the independent monthly for irish...
TRANSCRIPT
The independenT monThly for irish pharmacisTs
issue 11 volume 10 decemBer • 2008
www.greencrosspublishing.ie
67644 Chef 245x75 Trade Ad 18/08/2008 16:31 Page 1
NEWS•DorganReportrecommendationswouldhavecosttheStateanextra€40million•Feweradversedrugreactionsnotifiedbypharmaciststhananyothergroup•Oneinfouradultsonprescribedmedication•SixpharmaciesinlistofIreland’sTop50stores
PHARMACIST AWARDS 2009Meetthesponsors
ALL I WANT FOR CHRISTMAS IS…AsneakpreviewofyourletterstoSanta
Q&AProfessorJaneGrimson,HIQA
INTERVIEW
MrTomMcGuinn,FormerChiefPharmacistattheDepartmentofHealth
B R E A K T H R O U G HIntroducing anticoagulation with no injections or coagulation monitoring
Prescribing Information (Irl)PRADAXA®
Capsules containing 75mg or 110mg dabigatran etexilate (as mesilate) Action: Direct thrombin inhibitor Indication: Primary prevention of venousthromboembolic events in adult patients who have undergone elective total hip or kneereplacement surgery Dose and administration: Initial dose 110mg within 1-4 hours ofcompleted surgery, then 220mg once daily. In moderate renal impairment (Cr Cl 30-50ml/min) or patients >75 years reduce dose: initial dose 75mg, then 150mg once daily.After knee replacement surgery continue treatment for a total of 10 days; after hipreplacement surgery for 28-35 days. Delay initiation of treatment if haemostasis is notsecured. If treatment is not started on the day of surgery initiate with 220 mg (or 150mg)once daily. Contra-indications: hypersensitivity to any component; severe renalimpairment (CrCl < 30 ml/min); clinically significant bleeding; organic lesion at risk ofbleeding; impairment of haemostasis; hepatic impairment or liver disease expected tohave any impact on survival; concomitant quinidine Warnings & precautions: Notrecommended if liver enzymes > 2 ULN; measure ALT in pre-operative evaluation. Closeclinical surveillance (signs of bleeding or anaemia) is recommended throughout thetreatment period, especially when haemorrhagic risk is increased: diseases associatedwith a risk of bleeding such as coagulation disorders, thrombocytopenia or functionalplatelet defects, active ulcerative GI disease, recent biopsy or major trauma, recent ICHor brain, spinal or ophthalmic surgery, bacterial endocarditis, concomitant NSAIDs (t1/2
>12 hours). Patients < 50 kg or >110 kg; the elderly; patients at high surgical mortalityrisk and with intrinsic risk factors forthromboembolic events. If severe bleedingoccurs, discontinue treatment and investigatethe source of the bleeding. Avoid or use with
caution agents which may increase the risk of haemorrhage. Not recommended inpatients undergoing anaesthesia with postoperative indwelling epidural catheters; thefirst dose should be given a minimum of 2 hours after catheter removal; these patientsrequire frequent observation for neurological signs and symptoms. Contains SunsetYellow (E110) which may cause allergic reactions Interactions: anticoagulants andplatelet aggregation agents; amiodarone (reduce Pradaxa® dose to 150mg); cautionwith strong P-glycoprotein inhibitors (e.g. verapamil, clarithromycin) or inducers (e.g.rifampicin, St John's wort). Pregnancy and lactation: avoid pregnancy during treatment.Do not use in pregnancy unless clearly necessary. Discontinue breast-feeding duringtreatment Undesirable effects: Most common is bleeding (14%); major bleeds, includingwound site bleeding, < 2%. Common (≥ 1/100, <1/10): anaemia; haematoma(including traumatic or postprocedural); wound, gastrointestinal, skin or post proceduralhaemorrhage; haematuria; decreased haemoglobin; wound secretion, postoperative orpostprocedural anaemia, postprocedural discharge. See SPC for details of these andother undesirable effects. Pack sizes and MA numbers: 75mg 10 capsulesEU/1/08/442/001; 60 capsules EU/1/08/442/003 110mg 10 capsulesEU/1/08/442/005; 60 capsules EU/1/08/442/007 Legal category POM Marketing Authorisation Holder: Boehringer Ingelheim International GmbH, D-55216Ingelheim am Rhein, Germany. Prepared in April 2008. For further information pleasecontact Boehringer Ingelheim Ireland Ltd, Corrig Court, Corrig Road, Sandyford IndustrialEstate, Dublin 18.
Date of preparation: April 20082008-PRA-004
Please refer to the Summary of Product Characteristics for further information.
The independenT monThly for irish pharmacisTs
ediTorial
conTenTsissue 11 volume 10 • decemBer 2008
IrishPharmacistispublishedbyGreenCrossPublishing,LrGroundFloor,5HarringtonStreet,Dublin8.Tel:014789770.Fax:014789764.www.greencrosspublishing.ie
GreenCrossPublishingisarecentlyestablishedpublishinghousewhichisjointlyownedbyGrahamCookeandMauraHenderson.BetweenthemGrahamandMaurahaveover25yearsexperienceworkinginhealthcarepublishing.Theirstatedaimistopublishtitleswhichareincisive,vibrantandpertinenttotheirreadership.
EDITOR:JuneShannonDESIGn:BarbaraVasicSUB-EDITOR:TimIlsleyPUBLISHER:GrahamCookePARTnER:MauraHendersonCOnTRIBUTORS:DiarmuidCoughlan,DavidJordan,JulianJudge,FintanMoore,CormacO’neill
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© copyright Greencross publishing 2008
no part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form by any means – electronic, mechanical or photocopy recording or otherwise – whole or in part, in any form whatsoever for advertising or promotional purposes without the prior written permission of the publishers.
irish pharmacist endeavours to ensure accuracy of information given and of claims made in articles and advertisements. nevertheless, no responsibility is accepted in respect of such information or claims. any opinions expressed by contributors are entirely their own and do not purport to be the views of irish pharmacist.
It’sChristmas!!AndthismonthyourfavouritepharmacymagazinehasbroughtyouaspecialfestivethemededitioncompletewithSantahatsandChristmaswishlists.ItalsofeaturesacomprehensiveroundupoftheverylatestpharmacynewsyouhavecometoexpectfromIrish Pharmacist,aswellassomeexclusivenewsstories—rememberyouhavereadthemherefirst. Oneoftheseisthenewsthathadtheinterimrecommendationsof
theGovernmentCommissionedDorganReportbeenimplemented,itwouldhavecosttheStateanextra€40millioninpharmacyservices.AspointedoutatthepublicationofthereportbythePresidentoftheIPU,MsLizHoctor,theproposeddispensingfeesproposedbytheDorganreportcertainlydohighlighttheinadequacyoftheHSEofferof€5.RememberIrish Pharmacistisyourmagazinesoifyouhaveanyissuesyouwouldliketoraiseorstoriesyouthinkneedinvestigatingpleaseemailthemtomeatjune@greencrosspublishing.ieInthemeantimeeveryoneatIrish PharmacistandGreenCrossPublishingwouldliketotakethisopportunitytowishallourreadersandcontributorsaveryhappyandpeacefulChristmasandahealthy2009.Blessyouforreading!
4- 12NEWS
15 PHARMACIST AWARDS 2009 Meetthesponsors
16 ALL I WANT FOR CHRISTMAS Asneakpreviewatsomeofyourlettersto
Santa.
18 INTERVIEW Irish PharmacisttalkstoTomMcGuinn,
on30yearsasChiefPharmacistattheDepartmentofHeath
22 VIEW FROM ABOVE Aheartbreakingstoryoftwobabygirls
switchedatbirth
23 THE COALFACE DavidJordanwonderswhocouldbring
somemuchneededchangetoIreland’shealthsystem.
26 LAW
27 FINANCE
29 CLINICAL Alzheimer’sDisease
32 Q&A ProfJaneGrimson,HIQA
33 EPHARMACY
42 CROSSWORD
44 FINTAN MOORE’S OUTSIDE EDGE
4Issue11Vol10December2008
newsnews
TheimplementationoftheinterimrecommendationscontainedintheDorganReportwouldhaveaddedanextra€40millionayeartotheState’sbillforpharmacyservices,Irish Pharmacist haslearned.AccordingtotheCorporate
PharmaceuticalUnitoftheHSEitwouldcosttheStateanextra€40millionperyearifthecurrentmixoffeesandmark-upspaidtopharmacycontractorswerereplacedbythefeeperitemstructurerecommendedintheDorganReport.“However,asnocontractorhastaken
uptheinterimcontracttowhichthisfeestructurewouldhavebeenapplied,itissomethingofamootpoint,”theHSEadded.InareportpresentedtoanHSEboard
meetingbackinJuly,theCEOoftheExecutive,ProfessorBrendanDrumm,statedthat“basedonaveryhighlevelbriefingoftheproposals”containedintheDorganReporthehad“advisedtheSecretaryGeneralofthefinancialimplicationsshouldtheGovernmentapproveimplementationoftheReport”.ChairedbyMrSeanDorgan,the
BodyonPharmacyContractPricingwasestablishedinFebruarybytheMinisterforHealthtorecommendanew,interimdispensingfeeforcommunitydrugschemes.TheDorganReportidentified“one
substantialissue”insettingadispensingfee–“thewidevariationinsize,financialstandingandbusinesscompositionofpharmacies”.
“Asingleflatfeewouldhavequitedifferenteffectsfordifferentpharmacies.Asuitablefeestructurecanincentivisemoreefficientbusinessactivities,butabalancehastobeachievedwiththemaintenanceofessentialpublicservices.Largerpharmacieswithadiversebusinessbase(ofteninmoreprosperouslocations)couldadjustmorereadilytoarelativelylowdispensingfeethansmalleroutletsinlessadvantagedareas,”thereportread.Itthereforeproposedasystemof
tiereddispensingfeesbasedonthenumberofitemsdispensedperannum.Accordingtothereport,pharmaciesdispensingupto20,000itemswouldreceiveafeeof€7peritem;dispensingbetween20,001and30,000itemswould
bringafeeof€6.50,whilepharmaciesdispensingmorethan30,000itemsayearwouldreceiveafeeof€6.Respondingtothereportatthe
time,theIPUsaidthattheproposeddispensingfees“highlighttheinadequacyoftheHSEofferof€5”.ThepresidentoftheIPU,Ms
LizHoctor,saidthatthenewfeesproposed“don’tgonearcompensatingpharmacistsforthe30percentcutinfeesforcedthroughbytheHSEandacceptanceofthenewpaymentmodelwouldfurthererodepharmacists’incomesbyeliminatingthemarginoncertainschemes.ThisreportwilldolittleforthemanypharmacistswhoareingenuinefinancialdifficultyasaresultoftheHSEcuts.”
Postearlyforthe2009IrishPharmacistAwards
Dorgan Report would have increased HSE payments to pharmacists by v40M per year
JacobO’SheehanReadfromGreystonespostshisentryforthe2009HelixHealthIrishPharmacistAwards.MembersofthepubliccannominatetheirlocalpharmacistforexcellenceinpatientcareinthePatientnominatedCategory.TheHelixHealthIrishPharmacistAwardsrecognisethosepharmacistswhohavehadsignificantpositiveinvolvementinthepharmaceuticalprofession.Theclosingdatefor
entriesforthePatientnominatedAwardisFriday,09January2009andnominationscanbemadeatatwww.pharmacistawards.com.
FeweradversedrugreactionsarereportedtotheIrishMedicinesBoard(IMB)bypharmacists,thanbyanyotherhealthcareprofessionalgroup,delegatesattendingthePSInationalPharmacySummitinDublinlastmonthweretold.Addressingthesummiton
‘TheRoleofthePharmacistinPharmacovigilance,’DrAlmathSpooner,MarketSurveillanceExecutiveattheIMB,saidthat,oftheapproximately2,000casesnotifiedtotheIMBeveryyear,pharmacistsreportedjust100-150.AccordingtoDrSpooner,an
integrativeapproachtomedicationsafetyrequiredtheinvolvementofallofthestakeholdersincluding
pharmacists,doctors,patientsandpharmaceuticalcompaniesamongothers.Sheaddedthattherewasscopeforincreasedreportingfrompharmacistsastheyare“expertlyplaced”toprovideinformationonthelong-termsuseofproductssuchashomeopathicandOTCmedicines.ShealsosaidthattheIMBreceivesconsistentlymorereportsyearonyearfromhospitalpharmaciststhanfromtheircommunitycolleagues.“Weareverykeentopromote
pharmacistinvolvementincontinuousreporting.Duringthelastyear,therehavebeenanumberofinitiativestomakeadversereactionreportingmoreuserfriendly,”DrSpoonersaid.
Theseinitiativesincludetheprovisionofonlinereportingsystems,whichDrSpoonersaidmadeit“veryeasynowtoreportonline”.Atthesummit,thePSIlaunched
apublicawarenesscampaignonmedicinesanddriving,whichfeaturedthepublicationofaleaflet,‘Medicines and Driving’,createdtoensuredriversarebetterinformedonthedangersinthisarea.Thenewleaflethighlightsthe
medicinesthatmayreducetheabilitytodrivesafelyandadvisesthatpeoplealwayscheckwiththeirpharmacistordoctoriftheirmedicinescouldaffecttheirdriving.Thisincludesmedicinesprescribed
byadoctorornon-prescriptionmedicinesrecommendedbyapharmacistorherbalmedicines.Theleafletalsopointsoutthattheseeffectscanbeincreasedifthemedicineiscombinedwithalcoholorotherdrugsormedicines.Thecampaignwillalsofocuson
educatinghealthcareprofessionalsontheirresponsibilitiesanditisalsoplannedthatastickerwillbecreatedtobeusedbypharmacistsonpackagingtoflagmedicinesthatreducetheabilitytodrivesafely.Inaceremonytoclosetheevent,
thePSIpresenteditsnewcoatofarmstotheMinisterforHealth,MsMaryHarney,whoalsoaddressedtheconference.
Fewer adverse drug reactions reported by pharmacists than any other healthcare group
Irelandcannotkeepaddingnewproductstoitscommunitydrugsschemeswithoutatleastconsideringremovingtechnologiesthatdonotmeettheevidencebase,pharmacoeconomicsexpert,DrMichaelBarry,hassaid.Speakingatarecentconferenceofthe
IrishPlatformforPatients’Organisations,ScienceandIndustry(IPPOSI)inDublin,DrBarry,directorofthenationalCentreforPharmacoeconomicsatStJames’sHospital,Dublin,saidIrelandneededtoconsiderifcertainproductsshouldremainontheGMSif,followingassessment,theyareshownnottobecost-effective.AsreportedinIrish Pharmacist last
month,DrBarrysaidthattheseproductsmightincludecertainnutritionalproducts.“Inareaswherethereisaqueryabout
their[certainproducts’]effectivenesstheyshouldreallybesubjecttoareview…iftheyaredeemednottobe
cost-effectivethenwewouldhavetoreconsidertheirreimbursementstatus,”DrBarrysaid.Healsopointedoutthatunderthe
currentIPHAagreement,however,itmaynotbepossibletode-listproducts.DrBarryisChairofanewgroup
chargedwithdevelopingrecommenda-tionsforsafeandeffectiveprescribingwhichtheGovernmenthopeswillprovidesignificantscopeforsavings.DrBarry’sreportwasduetobe
submittedtotheDepartmentofHealthon1December.Meanwhilepharmacistshave
indicatedtotheGovernmentthattheyarewillingtoengageintalkstosecure“significantsavingsinthenationalmedicalbill”aspartofawiderdiscussiononanewpharmacycontract.ThepresidentoftheIPU,LizHoctor,
toldtheAnnualPresident’sDinneroftheIPUthatthatthiscanonlybeachievediftheGovernmentworksinpartnershipwiththeUnionanditsmembers.
GMSdrugslistnotalimitlessresource
For every cigarette, there’s
a nicorette®
PA Holder: McNeil Healthcare (Ireland) Ltd., Airton Rd, Tallaght, Dublin 24. PA: 823/49/2,9,10,13. Contains Nicotine. Product not subject to a medical prescription. Full prescribing information available on request.
NIK/019/00
6Issue11Vol10December2008
newsnewsDemandingpublicafactorinjob-relatedstressAdemandingpublic,lackofbreaks,isolation,newservicesandincreasedresponsibilities;thesearejustanumberoffactorswhichcontributetojob-relatedstressamongpharmacistsaccordingtonewresearch.Astudyofpharmacistsinnorthern
Ireland,presentedatthe4thAll-IrelandPharmacyConferenceinDundalklastmonth,revealedthat,whiletherehasbeengeneralsupportfordevelopmentincommunitypharmacy,“thishadtobetemperedbyconcernsastohowexpectationswouldbemetandhowallserviceswouldbedelivered”.ResearchersattheSchoolof
Pharmacy,Queen’sUniversity,Belfast,interviewed17communitypharmacistsforthisstudyandtheanalysisisstillunderway.However,accordingtoinitialresults,themainthemeswhichemergedinrelationtoworkplacestresswere:workplaceissues,e.g.staff,environment,lackofbreaksandisolation;professionalexpansionandrecognition,e.g.newcontractissues,newservicesandincreasedresponsibility;andademandingpublic.Accordingtoonecommunity
pharmacistwhotookpartintheresearch:“It’sverydifficultanditdoesn’tmatterifit’sasingle-handedpractitionerintheirownbusinessorwithinamultiple,they[pharmacists]arestillquiteisolated.”Theresearchersconcludedthat
theseresults“reinforcedthetensionbetweendevelopmentsinpracticeandtheabilitytodeliver”.“Developmentsinprofessional
practicecanbepositive,howevercommissionersandpolicymakersneedtoconsiderifcommunitypharmacistshavetheinfrastructureintermsofenvironment,personnelandmultiprofessionalsupporttodeliverwhatisrequiredofthem,”thereportstated.
AnewreporthascalledforincreasedinvestmentinbothstaffandfundingtoensurethesuccessfuldevelopmentofcontinuingpharmaceuticaleducationinIreland.Accordingto‘A Report on Continuing
Pharmaceutical Education in Ireland’bytheIrishCentreforContinuingPharmaceuticalEducation(ICCPE),themanagementcommitteeoftheICCPE“hasexpressedtheviewthatitisdifficulttosustaintheICCPEstructurewithinthecurrentstaffingandfundingconstraints”.Thereport,whichwascarriedout
toinvestigatethefuturedirectionoftheICCPEandrecommendanorganisationalmodelfortheeffectivedeliveryofpostgraduatecontinuingeducationforpharmacistsinthefuture,calledforthecurrentstaffvacanciesintheICCPEtobefilledasamatterofurgencyandforaninvestmentof€1.35millionoverthenextthreetofiveyears(or€450perpharmacistinIreland).Accordingtothereport,which
waslaunchedatthe4thAll-IrelandPharmacyHealthcareConferenceinDundalklastmonth,the2007grant
fortheICPPEforatargetpopulationofapproximately3,000pharmacistswas€800,000orapproximately€267perpharmacist.ThereviewalsopointsoutthatthisfigureisjustoverhalfofthelevelofinvestmentmadeinpharmaceuticaleducationandtraininginnorthernIreland.ThebudgetreceivedbythenorthernIrelandCentreforPostgraduatePharmaceuticalEducationandTraining(nICPPET)for2007-2008was€480perpharmacistinnorthernIreland.Inrelationtostaffinglevelsatthe
centre,thereportstates:“TheabilityoftheICCPEtofunctioneffectivelyevenwithinfundingconstraintshasbeengreatlyaffectedbythecurrentvacancyinthepositionofdirectorandalsointhegradeVIpost.Thereviewgrouprecommendsthatthesetwopostsbefilledasamatterofurgency.”Itfurtherrecommendsthatthecore
staffcomplementshouldbeincreasedfromthreetosevenoverthenextthreeyearswithtwoadditionalpharmaciststoactasassistantdirectors,twonewadministrativestaffandthecreationofanewbusinessmanagerposition.
Picturedatthelaunchof‘AReportonContinuingPharmaceuticalEducationinIreland’were:MrTomMcGuinn,chairmanoftheICCPEManagementCommittee;andProfessorClaireAnderson,ProfessorofSocialPharmacy,Universityofnottingham.
InBRIEF
National health literacy campaign launched
TheMSD/nALAHealthLiteracyInitiativewaslaunchedrecentlytohelphealthprofessionalscommunicateclearlywithpatients.Theinitiative,acollaborationbetween
MerckSharp&DohmeIreland(HumanHealth)Ltd.andthenationalAdultLiteracyAgency(nALA),aimsnotonlytorecogniseandrewardeffortsbyhealthprofessionalstocommunicateclearlywithpatientsbutalsotoprovidepracticaltoolswhichcanassisttheminimprovingtheircommunicationskillswithpatientswhomayhavehealthliteracydifficulties.Thesetoolsincludeadedicatedweb
portal(www.healthliteracy.ie)forhealthprofessionals.The2009MSDHealthLiteracyAwards
werealsolaunchedaspartofthisinitiative.TheAwardsaimtorecogniseand
rewardhealthcareprofessionalsbyacknowledgingtheireffortsthroughprofilingtheirworkandamonetaryprize.Forinformationpleasevisit:www.
healthliteracy.ieEntriesmustbereceivednolaterthan
Friday,30January2009.
Unicare and Helix Health in €400,000 deal
UnicarehassignedanexclusiveagreementwithHelixHealthtoinstallanenterprise-wideITsolutioninitscorporateheadquartersandacrossitsentirechain.HelixHealthandUnicarepharmacies
haveenteredintoanagreementthatwillseethe72pharmaciesinIreland’slargestpharmacygroupfittedwithcuttingedgeprescriptiontechnologyinadealworthinexcessof€400,000.Unicareispursuinganaggressive
growthstrategy,whichwillgreatlyincreasethepharmacygroup’spresencenationwide,andthestrategicpartnershipwithHelixHealthwilldeliversignificantcostsavingsforthechain.Allstoreswillbefittedwiththetechnology,QicScript.net,beforetheendof2008.
