s Is This The Ultimate in Food Replacement? | 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. 
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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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Is This The Ultimate in Food Replacement?

Staff Writer

articles by this author...

Editing and Researching news and stories about global and local Pharmacy Issues

A product with the name of Soylent may soon appear in health food stores, supermarkets and pharmacies within Australia.
It's more a functional food composite made from food components.
It contains all nutrients essential to sustain good health and is lower in cost than actual food.
While not a glamorous item it does have promise for people who want to spend time space travelling, or aid agencies who need to extend their budget.
It also has the potential to take pressure off the environment through the elimination of farms - both agricultural broad acre and animal farms.
Climate change may eventually force the use of food replacements such as Soylent as entire foods disappear because of hostile changes in climate.
Soylent is an interesting concept, and it was originally reported in The New Yorker.

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In December of 2012, three young men were living in a claustrophobic apartment in San Francisco’s Tenderloin district, working on a technology startup. They had received a hundred and seventy thousand dollars from the incubator Y Combinator, but their project—a plan to make inexpensive cell-phone towers—had failed. Down to their last seventy thousand dollars, they resolved to keep trying out new software ideas until they ran out of money. But how to make the funds last? Rent was a sunk cost. Since they were working frantically, they already had no social life. As they examined their budget, one big problem remained: food.

They had been living mostly on ramen, corn dogs, and Costco frozen quesadillas—supplemented by Vitamin C tablets, to stave off scurvy—but the grocery bills were still adding up. Rob Rhinehart, one of the entrepreneurs, began to resent the fact that he had to eat at all. Rhinehart, who is twenty-five, studied electrical engineering at Georgia Tech, and he began to consider food as an engineering problem. “You need amino acids and lipids, not milk itself,” he said. “You need carbohydrates, not bread.” Fruits and vegetables provide essential vitamins and minerals, but they’re “mostly water.” He began to think that food was an inefficient way of getting what he needed to survive. “It just seemed like a system that’s too complex and too expensive and too fragile,” he told me.

What if he went straight to the raw chemical components? He took a break from experimenting with software and studied textbooks on nutritional biochemistry and the Web sites of the F.D.A., the U.S.D.A., and the Institute of Medicine. Eventually, Rhinehart compiled a list of thirty-five nutrients required for survival. Then, instead of heading to the grocery store, he ordered them off the Internet—mostly in powder or pill form—and poured everything into a blender, with some water.
Rhinehart called his potion Soylent

After a month, Rhinehart published the results of his experiment in a blog post, titled “How I Stopped Eating Food.” The post has a “Eureka!” tone. The chemical potion, Rhinehart reported, was “delicious! I felt like I’d just had the best breakfast of my life.” Drinking Soylent was saving him time and money: his food costs had dropped from four hundred and seventy dollars a month to fifty. And physically, he wrote, “I feel like the six million dollar man. My physique has noticeably improved, my skin is clearer, my teeth whiter, my hair thicker and my dandruff gone.” He concluded, “I haven’t eaten a bite of food in thirty days, and it’s changed my life.” In a few weeks, his blog post was at the top of Hacker News—a water cooler for the tech industry.

One of Silicon Valley’s cultural exports in the past ten years has been the concept of “lifehacking”: devising tricks to streamline the obligations of daily life, thereby freeing yourself up for whatever you’d rather be doing. Rhinehart’s “future food” seemed a clever work-around. Lifehackers everywhere began to test it out, and then to make their own versions. Soon commenters on Reddit were sparring about the appropriate dose of calcium-magnesium powder. After three months, Rhinehart said, he realized that his mixture had the makings of a company: “It provided more value to my life than any app.” He and his roommates put aside their software ideas, and got into the synthetic-food business.

To attract funding, Rhinehart and his roommates turned to the Internet: they set up a crowd-funding campaign in which people could receive a week’s supply of manufactured Soylent for sixty-five dollars. They started with a fund-raising goal of a hundred thousand dollars, which they hoped to raise in a month. But when they opened up to donations, Rhinehart says, “we got that in two hours.” Last week, the first thirty thousand units of commercially made Soylent were shipped out to customers across America. In addition to the crowd-funding money, its production was financed by Silicon Valley venture capitalists, including Y Combinator and the blue-chip investment firm Andreessen Horowitz, which contributed a million dollars.

