Pharmaceutical Marketing

Pharmaceutical Marketing Merck â€Å"Merck has gone beyond developing and selling prescription pharmaceuticals. It formed joint ventures in 1989 with Johnson & Johnson to sell over the-counter pharmaceuticals; in 1991 with DuPont to expand basic research, and in 2000 with Scherigng-Plough to develop and market new prescriptions medicines. In 1997, Merck and Rhone-Poulenc S. A. (now Sanofi-Aventis S. A. ) combined animal health and poultry genetics business to form Merial Limited, a fully integrated animal health company.Finally, Merck purchased Medco, a mail –order pharmaceutical distributor, in 2003, and Sirna Therapeutics in 2006† (Kotler & Keller, 2012, p. 43-44). â€Å"For branding strategies to be successful and brand value to be created, consumers must be convinced there are meaningful differences among brands in the product or service category. Brand differences often related to attributes or benefits of the product itself . . Merck has lead (its) product catego ries for decades, due in part to continual innovation† (Kotler & Keller, 2012, p. 243).Merck has donated $100 million or more to charities in a year (Kotler & Keller, 2012, p. 632). Mission Statements Ex. Japan Both pharmaceutical and biotech companies are starting to make partnership a core competency (Kotler & Keller, 2012, p. 52). Intro: Michael Dawson, author of â€Å"The Consumer Trap,† states that the business of marketing, a trillion-dollar –a-year industry, is a social, economical, environmental, and unfriendly cost on Americans today as it â€Å"continues to soak up economic and environmental resources and dominate the personal lives of citizens† (Dawson, 2005, p. ). Dawson argues that corporate America is fueled by a continuous marketing race that manipulates people’s perceptions and actions of goods into thinking the economy is out to serve one’s pleasures and happiness, when in all reality, is only out to serve the demand of busin ess today (Dawson, 2005, p. 1). â€Å"It is critical that the U. S. government recognizes that intelligently focused nutrition-related efforts are important in helping lead Americans of all ages to lead healthier lifestyles.Marketing Nutrition shows how simple solutions can save lives. â€Å"–Congressman Timothy V. Johnson, United States House of Representatives (Wansink, 2007, p. 1). There are enormous economic dividends for health care providers, public health institutions, and commercial food companies if we are successful in doing this. â€Å"–Dr. David Mela, Expertise Group Leader, Unilever Health Institute(Wansink, 2007, p. 1). Marketing = A mechanism to help pharmacy develop, communicate, and sell future pharmaceutical services to consumers (Grauer, 1981, p. ). Pharmaceutical marketing is an â€Å"element of an information continuum, where research concepts are transformed into practical therapeutic tools and where information is progressively layered and ma de more useful to the health care system† (Levy, 1994, p. 1). Provides an informed choice of carefully characterized agents (Levy, 1994, p. 1). marketing assists physicians in matching drug therapy to individual patient needs (Levy, 1994, p. 1).Pharmaceutical marketing is presently the most organized and comprehensive information system for updating physicians about the availability, safety, efficacy, hazards, and techniques of using medicines (Levy, 1994, p. 1). pharmaceutical marketing strategies can negatively affect both- the end consumers or the patients and the health care profession (Need of New Pharmaceutical Marketing Strategies, 2010, p. 1). Also, the advertising strategies included in the marketing plan of any pharmaceutical company is not ‘direct to consumer' (Need of New Pharmaceutical Marketing Strategies, 2010, p. ). Any pharmaceutical marketing strategy targets the health care professionals or the Doctors who in turn prescribe the drugs to the patients (e nd consumers) liable to pay for the products (Need of New Pharmaceutical Marketing Strategies, 2010, p. 1). However, a few countries (till date two countries- New Zealand and United States) allow Direct-to-consumer advertising (DTC advertising) for pharmaceutical products (Need of New Pharmaceutical Marketing Strategies, 2010, p. 1). Pharmaceutical Market Trends 2010. Pharmaceutical & Drug Manufacturer Resources.Retrieved from: http://www. pharmaceutical-drug-manufacturers. com/articles/pharmaceutical-market-trends-2010. html The global pharmaceutical is forecasted to make a significant growth of about 4 – 6%, exceeding $975 billion, with global pharmaceutical market sales expecting to grow at a 4 – 7% compound annual growth rate (CAGR) through 2013, based upon global macroeconomy as well the â€Å"changing combination of innovative and mature products apart from the rising influence of healthcare access and funding on market demand† (Pharmaceutical Market Trend s 2010, p. ). pharmaceutical sales are growing at a fast rate in India, China, Malaysia, South Korea and Indonesia due to the rising disposable income, several health insurance schemes (that ensures the sales of branded drugs), and intense competition among top pharmaceutical companies in the region (that has boosted the availability of low cost drugs). India – 3rd Largest Producer of Pharmaceuticals Across the World- is already a US$ 8. 2 Billion pharmaceutical market.The Indian pharmaceutical industry is further expected to grow by 10% in the year 2010. (Pharmaceutical Market Trends 2010, p. 1). The development of infrastructure and rapidly changing regulations in the Middle East are being seen as the cause of its growth. Presently South Africa, Saudi Arabia and Israel dominate the region's pharmaceutical industry due to their better infrastructure and regulatory environment. However, The Middle East pharma market depends on imported pharmaceutical drugs and therapeutics.Th e governments of countries in this region are taking measures to raise their domestic production through heavy investments in the pharmaceutical industry (Pharmaceutical Market Trends 2010, p. 1). Pharmaceutical Drugs Trends of fastest expected growth consist of anti-Diabetic Drugs and those for cardiovascular diseases, due to the changes in demographics and lifestyle with anti-hypertensives drugs will dominate the global cardiovascular market with a market share of nearly 50% (Pharmaceutical Market Trends 2010, p. 1). Strategy:The pharmaceutical companies traditionally adopt four major marketing strategies for promoting their products: Giving drugs as free samples to doctors/ Gifts that hold the company logo or details of one or multiple drugs, providing details of their products through journal articles or opinion leaders; and Sponsoring continuing medical education (Need of New Pharmaceutical Marketing Strategies, 2010, p. 1). Pharmaceutical representatives, also popularly known as medical representatives, are the major pharma marketing strategy for marketing drugs directly to the physicians.Typically, the expense of this sales force of any pharmaceutical company comprises anything ranging from 15-20% of annual product revenues (Need of New Pharmaceutical Marketing Strategies, 2010, p. 1). â€Å"Marketing Nutrition offers a ‘win-win' proposition for all concerned. Insightful companies, health professionals, and policy makers can lead the way . . . in helping people eat better and enjoy food more. â€Å"–Dr. James O. Hill, Director of Human Nutrition, University of Colorado Medical School (Wansink, 2007, p. ). Take advantage of future growth