MARCH Edition # 22, 2001

A NOTE FROM THE EDITOR

Welcome to the twenty second edition of the Computachem e-newsletter.
We are sure that you will find the contents of this edition, both interesting and stimulating.
Rollo Manning explores some of the potential political fallout of the government decision to alter the make-up of the Pharmaceutical Benefits Advisory Committee (PBAC), following on from his article in edition #21.
We also publish the results of the last survey to gauge the feeling out there in community pharmacy about the PBAC alterations, and link the results with two other emerging and disturbing global trends.
A human resource problem is emerging for managers and executives, which goes a little deeper than individual "burnout". Management consultants are expanding their skill base to include psychology, to service an ever increasing demand for psychotherapy required by managers and executives.
This is a disturbing problem and it is beginning to be seen in Australian pharmacy.

"Food for Thought" is a story about genetically engineered foods and the methods that global companies employ to introduce these products to be market.
Our own government is obviously complying, and one wonders why there is any consideration at all for what these altered food products represent.
What real benefit are they to us?
They do not come with any safety testing for human health, or for ecological damage, and not even farm recording of the type of crop planted, when and where. This means researchers into health and ecological problems will have no basic data to track from if things go horribly wrong.
Nor is there any evidence that these crops grow faster, produce more or grow in poor soils...all properties that would be needed if they were being developed for starving Third World countries, as per the PR blurb.
There are emerging reports that genetic foods do not stack up at all.
The Australian and New Zealand Food Authority are inviting comment about their latest approvals for generically engineered foods to be used in Australia and New Zealand. Why don't you register a comment, because they are allowing six weeks for this process. The link is in the body of the article.

Jon Aldous continues his popular series on pharmacy education and in this edition he covers the raft of new biotech drugs that are coming on to the market at a rapid pace, also what may evolve with the unraveling of the human genome. Already, it seems, newly graduated pharmacists have a knowledge base that is rapidly becoming obsolete.

Leigh Kibby promotes a model for a dynamic and progressive organisation and the type of management philosophy needed to bring the workplace back into a creative and progressive environment.
Finally, our guest columnist "Roundup" discusses some developments towards remotely controlled dispensing in outback and isolated area.
Don't forget to register for any positions wanted or positions vacant. Follow the link from the email or click on this site to the home page, and follow the navigation bar link to "employment".

Neil Johnston
March 15th, 2001

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PHARMACY POLITICS

	FROM ROLLO MANNING: Time to look again at PR THE PHARMACEUTICAL SECTOR - A POWERFUL LOBBY?

"A weekend Newspoll showed Labor's support at 58 per cent for next Saturday's Ryan by-election on a two-party-preferred basis, up from 42 per cent in the 1998 federal election." news.com.au told us during the week just past.
How significant is this for pharmacy?
The Third Agreement brokered between the Pharmacy Guild (representing retail pharmacy) and the Federal Government is set for the next (now) four years.
Maybe all should be relaxed.
There is never a time to relax when public opinion rules the day.
The above statement is the reason all pundits are predicting a change in Government this year at the Federal level.
The APMA lobby will be watching this closely, as one would hope the rest of the pharmacy sector of the economy is doing. The question needs to be asked as to how much the PBAC fuss contributed to the poor showing of the Government inn the latest Morgan Gallup Poll?
This we will never know.
Further research would show the extent but that is a costly business.
The APMA and its member companies have spent a lot of money, and have won the day. The task ahead is for the total pharmacy lobby to work together to ensure the Labor Party, its shadow cabinet, and party machine, are fully aware of the gains that have been made for the industry, retail and manufacturing, during the life of the Howard Government.
This will be the real test of the pharmacy lobby, although it may not be known for three years if it has been successful.
The next three years will be significant for both sectors.
The decision from the National Competition Policy (NCP) review of pharmacy regulation to allow pharmacies to remain owned by pharmacists (in jurisdictions where this exists), will be up for review at end of 2003 and the groundwork for that will be commencing soon. By the same token the NCP review of poisons acts has also recommended a review of the need for a s2 and s3 schedule at the same time.
These two events will be highly significant, especially under a Labor Government, when the influence of private enterprise lobbies may not be expected to be so influential. Would a Labor Prime Minister have been willing to change the NCP Regulation report (Wilkinson) from a draft with 51% pharmacists ownership to a final with 100%?
The message for pharmacists then, is the get to know your Labor candidates, and especially members of the Shadow Ministry if they are in your electorate.
This will be a real test of the power of the lobby, but do not get too carried away with promises, especially made in the heat of an election campaign.
Even "honest" John had to resort to a definition of promises as being "core" promises, if they really meant something.
An interesting result to the last questionnaire - the question again was:
"Do you agree(YES),disagree(NO)with the lobbying actions of the pharmaceutical manufacturing industry in their approach to Government for greater representation on Statutory Committees?"
............ and 100 per cent of voters did not agree!!!
So if that is the view of the profession with the APMA lobby, try this one this month:
Do you think "retail pharmacy" will be better off under a Labor Government?
Yes - better off under Labor .......................No - not better off under Labor

