CommunicationA Publication of the Society of Pharmacists Inc.

Continuing Education: Therapeutic Options Focus on Continuous and Extended Hormonal Contraception The Last Word: Why it Takes so Long to Get New Drugs Approved – Behind the Science, Economics Rules

January/February 2008 Vol. 33, No. 3

The Voice of Pharmacists in Manitoba

Publication Mail Agreement No. 40013710 Return Undeliverable Canadian Addresses To: The Manitoba Society of Pharmacists 202–90 Garry St., Winnipeg, MB R3C 4H1 SERVING PHARMACISTS THROUGHOUT MANITOBA

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2 C OMMUNICATION J ANUARY /F EBRUARY 2008 THIS ISSUE J ANUARY /F EBRUARY 2008

Up Front Pharmacists New Year’s Resolutions 4 Manitoba Society of Pharmacists Can it really be time once again for Communications 3rd Bi-Annual “Pharmacist’s New Year’s Resolutions”? Board of Directors Jay Rich, President, Communication Chair Sounding Board Mel Baxter, Vice-President Members speak up and speak out 5 Elmer Kuber, Honorary Secretary Treasurer Bonnie Coombs, Government Relations Chair, By-Laws Chair Feature Article Michelle Glass, Pharmacare Chair Brent Havelange, Economics Chair MSP Holiday Reception 6 The Manitoba Society of Pharmacists annual Holiday Reception was held on Nancy Remillard, Professional Relations Chair December 13th, 2007 at the Hotel Fort Garry. Carey Lai Tim Pattern Nominations for MSP Award of Merit Liaisons Award of Merit 7 is bestowed upon an active member of the Manitoba Society of Pharmacists in Elmer Kuber, Insurance Liaison recognition for active participation and promotion contributing to the benefit of the Ron Guse, MPhA Liaison MSP and the Profession of . Elmer Kuber, CPhA Liaison Sarah Myk, Student Liaison Feature Article

Scott Ransome, Executive Director & Editor Non-migraine headache 8 Jill Ell, Assistant to the Executive Director, Editorial Assistant, Membership Benefits Chair Feature Article Bill 41 Regulations 11 Editor/Publisher It is the goal of MSP to make available all the information members need to be Manitoba Society of Pharmacists informed about the Bill 41 Regulations. 90 Garry Street, Suite 202, Winnipeg, MB R3C 4H1 Telephone: (204) 956-6680 or 1-800-677-7170 Feature Article [email protected] www.msp.mb.ca

COMMUNICATION is published six times a year. The subscription Expanding Clinical Offerings with the Right Tools 12 rate is $12.00 per issue, $77.04 per annum (including GST). The Catching up with the Clinical Services program’s first participants and seeing inclusion of proprietary names in this publication is for reference where they are one year later. only. The inclusion of brand names does not imply that the brands listed are in any way preferable to those not listed. The sources of information are published articles in pharmaceutical and medical Pharmacist Awareness Week 2008 journals, private communications, etc. Incorrect quotations or interpretations are possible but not intentional. The views “Pharmacists–Your Trusted Partner in Health” 14 expressed in COMMUNICATION do not necessarily reflect the views Your Professional Relations Committee is currently planning this year’s of the Manitoba Society of Pharmacists Inc. The Society assumes Pharmacist Awareness Week (PAW) and is looking forward to this year’s new no responsibility for the statements and opinions advanced by theme: Pharmacists – Your Trusted Partner in Health. contributors in COMMUNICATION. Material from COMMUNICATION may be copied provided that the source is acknowledged. The deadline for submission of material for inclusion in COMMUNICATION is the 15th of February, April, June, August, October and December. Q&A: Getting To Know Your Manitoba Pharmacists

ISSN 0829-6197 Lori Janeson 16

Printed in Canada by: Leech Printing (204) 728-3037 Classifieds Publication Mail Agreement No. 40013710 Pharmacist Wanted 17 Return Undeliverable Canadian Addresses to: Manitoba Society of Pharmacists 202–90 Garry Street The Last Word Winnipeg, MB R3C 4H1 Why it Takes so Long to Get New Drugs Approved Email: [email protected] – Behind the Science, Economics Rules 18 How long does it take for a new drug to be approved for used?

M ANITOBA S OCIETY OF P HARMACISTS C OMMUNICATION 3 UP FRONT Pharmacists New Year’s Resolutions

Can it really be time once again for Communications 3rd Bi-Annual “Pharmacist’s New Year’s Resolutions”? All I can wonder is where the time has gone, so without further adieu:

• “Remember to put the extra 2 tab- keep your New Year’s Resolution of will send this as a topic idea for the lets in the box when a patient fills 30 course… “College of Physicians and Surgeons and the pack size is 28”. Now seri- New Year’s Resolutions”…) ously, I’m all for saving the environ- • “Do not prejudge”. I’ve often won- ment as much as the next person, dered if the guy in the hardware but would it really take that much store listens to my question and JAY RICH more packaging to fit a lousy 2 more Communication Chair thinks to himself, “Wow, what an pills in that box at the manufac- idiot”. Remember that the next time turer level? Note to drug compa- you are repeating your recommen- nies: There are typically 30 days in • “Remember that the first question dation for the 3rd time… a months supply, not 4 weeks…buy is not the real question”. People will • “Be proud of your Profession”. It a calendar with all the money you often ask you some vague distract- has its warts, always seems to be in are saving… ing questions before getting to the some state of turmoil, and is really • “Repeat all recommendations a true issue (which is usually “can I fun to poke fun at (without such minimum 3 times”. Have you every have a drink with that…”). This is fodder, I do believe this column noticed that no matter how suc- particularly evident but not limited would not exist…), but really, is cinctly you deliver a recommenda- to the Friday and Saturday evening there a more diverse and rewarding tion, you have to repeat it at least pharmacy shifts… profession on the face of the earth? 3 times before it is accepted? And • “Check if it is a Doctor on the phone I am and always will be proud to be heaven forbid that the suggestion before leaving it on hold for a few a pharmacist (and no, I’m not dip- is not the one that they want to precious minutes”. How long do ping into the kool-aid a little early hear (maybe we should call them we spend on the phone every day for my 2008 celebration…) confirmations instead?), well then waiting to clarify something that Happy 2008! Here’s to You, Us, you have an all out war on your they have already had one chance and Our Profession…times 3… hands…just surrender and start at getting correct? Newsflash: we backing away, er, I mean after you are busy too. Enough said (I think I

