s Pharmedia: Oversighting Continued Medication | I2P: Information to Pharmacists - Archive
Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists


From the desk of the editor

Welcome to the July 2014 homepage edition of i2P (Information to Pharmacists) E-Magazine.
At the commencement of 2014 i2P focused on the need for the entire profession of pharmacy and its associated industry supports to undergo a renewal and regeneration.
We are now half-way through this year and it is quite apparent that pharmacy leaders do not yet have a cohesive and clear sense of direction.
Maybe the new initiative by Woolworths to deliver clinical service through young pharmacists and nurses may sharpen their focus.
If not, community pharmacy can look forward to losing a substantial and profitable market share of the clinical services market.
Who would you blame when that happens?
But I have to admit there is some effort, even though the results are but meagre.
In this edition of i2P we focus on the need for research about community pharmacy, the lack of activity from practicing pharmacists and when some research is delivered, a disconnect appears in its interpretation and implementation.

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News Flash

Newsflash Updates for July 2014

Newsflash Updates

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

Comments: 1

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Feature Contribution

Woolworths Pharmacy - Getting One Stage Closer

Neil Johnston

It started with “tablet” computers deployed on shelves inside the retailer Coles, specifically to provide information to consumers relating to pain management and the sale of strong analgesics.
This development was reported in i2P under the title Coles Pharmacy Expansion and the Arid PGA Landscape”
In that article we reported that qualified information was a missing link that had come out of Coles market research as the reason to why it had not succeeded in dominating the pain market.
Of course, Woolworths was working on the same problem at the same time and had come up with a better solution - real people with good information.

Comments: 5

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Intensive Exposition without crossing over with a supermarket

Fiona Sartoretto Verna AIAPP

Editor's Note: The understanding of a pharmacy's presentation through the research that goes into the design of fixtures and fittings that highlight displays, is a never-ending component of pharmacy marketing.
Over the past decade, Australian pharmacy shop presentations have fallen behind in standards of excellence.
It does not take rocket science - you just have to open your eyes.
Recently, our two major supermarkets, Woolworths and Coles, have entered into the field of drug and condition information provision - right into the heartland of Australian Pharmacy.

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The sure way to drive business away

Gerald Quigley

I attended the Pregnancy, Baby and Children’s Expo in Brisbane recently.
What an eye and ear opening event that was!
Young Mums, mature Mums, partners of all ages, grandparents and friends……...many asking about health issues and seeking reassurances that they were doing the right thing.

Comments: 1

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‘Marketing Based Medicine’ – how bad is it?

Baz Bardoe

It should be the scandal of the century.
It potentially affects the health of almost everyone.
Healthcare providers and consumers alike should be up in arms. But apart from coverage in a few credible news sources the problem of ‘Marketing Based Medicine,’ as psychiatrist Dr Peter Parry terms it, hasn’t as yet generated the kind of universal outrage one might expect.

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Community Pharmacy Research - Are You Involved?

Mark Coleman

Government funding is always scarce and restricted.
If you are ever going to be a recipient of government funds you will need to fortify any application with evidence.
From a government perspective, this minimises risk.
I must admit that while I see evidence of research projects being managed by the PGA, I rarely see community pharmacists individually and actively engaged in the type of research that would further their own aims and objectives (and survival).

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Organisational Amnesia and the Lack of a Curator Inhibits Cultural Progress

Neil Johnston

Most of us leave a tremendous impact on pharmacies we work for (as proprietors, managers, contractors or employees)—in ways we’re not even aware of.
But organisational memories are often all too short, and without a central way to record that impact and capture the knowledge and individual contributions, they become lost to time.
It is ironic that technology has provided us with phenomenal tools for communication and connection, but much of it has also sped up our work lives and made knowledge and memory at work much more ephemeral.

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Academics on the payroll: the advertising you don't see

Staff Writer

This article was first published in The Conversation and was written by Wendy Lipworth, University of Sydney and Ian Kerridge, University of Sydney
In the endless drive to get people’s attention, advertising is going ‘native’, creeping in to places formerly reserved for editorial content. In this Native Advertising series we find out what it looks like, if readers can tell the difference, and more importantly, whether they care.
i2P has republished the article as it supports our own independent and ongoing investigations on how drug companies are involved in marketing-based medicine rather than evidence-based medicine.

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I’ve been thinking about admitting wrong.

