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In
this edition we look at prescribing rights for pharmacists. The "P"
word has been around a long time in pharmacy circles, but tends to be
discussed only in whispers. Rollo Manning turns up the volume just a shade.
It is time for pharmacists to exert some pressure on the health systems to obtain recognition for a practice which has been going on for over 100 years. The prescribing of medications by pharmacists is part of the culture. What would be needed to have this incorporated into the billing system from Government coffers? Political will is the main factor to make it happen and a confrontation with the medical lobby. From Rollo Manning "Prescribing
Rights" is likely to become a strong issue for the medical lobby as Governments
try to find a way of reducing the cost of the Nation’s health bill. The
subject of "Nurse practitioners" has been on the agenda of the NSW, SA
and more recently Victorian Governments. The commonsense reason is to
allow health professionals to be able to practice in accordance with their
training and competency levels. The knowledge required to understand the
basis of therapeutics to enable the supply of medicines to the community
is already recognised in a number of legislative forms. After a training
program nurses in most States can distribute drugs to persons for acute
or short term illnesses. In some places, which are remote from mainstream
services, Aboriginal Health Workers are able to carry out this task. The
people missing out on access to nurses or other health professionals for
the treatment of short-term illnesses are the 70 per cent of Australians
who live in urban coastal cities. Yet in every metropolitan locality there
is a pharmacy with a health professional better versed than any other
on drugs and therapeutics. The knowledge base is achieved through an intensive
course of study in pharmacology (action of drugs on the body) and many
argue that the doctor of medicine should diagnose and the pharmacists
prescribe. Within certain guidelines it should be easy to work up protocols
to allow pharmacists to prescribe for short term illnesses with drugs
such as antibiotics. Checks and balances can be built in so after a certain
period the client or patient is responsible to seek medical advice if
the condition, which caused the initial pharmacist consult, has not improved.
Given this scenario, and a health system prepared to pay for the primary
health care service, it would not take the population long to recognise
an alternative practitioner, who can save the system big dollars. This
may seem a bit far-fetched to many, but recognise that prescribing rights
for persons other than doctors has been acknowledged through the health
system in the USA and Great Britain for some time. With more inventive
thinking, and seeking recognition for educated skills, the pharmacy profession
could stand taller and be seen readily as not just a "pill pusher". Through
the centuries pharmacists have been extolling their attributes as the
frontline health professional. The time has come for this to be taken
a step forward and into an era when efficiency of spending Government
dollars on health is a top priority. There is also big potential for savings
in the screening and initial treatment of chronic diseases. The supply
of repeat medications in chronic illness can be added to the list of benefits
in conferring prescribing rights on pharmacists for Schedule Four medications.
Such a move would surely have the pharmacists seen in a different light
when it comes to importance in the system. ECONOMIC STORM CLOUDS GATHERING Fears of high underlying inflation rates ( as distinct from the so-called once off effect of the GST), downstream fears of high interest rates, rising petrol prices eroding disposable income, and the dismal performance of the Australian dollar ( which will force importers to lift prices ), are all events that are colluding to cause a collapse in consumer confidence. Pharmacy is set to enter a cycle which is likely to cause some pain. Welcome to the Real World of Retail! Certain segments of the retail market serve as an early warning system to the market overall. These markets include whitegoods, electrical appliances, hardware, computer products and clothing. Currently, all these markets have become "patchy" and depressed, particularly in NSW and Victoria, which accounts for about 60% of the total market. It would be foolish not to acknowledge this pattern of events and take some corrective action, such as trimming inventory, reducing borrowings, adjusting staff hours, and investing only in market extensions that could give a reasonable return on investment. When retailing gets tough, one of the first responses is to slash prices (and margins). With Christmas looming, many retailers see this period as a last chance to "trim the sails". Given that pre-Christmas trading can account for up to 40% of annual turnover at higher gross margins than those averaged out of the rest of the year, many retailers are not