TheMinisterforHealthhasremovedthederogation,whichpreventednon-Irishqualifiedpharmacistsfromowning,operatingormanagingpharmacies,whicharelessthanthreeyearsold.TheCommencementOrderofthe
SecondPhaseofthePharmacyAct2007,whichwassignedbytheMinisterlastweek,alsorelatestotheregistrationofpharmacistsandretailpharmacies.Theseprovisionswillcommenceimmediatelyandincludestherepealofpreviouspharmacylegislationdatingfrom1875to1962.Welcomingthisdevelopment,
thepresidentofthePSI,DrBernardLeddy,saidthepharmacyregulatorwasproceedingtoestablishthenewregistrationsystemsintroduced.DrAmbroseMcLoughlin,PSIregistrar
andCEO,said:“TheregistrationofretailpharmacybusinessesinparticularmarksanewdepartureforthepharmacysectorinIrelandandwillensurepatientsafetyandpublicprotectionthroughthemaintenanceofhighstandardsofpractice.Inaddition,thenewclinicalandprofessionalmanagementandaccountabilitystructures,whereeverypharmacymust
haveasupervisingpharmacistandasuperintendentpharmacist,willensurethatpatientsandthepublicwillreceivesafe,high-qualityprofessionalcareandservicefromtheirpharmacistsandpharmacies.“ThenewstatutoryCodeofConduct
forpharmacists,whichputsthehealth,well-being,careandsafetyofthepatientasapharmacist’sprimaryconcern,willalsoensurethatthepubliccancontinuetoplaceahighleveloftrustinthepharmacyprofession.”Part7oftheAct,whichrelatesto
thenewpowersofinvestigationofthe
PSI,wasalsocommenced,aswellasanumberofstatutoryrulesrelatingtovariousfunctionsofthePSI.Thethird,andremaining,stage
ofthecommencementprocesswilldealwiththeremainingsectionsofthePharmacyAct.Thesesectionsconcerntheintroductionofafitness-to-practiceregimeforpharmacistsandpharmacybusinesses,itsoperationandtheprohibitionofcertaineconomicandbusinessrelationshipsbetweenpharmacistsorpharmaciesanddoctors.Itishopedthisfinalstagecanbecommencedinthefirsthalfof2009.
Three-year derogation on non-Irish qualified pharmacists removed
ICCPE calls for increased funding and staffing
Further prescribing information available on request. PA Holder: McNeil Healthcare (Ireland) Ltd, Airton Road, Tallaght, Dublin 24, Ireland
P22260 benylin Irish pharmacist trade ad 340x245 TS.indd 1 20/10/2008 15:33:10
8Issue11Vol10December2008
newsnews
HelixHealthiscurrentlyinvestigatingpotentialsavingsthatcouldbemadebytheintroductionofelectronictransmissionofprescription(ETP)technologyonanationalbasis.ThisisbeingcarriedoutfollowingasuccessfulETPpilot
projectinWaterford.ManyEuropeancountrieshavealreadysuccessfullyintroducedthistechnology,whichisbasedonanelectronicbarcodesystem,onanationwidebasis.HelixHealthhasappointedformerMinisterfor
E-GovernmentandtheInformationSociety,MrTomKittTD,toitsboardtohelpdrivethecompany’se-healthagenda,particularlyinrelationtoETP.“TheissueofETPtechnologyisincreasinglytopicalaswe
believeitsadoptioncandeliversignificantsavingsfortheDepartmentofHealthaswellasincreasepatientsafety,”saidMrHowardBeggs,ChiefExecutiveofHelixHealth.“TheappointmentofDeputyKitttotheboardwilladdconsiderableexperiencetoHelixHealthandreinforceoureffortstodeliverthebestpatientoutcomesaswellasreducingcosts.IamdelightedtowelcomehimtothecompanyandamconfidentthathisstrategicinputwillassistHelixHealthinachievingourgoalsin2009,”heconcluded.MrKitttakesuphispositionontheboardofHelixHealth
withimmediateeffectandwillprovidestrategicadviceonalle-healthissuesrelatingtopublicpolicy.AsformerMinisterforStateoftheDepartmentofEnterprise,TradeandEmployment,hewillalsoprovideinputonhowtousethecompany’sinternationaldimension.
Electronicprescriptiontechnologypilotscheme
Poor eating habits, a sudden change in diet, a disrupted routine due to changes like shift working, stress and lack of exercise can all mean the body’s digestive rhythm can easily become unbalanced and irregular.
For further information please contact your Kelkin representative or call the sales office on 01-4600 400.
Fruits &Fibres
Fruits & Fibres is now available in a pleasant fruit flavoured cube, a convenient tablet and a pleasant tasting apple flavoured liquid. Fruits & Fibres liquid is suitable for adults and children from 3 years.
Fruits & Fibres combines the natural goodness of figs, tamarinds, rhubarb and yoghurt ferments to produce the ideal recipe to help keep you regular.
F&F.indd 2 26/09/2008 17:51:12
OneineveryfouradultsinIrelandcurrentlytakesmedicationprescribedbytheirdoctor,withwomeninlowersocioeconomicgroupsmostlikelytotakeprescribedmedicines,newresearchhasfound.Thesefindingsarecontainedinafact-sheet
releasedlatelastmonthbytheWomen’sHealthCouncilentitled‘PrescriptionMedication’.BasedonresearchgatheredinJanuary,theresearchformspartofanOmnibussurvey,commissionedbytheCouncilfromMillwardBrownIMS.Thesurveyexaminedanationally
representativesampleof989adults,withquotassettoincludeaccurateproportionsregardinggender,age,socialclassandregion.Themostcommonreasonthatpeoplegave
fortakingprescribedmedicationwastotreatachronicphysicalcondition.Almostone-third(31percent)reportedtakingmedicationforthispurposeoverall—fourineverytenformen,comparedwithoneinfourforwomen.
However,womenweremorethantwiceaslikelyasmentomentionmentalhealthasareasonfortheirmedication(9percentversus4percent).Similarlythoseinlesswelloffsocioeconomicgroupsweremorelikelytocitelong-termmentalhealthconditions(8percentcomparedto4percent).ThisconfirmspreviousresearchbytheWHCthatfoundthatpoormentalhealthcouldbebothacommoncauseandoutcomeoffinancialdifficultiesanddebt.ThedirectoroftheWHC,MsGeraldine
Luddy,highlightedthefactthatwomenweremorelikelythanmentobetakingprescriptionmedication.“Asignificantfindingoftheresearchwasthatwomenintheleastwelloffsocioeconomicgroupsweremostlikelytobetakingprescribedmedication.ThisconfirmspreviousresearchcarriedoutbytheCouncilwhichidentifiedaclearlinkbetweendisadvantage,deprivationandpoorhealthstatusforwomen.”
Six pharmacies make top 50 list of Irish retail stores
AtotalofsixpharmacieshavebeenlistedamongIreland’stop50storesintheFBDRetailExcellenceAwards2008.nowintheir12thyear,theFBDAwardsarethelargestawards
programmeintheretailindustryandthisyearatotalof432storesenteredtheawards.Thepharmaciesthatmadethelistannouncedlastmonthwere:
GreenCrossPharmacyinKillaloe,CoClare;McCabe’sPharmacy,CityWestShoppingCentre,CoDublin;Meagher’sChemist,BarrowStreet,Dublin4;MellerickPharmacy,PatrickStreet,Fermoy,CoCork;SamMcCauleyChemist,MahonPointShoppingCentre,Cork;andUnicarepharmacy,CharlevilleTownCentre,CoCork.Anumberofpharmacieswerealsoshortlistedtoreceive
prestigiousFBDRetailExcellenceAwards:HealthExpresspharmacyinMullingarandUnicarepharmacyinCharlevillewerebothfinalistsintheFBDRetailExcellenceIrelandAwards’LargeStorecategory;andSamMcCauleyChemistintheMahonPointShoppingCentre,Cork,wasoneofsixstoresshortlistedintheMediumStorecategory.UnicarepharmacywasalsoafinalistintheBestRetailCompany
oftheyearintheBestEmployercategory,whileAnnMarieO’RiordanfromUnicarepharmacyinDungarvan,Waterford,wasafinalistintheRetailManageroftheyearcategory.
One in four Irish adults currently takes prescription medication
PicturedattheawardsceremonyinKilkennyweremembersoftheSamMcCauleyteamwithMiriamO’Callaghan.SamMcCauleyPharmacy,MahonPointwerefinalistsintheBestStorecategory.AlsointhephotographisPaulCandon(ChairmanRetailExcellenceIreland—3rdleft)
Untitled-1 1 19/12/2007 16:12:28
10Issue11Vol10December2008
newsnews
ThePharmaceuticalSocietyofIreland(PSI)haswelcomedtheintroductionofaninnovativepatientsafetytoolforIrishpharmacists.ThenewservicelaunchedlastmonthinvolvesapartnershipbetweenAegate,apatientsafetycommunicationscompany,andMcLernons,asoftwaredeveloperforthepharmaceuticalindustry.From2009,pharmacistswillbe
givenanewtoolthatwillprovidereal-timesafetyinformationaboutthequalityandsafetyofmedicinesatthemostcriticalpoint,justbeforetheydispensetopatients.Thenewpartnershipallows
Aegate’sservice,whichprovidesreal-timesafetyinformationaboutmedicinesatthepointofdispensing,tobeofferedtoallpharmaciesintheRepublicthatcurrentlyuseMcLernons’pharmacysoftware.Aegate’ssecureon-lineservicewill
createadirectcommunicationlinkintotheirMcLernonsMPSpharmacysoftware.Aspartoftheroutinedispensingprocess,thepharmacistwillscaneachitem,whichwillbeautomaticallyrecordedinthepatientrecord.Withtheadditionofthissoftwareupdate,Aegatewill
simultaneouslyvalidatethisscanandreturnanyimportantproductsafetyinformation,specifictoeachitem,tothepharmacistwhiletheyaredispensing.MrKeithMcLernon,Managing
DirectorofMcLernonsComputers,said:“McLernonshasbeensynonymouswithpharmacyinIrelandforover75years.ThisjointventurewithAegateshowsthatweareleadingthewayindevelopinganddeliveringinnovativepharmacysoftware.IbelievethattheAegateprogrammewillaugmentanalreadyimpressivearmouryoftoolswithwhichweequipourcustomers,fittingalongsideourMPSsystemwithitsrangeofinnovativefeatures.“Productrecallsarebecoming
prevalentandcounterfeitdrugsareappearingmorefrequentlyandpharmacistsarethelastlineinthefightagainstthese.WearedelightedtobeworkingwithAegatetodevelopitspotentialforIrishpharmacies.”PSIpresident,DrBernardLeddy,
said:“Initiativesthathavethepotentialtopromotepatientsafetyandsupportpharmaciststodeliverhigh-qualitypatientcareareverywelcome.”
MrKeithMcLernon,MDMcLernonsComputerswithGarynoon,CEO,Aegate.
newcoursefortreatmentofminorailmentsAnewcourseonthetreatmentofminorailmentsforpharmacysupportstaffwaslaunchedlastmonth.ThenewPharmaProcourseentitled
‘Health,MedicinesandtheTreatmentofMinorAilments’willbedeliveredinaseriesofmodulesthroughout2009inDublinandCork.Eachday-longmodulewillcover
aparticulartopicindetail,andemphasisethecorecompetenciesofsymptomrecognition,referralcriteriaandacomprehensivereviewoftheproductsusedinthetreatmentofeachcondition.Theoverallaimoftheprogramme
istoproduceaconfidentmemberofstaffwhowillprovideasafe,efficientandknowledgeableapproachtoofferinghealthadviceandappropriatetreatmentofminorailments.ThosewhoavailoftheExtended
ServiceSkillscoursewillalsobeabletoassistintheprovisionofhealthpromotion,lifestyleandeducationinitiativeswithinthepharmacy.ThecoursewillbetaughtbyOwenDalyMPSI,CicelyRocheMPSIandMaryButlerBSc.Eachoftheninemoduleswill
focusonaparticulartopicandwillemphasiseadvancedskilldevelopment,in-depthOTCproductknowledgeandreferralskillsaswellasofferingflexibilityandtheconvenienceofbothCorkandDublinlocations.Thefirstmodule,‘CustomerCare
inthePharmacy’,takesplaceon15JanuaryinCorkandon21JanuaryinDublin.Itwillformthefoundationforeachofthesubsequentmodules,underpinningthetechniquesandskillsrequiredofpharmacysupportstaffinthedeliveryofhealth,lifestyleandOTCmedicinesadvicetocustomersandpatients.Thiscourseissponsoredby
UniPhar,ReckittBenckiser,Johnson&JohnsonandSevenSeas.Formoreinformation,contact
JackieMaheron0860863487oremail:[email protected]
A cure for snoring?
ResearchersattheRCSIbelievethatantioxidantsmaybethekeytocuringobstructivesleepapnoea(OSA),adisorderoftencharacterisedbysnoring.InOSA,theairwaycollapsesduringsleepleadingtolowbloodoxygenlevels(hypoxia).ProfessorAidanBradfordandhis
teamfoundthathypoxiamightactuallymakeOSAworsebyexposingthepatient’stissuestooxidativestress,afactorthat’salreadyimplicatedinheartdiseaseandotherhealthproblems.Totesttheoxidativestressidea,theyusedpro-oxidantsandantioxidantsinexperimentswithanOSAmodel.Pro-oxidantsmadeoxidativedamageworse,whileantioxidantsreducedit.“Wewouldsuggestthatantioxidant
therapymightbebeneficialinpatientswithobstructivesleepapnoeabyhelpingtokeeptheairwaysopenduringsleep,”saidProfessorBradford.Thishasnotbeentestedinhumans
yet,butadietrichinhealthyfruitsandvegetablesmightsupplyenoughantioxidantstohelpbeatOSA,givingsnorers(andthosewhohavetolistentothem)abetternight’ssleep.Thisresearchstudyisoneofa
numbercontainedinPicture of Health,whichwasrecentlypublishedbytheHealthResearchBoard(HRB).ThepublicationisanexcellentsnapshotofsomeoftheresearchfundedbytheHRBandiswritteninplainEnglish.
New oral products for diabetes
MerrionPharmaceuticalsandnovonordiskhaveenteredintoadevelopmentandlicenseagreementtodevelopandcommercialiseoralformulationsofnovonordisk’sproprietaryinsulinanalogues,usingMerrion’sproprietaryGIPETtechnology.Undertheagreement,Merrionwill
receiveuptoUS$58million(€45.7million)forthefirstproductdevelopedundertheagreementtoreachthemarketbasedonachievementofcertaindevelopment,regulatoryandsalesmilestonesaswellasroyaltiesonsales.novonordiskisresponsibleand
willpayforthedevelopmentandcommercialisationoftheproductcandidates.Merrionisresponsibleforthedevelopmentandmanufactureoftheinitialclinicalbatches,withtheworkoverseenbyajointdevelopmentcommittee.ThispartnershipbetweenMerrion
andnovonordiskcanpotentiallydeliveramajorneworalproductforpeoplewithdiabetes.Theagreementalsoprovidesnovonordiskwiththeabilitytodevelopadditionaloralformulationsofnovonordisk’sinsulincompoundsusingMerrion’sproprietaryabsorption-enhancingGIPETtechnology.
InBRIEF
Formerrugbyinternationalandasthmasufferer,MrDenisHickie,andDrJeanHolohan,CEOoftheAsthmaSocietyofIreland,attendedaphotocalltoraiseawarenessofarecentmeetingattheRCPIentitled‘ControllingyourAsthma–FactstotakeyourBreathAway.’DenisandJeanarephotographedwith52differentcolouredasthmainhalers,
representingthenumberofpeoplewhodieeachyearasaresultofpoorasthmacontrol.ThemeetingheardthatpoorasthmacontrolleadstoonedeathperweekinIrelandandpeoplewithasthmacantakestepstocontroltheirasthma,ratherthanallowingittocontrolthem.Theseincludehavingawrittenasthmaactionplanandtakingpreventermedicationeveryday.
Poorasthmacontrolleadstoonedeathaweek
Innovative patient safety tool launched for pharmacists
Prescribing Information for Mobicam 7.5 mg & 15 mg Tablets.Qualitative and Quantitative Composition: Each tablet contains meloxicam 7.5 mg or 15 mg. Pharmaceutical Form: Pale yellow coloured round tablet with a score line on one side. Therapeutic Indications: Short-term symptomatic treatment of exacerbations of osteoarthrosis. Long-term symptomatic treatment of rheumatoid arthritis or ankylosing spondylitis. Posology and Method of Administration: Oral use. Exacerbations of osteoarthritis: 7.5mg / day up to a maximum of 15mg/day. Rheumatoid arthritis and ankylosing spondylitis: 15mg /day, which may be reduced to 7.5mg/day according to therapeutic response. Max. dosage: 15mg/day. Take as a single dose with water during a meal. Undesirable effects may be reduced by taking the lowest effective dose for the shortest time necessary. Elderly: For the treatment of rheumatoid arthritis and ankylosing spondylitis: 7.5mg/day. Renal and hepatic impairment: refer to the SPC. Contraindications: Hypersensitivity to meloxicam, to one of the excipients or to substances with a similar action e.g. NSAID’s, aspirin. This medicine should not be given to patients who have developed signs of asthma, nasal polyps, angioneurotic oedema or urticaria following the administration of acetylsalicylic acid or other NSAID’s. Third trimester of pregnancy and during lactation. Active or history of recurrent gastrointestinal (GI) ulcer. Severely impaired liver function. Non-dialysed severe renal failure. GI bleeding, cerebrovascular bleeding or other bleeding disorders. Severe heart failure. Severe congestive heart failure (chf). Special Warnings and Precautions for Use: Undesirable effects may be minimised by using the lowest effective dose for the shortest duration necessary to control symptoms. Appropriate monitoring and advice are required for patients with a history of hypertension and/or mild to moderate chf as fl uid retention and oedema have been reported in association with NSAID therapy. Patients with cardiovascular and/or cerebrovascular disease should only be treated with meloxicam after careful consideration. Similarly before initiating longer-term treatments of patients with risk factors for cardiovascular disease. Any history of oesophagitis, gastritis and/or peptic ulcer must be sought in order to ensure their total cure before starting treatment with meloxicam. Attention should routinely be paid to the possible onset of a recurrence in patients. Patients with or with a history of GI symptoms / disease (i.e. ulcerative colitis, Crohn’s disease) should be monitored for digestive disturbances, especially for GI bleeding. As with other NSAID’s, GI bleeding or ulceration/perforation, in rare cases fatal, have been reported at any time during treatment, with or without warnings symptoms or a previous history of serious GI events. Particular caution is required if treating the elderly. If GI bleeding or ulceration occurs in patients during treatment, the drug should be withdrawn. The possible occurrence of severe skin reactions and serious life threatening hypersensitivity reactions (i.e. anaphylactic reaction) is known to occur with NSAIDs including oxicams. Meloxicam should be withdrawn immediately and careful observation is necessary. Should any abnormality be present following laboratory analysis of serum or liver function tests, the administration of meloxicam should be stopped and appropriate investigations undertaken. Induction of sodium, potassium and water retention and interference with the natriuretic effects of diuretics and consequently possible exacerbations of the condition of patients with cardiac failure or hypertension may occur with NSAID’s. NSAIDs, by inhibiting the vasodilating effect of renal prostaglandins, may induce a functional renal failure by reduction of glomerular fi ltration. This adverse event is dose-dependant. For further information refer to the SPC. Sodium and water retention with possibility of oedema, hypertension or hypertension aggravation, cardiac failure aggravation. Hyperkalaemia can be favoured by diabetes or concomitant treatment known to increase kalaemia. Regular monitoring of potassium values should be performed. Adverse reactions are often less well tolerated in elderly, fragile or weakened individuals, who therefore require careful monitoring. As with other NSAIDs, particular caution is required in the elderly, in whom renal, hepatic and cardiac functions are frequently impaired. The recommended maximum daily dose should not be exceeded in case of insuffi cient therapeutic effect nor should an additional NSAID be added to the therapy because this may increase the toxicity while therapeutic advantage has not been proven. In the absence of improvement after several days, the clinical benefi t of the treatment should be reassessed. Meloxicam, as any other NSAID, may mask symptoms of an underlying infectious disease. This medicine, like those of it’s class may impair fertility and is not recommended in women attempting to conceive. In women who have diffi culties conceiving, or who are undergoing investigation of infertility, withdrawal of meloxicam should be considered. Caution is required if meloxicam is administered to patients suffering from, or with a previous history of bronchial asthma. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase defi ciency or glucose-galactose malabsorption should not take this medicine. Full information regarding special warnings and precautions is available in the SPC. Interaction with Other Medicinal Products and Other Forms of Interaction: Other NSAID’s, including acetylsalicylic acid, oral anticoagulants, thrombolytics and anti platelet drugs, diuretics, ACE inhibitors and angiotensin-II antagonists, other antihypertensice drugs (e.g. Beta-blockers), cyclosporins, glucocorticoids, intrauterine devices, lithium, methotrexate, cholestyramine. Please refer to the SPC for further information. Undesirable effects: Common: anaemia, light-headedness, headache, gastrointestinal disorders, pruritus, rash, oedema including oedema of the lower limbs. For further information, please refer to the SPC. Shelf Life: 3 years. Marketing Authorisation Holder: Ranbaxy Ireland Ltd, Cashel, Co. Tipperary. Marketing Authorisation Number: PA 408/62/1-2. Distributed by: Pinewood Laboratories Ltd., Ballymacarbry, Clonmel, Co. Tipperary. This medicine is a prescription only medicine. Further prescribing information is available on request. Date of Revision of Text: October 2008.
