Thursday, December 09, 2010

Pharmacy Profession changing by Force?

Pharmacists deserve a more democratic governing model.Written by Cristina Alarcon on November 3, 2010 for CanadianHealthcareNetwork.ca


I hope Manitoba pharmacists realize just how lucky they are. Their Governing Body, The Manitoba Pharmaceutical Association, is one of a kind, a pearl to be prized…

As reported for Drugstore Canada by Judy Waytiuk, Manitoba pharmacists are one of the only Canadian health professions with individual voting authority over their practice regulations. This is unlike the rest of Canada, where the regulatory body consults on, sets and implements practice changes.

And so, lucky Manitoba pharmacists get to voice their concerns on important issues ranging from technicians’ scope of practice, to prescribing authority, to a position on inducements.

Input is not merely advisory in nature, and pharmacists get the respect they deserve…

True, the Manitoban-democratic-approach can potentially slow down and—to the horror of policy drafters—squash brilliant initiatives. But pondered delay is not only salutary, it is essential.

Sure, asking for full membership participation in proposed regulatory changes would be a tedious, time-consuming task, but as the Manitoba experience shows, the licensing body is better off for it.
Never is this truer than when clouds loom dark on the horizon, something not uncommon in British Columbia… where, in fact, an event of unprecedented importance took place this year….

Welcome to Vancouver EGM 2010
At the petition of 500 community pharmacists, an Extraordinary General Meeting (EGM) was convoked by the College of Pharmacists of British Columbia and held in Vancouver on July 13, 2010. Over 160 pharmacists from across the province took great pains to be present in order to voice their concerns over regulatory changes that will make technicians a new class of College registrant, authorizing them to perform final prescription checks and take verbal orders from physicians.

Highlighting this event was the resignation of Board members Doug Kipp and Bev Harris, who courageously stepped down—later to be re-elected in landslide wins—so they could speak out freely against College policy changes, bypassing a newly reinforced rule requiring all Board members to “Speak with One Voice” .

Later, the tidy Board-approved minutes would fail to capture the lively exchange that transpired on that historical July evening when over 160 pharmacists took the College to task, leaving those who were there with a taste of Orwellian Double-Speak…

There, a resolution was presented calling on the Board to “reconsider its decision to establish the profession of Regulated Pharmacy Technicians for community pharmacy”. It was supported and passed by an overwhelming majority.

Attendees were reminded, lest they forget, that due to the College’s overriding mandate to protect the public the vote would be only advisory in nature. However, they added, results would be given “due consideration” at the next regularly scheduled Board meeting in September. Pharmacists did not hold their breath.

Come September…
On August 1st, just weeks after the EGM and over a month before the much-awaited September Board meeting, Ministerial approval of revised HPA Bylaws (inclusive of regulated pharmacy technicians) came into force. The changes will allow the College to bulldoze ahead in the New Year as planned, leaving pharmacists with the impression that “due consideration” of their resolution had never really been intended at all.

Having previously resigned her position, Bev Harris attended the September 24th Board meeting as an observer. “It all took about 30 seconds,” she told me.

The BC College of Pharmacists’ Board consists of elected members and non-pharmacist government appointees. At this meeting, one non-pharmacist moved the motion that the College go ahead as planned with technician regulation. This was seconded by another government appointee. The majority voted in favour, and so, it was…

No discussion ever took place.

And so it is that, in spite of unresolved concerns, the final step in the approval process regarding the legislative authority to register pharmacy technicians as registrants of the College of Pharmacists of BC is now complete.

After only eight months of training, technicians will be allowed to perform final med checks and take verbal orders. Meanwhile, pharmacists’ concerns—ranging from liability, to employment loss, to patient safety—remain unaddressed.

In all fairness, the College has expressed the need for “further communication and support to help manage change”. However, there is something terribly wrong with a professional governing body that appears to listen but fails to act on the concerns of its registrants, seeking instead to impose change by force. Alienation is the only possible outcome.

Re-education anyone?

Sure, asking for full membership participation in proposed regulatory changes would be a tedious, time-consuming task, but as the Manitoba experience shows, the licensing body is better off for it.