(Vote in the survey panel immediately below. Only one click needed.)
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The comments and views expressed in the above article are those of the author and no other. The author welcomes any comment and interaction that may result from this and future articles. The editor would be pleased to publish any responses.

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HAVE YOUR SAY!

Editors Note:
You are invited to give your opinion on the following topic, derived from Rollo Manning's article, by simply clicking on the "YES" or "NO" button in the panel below. The information is anonymous and the results will be published in the next edition.
We would like to get a good cross-section of pharmacy opinion from each survey, so please take the time to give us your view.

POLITICAL PARTY SURVEY YES             NO              Q: "Do you think "retail pharmacy" will be better off under a Labor Government?"

LAST POLL:
"Do you agree(YES),disagree(NO)with the lobbying actions of the pharmaceutical manufacturing industry in their approach to Government for greater representation on Statutory Committees?"

An overwhelming 100 percent voted NO
(2.4 percent of subscribers responded)

PS One extra vote came in after the count closed.
It is mentioned because it was the sole "yes" vote

EDITOR'S COMMENT:
Why then, did the government capitulate to drug industry demands to have representation on the PBAC?
Perhaps the following news clipping gives some insight as to the pressure the government was under.

THE FINANCIAL REVIEW
"Drug trade attacks Australian subsidies.
The United States pharmaceutical industry has recommended Australia be placed on a special watch list of countries believed to be breaching trade obligations. The industry has attacked Australia’s Pharmaceutical Benefits Scheme, claiming they undermine pharmaceutical manufacturers’ intellectual property rights."

This from a country that breaches its own free trade agreements through trade quotas, subsidies, dumping and predatory pricing into markets ethically derived and serviced by Australia!
The PBAC controversy also has to be read in conjunction with the government intervention in the Australian and New Zealand Food Authority (ANZFA) board changes, and the global drug manufacturer's legal fight with South Africa, seeking to stop the purchase of cheaper generics for AIDS patients.
World opinion is beginning to force the hand of the global drug manufacturers as evidenced by the following news clipping:

THE AUSTRALIAN
"Merck slashes cost of AIDS drugs in Africa.
Drug company Merck & Co said it would dramatically cut the price of HIV-treatment drugs Crixivan and Stocrin in developing countries. The company said it would not make a profit from the drugs in those countries."

An article appears further along this newsletter relating to ANZFA entitled
"Food for Thought".
Readers may be interested in researching this subject in more depth by visiting a resource page, set up by Dr Ken Harvey of Latrobe University at
http://www-sph.health.latrobe.edu.au/PBAC

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HUMAN RESOURCES

FROM NEIL JOHNSTON PSYCHOTHERAPY- A MANAGEMENT TOOL ESSENTIAL

Recently, I received my copy of the journal C2M (Consulting to Management), which is a journal sent to management consultants worldwide.
Management consultants were one of the first professional groups to set up a self-regulatory system to adopt standards for practice certificates, which are currently accepted in most economies of the world, interchangeably. Practice certificates are regulated and issued by single professional institutes unique to each country, and all institutes, are in turn, members of a single governing body called the Institute of Management Consultants (International).
That aside, the theme for a number of articles contained in this issue of the journal was "Consulting and Therapy" with the emphasis on psychotherapy.

