s Pharma-Goss - With Rollo Manning - July 2009 | 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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Pharma-Goss - With Rollo Manning - July 2009

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.

Comment to the Editor or email Rollo Manning on rollom@iinet.net.au

THE ANSWER TO EMPLOYEE PHARMACISTS PAY PROBLEMS

It is not possible in 2009 to continue a business structure that worked in 1960. Back then pharmacists were registered on the basis of their ability to dispense. No question about that. The knowledge of the product forms (mixtures, creams, emulsions and suppositories) was an imperative. The drug knowledge avoided incompatibilities in compounded medicines and the indexing system of the script book allowed medication reviews to be done routinely.

Fast forward to 2009 – anyone can read a typed script, select stock from the shelf, enter details into a PC and produce the repeat authorization and label.

And yet – the staff deployment and wage structure is still the same.

Today the pharmacy graduate has a vast knowledge of Pharma... – all sorts of things – cology, kinetics, cotherapies, codynamics and so on.

This is NOT the knowledge required for dispensing – it is knowledge to act as a true allied health professional in a primary health care (PHC) system that needs all the multi disciplinary input it can find in the best interest of the client (patient or consumer).

How can pharmacists ever expect to be recognised in the 2009 PHC setting while they are still working with a model of the 1960s?

All concerned with a future of prosperity for the profession must attend gatherings to talk again about where the profession is heading and advocate for a change in the paradigm of pharmacy practice.

Have the retail shops but do not expect them to be propped up by a National Health Scheme that must concentrate on the best interests of the consumer (and taxpayer).

Stop tying PBS Approval to a successful retail business model.

Start establishing professional agencies (Pharmcare agencies) that are the provider of pharmaceutical care to its clients at a cost to the taxpayer for a quality service.

There are too many messiahs out there calling on the wisdom of the past to determine the future.

In the words of Professor Dexter Dunphy – “you can only understand the future when you start living it”.

Pharmacy must start living a future – not just talking about it and living in the past.

 

BIG PROFITS BRING BIG CRITICS

The recent media sniping at the Pharmacy Guild strengthen the call for a review into the infrastructure for supplying PBS medicines to the Australian public is need of a review. It is the opinion of this writer that this must be done before any future agreements are entered in to between the Government and community pharmacy interests.

It is the late 1980s since there was a review of “pharmacy earnings costs and profits” with the base established then being updated by subsequent agreements ratified by the Pharmaceutical Benefits Remuneration Tribunal.

The fact that excessive charging for under co-payment PBS dispensing is happening as revealed in the Daily Telegraph is a sign of the times. However back in 1988 the co-payment was only $11 and hardly a factor in creating significant profits.

But in 2009 with a co-payment set at $31.90 there is a huge market of non-subsidised PBS medicines that are being paid for by consumers. It is not known how big this is despite there being a commitment in the 4th CPA for this information to be made available. A “research” project is underway to determine how this can be done. Really? This is a joke! The answer is on the PC of every dispensary computer - take a sample agreed with the stats experts and you have it.

The generic drug market has also expanded in the last 20 years and this too needs to be factored in.

When a supplier can buy in at $2 and sell for $15 it is a good profit. No wonder there is criticisms of these profits being made by an agency working for the Government in supplying an essential component of a National Health system.

Pharmacists expect more so long as this situation exists.

ALAN JONES AT IT AGAIN

Sydney broadcaster Alan Jones went back in time four years when he supported community pharmacy against the recent calls for change especially the Daily Telegraph mentioned above and then following the front page in the Financial Review pointing to the 5th Agreement and likely problems for the Guild.

As far as Alan in concerned this is all part of the big plot to allow Woolworths and Coles to have pharmaceutical products in their supermarkets.

The rhetoric is the same as in 2005 when the same broadcaster went on the offensive for pharmacists against the threat of NSW legislation (allegedly) opening the door for Woolworths to have pharmacies.

So strong is the opinion of this voice in forming public opinion in Australia that one wonders how such a voice can be so far off the beam.

