Episode 21: Quality use of medicines in an exceptional year – a 2020 wrap up

Voiceover:

Welcome to the NPS MedicineWise podcast, helping health professionals stay up to date with the latest news and evidence about medicines and medical tests.

Steve Morris:

Hi, I'm Steve Morris, CEO of NPS MedicineWise and this is the last podcast for 2020, and we've just wrapped up our NMS symposium and I'm joined by my good friend and so-called colleague, Andrew McLachlan.

Andrew McLachlan:

G'day Steve. Good to be here. And it was a fantastic NMS 2020. I think most people virtually participated, but I had the privilege to come in here to the ICC, Darling Harbour, a beautiful day. And I suppose an amazing journey over the last day, of the many different stories and also examples of medicine safety initiatives, which are pretty impressive really.

Steve Morris:

Yeah. Look, I thought it was a great day, though it's difficult to obviously assess the audience reaction when there's nobody in the audience, but hopefully the virtual participants had a great time.

Andrew McLachlan:

You're just used to not getting much of a reaction, when you use one of your lame jokes.

Steve Morris:

Too true. My dad jokes were in abeyance today, unfortunately.

Andrew McLachlan:

Yeah, well you told them to the usual audience that really loves them, yourself. So that was all right.

Steve Morris:

That's true. I was internally chuckling, really hard, most of the time.

Andrew McLachlan:

I thought the choice of Tim Ferguson as the chair was just brilliant, because not only does he have that comedic angle, which he took and applied very nicely, but also very seriously, of course, as a man living with MS, and also really engaged as an effective communicator. He was fantastic to bring it all together actually.

Steve Morris:

Yeah, I thought Tim Morrison was fantastic.

Andrew McLachlan:

What? He got your name wrong once. Is that a sensitive issue?

Steve Morris:

Am I a sensitive person, Andrew?

Andrew McLachlan:

Anyway, I think some of the messages though, that we saw were just fantastic. Of course it reminded us about the importance of having consumers, people living with health challenges, right in the middle of medication safety and actually the themes around empowering people and medicines literacy, I thought were really strong ones, and I know that NPS MedicineWise have really valued over a long period of time.

Steve Morris:

Yeah, that's right. And it's good to have, I think, different voices with different context, but the problems are the same as they've been for many years, I think, Andrew. And we've just got to work out how we have a different approach, work collectively and try and reduce medication problems for consumers.

Andrew McLachlan:

And actually your podcasts over this year, which I must say, don't tell anyone, but I do listen to them, have really identified many of the thought leaders, who have actually identified a lot of the solutions. And I think that came out in the NMS as well. So, we do know about a lot of the solutions, the question and the important aspect that we have to do now is how we bring it together.

Steve Morris:

Yeah, that's right. I think that's always the challenge Andrew, because I think there are many great things happening in our health system, and people have created solutions for local applicability. So, how do you systematise those? How do you contextualise it, in whatever system you're working in?

Andrew McLachlan:

Well, I think the scale-up is critical, as you say. And I think the NMS is a good example of how ideas start as a seed. People get to see them, ideas are shared and then you get a bigger audience and we do start to communicate it more widely. So, all power to the hand of the NPS MedicineWise to have the NMS. I know there was a couple of false starts really, and it ended up being virtually brilliant.

Steve Morris:

Yes, we were staring at the abyss on two occasions. Andrew, it's fair to say, but we brought the virtual event out of the hat, just before the end of the year.

Andrew McLachlan:

And I think few conferences are held on a Monday, but it was good.

Steve Morris:

Is today Monday?

Andrew McLachlan:

Yeah, it is.

Steve Morris:

Monday is the new Friday.

Andrew McLachlan:

The new Friday, particularly in December.

Steve Morris:

Every day is a Friday in December, isn't it?

