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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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News Flash

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 Pharmedia - Blackmore's Ignite an Inflammatory Debate to a social bookmarking site or email a link to the page.
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Pharmedia - Blackmore's Ignite an Inflammatory Debate

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.

Editor's Note: The Pharmacy Guild of Australia (PGA) and Blackore's Laboratories recently structured an alliance for a program surrounding nutrient deficiencies that certain drugs were known to induce.
A simple strategy was developed whereby the professional input by pharmacists was to be utilised to educate patients on how to correct these deficiencies.
Problem was, the PGA did not include the professional body representing the pharmacy profession (PSA) and that managed to get them completely offside.

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Simultaneously, Christine Holgate the CEO of Blackmore Laboratories likened the process to a standard up-selling strategy aimilar to "do you want coke and fries" in the fast food arena, displaying a lack of understanding of pharmacy and health politics in general.

The result has been a public relations disaster for both Blackmore's and the PGA with a range of national media and health organisations lining up to condemn the new relationship and in many cases promoting inferred commentary rather than reporting objectively.

i2P has a feeling that the pharmacy profession will be the big loser in that a business/professional opportunity may be lost temporarily - even permanently.

We have asked Mark Coleman to comment on the Pharmacy News article dated 26th September 2011 (one of many media articles) by trying and untangle the "spin" and suggest a way forward.

Evidence behind Blackmore's Companion range questioned

Evidence behind Blackmore's Companion range questioned

The announcement last week that GuildCare will incorporate the new Blackmore’s Companion range of dietary supplements into their professional service software has sparked debate over the evidence supporting their use.

As reported in Pharmacy News, the four supplements for antibiotics, blood pressure drugs, cholesterol drugs and proton pump inhibitors (PPIs), have been formulated to support the use of prescription medicines, and endorsed by the Pharmacy Guild of Australia.

As reported today in The Sydney Morning Herald and The Age, the program has triggered criticism from medical groups and consumer advocates.

Steve Hambleton, president of the Australian Medical Association, said he did not know of any solid evidence backing combining dietary supplements with prescriptions.

Dr Ken Harvey, a public health expert at La Trobe University, has written to Blackmores asking for clarification of the evidence behind the supplements. 

In response, Blackmores has said the “range is supported by scientific evidence that has been reviewed by the Pharmacy Guild of Australia, who are confident that the range will improve patient outcomes.”

Pam Stone, Blackmores director of education, said “certain medications can reduce levels of essential nutrients. Most pharmacists and GPs are aware of the role probiotics can play alongside antibiotics, and coenzyme Q10 alongside statins. There is also a need to consider zinc status in those taking certain anti-hypertensives, magnesium status in those taking PPIs, and vitamin D status in those taking statins”.

In a recent column in Pharmacy News, Kos Sclavos, National President of the Pharmacy Guild of Australia, said the range would allow pharmacists to use their clinical skills, “with knowledge that Woolworths and Coles will not undermine your time invested in subsequent sales of the products.”
 

  Mark Coleman

 

 

Lessons needs to be learnt from this debacle and the original opportunity developed in a manner that is transparent, ethical and supported from all levels of pharmacy - if that is retrievable

1. It is time that the PGA stopped developing professional services in a non-collaborative manner, isolating the PSA at every opportunity.
The core business of pharmacy is its professional activity, and how that is developed and delivered is very much a concern of the PSA. The physical structure of a pharmacy and its business process is absolutely necessary for pharmacy professional services to be delivered - this is very much the realm of the PGA.
The fuzzy areas at the boundaries of each organisation means that to be effective, they must work in a genuine partnership.
A healthy relationship between the two governing pharmacy peak bodies is desired by most pharmacists, however there is an elitist core within the PGA that devalues the collegiate relationship that used to exist between pharmacist owners and employed pharmacists.
This is damaging for the entire profession of pharmacy and unless it is pulled into line immediately, the business of pharmacy will continue its apparent decline at a more rapid pace.
A true profession puts its patients first and its remuneration second.
Unless that is seen to be done, co-professionals will continue to remain cynical and a general public will lose faith in pharmacists and view their services as of little or no value.

2. Leadership values are being reviewed on a world-wide basis because institutional bodies charged to deliver important programs of government or companies managed for the benefit of their  shareholders only are increasingly seen as being morally bankrupt and not generating a benefit for society as a whole. Pharmacy leadership is being measured in the same way.

3. For pharmacy, the erruption surrounding the Blackmore's/PGA Alliance is merely a symptom of how widely pharmacy is viewed in a negative manner by other health groups, consumer groups and the general public.
Of course, one has come to accept that groups like the AMA will take an aggressive negative stance against pharmacy at every opportunity, because it is likewise morally bankrupt.
But pharmacy leaders should have a collective vision and be prepared to have the courage to lead the profession down a pathway that has transparency coupled with the "right" beliefs- beliefs that have been fully tested.

4. The PSA has demanded an apology from Blackmore's for their "coke and fries" comment. It should be given unconditionally and the PSA should accept it on behalf of all pharmacists.
I too am offended by the Blackmore analogy even though I support their joint initiative with the PGA.

5. Likewise, the PGA should also build bridges with offended groups and deal with their perceptions and it should also apologise to the PSA for mishandling yet again, professional activity that is truly the "turf" of the PSA. If this does not occur an otherwise very good initiative will permanently disappear with the danger of a useful professional activity never being able to be revisited.

6. Peak pharmacy groups should also seize the opportunity to become gatekeepers to evidence surrounding all types of complementary medicines and it should be weighted to indicate to pharmacists the strength of the evidence. A standard is required once and for all to refute attacks on pharmacists who have an interest in complementary medicine, have good clinical judgement and who can see a benefit to the community at large.
The evidence should be set up in a central database conveniently accessed
Unless this is done, individuals with other agendas damaging to pharmacy can continue to take "potshots". I for one am sick and tired of this process, but I have little to defend myself with.
What are my peak leadership bodies doing?
Certainly not the job they are supposed to be doing.
Maybe future elections within those peak bodies will start to create the change necessary by voting in people who wish to see a real future for pharmacy by correcting anomalies that have existed for years but have just been ignored.
The PGA is a wealthy organisation deriving a lot of its wealth directly through managing or receiving government grants, plus a stream of income through the provision of various services.
Some of this money should be apportioned to an evidence database basically funded by the PGA managed jointly with the PSA with the PSA providing the weighting for each item of evidence.

7. Goverment initially nominated pharmacists as the best professionals to advise on complementary medicines because of their training. Pharmacists have never fully embraced this responsibility.
Given the level of sales of these medicines and the interest expressed by most pharmacists, it is more than past the time responsibility should be accepted.
The general public expects it, and other health groups would respect it - if it was managed appropriately.

8. Individual pharmacist members of peak pharmacy bodies expect the executive of those bodies to spend member's money on appropriate projects that have the support of its members.
Also to manage the public relations aspects appropriately, by being transparent and informative to all.

They way forward is simply to write to the executive of the organisation you belong to and demand that action be taken on your behalf to rectify the current Blackmore debacle.
The opportunity is there now that the respective executives will be experiencing fallout from a range of sources.
Take advantage and make them work on your behalf!

health news headlines provided courtesy of Medical News Today.

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