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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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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The IT Can of Worms in NSW

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.

When a simple business transaction does not seem to make sense, one is led to speculate on the agenda  behind that transaction.
An observation I have noted from personal experience is that the presence of a major Australian IT system within a public hospital environment, is almost non-existent.
This does not make sense.
There are many excellent Australian IT companies.

However, you tend to find only global brands in NSW hospitals, with the following characteristics:

* They are very expensive

* They do not integrate with other hospital systems

* They break down frequently, often necessitating the placement of a vendor company project manager within the hospital system, to cope with the breakdowns.

Australian companies are commonly told that they will not have the resources to develop their version of a needed hospital system and that they should partner or make a strategic arrangement with one of the existing global vendors already contracted to the hospital system, to overcome the problem.
Even when it can be demonstrated that coupling with a global vendor is not necessary, and that adequate resources exist to develop the Australian system, the arguments fall on deaf ears.
Forming a strategic relationship with a global vendor can be a daunting process and can ultimately lead to the Australian component being strangled or disenfranchised in a major capacity.

I recently came across an innovative Australian IT company that had developed an asset management and tracking system suitable for a hospital environment.

The company is located in the small north-coast town of Red Rock, which is found not far from the regional city of Grafton, in NSW.
In nearby Coffs Harbour, NSW Health had built a new hospital and had decided to dispose its old hospital and contents.
The building and a range of assets were sold to a developer.
A local company called In The Shed Asset Management (ITSAM) Pty Ltd, decided to purchase some of the surplus assets from the developer and negotiated a good buying price.
The entrepreneurial CEO of the company, Phil Clare, immediately set about finding a market for his purchases and was surprised to find he had a ready customer in very space where he had made the original transaction in NSW Health.
Their regional hospitals, including Coffs Harbour Hospital were eager customers.

Phil scratched his head in wonderment at this discovery, because it was evident that NSW Health did not have any viable form of asset management, and that the head of the organisation had no idea what was happening at its tail end.
Being a good entrepreneur, he quickly scoped an asset management and tracking system that was “state-of-the-art”, and took it to the senior management of NSW Health.

After a thorough briefing, NSW Health developed a tender for a pilot project that involved tracking assets, disposing of obsolete assets and the general cleaning up of facilities that had fallen into disuse as their spaces became overgrown with records, chemicals, equipment – all the miscellanea that accumulated from within the various hospital labyrinths. The wastage of space was considerable.

Some of the items stored, and the manner in which they were stored, had the alleged capacity to embarrass NSW Health and the NSW State Government in the areas of waste and non-compliance.

After many pilots ITSAM submitted a tender and won it, simply because it was the only tender.
The rest of the field did not seem to have an interest in this obscure hospital problem.

After being awarded the contract, ITSAM set about honouring its contract.
Given the position that government hospitals hold in the general scheme of the health system, this was an important contract for ITSAM and they were determined to do an efficient and thorough job.
They naturally wanted to keep renewing the contract and use it as a referral point to gain future contracts, so they gave it their all.

The work was performed between 2006 and 2008 for the Northern Sydney Central Coast Area Health Service. The work was documented and meticulously reported on. The quality of reportage moved hospital management to write an unsolicited commendation for the manner in which ITSAM carried out its work.

All appeared to be progressing well.
The contract was renewed and other area health services became interested as well. That is, until ITSAM attempted to claim payments for work completed under its contract.
The contract for a second renewal was then abruptly cancelled despite prior verbal assurances (how dare he ask for his money!).
He also alleged he was verbally threatened to be buried in paper work and legal action if he attempted his own legal action.
NSW Health had managed to drag out their contracted terms of payment (45 days) to up to six years.
Only a fraction of the total account has been paid since contracting with NSW Health and Phil Clare has had to renegotiate that under a separate Deed of Agreement.

The new year of 2011 was the point where Phil Clare decided to declare war on NSW Health.
He sent out  the latest round of invoices/statements to the eight area health services and a ninth
straight to NSWHealth.

Phil states: "I have heard staff were receiving warnings from their superiors to avoid contact with Intheshed. Last time we were bullied they threatened that they would bury us in legal issues.
They certainly followed up on that,” he said.
“(NSWMinister for Health) Carmel Tebbutt told Parliament that no payments to government contractors
extend beyond 45 days,” he said.
“We sent out the latest batch of invoices on December 29 2010 – more than 45 days ago.
“Plus Tebbutt met with local member Steve Cansdell about this and assured him that (NSW) Health would fast-track our stuff.”

