s Know Your Rights - and Fight for your Life | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists


From the desk of the editor

Welcome to the July 2014 homepage edition of i2P (Information to Pharmacists) E-Magazine.
At the commencement of 2014 i2P focused on the need for the entire profession of pharmacy and its associated industry supports to undergo a renewal and regeneration.
We are now half-way through this year and it is quite apparent that pharmacy leaders do not yet have a cohesive and clear sense of direction.
Maybe the new initiative by Woolworths to deliver clinical service through young pharmacists and nurses may sharpen their focus.
If not, community pharmacy can look forward to losing a substantial and profitable market share of the clinical services market.
Who would you blame when that happens?
But I have to admit there is some effort, even though the results are but meagre.
In this edition of i2P we focus on the need for research about community pharmacy, the lack of activity from practicing pharmacists and when some research is delivered, a disconnect appears in its interpretation and implementation.

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News Flash

Newsflash Updates for July 2014

Newsflash Updates

Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
Access and click on the title links that are illustrated

Comments: 1

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Feature Contribution

Woolworths Pharmacy - Getting One Stage Closer

Neil Johnston

It started with “tablet” computers deployed on shelves inside the retailer Coles, specifically to provide information to consumers relating to pain management and the sale of strong analgesics.
This development was reported in i2P under the title Coles Pharmacy Expansion and the Arid PGA Landscape”
In that article we reported that qualified information was a missing link that had come out of Coles market research as the reason to why it had not succeeded in dominating the pain market.
Of course, Woolworths was working on the same problem at the same time and had come up with a better solution - real people with good information.

Comments: 5

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Intensive Exposition without crossing over with a supermarket

Fiona Sartoretto Verna AIAPP

Editor's Note: The understanding of a pharmacy's presentation through the research that goes into the design of fixtures and fittings that highlight displays, is a never-ending component of pharmacy marketing.
Over the past decade, Australian pharmacy shop presentations have fallen behind in standards of excellence.
It does not take rocket science - you just have to open your eyes.
Recently, our two major supermarkets, Woolworths and Coles, have entered into the field of drug and condition information provision - right into the heartland of Australian Pharmacy.

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The sure way to drive business away

Gerald Quigley

I attended the Pregnancy, Baby and Children’s Expo in Brisbane recently.
What an eye and ear opening event that was!
Young Mums, mature Mums, partners of all ages, grandparents and friends……...many asking about health issues and seeking reassurances that they were doing the right thing.

Comments: 1

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‘Marketing Based Medicine’ – how bad is it?

Baz Bardoe

It should be the scandal of the century.
It potentially affects the health of almost everyone.
Healthcare providers and consumers alike should be up in arms. But apart from coverage in a few credible news sources the problem of ‘Marketing Based Medicine,’ as psychiatrist Dr Peter Parry terms it, hasn’t as yet generated the kind of universal outrage one might expect.

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Community Pharmacy Research - Are You Involved?

Mark Coleman

Government funding is always scarce and restricted.
If you are ever going to be a recipient of government funds you will need to fortify any application with evidence.
From a government perspective, this minimises risk.
I must admit that while I see evidence of research projects being managed by the PGA, I rarely see community pharmacists individually and actively engaged in the type of research that would further their own aims and objectives (and survival).

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Organisational Amnesia and the Lack of a Curator Inhibits Cultural Progress

Neil Johnston

Most of us leave a tremendous impact on pharmacies we work for (as proprietors, managers, contractors or employees)—in ways we’re not even aware of.
But organisational memories are often all too short, and without a central way to record that impact and capture the knowledge and individual contributions, they become lost to time.
It is ironic that technology has provided us with phenomenal tools for communication and connection, but much of it has also sped up our work lives and made knowledge and memory at work much more ephemeral.

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Academics on the payroll: the advertising you don't see

Staff Writer

This article was first published in The Conversation and was written by Wendy Lipworth, University of Sydney and Ian Kerridge, University of Sydney
In the endless drive to get people’s attention, advertising is going ‘native’, creeping in to places formerly reserved for editorial content. In this Native Advertising series we find out what it looks like, if readers can tell the difference, and more importantly, whether they care.
i2P has republished the article as it supports our own independent and ongoing investigations on how drug companies are involved in marketing-based medicine rather than evidence-based medicine.

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I’ve been thinking about admitting wrong.

Mark Neuenschwander

Editor's Note: This is an early article by Mark Neuenschwander we have republished after the soul-searching surrounding a recent Australian dispensing error involving methotrexate.
Hmm. There’s more than one way you could take that, huh? Like Someday when I get around to it (I’m not sure) I may admit that I was wrong about something. Actually, I’ve been thinking about the concept of admitting wrong. So don’t get your hopes up. No juicy confessions this month except that I wish it were easier for me to admit when I have been wrong or made a mistake.
Brian Goldman, an ER physician from Toronto, is host of the award-winning White Coat, Black Art on CBC Radio and slated to deliver the keynote at The unSUMMIT for Bedside Barcoding in Anaheim this May. His TED lecture, entitled, “Doctors make mistakes. Can we talk about it?” had already been viewed by 386,072 others before I watched it last week.

