s A Misplaced Medical Judgement | 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. 
Access and click on the title links that are illustrated

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Feature Contribution

Woolworths Pharmacy - Getting One Stage Closer

Neil Johnston

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

Comments: 5

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Intensive Exposition without crossing over with a supermarket

Fiona Sartoretto Verna AIAPP

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

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The sure way to drive business away

Gerald Quigley

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

Comments: 1

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‘Marketing Based Medicine’ – how bad is it?

Baz Bardoe

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

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Community Pharmacy Research - Are You Involved?

Mark Coleman

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

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Organisational Amnesia and the Lack of a Curator Inhibits Cultural Progress

Neil Johnston

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

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

Staff Writer

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

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I’ve been thinking about admitting wrong.

Mark Neuenschwander

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

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Dispensing errors – a ripple effect of damage

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

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

Mark Coleman

articles by this author...

Mark is a semi-retired pharmacist.

Approximately two weeks ago a Dr David Smith published an opinion piece in an online medical publication that was very derogatory towards pharmacy's professionalism.
It is one of many articles that seem to be "planted" in unison with other articles or events.
For example, the release of a Grattan Institute paper titled "Access All Areas", hinting at an expanded role for pharmacists in primary health care.
The article was authored by Dr David Smith who describes himself as "a GP and a consultant in clinical and corporate ethics".
Smith's comments are certainly a bit rich when you consider that pharmacy has always been involved with primary health care and when you further consider his client base he loses all credibility.

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This would centre him in Big Pharma activities and as such I would consider that he has no moral standing to criticise the ethics or procedures of community pharmacists.
In fact, that type of open criticism used to be a basis for an unprofessional conduct charge by a professional registration board.
Pharmacists could never advertise, for example, that they were better or had a "fast dispensing service" because that demeaned opposition pharmacists.
Big Pharma is certainly in need of an ethical injection having fraudulently contaminated clinical evidence over many years, as published in a range of articles within i2P and other publications.
So much in fact, that it is nearly impossible to rely on any clinical evidence that has been a result of direct, or indirect, Big Pharma sponsorship.
Doctors form part of the arrangements by accepting large payments from drug companies to help them launch on to the market, drugs that are ineffective or need to have deficiencies in their profile massaged away.
And don't they run for cover when a call is made for transparency regarding who receives these payments, and what dollar value.
Why is this so?
Dr Smith's article ends with the following statement:

Before community pharmacy can legitimately adopt an expanded role in primary healthcare, it needs to critically review its commitment to evidence-based medicine and full product disclosure. However, it seems that that will necessitate pressure from outside that profession. 

Dr Smith is a GP and consultant in clinical and corporate ethics. 

I am sure I am not alone in stating that I am sincerely sick and tired of the distortions, criticisms and outright lies levelled against the pharmacy profession and its practitioners, by members of the medical profession.
He opened the same article with the following:

A recent survey looking at public perception of the honesty and ethical standards of various professions found that 88% of respondents rated pharmacists as "very high", a rating exceeded only by nurses -- and ahead of doctors. 

What was this supposed to prove other than pharmacists are more honest and ethical than doctors?
At one stage pharmacists ranked as #1 in this annual survey, before nurses nudged pharmacists out of first position.
However this does not overly concern me because it is a public perception and therefore an accurate rating.
But it has long rankled medical practitioners that pharmacists and nurses are seen to continually beat them in the honesty and ethics stakes.
Rather than accept this as fact they try to demean the profession of pharmacy to  alter this public perception, by slanting media releases and statements.
The next extract (from the same story) is a great illustration:

Recently, a clash of values has become evident in pharmacists' response to the Therapeutic Goods Administration's edict that cough and cold mixtures should not be given to children under six in the light of evidence demonstrating lack of efficacy and potential harm. Many pharmacists insist that these products work, and deny a conflict of interest in respect to their share of a $70-million-a-year market. 

