s Let’s get moving – Pharmacy Renewal Needed ASAP! | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists

Editorial

From the desk of the editor

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

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Newsflash Updates for July 2014

Newsflash Updates

Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
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Feature Contribution

Woolworths Pharmacy - Getting One Stage Closer

Neil Johnston

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

Comments: 5

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Intensive Exposition without crossing over with a supermarket

Fiona Sartoretto Verna AIAPP

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

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The sure way to drive business away

Gerald Quigley

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

Comments: 1

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‘Marketing Based Medicine’ – how bad is it?

Baz Bardoe

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

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Community Pharmacy Research - Are You Involved?

Mark Coleman

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

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Organisational Amnesia and the Lack of a Curator Inhibits Cultural Progress

Neil Johnston

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

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

Staff Writer

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

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I’ve been thinking about admitting wrong.

Mark Neuenschwander

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

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Dispensing errors – a ripple effect of damage

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

Most readers will be aware of recent publicity relating to dispensing errors and in particular to deaths caused by methotrexate being incorrectly packed in dose administration aids.
The Pharmacy Board of Australia (PBA), in its Communique of 13 June 2014, described a methotrexate packing error leading to the death of a patient and noted “extra vigilance is required to be exercised by pharmacists with these drugs”.
This same case was reported by A Current Affair (ACA) in its program on Friday 20 June
http://aca.ninemsn.com.au/article/8863098/prescription-drug-warning

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Take a vacation from your vocation

Harvey Mackay

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

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Explainer: what is peer review?

Staff Writer

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

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Dentists from the dark side?

Loretta Marron OAM BSc

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

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Planning for Profit in 2015 – Your key to Business Success

Chris Foster

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

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

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

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Attracting and Retaining Great People

Barry Urquhart

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

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Updating Your Values - Extending Your Culture

Neil Johnston

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

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

Staff Writer

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

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

Staff Writer

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

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

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Culture Drive & Pharmacy Renewal

Neil Johnston

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

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

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

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Pharmacy 2014 - Pharmacy Management Conference

Neil Johnston

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

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Generation and Application of Community Pharmacy Research

Neil Johnston

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

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Let’s get moving – Pharmacy Renewal Needed ASAP!

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.

A little over a week ago I wrote an article on pharmacy renewal, based on the comparative experience of a Melbourne hardware store that had reached its “use by” date.
The “use by” date was, in reality, a self-inflicted one brought about by the owner’s refusal to depart from a service model that had not undergone any renewal processes since it opened its doors over 100 years ago.
The analogy with pharmacy was fairly obvious, but it did force me to review the current practice of pharmacy and its inability to find itself practicing out of a suitable business model.
In other words, pharmacy has also reached its “use by” date.
Unlike the family hardware store, pharmacy has adapted over the same period of time and has renewed some components of its business format.
The fact is that pharmacy is now relying on retailing, (and discount retailing at that), is not a suitable survival format- because it is not the core business of pharmacy.
Pharmacy’s core business is health care, or more succinctly, patient-centred care.
This is what needs renewing.

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Current pharmacy practice is based on managing symptoms. Nobody disputes that this is not valid, but for the patient care may cease with the handing over of a prescription

A competent pharmacist will provide medication counselling with the goal of ensuring optimal drug therapy. Ultimately, however, the underlying cause of the symptoms is not being addressed. At this point, dispensing drugs to patients without providing further “wellness” education only compounds the problem.
The problem is that few pharmacists have received any training in providing wellness to patients.
The current system only gives patients a temporary “crutch” to rely on believing that their problem has been “taken care of”.
And considering that most people only think about their health status when something is obviously wrong, a great opportunity for intervention and assistance with therapeutic lifestyle changes (TLCs) is missed.
The acronym TLC is also synonymous with Tender Loving Care which is a major component of patient-centred care that has slowly disappeared with the rise of PBS paperwork and dispensing pressure.
Therefore the patient is left with degrading health, a lack of awareness, and masked symptoms.
Furthermore, drugs may produce side effects, many times resulting in additional prescriptions. Under such conditions, it isn't hard to see how a downward spiral in the patient's health might be established.

Just stand back and take a quick look at our current healthcare system. Total health spending is on the rise, while the country's overall health deteriorates. Obesity, diabetes, heart disease and cancer are epidemic. The scope of allopathic medicine is too narrow to reverse this trend on its own. It certainly has its place in the healthcare arena, most notably for acute care, as in cases of trauma. And an incredible amount of information has been discovered under its umbrella. Still, what good is the most thorough understanding of biochemistry, pharmacology, or surgical technique if millions continue to suffer from debilitating chronic disease?

