s ‘All Trials’, Marketing Based Medicine, and the fight for clinical transparency | I2P: Information to Pharmacists - Archive
Publication Date 01/12/2013         Volume. 5 No. 11   
Information to Pharmacists

Editorial

From the desk of the editor

Welcome to the December edition of i2P-Information to Pharmacists.
As we wind down in 2013 for the holiday period we will be filing some updates, but at a little more leisurely pace.
Where has the year gone?
Certainly the rate of change for 2013 has been more than hectic and there has been little time to organise thoughts and set appropriate directions.
This is the season for hard negotiations for the 6CPA but there is little left to squeeze.
Pharmacy has had the equivalent of bariatric surgery.
Government has taken it all, as usual.
As current price changes work their way through the pharmacy cash flow cycle, for some there will be insufficient- and heartburn.
Crunch time is that there will be more bankruptcies over 2014.
Media reports that some pharmacies have received free shop refits as a form of payment for purchasing a specific generic drug range is certainly not obvious, as the average pharmacy is in need of some renovation or repair and looking a bit jaded.

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Recent Comments

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News Flash

Newsflash Updates November 2013

Newsflash Updates


Regular updates from the global world of pharmacy.
Access and click on the title links that are illustrated.

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Newsflash Items for December 2013 and January 2014

Newsflash Updates

Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
Access and click on the title links that are illustrated

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Feature Contribution

How to Avoid Becoming a Commodity

Chris Foster

These days more than ever the competitive advantage pursued by many is to discount and commoditise an industry.
The prime example of this is warehouse pharmacy stores.
However, this is not unique to pharmacy, but too many industries out there, including electrical retailing and hardware.
As a result, the relentless pursuit of being the cheapest product and service provider has meant that the smaller, service focused business is eventually forced out of business.

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A Clinical Services Pharmacy Design (Canadian Style)

Fiona Sartoretto Verna AIAPP

Editor's Note: This pharmacy design would suit an Australian pharmacy set up for clinical services and for survival over the next five years. Pharmacists interested in adapting this design to suit their local market should contact Neil Johnston at neilj@computachem.com.au for an introduction to Sartoretto Verna design services.

Villagio Market Pharmacy -St- PerreJolys , Manitoba, Canada Technical Data

Total area: 90 sq.m.
Area open to public: 75 sq.m. Area open to public / total area: 83%
Exposure: 39 lm
The task was to create a pharmacy inside the market in St -Pierre Jolys , a rural village which is situated not far from Winnipeg, Canadian province of Manitoba.
In recent years, the owner Mark Duddridge has transformed a simple grocery into a full-service drugstore that it is visited approximately by 400 visitors per day.
Sartoretto Verna was asked to create a pharmacy that can boast an excellent design with thorough attention to details.

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A Peaceful Christmas and a Productive New Year

Neil Johnston

The editor ans staff of i2P e-magazine would like to wish all of its readers the best wishes for a peaceful Christmas and a productive New Year.

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PGA Moves Into Primary Care

Neil Johnston

This week I received a pleasant surprise in the form of a PGA news item endorsing a range of primary health care services, an area that had been progressively abandoned from as far back as 1978, but in particular, within the last decade.
Importantly, the PGA has recognised that the current pharmacy business model has reached its “use by” date by stating:
 “The Guild’s National Council has recognised that the successful and widespread integration of these primary health care services into pharmacy businesses is likely to require significant changes to the traditional pharmacy operating model, including in relation to workflows and the roles and responsibilities of pharmacists and other staff.”

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Building a clinical services model in a difficult marketplace

Peter Sayers

It seems to me that there is a confluence of events overtaking pharmacy.
On one hand there is a genuine disappointment by health consumers that they have not been able to access pharmacists for basic primary care services, and on the other, there are a host of pharmacy critics and academic advisers that have a range of solutions, none of which are compatible with a community pharmacy environment.
And in the middle are a host of dedicated pharmacists working and piloting a range of solutions while simultaneously being torn apart, as unreasonable chunks of cash flow and profitability disappear from its business heart.

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My Best Team

Gerald Quigley

Quite coincidentally, over the last few months, I’ve been thinking about where we’ve been in our profession, and where we’re headed.
Some recent comments within this fine publication have cemented my thoughts on how we can recover some ground in our perceived role of “do what other health professionals tell you to do, and don’t dare step outside those parameters or your world will end.”
At the end of each football season, “expert” commentators rate their “best 18” (in the AFL) or the “best 11” (in cricket).
Lists like this often precipitate vigorous debate.
I’m no expert, but each of us has our professional heroes.
Some of mine are still with us, and some have gone to that big professional healthcare practice in the sky.
Within that latter group, I wonder what they are thinking.

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Continuity of care in residential care

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

In February 2011 I wrote on the topic of continuity of care with regard to hospital discharge (Volume 3 No. 2).
At that time I was working in hospital pharmacy practice.
Now I am sitting on the other side of the fence working in residential care undertaking medication reviews and I see just how fragmented care can be in the community.
The situation is exacerbated as the patients are usually elderly and they and their families are not always able to communicate important health information to the various health care providers involved.
This puts these patients at significant risk of medication misadventure and adverse outcomes. Some examples follow. All of these scenarios are based on real cases.

