the independent monthly for irish...

The independenT monThly for irish pharmacisTs

issue 11 volume 10 decemBer • 2008

www.greencrosspublishing.ie

67644 Chef 245x75 Trade Ad 18/08/2008 16:31

NEWS•DorganReportrecommendationswouldhavecosttheStateanextra€40million•Feweradversedrugreactionsnotifiedbypharmaciststhananyothergroup•Oneinfouradultsonprescribedmedication•SixpharmaciesinlistofIreland’sTop50stores

PHARMACIST AWARDS 2009Meetthesponsors

ALL I WANT FOR CHRISTMAS IS…AsneakpreviewofyourletterstoSanta

Q&AProfessorJaneGrimson,HIQA

INTERVIEW

MrTomMcGuinn,FormerChiefPharmacistattheDepartmentofHealth

B R E A K T H R O U G HIntroducing anticoagulation with no injections or coagulation monitoring

Prescribing Information (Irl)PRADAXA®

Capsules containing 75mg or 110mg dabigatran etexilate (as mesilate) Action: Direct thrombin inhibitor Indication: Primary prevention of venousthromboembolic events in adult patients who have undergone elective total hip or kneereplacement surgery Dose and administration: Initial dose 110mg within 1-4 hours ofcompleted surgery, then 220mg once daily. In moderate renal impairment (Cr Cl 30-50ml/min) or patients >75 years reduce dose: initial dose 75mg, then 150mg once daily.After knee replacement surgery continue treatment for a total of 10 days; after hipreplacement surgery for 28-35 days. Delay initiation of treatment if haemostasis is notsecured. If treatment is not started on the day of surgery initiate with 220 mg (or 150mg)once daily. Contra-indications: hypersensitivity to any component; severe renalimpairment (CrCl < 30 ml/min); clinically significant bleeding; organic lesion at risk ofbleeding; impairment of haemostasis; hepatic impairment or liver disease expected tohave any impact on survival; concomitant quinidine Warnings & precautions: Notrecommended if liver enzymes > 2 ULN; measure ALT in pre-operative evaluation. Closeclinical surveillance (signs of bleeding or anaemia) is recommended throughout thetreatment period, especially when haemorrhagic risk is increased: diseases associatedwith a risk of bleeding such as coagulation disorders, thrombocytopenia or functionalplatelet defects, active ulcerative GI disease, recent biopsy or major trauma, recent ICHor brain, spinal or ophthalmic surgery, bacterial endocarditis, concomitant NSAIDs (t1/2

>12 hours). Patients < 50 kg or >110 kg; the elderly; patients at high surgical mortalityrisk and with intrinsic risk factors forthromboembolic events. If severe bleedingoccurs, discontinue treatment and investigatethe source of the bleeding. Avoid or use with

caution agents which may increase the risk of haemorrhage. Not recommended inpatients undergoing anaesthesia with postoperative indwelling epidural catheters; thefirst dose should be given a minimum of 2 hours after catheter removal; these patientsrequire frequent observation for neurological signs and symptoms. Contains SunsetYellow (E110) which may cause allergic reactions Interactions: anticoagulants andplatelet aggregation agents; amiodarone (reduce Pradaxa® dose to 150mg); cautionwith strong P-glycoprotein inhibitors (e.g. verapamil, clarithromycin) or inducers (e.g.rifampicin, St John's wort). Pregnancy and lactation: avoid pregnancy during treatment.Do not use in pregnancy unless clearly necessary. Discontinue breast-feeding duringtreatment Undesirable effects: Most common is bleeding (14%); major bleeds, includingwound site bleeding, < 2%. Common (≥ 1/100, <1/10): anaemia; haematoma(including traumatic or postprocedural); wound, gastrointestinal, skin or post proceduralhaemorrhage; haematuria; decreased haemoglobin; wound secretion, postoperative orpostprocedural anaemia, postprocedural discharge. See SPC for details of these andother undesirable effects. Pack sizes and MA numbers: 75mg 10 capsulesEU/1/08/442/001; 60 capsules EU/1/08/442/003 110mg 10 capsulesEU/1/08/442/005; 60 capsules EU/1/08/442/007 Legal category POM Marketing Authorisation Holder: Boehringer Ingelheim International GmbH, D-55216Ingelheim am Rhein, Germany. Prepared in April 2008. For further information pleasecontact Boehringer Ingelheim Ireland Ltd, Corrig Court, Corrig Road, Sandyford IndustrialEstate, Dublin 18.

Date of preparation: April 20082008-PRA-004

Please refer to the Summary of Product Characteristics for further information.

The independenT monThly for irish pharmacisTs

ediTorial

conTenTsissue 11 volume 10 • decemBer 2008

IrishPharmacistispublishedbyGreenCrossPublishing,LrGroundFloor,5HarringtonStreet,Dublin8.Tel:014789770.Fax:014789764.www.greencrosspublishing.ie

GreenCrossPublishingisarecentlyestablishedpublishinghousewhichisjointlyownedbyGrahamCookeandMauraHenderson.BetweenthemGrahamandMaurahaveover25yearsexperienceworkinginhealthcarepublishing.Theirstatedaimistopublishtitleswhichareincisive,vibrantandpertinenttotheirreadership.

EDITOR:JuneShannonDESIGn:BarbaraVasicSUB-EDITOR:TimIlsleyPUBLISHER:GrahamCookePARTnER:MauraHendersonCOnTRIBUTORS:DiarmuidCoughlan,DavidJordan,JulianJudge,FintanMoore,CormacO’neill

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© copyright Greencross publishing 2008

no part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form by any means – electronic, mechanical or photocopy recording or otherwise – whole or in part, in any form whatsoever for advertising or promotional purposes without the prior written permission of the publishers.

irish pharmacist endeavours to ensure accuracy of information given and of claims made in articles and advertisements. nevertheless, no responsibility is accepted in respect of such information or claims. any opinions expressed by contributors are entirely their own and do not purport to be the views of irish pharmacist.

It’sChristmas!!AndthismonthyourfavouritepharmacymagazinehasbroughtyouaspecialfestivethemededitioncompletewithSantahatsandChristmaswishlists.ItalsofeaturesacomprehensiveroundupoftheverylatestpharmacynewsyouhavecometoexpectfromIrish Pharmacist,aswellassomeexclusivenewsstories—rememberyouhavereadthemherefirst. Oneoftheseisthenewsthathadtheinterimrecommendationsof

theGovernmentCommissionedDorganReportbeenimplemented,itwouldhavecosttheStateanextra€40millioninpharmacyservices.AspointedoutatthepublicationofthereportbythePresidentoftheIPU,MsLizHoctor,theproposeddispensingfeesproposedbytheDorganreportcertainlydohighlighttheinadequacyoftheHSEofferof€5.RememberIrish Pharmacistisyourmagazinesoifyouhaveanyissuesyouwouldliketoraiseorstoriesyouthinkneedinvestigatingpleaseemailthemtomeatjune@greencrosspublishing.ieInthemeantimeeveryoneatIrish PharmacistandGreenCrossPublishingwouldliketotakethisopportunitytowishallourreadersandcontributorsaveryhappyandpeacefulChristmasandahealthy2009.Blessyouforreading!

4- 12NEWS

15 PHARMACIST AWARDS 2009 Meetthesponsors

16 ALL I WANT FOR CHRISTMAS Asneakpreviewatsomeofyourlettersto

Santa.

18 INTERVIEW Irish PharmacisttalkstoTomMcGuinn,

on30yearsasChiefPharmacistattheDepartmentofHeath

22 VIEW FROM ABOVE Aheartbreakingstoryoftwobabygirls

switchedatbirth

23 THE COALFACE DavidJordanwonderswhocouldbring

somemuchneededchangetoIreland’shealthsystem.

26 LAW

27 FINANCE

29 CLINICAL Alzheimer’sDisease

32 Q&A ProfJaneGrimson,HIQA

33 EPHARMACY

42 CROSSWORD

44 FINTAN MOORE’S OUTSIDE EDGE

4Issue11Vol10December2008

newsnews

TheimplementationoftheinterimrecommendationscontainedintheDorganReportwouldhaveaddedanextra€40millionayeartotheState’sbillforpharmacyservices,Irish Pharmacist haslearned.AccordingtotheCorporate

PharmaceuticalUnitoftheHSEitwouldcosttheStateanextra€40millionperyearifthecurrentmixoffeesandmark-upspaidtopharmacycontractorswerereplacedbythefeeperitemstructurerecommendedintheDorganReport.“However,asnocontractorhastaken

uptheinterimcontracttowhichthisfeestructurewouldhavebeenapplied,itissomethingofamootpoint,”theHSEadded.InareportpresentedtoanHSEboard

meetingbackinJuly,theCEOoftheExecutive,ProfessorBrendanDrumm,statedthat“basedonaveryhighlevelbriefingoftheproposals”containedintheDorganReporthehad“advisedtheSecretaryGeneralofthefinancialimplicationsshouldtheGovernmentapproveimplementationoftheReport”.ChairedbyMrSeanDorgan,the

BodyonPharmacyContractPricingwasestablishedinFebruarybytheMinisterforHealthtorecommendanew,interimdispensingfeeforcommunitydrugschemes.TheDorganReportidentified“one

substantialissue”insettingadispensingfee–“thewidevariationinsize,financialstandingandbusinesscompositionofpharmacies”.

“Asingleflatfeewouldhavequitedifferenteffectsfordifferentpharmacies.Asuitablefeestructurecanincentivisemoreefficientbusinessactivities,butabalancehastobeachievedwiththemaintenanceofessentialpublicservices.Largerpharmacieswithadiversebusinessbase(ofteninmoreprosperouslocations)couldadjustmorereadilytoarelativelylowdispensingfeethansmalleroutletsinlessadvantagedareas,”thereportread.Itthereforeproposedasystemof

tiereddispensingfeesbasedonthenumberofitemsdispensedperannum.Accordingtothereport,pharmaciesdispensingupto20,000itemswouldreceiveafeeof€7peritem;dispensingbetween20,001and30,000itemswould

bringafeeof€6.50,whilepharmaciesdispensingmorethan30,000itemsayearwouldreceiveafeeof€6.Respondingtothereportatthe

time,theIPUsaidthattheproposeddispensingfees“highlighttheinadequacyoftheHSEofferof€5”.ThepresidentoftheIPU,Ms

LizHoctor,saidthatthenewfeesproposed“don’tgonearcompensatingpharmacistsforthe30percentcutinfeesforcedthroughbytheHSEandacceptanceofthenewpaymentmodelwouldfurthererodepharmacists’incomesbyeliminatingthemarginoncertainschemes.ThisreportwilldolittleforthemanypharmacistswhoareingenuinefinancialdifficultyasaresultoftheHSEcuts.”

Postearlyforthe2009IrishPharmacistAwards

Dorgan Report would have increased HSE payments to pharmacists by v40M per year

JacobO’SheehanReadfromGreystonespostshisentryforthe2009HelixHealthIrishPharmacistAwards.MembersofthepubliccannominatetheirlocalpharmacistforexcellenceinpatientcareinthePatientnominatedCategory.TheHelixHealthIrishPharmacistAwardsrecognisethosepharmacistswhohavehadsignificantpositiveinvolvementinthepharmaceuticalprofession.Theclosingdatefor

entriesforthePatientnominatedAwardisFriday,09January2009andnominationscanbemadeatatwww.pharmacistawards.com.

FeweradversedrugreactionsarereportedtotheIrishMedicinesBoard(IMB)bypharmacists,thanbyanyotherhealthcareprofessionalgroup,delegatesattendingthePSInationalPharmacySummitinDublinlastmonthweretold.Addressingthesummiton

‘TheRoleofthePharmacistinPharmacovigilance,’DrAlmathSpooner,MarketSurveillanceExecutiveattheIMB,saidthat,oftheapproximately2,000casesnotifiedtotheIMBeveryyear,pharmacistsreportedjust100-150.AccordingtoDrSpooner,an

integrativeapproachtomedicationsafetyrequiredtheinvolvementofallofthestakeholdersincluding

pharmacists,doctors,patientsandpharmaceuticalcompaniesamongothers.Sheaddedthattherewasscopeforincreasedreportingfrompharmacistsastheyare“expertlyplaced”toprovideinformationonthelong-termsuseofproductssuchashomeopathicandOTCmedicines.ShealsosaidthattheIMBreceivesconsistentlymorereportsyearonyearfromhospitalpharmaciststhanfromtheircommunitycolleagues.“Weareverykeentopromote

pharmacistinvolvementincontinuousreporting.Duringthelastyear,therehavebeenanumberofinitiativestomakeadversereactionreportingmoreuserfriendly,”DrSpoonersaid.

Theseinitiativesincludetheprovisionofonlinereportingsystems,whichDrSpoonersaidmadeit“veryeasynowtoreportonline”.Atthesummit,thePSIlaunched

apublicawarenesscampaignonmedicinesanddriving,whichfeaturedthepublicationofaleaflet,‘Medicines and Driving’,createdtoensuredriversarebetterinformedonthedangersinthisarea.Thenewleaflethighlightsthe

medicinesthatmayreducetheabilitytodrivesafelyandadvisesthatpeoplealwayscheckwiththeirpharmacistordoctoriftheirmedicinescouldaffecttheirdriving.Thisincludesmedicinesprescribed

byadoctorornon-prescriptionmedicinesrecommendedbyapharmacistorherbalmedicines.Theleafletalsopointsoutthattheseeffectscanbeincreasedifthemedicineiscombinedwithalcoholorotherdrugsormedicines.Thecampaignwillalsofocuson

educatinghealthcareprofessionalsontheirresponsibilitiesanditisalsoplannedthatastickerwillbecreatedtobeusedbypharmacistsonpackagingtoflagmedicinesthatreducetheabilitytodrivesafely.Inaceremonytoclosetheevent,

thePSIpresenteditsnewcoatofarmstotheMinisterforHealth,MsMaryHarney,whoalsoaddressedtheconference.

Fewer adverse drug reactions reported by pharmacists than any other healthcare group

Irelandcannotkeepaddingnewproductstoitscommunitydrugsschemeswithoutatleastconsideringremovingtechnologiesthatdonotmeettheevidencebase,pharmacoeconomicsexpert,DrMichaelBarry,hassaid.Speakingatarecentconferenceofthe

IrishPlatformforPatients’Organisations,ScienceandIndustry(IPPOSI)inDublin,DrBarry,directorofthenationalCentreforPharmacoeconomicsatStJames’sHospital,Dublin,saidIrelandneededtoconsiderifcertainproductsshouldremainontheGMSif,followingassessment,theyareshownnottobecost-effective.AsreportedinIrish Pharmacist last

month,DrBarrysaidthattheseproductsmightincludecertainnutritionalproducts.“Inareaswherethereisaqueryabout

their[certainproducts’]effectivenesstheyshouldreallybesubjecttoareview…iftheyaredeemednottobe

cost-effectivethenwewouldhavetoreconsidertheirreimbursementstatus,”DrBarrysaid.Healsopointedoutthatunderthe

currentIPHAagreement,however,itmaynotbepossibletode-listproducts.DrBarryisChairofanewgroup

chargedwithdevelopingrecommenda-tionsforsafeandeffectiveprescribingwhichtheGovernmenthopeswillprovidesignificantscopeforsavings.DrBarry’sreportwasduetobe

submittedtotheDepartmentofHealthon1December.Meanwhilepharmacistshave

indicatedtotheGovernmentthattheyarewillingtoengageintalkstosecure“significantsavingsinthenationalmedicalbill”aspartofawiderdiscussiononanewpharmacycontract.ThepresidentoftheIPU,LizHoctor,

toldtheAnnualPresident’sDinneroftheIPUthatthatthiscanonlybeachievediftheGovernmentworksinpartnershipwiththeUnionanditsmembers.

GMSdrugslistnotalimitlessresource

For every cigarette, there’s

a nicorette®

PA Holder: McNeil Healthcare (Ireland) Ltd., Airton Rd, Tallaght, Dublin 24. PA: 823/49/2,9,10,13. Contains Nicotine. Product not subject to a medical prescription. Full prescribing information available on request.

NIK/019/00


newsnewsDemandingpublicafactorinjob-relatedstressAdemandingpublic,lackofbreaks,isolation,newservicesandincreasedresponsibilities;thesearejustanumberoffactorswhichcontributetojob-relatedstressamongpharmacistsaccordingtonewresearch.Astudyofpharmacistsinnorthern

Ireland,presentedatthe4thAll-IrelandPharmacyConferenceinDundalklastmonth,revealedthat,whiletherehasbeengeneralsupportfordevelopmentincommunitypharmacy,“thishadtobetemperedbyconcernsastohowexpectationswouldbemetandhowallserviceswouldbedelivered”.ResearchersattheSchoolof

Pharmacy,Queen’sUniversity,Belfast,interviewed17communitypharmacistsforthisstudyandtheanalysisisstillunderway.However,accordingtoinitialresults,themainthemeswhichemergedinrelationtoworkplacestresswere:workplaceissues,e.g.staff,environment,lackofbreaksandisolation;professionalexpansionandrecognition,e.g.newcontractissues,newservicesandincreasedresponsibility;andademandingpublic.Accordingtoonecommunity

pharmacistwhotookpartintheresearch:“It’sverydifficultanditdoesn’tmatterifit’sasingle-handedpractitionerintheirownbusinessorwithinamultiple,they[pharmacists]arestillquiteisolated.”Theresearchersconcludedthat

theseresults“reinforcedthetensionbetweendevelopmentsinpracticeandtheabilitytodeliver”.“Developmentsinprofessional

practicecanbepositive,howevercommissionersandpolicymakersneedtoconsiderifcommunitypharmacistshavetheinfrastructureintermsofenvironment,personnelandmultiprofessionalsupporttodeliverwhatisrequiredofthem,”thereportstated.

AnewreporthascalledforincreasedinvestmentinbothstaffandfundingtoensurethesuccessfuldevelopmentofcontinuingpharmaceuticaleducationinIreland.Accordingto‘A Report on Continuing

Pharmaceutical Education in Ireland’bytheIrishCentreforContinuingPharmaceuticalEducation(ICCPE),themanagementcommitteeoftheICCPE“hasexpressedtheviewthatitisdifficulttosustaintheICCPEstructurewithinthecurrentstaffingandfundingconstraints”.Thereport,whichwascarriedout

toinvestigatethefuturedirectionoftheICCPEandrecommendanorganisationalmodelfortheeffectivedeliveryofpostgraduatecontinuingeducationforpharmacistsinthefuture,calledforthecurrentstaffvacanciesintheICCPEtobefilledasamatterofurgencyandforaninvestmentof€1.35millionoverthenextthreetofiveyears(or€450perpharmacistinIreland).Accordingtothereport,which

waslaunchedatthe4thAll-IrelandPharmacyHealthcareConferenceinDundalklastmonth,the2007grant

fortheICPPEforatargetpopulationofapproximately3,000pharmacistswas€800,000orapproximately€267perpharmacist.ThereviewalsopointsoutthatthisfigureisjustoverhalfofthelevelofinvestmentmadeinpharmaceuticaleducationandtraininginnorthernIreland.ThebudgetreceivedbythenorthernIrelandCentreforPostgraduatePharmaceuticalEducationandTraining(nICPPET)for2007-2008was€480perpharmacistinnorthernIreland.Inrelationtostaffinglevelsatthe

centre,thereportstates:“TheabilityoftheICCPEtofunctioneffectivelyevenwithinfundingconstraintshasbeengreatlyaffectedbythecurrentvacancyinthepositionofdirectorandalsointhegradeVIpost.Thereviewgrouprecommendsthatthesetwopostsbefilledasamatterofurgency.”Itfurtherrecommendsthatthecore

staffcomplementshouldbeincreasedfromthreetosevenoverthenextthreeyearswithtwoadditionalpharmaciststoactasassistantdirectors,twonewadministrativestaffandthecreationofanewbusinessmanagerposition.

Picturedatthelaunchof‘AReportonContinuingPharmaceuticalEducationinIreland’were:MrTomMcGuinn,chairmanoftheICCPEManagementCommittee;andProfessorClaireAnderson,ProfessorofSocialPharmacy,Universityofnottingham.

InBRIEF

National health literacy campaign launched

TheMSD/nALAHealthLiteracyInitiativewaslaunchedrecentlytohelphealthprofessionalscommunicateclearlywithpatients.Theinitiative,acollaborationbetween

MerckSharp&DohmeIreland(HumanHealth)Ltd.andthenationalAdultLiteracyAgency(nALA),aimsnotonlytorecogniseandrewardeffortsbyhealthprofessionalstocommunicateclearlywithpatientsbutalsotoprovidepracticaltoolswhichcanassisttheminimprovingtheircommunicationskillswithpatientswhomayhavehealthliteracydifficulties.Thesetoolsincludeadedicatedweb

portal(www.healthliteracy.ie)forhealthprofessionals.The2009MSDHealthLiteracyAwards

werealsolaunchedaspartofthisinitiative.TheAwardsaimtorecogniseand

rewardhealthcareprofessionalsbyacknowledgingtheireffortsthroughprofilingtheirworkandamonetaryprize.Forinformationpleasevisit:www.

healthliteracy.ieEntriesmustbereceivednolaterthan

Friday,30January2009.

