s Orthomolecular Medicine News Service, January 16, 2014 - Top 20 vitamin D papers for 2013 | I2P: Information to Pharmacists - Archive
Publication Date 01/12/2013         Volume. 5 No. 11   
Information to Pharmacists

Editorial

From the desk of the editor

Welcome to the December edition of i2P-Information to Pharmacists.
As we wind down in 2013 for the holiday period we will be filing some updates, but at a little more leisurely pace.
Where has the year gone?
Certainly the rate of change for 2013 has been more than hectic and there has been little time to organise thoughts and set appropriate directions.
This is the season for hard negotiations for the 6CPA but there is little left to squeeze.
Pharmacy has had the equivalent of bariatric surgery.
Government has taken it all, as usual.
As current price changes work their way through the pharmacy cash flow cycle, for some there will be insufficient- and heartburn.
Crunch time is that there will be more bankruptcies over 2014.
Media reports that some pharmacies have received free shop refits as a form of payment for purchasing a specific generic drug range is certainly not obvious, as the average pharmacy is in need of some renovation or repair and looking a bit jaded.

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Recent Comments

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News Flash

Newsflash Updates November 2013

Newsflash Updates


Regular updates from the global world of pharmacy.
Access and click on the title links that are illustrated.

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Newsflash Items for December 2013 and January 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

How to Avoid Becoming a Commodity

Chris Foster

These days more than ever the competitive advantage pursued by many is to discount and commoditise an industry.
The prime example of this is warehouse pharmacy stores.
However, this is not unique to pharmacy, but too many industries out there, including electrical retailing and hardware.
As a result, the relentless pursuit of being the cheapest product and service provider has meant that the smaller, service focused business is eventually forced out of business.

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A Clinical Services Pharmacy Design (Canadian Style)

Fiona Sartoretto Verna AIAPP

Editor's Note: This pharmacy design would suit an Australian pharmacy set up for clinical services and for survival over the next five years. Pharmacists interested in adapting this design to suit their local market should contact Neil Johnston at neilj@computachem.com.au for an introduction to Sartoretto Verna design services.

Villagio Market Pharmacy -St- PerreJolys , Manitoba, Canada Technical Data

Total area: 90 sq.m.
Area open to public: 75 sq.m. Area open to public / total area: 83%
Exposure: 39 lm
The task was to create a pharmacy inside the market in St -Pierre Jolys , a rural village which is situated not far from Winnipeg, Canadian province of Manitoba.
In recent years, the owner Mark Duddridge has transformed a simple grocery into a full-service drugstore that it is visited approximately by 400 visitors per day.
Sartoretto Verna was asked to create a pharmacy that can boast an excellent design with thorough attention to details.

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A Peaceful Christmas and a Productive New Year

Neil Johnston

The editor ans staff of i2P e-magazine would like to wish all of its readers the best wishes for a peaceful Christmas and a productive New Year.

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PGA Moves Into Primary Care

Neil Johnston

This week I received a pleasant surprise in the form of a PGA news item endorsing a range of primary health care services, an area that had been progressively abandoned from as far back as 1978, but in particular, within the last decade.
Importantly, the PGA has recognised that the current pharmacy business model has reached its “use by” date by stating:
 “The Guild’s National Council has recognised that the successful and widespread integration of these primary health care services into pharmacy businesses is likely to require significant changes to the traditional pharmacy operating model, including in relation to workflows and the roles and responsibilities of pharmacists and other staff.”

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Building a clinical services model in a difficult marketplace

Peter Sayers

It seems to me that there is a confluence of events overtaking pharmacy.
On one hand there is a genuine disappointment by health consumers that they have not been able to access pharmacists for basic primary care services, and on the other, there are a host of pharmacy critics and academic advisers that have a range of solutions, none of which are compatible with a community pharmacy environment.
And in the middle are a host of dedicated pharmacists working and piloting a range of solutions while simultaneously being torn apart, as unreasonable chunks of cash flow and profitability disappear from its business heart.

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My Best Team

Gerald Quigley

Quite coincidentally, over the last few months, I’ve been thinking about where we’ve been in our profession, and where we’re headed.
Some recent comments within this fine publication have cemented my thoughts on how we can recover some ground in our perceived role of “do what other health professionals tell you to do, and don’t dare step outside those parameters or your world will end.”
At the end of each football season, “expert” commentators rate their “best 18” (in the AFL) or the “best 11” (in cricket).
Lists like this often precipitate vigorous debate.
I’m no expert, but each of us has our professional heroes.
Some of mine are still with us, and some have gone to that big professional healthcare practice in the sky.
Within that latter group, I wonder what they are thinking.

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Continuity of care in residential care

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

In February 2011 I wrote on the topic of continuity of care with regard to hospital discharge (Volume 3 No. 2).
At that time I was working in hospital pharmacy practice.
Now I am sitting on the other side of the fence working in residential care undertaking medication reviews and I see just how fragmented care can be in the community.
The situation is exacerbated as the patients are usually elderly and they and their families are not always able to communicate important health information to the various health care providers involved.
This puts these patients at significant risk of medication misadventure and adverse outcomes. Some examples follow. All of these scenarios are based on real cases.

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More Pharma Abuse

Judy Wilyman

Editor's Note: The corrupt nature of Big Pharma's evidence-base to justify the marketing of bad medicine is slowly unraveling through courts of law around the world.
The corrupt medical academics who fuel this process through allowing themselves to be "bought" by a number of creative means will also be similarly addressed.
Different levels of government are also tainted when it is seen that mandatory vaccination is being used to drive corrupt health policies, even when evidence exists to the contrary.
i2P supports true evidence-based arguments or best evidence where something has had traditional use and is waiting for evidence support to occur.
We do not support the claims made by Skeptic extremists that permeate the landscape, that tend to support corrupt evidence even though it may have been published in a peer-reviewed journal.
How the medical fraternity and Big Pharma will sort out this absolute mess remains to be tested.
And they must realise that they are no longer trusted or respected by members of other health professions, simply because of this unprincipled and illegal behaviour.

