s Does this present an opportunity? | 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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Does this present an opportunity?

Neil Johnston

articles by this author...

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

Entrepreneurial pharmacists may find an opportunity in the recent Macquarie University study into patient self care, which was commissioned by the Australian Self Medication Industry, (ASMI).
The study has found that the rescheduling of the most commonly used prescription medicines to over-the-counter (OTC) status could save the Australian healthcare system approximately $2.1 billion a year
The study, found that the rescheduling, or ‘switching’ from prescription (Rx) to Pharmacist Only could achieve savings of $1.1 billion through some 17 million avoided GP visits, and a further $1 billion in productivity savings.

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Now that’s a good starting point and because of potential dollar savings, should interest government and pharmacists.

But I am wondering whether ASMI factored in that this effort needs to be facilitated within a pharmacy, and thereby hangs a tale.
Pharmacists who wish to provide clinical services (which could include “switching” services) are actively discriminated against by PGA hierarchy.
Instead of fostering collegiate pharmacist alliances for mutual benefit they continue in their past mode of greed and discrimination.

At the recent APP Conference, the PGA held an interactive session comprising 200 participants, to help shape the 6CPA.
About 70 percent of participants were pharmacy owners, the remainder being industry participants and non-owner pharmacists.
The majority of the discussion centred on professional service delivery and their reimbursement by government.
It was also reported (among pharmacy owners) that 70% of them indicated they already had a private consulting room with 68% employing an additional pharmacist to help provide professional services.
This may possibly be a skewed sample of pharmacy owners with a strong interest in professional service delivery, but it certainly cannot be extrapolated across the entire spectrum of community pharmacy.
Most pharmacies I have seen that have a private room for interviews use that room partly for storage, partly for non-patient interviews, partly for beauty therapies, and most are congested, because the space doubles up as a temporary storage space.
My experience also tells me that the professional service pharmacist has to share his service provision in between dispensing prescriptions or checking finished prescriptions or interviewing S3 patients on the shop floor.
There does not seem to be a truly dedicated pharmacist at this point in the process.
In terms of alliance partnerships, a handful are in some stage of formation/development, but the PGA mismanagement of HMR’s has stalled any momentum, with the real story behind that debacle yet to be published.
However, there is a glimmer of light if this article is read in conjunction with Mark Coleman's article on  dispensing hubs.
So, given that ASMI has produced evidence to support “switching” who is going to perform this role?

The study shows there is potential for considerable savings to governments and the community through a sensible approach to the scheduling of medicines, so there would eventually be money to pay an independent clinical pharmacist.

“Unfortunately, the process of switching medicines from prescription to non-prescription has all but stalled in Australia and this is impacting health outcomes, healthcare costs and is stifling innovation in the sector,” Dr Schoombie said.

In addition, the APP interactive survey participants rated current business conditions as average, and unsurprisingly with the increasing impact of price disclosure, 70% of them expected next financial year to be worse than this year.
Nearly two-thirds of participants indicated they will need to reduce staff or services to cope with the impact of price disclosure.”

So the question is again asked: who will be there to facilitate switching and drive professional services?

One non-owner pharmacist commented at the conclusion of the PGA interactive session:

“Having been at this forum and witnessed first hand how badly you can conduct a forum I would have to say it was a snapshot at best. The questions and the answers you were given to use for your data logger were at times too ambiguous, at other times they did not match. It was poor quality work.
One young pharmacist stated that he wanted to establish an aged care business supplying pharmacy services but did not want an S90 pharmacy. His questions were not answered and he was closed down.
This was not a good forum on so many levels. There was very little opportunity to ask questions or express an opinion.
This was an exercise for PGA to collect responses from a small percentile in the room.
Sadly as some of the questions were very poorly designed it was difficult for the audience to give correct feedback”

The above comment is published to illustrate the PGA attitude against independent pharmacists developing new business models for themselves.
The conflict of interest and the active hostility by PGA has almost reached a level where an ACCC ruling is probably long overdue.It will take an independent arbiter of this sort to remove the anti-competitive practices employed by the PGA.

The Macquarie University study examined the economic and budgetary impacts of switching 11 categories of common Rx medicines used in areas including flu prevention, migraine, cholesterol lowering and heartburn.

Dr Schoombie said that most of the medicines in the study have a long history of relatively safe use and many have already been switched to non-prescription in similar markets overseas such as the UK, US, Sweden, Germany, Canada and New Zealand.

“If government wants to achieve a more sustainable health budget, there are an estimated $2 billion in savings that would flow from increased consumer access to medicines with a long history of safe use,” he said.

The study, also sought to place a value on the current economic contribution of the OTC sector to the broader health economy.

It found that each dollar spent on eight categories of the most common OTC medicines saves the healthcare system more than four dollars.

Overall, the availability of OTC medicines produces savings of approximately $10.4 billion, made up of $3.8 billion in direct costs associated with visits to general practitioners (GPs), as well as $6.5 billion in indirect savings associated with lost productivity.

If OTC medicines were not available, there would be an estimated 58 million additional GP visits for people to obtain their medication.

Not wanting to be left out of the debate the AMA predictably forced its way into the discussion, necessitating a further statement having to be made by ASMI to correct misinterpretations.

“Dr Deon Schoombie, Executive Director of the Australian Self Medication Industry (ASMI), today argued that the Australian Medical Association (AMA) has misunderstood the findings of a study into the benefits that could arise from improving consumer access to a number of current prescription only medicines.1

Comments from AMA President, Dr Steve Hambleton, suggest the AMA has not properly understood the study’s key finding that ‘switching’ certain prescription only medicines to Pharmacist Only could save the health economy $2.1 billion.

We are not suggesting for a moment that GPs should somehow be cut out of the consultation process. GPs are at the centre of Self Care and are a critical partner in assisting consumers to understand and manage their conditions.

But there are clearly a number of prescription only medicines that have been down-scheduled in similar markets to Australia and which could be safely done so here. “

“Down-scheduling is not new.
Substances like lower dose NSAIDs, H2 antagonists, proton-pump inhibitors, nicotine replacement therapy, antihistamines, orlistat, and corticosteroid inhalers were all once prescription only medicines. We don’t have to think too far back when smoking cessation medications such as Nicorette and Nicabate, non-sedating antihistamines such as Claratyne, Telfast and Zyrtec and anti-diarrhoeal drugs such as Imodium were prescription only.

Consumers have been using these medicines safely, often under the guidance of GPs and pharmacists.

We strongly believe that GPs should be part of this debate. They are the medical experts and the key player in raising health literacy. The foundations of responsible Self Care are laid in the doctor’s consulting rooms. But we can’t afford to stop the clock on sensible, incremental reform that is in keeping with National Medicines Policy. “

The AMA have construed a switching process of a drug down scheduled from S4 to “pharmacist only” category as locking out GP's. The Pharmacist Only category is not “owned” by pharmacists as these drugs can be prescribed by GP's and most allied health practitioners

So that's the state of play – a situation that could rescue pharmacy from the doldrums and provide employment for pharmacists and contractor pharmacists is in danger of being lost allowing political decisions to overshadow valid economic decisions.
Independent pharmacists need to form up into a representative body and take the PGA on.
There would be plenty of helpers willing to support such a notion.

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