EDITORIAL for Monday 23 January 2017

Welcome back to i2P (Information to Pharmacists) E-Magazine dated Monday 23 January 2017.
The holiday break has been refreshing for me even though climate temperatures have been unbearable on some days.
But world politics is still in a bit of turmoil as Donald Trump assumes the role of president of the United States, with his opposition still completely in disarray – organising global protests against his administration, still not recognising that his support is due because people are fed up with government policies that destroy true democracy, create massive streams of fake or distorted news, export local jobs through so-called free trade agreements that simply increase the power of global corporates that do not even pay tax to the countries they operate in.
People will ignore his poor sexist behaviour, his ignorance of political process to have the more evil influences that have permeated most western economies overturned.

Australians are told they can no longer expect (as a right) any form of a pension (but global corporates can expect a range of grants and a reduced tax regime, that Medicare may disappear and be absorbed into some global corporate (despite protests by the current government to the contrary – is this really a “core” promise?)
Ordinary Australian who built this country to be a strong and wealthy economy see themselves as being penalised through corrupt government policy that simply transfers wealth from the middle and lower socioeconomic segments to the so-called elite – the 1 percent that concentrates wealth and power by virtual stealing.

The concept of a “border tax” being introduced by Donald Trump is one that Australia could well consider, but the good news is that the Trans Pacific Partnership Agreement (TPPA) has been dismantled by Trump and Australia has been saved from a massive transfer and exploitation of its wealth that this treaty promised global corporates.

A recent blog comment by well-known political commentator, Mungo MacCallum, summed up the situation  very succinctly:

“So in Australia at least we are starting the new year in the same way we finished the old one: unprepared, indecisive, slightly scared and insecure in the fervent belief that all will be well, and if it isn’t, then something will turn up.
After all, we are the lucky country:  Turnbull repeatedly tells us that we are the envy of the world.
But even if that is true it is hardly reassuring.
Being an object of envy is not the safest place to be in a restive and increasingly unpredictable global environment.”

Those comments apply equally as well to the profession of pharmacy and its micro-politics.
It is pharmacy-political leadership bodies that are not representing their constituents appropriately.
It gets back to the quality of each leader aspirant and their potential to change the culture of pharmacy through design thinking and design science creating a climate of creativity and innovation, and evolving and capturing this process as part of a commonsense pattern of progressive ideas.

The professional rivalry between GPs and Pharmacists looks to become more heated over 2017, against a backdrop of general pharmaceutical industry predation, and doctor tactics against perceived turf encroachment.
With the King Review stirring the pot in the background.

Who should write sick notes?
Who should supply codeine?

With a heavily congested curriculum, I don’t know if younger pharmacy graduates get the opportunity to study the history of the profession.
Some subscribers may be surprised to know that the argument about the separation between dispensing and medical advice has been going on in Europe for quite some time – so nothing new here.

In 1617, King James 1st of England granted the Apothecaries a Royal Charter which separated them from the Grocers.
Naturally the Grocers tried to resist, but the King stood firm as he saw the grocers as merchants having no professional skill, whilst the practice of the apothecary was an art and a mystery. (Skill & Knowledge)
These very same words were in use in apprenticeship indentures less than 100 years ago.

The defining moment, after almost 200 years of argument, came with the passing of the Apothecaries Act of 1815.
Prior to this, many apothecaries practised medicine, but they weren’t supposed to charge for their advice, only for the drugs they supplied.
The physicians weren’t supposed to dispense drugs, but many did and they even brought law suits against apothecaries who exceeded their powers.
Notice that medical hypocrisy has existed for a long time
Surgeons could only prescribe remedies for external ailments and not “physic”, and some of them also dispensed.
The outcome of the new Apothecaries Act was a clearer definition of the two streams of practice involving, medicine and pharmacy, but observers may consider that nothing has changed since 1617 – we still have the similar mix of predatory supermarkets, pharmacies (formerly apothecaries) with warehouse pharmacies trying to look and act like supermarkets, and physicians trying to inhibit or invade pharmacy space.

