Published by Computachem Services

P.O Box 297.
Alstonville. 2477
NSW Australia

Phone:
61 2 66285138

Aging populations, fast foods and sedentary lifestyles are combining to create an explosion in health problems, that is reflecting in escalating costs of government funded health systems.
For Australians, this means higher taxes to fund the National Health Scheme.
For Australian pharmacists, it means ever increasing pressure on Pharmaceutical Benefits costs.
These problems are not confined to Australia, and are reflected with a varying intensity on a global basis.

Australia is experiencing an epidemic in lifestyle diseases such as obesity, diabetes, hypertension etc. and despite an ever increasing array of drugs to combat these illnesses, it is obvious that an alternative strategy has to be developed, to curb the incidence of these diseases.
Governments around the world are increasingly looking at preventive strategies involving good choices of food, preventive medicine and lifestyle enhancements, as the key to managing these health problems.
Calls are becoming louder from some segments of the health community, to create a "lipid levy" on those fast foods or processed foods that have a high fat, or poor nutrient content.
There may be some validity for this call, because foods of this type often have flavour enhancers, preservatives and stabilisers as additives. Some of these substances have been shown to be addictive or create allergies and sensitivities.
It is quite common for the promoters of these foods to target children in their expensive advertising campaigns, and if they succeed in getting our children hooked on their flavour enhancers, basically they have a customer for life, and the health system has an ever-increasing cost involvement.
If you don't believe this problem exists, try changing your cat or dog to a different brand of pet food.
Very quickly you see your pet shun a new brand, because it does not contain their favourite "fix".
In this activity, the promoters of poor food choices are no different to the promoters of alcohol and tobacco, substances that already attract levies.
Large scale processing of foods began in the early 1900's, and as a means of preserving food, many nutrients were stripped out to prevent rancidity.
Oil soluble vitamins were prime casualties of this process, along with common minerals such as zinc and magnesium; also water soluble vitamins, often lost as an incidental side effect of processing or long term storage.
As nutritional deficiencies became evident, food "fortification" was introduced, particularly for milk and bread. Many food processors capitalised on this by advertising their original empty foods as now being health giving.
This process has continued unabated, to the extent that these foods are now promoted as "Functional Foods".
Japan is leading the world in the development of functional foods, specifically targeting their aging population. These foods are described in Japan as FOSHU-Foods of Specific Health Use, which are further defined as processed foods that aid specific body functions, as well as being nutritious.
FOSHU substances have three components-they are a food (not a capsule/tablet/powder) derived from naturally occurring ingredients; they are consumed as part of the daily diet;they regulate a particular body process such as the immune system, help to slow down the aging process, and help to prevent lifestyle diseases such as cancer and heart disease.
Japan has pioneered many of these foods and they were sold exclusively through pharmacies until 1999, when the market was deregulated to allow sales through all retail outlets. Food outlets have found marketing synergies between premium priced organic foods and functional foods, both promoting well-being.

The regulating authority, Food Standards Australia and New Zealand, is experiencing difficulty in determining the difference between various types of food products. For example, there are natural foods, dietary supplements, nutraceuticals, foodaceuticals, functional foods, and ordinary processed foods. Confusion is compounded as different countries select different names for the same classes of food.
Such foods can be found in health food stores, some pharmacies and supermarkets.
The FSANZ is having difficulty determining the interface between food and therapeutics.
The only common characteristic is that their role is supplementary to the normal diet, and they are presented as foods.
There is no consistent regulatory framework governing the manufacture, distribution or sale of these products. Nutrition claims are permitted but health claims cannot be published.
Basically, in Australia, products have to be considered either as either a food or a therapeutic substance, and the sale of the hybrid Food Type Dietary Substances (FTDS) are not permitted.
In New Zealand, some dietary supplements can be manufactured as foods.
Under the Trans Tasman Mutual Recognition Arrangement, they can be imported into Australia.
This has implication for Australian manufacturers (loss of opportunity and jobs) and for Australian consumers, who don't really understand what they are eating, relying on the fact that foods in Australia have generally been safe, up to this point.
It further "muddies" the current regulations.
FTDS are products presented as foods.
They contain, in a concentrated form, nutrients and other bioactive substances, herbs and phytochemicals. Food forms available include juices, snack-type bars, breakfast cereals, confectionery and yoghurts.