4 C OMMUNICATION J ANUARY /F EBRUARY 2008 SOUNDING BOARD

The Sounding Board is here for members to speak Jan. 2, 2008 up and speak out on issues that are of interest to pharmacy. The Sounding Board is not intended to Manitoba Society of Pharmacists be an expression of the opinions of the Manitoba 202-90 Garry St. Society of Pharmacists, but rather is meant to be a Winnipeg, MB R3C 4H1 forum for opinions and thoughts. We encourage you, our members, to write in with your opinions on the Re: Sounding Board topical issues of the day. I recently received the Pharmaceutical Act Draft Regulations, and it appears there has been some significant changes since the regulation discussion documents were circulated. I recognize that the new regulations will impact on the practice of pharmacy in Manitoba for many years, and like many of my I agree with your position on the managerial colleagues I have devoted considerable effort to requirements of new pharmacists. I can speak from keeping myself informed on the proposed legislative experience that Rossburn would not have had a and regulatory changes. pharmacist if the current recommendations were I would like to compliment the Manitoba Society law at the time of my graduation. I was licensed and of Pharmacists (MSP) on your efforts to provide the working as pharmacist/manager within 1 week. I membership with the resources necessary to understand was quite able to fulfill both of these roles with no the potential impacts the new regulations may have further training required. on the profession. Communication Plus provides timely information on all important developments. Tracy Lelond-Young The MSP website is a particularly useful resource. The questionnaire process has provided a structured approach that allowed me to view and approach the document piece meal versus the overwhelming whole. The results of the questionnaire provide an overview of opinions on many of the more significant topics, and the position statements which MSP has issued provide informative views. MSPs efforts to keep pharmacists informed helped me understand the discussion documents better. There are going to be significant developments with the regulation development process over the coming weeks and months. I trust that MSP will continue to demonstrate leadership and will also continue to Rexall Pharma Plus, a highly successful Canadian pharmacy retailer, is dedicated to its services, its standards provide the membership with the information and and, above all, the health and wellness of its customers. resources necessary to make informed decisions. I We are seeking the following professionals for positions hope that more pharmacists will choose to become across Manitoba: active in this process. After all, eventually all Manitoba Pharmacists pharmacists will be asked to decide whether they Pharmacy Technicians approve the draft regulations. Pharmacy Managers

If you are interested in joining our team or learning more Yours truly, about Rexall Pharma Plus opportunities, visit us online, Jason Pankratz or contact: Manitoba Pharmacist Alan Wilson, Regional Pharmacy Director E-mail: [email protected]

www.rexall.ca

M ANITOBA S OCIETY OF P HARMACISTS C OMMUNICATION 5 101407kat_v3.indd 1 6/22/2007 2:10:39 PM FEATURE ARTICLE MSP Holiday Reception

The Manitoba Society of Pharmacists annual Holiday Reception was held on Dec. 13th, 2007 at the Hotel Fort Garry. The reception was attended by the MSP Board of Directors and staff, representatives from the Canadian Society of Hospital Pharmacists – MB Branch, the Canadian Pharmaceutical Association, the Manitoba Pharmaceutical Association, Manitoba Health, Industry and stakeholders.

MSP Life Member Archie Orlikow, MPhA Registrar Ron Guse CSHP – MB Branch President Giuseppe Aletta and and MSP Board Member and Economics Committee Chair MSP Board Member Carey Lai Brent Havelange

6 C OMMUNICATION J ANUARY /F EBRUARY 2008 NOMINATIONS FOR AWARD OF MERIT Nominations for the Manitoba Society of Pharmacists Award of Merit The Award of Merit is bestowed upon an active mem- 5. This award is not presented posthumously. ber of the Manitoba Society of Pharmacists in recognition 6. Submissions for this award must be in the hands of the for active participation and promotion contributing to the Board of Directors prior to Feb. 4, 2008. benefit of the Manitoba Society of Pharmacists and the 7. The award is presented as such time as deemed appro- Profession of Pharmacy. priate by the Board of Directors. This award was established for initial presentation in 8. Power of decision for granting of the Award of Merit rests 1995. The criteria for nominations are: with the Board of Directors of MSP. 1. The nominee must be a pharmacist in good standing 9. The MSP Award of Merit is not necessarily granted every with MSP. year. 2. Nomination forms are to be submitted with the names and signatures of at least three (3) members in good Past recipients of the Award of Merit are: standing with MSP. 1995 Don Radley 2005 Ralph Whitfield 3. The submission shall outline the nominee’s qualifica- 1997 Barb Cinnamon 2006 Tom Busch tions and contributions for receipt of this award. 1999 Morna Cook 2007 Marian Kremers 4. The nominee may not be currently serving as a Director of the Society or on the Awards Committee, except in an If you would like to forward a nomination for the ex-officio capacity. Award of Merit please complete the form below.

NOMINATION PAPER Manitoba Society of Pharmacists Award of Merit 2008 TO THE CHAIR OF THE NOMINATING COMMITTEE, MANITOBA SOCIETY OF PHARMACISTS INC.

We, the undersigned members of the Manitoba Society of Pharmacists Inc., being entitled to vote at meetings of the Society, do hereby nominate the following member of the Society as a candidate for the 2008 Award of Merit.

The candidate is an active member of Manitoba Society of Pharmacists and their contribution to the benefit of the society include: ______NAME OF NOMINEE ADDRESS

(please print) NAME OF NOMINATING MEMBERS: 1. (please print) (signature) 2. (please print) (signature) 3. (please print) (signature)

The nomination is effective as of ______.

Please forward the completed nomination form to the Manitoba Society of Pharmacists 202-90 Garry St. Winnipeg, MB R3C 4H1 PRIOR TO FEB. 4, 2008.

