s Chiropractic mallets & other wacko widgets | 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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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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Chiropractic mallets & other wacko widgets

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

The philosophy behind 'fundamentalist' chiropractic is that spinal 'blockages' cause most illnesses and that removing them will restore health.
A range of chiropractic 'medical devices' are claimed to locate and remove these 'blockages'.
So what types of devices do chiropractors use, are they registered with the federal government, and do they work?

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The 19th century principle of chiropractic is that all disease results from the 'Vertebral Subluxation Complex' (VSC), a term invented by Daniel Palmer, chiropractic’s founder and religious leader. According to Palmer, VSCs cause pressure (irritation) on nerves and inhibit the transmission of 'energy' signals up and down the spinal cord. Removing these invisible 'blockages' allow the 'innate intelligence' of the body to heal itself. 'Fundamentalist' chiropractors support this false belief, claiming to detect and correct these 'blockages'.

Even though VSCs have never been proven to exist, this bizarre concept is promoted by the Chiropractors' Association of Australia (CAA), who represent most chiropractors. CAA's core values state "an innate intelligence within a living organism that strives to preserve life and, if uninhibited, will express optimal wellbeing". Furthermore, “subluxations compromise the expression of innate intelligence, and … prevention and removal of subluxations will facilitate the expression of optimal health".

By contrast with the CAA, the UK General Chiropractic Council (GCC) has issued a guidance document describing VSCs as an historical concept "not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease or health concerns" and that they are also “not supported by any clinical research evidence".

Finding and removing mythical VSCs by spinal manipulation or using a range of gadgets is big business in Australia.

One diagnostic device for detecting VSCs is the 'Insight Subluxation Station' using electromyography (EMG). It is on the Australian Register of Therapeutic Goods (ARTG) as a "non-invasive, multi-modality physiological monitoring device". It produces a range of spinal charts enabling chiropractors to see (sic) "how the nervous system is communicating with the organs" and to locate these non-existent VSCs.

There is no evidence any EMG device yields "any information about internal organs". According to evidence-based chiropractors and physiotherapists, these devices are mere gimmicks, used to "encourage people to have chiropractic care".

Some chiropractors use heat detecting devices, such as the ‘nervoscope’, supposedly pinpointing VSCs.
Many use 'devices' to remove non-existent VSCs. Often referred to as "sticks that go click", these mallets are available only to chiropractors who attend courses. According to pain management and medical specialists, they offer no more therapeutic benefit than a placebo.  

Some chiropractic mallet courses have been assessed by the CAA for formal learning activity (FLA) hours. The 'Activator Method', for example, approved as recently as April 2011, has been allocated 8.3 FLA hours. This is a diagnostic and treatment system centred on the idea that leg-length analysis can identify VSCs and help chiropractors adjust the spine.

Chiropractors also promote the 'Activator' to adjust the length of children's legs! This device is on the ARTG. An ‘Activator’ course is held at the Macquarie University graduate school of management.

Another similar device is the Torque Release. Its workshop has been allocated 16 FLA hours.

A number of 'devices' claimed by chiropractors to diagnose and treat patients lack any evidence to support claims made by their sponsors. Some of them are on the ARTG. If you wish to be more informed about any evidence of benefit, why not contact the TGA? After all, they are Australia's regulatory authority for all therapeutic goods!

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Submitted by Chiro Jacksonville on Mon, 24/12/2012 - 17:34.

You are so helpful! I don’t suppose I have read anything along these lines recently. It is so pleasing to find a person with genuine ideas on this topic. I really appreciate you are starting this up. This website is something which is really needed on the net, people with a little originality. Valuable job for bringing something new to the web!
For more detail you have to visit this site:
Chiro Jacksonville

Submitted by Mark Coleman on Sat, 08/12/2012 - 17:14.

