New PSI HQ declared as smoke

Transcription

issue 7 • volume 15 • JUly/AUGUST • 2013
www.greencrosspublishing.ie
THE
INDEPENDENTmonthly
MONTHLYfor
FORIrish
IRISHPharmacists
PHARMACISTS
The
independent
News
HSE earns over E84
million from prescription
charges p4
New PSI HQ declared as
smoke-free site by Minister
Complaints about
pharmacists fall by 30%
p4
IPU denounces latest
FEMPI pharmacy cuts p6
FIP 2013 preview p10
First interview with new
IPU Secretary General
Darragh O’Loughlin p12
In Focus
The growing importance
of infant nutrition p27-28
Minister for Health Dr James Reilly officially opened the new building of the Pharmaceutical Society of
Ireland(PSI) at Fenian Street, Dublin, in June. The PSI is the first health agency to declare its new building
tobacco free as part of a Government initiative to have all campuses and hospitals tobacco free by 2015.
Pictured with the Minister is immediate past PSI Vice-President Eoghan Hanly and Acting PSI Registrar
Ciara McGoldrick.
NEW
NEW
NEW
FOAM
AVAILABLE
IN
PHARMACY
ONLY
Your advice on using REGAINE Foam
can stay with them, even if you can’t.
®
FOAM
FOR THE
TREATMENT
OF HEREDITARY
HAIR LOSS IN MEN
Further information available
from www.regaine.ie
Regaine for Men Extra Strength Scalp foam 5% w/w Cutaneous Foam. PA Holder: McNeil Healthcare (Ireland) Ltd, Airton Road, Tallaght, Dublin 24.
PA Number: 823/48/3. Full prescribing information available upon request. Product not subject to medical prescription.
IRE/RE/13-0259b
Advanced Defence Sensitive
blocks 92% of dentine tubules
in just 6 rinses in vitro*
1
Introducing the first in a new expert range from Listerine® –
a twice-daily mouthwash built on potassium oxalate crystal
technology that blocks dentine tubules deeply for lasting
protection from sensitivity.2,3
In just six rinses Advanced Defence Sensitive blocks
92% of dentine tubules; twice as many as the leading
recommended pastes.1,4
It can be used alone for lasting protection,3 or in combination
with the most recommended paste from the leading
sensitivity brand, to significantly increase the number of
tubules the paste blocks in vitro.4,5
* Based on % hydraulic conductance reduction
References:
1. Dentine Tubule Occlusion, DOF 1 – 2012.
2. Tubule Occlusion Stability, DOF 3 – 2012.
3. Relief of Hypersensitivity, DOF 4 – 2012.
4. TNS – Sensitivity Market Research 1 – 2012.
5. Combination Tubule Occlusion, DOF 2 – 2012.
UK/LI/12-0494m
Recommend Advanced Defence Sensitive
for expert care when you’re not there
Do not recommend this product if patients have a history of kidney disease, hyperoxaluria, kidney stones or malabsorption syndrome, or take high doses of vitamin C (1000mg or more per day).
The independent monthly for Irish Pharmacists
contents
issue 7 volume 15 • JUly/august 2013
NEWS
4-6 8
10 12 14 NEWS
INTERNATIONAL NEWS
NEWS FEATURE
INTERVIEW
EU NEWS
PROFESSIONAL
DEVELOPMENT
18 PHARMACOLOGY
COMMENT & ANALYSIS
17 20 22 James Fogarty looks at
the increasing importance
of infant nutrition and
the role of pharmacists in
addressing the issue
28 FINANCE
with Iain Cahill
30 CAREERS AND EDUCATION
32 PICTURE GALLERY
33-34 PRODUCT NEWS
35 DIARY AND CROSSWORD
36 THE OUTSIDE EDGE
with Fintan Moore
LETTERS
VIEW FROM ABOVE
THE COALFACE
with David Jordan
LIFE
25-26 IN FOCUS – INFANT
NUTRITION
Keep up to date with all the latest news
from Irish Pharmacist
Follow our tweets at @irishpharmacist
To read the digital edition of Irish
Pharmacist log on to
Scan our handy
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jump straight to our
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Benetor
®
Olmesartan medoxomil
Benefit from Benetor®
For the Effective Management of Essential Hypertension
Greater BP reduction vs. other ARBs*1-7
Irish Pharmacist is published by
GreenCross Publishing Ltd.,
7 Leeson Street
Dublin 4.
Tel: 01 4410024.
[email protected]
Effective BP control maintained over 24 hours1,8
Proven achievement of recognised BP targets9,10
* vs. losartan, valsartan and candesartan
GreenCross Publishing was
founded in 2007 and is jointly
owned by Graham Cooke and
Maura Henderson. Between them
Graham and Maura have over
30 years experience working in
healthcare publishing. Their stated aim is to publish titles
which are incisive, vibrant and pertinent to their readership.
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.
© Copyright GreenCross Publishing Ltd. 2013
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.
Editor:
Mary Corcoran
ACTING EDITOR:
Priscilla Lynch
Design: Barbara Vasic
Publisher:
Graham Cooke
Publisher:
Maura Henderson
Contributors:
Iain Cahill, Dr Des Corrigan,
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Jordan, Fintan Moore, Terry
Maguire
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Bríd Ní Luasaigh
Letters to the Editor:
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Graham Cooke
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087 2222221
ABBREVIATED PRESCRIBING INFORMATION. Benetor 10, 20, 40mg film-coated tablets (olmesartan medoxomil). Refer to Summary of Product Characteristics (SPC)
before prescribing. Presentation: Film-coated tablets containing 10mg, 20mg, 40mg olmesartan medoxomil. Contains lactose. Uses: Treatment of essential hypertension.
Dosage: Adults: Recommended starting dose 10mg daily. If required the dose may be increased to 20mg daily. Maximum dose 40mg daily. Elderly: No dose adjustment
generally required. Patients with moderate renal or hepatic impairment: Maximum daily dose is 20mg. Children, adolescents (below 18 years) and patients with severe hepatic
impairment or severe renal impairment: Not recommended. Contra-indications: Hypersensitivity to any component. Second and third trimesters of pregnancy. Patients with
biliary obstruction. Warnings and Precautions: Correct intravascular volume depletion before administering. In patients with other conditions associated with stimulation of
renin-angiotensin-aldosterone system, possible side effects include acute hypotension, azotaemia, oliguria or, rarely, acute renal failure. Increased risk of severe hypotension and
renal insufficiency in patients with bilateral renal artery stenosis or stenosis of the artery to a single functioning kidney. Periodic monitoring of serum potassium and creatinine
levels is recommended in patients with impaired renal function. No experience in kidney transplantation or end-stage renal impairment. Hyperkalaemia (which may be fatal),
risk factors include diabetes, renal impairment, age (> 70 years), combination with medicines which increase potassium levels, potassium supplements, intercurrent events.
Close monitoring of serum potassium in at risk patients is recommended. Not recommended for combination use with lithium. Special caution is recommended in patients
suffering from aortic or mitral valve stenosis, or obstructive hypertrophic cardiomyopathy. Not recommended in patients with primary aldosteronism. The blood lowering effect
of olmesartan medoxomil is somewhat less in black patients than non-black patients. Do not initiate during pregnancy. Excessive blood pressure decrease in patients with
ischaemic heart disease or ischaemic cerebrovascular disease could result in a myocardial infarction or stroke. Interactions: Concomitant use with potassium supplements,
potassium sparing diuretics and drugs that increase serum potassium levels (e.g. heparin) is not recommended. The blood pressure lowering effect of olmesartan medoxomil can
be increased by concomitant use with other antihypertensive medications. Risk of acute renal failure with concomitant use of NSAIDs and angiotensin II antagonists. Monitoring
of renal function and regular hydration of the patient is recommended. Use with NSAIDs can reduce the effect of olmesartan maedoxomil. Coadministration of warfarin and
digoxin had no significant effect on the pharmacokinetics of olmesartan, warfarin or digoxin. Use in combination with lithium not recommended. If necessary, careful monitoring
of serum lithium levels recommended. No clinically relevant interactions between olmesartan and drugs metabolised by cytochrome P450 enzymes 1A1/2, 2A6, 2C8/9, 2C19,
2D6, 2E1 and 3A4 are expected. Pregnancy and Lactation: Contraindicated in second and third trimesters of pregnancy. Not recommended in first trimester and during breast
feeding. Discontinue as soon as possible if pregnancy occurs during therapy. Undesirable Effects: Market experience: The following have been reported very rarely (<1/10,000):
Thrombocytopenia, hyperkalaemia, dizziness, headache, cough, abdominal pain, nausea, vomiting, pruritus, rash, allergic conditions such as angioneurotic oedema, dermatitis
allergic, facial oedema, urticaria, muscle cramp, myalgia, acute renal failure, renal insufficiency, asthenia, fatigue, malaise, lethargy, abnormal renal function tests, increased
hepatic enzymes. Clinical Trials: Common side effects include dizziness, bronchitis, cough, pharyngitis, rhinitis, abdominal pain, diarrhoea, dyspepsia, gastroenteritis, nausea,
arthritis, back pain, skeletal pain, haematuria, urinary tract infection, chest pain, fatigue, influenza-like symptoms, peripheral oedema, pain, increased creatinine phosphokinase,
hypertriglyceridaemia, hyperuricaemia, and liver enzyme elevations. Less common side effects include vertigo, hypotension, angina pectoris, rash, hyperkalaemia. Overdosage:
Most likely effect is hypotension. In the event of overdosage, monitor the patient carefully and give symptomatic and supportive treatment. Pack Sizes: Blister containing
28 film-coated tablets. Legal Category: POM. Product Authorisation Numbers: PA 1595/1/1-3. Product Authorisation Holder: Daiichi Sankyo Ireland Ltd., Riverside One,
Sir John Rogerson’s Quay, Dublin 2. Additional information is available on request from: Daiichi Sankyo Ireland Ltd., Telephone: (01) 489 3000, Fax: (01) 489 3033, E-mail:
[email protected] Date of Preparation: November 2009.
References: 1. Smith D et al. Am J Cardiovasc Drugs 2005; 5(1):41-50. 2. Oparil S et al. J Clin Hypertens 2001;3;283−291,318. 3. Brunner HR et al. Clin Drug Invest
2003;23(7):419−430. 4. Brunner H and Arakawa K. Clin Drug Invest 2006;26(4):185−193. 5. Ball KJ et al. J Hypertens 2001;19(Suppl 1):S49−S56. 6. Stumpe KO and
Ludwig M. J Hum Hypertens 2002;16(Suppl 2):S24−S28. 7. Giles TD et al. J Clin Hypertens 2007;9:187−195. 8. Fabia M J et al. J Hypertension 2007, 25:1327-1336.
9. Püchler J et al. J Hypertension 2001, 19(Suppl 1):S41-48. 10. Barrios V et al. Vascular Health and Risk Management 2009:5 723-729.
Date of item: February 2013 DSIE/BEN54
3
news
issue 7 volume 15 • JUly/AUGUST 2013
HSE makes over €84.4 million
from prescription charges
THE HSE made a total of
€20,335,099 in prescription
charges income in the first
three months of 2013, following
its trebling of the charge, Irish
Pharmacist can reveal.
Following last year’s Budget
decision to increase the .50
cent charge to €1.50 per item
dispensed, the HSE has seen
a large increase in its income
from the controversial charge,
which was introduced in October 2010.
The HSE has made a total
of €84.452 million since the
charge was introduced up
until the end of March this year,
figures obtained from the HSE
by this publication reveal.
The total amount collected
by pharmacists in the first
12 months of the scheme
was over €24.66 million, just
roughly a fifth more than
what it collected in just three
months this year.
Broken down by county,
Dublin pharmacists have collected the most in prescription
charges to date at €19.858
million, followed by Cork at
€9.906 million, Galway at
€4.355 million, and Limerick at
€4.126 million.
The county that collected
the lowest amount was Fermanagh at €1,158.
While there are currently
over 1.8 million medical
cardholders in the country, the
prescription charge, which is
capped at €19.50 (originally
€10) a month per family, does
not apply to children in the
care of the HSE who have their
own medical card, those on
the Long Term Illness Scheme;
persons who receive services
under the Health (Amendment)
Act 1996; patients participating
in the Methadone Treatment
Scheme, or items dispensed under the Drugs Payment Scheme.
The charge has been widely
criticised by a number of
patient groups and the Irish
Pharmacy Union (IPU), but
some have pointed out that
it makes patients think more
carefully about their medications and helps stop abuse of
the GMS drugs budget, which
hit €1.9 billion in 2010.
Department of Health Secretary General
keen for increased role for pharmacists
in primary healthcare provision
The Secretary General of the
Department of Health is keen
to further widen the scope of
pharmacists to provide additional healthcare services, Irish
Pharmacist can reveal.
Dr Ambrose McLoughlin, a
former Registrar of the PSI, told
this publication that all three
Ministers in the Department
wish to increase the role of
pharmacists. Discussions with
pharmacists on contributing
to home care and self care
have already taken place, with
separate discussions being held
about pharmacists contributing more to elderly and mental
health care in the community,
he confirmed.
“Pharmacists have a wonderful opportunity to help facilitate
the reform programme, and we
in the Department are up for
major change,” Dr McLoughlin
said.
He added that the profession
has a significant advisory role
to play in the healthcare reform
programme, and hospital
pharmacists are playing an increasingly vital role in ensuring
patients are prescribed and dispensed the most cost-effective
therapies.
Dr McLoughlin also indicated
he is in favour of the creation of
a minor ailments scheme to be
rolled out in Irish pharmacies, a
move that it is being sought by
the IPU.
IPU Secretary General Darragh O’Loughlin welcomed Dr
McLoughlin’s comments, and
said he was keen to get the Government, policymakers and the
public to understand and appreciate not just the enormous
contribution that pharmacists
make already, but the huge
potential for pharmacists to add
further value to Irish healthcare
services.
“Patients don’t really care
who is providing their care
–whether it is a doctor, nurse
4
of the Act a decrease in the
number of complaints received
annually.
A total of 49 complaints were
referred to the Preliminary
Proceedings Committee (PPC)
in 2012, which was a decrease
on the 61 complaints referred
to the PPC in 2011.
Of these 49 complaints, it was
decided that there was sufficient
cause to warrant further action
in relation to 13 complaints, all
New appointments made to
the PSI Council
A number of appointments
to the PSI Council have been
made by Minister for Health Dr
James Reilly.
The following pharmacists
have been appointed (or reappointed) following the election
process earlier this year: Nicola
Cantwell, Richard Collis, Georgina Ann Frankish, Eoghan
Hanly and Conor Phelan.
Rita Purcell has been reappointed to the Council as the
nominee of the Irish Medicines
Board. Dr Chantelle McNamara
is a new appointment. All of
these appointments are for the
period ending June 17 2017.
In addition, Pat O’Dowd has
been appointed to the Council
for the period ending June 14
2015, as the nominee of the
HSE to fill the casual vacancy
arising for this position.
A further four Council members are in the process of being
appointed.
Further details, including a
short biography of the new
Council members, is available
on the PSI website (www.
thepsi.ie).
The first meeting of the new
Council is scheduled to take
place on July July 18, where
a new President and Vice
President will be elected, and
the PSI’s new five year strategy
document will be approved.
New NUIG Cert in Health
Promotion
Dr Ambrose McLoughlin
or pharmacist – as long as
they are assured that person
is qualified to deliver whatever healthcare service they
are delivering, and it is being
delivered to a high standard
with full quality assurance and
accountability.
“Countries like Canada and
the UK already have pharmacists delivering additional
services that haven’t yet been
considered in Ireland, he
pointed out.
30% decrease in complaints against Irish pharmacists
A total of 48 formal complaints were received under
Part 6 of the Pharmacy Act
2007 in 2012, figures from the
Pharmaceutical Society of Ireland (PSI) 2012 Annual Report
reveal.
This is almost a 30 per cent
reduction on the 2011 figures
where 68 complaints were
received in the same period
and represents for the first
time since the commencement
in brief
of which were referred to the
Professional Conduct Committee (PCC) for inquiry.