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More Pharma Abuse

Judy Wilyman

Editor's Note: The corrupt nature of Big Pharma's evidence-base to justify the marketing of bad medicine is slowly unraveling through courts of law around the world.
The corrupt medical academics who fuel this process through allowing themselves to be "bought" by a number of creative means will also be similarly addressed.
Different levels of government are also tainted when it is seen that mandatory vaccination is being used to drive corrupt health policies, even when evidence exists to the contrary.
i2P supports true evidence-based arguments or best evidence where something has had traditional use and is waiting for evidence support to occur.
We do not support the claims made by Skeptic extremists that permeate the landscape, that tend to support corrupt evidence even though it may have been published in a peer-reviewed journal.
How the medical fraternity and Big Pharma will sort out this absolute mess remains to be tested.
And they must realise that they are no longer trusted or respected by members of other health professions, simply because of this unprincipled and illegal behaviour.

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Medical Debate Censorship Attempt by NSW Government

Staff Writer

Editor's Note: Until today, I had never heard of the organisation Avaaz.
Avaaz—meaning "voice" in several European, Middle Eastern and Asian languages—launched in 2007 with a simple democratic mission: organize citizens of all nations to close the gap between the world we have and the world most people everywhere want.
Avaaz empowers millions of people from all walks of life to take action on pressing global, regional and national issues, from corruption and poverty to conflict and climate change.
The Avaaz model of internet organising allows thousands of individual efforts, however small, to be rapidly combined into a powerful collective force. (Read about results on the Highlights page.)
The Avaaz community campaigns in 15 languages, served by a core team on 6 continents and thousands of volunteers.
Avaaz takes action -- signing petitions, funding media campaigns and direct actions, emailing, calling and lobbying governments, and organizing "offline" protests and events -- to ensure that the views and values of the world's people inform the decisions that affect us all.

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Why is WHO guilty of WOO?

Loretta Marron OAM BSc

Acupuncturists claim that they can treat many serious illnesses, including depression, dysentery, osteoarthritis and whooping cough. As 'evidence', they even refer to the World Health Organisation (WHO) website.
What does WHO claim acupuncture can cure?
Does this match the evidence?

Comments: 1

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Unselfishness has a special place in business

Harvey Mackay

Bill Bradley recently spoke to a group of Minnesota Timberwolves season ticketholders.  The topic wasn’t his stellar career, basketball strategy or memorable wins.  Instead, he talked about unselfishness.  After 40 years of traveling America as a Hall-of-Fame basketball player and a U.S. Senator, the Rhodes Scholar has a lot of stories to tell about the remarkable unselfish accomplishments of people both famous and unknown.  He features them during his weekly American Voices program on Sirius/XM Radio.

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I’ve been thinking about, Boston, Belichick, UPS, and transporting properly prepared IVs to the right patients on time

Mark Neuenschwander

I’ve been thinking about, Boston, Belichick, UPS, and transporting properly prepared IVs to the right patients on time.
Boston is my favorite public transit city. I’m like a kid while being transported by user-friendly Charlie through the labyrinth beneath her historic streets.
It’s not uncommon for outsiders to say Bostonians are not so user friendly. Stereotyping suggests they are not terribly diplomatic, sometimes condescending, and always in a rush.
Sort of the way the Patriot’s Coach Belichick comes across on Sports Center’s post-game interviews.

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Big Data - A Business Power Shift

Barry Urquhart

Season’s greetings.

With the increasingly cosmopolitan nature of Australian society and its people the Christmas festive period is becoming progressively less dominant, particularly for businesses.
However, the Christian values of love, compassion, sharing and understanding are relevant at all times for all people.
We all benefit and should enjoy embracing the sense of family... Australians are all part of one cohesive, extended family. This year we should make the time and effort to reflect, reach out, respect and value the sense of virtue of family.
In commerce the same commitment should be given to virtues of quality customer service.
The following text highlights why. And remember, there is no holiday or break in the need for and advantages of service excellence.

Kindest Personal Regards

Barry Urquhart

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‘All Trials’, Marketing Based Medicine, and the fight for clinical transparency

Baz Bardoe

Editor's Note: i2P would like to introduce a new writer named Baz Bardoe, an experienced writer with an interesting background.
He joins our small group of writers looking at the ethics behind drug and other medical evidence that pharmacists rely on for their advice and recommendations to their patients.
Much of this evidence has been found to be fraudulent and will take decades to sort out.
This type of fraud also permeates other industries to the extent that information adverse to the interests of these industries (Big Pharma, Big Agriculture, Big Tobacco, Mainstream Media and Big Pesticide and Herbicide Manufacturers), is suppressed.
But they all seem to conspire using a similar methodology to the extent that human health is adversely affected through lack of information or publicising false information, or distributing misleading information.

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A Tribute to Nelson Mandela

Neil Johnston

Nelson Mandela had little to do with pharmacy (except that he was involved in action to obtain access to cheap HIV medications for his country) but his personal code of conduct was admired universally.
His strength of character and leadership style certainly avoided what might have become a blood-bath in South Africa.
His recent passing was a loss to the World Community and i2P decided to acknowledge this great man within its pages.
I also began to think about what his personal reaction might have been to some current issues in Australia and its health system, and how our leaders compare with his standards.
For example, would he have signed up to the current proposed version of the Trans Pacific Partnership Agreement and would he have endorsed the actions of Big Pharma, Big Tobacco, Big Agriculture, Big Herbicide/Pesticide where it involved human health?
I am sure the answer would have been a resounding NO!
The following is a statement he made and observed:

“What counts in life is not the mere fact that we have lived. It is what difference we have made to the lives of others that will determine the significance of the life we lead.”


The following synopsis of his life has been extracted from the Nelson Mandela Foundation website:

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Good Manners Create Good Communications and Illustrate Respect and Care

Peter Sayers

Pharmacy has always “won its stripes” utilising its ability to be able to relate to individuals in an empathetic manner.
Patients have always reacted positively in accepting what pharmacists have offered to them as a health benefit.
Trouble is, the health benefits have not expanded progressively and pharmacists have become less visible under the mountain of PBS paperwork, bureaucracy and sundry critics that drown out pharmacist voices.
Now the price is about to be paid as government payments to pharmacists will reduce according to their view of the value of a pharmacist, which will be seen as almost non-existent.
And pharmacists, being survivors, will have to limit their time-investment in the PBS because it will not represent good value to them or their patients.

