s Wholesalers Fire First Shots | 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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Wholesalers Fire First Shots

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.

Wholesalers are directly in the firing line of the recent decision by Pfizer to deal direct.
Pfizer is the largest manufacturer globally and its impact on wholesaler turnover is thought to be of the order of 17-20 percent downwards.
This has caused the National Pharmaceutical Services Association (NPSA) to rally its members to undertake an intense lobbying effort and persuade government to only allow drugs to be listed on the PBS if their manufacturer makes supply through CSO accredited wholesalers at ex-manufacturer prices.
The Pfizer move, initiated in December 2010 was obviously timed so that an industry response could not be quickly mounted, given that Christmas, school holidays and a parliamentary recess ensured that many-decision makers would not be in place to help plan any campaign.
The NPSA is trying to organise a forum of stakeholders through Nicola Roxon and this would obviously involve the Pharmacy Guild of Australia (PGA) that is deeply troubled by the potential downstream problems that would emerge a few years into the future.
It will be interesting to see whether government will exploit this problem to reduce PGA political power down a "notch or two".

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Terry Barnes, a former adviser to Tony Abbott when he was health minister, has commented in his recent blog:

“Going from their announcement, Pfizer is acting purely out of its own best commercial interests - it wants to reduce its margins and give its soon to be off-patent products the greatest possible support when they go into the cold of the generic market - but on a bigger stage its move is like the 1942 Dieppe raid into Occupied France - a risky gamble but one that shows that the Atlantic Wall of pharmacy protectionism, guarded zealously by the Pharmacy Guild of Australia, can be breached.

If Pfizer succeeds, other manufacturers will follow their lead. 
That will undermine and potentially marginalise the traditional pharnaceutical wholesalers, who have been faithful allies of the Guild in defending the community pharmacy settlement from economic rationalists, free marketeers and, especially, entrepreneurial supermarket operators who see a synergy between retail pharmacy and their extensive healthcare lines.

If wholesaling barriers fall, moreover, then it's suddenly possible that the Big One - pharmacist-only ownership of pharmacies - will come under real attack from genuine market- and customer-focused reform.
It's hard to avoid the conclusion that the current anti-competitive and archaic ownership and location restrictions make dispensing medicines less economically efficient, not more.  If economies of scale and scope, and modern retail management, could be introduced into community pharmacy without compromising dispensing quality and safety, the cost per prescription will fall, customer satisfaction will increase, and taxpayers propping up the hugely expensive Pharmaceutical Benefits Scheme (and the Treasury bureaucrats who hate demand-driven spending programmes like the PBS) could breathe a huge sigh of relief.

Reported but unsourced comments from the Guild about the Pfizer decision  indicate that they're very worried about its immediate implications, and I suspect that they also see the longer-term political  threat to their Community Pharmacy Settlement that goes way beyond the advent of direct distribution.  If that threat extends to ownership and location restrictions, expect the battle between the progressive and reactionary forces in the pharmacy world to be long, hard, and bloody.

And there will be big casualties, not least the federal and state governments who will be caught in the middle of the political power of the pharmacist lobby on the one side and the push for better and cheaper access to medicines on the other.

Oh, and a genuine cost-benefit debate on the Community Pharmacy Settlement based on hard evidence and analysis rather than hand on heart unblinking assertion of what's right would be a jolly good thing too.  Game on, you may say.”

Terry Barnes has been actively involved with the government side of pharmacy for many years. He has worked in the Defence, Immigration and Ethnic Affairs, Employment, Education and Training and Health and Family Service portfolios. 
He led policy reviews on pharmacy regulation and competition policy; the impact of the Trade Practices Act on general practice; and the future of higher education advisory structures.  From his APS career he has extensive experience in policy-making, programme administration, Cabinet processes and accountability to Parliament and now is actively involved with his specialist consultant service.

On his website, Terry Barnes states:

“In healthcare business planning and investment, an understanding of potential and emerging risks arising from government policy, processes and bureaucratic culture can give a crucial competitive edge to corporate managers, investors and business analysts. 

It’s also an area where policy-makers have little or no direct knowledge and experience of how to run any private sector business, let alone a major healthcare business. 
What’s more, few of them take the trouble to learn about the business whose futures they can make or break.


Drawing of his own extensive experience, Terry Barnes through
CORMORANT POLICY ADVICE can help healthcare sector providers, analysts and investors to understand the mindset of government funders and regulators and to engage with them more effectively.”

Terry Barnes is no real friend of pharmacy but is obviously an intelligent and well-informed “insider”.
In his own words he was one of those bureaucrats that had “little or no direct knowledge and experience of how to run any private sector business, let alone a major healthcare business”.
He could also be regarded as an "economic rationalist".

