Publication Date 30/04/2012         Volume. 4 No. 4   
Information to Pharmacists

Editorial

From the desk of the editor

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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News Flash

Newsflash Updates for May 2012

Newsflash Updates

Regular weekly updates that supplement the regular monthly homepage edition of i2P.
Access and click on the title links that are illustrated.

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Pipeline

Pipeline for May 2012

Pipeline Extras

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

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Feature Contribution

While doctors remain disempowered doctor shoppers needing help will die.

Dr Ian Colclough

Doctor shopping concerns everyone. It costs lives, erodes the fabric of our society and imposes unacceptable cost burdens on the Australian health system.
Online eScripts and Script Exchange interoperability are pivotal to solving doctor shopping and managing S8 and S4 drugs of addiction.

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Don’t Give Up

Gerald Quigley

As we wrestle with changes in healthcare, the patient more than ever wants a solution to his or her particular health challenge.
They want us to accept responsibility.
Perhaps as we wrestle with that puzzle, or that project, or that problem, the most likely reason we give up on it is the belief that “it can’t be done”.
That’s so different from “I can’t do it”.
Of course you can do it, and it can be done.
So why are we entrenched in the current pharmacy model?

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Seventeen Handy Tax Planning Tips for 2012

Chris Foster

Although the Government relies on the collection of taxes to balance its budget, it is critical as taxpayers to ensure that you do not pay any more tax that you have to.
Or, as the late Kerry Packer once told a Senate enquiry “Of course I am minimising my tax- and if anybody in this country doesn’t minimise their tax, they want their heads read, because as a government, I can tell you you’re not spending it that well that we should be donating extra!”

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Taking care of pharmacists’ health – what is it worth?

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

How much are you willing to pay for services to support health and well-being?
The working environment for many pharmacists is not ideal.
In both hospital and community settings pharmacists often experience many of the following: long periods of standing, non-ergonomic computers, minimal opportunity to take a break including visiting the toilet or eating lunch, constant demands and the expectation of working quickly without making a mistake, dealing with distressed or difficult people, working extended and sometimes unsociable hours and being a victim of hold-ups and threats of violence.

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Good news for community pharmacy from the Minister of Agriculture

Neil Retallick

Joe Ludwig, the Minister of Agriculture, recently released Australian Food Statistics 2010-11.
It provides a message of hope for community pharmacies.
This singular agrarian message of opportunity is in stark contrast to the constant proselytising in most media how technology in the form of the internet is going to ring the death knell (or beep) for local pharmacies.

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Do it right, or not at all

Barry Urquhart

I applaud and endorse creative, positive and well executed business development and local area marketing initiatives.
A recent personal experience highlighted the adverse image and business consequences of poorly structured and executed campaigns.
An unsolicited letter and “info-sheet” were received by mail from the State General Manager of a national, high profile, public listed legal practice.
The salutation of the letter immediately suggested inadequacy. It stated:
 
“Dear Barry Urquhart”
 
Very few people are addressed with their full or given and surnames. “Barry” or “Mr Urquhart” are the norm.

Comments: 1

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I’ve been thinking about admitting wrong.

Mark Neuenschwander

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.

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Homeopathy – Silly, Safe or Satanic?

Loretta Marron OAM BSc

In May 2006 a group of eminent UK Professors, concerned about ways in which disproved treatments in their National Health Service (NHS) were “being encouraged for general use”, published a letter in the Times to say so. Six years on, despite calls from the British Medical Association for the funding to end, the NHS still spends around £4 million a year on homeopathy.
More recently, the Australian National Health and Medical Research Council (
NHMRC) came out with their own report against homeopathy. So why has nothing changed?

Comments: 4

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When choice outflanks prime

Harvey Mackay

Diplomacy is all about making the right choices.
When I persuaded my wife, Carol Ann, to say "I do" ages ago, we entered serious negotiations to nail down the ground rules for our marriage.
Then we hit on it.
In our family, I would make all the major decisions, and she would make all the minor decisions!
Many of my friends have asked me, "Harvey, how on earth could that ever work out?"
My answer: "Very simple . . . There have never been any major decisions."

