s Picture - the wood for the trees | 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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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
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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Picture - the wood for the trees

Pat Gallagher

articles by this author...

Patrick Gallagher is well known in Information Technology circles. He has a vital interest in e-health, particularly in the area of shared records and e-prescriptions, also supply chain issues. He maintains a very clear vision of what ought to be, but he and many others in the IT field, are frustrated by government agencies full of experts who have never actually worked in a professional health setting. So we see ongoing wastage, astronomical spends and "top down" systems that are never going to work. Patrick needs to be listened to.

Another year has gone by and what have we done with technology in the health sector?
A good question that deserves a long and detailed review as a written dissertation by somebody learned and influential in health informatics, government, consulting or from the many agencies, departments and committees engaged in delivering e-health service to the Australian public; notably as a value proposition for the tax payers in the greater voting public cohort.

 

An E-health platform for all Australians is a goal that is so simple to express but one that seems to be bogged down in favour of endless policy, governing, enabling and service delivery announcements at the government levels of our society, as well as the interfering social engineers and hand-braking representatives scattered throughout the nation’s Health community.

There are two technology platforms as I see it: the underlining business use of ICT – supply, finance, assets, administration and the other is the clinical e-health applications. Both are pretty much in the same leaky boat.

In plain English - we haven’t seen done much done at all.

In this electronic publication I don’t have a role or the time to write the e-health application landscape review, even if I was remotely learned or influential, which I’m not.

If you read my monthly pot shots you will know that I do try to observe and criticise from a bottom up perspective which is focused more on the business use of ICT. Because I see immediate benefits for the taxpayer, the patient and ultimately the front line clinicians in terms of the use of business technology to realise huge savings to help bring about a brave new world.

Ironically the one good news event this year is the launch of prescription hubs.

Hooray for entrepreneurs, because in spite of the $millions spent on the top down policy and transitioning agencies – no one else has delivered anything of note.

So to bring 2009 to an end, how best to summarise this malaise we find ourselves in?

Keep it simple; keep it concise and to keep it interesting would seem to be a good idea; so to that end here below is the world today in ‘pictures’.

 

E-health in its many forms and with its many promises more or less kicked off in 2000 when the three-day ‘Health Online Summit’ attracted an audience of 700 enthusiastic delegates. If someone had stood up then and predicted that this is where we would be by 2009, he or she would have been stoned by an angry mob.

Since then there have been events and organisational input from PeCC, MCCA, ACOM, BMMS, HealthConnect, SmartHealth, HISA, IT-014, NeHTA and whoever else I have forgotten.
These people had a collective view that what was needed was a three tier answer –

a) policy and funding;
b) enablement and change management; and
c) implementation at the service delivery level.

 

What was seen to be needed was a clever outcome

 

 

 

 

Over the next little while, as the ideas and aspirations spread, this three-tier model, and by then its 100 sub-clauses and rules, had become a vision that changed the three-levels to also mean the three strands of security, privacy and interoperability.
So the picture changed somewhat to this:

What a series of consultants suggested the picture should be

 

Our story then moves on to a period when the powers-that-be decided that, above all else, the system needed strong roots and a strong centre piece that only a control freak could love - and thereby changed the picture so that they, the central powers, would be placed - smack bang in the middle

Clunk!
Bureaucracy rules, OK

 

But of course these intentions and self serving activities went haywire as the messy plot unfolded and other people took a look and decided that they must intervene and set these things right.
Right?

So something like this emerged

Gaps and work arounds started to multiply

 

Oh joy”, some people cried, “how clever are we?
Well yes.
That was also a good question so they thought a new consultancy, or three or thirty-three, was needed to sanity check the incredible magnificence as they knew it.
Tenders were written, tenders were reviewed, meetings were held, workshops and seminars abounded, and at last a picture emerged that to get this ‘right’ we needed to go back to basics, and paradigm shift ( a consultant term that is meaningless but looks good on Powerpoints) the picture to something that consultants can  manage for you.
From end to end. And back again.

