s Restrictive Distribution Services Will Increase- Time to Reorganise | 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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Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
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Feature Contribution

Woolworths Pharmacy - Getting One Stage Closer

Neil Johnston

It started with “tablet” computers deployed on shelves inside the retailer Coles, specifically to provide information to consumers relating to pain management and the sale of strong analgesics.
This development was reported in i2P under the title Coles Pharmacy Expansion and the Arid PGA Landscape”
In that article we reported that qualified information was a missing link that had come out of Coles market research as the reason to why it had not succeeded in dominating the pain market.
Of course, Woolworths was working on the same problem at the same time and had come up with a better solution - real people with good information.

Comments: 5

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Intensive Exposition without crossing over with a supermarket

Fiona Sartoretto Verna AIAPP

Editor's Note: The understanding of a pharmacy's presentation through the research that goes into the design of fixtures and fittings that highlight displays, is a never-ending component of pharmacy marketing.
Over the past decade, Australian pharmacy shop presentations have fallen behind in standards of excellence.
It does not take rocket science - you just have to open your eyes.
Recently, our two major supermarkets, Woolworths and Coles, have entered into the field of drug and condition information provision - right into the heartland of Australian Pharmacy.

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The sure way to drive business away

Gerald Quigley

I attended the Pregnancy, Baby and Children’s Expo in Brisbane recently.
What an eye and ear opening event that was!
Young Mums, mature Mums, partners of all ages, grandparents and friends……...many asking about health issues and seeking reassurances that they were doing the right thing.

Comments: 1

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‘Marketing Based Medicine’ – how bad is it?

Baz Bardoe

It should be the scandal of the century.
It potentially affects the health of almost everyone.
Healthcare providers and consumers alike should be up in arms. But apart from coverage in a few credible news sources the problem of ‘Marketing Based Medicine,’ as psychiatrist Dr Peter Parry terms it, hasn’t as yet generated the kind of universal outrage one might expect.

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Community Pharmacy Research - Are You Involved?

Mark Coleman

Government funding is always scarce and restricted.
If you are ever going to be a recipient of government funds you will need to fortify any application with evidence.
From a government perspective, this minimises risk.
I must admit that while I see evidence of research projects being managed by the PGA, I rarely see community pharmacists individually and actively engaged in the type of research that would further their own aims and objectives (and survival).

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Organisational Amnesia and the Lack of a Curator Inhibits Cultural Progress

Neil Johnston

Most of us leave a tremendous impact on pharmacies we work for (as proprietors, managers, contractors or employees)—in ways we’re not even aware of.
But organisational memories are often all too short, and without a central way to record that impact and capture the knowledge and individual contributions, they become lost to time.
It is ironic that technology has provided us with phenomenal tools for communication and connection, but much of it has also sped up our work lives and made knowledge and memory at work much more ephemeral.

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Academics on the payroll: the advertising you don't see

Staff Writer

This article was first published in The Conversation and was written by Wendy Lipworth, University of Sydney and Ian Kerridge, University of Sydney
In the endless drive to get people’s attention, advertising is going ‘native’, creeping in to places formerly reserved for editorial content. In this Native Advertising series we find out what it looks like, if readers can tell the difference, and more importantly, whether they care.
i2P has republished the article as it supports our own independent and ongoing investigations on how drug companies are involved in marketing-based medicine rather than evidence-based medicine.

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I’ve been thinking about admitting wrong.

Mark Neuenschwander

Editor's Note: This is an early article by Mark Neuenschwander we have republished after the soul-searching surrounding a recent Australian dispensing error involving methotrexate.
Hmm. There’s more than one way you could take that, huh? Like Someday when I get around to it (I’m not sure) I may admit that I was wrong about something. Actually, I’ve been thinking about the concept of admitting wrong. So don’t get your hopes up. No juicy confessions this month except that I wish it were easier for me to admit when I have been wrong or made a mistake.
Brian Goldman, an ER physician from Toronto, is host of the award-winning White Coat, Black Art on CBC Radio and slated to deliver the keynote at The unSUMMIT for Bedside Barcoding in Anaheim this May. His TED lecture, entitled, “Doctors make mistakes. Can we talk about it?” had already been viewed by 386,072 others before I watched it last week.

