s The Pharmacist Activist - Community Pharmacists are a National Treasure | 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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Newsflash Updates for July 2014

Newsflash Updates

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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The Pharmacist Activist - Community Pharmacists are a National Treasure

Staff Writer

articles by this author...

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

Editor's Note: Every now and then we publish excerpts from a US based pharmacy newsletter title "The Pharmacist Activist".
There are some philosophical similarities between this publication and i2P; its editor is a pharmacist named Daniel Hussar.
In this particular edition we note some US trends in respect of prescription plans.
Given that there are a number of dark forces working behind the scenes to introduce a health system to Australia similar to the U.S, we thought it might be informative to have a snapshot reference to understand what is actually meant by a managed prescription plan.
The recent attacks on the Australian health system through an extraordinary federal budget rationale that has the appearance of destroying Medicare, should be sufficient to put all health providers on guard.
For this current government, integrity seems to be a forgotten value.

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Managed care in all segments of health has proven to be expensive (through centralisation, concentration and manipulation), damaging to the health professionals conscripted into its delivery and not hitting the mark as far as patient health is concerned.
With the removal of profitability from the PBS and to stay alive, you are forced to do more with less - or automate your dispensary, join a prescription hub, harvest email addresses for a patient electronic newsletter, use prescriptions to leverage new services and do it all from an efficient website.
Also note that at least one warehouse pharmacy group is well down the track in this process.

Daniel Hussar's words follow:

http://www.pharmacistactivist.com/2014/April_2014.shtml

Pharmacy's National Treasure –
COMMUNITY PHARMACISTS!
But They are Threatened!

The extent to which members of the public are aware of and understand the responsibilities of pharmacists is almost always based on their interaction with community pharmacists. This is due, in part, to the fact that more pharmacists practice in the community setting than in any other area of pharmacy. However, more importantly, for the vast majority of individuals, the communication with their community pharmacist has been a very positive professional experience. These are the experiences they think of as they rate pharmacists so positively in opinion polls year after year for qualities such as integrity and ethics.

There are many dedicated and highly professional pharmacists in every area of pharmacy. However, very few people outside of my family and circle of friends know about my responsibilities as a pharmacist in a college of pharmacy. And the same is true for pharmacists in other areas of the profession such as hospital practice, long-term care practice, and pharmaceutical companies. We also value and benefit from the high ratings that pharmacists receive in opinion polls, but to what extent do we acknowledge and support the community pharmacists who have earned this positive reputation for all of us in pharmacy? WE DON'T!

Community pharmacy is the foundation of our profession. No other area of pharmacy would have started and grown were it not for this foundation (I will spare you the early history of pharmacy in the US when a group of community pharmacists convened to form the Philadelphia College of Pharmacy in 1821). Over the years additional practice settings and responsibilities have been developed within pharmacy, and many of these have had a more comprehensive, specialized, and/or professional emphasis and required additional training. However, even the combined influence and number of pharmacists participating in these areas do not come close to the number of community pharmacists and the scope/influence of this area of our profession.

Independent pharmacists

Pharmacist owners of independent pharmacies established the foundation for our profession, and have been the pillars (no pun intended) of this foundation during both good and challenging times. However, independent pharmacists are threatened and some have even predicted that they will disappear. I refuse to accept that prediction for many reasons. However, one of the most important reasons is that independent pharmacy may be the only area of the profession in which pharmacists still have some control over their responsibilities and professional destiny, as limited as that control may often seem.

The greatest threat to community pharmacy is the pharmacy benefit managers (PBMs) and the mail-order pharmacies they own. The PBMs steal patients from community pharmacies that patients have used for years (unless the PBMs also own the community pharmacies as CVS Caremark does). The following letter from CVS Caremark to a long-term patient of an independent pharmacy is an example of what is done:

Action Needed. Please Call Immediately To Ensure Your Refill Is Covered!



Dear xxxxxx xxxxxx:

We'd like you to know about an important part of your prescription plan: In order to save both you and your plan money, your plan design requires that you receive long-term medications in a quantity between 84 and 100 days at either a CVS/pharmacy retail store or through CVS Caremark Mail Service. It's important to call us toll-free at (xxx) xxx-xxxx as soon as possible to ensure that we are able to process your prescription without disruption. Our Customer Care team can then take care of obtaining your new long-term prescription(s) from your doctor and arrange for your next fill to be ready.

You will be able to choose one of these options:

Pick up at your local CVS/pharmacy

Use CVS Caremark Mail Service to have it delivered to the address of your choice in confidential, tamper-resistant and (when necessary) temperature controlled packaging. Standard shipping is available at no additional cost.