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Medical Debate Censorship Attempt by NSW Government

Staff Writer

Editor's Note: Until today, I had never heard of the organisation Avaaz.
Avaaz—meaning "voice" in several European, Middle Eastern and Asian languages—launched in 2007 with a simple democratic mission: organize citizens of all nations to close the gap between the world we have and the world most people everywhere want.
Avaaz empowers millions of people from all walks of life to take action on pressing global, regional and national issues, from corruption and poverty to conflict and climate change.
The Avaaz model of internet organising allows thousands of individual efforts, however small, to be rapidly combined into a powerful collective force. (Read about results on the Highlights page.)
The Avaaz community campaigns in 15 languages, served by a core team on 6 continents and thousands of volunteers.
Avaaz takes action -- signing petitions, funding media campaigns and direct actions, emailing, calling and lobbying governments, and organizing "offline" protests and events -- to ensure that the views and values of the world's people inform the decisions that affect us all.

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Why is WHO guilty of WOO?

Loretta Marron OAM BSc

Acupuncturists claim that they can treat many serious illnesses, including depression, dysentery, osteoarthritis and whooping cough. As 'evidence', they even refer to the World Health Organisation (WHO) website.
What does WHO claim acupuncture can cure?
Does this match the evidence?

Comments: 1

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Unselfishness has a special place in business

Harvey Mackay

Bill Bradley recently spoke to a group of Minnesota Timberwolves season ticketholders.  The topic wasn’t his stellar career, basketball strategy or memorable wins.  Instead, he talked about unselfishness.  After 40 years of traveling America as a Hall-of-Fame basketball player and a U.S. Senator, the Rhodes Scholar has a lot of stories to tell about the remarkable unselfish accomplishments of people both famous and unknown.  He features them during his weekly American Voices program on Sirius/XM Radio.

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I’ve been thinking about, Boston, Belichick, UPS, and transporting properly prepared IVs to the right patients on time

Mark Neuenschwander

I’ve been thinking about, Boston, Belichick, UPS, and transporting properly prepared IVs to the right patients on time.
Boston is my favorite public transit city. I’m like a kid while being transported by user-friendly Charlie through the labyrinth beneath her historic streets.
It’s not uncommon for outsiders to say Bostonians are not so user friendly. Stereotyping suggests they are not terribly diplomatic, sometimes condescending, and always in a rush.
Sort of the way the Patriot’s Coach Belichick comes across on Sports Center’s post-game interviews.

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Big Data - A Business Power Shift

Barry Urquhart

Season’s greetings.

With the increasingly cosmopolitan nature of Australian society and its people the Christmas festive period is becoming progressively less dominant, particularly for businesses.
However, the Christian values of love, compassion, sharing and understanding are relevant at all times for all people.
We all benefit and should enjoy embracing the sense of family... Australians are all part of one cohesive, extended family. This year we should make the time and effort to reflect, reach out, respect and value the sense of virtue of family.
In commerce the same commitment should be given to virtues of quality customer service.
The following text highlights why. And remember, there is no holiday or break in the need for and advantages of service excellence.

Kindest Personal Regards

Barry Urquhart

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‘All Trials’, Marketing Based Medicine, and the fight for clinical transparency

Baz Bardoe

Editor's Note: i2P would like to introduce a new writer named Baz Bardoe, an experienced writer with an interesting background.
He joins our small group of writers looking at the ethics behind drug and other medical evidence that pharmacists rely on for their advice and recommendations to their patients.
Much of this evidence has been found to be fraudulent and will take decades to sort out.
This type of fraud also permeates other industries to the extent that information adverse to the interests of these industries (Big Pharma, Big Agriculture, Big Tobacco, Mainstream Media and Big Pesticide and Herbicide Manufacturers), is suppressed.
But they all seem to conspire using a similar methodology to the extent that human health is adversely affected through lack of information or publicising false information, or distributing misleading information.

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A Tribute to Nelson Mandela

Neil Johnston

Nelson Mandela had little to do with pharmacy (except that he was involved in action to obtain access to cheap HIV medications for his country) but his personal code of conduct was admired universally.
His strength of character and leadership style certainly avoided what might have become a blood-bath in South Africa.
His recent passing was a loss to the World Community and i2P decided to acknowledge this great man within its pages.
I also began to think about what his personal reaction might have been to some current issues in Australia and its health system, and how our leaders compare with his standards.
For example, would he have signed up to the current proposed version of the Trans Pacific Partnership Agreement and would he have endorsed the actions of Big Pharma, Big Tobacco, Big Agriculture, Big Herbicide/Pesticide where it involved human health?
I am sure the answer would have been a resounding NO!
The following is a statement he made and observed:

“What counts in life is not the mere fact that we have lived. It is what difference we have made to the lives of others that will determine the significance of the life we lead.”


The following synopsis of his life has been extracted from the Nelson Mandela Foundation website:

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Good Manners Create Good Communications and Illustrate Respect and Care

Peter Sayers

Pharmacy has always “won its stripes” utilising its ability to be able to relate to individuals in an empathetic manner.
Patients have always reacted positively in accepting what pharmacists have offered to them as a health benefit.
Trouble is, the health benefits have not expanded progressively and pharmacists have become less visible under the mountain of PBS paperwork, bureaucracy and sundry critics that drown out pharmacist voices.
Now the price is about to be paid as government payments to pharmacists will reduce according to their view of the value of a pharmacist, which will be seen as almost non-existent.
And pharmacists, being survivors, will have to limit their time-investment in the PBS because it will not represent good value to them or their patients.

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Primary Health Care Teams – Will Community Pharmacists be Participants?

Neil Johnston

In the hospital setting pharmacists work well with nurses and doctors. Possibly because of close working proximity and the opportunity for social interaction, there is a better understanding of the role of each profession.
Politically, within a hospital setting, pharmacists feel disadvantaged.
It is a numbers game.
Nurses and doctors have the largest number of people on the ground and the strongest “hands-on” contact with patients.
Pharmacists have a lower profile with the patient, coming in later with an educational role that does not have the same sense of immediacy.

