s The Third Industrial Revolution – Digital Manufacturing Coming to a Pharmacy Near You | 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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The Third Industrial Revolution – Digital Manufacturing Coming to a Pharmacy Near You

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.

Sometimes you simply have to stand in awe at some new technology breakthroughs because they expand and transform human endeavours to such a remarkable degree.
In manufacturing, the first phase was the Industrial Revolution in the 19th Century and later, the production line in the early 20th Centrury-the second Industrial Revolution.
Right now we are on the cusp of the Third Industrial Revolution.
Digital manufacturing is upon us and it will transform the way we work and will be disruptive to all major economies.
I2P has always reported on trends that will affect future pharmacy, and we now note that a lot of remarkable technologies are converging in the form of clever software, novel materials, more human-like robotics, a multitude of web-based services plus new processes.
At the heart of these new processes is the 3D printer.
While pharmacists may regard these technologies as “distant” and are used to planning forward strategies on a five-year timeline, we advise that strategies will need to be planned on a continuous 12 month cycle to keep abreast of developments.
Accordingly, pharmacists must plan investment in their own research to harness this new technology.

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We are moving from mass production to mass customisation.

I think we can all relate to a product we have purchased that has broken down and requires a simple spare part to make it functional again.Except you cannot purchase it.
When I was a young teenager, my father taught me how to replace an electric jug filament by stretching a new and inexpensive filament over the old mounting.
Less than 10 cents of replacement cost.
Later in life when confronted with the same problem I was forced to purchase the entire mount and filament, with cost rising to $1.95.
Still later in life I was forced to throw the entire jug away as all the electrics were now “enclosed” and you had to damage the “enclosure” to get to the problem.
A new jug cost $8-$10 and was manufactured in China, as the Australian manufacturer had long gone out of business, not being able to match the scale and cheap labour of the Chinese.

And so began the disposable society with all the additional problems of pollution

However, 3D printers are reaching a scale that they can now actually print major components, virtually anywhere, at any time, on demand.
Imagine a mining company out in the middle of an Australian mining operation and a machine breaks down due to one component part.
To get a replacement may take weeks because the part may have to be imported, and when it arrives in Australia, transportation to an isolated region of Australia is another logistics problem.
With inexpensive computers and 3D printers and an assortment of special “inks” linked with an efficient Internet system, the new spare part can be printed in a matter of hours by people untrained in engineering or other skills required for the manufacture of the original component.

Already we are seeing car manufacturers reducing their new models to digital drawings capable of being printed.
In the process of being printed they can be customised as to colour and styling.
The labour cost involved in this process is very low, so we will see manufacturing gradually drift back to the richer economies, away from countries like China.

This has wider implications for countries like Australia that has an economy virtually dependent on the export of minerals to China to “balance the budget”.
How that transition eventually impacts will depend on who manufactures the value-added products such as the 3D printable inks.
Australians are smart enough to do the job but Australian politicians are not so well-endowed as to be so forward-thinking or fast on their feet, and will move to delay this type of innovation so as to prop up traditional industries and processes with taxpayer funds.

Other changes are nearly as momentous. New materials are lighter, stronger and more durable than the old ones. Carbon fibre is replacing steel and aluminium in products ranging from aeroplanes to mountain bikes.
I wonder if the Australian carbon tax will spur on the carbon fibre industry in such a way as to reduce atmospheric carbon?

New techniques let engineers shape objects at a tiny scale. Nanotechnology is giving products enhanced features, such as bandages that help heal cuts, engines that run more efficiently and crockery that cleans more easily.
Genetically engineered viruses are being developed to make items such as batteries. And with the Internet allowing ever more designers to collaborate on new products, the barriers to entry are falling.
Perhaps Australians should be more tolerant of the National Broadband Network and its cost, given that it may be able to support large numbers of “backyard manufacturers” producing goods or components that require much smaller investments of capital.
And the people performing this work can live in regions more suited to lifestyle and reduce pressures on overcrowded cities as the Third Industrial Revolution blurs the line between services and manufacturing.

Like all revolutions, this one will be disruptive. Digital technology has already rocked the media and retailing industries, just as cotton mills crushed hand looms and the Model T put farriers out of work.

Many looking at the factories of the future will see that repetitive assembly line jobs will almost be non-existent. Most jobs will not be on the factory floor but in the offices nearby, that will be full of designers, engineers, IT specialists, logistics experts, marketing staff and other professionals. The manufacturing jobs of the future will require more skills. Many dull, repetitive tasks will become obsolete: you no longer need riveters when a product has no rivets.

The revolution will affect not only how things are made, but where.
Factories used to move to low-wage countries to curb labour costs.
But labour costs are growing less and less important: a $499 first-generation iPad included only about $33 of manufacturing labour, of which the final assembly in China accounted for just $8. Offshore production is increasingly moving back to rich countries not because Chinese wages are rising, but because companies now want to be closer to their customers so that they can respond more quickly to changes in demand. And some products are so sophisticated that it helps to have the people who design them and the people who make them in the same place.