With the increasing complexity of the world of business, and resulting corporate stresses, such as re-engineering, redundancies, bankruptcies, corruption scandals, litigation, mergers, acquisitions, deregulation, intense global competition and a rapidly changing social environment, many executives are experiencing burnout or breakdown.
With the "bottom line" representing the supreme element in business, and with shareholders developing an insatiable thirst for dividends, executives are, at most times, forced to harden themselves against the "human" aspects of the people they manage and manipulate, to achieve results.
Corporations do not have a social conscience.
This causes a very high cost in terms of executive health.

In the dizzy heights of executive work environments, psychotherapy has always been a dirty word and a sign of weakness. To have to consult some form of therapist was to be avoided at all costs.
What was the alternative?
Well, management consultants adapted to provide a new service known as "executive coaching" or "mentoring", adding psychology as a new discipline within their skill range.
Thus the dirty word was avoided, and a need was serviced.

To what extent Australian pharmacists are suffering in this area, it is hard to estimate, for little data is available.
We know that both pharmacists entering the profession and pharmacists retiring (due to age) are expressing dissatisfaction, and are simply walking away, exacerbating the human resource problems within pharmacy.
Job satisfaction, with a few clinical exceptions, seems to be on the decline, and the protests forwarded to the Pharmacy Guild relating to quality care accreditation show some pharmacists are at the end of their tether, and regard the process as being of little value to them. It is seen as an additional and unnecessary regulation of their working environment.
On the other hand, the majority of pharmacists, are embracing the extra workload as a means of lifting standards, hoping for a reward at the end of the process.
The concept is good, but maybe the implementation needs some review, to provide some sensitivity into the process.
In fact, some sort of screening process may need to be applied to the applicants, to identify potential problems at source.
This would enhance the "quality" aspect by considering the human beings involved.

Could it also be that a significant segment of the pharmacy population is depressed or emotionally unbalanced, and may be in need of some form of therapy?
A case history was given in the C2M journal relating to an executive who sought out consultant help (as an executive coach) after suffering from a physical illness. The executive complained of anxiety that set in after his illness was "cured", although he could not remember the exact diagnosis of his illness.
Anxiety was most intense in the morning and reduced over the day as he became more absorbed in his workload.
On weekends, he felt well.
His overall concerns were mounting because he found himself daydreaming, and developing compulsive and obsessive activities, such as repeatedly calculating his net worth, or leaving the office frequently for a glass of water, all during working hours.
Family life was pronounced as being good, with his wife described as "perfect".
However, his father, working in a similar job to himself, had been recently forced to retire early. The executive identified strongly with his father and the executive felt distressed with his father's setback.
The consultant reasoned that the executive was suffering from "existential anxiety", a more formal term for a mid-life crisis, brought on by having to face his mortality for the first time, and concerned that his father's predicament could very easily be his own future.
At first glance an observer may think that this is a fairly common problem and that the executive should have been able to work through his own difficulties.
But with the clouding of the decision-making process, business problems were looming, setting up the executive for a future crash.
However, the story has a happy ending, with the consultant providing a constant coaching service, acting as a sounding board for executive decision making.
After twelve months the executive had lost his obsessive/compulsive behaviour, he felt well and was managing the company successfully. Some morning anxiety lingered on, but he was eager to tackle new challenges.

