s Chiropractic - A Cure-All or Con? | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists


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. 
Access and click on the title links that are illustrated

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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

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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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Chiropractic - A Cure-All or Con?

Loretta Marron OAM BSc

articles by this author...

From a Skeptics Perspective: Loretta Marron, a science graduate with a business background, was Australian Skeptic of the Year for 2007 and in 2011. She is the Chief Executive Officer of the Friends of Science in Medicine and that organisation won Australian Skeptic of the Year for 2012. On Australia Day 2014 she was awarded the Medal of the Order of Australia (OAM ) for "service to community health"  Loretta edits the websites www.healthinformation.com.au & www.scienceinmedicine.org.au

With hundreds of their members now being investigated, chiropractic in the UK is in meltdown. Here in Australia, however, it is easy to find chiropractors who promote the same unproven concepts and the same “bogus” claims that put their overseas counterparts under the spotlight.
When consumers think of chiropractic, they see it as synonymous with back pain, spinal manipulation, bone-cracking and mattresses. However, many chiropractors also claim that it can be used to treat just about every self-limiting and serious health condition as well.

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With principles no better than witchcraft, chiropractic was founded by Daniel Palmer in the 1890s. He was a grocer, magnetic healer and an all-round fairground salesmen who believed that all diseases originated from ‘chiropractic vertebral subluxations’, a term he made up to describe invisible lesions of the spine.

Palmer associated individual vertebra with specific internal organs and body parts claiming that by adjusting the correct vertebra to remove these lesions would enable “the recuperative powers of your body” to “build health”.

In May 2010 the General Chiropractic Council (UK) issued a guidance document describing chiropractic subluxations as a theoretical model, “not supported by any clinical research evidence”. It also stated that chiropractors “must provide evidence based care” and thatany advertised claims for chiropractic care must be based only on best research of the highest standard”.

Around 80% of us will have lower back pain at some point in our lives. It accounts for more sick leave and disability than any other medical condition and can be acute, subacute or chronic in duration. Fortunately, it usually shows a significant improvement within a few weeks.

For lower back pain there is some evidence that manipulation produces “slightly better outcomes than placebo therapy”, but this is only similar to other interventions such physiotherapy, ice, heat, bed rest, exercise, massage, and pain relief medications.

A systematic review by Prof Edzard Ernst, the first Chair of Complementary Medicines in the UK’s, “revealed no compelling evidence to suggest that chiropractic yields clinical effects that are distinct from those of placebo manipulation” and that “underreporting [of complications] can be as high as 100%.”

In a risk benefit analysis, Ernst stated that “essentially everyone receiving chiropractic treatment is at risk”. “Given this situation, a tentative risk–benefit analysis cannot produce a positive result” he also concluded that “chiropractic spinal manipulation does not demonstrably do more good than harm”.

Despite evidence to the contrary, many chiropractors also claim that they can treat a wide range of childhood health conditions including ADHD, allergies, asthma, bedwetting, colic, earaches and vaccine preventable infections and serious conditions such as Multiple Sclerosis, depression, heavy metal toxicity, hypertension and cancer.

Parents of sick children are a particularly vulnerable group easily exploited by chiropractors. While chiropractic care is generally safe for adults, Paediatricians are extremely concerned about manipulations on the soft developing spines of babies and children. A 2010 review of published cases identified numerous deaths after chiropractic manipulations concluding that the “risks of this treatment by far outweigh its benefit”.

Many chiropractors also advise parents against vaccinating their children. In July 2010, the Health Care Complaints Commission (HCCC) issued a public warning against the Australian Vaccination Network (AVN) for inaccurate and misleading information. Australia wide, over 120 chiropractors are members of the AVN.

With chiropractors making unproven claims that they can treat everyone from sick babies to major illness patients, chiropractic has clearly had difficulties policing it members.

On 1 July 2010, The Chiropractic Board of Australia issued a new Code of Conduct which now requires chiropractors to provide “treatment options based on the best available information” and to practice “in accordance with the current and accepted evidence base of the chiropractic profession, including clinical outcomes”.

With this new Code now in place, and many websites still making unproven claims, the Board released a communiqué on 22 September 2010, to remind chiropractors that there are criminal penalties for breaching section 133 of the National Law” and to review their advertising including their websites as a priority to ensure that the content meets the advertising requirements of the National Law and the provisions of the Guidelines on Advertising.”

So does this mean that chiropractic is willingly embracing evidence-based medicine?
We can only wait and see.

Return to home

Submitted by Jenni on Fri, 27/06/2014 - 22:40.

