s Dark Forces Emerging - Including Colesworth | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists

Editorial

From the desk of the editor

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

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Newsflash Updates for July 2014

Newsflash Updates

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

Woolworths Pharmacy - Getting One Stage Closer

Neil Johnston

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

Comments: 5

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Intensive Exposition without crossing over with a supermarket

Fiona Sartoretto Verna AIAPP

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

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The sure way to drive business away

Gerald Quigley

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

Comments: 1

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‘Marketing Based Medicine’ – how bad is it?

Baz Bardoe

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

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Community Pharmacy Research - Are You Involved?

Mark Coleman

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

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Organisational Amnesia and the Lack of a Curator Inhibits Cultural Progress

Neil Johnston

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

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

Staff Writer

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

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I’ve been thinking about admitting wrong.

Mark Neuenschwander

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

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Dispensing errors – a ripple effect of damage

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

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

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Take a vacation from your vocation

Harvey Mackay

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

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Explainer: what is peer review?

Staff Writer

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

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Dentists from the dark side?

Loretta Marron OAM BSc

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

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Planning for Profit in 2015 – Your key to Business Success

Chris Foster

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

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

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

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Attracting and Retaining Great People

Barry Urquhart

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

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Updating Your Values - Extending Your Culture

Neil Johnston

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

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

Staff Writer

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

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

Staff Writer

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

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

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Culture Drive & Pharmacy Renewal

Neil Johnston

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

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

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

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Pharmacy 2014 - Pharmacy Management Conference

Neil Johnston

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

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Generation and Application of Community Pharmacy Research

Neil Johnston

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

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Dark Forces Emerging - Including Colesworth

Neil Johnston

articles by this author...

Introducing current ideas, perspectives and issues, to the profession of pharmacy

Editor’s Comment:
The media extract this month comes from a Pharmacy News report that Woolworths is on the move once more with pharmacy in its sights.
We would assume that Coles is also in the mix.
There are many “dark forces” aligned against pharmacy interests. In all my years as a member of the pharmacy profession I don’t think I have seen so many diverse groups waiting in line to “knee-cap” pharmacy activity.
Because many of these “dark forces” overlap and help each other along, I have asked Mark Coleman to clarify these “dark forces” from his perspective, because he has been researching some of these organisations and has written an article about some of them in this edition.
In no way can I see a Liberal Government, the representatives of big business, move to restrain Colesworth, except for minor marginal activities.

Politically, to keep the economy in balance and to ensure strong employment, they will need a strong small business sector empowered.
Pharmacy is central to small business structure, and if it collapses, so does the stable employment sector disappear (and presumably so would the Liberal Government at the next election through affected voters).
Below is the media segment and below that again you will find Mark Coleman’s comments.

Government plans to restrict supermarkets’ power

30 October, 2013 Nick O'Donoghue

As supermarket giant, Woolworths eyes a push into the community pharmacy sector, the Federal Government is planning to restrict the power the big retailers have in the grocery market.

Bruce Billson, the Small Business Minister, is expected to issue a warning to Woolworths and Coles, today, that the new Government plans to tackle concerns about their market power, The Australian reported.

A draft of the speech Mr Billson is due to give to food industry leaders in Canberra today, seen by The Australian, suggests the Government is unhappy with the duopoly’s hold over the market.

“While intensified competition between the two major chains has reduced grocery retail prices, there are concerns that those reductions come at the expense of suppliers and impact on the long-term durable benefit to consumers.” Mr Billson’s draft speech says.

“Some of the alleged behaviour by supermarkets may not necessarily be breaches of the competition laws.

“At the same time, this does not mean that the status quo is necessarily delivering the most efficient or optimal outcomes in the market.”

While the current Pharmacy Location Rules prohibit the operation of pharmacies within supermarkets, many fear a change to allow the retail duopoly to open pharmacies would result in the breakdown of the community pharmacy network.

Responding to reports that Woolworths had applied to trademark its “Pharmacy-in-Supermarket” brand, one Pharmacy News reader said, “if Coles and Woolworths get [PBS] approval numbers there would ultimately be fewer and larger pharmacies as we see now with butchers, bakers, petrol stations, clothes stores, stationery stores, bottle shops, corner stores or any other retail outlet you wish to think of”.

However, others have suggested the arrival of the big retailers into the pharmacy sector could be a boon for employee pharmacists, with several readers claiming they would pay above the Pharmacy Industry Award rates, a view refuted by Anthony Tassone, Pharmacy Guild of Australia Victorian branch president.

“Pharmacies in supermarkets won't improve wages and opportunities,” he said on Twitter last night.

“They're unlikely to pay above award plus, [they] only work for shareholder return.”

Meanwhile, a Pharmacy News webpoll of more than 230 readers has found the profession is divided 2:1 against allowing Woolworths and Coles to open pharmacies.


