We now live in a world of science that most of us did not know or even understand when we finished our studies within pharmacy schools at various universities around Australia.
Unfortunately that science is now tinged by corruption of evidence by Big Pharma and skewed to an extreme by medical skeptics seemingly supporting orthodox science, but forever turning a blind eye towards the existence of this cancer within science.
Possibly because some of them helped to create it in the first instance through the largesse of research dollars flowing their way as researchers –now impossible to do without.
Pharmacists have always been on the front line delivering primary health care amidst all the confusion, criticism and disarray that corrupt science, hidden science (through journal suppression) and patient demand induces.
What can we trust as evidence-based medicine and do the same rules apply in evidence-based nutrition?
And is the medical version of evidence to be the only version accepted?
Do we ignore all the other health modalities that have been producing good results for hundreds of years?
For example, it is a fact that when you compare chiropractor results for lower back injury to those of the medical profession, chiropractors win hands down in terms of outcomes and cost, and do not further damage the patient with drug side effects – because they don’t prescribe drugs.
Modalities that have softer footprints can produce better results – why should we ignore them?
Why don’t we just accept that these are treatments that work and are just waiting for the evidence to catch up and even work in alliance with them.
Pharmacy practices over the years have held internal evidence of treatments that work but are now held improper because someone who may be a bureaucrat or an academic or a skeptic with an axe to grind says there is no evidence of efficacy for a particular product.
Cough mixtures for example.
No doubt these people have never had children, or that that there is no evidence for or against the use of cough mixtures.
The fact that this has been a successful Schedule 3 category pharmacist managed drug here in Australia with no adverse reports up to now seems to be ignored.
All reported deaths or misadventures were reported originally from US supermarket sales.
On that evidence why not ban all medicinal sales in supermarkets?
It seems fairly clear that pharmacists will be increasing their work capacity to embrace more primary health care roles.
It is also a probability that to maintain an economical cost in so doing that complementary medicine, particularly in the area of clinical nutrition will be involved.
Given the lack of clarity in the evidence minefield I turned, as always, to Seth Godin who is always guaranteed to cystallise thought leadership for the direction you wish to travel.
His first words of wisdom follow:
We expect authors, painters and singers to identify themselves, to sign the work they do.
And surgeons and lawyers as well.
What about managers, committee members, engineers and everyone else who makes something? Who made this policy? Who designed this menu? Who approved this project?
If you’re not proud of it, don’t ship it. If you are, sign your work and own the results. We’ll know who to thank. If you work for a place where work goes unsigned (internally, in particular) it’s worth asking why.
In other words, all that internal evidence that is generated – document it and own it.
For some time i2P has held the view that education needs to be decentralised and delivered regionally to pharmacists, and around that education there should exist an opportunity to introduce original research by participants and have peer review under the same roof.
Clinical pharmacists have yet to identify themselves as a separate association to represent themselves and protect themselves from unwarranted attack.
Perhaps they could form up around this element of education and research, vitally needed for reference and some sense of certainty (and sanity).
And because pharmacy is a business, we should not forget that management science and market research should sit alongside medicines research simultaneously.
Seth Godin, marketing guru extraordinaire, had one other message to deliver to me for this article and it follows:
Marketers make change happen. Good marketing can change governments, heal the sick and bring a new technology to the masses. Marketers spend money (sometimes lots of it), take our time and transform our culture. It’s quite a powerful position to be in.
Who decides, then, what and how it’s okay to market?
At a recent conference for non-profits, a college student asked me, “what right does a public health person have to try to change the behaviour of an at-risk group?”
That one was easy for me. How can they not work to tell stories and share information that will help those at risk change that behaviour?
And then, just a day later, I heard the story of a marketer who intentionally bankrupts the elderly by loading them up with worthless ‘investments’.
He said, “Hey, if it makes them happy in the moment and they voluntarily buy what I’m selling, who cares?
I’m not doing anything against the law, and if it’s not against the law, I’m not going to stop.”
Or the spam phone banks that steal brand names and generate tens of thousands of calls a day, tricking small businesses into buying fake SEO services. Or the e-cig makers who market to kids, looking to build a long-term business based on addiction.
For me, the line is clear.
If the person you’re trying to change knew what you knew, would they want to change?
And so the placebo is ethical, because in fact, it makes people better when they believe. And the expensive wine is ethical, because it’s a placebo, purchased by people who can afford it.
But the fraudulent penny-stock scam is wrong, because the withheld information about the fraud being perpetrated is a selfish lie.
If you’re okay saying to yourself and your family, “I tell selfish lies to the weak, the young and the uninformed for a living,” then I guess we need better laws. I’m hopeful, though that we’ll figure out how to do work we’re proud of first.
All the above has direct relevance for pharmacists but the single line that resonates is:
“If the person you’re trying to change knew what you knew, would they want to change?”
That is the test for pharmacists to observe – and they have been doing this quietly and honestly for well over 100 years – and it is the basis for the level of trust accorded pharmacists for their existing dispensing services, and it will be systematically earned for new clinical services as they are organised and rolled out.
When you make a decision for a patient you make it by assembling the best available knowledge.
Some of that decision will relate to your “internal evidence” base which will be attacked by detractors from time to time.
Be true to yourselves and provide your patients with the best you are capable of giving, backed by a professional delivery that includes as much documentation as is necessary.
Remember, most detractors will have never serviced a patient or managed a clinical practice at the coalface.
What would they really know even if they have “professor” as their first name?
So far the signposts from the limited research that has been conducted around clinical services, a clear message is emerging:
1. Each pharmacy needs a clinical pharmacist completely detached from the dispensary, with no obligation to dispense.
2. That pharmacist should be stationed in a “health bar” located in the front third of the pharmacy, well away from the dispensary.
3. That pharmacist should be styled as a clinical pharmacist and be involved in a range of advisory services, ranging from a three minute free services to a 15 minute paid service or be the driver of a group consultancy.
4. Trust should be built on a progressive basis to establish unsubsidised consultations of 15 minutes for around $30 as a payment. Smaller segments of time can be offered on the same dollar basis but marked up accordingly.
5. Consultations sold will be directly proportional to trust levels.
Build trust on every occasion.
If your patient recommendation is based on your own prior experience, tell the patient.
If there is no formal evidence for a complementary medicine tell the patient – but recommend it anyhow based on your experience.
If they know what you know they will follow your recommendation.
6. The ultimate level of trust is a patient agreeing to a paid consultation in an enclosed office environment.
Work on all the perceived obstacles preventing this objective.
Each failure is a new lesson to be embraced.
Don’t give up!
7. Forget the clock and do whatever it needs to retain a patient for 15 minutes.
Pro bono time can be given in addition, particularly on return visits.
8. Build relationships with other health professionals, particularly nurses.
There is evidence emerging that a pharmacist-nurse coalition may appear to be equal to a GP in a patient’s mind. Capitalise on this. Also, don’t forget to forge alliances with specialist pharmacy sales staff in key areas (skincare, pain management, sexual health).
9. Despite the fact that GP’s will see any clinical pharmacist activity as competition and will generally retaliate in a destructive manner, if you hold the fort and respond only in measured polite tones, (remaining 100 percent professional), you will win the day.
10. Do not react to the jibe that pharmacists work between the “toilet paper and the toothpaste”.
In future articles we will reveal how those elements can be capitalised through having a strategy to convert customers to patients.
Customers are the “people” pool that we recruit for conversion to committed patients.
Increasing customer levels will equate to increasing patient levels with the appropriate strategy.
The secret ingredient will still be trust.