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Primary Health Care Teams – Will Community Pharmacists be Participants?

Neil Johnston

In the hospital setting pharmacists work well with nurses and doctors. Possibly because of close working proximity and the opportunity for social interaction, there is a better understanding of the role of each profession.
Politically, within a hospital setting, pharmacists feel disadvantaged.
It is a numbers game.
Nurses and doctors have the largest number of people on the ground and the strongest “hands-on” contact with patients.
Pharmacists have a lower profile with the patient, coming in later with an educational role that does not have the same sense of immediacy.

Comments: 1

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Something’s Fishy About Macular Degeneration Fish Oil Studies

Staff Writer

Orthomolecular Medicine News Service, December 11, 2013

Something’s Fishy About Macular Degeneration Fish Oil Studies
by Bill Sardi

(OMNS Dec 11, 2013) Just seven months ago National Eye Institute researchers claimed fish oil “doesn’t seem to help macular degeneration,” (1) a sight-robbing eye disease that plagues adults in their senior years.
So how could another newly published study produce exactly opposite results?
In fact, fish oil didn’t just slow down the insidious progression of this eye disease, it restored vision to every patient placed on high-dose fish oil. It was therapeutic and curative, not just preventive.

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Vitamins, Minerals Reduce AIDS Mortality - Ignoring Supplements Means Unnecessary Deaths

Staff Writer

Orthomolecular Medicine News Service, December 17, 2013

Vitamins, Minerals Reduce AIDS Mortality - Ignoring Supplements Means Unnecessary Deaths
Commentary by Andrew W. Saul, Editor

(OMNS Dec 17, 2013) Twenty-six years ago, I worked with a client (woman, late 20s) who was HIV positive.
She was a heavy drinker and drug user, a smoker, had a terrible diet, and a series of bad personal relationships.
Her health was deteriorating.
Desperate, she decreased her drug and alcohol use.
She still smoked, ate a poor diet, and was under great stress.
She took multivitamin/multimineral supplements irregularly.
But she took a lot of vitamin C very regularly, for over two decades.

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Multivitamins play a key role in health and wellbeing for people with vitamin and mineral deficiencies

Marie Kelly-Davies

Australian consumers can continue to have confidence in the wealth of evidence that exists on the role of multivitamins in providing overall health and wellness benefits and filling dietary gaps in combination with healthy lifestyle choices, the Australian Self Medication Industry (ASMI) said today.

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What are we worth?

Gerald Quigley

I’ve been following the bleatings by many about the fee we “deserve” to be paid for aspects of our professional expertise, which the consumer doesn’t actually know we have.
What puzzles me more is that we are even speaking about a “fee” before asking the end-user (the patient) whether or not they feel they need this particular service.

Comments: 1

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Vitamins Help Prevent Alzheimer's Disease News Media Ignores Supplement Benefits . . .Again

Staff Writer

Orthomolecular Medicine News Service, December 20, 2013

Vitamins Help Prevent Alzheimer's Disease. News Media Ignores Supplement Benefits . . .Again

(OMNS Dec 20, 2013) Nutritional supplementation with antioxidants and the B-complex vitamins has been shown to help prevent dementia. Half of all cases of Alzheimer's, the most common form of dementia, could be attributable to known dietary and lifestyle risk factors, and at least one fifth of current cases could be prevented right now.

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Tracking Down Human Rights - Is Anyone at Home?

Judy Wilyman

Editor's note: For some time I have been following the arguments in support of official vaccination policy, and the other side of the argument as well.
Having been trained in pharmaceutical science and its objectives to align itself with “evidence-based medicine”, I have to admit that I have lost heart both in the process itself and the arguments in support of medical products that have supposedly  been submitted to testing, using orthodox and recognised processes.
The entire system of checks and balances has been torn apart.

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The New Battlegrounds

Peter Sayers

As pharmacists commit further to the expansion of clinical services over 2014, it will not take long for the local GP’s to begin the predictable strategy of reprisal.
In the past, that usually took the form of “channelling” prescriptions to opposition pharmacies (including Internet pharmacies).
However, PBS prescriptions are now so commoditised and cash flow disruptive, that they can no longer be part of the real growth platform of pharmacy’s future and therefore have less impact when channelled by a GP.
Similarly, nursing home business that has always been vulnerable to either GP pressure or a cut-price pharmacist competitor is no longer a concern, unless the pathway to “profitless prosperity” is part of a business model needing expanding cash flow volume at the expense of profit.

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Vitamin D supplements needed for many mothers and babies

Staff Researcher

Many pregnant women in New Zealand should be taking vitamin D supplements to ensure their babies are not at risk of rickets.
Young breastfed infants of Maori or Pacific Island women, or infants of women with dark skin or who are often covered or veiled when outdoors, are at the greatest risk of having low vitamin D levels.
The mother’s vitamin D level during pregnancy determines the vitamin D status of her newborn baby and remains an important determinant of vitamin D status while the infant remains exclusively breastfed.
A study to determine the optimum vitamin D dose for pregnant women and infants has recently been completed in Auckland and was published this month in the American Academy of Pediatrics journal ‘Pediatrics’.

