Is competition good or is it something to be avoided? Competition is actually a tremendous driving force; not only in life but also in business. First, let's look at competition as it involves life. In school we "competed" against other students for grades, honors, positions, play/music tryouts, and in sports. Can you imagine a football team that had a philosophy that their players did not have to compete for the "varsity team"?

Currently, popular "reality" television shows place talented individuals in direct competition with each other, and we enjoy watching them compete. In work and play, competition is good and builds character, maturity, and stamina.

How about competition in business though? What has happened to competition? I'm talking about healthy competition between "like businesses"? Let's look at what has happened in the business world to "eliminate competition"!

I remember years ago thinking that with the mergers of banks, department store chains, restaurants, gasoline/oil companies, and many other types of business that we were going to be losing something in our society. We now go to a cookie-cutter bank, restaurant, gasoline station, department store, etc., and have available to us the "most common" items that sell and have quick turnarounds, at businesses that employ clerks that can't even make change or are understandable if spoken to. If we are fortunate, we may also have access to some specialty shops and boutiques, etc. We have lost a lot of individualization and competition between similar businesses.

What has happened in the oil and pharmaceutical industry? It was easy to predict years ago what was happening with all the "mergers" and the "elimination of competition." Both of these industries can "set their own prices" and, guess what, there is very little we can do about it! The knee-jerk reaction is to let the government step in and handle it! However, that is not the answer. Government-approved mergers, corporate acquisitions, politics, and governmental programs encourage consolidation of activities and entities that the governmental agencies are required to work with (i.e., Medicare Part D).

So, we have a problem; now, what are we going to do about it? What would happen if we encouraged only "catastrophic medical insurance" instead of "colds, warts, and sniffles insurance" for which we pay through the nose? What would happen if individuals were required to pay for their medications for minor illnesses, etc. and only had insurance for major illnesses, such as cancer, heart attacks, etc. This could also impact state programs and tremendous savings if the states only paid for major illnesses and not minor, day-to-day expenses. This would place pharmacies more in a mode of handling cash instead of waiting on the "handout" from the insurance carriers.

I would not be surprised if families would save thousands of dollars annually this way. If one spends $500 to $1,000 per month for health insurance, catastrophic insurance should be much less and allow sufficient funds to cover minor ailments and have money left over. Not only that, but hospitals, physicians, pharmacies, etc. would be working with the patient/consumer, not with some cyber-space intermediary; isn't that a novel thought? This would also put the pharmaceutical industry back in the mode of competing for and servicing pharmacies instead of servicing primarily PBMs and seemingly not really caring about pharmacists.

I'm afraid that if we don't take a hard look at the loss of competition that we now have, we are going to see more and more monopolies in the business world and loss of control of our future! Think about this as you go by the bank for a loan to fill up your gas tank!

Loyd V. Allen, Jr., Ph.D., R.Ph
Editor-in-Chief

This Regulatory Update has been provided by the International Academy of Compounding Pharmacists. For more information, www.iacprx.org.

Senator Grassley Sends Letter to FDA, CMS on Compounding
On July 13th, Senator Chuck Grassley (R-IA, Chair of the Senate Finance Committee) sent a letter to the US Food and Drug Administration (FDA) and the Center for Medicare and Medicaid Services (CMS) that focuses on concerns with compounded inhalation medications. Among other requests, Grassley asked both agencies to comment on what they are doing to address concerns with compounding practice, what the federal role should be in regulating compounding, and whether the FDA needs additional authority over compounding to address the cited concerns. Specifically, the recent Midland victory in the question concerning enhancements to FDA's authority was cited. This implicit offer of legislative assistance to FDA is perhaps the most alarming element of Senator Grassley's letter.

Last week, the International Academy of Compounding Pharmacists and American Pharmacist Association met with Senator Grassley's staff to discuss some of the allegations raised in the July letter. We are working with other pharmacy organizations to explore solutions to the issues raised by Senator Grassley

IOM Issues Report on Prescription Errors
On July 20th, the Institute of Medicine (IOM) released a report that reviewed prescription errors in the US healthcare system. The report found that at least 1.5 million Americans are sickened, injured, or killed by preventable medication errors each year. The report provides numerous recommendations on how to reduce medication errors and suggests timelines for implementing changes.

