Computachem
E-Newsletter
Editor:
Neil Johnston
Regular Contributors:
Rollo Manning
WWW (WHO,WHAT AND WHERE) + E-VENTS
The recent problems with the Panadol poisoning scare drives
home the fact that drugs should definitely not be items of ordinary
commerce, and for the need of supervision that only a pharmacist can
provide. With the Galbally review into drug scheduling currently in
the public arena, what more stark reminder do our regulators need, to
see that drugs ought to be properly supervised, in an environment set
up for this process i.e a community pharmacy. Standards should not be
compromised. This philosophy has long been promoted by official pharmacy,
and now a media opportunity has presented itself to illustrate pharmacy
in a positive light. Further, the manufacturer of Panadol needs pharmacy
support to continue to sustain its market. Pharmacists need to advance
the idea publicly that their environment is a safe and supervised environment
and ensure that all analgesics are in a clearly supervised setting.
This week, some damaging viruses appeared in a number of Australian
e-mail messages, again as an attachment.
The .exe attachments were titled VBS as in VERY FUNNY.VBS This particular
virus is actually the "I Love You" virus in disguise and is particularly
damaging. Microsoft have finally provided a patch for the Outlook e-mail
program (which can be downloaded from their site). It resolves many
of the virus problems, including the "I Love You" virus, but already
hackers are boasting that they will crack this refinement very quickly.
Readers are again cautioned about opening attachments to e-mails from
unrecognised sources.
Dispensing of National Health pharmaceutical benefits is to begin on
July 1st. That's right, only a few days away! I had learnt that this
would happen some months ago and reported the facts, as I knew them,
in this newsletter. As far as I am aware, this newsletter was the first
to report on this activity, and there has been very scant reportage
in other pharmacy media. What is the big secret? Well, Rollo Manning
provides some of the background in his current article, and as I postulated
earlier, hospital pharmacy looks like a very cheap distribution source
for the Federal Government, and at the very least, creates a pressure
point for some very unequal future NHS negotiations. However, the current
situation in NSW hospitals (and I gather for a lot of the other states),
is that hospitals are nowhere near ready to accept this process and
are staggering under a shortage of pharmacists. At this stage, it seems
most of this type of dispensing will be actively deflected to community
pharmacies, which become, for the moment, short-term beneficiaries.
Some of you may have received two copies of the #5 edition of the newsletter.
Apologies all round, as the program interrupted during transmission.
To ensure all received a copy, a second transmission was made.
GLOBALISATION FORCES ALLIANCES
One of the interesting aspects of globalisation is the
fact that alliances are formed, sometimes with very strange bedfellows.
Competitors and enemies sometimes find that in their mutual interests
of growth and survival, they are forced to consider commercial arrangements,
that as little as twelve months ago, would have been deemed unworkable.
Alliances tend to reduce overheads, and in an era where margins are
becoming slimmer, profitability may be found in an alliance. With an
improvement in the bottom line, the prospects of a take-over becomes
more difficult. As reported in earlier editions, retailers such as Coles-Myer
have already begun this process, in an effort to remain competitive,
while global players such as Aldi, make their presence felt. It is not
surprising that pharmaceutical companies should be involved in this
process, and indeed most pharmacy manufacturers have either merged,
or formed alliances, to produce some very large commercial undertakings.
Recently, Fauldings and Baxter Healthcare announced that they had formed
a strategic alliance to enhance the service both companies provide to
hospital pharmacies throughout Australia. They state, in a joint press
release, that: "It represents a shared vision for customer service of
the two largest pharmaceutical manufacturers of hospital products in
Australia." The new alliance is seeking to work with hospital pharmacies
on an individual basis, to maximise cost efficiencies through capabilities
in areas such as:
* e-commerce and business to business solutions,
* an extensive product range,
* compounding services,
* distribution services.