When government bureaucrats talk about community pharmacy being non-competitive I often scratch my head.
In these days of Chemist Warehouse and their clones, a Woolworths or a Coles would have some difficulty in matching that supermarket style service – so where will the economies of scale come in?

Even in cyberspace the Coles purchase of Pharmacy Direct demonstrated a complete lack of expertise. They lost nearly 50% of their customer base before being forced to sell out to Terry White.

So how are these people able to dictate and ruin a well organised profession where product costs are well known and add-on margins are negotiated?

To that extent I can sympathise with the PGA as they have tried to button-down everything associated with community pharmacy at multiple levels – from government through to community pharmacy employees in a sustained effort to protect the pharmacy owner.
In this process they have stifled initiative and created an unbalanced profession.
As we have continuously pointed out since the year 2000 when all this pressure began, protectionism is not the way to go.
On the downside:

* Mutual respect between proprietors and colleague non-owner pharmacists has depleted leaving these natural innovators for professional pharmacy service provision in a weakened and defensive state.
They feel unwanted in the treadmill environment of the dispensary, not valued through the poor hourly rates being offered and not listened to when they have something to offer because it would not fit a supply-side business model.

* When people retire from their chosen profession they generally do so in such a way that they leave something for the future generation. They also like to continue in a mentoring mode, but even this role has disappeared. This has not happened since year 2000.
Age-discrimination is alive and well, and unless you can physically and mentally cope with the treadmill, you simply have to fall off and disappear.
Pharmacy has not valued their senior pharmacists to allow an orderly transfer of practical knowledge that you just can’t acquire through a university course.

* There is a high level of unemployment in pharmacy, particularly for new pharmacists – those people that refresh and renew the profession.
Pharmacy continues to devalue these people through not providing sufficient opportunity and poor salaries/wages.

* PGA protectionist policies are not only under attack from without, but an increasing number from within. Opportunities have been lost in continuing with the mind-numbing supply side model – a model that can hardly be called exciting or creative.

* PGA lack of arms-length with wholesalers has meant that the PGA spends a lot of energy protecting their turf instead of being watchful and representative for all pharmacies. This has led to complacency and poor management, so the wholesalers have not been as vibrant and competitive as they should have been.
It is significant that globally, all of Pfizer counterfeit drugs have entered the dispensary systems through wholesalers.
This was the trigger for Pfizer direct distribution in Australia and community pharmacy is the loser because the wholesaler cost base increases.
Does government see the difference between pharmacy wholesalers and community pharmacies?
I think not, and everyone from both sides is lumped into the same “pot”.

* Protectionism has not allowed proper external investment and perspectives.
Had this occurred, wholesalers would not be the major force in the purchase of pharmacies and new pharmacists may have been able to buy into stable company pharmacies that had the scale of economies to support a whole range of enterprises that are denied to the current pharmacy models.

So what happens from this point on?
Community pharmacies will attempt to regroup and form various purchasing arrangements to eliminate future disruption.
These new groups will concentrate on regional supply, plus retail margins and trading terms that are favourable to community pharmacies.
There will also be a punitive wing to deal with wholesaler and manufacturer skirmishes to include legal challenges under Trade Practices, active detailing of doctors to encourage support for a “compliant manufacturer”, plus an active attack on all costs involving supply on a group basis, and a fresh look at market group requirements to determine their necessity and scale.
Buying groups only form up if they can provide a better total service than wholesalers.
In so doing they alienate the PGA executive who will attempt to preserve the status qo for wholesalers.
But is that the right way to go for the PGA?
That problem should have been resolved back in the year 2000.
It is also inevitable that wholesalers will eventually trespass on to the turf of pharmacy clinical services. Remember their governing body is called the National Pharmaceutical Services Association. They see community pharmacies only as an extension of their own objectives.
Buying groups help to balance the power equation.
Community pharmacies can only insulate themselves by being progressive and sustainable, and taking new services into an increasingly ageing patient’s home.
They need to partner and support bright independent pharmacists who can deliver professional services.

Control the line of both information and supply of prescription medicines right into the patient’s home and you will keep out the manufacturer who wants to provide direct-to-consumer services.
Accept help from manufacturers who will sponsor your own service but under no circumstances allow them to access your databases with patient contact details and drug usage.

That is the way forward.

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Submitted by Terry Barnes on Sun, 08/05/2011 - 13:07.

Dear Neil

Just came across your commentary. If my comments make me an economic rationalist, so be it. My beefs are with the Guild, which in has betrayed pharmacies as small businesses by acting like a big one, with the rorts that are the Location Rules, and blatant abuse of the pharmacist-only principle, which enriches a small number of registered pharmacists to the detriment of the rest.

Thanks for sharing my blog too.

Kind regards, Terry Barnes

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