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Monoculture Pharmacy - How to Rise Above It

Neil Johnston

The problem with modern Australian community pharmacy is that it has evolved to become a monoculture that is lacking in diversity and depth.
The term is commonly used in agriculture to describe the production of one crop over vast quantities of land, with all the resultant havoc that such practice plays on the soil, water, native flora and fauna, and, to be perfectly clear, on the climate system as well.
For havoc in pharmacy read government induced profit losses leading to career opportunity loss for individuals, lack of suitable forward vision and direction, disruption in education and workforce planning - and the list goes on.
And that is a perfect analogy for pharmacy at the close of 2013.
In its extreme form monoculture becomes monomania and we would know it as the PBS and managed care, as we have all been brainwashed into believing that it is the world’s best health system.
What a joke!

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How to make New Year's resolutions you'll keep

Harvey Mackay

It is New Year's Eve and Charlie Brown says to Lucy:  “Next year I am going to be a changed person.”
“That's a laugh,” says Lucy sarcastically.

“I mean it,” says Charlie, “I'm going to be strong and firm.”
“Forget it,” says Lucy.  “You'll always be wishy-washy.”
“Well,” answers Charlie defensively, “One day I will be wishy and washy the next.”
Like Charlie Brown, most of us set New Year’s resolutions that are a little vague – lose some weight, spend more time with family and friends, quit smoking, quit drinking, enjoy life more, get out of debt, help others, get organized and on and on.
Just think, if everyone kept their New Year’s resolutions, the world would be a lot different:  We’d have healthier people that would show up for work on time, smoke and drink less and be more organized.

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Remove barriers to medication reviews for aged-care residents

Staff Writer

Written by Suzanne Newman from SHPA
An article by Amanda Vanstone in The Age and The Sydney Morning Herald this week highlights important issues in the aged-care sector in relation to medicine use.
In her article, Ms Vanstone described a resident of an aged-care facility being prescribed medications that she did not require.
SHPA believes that this case highlights why regular medication review by accredited pharmacists is an important service for all residents of aged-care facilities.

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Orthomolecular News Service January 3 & January 7 2014

Neil Johnston

Editor's Note:
The unnecessary war that is waged on vitamins and other nutritional supplements is continually and routinely engaged.
Is it because they offer a genuine alternative to mainstream medicine? Or a cheaper treatment? Or a safer treatment?
In the war of continuous disinformation it gets harder to separate truth from fiction particularly when it is generated through Big Pharma sources - the same sources that have had massive fines levied against them for publishing fraudulent research, not just once, but multi-times.
Will government ever legislate in this area?


Orthomolecular Medicine News Service, January 3, 2014

No Deaths from Vitamins. None.
Supplement Safety Once Again Confirmed by America's Largest Database
by Andrew W. Saul, Editor
PLUS

Orthomolecular Medicine News Service, January 7, 2014

Regulation of Vitamins: Politics As Usual

Commentary by Rolf Hefti

Comments: 1

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Gradually, and Then Suddenly- a Lesson in Life

Neil Johnston

I started publishing i2P in February 2000 because I was personally aware that community pharmacy policy was not going in an optimum direction and was becoming divisive within the profession.
At that stage there was only one writer (me), but I was soon tackled by other pharmacists with similar thoughts and very strong views, so I decided there was room for a “thought leadership” role for my then fledgling publication, and I invited my detractors/supporters to fill an Internet page that was theirs to manage and to write their own researched thoughts, without censorship or heavy editing (except for potential libel and grammatical errors).
So was born a publication that could publish completely opposite viewpoints simultaneously, creating a form of a “think tank” for all pharmacists.

Comments: 3

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Orthomolecular Medicine News Service, January 16, 2014 - Top 20 vitamin D papers for 2013

Staff Writer

Orthomolecular Medicine News Service, January 16, 2014

Top 20 vitamin D papers for 2013

by William B. Grant, PhD

(OMNS Jan 16, 2014) There were 3774 papers published in 2013 with vitamin D in the title or abstract according to pubmed.gov, up from 3099 in 2012.
Among the top 20 vitamin D papers chosen to highlight for 2013 were 11 reviews, five observational studies, one geographical ecological study, one trial, one laboratory study, and one analysis of data from published results.
The papers were chosen in part by the number of times they have been cited in other works as reported by Scholar.Google.com and in part based on expert opinion by vitamin D researchers.
The fact that two-thirds of the papers were reviews is an indication of the relative maturity of the field. However, as noted in the discussion, the weak link in the vitamin D story is the limited number of randomized controlled trials (RCTs) reporting beneficial effects of vitamin D.
As discussed in the paper by Heaney [2013], the primary reason for this result is that vitamin D RCTs have been poorly designed and conducted in general; researchers have generally designed vitamin D RCTs based on the pharmaceutical drug model, which assumes no other source of the agent and a linear dose-response relation. These conditions are not satisfied for vitamin D. As a result, many of the trials enrolled people who had relatively high serum 25-hydroxyvitamin D [25(OH)D] levels and gave them too little vitamin D to produce a beneficial effect.

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Vaccinations Still Have Problems in 2014

Judy Wilyman

Welcome to the first Vaccination Decisions newsletter for 2014.
I would like to provide you with information about the HPV vaccine that is given to all Australian adolescents in government funded school programs to prevent cervical cancer. This vaccine has had the highest number of reactions globally and thousands of girls (and now boys) have become permanently disabled after receiving this vaccine.

Comments: 3

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Leadership is a State of Mind

Neil Johnston

Leadership is often confused with management.

While it embraces management it is nonetheless ,an entirely different process.
An organisation that does not have a leader is an organisation that is going nowhere.

It is a follower.

It is a long time since I have seen a leader of our profession that really stood out – one who was not frightened to really speak up about their thoughts and actively defend them.