Because health knowledge has expanded and become highly regulated we have reached a stage where pharmacy and allied health professionals now see a need to blur the boundaries created in 1617, and formalised in 1815.
Becoming patient-centred requires collaboration between health professionals and to do so requires overlaps in function for patient benefit.
Rigid boundaries around the various health professionals work against patient interest – they feel more comfortable and less stressed when their professional advisers are in harmony.
Patient empowerment is impossible when their care is delivered with rigidity and a series of hard boundaries.
I see most future conflict will occur in the access and control of medical cannabis, which is discussed in more detail in a separate article in this edition – simply because of its exceptional potential to impact health favourably.
Medical cannabis is a perfect fit for the Australian model of community pharmacy, but there will be a problem in generating the ideal conditions to create that perfect fit.
Because of its health importance, medical cannabis will be given a dedicated page in all future editions of i2P.

For the first edition of 2017 we have concentrated on the importance of design as it applies to all forms of management thinking.
The ability to set sail in the right direction with a flexible plan is what all pharmacists, particularly the leadership component, need to fully explore and understand.

Our lead article is about the evolution of design and its transition from simply applying to artefact and progressing to a more intangible application involving thinking, knowledge sharing, innovation development, and in the process enabling design to simplify and humanise the entire process.
Read: Design Thinking- What it is

A more micro-version of design that has application generally in health needs to be read in conjunction with the first article.
It’s all about Biophilic Design – an application that brings “the outside to inside”.
Threads of this form of design are found in building design, the creation of store ambience, the attractiveness and pull of a merchandise display and more general marketing efforts.
General furniture and fittings as well as design of clinical spaces all fall under this topic.
Read:  Biophilic Design is a Natural Part of Life

Harvey Mackay is back with us and has prepared material on the subject of creativity, which sits next to innovation under a design-thinking context.

Read: Creativity can be a life-saver

Gerald Quigley is back and poses a problem that in the overall, is really asking for a design solution to the ageing process and its relationship to pharmacy care.
Really, we all know that the “senior’s demographic” is already large and will continue to increase – but where are the ideas forming up into an overall design that gives direction for the role pharmacy would play in a service capacity.
Read: Do we exclude our oldest customers?

We also publish the latest bulletin from the Orthomolecular Medicine News Service (OMNS) which illustrates how an industry sector falsified research into dietary science by successfully having fats indicted as the cause of obesity and associated with other forms of illness (like heart disease) when all the time these adverse events were related to the inflammatory effects of increased sugar levels in the daily diet.
The business model where Big Agriculture develops illness and patient numbers subsequently picked up by Big Pharma using their toxic drugs to service these patients is really the history of chronic disease and its ever increasing prevalence.
This business model, serviced by a 30 day prescription cycle is not a method for patient empowerment and the very reason why pharmacist collaboration with GP’s will never fully succeed because the cultures defining both professions can never be fully integrated.
History tells us why as noted above.
Read: OMNS – Sugar Fraud

Medical cannabis holds the promise of being able to treat a diverse range of chronic lifestyle illnesses and symptoms, with low toxicity and minimal side-effects.
The positive response by patients already using this substance for health-related issues is a “good news” story and is one that should be absorbed into a pharmacy culture, because of its positivity.
i2P will be running a permanent column in all future editions and would welcome any reports and experiences from readers who may have had some exposure to this product.
Read: Understanding Medical Cannabis

And we finish up this edition’s offering with media releases from some health leadership organisations that pharmacists interact with.
PSA – http://i2p.com.au/psa-media-releases-1-delivering-quality-health-care-2-welcome-to-new-health-minister-3-support-for-vic-chronic-disease-pilot/

ASMI – http://i2p.com.au/asmi-media-releases-1-welcome-to-new-health-minister-2-link-to-fish-oil-pregnancy-lower-asthma-incidence-3-protecting-children-with-sunscreen/

NPS – http://i2p.com.au/nps-media-releases-1-prescription-only-codeine-2-unnecessary-tests-contradictory-view/

We hope you enjoy the stimulation provided by all of our content variety and please don’t hesitate to join in a debate by posting comment in the panel at the foot of each article page.

Neil Johnston
Editor i2P E-Magazine
Monday 23 January 2017


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