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The Climate Change in Evidence-based medicine

Peter Sayers

Finally mainstream science and medical publications are waking up to the fact that evidence-based medicine has been hijacked by global Pharma companies and rewritten as part of a market plan, rather than a patient healthcare plan.
In the April edition of i2P it was reported that the British Medical Journal reported in its editorial that much of recent cancer research was fraudulent, and as a result, treatments based on this tainted evidence simply would not work (see Cancer Research Found to be Faulty )

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An Evidence-Based Conversation Between Ken Harvey, Gerald Quigley and Neil Johnston

Neil Johnston

Editor’s Note:
I recently received an email from Dr Ken Harvey the well-known academic from Latrobe University, who is trying to reform some aspects of the TGA, particularly in relation as to how drugs and complementary medicines are registered, and the quality of evidence used to support claims of efficacy.
It’s a subject that has gained traction since the beginning of the year, and there are a range of viewpoints that need to be sorted out so that coherent policies can be formulated that would be broadly supported by all health professionals (not just mainstream health professionals).
About the same time I received a communication from Gerald Quigley talking about the clinical and educational resources that exist within the Society of Hospital Pharmacists of Australia.
I reflected on both these communications and decided to publish them in a positive fashion, hopefully to create an ethical and clinical direction for community pharmacy.

Comments: 2

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Why clinical research should be freely exchanged

Staff Researcher

Dr Adam Dunn is a research fellow at UNSW’s Australian Institute of Health Innovation. Professor Enrico Coiera is the Director of the Institute’s Centre for Health Informatics.
Together, in the article below they are proposing a solution to the problems surrounding clinical evidence.
Something needs to happen to help resolve the current mess, particularly in respect of a full disclosure of evidence held by global drug manufacturers.
Currently, it could be said that thinking health practitioners have lost faith in the published evidence for any drug, no matter where it was published. Corruption has damaged any credibility the pharmaceutical industry once had, and diversionary tactics such as attacking non-mainstream medicine and their health professionals will not retrieve the situation.
What is needed is a totally new system and one where evidence can be fully and openly tested.

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An Evidence-Based Conversation Between Ken Harvey, Gerald Quigley and Neil Johnston- Part 2

Neil Johnston

Following the first conversation between Dr Ken Harvey, Gerald Quigley and Neil Johnston, which was recorded in last week’s update to i2P, Dr Ken Harvey stirred the pot a little by sending a letter to the editor with sufficient content to stimulate a second conversation.
What follows below is a copy of that letter with comments by the original participants.
Readers who have not read the first conversation should visit this link.

Ken has also placed additional comment on site at the foot of this original “conversation”
Anybody reading this material is invited to comment through the panels at the foot of the article (s). Gerald and I would particularly like to hear from pharmacists who may be feeling constricted within their own practice by being herded into a channel of activity that is uninspiring through lack of challenge and incomprehensible when you try to deal with “evidence” that is contradictory or developed from a fraudulent base.
What follows is Part Two of our tripartite “Evidence Based Conversation”.

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Friends of Science Fiction in Medicine

Neil Johnston

As pharmacists we believe we belong to a scientific discipline deeply involved in better patient outcomes.
We rely on “evidence” to base our own practice decisions on and we rely on reputable journals to deliver that evidence to us.
Deriving from scientific method it should be a very clear-cut process to test that evidence and build on it.
Yet increasingly, when evidence is tested for replication, it is found not possible to produce an identical result, suggesting that fraud or misrepresentation has occurred.

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A Lesson From SmartClinics

Peter Sayers

Most pharmacy owners would be aware that when you introduce a new professional service into the pharmacy environment that there is a period of time involved before the service begins to develop traction.
During that lead-time there is also a need to integrate the new service with as many of the existing services as possible.
The major service provided by pharmacy is dispensing. Another is “counter prescribing” often involving the sale of schedule 3 medications.
Other services are usually built around periodic promotions e.g. heart health and blood pressure monitoring; diabetes and blood sugar testing.

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Orthomolecular Medicine News Service, April 10, 2012 Top Vitamin D Papers of 2011

Staff Researcher

Dosage Recommendations and Clinical Applications

by William B. Grant, Ph.D.