No complaints were referred
to Mediation or to the Health
Committee in 2012. The PPC
determined that there was
not sufficient cause to warrant
further action in respect of 33
complaints received in 2012.
Three complaints were withdrawn by the complainant.
The PPC said the highest
level of complaints related
to dispensing errors and that
there had been a marked reduction in complaints involving
codeine.
Meanwhile, the total number
of retail pharmacy businesses
on the PSI register at the end
of 2012 was 1,784, an increase
of 27 pharmacies from 2011.
The number of new openings
decreased from 48 in 2011 to
45 in 2012.
NUI Galway is commencing
a collaborative education
initiative involving Diabetes
Ireland, Croí and the Irish Heart
Foundation, which may of
interest to pharmacists.
A Specialist Certificate
in Health Promotion –
Approaches to Cardiovascular
Health and Diabetes
Prevention is now open
to applications. This oneyear distance education
programme aims to provide
candidates with professional
education and training in
the principles and practice
of health promotion as
applied to the promotion of
cardiovascular health and
diabetes prevention.
The programme comprises
three modules, each carrying
five European Credit Transfer
System (ECTS) points.
Further information is available on the NUIG website or
by contacting Anne O’Grady at
[email protected] or
by telephone at 091 493644.
Healthcare (Ireland) Ltd.
news
IPU denounces latest FEMPI cuts
Reacting to the
announcement of further cuts
in pharmacists’ payments
under the Financial Emergency
Measures in the Public
Interest (FEMPI) Act in July,
the Irish Pharmacy Union
(IPU) stated that the capacity
of pharmacists to deliver
healthcare services has been
severely undermined.
The latest FEMPI cuts see
the retail mark-up of 20 per
cent paid to pharmacists for
dispensing drugs under the
drugs payment scheme (DPS)
and the Long-Term Illness
Scheme being ended, and will
result in at least a further €32
million being removed from
Irish pharmacies this year.
Mr Rory O’Donnell
Previous cuts since 2009
have seen cumulative savings
of €570 million to the
Exchequer.
Commenting on the
announcement, President
of the IPU, Rory O’Donnell,
said the profession is already
reeling from falling retail
sales, previous reductions in
fees and other payments, and
the significant business and
regulatory costs imposed on
the profession.
“Pharmacists are angry and
disillusioned that a real opportunity to engage in true reform
in the delivery of healthcare
services that will deliver savings and meet patients’ needs
has been ignored in favour of a
self-defeating ‘slash and burn’
policy that continues to undermine the pharmacy sector,
and the delivery of services to
patients,” he commented.
Community pharmacists can
deliver many more convenient,
accessible and cost-effective
healthcare services to patients,
Mr O’Donnell pointed out.
The IPU urged Minister for
Health Dr James Reilly to engage fully with the IPU in the
context of the wider healthcare reform agenda.
Pharmacists asked to submit views on
national cancer drugs protocols
The National Cancer Control
Programme (NCCP) has announced that work is commen
cing on the development of
national drug protocols for the
treatment of patients with can
cer, for those drugs already in use.
The NCCP is now inviting
all pharmacists, involved in
the treatment of patients with
cancer, to register their interest
in collaborating in this work.
The aim of these protocols is
to support the safe, evidencebased, and cost-effective
cancer treatment of all cancer
patients in Ireland. Once the
protocols have been developed and approved, they will
be disseminated to the hospitals involved in the care of
cancer patients, in addition to
being published on the NCCP
website. The NCCP drug protocols
are being developed based on
the latest evidence related to
the management of specific
cancers, under the guidance
of a medical consultant. The
intention is to develop these
protocols on a collaborative
basis with the healthcare
professionals involved in the
drug treatment of cancer
patients.
Drug protocols have already
been developed for all new
drugs for the treatment of
cancer since late 2012. Expressions of interest
should be emailed to: [email protected].
All persons contributing
to the drug protocol development will be individually
acknowledged as contributors
on the NCCP website.
Increased calls for pharmacists to publish and
display their prescription medicine prices and fees
The issue of medicine prices
and pharmacist fees have been
raised again in the Dáil, with
growing pressure for the profession to publish and display
this information for patients.
As reported by Irish
Pharmacist in June, the
Department of Health has
asked the Pharmaceutical
Society of Ireland (PSI) to
examine how greater price
transparency can be achieved,
as Minister of State at the
Department of Health Alex
White revealed when queried
on the issue in the Dáil in April.
He has since been asked
again by TDs about any
plans to make pharmacists
publish their dispensing and
other fees, which they are
currently not required to do.
However, under the PSI Code
of Conduct pharmacists are
required to provide honest,
relevant, accurate, current and
appropriate information to
patients regarding the nature,
cost, value and benefit of
6
medicines provided by them.
The PSI advises patients that
their pharmacist should be
in a position to provide them
with whatever information
or clarification they require,
including information about
the pricing of those medicines,
Minister White pointed out
when answering more queries
on the matter in the Dáil in
June.
He added the Health
(Pricing and Supply of Medical
Goods) Act 2013 provides
patients with an incentive to
seek products priced at or
below the reference price,
and he previously stated that
if patients are being charged
more than a 20 per cent retail
mark-up they should raise it
with their pharmacy.
“It is the view of the HSE
and the Department of Health
that there should be total
transparency provided when
any pharmaceutical service is
accessed by a member of the
public,” Minister White stated.
Mr Alex White
in brief
IPU pays tribute to former
Secretary General
The IPU has paid tribute to its
former Secretary General Seamus Feely.
Mr Feely stepped down from
the role in June after 12 years in
the IPU.
President of the IPU Rory
O’Donnell paid a warm tribute to
Mr Feely on his retirement from
the post: “Seamus was one of
our most outstanding Secretary
Generals. He oversaw a period
of very rapid change for the
profession and was instrumental
in improving the professionalism
of the Union. He was a stalwart
leader at a time of great pressure
and he will be fondly remembered by everyone in the IPU. On
behalf of the entire membership,
I wish Seamus and his family
every happiness and success in
the future.”
Mr Feely, writing in the 2013
IPU Annual Report, thanked each
and every member of the IPU for
their support and participation
in the work of the IPU and most
especially for their support to
him personally over the years.
He also praised the commitment of all the IPU Presidents he
had worked with.
“I have no doubt that the
IPU will continue to evolve and
change and go from strength to
strength in the years ahead, Mr
Feely said.
Darragh O’Loughlin is the
new Secretary General of the
IPU. See page 12 for interview.
New RCSI research discovers
how oestrogen can reduce
risk of liver and heart disease
in women
A team of researchers from the
Royal College of Surgeons in
Ireland (RCSI) and the University
of California (UC Irvine) have
discovered how oestrogen can
reduce the risk of liver and heart
disease. The study was recently
published in the journal Science
Signalling.
The research shows the beneficial effect that oestrogen has on
liver metabolism by revealing a
new type of oestrogen receptor
that controls oestrogen-responsive genes that regulate cholesterol and fatty acid production.
Prof Brian Harvey, RCSI
Principal Investigator, said:“Our
research has allowed us to gain
important insights into how
oestrogen may suppress some
genes and... leaves the door open
for the development of drugs
that can decrease the incidence
of liver and heart disease in
women.”
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international NEWS
Canadian conference offers global medicine shortages solutions
A global process to determine the list of critical or vulnerable medical products should be developed to help
address the growing problem of medicines shortages, a
major conference on the issue in Canada has been told.
Delegates from around the world gathered in Toronto
in late June at the first-ever International Summit
on Medicine Shortages, hosted by the International
Pharmaceutical Federation (IPF), and co-hosted by the
Canadian Pharmacists Association.
The Summit provided a forum to discuss the causes,
impact, and means to address medicine shortages with
a variety of stakeholders from around the world, including governments, practitioners, industry, and patients.
The Summit’s final communiqué offered a number
of recommendations and ideas on how to reduce the
occurrences of medicine shortages. These recommendations will be shared with all stakeholders as a tool to
advocate for measures to reduce shortages.
Recommendations include the following:
• Each country should establish a publicly accessible
means of providing information on shortages.
• A global process to determine the list of critical/vulnerable products should be developed.
• All procurers of medicines are urged to move towards
active procurement processes that assure the continuity of supply of quality medicines.
• All countries are encouraged to remove unnecessary
variability of regulatory practices within and between
countries.
• All countries should investigate the potential to
establish a national body charged with gathering and
sharing information about demand for, and supply of,
medicines within their jurisdiction.
• All countries are encouraged to develop evidencebased risk mitigation strategies, which might include
strategic buffer stockpiles, contingency plans, pandemic planning, etc..
“This Summit has provided a unique opportunity to
bring together stakeholders from around the world to
address an issue of top concern amongst pharmacists
and patients,” stated Dr Michel Buchmann, IPF President. “We hope that the ideas and recommendations
discussed here in Toronto will be shared widely and
acted upon swiftly in order to address this multinational
health crisis.”
A copy of the final communiqué can be obtained via
www.fip.org.
UK National Pharmacy
Association welcomes new
initiative in Northern Ireland
The UK’s National Pharmacy Association (NPA) has
welcomed the progress of the ‘Health + Pharmacy’
initiative, which is soon to launch in Northern Ireland.
The launch of ‘Health + Pharmacy’ follows the formation of the ‘Pharmacy Alliance’ set up by the Health and
Social Care Board and the Public Health Agency and
other stakeholders including the NPA to look at what
the concept of a health-promoting pharmacy might
look like in Northern Ireland.
Health + Pharmacy identifies a lead role for pharmacists in health and wellbeing, which builds on existing
best practice and extends the reach of public health
services delivered through community pharmacies. The
Health and Social Care Board has sent letters to pharmacies in Northern Ireland to register with expressions
of interest to take part in the initiative.
Commenting, Deborah Evans, Director of Pharmacy at
the NPA and Healthy Living Pathfinder Lead, said: “We’re
pleased to see pharmacies in Northern Ireland given the
opportunity to take part in this exciting initiative. The
evaluation of the HLP model in England has shown the
benefits for both patients and the pharmacy workforce
when pharmacy takes on a leading role in improving
the public’s health.”
The concept of Health + Pharmacy is one that originated in the DHSSPS Making it Better Strategy (2004)
and builds on the experiences of Healthy Living Pharmacies in England and the NI Building the Community
Pharmacy Partnership (BCPP) initiative.
Pharmacists removed from
Australian skilled visa programme
Light therapy reduces bacterial
colonisation in acne.
True of false?
Make sure you are up to date on the current treatment of
acne by completing the latest module on PharmacistCPD.ie
PharmacistCPD.ie
8
THE Australian Government has removed pharmacists
from its new skilled occupation list (SOL), which came
into effect on July 1.
The Australian Government, through its Department
of Immigration and Citizenship, issued a revised SOL for
the purposes of migrating to Australia under the skilled
migration programme, which saw the removal of five occupations. These included (ANZSCO Code 251511) hospital
pharmacists and (ANZSCO Code 251513) retail pharmacists.
The decision has been made independently by the
Australian Government that the pathway for independent skilled migration to Australia as a pharmacist is now
unavailable, and the move was based on expert advice
from the Australian Workforce Productivity Agency,
previously known as Skills Australia.
The Australian Pharmacy Council and other Australian pharmacy organisations were consulted during a
review of the skilled migration programme.
This decision does not affect overseas-born permanent residents of Australia.
The DIAC website is www.immi.gov.au, where further
information can be obtained on the changes.
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110,098 104,404
234,304
74,039 16,233
7,391
s
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A copy of the summary of product characteristics is available on request.
Medicinal product available for retail sale through pharmacy only. Always read the label.
2012/ADV/PAR/076
the world, in a city famous for its warm and friendly
people, cultural heritage and beautiful landscapes –
the FIP Congress 2013 will truly leave an impression!
www.fip.org/dublin2013
news
Preview
Final countdown to FIP 2013
FIP.2047_A4_EN-Dublin_TB_v2.indd 1
20-12-12 09:39
The holding of the FIP Annual Congress in Dublin this year gives Irish pharmacists
a rare opportunity to easily attend this highlight of the international pharmacy
calendar. Priscilla Lynch reports
T
he International Pharmaceutical Federation
(FIP) will host its Annual
Congress in collaboration
with the Pharmaceutical
Society of Ireland (PSI)
and its Irish partners from August 31 to
September 5 in the National Convention Centre, Dublin.
Then again you are probably well
aware of this, as the PSI has spent the
last couple of years heavily promoting
the fact that this prestigious event is
finally being held in Ireland again after
its last appearance here in 1975. The
timing of the conference coincides
with 2013 being the year of The Gathering, and it is estimated the conference will be worth in excess of c10
million to the Irish economy.
The FIP 2013 Annual Congress offers
five days of sessions, symposia, workshops, discussions and a variety of
social events that will bring together
over 3,000 international participants
from diverse areas of pharmacy practice and pharmaceutical sciences.
The theme of the 2013 conference
is ‘Towards a future vision for complex
patients: Integrated care in a dynamic
continuum’, and there will be a key
focus on the central role of the pharmacist in delivering patient care in an
ever more challenging setting.
In a constantly evolving environment, where advances in science,
technology and communications
require all pharmacists to adapt, it is
vital that the pharmacy profession is at
the forefront of change; responding to
medical innovations alongside changing patient needs, and the Annual
Congress is thus a not to be missed
opportunity for Irish pharmacists, according to FIP.
Pharmacy in Ireland is currently
undergoing its biggest transformation
in decades, thanks to new services
and the major expansion of the role of
pharmacists with the commencement
of the Health (Pricing and Supply of
Medical Goods) Act 2013.
Speaking to Irish Pharmacist, the
new Secretary General of the Irish
Pharmacy Union (IPU), Darragh
O’Loughlin, encouraged Irish pharmacists to attend FIP 2013 if at all
possible.
“It is a fascinating conference and it
is a great opportunity this year for Irish
pharmacists who wouldn’t have necessarily wanted to travel abroad with all
the costs that entails. And there is an
opportunity for Irish pharmacists to
get a day pass for n250, which means
they can come along, see what it is
about, and interact with thousands of
10
Members of the FIP Dublin host committee with visiting FIP Congress staff, Carola van der Hoeff and Mireille
Swakhoven. [From L-R (back) Dr Joan Peppard, Ms Helen McEnery, Ms Kate McClelland, Mr Keith O’Hourihane,
Mr Darragh O’Loughlin, Ms Mary Rose Burke, Ms Noeleen Harvey and Dr Mike Morris, (seated) Dr Martin
Henman, Ms Kate O’Flaherty, Ms Carola van der Hoeff, Mr Paul Fahey, Ms Mireille Swakhoven, Mr Eoghan Hanly]
pharmacists from all around the world
and get an idea of what pharmacy is
like worldwide. It promises to be really,
really interesting from a social as well
as an academic perspective, and it is
an opportunity for Ireland to showcase
all that’s best about Irish pharmacy,”
he commented.
Preparation
Kate O’Flaherty, Head of Communications and Public Affairs and Acting
Head of Pharmacy Practice Development, PSI, confirmed that the PSI’s
work on preparing for FIP 2013 began
back in late 2009 when their hosting pitch was successful. The PSI has
worked tirelessly since then to help
prepare a comprehensive academic
and social programme and promote
FIP 2013 nationally and internationally.
FIP celebrated its 100-year anniversary
last year, with the 2012 FIP Centennial Congress being held in Amsterdam, and the pressure is on to make
sure that this year’s event in Ireland
matches its success.
“It really is a prestigious conference
and it would be shame if people didn’t
take the chance to go. It is a great
opportunity to see what is going on
in the profession in other countries,
to engage in sharing experiences and
learning, show what we are doing and
see what other countries with similar
challenges to us to are doing,” she
said.
The Programme for this year’s
Annual Congress is very detailed
with something for everyone; from
students, interns, academics, policymakers, community, hospital and
industrial pharmacists and industry,
Ms O’Flaherty maintained.
With the aims of advocating increasing roles for pharmacists in the
management of complex patients, FIP
2013 will examine the issues from all
standpoints: Biological (emphasising
the current development of systems
biology), medical (demographics,
genetics, smoking, alcohol, diet and
multiple diseases), socioeconomic
(availability of resources, literacy) and
cultural (beliefs, traditions, religion).
