s Integrity - the word keeps appearing in a pharmacy context | 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

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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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Integrity - the word keeps appearing in a pharmacy context

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.

Editor's Note: Pharmacy media has been alluding to the lack of integrity in some pharmacy activities, both industry and professional.
Problem is, whether we are involved in the process described, or not, we all still get tarred with the same brush.
Others may combat the criticism by stating that they are in survival mode and that to meet their financial obligations they have to be involved in transactions that help to pay the rent.

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Integrity is bound up with core values, and whoever judges what integrity is will deliver a verdict based on their own core values. Different segments of the pharmaceutical industry will have differing perspectives based on their core "differences".
As pharmacists we have mostly been able to agree on the direction of pharmacy.
That is, until segments of pharmacy became corporatised.
From that point on, patient interests began to be supplanted by shareholder interests and at some point, incompatibilities began to appear.
It could be said that employed pharmacists are geared more to patient interest and that patient interest should correspond with employer interest.

Employer's would claim that as the major shareholder in their pharmacy business, anything that is not illegal and gives a good return on invested capital, is fair game.
Somewhere in between lies integrity and morality....and the patient.

i2P has been pointing out for some time that the collegiate atmosphere that used to exist between owner pharmacists and employed pharmacists has completely disappeared in some pharmacy environments.
Thus goodwill has been progressively eroding between the two groups and this is not good for any part of the industry.
It has a lot to do with imported corporate attitudes and values.

In the wider scale of things the issues can be tracked back to one phenomenon....greed!

We see this in Pfizer and its direct distribution model and their patient education scheme for Pfizer-branded products; we see it in wholesalers who have moved to brand individual pharmacies under one brand...their brand!
And we see the same traits in chain pharmacies that use predatory pricing to wrest market share from other pharmacies.
A philosophy of greed makes pharmacy very vulnerable because its strategies become predictable and easily checked.
A pharmacy based on integrity will always have that inner strength to be able to adapt to change and survive..
We have asked Mark Coleman to comment on the subject of integrity and the following media article that appears to illustrate a diminished integrity for pharmacy.

Analysis: Has the gloss gone off the Guild?


The Pharmacy Guild has long been seen as representing the trustworthy community pharmacist but now it is accused of making 'grubby' deals and putting profit before patients. How much has its brand been damaged?

The Pharmacy Guild is in trouble.

Over the past month, attacks on its integrity have come from its own heartland, from pharmacy and pharmacists, and from sectors it should be able to look to for support such as consumers, doctors and pharmaceutical wholesalers. Politicians have added to the mix.

Its most recent public problems began when Blackmores CEO, Christine Holgate, made a serious public relations blunder, describing her company's arrangement with the Guild for promotion of its so-called Companion Range as "coke and fries".

Initially trumpeted as a clever marketing coup, the arrangement soon turned into a PR nightmare, portrayed in the media as a cynical deal to generate revenue for the Guild, its members and Blackmores by pushing supplements onto patients.

After an uncomfortable week defending the deal, both Blackmores and the Guild junked it, backing away to minimise the damage.

But it cast a pall over the reputation of the Guild and its members, and left an impression of a kick-back culture permeating community pharmacies.

Last week that pall became thicker and more odious with the Fairfax media portraying Pfizer's brand-specific patient compliance programs, operated through Guild subsidiary, healthlinks.net, as another case of pharmacists and drug companies manipulating patients and putting profit before

professional care.

Pfizer's deal with Healthlinks.net was immediately tossed into the same basket as the Blackmores arrangement, helped by the fact that both involve pharmacists' dispensing programs prompting them to "up-sell" customers.

Pfizer has since struggled to distinguish its patient compliance efforts from Blackmores' sales pitch but nobody is listening.

Despite Pfizer Managing Director, John Latham, saying, "This is Pfizer's attempt to really connect with patients in a way which is compliant, not just with Pfizer's policies but also with the MA Code of Conduct and any legal, privacy concerns too," and Medicines Australia CEO, Brendan Shaw, backing him up, the association with the Blackmore's debacle refuses to go away.

