Editorial

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Welcome to the May 2012 homepage edition of i2P-Information to Pharmacists. Rollo Manning has been having some time out having staples removed from the site of his open heart surgery.He is now at home recuperating in Darwin, having arrived home last Friday, beating a cold and hasty retreat from Canberra.We all wish him a speedy recovery and hopefully, he will be fit enough to contribute by next month.
This month, Pharmedia discusses the toll that is taken when someone complains about you to an authority without good cause. Well, the good news is that you can now take action to protect yourself if such a complaint is made, and that may even include action for defamation. Read about a recent case involving two doctors, with Mark Coleman drawing on personal experience to illustrate.

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Big Pharma impacts on the pharmacy profession

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	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 21^st 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.

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