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Dispensing errors – a ripple effect of damage

Kay Dunkley - BPharm, Grad Dip Hosp Pharm, Grad Dip Health Admin, MPS, MSHPA

Most readers will be aware of recent publicity relating to dispensing errors and in particular to deaths caused by methotrexate being incorrectly packed in dose administration aids.
The Pharmacy Board of Australia (PBA), in its Communique of 13 June 2014, described a methotrexate packing error leading to the death of a patient and noted “extra vigilance is required to be exercised by pharmacists with these drugs”.
This same case was reported by A Current Affair (ACA) in its program on Friday 20 June
http://aca.ninemsn.com.au/article/8863098/prescription-drug-warning

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Take a vacation from your vocation

Harvey Mackay

Have you ever had one of those days when all you could think was, “Gosh, do I need a vacation.”
Of course you have – because all work and no play aren’t good for anyone.
A vacation doesn’t have to be two weeks on a tropical island, or even a long weekend at the beach. 
A vacation just means taking a break from your everyday activities. 
A change of pace. 
It doesn’t matter where.
Everyone needs a vacation to rejuvenate mentally and physically. 
But did you also know that you can help boost our economy by taking some days off? 
Call it your personal stimulus package.

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Explainer: what is peer review?

Staff Writer

This article was first published in the Conversation. It caught our eye because "peer review" it is one of the standards for evidence-based medicines that has also been corrupted by global pharma.
The article is republished by i2P as part of its ongoing investigation into scientific fraud and was writtenby Andre Spicer, City University London and Thomas Roulet, University of Oxford
We’ve all heard the phrase “peer review” as giving credence to research and scholarly papers, but what does it actually mean?
How does it work?
Peer review is one of the gold standards of science. It’s a process where scientists (“peers”) evaluate the quality of other scientists' work. By doing this, they aim to ensure the work is rigorous, coherent, uses past research and adds to what we already knew.
Most scientific journals, conferences and grant applications have some sort of peer review system. In most cases it is “double blind” peer review. This means evaluators do not know the author(s), and the author(s) do not know the identity of the evaluators.
The intention behind this system is to ensure evaluation is not biased.
The more prestigious the journal, conference, or grant, the more demanding will be the review process, and the more likely the rejection. This prestige is why these papers tend to be more read and more cited.

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Dentists from the dark side?

Loretta Marron OAM BSc

While dining out with an elderly friend, I noticed that he kept his false tooth plate in his shirt pocket. He had recently had seven amalgam-filled teeth removed, because he believed that their toxins were making him sick; but his new plate was uncomfortable. He had been treated by an 'holistic dentist'. Claiming to offer a "safe and healthier alternative" to conventional dentistry, are they committed to our overall health and wellbeing or are they promoting unjustified fear, unnecessarily extracting teeth and wasting our money?

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Planning for Profit in 2015 – Your key to Business Success

Chris Foster

We are now entering a new financial year and it’s a great time to reflect on last year and highlight those things that went well and those that may have impacted negatively in the pursuit of your goals.
It's also a great to spend some time re-evaluating your personal and business short, medium and long term goals in the light of events over the last year.
The achievement of your goals will in many cases be dependent on setting and aspiring to specific financial targets. It's important that recognise that many of your personal goals will require you to generate sufficient business profits to fund those aspirations

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Attracting and Retaining Great People

Barry Urquhart

Welcome to the new financial year in Australia.
For many in business the past year has been described as a challenging period.
Adjectives are a key feature of the English language.  In the business lexicon their use can be, and often is evocative and stimulate creative images.  But they can also contribute to inexact, emotional perceptions.
Throughout the financial pages of newspapers and business magazines adjectives abound.
References to “hot” money draw attention and comment.  The recent wave of funds from Chinese investors, keen to remove their wealth from the jurisdiction and control of government regulations is creating a potential property bubble in Australia.

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Updating Your Values - Extending Your Culture

Neil Johnston

Pharmacy culture is dormant.
Being comprised of values, unless each value is continually addressed, updated or deleted, entire organisations can stagnate (or entire professions such as the pharmacy profession).
Good values offer a strong sense of security, knowing that if you operate within the boundaries of your values, you will succeed in your endeavours.