7.5 mg & 15 mg Tablets
www.pinewood.ie
Ireland’s No.1 Generic Healthcare Specialists
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12Issue11Vol10December2008
newsnewsCommunitypharmacistsideallyplacedtohelptreatwinterxerosisCommunitypharmacistsareideallyplacedtohelpeducateandinformpatientsonhowbesttoadapttheirskincareregimetopreventandtreatxerosisordryskin,accordingtoaleadingdermatologist.DuringarecentvisittoIreland,DrMaryChang,
AssociateProfessorofPaediatricsandDermatologyattheUniversityofConnecticutSchoolofMedicine,saidthatIrishpharmacistshaveakeyroletoplayinhelpingpatientskeeptheirskiningoodconditionduringthewintermonths.AccordingtoDrChang:“Dryskinaffectsasignificant
numberofpeopleandisbecomingmoreprevalentasourpopulationgetsolder.Ashealthcareprofessionals,communitypharmacistsareatthefrontlineinadvisingpatientsonhowtoestablishadailyskincleansingandmoisturisingregimenthatrestoresthehydrationandbarrierfunctionoftheskin.”Givenourmodernlifestyles,DrChangsaiditwasno
surprisethatdryskinhasbecomesuchacommonproblem.“Duringwinter,thecombinationofdryindoorairandcoldoutdoortemperaturescanhaveastrongdrying-outeffectontheskin,makingititchy,irritatedorcracked.Thedailyuseofharshsoapsandshowergelscanalsostriptheskinofthenaturaloilsneededtomaintainhydration.This,inturn,exacerbatesthenegativeeffectoflowhumidity.“Appropriateselectionofcleansersandmoisturisers
isvitaltokeepdryskinmoisturisedandhealthyoverthewintermonths.Pharmacistsshouldexaminethepatient’sdailyskincareregimeninadditiontoassessingtheirmedicalandmedicationhistory.Iwouldadvisepatientstotrytoavoidusingproductsthatarehighlyfragrancedandtolimittheirexposuretocoloursandpreservativesasthesearealsohighonthelistofirritants.“Therearesomebasicstepspatientscantaketoimprove
theconditionoftheirskin.Evensimplechangesinaperson’sdailybathingroutinecanresultinquitedramaticimprovements.Patientspresentingwithsensitiveordryskincanbenefitgreatlyfromusingamild,soap-freecleanserfollowedbymoisturisationwitharich,emollientskinprotectantcreamtoassistandrestoretheskinbarrierandlimitmoistureloss.Productscontainingnaturalcolloidaloatmealcanalsoyieldexcellentresultsfordryskinastheycontainlipids,proteinsandpolysaccharidesthathaveprovenpropertiesforreducinginflammation,moisturisingandpromotingmoistureretention.”DrChangwasinIrelandthismonthasaguestofAveeno
SkinCareProducts.Duringhervisit,sheattendedclinicalcasesatOurLady’sChildren’sHospitalinCrumlinbeforegivingalectureonpaediatricdermatologyaspartoftheRoyalAcademyofMedicineinIreland’sclinicalandscientificmeetingofdermatologists.
PicturedattheRoyalAcademyofMedicineinIreland’sannualmeetingondermatologyareconsultantdermatologists,DrRosemarieWatson,OurLady’sChildren’sHospital,Crumlin,andStJames’sHospital,Dublin,andDrMaryChang,UniversityofConnecticutSchoolofMedicine.
TheHilaryHaydon&Co.Ltd.PharmacyManagementMedalwaspresentedtonewRCSIpharmacygraduate,MsLouisaKelly,atarecentconferringceremonyattheCollege.Atotalof195studentswereconferredwithdegreesinmedicine,pharmacyand
physiotherapyaswellaspostgraduateawardsatlastmonth’sevent.Speakingattheceremony,ProfessorFrankKeane,presidentoftheRCSI,said:“RCSIis
continuouslydevelopingwaysofdeliveringitsundergraduateandpostgraduateeducationandtraining.Conferringceremoniesarejoyousoccasionsforthegraduates,theirfamilies,friendsandacademicstaffwhohavecontributedtotheirsuccess.”
MsLouisaKelly,HilaryHaydon&Co.Ltd.,PharmacyManagementMedalwinnerwithMsFionaCottellandMrHilaryHaydon,SeniorPartnersatHilaryHaydon&Co.Ltd.
New pharmacy graduates at RCSI
CONTACT US TO ORGANISE YOUR FREE CONSULTATION CALL 1890 587 876
EMAIL [email protected] WWW.PHARMEPOS.COM
HEALTHY BUSINESS SOLUTIONS
Designed and developed specifically for the needs of the Irish Pharmacist
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• WEEE Compliant• CCTV Integration• Security Tag Deactivation• AVAILABLE IN SINGLE
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Labo Cosprophar Suisse
Cosmetic preparation For external use only
Distributed in Ireland by Ocean Healthcare Ltd Unit 6C, Nutgrove Office Park, Nutgrove Avenue,
Rathfarnham - Dublin 14 - Tel: (01) 2968080
LABO STRETCH MARKSwith striadene®
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FULL RANGE OF SERVICES –• ENLARGEMENTS • REPRINTS • B+W
DIGITAL PRINTING
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Total package for pharmacy
For further details about this special service contact:Sharon Doolan at [email protected] or call 068 22400
Colorcare_A4 AUGUST:Layout 1 17/09/2008 14:56 Page 1
Issue11Vol10December200815
pharmacisT awards 2009 sponsors
ClonmelHealthcareLtd.,thebiggestofthebrandedgenericcompaniesinIreland,isdelightedtobeassociatedwiththe2009IrishPharmacistAwardsas,accordingtoitsCEO,MrRoryO’RiordanMPSI,MMII,theeventrepresentsauniqueopportunitytosupportitskeycustomersandpartners.“Pharmacistsareourkey
customersandpartnersandwewanttodemonstrateoursupport,especiallyinthesetroubledtimes.Ithinkit’simportanttosponsortheseawards,toencourageexcellence
andprofessionalisminpharmacy.Thereissomuchfocusoncommerceandmarginsandcash,thattheprofessionalaspectsdon’tgetenoughattention,yettheseskillsarewhatdifferentiatepharmaciesfromotherplainretailactivities.Medicinesarenotnormalitemsofcommerce,theyarepotent,andpotentiallydangerousproductsonwhichthousandsdependfortheirongoinghealth.Encouragingexcellenceinthemanagementisgoodnotonlyforsociety,butforpharmacy’sreputationandforus.”
ClonmelHealthcareLtd.ispartoftheStadaAGGroup,aplcbasedinFrankfurt.Ithasover250employeesinIreland,inmanufacturing,R&D,quality,salesandmarketing.Thecompanyhasadiversifiedportfolioofproducts,includingthelargestrangeofgenerics,anOTCdivision(Clonmedica)andaspecialistdivision,withsingle-sourcebrandsinParkinson’sandanti-infectives.ItmanufacturesandmarketsproductsinIreland,EuropeandtheUSandhadaturnoverin2007ofover€75million.
Astheleadingadvisortothepharmacyprofessionforalmost20years,HilaryHaydon&CompanywashonouredtobeaskedtosponsortheIrishPharmacistAwards2009and,inturn,directlysupportcommunitypharmacywithinIreland.“Wefeelthatbysponsoringtheseawardswecanhelppharmaciststocontinuetoaddinnovationanddrivetotheirprofessionandpromotetheirrolewithinthecommunity.”Accordingtothecompany,
pharmacistsareundoubtedlyatthefoundationofourhealthcaresysteminIreland,buttheirhardworklargelygoesunnoticed.“Wefeelthat,bysponsoringtheseawards,wewillhelppeoplerecognisetheincrediblecontributionthatthewinnershavemadetotheirrespectivecommunities.Itisalsoveryimportantthatthehardworkandcommitmentofindividualpharmacistsisacknowledgedbytheirfellowpharmacists.”Establishedin1990,Hilary
Haydon&Company,charteredaccountants,isatop20financialservicesfirm.WithprestigiousofficesinDublin,CorkandBalbriggan,itisrecognisedastheleadingfinancialadvisortothepharmacysector.Thecompanyhassuccessfullyprovidedfinancialservicesforallthemajorretailpharmacychainsnationallyand,withaclientbaseofover200pharmacists,hasestablisheditselfasthefinancialservicesfirmofchoicefortheprofession.
UlsterBankisdelightedtobeasponsoroftheIrishPharmacistAwards2009.Theawardsrecognisepharmaciststhathavehadsignificantpositiveinvolvementinthepharmaceuticalprofessioninresearch,scienceorpracticefields.UlsterBankunderstandsthe
importanceofrecognisingandrewardingthosepharmacistswhoenrichtheirlocalcommunitiesandareattheforefrontofnewscientific
developments.Thissponsorshipsupportsanddevelopsthebank’sstrongpartnershipwithpharmacistsacrossIrelandtowhichitprovideseverydaysupportandadvice.UlsterBankisoneofIreland’s
fastestgrowingandmostdynamicbanks.AspartoftheRoyalBankofScotlandGroup,itbringsworld-classbankingsolutionsdirecttoitsbusinesscustomersinIreland.UlsterBankGroup,includingFirstActive
andUlsterBankservesapproximately1.8millionpersonalandbusinesscustomersthroughanetworkof287branches,60businessbankingcentresandover8,200staff.FourtimewinnersofKPMG’s
BusinessBankingExcellenceAwards,UlsterBankiscommittedtocustomerexcellenceandtodeliveringsolutionsthatmakedoingbusinessbetter.Formoreinformation,visit:www.ulsterbank.ie
Pharmacyawardssponsorsdiscusstheirreasonsforparticipatinginthe2009IrishPharmacyBenevolentFundAward
Sponsors of the 2009 pharmacist awards
Next month we will be interviewing three more sponsors
Clonmel HealtHCare
Hilary Haydon & Company
Ulster Bank
TOP QUALITY FILM PROCESSING
48 HOUR TURNAROUND
FULL RANGE OF SERVICES –• ENLARGEMENTS • REPRINTS • B+W
DIGITAL PRINTING
IMAGERY RECOVERY
PHOTO RESTORATION
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Total package for pharmacy
For further details about this special service contact:Sharon Doolan at [email protected] or call 068 22400
Colorcare_A4 AUGUST:Layout 1 17/09/2008 14:56 Page 1
I’mnotgettinggreedybutIthoughtthatImightitemisethislistforconvenience.AllIwantforChristmasis........
1. Anewhealthservicebecausetheoldoneisbroken.
2. AnewgovernmentbecauseIjustdon’tliketheoldone.
3. AnewcontractnegotiatedonafairbasisbetweentheIPU&HSE.
Ihopethatyoudidnothurtyourselfwhenyoufelloverlaughing.Thisendsthefantasysection.
4. AbrandnewFJR1300motorbike.
5. Someadvancedridinglessons.6. Sometimeofftotakeitaround
Europe.Maybe4&6shouldbeinthefantasy
section.Bythewayyoushouldditchthereindeerforamotorbike.you’llhavesomuchmorefun.
7. AdaddyonlyP.I.n.codefortheTVremote.SoIcangettowatchwhatIwantforachange.
8. Healthandhappinessformeandmyfamily.
9. IfIcan’thavetheFJRabovethenatleastanewsetofleathers,bootsandlid.
Ishouldaddbecauseoftradition,
10. Peaceandhappinesstoallmankind,womankindhumanity.
11. Loveandunderstandingbetweenfolkallcreedsandnone.
12. Forgivenessformyenemies,thereshouldnotbetoomanyleftasIhavekilled/outlivedmostofthem!
13. Patiencetoletmedealwith
editorswhoaskmetomakeuptheselists.
AsIsaidaboveI’mnottoogreedy.IfyoucannotmanagetheabovethenIwouldbehappywithjustonewinninglottoticket.FailingallthatIwillsettleforanice
bottleofportandaroaringfiretodrinkitinfrontof.
(David,awickedlygoodboywhoisreallyabittoooldtobelieveinSanta.)
David Jordan
AllIwantforChristmasis…
1. AllboardmembersofIrishBanks,especiallySheehyofAIB,tobepublicallyflogged(bymefirst).
2. AbigblackholeintowhichIcanthrowthefloggedboardmembersoftheIrishBanks(SheehyofAIBtogoinfirst).
3. A100percentuptakeonmywritingclassesforthenewyear.
4. SarahPalintoexplainglobalwarming(herversion)toapolarbearonRyanTubridy.
5. SarahPalininthezoo.(inpolarbearcage).
6. June’sfamilysizedCadburysselectionbox.
HappyChristmas!
Julian Judge
AllIwantforChristmasis…mynewwifeElaineandournewbabyOisintobehappyandhealthy.
Cormac O Neill
“AllIwantforChristmasis........Abanonanymentionofthewords
“CreditCrunch”(mycustomersareallonthedoleandthey’vestopshopping).TheresignationoftheAssembly’sFirstandDeputyFirstMinisterandtheirreplacementwithSantaClauswhocouldnotdoanylessofjobbutlooksbetter.Andfinallymynewbook“BusinessTrip”togettonumber1ontheIrishandUKbestseller’slist.(www.lulu.com/businesstrip.)
Terry Maguire
AllIwantforChristmasisformyfamilyandfriendsaroundtheworldtobehappyandhealthy...oh,andaholidayandanewiPodandadigitalcamera,andjewellery,hmmmanythingbutsocksreally!
Deirdre O’ Sheehan, Helix Health
AllIwantforChristmasissomegoodnewsabouttheeconomyandthechocolatemanfromthelynxad.
Jennifer Hughes, Helix Health
“AllIwantforChristmasisanendtohomelessness,anewGovernment,afamilysizedCadbury’sSelectionbox,tosleepforaweek,ooohandthatfabOrlaKielybagIspottedinBT’slastweek...thanksSanta!”
June Shannon, Editor Irish Pharmacist
ALL I WANT FOR CHRISTMAS IS …
“DearSanta,
ALL I WANT FOR CHRISTMAS IS …
• Clinically proven to kill head lice
• 10 minute treatment time*
• Easy to apply to scalp and hair
• No traditional pesticides
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• Value for money –
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headlice.ie1. Burgess IF, Brown CM, Lee PN, Randomised, controlled, single, parallel group clinical trials to demonstrate the efficacy of isopropyl myristate/cyclomethicone solution (Full Marks Solution) against head lice. Pharm Jnl 2008; 280; 371-375.*10 minute treatment time refers to two applications, seven days apart.
SSL Healthcare Ireland Ltd, Monarch Industrial Estate, Belgard Road, Dublin 24.
Full Marks is a trade mark of the SSL group.
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Fact: New clinical proof that a 10 minute head lice treatment time* is effective1
18Issue11Vol10December2008
inTerview
ligo-bornTomMcGuinnwasamongthefirstcohorttograduatefromthefirsteverclassofpharmacyatUCDin1964.Ongraduation,hejoinedAntigenPharmaceuticalsinRoscrea,CoTipperary,asheadoftheInjectionsDepartment.“TherewasnothinginthePharmacopeia
thatwecouldn’tmakeorvolunteertomakeinthosedays.TodayifyouwantedtodothesamethingyouwouldfirsthavetodotheresearchandthenapplytotheIrishMedicinesBoardforanauthorisationanditwouldtakeabouttwoyearsbeforeyouwouldgetyourproducttomarket.Inthosedays,youcouldconceiveaproductinthemorning,manufactureitintheafternoonandmarketitthesameday.Sothingshavechangedanenormouslotoverthoseyears,”TomtoldIrish Pharmacist.FollowingtwoyearsatAntigen,Tomwenttowork
forAllenandHanbury(nowpartoftheGlaxoGroup)asapharmaceuticalrep,anexperience,whichhesaid,“contributedtomydevelopmenttoagreatextent”.
an important letterAsarepTomcoveredamassiveareaincorporating12countiesfromDublintoBallina.Whileheenjoyedhistimewiththecompanyimmensely,afterayearofeatinghotelfood,hedecidedforthegoodofhishealthitwastimetomoveon.“Anadvertisementappearedinthepaperlookingfora
pharmacistforthenationalDrugsAdvisoryBoard(nDAB)[pre-runneroftheIMB]whichhadjustbeenestablishedin1966…nobodyreallyknewhowthecontrolofmedicineswouldprogressbutIchancedmyarmandappliedforthejob,”hesmiled.HetellsastoryoftheenvelopearrivingfromthenDAB,
whichheleftunopenedforanentireweekendpresumingitcontainedarejectionletter.Whenhefinallyopeneditatthebehestofhismother,tohishugesurprisehefounditcontainedajoboffer,whichhedulyaccepted.In1967,Tombecamethefirstpharmacisttobe
appointedatthefledglingorganisation,apositionhewastoholdfor10years.“Sometimesitwasquitefrustrating…allthe
evaluationswerecarriedoutintotalisolation.ForexampleyoumightknowthatthethenUKCommitteeonSafetyofDrugswasalsolookingatthesameproductbutyoucouldn’tpickupthephonetotalktothem.Ifonehadthecheektodoso,itwouldbeverypolitelyexplainedtoyouthattheseapplicationsweremadeinconfidenceandtheyweren’tinapositiontodiscussanythingwithyou.youvirtuallyworkaspartofawholeEuropeanTeam…it’satotallydifferentsetupnowintheEuropeansceneasopposedtothen,whereitwasverylocal.”ItwasduringhistimeatthenDABthatIrelandjoined
theEU(thentheEEC),whichTomsaidhadahugelybeneficialeffectonIreland,andpharmacy.
post of CHief pHarmaCistTomjoinedtheDepartmentofHealthaschiefpharmacistin1977,whichwasatimeofhugechangeforpharmacyandpublichealthinIrelandwiththeintroductionoftheGMSSchemein1971followingtheearlierpassageoftheHealthAct1970.“Therewerealotofchangestakingplace.Onthe
pharmacyside,therewasadebategoingonabouttheinvolvementofpharmacistsinthefuturescheme[GMS].Upuntil1971/2,whentheGMSSchemecamein,medicineswerepurchasedunderagovernmentcontract,whichhadoperatedunderthePoorLawSystemofthe
ApharmacistandagentlemanWiththeannouncementofhissuccessorimminent,MrTomMcGuinnsharedsomeofhisreflectionsonalmostthreedecadesasChiefPharmacistattheDepartmentofHealthwithIrish Pharmacist.
S
20Issue11Vol10December2008
inTerview
1830sandwhichwasintendedforpaupers.”AccordingtoTomthatPoorLawSystemwasnotveryreceptive
tothenewproductsthatwerebeingintroduced,asatthetimedispensarydoctorswerenotallowedtoprescribesomeofthenewer“verygoodproprietaryproducts”thatwerethenbeingintroducedtothemarketandpharmacistswerenotinvolvedinthechainofsupply.“Inorderforaproducttobesuppliedtoapatient,thatproducthad
tobeonalist.Ifitwasn’tonthelistitcouldn’tbesupplied…thereweremanyvery,veryimportantproductsavailableatthetimethatsimplyweren’tonthatlistbecauseitdidn’tfitinwiththeschemeofthings.Ifyoucouldaffordtogetityougotitprivatelyviathelocalpharmacy,butthepublicinIrelandwereverydifferentinthosedaysanditwasseenasastigmatohaveayellowcard,nowadaysknownasaGMScard.”
‘paUper’ stigmaThe‘pauper’stigmaassociatedwithayellowcardunderthePoorLawSystemmeantthatmanypeopleinIrelandatthetimesimplydidnotavailofit,preferringtopayfortheirmedicinerequirementsratherthanhurttheirpride.However,whenthegovernmentatthetimeintroduceda£7insurancechargeforeveryonewithoutacard,applicationsforthenewGMScardsoaredandthestigmadisappearedvirtuallyovernight.“WhentheintroductionoftheGMSwasbeingdiscussed
nobodycouldunderstandhowitwouldfitinwiththeold[contractpurchasing]systembecauseobviouslygovernmentwasanxioustopreservetheeconomicbenefitsofthatscheme,”Tomexplained.“AsfarasIrememberthedrugsbillinthoseyearsundertheold
contractsystemwaslessthan£1millionayear,andthey[healthservicemanagement]wereanxioustoretainthat…aftersomeprotractednegotiations…someonecameupwiththesuggestionthatinsteadofsupplyingcontractpurchasedstocktopharmacists,itwouldbebettertopaymoneytocoverthecostofthestockuptothetimethattheywouldgetpaid,nowit’sonemonth,andthatbecamethe‘advancepayment’.Sowhatthegovernmentdecidedtodoinassociationwiththepharmacistorganisationsatthetime,wasthatthemedicineswouldbepurchasedoffthemarketatthemarketprice,an‘advancepayment’wouldbemadebasedonthepharmacists’monthlyclaimsandthat,coupledwithalow‘feeperitem’becamethesystemforreimbursement,”heexplained.
a different irelandHowever,TompointedoutthathadthecontractpurchasingarrangementsnotbeenchangedintheIrishhealthservicesin1970/1,thechangeswouldhavebeenimposedonIrelandbyvirtueofitsmembershipoftheEuropeanCommunity.“Idon’tthinkthatisfullyappreciated,”hesaid.Apartfromsettlementdiscountsofbetweenoneandtwopercent
forpharmacistswhopaidsuppliersontime,accordingtoTom,unliketodaytherewerenosignificantwholesalediscountsinpharmacyatthattime.“OntheGMSside,therewerenomarkupsexceptforthese
settlementdiscountswhichweren’tseenasaproblem.Butyouarenotlookingatpharmacyasitistoday.Inthe1960s,1970sandearly1980sinIreland,theonlypharmacychainwasHayesCunninghamandRobinsonsand,toalesserextent,HamiltonLongs.Theyjust
didn’texist.Butinthe1990s…theBenDunneapproachtobusinessinIrelandalsohaditsimpactonpharmacy.Somepharmaciessawthattheyhadasignificantpurchasingpowerandthatiftheyopenednegotiationsbetweenthecompetingwholesalerstheycouldusethatmuscletogetbetterterms.”