(OMNS April 10, 2012) The biggest vitamin D story in 2011 was the report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine (IOM) [1]. This report was prepared during a two-year process by 14 nutrition experts, with funding from the U.S. Food and Drug Administration and the National Institutes of Health and Health Canada. The committee reviewed the evidence for beneficial and harmful effects of vitamin D, relying solely on randomized controlled trials (RCTs) of its liking for benefits, and prospective cohort studies for adverse effects. RCTs were considered to have the highest quality, with observational studies of moderate quality and ecological studies of very low quality. However, the case can be made that since solar UVB is the primary source of vitamin D for most people, observational and ecological studies are the most relevant and therefore are of high quality, and in fact, have provided most of the information on the health benefits of vitamin D. However, the committee appeared to have a bias of excluding RCTs on such outcomes as cancer and influenza incidence and effects during pregnancy that were not in line with its eventual recommendations.

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Encouraging news for heart patients

Staff Researcher

Inheriting gene variants that increase the risk of developing coronary heart disease does not necessarily mean an individual is going to have reduced life expectancy if he or she suffers a heart attack.
Two research papers revealing these findings by Dr Katrina Ellis and colleagues at the University of Otago, Christchurch have been highlighted in the leading international cardiology journal Circulation, along with 42 other papers from cardiac researchers around the world.

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Australian scientists discover key to halt nerve fibre damage in MS

Staff Researcher

Scientists from RMIT and Monash Universities announced today a discovery that shows blocking a specific protein may have the ability to act as ‘hand brake’ to the progression of the disease in people with Multiple Sclerosis (MS).
These findings are published today in the prestigious journal Brain from Oxford University Press. The study was led by Dr Steven Petratos from the Monash Immunology and Stem Cell Laboratories and RMIT University. The publication of this study is coincidentally at a time when Australians are asked to Kiss Goodbye to MS in many events leading up to World MS Day in May.

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Body clock genes unravelled

Staff Researcher

International travellers, shift workers and even people suffering from obesity-related conditions stand to benefit from a key discovery about the functioning of the body's internal clock.
Professor Chris Liddle
, from the Westmead Millennium Institute for Medical Research, the University of Sydney, worked with a team from the Salk Institute based in California, to demonstrate the importance of circadian receptors found in the brain and the liver. Their findings are published in Nature today.

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New way to protect eyes from strong light damage

Staff Researcher

Treating eyes with gentle infra-red light can help prevent the damage caused by subsequent exposure to bright light, new scientific research has found.
A breakthrough by researchers at Australia's Vision Centre offers new hope to people who suffer vision loss due to constant exposure to bright sunlight or artificial lights – such as construction workers, sportspeople, fishermen, farmers, welders, actors, entertainers and others.

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Researchers move closer to delaying dementia

Staff Researcher

Scientists at UQ's Queensland Brain Institute are one step closer to developing new therapies for treating dementia.
QBI's Dr Jana Vukovic said the work was aimed at understanding the molecular mechanism that may impair learning and memory in the ageing population.

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Tax time – a donation to PSS is a gift to your profession and a deduction for you

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

As the end of the financial year approaches the Pharmacists’ Support Service (PSS) invites all Australian pharmacists to consider making a tax deductible donation to support the work of PSS.
PSS is an independent incorporated association and relies on the generosity of the profession to continue its work.
The service, which is based in Victoria, has expanded to Tasmania, South Australia and Northern Territory over recent years and now has the rest of Australia in its sights.
PSS is planning to establish a website for all Australian pharmacists and also develop resources and support networks in NSW, ACT, Queensland and Western Australia when sufficient funding becomes available.

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New drug shrinks brain tumours in melanoma patients

Staff Researcher

Australian researchers have reported promising results with a new drug that shrinks brain tumours in melanoma patients. Their findings are published in The Lancet medical journal today.
Medical researchers at the University of Sydney, Melanoma Institute Australia, Sydney's Westmead Hospital and Westmead Millennium Institute, say a new drug they have been testing to treat deadly melanoma in the body also shows, for the first time, an ability to shrink secondary tumours (metastases) in the brains of patients with advanced forms of the disease.

