s Farcical Fraud in Medicine | 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

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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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Farcical Fraud in Medicine

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.

Medicines Australia (MA), the organisation representing drug manufacturers in Australia, has been struggling to produce an acceptable code of conduct on behalf of its members, that demonstrates integrity and transparency.
At issue is the range of payments made to doctors for services provided and the reluctance of Medicines Australia to name the doctors involved, the amounts paid to each individual doctor and what was the service actually performed.
Drug companies have agreed to disclose the total amount they pay to doctors to attend seminars or serve on advisory boards, but say any move to name individual doctors receiving the payments could be years away.

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Recent proposed changes to the Medicines Australia code of conduct include new requirements for drug companies to report payments to health professionals as from January next year.
They include providing overall figures on how much is paid to doctors to attend or speak at seminars, serve on advisory boards or act as consultants, along with the total number of doctors who receive the payments.

Why the reluctance to be transparent?

Obviously because there is something to hide, and given the recent admissions by the global drug company GlaxoSmithKline to fraud and other criminal activities attracting a total fine of US $3 billion, Australian consumers are left to wonder just how much of their own dollars are directed towards propping up this type of dishonesty.

As Derryn Hinch recently reported on his radio program, “big drug companies are up to their necks in bribing doctors. I have seen on the US news footage of a sales reps convention in Las Vegas for the huge drug company GlaxoSmithKline.
And there were executives in fancy dress and a hyped up MC shouting ‘Who wants to be a millionaire?’
That damning footage was used as evidence against GSK in a case where the drug company was ordered to pay $3 billion in the largest healthcare fraud settlement in US history.”.

US drug companies are represented in Australia under the umbrella organisation of Medicines Australia, so why shouldn't we assume similar imported behaviours of drug companies based here in Australia?

Given the continued dragging of the feet by Medicines Australia, it is now time for the Australian Government to impose a code that embraces all that is required for transparency and honesty.
The shocking revelations of drug company behaviour that is now on the public record, has revealed another peculiar set of circumstances as reported by the New York Times:

“No individuals have been charged in any of the cases. Even so, the Justice Department contends the prosecutions are well worth the effort — reaping more than $15 in recoveries for every $1 it spends, by one estimate.

But critics argue that even large fines are not enough to deter drug companies from unlawful behaviour. Only when prosecutors single out individual executives for punishment, they say, will practices begin to change.

“What we’re learning is that money doesn’t deter corporate malfeasance,” said Eliot Spitzer, who, as New York’s attorney general, sued GlaxoSmithKline in 2004 over similar accusations involving Paxil.

“The only thing that will work in my view is C.E.O.’s and officials being forced to resign and individual culpability being enforced.”

The federal whistle-blower law, officially the False Claims Act, dates to 1863 and was originally envisioned as a check on war profiteering after the Civil War.

Whistle-blowers get a share of any money recovered by the federal government. So far, according to Patrick Burns, spokesman for the whistle-blower advocacy group Taxpayers Against Fraud, at least $10 billion has been agreed to in settlements this fiscal year, which ends in September.

The settlement, which requires court approval, stems from claims made by four employees of GlaxoSmithKline, including a former senior marketing development manager for the company and a regional vice president, who tipped off the government about a range of improper practices from the late 1990s to the mid-2000s.

Prosecutors said the company had tried to win over doctors by paying for trips to Jamaica and Bermuda, as well as spa treatments and hunting excursions. In the case of Paxil, prosecutors claim GlaxoSmithKline employed several tactics aimed at promoting the use of the drug in children, including helping to publish a medical journal article that misreported data from a clinical trial.”

Just think about the patients who have died as a result of executive corruption and greed, and the fact that while the corporation pays a fine that becomes a line item in the cost of doing business, company executives do not have to resign or go to jail for their part in corrupt decision making.

Just business as usual, and this is not good enough.

Part of the conditions imposed on GSK has been the introduction of a Corporate Integrity Agreement.

GlaxoSmithKline has agreed to new restrictions by the U.S. government to prevent the use of kickbacks or other prohibited practices. The inspector general of the U.S. Department of Health and Human Services will oversee the "Corporate Integrity Agreement" for five years.
The company will not be able to compensate its salesmen based on sales goals for territories. It was also required to change its executive compensation program to allow the company to "claw back" certain pay for those engaged in misconduct.