Unicare and Helix Health in €400,000 deal

UnicarehassignedanexclusiveagreementwithHelixHealthtoinstallanenterprise-wideITsolutioninitscorporateheadquartersandacrossitsentirechain.HelixHealthandUnicarepharmacies

haveenteredintoanagreementthatwillseethe72pharmaciesinIreland’slargestpharmacygroupfittedwithcuttingedgeprescriptiontechnologyinadealworthinexcessof€400,000.Unicareispursuinganaggressive

growthstrategy,whichwillgreatlyincreasethepharmacygroup’spresencenationwide,andthestrategicpartnershipwithHelixHealthwilldeliversignificantcostsavingsforthechain.Allstoreswillbefittedwiththetechnology,QicScript.net,beforetheendof2008.

TheMinisterforHealthhasremovedthederogation,whichpreventednon-Irishqualifiedpharmacistsfromowning,operatingormanagingpharmacies,whicharelessthanthreeyearsold.TheCommencementOrderofthe

SecondPhaseofthePharmacyAct2007,whichwassignedbytheMinisterlastweek,alsorelatestotheregistrationofpharmacistsandretailpharmacies.Theseprovisionswillcommenceimmediatelyandincludestherepealofpreviouspharmacylegislationdatingfrom1875to1962.Welcomingthisdevelopment,

thepresidentofthePSI,DrBernardLeddy,saidthepharmacyregulatorwasproceedingtoestablishthenewregistrationsystemsintroduced.DrAmbroseMcLoughlin,PSIregistrar

andCEO,said:“TheregistrationofretailpharmacybusinessesinparticularmarksanewdepartureforthepharmacysectorinIrelandandwillensurepatientsafetyandpublicprotectionthroughthemaintenanceofhighstandardsofpractice.Inaddition,thenewclinicalandprofessionalmanagementandaccountabilitystructures,whereeverypharmacymust

haveasupervisingpharmacistandasuperintendentpharmacist,willensurethatpatientsandthepublicwillreceivesafe,high-qualityprofessionalcareandservicefromtheirpharmacistsandpharmacies.“ThenewstatutoryCodeofConduct

forpharmacists,whichputsthehealth,well-being,careandsafetyofthepatientasapharmacist’sprimaryconcern,willalsoensurethatthepubliccancontinuetoplaceahighleveloftrustinthepharmacyprofession.”Part7oftheAct,whichrelatesto

thenewpowersofinvestigationofthe

PSI,wasalsocommenced,aswellasanumberofstatutoryrulesrelatingtovariousfunctionsofthePSI.Thethird,andremaining,stage

ofthecommencementprocesswilldealwiththeremainingsectionsofthePharmacyAct.Thesesectionsconcerntheintroductionofafitness-to-practiceregimeforpharmacistsandpharmacybusinesses,itsoperationandtheprohibitionofcertaineconomicandbusinessrelationshipsbetweenpharmacistsorpharmaciesanddoctors.Itishopedthisfinalstagecanbecommencedinthefirsthalfof2009.

Three-year derogation on non-Irish qualified pharmacists removed

ICCPE calls for increased funding and staffing

Further prescribing information available on request. PA Holder: McNeil Healthcare (Ireland) Ltd, Airton Road, Tallaght, Dublin 24, Ireland

P22260 benylin Irish pharmacist trade ad 340x245 TS.indd 1 20/10/2008 15:33:10


newsnews

HelixHealthiscurrentlyinvestigatingpotentialsavingsthatcouldbemadebytheintroductionofelectronictransmissionofprescription(ETP)technologyonanationalbasis.ThisisbeingcarriedoutfollowingasuccessfulETPpilot

projectinWaterford.ManyEuropeancountrieshavealreadysuccessfullyintroducedthistechnology,whichisbasedonanelectronicbarcodesystem,onanationwidebasis.HelixHealthhasappointedformerMinisterfor

E-GovernmentandtheInformationSociety,MrTomKittTD,toitsboardtohelpdrivethecompany’se-healthagenda,particularlyinrelationtoETP.“TheissueofETPtechnologyisincreasinglytopicalaswe

believeitsadoptioncandeliversignificantsavingsfortheDepartmentofHealthaswellasincreasepatientsafety,”saidMrHowardBeggs,ChiefExecutiveofHelixHealth.“TheappointmentofDeputyKitttotheboardwilladdconsiderableexperiencetoHelixHealthandreinforceoureffortstodeliverthebestpatientoutcomesaswellasreducingcosts.IamdelightedtowelcomehimtothecompanyandamconfidentthathisstrategicinputwillassistHelixHealthinachievingourgoalsin2009,”heconcluded.MrKitttakesuphispositionontheboardofHelixHealth

withimmediateeffectandwillprovidestrategicadviceonalle-healthissuesrelatingtopublicpolicy.AsformerMinisterforStateoftheDepartmentofEnterprise,TradeandEmployment,hewillalsoprovideinputonhowtousethecompany’sinternationaldimension.

Electronicprescriptiontechnologypilotscheme

Poor eating habits, a sudden change in diet, a disrupted routine due to changes like shift working, stress and lack of exercise can all mean the body’s digestive rhythm can easily become unbalanced and irregular.

For further information please contact your Kelkin representative or call the sales office on 01-4600 400.

Fruits &Fibres

Fruits & Fibres is now available in a pleasant fruit flavoured cube, a convenient tablet and a pleasant tasting apple flavoured liquid. Fruits & Fibres liquid is suitable for adults and children from 3 years.

Fruits & Fibres combines the natural goodness of figs, tamarinds, rhubarb and yoghurt ferments to produce the ideal recipe to help keep you regular.

F&F.indd 2 26/09/2008 17:51:12

OneineveryfouradultsinIrelandcurrentlytakesmedicationprescribedbytheirdoctor,withwomeninlowersocioeconomicgroupsmostlikelytotakeprescribedmedicines,newresearchhasfound.Thesefindingsarecontainedinafact-sheet

releasedlatelastmonthbytheWomen’sHealthCouncilentitled‘PrescriptionMedication’.BasedonresearchgatheredinJanuary,theresearchformspartofanOmnibussurvey,commissionedbytheCouncilfromMillwardBrownIMS.Thesurveyexaminedanationally

representativesampleof989adults,withquotassettoincludeaccurateproportionsregardinggender,age,socialclassandregion.Themostcommonreasonthatpeoplegave

fortakingprescribedmedicationwastotreatachronicphysicalcondition.Almostone-third(31percent)reportedtakingmedicationforthispurposeoverall—fourineverytenformen,comparedwithoneinfourforwomen.

However,womenweremorethantwiceaslikelyasmentomentionmentalhealthasareasonfortheirmedication(9percentversus4percent).Similarlythoseinlesswelloffsocioeconomicgroupsweremorelikelytocitelong-termmentalhealthconditions(8percentcomparedto4percent).ThisconfirmspreviousresearchbytheWHCthatfoundthatpoormentalhealthcouldbebothacommoncauseandoutcomeoffinancialdifficultiesanddebt.ThedirectoroftheWHC,MsGeraldine

Luddy,highlightedthefactthatwomenweremorelikelythanmentobetakingprescriptionmedication.“Asignificantfindingoftheresearchwasthatwomenintheleastwelloffsocioeconomicgroupsweremostlikelytobetakingprescribedmedication.ThisconfirmspreviousresearchcarriedoutbytheCouncilwhichidentifiedaclearlinkbetweendisadvantage,deprivationandpoorhealthstatusforwomen.”

Six pharmacies make top 50 list of Irish retail stores

AtotalofsixpharmacieshavebeenlistedamongIreland’stop50storesintheFBDRetailExcellenceAwards2008.nowintheir12thyear,theFBDAwardsarethelargestawards

programmeintheretailindustryandthisyearatotalof432storesenteredtheawards.Thepharmaciesthatmadethelistannouncedlastmonthwere:

GreenCrossPharmacyinKillaloe,CoClare;McCabe’sPharmacy,CityWestShoppingCentre,CoDublin;Meagher’sChemist,BarrowStreet,Dublin4;MellerickPharmacy,PatrickStreet,Fermoy,CoCork;SamMcCauleyChemist,MahonPointShoppingCentre,Cork;andUnicarepharmacy,CharlevilleTownCentre,CoCork.Anumberofpharmacieswerealsoshortlistedtoreceive

prestigiousFBDRetailExcellenceAwards:HealthExpresspharmacyinMullingarandUnicarepharmacyinCharlevillewerebothfinalistsintheFBDRetailExcellenceIrelandAwards’LargeStorecategory;andSamMcCauleyChemistintheMahonPointShoppingCentre,Cork,wasoneofsixstoresshortlistedintheMediumStorecategory.UnicarepharmacywasalsoafinalistintheBestRetailCompany

oftheyearintheBestEmployercategory,whileAnnMarieO’RiordanfromUnicarepharmacyinDungarvan,Waterford,wasafinalistintheRetailManageroftheyearcategory.

One in four Irish adults currently takes prescription medication

PicturedattheawardsceremonyinKilkennyweremembersoftheSamMcCauleyteamwithMiriamO’Callaghan.SamMcCauleyPharmacy,MahonPointwerefinalistsintheBestStorecategory.AlsointhephotographisPaulCandon(ChairmanRetailExcellenceIreland—3rdleft)

Untitled-1 1 19/12/2007 16:12:28


newsnews

ThePharmaceuticalSocietyofIreland(PSI)haswelcomedtheintroductionofaninnovativepatientsafetytoolforIrishpharmacists.ThenewservicelaunchedlastmonthinvolvesapartnershipbetweenAegate,apatientsafetycommunicationscompany,andMcLernons,asoftwaredeveloperforthepharmaceuticalindustry.From2009,pharmacistswillbe

givenanewtoolthatwillprovidereal-timesafetyinformationaboutthequalityandsafetyofmedicinesatthemostcriticalpoint,justbeforetheydispensetopatients.Thenewpartnershipallows

Aegate’sservice,whichprovidesreal-timesafetyinformationaboutmedicinesatthepointofdispensing,tobeofferedtoallpharmaciesintheRepublicthatcurrentlyuseMcLernons’pharmacysoftware.Aegate’ssecureon-lineservicewill

createadirectcommunicationlinkintotheirMcLernonsMPSpharmacysoftware.Aspartoftheroutinedispensingprocess,thepharmacistwillscaneachitem,whichwillbeautomaticallyrecordedinthepatientrecord.Withtheadditionofthissoftwareupdate,Aegatewill

simultaneouslyvalidatethisscanandreturnanyimportantproductsafetyinformation,specifictoeachitem,tothepharmacistwhiletheyaredispensing.MrKeithMcLernon,Managing

DirectorofMcLernonsComputers,said:“McLernonshasbeensynonymouswithpharmacyinIrelandforover75years.ThisjointventurewithAegateshowsthatweareleadingthewayindevelopinganddeliveringinnovativepharmacysoftware.IbelievethattheAegateprogrammewillaugmentanalreadyimpressivearmouryoftoolswithwhichweequipourcustomers,fittingalongsideourMPSsystemwithitsrangeofinnovativefeatures.“Productrecallsarebecoming

prevalentandcounterfeitdrugsareappearingmorefrequentlyandpharmacistsarethelastlineinthefightagainstthese.WearedelightedtobeworkingwithAegatetodevelopitspotentialforIrishpharmacies.”PSIpresident,DrBernardLeddy,

said:“Initiativesthathavethepotentialtopromotepatientsafetyandsupportpharmaciststodeliverhigh-qualitypatientcareareverywelcome.”

MrKeithMcLernon,MDMcLernonsComputerswithGarynoon,CEO,Aegate.

newcoursefortreatmentofminorailmentsAnewcourseonthetreatmentofminorailmentsforpharmacysupportstaffwaslaunchedlastmonth.ThenewPharmaProcourseentitled

‘Health,MedicinesandtheTreatmentofMinorAilments’willbedeliveredinaseriesofmodulesthroughout2009inDublinandCork.Eachday-longmodulewillcover

aparticulartopicindetail,andemphasisethecorecompetenciesofsymptomrecognition,referralcriteriaandacomprehensivereviewoftheproductsusedinthetreatmentofeachcondition.Theoverallaimoftheprogramme

istoproduceaconfidentmemberofstaffwhowillprovideasafe,efficientandknowledgeableapproachtoofferinghealthadviceandappropriatetreatmentofminorailments.ThosewhoavailoftheExtended

ServiceSkillscoursewillalsobeabletoassistintheprovisionofhealthpromotion,lifestyleandeducationinitiativeswithinthepharmacy.ThecoursewillbetaughtbyOwenDalyMPSI,CicelyRocheMPSIandMaryButlerBSc.Eachoftheninemoduleswill

focusonaparticulartopicandwillemphasiseadvancedskilldevelopment,in-depthOTCproductknowledgeandreferralskillsaswellasofferingflexibilityandtheconvenienceofbothCorkandDublinlocations.Thefirstmodule,‘CustomerCare

inthePharmacy’,takesplaceon15JanuaryinCorkandon21JanuaryinDublin.Itwillformthefoundationforeachofthesubsequentmodules,underpinningthetechniquesandskillsrequiredofpharmacysupportstaffinthedeliveryofhealth,lifestyleandOTCmedicinesadvicetocustomersandpatients.Thiscourseissponsoredby

UniPhar,ReckittBenckiser,Johnson&JohnsonandSevenSeas.Formoreinformation,contact

JackieMaheron0860863487oremail:[email protected]

A cure for snoring?

ResearchersattheRCSIbelievethatantioxidantsmaybethekeytocuringobstructivesleepapnoea(OSA),adisorderoftencharacterisedbysnoring.InOSA,theairwaycollapsesduringsleepleadingtolowbloodoxygenlevels(hypoxia).ProfessorAidanBradfordandhis

teamfoundthathypoxiamightactuallymakeOSAworsebyexposingthepatient’stissuestooxidativestress,afactorthat’salreadyimplicatedinheartdiseaseandotherhealthproblems.Totesttheoxidativestressidea,theyusedpro-oxidantsandantioxidantsinexperimentswithanOSAmodel.Pro-oxidantsmadeoxidativedamageworse,whileantioxidantsreducedit.“Wewouldsuggestthatantioxidant

therapymightbebeneficialinpatientswithobstructivesleepapnoeabyhelpingtokeeptheairwaysopenduringsleep,”saidProfessorBradford.Thishasnotbeentestedinhumans

yet,butadietrichinhealthyfruitsandvegetablesmightsupplyenoughantioxidantstohelpbeatOSA,givingsnorers(andthosewhohavetolistentothem)abetternight’ssleep.Thisresearchstudyisoneofa

numbercontainedinPicture of Health,whichwasrecentlypublishedbytheHealthResearchBoard(HRB).ThepublicationisanexcellentsnapshotofsomeoftheresearchfundedbytheHRBandiswritteninplainEnglish.

New oral products for diabetes

MerrionPharmaceuticalsandnovonordiskhaveenteredintoadevelopmentandlicenseagreementtodevelopandcommercialiseoralformulationsofnovonordisk’sproprietaryinsulinanalogues,usingMerrion’sproprietaryGIPETtechnology.Undertheagreement,Merrionwill

receiveuptoUS$58million(€45.7million)forthefirstproductdevelopedundertheagreementtoreachthemarketbasedonachievementofcertaindevelopment,regulatoryandsalesmilestonesaswellasroyaltiesonsales.novonordiskisresponsibleand

willpayforthedevelopmentandcommercialisationoftheproductcandidates.Merrionisresponsibleforthedevelopmentandmanufactureoftheinitialclinicalbatches,withtheworkoverseenbyajointdevelopmentcommittee.ThispartnershipbetweenMerrion

andnovonordiskcanpotentiallydeliveramajorneworalproductforpeoplewithdiabetes.Theagreementalsoprovidesnovonordiskwiththeabilitytodevelopadditionaloralformulationsofnovonordisk’sinsulincompoundsusingMerrion’sproprietaryabsorption-enhancingGIPETtechnology.

InBRIEF

Formerrugbyinternationalandasthmasufferer,MrDenisHickie,andDrJeanHolohan,CEOoftheAsthmaSocietyofIreland,attendedaphotocalltoraiseawarenessofarecentmeetingattheRCPIentitled‘ControllingyourAsthma–FactstotakeyourBreathAway.’DenisandJeanarephotographedwith52differentcolouredasthmainhalers,

representingthenumberofpeoplewhodieeachyearasaresultofpoorasthmacontrol.ThemeetingheardthatpoorasthmacontrolleadstoonedeathperweekinIrelandandpeoplewithasthmacantakestepstocontroltheirasthma,ratherthanallowingittocontrolthem.Theseincludehavingawrittenasthmaactionplanandtakingpreventermedicationeveryday.

Poorasthmacontrolleadstoonedeathaweek

Innovative patient safety tool launched for pharmacists

Prescribing Information for Mobicam 7.5 mg & 15 mg Tablets.Qualitative and Quantitative Composition: Each tablet contains meloxicam 7.5 mg or 15 mg. Pharmaceutical Form: Pale yellow coloured round tablet with a score line on one side. Therapeutic Indications: Short-term symptomatic treatment of exacerbations of osteoarthrosis. Long-term symptomatic treatment of rheumatoid arthritis or ankylosing spondylitis. Posology and Method of Administration: Oral use. Exacerbations of osteoarthritis: 7.5mg / day up to a maximum of 15mg/day. Rheumatoid arthritis and ankylosing spondylitis: 15mg /day, which may be reduced to 7.5mg/day according to therapeutic response. Max. dosage: 15mg/day. Take as a single dose with water during a meal. Undesirable effects may be reduced by taking the lowest effective dose for the shortest time necessary. Elderly: For the treatment of rheumatoid arthritis and ankylosing spondylitis: 7.5mg/day. Renal and hepatic impairment: refer to the SPC. Contraindications: Hypersensitivity to meloxicam, to one of the excipients or to substances with a similar action e.g. NSAID’s, aspirin. This medicine should not be given to patients who have developed signs of asthma, nasal polyps, angioneurotic oedema or urticaria following the administration of acetylsalicylic acid or other NSAID’s. Third trimester of pregnancy and during lactation. Active or history of recurrent gastrointestinal (GI) ulcer. Severely impaired liver function. Non-dialysed severe renal failure. GI bleeding, cerebrovascular bleeding or other bleeding disorders. Severe heart failure. Severe congestive heart failure (chf). Special Warnings and Precautions for Use: Undesirable effects may be minimised by using the lowest effective dose for the shortest duration necessary to control symptoms. Appropriate monitoring and advice are required for patients with a history of hypertension and/or mild to moderate chf as fl uid retention and oedema have been reported in association with NSAID therapy. Patients with cardiovascular and/or cerebrovascular disease should only be treated with meloxicam after careful consideration. Similarly before initiating longer-term treatments of patients with risk factors for cardiovascular disease. Any history of oesophagitis, gastritis and/or peptic ulcer must be sought in order to ensure their total cure before starting treatment with meloxicam. Attention should routinely be paid to the possible onset of a recurrence in patients. Patients with or with a history of GI symptoms / disease (i.e. ulcerative colitis, Crohn’s disease) should be monitored for digestive disturbances, especially for GI bleeding. As with other NSAID’s, GI bleeding or ulceration/perforation, in rare cases fatal, have been reported at any time during treatment, with or without warnings symptoms or a previous history of serious GI events. Particular caution is required if treating the elderly. If GI bleeding or ulceration occurs in patients during treatment, the drug should be withdrawn. The possible occurrence of severe skin reactions and serious life threatening hypersensitivity reactions (i.e. anaphylactic reaction) is known to occur with NSAIDs including oxicams. Meloxicam should be withdrawn immediately and careful observation is necessary. Should any abnormality be present following laboratory analysis of serum or liver function tests, the administration of meloxicam should be stopped and appropriate investigations undertaken. Induction of sodium, potassium and water retention and interference with the natriuretic effects of diuretics and consequently possible exacerbations of the condition of patients with cardiac failure or hypertension may occur with NSAID’s. NSAIDs, by inhibiting the vasodilating effect of renal prostaglandins, may induce a functional renal failure by reduction of glomerular fi ltration. This adverse event is dose-dependant. For further information refer to the SPC. Sodium and water retention with possibility of oedema, hypertension or hypertension aggravation, cardiac failure aggravation. Hyperkalaemia can be favoured by diabetes or concomitant treatment known to increase kalaemia. Regular monitoring of potassium values should be performed. Adverse reactions are often less well tolerated in elderly, fragile or weakened individuals, who therefore require careful monitoring. As with other NSAIDs, particular caution is required in the elderly, in whom renal, hepatic and cardiac functions are frequently impaired. The recommended maximum daily dose should not be exceeded in case of insuffi cient therapeutic effect nor should an additional NSAID be added to the therapy because this may increase the toxicity while therapeutic advantage has not been proven. In the absence of improvement after several days, the clinical benefi t of the treatment should be reassessed. Meloxicam, as any other NSAID, may mask symptoms of an underlying infectious disease. This medicine, like those of it’s class may impair fertility and is not recommended in women attempting to conceive. In women who have diffi culties conceiving, or who are undergoing investigation of infertility, withdrawal of meloxicam should be considered. Caution is required if meloxicam is administered to patients suffering from, or with a previous history of bronchial asthma. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase defi ciency or glucose-galactose malabsorption should not take this medicine. Full information regarding special warnings and precautions is available in the SPC. Interaction with Other Medicinal Products and Other Forms of Interaction: Other NSAID’s, including acetylsalicylic acid, oral anticoagulants, thrombolytics and anti platelet drugs, diuretics, ACE inhibitors and angiotensin-II antagonists, other antihypertensice drugs (e.g. Beta-blockers), cyclosporins, glucocorticoids, intrauterine devices, lithium, methotrexate, cholestyramine. Please refer to the SPC for further information. Undesirable effects: Common: anaemia, light-headedness, headache, gastrointestinal disorders, pruritus, rash, oedema including oedema of the lower limbs. For further information, please refer to the SPC. Shelf Life: 3 years. Marketing Authorisation Holder: Ranbaxy Ireland Ltd, Cashel, Co. Tipperary. Marketing Authorisation Number: PA 408/62/1-2. Distributed by: Pinewood Laboratories Ltd., Ballymacarbry, Clonmel, Co. Tipperary. This medicine is a prescription only medicine. Further prescribing information is available on request. Date of Revision of Text: October 2008.