The alliance further promises to become a "one stop shop" with timely delivery of quality products. Both organisations state that they will continue to develop their independent existing hospital pharmaceutical businesses, while combining synergies which provide mutual benefit. Most major hospital pharmacy suppliers are already involved in developing Internet communications systems and simultaneously, bulk stores in hospital pharmacies are being programmed to become, initially, "order schedulers", scaling down all stock holdings on a progressive basis. This means that individual hospital wards will eventually order direct to pharmacy wholesalers via barcode readers, for their imprest stock, bypassing the dispensary and bulk store completely. Compounding is already big business with Baxter, and takes up the slack created by the shortage of skilled hospital pharmacists in sterile dispensing. Provided the hospital has a reasonable volume, it is much cheaper to manufacture in-house. With a pharmacist shortage, this area has to be let go so as to service more urgent hospital demand, even though the overall cost is higher for the hospital. Theoretically, the end result of the introduction of these services is to create surplus capacity within hospital pharmacists. It is inevitable that most of this capacity will be taken up with PBS dispensing, and the final mix of patient, hospital pharmacy and community pharmacy interaction will be an interesting one to observe. Community pharmacy may lose a significant market share. The chill winds of change are destined to affect much of what has been regarded as traditional activity for both community and hospital pharmacists, and the pressure to replace this activity with clinical services has its genesis in the Third Guild/Government Agreement. If you are not making plans to declare your own "niche" then a little bit of strategic planning would not go astray.
From Rollo Manning:
THE BACKGROUND TO PUBLIC HOSPITAL PBS DISPENSING
* The views expressed are those of the author
and no other
The impetus for the dispensing of PBS scripts by public
hospitals has been the guidelines from the Australian Pharmaceutical
Advisory Council (APAC) titled "A continuum of care - hospital to community".
The general thrust of the guidelines is to obtain continuity in the
treatment of a patient from their admission to hospital to their return
home in the community. On the basis of this simple principle there should
be no argument. Pharmacy is represented on the APAC by a representative
from the Society of Hospital Pharmacists of Australia (SHPA); the Pharmacy
Guild and the Pharmaceutical Society of Australia (PSA). It behoves
those representatives to keep their respective organisations informed,
and through it the members of those associations. So from a simple start
the process of agreement commenced some two years ago to develop a manner
in which the public and the private sector could work together to provide
PBS to patients attending a public hospital. "Double dipping", "cost
shifting" or not, the desire was to present the patient with a system
which would ensure them a continuum of care from entering hospital to
returning to community life. The need has arisen for hospitals to review
their admission and discharge procedures to ensure attention is given
to medication requirements of patients with a full knowledge of the
background.. So too will the pharmacy departments have to enhance their
IT systems for electronic claiming of PBS scripts. There will also be
the need for Medicare numbers, compatibility with future medication
management systems and the like. All of this by public hospitals for
not even a Pharmaceutical Benefits Remuneration Tribunal (PBRT) determined
dispensing fee. No, simply the costs of goods at wholesale level (price
to chemist). Recent announcements of the plan by the Commonwealth Government
have resulted in complaints from (retail) pharmacists that PBS is their
"turf", or that there is not a "level playing field". In this case the
playing field is not level, as it favours the retail sector, and the
"turf" is, as has also been pointed out, that of the patient. What are
the APAC Guidelines? Clause 35 of the 1998 AHCA has been varied to provide
for the implementation of the National APAC Guidelines to achieve a
continuum quality use of medicines between hospital and community. This
involves monitoring the patient’s medication requirements from admission
up until the time they return to the care of their community providers.
The steps outlined in the "principles" include: *Identify discharge
planner as soon as practicable after admission
* On admission obtain an accurate medication history including Over
The Counter (OTC) and Complementary Medicines.
* Conduct a review of the patients medication Plan for discharge in
consultation with the patient or patients carer
* In a timely planned manner prepare medications for discharge Provide
the patient with a folio containing information about their medication
* On discharge provide the patients community health care provider with
a discharge summary outlining details of the admission, hospital treatment
and follow up requirements.
The way ahead:
The manner in which pharmacists in both public and private sectors approach
this task may give decision makers in Government an insight to how planning
should take place in the future. Partnerships are needed between all
health care providers, and especially within the same professional group
(pharmacists). It is time to forget about the internal bickering and
sniping at each other and start to work together in the interest of
the patient. It is the APAC, which showed the lead in proposing the
guidelines, and it will be the same group, which will judge the success
of the operation. The "Better Medication Management System" is also
to rely on the success of the hospital venture to capture a more complete
data picture for patients who opt in to the system. It is hoped the
pharmacy organisations which represent the professions interests, as
stakeholders in the process, do a better job than was done with the
PBS dispensing and APAC guidelines exercise. In other words keep the
troops informed right along the way, and do not leave it until the last
minute when they feel they have been hardly done by. An oversupply of
information is far better than no information at all.
