s PGA has a “re-think” | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists

Editorial

From the desk of the editor

Welcome to the July 2014 homepage edition of i2P (Information to Pharmacists) E-Magazine.
At the commencement of 2014 i2P focused on the need for the entire profession of pharmacy and its associated industry supports to undergo a renewal and regeneration.
We are now half-way through this year and it is quite apparent that pharmacy leaders do not yet have a cohesive and clear sense of direction.
Maybe the new initiative by Woolworths to deliver clinical service through young pharmacists and nurses may sharpen their focus.
If not, community pharmacy can look forward to losing a substantial and profitable market share of the clinical services market.
Who would you blame when that happens?
But I have to admit there is some effort, even though the results are but meagre.
In this edition of i2P we focus on the need for research about community pharmacy, the lack of activity from practicing pharmacists and when some research is delivered, a disconnect appears in its interpretation and implementation.

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Feature Contribution

Woolworths Pharmacy - Getting One Stage Closer

Neil Johnston

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

Comments: 5

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Intensive Exposition without crossing over with a supermarket

Fiona Sartoretto Verna AIAPP

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

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The sure way to drive business away

Gerald Quigley

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

Comments: 1

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‘Marketing Based Medicine’ – how bad is it?

Baz Bardoe

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

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Community Pharmacy Research - Are You Involved?

Mark Coleman

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

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Organisational Amnesia and the Lack of a Curator Inhibits Cultural Progress

Neil Johnston

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

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

Staff Writer

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

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I’ve been thinking about admitting wrong.

Mark Neuenschwander

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

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Dispensing errors – a ripple effect of damage

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

Most readers will be aware of recent publicity relating to dispensing errors and in particular to deaths caused by methotrexate being incorrectly packed in dose administration aids.
The Pharmacy Board of Australia (PBA), in its Communique of 13 June 2014, described a methotrexate packing error leading to the death of a patient and noted “extra vigilance is required to be exercised by pharmacists with these drugs”.
This same case was reported by A Current Affair (ACA) in its program on Friday 20 June
http://aca.ninemsn.com.au/article/8863098/prescription-drug-warning

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Take a vacation from your vocation

Harvey Mackay

Have you ever had one of those days when all you could think was, “Gosh, do I need a vacation.”
Of course you have – because all work and no play aren’t good for anyone.
A vacation doesn’t have to be two weeks on a tropical island, or even a long weekend at the beach. 
A vacation just means taking a break from your everyday activities. 
A change of pace. 
It doesn’t matter where.
Everyone needs a vacation to rejuvenate mentally and physically. 
But did you also know that you can help boost our economy by taking some days off? 
Call it your personal stimulus package.

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Explainer: what is peer review?

Staff Writer

This article was first published in the Conversation. It caught our eye because "peer review" it is one of the standards for evidence-based medicines that has also been corrupted by global pharma.
The article is republished by i2P as part of its ongoing investigation into scientific fraud and was writtenby Andre Spicer, City University London and Thomas Roulet, University of Oxford
We’ve all heard the phrase “peer review” as giving credence to research and scholarly papers, but what does it actually mean?
How does it work?
Peer review is one of the gold standards of science. It’s a process where scientists (“peers”) evaluate the quality of other scientists' work. By doing this, they aim to ensure the work is rigorous, coherent, uses past research and adds to what we already knew.
Most scientific journals, conferences and grant applications have some sort of peer review system. In most cases it is “double blind” peer review. This means evaluators do not know the author(s), and the author(s) do not know the identity of the evaluators.
The intention behind this system is to ensure evaluation is not biased.
The more prestigious the journal, conference, or grant, the more demanding will be the review process, and the more likely the rejection. This prestige is why these papers tend to be more read and more cited.

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Dentists from the dark side?

Loretta Marron OAM BSc

While dining out with an elderly friend, I noticed that he kept his false tooth plate in his shirt pocket. He had recently had seven amalgam-filled teeth removed, because he believed that their toxins were making him sick; but his new plate was uncomfortable. He had been treated by an 'holistic dentist'. Claiming to offer a "safe and healthier alternative" to conventional dentistry, are they committed to our overall health and wellbeing or are they promoting unjustified fear, unnecessarily extracting teeth and wasting our money?

