s Gradually, and Then Suddenly- a Lesson in Life | 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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Gradually, and Then Suddenly- a Lesson in Life

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.

I started publishing i2P in February 2000 because I was personally aware that community pharmacy policy was not going in an optimum direction and was becoming divisive within the profession.
At that stage there was only one writer (me), but I was soon tackled by other pharmacists with similar thoughts and very strong views, so I decided there was room for a “thought leadership” role for my then fledgling publication, and I invited my detractors/supporters to fill an Internet page that was theirs to manage and to write their own researched thoughts, without censorship or heavy editing (except for potential libel and grammatical errors).
So was born a publication that could publish completely opposite viewpoints simultaneously, creating a form of a “think tank” for all pharmacists.

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The first writer to join i2P was Rollo Manning.
He was very critical of everything that I was doing, and at first I thought that maybe I had imported a problem rather than having created a solution.
However, I embraced all the criticisms and tried to provide a compromise that satisfied both of us.
Some issues were resolved and others were not, but I believe we have had a respectful relationship, and that the “thought leadership” role that has evolved through i2P has both irritated and benefited policy leaders for community pharmacy.
As other writers have come on board our thought leadership role simply expanded.

Over the past fourteen years of publishing, i2P has been particularly critical of PGA policy and direction and I think if you reflect on the “product” that is represented by community pharmacy currently, and the state it finds itself in, you would have to agree that i2P criticisms were substantially correct.
The previous 14 years has been characterised by divisiveness, bullying and conflict of interest issues-all resulting in flawed policies and a future direction.

We are pleased to note that there has been a distinct change in direction as new leadership is creating more rounded, reflective and sensible policies.
These changes also create an opportunity for i2P to support PGA policies and help all pharmacists to integrate and resume the collegiate relationship that once existed.
That relationship needs to be strong, stable and cohesive to enable our profession to speak substantially with a single voice to government, the medical profession and to our predators (Coles and Woolworths).

Writing on a continuous basis requires a lot of mental energy and discipline and writers need to be able to refresh themselves periodically, to avoid “writer’s block” and loss of creativity.
For that reason I have come to increasingly rely on the philosophy and writings of Seth Godin, an American marketing guru.
I can always rely on finding a passage or two that jumps of the page and is analogous to the thought message I am trying to communicate.
Like the following:

Gradually and then suddenly
This is how companies die, how brands wither and, more cheerfully in the other direction, how careers are made.

Gradually, because every day opportunities are missed, little bits of value are lost, customers become unentranced. We don't notice so much, because hey, there's a profit. Profit covers many sins. Of course, one day, once the foundation is rotted and the support is gone, so is the profit. Suddenly, apparently quite suddenly, it all falls apart.

It didn't happen suddenly, you just noticed it suddenly.

The flipside works the same way. Trust is earned, value is delivered, concepts are learned. Day by day we improve and build an asset, but none of it seems to be paying off. Until one day, quite suddenly, we become the ten-year overnight success.

This is the way it works, but we too often make the mistake of focusing on the 'suddenly' part. The media writes about suddenly, we notice suddenly, we talk about suddenly.

That doesn't mean that gradually isn't important. In fact, it's the only part you can actually do something about."

The above thoughts are quite profound when applied to community pharmacy.
Brand “pharmacy” has withered and is in a moribund state.
The core business of pharmacy has only been viewed as PBS activity for the past 14 years, and this has entirely consumed community pharmacists as they became the unwilling indirect employees of Medicare.
i2P has warned frequently that the PBS as a product, was on the downside of the bell-shaped curve that represents a product’s life cycle.
That has only recently been recognised by other pharmacy leaders as they make remarks about the commoditisation of dispensing and the rapid evaporation of gross profit with no “quick fix” to prevent further erosion.
As Godin points out, the “foundation is rotted, the support is gone, so is the profit”,
and apparently it is “suddenly” happening.
No, it’s been happening for well over the past 14+ years, otherwise there would have been no motivation for i2P to have been born.

I thought Godin’s comment on trust as an earned value helps to build an asset over time until it “suddenly” emerges as a concept that everyone needs and values, while competitors try to emulate and copy.
The ratings agencies for professions always have pharmacy near the top of their rankings for ethics and honesty.
But introducing the word “trust” and suddenly pharmacy takes a steep dive in a rankings chart defining that quality.

It does not mean that our patients distrust us overall, only in our capacity to build a clinical rapport with them-something new they have not experienced before.
We have not taught our patients to value our clinical services because we have never charged for them. If we had charged, patients would have automatically demanded value for money paid and we would have automatically built in a quality level that would have been acceptable to a patient.
So we have to begin that ten-year journey that Seth Godin describes before we “suddenly” become a ten-year overnight success.