Andrew McLachlan:

I think so. I also liked the start, Andrew, the board chair set out that idea of how we look at medicines and being medicine-wise, clarity of information, focused on healthcare professionals and their responsibilities and then the system stuff, which, we've got to get all those elements right. And I thought that was nicely reflected in all the contributions across the meeting actually.

Steve Morris:

Yeah. And obviously, me and you are relatively old geezers aren't we, Andrew?

Andrew McLachlan:

Yeah. Well, speak for yourself, young man.

Steve Morris:

And look, what we need is some enthusiasm and drive from many of the younger health professionals, I think.

Andrew McLachlan:

Yeah. Look, I think you're right. We can be building on about it, for a while, but we do have to cascade down now, to the next generation, the importance of taking this forward. We still have a lot to run, but also what really came out nicely again, was the importance of how we work with consumers, to make sure that this is a shared leadership responsibility. And I think that's really critical. So yeah, getting the message out there to people just entering practice, so that they're not falling into the same holes that we are, but they're starting from that base of valuing medication safety and quality right up there.

Steve Morris:

Yeah. One of my favourite phrases from today's conference was, "We need to move up the engagement ladder." So, how many rungs up the ladder, do you think? Are we at the bottom rung? Or are we in the middle?

Andrew McLachlan:

No. Look, if you think about the history of the National Medicines Policy in this country, of the work that NPS and NPS MedicineWise have done, the conversation is active, it's started. And there's a lot of people engaged in it. It is how we cascade it out further. I think with the 10th National Health Priority around medication quality and safety, that starts a new narrative, a new conversation. And that's why we've got to that as a platform, as a loudspeaker to get it out there.

Steve Morris:

I know you're great fan of slapstick comedy, Andrew. So how do we stop falling off the ladder?

Andrew McLachlan:

Well, you think we should ask Harry Enfield? Or is that a bit too obscure to do that?

Steve Morris:

Probably obscure for most of our Australian audience.

Andrew McLachlan:

Yeah. We shouldn't go down there. Well, first of all, get a grip on the ladder, metaphorically. And that's about being in control of the situation. So, understanding those elements related to... I think Alex Broom nicely summarised the idea of, what are the barriers, enablers? And then, who's got the ownership of that. That was a really nice theme.

Every year the NPS has a great speaker who challenges us to think a bit differently about something we thought we knew about. And Alex spoke about the social life of medicines and really was talking about social and cultural aspects, and that idea of understanding the problem, and then making sure that there's ownership. And I thought the message really was about shared ownership. That came through, really from the first talks today. And that's how we stop falling off that ladder, to make sure there's plenty of people holding you on it.

Steve Morris:

Holding the ladder steady. I think you're absolutely right there, I think often we look at these issues and look to somebody else to provide the solution and be accountable, whereas it's incumbent on all of us to be accountable to do what we can, I think.

Andrew McLachlan:

Yeah, I totally agree.

Steve Morris:

So, just maybe a bit of reflection on the COVID, let's call it the COVID year. So, the COVID 2020 wrap-up, let's have a brief discussion around some of those, what we would call antiquated medicines, that made a comeback.

Andrew McLachlan:

It gives us all... I want to be repurposed in a later life. I want to get to that stage of my career, where I'm going out the door backwards and I get repurposed. It turns out that everything they tried, everything they tried really didn't change the course of treatment.

And of course, my personal favourite, hydroxychloroquine. I'm taking it. Why wouldn't you take it? Look, it was very well worth doing the trials to investigate. There were plausible reasons to suspect it might help. But actually there was also reasons why, pharmacological reasons why, it was never going to work.

Andrew McLachlan:

And of course there was that incredible need from the community for a cure, I'm doing air quotes there, for a cure. And so that led a lot of this.

So, all sorts of medicines were explored. The way the media controlled a lot of that as well, was just quite incredible, but enormous community demand.

And I think as healthcare professionals, as people in the system, it was our job to help people understand and navigate that course. But hey, who wouldn't want to be repurposed in a later life, or later part of their career?