Maybe a Corporate Integrity Agreement is what the Australian government should impose on those manufacturers who wish to list on the Pharmaceutical Benefits Scheme drug schedule.
Then Medicines Australia could be left to develop a code of conduct in those areas not covered by an Integrity Agreement. 

The Greens Party has threatened to intervene by proposing legislation requiring drug companies to report fees paid to individual doctors, who would be named, if the industry failed to act.
A spokeswoman for the party said it would also consider Medicines Australia's code of conduct revisions, but was likely to introduce legislation aimed at achieving ''full transparency''.

MA responded that some of the Greens' proposals, including to ban payments for doctors to attend ''educational events'' in Australia and overseas, would be ''disastrous for patients and the development of new medicines''.

There are a range of fallouts that occur now that the extent of Big Pharma fraud is known and includes most of the major drug companies.

The “Friends of Science in Medicine” (FSM) organisation must be a bit bewildered by the current turn in events, particularly when comparing complementary medicine safety and known fraud with mainstream medicine.
I have informally discussed the possibility that FSM might turn its attention to medical fraud, given that a substantial number of its members are medical academics engaged in research that may have been influenced by Big Pharma.

The answer has been that there is insufficient time, personnel and funds to pursue this channel for the moment, even though mainstream medicine is head and shoulders in the lead as far as breaching the principles the FSM espouses.

They claim that they will eventually turn attention to mainstream medicine but there is no timeline (or perhaps even the will) given the make-up of its membership.
Nor is there a “code of conduct” imposed on its membership, which might be a good start in holding their membership responsible to good behaviour under a sensible code.

An organisational adjustment that would promote confidence within the industry. 

The US organisation “Taxpayers Against Fraud”, as a whistle-blower organisation, carries out investigations into falsified medical evidence based on tips from people within the industry.
Government pays this organisation a percentage of fines successfully imposed on drug companies.
It would seem to be a good model for the FSM to adopt, as it provides an ongoing income and balances up the thrust of FSM activities which are directed currently to a weaker complementary groups that have nowhere near the adverse impact caused by mainstream medicine. 

Another major fallout is the accuracy of all drug information currently available.

It would seem to me that although drastic, all current information needs to be designated unproven and that the entire registration of evidence started afresh.

Drug sponsors need to put in fresh applications to support their products and Australian organisations (such as the TGA and the NPS) must vigorously test those applications before registering any data.

As well, there must be a review process to enable any interested party to challenge any component of that data at any time.
Complementary medicines need to be part of this process and evidence must be graded to be meaningful, rather than prejudiced and discriminatory. 

If a genuine attempt is made to clean up medicine now, rather than hide behind deliberate confusion and obfuscation I would be proud to be part of the family of medicine as I once was.

Currently I feel and experience shame and the feeling of being powerless as I uncover levels of corruption that provoke feelings of disbelief.

It really is time to throw off these shackles.

Return to home

Submitted by Dr Ken Harvey on Mon, 16/07/2012 - 10:43.

Neil said, “Given the continued dragging of the feet by Medicines Australia, it is now time for the Australian Government to impose a code that embraces all that is required for transparency and honesty”.

Consumer and health professional representative have put that proposal to the, “Government Working Group on Promotion of Therapeutic Products” but with no success, see http://tinyurl.com/6u8cqnd. Ironically, the Australian Government’s preference is to maintain an emphasis on self-regulation, see http://tinyurl.com/7yhcwxs.

Neil said, “Currently I feel and experience shame and the feeling of being powerless”.

There is no need to feel so! I encourage Neil and others to put in submissions to the ACCC which has the task of ratifying the 17th Edition of Medicines Australia Code of Conduct. In the past the ACCC has imposed “conditions” when authorising the Code that has strengthened its provisions. Submissions commenting on the substantive arrangements should be made by 30 July 2012. See

http://www.accc.gov.au/content/index.phtml/itemId/1063694/fromItemId/278....

See also http://theconversation.edu.au/consumer-input-in-medicines-australias-cod...

And http://theconversation.edu.au/code-for-pharmaceutical-industry-falls-sho...

Finally, Neil will be pleased to know that I understand the “Friends of Science in Medicine” (FSM) intend to put in their own submission.

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