s Monoculture Pharmacy - How to Rise Above It | 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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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

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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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Monoculture Pharmacy - How to Rise Above It

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.

The problem with modern Australian community pharmacy is that it has evolved to become a monoculture that is lacking in diversity and depth.
The term is commonly used in agriculture to describe the production of one crop over vast quantities of land, with all the resultant havoc that such practice plays on the soil, water, native flora and fauna, and, to be perfectly clear, on the climate system as well.
For havoc in pharmacy read government induced profit losses leading to career opportunity loss for individuals, lack of suitable forward vision and direction, disruption in education and workforce planning - and the list goes on.
And that is a perfect analogy for pharmacy at the close of 2013.
In its extreme form monoculture becomes monomania and we would know it as the PBS and managed care, as we have all been brainwashed into believing that it is the world’s best health system.
What a joke!

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Pharmacy growth has only one unfettered pathway currently for opportunity, and that is through front-of-shop marketing free of PBS constraints.
However, many pharmacists have taken their eye off the ball and allowed themselves to become uncompetitive when compared to Colesworth and warehouse pharmacies.
Where this has happened, stock turns have reduced to a level that is impacting on gross profit, (a stock turn of less than 3 can be the trigger point), and cash flow is severely impacted.

While the industry is generally booming, growth has become uneven between pharmacies and the idea of treating patients may have been lost in the quest to pull in much needed dollars.
Patients are led through multiple aisles of products before lining up to receive a prescription from the back of the pharmacy, sometimes with no pharmacist contact at all.
Pharmacies are not pharmacies any more- they are merely miniature versions of your favourite supermarket with branding that is not yours, but one of a number of tribal franchises provided at a very high cost.
Experiences centred on the patient are minimal or non-existent as the quest for money always wins out over personalisation.
This has stimulated an industry shift that has been almost invisible up to this point.

Personal wellness and preventative care is developing as a trend, with the ability to form up a business model that is interesting, profitable and containing a level of care that is attractive to patients.
This type of pharmacy is being portrayed as a “boutique” pharmacy and is created around specialties such as pain management, diabetes care or anything that creates patient benefit.
Inventory is minimal and consists of items that can be recommended in support of the recommended care.
Activities can be limited or wide ranging.
At i2P we have been researching the concept of “convenient care clinics” that can be pharmacist-led or nurse-led, and to date it has proven to be a fascinating project with many facets to consider.
In many instances, solutions have been found in past practices developed by pharmacists even older than the current group of “old pharts” still practicing.
But they were the ones that built success in the 20th century, and a success that has provided the goodwill underpinning current pharmacy practice that is in danger of being lost, unless rejuvenation and renewal occurs quickly.

One of these newcomer boutiques is Assured Pharmacy, a US based pharmacy, and I quote from their website: http://irdirect.net/APHY/corporate_overview

“Assured Pharmacy, Inc. is a growing chain of specialty pharmacies that provide advanced prescription services to a diverse array of medical professionals and their patients. Assured Pharmacy is committed to providing these physicians and patients with a better prescription process. This enhanced process is achieved by blending advanced prescribing technologies with focused pharmacology.

Our business model targets physicians specializing in pain management - orthopaedics, neurology, oncology, psychiatry, physical rehabilitation and industrial medicine. The focus is on treating patients with long-term, acute, chronic pain conditions. Assured Pharmacy generates its revenue principally from the sale of prescription medications. Assured Pharmacy does not promote retail-oriented product sales, focusing instead on the distribution of Rx medications.

Assured Pharmacy is a service-focused organization. Our customer care support is dedicated to making the prescription process easier for both the physician and the patient.

We alleviate the burden of the refill/authorization process on the physician's administrative staff.

We are setup specifically to handle the needs of those dealing with chronic pain. As a result, our inventory and procedures ensure the prescription process, including any related verification, is handled smoothly and courteously. Patients can count on their prescriptions being filled accurately and completely without long, needless delays or return visits.

Patients may pick up prescriptions at the pharmacy or have them delivered to their home or office via courier or next day delivery.”

This model is a collaborative model but it is necessary to be highly selective in your choice of collaborative GP alliances.
Only work closely with those that are equalists, and have a high level of integrity and professionalism.
Avoid all others.