Mark Coleman

We’ve seen this all before. Government makes noises in the direction of restricting the monopolistic practices of Woolworths and Coles, and then it all fades away with the lobbyists getting to work to rationalise and “spin” the Colesworth moves.

Recently, through a report published by the Grattan Institute and written by Stephen Duckett highlighted savings that could be made by government through the acceleration of the price transparency scheme negotiated by the PGA under c legal contract with government.
The savings would be generated by adopting a New Zealand style equivalent of the Australian PBS, where no mark-up would be applied to goods, and pharmacist income was to be derived totally from a negotiated dispensing fee.
Problem is, the purchase of PBS drugs incurs supply chain costs that have to be recovered as a mark-up and this cost represents approximately 25% of the value of stock held.
The New Zealand model is fronted by a Woolworths supermarket containing a pharmacy that is half-owned by Woolworths. This is their test market for an Australian version of that model

So pharmacy has been caught in a vice because the loss of gross profits caused by the price transparency process are unable to be replaced from other sources in time to prevent business disruption, bankruptcies, reduced employment and unemployment of new graduates.
And while there a number of multi-factorial forces tearing down pharmacy at the moment, this is just creating a soft pharmacy competitor for Colesworth that is more malleable and more easily manipulated.
So why would they not help all those dark forces at work out there

Each time Colesworth get a knock back in respect of pharmacy ownership they simply accelerate the number of traditional pharmacy lines they hold in their inventories.
The irony is that pharmacy ownership by Colesworth is only prized for its ability to be a destination point for their customers-not any profit contribution.
Profit is made from their liquor, tobacco and petrol enterprises.

Coles in particular has no intent on creating a career for a pharmacist unless they are able to integrate within their existing line management structure.
In other words, you have to join a hypocritical anti-health process, and go against your own culture. How would AHPRA handle that?
The last Coles suggestion that I heard floated was that a central automated dispensing process be established to service a number of Coles stores – one pharmacist to control an automated machine by Internet, from a central point.
That is to say the dispensing would become a mind-numbing process far worse than anything existing today, but with jobs for fewer pharmacists.

Stephen Duckett offset his money saving suggestion with the follow-up “Access all areas” paper, suggesting that pharmacists be diverted to remote areas and be licenced to practice a range of clinical services.
Mind you, only in those remote areas where there is no current infrastructure and even if fully developed, would create limited job opportunities.
In other words a very cynical suggestion, because Stephen Duckett is an economic rationalist and no friend of pharmacy.

Supermarket suppliers are the ones mostly affected by Colesworth because they are unable to extract a fair price for their primary produce.
It may well be that pharmacy aspirations could be partnered as an alliance with supermarket suppliers because a common problem is experienced, but by a different method.

Pharmacy should be looking beyond its current boundaries and constraints to embrace new technologies and enter into health-related goods and services.
New technologies such as 3D printing need to be explored, as well as research into functional foods, methodologies for removing contaminants (including fluoride) from the water supply.
Paid clinical services are seen as one option and it is a very good option, provided certain cultural difficulties are overcome.
Mentors that can engage those cultural aspects need to be employed to get the show on the road, and they may be found among the “old phart community” if they can be persuaded.

Other difficulties are being experienced in introducing paid clinical services because our leadership organisations have not been active enough in negotiating a price for pharmacy services.
The services that are currently funded are a pitiful offering in that they have no pathway to expand along, they are underfunded and little thought has gone into their design.
You can blame a decade of opposition by the PGA in blocking any potential for a small pharmacist-owned business that is not a pharmacy. Pharmacy has squandered more than a decade of lost opportunity and is suffering the consequences right now for following a pathway of protectionism instead of expansionism, for an unhealthy reliance on the supply chain, for greed and processes that enriched a few to the detriment of the whole, for aggravation of employed pharmacists and treating them as “enemy” rather than the traditional method of “collegiality”.
And so the list goes on, and thank heavens we now see the end to that style of leader.

All pharmacists have been asleep at the wheel with just about all sources of sales growth blocked off, except for the deep discount channel.
Go down that channel only if you have the nerves of a professional gambler

Even pharmacy marketing groups have ceased to work with wholesalers now actively working against the interests of pharmacy because they too see clinical services as something they should own e.g. vaccination clinics. So expect more friction and competitive damage here because they will only feed their supply chain rather than make pharmacies profitable.
Also drug manufacturers are going down slightly different pathways, but they want your patient database so as to continue their lobby for “direct to consumer” marketing control.

Individual pharmacists, both owners and non-owners should be forming up into different lines so as to create strong internal alliances.
Just as you may have a Local Area Marketing System you need a Local Area Leadership System.
The old Division of General Practice for GP’s was an excellent model and pharmacists may well see a way to break free from their current heavy and slow-moving structures to develop a new format that is competitive, relevant and less costly.
Beat the supermarkets by being secure in your own market structure.
That only comes with hard work and good, strong leadership.

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