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Planning for Profit in 2015 – Your key to Business Success

Chris Foster

We are now entering a new financial year and it’s a great time to reflect on last year and highlight those things that went well and those that may have impacted negatively in the pursuit of your goals.
It's also a great to spend some time re-evaluating your personal and business short, medium and long term goals in the light of events over the last year.
The achievement of your goals will in many cases be dependent on setting and aspiring to specific financial targets. It's important that recognise that many of your personal goals will require you to generate sufficient business profits to fund those aspirations

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Attracting and Retaining Great People

Barry Urquhart

Welcome to the new financial year in Australia.
For many in business the past year has been described as a challenging period.
Adjectives are a key feature of the English language.  In the business lexicon their use can be, and often is evocative and stimulate creative images.  But they can also contribute to inexact, emotional perceptions.
Throughout the financial pages of newspapers and business magazines adjectives abound.
References to “hot” money draw attention and comment.  The recent wave of funds from Chinese investors, keen to remove their wealth from the jurisdiction and control of government regulations is creating a potential property bubble in Australia.

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Updating Your Values - Extending Your Culture

Neil Johnston

Pharmacy culture is dormant.
Being comprised of values, unless each value is continually addressed, updated or deleted, entire organisations can stagnate (or entire professions such as the pharmacy profession).
Good values offer a strong sense of security, knowing that if you operate within the boundaries of your values, you will succeed in your endeavours.

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Evidence-based medicine is broken. Why we need data and technology to fix it

Staff Writer

The following article is reprinted from The Conversation and forms up part of our library collection on evidence-based medicines.
At i2P we also believe that the current model of evidence is so fractured it will never be able to be repaired.
All that can happen is that health professionals should independently test and verify through their own investigations what evidence exists to prescribe a medicine of any potency.
Health professionals that have patients (such as pharmacists) are ideally placed to observe and record the efficacy for medicines.
All else should confine their criticisms to their evidence of the actual evidence published.
If there are holes in it then share that evidence with the rest of the world.
Otherwise, do not be in such a hurry to criticise professions that have good experience and judgement to make a good choice on behalf of their patients, simply because good evidence has not caught up with reality.

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Laropiprant is the Bad One; Niacin is/was/will always be the Good One

Staff Writer

Orthomolecular Medicine News Service, July 25, 2014
Laropiprant is the Bad One; Niacin is/was/will always be the Good One
by W. Todd Penberthy, PhD

(OMNS July 25, 2014) Niacin has been used for over 60 years in tens of thousands of patients with tremendously favorable therapeutic benefit (Carlson 2005).
In the first-person NY Times best seller, "8 Weeks to a Cure for Cholesterol," the author describes his journey from being a walking heart attack time bomb to a becoming a healthy individual.
He hails high-dose niacin as the one treatment that did more to correct his poor lipid profile than any other (Kowalski 2001).

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Culture Drive & Pharmacy Renewal

Neil Johnston

Deep within all of us we have a core set of values and beliefs that create the standards of behaviour that we align with when we set a particular direction in life.
Directions may change many times over a lifetime, but with life experiences and maturity values may increase in number or gain greater depth.
All of this is embraced under one word – “culture”.
When a business is born it will only develop if it has a sound culture, and the values that comprise that culture are initially inherent in the business founder.
A sound business culture equates to a successful business and that success is often expressed in the term “goodwill” which can be eventually translated to a dollar value.

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Pharmacy 2014 - Pharmacy Management Conference

Neil Johnston

The brave new world of health and wellness is not the enemy of Pharmacy, it is its champion.
Australian futurist, Morris Miselowski, one of the world's leading business visionaries, will present the Opening Keynote address on Pharmacy's Future in the new Health and Wellness Landscape at 2.00pm on Wednesday July 30.
Morris believes the key to better health care could already be in your pocket, with doctors soon set to prescribe iPhone apps, instead of pills.
Technology will revolutionise the health industry - a paradigm shift from healthcare to personal wellness.
Health and wellness applications on smartphones are already big news, and are dramatically changing the way we manage our personal health and everyday wellness.

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Generation and Application of Community Pharmacy Research

Neil Johnston

Editor’s Note: We have had a number of articles in this issue relating to pharmacy research.
The PGA has conducted a number of research initiatives over the years, including one recently reported in Pharmacy News that resulted from an analysis of the QCPP Patient Questionnaire.
Pharmacy Guild president, George Tambassis, appears to have authored the article following, and there also appears to be a disconnect between the survey report and its target audience illustrated by one of the respondent comments published.
I have asked Mark Coleman to follow through, elaborate and comment:

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PGA has a “re-think”

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 recent controversy over the Blackmore’s/PGA commercial deal has one positive - it opens up a debate on what would be the most appropriate processes for pharmacy to be involved in when engaging with patients and health consumers.
It also highlights how fractured each of the segments of the profession and industry are, in dealing one to the other, and to the community at large.