Well, Dr Smith, it is certainly a fact that pharmacists disagree with the ruling for totally different reasons to those that you infer.
But the fact is that we pharmacists are actually living with the new rules and within the legal guidelines.
Where is the conflict of interest in that?
And we pharmacists do not apologise for daring to have an opinion that differs from yours.
Most of us have prescribed cough mixtures for decades for our own families and patients, and most of us have seen genuine benefit even if this benefit does not equate to your standards for “evidence”.
I have to tell you that most of your so-called evidence standard is falsified, corrupted and fraudulent.
For me personally this reality has caused deep disappointment as the full extent of this problem becomes more evident.
And it is people from your “tribe” that have created the problem by colluding with Big Pharma companies. It t is only recently that the full cost of this collusion has been able to be measured.

So don’t preach to me about ethics and evidence while you condone the source of most drug evidence.
Just to remind our readers again, your article was tagged with the words “Dr Smith is a GP and consultant in clinical and corporate ethics.”
You see pharmacist disagreement with your view and pronounce it as a clash of values even though we are working legally and honestly with the new rules.
You don’t seem to be making much headway with the ethics of your Big Pharma clients or your co-professionals.

In an ongoing investigation by Australian-based “The Global Mail” they have uncovered a process of advisory boards created by Big Pharmas where individual doctors are invited to advise (with other invited doctors), as a group on drugs that require “spin”.
They are highly secretive and the participants are paid many more dollars than pharmacists could ever conceive in terms of selling cough mixtures.
In the first three months of 2013 Pharma advisory boards were paid just under $1 million.
The Global Mail describes one such secret meeting held at the Parkroyal at Melbourne Airport.
The involved doctors (eight haematologists) had to sign confidentiality agreements coupled with an assurance that the adviser doctor’s identities wouldl not be disclosed by the drug company.
The type of material discussed might include how to get the drug through regulation hoops, the appropriateness of marketing materials, or how the drug can be dispensed for greatest reach.
The products involved were two new, promising compounds for haemophilia.
Secrecy seems to serve a dual purpose: it protects sensitive information about new drugs or marketing plans from being leaked to the drug company’s rivals, and it protects the identity of participating doctors.
The advisory boards are only the first stage in an elaborate and expensive marketing campaigns called “educational events”.
The Global Mail has been able to pinpoint a figure of $320 million for the past seven years up to June 30, 2013.
$28 million was spent from October 2012 to March 2013 alone with spending continuing to run at an average of $1 million per week.

Additional research by The Global Mail shows that 75 per cent of specialists on critically important disease-definition panels have financial ties to pharmaceutical companies.
Many specialists are linked to multiple companies.
There’s nothing wrong with these ties in themselves – but to pretend that you can take this money and still be independent is the critically important point.

Ray Moynihan, a senior research fellow at Bond University, says of the ongoing secrecy surrounding participants’ identities: “I can't understand that a senior specialist can keep the fact of their financial relationships with drug companies secret from their patients.”

Medicines Australia has convened a transparency working group, chaired by the general manager of Shire Pharmaceuticals, Dominic Barnes. If the members agree to the proposals made in May 2013 by the working group, the identities of doctors, and the gifts and payments they receive from pharmaceutical companies, could be a condition of membership by 2015.

Dr Smith, in his article, talks about placebos and promoted products that have no evidence being sold in pharmacies
Might I also comment that doctors also do similar things in terms of prescribing placebos, prescribing for “off label” conditions, and when prescribing most drugs, do not do their own investigation of the evidence base to independently confirm the veracity of drug company “education”.
Meanwhile, as they say, people in glass houses should not throw stones.
May I suggest that there is far more ethical concern to be tidied up within the medical profession, and that you should make that your first priority.

Outside pressure is an option for all professions, not just for pharmacy.

Oh, and by the way, over 1 million people (pharmacy patients and customers) just recently signed a petition (floated by the Pharmacy Guild) on behalf of their local pharmacies. It was the largest ever received by government.
Pharmacists, as well as having the highest ratings for ethics and honesty compared to doctors, might also trump doctors for proven patient support (and this is proven from an evidence-based petition!)

This event happened because of a breach of contract by government regarding the timescale for price reductions of PBS items (unethical and illegal)
I don’t think that would happen if these people were concerned about the ethics of their local pharmacists.
Our support base seems to be sound and we maintain that by sincerely doing the best we can for our patients.
While our culture is definitely different to your view as to what it should be, it is suggested that yours may be the problematic area and in need of a patch-up
Can you, your fellow professionals and your drug company clients claim the support pharmacy has experienced?

 

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