Irish perspective
As well as bringing an exciting range
of leading international pharmacy figures to Dublin, some of Ireland’s bright
and best will also be featuring at this
year’s Annual Congress.
For those in attendance at the
beginning of the week, the Pharmacy
in Ireland session, on Sunday morning,
September 1, will provide a broad but
informative overview of the Irish pharmacy landscape. Speakers will outline
current developments in industry,
hospital and community pharmacy,
regulation and academia. It is aimed at
both local and international delegates,
providing an opportunity to meet with
Irish representatives in each of the
sectors. Dr Martin Henman of Trinity
College Dublin (TCD) will chair the
seminar.
On Monday, September 2, Dr
Tamasine Grimes, TCD, will take part
in a broad-based discussion on critical
patient needs along with three international contributors.
On Tuesday, September 3, Dr Denis
O’Driscoll will present on the ongoing
pharmacist involvement in the needle
exchange project and methadone
treatment in the Irish setting, while
current PSI President Paul Fahey will
take part in a debate examining future
trends in community pharmacy.
Aisling Reast, Pharmacy Practice
Development Unit, PSI, will present on
the current Irish situation regarding
social networking and its influence
on patient care with international
comparisons during a special session
on Wednesday, September 4.
The role of pharmacists in managing
patients with asthma will include an
Irish perspective from PhD researcher
Niamh Buckley in collaboration with
GP Dr Eamonn Shanahan, on Thursday,
September 5.
Tim Delaney, Programme Lead
for Medication Safety in the HSE’s
Quality and Patient Safety Directorate
will also present, while other Irish
speakers will cover topics such as
implementing new clinical services
in hospital pharmacy in line with
the Basel Statements, and the
role of pharmacists in delivering
humanitarian aid, among others.
In addition, there will be a significant number of poster research entries
from Irish pharmacists.
The PSI recently circulated details
of the reduced day rate of e250 for
Irish and Northern Irish registered
pharmacists. Pharmacists can preregister for this rate, offering the
opportunity to attend one day of
the congress for CPD or networking
purposes.Go to www.psi.ie for details.
Full information on FIP 2013 can be
seen on www.fip.org/dublin2013. The
September issue of Irish Pharmacist
will contain extensive coverage from FIP
2013.
news
interview
Taking the reins at
a time of change
Priscilla Lynch talks to new IPU Secretary General
Darragh O’Loughlin about the challenges and
opportunities that lie ahead for Irish pharmacists
N
o one could accuse the new Secretary General of the Irish Pharmacy
Union (IPU) of not being up for a
challenge.
Having taken up his position on
July 1, in succession to Seamus Feely,
who stepped down after 12 years with the IPU, Darragh O’Loughlin had to hit the ground running.
Pharmacy services in Ireland are in a state of
major turmoil and change, with falling sales, while
State fees continue to be cut alongside growing
responsibilities and demands on the profession.
“It is a really, really challenging time for pharmacists. We have always proved ourselves in challenging times to be very adaptable, to be able to
come up with solutions, to find a way through and
ultimately be able to survive, but we are being
stretched to our limits financially,” he acknowledged.
Mr O’Loughlin is well used to the turmoil of
the Irish pharmacy world and brings enormous
experience to his new role. He is a pharmacist by
profession and a former President of the IPU (2010
– 2012), and previously served on the Council of the
Pharmaceutical Society of Ireland (PSI). He is also
a member of the Board of HIQA and is Treasurer of
the Pharmaceutical Group of the European Union
(PGEU).
“As the role of pharmacists continues to change
and getting policymakers to understand what
else we can do, being
a pharmacist myself
means I can really
highlight all parts of
the equation,” he told
Irish Pharmacist.
“
to announce the decision. Having that hang over
pharmacists for so long meant it was impossible
for them to do business plans, revenue and staffing
projections because they didn’t know what the
revenues were going to be. In addition, the latest
CSO retail sales figures show that pharmacies have
been hit the hardest out of all the retail industries
in both the value and volume of sales,” he stated.
New legislation
The FEMPI cuts come at a time when Irish pharmacists are gearing up for some of the biggest changes to their primary role in decades. The commencement of the Health (Pricing and Supply of Medical
Goods) Act 2013 means that for the first time Irish
pharmacists can now substitute approved generic
prescription medicines for branded ones.
Generic substitution will go live as soon as the
Irish Medicines Board publishes the interchangeable medicines lists and then shortly after that
reference pricing will come into effect once the
HSE decides the reference price for each group of
medicines, Mr O’Loughlin explained.
“It really represents a fundamental change in the
way Irish pharmacists practice. So from a patient’s
perspective their medication may look different,
have a different name, and pharmacists will have
additional work in selecting the appropriate medicine and having a conversation with the patient to
reassure them that despite the medicine seeming
different, it is the same
medicine they have
previously been getting,” he noted.
The new changes
will mean a significant
extra workload for
pharmacies and the
IPU is in close contact
with the Department
of Health and the HSE
in terms of implementing the Act, Mr
O’Loughlin confirmed.
“The manner in
which the Act is
implemented and the
impact on patients
has to be managed
very carefully. We
are getting as much
information from the HSE and the Department as
we can and communicating it to pharmacists….
We are also trying to make the HSE cognisant of
the impact the changes will have on pharmacists
and the costs; as that extra input and extra time
spent with patients discussing the medicines will
mean extra costs in terms of staff and therapeutic
time that would have been spent on other
services,” he maintained.
The FEMPI Act
hangs over us
like a long, malevolent
shadow all the time.
Its application can at
times seem very unfair,
arbitrary and quite
capricious.”
FEMPI
On just his second
day in the office, Mr
O’Loughlin had to
deal with the news
that the Government
had yet again decided
to cut pharmacists’
fees for the provision
of services to public patients, under the FEMPI
Act, a move that he
and his IPU colleagues
denounced. The latest
round of cuts will take at least a further €32 million out of Irish pharmacies this year, and the previous FEMPI cuts since 2009 have seen cumulative
savings of €570 million to the exchequer.
“The FEMPI Act hangs over us like a long,
malevolent shadow all the time. Its application
can at times seem very unfair, arbitrary and quite
capricious. We had the last review over the Christmas and New Year period and it took six months
12
Darragh O’Loughlin, IPU Secretary General
Opportunities
While the challenges for the profession are formidable, it is also a time of opportunity with welcome
widening of the scope of Irish pharmacy services in
the last couple of years. The IPU has actively sought
discussions during this time on funding community pharmacists to deliver a range of new services
including medicine use reviews, a minor ailments
scheme, health screening and chronic disease
management.
Through the provision of vaccination and
emergency contraception services pharmacists
have proven their capacity to take on additional
roles and deliver them to the highest standards, Mr
O’Loughlin pointed out.
“I see a key part of my role in the IPU as helping
the Government see that some of the problems
they have can be solved by working with pharmacists and giving us the opportunity to provide
solutions to the public that the Government has
already promised them, but isn’t in a position to
deliver through the current existing channels.
“Right now, with fundamental changes happening in healthcare and how it is delivered and the
position the Government is in with a shortage of
resources, there are some exciting potential opportunities there for pharmacists,” he commented.
For example, pharmacists could play an increased role in primary healthcare provision to
support the Government’s plans to roll out free GP
care, he said.
“We don’t have sufficient GPs to deliver the adequate level of care that people require right now
but pharmacists are in a position to deliver a lot of
the [primary] healthcare that patients want, and
they are open to that.”
But expanding the role of pharmacists is not Mr
O’Loughlin’s only priority – he wants to be accessible to pharmacists around the country and hear
about their everyday concerns.
“I don’t intend to spend my time cooped up in
an office all the time. It is my intention to get out
and to continue meeting as many of the members as possible, to hear from them, to hear their
concerns and to keep them as informed as I can in
terms of what’s going on, and I also want to meet
as many other stakeholders as possible to make
sure we get as broad a coalition as possible behind
the moves to expand the role of pharmacists to
the benefit of the public, patients and the health
system as a whole,” he concluded.
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EU NEWS
Gary Finnegan,
European Correspondent
Gary Finnegan is an award-winning
Irish journalist with over ten years
experience of reporting on health
and medical affairs. He is based in
Brussels.
Europe facing medicines shortages
The EU and national governments
should take action to tackle the
ongoing shortage of medicines in
Europe, according to pharmacists.
In a joint call, the Pharmaceutical
Group of the European Union
(PGEU), which represents community
pharmacists, the European
Association of Hospital Pharmacists
(EAHP), and the European Industrial
Pharmacists Group (EIPG), said
the situation is worsening but
policymakers have been slow to act.
Pharmacists want national
regulators to investigate the impact of
national pricing and reimbursement
strategies on the medicines supply
chain. They also called for more
cooperation across borders and the
introduction of early warning systems
to highlight shortages.
John Chave, Secretary General
of PGEU, said evidence from the
community pharmacy sector suggests
the problem is hitting countries from
all corners of Europe and affects a
huge range of medicines.
“At a minimum, community
pharmacists need to be in a position
to properly inform patients when a
medicine is, or is likely to become,
unavailable, and the causes and
duration of the shortage. The
pharmaceutical sector as a whole has
a duty to avoid leaving patients in the
dark,” he said.
For its part, the EAHP has recently
completed a survey of hospital
pharmacists, which shows that
“virtually every hospital in Europe”
has felt the impact of disrupted
supply.
“Immense amounts of hospital
pharmacists’ time are being diverted
from other elements of patient care
to simply source medicines. With the
evidence strongly suggesting the
problem is becoming worse, doing
nothing is no longer an option,” said
EAHP President Roberto Frontini.
There is some concern that strict
conditions on the importation of
active pharmaceutical ingredients,
introduced as part of the new EU
Directive on Falsified Medicines,
could be having an unintended effect
on the production of medicines in
Europe.
Luigi Martini of the EIPG said
the directive in question was
broadly welcome, but he called
on the European Commission to
“understand the inter-relatedness of
pharmaceutical policy decisions”.
Wanted: Government buy-in to verification system
The consortium behind the new
European Medicines Verification
System (EMVS) is ramping up its
efforts to convince governments and
national regulators to embrace the
technology.
The system uses point-of-sale
2-D barcode scanners to confirm
that medicines packs dispensed by
pharmacists are authentic, have not
been sold before, and are not the
subject of an EU product recall.
Developed by groups representing
pharmacists, wholesalers and
manufacturers to meet the
requirements of the new EU Directive
on Falsified Medicines, the EMVS
will connect national databases to a
European hub.
At a workshop in Sofia, Richard
Bergström, Director General
of the European Federation of
Pharmaceutical Industries and
Associations (EFPIA), called on
national stakeholders to cooperate
and propose national medicines
verification systems in line with the
EMVS model.
The PGEU said the EMVS offers “a
modern technology solution to ensure
verification of product authenticity
by professionals at the point of
dispensing”.
Countries that do not want to
set up their own national system
will be given the opportunity to
join an existing product verification
infrastructure, according to Heinz
Kobelt, European Affairs Director of
the European Association of EuroPharmaceutical Companies, but the
ideal outcome would be for most
countries to develop their own
interoperable systems.
“The more national blueprint
systems we have in operation, the
more the costs per pack will fall to the
most cost effective level,” he said.
The EMVS will be managed by a notfor-profit stakeholder organisation
referred to as the European Medicines
Verification Organisation (EMVO).
Austerity ‘bad for health’ EU told
Austerity policies are coming under
fire from health experts in Brussels
amid growing concerns that the
impact on public health is greater
than anticipated.
At a hearing in the European
Parliament, several MEPs and interest
groups complained that pressure on
health budgets was exacerbating
health inequalities and introducing
disparities in access to medicines.
Cutbacks could ultimately lead
to later diagnosis and treatment of
illnesses, storing up problems for
the future. The cost of medicines
was highlighted by Greek MEP Dr
Antonyia Parvanova as a reason why
some patients are effectively locked
out of the health system.
This was echoed by Irish MEP
Marian Harkin who said drugs prices
in Ireland are excessively high.
“Even if, to a large extent, the Irish
14
healthcare system still functions
reasonably well, the exceptional price
of medicines is a huge burden on
the individual and on the healthcare
system that needs to be lifted,” she
said.
With rising levels of non-communicable diseases, access, affordability
and availability of medicines will be
a major issue in the years ahead, according to Monika Kosinska, Secretary
General of the European Public Health
Alliance (EPHA).
“The failure to consider the health
consequences of austerity policies
is preventing people from receiving
essential medicines. Medicines
are growing less affordable and
increasingly hard to access for many.
In particular, it has hit communities
who are already affected by the crisis
and the cuts and are struggling to put
food on the table, let alone to pay for
Marian Harkin MEP
the medicines they need,” she said.
Separately, the European
Association of Pharmaceutical
Full-line Wholesalers (GIRP) said the
medicines supply chain was been
kept afloat thanks in part to liquidity
provided by wholesalers.
European medicines wholesalers
are invoiced by manufacturers before
they can invoice their customers,
leaving them out of pocket to the
tune of billions of euro while they
typically wait around 44 days for
payment.
With profit margins being
squeezed, wholesalers will find it
difficult to continue to shoulder this
financial burden.
“There is a clear danger that with
rapidly lowering profitability levels
the distribution chain will be pushed
beyond its natural breaking point,”
said GIRP.
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COMMENT & ANALYSIS
EDITORIAL
LETTERS/editorial
Competition winner!
A summer of ups
and downs for Irish
pharmacy
I
t’s been a mixed summer for pharmacists so far.
While there was good news with the commencement of the long
awaited Health (Pricing and Supply of Medical Goods) Act 2013, the
appointment of the very experienced Darragh O’Loughlin to the post
of Secretary General of the Irish Pharmacy Union (IPU), and the official
opening of the new headquarters of the Pharmaceutical Society of
Ireland (PSI), the announcement of yet more cuts to pharmacists’ fees
under the FEMPI Act was a bitter blow for the already struggling sector.
Irish pharmacies are trying to cope from loss of business due to the
poor economic climate, previous reductions in fees and other payments, and the significant business and regulatory costs imposed on the
profession, and they seem to have been hit disproportionately hard by
FEMPI and other cuts over the last few years.
As Mr O’Loughlin descriptively put it in his interview in this issue; the
FEMPI Act hangs over Irish pharmacists like a “long, malevolent shadow
all the time. Its application can at times seem very unfair, arbitrary and
quite capricious”.
The latest cuts come at a time when pharmacists will be taking on
much more work under the new generic substitution and reference pricing changes, and at a time when the Department of Health has signalled
that it wants to further widen the scope of pharmacists to provide
additional healthcare services for patients. There will hardly be much
goodwill from Irish pharmacists now to these changes and plans.
Primary care, including pharmacy services, is the most efficient and
accessible part of the Irish health system, with consistently excellent satisfaction reports by patients. It is a pity that after all the lip service about
investing in the sector, all that is happening is further cuts.
FIP, FIP, hurray!
On a brighter note, the summer should end on a high for Irish pharmacy,
with the 2013 FIP World Congress taking place in Dublin.
A prestigious event for Ireland and Irish pharmacy, FIP is the largest
annual international gathering of practicing pharmacists, academics,
industry leaders and scientists in pharmacy.
The Congress will be held in the Convention Centre Dublin (CCD),
from August 31 to September 5, with extensive coverage to be carried in
the next issue of Irish Pharmacist.
Priscilla
There was an excellent response to
our competition in last month’s issue
to win a copy of Pharmacy Business
Management by Michael Tierney MPSI,
worth €50.
The competition question was:
Who is the current President of the
Pharmacy Benevolent Fund?
The correct answer is Aisling
Reast.
The winner of the book is Eilis Ryan,
Faheys Pharmacy,
Patrick Street,
Tullamore,
Co.Offaly.
As mentioned last month, all proceeds from the sale of the book are
being divided between two charities: The Jack Kavanagh Fund, a fund
for an Irish pharmacy student who broke his neck in an accident and
wants to complete his pharmacy studies, (go to www.jackkavanaghtrust.
com for more details and to donate); and the Pharmacy Benevolent fund,
which helps pharmacists and their families who have hit hard times.
Donations to the fund can made via www.mycharity.ie/charity/pharmacybenevolentfund/.