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newsnewsCommunitypharmacistsideallyplacedtohelptreatwinterxerosisCommunitypharmacistsareideallyplacedtohelpeducateandinformpatientsonhowbesttoadapttheirskincareregimetopreventandtreatxerosisordryskin,accordingtoaleadingdermatologist.DuringarecentvisittoIreland,DrMaryChang,

AssociateProfessorofPaediatricsandDermatologyattheUniversityofConnecticutSchoolofMedicine,saidthatIrishpharmacistshaveakeyroletoplayinhelpingpatientskeeptheirskiningoodconditionduringthewintermonths.AccordingtoDrChang:“Dryskinaffectsasignificant

numberofpeopleandisbecomingmoreprevalentasourpopulationgetsolder.Ashealthcareprofessionals,communitypharmacistsareatthefrontlineinadvisingpatientsonhowtoestablishadailyskincleansingandmoisturisingregimenthatrestoresthehydrationandbarrierfunctionoftheskin.”Givenourmodernlifestyles,DrChangsaiditwasno

surprisethatdryskinhasbecomesuchacommonproblem.“Duringwinter,thecombinationofdryindoorairandcoldoutdoortemperaturescanhaveastrongdrying-outeffectontheskin,makingititchy,irritatedorcracked.Thedailyuseofharshsoapsandshowergelscanalsostriptheskinofthenaturaloilsneededtomaintainhydration.This,inturn,exacerbatesthenegativeeffectoflowhumidity.“Appropriateselectionofcleansersandmoisturisers

isvitaltokeepdryskinmoisturisedandhealthyoverthewintermonths.Pharmacistsshouldexaminethepatient’sdailyskincareregimeninadditiontoassessingtheirmedicalandmedicationhistory.Iwouldadvisepatientstotrytoavoidusingproductsthatarehighlyfragrancedandtolimittheirexposuretocoloursandpreservativesasthesearealsohighonthelistofirritants.“Therearesomebasicstepspatientscantaketoimprove

theconditionoftheirskin.Evensimplechangesinaperson’sdailybathingroutinecanresultinquitedramaticimprovements.Patientspresentingwithsensitiveordryskincanbenefitgreatlyfromusingamild,soap-freecleanserfollowedbymoisturisationwitharich,emollientskinprotectantcreamtoassistandrestoretheskinbarrierandlimitmoistureloss.Productscontainingnaturalcolloidaloatmealcanalsoyieldexcellentresultsfordryskinastheycontainlipids,proteinsandpolysaccharidesthathaveprovenpropertiesforreducinginflammation,moisturisingandpromotingmoistureretention.”DrChangwasinIrelandthismonthasaguestofAveeno

SkinCareProducts.Duringhervisit,sheattendedclinicalcasesatOurLady’sChildren’sHospitalinCrumlinbeforegivingalectureonpaediatricdermatologyaspartoftheRoyalAcademyofMedicineinIreland’sclinicalandscientificmeetingofdermatologists.

PicturedattheRoyalAcademyofMedicineinIreland’sannualmeetingondermatologyareconsultantdermatologists,DrRosemarieWatson,OurLady’sChildren’sHospital,Crumlin,andStJames’sHospital,Dublin,andDrMaryChang,UniversityofConnecticutSchoolofMedicine.

TheHilaryHaydon&Co.Ltd.PharmacyManagementMedalwaspresentedtonewRCSIpharmacygraduate,MsLouisaKelly,atarecentconferringceremonyattheCollege.Atotalof195studentswereconferredwithdegreesinmedicine,pharmacyand

physiotherapyaswellaspostgraduateawardsatlastmonth’sevent.Speakingattheceremony,ProfessorFrankKeane,presidentoftheRCSI,said:“RCSIis

continuouslydevelopingwaysofdeliveringitsundergraduateandpostgraduateeducationandtraining.Conferringceremoniesarejoyousoccasionsforthegraduates,theirfamilies,friendsandacademicstaffwhohavecontributedtotheirsuccess.”

MsLouisaKelly,HilaryHaydon&Co.Ltd.,PharmacyManagementMedalwinnerwithMsFionaCottellandMrHilaryHaydon,SeniorPartnersatHilaryHaydon&Co.Ltd.

New pharmacy graduates at RCSI

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Colorcare_A4 AUGUST:Layout 1 17/09/2008 14:56 Page 1

Issue11Vol10December200815

pharmacisT awards 2009 sponsors

ClonmelHealthcareLtd.,thebiggestofthebrandedgenericcompaniesinIreland,isdelightedtobeassociatedwiththe2009IrishPharmacistAwardsas,accordingtoitsCEO,MrRoryO’RiordanMPSI,MMII,theeventrepresentsauniqueopportunitytosupportitskeycustomersandpartners.“Pharmacistsareourkey

customersandpartnersandwewanttodemonstrateoursupport,especiallyinthesetroubledtimes.Ithinkit’simportanttosponsortheseawards,toencourageexcellence

andprofessionalisminpharmacy.Thereissomuchfocusoncommerceandmarginsandcash,thattheprofessionalaspectsdon’tgetenoughattention,yettheseskillsarewhatdifferentiatepharmaciesfromotherplainretailactivities.Medicinesarenotnormalitemsofcommerce,theyarepotent,andpotentiallydangerousproductsonwhichthousandsdependfortheirongoinghealth.Encouragingexcellenceinthemanagementisgoodnotonlyforsociety,butforpharmacy’sreputationandforus.”

ClonmelHealthcareLtd.ispartoftheStadaAGGroup,aplcbasedinFrankfurt.Ithasover250employeesinIreland,inmanufacturing,R&D,quality,salesandmarketing.Thecompanyhasadiversifiedportfolioofproducts,includingthelargestrangeofgenerics,anOTCdivision(Clonmedica)andaspecialistdivision,withsingle-sourcebrandsinParkinson’sandanti-infectives.ItmanufacturesandmarketsproductsinIreland,EuropeandtheUSandhadaturnoverin2007ofover€75million.

Astheleadingadvisortothepharmacyprofessionforalmost20years,HilaryHaydon&CompanywashonouredtobeaskedtosponsortheIrishPharmacistAwards2009and,inturn,directlysupportcommunitypharmacywithinIreland.“Wefeelthatbysponsoringtheseawardswecanhelppharmaciststocontinuetoaddinnovationanddrivetotheirprofessionandpromotetheirrolewithinthecommunity.”Accordingtothecompany,

pharmacistsareundoubtedlyatthefoundationofourhealthcaresysteminIreland,buttheirhardworklargelygoesunnoticed.“Wefeelthat,bysponsoringtheseawards,wewillhelppeoplerecognisetheincrediblecontributionthatthewinnershavemadetotheirrespectivecommunities.Itisalsoveryimportantthatthehardworkandcommitmentofindividualpharmacistsisacknowledgedbytheirfellowpharmacists.”Establishedin1990,Hilary

Haydon&Company,charteredaccountants,isatop20financialservicesfirm.WithprestigiousofficesinDublin,CorkandBalbriggan,itisrecognisedastheleadingfinancialadvisortothepharmacysector.Thecompanyhassuccessfullyprovidedfinancialservicesforallthemajorretailpharmacychainsnationallyand,withaclientbaseofover200pharmacists,hasestablisheditselfasthefinancialservicesfirmofchoicefortheprofession.

UlsterBankisdelightedtobeasponsoroftheIrishPharmacistAwards2009.Theawardsrecognisepharmaciststhathavehadsignificantpositiveinvolvementinthepharmaceuticalprofessioninresearch,scienceorpracticefields.UlsterBankunderstandsthe

importanceofrecognisingandrewardingthosepharmacistswhoenrichtheirlocalcommunitiesandareattheforefrontofnewscientific

developments.Thissponsorshipsupportsanddevelopsthebank’sstrongpartnershipwithpharmacistsacrossIrelandtowhichitprovideseverydaysupportandadvice.UlsterBankisoneofIreland’s

fastestgrowingandmostdynamicbanks.AspartoftheRoyalBankofScotlandGroup,itbringsworld-classbankingsolutionsdirecttoitsbusinesscustomersinIreland.UlsterBankGroup,includingFirstActive

andUlsterBankservesapproximately1.8millionpersonalandbusinesscustomersthroughanetworkof287branches,60businessbankingcentresandover8,200staff.FourtimewinnersofKPMG’s

BusinessBankingExcellenceAwards,UlsterBankiscommittedtocustomerexcellenceandtodeliveringsolutionsthatmakedoingbusinessbetter.Formoreinformation,visit:www.ulsterbank.ie

Pharmacyawardssponsorsdiscusstheirreasonsforparticipatinginthe2009IrishPharmacyBenevolentFundAward

Sponsors of the 2009 pharmacist awards

Next month we will be interviewing three more sponsors

Clonmel HealtHCare

Hilary Haydon & Company

Ulster Bank

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Colorcare_A4 AUGUST:Layout 1 17/09/2008 14:56 Page 1

I’mnotgettinggreedybutIthoughtthatImightitemisethislistforconvenience.AllIwantforChristmasis........

1. Anewhealthservicebecausetheoldoneisbroken.

2. AnewgovernmentbecauseIjustdon’tliketheoldone.

3. AnewcontractnegotiatedonafairbasisbetweentheIPU&HSE.

Ihopethatyoudidnothurtyourselfwhenyoufelloverlaughing.Thisendsthefantasysection.

4. AbrandnewFJR1300motorbike.

5. Someadvancedridinglessons.6. Sometimeofftotakeitaround

Europe.Maybe4&6shouldbeinthefantasy

section.Bythewayyoushouldditchthereindeerforamotorbike.you’llhavesomuchmorefun.

7. AdaddyonlyP.I.n.codefortheTVremote.SoIcangettowatchwhatIwantforachange.

8. Healthandhappinessformeandmyfamily.

9. IfIcan’thavetheFJRabovethenatleastanewsetofleathers,bootsandlid.

Ishouldaddbecauseoftradition,

10. Peaceandhappinesstoallmankind,womankindhumanity.

11. Loveandunderstandingbetweenfolkallcreedsandnone.

12. Forgivenessformyenemies,thereshouldnotbetoomanyleftasIhavekilled/outlivedmostofthem!

13. Patiencetoletmedealwith

editorswhoaskmetomakeuptheselists.

AsIsaidaboveI’mnottoogreedy.IfyoucannotmanagetheabovethenIwouldbehappywithjustonewinninglottoticket.FailingallthatIwillsettleforanice

bottleofportandaroaringfiretodrinkitinfrontof.

(David,awickedlygoodboywhoisreallyabittoooldtobelieveinSanta.)

David Jordan

AllIwantforChristmasis…

1. AllboardmembersofIrishBanks,especiallySheehyofAIB,tobepublicallyflogged(bymefirst).

2. AbigblackholeintowhichIcanthrowthefloggedboardmembersoftheIrishBanks(SheehyofAIBtogoinfirst).

3. A100percentuptakeonmywritingclassesforthenewyear.

4. SarahPalintoexplainglobalwarming(herversion)toapolarbearonRyanTubridy.

5. SarahPalininthezoo.(inpolarbearcage).

6. June’sfamilysizedCadburysselectionbox.

HappyChristmas!

Julian Judge

AllIwantforChristmasis…mynewwifeElaineandournewbabyOisintobehappyandhealthy.

Cormac O Neill

“AllIwantforChristmasis........Abanonanymentionofthewords

“CreditCrunch”(mycustomersareallonthedoleandthey’vestopshopping).TheresignationoftheAssembly’sFirstandDeputyFirstMinisterandtheirreplacementwithSantaClauswhocouldnotdoanylessofjobbutlooksbetter.Andfinallymynewbook“BusinessTrip”togettonumber1ontheIrishandUKbestseller’slist.(www.lulu.com/businesstrip.)

Terry Maguire

AllIwantforChristmasisformyfamilyandfriendsaroundtheworldtobehappyandhealthy...oh,andaholidayandanewiPodandadigitalcamera,andjewellery,hmmmanythingbutsocksreally!

Deirdre O’ Sheehan, Helix Health

AllIwantforChristmasissomegoodnewsabouttheeconomyandthechocolatemanfromthelynxad.

Jennifer Hughes, Helix Health

“AllIwantforChristmasisanendtohomelessness,anewGovernment,afamilysizedCadbury’sSelectionbox,tosleepforaweek,ooohandthatfabOrlaKielybagIspottedinBT’slastweek...thanksSanta!”

June Shannon, Editor Irish Pharmacist

ALL I WANT FOR CHRISTMAS IS …

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inTerview

ligo-bornTomMcGuinnwasamongthefirstcohorttograduatefromthefirsteverclassofpharmacyatUCDin1964.Ongraduation,hejoinedAntigenPharmaceuticalsinRoscrea,CoTipperary,asheadoftheInjectionsDepartment.“TherewasnothinginthePharmacopeia

thatwecouldn’tmakeorvolunteertomakeinthosedays.TodayifyouwantedtodothesamethingyouwouldfirsthavetodotheresearchandthenapplytotheIrishMedicinesBoardforanauthorisationanditwouldtakeabouttwoyearsbeforeyouwouldgetyourproducttomarket.Inthosedays,youcouldconceiveaproductinthemorning,manufactureitintheafternoonandmarketitthesameday.Sothingshavechangedanenormouslotoverthoseyears,”TomtoldIrish Pharmacist.FollowingtwoyearsatAntigen,Tomwenttowork

forAllenandHanbury(nowpartoftheGlaxoGroup)asapharmaceuticalrep,anexperience,whichhesaid,“contributedtomydevelopmenttoagreatextent”.

an important letterAsarepTomcoveredamassiveareaincorporating12countiesfromDublintoBallina.Whileheenjoyedhistimewiththecompanyimmensely,afterayearofeatinghotelfood,hedecidedforthegoodofhishealthitwastimetomoveon.“Anadvertisementappearedinthepaperlookingfora

pharmacistforthenationalDrugsAdvisoryBoard(nDAB)[pre-runneroftheIMB]whichhadjustbeenestablishedin1966…nobodyreallyknewhowthecontrolofmedicineswouldprogressbutIchancedmyarmandappliedforthejob,”hesmiled.HetellsastoryoftheenvelopearrivingfromthenDAB,

whichheleftunopenedforanentireweekendpresumingitcontainedarejectionletter.Whenhefinallyopeneditatthebehestofhismother,tohishugesurprisehefounditcontainedajoboffer,whichhedulyaccepted.In1967,Tombecamethefirstpharmacisttobe

appointedatthefledglingorganisation,apositionhewastoholdfor10years.“Sometimesitwasquitefrustrating…allthe

evaluationswerecarriedoutintotalisolation.ForexampleyoumightknowthatthethenUKCommitteeonSafetyofDrugswasalsolookingatthesameproductbutyoucouldn’tpickupthephonetotalktothem.Ifonehadthecheektodoso,itwouldbeverypolitelyexplainedtoyouthattheseapplicationsweremadeinconfidenceandtheyweren’tinapositiontodiscussanythingwithyou.youvirtuallyworkaspartofawholeEuropeanTeam…it’satotallydifferentsetupnowintheEuropeansceneasopposedtothen,whereitwasverylocal.”ItwasduringhistimeatthenDABthatIrelandjoined

theEU(thentheEEC),whichTomsaidhadahugelybeneficialeffectonIreland,andpharmacy.

post of CHief pHarmaCistTomjoinedtheDepartmentofHealthaschiefpharmacistin1977,whichwasatimeofhugechangeforpharmacyandpublichealthinIrelandwiththeintroductionoftheGMSSchemein1971followingtheearlierpassageoftheHealthAct1970.“Therewerealotofchangestakingplace.Onthe

pharmacyside,therewasadebategoingonabouttheinvolvementofpharmacistsinthefuturescheme[GMS].Upuntil1971/2,whentheGMSSchemecamein,medicineswerepurchasedunderagovernmentcontract,whichhadoperatedunderthePoorLawSystemofthe

ApharmacistandagentlemanWiththeannouncementofhissuccessorimminent,MrTomMcGuinnsharedsomeofhisreflectionsonalmostthreedecadesasChiefPharmacistattheDepartmentofHealthwithIrish Pharmacist.

S


inTerview

1830sandwhichwasintendedforpaupers.”AccordingtoTomthatPoorLawSystemwasnotveryreceptive

tothenewproductsthatwerebeingintroduced,asatthetimedispensarydoctorswerenotallowedtoprescribesomeofthenewer“verygoodproprietaryproducts”thatwerethenbeingintroducedtothemarketandpharmacistswerenotinvolvedinthechainofsupply.“Inorderforaproducttobesuppliedtoapatient,thatproducthad

tobeonalist.Ifitwasn’tonthelistitcouldn’tbesupplied…thereweremanyvery,veryimportantproductsavailableatthetimethatsimplyweren’tonthatlistbecauseitdidn’tfitinwiththeschemeofthings.Ifyoucouldaffordtogetityougotitprivatelyviathelocalpharmacy,butthepublicinIrelandwereverydifferentinthosedaysanditwasseenasastigmatohaveayellowcard,nowadaysknownasaGMScard.”

‘paUper’ stigmaThe‘pauper’stigmaassociatedwithayellowcardunderthePoorLawSystemmeantthatmanypeopleinIrelandatthetimesimplydidnotavailofit,preferringtopayfortheirmedicinerequirementsratherthanhurttheirpride.However,whenthegovernmentatthetimeintroduceda£7insurancechargeforeveryonewithoutacard,applicationsforthenewGMScardsoaredandthestigmadisappearedvirtuallyovernight.“WhentheintroductionoftheGMSwasbeingdiscussed

nobodycouldunderstandhowitwouldfitinwiththeold[contractpurchasing]systembecauseobviouslygovernmentwasanxioustopreservetheeconomicbenefitsofthatscheme,”Tomexplained.“AsfarasIrememberthedrugsbillinthoseyearsundertheold

contractsystemwaslessthan£1millionayear,andthey[healthservicemanagement]wereanxioustoretainthat…aftersomeprotractednegotiations…someonecameupwiththesuggestionthatinsteadofsupplyingcontractpurchasedstocktopharmacists,itwouldbebettertopaymoneytocoverthecostofthestockuptothetimethattheywouldgetpaid,nowit’sonemonth,andthatbecamethe‘advancepayment’.Sowhatthegovernmentdecidedtodoinassociationwiththepharmacistorganisationsatthetime,wasthatthemedicineswouldbepurchasedoffthemarketatthemarketprice,an‘advancepayment’wouldbemadebasedonthepharmacists’monthlyclaimsandthat,coupledwithalow‘feeperitem’becamethesystemforreimbursement,”heexplained.

a different irelandHowever,TompointedoutthathadthecontractpurchasingarrangementsnotbeenchangedintheIrishhealthservicesin1970/1,thechangeswouldhavebeenimposedonIrelandbyvirtueofitsmembershipoftheEuropeanCommunity.“Idon’tthinkthatisfullyappreciated,”hesaid.Apartfromsettlementdiscountsofbetweenoneandtwopercent

forpharmacistswhopaidsuppliersontime,accordingtoTom,unliketodaytherewerenosignificantwholesalediscountsinpharmacyatthattime.“OntheGMSside,therewerenomarkupsexceptforthese

settlementdiscountswhichweren’tseenasaproblem.Butyouarenotlookingatpharmacyasitistoday.Inthe1960s,1970sandearly1980sinIreland,theonlypharmacychainwasHayesCunninghamandRobinsonsand,toalesserextent,HamiltonLongs.Theyjust

didn’texist.Butinthe1990s…theBenDunneapproachtobusinessinIrelandalsohaditsimpactonpharmacy.Somepharmaciessawthattheyhadasignificantpurchasingpowerandthatiftheyopenednegotiationsbetweenthecompetingwholesalerstheycouldusethatmuscletogetbetterterms.”