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Evidence-based medicine is broken. Why we need data and technology to fix it

Staff Writer

The following article is reprinted from The Conversation and forms up part of our library collection on evidence-based medicines.
At i2P we also believe that the current model of evidence is so fractured it will never be able to be repaired.
All that can happen is that health professionals should independently test and verify through their own investigations what evidence exists to prescribe a medicine of any potency.
Health professionals that have patients (such as pharmacists) are ideally placed to observe and record the efficacy for medicines.
All else should confine their criticisms to their evidence of the actual evidence published.
If there are holes in it then share that evidence with the rest of the world.
Otherwise, do not be in such a hurry to criticise professions that have good experience and judgement to make a good choice on behalf of their patients, simply because good evidence has not caught up with reality.

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Laropiprant is the Bad One; Niacin is/was/will always be the Good One

Staff Writer

Orthomolecular Medicine News Service, July 25, 2014
Laropiprant is the Bad One; Niacin is/was/will always be the Good One
by W. Todd Penberthy, PhD

(OMNS July 25, 2014) Niacin has been used for over 60 years in tens of thousands of patients with tremendously favorable therapeutic benefit (Carlson 2005).
In the first-person NY Times best seller, "8 Weeks to a Cure for Cholesterol," the author describes his journey from being a walking heart attack time bomb to a becoming a healthy individual.
He hails high-dose niacin as the one treatment that did more to correct his poor lipid profile than any other (Kowalski 2001).

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Culture Drive & Pharmacy Renewal

Neil Johnston

Deep within all of us we have a core set of values and beliefs that create the standards of behaviour that we align with when we set a particular direction in life.
Directions may change many times over a lifetime, but with life experiences and maturity values may increase in number or gain greater depth.
All of this is embraced under one word – “culture”.
When a business is born it will only develop if it has a sound culture, and the values that comprise that culture are initially inherent in the business founder.
A sound business culture equates to a successful business and that success is often expressed in the term “goodwill” which can be eventually translated to a dollar value.

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Pharmacy 2014 - Pharmacy Management Conference

Neil Johnston

The brave new world of health and wellness is not the enemy of Pharmacy, it is its champion.
Australian futurist, Morris Miselowski, one of the world's leading business visionaries, will present the Opening Keynote address on Pharmacy's Future in the new Health and Wellness Landscape at 2.00pm on Wednesday July 30.
Morris believes the key to better health care could already be in your pocket, with doctors soon set to prescribe iPhone apps, instead of pills.
Technology will revolutionise the health industry - a paradigm shift from healthcare to personal wellness.
Health and wellness applications on smartphones are already big news, and are dramatically changing the way we manage our personal health and everyday wellness.

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Generation and Application of Community Pharmacy Research

Neil Johnston

Editor’s Note: We have had a number of articles in this issue relating to pharmacy research.
The PGA has conducted a number of research initiatives over the years, including one recently reported in Pharmacy News that resulted from an analysis of the QCPP Patient Questionnaire.
Pharmacy Guild president, George Tambassis, appears to have authored the article following, and there also appears to be a disconnect between the survey report and its target audience illustrated by one of the respondent comments published.
I have asked Mark Coleman to follow through, elaborate and comment:

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Restrictive Distribution Services Will Increase- Time to Reorganise

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.

New supply chain restrictions are liable to hit Australian pharmacy following in the wake of the recent Pfizer distribution bombshell.
Recent developments in the UK point to this as an inevitable and worrying problem that looks like embedding itself in the distribution system representing permanent pharmacy disadvantage, particularly for the small to medium sized entities.
Australian pharmacy needs to reorganise itself quickly before it finds itself being further gouged for supply chain costs or being disadvantaged in the market place by not having access to particular medicinal products.
But first, a brief analysis and some history of the Australian supply chain processes.