The Webster technique practised by many chiropractors is a classic example of how dangerous the industry can get. The procedure is commonly used on pregnant women at full term when the unborn child is in breech position. The therapist theorises that the woman's pelvis is off line thus preventing the baby from turning. Such claims are made without proof of a scan and with no knowledge of whether the cord is round bubbys neck, a common cause of breech births. The Webster technique can and does result in dislocation of some babies pelvis. I'm not sure what studies are taken by chiropractors with regard to obstetrics, or, for that matter any internal medicine. I have to question why they are allowed to use the term doctor, as this may be seen as misleading to the general public, whom often place trust in any therapist using the title Dr before their name.

Submitted by Alan Henness on Sat, 01/10/2011 - 10:35.

An excellent summary, Loretta.

Peter Grieve said: "chiropractic is still in it's [sic] infancy"

Really? As Loretta pointed out, chiropractic was invented in 1890. How long do you think it'll be before it'll emerge from its hundred-year infancy and progress to childhood? Adulthood?

In the UK, we have regulatory bodies that exist to safeguard the public from misleading claims. One of them has shown themselves to be practically useless, but the Advertising Standards Authority are much more focussed on protecting the public. It's a pity we have to resort to using them to reign in the worst excesses of alternative therapists.

The evidence that chiropractic manipulations have any benefit over placebo is, at best, scant and certainly non-existent for non-musculoskeletal conditions. Until such time as robust scientific evidence becomes available for its efficacy and a plausible mechanism of action proposed and thoroughly tested, chiropractors would be advised to restrict their claims to what the current evidence shows, not second-guessing what might be discovered in the future or what they might like to imagine.

Submitted by chiropractic on Wed, 23/03/2011 - 16:59.

Thank you for such a nicely written and easily understood explanation of Chiropractic - A Cure-All or Con? history and use.Thanks in advance for your cooperation with the above conditions. I hope you find it useful.It helped me with ocean of knowledge so I really believe you will do much better in the future I appreciate everything you have added to my knowledge base.

Submitted by Peter Grieve on Fri, 21/01/2011 - 16:54.

It was not that long ago 1990's , I believe, that neurologists believed that the brains topography was 'fixed'and that specific parts of the brain performed specific functions.
If you care to peruse the book 'The Brain That Changes Itself' you will clearly find that Medical fundamentals, if not challenged, become dogma and this leads eventually to a very egotistically driven system that considers itself above the laws that govern the universe.
Australia has fast become the nation of pharmaceutically derived diseases in an attempt, for the most, to deal with lifestyle based disorders and this is evidenced by the mortality rate and hospital entry rates associated with yiatrigenically induced conditions.
Even though chiropractic is still in it's infancy, as a growing and highly enlightened profession as to the cause and prevention of disease as we know it, chiropractic serves well to remind all that we are a neuroendocrinally driven unit and that the 'stressors' spoken of by the well respected researcher, Hans Selye, abound and create the need for the human organism to constantly adapt to it's surroundings. The subluxation is yet another significant and demonstrable sign and is another indicator of the need to utilize specific and structured methods of stimulating 1alpha afferents to reassure the CNS that there is , infact, hope, the pituitary responses to such stimuli culminate in a healing response.
I beloieve that if professions such as chiropractic stay clear of the dogma of modern medicine and aim at enriching lives by motivating those under their care to live healthy lifestyles then medicine as we know it will be able to get on with the enhanced 1st aid work that is a need and not be inundated with the lifestyle based disorders filling my rooms and those of the medico.
Every profession has it's craft be it psychology, surgery, medical practitioning and chiropractic to mention but a few.
All of these professions have a body of evidence to support their particular persuasion but none have absolute evidence tto support the vast majority of utilized procedures.
I gather chiropractic has stated that 'what is good for the goose is good for the gander'.
Chiropractic is out there doing great stuff, it would be wonderful if we saw the 1/2 full glass as opposed the 1/2 empty one.
Yours in Chiropractic and more importantly reality.

Submitted by chris rook on Sun, 10/10/2010 - 09:24.

Another excellent (and I believe, accurate) article by Ms Marron. She mentions a principle that I think is not always appreciated by the public. Many illnesses are cyclical; like back-pain and Knee (osteoarthritis) pain for example. The pain in someone's knee (or back) will start to get worse and worse over the ensuing days until they finally go to seek help. When are they most likely to seek help? - clearly when the pain is getting more severe....so they go to a practitioner who gives them treatment and as sure as night follows day, the pain will start to improve in the near future. If you couple this with the long treatments that Chiropractors advocate it's easy to understand why some people think it works.

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