Hse and irisH pHarmaCistsAccordingtoTomwhatalotofpeoplemaynotrealiseisthatthe15percentmarginwhichhasbeenatthecentreoftherecentdisputebetweentheHSEandIrishpharmacists,wasfirstestablishedover60yearsagointhe1930sand1940s.InterestinglyhesaidthatittoowasthesubjectofaninvestigationbytheFairTradesCommissioninthe1950s.CommentingontherecentdisputeTomsaidhewas“disappointed

thatiteverhappened”.“Thedisputeinthepharmacycontextwasconcernedabout‘the

otherfellow’smargin’…Idon’tthinkithascontributedanythingotherthanalackofstabilitytothesituation.”DescribingtherecentjudgementintheHickeyCaseas“arock

ofcommonsense”,TomsaidthatinhispersonalopiniontheHSEshouldneverhaveattemptedtoimposethereducedpaymentstopharmacistsinthemannerithad.“Idon’tthinkthey[theHSE]shouldhavedonethat…thefigures

thatcameoutintheHickeyCaseareHickey’sfigures,thesmallpharmacyinBallydehobislookingatthesefiguresinamazement.Onesizedoesnotfitallandtothinkthatyoucantake7percent,8percentoffallpharmacistsandthatitwouldhaveequalimplicationsonthemallisillogical…thatmathematicalmodeljustdoesn’twork.“Thepotentialdamagesfromthattypeofaninterventionwerefar

toogreattohavegonedownthatroad,”Tomadded.“Theydoneedtogetintodiscussionswiththepharmacyunionin

ordertoresolvethat.Itcannotberesolvedwithoutdiscussion.Thereareenormouscontributionsthatpharmacycanmaketothehealthservice.Thosethingscannotcometofruitionwithoutdiscussionandhowtheseelementsarepaidformustalsobethesubjectofdiscussion;theyaretoocomplextobelefttochance.”

ever-inCreasing drUgs BillSowhatdoestheformerchiefStatepharmacistthinkistheanswertoIreland’sever-increasingdrugsbill?“IthinkitistimethattheystartedtolookattheEuropeanmodels

ratherthantheBritishmodels.ThereareagoodnumberofmodelsandconceptsouttherewhicharequiteforeigntotheIrishphilosophy[which]isderivedfromthePoorLawsituationwheretheintentionwastoprovideallthemedicationstothosepeoplewhocouldaffordtopaynothing(i.e.paupers).“ButtheIrelandoftodayandtheIrelandofyesterdayaretotally

different.Idoubtverymuchthattherearemanypeopleouttherethatcannotaffordtocontributesomething.OntheContinenttheyhavedividedmedicinesintovariouscategoriesofessentialmedicines,lesseressentialsandnon-essentials.Theessentialmedicinesarereimbursedfullyforeverybodyinanationalscheme,thenextgroupofmedicinesarereimbursedonapercentagebasisandthenon-essentialmedicinesarenotreimbursedatall.”

Hostile to generiCsHowever,asTomexplained,unfortunatelyitisnotsostraightforwardtointroducethistypeofsystemintoIrelandduetothelimitsposedbytheHealthActandthemultiplicityofschemesthatcurrentlyexist.“Ifthereisaseriousintentionofsavingmoney,aproperstructure

wouldfirstneedtobeputonreimbursemententitlementsundertheHealthAct.”TheareaisfurthercomplicatedbythecurrentsituationinIreland

whichTombelievesis“totallyhostiletogenerics”,abeliefwhichhesaidveryfewpeoplefullyappreciate.“Inthe1960s,1970sandtheearly1980s,therewerefouror

fivecompaniessupplyingpuregenericproductsinIrelandandthepotentialforrealcompetitioninthemarketwasthere.Thesecompanieshaveallpulledout-theyaregone.Thereasontheyaregoneisbecausethereimbursementsystemistotallyhostiletotheirproducts.

Genericprescribingproperlymanagedwouldcontributetoareductionofthedrugsbill,butitmustbeproperlymanagedandthesystembegenericfriendly.Eventhen,theresultswillnotbeseenovernight.

“


inTerview

“IfI,asadoctor,issuedanopenprescription,thereisnocertaintythatthebenefitofthatwillaccruetotheState.Thepharmacistswilldispensewhatisontheshelf…forexample,therearemanyproductsoutthereforwhichthereareupto10generics(usuallyreferredtoasbrandedgenerics).nopharmacistinhisrightmindisgoingtowanttocarryall10ofthoseinhisstock.Thecostofthatisprohibitiveanditiswhollyunrealistictoexpectthattheyshoulddoso.”Heexplainedthatnowadaysdoctorsprescribemainlyfromalist

ofbrandedproductsandthepharmacistisobligedtodispensewhatisontheprescription.Unlesstheprescriptioniswrittenonanon-proprietarybasis,thepharmacisthasnodiscretion.

tariff priCesTom’ssuggestionwouldbetocreateasystemsimilartothatinanumberofothercountrieswheretariffpricesareestablishedandwhichcomeintoplacewheneveraprescriptionisissuedonanon-proprietarybasis.“Thenyouhavethecertaintythatitisonlyaproductthatfalls

withinthetariffpricethatwillbereimbursed…butbecausesuchasystemisnotinoperationhere,thesystemremainshostiletogenericsandthereisnopossibilityinmyview,nomatterwhatyoudowithgenerics,ofmakinganysignificantin-roadsintothatandcertainlynotwithoutcreatingmajordifficultiesforall.ThatimpedimentisthereasonthatthepotentialforsavingsingenericsinIrelandremainssosmall.Thereimbursementsystemwheregenericsareconcernedishostileandperhapsanti-competitive.”Tom’sideawouldbetocreateatariffpricewherethereisarange

ofgenericswithpricesrangingsayfrom€1to€10.Itisimportantthatthepriceestablishedwouldnotcorrespondwiththepriceofthelowestpricedproductoranyproductavailableandthatthepricebereviewedregularlytofollowthecompetition.Withsuchagenericspolicyinplace,itisthetariffpricethatwouldbepaidinthecaseofallprescriptionsthatareissuedonanon-proprietarybasis.“Oncethesystemisunderstood,pharmacistswilllookforgeneric

productsthatarepricedbelowthetariffandtheyaretheproductsthattheywillthenkeepinstock…butitdoesdependonthedoctorsissuingprescriptionsregularlyonanon-proprietarybasis.Ifsuchanarrangementweretobeintroduced,someofthosegenericcompaniesthatpulledoutoftheIrishmarketinthe1970smayconsiderreturning,therebyincreasingcompetitionwitharesultantimpactonprices.“Genericprescribingproperlymanagedwouldcontributetoa

reductionofthedrugsbill,butitmustbeproperlymanagedandthesystembegenericfriendly.Eventhen,theresultswillnotbeseenovernight.”

refleCtions on 30 years at tHe doHTomofficiallyretiredfromtheDepartmentofHealthin2005andiscurrentlychairmanoftheManagementCommitteeattheIrishCentreforContinuingPharmaceuticalEducation(ICCPE).Reflectingonalmost30yearsattheDepartmentofHealth,hesaiditwasahugelyinterestingandverybusyjob.“Therewasanenormousamountofworkinvolved.youweren’t

alwaysinvolvedinthingsthathitthepubliceye,veryfewthingswouldbeinthatarea…attheendofthedayasapharmacistinthepublicserviceyouareanadvisorandtheycaneitherconsultyouortheymaynot…withyou,orwithoutyou,asanadvisor,thesystemmoveson.”DescribinghispredecessorMrShaneO’neillas“anabsolute

gentleman”,Tomsaidtheonlyadvicehehadforhisownsuccessorwas“tokeepanopenmind”.“Itisverydifficulttoadvisesomeoneinthatsituationbecausethe

circumstancesarechangingalmostbytheday.Ithinkitisimportanttofirstsettleintothejobandnottorushintoanything.Thepositionitselfwillevolve.Ifthepersonconcernedthoughttheyweregoingtoturntheworldupsidedownovernightthatcertainlywon’thappeningovernmentcircles.Itisalong,drawn-outprocessandyouhavetoconvincealotofpeopleoveralongtime.“Veryoftenthedemandforchange…willhavetocomefromthe

outside.Whenthedemandcomesandwhenitisagreedthatsomesortofactionisnecessary,thatisthetimethatthecontribution

becomesessential.Itisimportanttohaveanopenmindandgetthebestpossibleproposaloutthere…youhavetohavealloptionsavailable,andanopenmindisveryimportant.”

an aBsolUte gentlemanAnopenmindand,ifwearelucky,thenewappointeewillalsobeanabsolutegentleman(gentlewoman)justlikehisorherpredecessor,MrTomMcGuinn.

MrTomMcGuinn,chairmanoftheICCPEManagementCommittee

“AsfarasIrememberthedrugsbillinthoseyearsundertheoldcontractsystemwaslessthan£1millionayear,andthey[healthservicemanagement]wereanxioustoretainthat…


The coalface

“

havebeenwatchingandlisteningtoallthecoverageoftheUSelections.Tobehonest,itwouldbekindofhardtomissit.AsIwrite,BarackObamahasbeenhailedthevictor.SoIaskedmyself:‘DoesthishaveanyimplicationsforIrishpharmacyandIrishhealthcare?’Probablynot,butthisdoesn’tstopmeusingitasanattention-grabbingheadlineforthearticle!ThenIthoughtalittlebitmoreaboutit.MaybewhatIrishpharmacy

andhealthcareneedsisanObama-likefigure.Someonetouniteallstrandsinthehealthcarearena.Someonetoworkoutacommongoalandgetallsectorstoworktowardsit.Toputourdifferencesbehindus,inspireconfidenceandmovetowardsabrightnewfuture.TousethewordsofourbelovedMinisterforFinance:“Itisnothingmorethanourpatrioticduty.”

Yellow pack hospitalsInsteadwehaveSWMBOHarneyandProfessorDumb&Dumber.Theirinspirationalcatchcallsare‘It’smywayorthehighway’and‘Trustme,I’madoctor’.TobefairtoSWMBO,sheprobablydoeshaveaviewofwhereshewouldlikeIrishhealthcaretobe.Unfortunatelytheonlygroupthatsharesthisendpointarethedeveloperslookingfortaxbreakssothattheycanbuildmoreyellowpackhospitals.ShewantsaBoston-typehealthservice.Inpracticethismeansthatyoubetterhaveprivateinsuranceorlotsofmoney.Iguessthatsheisgettingherway.AsforDumb&Dumberitwouldbeunfairtosaythathesuffersfrom

agodcomplex.Moreaccurately,theIrishpublicsuffersfromhisgodcomplex.Hemovedfromaworldwherehiswordwasgospeltoonewherehiswordwas“thebasisforfurtherdiscussion”.Maybeheshouldhavestuckwithlookingaftersickchildrenratherthanmakingtherestofusfeelsick.Iwonderwhatskillshehadtodemonstratebeforebeingappointedhead

honchooftheHSE.OffthetopofmyheadIcouldthinkofafew.Theabilitytoworkwithprofessionalsfromdisparatebackgrounds.Theabilitytodealwithamassivebudget.TobebestbuddieswiththeMinisterforHealth.Haveaguesswhichwasofhighestprioritywhentheysatdownforthatinterview.

Minister Michael O’LearyWherewouldthismessiah-likefigurecomefrom?Perhapswecouldgetsomebodyfromtheworldofbusiness.Maybesomebodyfromtheworldofpharmacy.Thereareanumberofpharmacistsouttherewhohavebuiltuplargechainsfromhumblebeginnings.Theywouldhaveexperienceofmassagingdoctors’egos,negotiatingthelabyrinththatistheHSEbureaucracyandtryingtoworkoutwhodoeswhatinhospitals.Therealproblemwiththischoiceisthatoncetheyhadgotthehealth

servicesortedoutandefficienttheywouldthensellitofftothefirstBritish,GermanorDutchmulti-nationaltomakeanoffer.Thentakeasliceoftheprofitsandretireagain.ThefirstfigurethatcametomindwhenIstartedwritingthiswasMichaelO’Leary.Couldyouimaginewhatkindofhealthservicehewouldrun?“Doyouwantanextrablanketonyourbed?Thatwillbe€10please.”“Afreshbedpan?€10please.”“youwanttoseeadoctor?Ohandyouwanttotalktohimaswell?€20forthat.”“Don’tbotheraskingtoseeaconsultant,yourcreditcardhasalreadybeenmaxedout.”IfyourambulanceisdelayedgettingtoA&Etherewillbeanextracharge.

IfyougetsickorhaveanaccidentjustbeforeChristmasyoubetterhavearichrelative.youmaynotliketheresultanthealthservicebutthereisnodoubtthatitwouldmakeaprofit.

Long-term planAlasIfeelthatwemightbestuckwiththecurrentbunch.Ithinkthatthelong-termplanistohaveahealthservicethatissobadthatpeopleeithertakeoutprivateinsuranceordie.AndfromtheHSE’spointofviewdeadpatientsdon’tcostthemverymuch.Justthinkofthesavingsthatcouldbemadethen.ThemindsetfromHSEIvoryTowersmustbealongthelinesof‘Wecouldrunawonderfulhealthserviceifwedidn’thaveallthesepatientstotreat’.

Humble pieAndtofinish,abitofdessert.Andfordessert,apieceofhumblepie.Inapreviousarticle,IwasabitharshonthePSI.AndmayIsaythatthisparthasnotbeeninspiredbyanysnapinspectionsthatImayormaynothavehadinmypharmacy.ItookthemtotaskfornotinsistingthatEUpharmacistsregisteringinIrelandhadsufficientcompetenceintheEnglishlanguage.ItwasunfairofmetosingleoutthePSIforthis.TherealityisthateverypharmacyregulatorintheEUdeservesapieceofthisstick.ThecommonthreadisEUDirective2005/36/EC.Thisessentiallysaysthat

allwehavetodoistoshowupwithourCertificateofCompetencyandaLetterofGoodStandingand,heypresto,wecanregisteranywhereintheEU.Someoftheregulatorsmakeitabitmoredifficultbyonlymakingthisinformationavailableintheirlocallanguageontheirwebsites.WhatyoumayaskistheEuropeanCommission’sviewofallthis.TheEU

CommissionerforConsumershassaidthatthisisnotpartoftheirportfolioand,assuch,hasnoopiniononthematter.Ipointedouttothemthatpatientsareconsumerseitherbypayinghealthcareprovidersdirectlyorindirectlyviataxesorinsurancebutthismadenodifferencetothem.AndtheCommissionerforHealthandHealthcareIssues,welltheystillhavenotrepliedtomyemailaftermorethan10weeks,despitereminders.HoweverI’mnotlettingthisrest.Iamlikeaterrierwhohasjustgot

histeethintoajuicybone.I’llnotstopuntilIbitethroughtothemarroworbreakmyteethintheattempt.Solookawaynowifyouhaveaweakstomach.IfyouarestillreadingthenIwillseeyounextmonth.

CouldyouimaginewhatkindofhealthserviceMichaelO’Learywouldrun?“Doyouwantanextrablanketonyourbed?Thatwillbe€10please.youwanttoseeadoctor?Ohandyouwanttotalktohimaswell?€20forthat.

DavidJordanhasworkedincommunitypharmacysince1979,qualifyingasapharmacistin1983.HewaschairpersonoftheCommunityEmployeeCommitteeoftheIPUfrom1990to1998andtreasurerfrom1994to1996.Hismainstressreliefisridinghismotorbikewithhisfriendsfromwww.irishbikerforum.com

HailtothechiefInspiredbythe‘change’ethosofAmerica’sPresident-Elect,David JordanwonderswhocouldbringchangetoIreland’shealthcaresystem.

I

david jordan


goodfriendofmanyyearsandIhadafallingoutafewyearsback.Ifirstmetherin1980atafancydresspartythatsheattendeddressedasapregnantnunanditwasashocktofindthat,unlikethenunappearance,thepregnancywasveryreal.Atbirth,shegavethebabygirlupforadoptionandmovedonintoherchosenprofessionandherlife.yearslater,aroundtheChristmasdinnertableand

followingtoomanyglassesofwine,sheconfessedtoasignificantmentalhealthproblemstemmingfromhergrowingobsessionwithfindingherdaughter.Ibecameirrationallyhostile,castigatedhersorelyandaskedhertothinkcarefullybeforeshefurtherupsetthechildwhowasbynowayoungwoman.Thisencounterdamagedourrelationshipand,missinghercompany,IwonderedwhyIreactedthiswayandwhatIcoulddotomakereparation.Inasmugway,Isuppose,Iwastellingheroffforherchoice;thelabourI

hadinvestedraisingmychildrensoIcouldenjoythesuccessesintheirlives,inmyreasoning,shouldbedeniedhersinceshejustwalkedaway.Myerrorwasmadeclearertomeonlearningtheconclusionofanotherstorythathadgreatlyaffectedmeyearsbefore.

switCHed at BirtHGrowingup,mysisterhadtwoverygoodfriends,DeeandAnna(nottheirrealnames),andsomethinghappenedwhentheywere11yearsold,which,atthetime,becauseIwasnotmucholder,Ididnotfullyunderstand.Theevent,however,wasseismic—somuchsothatAnna’sfamilyreturnedtoItalywheretheyhadcomefromagenerationbeforeandthatseemedtobethat.WhenIwas18Idiscoveredthatthereasonfortheflightwasrumour;

arumourthatDeeandAnnahadbeenaccidentallyswitchedatbirthbyadrunkenmidwifeandthatafrecklydark-hairedCeltwasgrowingupinaswarthyItalianfamilywhereasabronzedblondebeautywas

growingupinaveryordinaryworkingclassIrishfamilyhatedandenviedbysistersandmotheralike.Distancemighthaveresolvedthematterbut,onaninvitedholidaytoRome,mysisterwasshockedtofindthatAnna,nowayoungwoman,wastheimageofDee’sfoursistersbackhomeandyetnothingwassaid.Anna’smother,mysisterfound,wasreclusiveandsufferedseverelyfromdepression.

different worldsDeelefthomeat18andbecameanurseinthenHSworkingforyearsinLondon.Shehadthreechildrenwithaviolentpartnerwhoshefinallyleft;apositivestepthatallowedhertomovefromdestitutionuptoabjectpovertybutslowlyanalcoholproblememergedthatrelapsedasquicklyasitresolved.AnnanevermarriedandranthefamilypropertybusinesssouthofRome,woreArmanianddroveanAlfaRomeosportscar.

a sad storyAnna’smother,Dee’sbiologicalmother,diedinItalyandtheprivatediariesthatshehadkeptforyearsgavesomesmallunderstandingofthepainandmentalanguishshehadsufferedduringherlifeintheknowledgeherdaughterwaselsewhere.ShelovedAnnaofcourseandIwonderedifthiswaswhyshedidnotmakecontactwithDee.Ijustdon’tknow.ShereturnedtoIrelandonlyonceand,duringthatshortstay,shewas

seensittinginthebackpewofourlocalchurchwhenDee’ssisterwasgettingmarried.DeewastobebridesmaidbutwaspregnantinLondonandunabletotravelandthepoorwoman,ondiscoveringthis,wasseenslippingawaybeforetheceremonybegan.ShegenerouslyrememberedDeeinherwillyetI’msureDee,gratefulforthenotinconsiderablereductioninheroverdraft,wouldhavepreferredtohavehadarelationshipwithherbiologicalmotherandperhapslessmentalillness.

sHeer reliefImademyabjectapologiesandmyfrienddidmovethroughthenecessaryformfillingandletterwriting.Herdaughteragreedtomeetherandtheybecamefriends,notgreatfriendsbutfriends,andhermentalhealthimproveddramatically.Myfriend’smother,amatriarchifthereeverwasone,initiallyrefusedtomeethergranddaughterbuteventuallyasshetoogotolderconcededandthenarticulatedthesheerreliefthatthisdecisionhadbrought.

ties tHat BindThetiesthatbindus,thesegeneticbonds,sopowerfultheyarealmostsuffocatingattimes,weignoreatourperilandtothedetrimentofourmentalhealth.Somethingispowerfullyhard-wiredintoourgeneticbeingandcreatesandsustainsthesebonds;ageneticselfishnessthatcanbringgreatjoyyetcancruellytortureforalifetime.Iwouldliketotakethisopportunitytowishaveryhappyandpeaceful

Christmastoyouandtoallyourfamily.

AheartbreakingstoryoftwobabygirlsbecomingswitchedatbirthhasalwaysgreatlyaffectedIrish Pharmacist’s Terry Maguire.

Family and mental health

...DeeandAnnahadbeenaccidentallyswitchedatbirthbyadrunkenmidwifeandthatafrecklydark-hairedCeltwasgrowingupinaswarthyItalianfamilywhereasabronzedblondebeautywasgrowingupinaveryordinaryworkingclassIrishfamilyhatedandenviedbysistersandmotheralike.