I have detailed this case study, because I am sure many strong-minded and very capable pharmacist managers can identify with some of the above processes.
I felt compelled to report in this publication, because I know a pharmacist who is an energetic, successful and intelligent manager, who has just gone through a process of rapid expansion.
He has also recently suffered a form of burnout and collapse.
I cannot say that I have contributed to his recovery, because I was not initially aware of the problem.
Nor was I approached to intervene.
But I will be building my skill base so that I can help these people to regenerate their morale, assisting them to remain healthy and effective managers, in charge of themselves and their businesses.
This newsletter has as one of its objectives, to report structural changes in the total fabric of pharmacy. I believe this to be just such a change.
As with most new processes, there has to be some form of a "trigger" to create awareness of the actuality of a problem.
The C2M journal certainly did that for me and I can see that with the increasing complexity of Australian pharmacy life, pharmacy managers will have to consider, that in addition to their solicitor and accountant, there will need to be a range of other specialists involved.
Official pharmacy, and associated service groups e.g. AIPM, also need to factor in these problems, in communicating with, and servicing their members.
Perhaps even a confidential "help" phone number may need to be established.
Most pharmacists will have difficulty in confronting this aspect of their life, but I would urge you to give it some profound thought.
It may save your health, your business and your family.

The comments and views expressed in the above article are those of the author and no other. The author welcomes any comment and interaction that may result from this and future articles.
Please note that Computachem Services provides a business coaching service more attuned to direct management problems, but has a number of alliances with executive coaches and mentors, skilled in psychology, who can provide a discrete and totally professional service for the problems listed in this article.

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GENETIC ENGINEERING

NEIL JOHNSTON

FOOD FOR THOUGHT

Australia was one of the first countries, in combination with New Zealand, to set up a tough regulatory system to monitor genetically engineered (GE) foods. The system was designed to cover the labeling of all processed foods containing GE substances, no matter what the concentration.
This legislation was not popular with food processors in Australia and New Zealand.
Now most of the major food processors (generally global, and who typically specify what they want grown for their branded products), have fought vigorously in the past for a voluntary code of self-regulation to cover all their activities.
Self-regulation was really a code for no regulation.

As many of the global food companies are American, it is interesting to observe what is happening in that country.
In the Spring of 2000, the Food and Drug Administration announced that the labeling of GE foods would remain voluntary. This, despite the fact that there is no indication that any company will voluntarily label GE foods.
Those companies that wish to do the reverse and label their foods "NON-GE" are having to face many burdensome regulations inflicted on them by the FDA, allowing all other companies to use GE foods in secret.
What is going on?
As always, it revolves around monopoly type practices and the large sums of money generated, that provide massive returns on investment.
For example, some crops grown from GE seeds (patented of course) cannot regenerate. The seed stock is programmed to be sterile, so that a farmer must continue to purchase from a single source.
The resultant crop may be resistant to pesticides and herbicides.
This tends to make the food chain more toxic than it currently is, as farmers are encouraged to use more chemicals to minimise crop yield losses through weeds, insects etc. The Monsanto version of this type of crop is dubbed "Roundup Ready", and governments have accommodated the process by legislating to allow higher levels of the herbicide Roundup, to be present in processed foods
The fact that the company providing the seed stock and the agricultural chemicals, may be the same company, gives an insight as to why there is a reluctance to provide consumer labeling information. It identifies chemically contaminated foods.
GE foods are perceived to be more toxic than other foods, and this is without the additional burden of the food also being a possible health hazard, as was the "Starlink" corn used in some Kellogg's products last year, and is alleged (by Greenpeace) to be continuing to be used, despite the fact that it is not approved for human consumption.
The Greenpeace organisation recently challenged Kellogg's to make a public statement that it was not using GE foods in any of its supermarket products.
The company refused to deny or confirm.
Greenpeace then went ahead with laboratory testing and found that Kellogg's was still using Starlink corn, as well as a GE soy, in a number of products.
Greenpeace has filed notice with the FDA calling for an order to recall all products using the unapproved Starlink corn. They are encouraging consumers worldwide to boycott Kellogg's products.
So what about the claims of potential benefit, that GE crops will feed more people?
This also appears to be a dubious claim, open to questioning.
According to Greenpeace, none of the GE crops on the market today have been engineered for higher yield.
"In fact, a two-year study at the University of Nebraska showed that the most widely grown engineered crop, Monsanto's GE soybean, actually yields less than natural soy varieties.
The Nebraska research confirmed findings from the University of Wisconsin and other independent trials comparing GE versus non-GE soy.
An analysis of 8,000 trials found that non-GE soy yields were significantly higher than the GE variety.
In 1999, a US Department of Agriculture report compared yields of biotech and natural varieties. There was a statistically significant yield gain in the biotech variety in only four of twelve region-crop comparisons. In seven there was no difference, and one region showed a significant yield loss for farmers using GE seed.
Biotech companies like to use the argument of feeding more people in their PR.
But this subject requires a closer look at the causes of hunger.
The world currently produces enough food to provide every person on the planet with over four pounds of food a day.
Hunger is the result of poverty and unequal access to food, not a lack of food."

