s Pharmedia - The PGA Role in Pfizer's Disruptive New Business Model | 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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Pharmedia - The PGA Role in Pfizer's Disruptive New Business Model

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.

Just in the last days before the 2010 Christmas break, Australian community pharmacy was confronted with a distribution coup engineered by Pfizer.
Essentially they announced that they were going to deal direct with individual pharmacies, with revised trading terms that were not going to be as favourable as the existing terms through wholesalers.
Nor were they going to deal with wholesalers or pharmacy buying groups.
The profession was stunned, but because of the timing of the announcement, it took a few weeks before hard questions began to be asked and reported in various pharmacy media.
The Pharmacy Guild of Australia (PGA) was uncharacteristically quiet and then Kos Sclavos, president of the PGA, made a statement through the Pharmacy News publication.
It seemed only to surface after other media pressure had built.
The enormity of the impications of the Pfizer decision for the whole of the pharmaceutical industry began to hit home as pharmacists began to analyse what was really going on, and the agenda and the flow-on problems that were going to be associated with the decision, in particular for community pharmacies and their wholesalers, also other major manufacturers.
The news release follows on below, and i2P has asked Mark Coileman to comment on this unusual train of events.

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"Pfizer’s new distribution model has sent shockwaves through the industry.

It is an audacious commercial move, and the Pfizer was not obliged to consult the Guild about its intentions.

Aware of significant problems when Pfizer made such a move in the UK some years ago, the Guild was pleased to be made aware of this market change, and to be given the opportunity to have some input.

The Guild entered a dialogue with Pfizer to do our best to protect members and ensure the best possible service delivery commitment under their direct-to-pharmacy model.

The Guild does not ‘endorse’ Pfizer’s model, nor were we asked to do so. We moved to secure a number of key tangible results for community pharmacy. Pfizer’s willingness to engage with us reflected our strong working relationship with them.

There will be an impact on pharmacy, and the wider industry, and the Guild’s job is to minimise that impact.

Pfizer is the biggest pharma company in the world. In many international markets there is limited engagement between them and pharmacy organisations, but thankfully that is not the case in Australia. Therefore via a legal agreement- a deed drawn up by our own Guild Legal lawyers - specific elements have been secured. That agreement lasts until June 2014.

* Neither Pfizer nor its chosen distributor DHL will access the CSO for Pfizer products.


* There will be service standards for Pfizer’s distributor which ensure that all but 17 pharmacies in Australia can place orders by 1pm and receive deliveries by the next working day. There will be a Monitoring Committee established with the Guild and Pfizer and sanctions will apply if standards are breached.


* There are agreed delivery costs and a list of essential and expensive medicines, for which there are no delivery costs no matter how many times those product are ordered.

Pfizer will be presenting a Commercial Deal Sheet which pharmacies are free to sign. The proposal does not involve the overt ‘bundling’ that is a feature of many generic company offers.

Pfizer has included trading terms for all pharmacies for their exclusive products even though they need not have done so being the only source of the product.

It is inevitable that the wholesalers will pass on most of the cost caused by Pfizer’s products leaving the channel.

There are however some efficiencies gained by the wholesalers not distributing these products.

There is a lot riding on Pfizer winning over pharmacists quickly. Seven Pfizer products account for over 70 per cent of their turnover. All those products come off patent over the next few years. To stay number one, they know they must win over community pharmacy.

While it is the Guild’s role to get ‘wins’ for our members, it is just as important on other occasions to minimise the detrimental impact of a proposal."

Mark Coleman

I have been asked to comment on what appears to be a very docile and wimpish statement by the PGA on this very serious turn of events that is set to bedevil the pharmaceutical industry in many ways from this point on.
There is no turning back - Pfizer have very carefully and thoughtfully put on the boxing gloves and made an extremely selfish decision.
Even though there has been some softening on extra deliveries at no cost there is no real change in direction by Pfizer.
The impact will be immediately felt on each community pharmacy bottom line and the wholesalers will feel they are in a very precarious position, because like the PGA they feel they have a limited response available to them, simply because of Pfizer's market power as the world's largest drug manufacturer.

