EDITORIAL for Monday 9 July 2018

Welcome to the current edition of i2P (Information to Pharmacists) E-Magazine for Monday 9 July 2018.
The RACGP executive have continued their unwarranted and unprofessional commentary regarding supposed “turf encroachments” by pharmacy.
This fractured organisation appears to have been led by an executive determined to create a disruptive distraction.
i2P believes that this is simply a smokescreen substituting for poor leadership and is why, in a recent lead article “Bypass the AMA if Collaborative Ventures are Required for Unmet Patient Needs”, we advised that pharmacist collaboration with GP’s should occur only at the coalface, where patient unmet needs could be negotiated based on respectful collaboration.
There are many instances of this already happening.

Where there is a genuine relationship between GP’s and pharmacists, both sides prosper as patients feel comfortable.
Where no relationship exists, patients begin to make alternative choices regarding their personal needs and that often means marching with their feet to alternative practitioners.
At that stage, pharmacists and GP’s lose shared patients jointly.

However, there is a newly elected leader, Dr Harry Nespolon, a Sydney GP, who is preparing to take up his position as head of the RACGP later this year, and he has said there needs to be a cultural change in the RACGP, with a move away from being an “autocratic organisation” to one focused on its 30,000 members.

That sounds promising and it is hoped that pharmacy leaders will collaborate and assist in this proposed cultural change so that respectful relationships can be restored.

But there is wider repair required in all of the health professions as Global Pharma ambitions become more obvious.
Global pharma specialises in buying favourable decisions, and this process has been previously discussed by i2P in an article titled “The Paradise Papers – Tax Evasion by The World’s ‘Elite’ and a Payments System that buys “Decisions”. and it has now reached epidemic proportions as you see the “one-world pharma government project” seemingly able to act corruptly and illegally because of the key people they have “bought”.
It’s happening right now in Australia and all other western economies.

A simple example occurred recently in the organisation of a Citizen’s Conference on Vaccination and Censorship, held on Saturday 30th June 2018.
Because of previous experiences, the venue address had to be kept secret until two hours before the start time, because various “influencers” attempt to shut down these conferences through threatening venue owners.
One participant, Elizabeth Hart, a long-time commentator on over-vaccination and conflict of interest in official vaccine policy decisions commented:
“That’s the state of our liberal democracy today in Australia, re citizens questioning vaccination policy.”

i2P has provided a transcript of her presentation at this conference and it is certainly an “eye opener” in regard to the levels of conflict of interest and “bought” decisions.
It is recommended that you read her conflicts of interest in vaccination policy transcript.

In an article in this edition, US-based investigative journalist Jon Rappoport writes on how vaccinations are now being designed in a form that can only be described as gene alteration experiments.
The objective is to initially (and permanently) alter a person’s DNA so as to enable that person’s immune system to deal with the flu virus irrespective of the strain of virus involved.
It is not a vaccine, but is disguised as a vaccine and as such, manufacturers will not be held liable for patient damage or for insufficient research to safely market such a product.
It becomes a massive experiment in gene therapy with the potential for patient coercion similar to childhood vaccines.
At this point we are entering the realms of Nazi-style experiments outlawed by the Nuremberg Convention at the end of World War 2.
As I commented in a recent editorial, we are fast approaching an extremist form of corporate government.
People will only find a solution in revolution, given that their elected leaders have sold out for “thirty pieces of silver”.

It is not a world I want to belong to and it is definitely not the Australia that I have known and been proud to be a part of.

And in another facet of medicine we find published in Lancet Public Health a study claiming no relief for non-cancer chronic pain sufferers when using medical cannabis.
Titled “Effect of cannabis use in people with chronic non-cancer pain prescribed opioids: findings from a 4-year prospective cohort study”.

Considering that many pharmacists have listened to patients suffering from chronic pain and who claim the opposite, this study may suffer from design flaws.
Certainly, a number of the researchers involved receive grants, income or fees from drug companies with vested interest in opioids and their derivatives, and are therefore conflicted, despite the fact that these funders did not necessarily contribute funds directly to this specific study.
Read the declaration of interests extracted from the study report and make your own assumptions.
Note that the initials appearing in the declaration are those of the original researchers.

“Declaration of interests

GCa reports grants from Reckitt Benckiser outside the submitted work. WDH reports grants from Australian Therapeutic Goods Administration and personal fees as a Member of the Australian Advisory Council on Medical Uses of Cannabis, both outside the submitted work. AP reports grants from Mundipharma and an untied educational grant from Sequirus for studies of tapentadol, both outside the submitted work. NL has received research grant funding from Indivior, Braeburn, and NSW Health, and consultancies or advisory board participation from Indivior and Mundipharma, all outside the submitted work. RB reports grants from Indivior for the development of an opioid-related behaviour scale and a study of opioid substitution therapy uptake among patients with chronic non-cancer pain, all outside the submitted work. BL reports grants from Reckitt Benckiser for studies of the development of an opioid-related behaviour scale, and a study of opioid substitution therapy uptake among patients with chronic non-cancer pain; and Indivior for studies of buprenorphine-naloxone and buprenorphine depot; an untied educational grant from Seqirus for studies of tapentadol; and grants from Mundipharma, all outside the submitted work. SN reports grants from the Nationabe eliminatedl Drug and Alcohol Research Centre during the conduct of the study, and grants from Indivior outside the submitted work. MC reports personal fees from Mundipharma outside the submitted work. RPM reports National Health and Medical Research Council project grants during the conduct of the study. MF received investigator-initiated untied educational grants from Indivior for studies of buprenorphine depot and naloxone; and an untied educational grant from Seqirus for studies of tapentadol, all outside the submitted work. LD received grants from Indivior for studies of buprenorphine-naloxone, buprenorphine depot, and naloxone; and from Reckitt Benckiser for the development of an opioid-related behaviour scale, and a study of opioid substitution therapy uptake among patients with chronic non-cancer pain; an untied educational grant from Seqirus for studies of tapentadol; and a grant from the Australian Therapeutic Goods Administration, all outside the submitted work. GCh, FB, MS, and TD declare no competing interests.”

