the first-person NY Times best seller, "8 Weeks to a Cure for Cholesterol," the author describes his journey from being a walking heart attack time bomb to a becoming a healthy individual.
He hails high-dose niacin as the one treatment that did more to correct his poor lipid profile than any other (Kowalski 2001).

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Culture Drive & Pharmacy Renewal

Neil Johnston

Deep within all of us we have a core set of values and beliefs that create the standards of behaviour that we align with when we set a particular direction in life.
Directions may change many times over a lifetime, but with life experiences and maturity values may increase in number or gain greater depth.
All of this is embraced under one word – “culture”.
When a business is born it will only develop if it has a sound culture, and the values that comprise that culture are initially inherent in the business founder.
A sound business culture equates to a successful business and that success is often expressed in the term “goodwill” which can be eventually translated to a dollar value.

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Pharmacy 2014 - Pharmacy Management Conference

Neil Johnston

The brave new world of health and wellness is not the enemy of Pharmacy, it is its champion.
Australian futurist, Morris Miselowski, one of the world's leading business visionaries, will present the Opening Keynote address on Pharmacy's Future in the new Health and Wellness Landscape at 2.00pm on Wednesday July 30.
Morris believes the key to better health care could already be in your pocket, with doctors soon set to prescribe iPhone apps, instead of pills.
Technology will revolutionise the health industry - a paradigm shift from healthcare to personal wellness.
Health and wellness applications on smartphones are already big news, and are dramatically changing the way we manage our personal health and everyday wellness.

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Generation and Application of Community Pharmacy Research

Neil Johnston

Editor’s Note: We have had a number of articles in this issue relating to pharmacy research.
The PGA has conducted a number of research initiatives over the years, including one recently reported in Pharmacy News that resulted from an analysis of the QCPP Patient Questionnaire.
Pharmacy Guild president, George Tambassis, appears to have authored the article following, and there also appears to be a disconnect between the survey report and its target audience illustrated by one of the respondent comments published.
I have asked Mark Coleman to follow through, elaborate and comment:

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FSM Strategy Has no Middle Ground

Peter Sayers

articles by this author...

Peter Sayers is vitally concerned about pharmacy professional practice - its innovation, its research and development, and its delivery to create an ongoing revenue stream. Delivery of healthcare is increasingly involved with Information Technology systems. All perspectives in IT must be considered for the impact on pharmacy practice and its viability.

Since developing ideas for the debate on clinical evidence that makes sense, I have to admit that it has been hard to find any middle ground.
Neither side (FSM vs Complementary Practitioners) seems to be able to have a reasoned dialogue.
On the one hand you have the recently formed FSM making a pre-emptive strike against universities providing accreditation and training of complementary therapists in scientific approaches.
This does not make sense if it is desirable to develop a scientific evidence base within the complementary modalities that can find a level of acceptance within the portals of Establishment Medicine.
The one quality surrounding complementary medicine is the level of care that is provided compared to establishment medicine.
It is obvious and proven that patients are looking for care and delivery outcomes that are not being provided by the Establishment.

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Care is the primary reason that seventy percent of the Australian population have used at least one complementary practitioner in the past twelve months, and quite curiously, up to fifty percent of GP’s have taken at least one complementary medicine, but would not prescribe that identical complementary medicine for their patients.
The medical profession has always known that “knowledge is power” so it is easy to understand that complementary medicine has been gaining “power” through the acquisition of knowledge, and in the process, the ability to gather evidence in support of their vocation.
With power comes political awareness and strength, something that the medical profession understands very well.
Therefore it is no surprise that funding agencies for complementary medicines are the second target for FSM. With the removal of funding, complementary practitioners would substantially fall over, but not completely, because it is the care component that is valued most by patients.
However, there are some moderates that are beginning to speak up.
Kerryn Phelps, a general practitioner, adjunct professor at Sydney University, and former president of the AMA, says that throughout her 30 years of practice she has referred her patients to complementary medicine practitioners on a regular basis. "There are so many people who benefit from complementary health, but what they don't benefit from is a poorly trained practitioner," she said. Instead of taking these courses out of universities she believes they need to be celebrated so that a more efficient dialogue between competing theories is encouraged.

Recently, I found an interesting blog that also attempts to find logic and reason within the debate. The blogger's name is Steve Jenkins, a specialist IT consultant based in Canberra who has an interest in health.
He comments:
“The only question is Patient Safety, but instead, prejudice, bias and dogma. Where are the FACTS on Alternate Medicine being unsafe?

Establishment Medicine needlessly kills an estimated 4500 people per year in Australia. On the facts, there's no contest.”

Recently, he tried to comment on an article written on the smh.com.au site titled “Potions, pills and promises” (Go to: http://www.smh.com.au/opinion/blogs/godless-gross/potions-pills-and-promises-20120315-1v6do.html#ixzz1qeXQ3sZP )
The article expresses a fairly honest viewpoint of a skeptic and a possible FSM supporter.
However, when Steve tried to lodge a comment on the article, it was evidently refused because it never appeared.
Undaunted, Steve lodged the comment within his own blog and it reads as follows (but you should read the article at the link first). He said:

First, this is an ideological debate. Nobody is going to be convinced by anything written here, but I'll make an effort.

You are conflating and confusing Science and Medicine. One is about Theory and Knowledge, the other is an Applied Performance Discipline.

"it is strange that Western medicine is so on the nose with so many people."
No, the Science may be good, but the Practice and Delivery are often appalling, if not deadly. Check the Medical Error Action Group site. If Aviation were run like Medicine, we'd have 20+ 747's crashing every year in Australia.