opportunities. These growth opportunities will be realized from unmet health-care needs and changing consumer life style trends and values (Grauer, 1981, p. 1). Dispensing and drug-knowledge-distribution pharmaceutical services are reviewed by a product life cycle analysis of sales profits versus time (Gra uer, 1981, p. 1). A marketing mix for new pharmaceutical services is developed consisting of service, price, distribution, and promotion strategies.Marketing can encompass those key elements necessary to meet the organizational goals of pharmacy and provide a systematic, disciplined approach for presenting a new service to consumers (Grauer, 1981, p. 1). The costs of pharmaceutical marketing are substantial, but they are typical of high-technology industries that must communicate important and complex information to sophisticated users. These costs are offset by savings resulting from proper use of medicines and from lower drug costs owing to price competition (Levy, 1994, p. 1). oint to the Food and Drug Administration (FDA) and find comfort in the fact that this agency is tasked with regulating drug advertising. â€Å"only† 8% of advertisements are in violation of regulations. at least one of the 11 advertisements in the April issue of the ARCHIVES is likely to be misleadin g and, thus, provide potentially harmful information. In fact, the FDA, according to David A. Kessler, MD, commissioner, spends most of its time developing the package insert and not, as asserted by Levy, preapproving advertising. According to Kessler, â€Å"Except under very special circumstances, the agency does not eview or approve advertising and promotional materials before their dissemination by a drug firm† Furthermore, Kessler states that an â€Å"†¦ enormous potential exists for misleading adver ¬ tisements to reach the physician and influence prescribing decisions. † (Shaughnessy, Slawson, ; Bennett, 1994, p. 1). Gifts: Giving drugs as free samples to doctors/ Gifts that hold the company logo or details of one or multiple drugs, A study was done in 1995 to gauge the outcome of a patient’s perception of pharmacy marketing regarding physician’s accepting gifts from the pharmaceutical industry.The objective of this study was to â€Å"examin e patient perceptions of professional appropriateness and the potential impact on health care of physician acceptance of gifts from the pharmaceutical industry,† via a random telephone suvey of 649 adjults living in the state of Kentucky. Through the random sampling, the outcome of the survey was that Patient awareness of officeuse gifts (eg, pens, notepads) and personal gifts to physicians from the pharmaceutical industry, patient exposure to office-use gifts, and attitudes toward physician acceptance of both office-use and personal gifts. Mainous, Hueston, ; Rich, 1995, p. 1). Eightytwo percent of the respondents were aware that physicians received office-use gifts, while 32% were aware that physicians received personal gifts. Seventy-five percent reported receiving free samples of medication from their physicians. Compared with office-use gifts, more respondents believed that personal gifts to physicians have a negative effect on both health care cost (42% vs 26%) and quali ty (23% vs 13%). After controlling for demographic variables, as well as awareness and exposure to physician gifts, individuals with at least a high school education were 2. times as likely to believe that personal gifts have a negative effect on the cost of health care and 2. 3 times as likely to believe that personal gifts would have a negative effect on the quality of health care. (Mainous, Hueston, ; Rich, 1995, p. 1). Conclusions These results suggest that the public is generally uninformed about personal gifts from pharmaceutical companies to physicians. If public perception regarding the objectivity of the medical profession is to serve as a guide, these findings suggest a reevaluation may be in order for guidelines regarding physician acceptance of gifts from the harmaceutical industry (Mainous, Hueston, ; Rich, 1995, p. 1). The World Health Organization, the American Medical Association, the American College of Physicians, and the Pharmaceuticals Manufacturers' Association have also published guidelines on perks to physicians from the drug industry. The bottom line is that all these guidelines are voluntary, and physicians have continued to vote â€Å"with their feet. † (Shaughnessy, Slawson, & Bennett, 1994, p. 1). controversial 1962 FDA amendments.Just before 1962, congress studied and concluded that because of patent protection, heavy promotion by the drug companies, consumer ignorance, and minimal incentives for physicians to be concerned with cost, drugs of dubious quality and unnecessarily high expense were being prescribed by physicians, criticisms that sound remarkably familiar even today. Up to that point, the FDA had only required â€Å"proof of safety,† which dated back to the origins of the modern drug era and the 1938 Food, Drug, and Cosmetic Act (Shaughnessy, Slawson, & Bennett, 1994, p. 1).Discussions about the influence of pharmaceutical promotion on physicians often focus on gifts and payments of relatively large economi c value. This focus is also evident in ethics guidelines addressing pharmaceutical promotion among many professional medical societies. 1 The underlying assumption is that smaller gifts are unlikely to exert influence on prescribing decisions. (Grande, Frosch, Perkins, & Kahn, 2009, p. 1). In contrast, a substantial body of marketing and psychology literature suggests that even trivial items can exert influence irrespective of economic value.For example, adding a small gift such as personalized mailing labels to a solicitation for donations has been shown to significantly increase contributions. 2 In pharmaceutical promotion, small gifts are often tethered to branding efforts, as items such as pens and coffee mugs display logos. Aside from the intrinsic value of promotional items, branded materials strengthen brand awareness and build brand equity through a variety of largely unconscious but powerful mechanisms. 3 Nonverbal information about the brand, such as symbols or logos, is o ften more influential than verbal cues. Stronger brands have a memory encoding and storage advantage over unknown brands,5 which facilitates the formation of strong positive associations with the brand. Strong branded products are more often in a â€Å"top-of-mind† set of alternatives for consumers to consider. 6 Strong brand awareness provides a justifiable reason for choosing a particular brand. 7-8 This research suggests that small branded promotional items should increase favorable attitudes for the brand being promoted.We are unaware of studies that test these effects in a clinical context with health professionals, but many physicians, because they are medical experts, believe they are not susceptible to these influences. 5, 9-10 In one survey, just 8% of physicians believed they were susceptible to influence by marketing items such as branded pens, whereas 31% of patients felt these items could influence physicians. 