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


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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It's Time to Draw a Line

Peter Sayers

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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.
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.


Dr Ken Harvey

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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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