Comments: 1

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Something’s Fishy About Macular Degeneration Fish Oil Studies

Staff Writer

Orthomolecular Medicine News Service, December 11, 2013

Something’s Fishy About Macular Degeneration Fish Oil Studies
by Bill Sardi

(OMNS Dec 11, 2013) Just seven months ago National Eye Institute researchers claimed fish oil “doesn’t seem to help macular degeneration,” (1) a sight-robbing eye disease that plagues adults in their senior years.
So how could another newly published study produce exactly opposite results?
In fact, fish oil didn’t just slow down the insidious progression of this eye disease, it restored vision to every patient placed on high-dose fish oil. It was therapeutic and curative, not just preventive.

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Vitamins, Minerals Reduce AIDS Mortality - Ignoring Supplements Means Unnecessary Deaths

Staff Writer

Orthomolecular Medicine News Service, December 17, 2013

Vitamins, Minerals Reduce AIDS Mortality - Ignoring Supplements Means Unnecessary Deaths
Commentary by Andrew W. Saul, Editor

(OMNS Dec 17, 2013) Twenty-six years ago, I worked with a client (woman, late 20s) who was HIV positive.
She was a heavy drinker and drug user, a smoker, had a terrible diet, and a series of bad personal relationships.
Her health was deteriorating.
Desperate, she decreased her drug and alcohol use.
She still smoked, ate a poor diet, and was under great stress.
She took multivitamin/multimineral supplements irregularly.
But she took a lot of vitamin C very regularly, for over two decades.

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Multivitamins play a key role in health and wellbeing for people with vitamin and mineral deficiencies

Marie Kelly-Davies

Australian consumers can continue to have confidence in the wealth of evidence that exists on the role of multivitamins in providing overall health and wellness benefits and filling dietary gaps in combination with healthy lifestyle choices, the Australian Self Medication Industry (ASMI) said today.

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What are we worth?

Gerald Quigley

I’ve been following the bleatings by many about the fee we “deserve” to be paid for aspects of our professional expertise, which the consumer doesn’t actually know we have.
What puzzles me more is that we are even speaking about a “fee” before asking the end-user (the patient) whether or not they feel they need this particular service.

Comments: 1

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Vitamins Help Prevent Alzheimer's Disease News Media Ignores Supplement Benefits . . .Again

Staff Writer

Orthomolecular Medicine News Service, December 20, 2013

Vitamins Help Prevent Alzheimer's Disease. News Media Ignores Supplement Benefits . . .Again

(OMNS Dec 20, 2013) Nutritional supplementation with antioxidants and the B-complex vitamins has been shown to help prevent dementia. Half of all cases of Alzheimer's, the most common form of dementia, could be attributable to known dietary and lifestyle risk factors, and at least one fifth of current cases could be prevented right now.

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Tracking Down Human Rights - Is Anyone at Home?

Judy Wilyman

Editor's note: For some time I have been following the arguments in support of official vaccination policy, and the other side of the argument as well.
Having been trained in pharmaceutical science and its objectives to align itself with “evidence-based medicine”, I have to admit that I have lost heart both in the process itself and the arguments in support of medical products that have supposedly  been submitted to testing, using orthodox and recognised processes.
The entire system of checks and balances has been torn apart.

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The New Battlegrounds

Peter Sayers

As pharmacists commit further to the expansion of clinical services over 2014, it will not take long for the local GP’s to begin the predictable strategy of reprisal.
In the past, that usually took the form of “channelling” prescriptions to opposition pharmacies (including Internet pharmacies).
However, PBS prescriptions are now so commoditised and cash flow disruptive, that they can no longer be part of the real growth platform of pharmacy’s future and therefore have less impact when channelled by a GP.
Similarly, nursing home business that has always been vulnerable to either GP pressure or a cut-price pharmacist competitor is no longer a concern, unless the pathway to “profitless prosperity” is part of a business model needing expanding cash flow volume at the expense of profit.

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Vitamin D supplements needed for many mothers and babies

Staff Researcher

Many pregnant women in New Zealand should be taking vitamin D supplements to ensure their babies are not at risk of rickets.
Young breastfed infants of Maori or Pacific Island women, or infants of women with dark skin or who are often covered or veiled when outdoors, are at the greatest risk of having low vitamin D levels.
The mother’s vitamin D level during pregnancy determines the vitamin D status of her newborn baby and remains an important determinant of vitamin D status while the infant remains exclusively breastfed.
A study to determine the optimum vitamin D dose for pregnant women and infants has recently been completed in Auckland and was published this month in the American Academy of Pediatrics journal ‘Pediatrics’.

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Monoculture Pharmacy - How to Rise Above It

Neil Johnston

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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How to make New Year's resolutions you'll keep

Harvey Mackay

It is New Year's Eve and Charlie Brown says to Lucy:  “Next year I am going to be a changed person.”
“That's a laugh,” says Lucy sarcastically.

“I mean it,” says Charlie, “I'm going to be strong and firm.”
“Forget it,” says Lucy.  “You'll always be wishy-washy.”
“Well,” answers Charlie defensively, “One day I will be wishy and washy the next.”
Like Charlie Brown, most of us set New Year’s resolutions that are a little vague – lose some weight, spend more time with family and friends, quit smoking, quit drinking, enjoy life more, get out of debt, help others, get organized and on and on.
Just think, if everyone kept their New Year’s resolutions, the world would be a lot different:  We’d have healthier people that would show up for work on time, smoke and drink less and be more organized.

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Remove barriers to medication reviews for aged-care residents

Staff Writer

Written by Suzanne Newman from SHPA
An article by Amanda Vanstone in The Age and The Sydney Morning Herald this week highlights important issues in the aged-care sector in relation to medicine use.
In her article, Ms Vanstone described a resident of an aged-care facility being prescribed medications that she did not require.
SHPA believes that this case highlights why regular medication review by accredited pharmacists is an important service for all residents of aged-care facilities.

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Orthomolecular News Service January 3 & January 7 2014

Neil Johnston

Editor's Note:
The unnecessary war that is waged on vitamins and other nutritional supplements is continually and routinely engaged.
Is it because they offer a genuine alternative to mainstream medicine? Or a cheaper treatment? Or a safer treatment?
In the war of continuous disinformation it gets harder to separate truth from fiction particularly when it is generated through Big Pharma sources - the same sources that have had massive fines levied against them for publishing fraudulent research, not just once, but multi-times.
Will government ever legislate in this area?


