Opportunities for Clinical Services

I was interested to read that Chemmart had introduced a genetic testing system designed to tailor drug treatments to an individual patient.
At least that has been the promise of these types of tests as they have gradually made their way into the market-place.
With the introduction of the myDNA test into a pharmacy environment we are simply seeing the evolution of this type of testing transitioning from an academic environment to pathology laboratory to pharmacy.
It has not arrived in pharmacy without extensive evaluation.

That this type of testing should have an association with pharmacists and patients taking drugs is not in doubt.
Pharmacists won that legal right many years ago.

It is perhaps the method of introduction that needs to be considered.

Pharmacists are slowly transitioning their “core” activity by changing their method of delivery of clinical knowledge from a free service to a paid service.
In so doing, pharmacists are coming to grips with changing their focus on “customers” and converting them to “patients”.
It becomes a “whole of pharmacy” process with the introduction of new clinical spaces being built and a new pharmacy staff person evolving – the clinical assistant.
The pharmacist is also in evolution with the realisation that community pharmacy needs two pharmacist types – the dispensing pharmacist and the clinical pharmacist.

Because the PBS has reached the end of its product life cycle and has become commoditised, it fits more as a department in a supermarket, rather than the primary component of a pharmacist’s core business.
This cultural change has been induced by government in terms of financial stress.
 Also the medical profession, ever protective of its turf, disrupts pharmacy at every opportunity, through various control mechanisms.

When economic rationalists attack pharmacy’s competitiveness as government advisers, it is often tinged with medical input.
By keeping pharmacy poor it becomes a weaker competitor on all fronts, even against traditional predators like Woolworths, who share complementary views on where pharmacy sits as a competitor.
We are a very valuable resource and the major players in government, retail and health want to own us – directly or indirectly.
Government has succeeded in capturing our core business through PBS controls, the medical profession would like to own us (directly and indirectly) and would never see pharmacists as “equal”. They will destabilise any attempts to create equality.
The major retailers make no pretence – they simply just want to own us because of the value that would transfer to their environments.

What part of competition do our political masters really understand?

The Chemmart initiative through introducing the myDNA test is applauded, but the problem is the way that it has been introduced.
It is a product-driven initiative that can be easily commoditised rather than a clinical tool that forms part of an investigative process into a patient’s medication profile – the actual clinical service of which the tool of genetic analysis forms only part of.
The price is currently listed at $149 for the product test and is promoted as an entry level clinical activity, but it positions consumers as “customers” rather than as “patients”.
The market positioning is traditional for a market franchise owned by a wholesaler that relies totally on an expanding product-driven supply chain.
This is not a proper orientation for pharmacist controlled and delivered clinical services.

Adjunct Associate Professor Ken Harvey and Dr Basia Diug, both from the school of public health and preventive medicine at Monash University, have criticised the Chemmart advertising claims.

In a joint article in The Conversation, they write that some of Chemmart’s claims may be misleading for consumers who lack detailed knowledge of DNA testing and may produce unrealistic expectations of the product’s effectiveness.

And here I find myself unusually in basic agreement with Ken Harvey and his partner, who have created a carefully crafted perspective in an article that creates doubt for the efficacy of the test, and neatly creates a medical disruption against a pharmacy initiative.
In the wake of the Conversation article, a range of doctor online publications have amplified and distorted the context with inflammatory headlines and the use of inflammatory language within the body of their reports.
This is not new but pharmacy attacks by the medical online media are becoming more frequent.

Like the words “Pharmacies attacked for selling DNA testing kit” and “Pharmacies are flogging a controversial DNA testing kit” deliberately continues and escalates medical disruption, plus denigrates pharmacists professionally.

Pharmacists, of course, have to fight back using their own methods to counter this disruption.
They must also insulate their professionalism to a level that is beyond attack.

The medical profession appears to think it has a divine right to interfere in any other health profession.
But they become outraged when the reverse takes place.
There are no holds barred to protect their prestige, health service monopoly and their abnormally high incomes – anything or anyone will be sacrificed to preserve these elements.
The pendulum is, however, swinging in a different direction as consumers, the ultimate masters of government, realise how short-changed they have been, as medical cost escalations have become the driver for increased health insurance and reduced government funding for existing health services.
They are looking for more economical and better quality choices, and with a unified approach, pharmacy can provide that.
And the medical profession are aware of the reality of this!

While the medical profession has never hesitated to use professional interference and disruptive tactics (prescription channelling is less effective now that the PBS is commoditised), pharmacists have kept more under the radar.
Some disruption also occurs through Big Pharma who continually run interference on any process that reduces their marketing capacity for their drugs.

I suspect that this is an influence not yet identified in the criticism of the Chemmart initiative.

It is interesting to note that as medical disruption has become more open, some pharmacy leaders have finally begun to speak out and become visible.
Great to see it finally happening!

And I think that this will be a natural evolution.
Pharmacists will have to fight for what they want and be prepared to deliver the fight through methods they are not used to employing.

i2P is no stranger to the tactics employed by the medical profession (particularly the medical skeptics) and the various front organisations formed to deliver them.
It is, unfortunately a fact of life, but unless the war is taken up to the level where both sides are hurting, a genuine collaboration between the medical profession and any other health profession, will not generate the true collaborations we all believe are possible.

What I am also saying is that while the current leadership bodies have been sufficient to develop pharmacy to its current level, they must fast-track change in their culture or encourage the formation of new organisations that can deliver what they are unable to deliver.

In the interim, congratulations to Chemmart on their initiative in introducing genetic testing and with some minor refinements, even Ken Harvey will be forced to find a new target.

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