EDITORIAL for Monday 11 December 2017

Welcome to the current edition of i2P (Information to Pharmacists) E-Magazine dated Monday 11 December 2017.
At this time of the year we usually go into recess over the holiday period, and appear once again in the New Year (towards the end of January 2018).
2017 was an uncomfortable year for most pharmacists as they  struggled to find unity and direction – a culmination reflecting many years of disunity by pharmacy leaders and their respective organisations.
Sensing pharmacy weaknesses, predator groups circled the pharmacy profession, manifesting in the form of special interest lobby groups, major retailers (local and global), as well as having to deal with a government focus on cost only, rather than a more balanced “value” approach.

Although i2P had warned for some time that the Pharmaceutical Benefits Scheme (PBS) had reached the end of its life-cycle there was little recognition by pharmacy leadership of this fact.
Without a replacement for PBS there was no sustainable argument for Location Rules, and this created a momentum for vested interest lobby groups to argue that they should not exist.

It was this pressure that crystallised the focus of pharmacy leaders as they mounted a defence against the lobbyists and persuaded government that pharmacy could save government health costs through assisting in the establishment of pharmacy clinical services.
This represented a new argument for the Location Rules retention that eventually resulted in a process of certainty, as government moved to legislate permanency for Location Rules.

A win for pharmacy leaders, but i2P would comment that it is an incomplete win, because pharmacy leaders moved into the services alternative far too late. If they had moved earlier, the profession would have been more unified in purpose and direction, keeping all the predators in a holding pattern.

With the PBS moving out of basic drugs into specialist high-cost drugs there is now a necessity for a private enterprise dispensing initiative to fill the gap.
A competitive and economical dispensing system needs to be created, possibly as a two-tier system involving cheap generic drugs plus a second level system involving more expensive drugs coupled with third-party funding (health fund or other format).
This could be structured by pharmacy leadership organisations as an embryonic Patient Benefit Manager system so that government and consumers can clearly measure benefit.

From a community pharmacy perspective, this type of system could be well established before the future disruptor of pharmacy ownership legislation is debated to an ultimate conclusion.
There are now so many local and global retailers lobbying for open ownership of pharmacies that politicians could collapse under their lobbying weight and accept “donations” that would, in effect, destroy the successful “home-grown” model of community pharmacy that is both competitive and evenly distributed through the Australian population, as well as moving into economical health system provision that can take pressure off the total health system workforce and influence the rate of spiralling health care costs.

Clearly, the momentum to position community pharmacy as a “health Hub” needs to accelerate and supportive activity to establish pharmacy practice “champions” needs to occur.
Allowing “champions” to flourish in a community pharmacy environment (as well as other environments such as GP practices and hospitals) instead of diverting or suppressing this activity (as has happened in the past), would provide the stimulus and incentive to such highly motivated people.
Collaboration and alliance partnerships need to materialise.
Our lead article for this edition discusses some of these issues, highlighting the Scottish model as a comparison.

Scotland and its pharmacy system has produced an innovative model of pharmacy that could easily be adapted to Australian conditions.
One little known aspect is the support of pharmacist practitioner “champions” that provide facilitation of government health activities through community pharmacies.
There are a small number of Australian pharmacists that could be described as “champions” similar to the Scottish incarnation.
Unfortunately they have not received appropriate support or recognition.
In fact the opposite has occurred as they were viewed as competitors to community pharmacies.
This resulted in suppression of this type of resource and the entire profession has suffered as a consequence.
Hopefully, pharmacy leadership will become more united in a resolve to nurture and foster these resources to be recognised as “champions” similar to the Scottish version.
They would surely spearhead a renaissance in pharmacy, long overdue and sorely needed.
Read: Scotland’s Pharmacist Practitioner Champions

Gerald Quigley points the way for pharmacist involvement in the area of mental health, specifically in the area of depression, a serious and expanding issue affecting pharmacy patients.
That the solution lies in clinical nutrition support, integrated with mainstream medicine, is no surprise.
Integrative medicine is a model best suited for a pharmacy practice environment that is able to be adapted to a range of chronic health conditions.
Gerald Quigley is an expert in the practice of Integrative Medicine and would qualify as a “practice champion” as described in the lead article for this edition.
Read: Depressive illness – can we get involved?

