s Do We Need to Reboot the Australian Experience of Vaccination Policy? | 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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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

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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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Do We Need to Reboot the Australian Experience of Vaccination Policy?

Baz Bardoe

articles by this author...

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

Last year Greens Senator Richard  Di Natale used parliament to chastise the Australian Vaccination Network, a community based group that takes an anti vaccination stance.
He accused them of promoting misleading information that he believed was hostile to good health outcomes.
He stated that as a man who adhered to Evidence Based Medicine there was no legitimate contrarian position on the vaccination issue.
Di Natale drew upon experiences derived in Third World countries to validate his position that vaccination is vital for combating infectious diseases.

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Di Natale is well within his rights to take the AVN to task.
The AVN has often posted material on their Facebook page which is non academic in nature, and speculative or emotive in content.
People should not be making such important decisions based upon information that may be unreliable. But this should surely apply even more strongly to our policy makers.
Rather than entering into the absolutist dualism of ‘for’ or ‘against’ positions, which seem to rapidly descend into dogma, policy via proclamation and hysteria, let’s frame the issue in common sense terms, bearing in mind that there are many different possibilities such as being pro vaccination, yet critical of a certain product, ingredient,  or aspects of policy.

Let’s ask a simple question:

Does the Australian experience of vaccination conform with world best practice, and do we have a regulatory and policy  framework in place that would ensure this?

In a previous article I explored the impact of pharmaceutical marketing upon the medical evidence base (1).
The ‘All Trials’ campaign which began in Britain in January 2013 arose as a direct result of the all pervasive problems of what psychiatrist Dr Peter Parry termed ‘Marketing Based Medicine’.
Writing as editor of The Lancet in 2002 Richard Horton stated that around 90% of clinical trial guidelines were being written by people with financial links to pharmaceutical companies. (2)
The current state of play is that these companies are not obliged to release all of their clinical data for independent assessment, and worse still it has become clear that articles appearing in medical journals are being ‘ghost written’ by people with financial links to pharmaceutical companies, and this is being hidden by non disclosure agreements.
It is a shocking state of affairs that has been decades in the making, and may take decades to unravel.
There is little doubt that massive fraud is involved.

Against this backdrop it is difficult to see how DiNatale can state that Evidence Based Medicine unequivocally supports his position.
It would be a positive development if he chose to support ‘All Trials’ and he would be in the company of the entire British medical establishment.
What the ‘All Trials’ initiative may reveal is yet to be determined, but as a subset of pharmaceutical products, vaccines are unlikely to be exempt from the overwhelming influence of pharmaceutical marketing on the medical evidence base.
And although there isn’t space here to dwell on this, there certainly isn’t consensus in the international scientific community on the safety and efficacy of all vaccines.
An example is Israel’s Professor Yehuda Shoenfeld who visited these shores awhile back and talked about Autoimmune Syndrome Induced by Adjuvant (ASIA).
He is certainly not anti vaccination, but his contention was that for some people with a genetic predisposition, aluminium adjuvants can trigger a catastrophic immune dysfunction.
And the senior post doctoral researchers in vaccine safety at the University of British Columbia, Professor Chris Shaw and Dr Lucija Tomijanovic, also problemise aluminium adjuvants, contending that their effect upon paediatric populations requires urgent investigation.

“Because infants and children represent those who may be most at risk for complications following vaccination, a more rigorous evaluation of potential vaccine-related adverse health impacts in pediatric populations than what has been provided to date is urgently needed”.
They state that “in spite of the widespread agreement that vaccines are largely safe and serious adverse complications are extremely rare, a close scrutiny of the scientific literature does not support this view”. (3)
There are many more examples.

Given that the evidence base is in turmoil, and there certainly isn’t medical consensus on safety and efficacy issues, a renewed call for coercive measures to ensure compliance with the Australian schedule, such as withholding family payments, is ethically fraught.
But what is particularly problematic is the fact that Australia has no vaccine injury compensation scheme. This stands at odds with virtually every other first world country. The World Health Organisation acknowledges that injuries, and even death, can result in some instances from vaccination and consider it ethically vital that nations that can afford to do so have such a scheme in place.
In the United States the ‘Vaccine Court’ makes hundreds of awards every year.
Although it is a ‘no fault’ system it does place a strong onus upon the complainant.
Despite being a wealthy country Australia has no such compensation system, and parents of children damaged by vaccination have to fend for themselves or undertake privately funded legal action.