M ANITOBA S OCIETY OF P HARMACISTS C OMMUNICATION 7 FEATURE ARTICLE Non-migraine headache

Pathophysiology Acute Muscle Contraction Headache (MCH) Cephalgia or headache is Acute muscle contraction headache also called an pain in various parts of the acute tension headache is the most common type of head, not confined to the area headache occurring in about 50% of the population on a of distribution of any nerve.1 monthly basis (intermittent). Its exact etiology is unknown The brain is not sensitive to but patients will often associate muscle tension and men- pain because it lacks pain-sen- tal stress with acute tension headaches. Symptoms of MCH sitive nerve fibers. The menin- include at least two of the following: ges and blood vessels have pain perception as do areas of • Bilateral the scalp, face, mouth and throat supplied by a network of • Non-pulsating nerves that relay the sensation of pain to • Mild to moderate intensity the brain. Muscles of the head also are • Not aggravated by routine activi- sensitive to pain. ties There are five types of headache: • Difference in duration (30 min- MEERA B. THADANI • myogenic (originating from mus- M.Sc.(Pharm.) utes to 7 days) compared with cles, for example muscle contrac- migraine (2 – 72 hours) tion headache) Symptoms such as nausea, photophobia, phonopho- • vascular (migraine and cluster headaches most com- bia with or without aura (usually visual) indicate a migraine mon) and require referral to a physician. • cervicogenic (originating from disorders of the Treatments for acute intermittent muscle contrac- neck) tion (tension) headaches with non-prescription analgesics • traction (traction or irritation of the meninges and (Figure 1) include: blood vessels) • acetaminophen • inflammatory (symptoms of other disorders such as • aspirin sinus infection) • ibuprofen This article will focus on myogenic and vascular head- • exempted codeine products5 aches. If the headache has not resolved after 5 days, guide the patient to their physician for further assessment. Headaches are described as: Non-pharmacological treatments such as massage, • acute or chronic warm baths or relaxation are also helpful for acute MCH. • intermittent or continuous The majority of patients suffer from acute intermittent headache broadly described in two diagnostic categories: • migraine headache and • muscle-contraction headache (MCH). Chronic headaches are those that occur on a daily or near daily basis. If they are less than four hours in dura- tion, they are likely to be included in the category of clus- ter headaches. If they longer than four hours in duration (continuous) they are likely termed chronic daily headache (CHD) with or without analgesic dependence. While not common, other forms such as “ice-cream”, “ice-pick” or “brain freeze” headache triggered by cold do occur. Figure 1; Non-prescription analgesics

8 C OMMUNICATION J ANUARY /F EBRUARY 2008 Cluster headaches • neck stiffness Cluster headaches occur more often in men than • migraine-like symptoms women. They are much less common with an estimated • pain lasting more than four hours duration on more prevalence of 0.1 to 0.24% in the general population.2,3 than 15 days of the month. Characterized by intermittent attacks of a unilateral head- ache (Figure 2) with symptoms that can include: 2. Chronic daily headaches with analgesic dependence • Sudden onset Patients who suffer from migraine headache or have a • Excruciating pain period of acute high frequency headaches may increase the • Located around the eyes use of analgesics during this time. The analgesic is effec- • Red, teary eye(s) tive but when analgesia wears off, the headache returns • Droopy eyelid (ptosis) (rebounds) stimulating the use of more drug. • Nasal congestion and rhinorrhea Therapy requires physician intervention with: • Forehead and facial sweating • Physiotherapy to the neck; hot and cold packs to A cluster headache can last between 15 minutes to 3 neck muscles hours occurring with a frequency of once every other day to • Effective use and monitoring of prescribed medica- up to eight times daily.4 Cluster headaches can be: tion • Episodic – most common (80-90%), characterized by • Avoidance of analgesics periods of headache lasting from weeks to months with months to years of remisson. “Ice-cream”, “ice-pick” or “brain freeze” headache • Chronic – less common (10-20%), symptoms for Up to 5% of referred patients experience “ice-cream” more than one year with pain free periods of less headache. This headache is described as: than 14 days. • a sharp, short, piercing pain • lasting from 15 to 30 seconds • occurring several times a day • being centered around one eye Figure 2. Cold temperatures or cold food can set off this head- Unilateral cluster headache ache. If the patient describes this type of headache in absence of triggers, it is cause for concern because there may be an underlying problem requiring investigation. Preventative therapy requires long acting NSAIDs pre- Patients suffering from cluster headaches require phy- scribed after physician assessment. Pharmacists can reas- sician referral. Non-prescription products are not effective sure patients that attacks triggered by cold are not the in the treatment of cluster headaches. Pharmacists can result of serious underlying disease. suggest non-pharmacological measures such as relaxation, Table 1 provides a summary of headaches encountered decreasing alcohol intake, smoking cessation and self- in clinical practice. assessment (headache diary) to help patients cope with this condition. Providing patients with drug information Assessment questions for their prescribed medications and knowledge about If the patient answers “yes” to any of the following cluster headaches is helpful to their understanding and questions, refer the patient to their physician as soon as management of their headaches. possible for further assessment for the presence of possible underlying secondary conditions. Chronic daily headaches 1. Is this a change in the pattern of your headaches? The chronic daily headache is a descriptive rather than 2. Is this a new or different headache? (Especially impor- diagnostic term. These headaches fall into two categories: tant for patients 50 or older) 1. Chronic daily headaches without analgesic dependence 3. Is this your worst headache ever? This headache is present on most days, over a six- 4. Is your headache associated with a fever, pain in your month period or longer and characterized by the presence jaw or weight loss? of: 5. Do you have symptoms such as, muscle weakness, hear- • low grade muscle contraction ing or vision disturbance?