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Dispensing errors – a ripple effect of damage

Kay Dunkley - BPharm, Grad Dip Hosp Pharm, Grad Dip Health Admin, MPS, MSHPA

Most readers will be aware of recent publicity relating to dispensing errors and in particular to deaths caused by methotrexate being incorrectly packed in dose administration aids.
The Pharmacy Board of Australia (PBA), in its Communique of 13 June 2014, described a methotrexate packing error leading to the death of a patient and noted “extra vigilance is required to be exercised by pharmacists with these drugs”.
This same case was reported by A Current Affair (ACA) in its program on Friday 20 June

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Take a vacation from your vocation

Harvey Mackay

Have you ever had one of those days when all you could think was, “Gosh, do I need a vacation.”
Of course you have – because all work and no play aren’t good for anyone.
A vacation doesn’t have to be two weeks on a tropical island, or even a long weekend at the beach. 
A vacation just means taking a break from your everyday activities. 
A change of pace. 
It doesn’t matter where.
Everyone needs a vacation to rejuvenate mentally and physically. 
But did you also know that you can help boost our economy by taking some days off? 
Call it your personal stimulus package.

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Explainer: what is peer review?

Staff Writer

This article was first published in the Conversation. It caught our eye because "peer review" it is one of the standards for evidence-based medicines that has also been corrupted by global pharma.
The article is republished by i2P as part of its ongoing investigation into scientific fraud and was writtenby Andre Spicer, City University London and Thomas Roulet, University of Oxford
We’ve all heard the phrase “peer review” as giving credence to research and scholarly papers, but what does it actually mean?
How does it work?
Peer review is one of the gold standards of science. It’s a process where scientists (“peers”) evaluate the quality of other scientists' work. By doing this, they aim to ensure the work is rigorous, coherent, uses past research and adds to what we already knew.
Most scientific journals, conferences and grant applications have some sort of peer review system. In most cases it is “double blind” peer review. This means evaluators do not know the author(s), and the author(s) do not know the identity of the evaluators.
The intention behind this system is to ensure evaluation is not biased.
The more prestigious the journal, conference, or grant, the more demanding will be the review process, and the more likely the rejection. This prestige is why these papers tend to be more read and more cited.

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Dentists from the dark side?

Loretta Marron OAM BSc

While dining out with an elderly friend, I noticed that he kept his false tooth plate in his shirt pocket. He had recently had seven amalgam-filled teeth removed, because he believed that their toxins were making him sick; but his new plate was uncomfortable. He had been treated by an 'holistic dentist'. Claiming to offer a "safe and healthier alternative" to conventional dentistry, are they committed to our overall health and wellbeing or are they promoting unjustified fear, unnecessarily extracting teeth and wasting our money?

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Planning for Profit in 2015 – Your key to Business Success

Chris Foster

We are now entering a new financial year and it’s a great time to reflect on last year and highlight those things that went well and those that may have impacted negatively in the pursuit of your goals.
It's also a great to spend some time re-evaluating your personal and business short, medium and long term goals in the light of events over the last year.
The achievement of your goals will in many cases be dependent on setting and aspiring to specific financial targets. It's important that recognise that many of your personal goals will require you to generate sufficient business profits to fund those aspirations

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Attracting and Retaining Great People

Barry Urquhart

Welcome to the new financial year in Australia.
For many in business the past year has been described as a challenging period.
Adjectives are a key feature of the English language.  In the business lexicon their use can be, and often is evocative and stimulate creative images.  But they can also contribute to inexact, emotional perceptions.
Throughout the financial pages of newspapers and business magazines adjectives abound.
References to “hot” money draw attention and comment.  The recent wave of funds from Chinese investors, keen to remove their wealth from the jurisdiction and control of government regulations is creating a potential property bubble in Australia.

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Updating Your Values - Extending Your Culture

Neil Johnston

Pharmacy culture is dormant.
Being comprised of values, unless each value is continually addressed, updated or deleted, entire organisations can stagnate (or entire professions such as the pharmacy profession).
Good values offer a strong sense of security, knowing that if you operate within the boundaries of your values, you will succeed in your endeavours.