confident of having a happy new year. Online retailers have an additional problem. Last Christmas, sales rose well above expectation and caught many cyberstores unprepared, to the extent that many orders were delivered after Christmas Day or not at all. The consumers who went through this experience are not likely to support a repeat performance, and the market for online retailing finds itself at the soft end of expectancy. Online retailers are becoming short of capital, because they did not adequately plan for the long haul. This means that they will not be able to attract sufficient funds to promote themselves for the peak Christmas period. No cash means no money for marketing; no marketing means no revenue; no revenue means big losses. Many online proprietors have simply lacked previous retail business experience. As a consequence, the Internet landscape will be littered with the bodies of these retailers over the next six months In short, there will be less money available for Christmas, both online and offline, particularly as the more alert consumers will be taking strategic action in their own personal financial area. Pharmacy has some degree of insulation from this in the medication area, but is equally vulnerable in those markets outside of this protection. As conditions tighten, price wars will break out, and some evidence of this is occurring right now. It does not end there. The much feared and anticipated opening of Aldi supermarkets will occur sometime in the new year. This secretive organisation is believed to have secured approximately 60 sites in NSW, and is believed to be planning to open 20-30 stores simultaneously, rather than just one at a time. Aldi's stated objective is to control ten percent of total supermarket sales by the year 2005. To achieve this, retail analysts have stated they will need 168 stores Australia-wide with an average of 10,000 customers per week spending $40 per average basket of goods. The opening of the first Aldi stores will coincide with a price cutting war, initially in NSW, which would quickly spread to all other states, with Queensland and Victoria becoming the second wave of casualties. Pharmacy will come to find itself in a pincer movement. The current problem of loss of consumer confidence will cause initial pain. The loss of market share due to an Aldi induced onslaught in the supermarket arena will intensify the pain, but the most excruciating pain will be experienced as supermarkets will seek to extract medication markets, through pressure on drug re-scheduling and pharmacy ownership. While it has been a difficult year for pharmacy and other businesses endeavouring to comply with millennium bugs, GST and BAS, there will be no respite for next year. Strategies should have already been developed to cope with some of the above already. We outline a few for consideration. For instance, how are you going to handle the problem of value-adding to drug schedules 2 and 3 so as to ensure they will stay in place, and in pharmacy? With individual pharmacists already overburdened by the daily workload and locum pharmacists becoming almost extinct, who is going to provide the requisite counselling? There are compelling health arguments which indicate that medicines should remain with pharmacy e.g the English experience with increased liver damage and subsequent hospitalisation parallelling the rise in paracetamol sales in supermarkets. Will these arguments be strong enough to overcome the supposed economic consumer benefits of selling drugs in supermarket environments? We propose the argument that it is now time to consider qualified pharmacy assistants to handle drug schedules. With proper training and education to diploma level, pharmacy assistants would have the skills to provide medication advice and information to CMI level. This would overcome the deficiency in value-adding to schedules 2 and 3 and would take pressure off pharmacist resources, particularly as additional resources are in exceedingly short supply. We further propose that this education could be provided by universities via the Internet. In our last newsletter edition #14, an illustration was given as to how Nottingham University in England was about to launch a program for pharmacist education. Why not a version for pharmacy assistants? Coping with the anticipated supermarket pressures will be not easy. There is not single pharmacy or pharmacy group that could match the resources of any current Australian supermarket or global supermarket operation such as Aldi. Sheer size will determine whether pharmacists will maintain ownership of their profession into the future, and believe me, that future is in the next five years. Where is the legislation to support the recent CoAG recommendations of allowing pharmacists to incorporate and own unlimited practices? We propose that if this does not happen very quickly, pharmacists will not be able to form strategic mergers to combat their competition, or provide a professional environment to attract future pharmacists. This must become a