Publication Date 01/11/2011         Volume. 3 No. 10   
Information to Pharmacists

Editorial

From the desk of the editor

Welcome to the November 2011 homepage edition of i2P - Information to Pharmacists.
The preceding weeks have seen an unprecedented reportage of the lack of integrity surrounding many decisions of the pharmaceutical industry.
Peter Sayers, Harvey Mackay,Loretta Marron and Mark Coleman (in the Pharmedia column) weigh in with their opinions and kick off a debate that will hopefully have all pharmacists adjust their core values and eliminate hypocrisy (the opposite side of the coin of integrity).

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Newsflash Updates for November 2011

Newsflash Updates

Regular weekly updates that supplement the regular monthly homepage edition of i2P.
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Pipeline

Pipeline for November 2011

Pipeline Extras

A range of global and local news snippets and links that may be of interest to readers.
Pipeline Extra simply broadens the range of topics that can be concentrated in one delivery of i2P to your desktop.

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Feature Contribution

The Health Village Concept

Neil Johnston

With pressures mounting on community pharmacy by the day, it is interesting to note that not many practical solutions are being piloted to develop a better, more professional business model for pharmacy.
You actually have to go to the UK to see a model that could suit Australia in the form of Health Village - a Lloyd’s Pharmacy pilot model.

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Professional Services Environment - is Community Pharmacy Sufficiently Developed?

Dr John Dunlop (PGDipPharm, MPharm, DPharm(Auck), FACPP, FNZCP, FPSNZ, MCAPA)

If the gossip is correct, the new pharmacy contract in New Zealand is going to see a shift from the old payment system of dispensing fee (plus a little bit of profit) to a lesser payment for dispensing and opportunities for payment for a range of services that might include point of care INR testing, vaccinations, MURs synchronising patients medication, and a raft of other ‘medication management processes.

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The industry that delivers community pharmacy is beginning to look like a Heath Robinson machine.

Neil Retallick

According to Wikipedia, “William Heath Robinson (signed as W. Heath Robinson, 31 May 1872 – 13 September 1944) was an English cartoonist and illustrator, best known for drawings of eccentric machines....In the UK, the term "Heath Robinson" has entered the language as a description of any unnecessarily complex and implausible contraption...”
I have been developing this notion for some time now but was crystallized when I was talking to a supplier to pharmacies recently.

Comments: 3

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It's Time to Draw a Line

Peter Sayers

Pharmacy integrity has become an issue once more, following on from the outcry surrounding the Pharmacy Guild of Australia and Blackmore's proposed alliance.
In another instance a formal complaint by Dr Ken Harvey, has been made to the Pharmacy Board of Australia relating to four online pharmacies promoting the product Sensaslim.
These pharmacies and any others following similar practices, need to reverse their policies that allow the unethical promotion of such products.

Comments: 3

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Integrity is all that matters

Harvey Mackay

In our country, and indeed all over the globe, we are facing so many crises that we hardly know which one to address first.
But one issue that is rarely identified as a real crisis, which I believe is at the root of so many of these other problems, is a crisis in integrity.  So many problems would be greatly diminished or perhaps even disappear if people had acted with integrity and honor.

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Pharmacy Guild & Blackmores - a quicky divorce?

Loretta Marron OAM BSc

A media release from the Pharmacy Guild on 5 October 2011 announced 'Gold Cross endorsement of Blackmores Companions range withdrawn'.  
This embarrassing back-down came after considerable media attention that followed a flood of complaints from both outraged health professionals and consumers about the scheme. 
Did the Guild really think that this ill-conceived initiative would be welcomed with open arms by both the health industry and concerned patients?
When the package was announced in late September, the Guild stated that they endorsed a range of complementary medicines (CMs) that they claimed had been designed specifically to offset the possible side-effects of four common prescription drugs.

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Support services for pharmacists and doctors in the United Kingdom – Part 1 Pharmacist Support

Kay Dunkley - BPharm, Grad Dip Hosp Pharm, Grad Dip Health Admin, MPS, MSHPA

In Australia the Pharmacists’ Support Service (PSS) provides a listening ear and support over the telephone to pharmacists in Victoria, Tasmania, South Australia and the Northern Territory and has plans for expansion to all states of Australia.
The medical profession in Australia has a range of state based Doctors’ Health Advisory Services including the AMA Victoria Peer Support Service which provides peer support over the telephone. 
Victorian is the only state to have a state based health program for doctors; the Victorian Doctors Health Program (VDHP).