Steve Morris:

Obviously there must be some re-purposing, isn't there a well-known entrepreneur that has got millions of doses of hydroxychloroquine in Australia?

Andrew McLachlan:

There is. We probably shouldn't say his name, in case he’s here. But it was in major newspapers. Maybe it's being used to try and tunnel into Western Australia at the moment. I'm not sure. What else could you use 33 million doses of hydroxychloroquine for?

Andrew McLachlan:

But anyway, it shows you how, unfortunately, the pendulum swung too far when it came to people really missing out on the fundamental aspects of quality use of medicines. And I know the NPS were on the front foot on this. And I really appreciated it, I suppose, as a healthcare professional, just being a bit serious for a moment, is that all of this really, was about applying QUM principles. And that's where it did go well actually, when we could explain to people how to use medicines safely and effectively.

Steve Morris:

Maybe construct a ladder of enablement to use hydroxychloroquine?

Andrew McLachlan:

Quite possibly. It'd be a lovely Christmas present, wouldn't it?

Steve Morris:

So, in summary, hydroxychloroquine, fake news.

Andrew McLachlan:

Fake news. I think we might have suspected that, as soon as it was a celebrity endorsement, from well-known figures.

Steve Morris:

So, Andrew, reflecting on the NMS symposium and some of the current news, what about beyond COVID? What about beyond 2020, beyond the COVID period we've been in?

Andrew McLachlan:

So, what COVID has given us though is, it's accelerated some of the things we've been trying to get cut-through really, telehealth, of course, and doing that well, things like electronic prescriptions, I think, have moved along nicely. It's also helped us... We put on pause the National Medicines Policy review.

I think we've got a new context for that now, to understand about, how the health system can really be active to help take a leading role when things are changing quickly. And a policy framework gives you how you make decisions in that area.

So, I do think National Medicines Policy has got to be on the agenda for 2021, a refresh of that, a reboot. And that's going to give us that framework to bring together those elements, I think.

Steve Morris:

Yeah, I think you're right. I think what COVID has demonstrated is what is actually possible.

Andrew McLachlan:

Yeah.

Steve Morris:

So all the things that were previously stated as being too hard, too difficult, it's a system problem, you can soon blast out of the way, if you have the motivation and focus to do so.

Andrew McLachlan:

But, look at the partnerships that were formed around the vaccination journey, the number of candidates, the scientists, the companies. The governments are working together to make sure that we could get to the stage of having candidate vaccines. Of course we haven't compromised. And I think that's important on the elements of safety and quality, but as was mentioned at the NMS, actually, in the opening session, now people are asking, "What is a phase three study?" They're getting a better understanding about, what are the steps in bringing a medicine to market? I think that that helps the community.

Steve Morris:

So, from a quality use of medicines perspective then, we're looking forward to 2021 with high optimism?

Andrew McLachlan:

Yeah, I think so. And look, we can only have a high optimism, in many ways, as we come out of COVID. There's obviously still a lot around the world. It is an international challenge. That's why the World Health Organization have taken it on as well.

But certainly, from an Australian point of view, a regional point of view, I think Australia will continue to be leaders in that area. And certainly from what I saw at NMS 2020 today, there's still a lot of very positive aspects for the next few years.

Steve Morris:

Yeah. Thank you, Andrew. I wish you a merry Christmas and a good new year. I know that you will over eat and over drink, so I look forward to seeing a larger version of you in 2021.

Andrew McLachlan:

I'll have a few Corona kilos. Cheers. Thanks Steve.

Steve Morris:

I'd just like to say thank you to our listeners, for engaging our podcasts this year. It is a new thing for NPS MedicineWise and we will continue to produce podcasts, which may not be so directed at COVID, but other qualities of medicines issues. Take care and have a happy new year.

Voiceover:

For more information about the safe and wise use of medicines, visit the NPS MedicineWise website at nps.org.edu.