Mark Neuenschwander

Editor's Note: This is an early article by Mark Neuenschwander we have republished after the soul-searching surrounding a recent Australian dispensing error involving methotrexate.
Hmm. There’s more than one way you could take that, huh? Like Someday when I get around to it (I’m not sure) I may admit that I was wrong about something. Actually, I’ve been thinking about the concept of admitting wrong. So don’t get your hopes up. No juicy confessions this month except that I wish it were easier for me to admit when I have been wrong or made a mistake.
Brian Goldman, an ER physician from Toronto, is host of the award-winning White Coat, Black Art on CBC Radio and slated to deliver the keynote at The unSUMMIT for Bedside Barcoding in Anaheim this May. His TED lecture, entitled, “Doctors make mistakes. Can we talk about it?” had already been viewed by 386,072 others before I watched it last week.

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Dispensing errors – a ripple effect of damage

Kay Dunkley - BPharm, Grad Dip Hosp Pharm, Grad Dip Health Admin, MPS, MSHPA

Most readers will be aware of recent publicity relating to dispensing errors and in particular to deaths caused by methotrexate being incorrectly packed in dose administration aids.
The Pharmacy Board of Australia (PBA), in its Communique of 13 June 2014, described a methotrexate packing error leading to the death of a patient and noted “extra vigilance is required to be exercised by pharmacists with these drugs”.
This same case was reported by A Current Affair (ACA) in its program on Friday 20 June

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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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Pharmedia: Oversighting Continued Medication

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.

Editor's Note:
The medical profession have a history of dominating anything connected with health.

When a new extension of an existing discipline is developed to fill a niche e.g. clinical pharmacists, we see a parallel development coming out of medicine e.g. clinical pharmacology.
We see similar strategies occurring in offshoots such as pathology.
Laboratories that have sprung out of complementary medicine origins have their laboratory results refused by GP's and instead insist the patient have additional tests performed through their own associated laboratories.
This even occurs when the complementary laboratory has achieved the same national accreditation standard as any other laboratory.
Now there is a move to have all "non medical" prescribing monitored by a "watchdog" organisation.
The call for such an organisation comes after the 5CPA agreement was passed into law.
Included in the new agreement was a provision for "continued dispensing" that appeared to provide the trigger.
The Medical Observer reported the doctor's views (as indicated in the news item below) so we asked Mark Coleman to give some insights from a pharmacy perspective.

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Non-medical prescribing watchdog needed: UGPA

2nd Mar 2012

Mark O’Brien

A UNITED General PracticeAustralialeaders' meeting inCanberrayesterday called for an existing national agency to be commissioned as a watchdog on non-medical prescribing.

The UGPA meeting – made up of representatives from peak GP groups including the AMA, RACGP, AGPN, ACRRM and the RDAA – heard concerns about two reviews, by Health Workforce Australia and the National Prescribing Service, looking into issues around prescribing by nurse practitioners, podiatrists, physiotherapists, optometrists and others.

The call for a national agency to be given oversight of the issue came as the Fifth Community Pharmacy Agreement Initiatives Bill passed through federal Parliament, giving pharmacists continued dispensing powers for the contraceptive pill and statins.

AMA president Dr Steve Hambleton said the legislation had the potential to “seriously compromise patient care”.

“A pharmacist has no way of knowing whether the patient’s medical practitioner intended to continue the medication, to adjust it, or to cease that treatment altogether,” Dr Hambleton said.

“Who will be responsible if something goes wrong after the pharmacist has given the patient more medication without review by the patient's doctor?

“We now have a situation where a health profession is able to expand its scope of practice outside the national registration arrangements, without any consideration of the patient safety implications.

“Dispensing prescription medication without a prescription also presents a fundamental conflict of interest – the pharmacist is both the prescriber and the dispenser.”

Health minister Tanya Plibersek described the passage of the legislation as “a big win for patients” and said it would complement existing emergency supply mechanisms.

“Importantly, the amendment will give patients access to the medicines through the PBS, meaning they will not have to pay full price as they would using the current emergency mechanisms,” she said.

Mark Coleman

I am asked to comment on the above news item and provide relevant background.

Well, to kick off the commentary, let me say that this type of strategy by the medical profession is not new, nor does it come as any surprise.
Medical organisations have proliferated around any development that had the remotest potential to dilute their power base (in their view).
The history always illustrates a negative medical view, and for this reason pharmacy has tended to operate "under the radar".
Diagnosing and prescribing for common ailments has always occurred in pharmacy despite efforts by various medical groups to jump all over it.
I have always resented this intrusion by doctors who seem to feel they can pick up a phone and interfere with a pharmacist's practice by "divine right".