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Marketing Focus: Pull the Digit Out

Barry Urquhart

FOLLOW THE LEADERS

There is proof-positive that smaller operators can take on, compete with and beat established trans-national and national trading groups.
However, be aware. Astute leaders of big groups are sufficiently flexible to  recognise and replicate strategies which work.
In recent times the IGA Supermarket network of independent stores throughout Australia (including Foodland in South Australia) has resonated with a broad cross- section of consumers and gained their patronage with the positioning statement:

"The Way the Locals Like It"

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A Major Retail Advance

Neil Johnston

There has been a long held dream within community pharmacies that there ought to be a system that, with the press of a button, could count all shelf stock and adjust any retail display price.
That system has nearly arrived in the form of Shelfx, a smart shelf that can communicate with other smart shelves and interface with a compact fileserver.

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Nurse Practitioners Succeeding in Community Pharmacies-Clinical Pharmacists Still Remain Invisible

Peter Sayers

Nurse practitioners based in community pharmacies have great potential to ease the burden in primary care, research by Curtin University and Griffith University has found.
The independently funded research, undertaken by Associate Professor Lynne Emmerton, of Curtin’s School of Pharmacy, and Sara McMillan, of Griffith’s School of Pharmacy, explored the roles of nurse practitioners who are based in community pharmacies in Western Australia.
Community pharmacies are a relatively new site for nurse practitioner clinics, which have traditionally operated in hospitals and, more recently, local general practitioner (GP) clinics.

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Walmart Plays Clinic Catch Up

Neil Johnston

It seems both sides of the Atlantic are looking to expand pharmacy hosted primary health care clinics.
In the UK Lloyd’s Pharmacy have launched a pilot for their version called Health Village, while in the US Walmart has announced that it is looking to partner a number of targeted primary health care practitioners.
Walmart’s stated aim is to become the largest (but lowest cost) pharmacy primary health care providers in the US.

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Walmart Launches New Mobile Apps

Neil Johnston

In time for the holidays, new Apps for iPad and iPhone developed by Walmart will give customers advanced shopping tools for use at home and on the go.
In Australia, Woolworths have launched a similar App with an extension for the Android market.
Walmart has a subsidiary company Walmart Labs that is dedicated to taking advantage of new innovations in IT and helping to develop or adapt them to a Walmart environment.
It is this type of infrastructure that creates the divide between small business and big business that is getting ever wider.
Wouldn't it be great if we had such a development wing in pharmacy that wasn't dominated by politics and truly represented innovation for the profession?
There's a lot of IT talent in pharmacy that is not being properly nurtured that also represents new job opportunities for pharmacists.

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Chemist Warehouse and the PGA prepare for Open Warfare

Neil Johnston

The battle for retail pharmacy control has just taken a very sharp turn.
Chemist Warehouse has thrown down the gauntlet and taken on the Pharmacy Guild of Australia (PGA) in respect of the new set of location rules negotiated by the PGA and the federal government - a set of rules that will severely hamper Chemist Warehouse expansion into the future.
At i2P we have never been in favour of location rules existing in the first place because of the artificiality created in the market place.
Nor have we been in favour of pharmacy company structure with only pharmacist shareholding - a system that keeps out specific skills from a board of directors that pharmacies badly need.

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The Face of Pharmacy's Moral and Financial Bankruptcy

Neil Johnston

The face of pharmacy has evolved to be that of the Pharmacy Guild of Australia (PGA).
Whether all pharmacists are accepting of this role is problematical as evidence of shabby commercial deals and political suppression of a pharmacist majority is seen to be a blatant reality.
Most pharmacists (including some members of the PGA) are trying to distance themselves from this bad behaviour, but find themselves inextricably bound up in these events with the 5CPA becoming the "glue".
Recently there has been a call from the Pharmacy Coalition for Health Reform to renegotiate the 5CPA, and a call by Greens Senator Richard Di Natale for an inquiry into the Government’s dealings with the PGA.
Pharmacy is beginning to be seen by the public at large as fast becoming morally and financially bankrupt.
I personally don't wish to be part of this image-do you?

Comments: 2

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Vitamin Supplements May Boost Risk of Death Among Older Women: Study

Staff Writer

Some dietary supplements may be associated with an increased risk of death for older women, even though those women tended to be healthier than those who did not take vitamins while alive, according to a study released Monday from the Archives of Internal Medicine.
While women who take dietary supplements tend to be healthier, a recent study found that older women who take at least one supplement per day tended to have a higher risk of mortality. In analysis of about 39,000 women who were at an average age of 62 at the beginning of the study, those who took vitamin supplements such as multivitamins, vitamin B6, folic acid, magnesium, zinc, copper and iron died at a higher rate during the 19-year research period, researchers led by a team at the University of Minnesota report.