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Pharmacies, the visible “bricks and mortar” segment, are the natural conduit to supply pharmaceutical goods and services.
This segment requires a large investment by certain investor pharmacists, the only legal owners of pharmacies.
The investor pharmacists carry a high financial risk (and it is getting higher by the day), so their focus tends to be primarily directed to the conservation of capital and to a reasonable return on the capital invested.
That is only logical.
Investors require a degree of certainty and stability, and it is at this point other segments of the pharmaceutical industry begin to conspire and destabilise/threaten the pharmacy investors.
These segments are identified as government, pharmacy wholesalers and pharmacy manufacturers.

Government is only concerned with getting the best pharmaceutical service at the most economical price for taxpayers.
Because they are the primary funders of health and pharmaceutical services, they are seen to have a very strong hand in any negotiations for the provision of a service, and can manipulate components of that service to shift financial advantage into their court e.g. delay or non-payment to pharmacists for certain PBS items; creating new regulations that relate to budgets rather than consumer health benefit such as the recent deferrals of PBS listings for drugs recommended for listing by the PBAC.
When government tries to devalue a contracted pharmacy service it affects all pharmacists, so it is an imperative (for unity) that all pharmacists are involved in the negotiating process through their umbrella organisations.
While government has nominated the PGA as the lead negotiating agent for pharmacy, this is not necessarily correct.
When government sneezes the impact can cause pharmacy to develop bronchitis or worse.

Government is also involved in signing up to far-reaching treaties that may impact on whole industries e.g. pharmaceutical and agricultural.
Global drug manufacturers take advantage here and ride in on their own government’s negotiations to break down Australian institutions such as the entire PBS system.
They seem to think that the Australian taxpayer funds the entire PBS for their benefit and would prefer to see a universal equity in health transposed to a monopoly system controlled by them.
This view would eventually destroy the health of the majority of the population.
Global drug manufacturers have recently begun to destabilise schemes such as PBS by developing a direct distribution service, (or non-service depending on your view), that is a more expensive form of distribution, eventually finding its own level through increased drug prices.
This increase immediately impacts on wholesalers, who are cut out of large market segments of drugs and have to elevate their margins on their remaining inventory to sustain their universal supply chain.
Pfizer, because of its large market share of the PBS, has been in a position to be disruptive to wholesalers.
Government is in a position to rectify part of this imbalance through the CSO agreement that wholesalers have signed up to, plus legislate for all PBS drugs to go through the wholesaling system. This has not happened to date, so pharmacies collectively will have to bear the brunt of the progressive increase in drug prices and delivery charges.
Or put in other terms, investor pharmacists have to take a reduced return or find another revenue stream to offset this cost.

It is little wonder that the PGA formed up the now discredited alliance with Blackmore’s as a potential revenue stream.

However, while everyone is relieved at the discontinuance of the alliance because of the negative perceptions that were raised, nobody seems to be looking at any alternative.
And the most vocal critics had hidden agendas in their attacks on pharmacy.
The Australian Medical Association attacked the “flags” that were to be introduced into pharmacy software. Yet for many years “flags” appeared in the Medical Director software that appeared on the majority of doctor’s desktops.
Flags have now disappeared from that system, but it is only recent history and comment and comparison has been scant in that regard.
And “shock-horror” that the PGA should have a commercial relationship with Blackmore’s when the medical profession has been engaged in more large-scale relationships with drug manufacturers for decades, involving payments to doctors well in excess of being regarded as reasonable and above board.
And it is still happening, but on a reduced scale.
Not that it excuses either profession for engaging in such practices, but “people who throw stones……..”

APESMA, the pharmacist trade union has been trumpeting that it single-handedly engineered the PGA pull back to protect its members from unnecessary coercion to participate in the scheme.
The fact that the scheme had some months to come into being and planned pilot studies to be commenced seems to have escaped them.
That is, they were fighting something that was only in the “thinking-aloud” stage and none of their members were being threatened or coerced.
No party really knew what was to be involved, but APESMA plus a chorus of other political bodies saw an opportunity for spin – and took it.
These bodies included the Pharmaceutical Society of Australia  (PSA), the  National Prescribing Service (NPS), the Pharmacist Coalition for Health Reform (PCHR) and the Consumer’s Health Forum (CHF).

The NPS produced a small, first ever database of clinical evidence for nutritional supplements that did not support the use of regular supplementation for patients taking prescription drugs potentially or actually, depleting nutrients in the body.
The fact that it was produced so quickly and directed patients to a GP as a first line of enquiry meant that it was more of a “knee-jerk” than a considered response.
Pharmacists are trained to be drug experts and many have nutritional or complementary medicine qualifications.
The investor pharmacists represented by the PGA were mostly unaware of what was coming out of the alliance with Blackmore’s and would have simply ignored anything in that arrangement that was unsuitable.
So the majority of pharmacists have had to shoulder criticism for an activity they were never really part of.
Some have even voiced concern over to what extent their GP relationship may have suffered (those same GP’s who previously had drug trade name prompts at multi-levels of their desktop software).
Not much to worry about there!