"Why do people believe in ..."
Because they get compassion, care and concern from the practitioners. Ever waited 12 hours in an ER? It's not about the patient or good care.

"So how do we strive for truth?"
A Question based on a false assumption: people are looking for care, not data.

"How can the state deal with such popular therapies when there are
questions over efficacy?"

Because it's not about the Absolute Theoretical Potential of treatment, but the reality of Delivered Service, like "Dr Death" and others named by the QLD Commission of Inquiry, there is often a huge gulf.

"What is the role of freedom and hope in this equation?"
People already vote with their feet and wallets, use these market forces. Establishment Medicine is hugely subsidised ($50+B/yr), yet a large fraction of people choose to pay more and go elsewhere.
That would seem to be a comprehensive market failure of a whole Industry/Profession.
As taxpayers and voters, why do we accept this woeful state of affairs?

In Australia and the US, complementary medicine is a billion dollar industry and growing.
When you compare the two health care systems (published by the Commonwealth Fund that compares seven countries) Australia’s system ranked third while the US ranked last.

If Australia’s system ranks so highly, where is the urgent need to overhaul it by deleting complementary practitioners?
Certainly strive to improve their course content, but don't obliterate them.

In trying to develop research to uncover why there was so much disparity in viewpoint between the medical academics in the FSM and basically everyone else I found a possible answer in a program about Asperger’s Syndrome presented recently on ABC television, as an address to the National Press Club.
As I had a grandchild recently diagnosed with this disorder, I was interested to learn about the condition.
It appears that Asperger people have a bit of a tortured existence in that they have very high IQ’s and are capable of high academic standards, particularly in the maths and science area, but their Social IQ is very low. They honestly do not know how to relate to other people socially, can’t read “body language”, and often respond inappropriately in a social setting.
The example given was that a child may notice his mother looking sad and form the solution that he should perform a humorous dance as a means of cheering her up.
Perhaps the last thing his mother wants to endure at that time.
The process of a simple embrace with a few words of sympathy seems to be beyond the Asperger child.
So the child forms few relationships during his development to adulthood, and the odd friend seems to be another person similarly afflicted.
These kids like to work in isolation, study from text books without the help of a tutor and rationalise end points to their own internal research, that are often quite brilliant.

The punch line from the presenter came when she stated “Universities are sheltered workshops for Asperger sufferers and they perform well in such a cloistered environment, and that is why you find so many of them in universities."
That turned on a light for me at that moment and at least offered an explanation as to why some medical academics and practicing doctors often come across as being uncaring, very blunt and very evidence-based- they are programmed that way from birth.
Selection for medical courses is based on a scoring process that is akin to always selecting the highest IQ but not necessarily the best practitioner. This fact has been recognised by course planners. So, the final applicants will have more than a sprinkling of Asperger’s syndrome among them in varying degree.

There it is.
My take on this issue is that it will never be resolved in the manner that each side would prefer, because neither side is built to adapt.
Therefore, compromise must occur.
Kerryn Phelps summed it up recently in Medical Observer:

“They (FSM) are putting those of us trying to navigate the real world of clinical medicine in an invidious position. 

Talk about a risky double standard!

Foremost is the reality that no one paradigm of healthcare has a monopoly on evidence. If you argue that only “our” brand of healthcare is science-based, then number one: it is just plain incorrect. And number two: how do we as doctors defend ‘medical’ scandals like the withdrawal of Vioxx or Reductil because of the number of deaths attributed to these heavily marketed “evidence-based” drugs?

A joint investigation by the British Medical Journal and BBC labelled the use of metal-on-metal hip joints “a very large uncontrolled experiment, exposing millions of patients to unknown risk” due to the release of chromium and cobalt from the prostheses. Try having that conversation with a patient wanting to know how best to manage their advanced osteoarthritis.

And let’s not even start with the French breast implants and their dodgy silicone! 

Those of us in general practice know that high level evidence is not available for much of the work we do, and we rely, not unreasonably, on our traditions, experience and clinical judgment. 

I work with and actively refer to a range of ‘complementary medicine’ practitioners, all of whom have been university trained. They include, but are not limited to, osteopaths, chiropractors, acupuncturists, naturopaths, exercise physiologists, herbal medicine practitioners and others. Some, like massage therapists, are not university trained, but I expect a minimum level of education and training.

Many of these disciplines rely, as we often do, on clinical judgment and traditional experience, but with a substantial and growing evidence base.

There may well be a point to be made to reassess the curriculums being offered in healthcare courses generally.

I, for one, would like to see our medical schools adopt an integrative medicine model of teaching like many major medical schools in the US.

This is a far better reflection of what our doctors are likely to encounter and would prepare them far better for clinical practice of the future. 

And while we’re at it, how about the NHMRC kick in some real funding to accelerate the gathering of more Australian clinical integrative medicine research?

And for the moment, that is where I am going to leave the debate as I do not think the FSM are on very solid ground and many of their members have not rationalised their real position prior to signing up. Nor do their personalities allow them to back off what they believe is the evidence reality.
FSM should go back to the drawing board, and tidy up its own backyard.
As i2P originally pointed out when FSM first appeared, when the very basics of supposed evidence has been tainted or corrupted (as illustrated in a number of i2P articles), no sane health practitioner would trust any of it let alone apply it through patients.
Pharmacists should concentrate on the delivery of care and trust their own judgement in respect of what they advise their own patients.
After all, we were trained to be the experts in drugs, and were also recognised by government as the best professionals to advise on complementary medicines.

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