s The Right to Die | 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. 
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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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The Right to Die

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 the last decade, Australians have been talking about their average age increasing, to the extent that at least 25% of the population will be over the age of 64 within twenty years.
With that increase in age comes an increase in lifestyle illness and the need to invest in aged care facilities and to provide funding for medicines on the PBS that will increasingly be utilised.
It seems demand will outstrip available resources.
But another social/ethical issue accompanies the ageing process and lifestyle illness, and that is quality of life.
What purpose is there to living a long life if it has no quality or becomes too unbearable and draining for the individual and their surrounding family?
So when somebody decides they wish to die ahead of schedule because of unbearable pain and suffering they suddenly find that right has been taken away from them by politicians.
Euthanasia is a subject that has been kept under the radar for a long time but containment now appears impractical as evidence of suffering will simply increase with the volume of aged persons.

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Dr Philip Nitschke has attempted to provide information and facilities to assist people to achieve a dignified death. He has formed an organisation called Exit International and written a book called “The Peaceful Pill Handbook” that promotes a veterinary drug “Sedalphorte” ( a border-controlled drug believed to be pentobarbital) as a means of providing euthanasia.
The handbook is banned in Australia and it is not so long ago that pentobarbital was prescribed by the bucketful on the PBS.

Recently, Exit International attempted to run a television advertisement arguing for euthanasia, and featured an actor playing a man with a terminal illness asking to be allowed die with dignity.

The advertisement was an attempt to relaunch the debate in Australia on the right to die, 14 years after the Northern Territory government became the first in the world to introduce a voluntary euthanasia law, only to see it overturned by the federal authorities.

The last time a similar advert was shown on Australian television was more than 10 years ago. It featured a woman suffering from what she believed was terminal bladder cancer pleading to be allowed to die. Her disease went into remission and the case became a rallying cry for the anti-euthanasia lobby.

In the new advert, which has been banned by the broadcasting regulators on the grounds that it promotes suicide (which is illegal), the man argues: "I chose to marry Tina, have two great kids. I chose to always drive a Ford. What I didn't choose was being terminally ill. I didn't choose to starve to death because eating is like swallowing razor blades.

"And I certainly didn't choose to have to watch my family go through it with me. I've made my final choice. I just need the government to listen."

Exit International stated that the ban violated the right to free speech, and said they would relaunch a new version of the ad within days.

The right to die has become the subject of agonised debate in many countries.
An increasing number of individuals are circumventing local laws by travelling to the Dignitas clinic in Switzerland, where they are given medical advice and assistance to commit suicide, which is legal under Swiss law.

In Australia, the pendulum is swinging in favour of euthanasia.
In a recent news item published by NT.News.com they state:

“ABOUT nine out of 10 Territorians want their voluntary euthanasia laws back, nearly 15 years after Canberra took them away "for their own good".
This comes as Greens leader Bob Brown told the NT News he'd use the new minority government set-up to try to remove the Commonwealth block on the issue.

More than 85 per cent of respondents to the NT News's Reader Issues Survey said the Rights of the Terminally Ill Act should be reinstated.

Support was evenly spread across the age groups - although it was marginally higher (about 87 per cent) with those aged 65 and over.

Should the Rights of the Terminally Ill Act be reinstated in the Northern Territory? - leave your comment below

NT euthanasia campaigner Dr Philip Nitschke said Territorians had a "proud history" on the issue, and that 85 per cent support was "fantastic".

"It's usually in the mid-70s (across Australia). That's one of the highest results we've ever seen," he said.

"I guess it probably reflects the Territory's original reasons as to why they passed the law. It's the most secular place in Australia.

"It's the place where people like to think they can do anything."

If Mr Brown's Bill succeeds, it would still require the Territory Parliament to vote on the issue again.

Dr Nitschke said he doubted today's NT politicians had the "drive, interest or guts" to bring the law back - even if the federal block was gone.