A

“

TerryMaguireownstwopharmaciesinBelfast.HeisanhonoraryseniorlecturerattheSchoolofPharmacy,theQueen’sUniversityofBelfast.Hisresearchinterestsincludethecontributionofcommunitypharmacytoimprovingpublichealth.

view from aBove

Terry maGuire


shorT sTory

TheMagicManPatwasthemagicman.Hehadnoaddress;well,hehadafewbutnonethatwouldlastlongenoughforacomputerfilesotherewasnopoint.Hisscriptsneverhadasurname,justPat.Everythingabouthimwasaverageexcepthisjackets,tiesand

hats.Thetieswerealwaysbatteredandbadlyknottedbutyoucouldseetherainbowinthemsuchweretheircolours,richanddeep.Hisjacketswerealwaysautumnbrown.Hesaiditmadethetiemorevisible,todistracttheaudience.Theyhadalotofpockets,muchmorethanyou’devenimagine.Lastlywashishat.Itwasstraightwithasolidrim.Peopleoftensaiditwasthehatthatkepthimtogether.Initiallyitwasabigproblem.Jackjustdidnotknowhowto

handleamanwhowouldn’tgivehissurname.Whatwashetoputonthelabel?Jackrangthedoctor.‘I’vebeenseeinghimforayearnowandhe’sstilljustPat.Let

meknowifhetellsyou.’JacktriedtoreasonwithPat,butitwasn’thappening.Pat’s

logicwasasfollows:‘Look,today’sTuesday.It’smyfavouritedayandyouseem

likeadecentfellasoI’lltellyou.I’mamagician.youselldrugsandIsellillusion.youselltrust.Peopleneedtotrustyouandsoyou’vegottohaveeverythingcorrect,theinformationandallthat.Well,it’stheoppositeIsell.Thelesspeopleknowortrustmethebetter.Idon’tselltrustorfactorcures.Isellillusionand,forthattosell,thelessyouknowthebetter.Infact,itcouldbesaidthatIsellnothing.‘nowlook,webothknowit’sasimpleprescription.I’vebeen

gettingthemforafewyearsnow.IonceknewaladydowninShannon.Iusedtohaveaboatthere.Anywaysheusedgivemeafewdozenatatimebutshe’sgonenowGodblessherandthat’swhyI’mherewithyou.Thequacksaidtocomehere,thatyou’dlookafterme.Solook,I’lljustaskfortheoneoffyou,nomore.yougivemetheblueinhalerandI’llgiveyouthefiver.youcan’tgetfairerthanthat.’AvoiceinJack’sheadsaid:‘Givemecouragetoknowthe

thingsIcanchange,patiencetoacceptthoseIcan’tandwisdomtoknowthedifference.’OthervoicessaiddifferentbutJackgavehimtheinhaler.Pat

startedlookingforhisfiver.‘It’sheresomewhere,’hesaidashepulledoutcolourfulhandkerchiefs,coins,piecesofpaper,elasticbands,tape,piecesofstring…itjustwenton.Finallyhefoundthefiverandgaveittohim.‘Thatfiver’syoursnow.’Jackhadneverheardthatbeforebutthenotefeltsharpand

fresh.‘Giveitbackhere.Iwanttochecksomething.’Jackgaveitback.Bynowthestaffhadgatheredaround.Pat

tookthenoteandheldituptothelightasifheweresayingMass.Heshookhisheadand,takingoutapairofscissors,cutthefiverintwo.Heheldouteachhandwithaflourishandplacedthetwohalvesonthecounter.‘Hangon,’hesaid.‘Ineedtotestsomething.’Heopenedtheinhalerandinhaledtwopuffs.‘That’sgoodstuff.Justwantedtocheck.nowI’llbegoodto

youtoday.’Hepickedupthetwohalvesofthefiverand,aftergreat

examination,suddenlyflashedhishandsandwithaclapthecleanfiverfloateddownontothecounterandbacktoJack.‘nevergivesomethingbackson.youmightneverseeitagain.

Byenowgirls.’Thiswentonallsummer.Everymonthhe’dgethisinhaler

eachtimewithanewtrick.ThewholeshopwouldstopandcustomersandstaffwouldwatchasPatmadeallsortsofthingsappearfromhishandkerchief.Childrenlovedhim,womenadoredhimand,aboveall,hecheeredeveryoneup.

Good Newsfor chesty coughs

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Monmouth Pharmaceuticals Limited, Hampshire International Business Park,Chineham, Basingstoke, Hampshire, RG24 8EP, UK. Distributed by: CahillMay Roberts, Pharmapark, Chapelizod, Dublin 20. Further information isavailable from: Shire Pharmaceuticals Limited, Hampshire InternationalBusiness Park, Chineham, Basingstoke, Hampshire, RG24 8EP, UK. Tel: +441256 894000. Date of revision: June 2008. Exputex is a registered trade-mark of Shire US Inc. in Ireland.

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Exputex 145x210 16/10/2008 10:51 Page 1


shorT sTory

TheMagicManOnemorninghegaveJackachoiceofafiverorwhateverthe

handkerchiefcouldproduce.AladyhadafewchildrenwithherandtheiropenfacesdictatedtoJackwhathehadtodo.Thatdayhegotpaidfourpoundcoins.Pathadthiswayabouthimthat,eventhoughyouknewyou

werebeingrobbed,youstillfeltthatyou’dgotsomething.He’ddrawyouinandyouwouldn’tevenknowit.EverybodywantedtoknowhowthetrickworkedbutPatwouldn’ttell.‘IfItellyouJack,youwon’twanttoknow.It’slikewonderingif

someonelovesyou.Onceyouknowitcan’tgetbetter.Iwilldosomethingforyouthough.Let’sputthemshinycoinsbackintothehandkerchiefandseewhatcomesout.’Againthechildren’sfacesgavetheanswer.Thewhitecloth

swallowedthemoneyandpaidbackthreelollipopsforthekidsandaduck’seggforJack.‘IthoughtItoldyoutonevergivesomethingback.Doyou

everlisten?’That’swhenJacknoticedhe’ddonethetrickoverthelollipopjar.Oncehecameinwithabadchestandaroughmood.He

handedJackatabletjarwithasinglepenicillincapsuleinit.‘Giveusafewofthose,wouldyou?It’sterriblethatIamtoday.

Andtomorrow’saTuesday.PleaseJack,don’tleavemebadonmyTuesdays.I’llpayallyouwant.’Jackknewhisdoctorcouldbe‘particular’andaskedPattosee

him.‘Ohnowdon’tmakemedothat.I’veonlyenoughonmeto

payyourself.Andtomorrow’saTuesday.PleaseJack,don’tleavemebadonmyTuesdays.Ohandlistencanyougivemeanotheroneofthoseblueyolks.It’sjustthatmychestisinbits.IleftthelastonedowninShannon.’Jackrangthedoctorwholaughed.‘Givethemtohimandwhateverelsehewants.Givethatto

himtoo.Surewhat’sthepointinmeseeinghim.He’lljusttellmewhattowriteandhowTuesdayishisfavouritedayandallhismoneyisspentonsomeboatinShannon.LasttimeIgotpaidaduckegg.Tellhimitwasgoneoff.’Thefollowingmonth,lateDecember,oneofthegirlshada

brainwave.WhenshegavethescripttoJackinthedispensaryshehadwritten‘themagicman’inbracketsbesidehisnameandthat’showithappened.Patfinallygotenteredinthecomputer.Thebaglabelsaid‘PatTheMagicMan.Address:Shannon.’Jackhadneverseenamagicianlaughbefore.Patreadthe

labeloverandover,eachtimetakingsmallstepsthatstoppedwithagiggleandahalfturn.Thenhebeckonedoneofthegirlsandwhisperedinherear.Sheblushedandnoddedandwentintothedispensary.Atthatmoment,someTravellerkidscameinshouting.

normallythey’dbreakyourheartandthatwasputtingitkindlybutforthefollowing10minutesallwassilentasPatgaveamagicshowyoucouldonlydreamof.ThegirlcamebackfromthedispensaryandhandedPatthe

bag.Hewrotesomethingonapieceofpaperandgaveittoher.Sheblushedmorebutseemedhappy.AfterwardsJackfoundoutthathejustwantedmoreofthose

labelsprintedwithhisnameandnewlyadoptedsurname.Shegavehimawholelabelroll.Patbecameoneofthosefavouritecustomersforwhomyou

wouldbendorbreakorignorejustabouteverydispensingruleeverinvented.Andthebestpartwasyouneverfeltbadaboutit.Hejust

cheeredyouup.

Julian Judge qualified as a pharmacist in 1990. He was recently accepted for a Masters in Creative Writing at the Department of English, UCD.

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The law

henIrecentlypointedouttoagroupofundergraduatepharmacystudentsthattheresearchanddevelopmenteffortsofthecompaniestheyhopedtojoinwererankedonlyasasecondarypriority,thestudentsweresurprised.Ipointedoutthatthislogicmeantthatmakingaprofitcomesfirst,whilemakingeffortstofindnewmedicalcuresfordiseasescomessecondto

achievingshareholdercapitalgrowth.Irememberasanaccountancystudentlearningofthisrealityand

askingifthiswasregulated.Ialsowonderedifcompaniesdecidednottopursueresearchintonewtechnologiesforcost-savingreasonswhatwouldhappen?

all-time lowOverthepastdecade,therateofnewdiscoveriesinpharmaceuticalresearchhasfallendramaticallytoanall-timelow.notsincebeforetheindustrialrevolutionhastechnological,scientificandmedicalbreakthroughsbeenatsuchalowrateofdiscovery.Althoughthenumberofnewpatentsbeingtakenoutisquitehigh,thediscoveriespatentedarenotgroundbreakingandtendtobenomorethanminorimprovementstoveryoldwaysofdoingthings.Whenapharmaceuticalresearchcompanyspendsmoney,itmustbe

categorisedaseitheranexpenseorasthepurchaseofanasset.Ifitiscategorisedasanexpense,itisincludedintheprofitandlossaccountandservestoreducetheprofitfigurebeingreportedfortheperiod.Thisresultsintheprimaryobjectiveofacompany,tomakeaprofit,beingoffended.Alternativelyifitistobecategorisedasanasset,itwillnotreducetheprofitfiguresimmediately.Insteaditisincludedinthebalancesheetandappearsasanasset.Accountantsandtheboardofdirectorsofdrugcompaniesarekeenlyawareofthisaccountancyrulewhichtheymustcomplywithandwillendeavourtousethisruletotheiradvantage.Iftheycansuccessfullyarguethattheexpenditureiscreatingasasset,suchasanewbuilding,theauditorswillallowittobeincludedinthebalancesheetandthedirectorswillenjoythepositiveeffectontheannualprofitfigure.

tangiBle and intangiBle assetsItisinterestingtonotethattherearetwotypesofassets,tangibleandintangible.Tangibleassetsarebuildings,machinesandeverythingelsewhichcanbeseenwiththeeye.Intangibleassetsincludebrands,intellectualpropertyandanythingelsewhichcanbesoldoffbutwhichdoesnothaveaphysicalreality.Increasinglythisisbecomingimportanttotechnologycompanies.Ifthe

directorscanarguethatthemoneywhichtheyarespendingiscreatinganintangibleasset,suchasanewandvaluablewayofperformingaprocessortreatingadisease,theexpenditurecanbeaccountedforasanassetandthiswillhavetheimmediateeffectofincreasingthevalueofthecompanyandtheshareprice.

finanCial sUffoCationThemostimportantruleofallinthisareaofaccountancyisthatexpenditureonpureresearchmustbeincludedintheprofitandlossaccountasanexpense.Expenditureonpureresearchcannotbeincludedtocreateanintangibleasset.Thethinkingbehindthisisthatmostexpenditureonpureresearchresultsinveryfewgenuinediscoveries.Thereforethemoneyaccordingtosomeshareholdersandmanyaccountantshasbeenwastedandmustbewrittenoffimmediately.Thisaccountancyrulehasbeenresponsiblefortheongoingsuffocation

offinancingofpureresearchglobally.Boardsofdirectorsofmanycompaniesinvolvedwithpharmaceuticalresearchhavebeenmuchmorewillingtoprovidefinancefordevelopmentexpenditurebecausethe

discoveryhasalreadybeenmadeandnowneedsonlytobedevelopedalittlebeforewindfallprofitsarerealised.Thereforetheinvestmentriskissubstantiallyreduced.Theaccountingrulesallowexpenditureondevelopmenttobecapitalisedandincludedasanassetonthebalancesheetinsteadofasanexpenseontheprofitandlossaccount.Inanutshell,expenditureondevelopmentmakesthecompanylook

goodimmediately,whileexpenditureonpureresearchmakesthecompanylookbadinfinancialterms,untilsuchtimeasagenuineworld-classbreakthroughisreached.

investment famineInaworldwhereshareholderswantresultsintheshortterm(withinthreemonths)andresearchoperatesoverdecades,theeffecthasbeenafinancialfamineforprojectsfocusedonpureresearch.Thisproblemhasbecomeworseoverthepast15years.Thishasresultedinsuchadramaticreductioninnewmedicaltreatmentscomingtothemarketthatinvestorshaveveryfewthingslefttoinvestinwhichofferanyreasonabledegreeofcapitalgrowth.Theyhavecollectivelybecomevictimsoftheirownsuccess.

opportUnity for irelandThiscrisisprovidesIrelandwithanopportunity.Ifwe,asanation,properlyledbyourgovernmentandacademicinstitutionsalongwithcommercialenterprises,seizethedaybyinvestinginpureresearch,thehugeriskinvolvedwouldresultinhugegainsbeingachieved.Weknowthiswithactuarialcertainty.Theworld’sneedfortechnologicaldevelopmentacrossawiderangeofareasincludingfoodproduction,transport,energy,medicine,educationandITisatanall-timehigh.Theexistingmethodsandpracticesinmostindustrieshavebeenpushedtothelimitsoftheircapabilitiesandnowgenuinedevelopmentisneeded.Theworldneedsinventionsatthelevelofthewheel,themicrochip

andpenicillin,yetpharmacistswhostumbleuponsuchground-breakingdiscoveriesareoftenmetwithafrostyreceptionbycompanieswhoprioritiseshort-termsharepricesabovelong-termdevelopment.Onlyachangeinculturewillovercomethishugehindrancetohumandevelopment.Atrulyentrepreneurialculturewillhavetobedevelopedforourcollectivegood.Itisnowmoreimportantthaneverforpeoplewithascienceor

technologybackgroundtofamiliarisethemselveswiththeserulesbecausetheyaregoingtobecomeoneoftheplanksuponwhichourfutureeconomicperformanceasanationwilldepend.

Happy pHarmaCistsTheworldrequiresleadershipinthisarea.Thedilemmaofshort-termshareholdervalueversuslong-termscientificachievementintheareaofpharmaceuticalresearchwillhavetobeaddressedsuccessfully.Thisproblemisnowofsuchimportancethat,tomymind,whoeversolvesitisworthyofanobelPrize.Solvingthisfundingproblemonaglobalbasiswillresultinaflowofnewdiscoveriescuringdiseasesandsavinglivesonascalewedonotpossesstoday.Thiswillleadtohappypharmacists,happyshareholders,happy

customers,happyaccountants,ahappiereconomyandahappiersociety.Theunansweredquestioniswhetheritwillbepharmacistswhoeventuallyleadtheworldortheaccountants?Inotherwords,willitbetheeggheadsorthebeancounterswhohavetheanswer?

Eggheadsversusbeancounters

Cormac O’Neillontheongoingbattlebetweenprofitandresearch

cormac o’neill

CormacO’neillisabarristerpractisingontheDublinandSouthWesterncircuits.Heisalsoacharteredaccountantwithconsiderableexperienceinindustryandbanking.Inaddition,CormaclecturesonBusinessandLawintheInstituteofTechnologyinTraleeandcanbecontactedon0876571124.

W


finance

uringtheyear,Iwasinvitedtopresenttonumerousbusinessownersthroughoutthecountry.Atarecentevent,Iwasaskedtofollowapresentationbyabusinessconsultantwhotalkedaboutpreparingabusinessforsale.Interestingpresentationandahardacttofollow,especiallywhenyouarebeingaskedtospeakoninvestmentstrategiesrightnow!

However,tomymind,therewasaflawintheessenceofhispresentation.Thespeakercasuallymadethepointthatvirtuallyallbusinesseshaveseenareductionintheirvaluesasaresultofthecurrentcreditcrunchandthatthisislikelytobesustainedasbankschangetheirlendingmodelandlookforgreateramountsofequitytobeputupbypotentialbuyers.Theflawinthisstatementisnotrecognisingthefactthat,fartoooften,businessownersseetheirbusinessastheirpensioninthebeliefthat,iftheykeepdoingwhattheydo,theywillcontinuetogrowthebusinessandeventuallysellitandretire.

redUCed wealtHIwilluseyourownindustryasanexampleandlookathow,inashortspaceoftime,industrychangeshavesignificantlyreducedthevaluesthatpharmacieswouldhavesoldforintherecentpast.Therealityiswhileyouhavebeenbusilygrowingyourbusiness,yourwealthhasbeenreducedthroughderegulationandtheongoingdisputewiththeHSEandnotthroughanyfaultofyourown.Wherepreviouslythevalueofapharmacycouldbecalculatedasa

multipleofturnover,itappears(fornow)thatthisformulacannolongerbeapplied.ThoughIacceptthatyourbusinessesmayrevertbacktothehighervaluesintime,Itendtothinkthatfinancialfreedomwillhavetobeachievedbymoreplannedmeansthanthesaleofabusiness.

How do we CHange tHis approaCH?Theansweristhatyouneedtolookatallthewaysinwhichyoumaydiversifyyourdependenceonthefuturevalueofyourbusiness.WhenIworkwithbusinessowners,thedebateinvariablycomesaroundtoputtingavalueonthebusinesstodaythatrepresentswhattheclientbelieveshewouldacceptforthebusiness.Iappreciatethatthisisaverysubjectiveapproachandthattherearemorescientificmethodsforcalculatingthevalueofabusiness.However,thisexerciseisnotnecessarilyaboutanabsolutevaluebut

moreaboutgettingclientstorecognisethat,whiletheyspendmostoftheirtimeworkinginthebusiness,theymayneglecttheriskassociatedwiththebusinessbeingtheirmainfinancialassetforthefuture.Theideaistopromptathoughtprocessabouthowtocreatesufficientindependentwealthshouldtheyeitherdecidetopassthebusinessontofamilymembersorfindthattheycannotsellthebusinessandareunabletomaintaintheirdesiredlifestyle.

taxing timesRightnow,weareinthemiddleofthe‘taxseason’.Thisisthe(only)timeofyearwhenbusinessownersthinkaboutusingtaxrelieftoavoidtaxationandcreateindependentwealth.Sowhileyoumaybeconsideringfollowingthenormsofinvestinginyourpension,youshouldalsobeconsideringalternativestructuresthatputyouinchargeofhowandwhatyouinvestin.In2007,FinancialEngineeringraised€13minBusinessExpansionScheme

(BES)fundsfollowingthechangesannouncedinthe2006budget,whichmadeusthelargestfundraiserofBES.Itwasnotourintentiontoraisethisamountofmoneywhenwebegantotalktoclientsaboutthisinvestmentproposition.Butthemoreclientswespoketo,themoredemandwefoundinthismarketfortherighttypeofinvestment.Whatismoreinterestingisthatmorethanhalfoftheinvestorswerebusinessownerslookingtousecompanyprofitstoinvestinotherprivateenterprisesinatax-efficientmanner.

Bes – an attraCtive tax-Based inCentiveBusinessexpansionschemesarenotanewconcept.Thegovernment-basedincentivewasfirstintroducedin1984,andtheideawastostimulateprivateinvestorstoinvestinprivatecompaniesandaidindigenousemploymentgrowthintheSMEsector.Thereareobviousparallelstothecurrentheadlinesweareseeing,butthankfullyweareinaverydifferenttimeand,asaconsequence,BESinnowinaverydifferentpropositionthanitwasinthepast.Inthepast,BEShadhadapoorhistoryofactuallydeliveringreturnsto

investorsbutwiththechangesintheinvestmentamountsthisneedstochange.WhatmakesBESanattractivetax-basedincentiveisthatthetaxreliefisallowableagainstalltypesofincome.Althoughneverforget-unlesstheinvestmentmakessense,thetaxbreakisirrelevant.Thisisalessonwelllearnedfromsomeoftheexistingproperty-basedtaxincentiveschemes.

proper adviCeInthesechangedeconomictimes,thereisnotonlyanoveralleconomicperspectivebut,especiallyfromwithinyourownindustry,aneedtoreallyfocusonhowyouaregoingtocontinuetoreducetheriskofbeingdependentonyouownbusinessintothefuture.Ensurethatyouareproperlyadvisedonallofthewaysthatcanallowthistohappentaxefficientlyandgetproperresearchmaterialonwhatmakesaninvestmentgoodorreallygood.Itismyadvicetousethetaxseasonasarealopportunitytoenhanceyour

personalwealth.

’Tis the (tax) season to be jollyThetaxseasonisarealopportunitytoenhanceyourpersonalwealthwritesIrish Pharmacist’sfinancialexpertIain Cahill

In2007,FinancialEngineeringraised€13minBusinessExpansionScheme(BES)fundsfollowingthechangesannouncedinthe2006budget,whichmadeusthelargestfundraiserofBES.

“

IainCahillACCAMBAQFA,Director,FinancialEngineering,32UpperFitzwillamStreet,Dublin2.Tel.+35316148000;directfax+35316148080;email:[email protected];web:www.fen.ie

ia in cahill

D

A stitch in time...