When in doubt, start afresh, eh? Oh, and that will be another $5 million – thank you

 

So the destruction, (sorry I meant he development) program entered into a statutory mess of mixed opinions that had many people see the same thing a different way.
So out came the call for more studies and more reporting and pontificating and several pictures then became in vogue, a bit like this.
With the fourth view being that of the environmental advisors, who never seem to get anything right!

A system for all seasons, all people and all budgets

 

This sophisticated view would not however be a very useful way to explain the vision to dumb politicians and even dumber taxpayers, so over time it was decided that they needed to sell the program to the pollies and the proles by letting them see this picture.

The promise of all things to all fools, eh, people

 

This was all well and good but by this stage the uncomfortable awareness that things were going to change reached those in our society that know better than the rest of us how things must be.
And so the nannies got into the act and demanded that everyone be protected from imagined threats and indignities never before suffered by modern mankind (oops, modern people-kind).

Nonsense of course – as if anything held on paper was protected or secure – pure malarky. Nevertheless the picture started to change again so that it looked a bit like like this:

If it wasn’t this way it must be no way

 

As time went by, budgets blew out, consultancies blew up, gravy trains went into overdrive and a gaggle of fools (er pressure groups), got control over many agendas and put the case to do things the ‘appropriate’ way.

Appropriate meaning practically impossible -but do it anyway

 

Meanwhile, and in all seriousness, the punters were starting to get a feeling that
a) something was crook in Tallarook;
b) those in control don’t seem to know what they are doing; and,
c) yet all the  propaganda, promises and press releases keep on coming to tell us that  ‘all will be well’. With a heavy dose of good old cynicism many people started to see a pretty bad picture looming up on the horizon.

Mixed messages started to deliver worrying outcomes

 

Whereas the really cynical among us began to picture a very sad scene along the lines of what will we see in our lifetimes.

“Don’t you worry about that” scenario because it aren’t ever going to happen

 

As an intelligent reader you will know by now what is coming next.
That  is, the question – “where the hell are we today?”

In project management terms the panic sets in when the fear of failure overtakes the staunch determination to deliver, no matter what.
When that happens events turn to  the subtle view of displaying a soothing picture that says ‘not working yet’, as below

Which is failed and flawed – almost nowhere in the large scheme of e-health things.
There are of course some bright spots and successful e-systems being used, that indicate if it is done right the benefits are well worth  waiting for.

So at this point, to use the tree analogy, the policy level has been designing a gigantic one-size-fits all monster (tree) system, that will be lowered  down from the top onto the user community.
Whereas what should have built was one little sapling at a time to gradually achieve a forest of working solutions.
Because after all, at the beginning, and at the end, the proverbial question is ……..

What did the individual users and patients simply need?

 

Frankly the underlining reason for perpetuating this policy mess is that people have tried to change the world unnaturally.
Big bang, wet dream, super-dooper systems rather than husbanding little changes, one step at a time, to achieve workable and sustainable evolution.

Most know that doing one thing right, even if it is tedious, slow, boring and pure hard work, is the better way than doing 100 things badly. 
Trouble is that this old fashioned truism really does  means that tedious, slow, boring and actual work has to be done.

Who wants to do that?
Not many elite volunteers it seems.

My view is that Australia has avoided the starting point of using the proven methodology to first map what happens in a paper-held information regime including how the data is manually exchanged. 
To then keep the good bits, throw away the bad habits, eliminate the unnecessary steps and replace them with a simply faster electronic alternatives.
An e-system that delivers better services more efficiently and more conveniently to a majority, rather than trying for 100% perfection to pander to extremists.

One bit of rope, one rubber swing, built in many ways for many uses

By this time there should be a forest of robust interrelated electronic saplings delivering on the promise of  vastly improved care for all Australians.

As we approach  ten years since the ‘Health Online Summit’ any question that starts with “What the hell…………….” - is certainly worth asking; trouble is where will the answer come from?
Worse, at no time over the years has any announcement or commitment ever been made to the Australian public on the detail of how to deliver e-health to the population at large.

One of these might help of course if you can find  anyone to ask why the hell not!.

I will leave you swinging into a safe and happy Christmas and so let me end by saying all the best to you and yours for a wonderful New Year.

Perhaps 2010 will be the tipping point year –perhaps not . We will check it out this time next year

Seeya

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