The book, which is an extensive and practical guide to managing
a pharmacy business in Ireland, can be purchased from Uniphar and
United Drug.
Call for letters from readers
Irish Pharmacist wants to hear from you!
Whether you want to comment on something in the magazine,
agree/disagree with one of our columnists, have a special charity event
that deserves coverage, or just want to get something off your chest
about pharmacy in Ireland/abroad, we are interested in hearing from
you.
Letters can be posted to: Editor, Irish Pharmacist, GreenCross
Publishing Ltd., 7 Upper Leeson St, Dublin 4, or emailed to: Priscilla@
mindo.ie.
You can also tweet us: @irishpharmacist.
We look forward to hearing from you!
Apps of the month – your guide to the top apps for pharmacists
Google Translate (Free)
Pill Reminder+ IE (Free)
mySugr, Diabetes Manager (Free)
This app is very useful for pharmacists when
dealing with non-English speaking patients. It
is compatible with Android, iPhone/iPod touch,
and the iPad. Google Translate allows you to
translate words and phrases in more than 65
languages, including English, Arabic, Catalan,
Chinese, Croatian, Czech, Danish, Dutch, Finnish,
French, German, Greek, Hebrew, Hungarian, Indonesian, Italian, Japanese,
Korean, Malay, Norwegian, Polish, Portuguese,
Romanian, Russian, Slovak, Spanish, Swedish,
Thai, Turkish, Ukrainian,
and Vietnamese.
Remembering to take the contraceptive pill can
now be much easier with the Pill Reminder+
app. This app is designed for use with combined
oral contraceptive pills. It is not recommended
for use with progestogen-only pills.
This app will help to make patients’ lives
easier by discreetly reminding them to take
their pill daily. Features
include: Daily reminders,
customisable reminder
times, and counting the
remaining pills in the
patient’s pill pack. It can
be used with 21- and 28pill packs.
This popular iPhone app is a charming and sometimes cheeky diabetes Type 1 manager and diary. It
helps patients document their day-to-day life, keep
a diary of their vital stats and treatments, provides
necessary feedback, and helps them to stay motivated about their management of their condition
permanently. Users earn points for each entry and
get the chance to bear down the defiant diabetes
monster. Challenges help
patients to set and pursue
some individual goals.
The company is now also
developing the mySugr
junior app for paediatric
diabetic patients.
17
pharmacology
PROFESSIONAL DEVELOPMENT
Monitoring
prescribed
drug misuse
d r d es co r rigan
Dr Des Corrigan is a former Director of the
School of Pharmacy at TCD and won the
Lifetime Achievement Award at the 2009
Pharmacist Awards. He was chair of the
Government’s National Advisory Committee
on Drugs from 2000 to 2011. He currently
chairs the Advisory Subcommittee on Herbal
Medicines and is a member of the Advisory
Committee on Human Medicines at the IMB.
He is a National Expert on Committee 13B (
Phytochemistry) at the European Pharmacopoeia in Strasbourg and he is an editorial
board member of the Journal of Herbal
Medicine and of FACT – Focus on Alternative
and Complemetary Therapy.
In the third article of his series on the need for a pharmaceutical drug misuse strategy,
Dr Des Corrigan discusses the necessary remaining elements of such a plan
I
n the June issue I looked at some of the
elements of a comprehensive strategy to
prevent and tackle pharmaceutical drug
misuse. The two remaining aspects of such
a strategy are prescription drug monitoring
programmes (PDMP), and methods for the
safe and secure return for disposal of unused and/
or expired narcotics and psychotropics.
While the suggested changes to the Misuse of
Drugs Act regulations provide a basis for a PDMP,
there is more to such initiatives than requiring
pharmacists to make returns to a central body
such as the HSE’s PCRS. For a start, all drugs with
a potential for misuse or over-prescribing would
have to be monitored. All prescribers including
dentists and nurses would have to be included,
as would supply by pharmacists by requisition
to practitioners and others. In addition, there is a
need for expert analysis of prescribing trends that
goes beyond a mere accountancy exercise in cost
saving. This means involving a group with clinical,
pharmaceutical and pharmacoeconomic expertise
that can provide timely and meaningful feedback
to prescribers and pharmacists.
PDMPs exist in 35 states in the US and are
claimed to be of value in assisting patient care,
providing early warning of drug abuse epidemics,
evaluating interventions, and investigating drug
diversion and insurance fraud. Many studies found
that such programmes were associated with lower
rates of substance abuse treatment admissions,
although one evaluation found no link between
overdose deaths and PDMPs. It is also clear that
while monitoring does reduce prescription rates,
this is not necessarily a good outcome because
it can lead to substitute prescribing of nonmonitored but problematic drugs, as happened
with hydrocodone in the US instead of the more
stringently scheduled oxycodone.
ADVANTAGES AND DISADVANTAGES
A major disadvantage of most schemes is
that they are paper based or involve delayed
reporting so that information is not available in
‘real time’ to prescribers and pharmacists, thus
making detection of ‘doctor shopping’ much
more difficult. In Australia they are looking at
co-ordinated medication management systems,
which would provide real time information on
patients complete medication histories. The data
protection implications of such an approach here
would seem highly problematic.
One advantage of a PDMP would be its ability
to provide evidence of any attempt by a small but
unscrupulous minority to prescribe narcotics or
psychotropics for profit. If such evidence became
18
available, then the power of the Minister of
Health to issue a direction preventing prescribing,
under Article 7 of the Misuse of Drugs Act, could
be invoked and a referral made to the Medical
Council.
DISPOSAL OF UNUSED MEDICINES
The final part of any strategy is that of the disposal
of unused medicines in an environmentally safe
manner that does not contaminate soil or water
supplies. In this regard I was bemused by a quote
in an Irish Times Health & Family Supplement article
of March 5 last entitled ‘Why throwing your
unused meds in the bin is a bad idea’.
“
If we are serious
about reducing
the huge annual death
toll attributable to the
misuse of prescribed
medicines, then we
urgently need a proper
nationwide DUMP
scheme.
A representative of the Irish Centre Council for
the Chartered Institute of Waste Management was
quoted as follows; “It’s probably worse putting
pharmaceuticals in the bin than flushing them
down the toilet. They could potentially leach
out into the groundwater eventually from an
unmanaged landfill. All research suggests you
should flush them down the toilet over binning
them”...
In fact, international advice flatly contradicts
this and specifically recommends against flushing
as it leads to contamination of water supplies. The
United Nations Commission on Narcotic Drugs
(CND) adopted a Resolution at its 56th Session in
Vienna in March on promoting initiatives for the
safe, secure return and disposal of prescription
drugs containing narcotics and psychotropic
substances. In this resolution the CND recognised
that inappropriate disposal through waste
management and wastewater could have
detrimental effects on the environment,
including on soil and water. This is recognised as
a growing issue and the detection of drugs and
their metabolites in wastewater entering sewage
treatment plants is a developing area of research.
Indeed, the EU drug monitoring agency (EMCDDA)
hosted a conference in May on detecting illicit
drugs in wastewater as a method of estimating the
level of drug consumption in the community, as
part of an European Commission-funded project
involving 15 cities.
The CND Resolution also highlighted the fact
that safe, secure medicines disposal programmes
helped raise awareness of the harms associated
with the abuse of prescribed medicines. It
encourages member states to work with relevant
partners such as pharmacists, pharmaceutical
manufacturers and distributors, physicians,
consumer groups and law enforcement
agencies to promote public education about
the risks associated with the long-term storage
of prescription drugs in the home, including
diversion for abuse. It encourages member states
to consider the establishment of initiatives for the
safe, secure return and disposal of prescription
drugs liable to abuse as part of comprehensive
measures based on models from countries such as
the US and Canada.
THE NEED FOR DUMP SCHEMES
In fairness to the Institute of Waste Management,
that quote above did finish up by saying
that “the best option is to return them to the
pharmacy”. This presupposes that there is a
national pharmacy-based scheme in operation
but as the Irish Times article makes abundantly
clear, the countrywide availability of Disposal of
Unused Medicines Properly (DUMP) schemes,
supported financially by the HSE, is patchy to say
the least. I cannot see why individual pharmacies
should have to bear the cost of disposing of
toxic waste such as unused medicines. While
there is merit in the article’s suggestion that a
producer-responsibility scheme for medicines,
operating along the lines of the existing
scheme for electrical goods, be set up, whereby
producers and importers of pharmaceuticals
would be responsible for establishing medicines
collection schemes through local pharmacies,
with the cost of disposal being borne by the
producers, the industry would hardly welcome
the additional cost, which would undoubtedly
end up being a cost to the patient. However, if
we are serious about reducing the huge annual
death toll attributable to the misuse of prescribed
medicines, then we urgently need a proper
nationwide DUMP scheme.
ORIGINAL
For more than 10 years, Ebixa® has
helped patients with Alzheimer’s disease
overcome everyday challenges.1
It’s one of the Originals from
Lundbeck, a company recognised
worldwide for its pioneering work within
the field of CNS disorders.
Abbreviated Prescribing Information: For full prescribing information refer to the Summary of Product Characteristics. Name: Ebixa Active Substance: Memantine Hydrochloride.
Indication: Treatment of patients with moderate to severe Alzheimer’s disease. Dosage & Administration: Treatment should be initiated and supervised by a physician experienced in the
diagnosis and treatment of Alzheimer’s dementia. Therapy should only be started if a caregiver is available who will regularly monitor the intake of the medicinal product by the patient. Regular
review to assess clinical benefit: The tolerance and dosing of memantine should be assessed regularly, with the first assessment within three months of the start of treatment and thereafter
regularly according to current clinical guidelines. Maintenance treatment can be continued for as long as a therapeutic benefit/tolerability continues for the patient. Discontinuation should
be considered when therapeutic benefit/tolerability for the patient is no longer present. Treatment is orally either as tablets (10 mg) or solution (5 mg/pump actuation) taken with or without
food once a day at the same time every day. The solution should only be dosed onto a spoon or into a glass of water using the pump. Maintenance dose is 20 mg/day (two tablets or 2 ml
solution equivalent to 4 pump actuations). Treatment starts with 5 mg/day (half a tablet or 0.5 ml solution equivalent to 1 pump actuation) for the first week; the 2nd week 10 mg/day (one
tablet or 1 ml solution equivalent to 2 pump actuations); the 3rd week 15 mg/day (one and a half tablets or 1.5 ml solution equivalent to 3 pump actuations) and the 4th week 20 mg/day
(two tablets or 2 ml solution equivalent to 4 pump actuations). Moderate renal impairment 10 mg/day (one tablet or 1 ml solution equivalent to 2 pump actuations) if well tolerated after
7 days the dose could be titrated up to 20 mg/day (two tablets or 2 ml solution equivalent to 4 pump actuations). Severe renal impairment- dose is 10 mg/day (one tablet or 1 ml solution
equivalent to 2 pump actuations). Mild-moderate hepatic impairment- no dose adjustment. Severe hepatic impairment- no data available, not recommended. Children & Adolescents: Not
recommended. Contraindications: Hypersensitivity to the active substance or any of the excipients. Pregnancy and Lactation: Pregnancy: Ebixa should not be used in pregnant women
unless clearly necessary. Lactation: Women taking Ebixa should not breast-feed. Special Warnings and Precautions for use: Caution is recommended in patients with epilepsy. Caution is
advised in patients with raised urine pH as this may elevate plasma levels. Clinical trial data are limited on patients with recent myocardial infarction, uncompensated congestive heart failure
and uncontrolled hypertension and patients with these conditions should be closely supervised. Avoid concomitant use of NMDA antagonists (see also interactions). Patients should be warned
to take special care if driving and using machines as Ebixa has minor to moderate influence on these tasks. Oral solution only: Patients with rare hereditary problems of fructose intolerance
should not take Ebixa 5 mg/pump actuation oral solution as it contains sorbitol. Interactions: Effects of L-Dopa, dopaminergic agonists and anticholinergics may be enhanced. Effects of
barbiturates and neuroleptics may be reduced. Concomitant administration of Ebixa with antispasmodic agents e.g. dantrolene and baclofen can modify their effects, dose adjustments may
be necessary. Increased plasma levels could occur with concomitant use of cimetidine, ranitidine, procainamide, quinidine, quinine and nicotine. Co-administration with hydrochlorothiazide
(HCT) may lead to a reduced serum level of HCT. Concomitant use of NMDA antagonists (amantadine, ketamine and dextromethorphan) or phenytoin should be avoided. Close monitoring
of prothrombin time or INR is advisable for patients treated concomitantly with oral anticoagulants. Adverse reactions: Common (≥1/100 to <1/10) headache, somnolence, hypertension,
constipation, dizziness, dyspnoea, drug hypersensitivity, balance disorders and elevated liver function test. Uncommon reactions (≥1/1,000 to <1/100): cardiac failure, fatigue, fungal infections,
confusion, hallucinations (mainly in patients with severe Alzheimer’s disease), venous thrombosis/thromboembolism, vomiting, gait abnormal. Very rare (<1/10,000): seizures. Not known:
Hepatitis. Isolated cases of pancreatitis and psychotic reactions have been reported post-marketing. Alzheimer’s disease has been associated with depression, suicidal ideation and suicide. In
post-marketing experience these events have been reported in patients treated with Ebixa. Overdose: Symptomatic treatment. Elimination: Mainly in unchanged form via the kidneys. Legal
Category: POM. Marketing Authorisation Holder: H.Lundbeck A/S, Ottiliavej 9, DK-2500 Valby, Denmark. Marketing Authorisation Numbers: EU/1/02/219/005 Ebixa 5 mg/pump actuation
oral solution-50 ml bottle. EU/1/02/219/006 Ebixa 5 mg/pump actuation oral solution-100 ml bottle. EU/1/02/219/007 Ebixa 10 mg film-coated tablets, 28 pack size. EU/1/02/219/008 Ebixa
10 mg film-coated tablets, 56 pack size. Further information may be obtained from: Lundbeck (Ireland) Ltd., 7 Riverwalk, Citywest Business Campus, Dublin 24.
Date of Preparation: May 2012
Reference: 1. Rive et al. Int J Geriatr Psychiatry 2004; 19: 458-464.
EB1/5/13
ORIGINAL
VIEW FROM ABOVE
COMMENT & ANALYSIS
The challenges
of change
management
t er ry m ag u i re
Terry Maguire owns two
pharmacies in Belfast.
He is an honorary
senior lecturer at the
School of Pharmacy,
the Queen’s University
of Belfast. His research
interests include
the contribution of
community pharmacy
to improving public
health.
Terry Maguire outlines the major work changes pharmacists in Northern Ireland are
undertaking, which aim to significantly improve patient services
“Willing is not enough; we must do.
Knowing is not enough; we must apply.”
Goethe
J
oe Brogan, Head of Integrated Care at
the Health and Social Care Board (HSCB),
Northern Ireland, stares out from the
magazine cover; inside his exclusive
interview is well worth the time invested
in its reading. In the past Joe would
have had the more recognisable title of Chief
Pharmacist at the Health Board but now, in an
attempt to remove the silo-thinking that pervades
our health service up here, he and his pharmacists
work within the Directorate of Integrated Care
alongside the Chief Doctor and the Chief Nurse. In
this structural change it is hoped to forge a new
culture that will bring
with it a change in
the way patients and
their conditions are
managed, and more
integration.
We are Joe’s
stakeholder group;
he needs us as the
HSCB attempts the
mammoth task of
changing the health
service radically and
totally as it implements
the Transforming
Your Care (TYC)
programme. As change
management projects
go, this is as big as it
gets. It’s nothing short
of a total revamp of our
health service and it’s
likely some will not be
happy.
Joe used his
interview in a local
pharmacy magazine
and a two-venue road show (hosted jointly with
our contractor negotiation body Community
Pharmacy Northern Ireland) to good effect. He
covered the key points: There is a need for change;
our model of healthcare is unsustainable; we need
to ‘shift left’ from more expensive venues of care
– such as hospitals – to less expensive ones closer
to patients’ homes. We also need to ‘shift left’ by
investing in disease-prevention services so less
“
of our population develop long-term conditions.
