s A Can of Worms- The Story Continues | 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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News Flash

Newsflash Updates for July 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

Comments: 1

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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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A Can of Worms- The Story Continues

Neil Johnston

articles by this author...

Neil Johnston is a pharmacist who trained as a management consultant. He was the first consultant to service the pharmacy profession and commenced practice as a full time consultant in 1972, specialising in community pharmacy management, pharmacy systems, preventive medicine and the marketing of professional services. He has owned, or part-owned a total of six pharmacies during his career, and for a decade spent time both as a clinical pharmacist and Chief Pharmacist in the public hospital system. He has been editor of i2P since 2000.

The NSW state elections began in earnest 16 days ago on the 20th February, 2011, when Barry O'Farrell launched the NSW Liberal and Nationals Election Campaign.
The following is an excerpt from his speech titled “Time to Start Real Change for NSW”.

“I was first elected in 1995 – the year Labor went into government.
It’s been a sixteen year lesson in how not to run government.Never before has Australia witnessed such a scandal-plagued government, a parade of MPs hauled before ICAC Ministers sacked for corrupt, disgraceful and embarrassing behaviour.
A record number of MPs quitting because they lack the courage to front up and answer for their role in the sorry mess that is NSW Labor.
And that’s why the next 34 days are about starting real change.”

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The 26th March 2011 is election day and Labor is tipped to retain only 13 seats and that will prove a massive loss for Kristina Keneally, the first female premier of NSW.

Against this election backdrop there are still real people trying to survive in business and make a difference in their chosen vocation. They are also trying to come to grips with a government in NSW and elements of the bureaucracy, who have forgotten what ethical boundaries are.

They seemingly exhibit behaviour and an absence of standards that make it impossible to sustain a progressive business relationship.

In the home page edition of i2P published on March 1st 2011, the feature article described a small business involved in health information technology systems, that was caught up in a NSW governemnt quagmire, where sevices had been provided for NSW Health but remained unpaid in excess of 45 days.

Many invoices in fact, alleged to have not been paid for up to six years.

Phil Clare, the owner of the business, was not only deprived of his cash flow, but also had to stand by and watch his current contract cancelled with no hope of a renewal.

Effectively, he had been blacklisted for simply asking for his money, and in desperation threatened to resort to legal action for recovery.

During the preparation for, and in the implementation of various contracts undertaken for NSW Health, it was found that that in a number of instances, NSW Health was in breach of an alleged range of regulatory and legislative issues that could prove extremely embarassing for the entire government.

When the contract with Phil Clare was cancelled, these issues still remained.

While the original contract called only for surplus asset management, what Phil was able to demonstrate was that if they did not manage all assets of value less than $10,000, (they were only trying to manage assets above that value), they would simply need a better system than the on they had.

Phil described this as a “turning on the lights” experience for the decision-makers of NSW Health because of their low level of experience, and he even had to brief and educate their consultants, Ernst & Young, so that they could better advise their client on the process.

These numerous reports and information papers prepared have now been used as a base by Health Support, the agency involved in the preparation of tenders for governement, to prepare the current tender (number HT10005) for “Integrated Asset and Facilities Management Software Support and Implementation Services”. It has been prepared with uncharacteristic speed given the time between cancelling Phil's contract and the preparation of a new tender.

Applicants are to lodge their tender by March 29 2011, just a few days past election day but well within a time frame to officially lock in the winner of this tender.

Of course, the above tender replicates the exact work that Phil Clare had successfully tendered for at an earlier date, most of which still remains unpaid.

It will be intriguing to find out who the winners of this tender will be.

I2P is betting that it will be IBM in conjunction with Thiess as part of the Infrashore Consortium, or an alliance partner with a different name.

Scott Gartrell, an original employee of Thiess and the short-term adviser to Carmel Tebutt (Minister for Health) has now recently emerged as CEO for Infrashore, the consortium with the contract to develop the Royal North Shore Hospital in Sydney.

He is a person who would have had access to a range of confidential government-held information, including the “know how” of Phil Clare's organisation.

It is a requirement for all government tenders that full information be disclosed so that government can evaluate whether the various systems are practical and will actually work.

He has been reported to ICAC by the Opposition health spokesperson, and he appeared last November During his appearance at the commission in November, Jeremy Gormly, SC, asked a final question.

''You'll appreciate the issue concerning cooling-off periods for people who have come out of government positions and then move into private positions where relationships or knowledge can appear to be sold.

''The only question I have about that is whether you consider that there is a material difference between the departmental officer on the one hand and the ex-minister on the other in terms of the length of the cooling-off period.''

Gartrell: ''I don't see any reason for any difference.''

It is also a fundamental condition of a government tender that the tenderer has no knowledge of any other tender, including prices.

While Phil Clare's original tender and his numerous reports are regarded as obsolete by NSW Health, it does give a basic blueprint for price and method that would be invaluable for a new applicant.

But where are the boundaries?

There is supposed to be a twelve-month cooling-off period for ministers and senior advisers when they move into private enterprise and begin dealings with their old department.
Here we have Scott Gartrell with a long history of moving in and out of Thiess (or associated entities) seemingly at will, and not missing a recent beat when he took up his position at Infrashore.

How can this be?

i2P has a proposition for Barry O'Farrell, the likely premier after the election.

If he wants to bring the state health budget back into line, he needs to move towards encouraging (even funding) consortiums of Australian-controlled vendors.
Only then will he stop the haemorrhage of taxpayer funds that eventually benefits other countries to Australia's detriment.

It is a given that it might take a little while to come up to speed and development mistakes would be made.
But Australia has the potential to provide a first class health system using its own local brains – it only needs the chance and a different government culture to rise from the current mess.

Global vendors are renowned for transplanting systems into Australia that have been developed in countries like the US or in Europe and finding, quite cynically, that they do not work under Australian conditions. Nor will these vendors rewrite their code to properly adapt these systems for Australian conditions.

The IBM system called “Maximo” for use in asset management and tracking has been utilised a number of times by NSW Health with problematic results and wasted dollars. It is possible that it may resurface again under Tender HT10005.

Only recently, another debacle occurred through the use of Cerner's FirstNet System that runs the Emergency Departments of NSW public hospitals.

“Difficulties retrieving patient records could delay treatment, and the system - on which $115 million has been spent - automatically cancelled pathology and radiology requests if the person was transferred from the emergency department without checking whether these were still needed”, according to the study by Jon Patrick, the director of the University of Sydney's health information technology research laboratory.

The Cerner system is so compromised that it has been recommended that it be scrapped.

''When do we stop throwing good money after bad?" said Dr McCarthy, who heads the emergency department at Prince of Wales Hospital. "Anything that takes staff off the floor to spend their working time on an inefficient IT system is a detriment to patients."

The project, part of a 10-year electronic medical records plan intended to make patient histories, X-rays and test results accessible from any hospital in the state, had proceeded too fast - apparently because of contractual obligations - for clinicians' feedback to influence it, Dr McCarthy said.

The potential for records to be linked to the wrong patient raised a serious risk they would be given incorrect treatment, she said, and the inability to compile multiple patient records into reports meant doctors could no longer evaluate new treatments or disease epidemics. "Simple audits and research projects are just impossible now," she said.

Phil Clare stated, “I also reported to NSW Health that that the Cerner/EMR First net was flawed, and I wasn’t picking on the software, ( it had enough of its own problems). My interest with the “blowout “of revenue was to do with the hardware.”

Meanwhile, i2P will be keeping a watching brief on the activities surrounding Phil Clare's difficulties and we hope that at some early date this injustice will be reversed.

Look out for the winners of tender number HT10005.

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