M ANITOBA S OCIETY OF P HARMACISTS C OMMUNICATION 9 6. Did the headache come suddenly (peak Table 1 Characteristics of Primary Headaches intensity seconds to minutes)? Migraine Tension Cluster Chronic Ice-pick Location Unilateral bilateral strictly neck/ unilateral The bottom line unilateral unilateral When patients experience a headache, Intensity Moderate Mild to Severe Low grade Sharp the pharmacist is the most accessible health to severe moderate ongoing professional available they can turn to for Duration 4 – 72 30 min – 7 15 – 90 15 – 90 15 – 30 help and counsel. Therefore, it is impor- hours days minutes minutes seconds tant for pharmacists to know the differ- Quality Throbbing Tight, Severe Ongoing Severe ences between various types of headaches. pressing Misdiagnosis, for example, of migraine Associated Yes – with No Yes – Yes – Yes – headache as an acute tension headache, symptoms or without autonomic muscular ocular can lead to delay in appropriate treatment aura and management. Non-prescription prod- Gender Female > Female > Male > Male > Male = ucts can manage only acute intermittent male male female female female muscle contraction (tension) headaches. Refer all other types for assessment by the References: physician. 1. Stedman’s Medical Dictionary on CD-ROM, 1997. 2. Worthington, I., Patient Self Care, Canadian Pharmacists Association, Ottawa, 2002. 3. Dawson, A.J., The Pharmaceutical Journal, Vol. 268, 176-178, 2002. 4. Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for headache disorders, cranial neuralgia and facial pain. Cephalagia, 8(Supplement 7), 1-96, 1998.

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10 C OMMUNICATION J ANUARY /F EBRUARY 2008 FEATURE ARTICLE

Bill 41 Regulations The second vehicle is the MSP Website. The Society has It is the goal of MSP to make available all the informa- used the website to create a one stop shop for information tion members need to be informed about the Bill 41 regarding the regulations including documents from MSP, MPhA, and various other Stakeholders. By visiting the Bill 41 Regulations. There are two vehicles that have been area of the website access can be gained to the results of the developed to assist with keeping members informed. MSP Online Questionaires, MSP Position Statements, both of The first is “Communication Plus” the email newsletter the MPhA Discussion Documents, the Draft Pharmaceutical that is forwarded to all members who have provided their Regulations Policy Document and many other background email addresses with their membership. “Communication materials that are related to the process. You can find all this Plus” is sent out when there is an issue that the mem- information at www.msp.mb.ca. bership should be aware of and has been an extremely The following Website illustrations can be used as a useful tool during the past year. If you are not receiving guide to access the Bill 41 – Regulations area of the MSP “Communication Plus” and would like too please contact Website. Please note the Forum which has been developed the Society at [email protected]. specifically for members to voice their opinions.

M ANITOBA S OCIETY OF P HARMACISTS C OMMUNICATION 11 FEATURE ARTICLE Expanding Clinical Offerings With The Right Tools Catcing up with the Clinical Services program’s first participants and seeing where they are one year later

Reprinted with the permission of the Pharmacists Association

Pharmacists who took the Clinical Services program a year ago are now making use of what they learned to expand their clinical programs. The British Columbia Pharmacy Association first intro- duced the Clinical Services Certification Program at the May 2006 Annual Pharmacy Conference. It was developed and is taught by pharmacist Diane Hindman. A second session followed in October 2006. Over 50 pharmacists enrolled in the program between the two sessions. The program provides the tools for community phar- macists to develop their own clinical services offering. It helps pharmacists define their clinical program and learn how to successfully market and communicate the benefits of their services. The course shows participants how to determine the cost of operating a clinical program, and Information learned in the Clinical Services program gives them the tools to calculate a fee. Pharmacists also helped pharmacist Derek Desrosiers develop “Breathing Matters,” and asthma education program. learn how to place a fair value on their services. Cameron Zaremba is a community pharmacist at Dyck’s Medicine Centre in Kelowna, and was one of the participants at the May 2006 program. “It’s useful in the How is the information being used? sense of thinking of all the variables that go into setting the The knowledge, tools and information learned through price, overhead, itemizing it, also if you’re looking at com- the Clinical Service program are serving different pharma- parative value,” he says. “I think we tend to undervalue the cists in a broad variety of ways. Zaremba, who had been price that we can charge.” offering patients a 2.5 hour hormone replacement therapy The Clinical Services program helps people set a more clinical session before attending, learned to place a more realistic price, and gives them the information and per- accurate and reasonable value on it. spective to be confident in that price, Zaremba says. “I raised the price,” he says. Looking at the tools and Derek Desrosiers, CEO of uniPHARM agrees. He also formula provided by the Clinical Services program, the took part in the May 2006 session. “That was one of the new price is fairly close to what would be recommended. things that I really liked about that program, it went right That costs is paid by the patient. Zaremba says that pricing into marketing and pricing. I think that’s a really big deal. things to cover costs and make a profit, “puts the onus on “This program was one of the simplest ways to learn you to ensure that what you’re providing is useful. how to go about adding a new service to your business,” “If they’re paying money for it, they’re actually expect- Desrosiers says. ing more.” Which is good, he says, because then your Danka Grguric, pharmacist at Macdonald’s audience are people who are serious about managing their Prescriptions, took the program in October 2006, and says health. Zaremba is also looking at providing additional it helps participants flesh out the steps they have to take clinics, one on diabetes, and expanding the size and depth turn an idea into a successful offering. “Everyone probably of his current HRT clinic. had some ideas of what they would like to do, and it could After taking the session Desrosiers got to work develop- help shape the idea, and it could promote, enforce or speed ing an asthma education program for all uniPHARM stores up the execution of that idea.” to use. “The [Clinical Services] program helped us move in a different direction,” he says. They also developed a foot