The widely trumpeted benefits of GE foods do not seem to bear close inspection.
What then, are we to make of recent Federal Government moves in Australia to alter the composition of the Australian and New Zealand Food Authority (ANZFA), the organisation set up to protect Australian consumers?
The authority appeared to be settling in quite comfortably when the government announced that it was increasing the board from nine to ten members, and that it was appointing five of the board members from the food industry.
Given that this is a similar procedure to that which has occurred within the Pharmaceutical Benefits Advisory Committee (PBAC), it creates a climate that is more favourable to the food manufacturers.
Is the ANZFA compromised?
I believe so, particularly in light of the fact that the government may be under trade pressure from the American government (see news clipping under the survey earlier in this newsletter).
The news that American drug manufacturers are requesting that Australia be put on a "watch list" for supposed breaches of trade agreements (the methodology of PBAC additions of drugs to the Pharmaceutical Benefits list, and pricing policies), appears to be a form of blackmail.
Claims are being made that Australia is undermining the "intellectual property rights" of drug manufacturers.
This is patent nonsense, but the government must be responding to pressures both in the food and drug industries, altering outcomes by having biased people involved in the process.
This week, the ANZFA has published safety assessments for four GE foods (corn, cotton, canola and sugar beet). All have been modified for herbicide tolerance.
It states that it has not found any evidence that the products posed any threat to people or the environment, and has given organisations and individuals six weeks to comment on the assessments.
It has obviously not been listening to the rising chorus of expert and informed dissent from around the world, and it should be stating the obvious, that while the ANZFA cannot see any problem, it does not mean that none exists, or the potential for serious health hazards cannot evolve.
As a starter, the American FDA still does not require any safety testing of GE food, and even from within the FDA, their doctors and scientists are warning that GE foods are different from traditional crops, and that these new foods can lead to health risks.
However, the American Environmental Protection Agency has just announced that it will no longer register GE foods for animal consumption "unless they have first been proven safe for human consumption".
Seems that American animals rate more highly than people.
GE foods can, and do, increase the risk of dangerous and possibly life threatening allergies (as for Starlink corn). The New England Journal of Medicine has already criticised the FDA's approach to GE foods and allergens, stating that the agency's policy "would appear to favour industry over consumer protection".
There is evidence to suggest that some GE crops may have an even greater allergenic potential than conventional crops and could severely undermine the treatment of human and animal disease. Many GE crops contain antibiotic resistance genes and if these genes spread to harmful bacteria, it could create a major outbreak of antibiotic resistant bacteria, already one of the greatest threats to public health.
GE foods can also increase food toxicity, and the FDA requires no screening for this potential problem.
Greenpeace report on a recent laboratory experiment where a GE yeast unexpectedly contained 40-200 times the level of a toxic agent found at low levels in natural yeast. This alone must raise questions for consumer safety and the FDA requires no screening for side effects.
Scientists have already introduced genes from bacteria, scorpions and jellyfish into food crops. Cucumbers and tomatoes are being introduced with bacteria and virus genes; potatoes with a chicken gene; salmon, trout and rice with a human gene, with many others are waiting in the wings.