"In some ways, the Territory Assembly is now more conservative in its breakdown than it was even back in '96," he said.

He said CLP chief minister Marshall Perron was able to get the law passed in a time when there was "almost no Opposition".

Dr Nitschke said the best explanation he ever got as to why politicians shied away from an issue that had such strong support came from former prime minister Gough Whitlam.

"He said, 'Don't expect politicians to take on an issue that will attract the ire of the church. It doesn't look good on your CV at pre-selection time to be known as someone who's anti-church'," he said.

"(So) to take up a prominent position and then find themselves being actively campaigned against by (Catholic Archbishop Cardinal George Pell) or someone is something they could just do without.

"I think that's probably the most likely explanation for why they run dead on it - pardon the pun."

No matter what your beliefs entail, pharmacists in Australia will begin to have requests for information about euthanasia in the immediate future.
There needs to be some form of national debate within pharmacy circles to get ahead of any potential to fall foul of the law.
If compassionate requests for advice are made what are the boundaries?
It would also seem to me that when pharmacists become comfortable with the concept of euthanasia, some will endeavour to provide professional counselling services to ensure their patients are properly informed.

Return to home

Submitted by Peter Kennedy on Thu, 30/09/2010 - 10:55.

Paul, giving a dying patient who is in great pain, the large doses of analgesics which are required to relieve his pain, knowing that this might, as an UNINTENDED adverse effect, accelerate the natural process of dying, is not euthanasia but good medical care. This is available to all, not just a select few, though it is true that our health systems need to invest a lot more resources into providing good palliative care to everyone who needs it.

If you are aware of any case where somebody gave a patient an overdose of an analgesic drug, purportedly for pain relief but with the intent of killing him, you should tell the police.

Submitted by Paul Drinkwater on Wed, 22/09/2010 - 10:33.

I agree that the Territories should be able to introduce legislation, in the same way as the States, without federal iterference.
I support voluntary euthanasia. Currently there is much hypocrasy about the subject. It happens frequently in hospitals under the guise of providing analgesia, but is only available to a select few

Submitted by Peter Kennedy on Wed, 22/09/2010 - 09:40.

How ironic that you end with a motherhood statement calling for pharmacists to ensure their patients are properly informed, when the entire preceding article is a diatribe of the usual long-discredited myths and misinformation.

Nobody is being "denied the right to die". What Nitschke and his group want is the right to kill - and to kill not just people with serious illness or disability, but perfectly healthy people. Nobody has ever had the "right" to kill, which politicians can neither give nor take away.

The fascist ideologue Nitschke, aided by "useful fools", surreptitiously tries to legalise murder by promoting the myth that there are people being forced to endure "unbearable pain and suffering" which no dose of any drug or treatment can relieve, or the myth that doctors are somehow legally prevented from prescribing such treatment because it might accelerate the natural dying process. And the myth that people are being forced to undergo expensive, burdensome or futile treatments which add little or nothing to their lifespan or quality of life.

" it is not so long ago that pentobarbital was prescribed by the bucketful on the PBS" - well I suppose to some people 40 years ago is not so long ago. Then thank God we got benzodiazepines and other far safer hypnotics and sedatives and could happily discard the extremely dangerous pentobarbitone. (I'm not sure why you call it by its USA name which has never been used in Australia).

Any pharmacist or scientifically trained person should know that the "results" of a self-selected "survey" are meaningless. Such surveys are routinely "mobbed" by organised groups. (Nitschke's organisation is based in the NT.)

Most ludicrous of all is the assertion that politicians are in terror of doing anything which is opposed by the Catholic Church, no matter how much the politicians want to do it. Governments seem to take less than zero notice of the Church's views. If anything, governments seem to go out of their way to take an opposite position from that of the Church - whatever the issue - contraception, aboriginal affairs, abortion, adoption, industrial relations, homosexuality, asylum seekers, poverty, war, marriage/divorce, foreign aid or anything else.

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