9 The guidelines of the American Medical Association regarding gifts to physicians from industry reflect this belief of lack of susceptibility by permitting â€Å"gifts of minimal value. â€Å"1 (Grande, Frosch, Perkins, & Kahn, 2009, p. ). The study used a randomized experimental design. Participants were third- and fourth-year medical students at the University of Pennsylvania School of Medicine (Penn) and the University of Miami Miller School of Medicine (Miami). We selected these institutions because of their differing policies regarding interactions between trainees and pharmaceutical company representatives. The University of Pennsylvania has restrictive policies in place that prohibit most gifts, meals, and samples while Miami continues to permit such marketing practices. (Grande, Frosch, Perkins, & Kahn, 2009, p. 1). 007-2008. Study participants were assigned to a control or primed condition based on their day of enrollment. Participants assigned to the â€Å"primed† condition were exposed to Lipitor (atorvastatin) br anded promotional items immediately prior to completing a computer-based study instrument. These exposures included Lipitor logos on a clipboard (used when signing in to the study room) and notepaper (used to provide participants with their study identification number). Participants assigned to the control condition completed the same procedures but with a plain (nonbranded) clipboard and notepaper.Randomization was conducted by day in order to avoid contamination of conditions. (Grande, Frosch, Perkins, & Kahn, 2009, p. 1). Participants were told they were enrolling in a study about clinical decision making under varying conditions (Grande, Frosch, Perkins, & Kahn, 2009, p. 1). Our study was designed to measure the influence of exposure to branded promotional items on relative attitudes toward 2 lipid-lowering statins. We examined differences in attitudes toward Lipitor and Zocor (simvastatin) in our exposed (Lipitor promotional items) and control groups.Lipitor is among the most p romoted brand-name statins in the United States while simvastatin is available generically and considered to be nearly equally effective. The study outcomes included measures of implicit and self-reported (ie, explicit) attitudes. (Grande, Frosch, Perkins, & Kahn, 2009, p. 1). Implicit attitudes were evaluated with the Implicit Association Test,11-15 a widely used tool in marketing and psychology research that is thought to be resistant to social desirability bias among research participants.Initial applications of the IAT, for example, demonstrated the persistence of racial and gender stereotypes and prejudices, even in the face of strong conscious beliefs that such attitudes do not exist and strong social norms that dictate they should not exist. 16-17 Results from the IAT are a better predictor of intergroup discrimination (eg, biased behavior against people of other races/ethnicities, gender, and sexual orientation based on existing attitudes and stereotypes) compared with osten sibly similar self-report measures. 13 In recent years, the use of the IAT has been expanded to research focused on branding and marketing. 8-19 Further details regarding application and validity of the IAT have been published elsewhere13-15; a demonstration can be found at the Project Implicit Web site (https://implicit. harvard. edu/implicit). (Grande, Frosch, Perkins, & Kahn, 2009, p. 1). Explicit attitudes were assessed by self-report. Following the IAT, participants were asked to compare Lipitor and Zocor in 5 dimensions (superiority, preference, efficacy, safety, and convenience) a follow-up anonymous Internet-based survey that assessed their attitudes toward pharmaceutical marketing.The purpose was to measure differences in attitudes among students at the 2 schools given the differing institutional policies as a possible explanatory factor(Grande, Frosch, Perkins, & Kahn, 200 Then there is the pharmaceutical industry's holy grail of marketing — the relationship between their sales representatives and medical doctors. To maintain this relationship, often called â€Å"detailing,† pharmaceutical companies spend a whopping $8,290 per doctor.The average family doctor receives 28 visits each week from drug reps, who provide free samples, explain new findings from company-sponsored drug trials, and demonstrate the latest innovation in their company’s medical devices. Some doctors, reporters and public health advocates have long decried the pharmaceutical industry's seemingly endless attempts to buy goodwill among medical professionals. But insidious marketing campaigns seeking to rebrand medical conditions as lifestyle choices, and the patients who suffer from them as consumers, have received little scrutiny. (Ebeling, 2008, p. 1). 9, p. ). providing details of their products through journal articles or opinion leaders; Worse, the trend is seriously undermining the regulatory authority of the FDA. It's not surprising that profit-driven, cu tting-edge marketing techniques have outstripped the government agency established to guide them. What is surprising is that public health advocates haven't made pharmaceutical rebranding and off-label promotions of drugs and medical devices major issues. In December, the advocacy group Consumers Union sent a letter (PDF) to the FDA requesting tighter DTC advertising regulations on medical devices. Ebeling, 2008, p. 1). The December 2007 issues of the women’s fashion magazines Allure and Harper's Bazaar both featured multi-page spreads on non-surgical cosmetic procedures, including the array of injectable wrinkle fillers. The articles outlined the pros and cons of each filler, evaluating injection pain, cost per injection (most run between $500 and $800 per shot), and how long each lasts (Ebeling, 2008, p. 1). Dermatologist and anti-aging cream entrepreneur Dr. Patricia Wexler is featured prominently in the Bazaar story.Her remarks about each injectable reflect the marketing language of the brands themselves. When she is discussing Sculptra ®, for instance, she describes how the product acts as â€Å"a trellis on which the collagen can grow† — a line marketers use to describe how the device works. She also repeatedly suggests what are off-label, unregulated product applications, such as using injectable fillers in the eye area, in the temples, in the jawline, on the cheekbones, and in the fine lines surrounding the mouth. Dr. Wexler's injectable filler romotions are especially credible among the target audience. Wexler regularly discusses non-invasive, anti-aging procedures on the â€Å"Oprah Winfrey Show,† the â€Å"Today Show,† and â€Å"Good Morning America,† and in the pages of Vogue and Marie Claire. The big pharma companies that make the injectable fillers likely dream of doctors touting their products and suggesting off-label uses for them in popular women's magazines. As the saying goes, they couldn't buy suc h good press — but they probably did. (Ebeling, 2008, p. 1). Dr. David J.Triggle, a pharmacologist at the State University of New York at Buffalo who has written about drug advertising, says a doctor’s endorsement should be scrupulously honest (Saul, 2008, p. 2). Dr. Robert Jarvik, known for the artificial heart he pioneered more than a quarter-century ago. began appearing in television ads two years ago for the Pfizer cholesterol drug Lipitor (Saul, 2008, p. 1). Skip to next paragraph The ads have depicted him, among other outdoorsy pursuits, rowing a one-man racing shell swiftly across a mountain lake. When diet and exercise aren’t enough, adding Lipitor significantly lowers cholesterol,† Dr. Jarvik says in the ad. Celebrity advertising endorsements are nothing new, of course. But the Lipitor campaign is a rare instance of a well-known doctor’s endorsing a drug in advertising — and it has helped rekindle a smoldering debate over whether it is appropriate to aim ads for prescription drugs directly at consumers. A Congressional committee, concerned that the Lipitor ads could be misleading, has said it wants to interview Dr. Jarvik about his role as the drug’s pitchman.Some of the questions may involve his credentials. Even though Dr. Jarvik holds a medical degree, for example, he is not a cardiologist and is not licensed to practice medicine. So what, critics ask, qualifies him to recommend Lipitor on television — even if, as he says in some of the ads, he takes the drug himself? (Saul, 2008, p. 1). Skip to next paragraphThe House Committee on Energy and Commerce is looking into when and why Dr. Jarvik began taking Lipitor and whether the advertisements give the public a false impression, according to John D.Dingell, the Michigan Democrat who is the committee’s chairman. â€Å"It seems that Pfizer’s No. 1 priority is to sell lots of Lipitor, by whatever means necessary, including misleading the American people,† Mr. Dingell said. Lipitor, the world’s single best-selling drug, is Pfizer’s biggest product, generating sales of $12. 