Comments: 2

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Court loss won't stop environmentalists' battle against modified-eucalyptus trees

Staff Writer

Environmentalists are vowing to continue their fight against genetically engineered "frankentrees" after losing a test case in Florida earlier this month.
"We're not terribly discouraged," said Anne Petermann, executive director of the Global Justice Ecology Project and the coordinator of the STOP GE Trees Campaign.
"We'll wait until the next stage of the regulatory process and intervene there," said Mike Stark, communications director for the Center for Biological Diversity, the lead plaintiff in a lawsuit that aimed to block field tests of genetically modified eucalyptus trees across the South.
The trees in question were developed by Arborgen, a joint venture of Memphis-based International Paper, MeadWestvaco Corp. and New Zealand-based Rubicon Ltd.
Industry expects the fight to continue.

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Obese people regain weight after dieting due to hormones

Staff Writer

Obese people may regain weight after dieting due to hormonal changes, a University of Melbourne and Austin Health study has shown.
The study was published in the New England Journal of Medicine.
Worldwide, there are more than 1.5 billion overweight adults, including 400 million who are obese. In Australia, it is estimated more than 50 per cent of women and 60 per cent of men are either overweight or obese.
Although restriction of diet often results in initial weight loss, more than 80 per cent of obese dieters fail to maintain their reduced weight.

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HPV vaccination for boys and young men

Staff Writer

Boys and young men should be vaccinated against human papillomavirus (HPV) to help protect against anal, penile and head and neck cancers and to benefit women’s health says Director of La Trobe University’s Australian Research Centre in Sex, Health and Society (ARCSHS) Professor Marian Pitts.
‘It’s an equity issue, we are currently denying a life saving vaccine to half of our young people, and keeping them in the dark about how the HPV vaccine could protect them from cancers, just as it does for our young women,’ Professor Pitts says.

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Superannuation Age Discrimination Removed

Staff Writer

Many barriers exist to discourage seniors from continuing participating in the workforce.
The need for seniors to keep working as a fallout from the global financial crisis, has been one situation where potential retirees have been forced to consider all their options.
One of the obvious benefits to government in having as many seniors as possible in Australia's workforce is that it increases the tax base - a base that was slipping further away in its ability to finance future government programs.
In the biggest change to superannuation in 20 years, around 8.4 million Australians will have their superannuation savings boosted as a result of the superannuation guarantee rate legislation introduced into the Parliament today.
The Superannuation Guarantee (Administration) Amendment Bill 2011 increases the superannuation guarantee (SG) rate from nine per cent to 12 per cent.

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Healthy ageing more important than aged care, expert says

Staff Writer

Deep-seated ageism is at the core of our culture and at the heart of an unproductive government approach to healthy ageing, says Professor Hal Kendig, Director of the Ageing, Work and Health Research Unit in the Faculty of Health Sciences at the University of Sydney.
Average life expectancy increased by 20 years during the 20th century and by the middle of the 21st century it is projected that one in four Australians will be aged over 65.

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A Lipitor Potential Replacement - New Drug by Sanofi-Aventis

Staff Writer

A new medicine being developed by Sanofi-Aventis of Paris, France, and Regeneron Pharmaceuticals of Tarrytown, N.Y., dramatically cut cholesterol on top of high doses of Pfizer's Lipitor, the best-selling cholesterol drug, the companies announced today.

Comments: 1

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Stem cell research hopes to repair brain cell damage of Parkinson’s disease

Staff Writer

Australian scientists have developed a new technique using stem cells, in the hope to replace damaged cells in Parkinson’s disease. The technique could be developed for application in other degenerative conditions.
Drs Clare Parish and Lachlan Thompson lead the research from the Florey Neuroscience Institutes and the University of Melbourne. They are members of the newly established Stem Cells Australia collaboration launched at the University of Melbourne today.

Comments: 1

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Researchers closer to the super bug puzzle

Staff Writer

Infectious diseases specialists from Austin Health are working closely with Microbiologists from the University of Melbourne to understand how Staph is becoming resistant to all antibiotic therapies.
The treatment of serious infections caused by Staphylococcus aureus (Golden Staph) is complicated by the development of antibiotic resistance. Seriously ill patients, vulnerable to infections can be at additional risk if antimicrobial agents become less effective in fighting infections.

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Bill Thomson receives SHPA’s highest award

Staff Writer

Medicines Management 2011, the 37th SHPA National Conference opened today in Hobart.  With over 800 delegates, 80 presented papers and 200 posters, this year’s conference is yet another example of the enthusiasm and dedication of pharmacists in hospitals and other parts of the healthcare system to share their work and learn from their peers.