Assured Pharmacy may be one such up-and-comer that is positioned to take advantage of these trends.  As a personalized - or 'boutique' - pharmacy with multiple locations already in operation, Assured has jumped into the chronic pain market and is consistently setting the standard for personalized and professional patient care in the pain prescription market.  In concentrating the first phase of its development in four smaller markets, Assured earned fourteen million dollars in revenue last year and has eyes towards significant expansion over the coming years.  
Since the precedent has already been set that the business model can work, much larger markets are now being targeted, with a location in Denver, Colorado slated to open next.
Encouragingly enough, and again according to the company's financials, it takes roughly $350,000 to open a new location - a relatively modest amount, given the financial girth of the industry.

It should also be noted that although the initial revenue streams look encouraging for future growth prospects, the company is still registering losses in some areas that should be overcome as the customer base could potentially grow exponentially on a per-capita basis, especially if Assured can capitalize on the personalized services that are being sought after by the "me" generation.  After all, in the absence of the daily threat of a global nuclear war breaking out, the population is in tune with the 'it's all about me' mantra more now than ever before.  That fact paves the way for boutique pharmacies such as Assured to thrive.

Established pharmacies are still going to pose a major threat to Assured gaining market share, regardless of the benefits provided, but the road ahead looks manageable.  Aside from just offering personalized services that cater to an individual patient's need, Assured can also benefit from its more stringent and tight monitoring of prescriptions and decreased potential for abuse that result from its business model, which could make the company a more desirable option for public and private health care professionals and/or relevant insurance companies.  Additional benefits exist in terms of cost-efficiency since the personalized model better enables doctors and patients to identify early on the medication most applicable to his or her condition.  The popular culture of 'try this and see what happens' may eventually disappear.

Pharmacies like Assured are sitting on the cutting edge of pharmacy clinical advancement and while there are risks in going down this pathway, those risks will diminish as the clinical market becomes more defined and matures.

Diversity comes with a different approach, and for comparison another pharmacy is illustrated at this link http://www.stanleyspharmacy.com/ .
Stanley George has developed his pharmacy around “medical drinks” that has struck a local chord that might suit new entrants into community pharmacy.
His total business mix includes a 30 percent contribution from drinks- the other 70 percent from prescriptions.

As the boutique pharmacy is now becoming a global concept the following link may prove interesting:

The big challenge in creating boutique opportunities is found in the marketing process – a process that has to communicate a precise message of what pharmacy clinical services are about and to create boundaries.
You do not want any unnecessary conflict (most likely to come from GP environments) because that will slow you down and cause you to waste unnecessary energy in re-communicating the process.
You also need to deliver concise messages to patients, and this is most likely going to occur during Q & A discourse through an online presence, otherwise it may become too time consuming.
It is all about investing in new experiences, refining the process, identifying the service product, branding the product and advertising the product to build acceptance and patients.
In the pharmacy crash that is progressively under way it will be primarily the small pharmacies that will be hardest hit, but it will also include larger pharmacies and we have already seen examples of that e.g. Harrison’s Group.
The survivors will be seen as “small but capable”.

Capability is built through being original and being willing to undertake a small sequence of risks, building one on the other until you have a proven concept.
If others are looking at the same concept and it becomes too crowded then head off in an entirely different direction and leave the others to fight over the “scraps”.

Your strategies need is to be long-term and patient, filling in the gaps on the run.
Market pressure will not allow you to delay your project. Digital culture both speeds up your project while simultaneously allowing others to keep breathing down your neck.
The only benefit you can generate in the marketing process is lead-time, and that is getting shorter and shorter as Internet skills build up within competing individuals.

Accessibility and education have to build exponentially to keep ahead of the pack, one creating the pressure for the other.

The business we now find ourselves in as pharmacists is one of problem solving for patients. We have to continually and accurately hit the target that they are displaying and to do it with as much flair as possible.
That way we will be noticed and we will have the satisfaction of knowing we have communicated our messages well and have a strong sense of connection.

We will be at our most creative when we are connected in both directions with the patient and the wider audience simultaneously.
Social media marketing is one way of achieving that.
However, it’s got to entertain and inform or prove itself useful somehow, or it’s not really worth doing. Always think, ‘What’s the idea? Do people need this in their lives?’ and be very rigorous about that.
At the instant you are connected both ways you will have a personal sense of wellbeing and enjoyment in a professional sense - something that has been lacking for many years.
The message for patients is “Look at us – we are interesting”.

2014 can be a stimulating and uplifting year if you wish it.
As a philosopher once said “If it’s to be…it’s up to me!”

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