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Evidence-based medicine is broken. Why we need data and technology to fix it

Staff Writer

The following article is reprinted from The Conversation and forms up part of our library collection on evidence-based medicines.
At i2P we also believe that the current model of evidence is so fractured it will never be able to be repaired.
All that can happen is that health professionals should independently test and verify through their own investigations what evidence exists to prescribe a medicine of any potency.
Health professionals that have patients (such as pharmacists) are ideally placed to observe and record the efficacy for medicines.
All else should confine their criticisms to their evidence of the actual evidence published.
If there are holes in it then share that evidence with the rest of the world.
Otherwise, do not be in such a hurry to criticise professions that have good experience and judgement to make a good choice on behalf of their patients, simply because good evidence has not caught up with reality.

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Laropiprant is the Bad One; Niacin is/was/will always be the Good One

Staff Writer

Orthomolecular Medicine News Service, July 25, 2014
Laropiprant is the Bad One; Niacin is/was/will always be the Good One
by W. Todd Penberthy, PhD

(OMNS July 25, 2014) Niacin has been used for over 60 years in tens of thousands of patients with tremendously favorable therapeutic benefit (Carlson 2005).
In the first-person NY Times best seller, "8 Weeks to a Cure for Cholesterol," the author describes his journey from being a walking heart attack time bomb to a becoming a healthy individual.
He hails high-dose niacin as the one treatment that did more to correct his poor lipid profile than any other (Kowalski 2001).

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Culture Drive & Pharmacy Renewal

Neil Johnston

Deep within all of us we have a core set of values and beliefs that create the standards of behaviour that we align with when we set a particular direction in life.
Directions may change many times over a lifetime, but with life experiences and maturity values may increase in number or gain greater depth.
All of this is embraced under one word – “culture”.
When a business is born it will only develop if it has a sound culture, and the values that comprise that culture are initially inherent in the business founder.
A sound business culture equates to a successful business and that success is often expressed in the term “goodwill” which can be eventually translated to a dollar value.

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Pharmacy 2014 - Pharmacy Management Conference

Neil Johnston

The brave new world of health and wellness is not the enemy of Pharmacy, it is its champion.
Australian futurist, Morris Miselowski, one of the world's leading business visionaries, will present the Opening Keynote address on Pharmacy's Future in the new Health and Wellness Landscape at 2.00pm on Wednesday July 30.
Morris believes the key to better health care could already be in your pocket, with doctors soon set to prescribe iPhone apps, instead of pills.
Technology will revolutionise the health industry - a paradigm shift from healthcare to personal wellness.
Health and wellness applications on smartphones are already big news, and are dramatically changing the way we manage our personal health and everyday wellness.

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Generation and Application of Community Pharmacy Research

Neil Johnston

Editor’s Note: We have had a number of articles in this issue relating to pharmacy research.
The PGA has conducted a number of research initiatives over the years, including one recently reported in Pharmacy News that resulted from an analysis of the QCPP Patient Questionnaire.
Pharmacy Guild president, George Tambassis, appears to have authored the article following, and there also appears to be a disconnect between the survey report and its target audience illustrated by one of the respondent comments published.
I have asked Mark Coleman to follow through, elaborate and comment:

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Know Your Rights - and Fight for your 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.

Editor's Note: Sometimes we find ourselves in difficulty and the subject of an official complaint.
Often, the first knowledge of this complaint is when an inspector from some agency arrives on the doorstep and begins to interrogate you over the counter.
Sometimes (and I think deliberately) in earshot of staff, customers and patients.
Suddenly you find yourself fighting for your professional life.
We asked Mark Coleman what he would do if faced with a situation similar to what happened below:

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Medical Observer:

Questions on mandatory reporting after defamation decision

30th Apr 2012 by Byron Kaye

Medico-legal experts will be reassessing mandatory reporting laws after a court ruled a doctor was entitled to sue her colleague for defamation after he reported her to the authorities.

Sydney psychiatrist Dr Julian Parmagiani reported his colleague, Dr Yolande Lucire, to the NSW Medical Board in 2008 after he claimed he saw her lying under oath about whether she had registration conditions whilst giving expert evidence in court.

Dr Lucire sued for defamation claiming the complaint did not fall under mandatory reporting requirements, which are for cases of suspected sexual or substance abuse or “impairment”.

Dr Parmegiani initially won in a bid to have the matter struck out, claiming he had “absolute privilege” when reporting a colleague to authorities.

But in a landmark ruling last week the NSW Court of Appeal ruled that Dr Parmegiani’s complaint was not covered by absolute privilege since the Medical Board “has no powers of investigation [and] exercises no quasi-judicial function; its process is purely administrative”.

As well as overturning the decision to strike out the defamation claim, the court ruled Dr Parmegiani must pay the cost of Dr Lucire’s appeal.

“It’s a great relief because it was double or quits,” Dr Lucire told MO.

Dr Parmegiani’s complaint and Dr Lucire’s legal action both predated national mandatory reporting rules which began on July 2010. But the matter is being seen within the medico-legal profession as a test case for the new rules since it concerns medical professionals’ ability to report their colleagues with impunity – something they are now legally required to do under certain circumstances.

