EDITORIAL for Monday 26 November 2018

Welcome to the current edition of i2P (Information to Pharmacists) E-Magazine dated Monday 26 November, 2018.
Since our last edition medical cannabis has been a major news feature for two differing reasons.

The first item concerns Chemist Warehouse and its decision to become involved in the marketing and distribution of medical cannabis and a range of other cannabis products.
The second item is more concerning as it involves the complex approval system for the legitimate use of medical cannabis resulting in a young man being denied the only treatment that has worked for him since he was a child.

The Chemist Warehouse decision is to be applauded because they have realised the value contained in connecting with what i2P would say is a natural market fit for community pharmacy.
The fact that official pharmacy has been almost invisible in the issue of medical cannabis regulation is quite deplorable, given the mass of unnecessarily restrictive regulation surrounding its access by real patients.

The full implication of pharmacy fully engaging with medical cannabis is perhaps not understood by many decision makers.
Medical cannabis is a product of low toxicity.
There is no recorded death from an overdose of cannabis.
Its CBD fraction is so benign that it needs only to be rescheduled under the Poison’s Act to Schedule 3.
The THC fraction in concentrations of 5 percent or less – also Schedule 3.

That creates instant patient access, backed by professional advice and information.
The Location Rules ensure a relatively even distribution through community pharmacies Australia-wide, serviced with a secure logistics system where you can consider Green Van Lines.

It simultaneously opens up a revenue stream in the form of Health Literacy consultations.
It also opens up a specialist market for compounding the various fractions of cannabis into mixtures best suited for various medical conditions.
It opens up a range of supportive investment opportunities for growing, processing and wholesaling of medical cannabis products.

Perhaps the most significant aspect of the medical cannabis market is its potential to become a major segment of a badly needed revamp of the Pharmaceutical Benefits Scheme (PBS).

i2P has long commented that as a product, the PBS was in the final stages of its life cycle.
It is a system that was originally designed for life-saving drugs only.
That is, until our politicians discovered it was a useful vote “winner”.

So it became a more universal prescription product distribution service until the budget “broke”.
Then it became a nightmare for pharmacy as attempts to balance the budget involved the wholesale disruption of legitimate pharmacy income that has continued to the current day.

The PBS had a major flaw – it focused on distribution only.

Research since the inception has confirmed the obvious.
Patients who are health literate take responsibility for their own health conditions and government costs per capita decline as patient health literacy increases.
Health literacy also provides patients with logic which results in better consumer health choices and to deal more effectively with dubious claims from all sources.

This means that a new and sustainable PBS must emerge with health literacy at its core.
And health literacy is what pharmacists have provided for a very long time – it’s what earns them “brownie points” in the polls for ethics and honesty.

A new and sustainable PBS must also fully involve the routine use of medical cannabis as a basic means of management of chronic illness.
With Australia’s ageing population, chronic illness is increasing rapidly.

The recently discovered endocannibinoid system in the human body has uncovered the fact that cannabinoid receptors have a wide distribution throughout the body and the reason that medical cannabis is such a unique product.
The body expects to find it and its action is such that it assists in the restoration of homeostasis.

Thus, a sustainable PBS must include medical cannabis as a front line defence.

Health literacy also underwrites and increases patient Self Care.
This also needs recognition in a sustainable PBS.

So that leaves the PBS as it currently exists to be converted to a funder of very expensive life-saving drugs and an opportunity to reduce existing mainstream drugs through the use of nutritional supplements as an integrated approach.

The introduction of pharmacist prescribers with no pecuniary interest in pharmacies would complete the transformation of this PBS segment that could be also include a Minor Ailment Program fully integrated within a new and sustainable PBS structure.

The above is all achievable and necessary if Australia is serious about its health management.

Now for the negative news involving an access to medical cannabis in Tasmania.

Jeremy Bester, a patient diagnosed with refractory epilepsy as a child, has been living with severe uncontrollable seizures ever since.
His carer, mother Lyn Cleaver, advised that Jeremy had trialed, and failed, 16 drugs over two decades.

An application was filed for access to medical cannabis through the Special Access Scheme.
It took 12 months before the application was notified as refused, on the grounds that Jeremy had not tried enough conventional treatments.

However Jeremy had been using cannabis since 2014 and found that it had dramatically reduced the frequency and severity of his seizures.
Lyn Cleaver commented:

“The ongoing stress of doing it illegally, it has been very difficult for our family. 

“It is also means that Jeremy is very restricted in what he can do in the community, because his carers are unable to administer his cannabis oil. 

“The idea of a legal prescription would have meant a lot less pressure on our family, even if the medicine wasn’t as beneficial.”

