s Pharma-Goss for September 2010 | 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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Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
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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 for September 2010

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.

Consumer welfare program or small business support program?

This is a controversial question that is sure to invoke hot debate.
It is to be welcomed.
Is the PBS a consumer welfare program as a part of a total National Health Scheme or a small business support program for retail pharmacies?
Where does the balance lie and is the consumer getting the best deal of the arrangements?
That is the question.
How dare such an assertion be made that suggests the Pharmaceutical Benefits Scheme may have lost its way and moved from being a part of a National universal welfare program.

The truth is that there were 197 million PBS items supplied by 5,000 Approved Pharmacies in the 12 months to 30 June 2010. The amount paid in “dispensing fees” of $6.42 each item means the total paid out for this component of the total cost was $1.26 billion. Add to this the mark up on cost of let’s say $4.00 on the average price of $32.84 that adds a further $ 788 million. The Safety Net recording fee of $1.02 adds a further $201 million giving a total $ 2.25 billion of a total of $ 7.93  billion.

28% of the PBS spend, or on average $450,000 goes to each of the 5,000 Approved Pharmacies.

Is this a concern of too large a spend or a subject to rejoice at the size of the spend going to retail pharmacies. No doubt the Pharmacy Guild would rejoice and say that this is the cost of maintaining an efficient, sustainable (and “world best”) network of pharmacies to distribute the PBS to the Australian population.

Well let’s have a look at what is obtained for that spend across the socio economic sectors of the Australian population.

The higher income families or individuals living in the more affluent suburbs of the cities and regional centres have any number of pharmacies to choose from to obtain their PBS and no doubt have as good relationship with any number of pharmacies. Take Lindfield in Sydney for example where there are six pharmacies within a two km radius. These people will receive their PBS medicines together with counselling and maintenance of their Safety Net record - should they spend an amount in excess of $1265 in any one calendar year they obtain their benefits cheaper.

The middle to lower income families or individuals will obtain a similar service to the above group regardless of where they live – be it an inner suburb of a big city (Collingwood in Melbourne has four pharmacies within 500 metres of each other) or on the outer fringes of a rural town. Geraldton in Western Australia has six pharmacies within 1.5 Km radius. Plenty to choose from and obtain the same advice and support as the high income earners.

In small rural and remote townships where there is one pharmacy again the same amount of dispensing fee is paid and the clients can expect exactly the same service as the urban dweller. In fact their pharmacy will get an additional allowance to ensure its sustainability over and above the amount already paid as part of their share of the National average of $450,000.

But if that pharmacy in the “one pharmacy town” is not performing and another pharmacy is seen as being needed to provide competition – market forces at work – a pillar of the free enterprise way of doing things - the new pharmacy would have to be located 10 Kms out of town – yes out with the abattoirs, wheat silos or sewerage farm.

Aboriginal Australians living in urban areas get an added benefit of a reduced co-payment on the cost of their PBS because of their added risk of acquiring a chronic disease – and that applies to all people over the age of 15 years “at risk” – which means everyone. $88 million is to be spent on this added benefit for the 370,000 Aboriginal people in urban Australia in the next four financial years

The people who miss out entirely are the remote living Aboriginals in communities with NO Approved Pharmacy and no access to a quality pharmacy service like their cousins in the urban areas or remote/rural towns. For these 150,000 people their health clinic obtains its PBS from an Approved Pharmacy but unlike the urban dweller with access to a pharmacist (at $6.42 a script for advice) they get nothing and yet make up one of the most disadvantaged and multiple chronic disease sufferers in the whole of Australia.

The question really is how equitably is the $ 2.25 billion being spent? Is it necessary to have so many outlets in the cities, towns and suburbs and such ludicrous rules pertaining to supply to people in remote places? Why is there not some special arrangement for dispensing to the most vulnerable of all Australians – who are living in Third World conditions – the remote living Aboriginals.

This writer hopes that in the course of the next 4.75 years and towards the end of the Fifth Community Pharmacy Agreement, some action can be taken to refer the PBS back to its roots of being  part of a universal welfare program for ALL Australians and less of a “cash cow” for too many retail pharmacies. That is one opinion – what is yours?

