s Progress with TB or a Return to the Dark Ages? | 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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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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Progress with TB or a Return to the Dark Ages?

Staff Writer

articles by this author...

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

This material has been provided by the Orthomolecular Medicine News Service
http://orthomolecular.org/subscribe.html ) and is archived at
http://orthomolecular.org/resources/omns/index.shtml .
The article was jointly written by Steve Hickey PhD and William B Grant PhD
(OMNS June 17, 2013) Tuberculosis (TB) was formerly one of the most devastating scourges of mankind and remains a leading cause of death.
The disease has been with humans over recorded history, and likely throughout the evolution of our species.
Through the industrial revolution and into the 20 century, TB became a long term medical emergency particularly with the poor.
Roughly one person in four was dying of the disease in England and similar death rates were observed in other modernising countries.
One solution was to isolate the afflicted in sanatoria.
The fresh air and sunlight solution practiced in those times may have been at least partly effective.

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Sunlight and vitamin D played an early role in preventing and treating TB. In the early 20th century, TB patients were often sent to sanatoria in the mountains where they were exposed to solar radiation. Dr. Auguste Rollier set up such facilities in the Swiss Alps. [1] Sun exposure is associated with a lower incidence of TB six months later. [2]. It wasn't until 2006-7 that researchers at UCLA determined how sunlight increased vitamin D levels and helps the body's immune system prevent bacterial infections [3]. Higher blood levels of 25-hydroxyvitamin D can reduce the time required to control TB during treatment. [4,5] Recent research suggests the sanatoria approach to treatment could have been at least partly effective.

The modern myth about conquering infectious diseases such as TB is that vaccination and antibiotics came to the rescue, saving humanity from the earlier suffering. However, TB like the other major life threatening infections had already declined to a low level before these interventions were introduced. The tubercle bacillus was identified by Robert Koch in 1882 [6] by which time the death rates in England and Wales had already reduced to about half the earlier levels. The introduction of the drug isoniazid in the early 1950s was a breakthrough in antibiotic treatment but had little effect on overall mortality. Similarly, BCG vaccination was first tried in people in the early 1920s but its widespread introduction was delayed until well after World War 2. A chart of mortality from TB shows its historical decline in England and Wales for which the most extensive historical statistics are available. [7] The decline of TB was similar to the reduction in mortality for the other major infectious diseases. This graph illustrates the relative contribution of vaccination and antibiotic chemotherapy. By the time these interventions had been introduced, the major infections had already been largely defeated.

The question raised by this graph is what really caused the decline in death rates from TB and other infections. We can answer this easily and directly. Firstly, TB did not go away. There is a reasonable chance that a reader is harbouring the disease. Roughly one person in every three in the world (2-3 billion) has the infection. However, only 10-20 million have the active disease. So only one person in every 100 or so infected will have any symptoms. The rest will happily coexist with their "infection" without concern.

TB Mortality Per Million

http://www.orthomolecular.org/resources/omns/v09n12-graph.jpg

People who come down with TB have poor or compromised immune systems. The disadvantaged were living in crowded and damp slum conditions. Although such conditions facilitate spread of the infection this explanation is insufficient. Poor nutrition provides a more direct explanation of why only some of the infected go on to succumb to the illness.

TB and Vitamin C

Despite the data strongly suggesting the impact of nutrition, corporate medicine has consistently decried the use of supplements. Recently, however, there has been a long overdue development. Catherine Vilcheze and colleagues have returned to testing the extraordinary antibiotic properties of vitamin C for TB.[8] They was found that "M. tuberculosis is highly susceptible to killing by vitamin C" [3] which is consistent with previous data. [9] Notably, the mechanism of action is similar to vitamin C's anticancer role in generating hydrogen peroxide locally which kills the unwanted cells. [10] Notably, we have been using antibiotic treatment of TB as a model for the role of vitamin C based redox therapy for cancer. The same mechanism is used to protect the body against both microorganisms and abnormal cancer cells.

Supplementation with vitamin C may prevent TB infection from becoming overt. Furthermore, vitamin C could provide an effective biological treatment for TB with the advantage of a mechanism refined by millions of years of evolution. As scientific history demonstrates, good nutrition, particularly vitamins C and D, are likely to be far more effective than antibiotics and vaccination in preventing this and other dangerous infective diseases.