12 C OMMUNICATION J ANUARY /F EBRUARY 2008 clinic and polished up a walking to wellness program, using Her goal is for the folder to “make patients more proac- different parts of the Clinical Services program. tive, and to make patients and their family aware that we Aside from that he has worked with around 15 indi- are here, that we can coordinate, at the same time we are vidual stores to put together their own unique clinical doing that with the renal teams, showing them that we can offerings. “I worked with the stores with that knowledge,” be more involved.” he says. His time investments are paying off, since the new Going forward with Clinical Services programs are doing quite well, “We’re having success in Offering clinical services is something all getting people to reach into their pocket and pay for these should be looking at says Desrosiers. “Pharmacists need things because [they’ve] been marketed right and designed to be planning now to find alternate revenue streams and right.” to expand their horizons in terms of the types of programs Grguric hasn’t yet implemented any changes using the they offer to their patients which will lead to a scope of knowledge she gained from the program, but it helped her practice change … now it the time,” bet the ball rolling on her first major idea. As a pharmacy “I think it a very useful program, its one of the most serving renal patients, her pharmacy has developed an idea useful ones I’ve taken,” says Zaremba. His advice to store’s for a comprehensive, personalized folder for each patient looking to start their own program is: “you have to be per- that coordinates the advice and directions given by each sistent. The biggest step is the first one, just trying it, and member of the entire renal team. “We did show it to the of course finding the time. It’s a lot of fun, that’s one reason Renal [Agency] and they liked it. It’s too early to see where’s that I keep doing it.” it’s going to go.”

t also means that pharmacists can play an increasingly important role as part of the primary health care team, working with patients “ I to ensure they are using medications appropriately and providing information to physicians and patients about the effectiveness and appropriateness of certain drugs for certain conditions. This expanded role would allow pharmacists to consult with physicians and patients, monitor patients’ use of drugs and provide better information and communication on prescription drugs. Roy Romanow – Page 207, Building on Values, The Future of Health” Care in Canada SAFEWAY PHARMACY CANADA SAFEWAY has current CAREER OPPORTUNITIES for both FULL TIME PHARMACISTS AND PHARMACY MANAGERS in Fort Frances, ON, Kenora, ON, Winnipeg, MB, Salmon Arm, BC and Duncan, BC. ❑ Are you looking to work in a patient focused care setting? ❑ Do you want to work for a company which provides a strong team environment? ❑ Are you looking for a company that can provide you room to expand your skills and future opportunities? ❑ Do you want to feel secure and work for a company that will provide you an outstanding benefits package as well as bonus potential for your skills? We offer a Full Compensation and Benefits Package with industry-leading components. Our Bonus Plan allows you to participate and receive benefits as a full time Pharmacist/Pharmacy Manager every year. In addition, we believe in reimbursement for cognitive services and have developed positions in many practicing specialties including: ◆ Long Term Care Clinical Pharmacists ◆ Certified Menopause Educating Pharmacists ◆ Asthma Certified Pharmacists ◆ Certified Diabetes Educating Pharmacists ◆ Men’s and Women’s Health Specialty Pharmacists Together, the Safeway family is one of the largest employers of retail pharmacists in North America, and in Canada operates pharmacies in British Columbia, , , Manitoba and . If you are a pharmacist who is licensed to practice in Canada and looking to provide patient-focused care within a strong team environment, then this opportunity may be for you. If you would like to pursue this opportunity further, please send a cover letter and resumé by e-mail or fax to the address below: CHRISTINE LEE, B.Sc. Pharm – Pharmacy Recruiter CANADA SAFEWAY LTD., 7280 Fraser Street, Vancouver, BC V5X 3V9 Phone: (604) 301-2632 • Cell: (604) 603-1079 • Fax: (604) 322-2508 • Email: [email protected] Web Site: www.safewaypharmacy.ca

M ANITOBA S OCIETY OF P HARMACISTS C OMMUNICATION 13 PHARMACIST AWARENESS WEEK 2008 “Pharmacists -Your Trusted Partner in Health” Your Professional Relations Committee is currently plan- raise provider and public awareness of the benefits of clear ning this year’s Pharmacist Awareness Week (PAW) and is communication to improving patient safety. looking forward to this year’s new theme; Pharmacists -Your In addition to our usual radio advertising, print ads and Trusted Partner in Health. This year’s PAW Campaign runs news releases throughout PAW, we will be holding a joint from March 3rd to 9th, 2008. seminar with MPhA and inviting Pharmacists to promote The Manitoba Society of Pharmacists, Manitoba both the Collaborative Abbreviation Project and the “It’s Safe Pharmaceutical Association and the Winnipeg Regional to Ask” Medication Card. The Med Card will be available Health Authority are partnering with the Manitoba Institute later this spring, and pharmacists will be the first health care for Patient Safety to promote two projects; providers to pre-order plastic folders & the Collaborative Abbreviation Project and ERIK kits with their store name and logo the “It’s Safe to Ask” Medication Card. Both imprinted on the front during the week projects will be advertised concurrently, TERESA MURRAY of PAW. Pharmacists are also encouraged the Abbreviation Project will target physi- to continue ordering the “It’s Safe To Ask” cians and other health care providers while posters and brochures from MIPS for the “It’s Safe to Ask” Medication Card targets the public. Pharmacy Awareness Week 2008. The Collaborative Abbreviation Project is a provincial If your pharmacy would like to order “It’s Safe to Ask” effort designed to build on the regional policy of medica- posters and brochures please call 204-927-6477 or email tion order writing standards, introduced by the WRHA. The [email protected]. If you have any questions about PAW project provides posters and a banned list of abbreviations, 2008 or for more information, contact Jill at the MSP office at acronyms and symbols. The posters and the “do not use list” 956-6680. will form part of a tool kit for organizations to promote aware- Your PR committee encourages you to start planning ness around the “do not use list”. The development of the tool your PAW event early… Spring is just around the corner! kit is underway, as well as a promotional video demon- strating the “do not use list” and how to complete the Medication Card. The “It’s Safe to Ask” Medication Card was devel- It’s Safe oped to support medication reconciliation, being con- ducted in acute, long term care and community settings to Ask throughout Manitoba. Focus groups are being con- ducted to test a final version of the Medication Card. The Boni-Vital Council for Seniors has also been approached Ask your doctor, to discuss possibilities of amalgamating the Med Card nurse or pharmacist… with the health information form that is currently part of the Emergency Response Information Kit (ERIK). What is The ERIK kit is widely distributed across Manitoba and my health widely recognized by the public and providers. In addi- 1 problem? tion, the Paramedics Association of Manitoba, a partner in ERIK, is interested in partnering in distribution to help What do I raise awareness of the new Med Card. 2 need to do? This year’s PAW Campaign will incorporate the Manitoba Institute for Patient Safety’s “It’s Safe to Ask” Why do I theme with the MSP “Pharmacists –“Your Trusted need to Partner in Health” campaign to bring awareness to 3 medication safety. do this? The goal of this year’s campaign is to show the importance of medication safety and its affect on patients, families and the health care system and to