Ends
DICK SMITH DECLARES WAR ON GLOBAL RETAILERS
Whatever you think of Dick Smith, you cannot help but
admire the man. He appears to have the ability to develop new business
ventures, totally diverse in nature, apparently without any prior experience,
and make a complete success of them. He is high profile, successful
and has the knack of keeping the mass media on side. Many would know
that he was recently stirred into food manufacturing, on the basis that
85% of processed Australian foods are in foreign hands.His stage management
of the media to promote his new food manufacturing business was superb,
showing up the "baddies" magnificently when they stole one of his proposed
trade names. And it was a cigarette manufacturer turned food processor
to boot that was the perpetrator. Now he has declared war on Aldi and
Wal-Mart. Aldi is notorious for its business secrecy, and Dick Smith
has vowed that he will expose their business methods whenever and wherever
he can, stating that these types of secret organisations may have been
suited to Germany before the Second World War, but not to Australia
in the twenty first century. With this comment he engaged the enemy
head on! He well knows that he has no chance of having his products
sold by Aldi, because they are selecting approximately 600 products
that they can retail off floor stacked pallets, mostly sourced outside
of Ausytralia, at approximately 20-30 percent under existing Australian
supermarket prices. By stimulating national pride and assisting to revitalise
a new green and gold "Australian Made" logo, he is stimulating a renewed
interest by consumers to seek out his, and other Australian products.
And he has had great early success! His peanut butter was totally sold
out in the first few weeks after launching, and he has already had to
make major extensions to his factory area and production equipment.
Dick is also incensed by rumours that Wal-Mart are planning to take
over Woolworths and perhaps Coles-or maybe both. He wonders why Australians
would wish to surrender profitable and well-managed businesses that
are creating wealth for Australia. He also wonders what will happen
to the opportunities in the workforce and for future generations when
decisions are made by non -Australian directors with primary responsibilities
to foreign shareholders and their country of origin. What is perhaps
motivating him is that Dick Smith electronics is a wholly owned subsidiary
of Woolworths, and that he could not conceive that his name would be
used for potential transfer of wealth to an organisation such as Wal-Mart.
Now pharmacy should take note of the sentiment that Dick Smith is stirring.
That he was able to start from scratch with an unknown label, provide
a market for Australian farmers and have the product stocked by all
major supermarkets, is a feat that many established brands would like
to emulate. He has struck a blow for the Australian economy and is generating
"home-grown" employment, with finest quality ingredients grown or made
in Australia.And this in a climate fuelled by globalised retailing!
There is a parallel here for pharmacy. What are the Australian success
stories for Australian pharmaceutical manufacturing? They do exist,
but they are small in number. One that does stand out is Herron Pharmaceuticals.
This company has been in the news with an extortion problem that has
been well publicised.Herron has never been seen as a true friend of
retail pharmacy, but maybe they should be, and just maybe Australian
pharmacies could offer a safe and secure environment to nurture this
Australian made product. Note that when Herron was able to re-introduce
their product again to the marketplace, Dick Smith was there to endorse
Herron and to give encouragement. Globalisation can, and does, produce
strange bedfellows as already noted in this newsletter. What would it
be worth to have Dick Smith endorsing Australian Pharmacy? I would venture
to say that the value would be inestimable, and the point of this story
is that pharmacy should look both within and without its ranks for strategic
opportunities. It must think "out of the square". Does pharmacy have
any Dick Smith clones who could move it to the higher moral ground and
give it charisma and prestige ? Are there any pharmacists who could
emulate Dick Smith and develop and control a range of Australian pharmaceuticals
that would be actively sought by the Australian public? Is there anyone
capable of capturing that vein of sentiment and loyalty that Dick Smith
has mined so successfully to develop a strong "brand" of a community
pharmacy model? What creative and innovative elements would Dick Smith
incorporate in an Australian community pharmacy? Perhaps someone should
ask him More importantly, what strategic alliances can be formed both
to protect, and grow, the Australian pharmacy market, particularly at
the community level? It seems logical that strategic alliances and mergers
should initially occur at the community pharmacy level, to develop strong
corporate entities. I pose these questions because pharmacy is already
vulnerable to globalised manufacturers and other predators who would
seek to own pharmacy practices outright.
