s How is Your Bedside Manner? | 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. 
Access and click on the title links that are illustrated

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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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How is Your Bedside Manner?

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 read with interest, Gerald Quigley's article featured in i2P this month. He is talking about Doctor/Pharmacist professional cooperation and the collaboration and development of a team approach to health issues such as geriatric health.
A simple question was asked by a panel of assorted doctors about why pharmacists were not more active in the care of the elderly.
“Why aren’t pharmacists more interested in older patients?”
“Surely they get to see an older person far more often that the local GP, and certainly more often that a geriatrician!”.
The upshot was that all the doctors thought the pharmacist's role was to supply nutritional products such as Ensure, at the cheapest possible price. Nothing more.
No collaborative clinical venture there as Gerald quickly discovered.

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I began to wonder how widespread the doctor attitudes are and if their perceptions of pharmacists and their place in health are truly representative.

Dr Livingstone is a pseudonym for a GP based in the UK, who writes opinion articles for the online publication, Chemist+Druggist. His attitude towards pharmacists are a bit on the sanctimonious side.

Do doctors earn your respect and are they good leaders in any collaboration activities?
Do they even manage their normal practice affairs in an efficient manner?

Perhaps you might like to comment.

I asked Mark Coleman comment on the article below.

Self-care campaigning

Published in C+D e-newsletter

"Dr Livingstone is a real-life GP lost somewhere in the NHS jungle. A reluctant part of a GP commissioning consortia, he offers his slightly wry look at all things NHS

Yawn. There's yet another campaign ongoing designed to encourage patients to self-care rather than visit their GP for coughs, sniffles, tummy upsets, dandruff and so on. Cue advice to go and see your friendly local pharmacist who is an expert in minor illness, yada yada yada.

Two problems. First, I'd rather a campaign to promote self-care for trivia didn't encourage patients to consult anyone at all – not even pharmacists. Most minor ills just need a dose of common sense and/or fluids and/or paracetamol, plus a little patience. I realise you have placebos to peddle of course. But you're simply perpetuating the notion of a pill for every ill – inadvertently generating GP attendance by donating to patients the opening gambit,  "I've already tried everything from the pharmacist, doctor."

And, second, the NHS has just spent gazillions on campaigns encouraging the public to believe that diarrhoea, cough and dandruff might be a sign of cancer of the lung, bowel and hair (I made that last one up, but it can only be a matter of time).
Now they've decided these symptoms are actually appointment-wasting trivia. Confused? The punters certainly are. And guess who they book an appointment with to sort it all out
."

 

Mark Coleman

I have been asked to comment on the above media item which is is no different to a dozen other articles Dr Livingstone has written, all implying that he always has to clean up a patient mess created by a pharmacist.
I should talk to him about patient messes found when conducting HMR interviews and never actioned by the referer.
The man is a pompous ass!

For as long as I can remember doctors have always exhibited a form of jealousy towards pharmacists, and it has its roots in the financial returns enjoyed by pharmacists compared to doctors.
Not that many pharmacists are enjoying their current financial returns, but the doctors don't believe that this is a genuine issue.
Early in my professional career I suffered in silence when confronted by statements from local doctors such as "You live off the top of my back", meaning that you have to locate next to my surgery to make a living!
This was always confusing to me for all the evidence available illustrated that when doctors and pharmacists coexisted in a professional relationship, patients felt supported and both the doctor and pharmacist prospered in that collaboration.

The tension that exists between the two professions has expanded from thinly veiled insults to virtually an all out war.
Doctors continually feel threatened and charge pharmacists with "turf infringement" and like the doctors on Gerald's panel, appear to have a complete ignorance of the role of the pharmacist.

Lately. I have lost respect for the medical profession through the issues promoted for evidence-based medicine (EBM). I have always wholeheartedly believed in the concept of EBM, but unethical and illegal relationships that have formed up with Big Pharma and doctor groups ranging from academics, the peer review panels for medical journals down to Pharma payments to so-called "opinion leaders" - doctors who are highly regarded within the profession who provide education to doctor groups and are highly paid to do so. Right down to the individual doctor who is bribed to attend these "educational meetings" with fringe benefits of various types.

