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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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From this page you can share PHARMEDIA: PCEHR - A Fight for Control? to a social bookmarking site or email a link to the page.
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PHARMEDIA: PCEHR - A Fight for Control?

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.

Squabbles are breaking out in respect of who is going to manage Person Controlled Electronic Health Records (PCEHR) with the Australian Medical Association (AMA) and the Pharmacy Guild of Australia (PGA) being the most vocal.
This against a backdrop of a contract being awarded to Accenture and their alliance partners, Oracle and Orion to develop the system on behalf of the Australian government.
Health Minister Nicola Roxon has said Accenture would receive $47.8m to develop the personally controlled e-health record system.
The department will also pay $17.8m to Oracle in licence fees for access to e-health records stored within all PCEHR repositories, and $11m in fees to Orion for operating a portal.
Many doubts are being raised about the security of PCEHR data, some of which is vulnerable because it will be accessed through cloud storage provided by Telstra (already been found to be sub-standard in security structure).
The PGA wants to be at the centre of PCEHR as illustrated by the story below in brown text.
i2P has asked Mark Coleman to try and sort out what is happening and what needs to happen.

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PHARMACY NEWS 29th August 2011:

PHARMACY’S PEAK BODIES DIFFER ON E-HEALTH RECORDS: AMA

Nick O'donohue

Leading pharmacy organisations appear to be on different pages when it comes to the introduction of Personally Controlled Electronic Health Records (PCEHRs), the AMA believes.

Responding to claims by Kos Sclavos, Pharmacy Guild of Australia national president, that the AMA would seek to lock other health professionals out of the PCEHRs, Dr Steve Hambleton (pictured), AMA president, suggested the Guild consult the PSA on the issue. In his fortnightly opinion piece in Pharmacy News, Mr Sclavos expressed concerns medical organisations including the AMA would seek to freeze other health professionals out of having input into PCEHRs, giving total control to doctors. “In my view some of the negativity comes from medical organisations questioning controls in the system, and by default reducing consumer confidence,” he said. “The AMA has again predictably run interference stressing their desire that the system must be doctor-centric, with the doctor controlling every step.

“They will do their best to lock out pharmacists and other health professionals.”

Dr Hambleton questioned if the Guild had read the AMA’s submission to the Department of Health and Ageing.

“I’m not sure if the Guild has had a chance to read our submission, based on the comments [made in Pharmacy News], because their comments don’t reflect the content of our submission,” he said.

“The AMA is taking a system wide view of the e-health record and has convened a meeting of medical professionals to make sure we get this up-and-running, and it works for the health system in Australia, including pharmacists.

“I’d suggest the Guild consults with the PSA over this, because it would appear that there might be a difference of opinion... I hope the Guild’s not out on its own on this issue.”

Mark Coleman

I have been asked to comment on the above media story.
This will really be a sequel to the Pharmedia item published in July 2011 that focussed on the consumer end of PCEHR.

I have to first of all say that evidence supports pharmacists as being best suited by training and temperament to manage a concentrated body of sensitive information as noted in the July Pharmedia.
Two US studies spanning over a decade support this view.

So on balance, I again find myself supporting (uncharacteristically) that PGA view of the world.
But is the PGA the best pharmacy group to assume control?
The hype that the PGA trumpet is that they spend their own money to make things work.
They point to the eRx system that started life with a government grant in excess of $5 million plus under the old Better Medication Management System - you know the one that disappeared assisted by a couple of PGA executives and consultants that was rebirthed in private enterprise but miraculously ended back in PGA hands.
Very little PGA money involved there!

Recently,the Pharmacy Guild-controlled FRED IT received $7.9m grant for its MedView medication management project, based around Geelong. In a pharmacy first, the aim is to allow doctors to see a combined list of prescribed and dispensed medications, no matter how many doctors or pharmacies a patient has attended.
This again gives the PGA a "leg-up" in its fight for dominance in the health IT market, but very little PGA money involved there to trumpet about.
But it does give leverage to the PGA to flag a success story in full view  of the AMA.