Soylent has been heralded by the press as “the end of food,” which is a somewhat bleak prospect. It conjures up visions of a world devoid of pizza parlors and taco stands—our kitchens stocked with beige powder instead of banana bread, our spaghetti nights and ice-cream socials replaced by evenings sipping sludge. But, Rhinehart says, that’s not exactly his vision. “Most of people’s meals are forgotten,” he told me. He imagines that, in the future, “we’ll see a separation between our meals for utility and function, and our meals for experience and socialization.”

Today, technological advances have created a new wave of anxiety about our edible present, and a growing nostalgia for a time before corporate food lobbies, genetically modified vegetables, industrial farming, and the weed killer Roundup.

But the farm-to-table ethos has essentially bypassed the working class, which is left, instead, to live with the fallout of the low-cost food industry—obesity, diabetes, and, ironically, malnutrition. A recent U.N. report warned that climate change is threatening the global food supply, and that its impact will worsen in ways that aren’t confined to the poor.

Tim Gore, the head of food policy and climate change for Oxfam, has noted, “The main way that most people will experience climate change is through the impact on food: the food they eat, the price they pay for it, and the availability and choice that they have.” And food is a major part of the problem: livestock cause almost fifteen per cent of all greenhouse-gas emissions. In California, which is suffering from its worst drought in a generation, about eighty per cent of all water goes toward agriculture.

In the formula that Rhinehart and his teammates have settled on, the major food groups are all accounted for: the lipids come from canola oil; the carbohydrates from maltodextrin and oat flour; and the protein from rice. To that, they’ve added fish oil (for omega-3s; vegans can substitute flaxseed oil), and doses of various vitamins and minerals: magnesium, calcium, electrolytes. Rhinehart is reluctant to associate Soylent with any flavor, so for now it just contains a small amount of sucralose, to mask the taste of the vitamins. That seems to fit his belief that Soylent should be a utility. “I think the best technology is the one that disappears,” he said. “Water doesn’t have a lot of taste or flavor, and it’s the world’s most popular beverage.”

People tend to find the taste of Soylent to be familiar: the predominant sensation is one of doughiness. The liquid is smooth but grainy in your mouth, and it has a yeasty, comforting blandness about it. Tasters compare it to Cream of Wheat, and “my grandpa’s Metamucil.”

Liquid food has been given to patients in hospital settings for decades. Fifty years ago, when a patient was too sick to eat, doctors ground up regular food and put it into feeding tubes. Eventually, companies like Abbott Nutrition, the maker of Ensure, got into the game. Food replacements became more standardized and scientific. In the early nineteen-sixties, NASA made powdered drinks famous by using Tang in its space flights; according to Bruce Bistrian, the chief of clinical nutrition at Beth Israel Deaconess Medical Center, in Boston, “the whole field exploded.” From the sixties to the nineties, liquid meal replacements became popular with the diet crowd, because they made it easy to quantify how many calories you consume. It was the era of Metrecal, Slimfast, and “a shake for breakfast, a shake for lunch, then a sensible dinner!” Today, aspiring bodybuilders drink Muscle Milk, a protein shake designed to add brawn. Bistrian, noting that the idea behind Soylent is “not rocket science,” said, “Any good nutritionist could put these ingredients in the proper amounts and make such a formula.”

Doctors agree that you could subsist on Soylent, but would it be a good idea? The debate, for the most part, revolves around substances found in real food, especially phytochemicals, which come from plants. Such compounds are not known to be essential for survival, but, in epidemiological studies, they appear to provide important health benefits. Lycopene, which makes tomatoes red, has been linked to lower rates of prostate cancer; flavonoid compounds, which make blueberries blue (and can be found in chocolate), have been associated with lower rates of diabetes. The science behind how our bodies use these chemicals isn’t precisely understood. But Walter Willett, the chair of the nutrition department at the Harvard School of Public Health, said that it would be unwise to miss out on them. “It’s a little bit presumptuous to think that we actually know everything that goes into an optimally healthy diet,” he told me. You can live without plant chemicals. “But you may not live maximally, and you may not have optimal function. We’re concerned about much more than just surviving.”

Living on Soylent has its benefits, though. As Rhinehart puts it, you “cruise” through the day. If you’re in a groove at your computer, and feel a hunger pang, you don’t have to stop for lunch. Your energy levels stay consistent: “There’s no afternoon crash, no post-burrito coma.” Afternoons can be just as productive as mornings.

During the next two months, Soylent plans to ship its product to all of its twenty-five thousand initial backers. The company has ten thousand dollars in new orders coming in every day, and has started to become profitable. U.S. military and space programs have asked to run trials on Soylent.

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