priority! Remember that as the global economy develops, we will be faced with overseas pharmacists wanting to establish ventures in Australia. Perhaps we should all be looking forward to signing up on a Bootes or a Wal-Mart franchise? This need not be so provided the legislation allows for Australian shareholders to be pharmacist only and most importantly, that the company structure is an exempt proprietary structure to prevent ownership by public companies, directly or indirectly. And finally, we propose that despite the difficulties in establishing an e-commerce extension to your existing pharmacy, to not do so will pose a serious short-term and a long-term disadvantage. The overwhelming reasons for e-commerce failures has been lack of planning, lack of retail management experience and lack of a "bricks and mortar" structures to support such a venture. You must become IT literate and see the challenges of e-commerce as a new tool to use and be able to reach outside of your neighbourhood to the entire world. Australia is currently regarded as "old economy" and our currency is downgraded as a result of this perception. Australian pharmacy is mostly "old economy" with signs of merging with the "new" economy. Pharmacy just needs to shake itself up a little more. GENETICALLY MODIFIED (GM) FOOD SCARE Australia's food regulations are set to become some of the toughest in the western world. The Joint Australia New Zealand Food Standards Code has been drafted for approval by State and Federal Health Ministers. Not a moment too soon according to some commentators, as one of Kellogg's American food processing plants was forced to close earlier this month. It used non-approved, genetically modified (GM) corn, which had proven health hazards. Should Australian Laws Close all Loopholes? In America, there is a genetically engineered variety of corn, approved for sale as animal feed. Known as "Starlink", this variety of corn has proven adverse reactions in humans, which include allergic reactions, diarrhoea, rashes and fever. Earlier this month, Kellogg's, the global breakfast foods cereal processor, was forced to close one of its U.S plants because Starlink was found in three of its supermarket products. What was more alarming was that Kellogg's could not find a replacement supply of corn that was free of genetic contamination. In a further U.S development, Tyson Foods, the world's largest poultry producer, stopped using the Starlink corn as a poultry feed, reasoning that if humans developed health problems, then animals may also develop a similar range, causing deterioration to end food quality. In a follow-up, the Greenpeace organisation sent a letter to 35 major U.S food companies, requesting information as to what steps they were taking to prevent unapproved GM foods from appearing in the food supply chain. The letter was prompted by reports that some companies were quietly removing products from stores without having previously advised consumers. Media comment triggered over 28,000 phone calls and letters to Kellogg's from concerned consumers. Responses to these communications indicated that American products are "likely to include biotechnology produced grain". There has been a spillover in Canada, where the same GM corn has appeared in Taco shells, resulting in a recall. Japan has requested that the US does not export GM corn, as consumer groups in that country had found traces in various imported foods. The White House responded immediately by calling a meeting of top biotechnology food policymakers to work out a strategy to address Japan's concerns. Scientists in England have called for improved safety to prevent GM crops cross-pollinating with conventional crops or other wild species, and fears are spreading through the midwest of the US that a major proportion of this year's corn crop may be contaminated with Starlink. The realisation that exports may be severely affected, is causing panic among farmers. Against this background of GM food disasters, the various Australian state and federal health ministers are set to approve a new food standards code. Developed by the new Australia New Zealand Food Authority (ANZFA) it basically proposes that all processed foods will be labelled so as to identify any GM ingredient, no matter how small the concentration. It does, however, exclude foods sold in restaurants, fresh foods, and pre-packaged foods as dispensed in airlines and canteens. The Australian Food and Grocery Council (AFGC) has been fighting to have some of the labelling requirements curtailed regarding processed foods, while consumer groups are fighting to have all food labelled, processed and unprocessed. The AFGC also supports the labelling of all foods, but not to the extent which will be now required by law. Given the recent overseas problems with the control of GM crops and processing, it would appear that the feelings of the majority of Australian consumers have been vindicated. GM foods therefore, should hasten slowly, and maybe, there is no place for the sowing of GM crops within