s Lifestyle Prescriptions – a Healthy Marketing Approach | 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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Lifestyle Prescriptions – a Healthy Marketing Approach

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.

Over the years I have noticed that patients respond positively to any interaction with them that is genuinely educational, and most importantly, gives them the knowledge to provide some of their own input into management of their condition, independent of their GP, pharmacist or any other health professional.
Surprisingly, not all the knowledge transfer is directly related to drug or condition knowledge.
Some years ago when I was working as a clinical pharmacist in a public hospital I turned up at a patient’s bedside with some drug information to assist this patient recover from his recent heart attack.
I had prepared a medicines use review and other supportive information for the patient to take home with him, after a discharge planned for the following morning.

I started the normal process, but I noticed that the patient was listless and I did not have his full attention. I enquired if he was feeling ok and he responded by saying, “No, I am dreading having to go home and face the mess my farm is in. I am facing bankruptcy and I don’t know what to do. I feel stressed, over-tired and I am worrying about the future for my wife and four children. I feel as though I have been dealt a death sentence because the constant strain and worry has caused my original heart attack and my fear is that it will happen again – and quickly.”

I asked a few pertinent questions to which he responded.
I said, “This morning, you don’t need a pharmacist with a load of information you are not ready to receive – you need a management consultant to provide basic advice and direct you to the appropriate people. It just so happens that I am a qualified management consultant, and if you are comfortable, I feel we can better use the time allocated for your briefing by resolving a financial strategy for you to discuss with your normal advisers.”

His face showed immediate relief, and I launched into the possibility of exploring potential solutions for his farm business, that simply revolved around a question and answer segment like, “Is this the type of problem you are experiencing? (giving an example)”, and then “Have you thought of trying this procedure and have you asked your accountant about this process?”

Sound like a familiar technique to you?

Within an hour the patient was again alert, one might say even excited, at the prospect of having a plan to implement.
He asked if I would repeat the process with his wife who was visiting that afternoon and I agreed to make the time available, also to document the questions to ask his advisers.
And yes, we did fit in extra time to discuss his medicines before he left hospital.
The gratitude the patient and his wife showered on me has stayed with me for a long time. That “feel good” incident gave me just as much benefit as the patient experienced.

It was the practice of the coronary care unit of this particular hospital to have regular follow-up briefings with heart patients, roughly every six weeks.
It was also my practice to give patients relevant information and file it in a simple red document folder.
I was amused one day when the nurse organising these sessions approached me and asked, “Neil, what is it you give the patients in those red files. When I ask them, they try to avoid any discussion with me and clutch them so tightly it would need an operation to separate them from their folders.”

I naturally disclosed that it was a range of information ranging from ideas on diet, exercise, nutritional supplements, medicines use and yes, even business direction.
But it was interesting to understand the positive impact my personal intervention was having on patients and their lives.

If that experience was translated to a community pharmacy environment, I know that no matter what the pharmacy down the road was offering, I would get at least 80% of a patient's total business.
They would still buy other goods and services at other outlets I could not match, but they would make the effort to visit me regularly because they valued what I had already offered them.
And interestingly, even if this type of interaction had only occurred once, it was valued so highly that they would spend the rest of their lives paying back the favour - and tell all their friends and relatives as well.

Some pharmacists have had this experience, but I fear that the opportunity is diminishing because the culture has changed and that approach is deemed “not profitable”.

So let us fast forward a little.
Unfortunately I am a Type 2 diabetic and have continual problems with weight management and the management of blood sugar levels.
Nothing unusual in that situation.
As one method of weight management I tried some of the protein formulas when they first came on the market and yes, they worked, but the weight progressively returned.
But it was the constipation side effect that concerned me most, having never experienced this problem before.
Eventually, I gave the protein supplements away.

Recently I was forced to review diet etc. and go on to insulin.
I decided to give protein formulas a try once again, but this time I determined to formulate my own version.

I reasoned that constipation occurred because of insufficient or no fibre in the formula. I also discovered that most protein formulas used whey or soy isolates, and these are not good forms of protein.
I eventually standardised on a base of organic whey protein (not isolate) and included psyllium husk powder plus raw wheatgerm for fibre. To this I added Chia seeds (black or white) as there is some evidence to show that Chia reduces cholesterol and aids in normalising blood glucose levels.
I further added a small quantity of blueberries and some Stevia for flavour and mixed all in a blender with reduced fat milk.
The result is a very pleasant and flavoursome drink that satisfies without any further need to snack.
Blueberries were chosen because I found a study undertaken by Texas Woman's University which found, “blueberry polyphenols play a role in adipocyte differentiation, the process in which a relatively unspecialized cell acquires specialized features of an adipocyte, an animal connective tissue cell specialized for the synthesis and storage of fat. Plant polyphenols have been shown to fight adipogenesis, which is the development of fat cells, and induce lipolysis, which is the breakdown of lipids/fat. The research revealed that the blueberry polyphenols suppressed adipocyte differentiation in a dose-dependent manner. As well, the highest dose of blueberry polyphenols yielded a 73% decrease in lipids.”

Often berry consumption is not recommended for diabetics because of the high fructose content that is thought to elevate blood sugars for extended periods.

I can happily report that the more I replace my meals with my formula; the better becomes my glucose management and weight management.

I do a small amount of locum work in a nearby pharmacy, and as the opportunity has presented itself with patients, I have suggested my formula to them and given information as to how they can vary the formula, depending on their condition.
Patients report back that they have explored additives such as coconut oil or coconut flour, colostrum powder, the herbals Irvingia gabonesis (mobilises central fat) and hoodia (appetite suppressant), fucoxanthin (from brown kelp), krill oil and pomegranate seeds, all with varying success.
My wife also talks to friends and her contacts to such an extent that I am continuously printing out an information sheet for this protein drink.
That caused me to think about the reasons for this unintended interest and in thinking it through it dawned on me that I was following the same basic information process as for my hospital cardiac patients, giving patients basic information to provide something under their control.
They have value-added to this formula as illustrated above, but they extend to me the courtesy of requesting my approval for each additive ingredient, something I have never sought to impose.

So if I owned my own pharmacy once more, I think I would have rolled this formula into a thriving business by creating recipes (lifestyle prescriptions) for various conditions and then made sure that I kept all the ingredients in stock.
This type of nutritional patient returns weekly to stock up on one or more of the ingredients, so it is great business – and it is promoting health under your own brand because consumers don’t see the individual ingredient brands – they only see your lifestyle prescription.

Most health food stores keep these ingredients as a normal stock range, but I recently noted that Coles (and possibly other supermarkets) had quite a range of these as well. Their “nutraceutical” section is expanding every time I am able to check it out.

If I have successfully conveyed the above message, pharmacist readers should readily see that here is a simple market approach that can generate professional satisfaction and build a patient base that can be rolled into other services.
You are entering the nutrition and diet market through "food as medicine" and patients will respond to your information-based approach because it allows them to compound the final product and vary it to suit their needs. This gives them the control that they enjoy and it only requires the pharmacist to act as a continuing mentor to maintain interest stimulus.
They will always return to your pharmacy for the required ingredients because they have your qualified sanction. They will also know that you will provide them with reasonably priced quality ingredients.

Protein formulas can be adapted for other lifestyle conditions e.g.arthritis, heart disease, asthma, because the underlying problems are often identical. Your skill as a pharmacist would lie in taking the base lifestyle prescription and prescribing additive nutrients or herbals that would differentiate for each condition.
Your formula, your product to your patient.

A better approach to marketing than selling rubber ducks and laundry detergents - don’t you think?

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