Pharmacy involvement in mental health can be a reality if an Integrative Pharmacy Practice is a vision.
OMNS illustrate how clinical nutrition can be a positive for mental health patients suffering from schizophrenia and provides confirming research that builds on this useful treatment that involves niacin supplementation.
This is evidence-based information that no pharmacist should ignore.
Read: OMNS – Niacin Treatment of Schizophrenia Recent Research Confirms Abram Hoffer’s Original Work

Harvey Mackay is back with a discussion on values – particularly the values of honesty and integrity – the values that are universal to all cultures that are not just options.
Documenting a range of values coupled with a vision statement will create a genuine business culture that can drive your business forward, recruiting staff, customers and patients who hold similar values and can thus align with and value your culture.
Read: Honesty, integrity, values – not optional

Barry Urquhart identifies problems and solution in the wider world of business, opinion articles that have analogy and relevance to the pharmaceutical industry.
His Marketing Focus column for this edition is comprised of six essays.
One is involved in describing an incident of medical arrogance.
There is a message here for pharmacists.

WHO has made a statement saying that cannabis should be decriminalised world-wide because existing laws cause health discrimination. In Australia, patients are being actively discriminated against as police are instructed to enforce existing laws and close down “illegal” supplies, leaving critically ill people with no workable solutions for their health problems. Flawed health policy generates bad laws and lowered community respect for policy and laws. Yet again, Pharmacy is in a position to provide solutions very simply and simultaneously create opportunity for the profession to treat chronically ill patients efficiently and economically. Pharmacy leaders need to be proactive in the regulatory area because other health professionals are actively competing to lock pharmacy out of any opportunity whatsoever Potential for pharmacists is found in the compounding of THC and CBD in specific ratios to match the best result for patients with chronic illness. Further pharmacist potential also lies in using cannabinoids in harm minimisation programs involving opioid dependencies and as an adjunct for the management of pain. Pharmacists also need to be active and have a voice in the regulation of these substances ensuring that maximum patient access can be obtained through the application of Schedule 3 of the Poison’s Act.
However, obstructionist policies are still preventing appropriate access to medical cannabis, with the latest instalment surrounding roadside testing for cannabis.
Alcohol has clearly defined limits but cannabis will not be measured (even prescription cannabis).
That is, a level that clearly would have no adverse effect on cognition would be deemed an offence.
Read: Understanding Medical Cannabis – 1. adelaidenow.com.au: Cannabis decision is just dopey, advocates say 2. cbdtesters.co: Hebrew University To Study Effects Of CBD On Asthma 3. leafly.com: Two New Import Deals Hurry Medical Cannabis Into Australia

“The science is settled”. So say the people who promote vaccination as some form of extreme medical ideology. “Scientism is settled” is a more accurate description of the manipulation of the science surrounding vaccines – and it is certainly “unsettling” to hear the dishonest claims that blare out in all forms of media. “First do no harm” is the concept that underwrites all medical practice. Australian vaccination policy is so poor and damaging, that it beggars belief that legislators can be so close to manufacturer sales objectives as to guarantee them a market through coercive legislation that involves simultaneous removal of patient choice. The evidence supporting vaccine policy failure and its lack of safety is becoming so voluminous that it will eventually destroy the unnatural power alliance that desperately tries to hold it all together.
As a footnote and testament to the corruption exhibited by vaccine manufacturers and government policy makers, an article has appeared in the International Journal for Crime, Justice and Social Democracy titled Immunity and Impunity: Corruption in the State-Pharma Nexus which begins by stating:
“Critical criminology repeatedly has drawn attention to the state-corporate nexus as a site of corruption and other forms of criminality, a scenario exacerbated by the intensification of neoliberalism in areas such as health. The state-pharmaceutical relationship, which increasingly influences health policy, is no exception. That is especially so when pharmaceutical products such as vaccines, a burgeoning sector of the industry, are mandated in direct violation of the principle of informed consent.”
Read: The Safe Vaccine Debate – 1. Robert Kennedy’s World Mercury Project: New Study Indicates that Widespread Exposure to Aluminum Is Setting the Stage for Catastrophic Neurological Damage 2. The Dr Judy Wilyman Report: Newsletter #182 and Newsletter #183 3. AVN-Skeptics: Screening of VaxXed to Far North Queensland Indigenous Community

Our offering concludes with media releases from two pharmacy leadership organisations.

PSA – http://i2p.com.au/psa-media-releases-1-red-tape-reform-to-boost-pharmacist-vaccinations-in-sa-2-helping-pharmacists-identify-principles-and-pathways-for-pain-management/

ASMI – http://i2p.com.au/asmi-media-releases-1-australia-left-behind-on-viagra-erectile-dysfunction-medicines-2-asmi-supports-the-role-of-oral-antihistamines-in-the-management-of-hayfever-3-asmi-announces-new-board-memb/

All of us at i2P hope you enjoy our current content and we wish all of our readers a happy and safe festive season.
We will return in 2018.

Neil Johnston
Editor, i2P E-Magazine
Monday 11 December 2017

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