Hse and irisH pHarmaCistsAccordingtoTomwhatalotofpeoplemaynotrealiseisthatthe15percentmarginwhichhasbeenatthecentreoftherecentdisputebetweentheHSEandIrishpharmacists,wasfirstestablishedover60yearsagointhe1930sand1940s.InterestinglyhesaidthatittoowasthesubjectofaninvestigationbytheFairTradesCommissioninthe1950s.CommentingontherecentdisputeTomsaidhewas“disappointed
thatiteverhappened”.“Thedisputeinthepharmacycontextwasconcernedabout‘the
otherfellow’smargin’…Idon’tthinkithascontributedanythingotherthanalackofstabilitytothesituation.”DescribingtherecentjudgementintheHickeyCaseas“arock
ofcommonsense”,TomsaidthatinhispersonalopiniontheHSEshouldneverhaveattemptedtoimposethereducedpaymentstopharmacistsinthemannerithad.“Idon’tthinkthey[theHSE]shouldhavedonethat…thefigures
thatcameoutintheHickeyCaseareHickey’sfigures,thesmallpharmacyinBallydehobislookingatthesefiguresinamazement.Onesizedoesnotfitallandtothinkthatyoucantake7percent,8percentoffallpharmacistsandthatitwouldhaveequalimplicationsonthemallisillogical…thatmathematicalmodeljustdoesn’twork.“Thepotentialdamagesfromthattypeofaninterventionwerefar
toogreattohavegonedownthatroad,”Tomadded.“Theydoneedtogetintodiscussionswiththepharmacyunionin
ordertoresolvethat.Itcannotberesolvedwithoutdiscussion.Thereareenormouscontributionsthatpharmacycanmaketothehealthservice.Thosethingscannotcometofruitionwithoutdiscussionandhowtheseelementsarepaidformustalsobethesubjectofdiscussion;theyaretoocomplextobelefttochance.”
ever-inCreasing drUgs BillSowhatdoestheformerchiefStatepharmacistthinkistheanswertoIreland’sever-increasingdrugsbill?“IthinkitistimethattheystartedtolookattheEuropeanmodels
ratherthantheBritishmodels.ThereareagoodnumberofmodelsandconceptsouttherewhicharequiteforeigntotheIrishphilosophy[which]isderivedfromthePoorLawsituationwheretheintentionwastoprovideallthemedicationstothosepeoplewhocouldaffordtopaynothing(i.e.paupers).“ButtheIrelandoftodayandtheIrelandofyesterdayaretotally
different.Idoubtverymuchthattherearemanypeopleouttherethatcannotaffordtocontributesomething.OntheContinenttheyhavedividedmedicinesintovariouscategoriesofessentialmedicines,lesseressentialsandnon-essentials.Theessentialmedicinesarereimbursedfullyforeverybodyinanationalscheme,thenextgroupofmedicinesarereimbursedonapercentagebasisandthenon-essentialmedicinesarenotreimbursedatall.”
Hostile to generiCsHowever,asTomexplained,unfortunatelyitisnotsostraightforwardtointroducethistypeofsystemintoIrelandduetothelimitsposedbytheHealthActandthemultiplicityofschemesthatcurrentlyexist.“Ifthereisaseriousintentionofsavingmoney,aproperstructure
wouldfirstneedtobeputonreimbursemententitlementsundertheHealthAct.”TheareaisfurthercomplicatedbythecurrentsituationinIreland
whichTombelievesis“totallyhostiletogenerics”,abeliefwhichhesaidveryfewpeoplefullyappreciate.“Inthe1960s,1970sandtheearly1980s,therewerefouror
fivecompaniessupplyingpuregenericproductsinIrelandandthepotentialforrealcompetitioninthemarketwasthere.Thesecompanieshaveallpulledout-theyaregone.Thereasontheyaregoneisbecausethereimbursementsystemistotallyhostiletotheirproducts.
Genericprescribingproperlymanagedwouldcontributetoareductionofthedrugsbill,butitmustbeproperlymanagedandthesystembegenericfriendly.Eventhen,theresultswillnotbeseenovernight.
“
Issue11Vol10December200821
inTerview
“IfI,asadoctor,issuedanopenprescription,thereisnocertaintythatthebenefitofthatwillaccruetotheState.Thepharmacistswilldispensewhatisontheshelf…forexample,therearemanyproductsoutthereforwhichthereareupto10generics(usuallyreferredtoasbrandedgenerics).nopharmacistinhisrightmindisgoingtowanttocarryall10ofthoseinhisstock.Thecostofthatisprohibitiveanditiswhollyunrealistictoexpectthattheyshoulddoso.”Heexplainedthatnowadaysdoctorsprescribemainlyfromalist
ofbrandedproductsandthepharmacistisobligedtodispensewhatisontheprescription.Unlesstheprescriptioniswrittenonanon-proprietarybasis,thepharmacisthasnodiscretion.
tariff priCesTom’ssuggestionwouldbetocreateasystemsimilartothatinanumberofothercountrieswheretariffpricesareestablishedandwhichcomeintoplacewheneveraprescriptionisissuedonanon-proprietarybasis.“Thenyouhavethecertaintythatitisonlyaproductthatfalls
withinthetariffpricethatwillbereimbursed…butbecausesuchasystemisnotinoperationhere,thesystemremainshostiletogenericsandthereisnopossibilityinmyview,nomatterwhatyoudowithgenerics,ofmakinganysignificantin-roadsintothatandcertainlynotwithoutcreatingmajordifficultiesforall.ThatimpedimentisthereasonthatthepotentialforsavingsingenericsinIrelandremainssosmall.Thereimbursementsystemwheregenericsareconcernedishostileandperhapsanti-competitive.”Tom’sideawouldbetocreateatariffpricewherethereisarange
ofgenericswithpricesrangingsayfrom€1to€10.Itisimportantthatthepriceestablishedwouldnotcorrespondwiththepriceofthelowestpricedproductoranyproductavailableandthatthepricebereviewedregularlytofollowthecompetition.Withsuchagenericspolicyinplace,itisthetariffpricethatwouldbepaidinthecaseofallprescriptionsthatareissuedonanon-proprietarybasis.“Oncethesystemisunderstood,pharmacistswilllookforgeneric
productsthatarepricedbelowthetariffandtheyaretheproductsthattheywillthenkeepinstock…butitdoesdependonthedoctorsissuingprescriptionsregularlyonanon-proprietarybasis.Ifsuchanarrangementweretobeintroduced,someofthosegenericcompaniesthatpulledoutoftheIrishmarketinthe1970smayconsiderreturning,therebyincreasingcompetitionwitharesultantimpactonprices.“Genericprescribingproperlymanagedwouldcontributetoa
reductionofthedrugsbill,butitmustbeproperlymanagedandthesystembegenericfriendly.Eventhen,theresultswillnotbeseenovernight.”
refleCtions on 30 years at tHe doHTomofficiallyretiredfromtheDepartmentofHealthin2005andiscurrentlychairmanoftheManagementCommitteeattheIrishCentreforContinuingPharmaceuticalEducation(ICCPE).Reflectingonalmost30yearsattheDepartmentofHealth,hesaiditwasahugelyinterestingandverybusyjob.“Therewasanenormousamountofworkinvolved.youweren’t
alwaysinvolvedinthingsthathitthepubliceye,veryfewthingswouldbeinthatarea…attheendofthedayasapharmacistinthepublicserviceyouareanadvisorandtheycaneitherconsultyouortheymaynot…withyou,orwithoutyou,asanadvisor,thesystemmoveson.”DescribinghispredecessorMrShaneO’neillas“anabsolute
gentleman”,Tomsaidtheonlyadvicehehadforhisownsuccessorwas“tokeepanopenmind”.“Itisverydifficulttoadvisesomeoneinthatsituationbecausethe
circumstancesarechangingalmostbytheday.Ithinkitisimportanttofirstsettleintothejobandnottorushintoanything.Thepositionitselfwillevolve.Ifthepersonconcernedthoughttheyweregoingtoturntheworldupsidedownovernightthatcertainlywon’thappeningovernmentcircles.Itisalong,drawn-outprocessandyouhavetoconvincealotofpeopleoveralongtime.“Veryoftenthedemandforchange…willhavetocomefromthe
outside.Whenthedemandcomesandwhenitisagreedthatsomesortofactionisnecessary,thatisthetimethatthecontribution
becomesessential.Itisimportanttohaveanopenmindandgetthebestpossibleproposaloutthere…youhavetohavealloptionsavailable,andanopenmindisveryimportant.”
an aBsolUte gentlemanAnopenmindand,ifwearelucky,thenewappointeewillalsobeanabsolutegentleman(gentlewoman)justlikehisorherpredecessor,MrTomMcGuinn.
MrTomMcGuinn,chairmanoftheICCPEManagementCommittee
“AsfarasIrememberthedrugsbillinthoseyearsundertheoldcontractsystemwaslessthan£1millionayear,andthey[healthservicemanagement]wereanxioustoretainthat…
22Issue11Vol10December2008
The coalface
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havebeenwatchingandlisteningtoallthecoverageoftheUSelections.Tobehonest,itwouldbekindofhardtomissit.AsIwrite,BarackObamahasbeenhailedthevictor.SoIaskedmyself:‘DoesthishaveanyimplicationsforIrishpharmacyandIrishhealthcare?’Probablynot,butthisdoesn’tstopmeusingitasanattention-grabbingheadlineforthearticle!ThenIthoughtalittlebitmoreaboutit.MaybewhatIrishpharmacy
andhealthcareneedsisanObama-likefigure.Someonetouniteallstrandsinthehealthcarearena.Someonetoworkoutacommongoalandgetallsectorstoworktowardsit.Toputourdifferencesbehindus,inspireconfidenceandmovetowardsabrightnewfuture.TousethewordsofourbelovedMinisterforFinance:“Itisnothingmorethanourpatrioticduty.”
Yellow pack hospitalsInsteadwehaveSWMBOHarneyandProfessorDumb&Dumber.Theirinspirationalcatchcallsare‘It’smywayorthehighway’and‘Trustme,I’madoctor’.TobefairtoSWMBO,sheprobablydoeshaveaviewofwhereshewouldlikeIrishhealthcaretobe.Unfortunatelytheonlygroupthatsharesthisendpointarethedeveloperslookingfortaxbreakssothattheycanbuildmoreyellowpackhospitals.ShewantsaBoston-typehealthservice.Inpracticethismeansthatyoubetterhaveprivateinsuranceorlotsofmoney.Iguessthatsheisgettingherway.AsforDumb&Dumberitwouldbeunfairtosaythathesuffersfrom
agodcomplex.Moreaccurately,theIrishpublicsuffersfromhisgodcomplex.Hemovedfromaworldwherehiswordwasgospeltoonewherehiswordwas“thebasisforfurtherdiscussion”.Maybeheshouldhavestuckwithlookingaftersickchildrenratherthanmakingtherestofusfeelsick.Iwonderwhatskillshehadtodemonstratebeforebeingappointedhead
honchooftheHSE.OffthetopofmyheadIcouldthinkofafew.Theabilitytoworkwithprofessionalsfromdisparatebackgrounds.Theabilitytodealwithamassivebudget.TobebestbuddieswiththeMinisterforHealth.Haveaguesswhichwasofhighestprioritywhentheysatdownforthatinterview.
Minister Michael O’LearyWherewouldthismessiah-likefigurecomefrom?Perhapswecouldgetsomebodyfromtheworldofbusiness.Maybesomebodyfromtheworldofpharmacy.Thereareanumberofpharmacistsouttherewhohavebuiltuplargechainsfromhumblebeginnings.Theywouldhaveexperienceofmassagingdoctors’egos,negotiatingthelabyrinththatistheHSEbureaucracyandtryingtoworkoutwhodoeswhatinhospitals.Therealproblemwiththischoiceisthatoncetheyhadgotthehealth
servicesortedoutandefficienttheywouldthensellitofftothefirstBritish,GermanorDutchmulti-nationaltomakeanoffer.Thentakeasliceoftheprofitsandretireagain.ThefirstfigurethatcametomindwhenIstartedwritingthiswasMichaelO’Leary.Couldyouimaginewhatkindofhealthservicehewouldrun?“Doyouwantanextrablanketonyourbed?Thatwillbe€10please.”“Afreshbedpan?€10please.”“youwanttoseeadoctor?Ohandyouwanttotalktohimaswell?€20forthat.”“Don’tbotheraskingtoseeaconsultant,yourcreditcardhasalreadybeenmaxedout.”IfyourambulanceisdelayedgettingtoA&Etherewillbeanextracharge.
IfyougetsickorhaveanaccidentjustbeforeChristmasyoubetterhavearichrelative.youmaynotliketheresultanthealthservicebutthereisnodoubtthatitwouldmakeaprofit.
Long-term planAlasIfeelthatwemightbestuckwiththecurrentbunch.Ithinkthatthelong-termplanistohaveahealthservicethatissobadthatpeopleeithertakeoutprivateinsuranceordie.AndfromtheHSE’spointofviewdeadpatientsdon’tcostthemverymuch.Justthinkofthesavingsthatcouldbemadethen.ThemindsetfromHSEIvoryTowersmustbealongthelinesof‘Wecouldrunawonderfulhealthserviceifwedidn’thaveallthesepatientstotreat’.
Humble pieAndtofinish,abitofdessert.Andfordessert,apieceofhumblepie.Inapreviousarticle,IwasabitharshonthePSI.AndmayIsaythatthisparthasnotbeeninspiredbyanysnapinspectionsthatImayormaynothavehadinmypharmacy.ItookthemtotaskfornotinsistingthatEUpharmacistsregisteringinIrelandhadsufficientcompetenceintheEnglishlanguage.ItwasunfairofmetosingleoutthePSIforthis.TherealityisthateverypharmacyregulatorintheEUdeservesapieceofthisstick.ThecommonthreadisEUDirective2005/36/EC.Thisessentiallysaysthat
allwehavetodoistoshowupwithourCertificateofCompetencyandaLetterofGoodStandingand,heypresto,wecanregisteranywhereintheEU.Someoftheregulatorsmakeitabitmoredifficultbyonlymakingthisinformationavailableintheirlocallanguageontheirwebsites.WhatyoumayaskistheEuropeanCommission’sviewofallthis.TheEU
CommissionerforConsumershassaidthatthisisnotpartoftheirportfolioand,assuch,hasnoopiniononthematter.Ipointedouttothemthatpatientsareconsumerseitherbypayinghealthcareprovidersdirectlyorindirectlyviataxesorinsurancebutthismadenodifferencetothem.AndtheCommissionerforHealthandHealthcareIssues,welltheystillhavenotrepliedtomyemailaftermorethan10weeks,despitereminders.HoweverI’mnotlettingthisrest.Iamlikeaterrierwhohasjustgot
histeethintoajuicybone.I’llnotstopuntilIbitethroughtothemarroworbreakmyteethintheattempt.Solookawaynowifyouhaveaweakstomach.IfyouarestillreadingthenIwillseeyounextmonth.
CouldyouimaginewhatkindofhealthserviceMichaelO’Learywouldrun?“Doyouwantanextrablanketonyourbed?Thatwillbe€10please.youwanttoseeadoctor?Ohandyouwanttotalktohimaswell?€20forthat.
DavidJordanhasworkedincommunitypharmacysince1979,qualifyingasapharmacistin1983.HewaschairpersonoftheCommunityEmployeeCommitteeoftheIPUfrom1990to1998andtreasurerfrom1994to1996.Hismainstressreliefisridinghismotorbikewithhisfriendsfromwww.irishbikerforum.com
HailtothechiefInspiredbythe‘change’ethosofAmerica’sPresident-Elect,David JordanwonderswhocouldbringchangetoIreland’shealthcaresystem.
I
david jordan
Issue11Vol10December200823
goodfriendofmanyyearsandIhadafallingoutafewyearsback.Ifirstmetherin1980atafancydresspartythatsheattendeddressedasapregnantnunanditwasashocktofindthat,unlikethenunappearance,thepregnancywasveryreal.Atbirth,shegavethebabygirlupforadoptionandmovedonintoherchosenprofessionandherlife.yearslater,aroundtheChristmasdinnertableand
followingtoomanyglassesofwine,sheconfessedtoasignificantmentalhealthproblemstemmingfromhergrowingobsessionwithfindingherdaughter.Ibecameirrationallyhostile,castigatedhersorelyandaskedhertothinkcarefullybeforeshefurtherupsetthechildwhowasbynowayoungwoman.Thisencounterdamagedourrelationshipand,missinghercompany,IwonderedwhyIreactedthiswayandwhatIcoulddotomakereparation.Inasmugway,Isuppose,Iwastellingheroffforherchoice;thelabourI
hadinvestedraisingmychildrensoIcouldenjoythesuccessesintheirlives,inmyreasoning,shouldbedeniedhersinceshejustwalkedaway.Myerrorwasmadeclearertomeonlearningtheconclusionofanotherstorythathadgreatlyaffectedmeyearsbefore.
switCHed at BirtHGrowingup,mysisterhadtwoverygoodfriends,DeeandAnna(nottheirrealnames),andsomethinghappenedwhentheywere11yearsold,which,atthetime,becauseIwasnotmucholder,Ididnotfullyunderstand.Theevent,however,wasseismic—somuchsothatAnna’sfamilyreturnedtoItalywheretheyhadcomefromagenerationbeforeandthatseemedtobethat.WhenIwas18Idiscoveredthatthereasonfortheflightwasrumour;
arumourthatDeeandAnnahadbeenaccidentallyswitchedatbirthbyadrunkenmidwifeandthatafrecklydark-hairedCeltwasgrowingupinaswarthyItalianfamilywhereasabronzedblondebeautywas
growingupinaveryordinaryworkingclassIrishfamilyhatedandenviedbysistersandmotheralike.Distancemighthaveresolvedthematterbut,onaninvitedholidaytoRome,mysisterwasshockedtofindthatAnna,nowayoungwoman,wastheimageofDee’sfoursistersbackhomeandyetnothingwassaid.Anna’smother,mysisterfound,wasreclusiveandsufferedseverelyfromdepression.
different worldsDeelefthomeat18andbecameanurseinthenHSworkingforyearsinLondon.Shehadthreechildrenwithaviolentpartnerwhoshefinallyleft;apositivestepthatallowedhertomovefromdestitutionuptoabjectpovertybutslowlyanalcoholproblememergedthatrelapsedasquicklyasitresolved.AnnanevermarriedandranthefamilypropertybusinesssouthofRome,woreArmanianddroveanAlfaRomeosportscar.
a sad storyAnna’smother,Dee’sbiologicalmother,diedinItalyandtheprivatediariesthatshehadkeptforyearsgavesomesmallunderstandingofthepainandmentalanguishshehadsufferedduringherlifeintheknowledgeherdaughterwaselsewhere.ShelovedAnnaofcourseandIwonderedifthiswaswhyshedidnotmakecontactwithDee.Ijustdon’tknow.ShereturnedtoIrelandonlyonceand,duringthatshortstay,shewas
seensittinginthebackpewofourlocalchurchwhenDee’ssisterwasgettingmarried.DeewastobebridesmaidbutwaspregnantinLondonandunabletotravelandthepoorwoman,ondiscoveringthis,wasseenslippingawaybeforetheceremonybegan.ShegenerouslyrememberedDeeinherwillyetI’msureDee,gratefulforthenotinconsiderablereductioninheroverdraft,wouldhavepreferredtohavehadarelationshipwithherbiologicalmotherandperhapslessmentalillness.
sHeer reliefImademyabjectapologiesandmyfrienddidmovethroughthenecessaryformfillingandletterwriting.Herdaughteragreedtomeetherandtheybecamefriends,notgreatfriendsbutfriends,andhermentalhealthimproveddramatically.Myfriend’smother,amatriarchifthereeverwasone,initiallyrefusedtomeethergranddaughterbuteventuallyasshetoogotolderconcededandthenarticulatedthesheerreliefthatthisdecisionhadbrought.
ties tHat BindThetiesthatbindus,thesegeneticbonds,sopowerfultheyarealmostsuffocatingattimes,weignoreatourperilandtothedetrimentofourmentalhealth.Somethingispowerfullyhard-wiredintoourgeneticbeingandcreatesandsustainsthesebonds;ageneticselfishnessthatcanbringgreatjoyyetcancruellytortureforalifetime.Iwouldliketotakethisopportunitytowishaveryhappyandpeaceful
Christmastoyouandtoallyourfamily.
AheartbreakingstoryoftwobabygirlsbecomingswitchedatbirthhasalwaysgreatlyaffectedIrish Pharmacist’s Terry Maguire.
Family and mental health
...DeeandAnnahadbeenaccidentallyswitchedatbirthbyadrunkenmidwifeandthatafrecklydark-hairedCeltwasgrowingupinaswarthyItalianfamilywhereasabronzedblondebeautywasgrowingupinaveryordinaryworkingclassIrishfamilyhatedandenviedbysistersandmotheralike.