Resources:
Washington Post. Medication Errors Harming Millions. July 21, 2006.
IOM Report: Preventing Medication Errors.

If you received a survey two weeks ago from IJPC and ACA, please take a few minutes to complete and return it. The survey was designed to assist ACA and other national pharmacy associations to better serve compounding pharmacies and assist all pharmacists in maintaining the right to compound prescription medications for patients of physicians and veterinarians. The results of the survey will be published in International Journal of Pharmaceutical Compounding (IJPC) in 2007. If you would like to learn more about ACA, please visit their website at www.acainfo.org.

Join IJPC at the First International Society of Pharmaceutical Compounding (ISPhC) Seminar held at the 66th International Congress of FIP on August 28, 2006, at Salvador Bahia, Brazil.

The first ISPhC Symposium will present an innovative and exciting vision of the role of quality pharmaceutical compounding in contemporary pharmacotherapy by six experienced speakers, coming from very different countries and working in different environments. They will discuss critical topics concerning pharmaceutical compounding, including the reasons and the need for compounding in modern pharmacotherapy, meeting individual patient needs through compounding, quality and regulatory issues, and the right and responsibility of the pharmacist to compound. It is important to understand the strengths and weaknesses of each country so we can learn from each other and incorporate the best practices of quality pharmaceutical compounding to better serve our patients. For details, go to www.isphc.com.

P.S. Don't forget your passport and visa!

There have been 39 citations on the subject of rosacea and 20 citations on alopecia added to CompoundingToday.com's literature search database this week. Here is a sampling of them:

The pharmacologic therapy of rosacea: A paradigm shift in progress.
Bikowski JB. Cutis 2005; 75(3 Suppl): 27-32, Discussion 33-36.

Niacinamide-containing facial moisturizer improves skin barrier and benefits subjects with rosacea.
Draelos ZD, Ertel K, Berge C. Cutis 2005; 76(2): 135-141.

Topical therapies for rosacea.
Nally JB, Berson DS. J Drugs Dermatol 2006; 5(1): 23-26.

Helicobacter pylori infection in skin diseases: A critical appraisal.
Wedi B, Kapp A. Am J Clin Dermatol 2002; 3(4): 273-282.

Treatment of rosacea with herbal ingredients.
Wu J. J Drugs Dermatol 2006; 5(1): 29-32.

Have a friend who needs the CompoundingToday.com e-newsletter? Forward them a copy of today's newsletter and let them know they can subscribe at http://CompoundingToday.com/Newsletter. It's FREE! It's easy. And maybe they will quit reading over your shoulder!

Iodine: Why You Need It, Why You Can't Live Without It
2nd Edition
David Brownstein, MD
Medical Alternatives Press; West Bloomfield, Michigan; 2006. $15.00
Review by Betty Jo Grajeda, MD

The first edition of this book was published in 2004. In the past two years so much new information has emerged that an updated second edition has been published. The second edition contains new information on iodine research and breast cancer. The author, Dr. David Brownstein, provides compelling evidence that iodine deficiency can adversely affect adrenal function, immune function, the thymus gland, ovaries, prostate, hypothalamus, and pituitary axis.

Read the complete review for this and other books on CompoundingToday.com's free book review section at http://compoundingtoday.com/Books/ReviewList.cfm

IJPC publishes a standard operating procedure (SOP) in each issue. The July/August 2006 issue features an SOP on Procedures in the Event of Nonconformance of Bulk Chemicals or Compounded Preparations. As the title would indicate, this particular SOP outlines the procedure to establish the proper protocol for the destruction of bulk chemicals and finished preparations that do not conform with quality assurance protocols. SOPs are important to the success of your business.

Sign up today at www.IJPC.com and start your journal print and electronic subscriptions. You can download what you are currently subscribed to and purchase electronic access to our complete set of back issues.

Need a good vehicle for "dog chewies"?
Purchase a good brand of dry dog food. Obtain the required amount for the prescription and pulverize it thoroughly. Add the desired medication, then slowly incorporate purified water or a gelatin solution into the powder to form a dough-type consistency. Pack into molds or roll and cut into the desired size and shape. Allow to dry for a hard, chewable dosage form, package, and dispense. A blend of glycerin and water can be used and the preparation only dried to the desired consistency to form a softer dosage form.