If anything, a more democratic governing model would ensure that our yearly dues were better spent. It would also shield the governing body against perceptions (however unfounded) of government run amok.

An ecological blind spot

There is a huge effort today to protect the physical environment from the unintended effects of human activity. We have international agreements and national policies to reduce global warming by curbing excess carbon, produced as human beings pursue their material wellbeing.
On a smaller scale, we each do our best to turn off the taps, turn down the lights, use public transport, cut down on the fumes, recycle, recycle, and definitely not flush any medicines down the sink – especially not the brain-altering or endocrine-disrupting kind. Yes, we are constantly seeking ways to reduce air and water pollution, and in Canada, the Environment Act even allows citizens to bring civil action when the government is not enforcing environmental laws.....
(to read more click on title above)

Thursday, October 21, 2010

Choice impacts Everyone!

Humans are notably inconsistent beings, which may account for the contradictory attitudes we currently see to the phenomenon of suicide. On the one hand, every effort is made to prevent people taking their own lives; there are safety barriers on bridges, crisis hotlines, suicide prevention programmes in schools. At the same time there are organised campaigns for assisted suicide and other forms of euthanasia to be sanctioned by law.

According to euthanasia advocates, we have the right to end our lives, and as autonomous individuals, each one should choose whether to live or die. There are people, it’s true, who think that autonomy and choice are too good to be wasted on just anyone. Someone commenting on a National Post blog recently insisted that “a 90 year old suffering dementia who is also blind, deaf and unable to walk is no longer a person.” The implication is that the infirm can have the time of their death chosen for them- by someone else of course.

Yet autonomy and choice do lend respectability to the pro-suicide campaign because, when not used as mere buzz words, they are truly signs of the rational spark that differentiates us from our pet birds and rabbits. Autonomy, however, is only part of the human story. No man is an island, and, as part of the universal human family, both the way we choose to live and the way we die does have an impact on others.

To read more click on title above.......

EGM Technician Regulation

Here are the EGM meeting highlights re: Technician Regulation....
The meeting was held in Vancouver on July 13 2010-- College of Pharmacists of BC.
(click on the title to view video)

Sunday, September 26, 2010

With euthanasia, ‘choice’ is a lie

With euthanasia and assisted suicide, the proponents of “choice” are rather na├»ve.

A favourite of euthanasia proponents is the autonomy/choice argument. When not used as mere buzz words, autonomy and choice are truly signs of the rational spark that differentiates us from our pet birds and rabbits. Yet though autonomous, no man is an island.


As part of the universal human family, both the way we choose to live and the way we die does have an impact on others. This is never truer than in the case of suicide… Across the globe, the suicidal jump off bridges every day. And from erection of safety barriers to provision of emergency hotlines, every effort is made to stop them.

To read more, click on the title above......

Thursday, August 19, 2010

The end can never really justify the means

By Cristina Alarcon, The Province, July 25, 2010
Last week, Canadian Army captain Robert Semrau was convicted of disgraceful conduct in the shooting a badly wounded Taliban insurgent in Afghanistan. But a military panel acquitted him of murder.

The court martial in Gatineau, Que., had been told by an eyewitness that Capt. Semrau "could not live with himself if he left an injured human being -- and that no one should suffer like that."

The suggestion was, in other words, that the 36-year-old father of two children was engaged in a wartime mercy killing.

Around the world, the trial sparked much debate, and got me thinking about what I might do in the young captain's place.

That's not an easy task, as scenes of wartime chaos are but shadows on a TV screen glimpsed from the bulwarks of a comfy couch.

Still, I can try. The young insurgent's legs were severed, his innards protruding, a horrific sight to behold. It was something a paramedic might encounter in the aftermath of an airline crash.

I had the same sort of feeling that can sometimes come over me when dealing with the hopelessly chronically ill . . . though I always manage to shake it off.

Confronted by such wartime misery, would I still hold firm to my principles that the ends (relief of suffering) can never justify the means (killing)?

Or would the stress of wartime terror blur my usual moral clarity, my sense of the uniqueness of human worth?

Would I, like Red Cross founder Henry Dunant, be inspired to greater self-giving?