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Over the years, supply systems into pharmacies have existed in a number of different formats, many designed to give advantage to specific retail outlets.
When I first joined pharmacy ranks a very strong format existed in the form of “Chemist Only” policy.
 While manufacturers complained that this was too restrictive for them, supermarkets had not developed on the scale of today’s offerings, so they were able to live with the outlet restriction.
Chemist Only (CO) policy was developed by the Pharmacy Guild and was one of the first of its protectionist policies developed. It is easy to see why the PGA has been wedded to that mode of thinking in all things pharmacy since the inception of CO.Not that the policy was bad for the times - it just never evolved or adapted to remain relevant until forced to by the Trade Practices Act.
Offsetting the manufacturer’s complaint about narrow distribution, pharmacy offered a channel where new products could be launched with minimal marketing effort, and at a high price-point. The general public had a high level of trust in its pharmacists and tended to accept products and prices promoted within pharmacies without question.
Pharmacists always felt let down when manufacturers deserted them for outlets like supermarkets, always being disadvantaged on price (how else would you attract new clients?).
This process continues in a slightly different format today as evidenced by Pfizer's new disruptive business model.In earlier days retail prices were actually controlled in various ways by legislation, and this simply reinforced acceptance of pharmacy prices by the community.
Excess padding developed within this system as retail and wholesale margins were vigorously protected. Wholesalers were indeed a distinct entity and direct dealing with manufacturers by retailers was actively discouraged in all industries, including pharmacy.

Over time, pharmacy wholesalers differentiated themselves.
Some formed up into specialty wholesalers dealing in what was called “sundries” (usually novelty and gift items, surgical items, veterinary items etc).
Others differentiated themselves by becoming “short line wholesalers”. This group operated by distributing only high turnover “ethicals” (prescription items and scheduled OTC items). The “short-liners” sold their products at the same price as everyone else but had a scale of rebates that effectively created a deep discount.

The other major wholesalers to pharmacy became known as “full line wholesalers” because they kept everything that all the others kept. Competition forced them to also offer a scale of rebates that the others offered (but not quite as attractive), but an uneasy tension always existed between pharmacy clients of the “full liners” because of the leakage of business to the “short liners”.
Full line wholesalers had their genesis as cooperatives of pharmacists plus one or two that developed from different origins e.g. F.H Faulding and Hofnung’s.

Surprisingly, when the pharmacy wholesale cooperatives eventually demutualised for commercial reasons, they found themselves in Australia’s top 200 performing companies.
Pharmacists had demonstrated a knack for efficient organisation and good management, profitability being maintained with up to two or more deliveries per day to their clients.
Now, it’s 2011 – a year that proposes to be one of distribution turmoil and Pfizer has caused this “tipping point” through its announced intention of distributing prescription products on a direct basis.
As this will represent a significant “bite” out of wholesale turnover and profits and because of Pfizer’s significant market share, a major re-arrangement of the pharmacy supply chain is under way.
The pieces of the supply chain jigsaw are still the same as mentioned in the brief history above. It’s just the shape, how they fit together and the final size that is yet to be determined.

The UK has been undergoing similar problems since 2007 and that also was triggered by Pfizer going direct in that country.
The system developed by Pfizer in the UK has simply been transplanted to Australia with the only point of difference being the logistics alliance partner (Boots Unichem in the UK and DHL here in Australia).
It is noteworthy that while pharmacists have learned to live with the Pfizer system in the UK, it is universally disliked because it restricts individual pharmacy choice.
The same applies here in Australia, and pricing issues are emerging through special deals being organised through groups like Chemist Warehouse that discriminate and divide retail unity.
This is the traditional method that manufacturers use to maintain a high ex-warehouse purchase price. This will, in the long-term, eventually work its way through to the PBS to all taxpayer detriment.
Small to medium pharmacies will find that their inventory investment in Pfizer stock will be cost-elevated because of purchasing terms unfavourable to them in comparison to Chemist Warehouse.
Wholesalers have traditionally created a more even price playing field.

Looking again at the UK to provide some idea of how the marketplace will play out, we see that the retail wing of Boots (the same Boots in the logistics group servicing Pfizer) have signed an exclusive deal with Meda Pharmaceuticals, who manufacture a product called Cyklo-F.
Valeant Pharmaceuticals and Meda AB have agreed to form joint ventures in Australia, Canada and Mexico to develop, market and commercialize certain current and future products. The joint ventures will be majority-owned by Meda; Valeant will own a minority interest. The joint ventures will initially include insomnia drug Sublinox and pain drug flupertine, with the option to include additional products in the future.
The UK Cyclo-F deal takes effect on the 31st January, 2011.