Despite the quiet delivery  of this news by Pfizer, community pharmacy must declare war on Pfizer's market base to reduce their dominance, if they are to succeed in surviving against this attack (and others) that are already in the pipeline, or being planned.

The wholesalers have led a counter-attack using the Consumer Service Obligation (CSO) as the centrepiece.

Essentially, they want government to delist any PBS item that is unable to be delivered by a CSO distributor arguing that they cannot honour their existing contract with government unless this is mandatory.
The government, through Nicola Roxon can do a number of things, such as:

* Alter the existing agreement to exclude manufacturers dealing direct, to not be a breach under the rules of the CSO agreement.
However, that would be a very weak response and would simply lead to further crumbling of the supply chain as other major manufacturers followed Pfizer's lead.

* Agree with the wholesaler arguments and delist manufacturers who will not deal with CSO distributors.
The PGA will be supporting this position so it might come down as to how strong the PGA lobby is with government.
If Nicola Roxon fails to agree, not only are wholeaslers and community pharmacies put in financial jeopardy, but the entire supply chain system may eventually disintegrate with consumers being the ultimate losers.
Another loser would be the PGA as it would be seen to lose political influence and strength in the eyes of its members.

* Of course the PGA could come out and employ guerilla tactics against Pfizer, encouraging its members to form buying groups to employ commercial pressure against Pfizer products to reduce their market share. I am sure Pfizer has already considered this position and is the principal reason that a legal agreement with the PGA has been drawn up well in advance of the direct distribution decision being publicly announced.
As the PGA has already locked itself into this agreement, PGA members watching their negotiating body give in without a fight, and not advising them as soon as Pfizer intentions were known (some months before the actual announcement) must now be wondering how they are going to take up the fight to Pfizer without their elected leaders.
They have been successfully "divided and conquered"before the actual fight has begun.
These events will also be a critical test for the PGA as independent-minded community pharmacists begin to find one another and group together under different leadership.
That is what will be needed, and the same pharmacists will come to a conclusion as they begin to develop their own organisational infrastructure on a regional/national basis - what relevance is the PGA?
They have already frittered away gross margins within the PBS system, and they have antagonised the PSA in not giving equal negotiating status around the PBS table.
If they had let PSA in and developed some decent professional services, all pharmacists-not just pharmacy owners, would not be looking at this desperate mess.

* Of course there is a new opportunity for community pharmacy to form up regionally and link nationally under a single administrative banner. This type of infrastructure could coordinate the new national buying group supply chain, and take up regional marketing initiatives, as well as developing direct detailing communications with GP's. It will be vital to have majority GP support in this battle and the links forged could be progressively built into some form of cooperation model with the GP's.

GP's are notoriously difficult to deal with, but on a local level have to be more amenable because both sides are dealing with the same patients. What is good for the patient will win out.
Community pharmacy also has the opportunity to adapt the new logistics system
as a spearhead for a Pharmacy-in-the Home iniiative.
This could be easily done by broadening the buying group logistics service to provide a regional delivery service for individual pharmacy patients.
This is a marketing necessity to keep pace with the large and growing numbers of medically intensive elderly patients who may find difficulty in getting hospital and nursing home beds as appropriate.
They can then only be dealt with at home so it is imperative that pharmacy look to some sort of gatekeeper role into a patient's home.
This also opens up an entirely new connectivity market for IT systems geared to link all the players (GP's. community nurses, pharmacists and other allied health people) to a patient.
This is the direction to take.

Also, as Medicare Locals develop, a strong local pharmacy representation will be required to gain positions on the management boards. Currently, pharmacy is not geared to take its place in these new primary health care initiatives.

* While a process of regrouping may initially appear to be slow, it will quickly gather momentum as it is freed from the shackles that surround the PGA years of blinkered policy and structural neglect.

So while there is a heap of work to be done, there is a defined direction to enable local community pharmacy leaders to take control.
Until the peak organisations can sort themselves out there has to be a revolt in the ranks.
Properly planned, it will give current pharmacy leaders an excuse to break existing political ties they have locked themselve in to and then look to become effective in a new arena.
This I believe.

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