s New Drugs for Old | I2P: Information to Pharmacists - Archive
Publication Date 01/11/2009         Volume. 1 No. 6   
Information to Pharmacists

Editorial

From the desk of the editor

Welcome to the November edition of i2P – Information to Pharmacists.
The month just finished has been an exceptionally busy one for pharmacy with an interesting PAC being concluded.
The “Great Debate” from PAC stirred considerable interest, also the talk given by John Menadue.
The latter has been reported and commented on in the article “Pharmacy’s Professional Future” and it is recommended that this article be bookmarked.
Better still, add your comment at the foot of the article.
All our columnists are back on deck and we are delighted to report that our New Zealand columnist, John Dunlop, has been accorded high honours by the New Zealand Pharmaceutical Society.
See the article in the Recent News section or look for the editor’s logo in the column section.
Our congratulations go out to John for this honour that resulted from his work in the pharmacy professional services area..

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Recent Comments

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Pharmacy’s Future Professional Services

Neil Johnston

The recent “Great Debate” at the 2009 Pharmacy Australia Congress had an excellent topic choice (“The answer to our future is increasing front of shop sales, not professional services”).
The answer is, of course, that pharmacies need both activities as “core business” to survive – it just depends on what balance is required for each unique pharmacy practice sufficient to allow for differentiation and emphasis on specialties (whether professional services or retail activities).
However, it could be argued that policies in recent years have tipped the balance in favour of supply services that favour retail activity.
Little research or effort has gone into the development of professional services (there is actually major amounts of unspent grant money from the Fourth Agreement), so many pharmacies see little relevance in promoting services they may not have the training for, or the infrastructure to deliver the necessary training (which comes at a cost).

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Servants to the world.

Ken Stafford

Recently I received a number of calls from a concerned relative of one of our veteran clients currently in an aged care facility.
The problems I am hearing about relate to the difficulty in getting the patient’s doctor to write prescriptions for necessary medications, echoing many of the stories I heard during my pharmacy visits about the problem of “owing scripts” and just how hard it is for pharmacists to get them written. If we break down the problem we get this sequence of events:

Comments: 2

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Communicate anywhere and everywhere – is getting nowhere

Pat Gallagher

Is talking about talk the best way to start solving the sharing of data in a health informatics scenario?

I have often written on the subject off interoperability; referring to broken and failed systems and in the attempts to get everyone in healthcare, primarily inside a hospital, to exchange information without re-working it all the time.

This can be a complex subject matter because it has little to do with technology and all to do with people. If various departments and fiefdoms want to share their data it can happen; if they behave in a recalcitrant manner, it won’t happen.

Which takes us down a path, for perhaps another time, regarding the subject of IT systems and collaboration? We Australians are not good at this – there is something in our makeup that resists sharing certain things, notably information management systems. Not sure whether it is a streak of independence or immaturity, or both. Anyway, moving on to the matters at hand, let’s continue.

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Power in Numbers rises up the charts in Pharmacy.

Chris Wright

There is power in numbers.

It is said that Chemist Warehouse is growing at 25/30% per annum, the traditional franchises are growing at about half that rate and the poor old unbranded Pharmacy is trailing behind at about 10%. This really means that Chemist Warehouse is flying along with a wet sail doing nicely and all others are wondering where to find growth or are spending far too much time with their accountants’ trying to work out how to survive the future.
This is no surprise of course; the Chemist Warehouse business model is brilliant, they are compelling marketeers and proof that the power in numbers prevails.

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It's all in the Genes

Staff Writer

When you think about it, genetics are likely to determine your skin type.
It is little wonder that if one or more of your relatives, including your ancestors, had a predisposition to skin cancer, then you may have inherited that trait.
Researchers believe that there is up to a 50 percent risk involved that you will develop skin cancer through genetic inheritance.

Skin cancer can be inherited: studies

Source: Reuters
http://www.reuters.com/article/healthNews/idUSTRE5984VM20091010?feedType=RSS&feedName=healthNews

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Why New Zealand must rapidly halve its greenhouse gas emissions

Staff Writer

Editor: It is good to see the New Zealand medical professionals getting behind climate change strategies in their country.
Pharmacy, particularly here in Australia is conspicuous by its absence in this activity.
Yet there are many things we can influence - particularly in the areas of the supply chain, shop design and the type of fixtures and fittings we select.
Unless we all begin to be proactive in this area, events will pass us by to our detriment.
Add your comments at the foot of this article to start off a discussion.