A
“
TerryMaguireownstwopharmaciesinBelfast.HeisanhonoraryseniorlecturerattheSchoolofPharmacy,theQueen’sUniversityofBelfast.Hisresearchinterestsincludethecontributionofcommunitypharmacytoimprovingpublichealth.
view from aBove
Terry maGuire
24Issue11Vol10December2008
shorT sTory
TheMagicManPatwasthemagicman.Hehadnoaddress;well,hehadafewbutnonethatwouldlastlongenoughforacomputerfilesotherewasnopoint.Hisscriptsneverhadasurname,justPat.Everythingabouthimwasaverageexcepthisjackets,tiesand
hats.Thetieswerealwaysbatteredandbadlyknottedbutyoucouldseetherainbowinthemsuchweretheircolours,richanddeep.Hisjacketswerealwaysautumnbrown.Hesaiditmadethetiemorevisible,todistracttheaudience.Theyhadalotofpockets,muchmorethanyou’devenimagine.Lastlywashishat.Itwasstraightwithasolidrim.Peopleoftensaiditwasthehatthatkepthimtogether.Initiallyitwasabigproblem.Jackjustdidnotknowhowto
handleamanwhowouldn’tgivehissurname.Whatwashetoputonthelabel?Jackrangthedoctor.‘I’vebeenseeinghimforayearnowandhe’sstilljustPat.Let
meknowifhetellsyou.’JacktriedtoreasonwithPat,butitwasn’thappening.Pat’s
logicwasasfollows:‘Look,today’sTuesday.It’smyfavouritedayandyouseem
likeadecentfellasoI’lltellyou.I’mamagician.youselldrugsandIsellillusion.youselltrust.Peopleneedtotrustyouandsoyou’vegottohaveeverythingcorrect,theinformationandallthat.Well,it’stheoppositeIsell.Thelesspeopleknowortrustmethebetter.Idon’tselltrustorfactorcures.Isellillusionand,forthattosell,thelessyouknowthebetter.Infact,itcouldbesaidthatIsellnothing.‘nowlook,webothknowit’sasimpleprescription.I’vebeen
gettingthemforafewyearsnow.IonceknewaladydowninShannon.Iusedtohaveaboatthere.Anywaysheusedgivemeafewdozenatatimebutshe’sgonenowGodblessherandthat’swhyI’mherewithyou.Thequacksaidtocomehere,thatyou’dlookafterme.Solook,I’lljustaskfortheoneoffyou,nomore.yougivemetheblueinhalerandI’llgiveyouthefiver.youcan’tgetfairerthanthat.’AvoiceinJack’sheadsaid:‘Givemecouragetoknowthe
thingsIcanchange,patiencetoacceptthoseIcan’tandwisdomtoknowthedifference.’OthervoicessaiddifferentbutJackgavehimtheinhaler.Pat
startedlookingforhisfiver.‘It’sheresomewhere,’hesaidashepulledoutcolourfulhandkerchiefs,coins,piecesofpaper,elasticbands,tape,piecesofstring…itjustwenton.Finallyhefoundthefiverandgaveittohim.‘Thatfiver’syoursnow.’Jackhadneverheardthatbeforebutthenotefeltsharpand
fresh.‘Giveitbackhere.Iwanttochecksomething.’Jackgaveitback.Bynowthestaffhadgatheredaround.Pat
tookthenoteandheldituptothelightasifheweresayingMass.Heshookhisheadand,takingoutapairofscissors,cutthefiverintwo.Heheldouteachhandwithaflourishandplacedthetwohalvesonthecounter.‘Hangon,’hesaid.‘Ineedtotestsomething.’Heopenedtheinhalerandinhaledtwopuffs.‘That’sgoodstuff.Justwantedtocheck.nowI’llbegoodto
youtoday.’Hepickedupthetwohalvesofthefiverand,aftergreat
examination,suddenlyflashedhishandsandwithaclapthecleanfiverfloateddownontothecounterandbacktoJack.‘nevergivesomethingbackson.youmightneverseeitagain.
Byenowgirls.’Thiswentonallsummer.Everymonthhe’dgethisinhaler
eachtimewithanewtrick.ThewholeshopwouldstopandcustomersandstaffwouldwatchasPatmadeallsortsofthingsappearfromhishandkerchief.Childrenlovedhim,womenadoredhimand,aboveall,hecheeredeveryoneup.
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Monmouth Pharmaceuticals Limited, Hampshire International Business Park,Chineham, Basingstoke, Hampshire, RG24 8EP, UK. Distributed by: CahillMay Roberts, Pharmapark, Chapelizod, Dublin 20. Further information isavailable from: Shire Pharmaceuticals Limited, Hampshire InternationalBusiness Park, Chineham, Basingstoke, Hampshire, RG24 8EP, UK. Tel: +441256 894000. Date of revision: June 2008. Exputex is a registered trade-mark of Shire US Inc. in Ireland.
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Exputex 145x210 16/10/2008 10:51 Page 1
Issue11Vol10December200825
shorT sTory
TheMagicManOnemorninghegaveJackachoiceofafiverorwhateverthe
handkerchiefcouldproduce.AladyhadafewchildrenwithherandtheiropenfacesdictatedtoJackwhathehadtodo.Thatdayhegotpaidfourpoundcoins.Pathadthiswayabouthimthat,eventhoughyouknewyou
werebeingrobbed,youstillfeltthatyou’dgotsomething.He’ddrawyouinandyouwouldn’tevenknowit.EverybodywantedtoknowhowthetrickworkedbutPatwouldn’ttell.‘IfItellyouJack,youwon’twanttoknow.It’slikewonderingif
someonelovesyou.Onceyouknowitcan’tgetbetter.Iwilldosomethingforyouthough.Let’sputthemshinycoinsbackintothehandkerchiefandseewhatcomesout.’Againthechildren’sfacesgavetheanswer.Thewhitecloth
swallowedthemoneyandpaidbackthreelollipopsforthekidsandaduck’seggforJack.‘IthoughtItoldyoutonevergivesomethingback.Doyou
everlisten?’That’swhenJacknoticedhe’ddonethetrickoverthelollipopjar.Oncehecameinwithabadchestandaroughmood.He
handedJackatabletjarwithasinglepenicillincapsuleinit.‘Giveusafewofthose,wouldyou?It’sterriblethatIamtoday.
Andtomorrow’saTuesday.PleaseJack,don’tleavemebadonmyTuesdays.I’llpayallyouwant.’Jackknewhisdoctorcouldbe‘particular’andaskedPattosee
him.‘Ohnowdon’tmakemedothat.I’veonlyenoughonmeto
payyourself.Andtomorrow’saTuesday.PleaseJack,don’tleavemebadonmyTuesdays.Ohandlistencanyougivemeanotheroneofthoseblueyolks.It’sjustthatmychestisinbits.IleftthelastonedowninShannon.’Jackrangthedoctorwholaughed.‘Givethemtohimandwhateverelsehewants.Givethatto
himtoo.Surewhat’sthepointinmeseeinghim.He’lljusttellmewhattowriteandhowTuesdayishisfavouritedayandallhismoneyisspentonsomeboatinShannon.LasttimeIgotpaidaduckegg.Tellhimitwasgoneoff.’Thefollowingmonth,lateDecember,oneofthegirlshada
brainwave.WhenshegavethescripttoJackinthedispensaryshehadwritten‘themagicman’inbracketsbesidehisnameandthat’showithappened.Patfinallygotenteredinthecomputer.Thebaglabelsaid‘PatTheMagicMan.Address:Shannon.’Jackhadneverseenamagicianlaughbefore.Patreadthe
labeloverandover,eachtimetakingsmallstepsthatstoppedwithagiggleandahalfturn.Thenhebeckonedoneofthegirlsandwhisperedinherear.Sheblushedandnoddedandwentintothedispensary.Atthatmoment,someTravellerkidscameinshouting.
normallythey’dbreakyourheartandthatwasputtingitkindlybutforthefollowing10minutesallwassilentasPatgaveamagicshowyoucouldonlydreamof.ThegirlcamebackfromthedispensaryandhandedPatthe
bag.Hewrotesomethingonapieceofpaperandgaveittoher.Sheblushedmorebutseemedhappy.AfterwardsJackfoundoutthathejustwantedmoreofthose
labelsprintedwithhisnameandnewlyadoptedsurname.Shegavehimawholelabelroll.Patbecameoneofthosefavouritecustomersforwhomyou
wouldbendorbreakorignorejustabouteverydispensingruleeverinvented.Andthebestpartwasyouneverfeltbadaboutit.Hejust
cheeredyouup.
Julian Judge qualified as a pharmacist in 1990. He was recently accepted for a Masters in Creative Writing at the Department of English, UCD.
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26Issue11Vol10December2008
The law
henIrecentlypointedouttoagroupofundergraduatepharmacystudentsthattheresearchanddevelopmenteffortsofthecompaniestheyhopedtojoinwererankedonlyasasecondarypriority,thestudentsweresurprised.Ipointedoutthatthislogicmeantthatmakingaprofitcomesfirst,whilemakingeffortstofindnewmedicalcuresfordiseasescomessecondto
achievingshareholdercapitalgrowth.Irememberasanaccountancystudentlearningofthisrealityand
askingifthiswasregulated.Ialsowonderedifcompaniesdecidednottopursueresearchintonewtechnologiesforcost-savingreasonswhatwouldhappen?
all-time lowOverthepastdecade,therateofnewdiscoveriesinpharmaceuticalresearchhasfallendramaticallytoanall-timelow.notsincebeforetheindustrialrevolutionhastechnological,scientificandmedicalbreakthroughsbeenatsuchalowrateofdiscovery.Althoughthenumberofnewpatentsbeingtakenoutisquitehigh,thediscoveriespatentedarenotgroundbreakingandtendtobenomorethanminorimprovementstoveryoldwaysofdoingthings.Whenapharmaceuticalresearchcompanyspendsmoney,itmustbe
categorisedaseitheranexpenseorasthepurchaseofanasset.Ifitiscategorisedasanexpense,itisincludedintheprofitandlossaccountandservestoreducetheprofitfigurebeingreportedfortheperiod.Thisresultsintheprimaryobjectiveofacompany,tomakeaprofit,beingoffended.Alternativelyifitistobecategorisedasanasset,itwillnotreducetheprofitfiguresimmediately.Insteaditisincludedinthebalancesheetandappearsasanasset.Accountantsandtheboardofdirectorsofdrugcompaniesarekeenlyawareofthisaccountancyrulewhichtheymustcomplywithandwillendeavourtousethisruletotheiradvantage.Iftheycansuccessfullyarguethattheexpenditureiscreatingasasset,suchasanewbuilding,theauditorswillallowittobeincludedinthebalancesheetandthedirectorswillenjoythepositiveeffectontheannualprofitfigure.
tangiBle and intangiBle assetsItisinterestingtonotethattherearetwotypesofassets,tangibleandintangible.Tangibleassetsarebuildings,machinesandeverythingelsewhichcanbeseenwiththeeye.Intangibleassetsincludebrands,intellectualpropertyandanythingelsewhichcanbesoldoffbutwhichdoesnothaveaphysicalreality.Increasinglythisisbecomingimportanttotechnologycompanies.Ifthe
directorscanarguethatthemoneywhichtheyarespendingiscreatinganintangibleasset,suchasanewandvaluablewayofperformingaprocessortreatingadisease,theexpenditurecanbeaccountedforasanassetandthiswillhavetheimmediateeffectofincreasingthevalueofthecompanyandtheshareprice.
finanCial sUffoCationThemostimportantruleofallinthisareaofaccountancyisthatexpenditureonpureresearchmustbeincludedintheprofitandlossaccountasanexpense.Expenditureonpureresearchcannotbeincludedtocreateanintangibleasset.Thethinkingbehindthisisthatmostexpenditureonpureresearchresultsinveryfewgenuinediscoveries.Thereforethemoneyaccordingtosomeshareholdersandmanyaccountantshasbeenwastedandmustbewrittenoffimmediately.Thisaccountancyrulehasbeenresponsiblefortheongoingsuffocation
offinancingofpureresearchglobally.Boardsofdirectorsofmanycompaniesinvolvedwithpharmaceuticalresearchhavebeenmuchmorewillingtoprovidefinancefordevelopmentexpenditurebecausethe
discoveryhasalreadybeenmadeandnowneedsonlytobedevelopedalittlebeforewindfallprofitsarerealised.Thereforetheinvestmentriskissubstantiallyreduced.Theaccountingrulesallowexpenditureondevelopmenttobecapitalisedandincludedasanassetonthebalancesheetinsteadofasanexpenseontheprofitandlossaccount.Inanutshell,expenditureondevelopmentmakesthecompanylook
goodimmediately,whileexpenditureonpureresearchmakesthecompanylookbadinfinancialterms,untilsuchtimeasagenuineworld-classbreakthroughisreached.
investment famineInaworldwhereshareholderswantresultsintheshortterm(withinthreemonths)andresearchoperatesoverdecades,theeffecthasbeenafinancialfamineforprojectsfocusedonpureresearch.Thisproblemhasbecomeworseoverthepast15years.Thishasresultedinsuchadramaticreductioninnewmedicaltreatmentscomingtothemarketthatinvestorshaveveryfewthingslefttoinvestinwhichofferanyreasonabledegreeofcapitalgrowth.Theyhavecollectivelybecomevictimsoftheirownsuccess.
opportUnity for irelandThiscrisisprovidesIrelandwithanopportunity.Ifwe,asanation,properlyledbyourgovernmentandacademicinstitutionsalongwithcommercialenterprises,seizethedaybyinvestinginpureresearch,thehugeriskinvolvedwouldresultinhugegainsbeingachieved.Weknowthiswithactuarialcertainty.Theworld’sneedfortechnologicaldevelopmentacrossawiderangeofareasincludingfoodproduction,transport,energy,medicine,educationandITisatanall-timehigh.Theexistingmethodsandpracticesinmostindustrieshavebeenpushedtothelimitsoftheircapabilitiesandnowgenuinedevelopmentisneeded.Theworldneedsinventionsatthelevelofthewheel,themicrochip
andpenicillin,yetpharmacistswhostumbleuponsuchground-breakingdiscoveriesareoftenmetwithafrostyreceptionbycompanieswhoprioritiseshort-termsharepricesabovelong-termdevelopment.Onlyachangeinculturewillovercomethishugehindrancetohumandevelopment.Atrulyentrepreneurialculturewillhavetobedevelopedforourcollectivegood.Itisnowmoreimportantthaneverforpeoplewithascienceor
technologybackgroundtofamiliarisethemselveswiththeserulesbecausetheyaregoingtobecomeoneoftheplanksuponwhichourfutureeconomicperformanceasanationwilldepend.
Happy pHarmaCistsTheworldrequiresleadershipinthisarea.Thedilemmaofshort-termshareholdervalueversuslong-termscientificachievementintheareaofpharmaceuticalresearchwillhavetobeaddressedsuccessfully.Thisproblemisnowofsuchimportancethat,tomymind,whoeversolvesitisworthyofanobelPrize.Solvingthisfundingproblemonaglobalbasiswillresultinaflowofnewdiscoveriescuringdiseasesandsavinglivesonascalewedonotpossesstoday.Thiswillleadtohappypharmacists,happyshareholders,happy
customers,happyaccountants,ahappiereconomyandahappiersociety.Theunansweredquestioniswhetheritwillbepharmacistswhoeventuallyleadtheworldortheaccountants?Inotherwords,willitbetheeggheadsorthebeancounterswhohavetheanswer?
Eggheadsversusbeancounters
Cormac O’Neillontheongoingbattlebetweenprofitandresearch
cormac o’neill
CormacO’neillisabarristerpractisingontheDublinandSouthWesterncircuits.Heisalsoacharteredaccountantwithconsiderableexperienceinindustryandbanking.Inaddition,CormaclecturesonBusinessandLawintheInstituteofTechnologyinTraleeandcanbecontactedon0876571124.
W
Issue11Vol10December200827
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uringtheyear,Iwasinvitedtopresenttonumerousbusinessownersthroughoutthecountry.Atarecentevent,Iwasaskedtofollowapresentationbyabusinessconsultantwhotalkedaboutpreparingabusinessforsale.Interestingpresentationandahardacttofollow,especiallywhenyouarebeingaskedtospeakoninvestmentstrategiesrightnow!
However,tomymind,therewasaflawintheessenceofhispresentation.Thespeakercasuallymadethepointthatvirtuallyallbusinesseshaveseenareductionintheirvaluesasaresultofthecurrentcreditcrunchandthatthisislikelytobesustainedasbankschangetheirlendingmodelandlookforgreateramountsofequitytobeputupbypotentialbuyers.Theflawinthisstatementisnotrecognisingthefactthat,fartoooften,businessownersseetheirbusinessastheirpensioninthebeliefthat,iftheykeepdoingwhattheydo,theywillcontinuetogrowthebusinessandeventuallysellitandretire.
redUCed wealtHIwilluseyourownindustryasanexampleandlookathow,inashortspaceoftime,industrychangeshavesignificantlyreducedthevaluesthatpharmacieswouldhavesoldforintherecentpast.Therealityiswhileyouhavebeenbusilygrowingyourbusiness,yourwealthhasbeenreducedthroughderegulationandtheongoingdisputewiththeHSEandnotthroughanyfaultofyourown.Wherepreviouslythevalueofapharmacycouldbecalculatedasa
multipleofturnover,itappears(fornow)thatthisformulacannolongerbeapplied.ThoughIacceptthatyourbusinessesmayrevertbacktothehighervaluesintime,Itendtothinkthatfinancialfreedomwillhavetobeachievedbymoreplannedmeansthanthesaleofabusiness.
How do we CHange tHis approaCH?Theansweristhatyouneedtolookatallthewaysinwhichyoumaydiversifyyourdependenceonthefuturevalueofyourbusiness.WhenIworkwithbusinessowners,thedebateinvariablycomesaroundtoputtingavalueonthebusinesstodaythatrepresentswhattheclientbelieveshewouldacceptforthebusiness.Iappreciatethatthisisaverysubjectiveapproachandthattherearemorescientificmethodsforcalculatingthevalueofabusiness.However,thisexerciseisnotnecessarilyaboutanabsolutevaluebut
moreaboutgettingclientstorecognisethat,whiletheyspendmostoftheirtimeworkinginthebusiness,theymayneglecttheriskassociatedwiththebusinessbeingtheirmainfinancialassetforthefuture.Theideaistopromptathoughtprocessabouthowtocreatesufficientindependentwealthshouldtheyeitherdecidetopassthebusinessontofamilymembersorfindthattheycannotsellthebusinessandareunabletomaintaintheirdesiredlifestyle.
taxing timesRightnow,weareinthemiddleofthe‘taxseason’.Thisisthe(only)timeofyearwhenbusinessownersthinkaboutusingtaxrelieftoavoidtaxationandcreateindependentwealth.Sowhileyoumaybeconsideringfollowingthenormsofinvestinginyourpension,youshouldalsobeconsideringalternativestructuresthatputyouinchargeofhowandwhatyouinvestin.In2007,FinancialEngineeringraised€13minBusinessExpansionScheme
(BES)fundsfollowingthechangesannouncedinthe2006budget,whichmadeusthelargestfundraiserofBES.Itwasnotourintentiontoraisethisamountofmoneywhenwebegantotalktoclientsaboutthisinvestmentproposition.Butthemoreclientswespoketo,themoredemandwefoundinthismarketfortherighttypeofinvestment.Whatismoreinterestingisthatmorethanhalfoftheinvestorswerebusinessownerslookingtousecompanyprofitstoinvestinotherprivateenterprisesinatax-efficientmanner.
Bes – an attraCtive tax-Based inCentiveBusinessexpansionschemesarenotanewconcept.Thegovernment-basedincentivewasfirstintroducedin1984,andtheideawastostimulateprivateinvestorstoinvestinprivatecompaniesandaidindigenousemploymentgrowthintheSMEsector.Thereareobviousparallelstothecurrentheadlinesweareseeing,butthankfullyweareinaverydifferenttimeand,asaconsequence,BESinnowinaverydifferentpropositionthanitwasinthepast.Inthepast,BEShadhadapoorhistoryofactuallydeliveringreturnsto
investorsbutwiththechangesintheinvestmentamountsthisneedstochange.WhatmakesBESanattractivetax-basedincentiveisthatthetaxreliefisallowableagainstalltypesofincome.Althoughneverforget-unlesstheinvestmentmakessense,thetaxbreakisirrelevant.Thisisalessonwelllearnedfromsomeoftheexistingproperty-basedtaxincentiveschemes.
proper adviCeInthesechangedeconomictimes,thereisnotonlyanoveralleconomicperspectivebut,especiallyfromwithinyourownindustry,aneedtoreallyfocusonhowyouaregoingtocontinuetoreducetheriskofbeingdependentonyouownbusinessintothefuture.Ensurethatyouareproperlyadvisedonallofthewaysthatcanallowthistohappentaxefficientlyandgetproperresearchmaterialonwhatmakesaninvestmentgoodorreallygood.Itismyadvicetousethetaxseasonasarealopportunitytoenhanceyour
personalwealth.
’Tis the (tax) season to be jollyThetaxseasonisarealopportunitytoenhanceyourpersonalwealthwritesIrish Pharmacist’sfinancialexpertIain Cahill
In2007,FinancialEngineeringraised€13minBusinessExpansionScheme(BES)fundsfollowingthechangesannouncedinthe2006budget,whichmadeusthelargestfundraiserofBES.
“
IainCahillACCAMBAQFA,Director,FinancialEngineering,32UpperFitzwillamStreet,Dublin2.Tel.+35316148000;directfax+35316148080;email:[email protected];web:www.fen.ie
ia in cahill
D
A stitch in time...