Abbreviated Prescribing Information: For full prescribing information refer tothe Summary of Product Characteristics. Name: Ebixa Active Substance:Memantine Hydrochloride. Indication: Treatment of patients with moderateto severeAlzheimer’s disease.Dosage&Administration:Treatment should beinitiated and supervised by a physician experienced in the diagnosis andtreatment of Alzheimer’s dementia. Therapy should only be started if acaregiver is available who will regularly monitor the intake of the medicinalproduct by thepatient. Treatment is orally either as tablets (10mg) or solution(10 mg/g) taken with or without food at the same time every day.Maintenance dose is 20mg/day, (two tablets or 40 drops once a day).Treatment starts with 5mg/day (half a tablet or 10 drops once a day) for thefirstweek; the 2ndweek10mg/day (one tablet or 20drops once a day); the 3rdweek 15mg/day (one and a half tablets or 30 drops once a day) and the 4thweek 20mg/day (two tablets or 40 drops once a day). Moderate renalimpairment 10mg/day (one tablet or 20 drops once a day), if well toleratedafter 7 days the dose can be titrated up to 20mg/day (two tablets or 40 dropsonce a day). Severe renal impairment- dose is 10 mg/day. Mild-moderatehepatic impairment- no dose adjustment. Severe hepatic impairment- nodata available. Children & Adolescents: Not recommended.Contraindications: Hypersensitivity to the active substance or any of theexcipients. Pregnancy and Lactation: Pregnancy: Memantine should not beused in pregnant women unless clearly necessary. Lactation: Memantine

should not be used in women who are breastfeeding. SpecialWarnings andPrecautions for use: Caution is recommended in patients with epilepsy.Caution is advised in patients with raised urine pH as this may elevate plasmalevels. Clinical trial data are limited on patients with myocardial infarction,uncompensated congestive heart failure and uncontrolled hypertension andpatients with these conditions should be closely supervised. Avoidconcomitant use of NMDA antagonists (see also interactions). Patients withsugar intolerance should not take Ebixa. Patients should be warned to takespecial care if driving and using machines as Ebixa has minor to moderateinfluence on these tasks. Interactions: Effects of L-Dopa, dopaminergicagonists and anticholinergics may be enhanced. Effects of barbiturates andneuroleptics may be reduced. Effect of concomitant treatment withantispasmodic agents e.g. dantrolene and baclofen may be modified. Plasmalevels of cimetidine, ranitidine, procainamide, quinidine, quinine and nicotinemay be increased. Co-administration with hydrochlorothiazide (HCT) maylead to a reduced serum level of HCT. Concomitant use of NMDA antagonist-amantadine, ketamine, dextromethorphan or phenytoin should be avoided.Close monitoring of prothrombin time or INR is advisable for patients treatedconcomitantly with oral anticoagulants. Adverse reactions: Common(>1/100 and <1/10) headache, somnolence, hypertension, constipation anddizziness. Uncommon reactions (>1/1000 and <1/100): fatigue, fungalinfections, confusion, hallucinations (mainly in severe Alzheimer’s disease),

venous thrombosis/thromboembolism, vomiting, gait abnormal. Very rare(<1/10,000): seizures.Not known: Isolated cases of pancreatitis and psychoticreactions have been reported post-marketing. Alzheimer’s disease has beenassociated with depression, suicidal ideation and suicide. In post-marketingexperience these events have been reported in patients treated withmemantine. Overdose: Symptomatic treatment. Elimination: Mainly inunchanged form via the kidneys. Legal Category: POM. MarketingAuthorisationHolder:H.LundbeckA/S,9Ottiliavej,DK-2500,Valby,Denmark.Marketing Authorisation Numbers: EU/1/02/219/005 Ebixa 10mg/g Oraldrops solution-50g bottle. EU/1/02/219/006 Ebixa 10mg/g Oral dropssolution-100g bottle. EU/1/02/219/007 Ebixa Tablets 10mg, 28 pack size.EU/1/02/219/008 Ebixa Tablets 10mg, 56 pack size. Further information maybe obtained from: Lundbeck (Ireland) Ltd., 7 Riverwalk, Citywest BusinessCampus, Citywest, Dublin 24. References:1. Ebixa Summary of ProductCharacteristics 2. Claxton et al. Clin Ther. 2001; 23:1296-1310 3. Shi et a.Exp Rev of Pharm Res. 2007;7: 187-2002 4.Wilkinson et al. Dement GeriatrCogn Disord. 2007;24(2) 138-145 Date of Preparation: May 2008.References: 1. Ebixa Summary of Product Characteristics 2. Claxon et al.Clin Ther. 2001;23:1296-1310 3. hi et al. Exp Rev of Pharm Res.2007;7:187-2002 4.Wilkinson et al. Dement Geriatr Cogn Disord. 2007;24(2) 138-145

Continuous treatment for Alzheimer’sDisease from the moderate stage onwards1

Ebixa: Now Once Daily1

Easier Administration = Convenience + Compliance Benefits 2,3

Ebixa: Stabilises symptoms of AD*. Fewer Ebixa

treated patients worsened versus placebo 4

*Moderate AD onwards

2/EB/05/08

05144 Ebixa with Refs245x340:Layout 1 08/08/2008 12:25 Page 1


clinical review

nestimated37millionpeoplearoundtheworldarelivingwithdementia,withAlzheimer’sdisease(AD)accountingforthemajorityofcases.1InIreland,itisestimatedthattherearecurrentlymorethan40,000peoplewithdementia.Thisfigureisexpectedtoincreaseto104,000by2037.Itisexpectedthat4,000newcaseswillbediagnosedthisyearalone.2

Therearemorethandozensofcausesofdementiabut,inthiscountry,ADisthemostcommoncause,accountingformorethan50percentofallcases.2

Atpresent,about5percentofIrishmenand6percentofIrishwomenovertheageof60yearsaresufferingwithAD.1

pHarmaCists’ ContriBUtionPharmacistscanplayacriticalroleinboththediagnosisandmanagementofAD.ManyindividualswithAlzheimer’slivenormalproductiveliveswithinthecommunity,particularlyearlyinthedisease.Forpatientsinlong-termresidentialcarefacilities,theearlysignsofAlzheimer’sareusuallyfirstdetectedbynursingormedicalstaff.However,amongcommunity-dwellingpeople,thecommunitypharmacistmaybethefirsttonoticesignsofmemorylossandthereforeageneralknowledgeofthesymptomsofAlzheimer’sanddementiaiswarranted.Thepharmacistmayalsobeinapositiontoprovidevaluableinformation

toassistinthedifferentialdiagnosisofthecondition.Alzheimer’sistheprimarycauseofdementiabutitisnottheonlycause.Medicationscancontributetothedevelopmentofdementiainasubstantialnumberofcases.Commonlyuseddrugs,suchasanti-epileptics,antihistamines,anti-diarrhoealagents,coldandflumedications,lithiumandtricyclicantidepressantsincludedementiaasapossiblesideeffect.Furthermore,druginteractionsmayexacerbatetheproblem.Inolder

people,polypharmacyiscommonandmedicationsareoftenprescribedbyseveraldifferentdoctors.Thepharmacistmaybethefirsttospotapatient’sdrugregimeasthepossiblecausefortheirdementiasymptoms.Withtheincreasinguseofover-the-counterandcomplimentarypreparations,thepharmacistmaybetheonlyhealthcareprofessionalwhoisfullyawareofthepatient’sdrugusage.OnceapatientisdiagnosedwithADandtherapyisinitiated,pharmacists

canbecrucialtoensuretheefficacyandsafetyoftreatment.Pharmacistinputhasbeenshowntohaveabeneficialeffectonthemanagementof

Alzheimer’spatients.Inapilotstudyofapharmacist-basedconsultingserviceforthe

pharmacologicalmanagementofbehaviouralandpsychologicalsymptomsofdementia,thevastmajorityofpatientswerefoundtohavereceivedefficientandsuccessfultreatmentfromtheconsultingpharmacistwithnoincidenceofadverseevents.Bothnursinghomestaffandprimarycareprovidersratedtheserviceasasuccess.3

SoitisobviousthattherearesignificantbenefitstobehadwhenpharmacistsareawareofthesymptomsandtreatmentofAD.

definition of dementiaDementiaisdefinedasthelossofthementalprocessingabilityincludingcommunication,abstractthinking,judgementandphysicalabilities,suchthatitinterfereswithdailyliving.Symptomsofdementiaincludeshort-termandlong-termmemoryloss,reducedmotivation,forgetfulness,personalityandmoodchanges,anddisorientation.Thecausesofdementiaarenumerousandincludestroke,Huntington’s

disease,Parkinson’sdisease,braintumours,metabolicdisorders,alcoholandsubstanceabuse,medicationsandinfections.However,Alzheimer’sdiseaseisthemostcommoncause,particularlyinthoseover65yearsofage.

risk faCtorsTheexactcauseofAlzheimer’sisnotknownbuttheconditionisassociatedwithanumberofriskfactors.Advancingageisthesinglemostimportantriskfactor.Alzheimer’scanoccurinyoungerpatients,butitismostcommonaftertheageof65years.TheprevalenceofADdoublesapproximatelyeveryfiveyearsbetweentheagesof65and95years.Inthe65to69yearagegroup,theprevalenceisestimatedatapproximately2percentbutinthoseover85years,prevalencerisestomorethan35percent.4

Thesecondmostimportantriskfactorisapositivefamilyhistory.Individualswithafirst-degreerelativewithADareuptofourtimesmorelikelytodevelopAD.Threegeneshavealreadybeenimplicatedinthedevelopmentofearly

onsetAD,whichgenerallypresentsbetween40and60years.Oneofthesegenesiscarriedonchromosome21,whichexplainswhymostpeoplewithDown’ssyndrome(whichischaracterisedbyanextrachromosome21)presentwiththeneurologicalfeaturesofADasyoungas40years.Women

With4,000newcasesofAlzheimer’sdiseaseexpectedthisyearinIreland,theroleofthepharmacistinbothdiagnosisandmanagementcouldn’tbemorecritical.Dawn O’ Sheareports.

A

Alzheimer’s disease in Ireland – a growing problem


clinical review

arealsothoughttobeatincreasedriskofAlzheimer’sbutthismaybelinkedtothefactthatwomentendtolivelongerthanmen.Otherfactorswhichhavebeenhypothesisedtoincreasetheriskof

Alzheimer’sincludebraininjury,certaininfections,aluminiumbuild-up,autoimmunedisorders,thyroiddisease,lowereducationallevelandadvancedageofmotheratbirth.

making a diagnosisUnfortunately,theonlysurewayofdiagnosingADisbyexaminingthebraintissueafterdeath.Consequently,amedicaldiagnosisofAlzheimer’sinalivingpatientiseither‘probable’or‘possible’.PossibleAlzheimer’sindicatesthatwhilethepatient’ssymptomsmaybecausedbyAD,alternativecausescouldnotberuledout.ProbableAlzheimer’sindicatesthatallotheralternativeshavebeendiscounted.Classically,Alzheimer’sismarkedbyaninsidiousonsetandprogressive

declineincognitivefunction.Diagnosisisinitiallybasedonsymptoms.Memorylossiscommonlythepresentingcomplaint.Generallythiswillbe-ginwithshort-termmemoryloss,manifestedbydifficultyinrecallingnewinformationandthepatientmayaskthesamequestionrepeatedly.Laterinthediseaseprocess,long-termmemorylosswillappear.Disorientationwithregardtotimeandplaceiscommon.Languageimpairmentisalsoaprominentfeature,althoughitmaynot

bepresentattheearlystages.Inadditiontocognitivedecline,behaviouralandpsychiatricsymptomsarefrequentinAD.Patientscanexperiencedepression,psychosis,paranoiddelusions,agitationandsleepdisturbances.nolaboratorytestsorimagingtechniquesexistthatcandiagnoseAD,

butthesediagnostictoolsareusedtoruleoutalternativecausesforthememorylossandothersymptoms.

treatmentAsofyetnocureforAlzheimer’sexists,althoughtherapiesareavailabletotreatthesymptomsandslowdiseaseprogression.ThemostsuccessfulADtreatmentstodatearetheacetylcholinesteraseinhibitors,whichreducethemetabolismofacetylcholine,therebyattenuatingthedeficiencyseeninAD.Treatmentwithacetylcholinesteraseinhibitorshasbeenshowntoimprovecognition,behaviour,functioningandactivitiesofdailyliving.Themainadverseeffectsaregastrointestinalandincludenausea,vomiting,diarrhoea,lossofappetiteandweightloss.Theseagentsarebesttakenonafullstomach.Asaclass,theacetylcholinesteraseinhibitorsarerecommendedformild-to-moderateAD.Memantineisann-methyl-D-aspartate(nMDA)receptorantagonist.It

istheonlytreatmentforADinitsclass(nMDAreceptoratagonist)anditalsohasaneffectonfunctionlikethechollinergicinhibitors.Ithasbeenshowntohaveabeneficialeffectoncognition,behaviourandactivitiesofdailylife.Itisgenerallylimitedtopatientswithmoderatediseasetoseveresymptomsandcanbeusedincombinationwithacetylcholinesteraseinhibitors.Adverseeffectscanincludehallucinations,confusion,dizzinessandheadache.BehaviouralandpsychologicalsymptomsareamajorfactorinAD.

Agitationmaybeprecipitatedbyinfection,dehydrationormedications,

sosuchpossiblecausesshouldberuledoutbeforeinitiatingmedications.Ifnoobviouscausecanbefound,antipsychotics,mood-stabilisinganti-epileptics,anxiolyticsandtrazodonecanbeused.Atypicalantipsychoticsarethetreatmentofchoiceforpsychotic

symptomsalthoughananalysisof17placebo-controlledtrialsfoundanincreasedmortalityratewhenthesedrugswereusedonelderlypatientswithdementiasotheseshouldbeusedwithcaution.5

Depressivesymptomscanbetreatedwithselectiveserotoninreuptakeinhibitors,combinednoradrenergicandserotonergicreuptakeinhibitorsoroneofthetricyclicantidepressantsthathavelowanticholinergiceffects.BenzodiazepinesshouldbeavoidedinADpatientsbecauseoftheirnegativeeffectsoncognition.non-benzodiazepineanxiolyticsshouldbeusedinsteadtotreatanxietyifrequired.AnticholinergichypnoticsshouldnotbeusedtotreatinsomniainAD

patients.non-pharmacologicalmeasuresshouldbeemployedfirst.Ifthisapproachisnotsuccessful,sedatingantidepressantsmaybebeneficial.5

non-pharmacologicalmeasuresshouldnotbeoverlooked.Patientidentificationbraceletsmaybebeneficialinpatientswhotendtowander.Basichomesafetymeasuressuchaslocksoncabinetsandovens,unpluggingdangerousdevicesandinstallingcomplexdoorlocksandanin-housealarmsystemcanbeinvaluable.PatientswithADoftenrequirecarefulmonitoringandasubstantiallevel

ofcarewhichisusuallyprovidedbyafamilymember.WhenassistinginthetreatmentofanADpatient,itisimportanttobeattentivetotheneedsofthecareralso.Fatigueanddepressioncandevelopeasilyincarers,particularlywhendealingwithapatientwithadvanceddisease.Oftensimplyenquiringaboutthecaregiver’swell-beingcanhaveapositiveeffect.ThecaregiverisoftenthepersonwhowillvisitthepharmacycountertorefillprescriptionsfortheADpatientandthiswillpresentauniqueopportunitytoinformthecareraboutsupportservicesthatmaybeavailableinthelocalarea.

sUmmaryAsthemostcommoncauseofdementiainthiscountry,Alzheimer’sdiseasehassubstantiallyhumanandfinancialcosts.Forthemoment,itremainsanincurableconditionalthoughtherapiesareavailabletotreatthesymptomsandslowthecognitivedeclinewhichisthehallmarkofthedisease.Equippedwiththerightinformation,communityandhospitalpharmacistscanplayaroleinidentifyingADpatientsandinmonitoringtheefficacyandsafetyoftreatment.

References1. Alzheimer’sDisease.MentalHealth.WorldHealthOrganization.http://

www.afro.who.int/mentalhealth/related_diseases/alzheimer_disease.htmlAccessednov2008.

2. FactsaboutDementia.TheAlzheimer’sSocietyofIreland.http://www.alzheimer.ie/eng/Media-Centre/Facts-About-Dementia.Accessednov2008.

3. Rojas-FernandezCH,EngM,AllienD.Pharmacologicmanagementbyclinicalpharmacistsofbehaviouralandpsychologicalsymptomsofdementiainnursinghomeresidents:Resultsfromapilotstudy.Pharmacotherapy2003;23(2):217-21.

4. GaoS,HendrieHC,HakkKSetal.Therelationshipbetweenage,sexandtheincidenceofdementiaandAlzheimer’sdisease:ameta-analysis.ArchGenPsychiatry1998;55:809-15.

5. yaariR,Corey-BloomJ.Alzheimer’sdisease.Seminalneurol2007;27(1):32-41.

Memorylossiscommonlythepresentingcomplaint.Generallythiswillbeginwithshort-termmemoryloss,manifestedbydifficultyinrecallingnewinformationandthepatientmayaskthesamequestionrepeatedly.

“

ABBREVIATED PRESCRIBING INFORMATION. Donesyn 5 and 10 mg film-coated tablets. Presentation: The 5 mg tablet is a white, round, film-coated tablet with D9EI on one side and 5 on the reverse. The 10 mg tablet is a yellow, round, film-coated tablet with D9EI on one side and 10 on the reverse. Indications: Symptomatic treatment of mild to moderately severe Alzheimer’s dementia. Dosage: Adults/elderly: Treatment is initiated at 5 mg/day (once-a-day dosing). Donesyn should be taken in the evening just prior to retiring. The 5 mg/day dose should be maintained for at least one month. Following a one-month clinical assessment of treatment at 5 mg/day, the dose can be increased to 10 mg/day (once-a-day dosing). The maximum recommended daily dose is 10 mg. Treatment should be initiated and supervised by a physician experienced in the diagnosis and treatment of Alzheimer’s dementia. Diagnosis should only be made according to accepted guidelines (e.g. DSM IV, ICD 10). Therapy should only be started if a caregiver is available who will regularly monitor medicinal product intake for the patient. Maintenance treatment can be continued for as long as a therapeutic benefit for the patient exists. Therefore the clinical benefit of Donesyn should be reassessed on a regular basis. Discontinuation should be considered when evidence of a therapeutic effect is no longer present. Individual response to donepezil cannot be predicted. Upon discontinuation of treatment, a gradual abatement of the beneficial effects of donepezil is seen. Renal and hepatic impairment: A similar dose schedule can be followed for patients with renal impairment. Due to possible increased exposure in mild to moderate hepatic impairment, dose escalation should be performed according to individual tolerability. There are no data for patients with severe hepatic impairment. Children and adolescents: Not recommended. Contraindications: Hypersensitivity to donepezil hydrochloride, piperidine derivatives or to any of the excipients. Warnings and precautions: Use of donepezil in patients with severe Alzheimer’s dementia, other types of dementia or other types of memory impairment has not been investigated. Donepezil, as a cholinesterase inhibitor, is likely to exaggerate succinylcholine-type muscle relaxation during anaesthesia. Because of their pharmacological action, cholinesterase inhibitors may have vagotonic effects on heart rate (e.g. bradycardia). This may be particularly important to patients with ‘sick sinus syndrome’ or other supraventricular cardiac conduction conditions, such as sinoatrial or atrioventricular block. There have been reports of syncope and seizures. The possibility of heart block or long sinusal pauses should be considered. Patients at increased risk for developing ulcers should be monitored for symptoms. However, the clinical studies with donepezil showed no increase, relative to placebo, in the incidence of peptic ulcer disease or gastrointestinal bleeding. Cholinomimetics may cause bladder outflow obstruction. Cholinomimetics are believed to have some potential to cause generalised convulsions. However, seizure activity may also be a manifestation of Alzheimer’s disease. Cholinomimetics may have the potential to exacerbate or induce extrapyramidal symptoms. Cholinesterase inhibitors should be prescribed with care to patients with a history of asthma or obstructive pulmonary disease. The administration of donepezil with other acetylcholinesterase inhibitors, agonists or antagonists of the cholinergic system should be avoided. Donesyn contains lactose. Interactions: CYP3A4 inhibitors such as ketoconazole, itraconazole, erythromycin and CYP2D6 inhibitors such as quinidine, fluoxetine. Rifampicin, phenytoin, carbamazepine, alcohol. Medications with anticholinergic activity, succinylcholine, other neuro-muscular blocking agents, cholinergic agonists, beta blocking agents. Undesirable effects: Most common: Diarrhoea, nausea, vomiting, abdominal disturbance, muscle cramps, fatigue, insomnia, headache, syncope, dizziness, urinary incontinence, rash, pruritis, anorexia, common cold, accident, pain, hallucinations, agitation, aggressive behaviour. For other undesirable effects see Summary of Product Characteristics. Pack size: 28 tablets. Marketing authorisation holder: Clonmel Healthcare Ltd, Clonmel, Co. Tipperary. Marketing authorisation numbers: PA 126/183/1-2. Full prescribing information is available on request. Please go to www.clonmel-health.ie or contact 01 6204000 for further information. Date last revised: August 2008. 2008/ADV/DON/001.

Familiaritybrings Content


Q&a

Europe’s Leading Contract Sales & Marketing Organisation

Q. Which other career might you have chosen?A.Medicine.

Q. Which figures in Irish life (living or dead) do you admire and why?A.Iadmirepeoplewhomanagetoremainpositiveinspiteoffacinghugepersonalchallenges.Iadmireyoungwomenwhosuccessfullyjugglecareerandfamilylife-ItookafiveyearcareerbreakwhenmychildrenweresmallsoIdidn’t

facethesameproblems.IndividualswhomIadmireincludeTomArnoldfromConcernforhiscontributiontoalleviatingpovertyinthedevelopingworld;GarretFitzGeraldforbeingdirectandhonest;JimDoogeforhiscontributiontopolitics,academiaandengineering;andmusicianssuchasBarryDouglas,HughTinneyandCharlesVilliersStanford.

Q. What is the one thing you would suggest to improve the Irish health service?A.Anintegrated,properlyresourced,standards-basedICTsystem.