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Australian Clinical Pharmacy Award 2011 to Adelaide Pharmacist, Greg Roberts

Staff Writer

During Medicines Management 2011, the 37th SHPA National Conference, held in Hobart last weekend, the SHPA Australian Clinical Pharmacy Award for 2011 was awarded to Mr Greg Roberts, Clinical Research Pharmacist at the Repatriation General Hospital in Adelaide.
Greg’s skills in research, collaboration and communication have enabled him to realise his visions of improving patient care and medication safety.  His research outcomes have been integrated into everyday clinical patient care by pharmacists, doctors and nurses in many parts of Australia.

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Integrity - the word keeps appearing in a pharmacy context

Neil Johnston

Editor's Note: Pharmacy media has been alluding to the lack of integrity in some pharmacy activities, both industry and professional.
Problem is, whether we are involved in the process described, or not, we all still get tarred with the same brush.
Others may combat the criticism by stating that they are in survival mode and that to meet their financial obligations they have to be involved in transactions that help to pay the rent.

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It's Time to Draw a Line

Peter Sayers

articles by this author...

Peter Sayers is vitally concerned about pharmacy professional practice - its innovation, its research and development, and its delivery to create an ongoing revenue stream. Delivery of healthcare is increasingly involved with Information Technology systems. All perspectives in IT must be considered for the impact on pharmacy practice and its viability.

Pharmacy integrity has become an issue once more, following on from the outcry surrounding the Pharmacy Guild of Australia and Blackmore's proposed alliance.
In another instance a formal complaint by Dr Ken Harvey, has been made to the Pharmacy Board of Australia relating to four online pharmacies promoting the product Sensaslim.
These pharmacies and any others following similar practices, need to reverse their policies that allow the unethical promotion of such products.

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Their actions bring the entire profession of pharmacy into disrepute, and while the majority of pharmacies refrain from following such practices, a small segment of high profile pharmacies with a large combined market share, actually do engage.
As these people impact on the public's perception of my personal reputation I am asking them to carefully consider their actions.

Other issues e.g. the price promotion of Panamax, have been highlighted previously and reported to the Pharmacy Board.
The Board has chosen not to take action in the past in these circumstances, with the result that professional integrity issues have increased because official boundaries have not been set.
A sense of outrage has been building among individual pharmacists, particularly employed pharmacists who have been directed by their employers to recommend or associate with unethically promoted products for some time.
It is clear that the profession of pharmacy is in an unbalanced state and that issues of profit are beginning to take precedence over issues of professionalism and integrity.
Brand "Pharmacy" is indeed in trouble.
Certainly pharmacy has traditionally managed a level of commercialism as a means of survival when dispensing margins surrounding PBS dispensing have been squeezed by government under the guise of "reform".
Integrity issues surround pharmacy in other forms where little control can be exercised.
For example, how can the manufacturers of Codral products justify taking their product range into unsupervised supermarket environments?
The same brand name but a slightly different formula. This is deceptive marketing and again, pharmacy gets dragged into a debate not of its own making.
The Pharmaceutical Society of Australia also needs to take a lead here and publicise activities that need to be flagged for pharmacists and the Pharmacy Board.
The lack of integrity surrounding purely commercial motives cannot be seen to be supported by pharmacy and the only protest that is left for pharmacists is to simply abandon support for the Codral brand and to do it as vigorously and publicly.
We always used to be very vocal in this regard with pharmacies writing to errant companies or blasting their representatives to flag attention and show disapproval.
Exacerbating the problem is the fact that many of these types of decisions are taken by global boards not located in Australia. It promotes a feeling of helplessness.
Compounding the mix is the sometimes irrational decisions taken by drug scheduling authorities.
Many pharmacists feel that drugs such as phenylephrine and ibuprofen have no place in an unsupervised supermarket.
When deaths of young children began to be reported from cough and cold remedies in the US, nearly all were tracked back to supermarket sales.
Not one instance of a similar problem was reported in Australia.
Why?
Because of Australian pharmacist supervision of Schedule 3 that embraced most cough and cold ingredients.
Yet in the interest of "consistency" and "harmonisation" cough remedies were banned for children of certain ages. The issues of pharmacist clinical experience were ignored to repair a problem that did not, and still does not, exist in Australia.
I guess it is little wonder that the boundaries appear problematical to some pharmacists as they are made to feel irrelevant in the scheme of things and they respond by turning a blind eye to Sensaslim and the price promotion of Panamax plus others.
APESMA is taking up the fight on behalf of their pharmacist members and individual employed pharmacists need to take up the fight in their own right and simply point out to pharmacy owners that they will not be associated with pressure to support unethical promotions. But they should feel entitled to a ruling from the Pharmacy Board, if it is requested and have the various boundaries debated and delineated.
It's time to draw the line and reverse the trend.