You can visit the ANZFA website at http://www.anzfa.gov.au and you can e-mail them at info@anzfa.gov.au .
You are encouraged to voice your comment.
The assessment data they are relying on comes primarily from each sponsor manufacturer, supplemented with material from their own working groups plus available scientific literature. Most of the data comes from American manufacturers who have no FDA compulsion to test for safety, or any other health or ecological issue.
Neither is there any compulsion for farmers to keep any sort of record or track any GE crop.
Genetically engineered foods look like a good earner.
Patented food crops at exorbitant prices, requiring more toxic chemicals, generating illnesses paid for by the National Health Scheme (advised by global drug manufacturers through the PBAC), all at taxpayer expense.
DR Wooldridge, the federal Minister for Health is intertwined in all these processes. He recently announced that no action would be taken against the global companies responsible for the escape of GE canola in Tasmania, jeopardising plans for a "clean green" state.
Why not?
If you or I were involved in a breach of regulations or the law, there would be no pardon for we mere mortals.
Why the protection?
As they (ANZFA) are inviting comment, I believe that pharmacists should involve themselves in this debate. We are supposed to be frontline health workers, promoting preventive health programs.
Apart from the PBAC survey conducted by this newsletter, there does not appear to be much official pharmacy comment or activity in respect of the PBAC or ANZFA manipulation and possible consequences.
Again,why not?
Internet resources discussing the above issues can be found at http://www.pha2000.org/shiva.htm also at http://www.pha2000.org/Global.htm also at http://www.pha2000.org/from_rachel.htm
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The comments and views expressed in the above article are those of the author and no other. The author welcomes any comment and interaction that may result from this and future articles.

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EDUCATION

FROM JON ALDOUS PHARMACY EDUCATION AND BIOTECHNOLOGY

Recent years have seen massive numbers of new drugs released onto world markets with subsequent effects on pharmacy education, as discussed last time.
An increasing proportion of these drugs are from biotechnology sources, as opposed to traditional pharmaceutical medicines.
Pharmaceutical medicines have generally followed the course of identifying a target in the body and designing a synthetic molecule (either completely novel or derived in some way from a natural product) to increase or decrease the effects.
This gave generally predictable efficacy and side effects.