Abbreviated Prescribing Information: For full prescribing information refer tothe Summary of Product Characteristics. Name: Ebixa Active Substance:Memantine Hydrochloride. Indication: Treatment of patients with moderateto severeAlzheimer’s disease.Dosage&Administration:Treatment should beinitiated and supervised by a physician experienced in the diagnosis andtreatment of Alzheimer’s dementia. Therapy should only be started if acaregiver is available who will regularly monitor the intake of the medicinalproduct by thepatient. Treatment is orally either as tablets (10mg) or solution(10 mg/g) taken with or without food at the same time every day.Maintenance dose is 20mg/day, (two tablets or 40 drops once a day).Treatment starts with 5mg/day (half a tablet or 10 drops once a day) for thefirstweek; the 2ndweek10mg/day (one tablet or 20drops once a day); the 3rdweek 15mg/day (one and a half tablets or 30 drops once a day) and the 4thweek 20mg/day (two tablets or 40 drops once a day). Moderate renalimpairment 10mg/day (one tablet or 20 drops once a day), if well toleratedafter 7 days the dose can be titrated up to 20mg/day (two tablets or 40 dropsonce a day). Severe renal impairment- dose is 10 mg/day. Mild-moderatehepatic impairment- no dose adjustment. Severe hepatic impairment- nodata available. Children & Adolescents: Not recommended.Contraindications: Hypersensitivity to the active substance or any of theexcipients. Pregnancy and Lactation: Pregnancy: Memantine should not beused in pregnant women unless clearly necessary. Lactation: Memantine
should not be used in women who are breastfeeding. SpecialWarnings andPrecautions for use: Caution is recommended in patients with epilepsy.Caution is advised in patients with raised urine pH as this may elevate plasmalevels. Clinical trial data are limited on patients with myocardial infarction,uncompensated congestive heart failure and uncontrolled hypertension andpatients with these conditions should be closely supervised. Avoidconcomitant use of NMDA antagonists (see also interactions). Patients withsugar intolerance should not take Ebixa. Patients should be warned to takespecial care if driving and using machines as Ebixa has minor to moderateinfluence on these tasks. Interactions: Effects of L-Dopa, dopaminergicagonists and anticholinergics may be enhanced. Effects of barbiturates andneuroleptics may be reduced. Effect of concomitant treatment withantispasmodic agents e.g. dantrolene and baclofen may be modified. Plasmalevels of cimetidine, ranitidine, procainamide, quinidine, quinine and nicotinemay be increased. Co-administration with hydrochlorothiazide (HCT) maylead to a reduced serum level of HCT. Concomitant use of NMDA antagonist-amantadine, ketamine, dextromethorphan or phenytoin should be avoided.Close monitoring of prothrombin time or INR is advisable for patients treatedconcomitantly with oral anticoagulants. Adverse reactions: Common(>1/100 and <1/10) headache, somnolence, hypertension, constipation anddizziness. Uncommon reactions (>1/1000 and <1/100): fatigue, fungalinfections, confusion, hallucinations (mainly in severe Alzheimer’s disease),
venous thrombosis/thromboembolism, vomiting, gait abnormal. Very rare(<1/10,000): seizures.Not known: Isolated cases of pancreatitis and psychoticreactions have been reported post-marketing. Alzheimer’s disease has beenassociated with depression, suicidal ideation and suicide. In post-marketingexperience these events have been reported in patients treated withmemantine. Overdose: Symptomatic treatment. Elimination: Mainly inunchanged form via the kidneys. Legal Category: POM. MarketingAuthorisationHolder:H.LundbeckA/S,9Ottiliavej,DK-2500,Valby,Denmark.Marketing Authorisation Numbers: EU/1/02/219/005 Ebixa 10mg/g Oraldrops solution-50g bottle. EU/1/02/219/006 Ebixa 10mg/g Oral dropssolution-100g bottle. EU/1/02/219/007 Ebixa Tablets 10mg, 28 pack size.EU/1/02/219/008 Ebixa Tablets 10mg, 56 pack size. Further information maybe obtained from: Lundbeck (Ireland) Ltd., 7 Riverwalk, Citywest BusinessCampus, Citywest, Dublin 24. References:1. Ebixa Summary of ProductCharacteristics 2. Claxton et al. Clin Ther. 2001; 23:1296-1310 3. Shi et a.Exp Rev of Pharm Res. 2007;7: 187-2002 4.Wilkinson et al. Dement GeriatrCogn Disord. 2007;24(2) 138-145 Date of Preparation: May 2008.References: 1. Ebixa Summary of Product Characteristics 2. Claxon et al.Clin Ther. 2001;23:1296-1310 3. hi et al. Exp Rev of Pharm Res.2007;7:187-2002 4.Wilkinson et al. Dement Geriatr Cogn Disord. 2007;24(2) 138-145
Continuous treatment for Alzheimer’sDisease from the moderate stage onwards1
Ebixa: Now Once Daily1
Easier Administration = Convenience + Compliance Benefits 2,3
Ebixa: Stabilises symptoms of AD*. Fewer Ebixa
treated patients worsened versus placebo 4
*Moderate AD onwards
2/EB/05/08
05144 Ebixa with Refs245x340:Layout 1 08/08/2008 12:25 Page 1
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nestimated37millionpeoplearoundtheworldarelivingwithdementia,withAlzheimer’sdisease(AD)accountingforthemajorityofcases.1InIreland,itisestimatedthattherearecurrentlymorethan40,000peoplewithdementia.Thisfigureisexpectedtoincreaseto104,000by2037.Itisexpectedthat4,000newcaseswillbediagnosedthisyearalone.2
Therearemorethandozensofcausesofdementiabut,inthiscountry,ADisthemostcommoncause,accountingformorethan50percentofallcases.2
Atpresent,about5percentofIrishmenand6percentofIrishwomenovertheageof60yearsaresufferingwithAD.1
pHarmaCists’ ContriBUtionPharmacistscanplayacriticalroleinboththediagnosisandmanagementofAD.ManyindividualswithAlzheimer’slivenormalproductiveliveswithinthecommunity,particularlyearlyinthedisease.Forpatientsinlong-termresidentialcarefacilities,theearlysignsofAlzheimer’sareusuallyfirstdetectedbynursingormedicalstaff.However,amongcommunity-dwellingpeople,thecommunitypharmacistmaybethefirsttonoticesignsofmemorylossandthereforeageneralknowledgeofthesymptomsofAlzheimer’sanddementiaiswarranted.Thepharmacistmayalsobeinapositiontoprovidevaluableinformation
toassistinthedifferentialdiagnosisofthecondition.Alzheimer’sistheprimarycauseofdementiabutitisnottheonlycause.Medicationscancontributetothedevelopmentofdementiainasubstantialnumberofcases.Commonlyuseddrugs,suchasanti-epileptics,antihistamines,anti-diarrhoealagents,coldandflumedications,lithiumandtricyclicantidepressantsincludedementiaasapossiblesideeffect.Furthermore,druginteractionsmayexacerbatetheproblem.Inolder
people,polypharmacyiscommonandmedicationsareoftenprescribedbyseveraldifferentdoctors.Thepharmacistmaybethefirsttospotapatient’sdrugregimeasthepossiblecausefortheirdementiasymptoms.Withtheincreasinguseofover-the-counterandcomplimentarypreparations,thepharmacistmaybetheonlyhealthcareprofessionalwhoisfullyawareofthepatient’sdrugusage.OnceapatientisdiagnosedwithADandtherapyisinitiated,pharmacists
canbecrucialtoensuretheefficacyandsafetyoftreatment.Pharmacistinputhasbeenshowntohaveabeneficialeffectonthemanagementof
Alzheimer’spatients.Inapilotstudyofapharmacist-basedconsultingserviceforthe
pharmacologicalmanagementofbehaviouralandpsychologicalsymptomsofdementia,thevastmajorityofpatientswerefoundtohavereceivedefficientandsuccessfultreatmentfromtheconsultingpharmacistwithnoincidenceofadverseevents.Bothnursinghomestaffandprimarycareprovidersratedtheserviceasasuccess.3
SoitisobviousthattherearesignificantbenefitstobehadwhenpharmacistsareawareofthesymptomsandtreatmentofAD.
definition of dementiaDementiaisdefinedasthelossofthementalprocessingabilityincludingcommunication,abstractthinking,judgementandphysicalabilities,suchthatitinterfereswithdailyliving.Symptomsofdementiaincludeshort-termandlong-termmemoryloss,reducedmotivation,forgetfulness,personalityandmoodchanges,anddisorientation.Thecausesofdementiaarenumerousandincludestroke,Huntington’s
disease,Parkinson’sdisease,braintumours,metabolicdisorders,alcoholandsubstanceabuse,medicationsandinfections.However,Alzheimer’sdiseaseisthemostcommoncause,particularlyinthoseover65yearsofage.
risk faCtorsTheexactcauseofAlzheimer’sisnotknownbuttheconditionisassociatedwithanumberofriskfactors.Advancingageisthesinglemostimportantriskfactor.Alzheimer’scanoccurinyoungerpatients,butitismostcommonaftertheageof65years.TheprevalenceofADdoublesapproximatelyeveryfiveyearsbetweentheagesof65and95years.Inthe65to69yearagegroup,theprevalenceisestimatedatapproximately2percentbutinthoseover85years,prevalencerisestomorethan35percent.4
Thesecondmostimportantriskfactorisapositivefamilyhistory.Individualswithafirst-degreerelativewithADareuptofourtimesmorelikelytodevelopAD.Threegeneshavealreadybeenimplicatedinthedevelopmentofearly
onsetAD,whichgenerallypresentsbetween40and60years.Oneofthesegenesiscarriedonchromosome21,whichexplainswhymostpeoplewithDown’ssyndrome(whichischaracterisedbyanextrachromosome21)presentwiththeneurologicalfeaturesofADasyoungas40years.Women
With4,000newcasesofAlzheimer’sdiseaseexpectedthisyearinIreland,theroleofthepharmacistinbothdiagnosisandmanagementcouldn’tbemorecritical.Dawn O’ Sheareports.
A
Alzheimer’s disease in Ireland – a growing problem
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arealsothoughttobeatincreasedriskofAlzheimer’sbutthismaybelinkedtothefactthatwomentendtolivelongerthanmen.Otherfactorswhichhavebeenhypothesisedtoincreasetheriskof
Alzheimer’sincludebraininjury,certaininfections,aluminiumbuild-up,autoimmunedisorders,thyroiddisease,lowereducationallevelandadvancedageofmotheratbirth.
making a diagnosisUnfortunately,theonlysurewayofdiagnosingADisbyexaminingthebraintissueafterdeath.Consequently,amedicaldiagnosisofAlzheimer’sinalivingpatientiseither‘probable’or‘possible’.PossibleAlzheimer’sindicatesthatwhilethepatient’ssymptomsmaybecausedbyAD,alternativecausescouldnotberuledout.ProbableAlzheimer’sindicatesthatallotheralternativeshavebeendiscounted.Classically,Alzheimer’sismarkedbyaninsidiousonsetandprogressive
declineincognitivefunction.Diagnosisisinitiallybasedonsymptoms.Memorylossiscommonlythepresentingcomplaint.Generallythiswillbe-ginwithshort-termmemoryloss,manifestedbydifficultyinrecallingnewinformationandthepatientmayaskthesamequestionrepeatedly.Laterinthediseaseprocess,long-termmemorylosswillappear.Disorientationwithregardtotimeandplaceiscommon.Languageimpairmentisalsoaprominentfeature,althoughitmaynot
bepresentattheearlystages.Inadditiontocognitivedecline,behaviouralandpsychiatricsymptomsarefrequentinAD.Patientscanexperiencedepression,psychosis,paranoiddelusions,agitationandsleepdisturbances.nolaboratorytestsorimagingtechniquesexistthatcandiagnoseAD,
butthesediagnostictoolsareusedtoruleoutalternativecausesforthememorylossandothersymptoms.
treatmentAsofyetnocureforAlzheimer’sexists,althoughtherapiesareavailabletotreatthesymptomsandslowdiseaseprogression.ThemostsuccessfulADtreatmentstodatearetheacetylcholinesteraseinhibitors,whichreducethemetabolismofacetylcholine,therebyattenuatingthedeficiencyseeninAD.Treatmentwithacetylcholinesteraseinhibitorshasbeenshowntoimprovecognition,behaviour,functioningandactivitiesofdailyliving.Themainadverseeffectsaregastrointestinalandincludenausea,vomiting,diarrhoea,lossofappetiteandweightloss.Theseagentsarebesttakenonafullstomach.Asaclass,theacetylcholinesteraseinhibitorsarerecommendedformild-to-moderateAD.Memantineisann-methyl-D-aspartate(nMDA)receptorantagonist.It
istheonlytreatmentforADinitsclass(nMDAreceptoratagonist)anditalsohasaneffectonfunctionlikethechollinergicinhibitors.Ithasbeenshowntohaveabeneficialeffectoncognition,behaviourandactivitiesofdailylife.Itisgenerallylimitedtopatientswithmoderatediseasetoseveresymptomsandcanbeusedincombinationwithacetylcholinesteraseinhibitors.Adverseeffectscanincludehallucinations,confusion,dizzinessandheadache.BehaviouralandpsychologicalsymptomsareamajorfactorinAD.
Agitationmaybeprecipitatedbyinfection,dehydrationormedications,
sosuchpossiblecausesshouldberuledoutbeforeinitiatingmedications.Ifnoobviouscausecanbefound,antipsychotics,mood-stabilisinganti-epileptics,anxiolyticsandtrazodonecanbeused.Atypicalantipsychoticsarethetreatmentofchoiceforpsychotic
symptomsalthoughananalysisof17placebo-controlledtrialsfoundanincreasedmortalityratewhenthesedrugswereusedonelderlypatientswithdementiasotheseshouldbeusedwithcaution.5
Depressivesymptomscanbetreatedwithselectiveserotoninreuptakeinhibitors,combinednoradrenergicandserotonergicreuptakeinhibitorsoroneofthetricyclicantidepressantsthathavelowanticholinergiceffects.BenzodiazepinesshouldbeavoidedinADpatientsbecauseoftheirnegativeeffectsoncognition.non-benzodiazepineanxiolyticsshouldbeusedinsteadtotreatanxietyifrequired.AnticholinergichypnoticsshouldnotbeusedtotreatinsomniainAD
patients.non-pharmacologicalmeasuresshouldbeemployedfirst.Ifthisapproachisnotsuccessful,sedatingantidepressantsmaybebeneficial.5
non-pharmacologicalmeasuresshouldnotbeoverlooked.Patientidentificationbraceletsmaybebeneficialinpatientswhotendtowander.Basichomesafetymeasuressuchaslocksoncabinetsandovens,unpluggingdangerousdevicesandinstallingcomplexdoorlocksandanin-housealarmsystemcanbeinvaluable.PatientswithADoftenrequirecarefulmonitoringandasubstantiallevel
ofcarewhichisusuallyprovidedbyafamilymember.WhenassistinginthetreatmentofanADpatient,itisimportanttobeattentivetotheneedsofthecareralso.Fatigueanddepressioncandevelopeasilyincarers,particularlywhendealingwithapatientwithadvanceddisease.Oftensimplyenquiringaboutthecaregiver’swell-beingcanhaveapositiveeffect.ThecaregiverisoftenthepersonwhowillvisitthepharmacycountertorefillprescriptionsfortheADpatientandthiswillpresentauniqueopportunitytoinformthecareraboutsupportservicesthatmaybeavailableinthelocalarea.
sUmmaryAsthemostcommoncauseofdementiainthiscountry,Alzheimer’sdiseasehassubstantiallyhumanandfinancialcosts.Forthemoment,itremainsanincurableconditionalthoughtherapiesareavailabletotreatthesymptomsandslowthecognitivedeclinewhichisthehallmarkofthedisease.Equippedwiththerightinformation,communityandhospitalpharmacistscanplayaroleinidentifyingADpatientsandinmonitoringtheefficacyandsafetyoftreatment.
References1. Alzheimer’sDisease.MentalHealth.WorldHealthOrganization.http://
www.afro.who.int/mentalhealth/related_diseases/alzheimer_disease.htmlAccessednov2008.
2. FactsaboutDementia.TheAlzheimer’sSocietyofIreland.http://www.alzheimer.ie/eng/Media-Centre/Facts-About-Dementia.Accessednov2008.
3. Rojas-FernandezCH,EngM,AllienD.Pharmacologicmanagementbyclinicalpharmacistsofbehaviouralandpsychologicalsymptomsofdementiainnursinghomeresidents:Resultsfromapilotstudy.Pharmacotherapy2003;23(2):217-21.
4. GaoS,HendrieHC,HakkKSetal.Therelationshipbetweenage,sexandtheincidenceofdementiaandAlzheimer’sdisease:ameta-analysis.ArchGenPsychiatry1998;55:809-15.
5. yaariR,Corey-BloomJ.Alzheimer’sdisease.Seminalneurol2007;27(1):32-41.
Memorylossiscommonlythepresentingcomplaint.Generallythiswillbeginwithshort-termmemoryloss,manifestedbydifficultyinrecallingnewinformationandthepatientmayaskthesamequestionrepeatedly.
“
ABBREVIATED PRESCRIBING INFORMATION. Donesyn 5 and 10 mg film-coated tablets. Presentation: The 5 mg tablet is a white, round, film-coated tablet with D9EI on one side and 5 on the reverse. The 10 mg tablet is a yellow, round, film-coated tablet with D9EI on one side and 10 on the reverse. Indications: Symptomatic treatment of mild to moderately severe Alzheimer’s dementia. Dosage: Adults/elderly: Treatment is initiated at 5 mg/day (once-a-day dosing). Donesyn should be taken in the evening just prior to retiring. The 5 mg/day dose should be maintained for at least one month. Following a one-month clinical assessment of treatment at 5 mg/day, the dose can be increased to 10 mg/day (once-a-day dosing). The maximum recommended daily dose is 10 mg. Treatment should be initiated and supervised by a physician experienced in the diagnosis and treatment of Alzheimer’s dementia. Diagnosis should only be made according to accepted guidelines (e.g. DSM IV, ICD 10). Therapy should only be started if a caregiver is available who will regularly monitor medicinal product intake for the patient. Maintenance treatment can be continued for as long as a therapeutic benefit for the patient exists. Therefore the clinical benefit of Donesyn should be reassessed on a regular basis. Discontinuation should be considered when evidence of a therapeutic effect is no longer present. Individual response to donepezil cannot be predicted. Upon discontinuation of treatment, a gradual abatement of the beneficial effects of donepezil is seen. Renal and hepatic impairment: A similar dose schedule can be followed for patients with renal impairment. Due to possible increased exposure in mild to moderate hepatic impairment, dose escalation should be performed according to individual tolerability. There are no data for patients with severe hepatic impairment. Children and adolescents: Not recommended. Contraindications: Hypersensitivity to donepezil hydrochloride, piperidine derivatives or to any of the excipients. Warnings and precautions: Use of donepezil in patients with severe Alzheimer’s dementia, other types of dementia or other types of memory impairment has not been investigated. Donepezil, as a cholinesterase inhibitor, is likely to exaggerate succinylcholine-type muscle relaxation during anaesthesia. Because of their pharmacological action, cholinesterase inhibitors may have vagotonic effects on heart rate (e.g. bradycardia). This may be particularly important to patients with ‘sick sinus syndrome’ or other supraventricular cardiac conduction conditions, such as sinoatrial or atrioventricular block. There have been reports of syncope and seizures. The possibility of heart block or long sinusal pauses should be considered. Patients at increased risk for developing ulcers should be monitored for symptoms. However, the clinical studies with donepezil showed no increase, relative to placebo, in the incidence of peptic ulcer disease or gastrointestinal bleeding. Cholinomimetics may cause bladder outflow obstruction. Cholinomimetics are believed to have some potential to cause generalised convulsions. However, seizure activity may also be a manifestation of Alzheimer’s disease. Cholinomimetics may have the potential to exacerbate or induce extrapyramidal symptoms. Cholinesterase inhibitors should be prescribed with care to patients with a history of asthma or obstructive pulmonary disease. The administration of donepezil with other acetylcholinesterase inhibitors, agonists or antagonists of the cholinergic system should be avoided. Donesyn contains lactose. Interactions: CYP3A4 inhibitors such as ketoconazole, itraconazole, erythromycin and CYP2D6 inhibitors such as quinidine, fluoxetine. Rifampicin, phenytoin, carbamazepine, alcohol. Medications with anticholinergic activity, succinylcholine, other neuro-muscular blocking agents, cholinergic agonists, beta blocking agents. Undesirable effects: Most common: Diarrhoea, nausea, vomiting, abdominal disturbance, muscle cramps, fatigue, insomnia, headache, syncope, dizziness, urinary incontinence, rash, pruritis, anorexia, common cold, accident, pain, hallucinations, agitation, aggressive behaviour. For other undesirable effects see Summary of Product Characteristics. Pack size: 28 tablets. Marketing authorisation holder: Clonmel Healthcare Ltd, Clonmel, Co. Tipperary. Marketing authorisation numbers: PA 126/183/1-2. Full prescribing information is available on request. Please go to www.clonmel-health.ie or contact 01 6204000 for further information. Date last revised: August 2008. 2008/ADV/DON/001.
Familiaritybrings Content
32Issue11Vol10December2008
Q&a
Europe’s Leading Contract Sales & Marketing Organisation
Q. Which other career might you have chosen?A.Medicine.
Q. Which figures in Irish life (living or dead) do you admire and why?A.Iadmirepeoplewhomanagetoremainpositiveinspiteoffacinghugepersonalchallenges.Iadmireyoungwomenwhosuccessfullyjugglecareerandfamilylife-ItookafiveyearcareerbreakwhenmychildrenweresmallsoIdidn’t
facethesameproblems.IndividualswhomIadmireincludeTomArnoldfromConcernforhiscontributiontoalleviatingpovertyinthedevelopingworld;GarretFitzGeraldforbeingdirectandhonest;JimDoogeforhiscontributiontopolitics,academiaandengineering;andmusicianssuchasBarryDouglas,HughTinneyandCharlesVilliersStanford.
Q. What is the one thing you would suggest to improve the Irish health service?A.Anintegrated,properlyresourced,standards-basedICTsystem.
Q. What is your earliest memory?A.Findingandeatingabanana,whichmymotherhadhiddenfrommybrothersandmyselfinacupboard.
Q. What is your greatest fear?A.Havingtohavefalseteeth.
Q. When and where were you happiest?A.Holdingmygrandsonforthefirsttime.
Q. What would your superpower be?A.Bi-location.
Q. What is the worst job you have ever done?A.PreparingaprojectproposaltotheEuropeanCommissionwhichinvolved26partnersfrom14countries-itwassuccessful!
Q. What is your best trait?A.Anopenmind.
Q. What is your most unappealing habit?A.Forgetfulness.
Q. What trait do you most dislike in others?A.Selfishness.
Q. Do you use alternative medicines? What kind?A.no.
Q. Cat or dog?A.Cat.
Q. What keeps you awake at night?A.AllthethingsIhaveforgottentodo.
Q. Who or what makes you laugh?A.Mygrandson.
Q. Who or what is the greatest love of your life?A.Myfamily.
Q. How do you relax?A.Hill-walking.
Q. What word or phrase do you overuse?A.‘noproblem’.
Q. Favourite TV/Radio programme?A.MorningIreland.
Q. Favourite film and book?A.Dr Zhivagoand The Story of San Michele whichwaswrittenbyAxelMunthe.MyfavouritepieceofmusicisChristmas OratoriobyBach.