Source: New Zealand Medical Journal
Article written by: Scott Metcalfe, Alistair Woodward, Alexandra Macmillan, et al; for the New Zealand Climate and Health group

http://www.nzma.org.nz/journal/abstract.php?id=3827

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The Pharmaceutical Society of New Zealand 2009 Honours

From the desk of the editor

In Issue number six of Pharmacy e-Edge, the newsletter of the Pharmaceutical Society of New Zealand, four New Zealand pharmacists were awarded a range of honours. The report was prepared by Richard Townley, the CEO of the Society. Among them was John Dunlop, our i2P writer representing New Zealand, and we are pleased to share in John's achievement. John was awarded a Fellow of the Pharmaceutical Society of New Zealand in recognition of his outstanding contribution to the advancement of the practice of pharmacy in New Zealand. Congratulations John!

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Brits love the NZ version - "Fush 'n Chups"

Staff Writer

In a press release by Dr Allan Bell of Auckland University of Technology (sure to raise eyebrows with some Australian i2P readers), it is stated that:

"The New Zealand accent has been rated the most attractive and prestigious non-British form of English, according to a BBC survey.
New Zealand English came in first ahead of Australian, American and most regional British accents in the study published in the international Journal of Sociolinguistics, edited by Professor Allan Bell, Director of AUT’s Institute of Culture, Discourse and Communication."

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Food as medicine - brown rice benefits diabetic patients

Staff Writer

Choosing your rice variety may provide an inexpensive support for a program to treat diabetes.
Menus involving varieties of brown rice may reduce glycation and the rate at which sugar is absorbed by the body.
Cinnamon is another food known to sensitise insulin and reduce sugar levels.
With a some thought it appears that a variety of foods that combat diabetes could be combined to create dishes that are not only functional, but delicious to eat as well.


Brown rice could aid diabetes control


By Anuradha Alahakoon

Source: SciDev.net

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The Starting Point

Neil Johnston

It was refreshing to read some positive recent announcements, comments and opinions in the media over the past three weeks.

First was the announcement by Nicola Roxon regarding the National Preventive Health Agency and the positioning by the Pharmaceutical Society of Australia firmly in support of this development of her initiative.
It is not quite 12 months ago that i2P ran a story on Nicola Roxon, her family and political background, at a time when she was relatively unknown in health circles.
Some observational and predictive points from that i2P article dated December 2008  -"Have you met Nicola Louise Roxon?" -are shown below.
Go to http://archive.i2p.com.au/?page=site/article&id=1168  for the full article.

"* Nicola appears to be a very normal and stable personality with strong family values, and is direct, straightforward and honest in her professional life.

* Nicola will endeavour to broaden the concept of health from illness treatment to illness prevention. She is well documented in many statements that “prevention is better than cure”.

* Pharmacy will be included within primary health care (something that other professions have tried to restrict), and the role pharmacy already plays in self-care will be recognised. I am sure that funds will be made available for the extension of self-care, work that has always been unpaid work performed by pharmacists.

* Nicola, however, needs to understand exactly what depth pharmacists have provided primary care, almost in a secretive fashion, because of constant harassment by doctors. While there is a surface cooperation between doctors and pharmacists, it is really only lip service.

The removal of this harassment would allow pharmacists to thrive as well as the general public.

* Nicola also needs to understand that while pharmacy owners provide infrastructure to provide medicine distribution, the pressure of this infrastructure works against the development of clinical services.

For this role she needs to recognise pharmacists individually as health practitioners and separate their income from the PBS model.

By providing incentives to individual pharmacist practitioners, development ideas and capital would flow in from these people and pharmacy owners would form beneficial relationships to harness benefit for the supply side of their businesses.

* From the recent address given at the Pharmacy Guild of Australia annual dinner, Nicola said, in part:

“The examples of existing Professional Programs and Services confirm the pharmacist’s role within the primary healthcare team.There may still be some debate about the borders of that role – but the direction is already well and truly established.

I want to be clear here – and I suspect my earlier comments have already given this away – any expanded role for pharmacists will take an incremental approach, and will be dictated by the need for safety and quality in health care.”

In other words, she will do what she has always done – carefully plan and test any program before it becomes policy.

It would seem that we were substantially correct and that the National Health Preventive Agency will offer a great opportunity for pharmacists to take advantage of their current training and skills set.

The second item was contained in a press release by the PSA dated 16/10/09 regarding a Memorandum of Understanding that was signed in Sydney by the President of the PSA, Warwick Plunkett, and the President of the RACGP, Dr Chris Mitchell, at a ceremony during the Pharmacy Australia Congress.

While details of the memorandum still have to be released, it may eventually mean that pharmacists will be able to practice independently and in alliance with GP's without the constant sniping that has been a feature of a relationship, which if worked cooperatively, has always been proven to provide maximum patient benefit. Good work PSA!