We need to be looking at systems of care that involve patients in part, researching their own conditions and discussing their findings with pharmacists.
The big problem here is that allopathic medicine has hijacked most of the government reimbursements for patient care, leaving pharmacy with a base of patients who are unable to pay fees to pharmacists. Without some form of remuneration model, pharmacists can only provide limited investment in time and money to those patients that can afford to pay, but it is a logical starting point.People will pay if they can see results.

The strength of the allopathic model can also be its weakness, depending upon the situation to which it is applied. When used to temporarily stabilize the body, system by system, there is no better approach. It fails miserably, however, for keeping individuals disease-free over the long run. The innate healing ability of the body is too complex, and the factors that contribute to chronic disease too numerous to lend themselves to a quick fix solution.
Patient-centred care is a softer form of medical management and founded on different principles and treatment practices.
Both allopathic care and patient-centred care models are complementary and represent two sides of the same coin.

If we don’t develop a more integrative model, health care will continue down a doomed path.
We cannot keep doing the same thing and expect different results.

There is a band of slowly growing group of medical doctors, pharmacists, educators, naturopaths, nutritionists and herbalists who are already hinting at a paradigm shift in medical thinking. Pharmacy must grasp the initiative and be prepared to fight for its beliefs.
However, there is a hard core element in allopathic medicine that is opposed to this trend and attacks it under the label of evidence-based medicine yet fails to acknowledge that a large body of allopathic evidence is flawed through dishonesty and straight medical fraud.
This group only acknowledges the still imperfect double blind placebo crossover type of trial, and does not allow that an experienced health practitioner has a knowledge base based on his/her own research and application.

You can’t lead by example (hard core allopathic) if the underbelly is corrupt- it simply falls apart as it becomes exposed.
Underlying this is the fact that patient-centred care is growing at a faster rate than allopathic medicine, as the real causes of this unnecessary conflict begin to emerge. In the current financial climate, allopathic medicine has become too expensive (even with $’s millions of government reimbursements and subsidies).
One way for allopathic medicine to improve its circumstances is to destroy the opposition on all fronts, but that is a pyrrhic victory, because the real problems still exist and the allopathic model is also in dire need of an overhaul.

Pharmacists, in particular, hold an excellent position for implementing positive changes. They are usually the first point of access to health care for the majority of Australians, owing to the accessibility and convenience of pharmacies and pharmacist training and interaction with a variety of people visiting the pharmacy is compatible with a patient-centred approach.
This is strength and it is now time to capitalise on this strength and drive an integrated health process.

The profession of pharmacy in Australia is already following a trend away from the dispensing role toward one of patient-centred care.
This is partly because most aspects of dispensing can now be accomplished by automated equipment or technicians leaving the clinical pharmacist without a role that is funded.
Why would a pharmacy practice want to dish out high salaries for a job that can be done by a robot, especially when robots don't make mistakes?
The transition to patient-centred pharmacy is hindered by the political structure of pharmacy which has also reached its “use by” date and must be renewed before pharmacy can move forward. In between time, the profession loses highly trained people because it cannot provide interesting or satisfying work for   them.

Remuneration no longer depends entirely upon filling as many prescriptions as possible. It also comes from functioning as a consultant, as an information expert, and as an educator.
So, why not take the next step and “just do it”.
Pharmacy services could promote wellness and optimal outcomes, not just optimal medication usage. Pharmacists have an opportunity to push the envelope, serving as genuine patient advocates, while securing their future as indispensable patient-centred healthcare providers.

Integrative pharmacies offer a glimpse of hope for the future of health care. These are centres of wellness, rather than centres of disease.
Here, conventional and complementary medicines go hand in hand.
Typical employees include naturopaths, nutritionists, nurses, massage therapists and aestheticians, as well as pharmacists.
Education is highly emphasized, with classroom lectures and workshops being a normal part of services. Many topics are covered including smoking cessation, weight reduction, dietary advice, yoga instruction, and management of various disease states. Nutritional supplements and herbal products are as commonplace as prescription drugs.

Components of integrative pharmacy business models are slowly emerging but until all of pharmacy embarks on a renewal process, any development will be lopsided and unbalanced.
Let’s get moving!

 

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