I can recall opening my first country pharmacy and introducing a blood pressure testing service when electronic monitors first came on the market.
This was introduced as a free screening service.
Imagine my surprise when a local GP telephoned me and suggested that I "stop playing the doctor".
I simply responded that it was not my policy to interfere in his practice procedures (and mentioned the flow of unlabelled drug samples distributed from his practice), and thus made an enemy for life.

There was no rational reason for that doctor to interfere in my professional activity.
When I began to refer those patients (that he also had on his books) with very high blood pressure, he responded by telling the patients that my equipment was inaccurate and not regularly tested, that I was not trained to take blood pressures, and as a final insult, cancelled the readings on the record card I issued and put in a reading that then represented the upper level of normal.

These patients were quite ill and many walked with their feet to other GP's.
In that process their entire health was put at risk.

This attitude is not isolated.
It often takes the form of a GP talking down to a pharmacist during professional conversations, channeling prescriptions as a form of retaliation (even though this is illegal), and generally behaving badly through other slights and insults.
The attitude can be described as arrogant, elitist, discriminatory, and in some cases, illegal.
Yet doctors seem to feel they have this divine right to impose their will on all things medical in pharmacy and Allied Health disciplines.

The objective is quite blatantly transparent.
In gaining control they soak up all the government dollars available and this has reached a point where government is now reacting to the high cost of health care that is not value for money, and is not integrated (for best outcomes), with other skilled health practitioners.

But back to the above news item.
I have no problem with some "watchdog" group overseeing prescribing providing it embraces all prescribers.
This means all doctors.
Nurse Practitioners are the only group that have been involved in any recent prescribing initiatives, and they have been made run the gauntlet in the decade that they have been developing this activity.
I am not aware of any serious problems resulting from their prescribing practices which are limited to their area of expertise.

But when you look at doctor prescribing the landscape is littered with casualties of inappropriate prescribing that reaches right back into the greedy tentacles of Big Pharma where we find fudged clinical trials involving doctors and medical academics all in bed together.

Other writers for i2P cover these activities better than I, but you have to wonder at the dishonesty and greed that drives this process.

The article above points to pharmacists (and others) not knowing what the prescriber's intent would be at the point of review of the patient.
This would not be a problem as pharmacists are trained to take a patient history and would have had a long association with the patient through dispensing.

I would also comment that any problems would completely disappear, if doctors had contributed to a shared patient record that was available for any patient health practitioner.
This is the primary reason that e-health development has been slow, cumbersome and exorbitantly expensive.
Doctor groups don't want to share information because to them, it represents a loss of control which leads to a loss of income. Patient welfare means nothing.

Because of all the above, doctors are continuing to lose respect and their position as leaders of the health care team (but this may be simply an illusion, because a permanent lack of cooperation means there was no team in the first place).

The statement appearing in the new item above-
“Dispensing prescription medication without a prescription also presents a fundamental conflict of interest – the pharmacist is both the prescriber and the dispenser.”
This is misleading.
My understanding is that there will be no fee for this service and that it is continuing the prescribing of a medical doctor for items they have already been taking for some time.
The doctor must bear the responsibility for any issues arising from their own prescribing and pharmacists are trained to pick up on prescribing problems.
Patient safety is hardly being compromised under those circumstances as precribing is only being "continued" and not "altered".

The argument about being "prescriber and dispenser" is also conveniently forgotten as doctors periodically lobby to own pharmacies.

Don't you get tired of all this one-eyed garbage?
If doctors just got on with what they do best and look for areas of co-operation instead of all the negativity they go on with, they might build back some respect.
After all, there is a small cohort of collaborative pharmacists and doctors who know through sensible practice, that patients respect and trust builds incrementally when they know both sides are in step with each other.
Every study that has ever investigated this effect reports only positives.
Why waste time?

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Submitted by Peter Kennedy on Thu, 08/03/2012 - 15:18.

"My understanding is that there will be no fee for this service"
You understand wrongly. The whole point of the Commonwealth legislation (which parliament has just passed) is to allow Medicare to pay pharmacists a fee for dispensing a month's supply of medicines without prescription or authorisation from a doctor. (The Commonwealth can't actually legalise pharmacists doing this, that can only happen when and if the various states and Territories amend their laws to allow it.)

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