The lines between manufacturing and services are blurring. Rolls-Royce no longer sells jet engines; it sells the hours that each engine is actually thrusting an aeroplane through the sky. Governments have always been lousy at picking winners, and they are likely to become more so, as legions of entrepreneurs and tinkerers swap designs online, turn them into products at home and market them globally from a backyard garage.
As the revolution rages, governments should stick to the basics: better schools for a skilled workforce, clear rules and a level playing field for enterprises of all kinds. Leave the rest to the revolutionaries.

So where will pharmacy fit in and what other areas of health might be affected by the Third Industrial Revolution?
Pharmacists are really small scale manufacturers and assemblers, so they should be able to take advantage of a range of opportunities.

Here are just a few examples:

Small scale manufacturing – generics multiple formulas.


A collaboration between the University of Leeds, Durham University and GlaxoSmithKline is looking at “printing” pills to order to create safer, faster-acting medicines.

 Drugs produced with this concept method would have the active ingredient “printed” onto the pill’s surface; the resulting pill would no longer need to be broken down by the digestive system before entering the bloodstream. The method makes it possible to print several drugs onto one pill, reducing the number of tablets swallowed by patients requiring multiple medicines.

Alternatively, a Nature Chemistry paper by researchers from the University of Glasgow describes a process for "printing" pharmaceutical compounds from various feedstocks, and supposes a future in which we have an ability to accurately manufacture short runs of generic drugs, singly or in combination. The process uses an off-the-shelf 3D printer technology to assemble pre-filled "vessels" in ways that create the desired chemical reaction in order to produce medicines. It's a scaled-down version of the industrial process used to manufacture drugs in bulk, and the paper's principal, Prof Lee Cronin, calls it "reactionware."  

"We can fabricate these reactionware vessels using a 3D printer in a relatively short time. Even the most complicated vessels we've built have only taken a few hours.

"By making the vessel itself part of the reaction process, the distinction between the reactor and the reaction becomes very hazy. It's a new way for chemists to think, and it gives us very specific control over reactions because we can continually refine the design of our vessels as required.

"For example, our initial reactionware designs allowed us to synthesize three previously unreported compounds and dictate the outcome of a fourth reaction solely by altering the chemical composition of the reactor."

Prof Cronin added: "3D printers are becoming increasingly common and affordable. It's entirely possible that, in the future, we could see chemical engineering technology which is prohibitively expensive today filter down to laboratories and small commercial enterprises.

"Even more importantly, we could use 3D printers to revolutionise access to health care in the developing world, allowing diagnosis and treatment to happen in a much more efficient and economical way than is possible now.

It does not take much imagination to envisage that generic medicines could be manufactured by a pharmacy (or even a group of pharmacies banding together), possibly at a much cheaper price than already exists through established generic medicine suppliers.
Further, these drugs can be customised for shape, colour and additive combinations.
It takes pharmacy dispensing back to its roots when it compounded galenicals.
Because of the accuracy of this form of manufacturing it should be possible to register such products through the TGA for supply on the PBS.
It should also be possible to manufacture products to a pharmacist prescription for sale over-the-counter, again a “roots-type” service abandoned because of lobbying from major manufacturers.

The two major pharmacy political bodies (PSA and PGA) need to be cognisant of this type of development because it will happen-and quickly.
Pharmacy needs their political bodies to be out in front for their profession, being proactive and not reactive, ensuring that external influences do not disrupt pharmacy progress in this new technology.

Remember that this process taken to an extreme could eliminate generic drug suppliers and it can open up an area of research to produce new drugs without the need for a large scale manufacturer to be involved.

Also for pharmacy it can generate additional new jobs that could absorb some of the pharmacist surplus, both in manufacture and research.

Specialised wound management
Bio-Printer Sprays Skin Cells Onto Wounds
Researchers at Wake Forest University are developing a new bio-printer that sprays skin cells onto the wounds of burn victims, promoting speedier and more efficient recovery.
A laser reads the depth and shape of the injury, and with the help of a computer the device sprays a precise layer of skin cells onto the wound.
The process can heal infection-prone wounds in just three weeks.

Other Bio-Medical Printing

3D Printer Successfully Creates Human Vein
The Organovo NovoGen printer is an emerging piece of technology in the area of regenerative medicine that recently created the first “printed” human vein, pointing to a future where individual organs could be printed on demand.
The printer is loaded with cartridges of “bio-ink,” a substance that acts as scaffolding for cells to retain their shape. A sophisticated computer is linked to the printer which is pre-programmed with a 3D blueprint of whatever is being made. The computer instructs the printer to lay down two dimensional layers of bio ink into cells that eventually form a physical body part.
There is no reason why interested pharmacists cannot become prescription suppliers for “body parts” if suitable partnerships can be formed with hospitals and specialists.

From time to time i2P will publish the innovation stream that relates to medicine generally, and pharmacy in particular. That stream will become a flood about twelve months from now.
Pharmacists alert to opportunity can break out of the mould created by the PBS and diversify their professional offerings, provided they put their existing logistics and managerial skills to work.
Obviously there will be a need to expand this skill base progressively to accommodate 3D printing, provided the educational gap is filled by entrepreneurial providers.

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