s Responsible Self Care | 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. 
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
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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Responsible Self Care

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.

The Australian Self Medication Industry (ASMI) has issued a media release to coincide with the installation of their newly-elected president, Lindsay Forrester.
Primary health, the turf that ASMI lay claim to in the non-prescription area is about to take off in 2011 with many supportive federal government initiatives set to be funded or rolled out.
Various points are made in the media release, one being support for expanding the role of the pharmacist.
I am wondering whether the role is fully understood by the industry at large, so i2P recruited Mark Coleman to comment on the ASMI media release and the implications for pharmacy.
The media release follows and Mark's comments flow on from that.

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Media Statement from the new President of ASMI Nov 30 2010

 The newly elected President of the Australian Self-Medication Industry (ASMI), Lindsay Forrest, Regional Director, Reckitt Benckiser Australia & New Zealand, today issued the following statement:

“I would like to extend my sincere appreciation to the ASMI Committee of Management, and to the members of ASMI who have supported me in taking this role.

“The opportunity of representing the non-prescription medicines industry in this capacity is a real honour and I look forward to helping to advance the debate around healthcare and healthcare products amongst all our key stakeholders, and the wider community.

“The non-prescription medicines sector represents a $3 billion industry in Australia, and it reaches into the homes of millions of Australians. We have a significant role and an ongoing obligation to ensure that all Australians have the tools and understanding to be able to effectively and safely look after their health and that of their families.

“This means not only providing them with access to medicines that are safe, efficacious, of high quality, and available as widely as possible, but also helping to advance levels of health literacy so that all Australians, no matter where they live or their economic circumstances, can avail themselves of the best health care options.

“We will continue to mount a case for appropriate self care, so that there is increasing awareness of the opportunity for individuals to take greater personal responsibility for their health, and a new understanding of the innovative solutions to make the best use of healthcare resources. One such opportunity is to expand the role of pharmacists in the treatment of many minor ailments as a way of alleviating the burden on overstretched GPs.

“ASMI will continue to lobby vigorously on behalf of members to ensure that the industry receives fair treatment in the regulatory environment. Globally, in recent times, we have seen a creeping risk-aversion on the part of regulators, which has seen some products with a long, safe history of use having their access restricted.

“There needs to be some fresh thinking about the implications of regulatory decisions which cause inconvenience to thousands of responsible consumers because of a tiny minority who grossly misuse medicines.

“We will continue to build positive and mutually beneficial relationships with our key stakeholders, particularly consumers and community pharmacy. Consumer health and safety is paramount in everything that our industry stands for. We are committed to working with consumer health representatives to ensure that we, as an industry, hear what is important, and so that all consumers can share in the things we have to offer.

“The community pharmacy sector represents the vital link between industry and the public, and we will build on the excellent relationship we currently have with professional pharmacy bodies, including in areas that will enable pharmacy to grow as a key point of contact in primary health care.

“We want to build lasting and positive relationships with GPs, who represent a critical element in the nation’s professional healthcare workforce. Some parts of the GP network have voiced their concern at ASMI’s recent work which identified the opportunity for some minor ailments to be treated at a local pharmacy as a means of reducing the burden on GPs.

“We strongly believe there is evidence to demonstrate that this can benefit Australia, and we want to work cooperatively with the professional associations to explore what, I am sure, can be a better outcome for all parties.

“I look forward to working closely with the Executive Director of ASMI, Dr Deon Schoombie, the very professional and dedicated team at the ASMI Secretariat, and my fellow members on the Committee of Management.

“I would like to offer my thanks and appreciation to my predecessor, Ralf Dahmen. Ralf has been an outstanding president of ASMI, and one whose energy, passion and drive have helped to raise the standing and authority of the association,” Mr Forrest said.

  Mark Coleman

I am asked to comment on the above press release.
The climate in Australia is set to change for primary health care and preventive medicine, so the media release is well timed to position ASMI in respect of their various health relationships.
As pharmacy is involved with virtually the entire spectrum of ASMI aspiration, it is logical that a partnership should be seen to be visible and supportive.
However, ASMI needs to recognise the duality of pharmacy (pharmacy owners and practice pharmacists) and contract separately with each sector to provide balanced outcomes.

And because there is an imbalance of resources between the two pharmacy sectors, ASMI might be able to develop a support process for the practice pharmacist area so that it is not submerged by the pharmacy owners. The fact is that good supply services are an integral factor in the provision of professional services.
Neither can live in isolation to the other.

Preventive medicine ought to be a fertile field for all pharmacy sectors as in involves a range of non-prescription medicines, nutritional supplements and herbal medicines as well as non medicinal interventions involving diet, exercise and healthy living.
As stated in the media release:

“The non-prescription medicines sector represents a $3 billion industry in Australia, and it reaches into the homes of millions of Australians."

The only problem here is that pharmacy itself is not currently geared up to service the home and much development work needs to occur to reach that target area. There are many innovative practice ideas that are already out there but not given the support or a creative environment in which to flourish.

Perhaps ASMI could establish a fund and award grants for innovative practice ideas that extend the reach of primary care and preventive medicine into the home?