14 C OMMUNICATION J ANUARY /F EBRUARY 2008 Save the Dates

April 11th, 12th and 13th, 2008

The Victoria Inn 1808 Wellington Avenue Winnipeg, Manitoba

Announcing the 2008 Honorary Conference Chair Bonnie Coombs Bonnie Coombs worked retail pharmacy for Super Thrifty Drugs for some 20 years before moving to Pharma-Medic Services in 1993. Since then she has managed Pharma-Medic Services and looked after the medication needs of the long term care residents in Brandon. In the past she has served on the Shared Services Committee (formation of the BRHC), on the Board of Fairview Home and on the Council for Post-Secondary Education for Manitoba. She has served on the MSP PCH Negotiating Committee for the past five years and has been a Director on the MSP Board for the past three years. Bonnie is currently Chair of the MSP Government Relations Committee, and By-laws Committee and is a member of the Economics Committee. She also serves on the Standards of Practice Committee at MPhA. Bonnie is a long time member of International Training in Communications and has served as President of Land O’ Lakes Region. She also reserves some time for her four grandsons, all under the age of two!

Prescription For A Bright Future Wal-Mart Canada is committed to providing superior Pharmacy service to our customers. We have an aggressive growth plan for the coming years and are looking to hire dedicated and dynamic professional Pharmacists to provide counseling and support to Wal-Mart customers. LivingSmart Pharmacy • Unparalleled career opportunities • A unique culture based on Respect for the Individual, Service to Customer and Strive for Excellence • Wal-Mart pharmacies take pride in offering top-quality products and personalized patient focused service • State of the art Connexus pharmacy software Our Benefits and Advantages • Discounts on entire range of Wal-Mart products & services, including grocery items • Comprehensive Benefits Package, including 100% Paid Pharmacy licensing • Student Bursary Program • Professional environment that pays for and encourages continual education • Paid overtime opportunities and flexible scheduling arrangements • Stability of working for the largest retailer worldwide Locations available throughout Canada To jump start your career, send your resume to [email protected]

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M ANITOBA S OCIETY OF P HARMACISTS C OMMUNICATION 15 Q&A: GETTING TO KNOW YOUR MANITOBA PHARMACISTS

Name: Lori Janeson Pet peeves: complaining without action Place/Year of Graduation: U of S 1992

Years in Practice: 15 Favorite fictional char- Currently Working: Jan Pharmacy 250-530 Kenaston Blvd, acter and why: Ash from Winnipeg, MB R3N 1Z4 the Dark-Hunter series Accomplishments in pharmacy: Worked as a staff phar- by Sherriln Kenyon, He is macist in Wadena, SK, Vancouver, BC, Saskatoon, SK and all powerful but has inte- Winnipeg, MB. grety. Owned Pharmasave #456 at 1883 Grant Avenue Winnipeg, What could you do with- MB from 2004-2007 out forever: Recorders Own and run Jan Pharmacy mailorder since 2004 What couldn’t you do without for even a day: Coffee Family: Husband David Janeson, 3 kids, Tony - 7 years, Annika - 5 years and Miles - 1 year. What you love about pharmacy: The interaction with people, learning about their lives and helping to make their Hobbies: Reading, scrapbooking, scuba diving, skiing, lives a little more pleasant. sledding, playing with kids. Community activities: Pastoral Care committee at Westworth United church from 2005-2007 Do you know someone who is making a difference Favorite thing about Manitoba: Close to family and friends, in the pharmacy community? wide variety of things to do and there is wide variety in We would like to highlight them in this article! landscape Please contact the MSP office at (204) 956-6681 Most relaxing vacation choice: Beach resort or [email protected].

Pharmacists-at-Risk Grant A. Stefanson Visit our website at (204) 925-5376 Richard M. Rice www.pharmarisk.mb.ca (204) 925-5358

D’ARCY & DEACON LLP enjoys a carefully built reputation as one of the foremost law firms in Winnipeg. Our lawyers bring comprehensive experience and proven expertise to the institutions, businesses, organizations and individuals we serve. Respect for the well-being of our clients, while “let us help...you...keep it together” maintaining the flexibility required to ensure the provision of direct and cost-effective representation and counsel, remain the cornerstones of our practice. Now two ways to contact us As part of that mandate, D’ARCY & DEACON LLP is proud e-mail us at to provide legal services to Members of the Manitoba Society of Pharmacists (“MSP”). In consultation with the MSP, the [email protected] Firm has developed a unique Legal Assistance Program to maximize advantages available to Manitoba Pharmacists. or Written information regarding D’ARCY & DEACON LLP Phone 992-2704 and the Legal Assistance Program is available to all Members from both the Firm and MSP. All calls are CONFIDENTIAL

16 C OMMUNICATION J ANUARY /F EBRUARY 2008 CLASSIFIEDS

PHARMACIST WANTED for an independent in Steinbach. Full colour advertisement rates range from 1/8 9AM-5PM Mon-Fri. Must have great communication skills and an attitude to match. PH: 346-1970 [email protected] page to full page. Save more with multiple issue ad placement. MSP members are entitled to place one free classified ad per membership year. Contact MSP for classified rates for non-MSP members and business (corporate) classified ads (priced according to size).

All rates are subject to GST. Space is limited. Call MSP today at (204) 956-6680 for the full current 2007 ad rate schedule. As a service to members, MSP maintains a list of employment opportunities. This list is updated every week and is available by fax or on our website at www.msp.mb.ca.