The deal is significant for two reasons:

* The entire UK consumer access to this product will only be through Boots, for a period of 15 months, sufficient time to establish a dominance for this single product in the market place. After 15 months the purchase quantities for all other pharmacies will obviously be scaled against Boots purchase quantities and it will be difficult for competitor pharmacies to match Boots retail price because of the commercial advantage offered to them.

* Cyklo-F has been prescription-only and has just been down-scheduled for sale in a pharmacy over the counter (obviously under Schedule 3 if it happened here in Australia).

From a consumer’s viewpoint, this development restricts choice and disrupts the care process.
The Medicines and Healthcare products Regulatory Agency confirmed that how a product is marketed does not have any influence on MHRA decisions. "It is up to the marketing authorisation holder as to how they choose to make that product available," a spokeswoman said.

The product is licensed for women over 18 years of age with heavy menstrual bleeding over several cycles who have regular 21–35 day cycles with no more than three days individual variability in cycle duration. It comes in packs of 18 film-coated tablets and will retail at £8.99. The prescription-only status to pharmacy OTC switch of the product was approved by the UK Medicines and Healthcare products Regulatory Agency in May 2010.

Now this process should be ringing alarm bells for the Pharmacy Guild of Australia because it should be a clear case of restrictive trade practice here in Australia and should be stopped in its tracks.
This process also represents a blueprint for all manufacturers who are continually trying to down-schedule their prescription medicines (and it has nothing to do with patient care and concern) and strategies will need to be developed to cope with this process at community pharmacy level.
While a product is scheduled as a prescription only medicine, the manufacturer uses Medicines Australia as its strategic political and marketing lobbyist.
When the product is down-scheduled, that activity is passed to the Australian Self-Medication Industry (ASMI) association. Membership of this latter association is very similar to Medicines Australia, although the products are usually manufactured and distributed by subsidiary companies under a different business name.

ASMI have been lobbying for a long time for a more rapid down-scheduling of drugs and it is evident they have achieved a degree of success when you see how some drugs are now appearing on supermarket shelves.
There does not seem to be a social dollar cost attributed to this process as for example when drugs like Voltaren are sold without caution to people who are on combinations of drugs, that when mixed, will cause patient harm – even death.

As pharmacies are in place to prevent this type of occurrence, why do industry and government continually bypass this consumer safety mechanism in the name of reduced consumer costs.
What about the increased taxpayer cost of rectifying the eventual damage this strategy causes?

Manufacturers have only the objective of selling maximum amounts of their drugs at the highest possible price.

The supply chain is part of the overall marketing-mix.
As this is now being thrown out of balance, all other systems that are contained in the pharmacy market mix will now be thrown out of balance, so that industry adjustments will continue to occur to offset disruption and loss of income, from government right down through the supply chain to individual pharmacies.

The PGA will also have to reconsider its position in respect of manufacturers and wholesalers, as well as industry bodies.
Major pharmacy retailers will generally not be members of the PGA.
Industry bodies such as ASMI will generate conflict in respect of pharmacy and pharmacist aspirations.
To properly represent its members, some of the lucrative arrangements that may have benefited PGA executives will have to be reviewed, because they will simply not be representing their members properly.

PGA members are beginning to wake up to what is going on around them and hopefully they will begin to ask hard questions of their elected representatives.
It’s certainly long overdue.

Meanwhile, pharmacies will have only one counter balance mechanism, and that is to form up into regional buying groups linked in to a national logistics system.
A national logistics system paralleling the buying group clients may prove just strong enough for the Pfizer's of this world to acknowledge.
If you can get communication and action along the chain of supply to ensure that there is always an active generic competitior for Lipitor (or any other Pfizer product) then you have checkmate.
If you have a detailing capacity to recruit local GP's, this will accelerate the balance of power to pharmacy's favour.
There are seven molecules coming off patent for Pfizer in the near future, so if pharmacy can organise itself to significantly affect Pfizer market share and profitability, it will be a win for pharmacy.

A regional system based loosely on the Division of General Practice model will provide an input system (bottom up) that will beat a central system (top down) that can provide a single voice that is truly controlled by its membership, not only to balance out the supply chain system, but to organise professional development and education through suitable alliance partners.
The clock is ticking!

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