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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. 
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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From this page you can share Direct Distribution - Time for Government to act to a social bookmarking site or email a link to the page.
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Direct Distribution - Time for Government to act

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.

In an earlier article, (found on the September homepage edition), by Peter Jackson, discussion occurred regarding drug distribution costs and drug shortages in the UK compared to Australia.
Parallel importing had resulted in a trade between low-cost European countries and high-cost countries, resulting in drug shortages in the lower cost countries.
It turns out that patients in the US are also facing drug shortages, very high prices and parallel importing systems set up by Canadian pharmacists who are able to service US patients at a lower price.
The only difference between the US and the European systems is that the US drug manufacturers have not been able to monopolise drug distribution as effectively as they have in the UK.
Australia, however, is particularly vulnerable to this new type of monopolistic supply chain and pharmacy wholesalers, supported by community pharmacists are lobbying government to legislate against this development.

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Daniel Hussar, is the Remington Professor of Pharmacy at the University of the Sciences in Philadelphia. He also publishes a newsletter called the Pharmacist Activist where he voices a well-articulated opinion on issues relating to pharmacy in the US.
i2P has carried a link to that publication for some years (you will find it on the homepage under “EPublications”).
In his latest newsletter Daniel strongly identifies the US problem as being one caused by drug manufacturers, and he further points out that by being the problem they should fix it.
He states:
“There have been numerous concerns voiced about the high cost of prescription medications to which the pharmaceutical companies have responded that this level of revenue is necessary to support their extensive research programs that will result in the development of new life-saving drugs. The companies have had their way and, unless there are strong competitive restraints, have been able to set the prices for their medications at whatever level they choose or, as some would suggest, whatever the market will bear. A recent example is ipilimumab (Yervoy), an important new drug for the treatment of metastatic melanoma, for which the cost of a four-dose treatment regimen is approximately $120,000. And it is not just these intravenously-administered monoclonal antibodies for which the cost is high. For example, the cost of the important orally-administered antibiotic linezolid (Zyvox) is more than $100 for each tablet.”

Instances of this type have occurred with similar patients here in Australia and while it is acknowledged that manufacturers need a fair return on their invested capital, that return seems to developing to an unreasonable level.
It is only a few short years ago that the manufacturers of HIV/AIDS drugs were called upon to reduce the prices of those drugs to service the epidemic that was (and still is) sweeping the continent of Africa.
The manufacturers argued that they had to recover research costs until somebody leaked the fact that the research had been paid for by the US government in the form of grants to various universities. The manufacturers had not paid one cent for research!
It was further leaked that the same drug manufacturers had mark-ups on these drugs at the rate of 15,000% plus.
India stepped in and provided generic versions to Africa, but even they had a mark up of 600% when sold to Africa.
In an industry where the clinical coal face deals compassionately with patients, it is obvious that something happens to company executives when they become part of the culture of a global company – and it is not a pretty sight.
Daniel Hussar describes part of this attitude as follows:

“Shortages of drugs used to be isolated experiences. However, in 2011 alone, more than 200 drugs have been in short supply and some of these situations have reached crisis proportions. There have been serious shortages of medications used in surgery (e.g., propofol), critical care situations (e.g., furosemide, norepinephrine, labetalol), and the treatment of certain cancers (e.g., cytarabine). Patients with a diagnosis of cancer have a huge challenge in coping with the implications of their illness. They should not have to experience the additional uncertainties and anxiety as to whether the medications they need will be available, or the fear prompted by a call from the oncologist to cancel an appointment because the dose of the medication to be administered is not available. The American Society of Health-System Pharmacists is providing important leadership in increasing the awareness and urging action with respect to the shortages and the extremely important risks presented, and the Food and Drug Administration is doing much more to identify situations in which drug shortages exist or can be anticipated. However, progress has been slow and the need for action is urgent.”

Not that the US Food and Drug Administration is a shining example of a government agency doing its job for the protection of health consumers. Drug manufacturers pay handsomely for the listing of their drugs and this has created a wealthy government agency that tends to serve drug manufacturers more than the general population.
There is often a regular interchange of company executives becoming FDA officials in a revolving door process. As Daniel notes above “progress has been slow and the need for action is urgent” – one can well imagine why!

Daniel comments further:
“Some of the medications for which there are shortages are life-saving drugs and patients may be endangered when they are not available on a timely basis. This is clearly the consequence that requires the highest priority attention.
Price-gouging has been another consequence of the shortages, with the prices requested for some drugs being 50 times their usual costs. An article titled, "Drug Shortages Lead to price gouging," (Liz Szabo in USA Today, August 18, 2011, p. 3D) begins:
"Scalping tickets to a rock concert can get you arrested. But reselling lifesaving medications at a hefty mark-up is a thriving business."
The antihypertensive drug labetalol is often used in emergency situations and is one of the examples cited. The usual cost is approximately $25 a dose but some hospitals have been asked to pay as much as $1,200.”


It is not hard to envisage a situation of this kind emerging within Australia unless government supports the CSO wholesalers to maintain a more level playing field within the supply chain.
Allowing manufacturers to develop a new form of monopoly by virtue of their market share of the PBS should be vigorously opposed by government, because Australian taxpayers will have to foot the bill along with the community pharmacists of Australia, who are “squeezed” within the system.
Global drug manufacturers do not operate within a free market system by virtue of the privileges received under patent laws for their respective drugs.
Further, the manipulation that a drug manufacturer can create is becoming quite evident under the current Pfizer Direct supply system just in reportage of fanciful delivery times by the nominated logistics supply company, DHL.

As Daniel Hussar says:
“There are even allegations that some pharmaceutical companies may be using concerns about drug shortages as a scare tactic in the marketing strategies for certain of their drugs. This could be done by suggesting to pharmacies that they buy a larger-than-usual amount of a drug so that they would be assured of having an adequate supply in the event of a shortage. A variation of this strategy is to note that there is only a limited supply of an important drug (e.g., an anticancer drug) and, that to guarantee the continued availability of this medication for their patients, physicians should register them in a special program with the company.”

The moral of that story is to watch out for a similar strategy when Lipitor comes off patent, and don’t give out or encourage patients to give their contact details to drug manufacturers under any circumstances.
Drug manufacturers have been slowly and progressively building patient databases for some time now, here in Australia and they will be used to bypass pharmacists.
It is only just over 12 months ago that i2P predicted the warfare between manufacturers and wholesalers.
i2P also predicted warfare between wholesalers and their pharmacist clients in the clinical services area. We are seeing franchised group intrusion into prescription prices and some screening processes already.
This is only a short step away from providing the services on a direct basis.
It might not happen overnight, but it will happen.
The PGA needs to be extracting some written promises now from wholesalers as they are being helped to stay in business through pharmacist support for their CSO payments.
To read the rest of Daniel’s comments go to:
http://www.pharmacistactivist.com/2011/August_2011.shtml

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