Welcome to the June edition of i2P, and to our new format. This edition also marks some changes in the type of content we are delivering. While we still retain our core material of opinion and advocacy pertaining to the pharmacy profession, we recognise the need for more information from all sources around the world, to enable pharmacists and pharmacies to lift their game in an increasingly competitive environment.
Our new design means that all this information can be accessed virtually in the centre of the home page and we encourage you to investigate the tripartite links that can access a range of material under the headings "Recent News", "Opinion" and "Pharmedia Commentary".
Our regular columnists are found under this editorial down the left hand side.
I think that as you explore the new site you will find some useful content that can only increase as we settle down in the management of the site.
Volume 1 Number 1
Volume 1 Number 2
Volume 1 Number 3
Volume 1 Number 4
Volume 1 Number 5
Volume 1 Number 6
Volume 1 Number 7
Volume 2 Number 1
Volume 2 Number 2
Volume 2 Number 3
Volume 2 Number 4
Volume 2 Number 5
Volume 2 Number 6
Volume 2 Number 7
Volume 2 Number 8
Volume 2 Number 9
Volume 2 Number 10
Volume 2 Number 11
Volume 3 Number 1
Volume 3 Number 2
Volume 3 Number 3
Volume 3 Number 4
Volume 3 Number 5
Volume 3 Number 6
Volume 3 Number 7
Volume 3 Number 8
Volume 3 Number 9
Volume 3 Number 10
Volume 3 Number 11
Volume 4 Number 1
Volume 4 Number 2
Volume 4 Number 3
Volume 4 Number 4
Volume 4 Number 5
Volume 4 Number 6
Volume 4 Number 7
Volume 4 Number 8
Volume 4 Number 9
Volume 4 Number 10
Volume 4 Number 11
Volume 5 Number 1
Volume 5 Number 2
Volume 5 Number 3
Volume 5 Number 4
Volume 5 Number 5
Volume 5 Number 6
Volume 5 Number 7
Volume 5 Number 8
Volume 5 Number 9
Volume 5 Number 10
Volume 5 Number 11
Volume 6 Number 1
Volume 6 Number 2
Volume 6 Number 3
Academic and professional bullying is not a new phenomenon - it is just not spoken about openly. Similar practices have been documented in businesses, hospitals and all school systems within Australia. Pharmacists are well used to this form of behaviour that is practised by some health professionals against them in their normal daily practice. It is used as a form of intimidation by one health professional to exert power and influence over another. We see it practiced within the Pharmaceutical Benefits Scheme (PBS) where doctors refuse to conform to state regulations by deliberately not correctly writing schedule 8 prescriptions, or having prescription software altered illegally to permanently tick the "no substitution" box or it may simply be a belittling response to a normal professional telephone contact. Other parties such as drug manufacturers, may reinforce attitudes of some health professional groups when it suits their purpose. You see these sorts of arguments when bio-identical hormones are prescribed by one practitioner and denounced by another, using distorted references or references that are simply untrue. The following news item comes via a group of "heavy-hitter" gerontologists and it is disturbing to see how entrenched this process is and at such a high level.
There were many sighs of relief on Budget night from pharmacists who had expected the Government to further reduce the profit margins provided by the PBS. Talk of steep reductions in the prices of a hundred or more high volume medicines did not eventuate, leaving many pharmacists believing that the Government was beginning to understand that there is only so much that can be wrung out of the current PBS structure. How wrong can a pharmacist be?
Hugh Mackay does not need a thesis for an introduction, for we are all somewhat familiar with his work.
A psychologist, social researcher and gifted writer, his lifelong devotion to studying the attitudes and values of people has struck a chord with most students of human nature.
Many wonder exactly what an Australian is these days but above all, we mostly hold dear the two core (sorry Kevin) principles of a “fair go” and being respectful of those of a different culture than us.
For example, I have a Jewish friend who recently married a hajib wearing Muslim.
The case of pharmacist Elizabeth Lee in the UK where a suspended jail sentence was given following a dispensing error, has triggered worldwide interest and support in pharmacy circles, for the plight of Elizabeth. Pharmacist support groups have begun to appear on social networking sites such as Facebook and petitions have been taken up to have pharmacy dispensing errors decriminalised. Many Australian pharmacists have contacted Elizabeth directly and voiced their concern and support.
Whether it be New Zealand, Canada or Australia, pharmacists are facing almost identical problems, particularly in their relationsships with GP's. Any attempt at role expansion by pharmacists is aggressively attacked by GP's as intruding on "their turf" and they go public with a prepared litany that appears to have been written by one person for global media distribution. It is such a similar message country to country, one wonders what the GP's really have to fear. The following story appeared in the New Zealand Herald:
Pharmacy vending machines have been in Australia for some years now, but could not be regarded as having impacted any part of the pharmacy market for automated dispensing machines. Canada is taking the next step to set up a vending machine network and their location and control will be determined by the Canadian College of Pharmacists. But they will end up in malls and medical centres alongside ATM machines, and possibly in rural and remote parts of the country. Government is seeing this type of dispensing as a means of providing medicines at a lower cost. The system has the potential to impact on pharmacies, pharmacist and technician numbers, depending on the number deployed and how popular they become. Dispensing, as we currently know it, could be reduced almost to the status of a credit card transaction. The equivalent system in Australia is known as Express Rx, but has yet to find favour with pharmacy authorities.
Hospitals and their emergency vehicles, which are major polluters, must join the fight against climate change, the World Health Organization said.
"The health sector can contribute a lot to reduce the carbon footprint because the health sector in many countries is the second most important user and energy consumption is very high," Maria Neira, director of the WHO's department of public health and environment, said.
Australian pharmacy has been innovative in many of its activities when compared to pharmacy development in other countries.
Schedule 3 is one such innovation where drugs are able to be sold without prescription but require counselling support from a pharmacist, perhaps backed up again with written information such as a Consumer Medication Information (CMI) leaflet or other acceptable format. The US is moving towards a Schedule 3 equivalent and so it seems is the UK according to the letter below by Jeffrey Aronson, published in the BMJ in May 2009.
Concerns have been raised for some time about S2 and S3 implementation in Australia and pharmacies have come under criticism for the management of this schedule.
Not all patients require ongoing counselling with repetitive sales of a single product and there is patient resistance to accepting CMI's with every sale. They see it as wasteful in terms of paper usage and duplication of existing knowledge and information.
There is also not a full support from pharmacists for CMI's because of the way they are structured.
There is a perception that CMI's are more for manufacturer protection rather than for patient education.
Pharmacists had little input into CMI original design when they were first conceived, and see little reason to support them.
The bureaucratic "stuff up" in this area has given critics of pharmacy a wider range of options to highlight and portray pharmacists as being unprofessional and not doing their job.
Jeffrey Aronson sees pharmacists as providing a monitoring and referral function utilising linked electronic records that extend to facilitating research into patient outcomes.
This all sounds great, but in the Australian climate, how is this all going to be paid for?
On paper it looks good and could be a great impetus for clinical pharmacists, but who is going to supervise the relentless flow of prescriptions (electronic or paper-based) to generate sufficient time to accommodate this service and how will the cost be maintained at an economic level.
Given the competition waged by warehouse style pharmacies, there will never be sufficient product margin to fund all this activity.
So where to from here?
Two related papers have been recently published.
One is about Schedule 3 (here) and the other is about couselling (here).
Please read these papers in conjunction with the BMJ letter to inform yourself about the material being published that government will refer to when making decisions involving schedule 3 drugs and their availability.
Then read Mark Coleman's commentary to see if you agree and please register your own comments through the link at the base of this page.