The third item of interest was an opinion article written by Geoff Marsh, president of APESMA.
Few comments have originated from APESMA, so it was good to see a comment from this organisation, as is really the voice of non-pharmacy owners, or to put it more succinctly, the logical representative of the pharmacists who provide professional services (whether or not they are paid up members).
The following appeared in Pharmacy e-News on 23/10/09 (located at
http://static.rbi.com.au/common/contentmanagement/pharmnews/PDFNOAD/20091023.pdf

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New Drugs for Old

Staff Writer

articles by this author...

Editing and Researching news and stories about global and local Pharmacy Issues

Seems like drug companies are being forced to review old medicines to drive their businesses into the future.
The cost of developing new drugs is beginning to overwhelm resources and making the end product too expensive for future patients and their funders.
With advances in genetic knowledge it is becoming possible to better "fit" a drug to a patient.
It is also cheaper to explore new indications for old drugs, a process already begun with some drug companies already illegally promoting "off label" uses for medicines within their armoury.

Going back to the future in personalised medicine

Source: Reuters
http://www.reuters.com/article/reutersEdge/idUSTRE59B2YN20091012?sp=true

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Shaping the future of personalised medicine is not all about developing expensive new drugs -- it will also mean revisiting older, cheaper medicines armed with new genetic knowledge.

Recent discoveries of genetic clues as to why medicines work better in some patients than others suggests combining new tests with old drugs will be a cost-effective approach -- attractive to governments and insurance companies, experts say.

"There are two sides to personalized medicine -- there is work in looking for new gene clues for the design of new drugs, and we are also doing a lot of work on currently used medications," said Colin Palmer of Dundee University, whose role as head of pharmacogenomics puts him at the heart of work to use genetic information to personalize medicine.

"We're trying to get rid of the one-size fits all approach ... and create more effective drugs tailored to the individual."

Few believe it is possible to make all drugs work for all patients all the time, but experts say the current situation -- where many patients do not get any benefit -- demands action.

Its easy to see why. According to a report by PricewaterhouseCoopers earlier this year, patient response rates to medicines "can be very low -- varying from 20 percent to 75 percent, depending on the drug."

It is no surprise that industry is under pressure to improve efficacy and safety, thereby making drugs more cost-effective.

It is already the case that more and more new drugs, particularly for cancer, are coming to market with a so-called companion diagnostic -- a test allowing doctors to determine if a patient has the right genetic makeup to respond to treatment.

In Europe, there are around a dozen drugs -- including GlaxoSmithKline's Ziagen for HIV and AstraZeneca's lung drug Iressa -- that require the use of companion diagnostics.

And in the United States, the Food and Drug Administration requires patients be tested for genetic variants before taking Pfizer's HIV drug Selzentry, Eli Lilly and Bristol-Myers Squibb's Erbitux for colorectal cancer and Roche's Herceptin for breast cancer, among others.

GENETICS AND GENERICS

But these are new and highly pricey drugs -- and experts say payers may be more encouraged by recent studies which show genetic clues being found for response rates in generic drugs.

"In the last year or so people have been beginning to find gene markers in much more common areas," said Donald Singer, a professor of clinical pharmacology and therapeutics at the University of Warwick's medical school. "We are really on the cusp at the moment in terms of the cost effectiveness."

While pharmaceutical companies would rather promote new drugs, he believes a better approach for payers may be to revisit old drugs armed with greater genetic knowledge.

A study published last week showed that common asthma drugs -- salbutamol, a popular inhaler medicine also known as Ventolin, and salmeterol, an ingredient in Glaxo's Advair -- do not work in patients with a particular genetic make-up and may make things worse.

Another study showed that about half of patients given the generic drug tamoxifen as a hormone therapy in breast cancer have a genetic variation which helps them metabolize the drug -- meaning they are likely to respond well -- but 8 percent have a gene type which means it will not work.

Palmer's team is also investigating the genes involved in defining whether a patient can respond well to statins, a class of drugs used by millions of people to try to lower cholesterol.

In some of these areas, scientists say a relatively cheap and easy test, such as a cheek swab or blood test, could be carried out to see ahead of time whether a patient is likely to respond well to the medicine usually prescribed.

"From the point of view of governments, testing and then going for the older off-patent drugs could be more cost-effective, rather than plowing money into new ones," Singer said.

Experts in this field point to rapid acceleration in genetic technology since 2003 when scientists completed the Human Genome Project -- a decade-long race to sequence all the DNA in people.

Some companies already offer a "genotyping service," where you can send in a DNA sample and, for a fee, they give you a typing for as many as a million genetic variants.

For now such information is not widely useful without the ability to act on it, but as studies on common medicines reveal more about how and when they work, clinical knowledge about how to exploit those genetic variations to best effect is growing.

"In real life what you really want is to be able to go to your doctor, get a blood test which could lay out a genetic map, and then they prescribe based on the test results," said Singer.

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