A World Health Organisation document on compensation schemes discusses this and cites ethicist Michelle Mello. It  “…..argues that solidarity means members of a community do not bear the risks of vaccination alone. Vaccine injuries can be severe and complex, and are often suffered by children who require a lifetime of care and may not qualify for other benefits under accident insurance schemes.

In a vaccination program, the injured and uninjured pay unequal shares……… Mello argues that, in line with principles of fairness and solidarity, mechanisms are needed to prevent the uninjured (unintentionally) “free-riding” on the injured.)(4)
The absence of a compensation scheme alone should be considered a scandalous lapse in policy. Is it ethically acceptable to pressurise people who are healthy to take a risk, and have no ‘safety net’ in place?

Most vaccination proponents will argue that serious adverse reactions are rare, but if you are affected by one this is not only cold comfort but a life changing challenge, made much worse by having no recourse to compensation.
But another big problem is that we do not have accurate, agreed upon figures.
During the height of the flu vaccine adverse reactions in 2010  Peter Collignon, a professor of infectious diseases from the Australian National University  was interviewed by ABC news.
He felt the number of adverse reactions was probably under estimated, given that authorities don’t have a congruent and approachable system to monitor peoples’ reactions.
He believed that an effective surveillance system should monitor a sample group of thousands for one or two weeks before a new vaccine is rolled out for the entire population.
"We need a better system than voluntary notification to the TGA (Therapeutic Goods Administration) that there's a problem," he said. "Because whenever you do that you really underestimate how much of a problem there is. (5)
This is a position he reiterates today. (6)
When I interviewed families who claimed to have experienced an adverse reaction there was a common thread – medical professionals were unwilling to countenance the possibility, even when the symptoms were extreme and immediate, and their cases were never referred to the TGA.

If we don’t have statistics on adverse reactions, both those supported by medical staff and ‘possibles’, how can we reasonably expect people to make informed decisions, or support a schedule where this remains an unknown?
And how can problems with a product be identified in a timely fashion so harm can be minimised? Collignon’s proposal, namely that before a new vaccine is released, it could be tested on a sample group, and these people could be closely and independently monitored, would go a long way towards ensuring that products are safe and effective.
And whilst people might accept some risk in combating highly infectious diseases with a high morbidity rate, vaccines meant to prevent diseases that have a very low morbidity rate in robust individuals need to be unequivocally safe.
The adverse reactions that followed an iteration of the flu vaccine in 2010 have had a dramatic impact upon families who thought they were using a safe and effective product. (5)

And we should be looking at what other nations with excellent health outcomes are doing. 
Denmark has less vaccinations on its schedule than Australia. 
They have a very strong record of controlling infectious disease, and do not experience the high incidence of broad spectrum neurological and immune dysfunctions Australia suffers from.
There is no doubt that Denmark does very well on health issues, and yet presumably someone following the Danish vaccination schedule would be considered not compliant with the Australian schedule.

We also have to question what is actually driving the current media campaign, and whether the apparent concern over vaccination rates is justified?
Associate Professor Julie Leask, and Research Fellow Hal Willaby, (School of  Public Health), both from the University of Sydney, suggested in an opinion piece in ‘The Conversation’, that elements of the media were hystericising the issue, and trading in stereotypes.
They risked polarising the community, when the reality was that vaccination rates generally remained high.
They proposed a more conciliatory approach and suggested that some families who are not up to date may already be struggling with a lack of access or practical support, and penalising them will only create further disadvantage. (7)
And is the current rate of ‘Conscientious Objections’ (CO) really a threat to the theory of ‘herd immunity’?
An opinion piece on the Australian Medical Association website states,

"First, you don’t need everyone to be immune to prevent an epidemic occurring. If 90 per cent or more are immune, they create sufficient fire breaks to prevent the easy transfer of most infectious diseases. So, good levels of public health could be maintained even if the CO rate climbed substantially – which it is not likely to do in real terms." (8)

The Cochrane Collaboration has established a reputation for independent assessment of medical products and procedures.
They have played an integral role in the establishment of the ‘All Trials’ initiative, and continue to hold pharmaceutical companies accountable.

