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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 Are we planning for future skill shortages? to a social bookmarking site or email a link to the page.
Social Web

Are we planning for future skill shortages?

Neil Johnston

articles by this author...

Introducing current ideas, perspectives and issues, to the profession of pharmacy

National Seniors Agency have published a report indicating that Australia will have a shortfall of 1.4 million workers by 2025.
This shortage will also be reflected in the profession of pharmacy.
It is pointed out that a smart move would be to match an improved workplace to match specific requirements for mature-aged employees and thus retain them for longer periods..
APESMA has recently published an online survey in an endeavour to poll employed pharmacists on the issues that affect them specifically. Obviously, this is a move in the right direction, and much of what they are polling has a direct relationship to mature-aged employees.

So what is community pharmacy doing to retain their senior pharmacists?

Very little, it seems.

i2P asked Mark Coleman to comment and his commentary appears below the news item:

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"A new report predicts there will be a shortfall of 1.4 million workers by 2025 and further highlights the need for immediate action on the issue of mature age employment, according to National Seniors Australia (NSA).

NSA has welcomed the Workplace Futures report by the Victorian Employers Chamber of Commerce and Industry, which provides yet more evidence that leadership is needed to plan for Australia's future.

NSA chief executive, Michael O'Neill, said mature age employment was the key to addressing the rapidly ageing population and looming skills shortage.

“One of the smartest things we can do as a nation is create a level playing field for our mature age workers by improving employment opportunities and addressing age discrimination in the workforce,” Mr O'Neill said.

“While all Australians have the right to decide when they retire, an increasing number are choosing to continue working past traditional retirement age. Half of all people aged 55+ currently working part-time want more work.”

Mr O'Neill said with the economy now starting to turn a corner, government and businesses must focus on utilising the skills and experience of older Australians who want to work.

“The elimination of age limits, such as those applying to superannuation and workers' compensation, should be central to any policy response- it is currently the case that the 9% employer superannuation contribution is no longer mandatory once a worker is over the age of 70.”

Over the last 12 months, NSA has driven the national debate on this issue through representations to government, business and union representatives."

  Mark Coleman

I have been asked to comment on the above news item and matters in the introduction to this Pharmedia column.

As I am an active senior pharmacist, I do think I have the credentials to comment.

As I progress through my senior years I have looked on in stunned amazement as I find myself continually "dumbed-down" into a repetitive and sometimes soul-destroying dispensing daily grind.
Although expected to answer any patient queries ranging from the sale of S3 products, specific questions relating to a dispensed drug etc. I am still expected to keep up with the production line.
The result is that I counsel a patient with one eye over my shoulder, watching the dispensing pile grow ever larger.
The result is an unsatisfactory transfer of information (by my standards and possibly those of the patient), a pressure-laden dispensary production line, with the capacity for error to occur at any point when focus is lost - even if it is only for a few seconds.

I do have the capacity to counsel patients on a range of topics and when given the opportunity I can form lasting and loyal professional relationships. Always I am able to value-add, but it does not necessarily follow that every single contact adds $ value - but it always does eventually.

When I have queried my employer as to why my talents are not being appropriately used, I have simply been told that "dispensing is where the money is".
No attempt to build up any form of professional service or even co-invest in that activity.

What particularly destroys my day is that the pharmacy technicians are given multiple tasks apart from straight dispensing input. This means they get to sit down at various points over the day.
But the pharmacist - no way!
You are expected to stand from the beginning of a shift until the end.
Your only defence sometimes is to simply work shorter working day to avoid the distress of overworked leg muscles.

So APESMA, I tick your survey box for ;
(i) Lack of rest breaks, and
(ii) Standing for long periods of time

Because you are not as fast as you used to be, you then begin to suffer the silent condemnation by the dispensing technician by way of body language, sighs and heavy breathing.
You also have to face authority issues because technicians are sometimes vested by the proprietor with a power base much larger than your own.
You have become a commodity and your value relates to the total number of hours you can churn out high rates of scripts dispensed, and how many of those hours you can actually sustain on a daily basis - it has nothing to do with the skills acquired over a lifetime.
Because you may be working less hours over a day, you are suddenly seen as "old" and become a second-class employee, even having days reduced in favour of a younger pharmacist, rather than match you to work that you are qualified to do.

There is active discrimination.

In peak periods, workloads can become excessive, so APESMA, I tick another of your boxes.

Workstations are not ergonomic (adjustable computer screens, desk chairs, keyboards etc) and there is inadequate workspace to move comfortably. Another two boxes ticked.

Bullying at all levels is actually quite common and is sytemic in most workplaces (although it can be very subtle). A lot of bullying comes from customers/patients fortified with adverse press comments relating to "rorts", "overpricing" and "rip-offs" often generated by colleagues exhorting "don't pay too much". Another box ticked.

Management by fear is often employed, and with a global economic crisis still producing after-effects, the opportunity to increase pressure and avoid paying fair hourly rates, has also increased.

I have tried to negotiate alliances in professional services for a fee. There is almost a universal disbelief among pharmacy proprietors that this is possible.
Even being willing to work as a contractor and bear any losses on my side has met with resistance.
Because to do the job properly involves redesigning the professional area of the pharmacy and that is a cost most pharmacy owners will not tackle. More than that, it requires a commitment from the proprietor and a belief that professional services can be viable.

With that attitude prevailing one has to question why the PGA insist on having all professional services tied to a pharmacy?
If prorietors are not interested and will not develop appropriate alliances with clinical pharmacists, why should they be involved at all?

Fortunately, pharmacies are not the only environment where clinical pharmacists can practice.
But there is a golden opportunity that has been squandered (and continues to be so) and it will now take enormous amount of time and effort to establish.
The stimulus to do so will only occur when someone like Colesworth gets stuck into pharmacy and generates the incentive.

So what is official pharmacy doing to avoid the future skill shortage?
Not a lot it seems apart from being negative and driving wages down and discouraging new pharmacists through a lack of career path (ecept in retail management and marketing).

As a senior pharmacist I believe that with support I could provide a valuable clinical service from a retail environment, and that I could mentor a number of new graduates to take over the various services.
I believe I could achieve this without all the "top down" protocols and accreditations that are currently in vogue.
What better accreditation is there than a Bachelor of Pharmacy degree from an accredited university?

I believe that such services would be self sufficient with the ability to generate new jobs for pharmacists and with a research stream to identify and develop new pharmacy clinical services.

In a slightly different direction where are all the independent directors for all the newly formed company pharmacies? This is an excellent level to have experience and skills translated into policy and planning from a good working board of directors.

It does not appear to have happened and that is very disappointing - but it would be a useful position for a senior pharmacists at a level where corporate knowledge can be transferred, archived and actioned appropriately.

Unfortunately there is little to encourage me to stay on in pharmacy, yet the current crop of active "baby-boomers" would like to have that option. And believe me, in the not too distant future, today's community pharmacy proprietors and their governing body will rue the decision not to invest in senior pharmacists to provide clinical and mentoring services to those vanished graduate pharmacists who were only seen as cheap "sausage machine" dispensers.

And a final note - many of the patients in pharmacy over the next 30 years will look a little bit like me - on the grey (or no hair) side. They may just remain comfortable with talking to someone of a similar age and background and maybe trying to manage the same lifestyle disease.
That could be a confidence builder and an asset for any pharmacy.

health news headlines provided courtesy of Medical News Today.

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