Biotechnology products are similar in many ways, but their highly targeted actions result in far greater therapeutic potential and range of potential applications.
The US FDA in the 2000 calendar year approved more than 30 new biotechnology derived products. This makes a total of more than 110 on the US market.
Few are available in Australia, mainly due to their prohibitive costs and our more stringent regulatory processes.
Australia is a small market and many of these high cost products (one is hesitant to call them drugs) would not be viable commercial ventures for their respective manufacturers.
The first wave of biotechnology products arrived in the 1990s with the development of recombinant DNA techniques. These allowed bacteria or other organisms to produce human products such as insulin and dornase-alfa. But these are difficult medicines to give, and surely it would be far more elegant to simply create them inside the human body via some stimulant, rather than resort to needles or inhalations?
Islet cell transplants are being touted for Type 1 diabetes sufferers as a virtual cure, but requires continual surgical replacement of the transplanted cells.
Stay tuned for biotechnology-derived means for treating genetic diseases such as diabetes and cystic fibrosis.
A product which created considerable controversy in Australia recently was the Roche manufactured Herceptin, a breast cancer treatment that can add months to the life of a palliative patient. It didn't interest the old Pharmaceutical Benefits Advisory Committee, due to its high cost (in excess of $10000 a month) for a perceived marginal benefit.
Schering is now suing the PBAC for its refusal to recommend for subsidy it's new treatment for irritable bowels, infliximab.
Ignoring the controversy, they are good examples of a new group of drugs known as monoclonal antibodies. These target receptors and proteins in the body with absolute specificity, in a similar way to the antibodies our own immune system produces. Already other monoclonal antibodies are marketed to prevent organ transplant rejection and blood clotting in cardiac surgery to name but two.
Their use is still limited as practitioners await more data, and again because of their cost.
A major area of research in biotechnology is obviously in the treatment of cancer.
In the development pipeline are treatments that have a degree of selectivity for a specific type of tumour. This is in stark contrast to current chemotherapy which targets only the most rapidly dividing cells in the body, resulting in dramatic toxicity effects, which manifest most vividly as nausea, vomiting and hair loss.
New treatments being developed for breast, prostate and lung cancers are in clinical trials.
Preliminary results suggest impressive remission rates without the toxicity of traditional cytotoxic medicines.
There is a great variety in the nature of products currently in development, but a common facet to most is their ability to utilise our body's own cellular processes to their advantage, a quantum leap in drug design.
This brief overview doesn't even take into account future therapies based on our genome. Genetic therapies are likely to prove one of the biggest growth areas in medicine in the next decade.
Newspaper reports in the last month suggest researchers have found ways to 'turn back the clock' on cells in the body, to enable them to be used to replicate other types of cells in the body. This creates the possibility of growing replacement organs from a small tissue sample, possibly as simple as a mouth swab, and all without the need for the controversial technique of embryo harvesting which is being touted by pro-cloning groups.
The likelihood of human cloning within two years opens a minefield of ethical and moral issues that will require education of health professionals to be aware of patient concerns in this area.
So what will we need to learn?
Biotechnology will require a major shift in the focus of modern pharmacy training towards the many future treatments for both genetic diseases, and other health problems.
Current treatments, based on exogenous chemicals and surgical procedures, could all be changed by the harnessing of our ever-increasing knowledge of the body, and how it works.
And that is what the biotechnology revolution seems largely to be about, using our own bodies (with some external assistance) to fight diseases, with far fewer complications and a higher success rate that was possible in the past.
Should pharmacy fail to grasp this opportunity could a new field of biochemists emerge as practitioners, specifically dealing with these new therapies?
Much work will be required in designing dosage forms for these new therapies.
Genetic material, peptides and proteins have all proven notoriously difficult to administer successfully in the past.
Pharmacy will have to lead the way, with a renewed interest in the true art of pharmaceutics, a cornerstone of traditional pharmacy practice.
While an understanding of dosage forms should always be an essential part of the drug design process there is a risk it could be overlooked in the rush to get new therapies to the market.
Many antivirals used for HIV have surprisingly poor delivery in oral forms, which could have been improved if there was not such a pressing need for new drugs in the marketplace. Patient acceptance of biotechnology-derived therapies may depend on whether pharmacists can play their role and come up with novel oral or inhaled dosage forms to avoid the need for ongoing injections.
The challenge is there for those who wish to educate pharmacists into the next century.
These new therapies will change a large part of our existing therapeutic knowledge. They will require specialist knowledge, to enable patients to be comfortable with the therapies, from a safety and efficacy standpoint, and possibly a moral one as well. Educators will need to ensure that an increased understanding of biochemistry, genetics and pharmaceutics is passed on to future pharmacy graduates to enable them to remain at the forefront of knowledge about emerging treatments.

Next time: In the same vein, we'll take a look at the development of genetic counseling and a possible new role for pharmacists.
Ends
The comments and views expressed in the above article are those of the author and no other. The author welcomes any comment and interaction that may result from this and future articles.

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MANAGEMENT

FROM LEIGH KIBBY ALIGNMENT PLUS+ THE NEW ORGANISATIONAL LEADERSHIP

Dynamic and successful organisations go beyond the ordinary.
They surpass the normal and achieve excellence in their outcomes and become powerful leaders of change.
They do this by becoming a more effective, efficient and caring organisation - an A+ organisation.
A process to achieve this must be simple, person centred, practical and self-generating. Additionally, it must trigger the core elements without which personal and organisational evolution will not take place.
Those core elements are "Self-esteem" and "shared values" which exist at an individual and corporate level.
Techniques can achieve short term success, but they can also become limitations beyond which individuals dare not, then cannot, go. The belief systems are fundamental and instill change at an organic level. High self-esteem results in individuals and organisations becoming self-generators of learning and change.
It is no longer sufficient to talk about Learning Organisations.
We now need to take the next step.
This means nurturing and leading the creation of A+ organisations - the people centred organisations which care, learn, change, grow then achieve.
Leaders of organisations must model this dynamic process in order for it to become enacted. So Leaders, then their colleagues, must evolve by sharing their values, esteeming one another as well as their teams, then learning, changing, growing and doing.
They can only achieve this with the right structure underpinned by the crucial beliefs.
The structure itself is called the Alignment Plus (A+) process. A+ is a system that identifies key structural steps, highlights key elements and provides a systematic approach that will lead to evolutionary results and outcomes. The process also identifies foundation beliefs that need to be addressed before an evolving nature can be established within both the learner and the organisation.