You are more likely to see someone who waits for someone else to “do something”, and then slavishly copy them. In the interim those pseudo-leaders fade into the background because they can never be original.

Certainly examine some other person's work, but only to see what deficiencies exist so that your version might be greatly improved.

But in researching and value-adding a leader will come up with an essentially new approach that will give his organisation a point of difference. And he will launch his product as an incomplete (eighty-percent) version to be refined “on the run”.

That leader gets to achieve his goal before the rest of the pack.

That leader will stand out.

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ASMI welcomes community pharmacy support for S3 information-based advertising

Marie Kelly-Davies

The Australian Self Medication Industry (ASMI) is encouraged by strong signals of support from community pharmacy to expand the range of Pharmacist Only (S3) medicines as well as its widespread support of an information-based communications approach to consumers for S3 medicines, as demonstrated by the UTS Pharmacy Barometer released this week.1
Prescription to non-prescription reclassification (‘Rx to OTC switch’) and lifting the current advertising restrictions on S3 communication are key issues that remain high on ASMI’s agenda.

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Nearpod helps revolutionize medical education teaching using mobile devices

Staff Writer

One of the most impressive apps for medical education purposes is Nearpod.
The premise behind nearpod is simple–to bring the classroom to life with interactive mobile presentations that teachers can create and customize themselves.
Nearpod relies on a  cloud based system to distribute interactive presentations to students in a classroom. It is particularly well suited for institutions that own or use tablets regularly (although you can use a phone).

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New discoveries in quest for better drugs

Staff Researcher

A new crystal structure of a GPCR bound to both an activating molecule and a drug
Two studies into alternative drug recognition sites on G protein-coupled receptors have been published in Nature.
Scientists have combined cutting edge computer modelling, structural biology, pharmacology and medicinal chemistry to reveal new insights into how the body interacts with novel drug treatments, in research that could lead to the creation of drugs that are more targeted and with fewer side effects.

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SHPA’s new president to champion excellence in medicines management

Staff Writer

Story by Suzanne Newman

At a meeting of SHPA’s Federal Council on the weekend, Professor Michael Dooley, Director of Pharmacy at Alfred Health, and Professor of Clinical Pharmacy, Centre for Medicine Use and Safety, Monash University, was elected as the new President of SHPA.

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SHPA welcomes prescribing pathway for health professionals

Staff Writer

Story by Suzanne Newman

SHPA welcomes the news that the Health Professionals Prescribing Pathway has been approved by Australian health ministers.
The Health Professionals Prescribing Pathway project has been undertaken by Health Workforce Australia (HWA) to develop a nationally recognised approach to prescribing. SHPA has been involved in this project from the outset: contributing feedback on a draft version and being represented in workshops and other settings by SHPA representatives including former President Sue Kirsa, CEO Helen Dowling, Yvonne Allinson and Greg Weeks. SHPA member, Dr Lisa Nissen, has been a clinical advisor to the project.

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Prime Minister announces new funding to support delivery of chemotherapy

Staff Writer

Story by Helen Dowling

SHPA welcomes the announcement on 30 November 2013 by the Prime Minister, Tony Abbott of more than $82million additional funding to support the delivery of chemotherapy medicines in Australia’s public and private hospitals.
Although few details have been released, the new funding that commences from 1 January 2014 removes the immediate concerns of SHPA members regarding the delivery of chemotherapy medicines.

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Professional Pharmacists Thank Sue Kirsa for her Contribution to Pharmacy

Professional Pharmacists Australia Spokesperson

Professionals Pharmacists Australia today paid tribute to the hard work and vision of Sue Kirsa who recently resigned as President of the Society of Hospital Pharmacists Australia.
CEO of Professional Pharmacists Australia, Chris Walton said Ms Kirsa worked tirelessly to see pharmacists better able to utilise their skills to improve community health.

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A Tribute to Nelson Mandela

Neil Johnston

Nelson Mandela had little to do with pharmacy (except that he was involved in action to obtain access to cheap HIV medications for his country) but his personal code of conduct was admired universally.
His strength of character and leadership style certainly avoided what might have become a blood-bath in South Africa.
His recent passing was a loss to the World Community and i2P decided to acknowledge this great man within its pages.
I also began to think about what his personal reaction might have been to some current issues in Australia and its health system, and how our leaders compare with his standards.
For example, would he have signed up to the current proposed version of the Trans Pacific Partnership Agreement and would he have endorsed the actions of Big Pharma, Big Tobacco, Big Agriculture, Big Herbicide/Pesticide where it involved human health?
I am sure the answer would have been a resounding NO!
The following is a statement he made and observed:

“What counts in life is not the mere fact that we have lived. It is what difference we have made to the lives of others that will determine the significance of the life we lead.”


The following synopsis of his life has been extracted from the Nelson Mandela Foundation website:

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Debbie Rigby to lead SHPA’s new accredited pharmacist group

Staff Writer

From Natalie Collard
SHPA is pleased to announce that Debbie Rigby will chair the SHPA Accredited Pharmacists Reference Group. Debbie is a highly regarded consultant clinical pharmacist, and comes with much experience in education, research, governance and communication. She is a Director at NPS MedicineWise and was the inaugural AACP Consultant Pharmacist of the Year in 2008. Debbie has much to offer.
SHPA President Professor Michael Dooley said “SHPA is fortunate that Debbie has agreed to chair this important group. Under her leadership this group will consolidate SHPA’s support for pharmacists who provide medication reviews and guide SHPA and our members through changes in pharmacy practice such a post-discharge hospital referral pathway for HMRs, which is on the horizon.”

