s PSE Diversion in the US | 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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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

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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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PSE Diversion in the US

Con Berbatis

articles by this author...

Con Berbatis is a pharmacy researcher attached to Curtin University in Western Australia. For i2P, he identifies Australian and global research reports that may be useful for pharmacists to include in their own planning initiatives.

Editor : Up to the year 2005, Australia and the USA appear to have had the highest per capita consumption of pseudoephedrine (PSE) of any country.

PSE has been widely diverted as a precursor into the production of methamphetamine which has been most commonly synthesised in domestic labs for local distribution.

The widespread abuse of PSE have led to epidemic criminal activity and human misery in both countries.

Pharmacies in the USA and Australia have been a major source of pseudoephedrine and the retail control is a serious challenge to pharmacy.

In the June 2007 issue of i2P , research reporter Con Berbatis reported the benefits of the Project Stop program together with supporting statistics.
Since then, the Drug and Alcohol Review journal has published a report by the Curtin University team entitled :
Linked electronic ,medication systems in community pharmacies for preventing pseudoephedrine diversion : a review of international practice and analysis of results in Australia.

The US National Association of Boards of Pharmacy (Mount Prospect, Illinois) have published the following commentary on the study in the August 2009 issue of the NABP Newsletter.

This is the first known occasion that the NABP has published Australian work.

Reference: Lewalski E. Interconnectivity of electronic PSE tracking systems shown to reduce illegal manufacture of Meth. NABP Newsletter. August 2009 .
At : http://www.nabp.net/ftpfiles/newsletters/NABP/nabp082009.pdf

Interconnectivity of Electronic PSE Tracking Systems Shown to Reduce Illegal Manufacture of Meth

Much like bacteria that mutate to resist antibiotics, methamphetamine traffickers have adapted their methods to evade the restrictions that, for a while, weakened their operations. In response to these tactical mutations, regulatory and law enforcement authorities are augmenting their curative strategies. The use of interconnected electronic tracking systems to record and monitor pseudoephedrine sales at the point of purchase has proven effective in reducing diversion of these products. A study published in 2009 in Drug and Alcohol Review, which followed diversion trends by jurisdiction in Australia, confirms the efficacy of this technological remedy.

In the few years follow¬ing implementation of the Combat Methamphetamine Epidemic Act of 2005 in the United States, which restricted consumer pur¬chases of pseudoephedrine-containing products and required pharmacists to log all such purchases, the illicit production of meth¬amphetamine in the US declined. After a signifi¬cant drop in 2007, how¬ever, “methamphetamine availability stabilized and possibly increased after the first half of 2008,” accord¬ing to the National Drug Threat Assessment 2009 compiled by the National Drug Intelligence Center of the US Department of Jus¬tice (DOJ). The report ties the increased availability to escalated domestic produc¬tion of the drug.

DOJ attributes the resur¬gence in US methamphet¬amine production, in part, to producers obtaining the precursor ingredients from local retail sources. To buck the tracking system, meth¬amphetamine traffickers are known to acquire large quan¬tities of pseudoephedrine, the precursor chemical used in the manufacture of meth¬amphetamine, by organizing multiple, successive purchases of pseudoephedrine-contain¬ing products in quantities at or below legal limits in mul¬tiple retail locations – a prac¬tice known as “smurfing.” Pseudoephedrine tracking systems that are not intercon¬nected generally fail to flag these multiple purchases.

To address this shortfall, several states in recent years have implemented or shown interest in implementing electronic tracking systems that record the sales of pseudoephedrine-containing products. Such systems enable retailers to transmit informa¬tion on pseudoephedrine sales to an electronic database accessible to appropriate law enforcement and regulatory agencies at the state level. In¬formation from these systems can be used by enforcement authorities to reduce the number of domestic metham¬phetamine labs by preventing the sale of pseudoephedrine in excess of legal limits, and to identify and prosecute individ¬uals involved in smurfing and others involved in metham¬phetamine production.