AP has four Key Elements:-
1/ Vision - the dream or aim;
2/ Goals - the measurable outcomes and tangible results;
3/ Process - the plan or methodology; and
4/ Beliefs - the values and thoughts that guide individuals, decisions and actions. Vision.

A Vision is the star in the night. It is the dream that calls. It is the yearning within the heart and the hope for the future.
Without a Vision, there is no call to change, no growth and no action.
A Vision is both intangible and emotive but it initiates action that will produce real outcomes.
An organisation without a Vision has nowhere to go.
A trainer without a Vision, or Aim, has no guiding star.
Goals are the measurable things, the real and measurable outcomes, that tell you that you have arrived at the destination to which your Vision was leading you.
If a Vision is like the clouds in the sky, Goals become the top of the mountain.
With Goals, you can see how far you have to go and how far you have already come. Goals put the world, and your achievements, into a healthy perspective.
In a measurable, Goals become the behaviours and skills that demonstrate achievement. They are also the signposts that recognise achievement and signify growth.
Process:
To climb a mountain, you need a route. To build a bridge, you need a plan.
Process becomes the route and the plan.
The Processes are the things you are going to do, the step by step actions and the methodology you will follow, to achieve your goals.
Process means having the plan and skills to demonstrate then having a Belief System and management plan that will facilitate evolution. Beliefs and Values Beliefs are the foundations for human, hence organisational, action.
Beliefs also guide behaviour and so govern outcomes.
To achieve a powerful outcome and create and to evolve, an organisation must have a belief or value system that supports the Process.
The most important belief is self-esteem, it is the key stone for growth. Self-esteem supports creativity, willingness and encourages adventure.
Without these, hence without self-esteem, no learner can evolve because they will never dare to be different, they will not attempt new challenges and they will not evolve nor be happy, empowered or powerful.
You cannot talk about self-esteem and expect that it will be learnt.
But, you can model self-esteem and expect that it will be copied.
Often with that belief, trainers will acquire the skills or evolve the capacity to enact the group management processes which will support personal evolution, growth and happiness.
Likewise, shared and common values, which esteem and value people, which empower and support which find strengths, which nurture and then which provide a structure for growth, are also fundamental to the process and are the only ways to really demonstrate personal and organisational self-esteem.

Summary:
Self-esteem must be awakened within before it can be experienced. This awakening becomes the seed from which growth is a natural result if planted in rich soil and well supported by a nurturing environment - in an organisation sense A+ provides the rich soil and nurturing.
Ends

The comments and views expressed in the above article are those of the author and no other. The author 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 , or you can visit Leigh's website at http://www.kinematic.com.au .
Alternatively, the editor would be pleased to publish any responses directed to neilj@computachem.com.au .

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RURAL AND REMOTE

FROM A GUEST COLUMNIST ROUNDUP Remote Dispensing

A regular column devoted to Rural and Isolated Health Issues
(N.B.The photograph is of two emus in outback NSW. Australia)

Electronic transmission will be a gain.
Pharmacists in remote areas will have access to a whole new range of services when electronic transmission of prescriptions and dispensing data is possible.
Doctors working in "one doctor" towns will be able to e-mail scripts to a pharmacy, and in return receive back dispensing information.

If remote controlled dispensing machines are ever brought in to Australia, the patient anywhere in remote parts will be able to have dispensed their medication at the same time as the doctor visit.
For remote communities, with only a visiting doctor, repeat scripts will be able to be dispensed without the presence of a pharmacist or doctor, but supervised through video by the pharmacist.
Commonwealth legislation is on the way through Federal Parliament.
It will only remain the province of the States/Territories to amend their Poisons Acts to allow electronic transmission, rather than paper based systems with a signature.
The new signature will be digital.
The change this will have for clients in remote parts has the potential to be enormous.
Watch this space.
Ends

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THE NATIONAL RURAL HEALTH ALLIANCE

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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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