s Revive, Renew and Refresh – the Clinical Cycle is Starting | 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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Revive, Renew and Refresh – the Clinical Cycle is Starting

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.

For all good ideas to get off the ground there is a need to establish a sound education base, a strong infrastructure and the right rules to allow the idea to grow and bloom.
And underpinning all that is a required investment in human capital, also the realisation that “What can’t go on, won’t go on”.
I am referring to the great idea that pharmacy should build on its once pre-eminent position in primary health, and underpinning that idea with a population of pharmacy practitioners specialising in lifestyle illness. Their capabilities to include the delivering of a quality service the general public would value and pay for, without subsidy.
There is a need to revive, renew and refresh the concepts for that good idea.

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Education in pharmacy is reasonably sound but is in need of some form of revival. It is university-based and recognised with a range of degrees and the quality is good. There are many supplementary courses designed to allow pharmacists to hone specialties and there is now enough competition between pharmacy schools to cater for any specialty that gains popularity,
One such emerging school is found at the University of Technology Sydney under the stewardship of Professor Charlie Benrimoj well known for his tenacity and drive in developing innovative pharmacy services.
To me, this looks like the tipping point for a revival.

The UTS appointed Professor of Pharmacy Practice, Shalom (Charlie) Benrimoj has been charged to develop the new pharmacy school which will be the first school launched under the University’s new strategy to expand its offerings in health disciplines.

Professor Benrimoj said UTS had a well-deserved reputation for offering highly practice-oriented education and was an ideal setting to develop graduate-entry pharmacy degrees that are research-led, student-focussed and career-relevant.

"As a new school, UTS has been in a unique position to employ best practice at every stage of development," Professor Benrimoj said. "Working with key professional partners and an educational designer, our pharmacy academics have created an innovative and rigorous graduate entry curriculum.

"The programs utilise cutting-edge tools to integrate pharmaceutical science with clinical practice, technology and interdisciplinary skills. UTS pharmacy graduates will be competitive in the workplace. Not only will they have a strong foundation in pharmaceutical science, they will also be skilled in understanding its relevance and applying their knowledge in real-life situations."

Professor Benrimoj said the University's student focus and purpose-built facilities would offer students an enhanced learning experience. "Small cohorts and class sizes together with each student being assigned an academic mentor will set the UTS programs apart," he said.

"Students will also benefit from UTS’s investment in infrastructure – learning in a state-of-the-art simulated pharmacy, purpose built dry labs and comfortable student spaces for group and individual study."

The research interests of Charlie Benrimoj encompass the future of community pharmacy and professional cognitive pharmaceutical services from community pharmacy. These include the provision of drug information to consumers, clinical interventions, patient medication reviews, disease state management systems, Pharmacy and Pharmacist only medications, change management and international pharmacy practice. His research interests also involve the clinical, economic and implementation aspects of cognitive pharmaceutical services from community pharmacy in current and emerging health care systems.

This looks like the “missing link” in current pharmacist education and training to underpin a fee for service clinical model.
More information can be found at http://www.pharmacy.uts.edu.au .

The second link in the practitioner chain is infrastructure, and this is badly in need of a renewal to accommodate pharmacy professional services.
Logically, this infrastructure should be found in a community pharmacy, but other forms could be considered.
Barriers currently exist in the form of the Pharmacy Guild of Australia who see clinical services being delivered by “top down” computer systems.
Would-be-practitioners should be working on this aspect because they will have to invest in the “last mile” of infrastructure themselves because it will be different to what is currently available. They will have to “own” it and gradually increase their investment to match a growing service.
The investment may be modest and initially may simply be a modular and portable interview station that takes up minimal room in an existing pharmacy. It will need to be private and have the capacity to store reference materials, patient records and have a wireless-enabled computer system.
Investment in sophisticated clinical software could be costly and an independent communications system that is encrypted and portable will also have to be considered.
And apart from that type of infrastructure, some of the services may need to be integrated and coordinated on a shared basis, using pharmacy staff and other pharmacy facilities.
The designing and planning of this infrastructure backup has to be “packaged” so that it is visible and supported by both parties - the pharmacy owner and the practitioner pharmacist.

In the second quarter of 2012 pharmacy owners will begin to get nervous as economic conditions tighten around them. Firstly the internal “PBS Reforms” version of economic tension, and then the general “macro” version as unemployment increases, banks tighten up their lending and pharmacy customers begin to default on their credit arrangements –the whole cascade of events that will unravel rapidly.
Those practitioner pharmacists that have a plan of action ready are likely to be snapped up quickly, provided there is a reasonable return for the pharmacy owner.
The return can be measured as a tangible or an intangible – it depends on how the value multiplies into the pharmacy environment.
Pharmacy owners need to maintain their return on invested capital, but few have looked outside of their four walls to see how this could be done fairly and equitably with non-owner pharmacists.
The wheel is about to turn so both sides need to be prepared.

The realisation that pharmacists are on the brink of being automated right out of their current professional model looms very real.
Unless there is a massive investment in human capital with real jobs being created, the pharmacy professional direction is looking bleak.
There are massive dollars being invested in pharmacy but it all revolves around the PBS.
That is all that pharmacy is offering so government directs its energies and dollars to refining the PBS product that shortly will be returning an almost nil dividend.

So pharmacy needs to create a renewal link that creates a vision for all pharmacists to embrace. This is the entry point where investment needs to be made in the form of human capital – top thinkers from within and without the ranks of pharmacy.
This is also where the right rules are decided and documented.
There is a desperate need for a pharmacy think-tank that can generate a range of scenarios, a technique that is accepted universally as a means of dealing with turbulence, complexity, tipping points and disruption.
A group of thinkers that can transcend the petty politics of our existing representative organisations, creative enough to embrace the entire profession of pharmacy and perceptive enough to take testimonies from the existing experts – the individual pharmacists themselves (“bottom up” approach).
Problems can be solved and everyone has the power, even at a personal level, to take action, develop solutions and remake our world of pharmacy as it can and should be.
All that is needed is a road map.

Meanwhile, our entire world seems entangled in systems increasingly dominated by power, greed, ignorance, self-deception and denial, with spiralling inequity and injustice.
Viewed against a backdrop of climate change, failing ecosystems, poverty, crushing debt levels and corporate exploitation, it will require some clear-headed thinkers who can project into the future and weave a pathway to raise pharmacy to the level it needs to be.
I prefer to take “the glass is half-full” optimistic approach to a better future and work towards a solution – what will you do?

Footnote: If any pharmacist or pharmacy owner is interested in developing a scenario, i2P has input that might be of assistance.
Please share your thoughts privately with the editor at neilj@computachem.com.au .
We are also seeking interest from pharmacies that would be willing to use their pharmacy as a test bed to trial professional services; also individual pharmacists who would be interested in developing a practitioner role as clinical primary care pharmacists.

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