Ms Cleaver said it would be cruel to consider making Jeremy trial any more conventional drugs. 

“We already know cannabis is effective for Jeremy and while a legal script would make our lives easier, we will not force him to try more drugs in order to be eligible.”

i2P sees this type of obstruction as unconscionable and little more than the result of a successful Pharma lobbying campaign.
Pharmacy leadership organisations need to stand up and be counted on this issue.
After all, you are supposed to be leading the profession towards a viable professional future!

Our lead article for this edition is the final in a series relating to mobile professional services being the driver to transforming the entire business model of community pharmacy.
While community pharmacy evolves to this new view, some structural changes may have to be performed to contain costs.
For example, a cheaper rental location.
This article is designed to be a future directions guide for community pharmacy.
It suggests a model that evolves from the existing model through modifying and creating new emphasis on different components of traditional community pharmacy core business.
It is based on original research by the writer who created the first fee for service pharmacist consultation system more than 40 years ago.

The stimulus for this change has been accelerated through the PBS product life cycle that is now in its end stage.
The original PBS was designed as a distribution system for life-saving drugs.
It was transformed by politicians chasing votes, to a universal prescription product distribution system which ultimately became too expensive and was hacked to pieces in various ways, to provide sustainability.
Read: Outreach Services are Drivers for Clinical Services that can Expand Market Share

Nutritional deficiencies can arise from drug treatments, poor diet choices, or by fresh produce becoming contaminated with herbicides and pesticides and then entering the diet.
Restoring basic nutrition requires having an understanding of the bio-markers that a patient may present with.
Nutritional restoration can provide patient comfort and well-being.
Read: Do You Know the Signs of Seven Common Nutrient Deficiencies?

Most of us experience propaganda at an increasing level.
Originally developed as a tool for demoralising populations during major warfare it is now commonplace as a force behind dubious marketing practices.
Pharma’s are actively engaged in propaganda.
Logic is your only defence.
For patients, Health Literacy based on logic creates better choices.
Read: Propaganda is the Art of Overwhelming Logic

We often hear the expression “The science is settled,” however, science is a process.
The idea that “science” cannot consider new information contradicts the definition of science.
People who promote vaccination as an extreme medical ideology are involved in “scientism” – the manipulation of the science surrounding vaccines.
Such practices use propaganda techniques in their delivery.
And it is certainly “unsettling” to hear the dishonest scientism 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.
Read: The Safe Vaccine Debate – 1.Dr Judy Wilyman Report: Newsletter 214 The Australian Media will not Report the Case for Vaccination Choice 2. Robert Kennedy’s Children’s Health Defence: $4 Billion and Growing: U.S. Payouts for Vaccine Injuries and Deaths Keep Climbing 3. GreenMedInfo: Attacking Ourselves – Top Doctors Reveal Vaccines Turn Our Immune System Against Us

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.
Read: Understanding Medical Cannabis – 1. Medical Marijuana Inc News: Iowa Medical Cannabis Board Recommends Adding Autism to List of Qualifying Conditions 2. Project CBD: Cannibidiol and Epilepsy Meta-Analysis  3. Cannabis tech: The Cannabis Contribution

Innovation is a process that develops with practice.
As a conditioning requirement, innovation is best developed in peaceful surrounds and in comfortable spaces.
This can mean different things to different people.
But by being cognisant of the underlying requirements you are enabled to innovate to a higher level.
Read: Innovation Requires Creative Space

Being a small business owner/manager requires a high level of focus and application.
Also the discipline to follow through.
Big business has the luxury of being able to delegate many support levels to their managers.
Small business means that generally, you are it!
The stress of this can reach overwhelming proportions.
Always remember, it is you that has to be the solution.
Read: Marketing Focus Newsbrief – Much Small Business Self-Induced

We conclude our offering for this edition with some media releases from two pharmacy leadership organisations.

SHPA – SHPA Media Releases – 1. New opioid data drives urgency for national action 2. Pharmacists shine as first Advancing Practice credentials awarded 3. JPPR doubles down on deprescribing  4. SHPA Queensland Branch welcomes pharmacy policy support 5. More than conversations: Pharmacists get to the heart of patient-centred care 6. Hospital pharmacy essential to patient safety and high-quality care in hospitals

NPS – NPS Media Releases – 1. New resources to improve the quality of at-home palliative care service delivery 2. Getting to the heart of diabetes webinar replay now available  3. Gabapentinoid misuse: an emerging problem  4. Australian Prescriber  5. Are you up to speed on antibiotic resistance?

We hope you enjoy our content in this edition and invite you to debate any issue raised by commenting in the panel provided at the foot of each article.

Neil Johnston
Editor, i2P E-Magazine
Monday 26 November 2018

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