We need people to take more responsibility for
their own health. Unless stakeholders engage with
this change programme it will not happen. Unless
GPs, pharmacists, OTs, social workers, hospital
consultants, nurses, the NHS Health Trusts and the
public buy in then it will be an abject failure.
Joe did well selling the vision – more public
health from pharmacies, pharmacies supporting
self-care, pharmacies dealing with long-term
conditions and reducing ADRs, and an IT
investment in our pharmacy network to support it.
FROM CONCEPTION TO REALITY
Talk about change is one thing, making it happen
is something else. At the same time as Joe
was speaking about TYC, the Ulster Chemists’
Association – the pharmacy trade union – was
running training workshops to help managers
and contractors create
the necessary change
to practice. Change is
not easy and unless
the 533 pharmacy
managers in N. Ireland
(including myself) begin
to do things differently;
stop doing things we
don’t need to do and
start doing the things
we do, then TYC will
not happen. If, as a
pharmacy manager,
I think that simply
saying “I will do in this
year”, for example, 120
MURs, 100 smoking
cessation interventions,
30 managing your
medicines interventions,
40 vascular screens and
20 weight-management
interventions without
making radical changes
to the day-to-day
pharmacy operation,
then I am living in cloud-cuckoo land.
Joe’s article and his CPNI joint road show and
the UCA workshops are a good start. I have little
doubt, judging by attendances at these meetings,
that the profession is up for TYC. Momentum for
change is building.
A number of newly-funded services are being
commissioned. Medicines use reviews (MURs)
on asthma and COPD will attract a fee of £28.00
We are keen to
move away from
prescription management
(collection and delivery
of medicines in fancy
packs) to medicines
management and public
health, because we
know it will be more
professionally satisfying,
and enable better patient
outcomes.
20
and each pharmacy can do 120 in a year. At the
first MUR training workshop in Ballymena, which
I attended, one hundred pharmacists turned up;
they expected 50. In Belfast a few nights later over
300 turned up; they expected 150.
The plan is now to translate this enthusiasm
into high-quality MUR interventions that make
real improvements to the management of asthma
and COPD. This is the challenge and if effective
will contribute to a ‘shift left’ for those suffering
from respiratory disease. Our targeted MUR is a
small but important part of the bigger vision set
out in the TYC programme – services provided
closer to the patient resulting in better patient
outcomes and reduced costs, and less wastage
and less hospitalisation. We know many patients
use their inhalers incorrectly. We also know that
few patients are effectively managed through a
personal disease management plan. The targeted
MUR is designed to address this and bring about
change though pharmacists working with others;
that’s the real meaning of integration.
Of course it was always said the pharmacists
should advise on proper inhaler technique, but in
practice that aspiration was never fully realised.
In the absence of a formal paid service only some
pharmacists sometimes did – in reality most
mostly didn’t.
JUST THE BEGINNING
Now we have a targeted MUR and we must see
this as only the start of N.Ireland pharmacists
working with the Health Board, with GPs and
with patients to help ensure better outcomes in
a systematic and organised way for all chronic
conditions. Respiratory disease is part of the
FREDS (Frail Elderly, Respiratory, End of Life,
Diabetes and Stroke) list and these conditions are
likely to be addressed first through integrated care
partnerships (ICPs).
This is the change the profession has been
asking for and we must not make the mistakes
that were made with the introduction of MURs in
England in 2005. We must ensure that all pharmacies undertake the work to the required level.
We are keen to move away from prescription
management (collection and delivery of
medicines in fancy packs) to medicines
management and public health, because we
know it will be more professionally satisfying,
and enable better patient outcomes. It will be
worth the effort but it will not be easy. Most don’t
understand just how difficult change is. Perhaps
that’s why Joe Brogan looks so nervous in his front
cover photograph.
The Helix Health
Pharmacist Awards 2013
Celebrating Excellence, in aid of the Pharmacy Benevolent Fund
2013
Saturday 23rd November 2013,
The Mansion House, Dublin 2
“Winning this Award has meant so much
to me. To this day, colleagues and patients
continue to congratulate me and the local
publicity that I gained was phenomenal.”
Ronan Sheridan, Market Point Pharmacy,
Winner of the Young Pharmacist Award 2012.
Howard Beggs, CEO, Helix Health, Ronan Sheridan, Market Point Pharmacy,
Award Categories
Mullingar, Co. Westmeath, Aisling Reast, PBF President
• Professional Excellence Award
For further information and to nominate
online go to www.pharmacistawards.com
• Community Pharmacy Team of the Year Award
• The Pinewood Healthcare Pharmacist Contribution
to the Community Award
• The Actavis Excellence in Community Practice Award
• The Teva Patient Nominated Award
For more information contact:
Tara Kearns, The Pharmacist Awards, Helix Health,
3094 Lake Drive, Citywest Business Campus, Dublin 24
T : + 353 1 463 3000 F : + 353 1 463 3011
E : [email protected]
• Excellence in Hospital Pharmacy
• The Lundbeck Practice-Based Research Award
• Young Pharmacist of the Year Award
• The JPA Brenson Lawlor Liz Herbert Memorial Lifetime
Achievement Award
The Awards are open to pharmacists registered in Ireland,
including hospital, community, industrial and academia.
Closing date for nominations:
19th July 2013
• The Overall Pharmacist of the Year Award
With special thanks to our sponsors
opinion
COMMENT & ANALYSIS
I’m forever blowing
bubbles!
David Jordan ponders when the pharmacy bubble
will burst and suggests some actions that pharmacists
can take to add value to their service
S
o the Celtic Tiger bubble has burst and
we are left dredging at the bottom of
the barrel for any left over scraps. Like
a lot of properties and other businesses, many pharmacies were bought
with borrowed money for way too
high a price. A good number of these have been
holding on by their fingernails for the past year.
Already one in four are in a loss-making situation. We’ve seen pharmacies in receivership. One
multiple that we know of is in hock to NAMA for
more than the value of the chain. This latest round
of cuts will be the final straw for many. A previous
Minister for Health often asked about how many
pharmacies have closed. The answer will come
next year. In my opinion the current Minister and
the HSE will not leave us alone until 300/400 pharmacies have closed.
Three years ago all we heard about was FEMPI
and reference pricing. Many argued that we had
too many pharmacies. Now three years later nothing seems to have changed. New pharmacies are
still opening. We are still waiting for the roll-out of
reference pricing, though the legislation has finally
been enacted. We still think that there are too
many pharmacies. Let’s not forget why we have
so many pharmacies in Ireland, including so many
uneconomic ones. It is because we are unique in
Europe in having no restrictions on new openings.
It is as if somehow pharmacy was in its own
bubble exempt from the Celtic Tiger. While I don’t
think that the bubble is expanding as much as
before, I believe that it is still there. I don’t know
how or when the bubble will burst but burst it will.
And it will bring many good pharmacies with it.
Banks will look at their loan portfolio and decide if
the pharmacists who are mortgaged to the hilt can
still repay in the light of the latest round of cuts.
Many will struggle. But who will survive?
A LITTLE TALE
The names have been changed to protect the
guilty and innocent alike.
Back in February my good wife and myself decided to take some time out and avail of one of the
many cut-price weekend breaks that fill my email
inbox every day. It had to be a cut-price weekend
as I’m a poor, small independent pharmacist and
that’s all I can afford.
As we drove to our destination we took a break
for a cup of tea and a bun. We stopped in what
used to be a two-horse town before the recession
but is now down to one horse, and even that now
looks like it is on the way to the nearest burger
factory. We walked the main drag of this town in
search of sustenance and
being in the trade I took
note of the pharmacies
that were located there.
We saw five pharmacies; two owned by an
Irish chain and three
independents. This was a
Friday about noon. These
were all of a similar size
and laid out in such a way
so that just by passing
you could see all of the
interior.
Being the nosey git
that I am I made note of
the customers. One had
three customers, one had
two and the third had
one. Two were empty
apart from staff. Which
was which? The empty
ones were the chains. The one- and two-customer
pharmacies looked standard enough. The busiest
was also the smallest. There was one customer at
the cosmetics counter, one at the OTC counter, and
a third one talking to the pharmacist. The pharmacist was a man after my own heart – open collar,
cardigan and looking totally at ease. So as the
recession bites and this town loses its last surviving horse who will survive? My money is on the
independents.
“
nearby locations, leapfrogging, etc. The problem
with this model is that they are relying on an upturn in the economy to allow them to put up prices
and recoup their losses when things get better
(if ever). But then they will be scrapping among
themselves. They will end up like the US model,
dependent on low standards and high volumes.
There have been many attempts to claw back
market share. Cut-price special offers and competing against Tesco and the like may work if properly
done in some locations, but it takes up precious
pharmacist time. The big supermarkets don’t
employ pharmacists to
manage their shop floor,
why should we?
Our price model
has to change.
Taking a mark-up and
providing the service for
free can’t last. When was
the last time that you
got a decorator to paint
your pharmacy for just
the cost of the paint?
HERE’S MY TAKE
I may be a paranoid conspiracy theorist (nothing
new there) but here’s my take on it.
The chains, both foreign and Irish, medium and
large, are trying to squeeze out any competition
(read small and medium independents). This may
not be a conscious decision but the effect is the
same. Suck up all the available food and kill off the
smaller animals by starvation. Yes, they will suffer
as well, but they reckon that they have enough fat
to outlast the smaller pharmacies. Kill them off and
then have the field for themselves.
They are using cut-price models, opening in
22
dav id j o rdan
David Jordan has worked
in community pharmacy
since 1979, qualifying as
a pharmacist in 1983. He
was chairperson of the
Community Employee
Committee of the IPU from
1990 to 1998 and treasurer
from 1994 to 1996. His
main stress relief is riding
his motorbike with his
friends from
www.irishbikerforum.com
WHAT CAN WE DO?
The way to go for independents, in my opinion,
is to look at other healthrelated niches: Medicine
use reviews, cholesterol
testing, cardiac assessments, health screening
and chronic disease management. Establish them
now, create a market and
put a price on everything. Sell them and their
cost-saving potential
to VHI and the like. No
more free advice! There
has to be an economic
price on everything we
do. If the HSE wants them for medical card patients
then let them come to us. That way we will already
know the cost of running them, know the value to
payees and, most importantly, we can still operate
them without relying on the GMS. Thanks to the
HSE’s manoeuvring flu vaccination is a loss-making
service. Yes, we did it to get the foot in the door, but
the door has been opened so no more freebies.
We’ve been price takers for too long, we have to
start determining the market and setting the price.
Our price model has to change. Taking a markup and providing the service for free can’t last.
When was the last time that you got a decorator to
paint your pharmacy for just the cost of the paint?
You paid for the paint and his time putting it up.
How many of us dispense the morning-after pill
OTC for just a straight mark-up? A GP provides a lot
of service and very little product for his fee. Tesco
provides a lot of product and very little service for
their price. Which way do you want to go? Who
does the patient/customer have more respect for?
It’s a no brainer to me.
Here’s hoping that we are all still here next
month, never mind next year.
Low testosterone
■
17% prevalence in men with Type 2
Diabetes1 and 10-20% prevalence with
Erectile Dysfunction2
■
In hypogonadal men, testosterone
treatment alone may restore erectile
function and significantly increase
sexual desire3
■
Tostran® - returns hypogonadal men’s
testosterone levels to the normal range
and keeps them there4
■
Tostran® is the only 2% testosterone gel:
- Accurate 10 mg dosing5
- Simple dose titration5
- Easy to apply, with minimal waste5
A simple solution to a serious problem
Tostran® (testosterone) 2% Gel Prescribing Information
Please refer to Summary of Product Characteristics (SPC) before
prescribing. Presentation: Tostran 2% Gel, contains testosterone,
20 mg/g. Indications: Replacement therapy with testosterone for
male hypogonadism when testosterone deficiency has been
confirmed by clinical symptoms and laboratory analyses. Posology:
The starting dose is 3 g gel (60 mg testosterone) applied once daily
at approximately the same time each morning to clean, dry, intact
skin, alternately on the abdomen or to both inner thighs. Adjust
dose according to clinical and laboratory responses. Do not exceed
4 g of gel (80 mg testosterone) daily. Apply after washing, bathing
or showering. Do not apply to the genitals. Do not use in women,
or children under the age of 18 years. Contraindications: Known or
suspected carcinoma of the breast or the prostate; hypersensitivity
to any of the ingredients. Special warnings and precautions for
use: Tostran should not be used to treat non-specific symptoms
suggestive of hypogonadism if testosterone deficiency has not been
demonstrated and if other aetiologies responsible for the symptoms
have not been excluded. Not indicated for treatment of male
sterility or sexual impotence. All patients must be pre-examined to
exclude a risk of pre-existing prostatic cancer. Perform careful and
regular monitoring of breast and prostate. Androgens may
accelerate the development of subclinical prostatic cancer and
benign prostatic hyperplasia. Oedema with/without congestive
heart failure may be a serious complication in patients with
pre-existing cardiac, renal or hepatic disease. Discontinue
immediately if such complications occur. Use with caution in
hypertension as testosterone may raise blood pressure. Use with
caution in ischemic heart disease, epilepsy, migraine and sleep
apnoea as these conditions may be aggravated. Care should be
taken with skeletal metastases due to risk of
hypercalcaemia/hypercalcuria. Androgen treatment may result in
improved insulin sensitivity. Inform the patient about the risk of
testosterone transfer and give safety instructions. Health
professionals/carers should use disposable gloves resistant to
alcohols. Interactions: When androgens are given simultaneously
with anticoagulants, the anticoagulant effect can increase and
patients require close monitoring of their INR. Concurrent
administration with ACTH or corticosteroids may increase the
likelihood of oedema and caution should be exercised. Undesirable
effects: Very common (≥1/10): application site reactions
(including paresthesia, xerosis, pruritis, rash or erythema); common
(≥1/100, <1/10): increased haemoglobin, haematocrit;
increased male pattern hair distribution; hypertension;
gynaecomastia; peripheral oedema; increased PSA. Certain
excipients may cause irritation and dry skin. Consult SPC for other
undesirable effects of testosterone. Pack Size: Packs contain one
60 g metered-dose canister. Legal Category POM.
Further information is available from the following:
UK - Marketing Authorisation Holder: ProStrakan Limited,
Galabank Business Park, Galashiels, TD1 1QH, UK. ROI: Clonmel
Healthcare Limited, Nangor Road, Dublin 12.
Marketing Authorisation Number:
UK: PL16508/0025; ROI: PA1049/5/1
©ProStrakan. ®Registered Trade Mark.
Date of PI Preparation: December 2012.
Adverse events should be reported. Reporting forms and
information can be found at www.mhra.gov.uk/yellowcard.
Adverse events should also be reported to ProStrakan Ltd on
+44 (0)1896 664000.
References:
1. Kapoor D. et al. Diabetes Care 2007; 30: 911-917.
2. Roumeguere T. European Urology 2006; 50: 898-900.
3. Greenstein A. et al. The Journal of Urology 2005;
173: 530-532.
4. Dumas C. Poster presented at the 25th Scandinavian Meeting
of Urology, Göteborg, June 2005.
5. Tostran® Summary of Product Characteristics.
2013/ADV/TES/061
TOSTRAN IS THE
CLONMEL BRAND
OF TESTOSTERONE.
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PharmacistCPD.ie
life
in focus
The growing importance
of infant nutrition
James Fogarty reports on emerging issues and changes in the field of infant
nutrition, and the opportunity for pharmacists to play a bigger role in helping parents
W
hile the obesity crisis affects
every rung of Irish society,
childhood obesity is perhaps
the most tragic example of
the epidemic. According
to a recent damning World
Health Organisation (WHO) report, 31.8 per cent
of Irish seven-year-olds are either overweight or
obese. This equates to 100,000 obese children
and a further 300,000 who are overweight. If
current patterns continue almost half of adults
living in Ireland could be obese by 2030, WHO
has warned. While the loss of having an active
childhood is inestimable, the medical profession
is more concerned about the impact of obesity
on long-term health and life expectancy, and
the development of chronic diseases, which are
placing unsustainable pressure on our health
services.
“The childhood obesity problem is an epidemic.
To tackle it we have to try to encourage parents
and young kids to change their lifestyles,” Kathy
Maher, Vice President of the Irish Pharmacy Union
(IPU) told Irish Pharmacist.