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M ANITOBA S OCIETY OF P HARMACISTS C OMMUNICATION 17 THE LAST WORD Why it Takes so Long to Get New Drugs Approved – Behind the Science, Economics Rules

How long does it take for a new drug to be approved There is some rationality in the different wait times. Biologicals tend to have more new active substances (NAS) for use? It depends on the type of drug, who is doing than pharmaceuticals. A NAS is defined as a therapeutic the approving, and the peculiar balance of winners and material that has not previously been approved in any form, losers in drug regulation. not previously approved for sale in Canada, a derivative of The average time it takes to approve a new drug in a previously approved substance that differs in safety or Canada was 462.6 days between 2001 and 2005 compared efficacy, or a biological material that has previously been to 418.8 days in the U.S. in the same period, according approved for sale in Canada but that differs in molecular to data from Health Canada and the U.S. Food and Drug structure, source material or method of manufacture. Administration. If the issue at hand is eczema, the differ- Any new drug containing a new active substance tends ence may not matter. If it’s cancer, it could hardly matter to face a longer and more rigorous review than a pharma- more. ceutical that is just a reformulation or manipulation of exist- Brett J. Skinner is Director of Health, Pharmaceutical and ing approved drugs. Health Canada has a fast-track method Insurance Policy Research at the Fraser of review for innovative new drugs and Institute, a Vancouver-based think tank. for drugs that are to be used on serious or In an article he co-authored with Fraser life-threatening illnesses where there is Institute policy analyst Mark Rovere, no existing drug in Canada or the existing drugs appears to be less efficacious than “Waits for Access to New Biological and ANDREW ALLENTUCK Pharmaceutical Medicines: Evidence of the new drug. All that is merely right and Government Failure,” in the June, 2007 reasonable, but there is another reason issue of the Fraser Forum, an institute publication; he exam- for delays that has little to do with efficacy ines the causes of delays in drug approval. and more to do with bureaucracy. Skinner and Rovere note that Health Canada has only a As Skinner and Rovere point out, the incentive for tenth of the FDA’s staff. But there is more to delays than just approving drugs varies depending on who pays for getting lack of personnel. The pace of approval also depends on the the review process wrong. If an unsafe drug is allowed into kinds of drugs under review, the process of qualifying drugs the market, the regulators pay in the form of bad publicity, for reimbursement by provincial health plans, and the per- injury to careers and even in the form of financial damage verse economics of fault. awards. In contrast, if a safe drug is not allowed into the Not all drugs are equal when it comes to the approval market, patients and drug makers pay in the form of loss of process. Health Canada reports that it used 633 days on beneficial treatments and lost sales. average in 2005 to approve new biological drugs compared In the case of a harmful drug that is admitted to the to an average of 397 days for new pharmaceutical medicines. market, damage is explicit and lawsuits can be plentiful. In What’s more, the disparity appears to be growing. In 2002, the case of a beneficial drug that is withheld from the mar- pharmaceuticals took 473 days for approval on average ket, lawsuits are unlikely. The balance of liability law and while biologicals took an average of 513 days. The disparity of career risk for those in the approval pipeline tilts toward was 40 days. But by 2005, approval took 397 days for phar- caution. maceuticals and 633 days for biologicals. The difference had There are also direct cost issues. New biologicals tend to grown to 236 days. be more expensive than other, older drugs. The provinces, The approval process only begins with Health Canada keenly aware of costs, tend to be slow in actions that may efficacy and safety reviews. Add in the Common Drug Review raise their drug budgets, Skinner and Rovere assert. process that added 186 days for biologicals and 257 days for “The impression [is] that cost, and not scientific assess- pharmaceuticals and the provincial reimbursement reviews ments of value, is driving decisions on public reimburse- that added 187 days for biologicals and 201 days for pharma- ment,” they explain. Their cure: 1) harmonize review stan- ceuticals in 2005 and we come up with an astonishing estimate dards with the EU and the U.S.; 2) set user fees paid by drug of 2.8 years needed for approval and review of biologicals and makers for drug reviews – regardless of outcome - on the 2.3 years needed for approval and review of pharmaceuticals, speed of processing of new applications by Health Canada; according to data collected by Skinner and Rovere. and 3) shift reimbursement for drug expense from provin-

18 C OMMUNICATION J ANUARY /F EBRUARY 2008 cial plans to what Skinner and Rovere say are more gener- Cap liability awards for damages caused by drugs. ous private insurance plans. Those private plans work less Capping would reduce the economic costs of injury by new on inclusion of drugs in formularies than on annual caps, drugs.. The downside of capping awards is that those injured copayment and deductibles, Skinner explains. by new drugs that, in hindsight, should not have been This set of solutions amounts to a shift of regulatory approved may not be adequately compensated. Capping power away from Canada and of drug insurance away from would add to drug makers’ profits as their payouts for injury government. Canada’s drug approval process would more and for product liability insurance decline. closely resemble that in the U.S., according to the Skinner Create a fund for compensating victims of drugs that and Rovere recommendations. turn out to be harmful. Drug makers would be required to Drug makers are adept at finessing the politics of regu- contribute to the fund or to establish bonds that would be lation. Adopting U.S.-style testing of new drugs would forfeit if, in hindsight, a drug approved should not have be likely to add to manufacturer profits. Joel Lexchin, a been. The fund would merely speed up the decades the con- Toronto physician, drug safety expert and professor at York ventional judicial process takes to compensate victims. The University’s School of Health Policy & Management, has cost of insurance or the cost of contributions to a compen- written extensively on the dangers of letting drug companies sation fund initially borne by drug makers would tend to be finance the regulatory process. He notes that in the U.S., passed on and add to total drug costs borne by patients or 70% of the $6 billion that goes into clinical research each their insurers. This cost could be diminished over time if the year comes from drug companies. “Research is kept secret money in insurance pools or held in accounts for possible to ensure that companies derive the maximum value from payouts were wisely invested as, for example, the Canada their investment,” he wrote in, “Pharmaceutical Secrecy Pension Plan does with funds it will eventually pay out as Endangers our Health,” a paper published by the left-lean- benefits. The cost per new drug approved might be relatively ing Canadian Centre for Policy Alternatives in May, 2007. small. After all, many drugs are approved each year but few Secrecy tilts the balance of interests to the side of those who turn out to be harmful. have data. Lexchin’s solution – reduce drug makers’ influ- Government should not manipulate science for finan- ence on the drug evaluation process. cial purposes, but it can adjust the balance of financial forces There are alternate ways of adjusting the economics of that obstruct the ability of science to help people. the drug approval process.