Orthomolecular Medicine News Service, January 3, 2014

No Deaths from Vitamins. None.
Supplement Safety Once Again Confirmed by America's Largest Database
by Andrew W. Saul, Editor
PLUS

Orthomolecular Medicine News Service, January 7, 2014

Regulation of Vitamins: Politics As Usual

Commentary by Rolf Hefti

Comments: 1

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Gradually, and Then Suddenly- a Lesson in Life

Neil Johnston

I started publishing i2P in February 2000 because I was personally aware that community pharmacy policy was not going in an optimum direction and was becoming divisive within the profession.
At that stage there was only one writer (me), but I was soon tackled by other pharmacists with similar thoughts and very strong views, so I decided there was room for a “thought leadership” role for my then fledgling publication, and I invited my detractors/supporters to fill an Internet page that was theirs to manage and to write their own researched thoughts, without censorship or heavy editing (except for potential libel and grammatical errors).
So was born a publication that could publish completely opposite viewpoints simultaneously, creating a form of a “think tank” for all pharmacists.

Comments: 3

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Orthomolecular Medicine News Service, January 16, 2014 - Top 20 vitamin D papers for 2013

Staff Writer

Orthomolecular Medicine News Service, January 16, 2014

Top 20 vitamin D papers for 2013

by William B. Grant, PhD

(OMNS Jan 16, 2014) There were 3774 papers published in 2013 with vitamin D in the title or abstract according to pubmed.gov, up from 3099 in 2012.
Among the top 20 vitamin D papers chosen to highlight for 2013 were 11 reviews, five observational studies, one geographical ecological study, one trial, one laboratory study, and one analysis of data from published results.
The papers were chosen in part by the number of times they have been cited in other works as reported by Scholar.Google.com and in part based on expert opinion by vitamin D researchers.
The fact that two-thirds of the papers were reviews is an indication of the relative maturity of the field. However, as noted in the discussion, the weak link in the vitamin D story is the limited number of randomized controlled trials (RCTs) reporting beneficial effects of vitamin D.
As discussed in the paper by Heaney [2013], the primary reason for this result is that vitamin D RCTs have been poorly designed and conducted in general; researchers have generally designed vitamin D RCTs based on the pharmaceutical drug model, which assumes no other source of the agent and a linear dose-response relation. These conditions are not satisfied for vitamin D. As a result, many of the trials enrolled people who had relatively high serum 25-hydroxyvitamin D [25(OH)D] levels and gave them too little vitamin D to produce a beneficial effect.

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Vaccinations Still Have Problems in 2014

Judy Wilyman

Welcome to the first Vaccination Decisions newsletter for 2014.
I would like to provide you with information about the HPV vaccine that is given to all Australian adolescents in government funded school programs to prevent cervical cancer. This vaccine has had the highest number of reactions globally and thousands of girls (and now boys) have become permanently disabled after receiving this vaccine.

Comments: 3

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Leadership is a State of Mind

Neil Johnston

Leadership is often confused with management.

While it embraces management it is nonetheless ,an entirely different process.
An organisation that does not have a leader is an organisation that is going nowhere.

It is a follower.

It is a long time since I have seen a leader of our profession that really stood out – one who was not frightened to really speak up about their thoughts and actively defend them.

You are more likely to see someone who waits for someone else to “do something”, and then slavishly copy them. In the interim those pseudo-leaders fade into the background because they can never be original.

Certainly examine some other person's work, but only to see what deficiencies exist so that your version might be greatly improved.

But in researching and value-adding a leader will come up with an essentially new approach that will give his organisation a point of difference. And he will launch his product as an incomplete (eighty-percent) version to be refined “on the run”.

That leader gets to achieve his goal before the rest of the pack.

That leader will stand out.

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ASMI welcomes community pharmacy support for S3 information-based advertising

Marie Kelly-Davies

The Australian Self Medication Industry (ASMI) is encouraged by strong signals of support from community pharmacy to expand the range of Pharmacist Only (S3) medicines as well as its widespread support of an information-based communications approach to consumers for S3 medicines, as demonstrated by the UTS Pharmacy Barometer released this week.1
Prescription to non-prescription reclassification (‘Rx to OTC switch’) and lifting the current advertising restrictions on S3 communication are key issues that remain high on ASMI’s agenda.

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Nearpod helps revolutionize medical education teaching using mobile devices

Staff Writer

One of the most impressive apps for medical education purposes is Nearpod.
The premise behind nearpod is simple–to bring the classroom to life with interactive mobile presentations that teachers can create and customize themselves.
Nearpod relies on a  cloud based system to distribute interactive presentations to students in a classroom. It is particularly well suited for institutions that own or use tablets regularly (although you can use a phone).

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New discoveries in quest for better drugs

Staff Researcher

A new crystal structure of a GPCR bound to both an activating molecule and a drug
Two studies into alternative drug recognition sites on G protein-coupled receptors have been published in Nature.
Scientists have combined cutting edge computer modelling, structural biology, pharmacology and medicinal chemistry to reveal new insights into how the body interacts with novel drug treatments, in research that could lead to the creation of drugs that are more targeted and with fewer side effects.

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SHPA’s new president to champion excellence in medicines management

Staff Writer

Story by Suzanne Newman

At a meeting of SHPA’s Federal Council on the weekend, Professor Michael Dooley, Director of Pharmacy at Alfred Health, and Professor of Clinical Pharmacy, Centre for Medicine Use and Safety, Monash University, was elected as the new President of SHPA.

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SHPA welcomes prescribing pathway for health professionals

Staff Writer

Story by Suzanne Newman

SHPA welcomes the news that the Health Professionals Prescribing Pathway has been approved by Australian health ministers.
The Health Professionals Prescribing Pathway project has been undertaken by Health Workforce Australia (HWA) to develop a nationally recognised approach to prescribing. SHPA has been involved in this project from the outset: contributing feedback on a draft version and being represented in workshops and other settings by SHPA representatives including former President Sue Kirsa, CEO Helen Dowling, Yvonne Allinson and Greg Weeks. SHPA member, Dr Lisa Nissen, has been a clinical advisor to the project.