Q. What is your earliest memory?A.Findingandeatingabanana,whichmymotherhadhiddenfrommybrothersandmyselfinacupboard.

Q. What is your greatest fear?A.Havingtohavefalseteeth.

Q. When and where were you happiest?A.Holdingmygrandsonforthefirsttime.

Q. What would your superpower be?A.Bi-location.

Q. What is the worst job you have ever done?A.PreparingaprojectproposaltotheEuropeanCommissionwhichinvolved26partnersfrom14countries-itwassuccessful!

Q. What is your best trait?A.Anopenmind.

Q. What is your most unappealing habit?A.Forgetfulness.

Q. What trait do you most dislike in others?A.Selfishness.

Q. Do you use alternative medicines? What kind?A.no.

Q. Cat or dog?A.Cat.

Q. What keeps you awake at night?A.AllthethingsIhaveforgottentodo.

Q. Who or what makes you laugh?A.Mygrandson.

Q. Who or what is the greatest love of your life?A.Myfamily.

Q. How do you relax?A.Hill-walking.

Q. What word or phrase do you overuse?A.‘noproblem’.

Q. Favourite TV/Radio programme?A.MorningIreland.

Q. Favourite film and book?A.Dr Zhivagoand The Story of San Michele whichwaswrittenbyAxelMunthe.MyfavouritepieceofmusicisChristmas OratoriobyBach.

Q. What is your motto?A.There’sasolutiontoeveryproblem.

Q. How would you like to be remembered?A.ThatIcontributedtothedevelopmentofanelectronichealthrecordforIreland.

ProfessorJaneGrimsonistheDirectorofHealthInformationTechnologywiththeHealthInformationQualityAuthority(HIQA)andisoneofIreland’sforemostexpertsinhealthinformatics.ProfessorGrimsonischairoftheCentreforHealthInformaticswhichshehelpedtoestablishatTCD.Sheisalsoaformervice-provostoftheCollegeandchairoftheIrishResearchCouncilforScience,EngineeringandTechnology.ProfessorGrimsonisamemberoftheBoardofScienceFoundationIrelandand,untilrecently,presidentoftheHealthcareInformaticsSocietyofIreland.Shehaswrittenover100papersandco-authoreda

textbookondistributeddatabasesystems.professor jane Grimson

DirectorofHealthInformationTechnologywiththeHealthInformationandQualityAuthority(HIQA)

UNIFLU is owned by Irish pharmacists and is only available in pharmacies

IRELAND’S BEST SELLING COLD AND FLU PREPARATION SOLD IN PHARMACY1

Uniflu Plus Product Information. Each Uniflu Plus Coated Tablet contains: Active Ingredients: Paracetamol 500mg, Codeine phosphate hemihydrate 10mg, Diphenhydramine hydrochloride 15mg,Phenylephrine hydrochloride 10mg, Caffeine 30mg. Each Vitamin ‘C’ Chewable Tablet contains: Active Ingredients: Ascorbic acid (Vitamin C) 300mg (as ascorbic acid/sodium ascorbate). Before TakingUniflu Plus Tablets. Consult your doctor before taking UNIFLU PLUS tablets if any of this applies to you: i. If you are already taking other paracetamol-containing products. ii. If you are allergic to paracetamolor any of the other ingredients. iii. If you are currently taking metoclopramide, domperidone or cholestyramine (as these medications can interfere with the paracetamol). iv. If you are currently taking bloodthinning tables (warfarin and other coumarins). v. If you are currently taking antidepressants (monoamine oxidase inhibitors) or within 14 days of stopping such treatment. vi. If you are currently takingchloramphenicol. vii. If you are suffering from breathing problems. viii. If you are currently being treated for, or suffering from an overactive thyroid, high blood pressure or heart disease. ix. If your liver orkidneys do not work properly, or if you have an enlarged prostate gland causing difficulty in passing urine or suffer from epilepsy or glaucoma. x. If you are planning a pregnancy or are pregnant or breastfeeding. xi. If you are taking any other regular medication. Special Warning: This product contains codeine. This medicine should only be taken when necessary. Do not take more than the stated dose and donot take every day for more than 3 days unless told to do so by your doctor. Prolonged regular use, except under medical supervision, may lead to physical and psychological dependence (addiction) and result inwithdrawal symptoms, such as restlessness and irritability once the drug is stopped. If you find you need to use this product all the time, it is important to consult your doctor. The risk of overdosage is greater inpatients with certain types of liver disease. Drowsiness may be experienced whilst taking UNIFLU PLUS tablets. If you are affected, DO NOT drive or operate machinery. Avoid alcoholic drink whilst takingUNIFLU PLUS. UNIFLU PLUS tablets should not be used to treat persistent or chronic coughs such as occurs with smoking, asthma or emphysema or if cough is accompanied by excessive mucus (phlegm),unless directed by the doctor. DO NOT take other paracetamol-containing products with UNIFLU PLUS tablets. DO NOT exceed the stated daily dose. DO NOT use this or any codeine containing product if youare breastfeeding unless under the supervision of your doctor. Use of this product may harm your baby. UNIFLU PLUS tablets contain Sucrose, Vitamin ‘C’ tablets contain Sucrose and Lactose. If you have beentold by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicinal product. Dosage: (a) Adults and Elderly. One UNIFLU PLUS tablet to be swallowed wholewith water and one Vitamin ‘C’ tablet to be swallowed whole, sucked or chewed. Dose to be repeated every SIX (6) hours until the symptoms disappear. NOT MORE THAN FOUR (4) UNIFLU PLUS TABLETSTO BE TAKEN IN 24 HOURS. (b) Children Under 12 years – Not Recommended. Over 12 years – One UNIFLU PLUS tablet to be swallowed whole with water and one Vitamin ‘C’ tablet to be swallowedwhole, sucked or chewed. Dose to be repeated every EIGHT (8) hours until symptoms disappear. NOT MORE THAN THREE (3) UNIFLU PLUS TABLETS TO BE TAKEN IN 24 HOURS. If you do not feelany better after taking a course of the medicine, consult your doctor or pharmacist. Overdosage UNIFLU PLUS Tablets – Overdosage may lead to increased heart rate, high blood pressure, sickness, liverdamage and breathing problems. Immediate medical advice should be sought in the event of an overdosage, even if you feel well, because of the risk of delayed, serious liver damage. Vitamin ‘C’ Tablets –No cases of overdosage have been reported. If, however, you think you may have taken too many tablets, drink plenty of water and contact your doctor or pharmacist immediately.Marketing Authorisation Number – Ireland: PA 1455/2/1

Ref1. IMS data. June 2008 MAT.

UNIFLU UNIFLU PLUS

Analgesic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Paracetamol is safe; it relieves pain and reduces temperature

Antihistamine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Alleviates such symptoms as watery eyes or a runny nose

Anti Tussive . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Codeine Phosphate to relieve tickly coughs

Decongestant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Reduces nasal congestion and swelling, makes breathing easier

Antioxidant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Vitamin C

Stimulant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Caffeine

leavepiece ad02 12/09/2008 11:13 Page 1


e-pharmacy

TIMEMagazinerecentlylauncheditsTop10Gadgetsof2008,whichincludeamobileemailchecker,avideocamera,aMaclaptopandnintendo’sWiiFit–whiletheabovemaysoundlikealistfromtheGenerationGameforthe21stCentury,restassuredthereisnotacuddlytoyinsight.

Flip MinoFirstlaunchedintheUKinMaythisyear,theFlipVideoUltraSeriesisarangeofultra-smart,idiot-proofvideocameras,whichdon’tneedvideotapes,memorycardsorevenbatteries(itcanbechargedthroughaPC).Smallenoughtocarryanywhere,theyprovideunmatchedsimplicityforcapturing,editingandsharingvideo.AccordingtoTIME“liketheiPodand

theBlackBerrybeforeit,theFlipMinoexplodedintothemainstream,quicklybecomingthemostpopularvideocameraintheUSAinitsfirstyear.“Itstoresuptoanhourofvideoclips

onitsinternaldrive…theFlipissimpletouse:pressthebigredbuttontostartandstoprecording.Thenpopoutthecamera’sUSBconnector,plugitdirectlyintoyourcomputerandemailyourvideosoruploadthemtoyouTube.“FlipVideocurrentlyaccountsforover

13percentofallUScamcordersalesandismarketedinEuropebyFlipVideoUK.TheFlipVideoUltraistheflagship

productintheFlipVideofamilyofdigitalcamcordersandfeaturesproprietaryvideoprocessingtechnology,whichdeliversstunningvideoandsoundquality,evenwhenplayedonlarge-screenTVs.Italsoincorporatesawiderangeofadvancedfeatures,includinga

high-resolution1.5inchdisplayforclearviewingineventhebrightestsunlight,latest-generationvideoprocessingtechnologyand2GBon-boardmemorytohold60minutesofvideo.Formoreinformation,visit:www.theflip.com

Simply emailIflikemeyousufferfromacute‘inboxseparationanxiety’whenyouaredeniedaccesstoyouremailformorethananhour,thentakeapeekatPeek-asuper-thinstylishdevicethatletsyoutakeyouremailwithyoueverywhereandstayconnected.Peekisthefirstelegantlysimple,

email-onlydevicecreatedforpeoplewhodon’tneedorwantanexpensivemobilephonefulloffunctionsandsoftware.ThePeekdevicedeliversunlimitedemailtoandfromexistingaccountsandisextraordinarilysimpletosetupanduse.Itconnectstoanationwidewirelessnetworkwhichensurescoverageeverywhere.Astraightforwardandstylish,pocket-

sizeddevicewithoutthecomplicatedfeaturesusuallyfoundpackedintoanall-in-oneSmartphone,Peekisthefirstandonlyproductthatallowsuserstostartsendingandreceivingemailinlessthantwominutes.CurrentlyavailableforaflatmonthlyfeeintheUS,wearesure(andhope)itisonlyamatteroftimebeforeitarrivesinIreland.Takeapeekonlineat:www.getpeek.com

Wii Fit AccordingtoTIME:“Weightlosshasneverbeeneasierwithnintendo’sWiiFit,whichismoreafitnesstoolthanavideogame.”WiiFitisaninteractivetraining

programmethatguidesyouthroughstrength-building,yoga,aerobicsandbalanceexercises.Manyoftheworkoutsarecleverly

disguisedasfunactivities,likevirtualskiingandskijumping,stepdancing,evenheadingavirtualsoccerball,enticingthemoststubbornslackerstogetoffthecouch.Playerssimulatethegame’spursuitsbyusingwirelessWiicontrollersandadigitalbalanceboard(whichdoublesasascale)thattracksmovementsanddistributionofweight.Toevaluateyourprogress,theWiiFit

measuresyourweight,bodymassindexandsenseofbalanceatregularintervals,andchartsyourresults.Forfurtherinformation,visit:www.

nintendo.com/wiifit

‘Google Phone’TIMEmagazine’sTop10GadgetlistalsoincludesthefirstmobilephoneofferingfromGoogle-theT-MobileG1.AsthefirstSmartphonetorunGoogle’snewAndroidoperatingsystem,theT-MobileGhasaslickslide-outkeyboard,abigbrightscreenandalotofpower.Accordingtothemagazine:“The

‘GooglePhone’supportsloadsofapplicationsdownloadedfromtheonlineAndroidmarketplace—gamesandprograms,likeencyclopaedias,guitar-teachingtoolsandtimewasterslikePacMan—andeasilyhandlesgraphics-heavyapplicationssuchasGoogleMaps,webbrowsingandvideo.TheAndroidmarketplaceisn’tasrobustastheiPhoneappstoreyet,butsomedayitwillbe,asmoreAndroidphoneshitthemarketanddevelopersstartchurningoutapps.”Todate,therehasbeenno

confirmationregardingacarrierforthe‘GooglePhone’hereinIrelandbutlikewepredictedwithPeek-watchthisspace.Moreinformationisavailableat:

www.t-mobileg1.com

Have a techno ChristmasThefollowingdevicesalsomadeitontoTIME’sillustriousTop10Gadgetsof2008:• TheEye-FiExploreSDCard–a2GBwirelessSDmemorycardwhichuploadsphotosautomaticallyfromyourcameratoyouronlinephotoserviceandcanalsobeampicturestoyourhomecomputer'sharddrive,soyounolongerneedtophysicallyconnectyourcameratoacomputertotransferimages.

• Dash–ahighlyintelligentGPsdeviceforyourcar,whichgathersreal-timeinformationfromtheinternetandassesseslocaltrafficinformationusinganetworkofdrivers.Itwillrecommendandfindyouanearbyrestaurant,searchforyournearestcinemaandshowyoufilmreviewsbeforeyougo.Italsoallowsuserstocomparepricesatnearbypetrolstationstofindthebestdealandwillevenkeepaneyeoutforspeedtrapsinyourarea.

• TheCanonPowerShotA590–aneightmegapixeldigitalcamera.

• Sanyo'sXacti–anultrasleekdigitalandvideocamerainone.

• ThenewappleMacBook.• Finally,myfavourite(getthehintSanta),theiPodTouch.

TIMEiscurrentlyinvitingpeopletovotefortheirfavouritegadgetfromitstop10list,castyourvotenowatwww.time.com

DearSanta…Asthefestiveseasonapproaches,June Shannonreportsonsomeofthetop10gadgetsguaranteedtobeoneverytechnophile’sChristmaswishlistascompiledbyTIMEmagazine.

june shannon

Buttercup 24.5cm x 11.5cm Ad 10/09/2008 02:30 pm Page 1


e-pharmacy

BrianPagniandhisstaffintheRingsendbranchofBradley’spharmacy.

nasectorwhereconsumersarewatchingwhattheyspendandthegovernmentiscuttingbackwherevertheycan,pharmacylikemanyothersectorsisunderpressureintoday’stightereconomicconditions.Toremaincompetitiveandkeepturnovergrowing,pharmacistsneedtoreducecosts,whilecontinuingtodelivervalueandexcellentservicetocustomers.Thismaysoundlikeastandardapproachtakeninmanyconsumer-ledindustriestoday,butobviouslyitcanbechallengingto

deliveroninpractice.Oneapproachthatcancertainlygetyourbusinessonamorecompetitive

footingistocapitaliseontheuseofinformationandcommunicationstechnology(ICT)tohelpmanageyourbusiness.ICTsystemscanprovideup-to-the-minuteinformation,reducestafftimespentontransactionalprocessesandenablebusinessestopositionthemselveseffectivelytocapitaliseonchangesinconsumerspendpatterns.newinnovationsinpharmacy,suchasbusinessintelligencereporting,

centralaccesstobusinessinformationacrosschains,roboticsandvalue-addingmodulesindispensingsoftware,canassistpharmacistsandbusinessmanagerstomakebetter,more-informeddecisionsandfreeuptimetodevelopandofferimprovedservicestopatientsandcustomers.

PharmacychainsreapingbenefitsofIT

BrianPagni,managingdirectorofthe16-storeBradley’sPharmacyGroup,hashadQicScript.netfromHelixHealthinstalledinall16stores.Bradley’sPharmacyisanindependent,whollyIrish-ownedcompanyestablishedin2001andislocatedacrossDublin,surroundingareasandthenorth-eastofIreland.ThekeytoBrian’sdecisiontogowithQicScript.netwasthebusiness

intelligencereportingmodulewhichallowsinstantaccesscentrallytoeachofthepharmacies’dispensingdetails,providingmanagementwithkeyinformationimmediately.BrianseesclearefficienciesandvaluefromimplementingtheBIsystem.

“Ourdispensaryefficienciesandproductivityhaveimproved.Itallowsforaccuratedeploymentofmanhoursforthebusierdispensingperiods.Centrallywehaveup-to-datedispenseddrugfiguresandreporting,thereforeimprovingourbuyingwithsuppliersandconsequentlyreducingourdispensarystocklevels,givingusimprovementstoourmargins.”Anotherareaofimprovementhasbeenthemovetoasecondgeneration

claimscompatibleplatform.“Wenowhavethebenefitofearlypaymentofreclaimswithinthecurrentmonthofdispensing,”explainedBrain.Brianbelievesthatthekeytothesmoothroll-outandquick

implementationinall16storeswasgoodandopencommunicationbetweenbothorganisations.ChangingyourITsystemisalwaysdifficultand“someproblemsdidariseofcourse,butwithalllinesofcommunicationopenbetweenourselvesandHelix,theissueswereaddressedinanappropriatetimeperiod.“Theday-to-dayuseoftheoperatingsystemhasbeenwelcomedand

appreciatedbyallBradley’spharmacists,techniciansandlocumsalike.ItisuserfriendlyundertheWindowsapplicationformatandtherewasashortshallowlearningcurveforeveryonetoadjust.”

I


e-pharmacy

CormacTobin,MDofUnicarewithHowardBeggs,CEO,HelixHealth

noelStenson,AchillPharmacy

UnicarepharmacyisanotherchainthathasmadethedecisiontoinvestinICTsystemsrecently,therebyprovidingmanagementwithkeybusinessinformationtomakeinformedandtimelydecisionswhileofferingthebestpossiblecustomerexperienceinallstoresacrossthegroup.UnicarepharmacyisIreland’slargestgroupwith73storesnationwide.ItispartoftheCelesioGroup,Europe’sleadingtradingcompanyandserviceproviderforpharmaceuticalsgeneratingvv22.3billionrevenuein2007.UnderthemanagementofCormacTobin,thecompanyispursuingan

aggressivegrowthstrategywithplanstovastlyincreaseUnicare’spresencenationwide.Cormac’scomprehensiveknowledgeofretailbusinessesmeanshefullyunderstandstheimportanceofITtoachievesustainablegrowthandcompetitiveness.ThehighperformanceQicScript.netheadofficesolution,designedspecificallyforchains,givescompletevisibilityandcontrolovertheentiregroup.Unicarewillyieldsignificantcostsavingsthroughpreferredproduct

managementandheadofficemanagerscandistributeanyupdatesoramendmentstoallstoresatthetouchofabuttonensuringthecompleteorganisationisusingthelatestinformationatalltimes.Thiseliminatesmanualintervention,reducescosts,speedsupprocessesandmaximisesefficiencieswithintheorganisation.Inaddition,up-to-dateinformationongroupperformanceisavailable,enablingtimelymanagementdecisionsthatcanpositivelyaffectindividualstoreoperationsandconsequentlyfinancialperformance.Thedramaticincreaseintypeandamountofdatacollectedbypharmacy

todaymeansthereisagreaterneedtounderstandand,ofcourse,interpretthisdataintomanageableandusefulinformation.Traditionalreportingtoolsofferusersastaticviewofdatafromasetofspecificparameters,suchasasimpledaterange.Businessintelligencereportsallowausertointeractwiththedatareturned,drilldownintothemandcreatenewviewsonthefly,makingmanagementdecisionsmorerelevantandeffective.AnotherICT-ledinnovationinretailpharmacyinIrelandtodayisthe

adoptionofautomateddispensingroboticsolutionstohelppharmacistssignificantlyimprovetheservicestheycanoffertopatients.noelStensonownsapharmacyinAchillSound,CoMayo,andwasthefirstretailpharmacistinIrelandtoinstallaWillach+HeiseConsisdispensingunittohelpwiththelogisticalandstockmanagementofhisbusypharmacy.TheConsisrobot,suppliedbyHelixHealth,enablesnoelandhisstaffto

automatetheirdrug-dispensingprocess.Prescribinginformationisenteredintoacomputerwhichthensendsamessagetotherobottoquicklyandaccuratelydispensetherequireddrugstoanouttraylocatedatthefrontofthemachineatthepharmacycounter.Themachinesavesspaceandreducestimespentwalkingbackandforthfromthecountertodispensingshelves,allowingthepharmaciststospendthetimecounsellingandhelpingpatients.

Anothermajorbenefitofthemachineisthatiteliminateshumaninterventioninpickingthedrugs,reducingthepotentialformedicatingerrors.Accordingtonoel:“Pharmacyisevolvingfromatraditionalsupplyfunctiontoanextendedservicesoperation.Thesedaysit’smuchmoreabouttheextraservicesyoucanofferyourpatientssuchasmonitoreddosageservices,healthchecks,medicineusereviewsandothercounselling.EventheHSEhasacknowledgedthatpharmacyiswellpositionedtoexpandintothisrole.”noelisconfidentofthebenefitstohispatients,saying:“Thereisdefinitely

directvaluetomypatients.Prescriptionscanbeprocessedmuchfaster,leavingmyteamwithmoretimewithourpatientsandallowingmetoredirectstafftoadditionalvalue-addingservicesandincomestreams.”Inaddition,Gormley’sPharmacy,abouttoopenitsdoorsin

Ballyjamesduff,CoCavan,isinstallingaConsismachinetohelpstaffmeettheneedsofagrowingcommunity.AccordingtoBrianO’Donaghue,ownerofGormley’sPharmacy,inrecentyearsBallyjamesduffhasbecomeoneofthemanycommutertownstoDublin.Withthisgrowthbringsanewkindofcustomerwithdifferentexpectationsofwhattheywouldliketheirpharmacisttooffer.“ByinstallingaConsismachineinthenewshop,notonlyarewesaving

space,therebyleavingmoreroomforawiderrangeofcosmeticbrandswhichisinhighdemandandanewmotherandbabysection,wewillalsonowhavemoretimetoofferextendedservicessuchasaslimclinicandhealthscreeningtests.”InstallingtheConsissystem,whichisfullyintegratedwithHelix’s

QicScript.netdispensingapplication,fromthebeginninginhisnewbusinessventurewillensuretheygetitrightfromdayoneandintothefuture.“Weplanonservingthecommunityformanyyearstocome.Wearesettingthepharmacyupforthefuture.”