Dunant embarked on his great project in 1862 from the "chaotic disorder, despair unspeakable and misery of every kind" he earlier witnessed in the bloody Battle of Solferino in modern-day Italy.

As a pharmacist, I have witnessed the devastating psychological effects of war on men many years after combat.

Stress, much like drugs, can affect us in unpredictable ways. It can bring out the best and the worst in us. Still, our actions remain free.

Writing on his blog about the moral justification for killing in war, U.S. soldier-ethicist Pete Kilner points out that good rules of engagement provide guidelines to assist [the] decision-making process.

Nevertheless, given the complexity of combat, mistakes happen.

Kilner explains that the default setting for a human being is to possess the right not to be killed, so when a person is no longer a threat he should not be killed.

This is why it is morally wrong to kill a detainee or an incapacitated insurgent.

Still, Kilner maintains, the profession of arms has two moral codes. There's the public one, based on black-and-white legal rules, and private code, known only by those who have to do the messy work of war.

It's not healthy psychologically, he says, to have made difficult moral decisions that you cannot talk about publicly for fear of being punished.

The prosecution alleged that Semrau committed a mercy killing because he felt bound by a "soldier's pact" to end the suffering of gravely wounded combatants.

There is no defence for mercy killing in the law.

Nor is it, in my view, something that ought to be applauded.

Still, supporters argue it was unfair for a soldier to have to face prosecution for decisions made on the battlefield.

If during wartime, we can succumb to less than humane actions, what excuse is there for us at home in a comfortable world of Ritalin for the young, Viagra for the old -- and, as some propose, an overdose of pills to help us along, should kick-the-bucket time draw near?

We can be tempted to lose moral clarity, to lose the sense of the uniqueness of our species, of the fact that we are the ones for which the planet was made.

Though most of us would like to have it otherwise, the end or purpose of our actions can never justify the means.

If mercy killing is allowed in some instances, why not in others, and who is to decide?

Yes, from the sanctuary of my couch it is all too easy for me to judge.

Yet it also gives me a clearer perspective from which to respectfully ask: How could anyone in his right mind finish off a dying man as he would a dying horse?

Vancouver pharmacist Cristina Alarcon can be reached at cristinaalarcon365@hotmail.com

© Copyright (c) The Province

Pharmacy Plan will Hurt Quality Control

By Cristina Alarcon, Special to Coquitlam NOW, August 13, 2010
Next time you walk into a drugstore, you may want to ensure your prescription has been properly filled and checked by a real apothecary -- a pharmacist, that is.

And if you or your loved ones are on a complicated medication regime and technicians are doing the final check on your medicine, then perhaps you ought to be signing a consent form.

This is because the College of Pharmacists of British Columbia has decided to pursue the licensing of technicians by Dec. 31, triggering a debate among community pharmacists who fret over liability, the profession's integrity and public safety.

For years now, the pharmacy profession has been easing the technical aspect of the job, first via specialized technology, then via technical support, but never before by leaving order entry, preparation and final check of prescriptions to unsupervised, largely under-qualified personnel.

While the college claims that pharmacists will still be ensuring the appropriateness of the drugs prescribed to begin with, quality control will certainly give way to monetary gain.

If one pharmacist must oversee the appropriateness of hundreds of scrips churned out daily by an army of techs, major mishaps will undoubtedly occur.

This idea may well work in a hospital setting, where errors are quickly caught and contained. Not so out in the community where once the wrong drug goes out that door it's gone -- and so, perhaps, is the patient.

But let's face it: most people have no clue just how much care goes into filling prescriptions. From searching for drug incompatibilities to making phone calls to refusals to fill when directions are inadequate or the wrong drugs are prescribed for a given condition -- you name it, good pharmacists catch it. There are myriad prescribing errors made and caught daily. This is far from mindless work.

Yet from their ivory towers academics believe the technical and cognitive aspects of this work can be separated -- imagine a chef who cannot cook, a plumber who cannot use a pump -- while drug store chain owners greedily wait to cash in on the techs' much-lower wages.

The regulation of pharmacy technicians will ultimately result in the creation of a new health-care professional and new registrant of the College of Pharmacists of BC.