7 billion last year. But as it has come under competition from cheaper generic alternatives, Pfizer has used the Jarvik campaign, introduced in early 2006, to help protect its Lipitor franchise. Wherever the Congressional inquiry leads, the controversy risks damaging Dr.Jarvik’s credibility and undermining his real medical mission. The Jarvik campaign was rolled out the same year that Zocor, Lipitor’s chief competitor, became available as a generic drug that is widely considered about as effective as Lipitor but is sold at a fraction of the cost. (Saul, 2008, p. 1). Skip to next paragraph Criticism of consumer advertising of pharmaceuticals flared as an issue back in 2004, when Merck withdrew Vioxx, a heavily advertised painkiller, after a clinical trial showed that it sharply increased the risk of heart attack s and strokes.The pharmaceutical industry adopted voluntary guidelines the next year suggesting that companies delay advertising new products for an unspecified period after they first reach the market (Saul, 2008, p. 1). In early January, the U. S. House Committee on Energy and Commerce began investigating celebrity endorsements in television ads for brand-name drugs. These direct-to-consumer (DTC) ads have been controversial since the Food and Drug Administration (FDA) loosened the rules governing pharmaceutical marketing in 1997.Before Lipitor made headlines, there was Viagra. Pfizer's â€Å"Viva Viagra! † campaign was criticized by the FDA and organizations including the AIDS Healthcare Foundation, who said the DTC ads encouraged recreational use of the erectile dysfunction drug. One print ad suggested that Viagra be used to â€Å"celebrate† events such as the Super Bowl or New Year's Eve. (Ebeling, 2008, p. 1). While troubling, DTC ads represent only 14 percent of pharmaceutical companies' marketing budgets.By the time a 30-second drug commercial airs, the company has conducted months of segmentation studies, held dozens of meetings to define the â€Å"communication target† (typically a woman, usually a mother, and of a certain income), and spent millions of dollars to develop the drug's brand and its market. This strategic marketing, which represents the remaining 86 percent of drug promotion expenses, should receive at least as much attention from regulators and lawmakers as DTC ads. (Ebeling, 2008, p. 1).While DTC ads seek to change patients' behavior, pharmaceutical companies are more interested in changing doctors' behavior. Drug marketers work hard to persuade doctors to prescribe their branded drug over generics and other competitors, and to change other medical practices that limit company profits. To cultivate medical professionals, drug companies may retain a doctor as a spokesperson, position friendly medical â€Å"thought -leaders† in the media, or organize free events at posh resorts and expensive hotels to â€Å"educate† doctors about a new disease state (think Restless Leg Syndrome) or their latest drug.In 2000, the biggest 10 pharmaceutical companies spent $1. 9 billion on promotional events alone (Ebeling, 2008, p. 1). For example, the FDA found that Eli Lilly's television broadcast advertisement for Strattera (atomoxetine) was false or misleading because it inadequately communicated the indication for the drug (attention-deficit–hyperactivity disorder) by means of competing visuals, graphics, and music presented concurrently. Similarly, serious risk disclosures were minimized for Strattera, the FDA said, by the distracting visuals and graphics (e. . , erratic camera movement, quick scene changes, and visual changes in point of view). In another case, the FDA said Pfizer's print advertisement for Zoloft (sertraline) was false or misleading because it omitted important informa tion relating to the risk of suicidality in patients, a risk stated on the product's label at the time the advertisement ran. (Donohue, Cevasco, & Rosenthal, 2007, p. 1). Drugs that are advertised to consumers are predominantly new drugs used to treat chronic conditions.Ten of the top 20 drugs, as ranked by advertising spending, were introduced in 2000 or later. Advertising campaigns generally begin within a year after the introduction of a pharmaceutical product, which raises questions about the extent to which advertising increases the use of drugs with unknown safety profiles. At least one pharmaceutical manufacturer (Bristol-Myers Squibb) recently announced a voluntary moratorium on direct-to-consumer advertising for drugs in the first year after FDA approval.And PhRMA, the industry trade group, has recommended that manufacturers delay such campaigns for new drugs until after health professionals have been sufficiently educated, although no details have been provided on how long a period was deemed necessary. 20 Finally, in a recent study of drug safety, the Institute of Medicine recommended that the FDA restrict advertising for newer prescription drugs. 8 Our data show that a mandatory waiting period on advertising for new drugs would represent a dramatic departure from current industry practices.For example, the FDA found that Eli Lilly's television broadcast advertisement for Strattera (atomoxetine) was false or misleading because it inadequately communicated the indication for the drug (attention-deficit–hyperactivity disorder) by means of competing visuals, graphics, and music presented concurrently. Similarly, serious risk disclosures were minimized for Strattera, the FDA said, by the distracting visuals and graphics (e. g. , erratic camera movement, quick scene changes, and visual changes in point of view).In another case, the FDA said Pfizer's print advertisement for Zoloft (sertraline) was false or misleading because it omitted important in formation relating to the risk of suicidality in patients, a risk stated on the product's label at the time the advertisement ran. (Donohue, Cevasco, ; Rosenthal, 2007, p. 1). direct-to-consumer advertising of prescription drugs on television. Such advertising has been criticized for encouraging inappropriate use of medications and driving up drug spending. ,2 Concern that such advertising may lead to increased use of expensive medications was amplified by the introduction of a prescription-drug benefit in Medicare in 2006 (Part D). Studies of the effect of advertising on prescribing practices have shown that such advertising increases classwide sales, helps to avert underuse of medicines to treat chronic conditions, and