Our records show that your long-term prescription(s) for: (The name of the medication, prescription number, and date when dispensed are provided here.)

was filled at: (The name and address of the current pharmacy are provided here.)

Please keep in mind that if you continue to utilize the pharmacy identified above no additional fills of your prescription(s) will be covered. However, when you call the phone number listed above we can help you save money and get your prescription(s) without disruption through CVS/pharmacy or CVS Caremark Mail Service Pharmacy.

CVS Caremark is pleased to manage your prescription benefit plan. Learn about your prescription benefit and more by visiting xxx.xxxxxxxx.xxx. We are ready to help you save money and get your medications easily.

Sincerely,
CVS Caremark


Prescription "benefit" plans like this are a disservice to patients (or "customers" to use the terminology of the letter). It is also noteworthy that there is no mention in the letter of communication with a pharmacist or the services that pharmacists could provide. In my opinion, programs like this significantly compromise the pharmaceutical services and health care for patients and, therefore, increase risk. However, the profession of pharmacy has not been effective in preventing these programs that undermine the goals for which we strive.

Chain pharmacists

There are many very capable and highly professional pharmacists working in chain pharmacies, and some enjoy their responsibilities. However, many others do not. Their greatest threat comes from the executives and other decision-makers in the companies in which they are employed. The concerns I hear most often from chain pharmacists pertain to the stressful workplace environment, inadequate staffing (both pharmacists and technicians), very low salaries for technicians, the metrics and the clock (e.g., quotas for the number of prescriptions and immunizations; the number of minutes in which a prescription is expected to be dispensed; the number of rings within a phone call must be answered), no or limited time to speak with patients, the lack of professional fulfillment, and the intimidation of higher managers and a fear of retaliation. These concerns are even greater now than they were just several years ago because of the tightening of the employment market for pharmacists. Chain pharmacists who have concerns or even constructive suggestions are more reluctant to communicate them to their manager and above for fear they might be putting their job at risk at a time when employment elsewhere may not be available.

Many organizations and individuals within the profession are giving the highest priority to attaining "provider status" for pharmacists. It is anticipated that attaining this status will result in the provision by pharmacists of more comprehensive services for patients and the opportunity to be paid for these services. The Patient Access to Pharmacists' Care Coalition (PAPCC), comprised of 22 organizations, has been formed and I support its mission to develop federal policy that would enable patient access to Medicare Part B services and payment for pharmacists that provide them. The Coalition includes most (but not all, and that is another story) of the national organizations that we would expect to be supportive of this initiative (e.g., APhA, ASHP, NCPA, AACP, ASCP). The Coalition also includes chain pharmacies such as CVS Caremark, Rite Aid, and Walgreens, and this is where I have great concern. I do not believe that their concept of "Pharmacists' Care" comes anywhere close to what I and most of the national organizations of pharmacists advocate. The following situation is an example that underlies my concern.

There is litigation in Pennsylvania (Landay v. Rite Aid) that revolves around the question of whether individuals who obtain prescriptions at Rite Aid are considered "customers" or "patients." Shockingly, because it can charge more to provide copies of prescription records if individuals are classified as customers rather than patients, Rite Aid is insisting that those whom it serves should be considered customers and is appealing the decision of a judge who recognizes the broader responsibilities of pharmacists. (I encourage you to read David Stanley's column on page 17 of the April issue of Drug Topics). Rite Aid's obsession with charging more for prescription records undermines the professional standing of its pharmacists, and contradicts its company's message that it is interested in the health of its customers.

The Coalition mentioned above includes the word "Patient" in its title. Rite Aid should either withdraw its appeal of the judge's decision in Landay v. Rite Aid, or it should withdraw from the Coalition. It must not be permitted to continue its blatant hypocrisy. If it takes neither of these actions, the other members of the Coalition should expel Rite Aid.

The rest of us

Every pharmacist has a responsibility to give something back to the profession, and I would extend this further to indicate that every pharmacist has a responsibility to support community pharmacists in their battles against injustices and disservices that compromise the scope and quality of pharmacists'services. However, many of us even work at professional organizations, hospitals, colleges of pharmacy, and pharmaceutical companies that use the egregious prescription plans identified earlier, and most of us do not voice any concern about them.

For much of our history, independent pharmacists have had the primary responsibility of advancing and protecting the profession of pharmacy. However, they are now severely threatened by PBMs, mail-order pharmacies, and even the executives of chain pharmacies who should be allies in efforts to further strengthen community pharmacy.

In my opinion, the future success of the entire profession of pharmacy is inextricably entwined with the extent to which independent pharmacists can not only survive, but thrive. We all have a responsibility to support them!

Daniel A. Hussar

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