The balance of this article can be found here

Mark Coleman

I have been asked to review integrity issues surrounding recent events in the world of pharmacy.
The excellent analysis of events, prepared by Pharmainfocus, certainly points to the fact that standards within the pharmacy environment have slipped - and it is not just the "pharmacist troops" that are leading the charge downwards, but a significant number of industry leaders who are paving the way.
Individually employed pharmacists claim to feel pressured against their will because of fears of loss of employment and "blacklisting".
While there is some evidence that this is occurring in Australia, the overseas experience points to the fact that it will eventually happen.
How is integrity defined?
Wikipedia says:

"Integrity is a concept of consistency of actions, values, methods, measures, principles, expectations, and outcomes. In ethics, integrity is regarded as the honesty and truthfulness or accuracy of one's actions. Integrity can be regarded as the opposite of hypocrisy,[1] in that it regards internal consistency as a virtue, and suggests that parties holding apparently conflicting values should account for the discrepancy or alter their beliefs.
The word "integrity" stems from the Latin adjective integer (whole, complete).[2] In this context, integrity is the inner sense of "wholeness" deriving from qualities such as honesty and consistency of character. As such, one may judge that others "have integrity" to the extent that they act according to the values, beliefs and principles they claim to hold."

Consistency indicates a lack of contradiction-holding fast to a code of ethics as genuine core values.
It was perfect timing for the Pharmaceutical Society of Australia (PSA) to introduce their new code almost at the very centre of all the media controversy.
Hypocrisy as defined, (the opposite to integrity), for me crystallises how much the pharmaceutical industry has declined around me.
Hypocrisy abounds at many levels and I include the latest brand transfer of Codral products to supermarkets as a shining example.
While a manufacturer may claim "their" brand is their intellectual property, it also includes the added value of pharmacist support and recommendation. To cynically ignore that measurement and hijack the brand name with a different formula is hypocritical in the extreme - and is exceptionally dishonest to consumers who put faith in a brand because they expect consistency.
This form of dishonest marketing needs to be publicly criticised by pharmacy and all consumer groups- even legislated against by government.

When you hold the PGA/Blackmore's deal up to the light the hypocrisy is revealed when you see that PGA software flags were not generic and assumed that if a patient was on a certain drug that may deplete certain nutrients, all patients could be treated for deficiencies (proven or not).
The hypocrisy was confirmed when it was revealed that Blackmore's had already scoped the potential market in terms of existing PBS scripts dispensed for the drugs targeted.
Disenfranchised in the deal was the clinical pharmacist who wished to ethically use their clinical judgement and skills to identify what total problems existed for a patient that could be treated.
That was not necessarily going to be a Blackmore's product used for treatment.

You also see hypocrisy when regulatory agencies to not create a uniformity of regulation e.g. as when the TGA simply does not do its job in product registration or when the Pharmacy Board does not rule on obvious anomalies such as the deep discounting of Panamax or the proper oversight of pharmacy ownership.

You also see hypocrisy in those pronouncing their value system for clinical evidence as being better or the only acceptable measure, when the truth is that all evidence is acceptable, (not just the double-blind placebo crossover gold standard), with just different weightings applied to the type of evidence recorded.
The corrupt practices in documenting evidence by some major global manufacturers is a practice that causes many divisions within the pharmaceutical community, and the misuse of evidence (corrupted or otherwise) is another form of hypocrisy misused to maintain power bases between different levels of clinicians.

And nobody appears to be willing to engage in accountability.

In the context of accountability, integrity serves as a measure of willingness to adjust a value system to maintain or improve its consistency, when an expected result appears incongruent with an observed outcome.
Most regard integrity as a virtue in that they see accountability and moral responsibility as necessary tools for maintaining such consistency.

My view is that an integrity clean-up needs to start at the top - from government agencies down through all levels of the industry, because if it is performed piecemeal or in an unbalanced fashion, it will not be adequate.

My belief is that what we have seen emerging in recent times is only the tip of the iceberg.
Everyone needs to open their eyes because complacency allows hypocrisy to flourish.

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