leads to some overuse of prescription drugs. (Donohue, Cevasco, ; Rosenthal, 2007, p. 1). Direct-to-consumer advertising has also been controversial in light of postmarketing revelations regarding problems with drug safety.Specifically, clinical trials that are requ ired for drug approval are typically not designed to detect rare but significant adverse effects, and contemporary methods of postmarketing surveillance often fail to connect adverse events that have a high rate of background prevalence with the use of particular drugs. After the market withdrawal of Vioxx (rofecoxib), a drug heavily promoted to consumers,6 critics called for the FDA to place limits on direct-to-consumer advertising, particularly for new drugs,7 a view that was reiterated in a recent report by the Institute of Medicine on the safety of medicines. (Donohue, Cevasco, ; Rosenthal, 2007, p. 1). Sponsoring continuing medical education describes the influence of sponsoring on the results, protocol and quality of drugs studies (Deutsches Aerzteblatt International, 2010, p. 1). The authors conclude that pharmaceutical companies exploit a wide variety of possibilities of manipulating study results. Apart from financing the study, financial links to the authors, such as payme nts for lectures, may tend to make the results of the study more favourable for the company.Not only the results themselves, but also their interpretation, are significantly more often in accordance with the wishes of the sponsor. (Deutsches Aerzteblatt International, 2010, p. 1). In some publications, the authors detected evidence that sponsors from the pharmaceutical industry had influenced study protocols. For example, placebos were more frequently used in drug studies than was the case with independently financed studies. On the other hand, some favourable effects were linked to financial support from the pharmaceutical industry.The methodological quality of studies with industrial support tended to be better than with independent drug studies(Deutsches Aerzteblatt International, 2010, p. 1). Most physicians must complete accredited continuing medical education (CME) programs to maintain their medical licenses, hospital privileges, and specialty board certifications. Data from t he Accreditation Council for Continuing Medical Education (ACCME) show that CME is a $2 billion per year business in the United States that earns less than half its revenue from physician learners themselves. CME is increasingly underwritten by commercial sponsors — primarily manufacturers of drugs, biologic therapies, or medical devices — that spend more than $1 billion per year in educational grants and other funding to cover more than half the costs for CME activities (Morris ; Taitsman, 2009, p. 1). In recent years, a number of studies have shown that clinical drug trials financed by pharmaceutical companies yield favorable results for company products more often than independent trials do. Moreover, pharmaceutical companies have been found to influence drug trials in various ways. Schott, Pachl, Limbach, Gundert-Remy, Ludwig, ; Lieb, 2011, p. 1). Published drug trials that were financed by pharmaceutical companies, or whose authors declared a financial conflict of interest, were found to yield favorable results for the drug manufacturer more frequently than independently financed trials whose authors had no such conflicts. The results were also interpreted favorably more often than in independently financed trials. Furthermore, there was evidence that pharmaceutical companies influenced study protocols in a way that was favorable to themselves.The methodological quality of trials financed by pharmaceutical companies was not found to be any worse than that of trials financed in other ways. Conclusion: Published drug trials that are financed by pharmaceutical companies may present a distorted picture. This cannot be explained by any difference in methodological quality between such trials and trials financed in other ways. (Schott, Pachl, Limbach, Gundert-Remy, Ludwig, ; Lieb, 2011, p. 1). Clinical drug trials funded by pharmaceutical companies yield favorable results for the sponsor’s products more often than independent trials do.This has been demonstrated by a number of studies in recent years Various ways have been described in which pharmaceutical concerns exert influence on the protocol and conduct of drug trials, as well as on the interpretation and publication of their results. This systematic review showed widespread conflicts of interest in the shape of financial connections between scientists, academic institutions, and the pharmaceutical industry. Around one quarter of academic staff and two thirds of academic institutions had financial relationships with industry.Analysis of 8 review articles embracing a total of 1140 original articles (including randomized controlled trials [RCT], economic analyses, and retrospective cohort studies) revealed a statistically significant association between funding by biomedical companies and conclusions favorable to the pharmaceutical industry (summarized odds ratio [OR] 3. 6, 95% confidence interval [CI] 2. 6–4. 9). Industry financing was also connected with l imitations of publication rights and constraints on access to trial data. Schott, Pachl, Limbach, Gundert-Remy, Ludwig, ; Lieb, 2011, p. 1). In the second review, a systematic analysis of 30 publications, Lexchin et al. showed that drug trials financed by pharmaceutical companies are less likely to be published, but that those published more frequently yield positive results for the sponsors’ products than do independently funded studies (8). The quality of the methods employed (analyzed in 13 publications) in trials financed by pharmaceutical companies was not inferior to that in studies with other sources of funding. Schott, Pachl, Limbach, Gundert-Remy, Ludwig, ; Lieb, 2011, p. 1). The authors of the present systematic review set out to assess whether recently published studies reveal a connection between financing of drug trials by pharmaceutical companies and results favorable to these companies’ products. Part 1 investigates whether and, if so, how the type of fu nding affects study protocol and quality. Part 2 identifies and depicts the aspects of clinical drug trials that can be influenced by financial support from the pharmaceutical industry. Schott, Pachl, Limbach, Gundert-Remy, Ludwig, ; Lieb, 2011, p. 1). The publications included were primarily studies performed with the expressed goal of comparing clinical trials funded by pharmaceutical companies with clinical trials that had not received financial support from such companies, e. g. , with regard to the results or conclusions. These studies were accompanied by a number of publications that investigated the consequences of financing of a study by pharmaceutical companies.These included, for example, articles in which information from the files of the US licensing authority (Food and Drug Administration, FDA) was compared with data from publications in medical journals, and case studies on individual substances. (Schott, Pachl, Limbach, Gundert-Remy, Ludwig, ; Lieb, 2011, p. 1). Conne ction between type of funding and results of drug trials Twenty-six of the 57 publications analyzed sought to ascertain whether the results and/or conclusions of drug trials depended on the type of funding or on financial conflicts of interest on the part of the authors (eTable). Schott, Pachl, Limbach, Gundert-Remy, Ludwig, ; Lieb, 2011, p. 