Regulated pharmacy technicians will essentially take over the technical functions of the pharmacists' job, and pharmacists will be sitting back sipping margaritas by their pools, waiting for a call from their lawyers over the next casualty.

No really, the idea is to free up the pharmacist for consultation on disease management and drug care, but for a hefty, never-before-seen fee. Thus the most readily accessible health-care professional will be available no more, and your drug reviews and queries will be charged speedily to your Master Card or Visa.

Largely taken over by bureaucrats, academics and drug store chain owners, the College of Pharmacists of BC is giving in to their vested conflicts of interest. Meanwhile, the college board is conveniently silencing those who oppose their agenda by claiming that all must speak with "one voice."

Most recently, input was seemingly sought from the public on proposed bylaw changes that would create this new technical profession. Yet board member Bev Harris (a Coquitlam pharmacist) was reprimanded for speaking in a public forum to point out the problematic draft changes. And so it appears the consultation process was merely a sham. Fruitful discussion was never really the aim.

Over 500 community pharmacists have petitioned the college to hold off on bylaw changes that would give technicians the authority to take over their dispensing functions after a mere eight months of training. Technician certification, rather than licensing, is what pharmacists would like to see.

And it's not that pharmacists want to go back to all that counting and licking and sticking. Trained technicians are already helping greatly with that and much more.

While providing appropriate and timely services, pharmacists want to be sure that no errors are made along any step of the way, and that what your label says you're getting is really what's in the bottle.

A wrong drug or dosage may not be life threatening when you are young and healthy, but it may be lethal if dispensed to your 80-year-old mother or to your two-year-old son.

- - -

Cristina Alarcon is a Vancouver pharmacist.

© Copyright (c) Coquitlam Now

Saturday, July 17, 2010

Washington State victory

I was thrilled to learn that Washington State will be creating new rules for pharmacists who have conscientious objections to providing services or products they find morally objectionable. It will allow pharmacists to refuse to sell anything or provide services that go against their conscience and deeply held beliefs.
The reason for the new rules was because of a lawsuit concerning a pharmacy that, against the objections of the state, refused to stock or dispense the Plan B morning-after pill, based on their belief that life is sacred from the moment of conception and the pill can sometimes work as an abortifacient.
This is a great turnaround by both the state and the Pharmacy State Board, which for several years maintained that religious freedoms of pharmacies and pharmacists had to be restricted in order to ensure patient access to the morning-after pill.
In 2006, Pharmacy Board members unanimously supported a rule that would protect conscience for pharmacists and pharmacy owners. Shortly after, though, the board buckled under political pressure and mandated pharmacies to stock and dispense the medication despite any conscientious objections.
The board adopted this regulation even though it admitted it found no evidence that anyone in the state had ever been unable to obtain Plan B (or any other time-sensitive medication) due to religious objections.
In the aftermath, a pharmacy and two individual pharmacists filed suit to prevent the new regulation from forcing them out of their profession. The Becket Fund also came to their defence.
In its most recent filing, the state conceded that allowing pharmacists with conscientious objections to refer patients to other pharmacies “is a time-honoured pharmacy practice that is often in the best interest of patients, pharmacies and pharmacists, and [does] not pose a threat to timely access to lawfully prescribed medications.”
Although I do not advocate mandated referral, this is a clear victory for the profession and it sends a clear message to all: The state and professional boards ought to remain neutral in matters of faith and morals as they relate to individual conscience, in so far as there is no threat to public safety or to the common good.
While the state plays an important role in ensuring the health, peace, morality and safety of its citizens, it should not use its power in a dictatorial way, imposing limits on individual conscience in legitimately disputable matters.
But is this not a case of a religious pharmacist or store owner imposing his or her values on others, and will it not cause great inconvenience to customers, which some would argue should be a professional’s first priority?
To the question of fairness I would answer that justice is for all. In any agreement, one party must not be oppressed at the expense of another. In the case of the Plan B provision, both parties can be readily respected by placing the onus on provincial pharmacy boards to provide information on non-dissenting providers via toll-free numbers.
Some might argue that inconvenience is a form of oppression. But isn’t it a greater oppression to ask one to betray deeply held beliefs than walk a few extra blocks?
A version of this article was originally published in “Holy Post”, the religion blog of the National Post.