"A recent study from US Public Citizen found that, since 1991, there have been 239 legal settlements, totaling $30.2 billion in federal and state penalties, levied against US pharmaceutical companies. There’s a real laundry list of crimes, but defrauding the government, hiding drug safety information, and hawking drugs for purposes beyond which they are approved are the main ones.
Drug companies have pledged to change, signed ‘corporate integrity agreements’ and indicated that they want to move on, promising a better future.
We can be hopeful, but we also have to be realistic.
Paying huge fines for illegal activity is one thing, but will they be still playing the eminence game?
Will they continue to fund their own experts and do research that goes through a selective reporting of ‘the evidence’?
Sadly, that’s probably going to be the case so you must immunise yourself: keep asking questions and questioning answers." (9)

In America the Centre for Disease Control has come under fire for blurring the lines between regulation and marketing.
The Huffington Post alleges they massively inflated flu morbidity figures, then “….. unabashedly decided to create a mass market for the flu vaccine by enlisting the media into panicking the public.
An obedient and unquestioning media obliged by hyping the numbers, and 10 years later it is obliging still”. (10)
This isn’t America, but we do take many of our cues from the American experience, and their multi nationals reach deep into our market.
What we can learn from this is the need to insulate regulatory bodies from pharmaceutical marketing. This point is strongly underscored by an article in the ‘Journal of Law, Medicine and Ethics’, entitled ‘Institutional Corruption of Pharmaceuticals and the Myth of Safe and Effective Drugs’ which alleges that the medical evidence base has been massively compromised since at least 1966.
The “…..proportion of new products with clinical advantages seems to have moved from about 1 in 8 down to 1 in 12, while the proportion with serious harms has gone up from 1 in 5 towards 1 in 3 as the number of drugs given priority status increases......" (11)
Whilst there is mounting consciousness of the extent of the problem overseas, here in Australia it seems to be business as usual for the most part.

Writing in the journal of the Association of American Physicians and Surgeons, Marilyn Singleton asked us to question whether we can always trust Evidence Based Medicine.
She states that “…reporting bias is systemic in medical literature. A 2012 Cochrane independent review found that company-sponsored trials were more likely to report favorable efficacy results compared with non-industry sponsored studies.
Even in academic studies positive results are more likely to be published.
A 2009 analysis of 18 surveys by multiple authors found 34 percent of researchers admitted to “questionable research practices.”
Instead of blindly accepting that research is bone fide and regulatory bodies are vigilant and unbiased, she suggests that  “government intervention in medicine can be harmful to your health.
Rigid rules and restrictive drug formularies are advanced based on consensus, leaving no room for individualized treatments.
We want physicians whom we can trust to be open, honest critical thinkers, not “providers” who are government puppets”.(12)
Once again these are sentiments which we could afford to apply to the Australian context.

Returning to the original question, does the Australian experience of vaccination adhere to global best practice, and do we have the policy and regulatory framework to ensure this?
Adopting Peter Collignon’s sensible proposals would be a good step, as would support for ‘All Trials’ amongst our policy makers. In the meanwhile Australian consumers might perhaps take the Cochrane Collaboration’s advice – “immunise yourself: keep asking questions and questioning answers."


(1) Here: http://www.i2p.com.au/article/%E2%80%98all-trials%E2%80%99-marketing-based-medicine-and-fight-clinical-transparency

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

(3) L Tomljenovic and CA Shaw (2012). Mechanisms of aluminum adjuvant toxicity and autoimmunity in pediatric populations. Lupus. Here:http://lup.sagepub.com/content/21/2/223

(4) Here: http://www.who.int/bulletin/volumes/89/5/10-081901/en/

(5) Simmons, Amy and Anderson, Brigid. (2010). Parents recount flu jab nightmare. ABC News. Here: http://www.abc.net.au/news/2010-04-29/parents-recount-flu-jab-nightmare/414908

(6) Peter Collignon via email.  30/01/2014

(7) Here: https://theconversation.com/with-vaccination-rates-stable-no-jab-no-play-rules-are-beside-the-point-14522

(8) Here: https://ama.com.au/ausmed/node/3740

(9) Here: http://www.cochrane.org/news/blog/eminence-vs-evidence

(10) Solomon, Lawrence (2014). Don’t believe everything you read about flu deaths. The Huffington Post. Here: http://www.huffingtonpost.ca/lawrence-solomon/death-by-influenza_b_4661442.html

(11) Light, Donald W and Lexchin, Joel and Darrow, Jonathan J (2013)  Institutional Corruption of Pharmaceuticals and the Myth of Safe and Effective Drugs - Journal of Law, Medicine and Ethics.. Here: http://www.pharmamyths.net/files/JLME-PROOFS__7-10-13.pdf

(12 Singleton, Marilyn M  (2014) Warning: Government Can Be Harmful to Your Health. AAPS. Here: http://www.aapsonline.org/index.php/site/article/warning_government_can_be_harmful_to_your_health/

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