Infants
As shocking as the WHO figures are they come as
no surprise, as attempts have been underway for
some time to understand the causes of the obesity
epidemic. One report lays the blame partly on
poor infant nutrition.
More than seven in ten infants are being
weaned onto solid foods too early, the Food
Safety Authority of Ireland (FSAI) announced last
year. Not only are children being given solids
too soon, the Authority also notes that crisps,
chocolate pudding and soft drinks are being given
to some babies as young as six months old. The
long-term consequences of this sort of diet at
such a young age are only now beginning to be
properly understood.
“It is now recognised worldwide that the
first 1,000 days of a human’s life – starting at
conception and ending at age two years, presents
a unique opportunity to shape healthier futures,”
Dr Mary Flynn, Chief Specialist Public Health
Nutrition, FSAI writes. “How well humans grow and
develop during this time can have far-reaching
effects on health in childhood and throughout
adult life. We now know that health problems,
including heart disease, diabetes and obesity,
that affect many adults in Ireland today may be
partly due to the inadequacy of their mother’s
diet during pregnancy and how they were fed as
babies – especially during the first year of life.”
Based on Dr Flynn’s research, the FSAI launched
a report last year – Scientific Recommendations
for a National Infant Feeding Policy in Ireland –
highlighting current infant feeding trends and
providing recommendations for specific actions
and advice. Despite attempts to educate health
professionals and members of the public, the
report also indicated that a number of key issues
relating to milk and complementary feeding still
exist.
While many European countries have adopted
the WHO recommendation of exclusive breastfeeding for six months, in Ireland breastfeeding
initiation and duration rates remain far below
other countries, despite the well-established
health benefits of breastfeeding.
“Mothers of young children are among our
most frequent visitors to our pharmacies and we
encourage pregnant women to try breast feeding
because it’s so important, “ adds Ms Maher. “With
breastfeeding, anything is better than nothing
even if it isn’t possible to go to the recommended
age limit.”
However, not only does the FSAI report show a
prevalence of formula-based feeding in Ireland,
many parents do not know how to correctly
25
in focus
life
Ms Kathy Maher, IPU Vice President
handle and prepare formula for their infants.
The most significant immediate risks concern
bacterial contamination of powdered infant
formula, which is especially worrying as infants
are among the most vulnerable group for food
and waterborne illnesses. Contamination with
Salmonella enterica is a common concern, as is
the more recently recognised Cronobacter spp
(formerly known as Enterobacter sakazakii).
Vitamin D
While universally recognised as the food of choice
for infants breast milk is considered low in vitamin
D, and although formula milk and certain cerealbased baby foods are fortified with small amounts
of vitamin D, many infants will continue to be
at risk of suboptimal intakes. Therefore it is now
national policy that all infants in Ireland receive
5µg of vitamin D as a daily supplement in the first
year of life. It is in this area of providing advice
that the pharmacist’s role is key.
Special attention to growth and nutrition
during the first year of life is essential. It has been
recommended that children reach a weight-forlength status of at least the 50th percentile by two
years of age (Stallings et al, 2008), and that BMI
should be calculated frequently during childhood
and plotted on appropriate BMI percentile charts.
This is particularly important for patients with
cystic fibrosis as there is also a strong association
with BMI/BMI percentile and lung function.
“Many pharmacies around the country are
offering ad-hoc weight management services,
where they measure BMI, but they can only do
this when they have the time,” Ms Maher noted.
“If there was an effective protocol adopted by the
HSE to manage weight screening in pharmacies
this could be a very effective tool in tackling this
crisis.”
Weaning
A major challenge for Ireland is that the majority
of infants in Ireland begin the weaning process
before the recommended age, something that
has been linked with the development of allergies
and certain chronic conditions such as coeliac
disease, as well as an increased risk of choking.
Research carried out in Irish mother-infant pairs
in west Dublin has indicated that over 60 per
cent of infants continue to be weaned before the
recommended age, with data reporting that 23
per cent of infants were weaned by 12 weeks, and
4 per cent were weaned onto solids by six weeks
of age (Tarrant et al, 2010). From a public health
perspective, the types of weaning foods used are
26
also far from ideal, with Irish research revealing
infants in the capital receive high-fat, high-sugar
confectionary foods more frequently than fruit
and vegetables.
Ms Maher believes that misinformation and lack
of education lay at the heart of this problem.
“Mothers can wean too early because of
misinformation, a lot of the time they might
be advised that the child will sleep better with
solids but that’s not true,” she says. “In relation
to weaning, health policy has changed over the
last number of decades. Very often people tend
to turn to their mothers or grandmothers for
advice but health policies are different to when
they were having children. We would encourage
mothers to ask their pharmacists because they
can offer the most up to date advice.”
However, weaning can be a delicate balancing
act. Delaying the start of weaning beyond seven
months of age may also lead to problems such as
an increased risk of nutrient deficiency, as well as
delayed oro-motor development. Delaying the introduction of certain foods, e.g. gluten-containing
foods such as bread,
pasta and glutencontaining cereals
past the age of seven
months, may also
be associated with
an increased risk of
developing allergies
or coeliac disease in
later years.
Furthermore, as a
consequence of the
weaning process,
infants learn many
new skills that allow
them to manage
new food textures.
These skills are also
linked with the
development of
speech, and delayed
texture progression
has been associated
with an increased
risk of developing
speech impediments. Parents should be made
aware that adding solids, such as baby rice to their
infant’s bottle, prevents infants benefiting from
the experience of eating solid foods, and has been
associated with a greater risk of choking, dental
caries and hypernatraemia. This practice may also
lead to excessive weight gain, which can affect
the infant’s health, both in the short-term as well
as in later years.
“
manufacture and sales of breast milk substitutes,
particularly in developing countries. Some
international food giants have been criticised for
allegedly violating the international code on the
marketing of such substitutes in these countries.
The European Commission said it recognises
that current rules in force for these products are
complex and fragmented since different sets of
rules and concepts overlap and create confusion
for businesses and national authorities. It is
understood that abuses of current legislation
occur across the EU due to this confusion.
However, the Commission stated: “Businesses
tend to pick and choose a piece of legislation
to match the characteristics of their products,
avoiding stricter acts or pieces of legislation
regulating production and manufacture. It was
necessary to remove the concept of dietetic
foods to close loopholes in the existing EU
legislation to limit the possibility for companies
to do ‘legislative shopping’ –i.e. select the piece
of legislation they prefer–, thus circumventing
important rules.”
While the vast
number of food
products on the
market today target
specific groups, the
new regulations will
do away with the
dated broad concept
of ‘foodstuffs for
particular nutritional
uses’, the Commission
added.
This agreement,
said EU Health
Commissioner Tonio
Borg, “goes exactly
in that direction by
maintaining rules to
protect vulnerable
groups of consumers
and by getting rid of
outdated rules that
no longer serve any
purpose”.
The new
regulations are expected to be published in the
EU Official Journal in the coming weeks and will
only apply from 2016 to allow time for businesses
to adapt their commercial practices. In the
meantime, the Commission has identified infant
nutrition as a particular area of interest. So it
seems that despite Ireland lagging behind Europe
in breast-feeding rates, these new regulations will
force re-evaluation of infant nutrition.
It is also time that the role of pharmacists in
this area is re-evaluated, both Ms Maher and IPU
Secretary General Darragh O’Loughlin point out.
Mr O’Loughlin noted that the Irish public
healthcare budget for infants and small children
has been cut in the last few years, despite the
health importance of these formative years.
“However it is a space that pharmacists could
very easily step into because most pharmacies
already have the facility to weigh babies and as
part of our training we are pretty clued in on
nutrition and child health. There is a need for
support services for mothers of small children,
and parents of young children are frequent
visitors to pharmacies anyway so it would be
useful to offer them services in this area,” he told
Irish Pharmacist.
However it is
a space that
pharmacists could very
easily step into because
most pharmacies already
have the facility to weigh
babies and as part of our
training we are pretty
clued in on nutrition and
child health.”
EU Legislation
A legislative spotlight is now being placed on
the exact composition of weaning foods and
so-called ‘growing-up-milks’. Recently the
European Parliament gave the go ahead for
stricter regulation of ‘dietetic foods’ or foods
targeted at specific groups including infants and
young children. Within the next two years the
European Commission will adopt detailed rules
on infant food and will present two reports on the
necessity to develop specific rules for ‘growing up
milks’. The new regulations will streamline current
legislation by replacing it with a more simplified
framework.
It is hoped that this new legislation will
put an end to controversies surrounding the
BUPLEX Rx
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Muscular and joints disorders
ABBREVIATED PRESCRIBING INFORMATION
Please refer to the Summary of Product Characteristics (SmPC) before prescribing Buplex Rx 200 mg, 400 mg and 600 mg film-coated tablets
Indications: 200mg and 400mg only: Mild to moderate pain, such as headache including migraine headache, dental pain. Primary dysmenorrhoea. Fever. All strengths: Rheumatic conditions, other muscular and joint disorders, and soft tissue injuries.
Dosage: Mild to moderate pain and fever: Adults, adolescents older than 12 years (≥40 kg): 200-400 mg as single dose or 3-4 times every 4-6 hours. (Migraine headache: 400 mg as single dose or at intervals of 4-6 hours.) Max 1200 mg/day. Children
6-9 years (20-29 kg): 200mg 1-3 times every 4-6 hours. Max 600 mg/day. Children 10-12 years (30-39 kg): 200mg 1-4 times every 4-6 hours. Max 800 mg/day. Primary dysmenorrhea: Adults and adolescents over 12 years of age: 200-400 mg 1-3 times a
day every 4-6 hours, as needed. Max. 1200 mg/day. Rheumatic diseases: Adults: 400-600 mg 3 times a day. Maintenance dose 600 mg-1200 mg/day. In acute and severe conditions may be increased to a maximum of 2400 mg in 3 or 4 divided doses.
Children and adolescents over 12 years of age (>40 kg): use alternative dosage forms. Special groups: Elderly: Use with cautions. Kidney and liver insufficiency: Mild to moderate, keep the low to a minimum for shortest possible time, severe insufficiency
contraindicated. Contraindications: hypersensitivity to ibuprofen or excipients, previous hypersensitivity reactions (e.g. asthma, rhinitis, urticaria or angioedema) to other NSAIDs, of gastrointestinal bleeding or perforation related to previous
NSAIDs therapy, active or past recurrent peptic ulcer/haemorrhage, severe hepatic renal insufficiency, severe heart failure or coronary heart disease, last trimester of pregnancy, significant dehydration (due to vomiting, diarrhoea or insufficient
fluid intake), cerebrovascular or other active bleeding, dishaematopoiesis of unknown origin, children younger than 6 years of age (200mg and 400mg) or younger than 12 years of age (600mg). Warnings and precautions: Avoid concomitant use
with NSAIDs (incl. COX-2 selective inhibitors). Asthma, seek doctor’s advice. Patients treated with NSAIDs long term should undergo regular medical supervision to monitor for adverse events. Administer under strict consideration of B/R ratio in:
Systemic Lupus Erythematosus (SLE) or other autoimmune diseases, Acute intermittent porphyria, First and second trimester of pregnancy, Lactation. Use special care in: Gastrointestinal diseases including chronic inflammatory intestinal disease
(ulcerative colitis, Crohn’s disease), Cardiac insufficiency and hypertension, Reduced renal function, Hepatic dysfunction, Disturbed haematopoiesis, Blood coagulation defects, Allergies, Hay fever, Chronic swelling of nasal mucosa, Adenoids, Chronic
obstructive airway disease or bronchial asthma, Immediately after major surgical interventions. GI bleeding, ulceration or perforation, which can be fatal, has been reported with all NSAIDs with or without warning symptoms. Consider combination
therapy with protective agents especially in long term treatment. Caution in patients receiving concomitant oral corticosteroids, anticoagulants SSRIs or acetylsalicylic acid. Withdraw treatment if GI bleeding or ulceration occurs. Cardiovascular
and cerebrovascular, Appropriate monitoring required for patients with a history of hypertension and/or mild to moderate congestive heart failure (fluid retention, hypertension and oedema have been reported). Serious skin reactions, (exfoliative
dermatitis, Stevens-Johnson syndrome, and toxic epidermal necrolysis) have been reported very rarely. Other precautions, Bronchospasm, urticaria or angioedema may be precipitated in patients suffering from or with a previous history of bronchial
asthma, chronic rhinitis, sinusitis, nasal polyps, adenoids or allergic diseases. May mask signs or symptoms of an infection. Headaches may occur in long-term/high dose treatment which should not be treated with elevated doses of the medicinal
product. In patients with existing auto-immune disorders some cases with symptoms of aseptic meningitis have been observed. May temporarily inhibit platelet aggregation and prolong the bleeding time (observe carefully patients with coagulation
defects or on anticoagulant therapy). Periodical monitoring of hepatic and renal function and blood count with long-term treatment. Avoid alcohol. Patients should report signs or symptoms of: GI ulceration or bleeding, blurred vision or other
eye symptoms, skin rash, weight gain or oedema. Interactions: Avoid: Low dose acetylsalicylic acid. Other NSAIDs. Anti-coagulants. Ticlopidin. Methotrexate. Take with caution: Moclobemide. Phenytoin, lithium. Cardiac glycosides. Diuretics and
antihypertensives. Captopril. Aminoglycosides. SSRIs. Ciclosporine. Cholestyramine. Tacrolimus. Zidovudine. Ritonavir. Mifepristone. Probenecid or sulfinpyrazone. Quinolone antibiotics. Sulphonylureas. Corticosteroids. Anti-platelet aggregation
agents. Alcohol, bisphosphonates and oxpentifylline. Baclofen. Pregnancy and Lactations: Pregnancy: First and second trimester, do not use unless clearly necessary, and dose should be kept as low and duration of treatment as short as possible.
Contraindicated during the last trimester. Lactation: Ibuprofen is excreted in breast milk. With therapeutic doses during short term treatment the risk for infant seems unlikely. If longer treatment is prescribed, early weaning should be considered.
Fertility: Not recommended in women attempting to conceive. Side Effects: Very common: gastrointestinal disorders (heartburn, dyspepsia, abdominal pain and nausea), vomiting, flatulence, diarrhoea, constipation. Common: headache, somnolence,
vertigo, fatigue, agitation, dizziness, insomnia, irritability, gastrointestinal ulcers, occult blood loss which may lead to anaemia, melaena, haematemesis, ulcerative stomatitis, colitis, exacerbation of inflammatory bowel disease, complications of colonic
diverticula. Shelf Life: 3 years. Pack size: 100 tablets. Marketing Authorisation Holder (MAH): Actavis Group PTC ehf, Reykjavikurvegi 76-78 220 Hafnarfjordur, Iceland. Marketing Authorisation Number: 200mg: PA 1380/88/1 - 400mg: PA 1380/88/2
- 600mg: PA 1380/88/3. Legal Category: Medicinal product subject to medical prescription.
Full prescribing information including the SmPC is available on request from Actavis Ireland Limited, Euro House, Little Island, Co. Cork or email [email protected]. Information about adverse event reporting can be found on the IMB website
(www.imb.ie) or by contacting Actavis Ireland Limited [email protected].
Date of Generation of API: April 2012.
Date of Preparation: March 2013
FADHCP-017-02
Actavis Ireland Ltd.
Euro House, Euro Business Park Little Island, Co. Cork
T: 1890 33 32 31 F: 021 461 90 49 E: [email protected]
For more information on Buplex Rx and other Actavis products visit www.actavis.ie
FINANCE
life
On the theme
of control
Iain Cahill discusses the need for taking a proactive
approach to managing your financial affairs, particularly
pensions
Y
ou may recall that in my last column,
one of the clear themes that came
through for my client was the need
for financial control. I spent a day
in Armagh recently mapping out
a presentation for an event I am
invited to in October to speak about financial
planning and the organiser raised the same
theme. How can you demonstrate to the audience
how they can take control of their own financial
situation? As I sat in the airport in London on the
day I wrote this column, I reflected on the day’s
meetings, whereby we are structuring a financial
investment strategy that will pay our clients 7.5
per cent every six months, capital secured. You’ve
guessed it; the majority of the meeting was about
how we control the capital security.