This whole process is currently under review with Medicines Australia being forced to disclose payments their members make and identify the doctors involved. This has created a "can of worms" in that an open disclosure may embarrass the doctors receiving payments and shine a light on the entire corrupt process. And in the process an open disclosure would destroy one arm of Big Pharma marketing that would deplete corruptly earned revenues from their drugs.
Why then should I, or any other pharmacist show respect for a medical profession that has allowed corruption to become mainstream and secondly, provide sparse and half-hearted attempts to clean these issues up?

Dr Livingstone states that pharmacists should not engage in self-care because they will only use "placebos" furthering the notion that the medical profession are the only true gatekeepers for medical knowledge and what it constitutes.
In stating that pharmacists prescribe placebos what is his position in prescribing active drugs promoted by corrupt evidence? Which is worse?

Evidence from other sources is ignored by doctors and excluded to the extent that my professional judgement does not count because I only deal in placebos!
Even though I am scientifically trained in pharmaceutical and nutritional disciplines taught in a university.
Well that is the tipping point as far as I am concerned and until the medical profession cleans itself up and learns to be polite to co-profesionals such as pharmacists and nurses, they make it impossible to form alliances and accept doctors in leadership roles.

This is forcing pharmacists to follow an independent course, which they are trying to define currently.
Yes, there are divisions within pharmacy that promote a mainly supply model and others (like myself) who support an expansion into various clinical models of pharmacy.
It is only a matter of application and time before proven models begin to emerge.

It is not my business to instruct doctors how to run their practices.
It is definitely not a doctor's right to be able to determine how a pharmacy practice should be run, yet many think they have that right.
Both professions have to have sensible boundaries where they interface and it seems that this will not occur through collaboration, alliance partnership or even by negotiation.
Just look at the efforts by the RACGP and the PGA in their efforts to dominate the e-script market, and government interference in the form of poor policy and its procedural wing called NEHTA.
It has become a disgraceful and expensive mess, an unnecessarily cumbersome infrastructure and will not work because of its "opt-in" requirement by government.

The medical profession will never remove itself from a policy of complete domination and control of the e-script sector, and open warfare by the medical profession has exacerbated their offensive on pharmacy without even a formal declaration. So you might have noticed through Pharmedia and other entries on the i2P site, I will simply punch any doctor on the nose who is rude to me or my profession, corrupt in their dealings or who attempts to manipulate my professional practice in any manner.

Tension between the medical and pharmacy professions has existed for a long time.
I can remember shortly after graduating as a pharmacist, I came into possession of a book written by a senior Faculty of Medicine lecturer describing how doctors should interrelate with other professions.
It discussed pharmacists in a very derogative manner by stating that pharmacists carried on unprofessional activities, but that some dealings were necessary with them to comply with the Law.
That was around 1950's before the PBS got a stranglehold on dispensing and pharmacists used to prescribe over the counter.
Just starting out in my chosen profession I was appalled to read this as formal instruction to students in Medicine.
Then, and now, it has always been a political strategy to position Pharmacy in a lowly status.
Supposedly, pharmacists then were not considered capable of prescribing, yet they carried the lion's share of primary health activity- an achievement that has never been acknowledged and the reason that pharmacy roles are never promoted in various government sponsored health programs today, because doctors fear they will be displaced by pharmacists.

Our leaders in Pharmacy have generally performed well, from about 1970-2003. Since 2003 there has been a decline in the role of the pharmacist. A role that is not adequately defended or promoted.
The current Pharmacy Guild of Australia has been a corrosive and divisive influence that inherited a reputation in 2003 that was exactly the opposite, from the inspirational lead of Kevin McAnuff, who died prematurely.
They have excluded a collaborative leadership role by the PSA, which has flowed through to non-owner pharmacists being excluded from developing clinical roles and applications in pharmacy environments.
Pharmacists will not progress in new clinical roles unless they are reimbursed individually (as doctors and nurses are when working in a medical centre environment) and they are being reimbursed for at least a 15 minute consultation involving quality use of medicines and patient education, particularly those with chronic diseases.

When the PGA announce that they have negotiated an agreement with government surrounding payment for 15-30 minute consultations for QUM and chronic disease education, they will have given pharmacists the tool to resist medical encroachment.
But I'm not holding my breath.

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