The FSANZ is currently inviting input so as to eventually provide a consistent regulatory framework, harmonising with New Zealand.

Pharmacy should be part of this process.
Pharmacists cannot stand out from this debate.
Consider that some recently launched teas include St Johns Wort Tea, Echinacea Tea, Gingko Tea, Ginseng Tea and a Sleep Tea containing passionflower and chamomile.

We are aware of St Johns Wort being interactive with the SSRI class of drugs, echinacea and ginkgo being interactive with warfarin and ginseng being additive to steroid hormone supplementation.
Where should these products be sold; should they be graded under the Poisons Schedules; what sort of information should be on the product labels; and what sort of supportive information (hard copy or counseling) should be made available?

Should these substances be taken on a continuing basis in food form?
What will be the long term implications for the continuing ingestion, albeit in small, but regular doses?
Who will inform consumers if genetically modified substances are utilised?

Global manufacturers are well aware of the massive disposable income available through the "baby boomer" population, and the fact that this population group collectively wish to have their lifespan extended, with a commensurate good quality of life.
Governments of all persuasion are encouraging the process as a means of cutting down on the health bills.
Major food retailers see this as an additional entry point in their quest to provide a health service equal to, or better than, a pharmacy.
In America, over 80 percent of Functional Food sales are happening in supermarkets, and the already large market is expected to rise by 39 percent from 2001 to 2006.
Recent consumer surveys indicate that 74 percent believe that nutrition is the key to good health.
Those consumers who reported their health as "excellent," had a 72 percent component using functional foods on a regular basis.
People who reported their health as "fair" or "poor" had a 54 percent usage of functional foods.

It would appear that if pharmacy is to have some influence over events, it must become proactive in this market trend.
Pharmacy must be seen as an active participant in providing strategies for improving consumer health, plus reducing government health expenditure.
For this to happen, the traditional retailing skills of pharmacists will need to be upgraded.
Simultaneously, staff training and qualifications in the complementary medicines field must be formalised, before considered decisions can be made in the range and depth of appropriate inventory items.
Store redesign and size would be a major consideration.
Corporate structure and mergers to create an efficient economy of scale, are required.
Investment in Information Technology and the provision of adequate manager resources is a must.
Ethical marketing, including the development of an EDLP strategy, highlighted in my article of last month, would also seem to be both desirable and essential.

The evidence supporting health benefits of functional foods needs to be continually confirmed by government agencies, that can provide both the finance and lack of bias.
It would seem that government dollars spent in this endeavour would represent a better investment in community health, than funding an ever-expanding drug list for the Pharmaceutical Benefits Scheme.
It would also represent a valid pharmacy market to replace a future declining prescription number, as health strategies took hold and reversed current trends, or as governments simply deleted drugs from their list to balance a health budget.

Pharmacy has traditionally held on to retail markets to act as a buffer in the provision of periodically declining formal professional markets. Pharmacy image has often been attacked because of the poor selection within a product range e.g. laundry soap powders.
Functional foods would be an image enhancement, would require professional information and oversight, and would be a customer traffic stimulator.
Customer traffic is an essential retail ingredient.
Conditions today are no different to those of the past, but events are outpacing individual pharmacy managers in their ability to manage complexity.
Many are contemplating a reduction, or elimination of retailing, in favour of new clinical services.
This, because they do not have the ability to graft new markets to their offering, unlike their major retail competitors.
Why give away what has been so difficult to create, and why give a competitor a free ride?