Sensitive area as is the pharmacies in supermarkets push by the Pharmacy Guild, that one could be excused of thinking that the Alan Jones button on the defence of pharmacies was pushed after the Guild alerted him to the need for another rant.

Money in the past has proved to be no barrier to telling a good story – as false as it may be. However back in 2005 when this writer suggested to Alan Jones that he may be getting paid by the Guild a quick response came back saying the suggestion was “idiotic”. The same will not be tried again in 2009 although the suspicions are still there.

 

BILL C OPENS PHARMACY OWNERSHIP DEBATE

The introduction of the new National Registration Authority for Health Professionals provides the opportunity for the question of who should own a pharmacy to be opened up as new legislation is needed in every State to ratify the status quo. However the introduction of a Bill to a Parliament always opens up the subject for debate and gives proponents for change the opportunity to put forward an alternative case.

The new Acts of State Parliaments to cover registration will only have the registration and assessment of professional standards. A separate Bill will have to be introduced to retain all those other factors that were in the previous Pharmacy Act and covered subject areas not included in the new laws. Expect some activity from the retail lobby that wants to see a loosening of the rules associated with the ownership of pharmacy.

One thing that one could be excused for putting money on is that Alan Jones will be in the mix somewhere.

The time has come for these business aspects of a retail small business to be included in legislation administered by a business or trade area of the legislature and NOT of a Health Department. That is if there needs to be legislation at all.

The old argument that pharmaceuticals are not ordinary items of commerce fails to draw interest while the discount stores flourish. Also the marketing aspects of pharmaceuticals are debated around the schedule of poisons register which is moving to a wider range of medicine products available in supermarkets.

It is possible to have a supermarket in a pharmacy but NOT a pharmacy in a supermarket. This has to stop and the market place used to decide who succeeds and who fails.

 

Send your subject suggestions to Pharma-Goss for comment.

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

 

Return to home

Submitted by Neil Johnston on Sat, 04/07/2009 - 09:17.

Conceptually, I have often been at loggerheads with Rollo, but on the issues discussed in Pharma-Goss this month, I am in full agreement.
Rollo has always taken the perspective from a consumer viewpoint while I have considered issues from the standpoint of a practitioner pharmacist.
The fact is that a professional service will not work unless it is acceptable and provides value for a consumer, otherwise there would be no interest in paying for it.
The trick is now for the decision makers in pharmacy to put aside their power plays and get down to the "nitty-gritty" of genuine consideration for the profession holistically.
This process has to embrace the restructure of a community pharmacy.
There is some evidence that this process has started (even Rollo and I are starting to agree!)

Submitted by Rollo Manning on Sun, 05/07/2009 - 12:32.

The imperative is to have a product that will sell. The position of a pharmacist behind a dispensary bench entering data into a PC and producing labels and repeats does not inspire anyone. Get out there and do what you are trained to do and progress might be made. Stay behind in the dispensary and get paid for what you are worth - very little in adding value to the prescribed medicine.

Submitted by Guest John Gibson on Fri, 03/07/2009 - 13:09.

I support Rollo Manning's call for a review into the infrastructure for supplying PBS medicines to the Australian public. I agree also that this must be done before any future agreements are entered into between the Government and community pharmacy interests.

Any review must take ino account the fact that there are thousands of well trained pharmacists working in the community whose skills are vastly underutilised and develop a structure that facilitates the use of these skilled in raising standards of care.

It is a national disgrace that the government has not tapped into this massive health care resource for the benefit of the public.

John Gibson

Submitted by Rollo Manning on Sun, 05/07/2009 - 12:38.

Thanks for the support John.
It needs more than you and me though. Lets hope other key stakeholders will band together and insist on a full review of the way medicines are supplied through the PBS to the public before any further agreements. I want to know where the legislative backing is for another agreement. Can anyone help on this? Is it written into the National Health Act that there must be a five yearly agreement or is it another ploy by the industry's lobby groups to maintain the good ole status quo?
Rollo

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