More importantly, has ASMI grasped the fact that it is practice pharmacists (as distinct from pharmacy owners) who are the actual professionals who can deliver the "health literacy" mentioned in the media release?
Given that the salaries of these pharmacists are generally paid from PBS remuneration, the future begins to look bleak for these people as pharmacy owners insist on a narrow prescription focus within their pharmacies, and because of progressively poorer returns, begin to limit the hours worked by these pharmacists or even the numbers employed.
Specific grants and incentive payments need to be directed to the individual (not the pharmacy) if inroads are to be made.

There is an obvious alliance for ASMI in two areas.
One with the PSA to help establish health literacy for patients, the other is with the PGA to assist pharmacy owners to merchandise effectively through display and product support.
The more independent a practice pharmacist is in terms of salary, the more effective he/she can be.

ASMI has some areas of potential conflict with pharmacy and one area relates to the scheduling of drugs.
ASMI has as an aspiration the downscheduling of all drugs to create the widest distribution at the lowest possible price.
Practice pharmacists genuinely worry about patient harm as drugs are more widely distributed and become commoditised.
Pharmacy owners worry about the manipulation of market share as they see their investment in developing a product segment evaporate overnight.
And then the feeling of despair by everyone when the market is skewed by people who divert or abuse themselves with deregulated products, and the regulators move back in again with a new and repressive set of rules that are generally over-reactive.

I remember many years ago when I first started in pharmacy as an apprentice.
My master pharmacist commented then that if all medicines could be left with pharmacies, the grocers could be left with food and everything else.
I believe that even today that is an observation that is still valid.
What is the point of developing highly trained pharmacists in the various pharmacy schools when the market place is unable to absorb them?
What is the point in having drug schedules that allow drugs to be sold in deregulated retail areas when it is known they will cause patient harm, and no pharmacist on hand to provide "health literacy".
ASMI needs to have a more in-depth liaison with pharmacy on these issues and develop more ideal policies that will prevent patient harm.
The ASMI aspiration noted in the media release relating to "consumer health and safety is paramount in everything that our industry stands for" has not worked in recent instances involving various combinations of codeine, ibuprofen and paracetamol.
The health literacy needed to allow patients to take responsibility for their conditions has not been put in place for these items.
It is not just the responsibility of pharmacy and pharmacists to provide this literacy, yet many vocal groups and individuals are quick to point the finger when things go wrong.
It is more a mutual obligation by all players in the industry to provide that service.
How can this be done?
A few suggestions:

* Help pharmacies to develop their own branded drug information website.

* Subsidise the cost of in-store computer kiosks so that patients can be mentored in computer use.

* Hold regional conferences to provide education for pharmacists and pharmacy staff. Working through regional groups of pharmacists in regions corresponding to hospital area health services would be one option. This way, content could be tailored to suit the region and presenters may be able to be recruited locally. It is the infrastructure that is badly needed.

* Use regional forums to allow innovative pharmacists to present ideas - and then find a way to support any idea of merit e.g. one pharmacist, Roy Stevenson from Newcastle, had developed an idea for "palm cards- business card size presentations of information suitable for giving out with products that require input e.g. Schedule 3 products.
Using these cards staff are then able to service patients efficiently when the pharmacist is tied down in some pressing professional activity (the norm rather than the exception).

* We have environmental impact studies when major development and building is to occur in most areas of Australia, particularly areas that have endangered species or sensitive habitat.
Yet there are no impact studies performed when there are major changes in drug legislation or changes in poison schedules. These are needed and could be promoted by ASMI to avoid problems of diversion, abuse or unwanted side effects.

I often wonder what part of the words "health team" the GP's of Australia don't understand - you know, those people that all have "doctor" as their first name.
In the media release above ASMI stated:

"Some parts of the GP network have voiced their concern at ASMI’s recent work which identified the opportunity for some minor ailments to be treated at a local pharmacy as a means of reducing the burden on GPs."
They have never in my experience acted towards pharmacy as part of a team, even though pharmacy has always deferred to them as the logical head of a health team.

Pharmacy has always "counter prescribed" since time began, always referring the more complex patients on to a GP (or other suitable health practitioner).
Yet doctors have always reacted aggressively to pharmacy and have politically blocked those elements of growth that would expand services to patients.
They do not demonstrate the qualities of leadership and most health profesions are starting to break away from the concept of a team.
I note that the clinical nurse consultants now have some equivalence with GP's and can prescribe in a limited fashion on the PBS and be reimbused through Medicare for their services.
Already they are lobbying for parity of rebate with GP's claiming they offer at least an equivalent service and in some cases, a better service.
In the UK, primary healthcare consortia (the equivalent to our Medicare Locals currently under development), are contracting services to any competent health practitioner or partnership of different practitioners as the cheapest and most effective means of getting the best health outcomes. Many service partnerships do not contain doctors, so that means in the UK at least, doctors have not earned their leadership role and thus they are progressively losing it.
In Australia, even though it has not been publicised, there is a lot of opposition to GP control of a Medicare Local board of management.
So the process may well be under way in Australia to end GP dominance allowing other health professionals such as nurses and practice pharmacists to provide alternate services and hopefully, better outcomes.

I think that is a reasonable point to end the year 2010 on and I wish all i2P readers a Merry Christmas and a Happy New Year.
May 2011 be the year of genuine progress for pharmacy practice and good luck to the newly elected President of the Australian Self-Medication Industry (ASMI), Lindsay Forrest, Regional Director, Reckitt Benckiser Australia & New Zealand.

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