I am just questioning why you would spend so much energy on therapies of which you may not approve, but which kill or maim virtually no-one, whilst ignoring the hundreds killed or otherwise affected by adverse medical events each week.
Just recently, the journal "Pediatrics" stated 86 deaths a week are due to 'patient safety events' in the states that were surveyed !!
Do you as CEO of the Friends of Science in Medicine take anything like this on board?
Patients only go to the “alternates” because of dissatisfaction with mainstream medicine, which then shows up as diminished trust, in well-known polls and surveys.
This type of survey result not only breaks the cash flow cycle within the medical system, but embarrasses the mainstream due to the success rates, and SATISFACTION rates of these people.

And that is even before we get to the enormous fines paid by the largest drug manufacturers in the world ($4.2 billion for GSK alone in 2011) for publishing and orchestrating fraudulent clinical trials and research results.

Surely you can do better than chasing soft targets like chiropractors?
And given the academic calibre of the FSM membership, surely they need to re-arrange their priorities because one could be forgiven in thinking that they are the problem, rather than the purported solution
Britain’s Daily Mail has recently been highly active over just one week (23-30 November 2012) in exposing the ongoing ignorance, quackery and downright lethal culture of Britain’s National Health Service (NHS).
Are you trusting your life to a failing system?
NOW SICK BABIES GO ON DEATH PATHWAY: DOCTOR’S HAUNTING TESTIMONY REVEALS HOW CHILDREN ARE PUT ON END-OF-LIFE PLAN: The Mail can reveal the practice of withdrawing food and fluid by tube is being used on young patients as well as severely disabled newborn babies.
EPILEPTIC GIRL, 17, WHO CHOKED ON HER OWN VOMIT IN A HOSPITAL BED ‘WAS IGNORED BY TWO NURSES’:Lassania Aslam, 17, suffered five epileptic fits in the space of just 24 hours at The Whittington Hospital in Archway, north London. Nurses Caroline O’Rourke and Mary Subaste face being struck off by the Nurse and Midwifery Council panel which is sitting in London today.
HOSPITAL THAT OPERATED ON WRONG PATIENT AND LEFT SURGICAL INSTRUMENTS INSIDE TWO OTHERS IS INVESTIGATED BY WATCHDOG: Within a month, Cambridge University Hospitals NHS Foundation Trust performed four botched surgeries, including leaving instruments inside two patients and performing surgery on the wrong person.
PATIENT KILLED IN OXYGEN EXPLOSION AS A SECOND DIES IN BROKEN LIFT: DAMNING DOSSIER REVEALS NHS FAILINGS THAT CAUSED DEATH: A horrifying catalogue of serious errors at NHS hospitals in Scot¬land has come to light, following a Freedom of Information request.
STUDENT WITH HEART CONDITION, 20, DIED HOURS AFTER DOCTORS SENT HIM HOME FOR FIFTH TIME CLAIMING HE WAS ‘STRESSED’: Andrew Moore, 20, from Cheadle, Stockport, seen with father Peter, was admitted to three different hospitals on five occasions in the weeks before his death after collapsing and feeling unwell. Less than 24 hours after his final hospital visit, to Stepping Hill in Stockport, Andrew collapsed at his family home and never regained consciousness.
PATIENT RECOVERING FROM SURGERY ‘AWOKE TO FIND NURSE LYING ON FLOOR IN DRUNKEN SLUMBER’: Nurse Janet Gill smelled strongly of alcohol and when the patient discovered her in his room at BMI The Duchy Hospital in Harro¬gate, Yorkshire.
MINISTERS ORDER AN INQUIRY INTO THE CARE PATHWAY PAYMENTS THAT SAW HOSPITALS RECEIVE MILLIONS TO IMPLEMENT CONTROVERSIAL SYSTEM: Care and sup¬port minister Norman Lamb said there had been too many cases of patients dying on the pathway while their families were told nothing.

From what I have seen, the Australian system is just as bad, with one of the leading problems being doctors not washing their hands.
Now there is a more basic and suitable problem to target.

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