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Support for pharmacists throughout the holidays Call 1300 244 910 to talk it over with a colleague

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

Not everyone enjoys this time of the year. Work pressures in pharmacy can be substantial with the end of the year “safety-net” rush, Boxing Day sales, holiday crowds in tourist areas and limited access to other health services.
Many pharmacists do not have the opportunity to relax with family and friends.
A sense of isolation can be exacerbated, especially if those around you are relaxing and celebrating and you are not.

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ASMI supports voluntary move to add front-of-pack warnings to S3 codeine-containing analgesics

Marie Kelly-Davies

The Australian Self Medication Industry (ASMI) has today confirmed that it supports industry-wide measures for a voluntary front-of-pack warning statement to be added to S3 codeine-containing analgesics, and that ASMI members who supply these products have agreed to implement the voluntary label changes as soon as possible.

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PHARMACY OWNERS CAUGHT UNDERPAYING HUNDREDS OF EMPLOYEE PHARMACISTS IN NEW AUDIT

Professional Pharmacists Australia Spokesperson

One quarter of Australia's pharmacy owners are breaking workplace laws, including underpaying their pharmacists and other staff, according to a shocking new Fair Work Ombudsman's audit report released today.
CEO of Professional Pharmacists Australia, Chris Walton, said the PPA's campaign to establish the audit was justified after it found 599 cases of pharmacists and other staff being underpaid, and more than $280,000 had to be paid back to pharmacy employees.

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Contact Lenses- a Platform for Glucose Measurement by Google

Staff Writer

Editor's Note: There is no doubt that health services are undergoing a revolution in the form of mobile apps and wearable technology.
The process is disruptive in terms of potential reductions in visits to various health professionals, including pharmacists,
Opportunity exists for pharmacists who can provide (for a fee) bridging technology and supporting information and advice to enable a patient to self manage their condition.
There is also a general movement in health development to create a self care environment with barriers being progressively removed e.g. S3 advertising.
Pharmacists need to develop also a recognisable and marketable patient mentoring service.


Diabetes is a disease without borders — one in 19 people across the globe deal with this illness that requires constant blood measurements and insulin treatment.
Google might soon make day-to-day care a little easier for diabetics with contact lenses that can read a person’s blood sugar through their tears – bringing new meaning to the popular wearable tech trend.

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Role of vitamin D, in combination with calcium, indisputable for bone health

Marie Kelly-Davies

Despite the current debate surrounding vitamin D, its role in maintaining good bone health and protecting against osteoporosis, in combination with calcium, is indisputable.

While evidence of the potential role vitamin D may play in non-skeletal conditions mounts, the Australian Self Medication Industry (ASMI) agrees with recent editorial comments in The Lancet that large clinical studies would help to properly assess the effects of vitamin D for health conditions such as heart diseases, diabetes, cancer, dementia and inflammatory diseases.1

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Pharmedia: No Benefit in Pharmacist Intervention

Neil Johnston

Editor's Note:
The media item below was recently published in MJA Insights.
It, along with many other articles, is a sample of the ongoing anti-pharmacy sentiment that is being spread by official medicine.
To me it is a nonsense to talk of collaboration between pharmacy and medicine on one hand, and to be professionally insulting on the other.
My view is that the medical profession has a lot of repair work to undertake to purify the drug evidence base that has been damaged beyond belief by its collaboration with Big Pharma, and the ongoing bid to denigrate the profession of pharmacy at every opportunity.
What seems to terrify official medicine about pharmacy and other registered health professionals such as nurses?
I2P asked Mark Coleman to comment on this situation, and his comments appear below the Insights item.

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‘All Trials’, Marketing Based Medicine, and the fight for clinical transparency

Baz Bardoe

articles by this author...

Baz Bardoe is a post graduate researcher, journalist and media analyst. He has qualifications in anthropology, marketing and business. His articles have appeared in 'Popular Science', 'Defence Today', 'Online Opinion' and many others. He is currently a military officer and hopes to commence PhD studies in 2014. He has an ongoing interest in issues relating to ethics and accountability. His views are from a personal perspective and do not purport to represent the views of the ADF in any capacity.

Editor's Note: i2P would like to introduce a new writer named Baz Bardoe, an experienced writer with an interesting background.
He joins our small group of writers looking at the ethics behind drug and other medical evidence that pharmacists rely on for their advice and recommendations to their patients.
Much of this evidence has been found to be fraudulent and will take decades to sort out.
This type of fraud also permeates other industries to the extent that information adverse to the interests of these industries (Big Pharma, Big Agriculture, Big Tobacco, Mainstream Media and Big Pesticide and Herbicide Manufacturers), is suppressed.
But they all seem to conspire using a similar methodology to the extent that human health is adversely affected through lack of information or publicising false information, or distributing misleading information.

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It is fueled by greed which pays for corrupt lobbying activities to introduce legislation, which further supports and promotes these immoral/illegal activities.
It even overwhelms democratically elected governments in a subversive format such as a trade treaty.
Are you aware that Big Tobacco is currently trying to overcome recent Australian laws involving plain packaging for tobacco products utilising a back door treaty?
If Australia signs up to the current Trans-Pacific Partnership Agreement this will happen and the Australian government is then open to be sued by a corporation,for any internal legislation that impinges on the profits of Big Tobacco (and others).
If this activity is not stopped, all western economies (including Australia) will be faced with a tsunami of induced ill health. It is progressively happening in plain sight already and with pharmacists being the most accessible health professionals, we need to acknowledge the problem and then be part of the solution to stem the tide at both the political and informational levels to gate-keep on behalf of our patients.

Baz Bardoe's article, which was first published in Online Opinion 4/12/2013, follows:

“We don't have "evidence-based medicine" (EBM), rather we have "marketing-based medicine" (MBM).” – Dr Peter Parry

If you have ever used a pharmaceutical product, or if you are a healthcare provider, you need to read this article. At the end of it you may well be shocked into a major paradigm shift.