Any reader who wants to join this discussion or dispute any of the stats, figures or claims made in this item are invited to advise the author and keep in touch. Contact rollom@iinet.net.au or mobile number 0411 049 872
A PDF file Fact Sheet of this article with illustrations is available on request.

Mental health a big issue

So pharmacists get in there and play a part in helping to forge better relationships between people, organisations and government agencies. This will be the key to a more harmonious population in the future and at the grassroots community level is the place to start.

A full page advert in the daily newspapers listed 65 organisations that are members of the Mental Health Council of Australia and NO pharmacy organisations are included.

How long does it take for the so called peak organisations to take their responsibilities on behalf of the profession seriously and start talking to others?

The Pharmacy Guild talks about its key role and this is challenged by the Pharmaceutical Society of Australia saying that it really represents the total profession.

Maybe it is time for both to stop arguing and get on with liaising with other key organisations. The mental health of pharmacists is at stake and better relationships will go along way to building better links and forging partnerships.

For those interested have a look at the full page ad can be seen at

http://www.mhca.org.au/documents/MH_end%20the%20neglect_A3_print3.pdf

As this columnists likes to say –“It is not until you are out there doing it that anyone will know what you can do”

In terms of the future we must be talking with others and not just doing research is our own little cocoon of medicine supply experts – even this can be questioned. Any number of “roadmaps” and “paths to the future” will be worthless if the basic direction is flawed and end goal not clearly articulated and agreed with the profession as a whole.

See next item – A future role for graduated pharmacists.

A future role for graduated pharmacists
The Early Graduated Pharmacists Group of the Pharmaceutical Society of Australia is to be congratulated on its stand in seeking a wider role for pharmacists in primary health care. Just because a person is a “pharmacist” does not mean they have to be confined to the supply of medicines. The degree of Bachelor of Pharmacy should be only the starting point of a career that could take the holder anywhere in the health sector of the economy. People holding the degree can be found in over 12 different government departments at both the State/Territory level and Commonwealth public services. Jobs for policy officers are being continually advertised is areas of expertise where pharmacists have a basic training. Give it as go. If you would like to see more of the opportunities that exists and training options needed or offered to do the work effectively write to the author at rollom@iinet.net.au for a list of opportunities.

QUOTE OF THE MONTH

If a free society cannot help the many who are poor, it cannot save the few who are rich.
John F. Kennedy
(1917-1963, 35th American President)

Return to home

Submitted by Karalyn Huxhagen on Sat, 11/09/2010 - 10:43.

Hi Rollo raises a few issues that are still on the table even though a lot of money has been spent trying to make the access to pharmacy services more equitable for all Australians.

We now have several systems in place for the Aboriginal and Torres Strait Islander people to access pharmacy services. We have section 100 supply in remote communities which is the most ass about system in terms of providing quality pharmacy services.

Then we have Closing the Gap services for PBS copayment for urban dwellers, public hospital supply and QUMAX that provides other services like DAA's and access to pharmacy services.

So in fixing one problem we have created another as there is no connectivity between these programs. Therefore the more mobile of the Aboriginal and Torres Strait islander people are accessing different systems with different eligibility rules and payment structures. It is confusing to say the least.

In some communities we have different systems being managed by the practice as the outlying station is remote while the central Aboriginal health service is urban.

Then there is the Australian Pharmacy Council report " Remote/Rural Pharmacists project Final Report 2009" which provided recommendations on alternative modelling for pharmacy services in remote and rural communities. All major bodies including the Pharmacy Guild of Australia were part of the working party that developed this report. The PGA has publicly claimed that the APC report has no worth and dismissed its outcomes.

These issues have also been raised with the Australian Health Ministers rural steering group in a series of workshops around Australia

A lot has been done in the past 10 years but we still have a very long way to go.

Pharmacy services to outreach areas of Australia is not a pipe dream that can never be solved. There are so many models that already work in small pockets in both Australia and with other cultures like the indigenous people of Canada and America.

What we need is a willingness to look at the whole package of health services in these locations and develop protocols that allow pharmacists to do more than drop off a bundle of drugs (S100).

we can be providing health screening services, immunisation, chronic disease monitoring and oh so much more

I had hoped that the current Minister would have seen the opportunity for pharmacists expanded roles in what he has been presented with but alas the funding has gone to GP services and Divisions of GPs once again!!!

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