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Prime Minister announces new funding to support delivery of chemotherapy

Staff Writer

Story by Helen Dowling

SHPA welcomes the announcement on 30 November 2013 by the Prime Minister, Tony Abbott of more than $82million additional funding to support the delivery of chemotherapy medicines in Australia’s public and private hospitals.
Although few details have been released, the new funding that commences from 1 January 2014 removes the immediate concerns of SHPA members regarding the delivery of chemotherapy medicines.

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Professional Pharmacists Thank Sue Kirsa for her Contribution to Pharmacy

Professional Pharmacists Australia Spokesperson

Professionals Pharmacists Australia today paid tribute to the hard work and vision of Sue Kirsa who recently resigned as President of the Society of Hospital Pharmacists Australia.
CEO of Professional Pharmacists Australia, Chris Walton said Ms Kirsa worked tirelessly to see pharmacists better able to utilise their skills to improve community health.

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A Tribute to Nelson Mandela

Neil Johnston

Nelson Mandela had little to do with pharmacy (except that he was involved in action to obtain access to cheap HIV medications for his country) but his personal code of conduct was admired universally.
His strength of character and leadership style certainly avoided what might have become a blood-bath in South Africa.
His recent passing was a loss to the World Community and i2P decided to acknowledge this great man within its pages.
I also began to think about what his personal reaction might have been to some current issues in Australia and its health system, and how our leaders compare with his standards.
For example, would he have signed up to the current proposed version of the Trans Pacific Partnership Agreement and would he have endorsed the actions of Big Pharma, Big Tobacco, Big Agriculture, Big Herbicide/Pesticide where it involved human health?
I am sure the answer would have been a resounding NO!
The following is a statement he made and observed:

“What counts in life is not the mere fact that we have lived. It is what difference we have made to the lives of others that will determine the significance of the life we lead.”


The following synopsis of his life has been extracted from the Nelson Mandela Foundation website:

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Debbie Rigby to lead SHPA’s new accredited pharmacist group

Staff Writer

From Natalie Collard
SHPA is pleased to announce that Debbie Rigby will chair the SHPA Accredited Pharmacists Reference Group. Debbie is a highly regarded consultant clinical pharmacist, and comes with much experience in education, research, governance and communication. She is a Director at NPS MedicineWise and was the inaugural AACP Consultant Pharmacist of the Year in 2008. Debbie has much to offer.
SHPA President Professor Michael Dooley said “SHPA is fortunate that Debbie has agreed to chair this important group. Under her leadership this group will consolidate SHPA’s support for pharmacists who provide medication reviews and guide SHPA and our members through changes in pharmacy practice such a post-discharge hospital referral pathway for HMRs, which is on the horizon.”

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Support for pharmacists throughout the holidays Call 1300 244 910 to talk it over with a colleague

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

Not everyone enjoys this time of the year. Work pressures in pharmacy can be substantial with the end of the year “safety-net” rush, Boxing Day sales, holiday crowds in tourist areas and limited access to other health services.
Many pharmacists do not have the opportunity to relax with family and friends.
A sense of isolation can be exacerbated, especially if those around you are relaxing and celebrating and you are not.

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ASMI supports voluntary move to add front-of-pack warnings to S3 codeine-containing analgesics

Marie Kelly-Davies

The Australian Self Medication Industry (ASMI) has today confirmed that it supports industry-wide measures for a voluntary front-of-pack warning statement to be added to S3 codeine-containing analgesics, and that ASMI members who supply these products have agreed to implement the voluntary label changes as soon as possible.

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PHARMACY OWNERS CAUGHT UNDERPAYING HUNDREDS OF EMPLOYEE PHARMACISTS IN NEW AUDIT

Professional Pharmacists Australia Spokesperson

One quarter of Australia's pharmacy owners are breaking workplace laws, including underpaying their pharmacists and other staff, according to a shocking new Fair Work Ombudsman's audit report released today.
CEO of Professional Pharmacists Australia, Chris Walton, said the PPA's campaign to establish the audit was justified after it found 599 cases of pharmacists and other staff being underpaid, and more than $280,000 had to be paid back to pharmacy employees.

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Contact Lenses- a Platform for Glucose Measurement by Google

Staff Writer

Editor's Note: There is no doubt that health services are undergoing a revolution in the form of mobile apps and wearable technology.
The process is disruptive in terms of potential reductions in visits to various health professionals, including pharmacists,
Opportunity exists for pharmacists who can provide (for a fee) bridging technology and supporting information and advice to enable a patient to self manage their condition.
There is also a general movement in health development to create a self care environment with barriers being progressively removed e.g. S3 advertising.
Pharmacists need to develop also a recognisable and marketable patient mentoring service.


Diabetes is a disease without borders — one in 19 people across the globe deal with this illness that requires constant blood measurements and insulin treatment.
Google might soon make day-to-day care a little easier for diabetics with contact lenses that can read a person’s blood sugar through their tears – bringing new meaning to the popular wearable tech trend.

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Role of vitamin D, in combination with calcium, indisputable for bone health

Marie Kelly-Davies

Despite the current debate surrounding vitamin D, its role in maintaining good bone health and protecting against osteoporosis, in combination with calcium, is indisputable.

While evidence of the potential role vitamin D may play in non-skeletal conditions mounts, the Australian Self Medication Industry (ASMI) agrees with recent editorial comments in The Lancet that large clinical studies would help to properly assess the effects of vitamin D for health conditions such as heart diseases, diabetes, cancer, dementia and inflammatory diseases.1

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Pharmedia: No Benefit in Pharmacist Intervention

Neil Johnston

Editor's Note:
The media item below was recently published in MJA Insights.
It, along with many other articles, is a sample of the ongoing anti-pharmacy sentiment that is being spread by official medicine.
To me it is a nonsense to talk of collaboration between pharmacy and medicine on one hand, and to be professionally insulting on the other.
My view is that the medical profession has a lot of repair work to undertake to purify the drug evidence base that has been damaged beyond belief by its collaboration with Big Pharma, and the ongoing bid to denigrate the profession of pharmacy at every opportunity.
What seems to terrify official medicine about pharmacy and other registered health professionals such as nurses?
I2P asked Mark Coleman to comment on this situation, and his comments appear below the Insights item.