Dr Ken Harvey's letter to the Pharmacy Board follows.



26 October 2011

Mr Stephen Marty
Chair, Pharmacy Board of Australia
G.P.O. Box 9958
Melbourne VIC 3001

Dear Mr Marty,

Re: Breaches by pharmacists of Health Practitioner Regulation National Law Act 2009

Subdivision 4, S. 133 of the National Law Act states that, “a person must not advertise a regulated
health service or a business that provides a regulated health service, in a way that:
a) is false, misleading or deceptive or is likely to be misleading or deceptive; or
b) creates an unreasonable expectation of beneficial treatment”.
I bring to your attention some Australian pharmacists who continue to promote the product
SensaSlim on the Internet with claims that have been shown to be false, misleading and deceptive
by Federal Court Orders1,2 and Complaint Resolution Panel determinations3,4,5. Examples of these
pharmacies and screen shots of their SensaSlim promotion (taken today) are listed in Appendix I.
In addition, other pharmacies continue to promote and sell this discredited product albeit without
making specific claims. Examples are in Appendix II.
There has been considerable publicity about SensaSlim over the last six months (Appendix III) and if
a pharmacist was unaware of this then, in my opinion, that person is not keeping up‐to‐date and is unprofessional.
An alternative explanation is that commercial considerations have a higher priority for some practitioners than professional obligations.
I ask the Board to determine if the ongoing promotion and sale of Sensaslim by pharmacies is in breach of the National Law Act.
If so, I ask the Board to apply the maximum penalty available under the Act.

Sincerely,

Dr Ken Harvey

Return to home

Submitted by Peter Kennedy on Thu, 03/11/2011 - 11:31.

I fully endorse the main thrust of your article.

However the claim of "irrational decisions taken by drug scheduling authorities" needs correction.

Unlike the other people and bodies whose grossly irrational and unhealthy decisions you rightly criticise, drug scheduling authorities are required by law to make their decisions on a rational basis, to invite and consider comments on proposed decisions from anyone who wishes to comment, and to publish the full reasons for each decision, which they do.

If your research for this article was a little better you would realise that NO cough remedies have been "banned" for children of any ages. That because of concerns about a very poor efficacy versus adverse effects profile (where there is little or no evidence of efficacy, even a very low reported incidence of adverse effects may be unacceptable), SOME (by no means all) cough/cold remedies for children containing SOME (by no means all) active ingredients (INCLUDING phenylephrine and ibuprofen) were up-scheduled to Schedule 2, 3 or 4. The issues of pharmacist clinical experience and Australian pharmacist supervision of Schedule 3 medicines were indeed one of the bases for these decisions. "Consistency" and "harmonisation" with the USA was not at all a basis for the decisions.

Submitted by Mark Coleman on Mon, 14/11/2011 - 10:23.

Perhaps Peter Sayer’s use of the word “banned” was just a little wide in interpretation and should have read “effectively banned” because that has been the result of the scheduling decisions.
In respect of the quality of evidence relating to those decisions it has become obvious that there is serious disagreement within the committee, with some members pointing out that the quality of “evidence” is extremely poor.
This is probably a result of decisions being driven by “expert opinion” rather than “evidence”. “Consistency” and “harmonisation” as committee decision factors may indeed intrude in the discussions as part of the arguments presented by expert opinion.
Expert opinion has as its underlying driver a vigorous political agenda where in the final vote medical members of the committee outvote the pharmacist members.
Evidence is not even a consideration under these circumstances; just another pressure point in the endless "turf" war between the professions.

Submitted by Peter Kennedy on Fri, 25/11/2011 - 17:47.

"Effectively banned"? Why? Because pharmacists refuse to recommend/sell a particular S2 or S3 medicine, or doctors refuse to prescribe a partcular S4 medicine? Presumably they have sound professional reasons for doing so.

So we can't trust doctors, pharmacists or any other experts to contribute to decisions about scheduling of medicines because they apparently invariably are driven by a vigorous political agenda to protect their own turf. So who would you have make these decisions? Politicians are obviously out because they of course have political agendas. Perhaps all decisions about the scheduling of medicines should be made by a High Court judge? Or perhaps referred to a national referendum of all citizens? How would you make these decisions "rational"?

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