The response by the PSA was to defend the reputation of pharmacists, and this is quite correct.
But having resolved the question of reputation, they have contributed nothing to solving the real problem which is how to create a “bottom–up” clinical service for a fee. This would take pressure off PBS margins and enable employment of newly graduated clinical pharmacists, while simultaneously introducing new revenue streams to provide clinical service expansion.

And more to the point, where does the PSA stand in the evidence debate?
As representative for the drug experts are they going to allow some other organisation to provide a database for evidence that can be relied upon by all health practitioners?
Does PSA see itself as central to this issue?

Australian Pharmacists need an independent repository for evidence claims plus an independent ratings agency as to the strength of that evidence.
Indeed the financial markets deem it necessary to rate the economies of various countries and their institutions, but we don’t seem to have any similar agency rating health evidence - that surely is a major segment of any economy?

It has been suggested that the TGA would be the appropriate organisation to be the repository for properly evaluated evidence.
With streamlining and website adjustments I would agree.
The only gap left, then, is who would provide the rating?
There must surely be an opportunity here for the health equivalent of a Moody’s rating service?

The first article by i2P surrounding the PGA/Blackmore’s alliance was titled
“Pharmacy Leaders Need Courage- a View of the Blackmore's Controversy”

While acknowledging that the PGA had made an error of judgement we uncharacteristically supported the PGA attempt, but not the mechanism.
We suggested that the PGA should be given the time and space to correct the problem which it has now commenced by walking away from the proposed alliance with Blackmore’s.
But that should only be a beginning.

The points we would like to reinforce are:

1. Having discovered the problems of trying to create a professional process without first embracing the profession, how does the PGA plan to create any future professional direction?
Using the lessons learned from this recent encounter will a genuine alliance occur with the PSA and will some of the elements of PGA policies surrounding clinical systems and programs be more appropriately delegated to the PSA (appropriately funded)?

2. Will any revised policies and procedures in lesser areas of professional activity e.g. software development (clinical and management) be more fairly dealt with so as to not obstruct private software developers from competing in the community pharmacy market?
For example, is it really appropriate that the PGA should be part-owner of an e-prescription system that may delay full implementation of e-prescriptions from ever reaching a true potential?

The PGA is encouraged to think through all of its activities and re-invent itself in a more collaborative and collegiate model, because the recent rebellion against the Blackmore’s alliance is only the tip of the iceberg.
Resentment has been building over a decade now and it is time for a full review, otherwise pharmacy will continue the professional slide it is already on.
We also ask the question again: Do pharmacy leaders have the courage to lead?

Footnote: Kos Sclavos, PGA president, did have the courage to apologise to pharmacists publicly.

Return to home

Submitted by Dr Ken Harvey on Mon, 10/10/2011 - 09:58.

Neil said, “Australian Pharmacists need an independent repository for evidence claims plus an independent ratings agency as to the strength of that evidence”.

I agree! Medical practitioners and consumers also need such a repository. However, it must be product specific. While there is good clinical evidence to support the use of certain complementary medicines (some of which have been registered by the TGA) the evidence is specific to a particular herbal extract or formulation.

Just as all red wine is not Grange Hermitage, different products containing the same herb (or other substances) are not necessarily chemically or therapeutically equivalent. [1,2] The TGA web site could assist by making it easy to find registered complementary medicines that have been properly evaluated.

1. CHOICE. St John's Wort: Studies show it helps relieve mild depression, but can you be confident the brand you buy will work? http://www.choice.com.au/reviews-and-tests/food-and-health/general-healt...
2. Vlad SC, LaValley MP, McAlindon TE, Felson DT. Glucosamine for pain in osteoarthritis: why do trial results differ? Arthritis Rheum 2007; 56: 2267–77.

Submitted by David More on Sun, 09/10/2011 - 21:16.

Neil,

The issue before pharmacists is to work out what they want to be and work out how to get there. They can be clinical professionals (paid fee for dispensing services and advice) or for-profit shopkeepers. I am not sure you can easily be both in the present environment.

This seems to be the core of the issue.

We have stopped most other professionals doing this sort of stuff conceptually - e.g. financial planners - to prevent conflicts (real or imagined) and I think the public now wants a clear view of who you are working for and whose interests you serve.

David.

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