How are drugs reviewed in Canada?

Drugs are authorized for sale in Canada once Pharmacy is the most important part of our business at Shoppers they have successfully gone through the drug Drug Mart®/Pharmaprix®, and we want you to be a part of it! review process. This process is the means by which As Canada's leading pharmacy, we have tremendous career opportunities. We offer competitive salaries and benefits and, if you a drug application is reviewed by scientists in the have an entrepreneurial spirit, the chance to become a Pharmacist Owner. You will also have access to rewarding professional practice Therapeutic Products Directorate (TPD) of Health opportunities, career development, and leading-edge technology. Canada, and on occasion, outside experts, to assess Achieve your full potential while providing top patient care. the safety, efficacy and quality of a drug. We are currently looking for Licensed Pharmacists for the following store locations: Throughout the process, the safety and well- being of Canadians is the paramount concern. • Winnipeg, Manitoba • Thunder Bay, Ontario • Kenora, Ontario • Calgary, Alberta What is the Therapeutic Products • Red Deer, Alberta • Campbell River, B.C. • Osoyoos, B.C. Directorate? Shoppers Drug Mart has opportunities for pharmacists Health Canada’s TPD is the national authority and pharmacists/owners across Canada! Visit our website for more information. that regulates, evaluates and monitors the safety, efficacy, and quality of therapeutic and diagnostic www.shoppersdrugmart.ca products available to Canadians. These products For the experience of a lifetime, please contact, in strict confidence: include drugs, medical devices, disinfectants and Kari Ferguson, Recruitment Coordinator sanitizers with disinfectant claims. Phone: (403) 410-4800 e-mail: [email protected]

M ANITOBA S OCIETY OF P HARMACISTS C OMMUNICATION 19 8.25"

a healthy career matters take your career from coast to coast

POSITIONS ARE AVAILABLE THROUGHOUT CANADA INCLUDING: Alberta: Bonnyville, Calgary, Cold Lake, Drumheller, Fort McMurray, Fort Saskatchewan, High 10.875" Level, Lac La Biche, Lacombe, Lethbridge, Medicine Hat, Olds, Peace River, Rocky Mountain House, Vegreville, Wainwright, Whitecourt. British Columbia: Burns Lake, Campbell River, Courtney, Dawson Creek, Fort St. John, Merritt, Prince Rupert, Squamish, Williams Lake. Manitoba: Flin Flon, Winkler. : Edmundston, Grand Falls, Saint John, Shediac. Newfoundland: Grand Falls, St. John’s. : Antigonish, Barrington Passage, Kingston, Tantallon, Yarmouth. Ontario: Barrie, Beaverton, Bells Corner, Brockville, Cornwall, Dryden, Embrun, Gloucester, Guelph, Hamilton, Kapuskasing, Kemptville, Kingston, Kirkland Lake, Lindsay, Midland, Napanee, Nepean, Orillia, Oshawa, Ottawa, Owen Sound, Peterborough, Picton, Port Hope, Port Perry, Renfrew, Smiths Falls, St. Mary’s, Strathroy, Toronto, Whitby. Saskatchewan: Estevan, Moose Jaw, Prince Albert, Tisdale, Weyburn.

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CONTACT INFO For more information about available opportunities, please contact or forward your résumé to: DRUGStore Pharmacy National Recruitment Centre Phone 1-877 NATL JOB (1-877-628-5562) E-mail [email protected] Fax 1-866 NATL FAX (1-866-628-5329) Online www.drugstorepharmacy.ca

join our team – apply online www.drugstorepharmacy.ca

20 C OMMUNICATION J ANUARY /F EBRUARY 2008

Leech Printing, Brandon 157295

printed at 100% project information digital file information printing inks/colours, substrate, die line targets/tints internal perennial approvals

client: Loblaws file name: 9833LMO_DSP_ManCommAd_17Apr.ai Substrate Trim Pantone 369 C artwork approved: Y/N initials date(d/m/y) project: DSP Manitoba Ad job folder name: 9833LMO DrugStore Pharma_Manitoba (No Ink) (Do Not Print) (Process Target) Cyan Magenta Pantone 2935 C production artist: 07 docket #: 9833LMO-OR software/version: Adobe Illustrator CS2, Macintosh (Process Target) bill to docket #: 9833LMO-OR fonts used: Helvetica, Helvetica Bold, perennial inc. Yellow Black PMS 2935 Gradient production director: 07 artwork description: DSP Manitoba Ad Helvetica Black, Helvetica Light, (50% to 25% to 50%) 15 waulron street die line #/size: 8.25" x 10.875" Helvetica 77 Bold Condensed, proofreader: 07 toronto, on, canada M9C 1B4 print process: Digital Imaging Helvetica 67 Medium Condensed designer/ 07 colours available: 4 creative director: t) 416 •251•2180 line screen: Not supplied business manager: 07 f) 416 •251• 3560 upc size: n/a www.perennialinc.com ©2007 pre-press/printer: Not supplied perennial info panel - 02/01/07 Client is responsible for checking all copy before project prints. Colour special instructions production file history proof number perennial team separators, pre-press service bureaus and/or printers are responsible for verifying all technical/mechanical specifications, including but not • This mechanical artwork has been prepared size as - 100% start date: April 13, 2007 production artist: vhs limited to tolerances, registration, accuracy of measurements and • Placed images in this artwork are FINAL Hi-Res, to be used for colour separations and printing. production director: G.Athanasiou construction details before film and plates/cylinders are generated. date last modified: April 16, 2007 Any changes to accommodate print requirements must be submitted • This is a digital colour mechanical, no traps have been made. Trapping to be applied by separator. proofreader: K.Doris / C.Jordan to client for approval. Perennial makes every reasonable effort to • This proof/PDF is for colour break and content only and may not accurately reflect final printed inks. date released: 1. April 16, 2007 (vhs) 2 designer/creative director: N.Calalang / M.Kazalac ensure all artwork is error-free; however, we cannot be held responsible for any errors present once client provides final sign-off. • Do not open this file with software and version other than that specified. 2. - - - business manager: A.Bramnik