1). Altogether, 23 of these 26 studies came to the conclusion that there was a positive correlation between the financing of a study by pharmaceutical companies and/or conflicts of interest on the part of the authors and results or conclusions that were favorable to the sponsor. The statistical significance of this finding was investigated in 22 cases and confirmed in 20. (Schott, Pachl, Limbach, Gundert-Remy, Ludwig, ; Lieb, 2011, p. ). In 4 cases it was apparent that the findings were interpreted favorably towards the pharmaceutical concern that had funded the study, independent of the results (e5–e8). (Schott, Pachl, Limbach, Gundert-R emy, Ludwig, ; Lieb, 2011, p. 1). Another study investigated the connection between the conclusions and the source of financial support in clinical trials that had appeared in 5 influential medical journals over a period of 20 years (e10).Most trials yielded positive results for the drug in question regardless of the funding source, but this study also revealed a trend over the course of time towards more positive findings in industrially financed trials than in trials supported by non-profit organizations (e10). The third study compared the results (but not the interpretations or conclusions) of clinical trials of drugs used in pain management, some of them long available as generics (e9). (Schott, Pachl, Limbach, Gundert-Remy, Ludwig, ; Lieb, 2011, p. ). Five of the 57 studies analyzed investigated whether funding by pharmaceutical companies affected the design of the study protocol (Table 1 gif ppt). The use of placebos was shown to be significantly more common in RCTs of drugs f or psoriasis that were financed by such companies than in those with funding from other sources (e12). Moreover, several studies of treatment for premature ejaculation that were sponsored by a pharmaceutical company were found to have disregarded the relevant objective endpoint (e13).In an investigation of inhaled corticosteroids, significant differences in the frequency of adverse drug reactions (ADR) between the probands and the control group occurred only half as often when the study had been funded by the manufacturers (see also Part 2). The differences could be attributed wholly to the study design. For example, studies financed by pharmaceutical companies used lower dosages. (Schott, Pachl, Limbach, Gundert-Remy, Ludwig, ; Lieb, 2011, p. 1).The pharmaceutical company concerned investigated the marketing effect of the study, finding that participating physicians did indeed prescribe rofecoxib significantly more often than non-participants in its first 6 months on the market. (S chott, Pachl, Limbach, Gundert-Remy, Ludwig, ; Lieb, 2011, p. 1). The results of clinical drug trials that are funded by pharmaceutical companies or whose authors have financial conflicts of interest are favorable to the products of the sponsoring company far more frequently than studies whose funding comes from other sources.Furthermore, interpretation of the data in the conclusions of industrially financed trials more often favors the sponsor. This was shown by the present systematic review and analysis of investigations, published between 1 November 2002 and 16 December 2009, into various diseases, study types (e. g. , RCTs and observational studies), and drugs. The results confirm the conclusions of 2 systematic reviews, both published in 2003, conducted with similar intent (7, 8).The principle of equipoise, i. e. , uncertainty which of the alternative approaches benefits the patient most, forms the ethical foundation of clinical studies in which the probands receive various tre atments (14). This principle seems to be violated in many studies funded by pharmaceutical companies. (Schott, Pachl, Limbach, Gundert-Remy, Ludwig, ; Lieb, 2011, p. 1). There are numerous reasons why studies financed by pharmaceutical manufacturers more often yield positive results.Four investigations found evidence that pharmaceutical companies influence the study protocol to their advantage (e12–e14, e19), e. g. , by more frequent use of placebos in control groups than in independently funded studies (e12). Although the responsible authorities sometimes demand placebo-controlled trials as a condition of licensing, they also request active controls (15). Further factors leading to higher frequency of results favorable to the sponsor in trials funded by pharmaceutical companies are described in Part 2 of this review. Schott, Pachl, Limbach, Gundert-Remy, Ludwig, ; Lieb, 2011, p. 1). Trials financed by pharmaceutical concerns displayed no signs of poorer methodological qualit y. On the contrary, two studies showed superior quality (e16, e17). It must be taken into account, however, that some factors that serve to assess the quality of the instruments used in a study were not determined, among them the clinical relevance of the target parameters. In oncology, for instance, there are currently major defects in the protocols of industrially sponsored clinical trials, e. . , deficiencies in the definition of patient-relevant endpoints and in the selection of suitable substances for the control arm of RCTs (16–19). Moreover, clinical trials in oncology are often discontinued after preliminary analysis (20), with the result that only a short time after the licensing of a drug its additional benefits and the safety of new substances can frequently no longer be evaluated, preventing any benefit/risk analysis (21). (Schott, Pachl, Limbach, Gundert-Remy, Ludwig, ; Lieb, 2011, p. 1). Conclusion:Wansink argues that the true challenge in marketing nutrition li es in leveraging new tools of consumer psychology (which he specifically demonstrates) and by applying lessons from other products' failures and successes. The same tools and insights that have helped make less nutritious products popular also offer the best opportunity to reintroduce a nutritious lifestyle. The key problem with marketing nutrition remains, after all, marketing. (Wansink, 2007, p. 1). New services must therefore be oriented toward consumers (i. e. , patients, health professionals, and third-party agencies) to gain acceptance (Grauer, 1981, p. ). We encourage family physicians interested in providing the best care for their patients to become educated in the advertising techniques used by the pharmaceutical industry. (Shaughnessy, Slawson, & Bennett, 1994, p. 1). | | | | | | | | | | | new challenges as well as opportunities for increasing profitability. If the pharmaceutical companies want to improve their Return-On-Investment (ROI), they have to adopt new communicat ion technologies (digital media) along with their conventional sales force of medical representatives.They really need to adopt this multi channel marketing strategies for the following reasons: The concept of blockbuster drugs is dying out for big pharmaceutical companies where 2-3 drugs were good enough to pay back the whole investment for a larger number of manufactured drugs. Now the limited prospective for blockbuster drugs (thanks to low investment on R&D and patent expiry) makes it essential to focus on more specialized drugs sold in lower volumes. And when there is low volume products, sales driven marketing strategy (with high cost of sales force) is not feasible.As far as small pharma companies are concerned, they already have small sales force. However, with the use of digital media, having a lower investment cost (both for the company and its targeted customer) they can easily get return on