This also means that the entire profession of pharmacy needs to start that ten-year process and creating all the intellectual capital required, to provide a base for clinical services. And community pharmacies need to provide a proper home for these services.
If pharmacies do not provide suitable “homes” then clinical pharmacists will seek alternate venues and opportunity will again be lost.

As Seth Godin reinforces:
“Gradually, because every day opportunities are missed, little bits of value are lost, customers become unentranced.
We don't notice so much, because hey, there's a profit. Profit covers many sins”.


This is where collegiality can begin its rebirth.
i2P has consistently advocated for a business model that would allow non-owners of pharmacies to incorporate into a service practice that could contract directly with community pharmacies to provide a range of clinical services.
This would create a distinction in roles – the pharmacy owner concentrates on infrastructure and all the business elements required to sustain a viable pharmacy, while the service contractor invests in its own education and training, as well as developing marketing systems that would efficiently engage with that pharmacy’s patient base, also provide for an independent infrastructure that looks after its own wages, superannuation etc.

It is important that clinical service pharmacists not have a pecuniary interest in the pharmacy in which they practice so that it would enable future prescribing services to develop without concerns for conflict of interest.

This is one area that the PGA has consistently ignored, with the result that they have nobody to develop and manage their clinical services program, or anyone who could engage in independent prescribing within member pharmacies.
Unless suitable policy frameworks are established in the near future, the pharmacist professional services area will lag behind all of its competitive allied health equivalents.
Perhaps this is a role for the Pharmaceutical Society of Australia as they seek to find relevance in their own activities.
This would not compete with the PGA and would create a trusted framework to develop policy and practice procedures that could embrace all pharmacists involved in paid clinical services.

At the time of launching i2P I also considered launching a second publication involving consultant pharmacists.
This was at a time when nurses had just gained clinical nurse practitioner status, and consultant pharmacist political structures had not been formed.
Clinical nurse practitioners quietly gained in strength over the following years while consultant pharmacists did not because their scope was limited by medical profession referrals.

Clinical pharmacists need complete freedom to develop their scope of practice and no impediments should be artificially placed in their way as has followed previous endeavours to establish professional services.
Collegiality will be assured if parochial issues, particularly from the PGA are quietly negotiated instead of being attacked and demolished.

Let’s see what can be done.
After all, we have nothing to lose except for our entire professional base and future direction.

Return to home

Submitted by Gerald Quigley on Wed, 22/01/2014 - 19:53.

Your editorial is a rather sobering way to start 2014, wherein the pharmacist must re-invent him or herself and have a ready answer to that question often asked.........." If you don't own or work in a pharmacy, what exactly do you do?" Seth Godin should be a "must" for every pharmacist to read and enjoy each day. His perceptions are incredibly relevant to our profession as it stands today. I wonder how many of us actually subscribe (it's free!)

Submitted by Rollo Manning on Wed, 22/01/2014 - 11:21.

Very good summary Neil and well done on the past 14 years. You like me must be considering future pastures that you have been putting aside over the last 14 years. What are yours? Mine are writing about other things than pharmacy. One does get tired of hitting heads against brick walls but as your friend Seth points out is is all a part of the aggregate below the surface change taking place unnoticed.
I wish you well in the future and hope that the past 14 years will be viewed in history as a significant contribution to the pharmacy dialogue.
My only concern as I have often expressed to you is "anyone listening" and I do believe still that the readership of I2p has also been an untapped source for specialized activity in group interests. Maybe your idea of another publication for consultant pharmacists is the answer as I know there are many wanting to carve out that career opening.
All the best
Rollo

Submitted by editor on Wed, 22/01/2014 - 21:57.

Thanks Rollo and yes I am considering alternative pastures.
For some time I have been collecting data relating to clinical service development in pharmacy, which is at an appalling low level given the money that has been made available over the years.
As you would remember from previous conversations, management consultant practices are very close to the skills pharmacists need to acquire to provide a confident and structured approach for clinical service delivery.
Unlike consultant pharmacists, management consultants have an identifiable client they engage directly with.
No other parties involved!
Consultant pharmacists initially could only deal with their clients through s pharmacy after receipt of a doctor referral.
This binding up of consultant pharmacists became a cumbersome, convoluted and expensive process with the consultant pharmacists receiving insufficient value for their wotk.
And of course let's not forget the doctors who generally believe they can deliver objective medication reviews around their own prescribing!
I find that weird thinking and the reason I have been critical of the consultant pharmacist process and its lack of ownership of its own governing body.
So yes, anyone who would like to go on a journey into paid clinical services with me, please contact me.
There is much information already in existence, but it is under the radar until there is a stronger recognition by pharmacists of their own abilities, coupled with the realisation that there is no "quick fix".
Good luck to you as well Rollo I hope we both achieve our respective goals before the ageing process thwarts our vision.
Best wishes for 2014.
Neil

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