When most people use a pharmaceutical product, they assume that it has been independently tested, and found to be safe and effective before being released onto the marketplace. But the reality is very different. In some cases drug companies finance clinical trials and only selectively release data and reports that support their marketing goals. And many of the reports in medical journals which medical professionals rely upon to reach opinions about pharmaceutical products, are written by people with financial links to drug companies. In some cases reports are even being ‘ghost written’ by people employed by pharmaceutical companies. In short, medical literature and data is massively compromised by pharmaceutical marketing.

If this seems like some preposterous conspiracy theory then consider the work of Dr Peter Doshi and the independent Cochrane Collaboration which should give us pause for thought. “The current system……. is one in which the meager details of clinical trials published in medical journals, often by authors with financial ties to the companies whose drugs they are writing about, is insufficient to the point of being misleading”. (1)

And then there’s the even stronger position of epidemiologist Dr Ben Goldacre, as reported in The Guardian. "The decades-old industry practice of suppressing scientific evidence (and some independent researchers doing the same), leads Goldacre to declare that nothing we know about modern medicine should be assumed to be correct, and he makes the urgent case for forcing the release of all that pharma dark matter so scientists can re-run the numbers and work out what actually does work." (2)

Statements like this are sending shockwaves through the medical establishment, and with good reason. But as Goldacre indicates, it is an issue that has been brewing for a long time. Writing as editor of the prestigious medical journal ‘The Lancet' in 2002, Richard Horton stated that “a study of the interactions between authors of clinical practice guidelines and the pharmaceutical industry……… found serious omissions in declarations of conflicts of interest. Almost 90% of authors received research funding from or acted as consultants for a drug company. Over half had connections with companies whose drugs were being reviewed in the guideline, and the same proportion indicated that there was no formal procedure for reporting these interactions.” (3)  He also wrote in 2004 that “journals have devolved into information laundering operations for the pharmaceutical industry”. (4)

Clearly there is a problem. A very serious and shocking problem that goes to the core of which pharmaceutical products are safe and effective, and those which are not. And there is no doubt that consumers, policy makers and medical professionals alike have been consistently misled. Which brings me to the ‘All Trials’ initiative and Dr Peter Parry, a child and adolescent psychiatrist, and senior lecturer at the University of Queensland. All Trials is an initiative which began in the UK in January and is now attracting widespread support from the medical community there. Dr Parry is a staunch supporter and would like to see it gain traction here as well. He explains:

“The ‘All Trials’ campaign calls for all clinical trials to be registered on a regulated and enforced website and the methodology and results of the trials to be published on the website so that researchers and journals can be sure of the data and the context of the data. In other words to make medical science transparent. There is a lot of detail to pin down the process and make it enforceable because voluntary and semi-voluntary systems such as www.clinicaltrials.gov just aren't working. So the AllTrials website has a full explanation on their website if you follow the link "why this matters" and then "more information" (http://www.alltrials.net/all-trials/ ).”

Parry believes that the problem of pharmaceutical company influence on clinical data is pervasive and long standing.

“The problem has been bad for a long time. It has been getting a little better in recent years, but only a full overhaul of the system – in other words the "AllTrials" process – can truly rectify things. I am mainly aware of my own specialty of psychiatry. In the last 3 or 4 years there has been a shift in awareness within the profession. Previously there was a collective view that the few "radicals" who were complaining about the overly cosy relationship with Pharma had a point but were exaggerating. However now I think the collective view accepts that the outspoken members of our profession have had a valid and vital point – our whole "evidence-base" for our clinical, research and teaching practice has been compromised. To what extent compromised is hard to say – and that is precisely because of the lack of transparency with the data. Some research and guidelines could be based on fully accurate scientific data – but we cannot be sure what is and what is not. “

To an outsider this situation seems incredible and deeply shocking. It must have developed incrementally, but one wonders how it has been allowed to get to such a point?

“That is a good question”, says Parry. “Personally I haven't researched the literature on the sociology of medicine-pharma relationship to be able to give a detailed answer. However my gut feeling and discussions with colleagues over the years is that doctors may be clever guys and gals but we are realizing we are not marketing savvy. Even in a specialty like psychiatry, where you'd think we should be wise to the possibility of subconscious influence and the power of persuasion, there must have been a lot of naivety and also not enough guarding against having one's narcissism stroked in the past. Looking back, the level of advertising at conferences, the suave persuasiveness of the drug rep visits, using all the sophisticated psychology of marketing, seems outrageous – but surveys of doctors repeatedly showed that we thought we were above being persuaded and could remain rational, totally independent agents. In which case why did we even bother accepting all the marketing? Well, money has a lot to do with it.

But the overt marketing has been shown to be the lesser problem. The greater problem lies with what doctors always thought was the real science – the peer-reviewed articles published in the journals. It is interesting that Pharma have taken the increased restrictions on overt marketing with relative equanimity, but seem to have drawn a line in the sand over handing over the raw scientific data that the articles in medical journals are supposedly based upon.”

There now seems to be an impetus towards demanding change. All Trials has gained huge support in the UK. But given how pervasive the pharmaceutical companies influence has been on the medical edifice, one wonders what has prompted the more recent demands for transparency?