Australia at all. It is refreshing to hear of a good news story through all the GM controversy. Australia's largest producer of whole bean soymilk, "So Natural Foods", has launched what it claims is Australia's first "fresh" chilled soymilk made from "certified organic" Australian grown soybeans.The product is called "So Good Soy Milk". The product uses sprouted soybeans instead of reconstituted soy protein powder used by larger manufacturers. Some batches of imported soybean protein powder have already been shown to be GM contaminated. The Biological Farmers of Australia is a governing body that establishes strict guidelines for organic agriculture and food production in Australia. "So Natural Foods" is accredited with this organisation and is able to demonstrate that its product is completely free of chemicals or genetic modification. With Australia's reputation of having "clean-green" food, organic exports are growing at the rate of 45% each year. This market opportunity is allowing "So Good" to increase its current production capacity by 100% towards the end of this year, and due to its close cooperation with growers, organic soybean production has increased by 300% over the past three years. It is refreshing to hear of a manufacturer who is profitably addressing consumer concerns and is probably developing what could be regarded as a proper "functional food", retaining all the phytochemicals that can produce a health benefit outcome. Being a refrigerated product, the potency of these substances will have a reasonable shelf-life expectancy. The product is also one that pharmacists could endorse when giving health counselling for any condition where the indications would be supportive. The fact that functional foods are cited as shaping the future of preventive health is a major reason for pharmacists to be involved in an advisory and a retail role. The term "functional food" is a generic term used to describe anything from a genetically modified potato that can produce vaccines, to cholesterol lowering margarines, to normal foods laced with some additive such as a vitamin or health giving herbal preparation. There is consumer confusion with the term "Functional Food", for, after all what food isn't in some way functional? Most people are aware of the link between nutrition, diet and health, but only a handful are aware of the terms functional food or nutraceutical. With more consumers wishing to take more responsibility for their health, the importance of these food items will increase as the "self care" model of health takes hold. Pharmacists should be prepared to respond to these consumer initiatives for they are seen as a response to the frustrating conventional model of managed health costs rather than providing patient care. The self care movement is about being proactive about health and working continuously towards a state of wellness. The market that results represents opportunity for pharmacy, and development could ease competitive pressures that are forecast down the track. With Internet fraud developing as a major issue, particularly in the e-commerce area, the need to mount a defence is critical to the future success of web business and systems. A novel idea of protection based on the human immune system is being developed Will Consumer Fears be Overcome? Just as our own immune system distinguishes between "self" and "foreign" to recognise harmful invaders, an electronic version has been developed to distinguish between legal transactions and fraudulent transactions. The system relies on thousands of tiny programs known as "detectors" which are designed to recognise a specific type of transaction. The detectors travel around computers and networks seeking out invaders, much like white cells do in a human immune response. Before releasing the detectors, researchers challenge them with all sorts of legitimate processes. After release, detectors that match up with legal patterns are disposed of, leaving only the detectors that identify fraud as remaining. In this way it is thought that organisations such as banks will be able to monitor account transfers and government agencies to monitor social welfare benefits. The detectors may also be able to monitor credit card transactions, but it is thought that encryption processes will have to be developed and made more secure, to guarantee absolute success. When a detector finds a match, an alarm is raised and a human physically looks to see if the transaction is legal. If the match is a legal one, the detector is removed. Detector programs that identify fraud are then multiplied and are designed so that if fraud is identified, a memory will be retained. They are also constructed to allow mutation and be able to evolve over time. Thus the system can update itself and combat new types of fraud. The advantage of this method is that it starts off with a random population of detectors, and once the faulty detectors have been removed, the remainder should be able to recognise all others. This includes fraudulent transactions that have not