Both Kentucky and Arkan¬sas have demonstrated success with linked electronic moni¬toring systems in reducing pseudoephedrine diversion. The implementation of Meth¬Check in 15 Laurel County, KY pharmacies in 2005, and of LeadsOnlabs MethMontior in 18 North Little Rock, AR pharmacies in 2006, both led to increased numbers of local illicit laboratory seizures, in¬creases in methamphetamine-associated arrests, and savings in law enforcement resources. In 2008, Kentucky and Arkan¬sas became the first two states to legislate linked monitor¬ing systems to be installed in pharmacies for recording and tracking pseudoephedrine purchases.

To support states in their efforts to set up linked track¬ing systems, and to encourage and support planning for interconnectivity between state systems, the DOJ Office august 2009 147

of Justice Programs’ Bureau of Justice Assistance (BJA) in spring 2009 was accept¬ing grant applications for a Methamphetamine Precursor Chemical Diversion Train¬ing and Technical Assistance provider. Applications were due June 23 for the grant, which is being funded under the Edward Byrne Memo¬rial Justice Assistance Grant Program.

The recently published results of the aforementioned study conducted in Austra¬lia support the theory that interconnectivity between tracking systems reduces methamphetamine produc¬tion. The study, undertaken by researchers at two Austra¬lian universities, found linked electronic tracking systems to be successful in preventing pseudoephedrine diversion in Queensland, Australia.

The study evaluated the effectiveness of a linked elec¬tronic medication recording system (LEMS), implemented into Queensland pharmacies in 2005 as part of the Pharma¬cy Guild of Australia’s “Project STOP” initiative to prevent the diversion of pseudoephedrine. The LEMS is a Web-based sys¬tem that electronically records pseudoephedrine purchase information at the point of sale and instantaneously transfers the data to a central collection system. A global positioning system depicts the location of the pharmacy where the data were entered. The system enables authorized pharma¬cists, law enforcement officials, and health department staff to view the data to identify cases of suspected diversion and to compare pseudoephedrine purchases with wholesaler supplies to pharmacies.

To measure the impact of the LEMS program on Queensland pharmacies, the study tracked the number of illegal laboratories seized in Australia by jurisdiction from 1996-1997 to 2005- 2006. Based on the histori¬cal trends for lab seizures in each jurisdiction over the span of years, researchers were able to measure actual results against projected results that follow historical trends.

Results indicated that the total numbers of illegal laboratories seized yearly in Australia by jurisdiction from 1996-1997 to 2005- 2006 appeared to stabilize – except in Queensland. The reported number of illegal seizures in Queensland in 2005-2006 was significantly lower than that predicted from historical data. Nation¬ally, however, the num¬ber of labs seized was not significantly different from predictions. In other words, the study found a significant decline in the number of illegal methamphetamine labs seized in Queensland in 2005-2006 compared to that of other Australian jurisdictions that did not use a LEMS. The authors point to this decline as suggestive of the effective use of LEMS in Queensland pharmacies to reduce pseudoephedrine diversion.

While an increased raw number of seizures in a single year would suggest improved enforcement, as it did in Kentucky and Arkansas, the decline seen in Queensland compared to projections based on historical trends and actual results seen in other juris¬dictions, on the other hand, points to a reduction in the existence of these illegal labs in the first place.

“For the 12-month pe¬riod ending June 2006,” the study authors report, “the Australian Crime Com¬mission attributed Project STOP with part of the reduction in illegal labora¬tories in Queensland and with more than 30 arrests following electronic com¬munications from partici¬pating pharmacies.”

While the study authors note that the “reliance on total yearly results of just one indicator, namely a reduction in the number of seized illegal laboratories, is insufficient in drawing firm conclusions,” the trends were indicative enough that in April 2007, 85% of Queensland’s com¬munity pharmacies were enrolled in Project STOP. In 2008, the Pharmacy Guild of Australia began implement¬ing the LEMS nationally through pharmacies with the assistance of a government grant.

Thus far, the evidence points to interconnectivity between pseudoephedrine tracking systems as a promising remedy to the societal ill brought on by the illegal production of methamphetamine


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