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Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists


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

Comments: 1

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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

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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 Big Pharma impacts on the pharmacy profession to a social bookmarking site or email a link to the page.
Social Web

Big Pharma impacts on the pharmacy profession

Peter Jackson

articles by this author...

Peter works in the pharma industry and has a specialty interest in pharmaceutical supply systems and logistics. He is based in Sydney with his wife and two children.

“Staff in almost one fifth of pharmacies could be wasting more than five hours per week, the equivalent of one month's working time a year, trying to source out-of-stock medicines.”
So claims a report published in the UK newsletter Chemist & Druggist this month.
The report goes on to claim:

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“Adding to the growing weight of evidence about the impact shortages are having on the sector, the C+D Stocks Survey 2011 found 95 per cent of pharmacists spend over an hour a week trying to obtain drugs, with 62 per cent saying they spend more than two hours a week on the task.”
“More than 18 per cent of the 322 survey respondents reported taking more than five hours a week to deal with stock shortages, which equates to over 26 10-hour working days per year.”

While Australia may not be quite to the degree that UK pharmacy has to endure, it is no accident that this state of affairs is occurring.
It is simply the result of manipulation by Big Pharma in its continuing effort to control the supply chain in all of its aspects.
In the process it adds to the charge on pharmacy time and its investment in patient goodwill.
It is costly, unnecessary and needs government intervention in both the UK and Australia.
In Australia, government intervention would be a simple process – just an insistence that the only drugs reimbursable through the PBS be available through CSO wholesalers.
Manufacturers can continue to promote direct distribution, just as long as back up supplies are available through other wholesalers.

But this is only a partial solution to supply manipulation. Government need to insist that manufacturers themselves keep a 90 day reserve as one of the conditions of supply through PBS. If government is not prepared to use the muscle available to it then its health reform processes will begin to stagger through loss of pharmacist time, increased workplace stress and increased costs.
As the Chemist & Druggist report says:
“The findings confirm pharmacists' claims that supply chain problems have shown no signs of improvement in the past two years – in 2010, 89 per cent of pharmacists responding to C+D's Stocks Survey reported spending at least an hour a week chasing medicines; while in 2009 the figure was 90 per cent..

"Sadly these findings do not come as a surprise," said a Pharmacy Voice spokesperson. They said they were concerned that "precious time" was being allocated to "a frustrating medicines hunt", and asked: "How many lifestyle interventions and medicine consultations could be delivered in the time it takes to jump through these hoops?"

Is part of the Big Pharma agenda an attempt to suppress pharmacy clinical initiatives by creating a series of workplace stresses on pharmacists to discourage them from gaining more direct time with patients?
Certainly it is a Pharma objective to develop a Direct to Consumer wing as a support mechanism to protect both market share of its drug portfolio and also maximum price.
The reality is that for most UK pharmacies, with Australian pharmacies not far behind, a permanent layer of unnecessary administration has to be formed up to support and control the problem. Small pharmacies simply do not enjoy the luxury of having the resources to provide that overlay of management.

In the UK it is taking up to five working days to source emergency medicines - a situation that is not tenable in a 21st Century medical environment.

Back in 2007 Big Pharma commissioned a report on its future through Price Waterhouse Cooper.
In part, Pharma was told:

1. The burden of chronic disease is soaring.
Because people are living longer, chronic diseases often hit people at a time when they are still working. Governments have reacted by forcing up the retirement age increasing the social and economic value of treatments. Pharma will have to reduce its prices and rely on volume sales because many countries will not be able to afford their medicines.

2. Healthcare policy-makers and payers are increasingly mandating or influencing what doctors can prescribe.
Treatment protocols are being developed to replace individual doctor prescribing.
This cuts across Pharma marketing strategy in that the target market is becoming consolidated and more powerful, forcing the industry to work harder for its sales dollars.

3. Pay-for-performance is on the rise.
Healthcare payers are demanding more “bang for the buck” and are measuring pharmacoeconomic performance. Electronic health records are thought to be able to develop more precise measurements and allow payers to devise and insist on best practice. These are yet to surface in Australia and one wonders why when the technology is relatively simple.
Is Pharma running interference at any level?
Again, Pharma will have to work harder for each sales dollar when PCEHR eventually arrives.

4. The boundaries between different forms of healthcare are blurring
The needs of patients are changing accordingly.
Where treatment is migrating from the doctor to ancillary care or self-care, patients will require more comprehensive information. Where treatment is migrating from the hospital to the primary-care sector, patients will require new services such as home delivery.

This process needs a community centred easily accessed information service and a “pharmacy in the home” service.
Government is looking towards Medicare Locals to provide the information service which may extend to a home delivery service.
Why pharmacy was not directly involved before Medicare Locals became a reality is anyone’s guess, but pharmacy still has the opportunity to develop this sector, but might have difficulty in receiving a government payment if the service is provided from a pharmacy.
i2P has been advocating a “pharmacy in the home concept” for ages which has a number of advantages, one being that a pharmacy need not be located in a major shopping centre at a high rental.
The self-medication sector is also increasing as more prescription products are switched to over-the-counter status.

5. The markets of the developing world, where demand for medicines is likely to grow most rapidly over the next 13 years, are highly varied.

Developing countries have very different clinical and economic characteristics, healthcare systems and attitudes towards the protection of intellectual property.

Any company that wants to serve these markets successfully will therefore have to devise strategies that are tailored to their individual needs.
Hence we have seen many and varied strategies developed here in Australia designed to extend patents or obtain a new patent using mixtures of drugs.

6. Many governments are beginning to focus on prevention rather than treatment, although they are not yet investing very much in pre-emptive measures.

This change of emphasis will enable Pharma to enter the realm of health management. But if it is to do so, it will have to rebuild its image, since healthcare professionals and patients will not trust the industry to provide such services unless they are sure it has their best interests at heart.
Remember Pharma was told this in 2007 yet they are still trying to devise methods to bypass pharmacy or disrupt it to reduce its clinical output through supply chain manipulation.
Pharmacy must win in this area and government must support this effort.

7. The regulators are becoming more risk-averse.

The leading national and multinational agencies have become much more cautious about approving truly innovative medicines, in the wake of problems with medicines like Vioxx.
It is in this area we have seen Pharma manipulate drug evidence involving corrupt practices with researchers and the peer group review panels to prestige-type journals who publish the evidence.

Pharma approach to risk management is simply to pay insurance claims.
Provided the dollars paid in insurance premiums balance with patient settlements of claims and Pharma profits, Pharma has delivered for its shareholders.
It has done nothing for its reputation or the real damage inflicted on unsuspecting patients.

The above seven points were what was delivered to Big Pharma in 2007.
The response, to preserve the enormous profit margins Pharma is used to, could not be regarded as ethical or honest.

Because Pharmacy is so intimately tied to these companies for its survival it is essential that our governing bodies at all levels engage with Pharma and iron out the anomalies that inflict pain and suffering on pharmacists in such a global fashion.
It would be more productive for the PGA, and to a lesser extent the PSA, be less reliant on Pharma grants, subsidies and promotional allowances in the conduct of their activities.  Our political bodies ought to be to be advocates for all levels of pharmacy – both professional and commercial, in a transparent fashion.
This would mean a greater reliance on members allowing them to exert more influence over policy development.

A good start might be a combined effort to eradicate sole direct distribution by Pharma in the interests of the entire profession. It might disturb the available pool of fringe benefits, but we pharmacists and the taxpayer end up paying for it anyhow.
I would prefer to see transparent dealings by all our political bodies in respect of Pharma.

health news headlines provided courtesy of Medical News Today.

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