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Orthomolecular Medicine News Service, January 16, 2014 - Top 20 vitamin D papers for 2013

Staff Writer

articles by this author...

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

Orthomolecular Medicine News Service, January 16, 2014

Top 20 vitamin D papers for 2013

by William B. Grant, PhD

(OMNS Jan 16, 2014) There were 3774 papers published in 2013 with vitamin D in the title or abstract according to pubmed.gov, up from 3099 in 2012.
Among the top 20 vitamin D papers chosen to highlight for 2013 were 11 reviews, five observational studies, one geographical ecological study, one trial, one laboratory study, and one analysis of data from published results.
The papers were chosen in part by the number of times they have been cited in other works as reported by Scholar.Google.com and in part based on expert opinion by vitamin D researchers.
The fact that two-thirds of the papers were reviews is an indication of the relative maturity of the field. However, as noted in the discussion, the weak link in the vitamin D story is the limited number of randomized controlled trials (RCTs) reporting beneficial effects of vitamin D.
As discussed in the paper by Heaney [2013], the primary reason for this result is that vitamin D RCTs have been poorly designed and conducted in general; researchers have generally designed vitamin D RCTs based on the pharmaceutical drug model, which assumes no other source of the agent and a linear dose-response relation. These conditions are not satisfied for vitamin D. As a result, many of the trials enrolled people who had relatively high serum 25-hydroxyvitamin D [25(OH)D] levels and gave them too little vitamin D to produce a beneficial effect.

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Especially Important Original Studies

A randomized controlled trial with 400 or 2000 IU/d vitamin D3 found that gene expression in white blood cells was affected by vitamin D [Hossein-nezhad et al., 2013]. There was some improvement in 291 genes and significant improvement in 66 genes. In addition, 17 vitamin D-regulated genes were found with new candidate vitamin D response elements "which have been shown to be important for transcriptional regulation, immune function, response to stress and DNA repair". This study provides strong support for the role of vitamin D in affecting risk of cancer, autoimmune disorders and cardiovascular disease.

An observational study found that serum 25(OH)D levels below 30 nmol/l (12 ng/ml) were associated with 1.0-1.6 additional cases of spontaneous preterm birth before 35 weeks' gestation per 100 births for nonwhite mothers compared to levels above 75 nmol/l (30 ng/ml) [Bodnar, 2014]. Placental inflammatory lesions played a role in this relation. It was not understood why there was no relation between serum 25(OH)D level and risk of premature birth for white mothers. This paper adds to the literature on the beneficial role of higher serum 25(OH)D levels during pregnancy.

Vrieling et al. [2013] conducted a prospective cohort study in Germany including 2,177 incident stage I-IV postmenopausal breast cancer patients aged 50-74 years. Lower concentrations of 25(OH)D were significantly associated with an 86% higher risk of overall mortality and a 76% higher risk of distant disease in stage I-IIIa but not in stage IIIb-IV breast cancer patients. This study adds to the evidence that vitamin D plays an important role in cancer and all-cause survival.

A laboratory study identified several genes associated with triple negative/basal-like breast cancer that are regulated by vitamin D receptors [Laporta and Welsh, epub], thereby providing additional evidence that vitamin D can be useful in reducing risk of and treating breast cancer.

A pair of papers published in the open-access journal Dermato-Endocrinology discussed the evidence that solar ultraviolet-B irradiance and vitamin D reduce the risk of autism. In one, the prevalence of autism by state for those aged 6 to 17 years was found inversely correlated with summertime solar UVB doses [Grant and Cannell, 2013]. Rates for African Americans were higher than for European Americans. The variation with respect to solar UVB doses is similar to that reported previously for many types of internal cancer and dental caries in the United States. Summertime solar UVB doses in the United States are highest in the Southwest, lowest in the Northeast due to a combination of factors involving surface elevation, aerosol and cloud levels, and stratospheric ozone amounts. In the second paper, the evidence supporting the role of vitamin D in reducing the risk of autism and treating those with autism was presented and discussed. The mechanisms seem to include effects on reducing DNA mutations, anti-inflammation and antiautoimmune effects, and upregulating glutathione [Cannell and Grant, 2013]. It is not clear from either study what the relative contributions of maternal and infant serum 25(OH)D levels might be. These two papers add to the understanding of the roles of solar UVB and vitamin D in reducing risk of autism and could lead to a reduction in the epidemic of autism.

One of the roles of vitamin D is the reduction of inflammation. In a study of morbidly obese women, serum 25(OH)D levels were found inversely correlated with several indicators of inflammation including high-sensitive C-reactive protein, interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) after accounting for confounding factors including body mass index (BMI) [Bellia et al., 2013]. This study adds to the literature connecting low serum 25(OH)D level to increased risk of inflammation. This is important since inflammation is an important risk factor for many chronic diseases.

Another paper analyzed data from 21 adult cohort studies involving 42,000 participants with information on BMI, serum 25(OH)D levels, and genes related to BMI and 25(OH)D. The analysis found that each 1 kg/m(2) increase in BMI was associated with a 4.2% lower serum 25(OH)D level [Vimaleswaran, 2013]. The authors were also able to conclude that changes in serum 25(OH)D level would not affect BMI.

One of the concerns regarding taking vitamin D supplements is the possible risk of developing kidney stones. An analysis of data on 2000 participants of the GrassrootsHealth.net vitamin D testing program followed for an average of 19 months found no statistically significant association between serum 25-hydroxyvitamin D and kidney stones (P?=?0.42) in the range of 20-100 ng/ml. However, higher BMI was associated with an increased risk [Nguyen et al., 2013].