Slater & Gordon group leader for medical law Bill Madden said the ruling should broadly reassure doctors because it ensured that, if a complaint were made against them, they had the right to test whether it was made in good faith.

“It’s always been understood that under the new national law there is a protection in place for good faith reports,” he said.

“What we’re talking about here is [what happens if] there is a report made in bad faith.

“You would assume that most doctors would want that position to apply because that means that if somebody does make malicious reports they [the recipient of the complaint] still have the option of being able to turn around and demonstrate bad faith. It’s a balance.”

Dr Parmegiani declined comment when contacted by MO.

A directions hearing will be set down for a later date.

Mark Coleman

The following comments must not be construed as legal advice and reliance must not be placed on these comments if you find yourself in legal difficulties as a result of a formal complaint against you.

I once found myself the subject of a complaint made by the local GP to the Pharmacy Board.
The first glimmering that I was in trouble occurred when I received a telephone call from one of my staff during a period when I was having a short break, after some months of high-intensity workload - you know, one of those periods when one day merges with the next and although you go to bed reasonably early, you still wake up exhausted.
I prescribed for myself a beach-side holiday.
Although I had given my telephone number out to a senior staff person for any emergencies, I was not anticipating that one would occur.
The staff person calling me told me that there was a Pharmacy Board inspector rummaging around through my store of PBS duplicates and that he had demanded to speak with me.
I agreed, and was then subjected to a threatening discourse for about 10 minutes.
I was told in no uncertain terms to present myself back at the pharmacy that day (the holiday resort was only about 90 minutes away) otherwise a warrant would be taken out.

In those days I was in my early 30's and had not had anything of a crisis nature happen before.
I was "wet behind the ears", otherwise I would have rung my solicitor immediately and brought this inspector to heel.

Anyhow, I returned to the pharmacy.
I was not immediately told what my transgression had been, only that I was to find a PBS duplicate for a particular patient.
I found the duplicate (it was for an eye drop) and the inspector departed, stating that he would be in contact again.
At no stage was I given an outline of the complaint by the doctor or the Board inspector.

Naturally, I became quite worried, but still tried to relax on the remainder of my break (the definition of impossibility).
About two months later I received the formal paperwork outlining the complaint with the demand that it be responded to in writing, which I did.
It seemed that I had been accused of changing the prescription of a doctor - and mislabeling it to boot!
The eye drops had been prescribed by a specialist. At the point of dispensing, I did not have the stock on hand. I rang the specialist to get a change agreed to, for a brand that we did have in stock (but a slightly different formula).
A simple enough process that we are all familiar with.
During that process I forgot to alter the dispensary label to illustrate the label of the new product.

The local GP got in on the act when he was asked to write a new prescription and noted the differences at that time.
An official complaint was immediately lodged - no courtesy there. particularly as I was not copied in.
The Board complaint was responded to quickly by me, but they were not satisfied and a hearing was set down for a future date.

To me (then and now) the process seemed to be a complete over-reaction and I began to suspect other forces at work (such as a disgruntled opposition with good political contacts who was losing a major market share to me at that time).

The hearing went ahead and I received a reprimand for the mislabeling - not the original charge of changing the prescription of a doctor.
Somehow, during the hearing a press item appeared in the local paper that alleged that I was under a cloud facing possible deregistration.

I asked my legal people what options I had in pursuing the doctor and the board inspector, believing that I had been defamed.
The best I could do at that time was force the local paper to print the result of the Board hearing.

Now it seems that with the passage of time and the recent case fought out between the doctors identified in the above news item, I might now have a chance at winning.
In the days I am talking about we did not log Incident Reports as we do today and professional discourse was usually a bit more courteous.
All I can say is that if that incident had occurred today, I would certainly have been more aggressive in my pursuit of both the doctor and the Board inspector - but that only becomes possible through the experience gained over the years.
In fact the opportunity did come up many years later when I was accused of running a clinical practice while being employed in a public hospital.
I erupted immediately, threatening legal action against a GP who made the allegation, the Director of Medical Services who drafted a letter of reprimand and the hospital EO who also got in on the act.
Again, not one of these people thought to approach me for an explanation.
The matter resolved that same evening with all parties apologising-the GP actually called around to my home to present his apology.

What gets into these people?
Both these events are still indelibly etched on my mind to this day.

Return to home

Submitted by Kay Dunkley on Thu, 03/05/2012 - 23:31.

In any instance where a complaint is received, health professionals should immediately contact their professional indemnity provider. In the case of pharmacists this is usually PDL. Membership and indemnity insurance entitles you to immediate expert advice at no additional fee. For support through these type of situations the Pharmacists' Support Service is available on 1300 244 910 to provide a listening ear and support over the phone for the cost of a local call.

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