Pharmacy needs to demonstrate some backbone and initiative because I
am sure that regulators would not dare throw a "Dick Smith Pharmacy"
to the wolves.
The Australian public would not allow it!
GENETICALLY
MODIFIED PLANTS AND ANIMALS:
THE MOST EFFICIENT DRUG FACTORIES?
As the boundaries begin to blur between what is traditionally regarded as a food or a drug, we are now being confronted with a range of extensions that consumers appear to have little, or no control, as to how they are promoted or used, because they are quickly becoming the realm of global business. Take, for example, the picturesque Oak Hill farm that occupies 215 acres in southern Wisconsin, USA. A small herd of Holstein cows graze peacefully, but one in particular (called Cressy) gets personal attention. Cressy is a transgenic cow and is genetically programmed to produce a special protein in her milk which, when isolated, will protect humans against a specific strain of hepatitis B. The Oak Hill farm is a blueprint for biotech-based pharmaceutical farms, now known as "pharm factories". Cressy's milk is handled one bucket at a time and results are being closely monitored by a group of scientists based at the University of Wisconsin. Now, if Cressy is mated to a conventional bull, half of her calves will be likely to carry the dominant transferred gene, and so a herd will be able to be built up. This is hailed as a major advance in production efficiency in terms of drug manufacture, with the whole process now being dubbed as "pharming". Other "pharmers" have begun production of Antithrombin 111 using the milk of cloned transgenic goats, and another has developed a range of human proteins to "humanise" cows milk for paediatric formulas. Other transgenic work involving plants has produced success in developing edible vaccines. A cancer fighting protein antibody has been produced from transgenic corn. Also, Monsanto recently formed a unit called Integrated Protein Technologies to produce transgenic pharmaceutical proteins, vaccines and industrial enzymes in crops. Worldwide, approximately 1200 molecules are being researched for possible production by transgenic livestock or crops. Another slant to this new technology is the "pharming" of body parts. Using the same technology that produced that famous cloned sheep Dolly, scientists have pioneered a method for harvesting and developing stem cells. With a specific biochemical signal, these cells can be triggered to develop into almost any body tissue or organ and can be tailored to a particular person by replacing the DNA in these special cells with DNA from a patient, thus eliminating rejection. Stem cells have the ability to divide and grow indefinitely, so the promise of immortality is only just around the corner. In other developments, a vaccine that can prevent cervical cancer has been developed by North Carolina State University, which is looking to enter into production using transgenic tobacco plants. Production trials have just begun to see if the required volume of proteins can be produced. Outside of pharmaceutical research, scientists at Michigan Technological University have discovered a way to genetically modify aspen trees which reduces the amount of lignin concentration coupled with a doubling of the growth rate. It is lignin which has to be bleached out with chlorine in the production of paper, making paper production environmentally damaging. The low lignin, increased cellulose content and high growth rate of these transgenic trees may ultimately offer a more eco-friendly method of plantation farming for paper manufacture. Developments are also occurring in the energy field, where soy-based products are rapidly being developed. Such products range from lubricants, diesel fuel, solvents and plastics. Perhaps the most worrying aspect of all this genetic manipulation is what will occur down the track as more fruits, vegetables and meat products appear at the local supermarket for general consumption. Manufacturers are resisting all labelling requirements for fear consumers will reject such products, and they are possibly right. Regulations and labels are beginning to appear, but will they be adequate? While governments expound at great length on how safe all these products are, do they really know? Considering that herbicides and pesticides were initially promoted as "safe" and have now become a health hazard. Will this occur with transgenic foods? In some instances, transgenic foods have been produced so that they are resistant to herbicides and pesticides e.g Roundup Ready Soy, and governments have cooperated by allowing higher levels of Roundup to be used on crops, which contaminates the food chain further. It also creates weed resistance, Australia being the first to report this occurrence. I personally would like the right to choose what I put into my body. I would also refer you to a previous newsletter noting a trial store being established by Woolworths to retail nutraceuticals, foodaceuticals, nutritional supplements etc and noted that this type of operation would impact on pharmacies and health food stores. This will be a "natural" outlet for any food that bears a health or "pharm" claim, and it is coicidentally appearing as transgenic products are about to be mass promoted world-wide. Where will the borders exist between foods and drugs? There will obviously be a need for good information and a trusted supply source, such as pharmacy, to be available to assist consumers resolve these problems. Health and safety issues are paramount and downstream potential health problems need to have some form of monitoring. Is this an area that pharmacy should evolve to, or should we leave it to Woolworths?