Comprehensive Reviews of the Health Benefits of Vitamin D

Pludowski et al. [2013] reviewed the evidence of health benefits of vitamin D as one of the outcomes of a vitamin D conference attended by over 500 people in Warsaw, Poland in October 2012. The evidence reviewed was primarily from observational studies. They found "Adequate vitamin D status seems to be protective against musculoskeletal disorders (muscle weakness, falls, fractures), infectious diseases, autoimmune diseases, cardiovascular disease, type 1 and type 2 diabetes mellitus, several types of cancer, neurocognitive dysfunction and mental illness, and other diseases, as well as infertility and adverse pregnancy and birth outcomes. Vitamin D deficiency/insufficiency is associated with all-cause mortality." This paper provided the basis for recommending serum 25(OH)D levels of at least 30 ng/ml (75 nmol/l) for Central and Eastern Europe.

Hossein-nezhad and Holick [2013] reviewed the effects of vitamin D on the risk of chronic illnesses, including some cancers, autoimmune diseases, infectious diseases, type 2 diabetes mellitus, neurocognitive disorders, and mortality. The authors recommend a serum 25(OH)D level of at least 30 ng/ml. This paper has open access.

The paper by Haussler et al. [2013] summarizes the molecular mechanisms of vitamin D, with primary emphasis on the classical functions of vitamin D on intestinal calcium and phosphate absorption and effects on skeletal and calcium homeostasis, but also discussion of how the active form of vitamin D, 1,25-dihydroxyvitamin D, affects gene expression and, thus risk of chronic diseases such as cancer, cardiovascular disease, and type 2 diabetes mellitus.

The paper by Palacios and Gonzalez [2013] presents an overview of what is known about serum 25(OH)D levels globally. Six maps are presented with data on vitamin D status (percent of population50% for European countries, but are 36% for China and 91% for India.

The Actions of Vitamin D

The effects of vitamin D on gene expression are controlled by the action of the hormonal metabolite of vitamin D, 1,25-dihydroxyvitamin D on vitamin D receptors (VDRs). A paper by Carlberg and Campbell [2013] reviews the actions of the VDR in comparison with those of other transcription factors in order to better understand the role of vitamin D on gene expression.

The Role of Vitamin D for Specific Health Outcomes

The paper by Song et al. [2013] presents a meta-analysis of 21 prospective studies of type 2 diabetes mellitus incidence with respect to serum 25(OH)D level at time of enrollment in the studies. The studies involved a total of 76,220 participants and 4,996 incident type 2 diabetes cases. The second order fit to the data went from a relative risk of 1.00 at 35 nmol/l (14 ng/ml) to 0.45 at 150 nmol/l (60 ng/ml). This analysis provides strong support for the role of vitamin D in reducing the risk of type 2 diabetes mellitus.

Girgis and colleagues [2013] published a comprehensive review of the role of vitamin D on skeletal muscle. It has 51 pages and 390 references. It should be the standard reference on the topic for years.

A paper by DeLuca et al. [2013] reviewed the evidence from 225 papers for the role of vitamin D in reducing risk of nervous system diseases: Alzheimer's disease, amyotrophic lateral sclerosis, autism, multiple sclerosis, Parkinson's disease, and schizophrenia. The strongest evidence is for multiple sclerosis. They note that evidence from many types of studies finds that vitamin D plays a crucial role in cellular proliferation and differentiation, neurotrophism, neuroprotection, neurotransmission, and neuroplasticity. Given the importance and devastation of neurological diseases, more research on the role of vitamin D in reducing risk of these diseases is warranted.

A Skeptical Viewpoint

One paper that has gotten considerable publicity is one calling into question the health benefits of vitamin D. Autier and colleagues published a paper comparing vitamin D randomized controlled trials to prospective studies based on health outcomes with respect to serum[25(OH)D levels [Autier et al., 2013]. While they found reasonable evidence from the observational studies that higher serum 25(OH)D levels were correlated with lower disease and mortality rates, they noted that few randomized controlled trials (RCTs) agreed with the observational studies. They also noted that inflammation is an important aspect of many diseases, but that RCTs have not shown that vitamin D can reduce inflammation. They proposed "the hypothesis that variations in 25(OH)D concentrations would essentially be a result, and not a cause, of ill health." As noted with respect to the paper by Bellia et al. [2013], there is evidence that serum 25(OH)D levels are inversely correlated with markers of inflammation. The vitamin D RCTs conducted to date have for the most part been poorly designed and conducted as pointed out by Heaney [2014]. Vitamin D RCTs have mostly been done using the pharmaceutical drug model, paying limited attention to other sources of vitamin D, not seeking to enroll people with low serum 25(OH)D levels, supplement them with sufficient vitamin D to raise their levels to those that have significant impact on health outcome, and also measure serum 25(OH)D levels later in the study. The proper way to examine causality with respect to vitamin D is to apply Hill's criteria for causality in a biological system [Hill, 1965]. These criteria appropriate for vitamin D include strength of association, consistent findings in different populations, temporality, biological gradient, plausibility (e.g., mechanisms), coherence, experiment (e.g., RCT), and analogy. Not all criteria need be satisfied, but the more that are, the stronger the case. A number of health outcomes have been found to satisfy Hill's criteria for causality for vitamin D including many types of cancer. Unfortunately, the paper by Autier and colleagues will likely dissuade many from recommending vitamin D in their practice or using it personally.

To learn more:

For further information on vitamin D, the interested reader is directed to these websites: http://www.Grassrootshealth.net, http://www.VitaminDCouncil.org, and http://www.VitaminDWiki.com.

Dr. William Grant directs the Sunlight, Nutrition and Health Research Center http://www.sunarc.org/ . This paper was reviewed by:

Carole A. Baggerly, Director, http://www.Grassrootshealth.net

Barbara J Boucher. MD, FRCP, Centre for Diabetes, Blizard Institute, Bart's & The London School of Medicine & Dentistry, Queen Mary University of London, London, UK.

Michael F. Holick, MD, PhD, Department of Medicine, Section of Endocrinology, Nutrition, and Diabetes, and the Vitamin D, Skin, and Bone Research Laboratory, Boston University Medical Center, Boston.