Q. What is your motto?A.There’sasolutiontoeveryproblem.
Q. How would you like to be remembered?A.ThatIcontributedtothedevelopmentofanelectronichealthrecordforIreland.
ProfessorJaneGrimsonistheDirectorofHealthInformationTechnologywiththeHealthInformationQualityAuthority(HIQA)andisoneofIreland’sforemostexpertsinhealthinformatics.ProfessorGrimsonischairoftheCentreforHealthInformaticswhichshehelpedtoestablishatTCD.Sheisalsoaformervice-provostoftheCollegeandchairoftheIrishResearchCouncilforScience,EngineeringandTechnology.ProfessorGrimsonisamemberoftheBoardofScienceFoundationIrelandand,untilrecently,presidentoftheHealthcareInformaticsSocietyofIreland.Shehaswrittenover100papersandco-authoreda
textbookondistributeddatabasesystems.professor jane Grimson
DirectorofHealthInformationTechnologywiththeHealthInformationandQualityAuthority(HIQA)
UNIFLU is owned by Irish pharmacists and is only available in pharmacies
IRELAND’S BEST SELLING COLD AND FLU PREPARATION SOLD IN PHARMACY1
Uniflu Plus Product Information. Each Uniflu Plus Coated Tablet contains: Active Ingredients: Paracetamol 500mg, Codeine phosphate hemihydrate 10mg, Diphenhydramine hydrochloride 15mg,Phenylephrine hydrochloride 10mg, Caffeine 30mg. Each Vitamin ‘C’ Chewable Tablet contains: Active Ingredients: Ascorbic acid (Vitamin C) 300mg (as ascorbic acid/sodium ascorbate). Before TakingUniflu Plus Tablets. Consult your doctor before taking UNIFLU PLUS tablets if any of this applies to you: i. If you are already taking other paracetamol-containing products. ii. If you are allergic to paracetamolor any of the other ingredients. iii. If you are currently taking metoclopramide, domperidone or cholestyramine (as these medications can interfere with the paracetamol). iv. If you are currently taking bloodthinning tables (warfarin and other coumarins). v. If you are currently taking antidepressants (monoamine oxidase inhibitors) or within 14 days of stopping such treatment. vi. If you are currently takingchloramphenicol. vii. If you are suffering from breathing problems. viii. If you are currently being treated for, or suffering from an overactive thyroid, high blood pressure or heart disease. ix. If your liver orkidneys do not work properly, or if you have an enlarged prostate gland causing difficulty in passing urine or suffer from epilepsy or glaucoma. x. If you are planning a pregnancy or are pregnant or breastfeeding. xi. If you are taking any other regular medication. Special Warning: This product contains codeine. This medicine should only be taken when necessary. Do not take more than the stated dose and donot take every day for more than 3 days unless told to do so by your doctor. Prolonged regular use, except under medical supervision, may lead to physical and psychological dependence (addiction) and result inwithdrawal symptoms, such as restlessness and irritability once the drug is stopped. If you find you need to use this product all the time, it is important to consult your doctor. The risk of overdosage is greater inpatients with certain types of liver disease. Drowsiness may be experienced whilst taking UNIFLU PLUS tablets. If you are affected, DO NOT drive or operate machinery. Avoid alcoholic drink whilst takingUNIFLU PLUS. UNIFLU PLUS tablets should not be used to treat persistent or chronic coughs such as occurs with smoking, asthma or emphysema or if cough is accompanied by excessive mucus (phlegm),unless directed by the doctor. DO NOT take other paracetamol-containing products with UNIFLU PLUS tablets. DO NOT exceed the stated daily dose. DO NOT use this or any codeine containing product if youare breastfeeding unless under the supervision of your doctor. Use of this product may harm your baby. UNIFLU PLUS tablets contain Sucrose, Vitamin ‘C’ tablets contain Sucrose and Lactose. If you have beentold by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicinal product. Dosage: (a) Adults and Elderly. One UNIFLU PLUS tablet to be swallowed wholewith water and one Vitamin ‘C’ tablet to be swallowed whole, sucked or chewed. Dose to be repeated every SIX (6) hours until the symptoms disappear. NOT MORE THAN FOUR (4) UNIFLU PLUS TABLETSTO BE TAKEN IN 24 HOURS. (b) Children Under 12 years – Not Recommended. Over 12 years – One UNIFLU PLUS tablet to be swallowed whole with water and one Vitamin ‘C’ tablet to be swallowedwhole, sucked or chewed. Dose to be repeated every EIGHT (8) hours until symptoms disappear. NOT MORE THAN THREE (3) UNIFLU PLUS TABLETS TO BE TAKEN IN 24 HOURS. If you do not feelany better after taking a course of the medicine, consult your doctor or pharmacist. Overdosage UNIFLU PLUS Tablets – Overdosage may lead to increased heart rate, high blood pressure, sickness, liverdamage and breathing problems. Immediate medical advice should be sought in the event of an overdosage, even if you feel well, because of the risk of delayed, serious liver damage. Vitamin ‘C’ Tablets –No cases of overdosage have been reported. If, however, you think you may have taken too many tablets, drink plenty of water and contact your doctor or pharmacist immediately.Marketing Authorisation Number – Ireland: PA 1455/2/1
Ref1. IMS data. June 2008 MAT.
UNIFLU UNIFLU PLUS
Analgesic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Paracetamol is safe; it relieves pain and reduces temperature
Antihistamine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Alleviates such symptoms as watery eyes or a runny nose
Anti Tussive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Codeine Phosphate to relieve tickly coughs
Decongestant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Reduces nasal congestion and swelling, makes breathing easier
Antioxidant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Vitamin C
Stimulant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Caffeine
leavepiece ad02 12/09/2008 11:13 Page 1
Issue11Vol10December200833
e-pharmacy
TIMEMagazinerecentlylauncheditsTop10Gadgetsof2008,whichincludeamobileemailchecker,avideocamera,aMaclaptopandnintendo’sWiiFit–whiletheabovemaysoundlikealistfromtheGenerationGameforthe21stCentury,restassuredthereisnotacuddlytoyinsight.
Flip MinoFirstlaunchedintheUKinMaythisyear,theFlipVideoUltraSeriesisarangeofultra-smart,idiot-proofvideocameras,whichdon’tneedvideotapes,memorycardsorevenbatteries(itcanbechargedthroughaPC).Smallenoughtocarryanywhere,theyprovideunmatchedsimplicityforcapturing,editingandsharingvideo.AccordingtoTIME“liketheiPodand
theBlackBerrybeforeit,theFlipMinoexplodedintothemainstream,quicklybecomingthemostpopularvideocameraintheUSAinitsfirstyear.“Itstoresuptoanhourofvideoclips
onitsinternaldrive…theFlipissimpletouse:pressthebigredbuttontostartandstoprecording.Thenpopoutthecamera’sUSBconnector,plugitdirectlyintoyourcomputerandemailyourvideosoruploadthemtoyouTube.“FlipVideocurrentlyaccountsforover
13percentofallUScamcordersalesandismarketedinEuropebyFlipVideoUK.TheFlipVideoUltraistheflagship
productintheFlipVideofamilyofdigitalcamcordersandfeaturesproprietaryvideoprocessingtechnology,whichdeliversstunningvideoandsoundquality,evenwhenplayedonlarge-screenTVs.Italsoincorporatesawiderangeofadvancedfeatures,includinga
high-resolution1.5inchdisplayforclearviewingineventhebrightestsunlight,latest-generationvideoprocessingtechnologyand2GBon-boardmemorytohold60minutesofvideo.Formoreinformation,visit:www.theflip.com
Simply emailIflikemeyousufferfromacute‘inboxseparationanxiety’whenyouaredeniedaccesstoyouremailformorethananhour,thentakeapeekatPeek-asuper-thinstylishdevicethatletsyoutakeyouremailwithyoueverywhereandstayconnected.Peekisthefirstelegantlysimple,
email-onlydevicecreatedforpeoplewhodon’tneedorwantanexpensivemobilephonefulloffunctionsandsoftware.ThePeekdevicedeliversunlimitedemailtoandfromexistingaccountsandisextraordinarilysimpletosetupanduse.Itconnectstoanationwidewirelessnetworkwhichensurescoverageeverywhere.Astraightforwardandstylish,pocket-
sizeddevicewithoutthecomplicatedfeaturesusuallyfoundpackedintoanall-in-oneSmartphone,Peekisthefirstandonlyproductthatallowsuserstostartsendingandreceivingemailinlessthantwominutes.CurrentlyavailableforaflatmonthlyfeeintheUS,wearesure(andhope)itisonlyamatteroftimebeforeitarrivesinIreland.Takeapeekonlineat:www.getpeek.com
Wii Fit AccordingtoTIME:“Weightlosshasneverbeeneasierwithnintendo’sWiiFit,whichismoreafitnesstoolthanavideogame.”WiiFitisaninteractivetraining
programmethatguidesyouthroughstrength-building,yoga,aerobicsandbalanceexercises.Manyoftheworkoutsarecleverly
disguisedasfunactivities,likevirtualskiingandskijumping,stepdancing,evenheadingavirtualsoccerball,enticingthemoststubbornslackerstogetoffthecouch.Playerssimulatethegame’spursuitsbyusingwirelessWiicontrollersandadigitalbalanceboard(whichdoublesasascale)thattracksmovementsanddistributionofweight.Toevaluateyourprogress,theWiiFit
measuresyourweight,bodymassindexandsenseofbalanceatregularintervals,andchartsyourresults.Forfurtherinformation,visit:www.
nintendo.com/wiifit
‘Google Phone’TIMEmagazine’sTop10GadgetlistalsoincludesthefirstmobilephoneofferingfromGoogle-theT-MobileG1.AsthefirstSmartphonetorunGoogle’snewAndroidoperatingsystem,theT-MobileGhasaslickslide-outkeyboard,abigbrightscreenandalotofpower.Accordingtothemagazine:“The
‘GooglePhone’supportsloadsofapplicationsdownloadedfromtheonlineAndroidmarketplace—gamesandprograms,likeencyclopaedias,guitar-teachingtoolsandtimewasterslikePacMan—andeasilyhandlesgraphics-heavyapplicationssuchasGoogleMaps,webbrowsingandvideo.TheAndroidmarketplaceisn’tasrobustastheiPhoneappstoreyet,butsomedayitwillbe,asmoreAndroidphoneshitthemarketanddevelopersstartchurningoutapps.”Todate,therehasbeenno
confirmationregardingacarrierforthe‘GooglePhone’hereinIrelandbutlikewepredictedwithPeek-watchthisspace.Moreinformationisavailableat:
www.t-mobileg1.com
Have a techno ChristmasThefollowingdevicesalsomadeitontoTIME’sillustriousTop10Gadgetsof2008:• TheEye-FiExploreSDCard–a2GBwirelessSDmemorycardwhichuploadsphotosautomaticallyfromyourcameratoyouronlinephotoserviceandcanalsobeampicturestoyourhomecomputer'sharddrive,soyounolongerneedtophysicallyconnectyourcameratoacomputertotransferimages.
• Dash–ahighlyintelligentGPsdeviceforyourcar,whichgathersreal-timeinformationfromtheinternetandassesseslocaltrafficinformationusinganetworkofdrivers.Itwillrecommendandfindyouanearbyrestaurant,searchforyournearestcinemaandshowyoufilmreviewsbeforeyougo.Italsoallowsuserstocomparepricesatnearbypetrolstationstofindthebestdealandwillevenkeepaneyeoutforspeedtrapsinyourarea.
• TheCanonPowerShotA590–aneightmegapixeldigitalcamera.
• Sanyo'sXacti–anultrasleekdigitalandvideocamerainone.
• ThenewappleMacBook.• Finally,myfavourite(getthehintSanta),theiPodTouch.
TIMEiscurrentlyinvitingpeopletovotefortheirfavouritegadgetfromitstop10list,castyourvotenowatwww.time.com
DearSanta…Asthefestiveseasonapproaches,June Shannonreportsonsomeofthetop10gadgetsguaranteedtobeoneverytechnophile’sChristmaswishlistascompiledbyTIMEmagazine.
june shannon
Buttercup 24.5cm x 11.5cm Ad 10/09/2008 02:30 pm Page 1
34Issue11Vol10December2008
e-pharmacy
BrianPagniandhisstaffintheRingsendbranchofBradley’spharmacy.
nasectorwhereconsumersarewatchingwhattheyspendandthegovernmentiscuttingbackwherevertheycan,pharmacylikemanyothersectorsisunderpressureintoday’stightereconomicconditions.Toremaincompetitiveandkeepturnovergrowing,pharmacistsneedtoreducecosts,whilecontinuingtodelivervalueandexcellentservicetocustomers.Thismaysoundlikeastandardapproachtakeninmanyconsumer-ledindustriestoday,butobviouslyitcanbechallengingto
deliveroninpractice.Oneapproachthatcancertainlygetyourbusinessonamorecompetitive
footingistocapitaliseontheuseofinformationandcommunicationstechnology(ICT)tohelpmanageyourbusiness.ICTsystemscanprovideup-to-the-minuteinformation,reducestafftimespentontransactionalprocessesandenablebusinessestopositionthemselveseffectivelytocapitaliseonchangesinconsumerspendpatterns.newinnovationsinpharmacy,suchasbusinessintelligencereporting,
centralaccesstobusinessinformationacrosschains,roboticsandvalue-addingmodulesindispensingsoftware,canassistpharmacistsandbusinessmanagerstomakebetter,more-informeddecisionsandfreeuptimetodevelopandofferimprovedservicestopatientsandcustomers.
PharmacychainsreapingbenefitsofIT
BrianPagni,managingdirectorofthe16-storeBradley’sPharmacyGroup,hashadQicScript.netfromHelixHealthinstalledinall16stores.Bradley’sPharmacyisanindependent,whollyIrish-ownedcompanyestablishedin2001andislocatedacrossDublin,surroundingareasandthenorth-eastofIreland.ThekeytoBrian’sdecisiontogowithQicScript.netwasthebusiness
intelligencereportingmodulewhichallowsinstantaccesscentrallytoeachofthepharmacies’dispensingdetails,providingmanagementwithkeyinformationimmediately.BrianseesclearefficienciesandvaluefromimplementingtheBIsystem.
“Ourdispensaryefficienciesandproductivityhaveimproved.Itallowsforaccuratedeploymentofmanhoursforthebusierdispensingperiods.Centrallywehaveup-to-datedispenseddrugfiguresandreporting,thereforeimprovingourbuyingwithsuppliersandconsequentlyreducingourdispensarystocklevels,givingusimprovementstoourmargins.”Anotherareaofimprovementhasbeenthemovetoasecondgeneration
claimscompatibleplatform.“Wenowhavethebenefitofearlypaymentofreclaimswithinthecurrentmonthofdispensing,”explainedBrain.Brianbelievesthatthekeytothesmoothroll-outandquick
implementationinall16storeswasgoodandopencommunicationbetweenbothorganisations.ChangingyourITsystemisalwaysdifficultand“someproblemsdidariseofcourse,butwithalllinesofcommunicationopenbetweenourselvesandHelix,theissueswereaddressedinanappropriatetimeperiod.“Theday-to-dayuseoftheoperatingsystemhasbeenwelcomedand
appreciatedbyallBradley’spharmacists,techniciansandlocumsalike.ItisuserfriendlyundertheWindowsapplicationformatandtherewasashortshallowlearningcurveforeveryonetoadjust.”
I
Issue11Vol10December200835
e-pharmacy
CormacTobin,MDofUnicarewithHowardBeggs,CEO,HelixHealth
noelStenson,AchillPharmacy
UnicarepharmacyisanotherchainthathasmadethedecisiontoinvestinICTsystemsrecently,therebyprovidingmanagementwithkeybusinessinformationtomakeinformedandtimelydecisionswhileofferingthebestpossiblecustomerexperienceinallstoresacrossthegroup.UnicarepharmacyisIreland’slargestgroupwith73storesnationwide.ItispartoftheCelesioGroup,Europe’sleadingtradingcompanyandserviceproviderforpharmaceuticalsgeneratingvv22.3billionrevenuein2007.UnderthemanagementofCormacTobin,thecompanyispursuingan
aggressivegrowthstrategywithplanstovastlyincreaseUnicare’spresencenationwide.Cormac’scomprehensiveknowledgeofretailbusinessesmeanshefullyunderstandstheimportanceofITtoachievesustainablegrowthandcompetitiveness.ThehighperformanceQicScript.netheadofficesolution,designedspecificallyforchains,givescompletevisibilityandcontrolovertheentiregroup.Unicarewillyieldsignificantcostsavingsthroughpreferredproduct
managementandheadofficemanagerscandistributeanyupdatesoramendmentstoallstoresatthetouchofabuttonensuringthecompleteorganisationisusingthelatestinformationatalltimes.Thiseliminatesmanualintervention,reducescosts,speedsupprocessesandmaximisesefficiencieswithintheorganisation.Inaddition,up-to-dateinformationongroupperformanceisavailable,enablingtimelymanagementdecisionsthatcanpositivelyaffectindividualstoreoperationsandconsequentlyfinancialperformance.Thedramaticincreaseintypeandamountofdatacollectedbypharmacy
todaymeansthereisagreaterneedtounderstandand,ofcourse,interpretthisdataintomanageableandusefulinformation.Traditionalreportingtoolsofferusersastaticviewofdatafromasetofspecificparameters,suchasasimpledaterange.Businessintelligencereportsallowausertointeractwiththedatareturned,drilldownintothemandcreatenewviewsonthefly,makingmanagementdecisionsmorerelevantandeffective.AnotherICT-ledinnovationinretailpharmacyinIrelandtodayisthe
adoptionofautomateddispensingroboticsolutionstohelppharmacistssignificantlyimprovetheservicestheycanoffertopatients.noelStensonownsapharmacyinAchillSound,CoMayo,andwasthefirstretailpharmacistinIrelandtoinstallaWillach+HeiseConsisdispensingunittohelpwiththelogisticalandstockmanagementofhisbusypharmacy.TheConsisrobot,suppliedbyHelixHealth,enablesnoelandhisstaffto
automatetheirdrug-dispensingprocess.Prescribinginformationisenteredintoacomputerwhichthensendsamessagetotherobottoquicklyandaccuratelydispensetherequireddrugstoanouttraylocatedatthefrontofthemachineatthepharmacycounter.Themachinesavesspaceandreducestimespentwalkingbackandforthfromthecountertodispensingshelves,allowingthepharmaciststospendthetimecounsellingandhelpingpatients.
Anothermajorbenefitofthemachineisthatiteliminateshumaninterventioninpickingthedrugs,reducingthepotentialformedicatingerrors.Accordingtonoel:“Pharmacyisevolvingfromatraditionalsupplyfunctiontoanextendedservicesoperation.Thesedaysit’smuchmoreabouttheextraservicesyoucanofferyourpatientssuchasmonitoreddosageservices,healthchecks,medicineusereviewsandothercounselling.EventheHSEhasacknowledgedthatpharmacyiswellpositionedtoexpandintothisrole.”noelisconfidentofthebenefitstohispatients,saying:“Thereisdefinitely
directvaluetomypatients.Prescriptionscanbeprocessedmuchfaster,leavingmyteamwithmoretimewithourpatientsandallowingmetoredirectstafftoadditionalvalue-addingservicesandincomestreams.”Inaddition,Gormley’sPharmacy,abouttoopenitsdoorsin
Ballyjamesduff,CoCavan,isinstallingaConsismachinetohelpstaffmeettheneedsofagrowingcommunity.AccordingtoBrianO’Donaghue,ownerofGormley’sPharmacy,inrecentyearsBallyjamesduffhasbecomeoneofthemanycommutertownstoDublin.Withthisgrowthbringsanewkindofcustomerwithdifferentexpectationsofwhattheywouldliketheirpharmacisttooffer.“ByinstallingaConsismachineinthenewshop,notonlyarewesaving
space,therebyleavingmoreroomforawiderrangeofcosmeticbrandswhichisinhighdemandandanewmotherandbabysection,wewillalsonowhavemoretimetoofferextendedservicessuchasaslimclinicandhealthscreeningtests.”InstallingtheConsissystem,whichisfullyintegratedwithHelix’s
QicScript.netdispensingapplication,fromthebeginninginhisnewbusinessventurewillensuretheygetitrightfromdayoneandintothefuture.“Weplanonservingthecommunityformanyyearstocome.Wearesettingthepharmacyupforthefuture.”
Benefits of iCtAdoptingastrategicICTplanisanessentialtooltogainingcompetitiveadvantageinaslowingeconomy.Takingalong-termviewandmakinganinvestmenttailoredtotheneedsofthebusiness,regardlessofitssize,canreapconsiderablebenefits.ICTsystemsandtheircarefulapplicationandmanagementcanhelpretail
pharmacyinIrelandtonavigatethecurrentdifficulteconomicconditionsbydeliveringreal-timedataanalysis,drivingtightercostmanagementand,ultimately,leadingtoamoreprofitablebusinessinthelongterm.
36Issue11Vol10December2008
picTure Gallery
Pictured(ltor)withProfessorJohnKelly,HeadoftheSchoolofPharmacy,RCSIarenewPharmacygraduatesMsEmmaTreacyfromPortmarnock;andMsKaraTedfordfromShankill.
RCSI Pharmacy Conferring Ceremony, 14 November 2008
4th All Ireland Pharmacy Healthcare Conference, Dundalk, 11 November 2008
PicturedfromltorareGrainne,Hilary,Fiona,andRoisinIkelefromMayo.FionaIkelewasconferredwithaDegreeofBachelorofScience(BSc)inPharmacyattheRoyalCollegeofSurgeonsinIreland(RCSI)’sconferringceremony.
GillianPlantandKarenDolan CathyHarrison(left),LezleyAnneHannaandJohanneBarry
MohammedAlhrasenandDarylConnolly EmerMcLean(left),MarkTimoneyandHelenBell
For further information please contact: Bayer Consumer Care, The Atrium, Blackthorn Road, Sandyford Industrial Estate, Dublin 18. Telephone: 00 353 (0)1 2999313.