yet been thought of. Just as our bodies fight off new infections, the new system is able to fight off any kind of attack that has yet to be devised. VITAMIN E VARIANT PROTECTS AGAINST CANCER In a finding that could change the way vitamin supplements are manufactured, a team of University of California-Berkeley biologists has found that a less popular form of vitamin E may play a powerful role in protecting against cancer and heart disease. Perhaps Nature Provides the Best Form Vitamin E is usually sold as alpha tocopherol, the most active isomer. However, there are eight known isomers with varying degrees of activity, most of which can be found in wheat germ oil and other seeds. Recently, the gamma isomer was researched by the University of California (Berkeley), and was found to play a critical role in the defence against cancer and cardiovascular disease by inhibiting the inflammation process. In a study published in the journal Proceedings of the National Academy of Sciences, scientists demonstrated that gamma tocopherol plays a superior role in suppressing inflammation than the alpha form by inhibiting prostaglandin formation in cells. "The anti-inflammatory role of the gamma form makes it an important factor in helping to prevent disease", scientists said. "Cancerous human tissues have been found to correspond with increased amounts of and enhanced expression of prostaglandins, which the gamma form was found to inhibit. Inflammation has also been shown to play a significant role in the initiation and development of atherosclerosis." In addition to its anti-inflammatory ability, other properties of the gamma form may make it an even more effective agent in scavenging and removing free radicals from the body. The gamma form structure allows it to react and detoxify free radicals such as nitrogen oxide species more efficiently than the alpha form. The finding could potentially bring about changes in the manufacturing of supplemental vitamin E pills. Scientists concluded: "Because gamma (tocopherol) clearly shows natural anti-inflammatory properties, vitamin supplements should be changed to include this much overlooked form, it could result in better long-term public health and reduce the risk of various inflammatory-related diseases such as cardiovascular diseases and some forms of cancer. YOU'VE GOT MALE Through this regular column, Leigh Kibby has been giving insights into how men think and feel, and how their very real twenty first century problems are causing serious health and social concerns. Understanding the problems gives rise to solutions. The following very human illustrations arose from letters to an advice column. Dear Leigh.......... An
attractive new girl started work in our office and I can’t keep my eyes
off her. I want to ask her out but don’t know what to do. What if she
says no, I’ll look like an idiot. And, what if she thinks it’s sexual
harassment? What should a guy do nowadays? DearPeter,
Dear
Leigh...... Dear
Jenny, Dear
Leigh......... Dear
John, Dear
Leigh....... Dear
Lenny, The comments and views expressed in the above article are those of the author and no other. The author(s) welcomes any comment and interaction that may result from this and future articles, and can be contacted directly by e-mail at kinematic@bigpond.com . Alternatively, the editor would be pleased to publish any responses directed to neilj@computachem.com.au . ROUNDUP Money set-aside for improving the Aboriginal Health Worker opportunities to understand how to be a pharmacy assistant or technician needs to be used. Both the Federal Budget and the Third Agreement for Community Pharmacy in May had commitments to provide education and training opportunities for indigenous people. "Pharmacy" at remote places is now relying on the good grace of a retail pharmacist to supply pharmaceuticals through the PBS. This is using the special arrangements negotiated by the Pharmacy Guild for supplying Aboriginal Medical Services using Section 100 of the National Health Act. The big stumbling block in the whole scheme is NO dispensing fee. A retail pharmacy cannot be expected to add a great deal of value when being remunerated at 10 per cent on cost and a "handling fee" of $1-14 an item. The Guild "deal" includes the pharmacy having to meet the cost of freight. What an ideal time for Aboriginal Health Workers to be "upskilled" as pharmacy technicians so as to have a new role at the clinic end in managing medication supply. All involved wait for the announcements on how the money is to be spent and how much will be available to individual health services that may be hundreds of kilometres from a Guild member. THE NATIONAL RURAL HEALTH ALLIANCE Want to subscribe to another interesting newsletter? The National Rural Health Alliance has a publication dedicated to news and reviews of all aspects of rural health. You can subscribe on the website at http://www.ruralhealth.org.au or you can contact the independent editor, Jim Groves, at grovesc@winshop.com.au *
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