Vilcheze's suggests that drugs with a similar mechanism of action to vitamin C might be developed (presumably with great commercial advantage). However, such drugs are an unnatural intervention, and are likely to have unnecessary side-effects while vitamin C is safe. The rather obvious implication of providing high-dose nutritional supplements is once again ignored. If supplementation were to be widely applied, our society may find controlling TB is unexpectedly easy.

The recent history of antibiotics is one of misuse leading to microbial resistance. Following Multiple Drug Resistant TB (MDRTB) and eXtensively drug resistant forms (XDRTB) we are now faced with Totally Drug Resistant forms (TDRTB). The increasingly ineffective antibiotics have helped promote the return to study vitamin C as a potential treatment. However, we may be faced with something far more threatening. The history of antibiotic abuse is not reassuring. It may be possible to generate more virulent forms despite Vilcheze's confirmation that resistance to vitamin C is exceptionally difficult to induce. The use of drugs with a similar mechanism to vitamin C may lead to resistance to our basic biological defence mechanisms. In other words, corporate misuse of this latest development could return us to the dark days of uncontrolled infections when TB was killing 1 in 4 people in the developed nations.

Conclusion

Much of the recent freedom from deadly infectious disease reflects historical improvements in nutrition. Over time the mechanisms by which nutrients help people be more resistant to infections are being elucidated. Increased levels of vitamin D may have provided a lower risk of TB and other infections as well as the deficiency disease rickets. It now appears that vitamin C is "extraordinarily" effective in killing the TB microorganism. Importantly vitamin C kills TB in essentially the same way as it destroys cancer cells. Linus Pauling, Robert Cathcart and others may have been prescient in suggesting vitamin C provides a unique way of maintaining good health.

 

For further reading:

To access forty years of articles describing orthomolecular approaches to health management and treatment of disease visit http://orthomolecular.org/library/jom/

 

References:

1. Hobday R.A. (1997) Sunlight therapy and solar architecture, Med Hist, 41(4), 455-472.

2. Koh G.C. Hawthorne G. Turner A.M. Kunst H. Dedicoat M. (2012) Tuberculosis incidence correlates with sunshine: an ecological 28-year time series study, PLoS One, 8(3), e57752.

3. Liu P.T. Stenger S. Tang D.H. Modlin R.L. (2007) Cutting edge: vitamin D-mediated human antimicrobial activity against Mycobacterium tuberculosis is dependent on the induction of cathelicidin, J Immunol, 179(4), 2060-2063.

4. Sato S. Tanino Y. Saito J. Nikaido T. Inokoshi Y. Fukuhara A. Fukuhara N. Wang X. Ishida T. Munakata M. (2012) The relationship between 25-hydroxyvitamin D levels and treatment course of pulmonary tuberculosis, Respir Investig, 50(2), 40-45.

5. Coussens A.K. Wilkinson R.J. Hanifa Y. Nikolayevskyy V. Elkington P.T. Islam K. Timms P.M. Venton T.R. Bothamley G.H. Packe G.E. Darmalingam M. Davidson R.N. Milburn H.J. Baker L.V. Barker R.D. Mein C.A. Bhaw-Rosun L. Nuamah R. Young D.B. Drobniewski F.A. Griffiths C.J. Martineau A.R. (2012) Vitamin D accelerates resolution of inflammatory responses during tuberculosis treatment, Proc Natl Acad Sci U S A, 109(38),15449-15454.

6. Mörner K.A.H. (2005) Nobel Prize in Physiology or Medicine 1905, Presentation Speech, www.nobelprize.org/nobel_prizes/medicine/laureates/1905/press.html.

7. McKeown T. (1979) The Role Of Medicine, Blackwell.

8. Vilchèze C. Hartman T. Weinrick B. Jacobs W.R. (2013) Mycobacterium tuberculosis is extraordinarily sensitive to killing by a vitamin C-induced Fenton reaction, Nature Communications, doi:10.1038/ncomms2898.

9. Hickey S. Saul A.W. (2008) Vitamin C: The Real Story, the Remarkable and Controversial Healing Factor, Basic Health.

10. Hickey S. Roberts H. (2013) Vitamin C and cancer: is there a role for oral vitamin C? JOM, 28(1), 33-46.

 

Nutritional Medicine is Orthomolecular Medicine

Orthomolecular medicine uses safe, effective nutritional therapy to fight illness. For more information: http://www.orthomolecular.org

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