Benefits of iCtAdoptingastrategicICTplanisanessentialtooltogainingcompetitiveadvantageinaslowingeconomy.Takingalong-termviewandmakinganinvestmenttailoredtotheneedsofthebusiness,regardlessofitssize,canreapconsiderablebenefits.ICTsystemsandtheircarefulapplicationandmanagementcanhelpretail

pharmacyinIrelandtonavigatethecurrentdifficulteconomicconditionsbydeliveringreal-timedataanalysis,drivingtightercostmanagementand,ultimately,leadingtoamoreprofitablebusinessinthelongterm.


picTure Gallery

Pictured(ltor)withProfessorJohnKelly,HeadoftheSchoolofPharmacy,RCSIarenewPharmacygraduatesMsEmmaTreacyfromPortmarnock;andMsKaraTedfordfromShankill.

RCSI Pharmacy Conferring Ceremony, 14 November 2008

4th All Ireland Pharmacy Healthcare Conference, Dundalk, 11 November 2008

PicturedfromltorareGrainne,Hilary,Fiona,andRoisinIkelefromMayo.FionaIkelewasconferredwithaDegreeofBachelorofScience(BSc)inPharmacyattheRoyalCollegeofSurgeonsinIreland(RCSI)’sconferringceremony.

GillianPlantandKarenDolan CathyHarrison(left),LezleyAnneHannaandJohanneBarry

MohammedAlhrasenandDarylConnolly EmerMcLean(left),MarkTimoneyandHelenBell

For further information please contact: Bayer Consumer Care, The Atrium, Blackthorn Road, Sandyford Industrial Estate, Dublin 18. Telephone: 00 353 (0)1 2999313.

Canesten_Daisies_245x340:Canesten_Daisies_245x340 27/06/2008 11:36 Page 1


producT news

IMPORTANT NOTICE

Re; Nozinan (Levomepromazine HCl) 25mg/ml Solution for Injection or Infusion – PA 540/115/1

Change of ampoule size

Sanofi-aventis wish to announce that Nozinan 25mg/ml Solution for Injection for Infusion will now be supplied in a larger 2ml capacity glass ampoule. Please note that the fill volume and concentration remains unchanged i.e. each ampoule contains 1ml of 25mg/ml Solution for Injection of Infusion.

For further information please contact sanofi-aventis at phone # (01) 403 5600 or [email protected]

CreateandpersonaliseaVichygiftthisChristmasVichyLaboratoires,thenumberoneskincarebrandinEuropeanpharmacies,offerstailor-madeexpertsolutionsforallskincareneeds.ThisChristmas,youcancreateandpersonaliseaVichyskin-healthcaregiftinastylishsilverandwhitebox.Simplydescribetheindividualskincareneedsofyourrecipientaswellas

yourpricepointtothetrainedderma-skincareadvisoratyourpharmacy.TheywillsuggestanexpertcustomisedsolutionofaprescribedskincareroutinetosuitanylifestyleandpersonalityinanattractivesilverChristmasbox.Theproductsstemfromyearsofexpertskinresearchonallaspectsof

skinproblemsincludingdryness,excessoil,dehydration,imperfections,dullness,sundamageandanti-ageing.Testedonandsuitableforeventhemostsensitiveskintypes,theycontainpatentedingredientswithclinicallyprovenresultsforeveryproduct.Formulatedandmanufacturedtothehighstandardsofthepharmaceuticalindustry,theproductscombinecutting-edgetechnologyformaximumefficacyandtolerance,withexcellenttexturesandcosmeticity.Vichyproductsoffervisible,rapidresultscombinedwithpleasureofuse.AVichySkinHealthChristmasboxcouldbepersonalisedforateenager

withskinpronetoimperfections,awomanwhowantstogiveherskinthebestsunprotection,amother-to-bewhowantstobepampered,or

ahusbandwholikesaneffectiveanti-ageingskincareroutine.Vichyhasatailor-madesolutionforeachoftheseexamplesandcansuggestroutinesforanyother.Vichyproductsare

guaranteedhypoallergenic,non-comedogenicandcontainVichyThermalSpaWater,clinicallyproventosootheandfortifytheskin.www.vichy.ie

PharmatonrelievessymptomsoffatigueandmemoryPharmatonhasbeenproventonotonlyhelprelievesymptomsoftirednessandfatiguecausedbyshift-work,butalsotocounteractthereductioninabilitytostoreandretrieveinformationfrommemorycausedbyfatigue.Adouble-blindstudywasconductedamongshift-worknursesto

investigatetheusefulnessofacombinationofPanaxginseng,vitaminsandminerals(Pharmaton)inreducingfatigue-induceddeficitstocognitivefunctionandmood.shift-workmodelwasdevelopedinwhichnurseswererepeatedlyevaluatedonavarietyofcognitivetestsandquestionnairesimmediatelypriortoundertakingathree-nightshiftandthenagainimmediatelyafterwards.After12weeksofdosing,statisticallysignificantbeneficialeffectsofPharmatonwasobservedonvariousaspectsofcognitivefunctionandmood.Inparticular,qualityofmemoryandself-ratedcalmnessweresignificantlyimprovedinnursesworkingnightshiftsandtakingPharmaton.Onthedaybeforetheshift,29nursesperformedaselectionoftestsfrom

theCognitiveDrugResearchcomputerisedassessmentsystem,aswellasBond-Ladermoodandalertnessscales.TheyalsocompletedtheChalderfatiguescaleonceduringthistime.Onthedayimmediatelyfollowingthe

three-nightshift,theyreturneddirectlytothelaboratoryandunderwentanidenticalscheduleoftesting.Thenurseswerethenassignedrandomlytoreceiveeitheronetabletof

thecombination(Pharmaton)orplaceboforthenext12weeksinadouble-blind,parallelgroupdesign.Theshiftmodelwasthenrepeated6and12weekslaterusingexactlythesamescheduleofassessments.Toconfirmthattheshiftmodelwaseffectiveinimpairingcognitive

functionandinducingfatigue,thedatafortheshiftmodelrunpriortorandomisationwereinitiallyevaluated.Thethree-dayshiftresultedinsignificantdeclinesinbothspeedandaccuracyofattention,andtheabilitytostoreandretrieveinformationfrommemory.Deficitstoself-ratedcalmnessandcontentmentwerealsoidentified.Inaddition,increasedlevelsoffatiguewereseenontheChalderfatiguescale.Thisshift-induceddeficitwasthenusedasthemajorstudyoutcome.Thepre-studydeficitwasusedasabaseline,andthedeficitsmeasuredatweeks6and12wereadjustedto‘changefrombaselineshiftdeficits’.Theseadjustedscoreswerethencontrastedbetweenthetwogroupsat6and12weeks.Ontheperformanceassessments,itwasfoundthatthecombination

(Pharmaton)reducedthedeficitsresultingfromthethree-dayshiftontheQualityofMemory,theseeffectsbeingsignificantatthefirstthreetimeassessmentsatweek12.Thecombinationalsosignificantlyreducedtheself-reporteddeclineincalmnessattheendofthemeasurementsessionatweeks6and12.Further,thecombinationhelpedtoreducetheincreaseinself-reportedfatigueasassessedbytheChalderfatiguescale.

Diamicron80mg–productwithdawalServierLaboratorieshaveadvisedofthewithdrawalofDiamicron80mg.StockofDiamicron80mgwillbecompletelywithdrawnbyDecember2008.DiamicronMRisnowrecommendedforpatientsformallyon

Diamicron80mg.Thepatientbenefitsarehighlightedwithnewmorbi-mortalitydatafromthelargesteverstudyintype2diabetes–ADVAnCE.Theresultsofthistrial,recentlypublishedinThenewEngland

JournalofMedicine,showedintensiveglycaemiccontrolwithaDiamicronMR-basedregimenandachievedatargetHbA1cof6.5%withsignificantlyreducedmajormicrovascularandmacrovascularcomplicationsintype2diabeticpatientsversusstandardcontrol.PrescribersareadvisedtoprescribeDiamicronMRasanalternativeto

Diamicron80mgfrom30november2008.Themodifiedreleaseformulation,DiamicronMRismoreeffective

thanDiamicron80mgwithoutcompromisingsafetywithaverylowlevelofhypoglycaemiceventsreportedandnoincreaseinbodyweight1.Fortheabovereasons,ServierIrelandhasdecidedtowithdrawDiamicron80toavoidconfusionandimprovepatientcareinIreland.TofacilitateasmoothtransitionfromDiamicron80toDiamicronMRpatientinformationleafletsoutliningthereasonsforwithdrawalwillbedistributedtosurgeriesandpharmaciespriortothewithdrawaldate.Formoreinformation,pleasecontactKieranLeahy,GroupProduct

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Abidec—proudsponsorsofTV3’s‘RaisingChildren’.RaisingChildrenisaweekly30-minutehumorouspeekintoraisingchildreninIreland.TheshowisairedonMondaynightsat8pmthroughtomid-December.Abidechasbeenhelpingtobuildhealthychildrenforover60yearsandwithaformulationtosuitallchildrenfrombabiesto12yearolds,whoelsewouldyoutrusttohelpbuildstronghealthykids.AbidecOptiMUMSyrup—FolicAcid,

Omega3plus6essentialVitamins.Forbefore,duringandafterpregnancy.AbidecMultivitaminDrops—7essential

vitaminsforbabies0to12years.(AbidecMultivitaminDropsisamedicine.Alwaysreadthelabel)AbidecVitaminD3Drops—VitaminD3forstrongteethandbones.Forchildren0to3years.AbidecMultivitaminSyrupwithOmega

3—Helpsmaintainhealthygrowthanddevelopment,supportshealthybrainfunctionandconcentration.ForChildren1to5AbidecOmega3Syrup—Mayhelpmaintainconcentrationlevels.Forchildrenfrom3years.

ObesityandsmokinginaccuratelyidentifiedbypublicasbiggestriskfactorsindevelopingbloodclotsRecentresearchintothepublic’sawarenessofbloodclotsandassociatedrisks,foundthat31%ofpeopleinaccuratelyreportedobesityandsmoking(29%)asthebiggestriskfactorsindevelopingbloodclots.Only19%ofpeopleunderstoodthathavingsurgerywasafactorwheninfactitincreasestheriskofbloodclots10-fold.Smokingmoderatelyincreasestheriskandmoresoinwomenthaninmenandobesityincreasestherisk3-fold.TheBritishledresearchwasunveiledatthelaunchofXareltowhichislicensedforthepreventionofbloodclotsinadultpatientsundergoinghiporkneereplacementsurgery.Xareltoisabloodthinningmedicinewhichistakenorally,onceadayanddoesn‘trequireroutinemonitoring.Significantly,Xareltoreducespatient’srelativeriskofdevelopingabloodclotby70%.Theresearchshowedthat55%ofpeoplearemostconcernedabouthow

successfultheiroperationwillbewhenundergoingsurgeryand30%worryaboutcontractingMRSA.Developingabloodclotrankedthirdandisofmoreconcerntowomenthanmen.BloodclotskillmorepeopleinEuropeannuallythanbreastcancer,prostatecancer,HIV/AIDSandroadtrafficaccidentscombined.Peopleundergoingorthopaedicsurgicalproceduresincludingtotalknee

replacementandhipreplacementarepronetodevelopingbloodclotsunlesspreventivemeasuresareused.Infactwithoutpreventivecare,bloodclotsoccurin40%-60%ofpatientshavingorthopaedicsurgery.Thefindingsalsorevealedthat78%ofpeoplearemorelikelytodosomeresearchinadvanceofanoperationinordertobefullyawareofwhattoexpect.“Bloodclotsafterhiporkneesurgeryareacomplicationorthopaedic

surgeonshavebattledagainstsincethebeginningofjointreplacementsurgery.Xarelto,anorallyadministereddrug,withouttheneedformonitoringisamajoradvanceandofferssignificantadvantagestousassurgeonsintheon-goingbattle.Evidencehasshownitwillcertainlybenefitmypatients,”saidMrGaryO’Toole,ConsultantOrthopaedicSurgeon,StVincent’sUniversityHospitalandCappaghnationalOrthopaedicHospital,Dublin.Duringhiporkneereplacementprocedures,thelargeveinsofthelegthat

carrybloodbacktotheheartaredamaged,whichsignificantlyincreasestheriskofbloodclotsforpatientsundergoingsuchmajororthopaedicsurgery.Forfurtherinformationonbloodclots,visitwww.thrombosisadviser.com

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couldhavevisitedanywhereintheUKbutsawhiswinasanidealopportunitytohavefunwiththeirthreeyoungchildrenOrla(6),neasa(4)andCathal(2).TheirvisitstartedwithaspectacularfireworksdisplayonSundaynightwhich,accordingtoBreda,“wasthebesttheyhadeverseen”.Andtothedelightofthechildrenitstartedtosnowthenextday.Byallaccountstheyhad

awhaleofatime.Pernatonorganizedspecialprioritypassesforthemwhichcutoutallthequeuesandhelpedthemseeeverythingtheyhadplanned.needlesstosaythechildrenhadlotsofstoriestotelltheirfriendsaftertheirgreatadventure.

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producT news

ip Crossword No. 159

LASTMOnTH’SCROSSWORDAnSWERS

name:

Address:

E-mail:

Across6 Oatpie,stewed,producesnarcotic(6)7 ConditionsinAmerica?(6)8 Wineleftatsea?(4)9 HiBenson!Fracturedyourtibia?(4,4)10 Jabberinthedoctor’ssurgery?(7)12 It’saneyesore!(4)13 AreversiblegroupofSwedes(4)15 Maladyduetostormyseaside!(7)17 Shebarelyworksforaliving!(8)20 It’sapositivesign(4)21 Wellbeinginachealthoughconcealed(6)22 Hoetrekkiesgo—bydoll,perhaps!((6)

Down1 Protectivegarmentswithstringsattached!(6)2 Ieatcrabgoulashtofindgerms(8)3 Looksbothways!(4)4 Maryhadalittleone(4)5 yellananomalywithnoexcessfat(6)7 Arachnophobic’sworstfears(7)11 Thepond,surprisingly,isshallow(2,5)12 Thecuttingedgesofsurgicalscience?(8)14 Dairyproduct—foraram?(6)16 Thesameasonespeers?(6)18 Man,DogsorCapri!(4)19 Bonesthatmaybetickled!(4)

Congratulationstothewinneroflastmonth’scrossword,MrsEimearMellett,OranmorePharmacy,MainStreet,Oranmore,CoGalway.Forachancetowin€70,pleasesendcompletedentries:theEditor,IrishPharmacist,GreenCrossPublishing,LrGroundFloor,5HarringtonStreet,Dublin8orfaxto(01)4789764by22December2008.

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CalltoManageColds&FluAppropriatelythisWinter75%ofIrishemployeeswouldprefertheirsickcolleaguestorecoverathomeratherthanriskspreadinginfectionintheworkplace1.Thisviewissupportedby86%ofIrishmanagerswhobelievethattheiremployeeswouldbemoreproductiveaftertakingarestdayandrecovering1.Theresearchwasunveiledtodayatthelaunchof“TakeaBenylinDay”–acampaigntoinformpeoplethatwhentheyaresickwiththeflu,itisasimportanttoresttorecoverasitistotakeafluremedy.

ThecampaignwhichstartedinnovemberincludesTV,radio,consumer&tradepress,outdoorpress,Tsides&,publicrelationsandawww.takeabenylinday.iewebsite.Thewebsitehasbeendevelopedasa‘getwell’repositoryfilledwithtipsandadviceonmanagingyourflusymptoms.Featuresonthewebsiteinclude–‘responsiblesickleave’andonlinegamessuchas‘GermInvaders’.Formoreinformationonthecampaignvisitwww.takeabenylinday.ie.

BenylinisIreland’snumberonecoughbrand2andhasthewidestrangeofcough&coldproductsforbothadultsandchildreninIreland.BesuretostockuponBenylinproductsthiswinterseason.

ALWAYS READ THE LABEL

References:TaylornelsonSofres(TnS)mrbiPhoneBus®consumerresearchinto

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A body� of evidenceCubitan is the only wound care sip feed. Enriched with added free arginine, it stimulates tissue repair and improves immune function.

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ouTside edGe

SotheProgressiveDemocratshavedecidedtodissolve,whichwillhardlycreateanykindofseismicshock.Sincethelastelectiontheywerealready‘defactodefuncto’.TouseaphraseusedbyDrRuairiHanleyinalettertotheIrish Timessomemonthsago,thePDsnolongerhadaroleotherthantoactas“thepoliticalwingoftheHSE”.HistorymaybekindtothePDs,butI’mdamnedifIwillbe.Thepartyhadonegoodideabackinthelate80s,whichwastolowerincometaxesfromthesavagelyhighlevelsthatpertainedbackthendowntoareasonablepercentageofpeople’sincome.ThatreductionstimulatedeconomicactivityandhelpedtocreatetheCelticTigeryears.

Token victoriesThedownsidewasthatdespitebeingfoundedbypeoplewhodespisedHaugheyitecorruption,thePDsspentmostofthelast20yearskeepingFiannaFáilinpower.TheyscoredafewtokenvictoriesagainstsomesmallerFiannaFáil-backedlobbygroups,suchasthebanningofsmokeycoalandderegulationoftaxis,buttheconstructionindustrywasallowedtorunriot.Theboominpropertypricessloshedmoneyintothegovernmentwhichthenloweredincometaxesbeyondapointthatwassensible.nowthattheboomisover,wecanallseethatFiannaFáilhasspentthelastdecadeblowingthecashlikeavillageidiotwithalotterywin.

Ironically,whatdidforthePDsinthelastelectionwasMichaelMcDowell’slast-minutewobblingaboutwhetherornottopulloutofgovernmentinresponsetoBertieAhern’stribunalproblems.Byultimatelystayingin,McDowelllostthe‘watchdog’vote,butthethreattopulloutcosthimtheFiannaFáiltransfers.HehadignoredoneofFiannaFáil’scoreprinciples,namelythatwhenyou’vebeenbought,youstaybought.

A new Minister for Health?Fromapharmacyperspective,thedemiseoftheProgressiveDemocratsdoesn’tchangemuchforusintheimmediatefuturebecauseMaryHarneywillcontinueasMinisterforHealth.Therearetwoschoolsofthoughtabouttheobviousquestionofwhetherwearebetteroffwithherorsomebodyelse.Ihadalwaysreckonedthatwewouldbebetteroffwithsomebody(anybody)else,becausetheHSEwashercreationandshewillalwayssupportit,nomatterhowbadlyitscrewsup.MytheorywasthatadifferentMinisterforHealthwouldtelltheHSEtostopactingthemaggot,andtonegotiateadealwithus.However,thereisanotherpointofview,whichisthatHarney

hasareasonablegraspoftheissuesinvolvedandisthereforewellpositionedtoreachagreement.Ifanewministerwereappointedtherewouldbeaninevitablehiatusbeforeheorshewouldbewell-enoughinformedtoauthoriseadeal.Ican’tpickanyholesinthisscenario,soyoucanmakeupyourownminds–don’texpectmetohelpyou!AssumingHarneystaysonasMinisterforHealth,the

outcryoverthecancellationofthecervicalcancervaccinationprogrammemightfocushermindonfindingaresolutiontothepharmacyproblem.It’spatentlyobviousthataweekendofhardtalkingwiththeIPUwouldbeenoughtoachieveafairandlastingoutcomeforbothsides.Someoftheresultantsavingscouldrescuethevaccinationprogramme.Hersolutiontotwodifferentheadachesisthereforthetaking–ifshewantsit.

No commentSomeyearsago,Ihadanunpleasantencounterwithanexceptionallyobnoxiouscustomer.Afterhehadleftthepharmacy,Iwasstillseethingwithrage.Beingyoungerandmorerashinthosedays,Iwentbacktothecomputer,reopenedhispatientfile,andonthelinereservedfor‘Comment’Itypedintheword‘P***K!!!’.Ineverlaideyesonthemanagain,butsomemonthslater

Igotacallfrommyboss.MrObnoxioushadjustbeenintorequestaMed1printout,whichmybosshaddulyprintedoff.Asmybosswaswalkingouttothecounterwiththereceiptinhishandheidlyglancedupatthetoprightcornerofthepageandtherefortheworldtoseewastheword‘P***K!!!’.Hedidanabruptabout-turnand,havingremovedmycomment,reprintedthereceipt–Ithinkmybossmaythenhaveutteredafewcommentsaboutme!

Coded messagesToavoidsimilarproblems,abbreviationsusedbydoctorsinpatientnoteshaveoftenincludedthefollowingcodeddescriptions:

FLK–FunnyLookingKidCnS/QnS–‘CentralnervousSystem/QuantitynotSufficient’(i.e.someonenottoobright)TEETH–TriedEverythingElse,TryHomeopathy.

Perhapsacodedwarningsystemcouldbedevisedforourprofession.Howabout:

SLACKJAWS–ShopLiftsAsCretinousKidsJumpAroundWreckingShopBAB3C–BelievesAntibioticCuresCommonColdSTD–SleepingTablets‘Disappear’SMA–SpilledMethadoneAgain.

Butthenagain,I’mjustaKnOP(KnownothingOpinionatedPharmacist).

notsurprisedbythedissolutionofthePDs,FintanMooretheorisesonanewMinisterforHealthandwhatthatwillmeanforIrishpharmacists.

PD or not to be? finTan moore

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