Canesten_Daisies_245x340:Canesten_Daisies_245x340 27/06/2008 11:36 Page 1
38Issue11Vol10December2008
producT news
IMPORTANT NOTICE
Re; Nozinan (Levomepromazine HCl) 25mg/ml Solution for Injection or Infusion – PA 540/115/1
Change of ampoule size
Sanofi-aventis wish to announce that Nozinan 25mg/ml Solution for Injection for Infusion will now be supplied in a larger 2ml capacity glass ampoule. Please note that the fill volume and concentration remains unchanged i.e. each ampoule contains 1ml of 25mg/ml Solution for Injection of Infusion.
For further information please contact sanofi-aventis at phone # (01) 403 5600 or [email protected]
CreateandpersonaliseaVichygiftthisChristmasVichyLaboratoires,thenumberoneskincarebrandinEuropeanpharmacies,offerstailor-madeexpertsolutionsforallskincareneeds.ThisChristmas,youcancreateandpersonaliseaVichyskin-healthcaregiftinastylishsilverandwhitebox.Simplydescribetheindividualskincareneedsofyourrecipientaswellas
yourpricepointtothetrainedderma-skincareadvisoratyourpharmacy.TheywillsuggestanexpertcustomisedsolutionofaprescribedskincareroutinetosuitanylifestyleandpersonalityinanattractivesilverChristmasbox.Theproductsstemfromyearsofexpertskinresearchonallaspectsof
skinproblemsincludingdryness,excessoil,dehydration,imperfections,dullness,sundamageandanti-ageing.Testedonandsuitableforeventhemostsensitiveskintypes,theycontainpatentedingredientswithclinicallyprovenresultsforeveryproduct.Formulatedandmanufacturedtothehighstandardsofthepharmaceuticalindustry,theproductscombinecutting-edgetechnologyformaximumefficacyandtolerance,withexcellenttexturesandcosmeticity.Vichyproductsoffervisible,rapidresultscombinedwithpleasureofuse.AVichySkinHealthChristmasboxcouldbepersonalisedforateenager
withskinpronetoimperfections,awomanwhowantstogiveherskinthebestsunprotection,amother-to-bewhowantstobepampered,or
ahusbandwholikesaneffectiveanti-ageingskincareroutine.Vichyhasatailor-madesolutionforeachoftheseexamplesandcansuggestroutinesforanyother.Vichyproductsare
guaranteedhypoallergenic,non-comedogenicandcontainVichyThermalSpaWater,clinicallyproventosootheandfortifytheskin.www.vichy.ie
PharmatonrelievessymptomsoffatigueandmemoryPharmatonhasbeenproventonotonlyhelprelievesymptomsoftirednessandfatiguecausedbyshift-work,butalsotocounteractthereductioninabilitytostoreandretrieveinformationfrommemorycausedbyfatigue.Adouble-blindstudywasconductedamongshift-worknursesto
investigatetheusefulnessofacombinationofPanaxginseng,vitaminsandminerals(Pharmaton)inreducingfatigue-induceddeficitstocognitivefunctionandmood.shift-workmodelwasdevelopedinwhichnurseswererepeatedlyevaluatedonavarietyofcognitivetestsandquestionnairesimmediatelypriortoundertakingathree-nightshiftandthenagainimmediatelyafterwards.After12weeksofdosing,statisticallysignificantbeneficialeffectsofPharmatonwasobservedonvariousaspectsofcognitivefunctionandmood.Inparticular,qualityofmemoryandself-ratedcalmnessweresignificantlyimprovedinnursesworkingnightshiftsandtakingPharmaton.Onthedaybeforetheshift,29nursesperformedaselectionoftestsfrom
theCognitiveDrugResearchcomputerisedassessmentsystem,aswellasBond-Ladermoodandalertnessscales.TheyalsocompletedtheChalderfatiguescaleonceduringthistime.Onthedayimmediatelyfollowingthe
three-nightshift,theyreturneddirectlytothelaboratoryandunderwentanidenticalscheduleoftesting.Thenurseswerethenassignedrandomlytoreceiveeitheronetabletof
thecombination(Pharmaton)orplaceboforthenext12weeksinadouble-blind,parallelgroupdesign.Theshiftmodelwasthenrepeated6and12weekslaterusingexactlythesamescheduleofassessments.Toconfirmthattheshiftmodelwaseffectiveinimpairingcognitive
functionandinducingfatigue,thedatafortheshiftmodelrunpriortorandomisationwereinitiallyevaluated.Thethree-dayshiftresultedinsignificantdeclinesinbothspeedandaccuracyofattention,andtheabilitytostoreandretrieveinformationfrommemory.Deficitstoself-ratedcalmnessandcontentmentwerealsoidentified.Inaddition,increasedlevelsoffatiguewereseenontheChalderfatiguescale.Thisshift-induceddeficitwasthenusedasthemajorstudyoutcome.Thepre-studydeficitwasusedasabaseline,andthedeficitsmeasuredatweeks6and12wereadjustedto‘changefrombaselineshiftdeficits’.Theseadjustedscoreswerethencontrastedbetweenthetwogroupsat6and12weeks.Ontheperformanceassessments,itwasfoundthatthecombination
(Pharmaton)reducedthedeficitsresultingfromthethree-dayshiftontheQualityofMemory,theseeffectsbeingsignificantatthefirstthreetimeassessmentsatweek12.Thecombinationalsosignificantlyreducedtheself-reporteddeclineincalmnessattheendofthemeasurementsessionatweeks6and12.Further,thecombinationhelpedtoreducetheincreaseinself-reportedfatigueasassessedbytheChalderfatiguescale.
Diamicron80mg–productwithdawalServierLaboratorieshaveadvisedofthewithdrawalofDiamicron80mg.StockofDiamicron80mgwillbecompletelywithdrawnbyDecember2008.DiamicronMRisnowrecommendedforpatientsformallyon
Diamicron80mg.Thepatientbenefitsarehighlightedwithnewmorbi-mortalitydatafromthelargesteverstudyintype2diabetes–ADVAnCE.Theresultsofthistrial,recentlypublishedinThenewEngland
JournalofMedicine,showedintensiveglycaemiccontrolwithaDiamicronMR-basedregimenandachievedatargetHbA1cof6.5%withsignificantlyreducedmajormicrovascularandmacrovascularcomplicationsintype2diabeticpatientsversusstandardcontrol.PrescribersareadvisedtoprescribeDiamicronMRasanalternativeto
Diamicron80mgfrom30november2008.Themodifiedreleaseformulation,DiamicronMRismoreeffective
thanDiamicron80mgwithoutcompromisingsafetywithaverylowlevelofhypoglycaemiceventsreportedandnoincreaseinbodyweight1.Fortheabovereasons,ServierIrelandhasdecidedtowithdrawDiamicron80toavoidconfusionandimprovepatientcareinIreland.TofacilitateasmoothtransitionfromDiamicron80toDiamicronMRpatientinformationleafletsoutliningthereasonsforwithdrawalwillbedistributedtosurgeriesandpharmaciespriortothewithdrawaldate.Formoreinformation,pleasecontactKieranLeahy,GroupProduct
Manager,ServierIrelandonTel:[email protected]
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40Issue11Vol10December2008
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Abidec—proudsponsorsofTV3’s‘RaisingChildren’.RaisingChildrenisaweekly30-minutehumorouspeekintoraisingchildreninIreland.TheshowisairedonMondaynightsat8pmthroughtomid-December.Abidechasbeenhelpingtobuildhealthychildrenforover60yearsandwithaformulationtosuitallchildrenfrombabiesto12yearolds,whoelsewouldyoutrusttohelpbuildstronghealthykids.AbidecOptiMUMSyrup—FolicAcid,
Omega3plus6essentialVitamins.Forbefore,duringandafterpregnancy.AbidecMultivitaminDrops—7essential
vitaminsforbabies0to12years.(AbidecMultivitaminDropsisamedicine.Alwaysreadthelabel)AbidecVitaminD3Drops—VitaminD3forstrongteethandbones.Forchildren0to3years.AbidecMultivitaminSyrupwithOmega
3—Helpsmaintainhealthygrowthanddevelopment,supportshealthybrainfunctionandconcentration.ForChildren1to5AbidecOmega3Syrup—Mayhelpmaintainconcentrationlevels.Forchildrenfrom3years.
ObesityandsmokinginaccuratelyidentifiedbypublicasbiggestriskfactorsindevelopingbloodclotsRecentresearchintothepublic’sawarenessofbloodclotsandassociatedrisks,foundthat31%ofpeopleinaccuratelyreportedobesityandsmoking(29%)asthebiggestriskfactorsindevelopingbloodclots.Only19%ofpeopleunderstoodthathavingsurgerywasafactorwheninfactitincreasestheriskofbloodclots10-fold.Smokingmoderatelyincreasestheriskandmoresoinwomenthaninmenandobesityincreasestherisk3-fold.TheBritishledresearchwasunveiledatthelaunchofXareltowhichislicensedforthepreventionofbloodclotsinadultpatientsundergoinghiporkneereplacementsurgery.Xareltoisabloodthinningmedicinewhichistakenorally,onceadayanddoesn‘trequireroutinemonitoring.Significantly,Xareltoreducespatient’srelativeriskofdevelopingabloodclotby70%.Theresearchshowedthat55%ofpeoplearemostconcernedabouthow
successfultheiroperationwillbewhenundergoingsurgeryand30%worryaboutcontractingMRSA.Developingabloodclotrankedthirdandisofmoreconcerntowomenthanmen.BloodclotskillmorepeopleinEuropeannuallythanbreastcancer,prostatecancer,HIV/AIDSandroadtrafficaccidentscombined.Peopleundergoingorthopaedicsurgicalproceduresincludingtotalknee
replacementandhipreplacementarepronetodevelopingbloodclotsunlesspreventivemeasuresareused.Infactwithoutpreventivecare,bloodclotsoccurin40%-60%ofpatientshavingorthopaedicsurgery.Thefindingsalsorevealedthat78%ofpeoplearemorelikelytodosomeresearchinadvanceofanoperationinordertobefullyawareofwhattoexpect.“Bloodclotsafterhiporkneesurgeryareacomplicationorthopaedic
surgeonshavebattledagainstsincethebeginningofjointreplacementsurgery.Xarelto,anorallyadministereddrug,withouttheneedformonitoringisamajoradvanceandofferssignificantadvantagestousassurgeonsintheon-goingbattle.Evidencehasshownitwillcertainlybenefitmypatients,”saidMrGaryO’Toole,ConsultantOrthopaedicSurgeon,StVincent’sUniversityHospitalandCappaghnationalOrthopaedicHospital,Dublin.Duringhiporkneereplacementprocedures,thelargeveinsofthelegthat
carrybloodbacktotheheartaredamaged,whichsignificantlyincreasestheriskofbloodclotsforpatientsundergoingsuchmajororthopaedicsurgery.Forfurtherinformationonbloodclots,visitwww.thrombosisadviser.com
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DingleFamilycelebratePernatonwininLegolandSeanDuffyandhisfamilyarejustbackfromanactionpackedholidayinLegoland.TheDinglemanwhowonthe‘PernatonMilkCupTripofaLifetime’earlierthissummersaidhisfamilywasabsolutelywowedbytheexperience.SeanandhiswifeBreda
couldhavevisitedanywhereintheUKbutsawhiswinasanidealopportunitytohavefunwiththeirthreeyoungchildrenOrla(6),neasa(4)andCathal(2).TheirvisitstartedwithaspectacularfireworksdisplayonSundaynightwhich,accordingtoBreda,“wasthebesttheyhadeverseen”.Andtothedelightofthechildrenitstartedtosnowthenextday.Byallaccountstheyhad
awhaleofatime.Pernatonorganizedspecialprioritypassesforthemwhichcutoutallthequeuesandhelpedthemseeeverythingtheyhadplanned.needlesstosaythechildrenhadlotsofstoriestotelltheirfriendsaftertheirgreatadventure.
For more information about the awards or to reserve a table please contact:
T: 01-4633000 F: 01-4633011 E: [email protected] W: www.helixhealth.com
Helix Health Limited 52 Broomhill Road, Tallaght, Dublin 24, Ireland.
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Professional Excellence Award
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Award Categories:
Pharmacist Awards 2009
RECOGNISING EXCELLENCE IN PHARMACY
In association with
�e Pharmaceutical Society of Ireland
Benevolent Fund
�e Awards are open to all pharmacists registered in Ireland,
including hospital, community, industrial and academic.
2009
Saturday, 9th May 2009
�e Mansion House, Dublin 2
Nomination
Form
Nominate online at www.pharmacistawards.com
It’s now time to make yournomination for the 2009Pharmacist Awards
�e Awards are open to all pharmacists registered in Ireland,including hospital, community, industrial and academic.
�e Mansion House Dublin on Saturday 9th May 2009.
Closing date for nominations 12th December 2008.
Is there someone youbelieve to be worthyof recognition?Complete a formor nominate online.
Nominate online @ www.pharmacistawards.com
Brought to you by the Pharmacist Awards Committee and our generous sponsors:
Committee Members: Chairperson Fintan Moore M.P.S.I. , Cicely Roche M.P.S.I. , John Bourke M.P.S.I. ,Tom Mc Auli�e M.P.S.I. , Fiona Roche M.P.S.I.
In association withThe PharmaceuticalSociety of IrelandBenevolent Fund
42Issue11Vol10December2008
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ip Crossword No. 159
LASTMOnTH’SCROSSWORDAnSWERS
name:
Address:
E-mail:
Across6 Oatpie,stewed,producesnarcotic(6)7 ConditionsinAmerica?(6)8 Wineleftatsea?(4)9 HiBenson!Fracturedyourtibia?(4,4)10 Jabberinthedoctor’ssurgery?(7)12 It’saneyesore!(4)13 AreversiblegroupofSwedes(4)15 Maladyduetostormyseaside!(7)17 Shebarelyworksforaliving!(8)20 It’sapositivesign(4)21 Wellbeinginachealthoughconcealed(6)22 Hoetrekkiesgo—bydoll,perhaps!((6)
Down1 Protectivegarmentswithstringsattached!(6)2 Ieatcrabgoulashtofindgerms(8)3 Looksbothways!(4)4 Maryhadalittleone(4)5 yellananomalywithnoexcessfat(6)7 Arachnophobic’sworstfears(7)11 Thepond,surprisingly,isshallow(2,5)12 Thecuttingedgesofsurgicalscience?(8)14 Dairyproduct—foraram?(6)16 Thesameasonespeers?(6)18 Man,DogsorCapri!(4)19 Bonesthatmaybetickled!(4)
Congratulationstothewinneroflastmonth’scrossword,MrsEimearMellett,OranmorePharmacy,MainStreet,Oranmore,CoGalway.Forachancetowin€70,pleasesendcompletedentries:theEditor,IrishPharmacist,GreenCrossPublishing,LrGroundFloor,5HarringtonStreet,Dublin8orfaxto(01)4789764by22December2008.
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CalltoManageColds&FluAppropriatelythisWinter75%ofIrishemployeeswouldprefertheirsickcolleaguestorecoverathomeratherthanriskspreadinginfectionintheworkplace1.Thisviewissupportedby86%ofIrishmanagerswhobelievethattheiremployeeswouldbemoreproductiveaftertakingarestdayandrecovering1.Theresearchwasunveiledtodayatthelaunchof“TakeaBenylinDay”–acampaigntoinformpeoplethatwhentheyaresickwiththeflu,itisasimportanttoresttorecoverasitistotakeafluremedy.
ThecampaignwhichstartedinnovemberincludesTV,radio,consumer&tradepress,outdoorpress,Tsides&,publicrelationsandawww.takeabenylinday.iewebsite.Thewebsitehasbeendevelopedasa‘getwell’repositoryfilledwithtipsandadviceonmanagingyourflusymptoms.Featuresonthewebsiteinclude–‘responsiblesickleave’andonlinegamessuchas‘GermInvaders’.Formoreinformationonthecampaignvisitwww.takeabenylinday.ie.
BenylinisIreland’snumberonecoughbrand2andhasthewidestrangeofcough&coldproductsforbothadultsandchildreninIreland.BesuretostockuponBenylinproductsthiswinterseason.
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References:TaylornelsonSofres(TnS)mrbiPhoneBus®consumerresearchinto
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A body� of evidenceCubitan is the only wound care sip feed. Enriched with added free arginine, it stimulates tissue repair and improves immune function.
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Prescribe Cubitan and see the evidence yourself.1 Soriano et al. The effectiveness of nutritional supplementation in the healing of pressure ulcers. Journal of Wound Care. 2004 Vol 13(8)pp.319-232 Benati et al. Impact on pressure ulcer healing of an arginine enriched nutritional solution in patients with severe cognitive improvement. Acch. Gerontol Geriatr. Suppl 7 2001; 43-47
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44Issue11Vol10December2008
ouTside edGe
SotheProgressiveDemocratshavedecidedtodissolve,whichwillhardlycreateanykindofseismicshock.Sincethelastelectiontheywerealready‘defactodefuncto’.TouseaphraseusedbyDrRuairiHanleyinalettertotheIrish Timessomemonthsago,thePDsnolongerhadaroleotherthantoactas“thepoliticalwingoftheHSE”.HistorymaybekindtothePDs,butI’mdamnedifIwillbe.Thepartyhadonegoodideabackinthelate80s,whichwastolowerincometaxesfromthesavagelyhighlevelsthatpertainedbackthendowntoareasonablepercentageofpeople’sincome.ThatreductionstimulatedeconomicactivityandhelpedtocreatetheCelticTigeryears.
Token victoriesThedownsidewasthatdespitebeingfoundedbypeoplewhodespisedHaugheyitecorruption,thePDsspentmostofthelast20yearskeepingFiannaFáilinpower.TheyscoredafewtokenvictoriesagainstsomesmallerFiannaFáil-backedlobbygroups,suchasthebanningofsmokeycoalandderegulationoftaxis,buttheconstructionindustrywasallowedtorunriot.Theboominpropertypricessloshedmoneyintothegovernmentwhichthenloweredincometaxesbeyondapointthatwassensible.nowthattheboomisover,wecanallseethatFiannaFáilhasspentthelastdecadeblowingthecashlikeavillageidiotwithalotterywin.
Ironically,whatdidforthePDsinthelastelectionwasMichaelMcDowell’slast-minutewobblingaboutwhetherornottopulloutofgovernmentinresponsetoBertieAhern’stribunalproblems.Byultimatelystayingin,McDowelllostthe‘watchdog’vote,butthethreattopulloutcosthimtheFiannaFáiltransfers.HehadignoredoneofFiannaFáil’scoreprinciples,namelythatwhenyou’vebeenbought,youstaybought.
A new Minister for Health?Fromapharmacyperspective,thedemiseoftheProgressiveDemocratsdoesn’tchangemuchforusintheimmediatefuturebecauseMaryHarneywillcontinueasMinisterforHealth.Therearetwoschoolsofthoughtabouttheobviousquestionofwhetherwearebetteroffwithherorsomebodyelse.Ihadalwaysreckonedthatwewouldbebetteroffwithsomebody(anybody)else,becausetheHSEwashercreationandshewillalwayssupportit,nomatterhowbadlyitscrewsup.MytheorywasthatadifferentMinisterforHealthwouldtelltheHSEtostopactingthemaggot,andtonegotiateadealwithus.However,thereisanotherpointofview,whichisthatHarney
hasareasonablegraspoftheissuesinvolvedandisthereforewellpositionedtoreachagreement.Ifanewministerwereappointedtherewouldbeaninevitablehiatusbeforeheorshewouldbewell-enoughinformedtoauthoriseadeal.Ican’tpickanyholesinthisscenario,soyoucanmakeupyourownminds–don’texpectmetohelpyou!AssumingHarneystaysonasMinisterforHealth,the
outcryoverthecancellationofthecervicalcancervaccinationprogrammemightfocushermindonfindingaresolutiontothepharmacyproblem.It’spatentlyobviousthataweekendofhardtalkingwiththeIPUwouldbeenoughtoachieveafairandlastingoutcomeforbothsides.Someoftheresultantsavingscouldrescuethevaccinationprogramme.Hersolutiontotwodifferentheadachesisthereforthetaking–ifshewantsit.
No commentSomeyearsago,Ihadanunpleasantencounterwithanexceptionallyobnoxiouscustomer.Afterhehadleftthepharmacy,Iwasstillseethingwithrage.Beingyoungerandmorerashinthosedays,Iwentbacktothecomputer,reopenedhispatientfile,andonthelinereservedfor‘Comment’Itypedintheword‘P***K!!!’.Ineverlaideyesonthemanagain,butsomemonthslater
Igotacallfrommyboss.MrObnoxioushadjustbeenintorequestaMed1printout,whichmybosshaddulyprintedoff.Asmybosswaswalkingouttothecounterwiththereceiptinhishandheidlyglancedupatthetoprightcornerofthepageandtherefortheworldtoseewastheword‘P***K!!!’.Hedidanabruptabout-turnand,havingremovedmycomment,reprintedthereceipt–Ithinkmybossmaythenhaveutteredafewcommentsaboutme!
Coded messagesToavoidsimilarproblems,abbreviationsusedbydoctorsinpatientnoteshaveoftenincludedthefollowingcodeddescriptions:
FLK–FunnyLookingKidCnS/QnS–‘CentralnervousSystem/QuantitynotSufficient’(i.e.someonenottoobright)TEETH–TriedEverythingElse,TryHomeopathy.
Perhapsacodedwarningsystemcouldbedevisedforourprofession.Howabout:
SLACKJAWS–ShopLiftsAsCretinousKidsJumpAroundWreckingShopBAB3C–BelievesAntibioticCuresCommonColdSTD–SleepingTablets‘Disappear’SMA–SpilledMethadoneAgain.
Butthenagain,I’mjustaKnOP(KnownothingOpinionatedPharmacist).
notsurprisedbythedissolutionofthePDs,FintanMooretheorisesonanewMinisterforHealthandwhatthatwillmeanforIrishpharmacists.
PD or not to be? finTan moore