On the 26th May, proposed legislation was introduced to ensure that high income earners i.e income above $50,000 p.a , who take out medical and hospital insurance after that date will have to watch what annual excess they elect to sign up for. Any excess greater than $500 for singles or greater than $1000 for families will still attract the Medicare surcharge.
Have you signed up for your ABN yet? If not, the tax office will still be pleased to receive your details and issue a number, despite the 31st May deadline. The public information in relation to your ABN will be displayed at www.abr.business.gov.au where you are able to check your own, plus any other business ABN or GST registration. The public outcry over the fact that the Australian Taxation Office released details of ABN's in electronic format to commercial entities, such as Dun and Bradstreet, has forced a review of information policy. The Federal Privacy Commission has also indicated that the ATO did not satisfy the Information Privacy Principles of the Privacy Act, with the upshot that the ATO will now comply. It would appear that, in general, the fight for privacy may have been lost. Now the focus of legislation and energy will need to force entities holding data on individuals, to actually account to people directly, regarding the integrity of those details. This will have increasing relevance for pharmacy, as data bases of individual health details are added to and subtracted from, using a "patient specific" number. This number will be utilised by a variety of different health providers over a wide range of disciplines. Computerisation, automation and now globalisation, are creating change at a pace faster than any other recorded period, making it almost impossible for regulation to keep pace.
Under the old rules with sales tax, major retailers enjoyed a substantial advantage in price. Sales tax was always levied at the distribution point immediately prior to the retailer, so for Woolworths it was the manufacturer, but for a pharmacy, it was the wholesaler, which had a loading that was always sales taxable. It was hoped that with the introduction of the GST that this advantage to large stores would be lost. However, it is alleged that Woolworths has sought to pressure manufacturers into maintaining this tax advantage, with the result that the GST watchdog is now investigating the matter. Senator Boswell told an Independent Grocers' Association (IGA) conference in Brisbane that the Australian Competition and Consumer Commission would take a close look at whether the supermarket giant in question was acting against the Trade Practices Act. It has been alleged that manufacturers were being pressured to increase their prices in such a way as to discriminate against all other retailers. The form of discrimination was to be a rebate, so that the dollar value margin advantage lost through GST could be maintained. Senator Boswell said the government had sought advice from the ACCC. "They say that while this approach to rebates does not appear to breach the price exploitation provisions of the Trade Practices Act, it may constitute a misuse of market power or unconscionable conduct," he said. The ACCC would take a closer look at the issue, he said.
* Residential Property A recent ruling by the ATO has
declared that a residential property owner does not need an ABN. This
means that any payments made by the tenant to the landlord do not have
any PAYG withholding. Commercial property owners will need an ABN as
leasing a commercial property is deemed to be an "enterprise"
* Lay-Bys Businesses which use the "non-cash" basis to account for GST
can account for the GST component of lay-bys in the tax period when
the final instalment is received. This is another change to the rules.
You are invited to visit the
Computachem web site at http://www.computachem.com.au
. Any interested persons who would like to receive this free newsletter
on their desktop each fortnight, please send a single word e-mail "Subscribe"
to neilj@computachem.com.au
.
Looking for an organised reference site for medical or other references?
Why not try the Computachem Interweb Directory for an easily accessed
range of medical and pharmacy links, plus a host of pharmacy relevant
links. The directory also contains a very fast search engine for Internet
enquiries.