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New global study: seagrasses can store as much carbon as forests

Staff Researcher

Researchers at The University of Western Australia have contributed to the first global analysis of carbon stored in seagrasses which shows they can hold as much carbon as the world's temperate and tropical forests.
The study 'Seagrass Ecosystems as a Globally Significant Carbon Stock,' published in the journal Nature Geoscience provides further evidence of the important role the world's declining seagrass meadows have to play in mitigating climate change.

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Research holds out hope for stroke patients

Staff Researcher

People with a curious condition that causes them to apply make-up on only one side of their face, or ignore food on half of their plate, are playing a new role in understanding stroke recovery.
Researchers from the Queensland Brain Institute (QBI) at The University of Queensland have found the condition, a subset of the stroke called ‘unilateral spatial neglect', tend to have the worst recovery outcomes in regaining lost functioning in their bodies, leading them to believe attention may have an important impact on recovering successfully.

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Know Your Rights - and Fight for your Life

Neil Johnston

Editor's Note: Sometimes we find ourselves in difficulty and the subject of an official complaint.
Often, the first knowledge of this complaint is when an inspector from some agency arrives on the doorstep and begins to interrogate you over the counter.
Sometimes (and I think deliberately) in earshot of staff, customers and patients.
Suddenly you find yourself fighting for your professional life.
We asked Mark Coleman what he would do if faced with a situation similar to what happened below:

Comments: 1

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Taking care of pharmacists’ health – what is it worth?

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

articles by this author...

Kay Dunkley is a pharmacist who has worked in hospital and organisational pharmacy for over 20 years.  She has a broad experience working in public hospitals and in providing support to health professionals through government funded bodies and professional organisations.  Kay also has a strong interest in the health and well being of health professionals and especially the role of peer support.  Kay first became involved as a volunteer with the Pharmacists’ Support Service, a group which has been providing telephone support for pharmacists in Victoria since 1995.  In 2005 Kay became the Program Coordinator for the Pharmacists’ Support Service and has assisted the service to become an independent organisation which is currently seeking to expand to provide support to pharmacists throughout Australia.  In 2007, when AMA Victoria approached the Pharmaceutical Society of Australia (Victorian Branch) with a view to establishing their own Peer Support Service; Kay accepted an invitation to assist.  The AMA Victoria Peer Support Service commenced operation in February 2008.  Kay currently coordinates both of these services and also works part-time as a consultant pharmacist in Residential Care Facilities.

How much are you willing to pay for services to support health and well-being?
The working environment for many pharmacists is not ideal.
In both hospital and community settings pharmacists often experience many of the following: long periods of standing, non-ergonomic computers, minimal opportunity to take a break including visiting the toilet or eating lunch, constant demands and the expectation of working quickly without making a mistake, dealing with distressed or difficult people, working extended and sometimes unsociable hours and being a victim of hold-ups and threats of violence.

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The pressures can also be significant for pharmacists with ethical dilemmas, red tape and procedural demands, legal requirements and extensive regulation, policy changes, CPD requirements and the need to keep up-to-date, financial concerns, demands from patients and prescribers as well as the risk of litigation if you do not take due care and give the wrong advice or make a dispensing error. Can you identify with this? How often do you go to bed thinking about an incident that occurred at work or wake up after a nightmare about dispensing?

The most common reason that pharmacists call the Pharmacists’ Support Service (PSS) is stress followed by workplace and workload issues. Complaints of bullying seem to be increasing. More recently the service has received an increased number of calls from pharmacists who are experiencing difficulties finding employment. The environment and the pressures on pharmacists can lead to health issues including mental health and substance abuse as well as pharmacists leaving the profession.

Unfortunately there has been little research on the impact of the working environment and policy change on the health and well being of Australian pharmacists and on workforce retention. In comparison in the United Kingdom, a team of researchers at the Centre for Pharmacy Workforce Studies at the University of Manchester under the direction of Professor Karen Hasell, have undertaken research on the workforce, the labour market, and on organisational change and development within the pharmacy profession. We need similar Australian research to guide the profession and to inform future workforce planning.

In comparison although doctors may not face the same physical and environmental stresses as pharmacists it is well recognised that they work in a stressful environment. Callers to the AMA Victoria Peer Support Service, which operates in a similar fashion to PSS providing a listening ear and telephone triage, also report stress as the most common reason for calling. Career issues and training pathways feature as the next most common reason. Personal affairs and mental health issues also feature significantly as does bullying, all at a higher rate than among the pharmacist callers to PSS.