There is so much conflict of interest in Health IT that the players seem to have lost track of one another - also their ethics.

Referring again to the news item, the AMA point the PGA towards the PSA to regain their perspective.
It is true that the PSA have a golden opportunity to insert themselves into the pharmacy IT power structure, by endorsing systems that would genuinely benefit pharmacy practice.
Their opposite number, the Royal Australian College of General Practice already do this for GPs who will not even look at practice software unless it has the RACGP "thumbprint" on it.
If the PSA will not play "honest broker" for pharmacy IT, pharmacy vendors will find themselves having to bend to rules imposed informally by the PGA that serve to block their aspirations, plus pharmacy practice losing good quality IT systems.
With the PGA as gatekeeper, software developer, grants manager, political lobbyists, supreme annointers for community pharmacy - it is little wonder that the PGA sees itself as the sole arbiter of Health IT.
All done with their "own money" - the $28.5 million annual profit plus a new grant of $7.9 million.
All at a time when PGA members are financially stressed and not getting unbiased practice direction, because the PGA is conflicted by only introducing systems that are "top down" and benefit the executive coffers.

There are other side issues with PCEHR.
The medical profession will only recognise health records assembled by health professionals, and because of potential legal implications, they are probably right.
They would prefer an opt-out system.

The consumers (those that opt-in) want to be able to suppress medical information and supply only edited information to various health professionals. This type of record will never be implemented successfully.
Yet the government have stated that this is the system they want for PCEHR. Some commentators note that a cynical government does not care, as it only wants what is a de facto Australia Card.

Another noteworthy point is that Accenture will not be able to develop a PCEHR in line with NEHTA specifications - there will simply not be time. What is more likely to happen is that their successful model developed for the government of Singapore will be crafted to create an Australian version. This is how global software normally reaches Australia and never quite works under Australian conditions.

The biggest ticking time bomb for PCEHR is the legal issue.

An electronic health record (EHR) is more than just an electronic representation of a paper chart. It is a legal representation of a patient's medical condition and treatment at a given point in time, one that could be admissible in court. And that could present a whole new set of challenges for healthcare organizations.
If nothing else it will be a magnet for hackers and identity thieves.

EHRs make patient information more readily accessible to far more people than any paper chart stashed away in a filing room. They also change how and to what extent medical professionals document patient encounters and add in safety-related features such as clinical decision support.
They will require more time to assemble, particularly for doctors, and have the potential to cause errors when time pressures occur.

Privacy and security rules require anyone that handles electronic healthcare data to keep an audit log of access to any personally identifiable information, and records have helped organizations catch employees taking an unauthorised look at patient records-sometimes also landing the organisations themselves in hot water.

Indeed, some worry that audit logs can reveal too much and there are concerns by providers that access reports could be used in malpractice suits.
The US experience has found that the scope of traditional discovery is expanded, with more and more courts finding that metadata and access to the inner workings of the EHR system is relevant and discoverable.
With all those lawyers licking their lips maybe it will be not such a great experience to be a gatekeeper to all that contentious information.

Eventually there will be situation where medico-legally the PCEHR might be forced to turn over information to the courts or lawyers against the wish of the patient.
I wonder how many patients will opt-in when they discover that fact?

And there are sure to be issues around the quality and reliability of software that is implemented without sufficient testing. Who will be responsible for errors and how does a complainant obtain access to a system's internals to check?
Will the PGA be putting all its members at risk by accepting legal responsibility for managing PCEHR?
Members need to wake up and do a bit of their own research here.

The PGA view of the AMA wanting to marginalise pharmacy and all other allied health professions is probably true.
For this reason the AMA is generally losing the respect of other health professions and they need to re-focus their activities in a more positive light.

health news headlines provided courtesy of Medical News Today.

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