Henry Lahore, Director, http://www.vitaminDwiki.com

Pawel Pludowski, MD, Department of Biochemistry, Radioimmunology and Experimental Medicine, The Children's Memorial Health Institute, Warsaw, Poland

References:

Autier P, Boniol M, Pizot C, Mullie, P. Vitamin D status and ill health: a systematic review. Lancet Diabetes & Endocrinology, Early Online Publication, 6 December 2013. doi:10.1016/S2213-8587(13)70165-7.

Bellia A, Garcovich C, D'Adamo M, Lombardo M, Tesauro M, Donadel G, Gentileschi P, Lauro D, Federici M, Lauro R, Sbraccia P. Serum 25-hydroxyvitamin D levels are inversely associated with systemic inflammation in severe obese subjects. Intern Emerg Med. 2013 Feb;8(1):33-40. http://link.springer.com/article/10.1007/s11739-011-0559-x

Bodnar LM, Klebanoff MA, Gernand AD, Platt RW, Parks WT, Catov JM, Simhan HN. Maternal vitamin D status and spontaneous preterm birth by placental histology in the US Collaborative Perinatal Project. Am J Epidemiol. 2014 Jan 15;179(2):168-76. http://aje.oxfordjournals.org/content/179/2/168.short

Cannell JJ, Grant WB. What is the role of vitamin D in autism? Dermatoendocrinol. March 18, 2013;5(1):199-204. https://www.landesbioscience.com/journals/dermatoendocrinology/article/24356/

Carlberg C, Campbell MJ, Vitamin D receptor signaling mechanisms: integrated actions of a well-defined transcription factor. Steroids, Feb. 2013;78(2):127-36. http://www.sciencedirect.com/science/article/pii/S0039128X12003091

DeLuca GC, Kimball SM, Kolasinski J, Ramagopalan SV, Ebers GC. Review: the role of vitamin D in nervous system health and disease. Neuropathol Appl Neurobiol. 2013 Aug;39(5):458-84. http://onlinelibrary.wiley.com/doi/10.1111/nan.12020/abstract

Girgis CM, Clifton-Bligh RJ, Hamrick MW, Holick MF, Gunton JE. The roles of vitamin D in skeletal muscle: form, function, and metabolism. Endocr Rev. 2013 Feb;34(1):33-83. http://press.endocrine.org/doi/abs/10.1210/er.2012-1012

Grant WB, Cannell JJ. Autism prevalence in the United States with respect to solar ultraviolet-B doses: An ecological study. Dermatoendocrinol. 2013;5(1):159-64. https://www.landesbioscience.com/journals/dermatoendocrinology/article/22942/

Haussler MR, Whitfield GK, Kaneko I, Haussler CA, Hsieh D, Hsieh JC, Jurutka PW. Molecular mechanisms of vitamin D action. Calcif Tissue Int. 2013 Feb;92(2):77-98. http://www.researchgate.net/publication/229065129_Molecular_Mechanisms_of_Vitamin_D_Action/file/d912f50117bf975fd6.pdf

Heaney RP. Guidelines for optimizing design and analysis of clinical studies of nutrient effects. Nutr Rev. January 2014;72(1):48-54. [Epub ahead of print] http://onlinelibrary.wiley.com/doi/10.1111/nure.12090/abstract

Hill AB. The environment and disease: Association or causation? Proc R Soc Med. 1965 May;58:295-300. http://www.ncbi.nlm.nih.gov/pmc/articles/pmid/14283879/

Hossein-Nezhad A, Holick MF. Vitamin D for health: A global perspective. Mayo Clin Proc. 2013;88(7):720-55. http://linkinghub.elsevier.com/retrieve/pii/S0025-6196(13)00404-7

Hossein-Nezhad A, Spira A, Holick MF. Influence of vitamin D status and vitamin d3 supplementation on genome wide expression of white blood cells: a randomized double-blind clinical trial. PLoS One. 2013;8(3):e58725. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0058725

Laporta E, Welsh J. Modeling vitamin D actions in triple negative/basal-like breast cancer. J Steroid Biochem Mol Biol. 2013 Nov 14. pii: S0960-0760(13)00215-X. doi: 10.1016/j.jsbmb.2013.10.022. [Epub ahead of print] http://www.sciencedirect.com/science/article/pii/S096007601300215X

Nguyen S, Baggerly L, French C, Heaney RP, Gorham ED, Garland CF. 25-hydroxyvitamin D in the range of 20 to 100 ng/mL and incidence of kidney stones. Am J Public Health. 2013 Oct 17. [Epub ahead of print] http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2013.301368

Palacios C, Gonzalez L. Is vitamin D deficiency a major global public health problem? J Steroid Biochem Mol Biol. 2013 Nov 12. doi:pii: S0960-0760(13)00233-1. 10.1016/j.jsbmb.2013.11.003. [Epub ahead of print] http://www.sciencedirect.com/science/article/pii/S0960076013002331

Pludowski P, Holick MF, Pilz S, Wagner CL et al. Vitamin D effects on musculoskeletal health, immunity, autoimmunity, cardiovascular disease, cancer, fertility, pregnancy, dementia and mortality-a review of recent evidence. Autoimmun Rev. 2013 Aug;12(10):976-89. http://www.sciencedirect.com/science/article/pii/S1568997213000402

Song Y, Wang L, Pittas AG, Del Gobbo LC, Zhang C, Manson JE, Hu FB. Blood 25-hydroxy vitamin D levels and incident type 2 diabetes: a meta-analysis of prospective studies. Diabetes Care. 2013 May;36(5):1422-8. http://care.diabetesjournals.org/content/36/5/1422.full

Vimaleswaran KS, Berry DJ, Lu C, Tikkanen E et al. Causal relationship between obesity and vitamin D status: bi-directional Mendelian randomization analysis of multiple cohorts. PLoS Med. 2013;10(2):e1001383. http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001383

Vrieling A, Seibold P, Johnson TS, Heinz J et al. Circulating 25-hydroxyvitamin D and postmenopausal breast cancer survival: Influence of tumor characteristics and lifestyle factors? Int J Cancer. 2013 Nov 22. doi: 10.1002/ijc.28628. [Epub ahead of print] http://onlinelibrary.wiley.com/doi/10.1002/ijc.28628/abstract

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