s Pharma-Goss - With Rollo Manning - August2009 | 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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News Flash

Newsflash Updates for July 2014

Newsflash Updates

Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
Access and click on the title links that are illustrated

Comments: 1

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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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Pharma-Goss - With Rollo Manning - August2009

Rollo Manning

articles by this author...

Rollo Manning has experienced pharmacy practice from all sectors of the industry – retail, administrative, policy and remote Aboriginal practice. He spent 10 years with Glaxo Australia and was the first Director of Public Relations at the Pharmacy Guild National Secretariat in Canberra.
He has also held the position of Pharmacy Policy Officer for Territory Health Services in Darwin.
Rollo is currently a Consultant working in his own practice with remote Aboriginal communities, in Northern Australia.

For August i2P

Pharma-goss - With Rollo Manning

For news behind the news.

Please comment on an issue raised by this column through the panel at the foot of this article.

 

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A SINGLE ISSUE COULD CHANGE THE WORLD

Single issue parties rarely succeed in a political race but one Sydney pharmacist believes the “location rules”, if abandoned, could change the pharmacy landscape for the better through the 5th Community Pharmacy Agreement (5CPA). The rules governing the distance between Approved Pharmacies for PBS dispensing are up for review during the course of the 4th CPA and will be “on the table” for negotiation if there is to be a fifth agreement between the pharmacies of Australia, represented by the Pharmacy Guild and the Commonwealth Government.

Tim Flaherty, who has owned some 20 pharmacies in his 20 years as a pharmacist told Pharma-Goss that the profession would always remain stalled on professional development activities while competition between Approved Pharmacies was so limited.

“The only way to improve things is by competition that would put everyone in a situation where they had to perform or go broke”, Mr. Flaherty said.

As a contribution to the 5th CPA the attached one page explanation (click here) of a world without location rules is offered by Tim Flaherty. He is urging all pharmacists to forward this to their local member of Federal Parliament so representations can be made to the Minister for Health, Hon Nicola Roxon.

“There is no reason to restrict the opportunity for young pharmacists to open a business wherever they like and compete with the ‘big boys’ for dispensing PBS scripts and add value with knowledge in the form of information to patients”, according to Tim Flaherty. “We have to get away from this idea that the system dictates the process and start focusing on the patient. While the Pharmacy Guild comes up with all the reasons why something should NOT be done the patient is the one that is missing out in the name of protecting the business interests of a pharmacist.” he added.

 

MISTAKES WE’VE HAD A FEW

Another report this month (July) pointing to the number of mistakes in the taking of medicines by Australians that has lead to hospital admissions. The headline in The Australian (8th July) said “Medicine harming patients” at the same time as pharmacy leaders were shouting to the rooftops the wonderful contribution “community” pharmacy could make in helping the Government implement its National health policy. Let’s be honest about this – pharmacists are still seen as the ones who supply medicines – put the labels on the boxes and hand them out – with little patient intervention and invariably with the pharmacist making no contact with the patient.

It is one thing to state that this can be done – but another to demonstrate through research what is happening now. Everyone associated with retail pharmacy knows that there are hundreds of pharmacy businesses that simply supply - so let’s get real and put the house in order before claiming to be able to do more that what is humanly possible.

A position exists around the country where pharmacists are being required to work a 12 hour day dispensing 400 plus scripts a day and thus without the time to have a lunch break. When is the time going to be available to enhance the preventive health measures of the government?

 

Structural reform is needed to make way for high volume dispensing outlets with the critical mass to employ enough pharmacists to use their knowledge in helping patients to understand the elementary elements of primary health care and the social determinants of ill health. Until this happens through a major restructuring of how the PBS is supplied to the Australian public pharmacists will be bound to the dispensing bench trying desperately to convert investment capital into useful dividends. This is not the climate for a successful primary health care approach to pharmacy practice.