The reality about taking control is that it isn’t
easy. Most of us are financially conditioned to
act and respond a certain way. Whether it is
through our upbringing, our life experiences or
indeed our personality, taking financial charge
goes against the grain. The result (for most of
us) is, at best, mediocrity in the returns we make
on our financial decisions. As you may be aware
(assuming you follow my column), I spend equal
parts of my professional time dealing with clients
with financial issues while at the same time
dealing with wealth creation. Personally, I believe
the process between the two is fundamentally
the same. Visualise what you are looking to
achieve, ascertain exactly where you are today
and create the plan that will best get you there.
28
Along the way ensure that you are as safe and
secure as you can be and, above all, stay in control
of your decisions and your money. The push back
from our meeting in Armagh was that, quite
simply, how can we take control? For those of us
who were part of the Celtic Tiger ethos of using
other people’s money to create wealth, and so
are embattled with the banks, this is decidedly
difficult. The banks are seeking to wield their
power and hide behind contract law as the basis
for every hare-brained means of enforcing what
are currently unenforceable contracts. The legal
system has simply contrived
to support their actions and
no one is standing up for
those of us with legitimate
desires to reach sensible
conclusions.
“
Iain Cahill ACCA MBA QFA
Director
Art of Wealth Ltd.
Dunlair House,
Old Athlumney,
Navan,
Co Meath
Mob: 087 2411371
Tel: 046 9072824
I ain C a h ill
a ploy to have the revised agreements signed,
which hardens their position but lessens ours. If
you are feeling embattled, hold your ground a
there will be no choice but to resolve things.
The issue of pensions
In terms of controlled protection, I should mention
the issue of pensions. From a bank negotiation
perspective, not all pensions are equal. Indeed,
in a presentation that I did recently I pointed out
that, in principle, company pension schemes
are protected from secured personal creditors,
however, we have
spent some time
working with
cooperative pension
trustees to ensure
that this protection
is more sacrosanct.
By enhancing the
underlying trust
agreements on their
pension schemes,
we feel that it
provides better
security for those
clients who need it.
I mention pensions
as heretofore for
many people the
focus on their wealth had been more on their
personal property assets than the ‘pension’ set
up a number of years ago as a favour to their
golf buddy. All of a sudden these investments
are becoming more important than ever. With a
stock market that may correct and the ability of
insurance companies to impose restrictions on
how you access your funds now and in the future,
think again about how and who manages these
funds.
We are undertaking an exercise for a client of
ours to maximise the lump sum he has available on
this pension having just turned 60. Of the funds he
has, effectively €40,000 would be lost if he looked
to trigger access to these funds today. Due to
‘market value adjustments’ imposed on the fund, if
he seeks to transfer or encase them, he faces being
penalised. As he said himself, “they seem to get me
every way!” I am not advocating one institution
over another at this stage, but I am counselling
caution and that depending on your own circumstances, that you seek the appropriate advice on
whether your own pension is properly structured. I
have always and will continue to advocate the use
of self-administered pension structures that put
you firmly in control of the charges, investment
decisions, and depend on which trustee you use,
security for creditors. I hope this helps.
Whether it is
through our
upbringing, our life
experiences or indeed
our personality, taking
financial charge goes
against the grain.
The stress of debt
The stress of dealing with
debt is no doubt the most
difficult thing anyone faces
right now. I met with a new
client very recently who
admitted that his entire
day had been lost worrying
about the banks’ actions
following a phone call
he had received from his
business partner. Taking charge is about focusing
on the outcome and action plan that you feel
you can deliver. Decisions about disposing of
properties, extending interest-only, or indeed
not fighting over a bank decisions are very
personal. The last way to solve it (in my
humble but experienced opinion) is to seek
someone else to provide your solution. You
take change first by deciding your own fate
and then seeking the right team who can help
you ache what you want. I do believe there is light
at the end of the tunnel.
With the new insolvency laws about to be
enacted, banks are not willingly to be engaged
in a protracted six – to seven-year process
to receive a share of a paltry sum of
money. In our ongoing negotiations
on behalf of clients, the conversation
is moving towards co-operative
agreement and, dare I say it (shhhhh),
write offs. I have it recorded by the
way, but in a bank meeting the bank
official stated: “light at the end of the
tunnel, based on a restructure of
the debt and partial write off.”
Sadly we have yet the see the
paperwork and so the cynic
in me is concerned that it was
CAREERS & EDUCATION
life
Diary of a pharmacy student
So where to now?
Pharmacy intern Siún Tobin ponders where her future in
pharmacy lies, both geographically and specialisation-wise
Y
ou might say that the past few
weeks have been a drag. Marooned
in Galway with the heavy weight of
an imminent assignment deadline,
the loneliness wasn’t long creeping
in. For the first time all year, I felt a
terrible yearning to be home in the bosom of my
family and friends in Cork. What a contrast to my
general upbeat impression of my new homeland!
Over the last number of weeks I became aware
that, much and all as I am as happy as a clam on
the shores of the west, there really is nowhere like
home. I have been very fortunate that all year it
has seemed I was only ever five days from the next
exciting weekend trip, visit to the homeland or
visitor through the door. In pondering my recent
isolation, my thoughts turned to the changes I can
expect over the next number of years. This year is
a precious one and one where I am very fortunate
to have little to complain about. Friends visit from
Cork, family are eager to see my new set-up and
with no weekend work, I have the liberty to venture
home as I please. But what about the next number
of years? I can expect to see a considerable evolution of my current situation. Friends may be more
occupied – some may be working in the UK, others
off on world trips, others consumed with setting up
their own pharmacy business or starting into a new
degree. Weekend freedom may be a thing of the
past and getting two back-to-back days to make a
visit home worthwhile might be scarce.
Such has been my experience of Galway; I have
long established a vision of myself living long in
the west with my 2.5 kids and garden pond. Perhaps the only thing standing in my way is my job
prospects. Currently, hospital pharmacy has stolen
my heart and it is an area of pharmacy that I would
love to remain in. However, it seems that hospitalbased pharmacy jobs are almost impossible to find
for the pre-reg graduate. It is hard to know what
exactly to prioritise going forward – the perfect job,
the perfect location or climbing the career ladder? I
am torn between my drive to pursue my preferred
career path and my desires to remain surrounded
by family and friends. Should I settle for a community-based pharmacy job to fill my pockets with
pretty pennies? Should I make the daunting move
to the UK and pursue my calling in the hospital profession? Or, what about taking off into the exciting
pastures of Canada or New Zealand?
PharmaConex on the move
PharmaConex, Ireland’s premium locum and recruitment agency
for pharmacy, is delighted to announce that they are moving to new
offices in Dublin city centre from August 1.
The new offices are located in the landmark Capel Building on the
Luas line between the Jervis Centre and the Four Courts.
PharmaConex are really looking forward to the move to the
prestigious new location, which boasts a host of amenities both
internally and nearby – we hope that both candidates and clients will
feel free to drop in for a coffee and a chat anytime they are in the area.
PharmaConex have grown over the past three years from one
full-time employee to five office staff across two locations and 10
full-time relief pharmacists. As well as providing full-time and locum
pharmacists, they now also provide technicians, both full-time
and locum, and deal with most major groups in Ireland as well as
independents across the country.
Pictured are the Dublin team from PharmaConex in the reception
area of their new offices
30
A huge factor in making such a decision relates
to my friends and what their plans are. Notwithstanding the fact that I am a very independent lady,
to head abroad on my own would see me gamble
a lot. With a boyfriend here, as well as a wide group
of friends, who all make my world go around,
emigrating is no small decision. What’s not to love,
you might say, about the prospect of working in a
warmer climate where one can take a swim in the
sea on the way home from work? Yet who wants
to be off in the glitter of the Canadian sunshine
if they have nobody to share a beach day with?
Equally, who wants to be stuck at home, continuing
with the humdrum of Irish life whilst their friends
are surfing waves abroad? It’s all a balancing act.
Another major consideration relates to how attaining pharmacy experience in different locations contributes to a pharmacy career. Is experience gained
overseas in the likes of New Zealand or Canada
attractive to future Irish employers? Hundreds of
thoughts flood my mind.
It will be a number of months yet before a decision can be made and who knows what developments may present in the interim. In an ideal
world the prospect of a steady job in Ireland when
we graduate would do just nicely. After 23 years
of relative financial dependence on our parents,
most would not decline a sound job offer and the
prospect of financial stability at this point in time.
And, maybe then, when money has been put aside
and experience gained, we would be better poised
to head off on our travels. Personally, I will continue
to hawk for hospital-based work for the time being
and maybe my job angel will fly in at the opportune
moment. In the meantime, the small matter of drafting my thesis will be sure to occupy my thoughts.
PSI provides update on new
education and training framework
The new undergraduate pharmacy education and continuing
professional development (CPD) framework in Ireland is positioning
the country at the forefront internationally of pharmacy innovation and
education, according to Acting Pharmaceutical Society of Ireland (PSI)
Registrar/CEO Ciara McGoldrick.
She was speaking at the publication of the regulator’s 2012 Annual
Report in June, which highlighted the launch by An Taoiseach Enda
Kenny of the Irish Institute of Pharmacy and the National Forum for
Pharmacy Education and Accreditation, which are to facilitate excellence
in patient care in Ireland.
“Work on progressing the implementation of the five-year fully
integrated masters degree in pharmacy is ongoing, and establishing
the main operating principles and structures of the Institute was an
important step in 2012,” Ms McGoldrick said.
“In 2012 the PSI Council also approved the first core competency
framework for pharmacists, which will be the cornerstone of the
educational reforms and support pharmacists with their CPD throughout
their careers.
“The PSI has also continued to work closely and effectively with other
regulatory bodies both at home and abroad over the year, as well as
completing a baseline analysis of hospital pharmacy practice, which
provides valuable insight into services being delivered in this area in
Ireland,” she said.
“We now look forward to, as a member of the International
Pharmaceutical Federation (FIP), co-hosting the FIP World Congress in
Dublin later this year,” Ms McGoldrick said.
The Congress will be held in the Convention Centre Dublin (CCD) from
August 31 to September 5, with extensive coverage to be carried in the
next issue of Irish Pharmacist.
Significant work took place in 2012 in relation to the promotion of the
2013 event both locally and internationally, the PSI has stated.
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PICTURE GALLERY
life
Official opening of new PSI Headquarters
Attendees at the PSI House opening 2013
Minister for Health Dr James Reilly with members of the architect, engineering and
construction team. L-R: Glenn Nunan (GNCE Consulting Engineers), Gerry Murphy, Architect
(Fitzgerald Kavanagh + Partners), Minister Reilly, and TJ Walsh (Townlink)
Mr Paul Fahey opening address with
Minister Dr James Reilly and Ms Ciara
McGoldrick
PSI Acting Registrar Ms Ciara McGoldrick
Minister James Reilly and Marion Shanley
Ms Liz Hoctor, IPU with Mr Paul Fahey, PSI
New history of
literary Dublin
One of the highlights of this year’s celebrations
of James Joyce’s Bloomsday was the launch
(June 11) by Joyce biographer, Peter Costello, of
Brendan Lynch’s latest book, City of Writers. The
Lives and Homes of Dublin Authors.
Ms Bridget Caffrey, pharmacy assistant; Ms Rebecca Breslin, pharmacist; Mr Brendan Lynch;
Ms Margie Lynch, pharmacy technician; Ms Mary O’Connor, pharmacist assistant; Mr Michael
O’Connor; and Ms Chin Nee, pharmacist
32
Mr Brendan Lynch, Ms Margie Lynch,
pharmacy technician, Foley’s, Thomas Street,
and Mr Peter Costello
Only one in ten women seek advice
for PMS from their pharmacist –
Cleanmarine research
Only one in ten Irish women get advice for PMS from their
pharmacist, recent Irish research conducted by Cleanmarine® Krill
Oil for Women on premenstrual syndrome (PMS) has revealed.
This is despite the fact that over half of women’s daily lives are
affected due to suffering with PMS. Nearly half of the surveyed
women (43 per cent) are not currently taking any action to manage
their PMS symptoms. The age-group who said they suffer the most
from PMS symptoms are females between 25 and 34 years.
Speaking about the study findings (based on over 500 women),
Grace O’Connor, pharmacist, said: “We have long known that
women are the gatekeepers of the family’s health. However, they
are less proactive when it comes to managing the symptoms
of their monthly cycle. The Cleanmarine® Krill Oil for Women
research shows that symptoms such as cramps, mood swings and
feeling low or sensitive are the most common. This represents an
opportunity for pharmacists to speak to
female customers more activity about
PMS and about effective natural solutions.
Staggeringly almost 90 per cent of women
believe that PMS is a normal part of a
woman’s monthly cycle so I find it’s a good
starting point to let them know that they
don’t have to suffer from this.”
Cleanmarine Krill Oil for Women is an
Irish brand of Omega 3 supplement that
has been developed to help women
manage their monthly PMS symptoms
while simultaneously improving their skin,
hair and nail quality.
Cleanmarine Krill Oil for Women can be
ordered from Naturalife. The ROI sales and
enquiry line is 0404 62444.
The UK sales and enquiry line is 0845 0800 726. For more information
and testimonials visit www.cleanmarinekrilloil.com or speak to your
Naturalife rep.
Alternative treatment for bedwetting
In Ireland, over 46,000 children above
the age of five years regularly deal
with occurrences of bedwetting.
Drytime offers parents and
children a safe, alternative treatment
to bedwetting.
Drytime is a hop extract,
originating from a plant called
Humulus Lupulus, which helps
children to control the urge to urinate
or suffer leakage of urine, while
sleeping. The aromas released by
Drytime provide a relaxing stimulant
to the central nervous system, which
in turn improves overnight urine
retention.
Humulus Lupulus has no side
effects or addictive qualities so is
a perfectly safe alternative to treat
children’s nocturnal enuresis.
Drytime is available in pharmacies
nationwide
For further information contact
Fannin Ltd. on 01 290 7000, info@
fannin.eu, or visit www.fannin.eu.
product news
Viagra reduces in price following
patent expiry in Ireland
Pfizer Healthcare Ireland has announced that following the Irish
expiry of the patent for Viagra (sildenafil citrate) on June 20, as
per the supply agreement between the IPHA and the Department
of Health, Viagra’s price will initially reduce to 70 per cent of the
original price, and to 50 per cent of the original price in 2014.
Viagra, the iconic blue diamond, will remain available to ensure
that men with erectile dysfunction have ongoing access to a Pfizer
medicine that they already know and trust, the company said.
“Not only has Viagra helped millions of men to overcome erectile
dysfunction, it has also paved the way in terms of removing stigma
associated with the condition and legitimised discussions around it
with healthcare professionals,” said Mr Ted McDermott, Consultant
Urologist, Tallaght Hospital. “ Viagra represented the biggest
ever breakthrough for the treatment of erectile dysfunction and
became a brand which entered the public consciousness and
ignited public imagination worldwide.”
Paul Reid, Managing Director, Pfizer Healthcare Ireland said:
“Pfizer remains committed to men with erectile dysfunction and
we will continue to invest in innovation to ensure that patients
and prescribers have ongoing access to a range of trusted,
Pfizer-quality medicines. We anticipate that Viagra will remain an
important medicine as patients will want to have on-going access
to a Pfizer medicine that they already know and trust.”
New treatment option for ADHD
in children and adolescents
as Shire launches Tyvense
(lisdexamfetamine dimesylate)
Shire Pharmaceuticals Ireland Ltd has announced that its singledaily dose long-acting prodrug stimulant, Tyvense, has been
authorised by the Irish Medicines Board for the treatment of ADHD
in children aged six years and over when response to previous
methylphenidate treatment is considered clinically inadequate.
Tyvense is the first stimulant prodrug to be launched in Europe
for the treatment of ADHD. It provides a long duration of effect
to help patients achieve control of their ADHD symptoms. The
prodrug is ingested in an inactive form and subsequently activated
within the body, meaning that the active part of Tyvense is
gradually released over time.
ADHD is a complex condition and every patient has specific
needs. European guidelines recommend the use of ADHD
medications that reduce the need for children to take medication
through the course of the school day.