investment. Customer behavior (doctors behavior) is rapidly changing. Doctors, wh o are getting more and more busy with increasing patients, can be hardly seen by the medical representatives. They are more inclined towards Internet for obtaining relevant information.It is the time for pharmaceutical companies to build their marketing strategies around this digital media. Website marketing, online marketing, blogs, social media, forums, chat rooms and any other such media is an influential means to present the company's products and offers through opinion leaders (Need of New Pharmaceutical Marketing Strategies, 2010, p. 1). The right marketing strategy for any pharmaceutical company would be to build on proven strategic marketing principles, along with a focus on changing customer behavior.Use of digital media through Internet marketing plan is the best marketing strategy that can provide the basis for a changed business model. However, there should be some planning for using digital media for marketing too. It should be a multi channel marketing strategy but sho uld identify the target audience. Every digital media used for all people can not be called the right marketing strategy. The focus should be on the high value customer segment for pharmaceutical products (Need of New Pharmaceutical Marketing Strategies, 2010, p. 1).

Is Addiction a Brain Disease? Essay

Addiction, it is all around us, affecting people from all walks of life, it is not limited to certain social classes or lifestyles. It is found in every ethnic group, regardless of gender or age. It affects our neighbors, our friends, and our family either directly or indirectly. Although substances such as alcohol and illegal drugs are two of the most common addictions we hear about, there is a wide range of substances and even activities such as gambling and shopping. There is some debate whether addiction is a brain disease or a choice. This controversy has been going on for years and a decision whether or not addiction is a brain disease has yet to be reached. According to a publication Is Addiction a Brain Disease? (1998) , by two psychiatrists, Sally Satel, M.D., and Frederick K. Goodwin, M.D., both argue â€Å"the virtues of thinking about addiction as a primary, though modifiable, behavioral phenomenon, rather than simply as a brain disease†. That is, addiction is a function of a person, rather than simply a physical state† (Satel, Goodwin, 1998, p. 3). According to a publication by the National Institution of Drug Abuse (NIDA, 2007), â€Å"addiction is a chronic, relapsing disease characterized by compulsive drug seeking and use despite harmful consequences as well as neurochemical and molecular changes in the brain† (NIDA, 2007). For the purpose of this paper the focus will be on the substance of drugs of abuse when discussing ‘addiction’, but before getting into the two controversial sides another definition we can look at outside of these two opinions is taken from textbook, Psychology 10th Ed, by David G. Myers: â€Å"Addiction is a compulsive drug craving and use, despite adverse consequences† (Myers, 113). PRO: Drug Addiction is a Brain Disease. The National Institute of Drug Abuse (NIDA) explains that addiction is a brain disease. The initial decision to take drugs is a person’s voluntary choice. However, once a person takes that drug of abuse it can effect â€Å"the pleasurable area of the brain† (NIDA, 2007), in which, addiction takes over the person’s capability of self control, which can result in harmful actions. Thus, when a person uses drugs over a long period of time the brain structure and the way it operates changes resulting in harmful effects and actions. Addiction is tied to changes in brain structure and function, basically making it a brain disease. Furthermore, all drugs of abuse have common affects one way or another within the brain, which activates â€Å"the pleasurable area of the brain† (NIDA, 2007). Drugs of abuse reward our normal actions, therefore, if the brain gets a lot of stimulation it produces pleasant feelings, which drives a person to continually use drugs over and over. NIDA also points out that from science research â€Å"brain-imaging studies from drug-addicted individuals have shown physical changes in areas of the brain that are critical for judgment, decision making, learning and memory, and behavior control† (NIDA, 2007) which indicates that once those areas of the brain are disturbed so is a person’s capability of freely choosing not to take drugs, leading to negative actions. Additionally, science research shows that these changes alter the way the brain functions, which may explain the uncontrollable and negative actions of a person. Furthermore, according to NIDA addiction can be treated and managed successfully since it is a chronic disease and research has shown that combining behavioral therapy with medications is the best way to ensure success for most patients with this chronic disease indicating that it is a treatable and manageable similar to other brain diseases. CON: Addiction is not a Brain Disease. According to a publication retrieved from Ethics and Public Policy Center (EPPC) â€Å"Is Addiction a Brain Disease?† two psychiatrists, Sally Satel, M.D., and Frederick K. Goodwin, M.D., they do not agree with NIDA’s claim that â€Å"addiction† means compulsive drug-taking driven by drug-induced brain changes. They believe â€Å"addiction is a function of a person rather than simply a physical state and a person is in voluntary control of their decision and actions† (Satel, Goodwin 3). If a person can make the choice to take drugs then they can also make the choice to stop taking drugs, especially during those times in between when they are not taking drugs. For a person to voluntarily continue taking drugs of their own accord then they should be held accountable for their addictive behavior and not use brain disease as an excuse. Further, circumstances such as economical, health, or personal issues resulting in a person’s choice to take drugs ironically can be the same reasons for them to either change their pattern, stop taking drugs, or get help versus the unavoidable, involuntary effect of a diseased brain. Additionally, those that choose to continue being addicted over a long period of time illustrates that by making that choice they are not helpless compared to a person who has a chronic disease. â€Å"Rather than being the inevitable, involuntary product of a diseased brain, these actions represent the essence of voluntariness. The addict’s behavior can be modified by knowledge of the consequences. Involuntary behavior cannot (Satel, Goodwin, 1998, pg. 5). As a result of that knowledge the addicted person is in control and can take be in charge of their actions to change the cycle and make a deliberate effort to change. My Position: My position is optimistic on the subject Is Addiction a Brain Disease? Addiction is a primary, progressive, and chronic disease of the brain, which creates physical, emotional, and spiritual impairments. I have seen this disease affect people close to me and can only have hope that someday there will be a treatment. First hand, I have seen three families, with different backgrounds, affected by addiction. Two lost a loved one to the overdose of drugs and the other is struggling along with their loved one, who is addicted, to defeat it. One mother wanted to know how this could have happened to her son, how he could lose control of his life and eventually lost the battle of