Big Pharma has a lot to lose if opioids can be eliminated with a natural substance such as medical cannabis.
This particular study has other caveats when you read it, and in my mind is more designed to confuse issues, rather than provide a real contribution to the science of medical cannabis, because there are other studies that support its ability to manage chronic pain.

Our lead article for this edition discusses the transition of Australian pharmacy into a global context.
It is thought that at least one Australian group is looking outwards, while quite a few others, led by Amazon and Bootes are looking for an opportunity inwards to a deregulated pharmacy environment.
The Amazon purchase of PillPack in the US provides a vehicle that has regulatory compliance for all states in the US.
Its acquisition will enable Amazon to fast-track its pharmacy model.
The media release regarding the $US1 billion purchase has already driven down share prices for most of the major pharmacy chains, and that has provided stimulus to work out new methods for preserving market share.
While Australia is not immediately affected it is an eventual part of Amazon strategy to break in to our highly regulated pharmacy market.
Other global pharmacy chains will also see similar opportunity, so pressure will now build on Australian policy makers to favourably deregulate the Australian market.
Local pharmacies can survive if they concentrate on core business – the reason for being!
Read: Countdown as Australian Pharmacy Begins the Transition as Part of a Global Network

Gerald Quigley is back and points out some flaws in the Medical Cannabis study referred to in the editorial above titled “Effect of cannabis use in people with chronic non-cancer pain prescribed opioids: findings from a 4-year prospective cohort study”.
The majority of researchers involved received payments of some kind from opioid manufacturers, but no funds directly for the study.
They had conflict of interest issues because those payments made it so.
The design of the study is also flawed due to the use by patients, of non-standardised illegal cannabis product.
Coupled with the biased reporting in medical media, this study needs to be viewed with extreme scepticism.
Read: Cannabis Confusion

John Rappoport, US-based investigative journalist, reports that global vaccination policy is about to take a turn for the worse starting already from a dismal low point.
Vaccines are about to become a massive experiment in gene therapy, delivered with the same rules as for vaccines – no accountability for manufacturers, inadequate science and safety and in contravention of at least six international treaties banning human experimentation with drugs.
All health professions need to take a stand on this issue – including pharmacy.
Is gene therapy going to be part of your vaccination program?
Read: Next Generation Vaccines Built to Alter Human Genetics

“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.
Read: The Safe Vaccine Debate – 1. Samer Hakim: Gardasil/Cervarix HPV Vaccination – to jab or not to jab? 2. Dr Judy Wilyman: Newsletters #201 & #202 3. Robert Kennedy’s World Mercury Project: Vaccines and the Liberal Mind

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.CannabisTech: Distillation becomes another invaluable step towards a better understanding of individual cannabinoids. 2. CBD Testers: World Health Organization To Possibly Reschedule Cannabis 3. Jerusalem Post:  A higher calling: How Israeli marijuana research changed the world

Harvey Mackay is back with an article about how mistakes are made as part of life’s experience in learning.
Mistakes do create a learning process that eventually forms up into a body of useful knowledge.
That the process can be painful is sometimes the reason why people fail to make decisions.
Australian pharmacy is about to transition into a global network and it is unprepared.
It will be less painful making mistakes now than it will be as events begin to overtake and dictate unfavourable terms.
Time to get a move on!
Read: Mistakes Are Opportunities To Learn

Barry Urquhart is back with a series of essays that reflect the management culture of businesses outside of pharmacy. 
Pharmacy experiences the same range of problems so comments made are translatable to a pharmacy environment.
Pharmacy, as well as any other health profession, is vulnerable to the same issues and strategies that need to be constantly reviewed, particularly as the transition to the global economy takes hold.

And we conclude our offering for this edition with media releases from two pharmacy leadership organisations.

PSA – PSA Media Releases – 1. Pharmacy Shark Tank finalists to take the plunge 2. Pharmacists and GPs must work together for the best patient outcomes 3. New training for pharmacists to re-enter the profession 4. New PSA Early Career Pharmacist Director to focus on the future

NPS – NPS Media Releases – Australian Prescriber

We hope you enjoy reading this edition and that you contribute to any debate by adding a comment or two in the panel provided at the foot of each article.

Neil Johnston
Editor, i2P E-Magazine
Monday, 9 July 2018




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