There has been a lot of research undertaken on the topic of doctors’ health and well being in addition to workforce planning and lots of publicity. At present there is a large longitudinal study known as the MABEL (Medicine in Australia: Balancing Employment and Life) study underway and this will continue until 2016. Also there have also been many campaigns by medical groups addressing doctors’ working hours such as the AMA Safe Hours campaign for doctors working in hospitals. Doctors in private practice are also able to regulate the number of patients they see through appointment systems and are able to close their books to new patients or have waiting periods before an appointment is available. Doctors do however face many pressures associated with life and death decisions and are more likely to face complaints and litigation.

PSS is the only pharmacist specific support service available to pharmacists in Australia and is available to any pharmacist and pharmacy students and interns who wish to call. The service offers the opportunity to speak with another pharmacist who is trained in telephone counselling. The benefit of this is to be able to speak to someone with a good understanding of pharmacy and to be able to access to pharmacist specific information and resources. PSS originated in Victoria in 1995 and now operates independently. PSS has expanded to Tasmania, South Australia and Northern Territory. If funding can be secured PSS aims to become a national service and develop a website to broaden the outreach of its services. Australian pharmacy organisations provide assistance to members but apart from PSS none are solely concerned with the health and well being of pharmacists. PSS offers anonymity and confidentiality (unless there is a risk of harm) to callers to enable open and honest discussion without fear of recognition and to avoid mandatory reporting requirements. The pharmacy profession is relatively small in some parts of Australia and so the Victorian base for PSS enables pharmacists from smaller states to contact the service without concern that they will be speaking with a close colleague.

Australian doctors are well serviced with a range of support services. Many of these services provide support over the phone including the AMA Victoria Peer Support Service which is available to Victorian and Tasmanian doctors and medical students, the NSW Doctors’ Health Advisory Service, the Queensland Doctors’ Health Advisory Service (which is also available to pharmacists), the South Australian Doctors’ Health Advisory Service and Colleague of First Contact in Western Australia and in ACT. There are also Benevolent Associations for doctors in Victoria and NSW. The RACGP GP Support Program provides both telephone and face-to-face counselling services. Face to face medical assessment and treatment is available through the Victorian Doctors Health Program (VDHP) and there are a few GP clinics which specifically treat doctors. I am only aware of the latter being available in Melbourne and Adelaide. The VDHP has the most well developed model of service in Australia and includes ongoing support groups for recovering doctors and back to work programs.

I believe that the Australian pharmacy profession can learn from the attention our medical colleagues pay to their own health and well being and to their workplace stress and pressures. We can also learn from the services available in the United Kingdom as described in my previous contributions to i2P. Profession-specific health and support services for doctors and pharmacists are very valuable in that they are able to address specific issues in relation to the practice of the health professional.

The Medical Board is currently undertaking consultation with doctors by asking if they are willing to pay an additional levy on their registration to fund doctors’ health programs, like VDHP, around Australia. If the Australian medical profession supports this proposal a precedent will be set which could be applied to the pharmacy profession, with a levy added to pharmacist registration fees to fund expansion and further development of PSS. I am interested to hear if you would be willing to support the work of PSS through a higher registration fee and if so how much you as a pharmacist are willing to pay. I invite your comments and look forward to your feedback.

In the interim the pharmacy profession can assist PSS through tax deductible donations. If you wish to support the work of PSS send your donation to Pharmacists’ Support Service c/o 381 Royal Pde, Parkville 3052. Donations can also be made over the phone using a credit card through the PSA (Victorian Branch) office on (03) 9389 4000 or by direct deposit into the Pharmacists’ Support Service bank account BSB 083155 and account number 481820199 (include name and contact details so that a receipt can be issued).

I recommend that you take a moment to put the PSS phone number in your phone’s contact list as you never know when you may need it. Pharmacists and pharmacy students and interns requiring assistance can contact PSS for anonymous and discreet support on 1300 244 910 between 8.00 am and 11.00 pm every day of the year.

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