s Pharmacy Renewal-Will it be Modelled on Price or Service? | 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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Pharmacy Renewal-Will it be Modelled on Price or Service?

Neil Johnston

articles by this author...

Neil Johnston is a pharmacist who trained as a management consultant. He was the first consultant to service the pharmacy profession and commenced practice as a full time consultant in 1972, specialising in community pharmacy management, pharmacy systems, preventive medicine and the marketing of professional services. He has owned, or part-owned a total of six pharmacies during his career, and for a decade spent time both as a clinical pharmacist and Chief Pharmacist in the public hospital system. He has been editor of i2P since 2000.

It was a grey and wet Sunday afternoon when I recently watched a program produced by the ABC about Faram Brothers, one of the last independent hardware stores.They closed their doors in a Melbourne suburb (Port Melbourne) circa 2007.
It had been an institution in Port Melbourne since the very early 1900’s and attracted my attention because of the historical perspective it covered.
But it also paralleled the story of pharmacy over the same period, because it had started life as a family business that by choice set out to be as helpful as possible to the community, and valued the retention of customers through goodwill and providing service well above customer expectation.
And in some cases, well above the ability of those customers to afford the service they received (but they still received it nonetheless).

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It was a great story illustrating not only how excellent customer relationships were built over the decades, but was also an effective demonstration of how staff relationships had been cemented over the same period.
Staff turnover was virtually nonexistent and each staff member was a long-term employee and totally loyal and dedicated to the survival of that business.

It was a text book story of how customer service should be, but it was also a graphic story as to how market forces changed the local environment and how this initially successful business eventually reached its “use by” date.

Immigration and new home building sustained the initial growth phase of the business. Industrial development and the rise of a range of engineering workshops sustained the business growth until the end of the 20th century until both these activities went into decline.
Market forces causing population movements and cultural changes within the local community eventually had its effect on the hardware business to the extent that Faram Brothers had to close their business and auction off the premises and remaining stock.
As one staff member ruefully pointed out, there was now an ability to sustain six coffee shops and almost the same number of hairdressing salons, but no ability to sustain even one hardware store.

What was heart-warming was that once the news of the imminent closure of the hardware store became general knowledge, customers old and new came to pay a visit to a local business that had been a “good friend” and an integrated part of their growing up. They came from everywhere, just to soak up a last impression of something that had obviously been something more than just a business transaction.
This has also been the experience of many pharmacy customers that many seniors remember. although the memory is diminishing each year with their passing.
It is also the reason that pharmacy has scored high in the annual Morgan-Gallup poll each year (but now trending downwards as seniors depart).

I too can remember the wonderment of these types of hardware stores, which to a  young boy represented a virtual Aladdin’s Cave, when I needed spare parts for my billycart and various bikes that I owned over my childhood.
The advice and help I received in keeping these vital methods of transport going by my friendly hardware man, was indispensable.

In reflecting on the changes that I have personally experienced as a pharmacist, I was able to align with every experience that Faram Brothers had gone through.
As one commentator said about the film:
“The film chronicles the last days of the Faram Bros Hardware in Port Melbourne and deals with the impact of changing demographics in inner urban areas, the resulting sense of loss and the need for renewal.”

The need for renewal!

That got me to thinking about the current experiences in pharmacy that have been evolving since the late 1970’s and I have reached some conclusions that may help illuminate a pathway for pharmacists in general:

1. Pharmacy (more specifically community pharmacy) has reached its “use by” date in its current format and that on April 1 2012 and beyond, will be unsustainable if any attempt is made to remain fully in that format.

2. Pharmacy is in urgent need of renewal to create the environment for innovation that will absorb the current oversupply of pharmacists and provide them with creative work choices that are both interesting and sustainable.

3. As part of the renewal process, pharmacy will need to rid itself of all protectionist mentality and be prepared to survive within its own competitive skill set as the primary means of success and survival.

4. Pharmacists will have to develop professional practices that give them a “hands on” interaction with their patients. They must also develop a direction towards integrative medicine.
While many may vehemently disagree with me, I believe the allopathic practices we are forced to currently observe have also reached a “use by” date. These practices vary from the corrupt to the unrealistic and are as far away from true patient care as you can get.