In the ten years from 1998 to 2008 the number of adverse effects from medication rose by 20% and this at a time when pharmacists are claiming to be the most accessible and informed health professional at the coal face with the community. If it is that good these reports would not exist. Get on with doing what you are supposed to be doing well before branching out into something else and that includes the ability to prescribe. Nurses are fast becoming the number two behind doctors in prescribing stakes and pharmacists should be supporting them as much as possible with drug knowledge rather than trying to compete in the proscribing role.

 

SCLAVOS AT NATIONAL PRESS CLUB

It is the opinion of this columnist that if something is said passionately and often enough the audience might start to believe it is true. However to stretch the truth and use words that imply something is better than it really is leaves the speaker open to harsh criticism when the truth is found out.

Mr. Kos Sclavos, National President of the Pharmacy Guild of Australia, the peak National body for the owners of pharmacies in Australia, indulged in this poetic license when addressing the National Press Club in Canberra on Wednesday 29th July 2009.

In fact the billing alone is enough to turn off the honest listener. The Guild is a peak body for the owners of pharmacies and not health in Australia.

For some examples the following is from the address given by the Guild President:

(Reviews of the health system) no systemic issue was identified as being problematic with community pharmacy or the PBS.

Reviews are about identifying opportunities for improvement and it could be equally honest to say that no opportunities were identified for future involvement of pharmacists.

200 million prescriptions or 80% of PBS medicines dispensed each year to price is the same…$5.30 everywhere…

This is using a very bureaucratic definition of “PBS medicines”. At $5.30 the Pensioner/HCC price is the same by definition. However to make out this is a lot at 80% by excluding the huge volume of non subsidised PBS listed medicines is deceiving.

(The Guild) is the peak health organisation to help shape the PBS…

The Guild is the only organisation to represent the owners of pharmacy businesses – no more – no less. To say it is a peak health organization is extending the scope to a level that is not acceptable. The Guild is the ONLY organisation listed in the National Health Act with respect to the PBS so the PBS is in its charter.

…we invest our own funds in many projects.

With extreme help from the taxpayers of Australia through the $500 million plus for research and development through the 4th CPA. This is not “own funds”.

Community pharmacy is a $12 billion a year health industry

It is a $12 billion retailing business that has the license to distribute the PBS to the public.

70 per cent of that $12 billion comes from directly dispensing prescription medicines – about 250 million scripts a year.

Oh yes! So there are 200 million Pensioner/HCC scripts – so is this saying there are ONLY 50 million scripts for general patients? Surely the under co-payment dispensing is in itself a large number but one which the Guild is reluctant to state in case someone works out how much money is being made from that sector of the script market. Let’s have the facts on the total dispensing business and not try and make out that PBS subsidised is the only sector.

(Increased wages) will cost jobs…because every other sector can just put up prices but for community pharmacy the prices are fixed.

Garbage- the only fixed charges are the $5.30 and $32.90 patient contribution – and even these can be discounted. Surely this unbelievable statement would have made the listener wonder how Chemist Warehouse and Discount Pharmacies can get away with the lies they advertise. The Government cannot fix the prices – it would be in breach of its own Trade Practices Act.

Their (the 3200 line items on the PBS) average price is around $43

Wrong. This is the average of the items where the PBS pays part of the price and does not include the large sector of dispensing where the patient pays the full cost as there is no Government subsidy.

…the Australian public pay either (the $32.90 or $5.30 patient co-payment) wherever they are on this great continent – that’s a triumph for equity and access.

What!! Either $5.30 or $32.90? What about all the values in between that can vary depending on location (remote or urban), mode of shopping (Internet or mail order), and government policy – Queensland where PBS on hospital discharge is a flat fee. That is no triumph in equity but a competitive market place treating medicines as items of commerce.

While there is much media speculation about generic medicine prices there is no other area of the Australian economy that has that level of transparency.

And what about the discounts, bonuses and incentives that are loaded on pharmacies just to stock a range of generic brands. The Guild President knows as well as anyone how cheap these can get the buy in price down to – let’s see the consumer benefit from low prices. Where is the transparency?

 

Over to you Mr. Sclavos – care to respond to these comments?

 Send your subject suggestions to Pharma-Goss for comment by using the panel below.

Edited by Rollo Manning at rollom@iinet.net.au

 

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