“I think the evidence simply became overwhelming that the academic medical literature has been severely compromised”, explains Parry. “Authors on articles in journals may not have had access to the raw data themselves, many it now seems were recruited late in the study and articles were "ghost-written" by undisclosed authors within or working for the pharmaceutical company. Authors usually signed commercial confidentiality agreements that restricted their rights to publish the data. I know a professor of psychiatry who was involved in half a dozen trials of an antipsychotic medication in a developing nation. He told me four of those trials were negative and the results never published, only the positive findings from the remaining two were published. He was appalled but legally could do nothing because of the confidentiality agreement he had signed. Behind the scenes these things got talked about and outrage gradually grew, too slowly to be sure, but thankfully it has reached a critical mass now.”

Parry suggests the independent Cochrane Collaboration has played a big part in the push for change, but even they have found investigating the thousands of articles that may be compromised a bit like “sifting through mud”. The literature is simply too “opaque”.

“The momentum has come from the UK, probably because of the Cochrane Collaboration's base there”, he says. “But also because of the strong stance taken by the British Medical Journal. The previous chief-editor of the BMJ, Richard Smith, after he finished his 25 years as editor wrote an article in the high-ranking PLoS Medicine journal titled "Medical Journals are an Extension of the Marketing Arm of Pharmaceutical Companies" (5). And the current chief-editor of the BMJ, Fiona Godlee, said to a British parliamentary committee in 2013 that ‘drug companies should not be allowed to evaluate their own products’. This leadership, coupled with the energy and drive of British medical epidemiologist, Ben Goldacre (6) seems to have super-charged the drive for change within the UK. The All Trials campaign  started in the UK in January 2013 and quickly got most of the British medical specialty colleges and other prominent medical academic organisations signed up as supporters. The question now is will the rest of the world follow? I am glad to see that the College I belong to, the RANZCP, is now looking at the AllTrials proposal. Hopefully we’ll soon follow the British RCPsych and sign on for this game changing reform of the academic medical base.”

Parry agrees with Goldacre’s view that if transparency can be achieved it will effectively rewrite the book on everything believed to be true in modern medicine.

“He is right”, he asserts.  “As I understand it, the AllTrials process would bring to light data and methodology from clinical trials going back years, as well as clean up the mess to provide an Evidence Based Medicine future rather than a Marketing Based Medicine one. As data comes to light about past clinical trials, then this may well shed light on current guidelines and clinical practices that need revising. Thus the implications are huge. AllTrials hopefully will mean we have a world of EBM and cost-effective medicine. There will be some red-faces, there is almost certainly a lot of fraudulent behaviour that may result in legal scrutiny. Many journal articles may need to be corrected or withdrawn and republished.”

He cites the example of an infamous article published on the drug Paroxetine in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP). The article was sponsored by Paroxetine's manufacturer SmithKlineBeecham, now known as GlaxoSmithKline (GSK) and is also known as "Study 329".  “The data and methodology of the clinical trial was released in a court case and shows that the published article markedly overstated the benefits of Paroxetine (strictly speaking it didn't differentiate from placebo) but was published as being "generally well tolerated and effective for depression in adolescents". The sales pitch in the company advertising went further stating Paroxetine ‘delivers remarkable efficacy and safety in adolescent depression’. Worse still, the article suppressed data on suicidal agitation and other "serious adverse events" of the adolescents on Paroxetine………….Enough is enough, things have to change. Thank goodness for AllTrials and I hope it works. In my opinion any health professional not supporting it needs to think again.”

Despite the importance of All Trials, Parry has been disappointed by the response in Australia to date.

“Almost none of the colleagues I've spoken to know about it, including across other specialties and general practice. I asked friends at a recent medical school reunion and they hadn't heard about AllTrials. However the Australian Medical Students Association signed up months ago, and good on them. Clearly they have an eye to the future! I'm hopeful though that the specialty colleges and the RACGP and our academic institutions such as the NH&MRC will follow their British counterparts soon.”

Every day people use pharmaceutical products in good faith, believing they are safe and effective. Medical professionals in turn condone products based upon what they believe to be Evidence Based Medicine, published in medical journals. This also has a direct bearing upon government health policies.

But if this turns out to be little more than the work of pharmaceutical PR professionals, consumers, medical professionals and policy makers are effectively playing a vast game of Russian Roulette. The Vioxx debacle, which saw a major pharmaceutical company withhold information from doctors and consumers for up to five years, and resulted in tens of thousands of deaths, is an extreme example of what can happen if we don’t get this right. But it may also be that billions of dollars are being wasted on products that don’t work as well as doctors and patients have been told they do; or symptoms may be worsened by some; or whole new medical problems may be being created by others. Right now we just don’t know.

It may be that we will have to rewrite a great deal of what we think we know about medicine. And if that is the case, we need to start right away. No one wants to look back and say “We should have acted sooner!”

www.alltrials.net

Dr Parry was interviewed via email on 14/11/2013.

(1) Thomas, Katie (2013). Breaking the seal on drug research. New York Times. Here: http://www.nytimes.com/2013/06/30/business/breaking-the-seal-on-drug-research.html?ref=todayspaper&pagewanted=all&_r=1&

(2) Doctorow, Cory (2012). Why all pharmaceutical research should be made open access. The Guardian. Here: http://www.theguardian.com/technology/2012/nov/20/pharmaceutical-research-open-access

 (3) Horton, Richard. (2002) Just how tainted has medicine become? The Lancet, Volume 359, Issue 9313, Here:http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2802%2908198-9/fulltext

(4) Horton Richard (2004) The dawn of McScience. New York Review of Books. Here: http://www.nybooks.com/articles/archives/2004/mar/11/the-dawn-of-mcscience/

(5) Smith, Richard (2005). Medical Journals Are an Extension of the Marketing Arm of Pharmaceutical Companies. PLOS Medicine. Here:  http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0020138

 

(6) Ben Goldacre. Here: http://www.badscience.net/about-dr-ben-goldacre/

 

 

 

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