Speaking at the launch of this important new treatment, Dr
Eithne Foley, Child and Adolescent Psychiatrist with the HSE,
said: “Every child with ADHD is different and will vary in his or her
response to the available treatments, which include behavioural
and psychological interventions, educational strategies and
pharmacological treatments.
“This new stimulant treatment is a very welcome development
and means that we have an additional pharmacological treatment
option for those patients who have not responded to a first
line medication. This new medication will give an additional
pharmacological treatment option as part of a comprehensive
treatment package for ADHD.”
Commenting on the launch of Tyvense, Brian Martin, General
Manager, Shire Pharmaceuticals Ireland Ltd said, “We are delighted
that Tyvense is now licensed for use in children and adolescents
with ADHD in Ireland. Shire is committed to improving the understanding and treatment of ADHD and to ensuring that patients
diagnosed with ADHD continue to benefit from these advances.”
33
product news
Udo Erasmus lauds the many
health benefits of Krill Oil
New research reveals men are too
embarrassed to talk about baldness
Udo Erasmus, creator of Udo’s Oil has just launched a new marine
oil to the Udo’s Choice range; O-Krill 3, which is rich in EPA and DHA
and is highly absorbable, concentrated and sustainable.
Renowned for his research and writings on the health benefit of
essential fatty acids, Dr Erasmus is convinced that Krill, after seeds,
are the next best source of omega 3 on the planet. For him, among
the factors which make Krill Oil so ‘special’ are that the Antarctic
Krill (Euphrasia Superba) used in “O-Krill 3” live in the most pristine,
unpolluted waters on earth, and they have a unique biochemical
composition containing omega 3 fatty acids, phospholipids and the
natural antioxidant, Astaxanthin.
It is this composition that scientists
believe make Krill Oil more stable and more
effective than fish oil. Krill are ‘harvested’
in a sustainable manner that is strictly
regulated by the Commission for Antarctic
Marine Living Resources, meaning that Krill
will remain a sustainable resource for future
generations of sea life and humans.
Most individuals consume Krill Oil without
experiencing any unpleasant ‘burps’ familiar
to fish oil users.
Udo’s Choice O-Krill 3 is distributed by
Naturalife. It bears a RRP of €24.99 for 60
capsules. A national advertising campaign is
supporting the launch.
Further details and support material are available from the company
on 0404 62444 and [email protected]. Additional product information is
also available on www.udoschoicekrill.com
Hair loss is a major concern for Irish men yet most are reluctant to
talk about it even with those closest to them, according to the results
of a new study that was commissioned by REGAINE for Men Foam.
Nearly four out of ten men (38 per cent) admitted to being
concerned about losing their hair. Yet 71 per cent of those surveyed
admitted that they have never discussed their hair loss with a
partner, while just 17 per cent have sought advice from a healthcare
professional such as a doctor or pharmacist.
Commenting on the research, Dr Maurice Collins FRCSI, specialist
in hair restoration medicine, said: “The results indicate that hair loss
is a sensitive issue that can effect men deeply. The effective medical
treatments now available will help to encourage a more open
discussion on the subject of hair loss in men and its treatment.”
For more information about REGAINE and the entire product range,
please visit: www.regaine.ie.
Xtandi (Enzalutamide) authorised in
the European Union for treatment
of advanced prostate cancer
The European Commission (EC) has now granted the marketing
authorisation for Xtandi (enzalutamide) capsules for the treatment
of adult men with metastatic castration-resistant prostate cancer
whose disease has progressed on or after docetaxel therapy.
Xtandi had previously received a positive opinion by the
European Medicines Agency (EMA) and a positive Committee for
Medicinal Products for Human Use (CHMP) opinion on April 25
2013.
Enzalutamide is a novel, once-daily, oral androgen receptor
signalling inhibitor, that has been jointly developed by Medivation
Inc. and Astellas. It inhibits multiple steps in the androgen receptor
(AR) signalling pathway, which has been shown to decrease cancer
cell growth and induce cancer cell death (apoptosis).
The EU authorisation is based on results from the phase III
AFFIRM study, which confirmed that enzalutamide demonstrated a
statistically significant improvement (4.8 months) in overall survival
compared to placebo, with a median survival of 18.4 months in
the enzalutamide group versus 13.6 months in the placebo group.
The study also concluded that enzalutamide was generally well
tolerated by patients and met all secondary endpoints.
For further information please contact: Astellas Medical Department,
Astellas Pharma Co Ltd, 5 Waterside, Citywest Business Campus, Dublin
24. Tel: 353 (0) 1 467 1555
TouchStore introduces in-store
broadband ordering in Ireland
The distinctive chatter of a dial-up when sending orders is rapidly
becoming a sound of the past, as TouchStore introduces this feature
over broadband.
In June, John Gleeson of Woodview Pharmacy in Limerick was
the first Irish pharmacist to send a live order to Uniphar from the
TouchStore Rx dispensing system in his pharmacy over a broadband
link. This broadband order transmission was performed according
to an IPU protocol, which all the pharmacy wholesalers and software
vendors have agreed to implement.
“I am well aware of the work and co-operation that has been done
to enable this to happen. I am also aware of the added benefits and
functionality that broadband ordering is going to bring to community
pharmacists,” said Mr Gleeson.
This new ordering breakthrough serves many advantages. Not only
does broadband operate from 10 to 20 times faster than a dial-up
connection, it also gives pharmacists the ability to use the telephone
simultaneously while sending orders, said Touchstore.
“Retail pharmacy has waited a long time for this. At TouchStore
we pride ourselves on being at forefront of pharmacy software
innovation and I am delighted we now offer this feature to our
customers. The dial-up method is going strong for 25 years now.
However, it has been a consistent cause of concern to pharmacy
system vendors that they are probably the only IT companies still
scouring the market place for 56K modems. At last those days are
coming to an end,” said Gerard Cassidy, CEO, TouchStore.
John Gleeson of Woodview pharmacy, sending the first live broadband
order to Uniphar on his TouchStore Rx dispensing software
34
classifieds/crossword
modern technologies to
tackle cholera, AIDS and
malaria. mHealthEd aims to
promote the creation and
utilisation of easily dubbed
educational animated films
for use on mobile phones,
which teach about prevention
of cholera, AIDS, malaria,
child malnutrition and other
preventable health-related
dangers that kill millions
each year in developing
countries. See www.
mernaghcommunications.com
for more information.
September
OCTOBER
Name:
Address:
A
N
A
R
E
R
E
F
U M
I
I
I
L
A
I
18
N
T
A
C
A
C
H
8
I
I
T
N
O
O
L
I
21
V
U
R
C
I
E
19
U
M
16
I
R
E
N
A
17
G
Y
13
A
R
12
7
I
A
E
9
N
S
X
T
U
E
N
A
E
R
22
E
N
20
14
B
U
O
15
B
11
O
T
21
M
20
T
19
18
A
17
R
16
10
15
Down
1 Malice in native nomads (5)
2 I’m one gallery, or copy one (7)
3 Never an anti-climax (6)
4 Decoration in domed alcove (5)
5 This brings back trouble! (7)
6Re-live around the east to mitigate dicomfort (7)
10 Ties boy in a knot for being overweight (7)
11 Would ague fit this description of weariness? (7)
13 Despite hitting an iceberg, intact I would be (7)
14 This wierd nebula cannot! (6)
16 A bite of the dog could make one furious (5)
18 Extort money in double edged deal (5)
6
14
Across: 2 Radiology, 6 Atone,
7 Antic, 9 Air, 10 Tuber, 12 Yacht,
14 Ennui, 17 Ilium, 19 Nag, 20
Toxic, 21 Lifer, 22 Reservoir.
Down: 1 Heartbeat, 2 Rhomb,
3 Drear, 4 Ovary, 5 Optic,
8 Catamaran, 11 Emu, 13 Ail,
15 Nexus, 16 Incur, 17 Igloo,
18 Infer.
13
Y
12
P
11
O G
10
5
9
L
8
For further information please contact:
Ricesteele Manufacturing Ltd,
Unit 21, Cookstown Industrial Estate,
Belgard Road, Tallaght, Dublin 24.
Tel: 01 4510144
V
7
Across
1 Would this rivet go crooked from giddiness? (7)
4 Moral difference concerning back teeth (5)
7 Would nuns rig a sisters’ profession? (7)
8 Am I an unusual case of euphoria? (5)
9Recovery of wreckage is enough to make veal sag (7)
10 Change of efts is compensating (6)
12 Stoker causes apoplexy! (6)
15Rent one for the intestinal tract (7)
17 Stirred broth causes palpitation (5)
19 ...and beg a change of dressing (7)
20 Give way to triangular road-sign? (5)
21 Strange seed-cap got out (7)
O
6
4
5
I
4
D
3
R
2
This crossword is sponsored
by an educational grant from
3
1
Wednesday, November 6
Medicines management
CE
in palliative Care ERVI
S
S
A one-day
IED
SSIF MACIST
A
education course
L
C
AR
Y/
o
on medicines
DIAR IRISH PH your ad t
l
T
ai
A
management
nx.ie
e em
in palliative
Pleas ra@gree
mau
care will be held
on November 6.
A
ip Crossword No.210
November
H
Saturday, August 31 to
Thursday, September 5
FIP 2013
The 2013 FIP Congress, which
will be co-hosted with the PSI,
Friday and Saturday,
October 11 and 12
ICHMC 2013
The third International
Conference for Healthcare and
Medical Students (ICHMC) will
take place from October 11-12.
This student-led conference,
supported by the Royal
College of Surgeons in Ireland
(RCSI) faculty office, seeks
to provide an opportunity
R
Thursday and Friday,
September 12 and 13
International health and
tech summit
An international health
and tech summit called
‘mHealthEd’ will take place
at Dublin’s Mansion House,
from September 12-13. The
summit will welcome 200 top
global mobile technologists,
animation artists, academics
and government healthcare
officials in a bid to use
august/
september
Thursday, October 17
PSI Council meeting
The Council of the PSI will
meet on Thursday, October
17. A venue and time for
the meeting had not been
confirmed at the time of going
to print.
2
Thursday, July 18
PSI Council meeting
This will be the first meeting
of the new Council of the
Pharmaceutical Society of
Ireland (PSI). A new President
and Vice President will be
elected at this meeting and
the Council’s new Five Year
Corporate Strategy will be
launched. See www.thepsi.ie
for more details.
E
july
H
2013
Developed by Our Lady’s
Hospice and Care Services,
this comprehensive education
day, aimed primarily at
pharmacists, focuses
specifically on medicines in
palliative care. This is a unique
opportunity for learning
offered by the Palliative
Meds Info service and the
multidisciplinary specialist
palliative care team at Our
Lady’s Hospice and Care
Services. The course will
provide training in the optimal
use of medicines for patients
with palliative care needs in
all care settings, examining
the principles of palliative care
as they apply to the use of
medicines.
ANSWERS TO LAST MONTH’S CROSSWORD No. 209
Diary
for undergraduate medical
and healthcare students to
develop their research skills
and expand their network in
an international setting.
It will take place in the RCSI,
123 St Stephen Green, Dublin
2, Ireland. For further details
go to: http://ichams.org.
1
will take place in Dublin from
August 31 to September 5.
The theme of FIP 2013 is
‘Towards a Future Vision for
Complex Patients – Integrated
Care in a Dynamic Continuum.’
This programme will address
the complexity of the
newest and most advanced
treatment methods as well
as the complexity of patients
themselves in terms of biology,
chemistry, mentality and
sociology.
Congratulations to the winner of last month’s crossword:
Celeste Slye, O’Keeffe’s Pharmacy, Strand Street, Dingle, Co Kerry.
For a chance to win €70, please send completed entries by August 15, 2013 to:
The Editor, Irish Pharmacist, GreenCross Publishing,
7 Leeson Street, Dublin 4.
E-mail:
Please note the winner's cheque will be issued 45 days after publication.
35
outside edge
Is 35 the new 55?
L
ife is a funny thing. You start out young and
go through your twenties feeling indestructible, and even carry on into your thirties with the self-image that you are still a
fresh blade out on the cutting edge. There
are of course signs that you are physically
not the person you once were – the blade has new
nicks and scratches, but if you stop playing team
sports against guys who are fifteen years younger
then you can airbrush the evidence from your mind.
And mentally you are still bright and fresh as any
sprinting youngster. But I’ve crept into my mid-forties
and every once in a while the reality of that comes
home, and not just on those days when I see a bit
more of my father’s face in the mirror.
At the Pharmacist Awards last November I recall
looking around the Mansion House and thinking
‘where have all these young pharmacists come from?’
COMMENT & ANALYSIS
It was a great thing to see, but it did also make me
conscious of how the profession has changed. When I
graduated back in 1990 the demographic of the profession was such that 50 per cent of pharmacists were
aged over 55. The consequences of this cohort retiring
allied to a single school of pharmacy were that right
up to the mid-2000s it could be difficult to find employees and even tougher to find locums. This wheel
has certainly turned, and the numbers explain why.
I recently got the figures for the 4,966 pharmacists
currently on the PSI’s register, along with their age
profile. The breakdown is:
Age
20-25
26-35
36-45
46-55
56-65
66-75
Over 75
Unclassified
Grand Total
Number
363
2,108
1,396
627
282
109
65
13
4963
%
7.3
42.5
28.1
12.6
5.7
2.2
1.3
0.3
100
So 49.8 per cent of pharmacists are now aged 35
fintan m oo re
Fintan Moore graduated as
a pharmacist in 1990 from
TCD and currently runs a
pharmacy in Clondalkin.
His email address is:
[email protected]
and under, which is a drop of twenty years in the
median age from twenty years ago. As I write this I
am exactly 45 so I am declaring myself to be in with
the ‘young’ majority, which I’m classing as aged 20 to
45 because it suits me. However, by next November’s
Pharmacist Awards I will have seen another birthday
and moved on a demographic, so if you whippersnappers could turn the music down and bring me a nice
glass of sherry I’ll sit wrapped in a rug by the fireplace.
Sweet and Nasty
It is obvious from looking around you on the streets
that the people of this country are getting bigger all the
time. The statistics for the rate of obesity in adults are
scary enough, but the figures for children are horrifying.
This growth in the rate of over-growth replicates the
same phenomenon observed in the United States for
years. The implications for the health of the population in terms of increased levels of diabetes and heart
disease are dire, and the attendant economic effect of
this is equally worrying. For years there has been much
debate on why the environment we live in is so much
more obesogenic, and the finger of blame has tended
to point at excess fat in our diet. However, more and
more studies are now indicating that a more significant
culprit is likely to be sugar.
The current situation regarding the threat to health
posed by sugar, especially fructose in fizzy drinks, is
best compared to the period a couple of decades ago
when the research into tobacco was stacking up to
prove that smoking was dangerous, but the tobacco
industry fought a protracted battle to delay action by
governments against the threat. Recent competent,
ethical studies indicate that drinking one standard can
of a sugar-sweetened drink every day increases your risk
of diabetes by 22 per cent. It is worth looking online to
see the accumulated evidence linking sugary soft drinks
to weight gain and diabetes.
This topic does crop up in the media from time to
time, and the standard line spouted by PR guys from
the food industry is that sugary drinks and snacks
should be “eaten as part of a balanced diet”, and that
the link between these and obesity is “not proven”. This
is junk-speak from the makers of junk-food. The lobbying power of these companies is enormous so it will
take years before any government does anything. While
we are waiting, I would suggest that whenever pharmacists get a chance to influence patient behaviour that
we advise them to cut out the fizzy sugar, especially for
children. No sane parent would defend giving a child
just one cigarette every day as a “treat” so why give
them “just one” soft drink a day?
Get The Mind Young, and the Liver Will Follow
Moving on from soft fizzy drinks being fed to kids I
come to the topic of slightly harder drinks being promoted to kids too young to legally buy them yet. There
is talk these days of a ban on drinks companies sponsoring sports, which is probably the right thing to do,
although alternative funding could be hard for sporting
bodies to find.
A related topic which I’ve never heard raised is why
is there no watershed for alcohol advertising on TV?
Some of the sharpest and wittiest ads for alcohol have
a humorous appeal to kids as well as adults. Why is
this permitted?
36

New PSI HQ declared as smoke

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