s Leadership.... A Scarce Resource Getting Scarcer | 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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Leadership.... A Scarce Resource Getting Scarcer

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 want to start this article off by congratulating Matthew Eaton, editor of the AJP , who made some strong comment on pharmacy leadership in his editorial in the August edition of the AJP.
Not only strong comment, but some sensible direction.
Against a background of unprecedented pharmacy bankruptcies and a Pharmacy Guild-inspired Business Network Conference in late September, the PGA is belatedly trying to sustain its failed leadership of community pharmacy.

Or is it?

The seeds of its failure were sown as far back as the year 2000 - the year i2P was born and the major reason why i2P has consistently targeted its flawed policies.
Since 2000, i2P has endeavoured to not just target flawed policy, but to suggest alternatives based on local and global initiatives.

The entire profession is sitting on a knife-edge watching who is going to disappear next – and waiting to see what their leadership is going to initiate in terms of a realistic and sensible direction, backed with resources that members had created, through high membership fees and loyalty inputs to various projects (software and otherwise), so that they could be made to work.
Spin-doctoring is all PGA members have received in return for their backing of their executive.

Meanwhile, the Pulse group of pharmacies have become the latest bankruptcy casualty.

Matthew Eaton suggests that existing PGA members scrutinise their leaders and policies more closely, or even stand for a leadership role in the next elections.
Or alternatively, build your own network of practising pharmacists and do your own research and development on what may work for you.
This latter suggestion is one that I personally favour, having been involved in this type of initiative (as a coordinator) some years ago.

Don't wait for government to subsidise research – it's too slow and not cost effective.
Don't wait for governments to subsidise any new service – it's always inadequate and cumbersome to introduce.
Any new service development should be robust enough to stand on its own two feet.If it attracts government subsidy, that will maybe constitute a bonus.
If it's your own service initiative at least it can operate with a minimum of red tape.

This very process is being undertaken in the UK. The online publication, Chemist+Druggist reports that:

“Pharmacy multiples team up to fund national services pilot

Independent pharmacy bodies have hailed the Community Pharmacy Future project – funded and piloted by Boots, the Co-operative Pharmacy, Lloydspharmacy and Rowlands – as an example of pharmacy "pulling together" to secure two new national services for community pharmacy and pave the way for future commissioning.

Launched last week, the project will see pharmacists at multiples in the north-west of England trial medicines support services for COPD sufferers and older patients on multiple drugs.

The six-month project has been developed in conjunction with PSNC, the Department of Health and national and local commissioners, and the multiples involved hope it will lead to "new national pharmacy services".

Alliance Boots healthcare public affairs director Tricia Kennerley told C+D that, while they hope the services are commissioned, it "will be something that PSNC will have to negotiate on behalf of community pharmacy with the NHS commissioning board".

And Andy Murdock, external relations and policy director at Lloydspharmacy parent company Celesio UK, said the project involved the first example of a full health economic evaluation of a community pharmacy service and that this could form a template for future evaluation and commissioning of more national pharmacy services.

The evaluation will be carried out by health economists IMS Health. "We hope to gather a vast amount of data... to prove what the value of pharmacy is worth," Mr Murdock told the C+D Senate last week. "If we can establish from that a template… why can't that be repeated with diabetes, cardiac, other services that pharmacy might want to deliver?"

In a week in which C+D readers suggested that upcoming funding cuts were easier for multiples to endure, Ms Kennerley was quick to stress that the project was intended to benefit community pharmacy as a whole.

So on one hand it's good to hear that major retail pharmacy groups involved in community pharmacy service delivery, are developing projects for the benefit of all pharmacists.
They too, are fed up with the inaction and discrimination coming from government funded bodies supposed to commission pharmacy services into the community.
Because medical doctors are involved in deciding what pharmacists can and can't do, pharmacists have been left out in the cold.

How unusual!

While the system is not quite the same here in Australia, doctor attitudes are.
Pharmacists since 2000 have seen the medical team of doctor-nurse-pharmacist morph into doctors+all the rest.

In the process pharmacy has become invisible in primary health care, and if you have been following the ridiculous agenda established through the TGA for the recommendation and sale of cough mixtures, you will note in the following advice for parents an extract appearing on the TGA website.

What to do for a child with a cough or a cold

As for all medicines, it is important to read and follow the instructions on the label.
If you have any doubt about whether your child has a common cold or something more serious, consult a doctor or nurse practitioner.

Where did the pharmacist disappear to?
And why hasn't the PGA protected pharmacy interests in this type of regulation?

But back to the interesting development of individual pharmacists operating large pharmacies, developing and funding services for themselves and independent pharmacists.
The reality is that independent pharmacies are needed to support and market these services in the marketplace for them to gain traction.They have the "trust" factor that larger groups do not have.
Without the independents the services would flounder.
But I guess the proposition is better than nothing and at least the larger pharmacies are seen to be “giving back”, even though the independents are approaching the proposition with a healthy scepticism.
Barry Urquhart in his Marketing Focus column this month summed the issue up very neatly:

For most things in life there is a logical sequence. For marketers at present a new adage has evolved.
“Open the consumers' minds
Before you open their pockets”
This may and probably will involve the re-education, refocus, reassurance and reaffirmation.
In short, the mind needs to be settled before the deal is settled.

Published concurrently in Chemist+Druggist was this item that has a familiar ring to it here in Australia.

Pharmacists need ‘drastic change in mentality’ as dispensing takes a back seat

Pharmacists need a "drastic change in mentality" and a focus on services as government may no longer pay for dispensing alone, C+D Senators have warned.
Speaking at the C+D Senate on September 21, SG Court Group general manager Kevin Cottrell warned that in future the government is "not going to pay pharmacists' wages to actually dispense".

Mr Cottrell said that a rise in the number of pharmacies meant that there was less government money available for community pharmacy and warned that one of the areas where the government may look to cut back was in the money paid to pharmacists for dispensing.

And C+D Senator Raj Jain – pharmacist at WR Evans (Chemist) Ltd t/a Manor Pharmacy – agreed that there had to be a "drastic change in the mentality of pharmacists to not dispense, not put a label on boxes, but to go out and talk to the people".

I don't disagree entirely with the sentiments expressed, but why are pharmacists being backed into a corner not of their own making? For what reason? Enough is enough!

Someone has to dispense and have a broad background in pharmacology to do it safely.
So why not a pharmacist?
Why should we devalue any part of our core business or practice?

If dispensing was properly paid for then it would give a platform to leverage new services from – and I am tired of listening to armchair bureaucrats and others who say that pharmacists are overpaid etc.
Why would pharmacists want to disprove those theories (and that's all they are) by going bankrupt at an escalating rate.

Another worrying and compounding problem is the fact that some PGA executives are also shareholders/partners in some of the larger community pharmacy groups.
There is some evidence to support the notion that with insider knowledge they are promoting the interests of their group at the expense of the broader PGA membership.
This may not have been a problem in earlier days, but groups are poised to concentrate their membership (as bankruptcies occur and others sell out in panic), and conflict of interest is the order of the day.

This is the primary reason the PGA is becoming ineffective, because there is no trust left.
Their policies have been so divisive to the broader pharmacy community – now they are dividing internally.

So go form your own network and create alliances with other networks around any emergent problems.

We are now embracing survival mode with everyone in the leaky boat with not enough life jackets to go round.Sink or swim? Your choice.

However if anyone is looking to form an alliance, i2P would be happy to contribute to its formation and success- just email neilj@computachem.com.au

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