The government background to this dispute makes fascinating reading.
Recently, one of Carmel Tebutt's senior advisers was sacked for being in possession of prohibited drugs. His trial is set down until after the looming NSW state elections.

He was replaced by Scott Gartrell, a person who was previously a lobbyist and was instrumental in assisting a company called Infrashore, the consortium in charge of the $1 billion Royal North Shore Hospital redevelopment.
This is the major hospital that ITSAM was involved with under its contract with NSW Health.

Years earlier (1997) Scott Gartrell worked for Thiess, a major shareholder in Infrashore.
Late in January 2011 he deserted Carmel Tebbutt  to head up Infrashore and is therefore seen to be dealing with his old department.
Jillian Skinner, the current opposition spokeswoman, immediately reported the event with the Independent Commission Against Corruption (ICAC).
The story is best told in the National Times article dated January 30 2011.

The point to this background is that a major global IT vendor in association with Infrashore, has recently become interested in asset management and tracking and has developed software to be used in NSW Health environment.
Remember, when Phil Clare tendered for this service, no other vendor submitted a tender.
I think that the commercial-in-confidence implications as well as the lack of arms-length dealing would be obvious. You have a serious "can of worms".
It will be interesting to see how effective ICAC is after the March election for the state government of NSW.

Obviously, all these dealings did not sit comfortably with ITSAM which is still waiting for its money after a total of six years and which now tallies at $2.7 million.
This is serious stuff for a small business that has now had to put off staff and cancel expansion plans.

In an attempty to pressure the NSW State Government to honour its legal contractual obligations, Phil Clare has begun to talk to various media, including the local Grafton Examiner, the Sydney Morning Herald and i2P.
In addition, a website has been set up along the lines of the now famous "Wikileaks", whose founder, Julian Assange, coincidentally hails from the Norther Rivers Area of NSW - the same as Phil Clare.
It is obvious now that Wikileaks looks like it should have made an appearance decades ago, to counter corrupt public processes, that continually hide just under the radar

Phil Clare is encouraging anyone who has not been paid by the NSW Government to post their details with him, so that pressure can be maintained for mutual benefit.
You can find the site at http://haveyoubeenpaidyet.com.au/.

No individual details have been posted as yet, but they have been flowing in.
It is also obvious to i2P that the recent departures of NSW Labour MP's in large numbers will have something to do with their insider knowledge of the "rotten core" of this current state government.

Meanwhile, Phil Clare is expected to support his family, run a small business, be an upright citizen, pay his state taxes and do everything that is expected of him by a state government that runs to a different set of rules, and simply rips him off.

This disgusts me absolutely, and when you know that the debacle that is e-health generally and the $'s billions that have been wasted nationally and derailed Australian IT enterprise, you know that the heart must be cut out of the body of this corrupt exercise.

It is also obvious that Victoria has woken up through the following media report:

The Age Monday 21st February 2011

Last rites for health IT system

Kate Hagan

February 21, 2011

HEALTH Department staff fear Victoria's $360 million health technology program is being shut down after being told that no contracts will be renewed for people working on it.

The same medicine will have to be applied in NSW and other Labour states, and certainly a review at the federal level to stop this deplorable wastage at taxpayer expense.

Public hospitals should be a crucible for Australian research, invention and creativity.
Dealing with decent Australian IT companies might just encourage consortiums strong enough to deliver a world-class e-health system if the obstructions can be excised from government bureaucracy and its political masters.

Maybe Victoria has flagged a national "winds of change".

Return to home

Submitted by chris wright on Fri, 04/03/2011 - 17:39.

To the casual observer with a balanced view, it is difficult to come to the conclusion that Phil Clare has not been seriously wronged.
Equally, if the "other party" was anybody on the Planet other than the NSW Labor Party or Tony Soprano it may not be such a "Lay Down Misere" and therefore perhaps debatable.
Actually, I doubt that not even Tony Soprano would pull a stunt like this.
My advice to NSW Health is to;
"Get real, or get done".
Hmmm, I wonder who is culpable here, the bureaucrats or the politicians?

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