5. In any renewal process, the original model is usually destroyed with only the best of the “old” elements carried forward after a full revision.
Pharmacy renewal means also renewing pharmacy political structures (do you know any pharmacist that really respects the current versions and is truly happy with them?), the transitioning of true and useful pharmacy services (both clinical and supply) and the will to fight for a pharmacy place in the sunshine in its own right, and not as the handmaiden of the medical profession.
Government shackles have also to be thrown off.
Government now owns pharmacy destiny through the PBS and its heavy hand is very destructive. Time to stop fence-sitting and being timid and exchange this attitude and thinking for something more positive and disruptive.

6. In a sense, some renewal is occurring through the development of warehouse pharmacies. However, I believe the current versions are fatally flawed, but do have the ability to transition to something more sensible and durable.
At least there are a few risk-takers at work here.

The lesson from Faram’s hardware store has been illuminating and positive.
On one hand it has illustrated how a fully service-oriented business retains loyalty and profitability for very long periods.
On the other hand it entrenches an attitude that refuses to adapt and create innovation and change.
Many pharmacists (including myself) long for the “good old days” where job satisfaction and job security seemed impregnable.
This is why pharmacy location rules have to disappear to allow market forces to prevail and create a renewal climate.
The seeds of preservation that created the location rules are now the seeds of destruction.

Perhaps the biggest lesson that I have personally derived from the Faram story is the fact that in the perpetual contest between price and service in a retail environment, price will always prevail.
Service will allow for a price premium to emerge, but that has to be permanently monitored. Because base prices are always changing and eroding any renewal pharmacy model will have to always be price competitive.
Any service premium will have to be justified and fought for, because consumers are quick to establish value in their own minds. Larger retailers such as Bunning’s Hardware have pared down the small retailer advantage of superior services because they have focused on developing a “store within a store” for all the various departments”.
As one blogger commented online:

“Last Sunday, I was at Bunnings buying a $23.50 bag of hay and four packets of seeds.
I was struck by the zeal of my fellow shoppers, who found palpable pleasure at actually being able to find the 12mm self-tapping screws. Even those who waited in seemingly endless queues had perma-smile grins ironed to their face. These hardware shoppers looked as happy as Hillsongers after a good clap and sing.
It made me think Bunnings had somehow elevated itself from a humble hardware store into an ecclesiastical retail experience. After all, the airline-hangar-sized stores must seem as spiritual as the 5.7acre St Peters Basilica in Rome back in 1626. Even the red-shirted Bunnings sales assistants talk in tongues:”The toggle switch resets can be found in aisle 6,457”
Had Bunnings somehow called upon God to make hardware interesting? How do shoppers spend so much time in there without praying for divine intervention?”

This may have something to do with the “sausage sizzles” made freely available and the fact that a more relaxed and friendly atmosphere results because of this, making Bunnings more of a meeting place than a commercial environment.
Whatever their secret, pharmacy is finding it hard to replicate a similar environment to arrest the erosion of its customer base as did Faram’s Hardware Store.
They had all the ingredients but failed to make the conversion.

So what are your plans?
Do you have one to transition to a renewal model and will you be part of the movement that sets this transition in motion.
Or are you going to complacently enjoy the demise experience that Faram's went through because they were not quick enough on their feet to think through some positive change.

Pharmacy has been a great experience and I enjoyed it at its peak.
I feel very sorry for those of you who do not see opportunity and are a bit slow-footed.
I feel even sorrier for those young pharmacists who have been let down through their inheritance of a pharmacy model that is rusting and badly in need of a complete replacement.
They will have to pioneer a new direction without the necessary experience or resources held captive by a generation of pharmacy owners that have forgotten what service is, or the need to put something back into a profession that you have taken from.

See also earlier related articles:

* Where is the Best Future Business Model for Pharmacy?

* Pharmacy Needs a Peak Body

* Nicola Roxon’s Parting Advice

* Does the PGA Really Represent its Members

* Come to Shop – Return to Learn

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