addiction. I do not believe that a person voluntarily WANTS to be addicted, or that they even realize what addiction truly is prior to becoming addicted. However, I do agree with both sides that a person does voluntarily make the choice to take a drug of abuse. But have given more thought into it about why a person can’t just stop taking the drug when they know it is harmful and changes their behavior. My conclusion is that addiction is caused by drugs that are induced with one or more certain types of chemicals that travel through the brain and have an effect on the area of the brain where we feel pleasure and joyful feelings. Also, some people are more susceptible than others to becoming addicted to drugs of abuse than others because their brain reacts differently to the chemical(s) in a drug. Furthermore, addiction has signs and symptoms and a predictable progression and it is apparent that the characteristics of the disease and the approaches to treatment is not any different from other chronic brain diseases. Addiction is a brain disease since its causes are complex but its results are clear. I’m in agreement with NIDA that an 6 addicting substance changes the way the brain works over a long period of time, which leads to the activities of what we recognize as addiction and like most other brain diseases, addiction can be treated. Although treatment can be long and diff icult and there are often relapses, it can be successful if people acknowledge it as such and treat it accordingly. Multicultural Application Addiction affects, if not to all, most countries and cultures. According to the annual report of the UN International Narcotics Control Board (INCB), the estimated number of drug abusers worldwide in 2009 was between 172 million and 250 million people. Varying by different narcotics, the 2007 report national rates range from 0.8% to 11% overall with the highest rates in Italy, Spain, and the United Kingdom and the lowest rates recorded in Romania, Malta, followed by Bulgaria, Greece and Sweden (INCB, 2007, pg. 98). Although we come from different cultures, most of the world shares common diseases and since most countries are affected by addiction the sharing of awareness, knowledge, and research information between cultures could have a huge positive impact on the world. Critical Literacy NIDA’s position of â€Å"Yes, Addiction is a brain disease† is based on their commitment of continued studies and research into drugs of abuse, addiction, backing up their argument that addiction is within the brain not the individual. Satel and Goodwood’s position of â€Å"No, Addiction is not a Brain Disease† is based on their conclusion, according to their research into other’s researches and their knowledge in the positions they hold as psychiatrists that addiction is an individual’s choice not a disease within the brain. Both are able to support their claims by information provided through research. Civic Literacy Besides the known fact that millions of people around the world are directly or indirectly affected by addiction, it has a huge impact on our society. Not only with the economical costs involved for medical and healthcare, there is the cost of crime as a result of consequences from addiction, loss of productivity in the workforce, and many deaths that result from complications of addiction and overdose. By being aware and informed of addiction, citizens can be supportive and helpful to those battling addiction and help prevent others from getting the disease. They can also help by being understanding and supportive to those who are addicted and encourage them get the treatment they need to battle it. Another way to lend a hand is citizens can get involved within their community and promote physical and social activities for all age groups. Citizens can make a difference just by starting somewhere instead of doing nothing and thinking â€Å"oh that’s their problem† or â€Å"it will never affect me† or worse â€Å"it is their fault they are addicted†. It is happening, it can happen to anyone directly or indirectly, and it isn’t anyone’s fault. We need stricter laws on drug making and trafficking to help our society, otherwise we will become an addictive society. Our leaders can invest in continued and advanced scientific research for prevention and treatment. Values Literacy Clearly with as much research as there has been on this topic there is a huge interest and concern of what is happening in our society. By upholding moral values we can consider others opinions with an open mind on topics such as this knowing that while we carry our own values, we must encourage those values as a society to help combat addiction and by being open to the opinions of others we can all come together to battle this disease. With NIDA’s investment into research and treatment it shows they have a special interest and concern on the value of life and  our society. It appears the opposing side would rather dispute the issue and disregard it as a disease, but rather the behavior of a person. Scientific Literacy NIDA is known as being one of the largest supporter’s of the world’s research on drug abuse and addiction. Government funds are used for scientific research by tracking emerging drug use trends, understanding how drugs work in the brain and body, developing and testing new drug treatment and prevention approaches, and disseminating findings to the general public and special populations (NIDA, 2007). They claim that the Science of Addiction has evidence backing up their argument that addiction is a disease of the brain. Psychiatrists Satel and Goodwin, claim that based off biological studies and scientific findings there are not sufficient facts to back up NIDA’s claim that addiction is a brain disease, supporting their argument that addiction is not a brain disease. Conclusion After completing my research, it was not a surprise to find there are differences of opinion on this topic and understandably so. This research and my experience of having observed the affects of addiction first hand have not only driven my passion to understand addiction and the brain, but strengthen my position that addiction is a brain disease. By keeping an open mind allows me to learn and recognize the views of others. Addiction is a common disease we all share directly or indirectly, it is an International problem. The more people know and understand addiction the chances they will be open to looking at it differently. Knowledge and understanding are two biggest parts of moving forward in taking this disease more seriously. It does no good to blame the abuser My hope is that people will look at addiction and take it more seriously if it is considered a brain disease and put more time and money into further research to find out what is actually causing the addiction in the brain and why some people are more susceptible than others. One may lean more toward the idea of addicts choosing to be addicts and that they have complete control over their actions; however, if the addict chooses a path to moderation, they face medical complications associated with withdrawal. The physical effects of withdrawal can become severe enough to cause death and require medical treatment, thus suggesting addiction is a form of disease. No matter what side you choose on this debate, you should expect to run across supportive evidence of the alternate side while arguing your point. It is a choice to try a substance, but it is not a choice to become addicted. Although this brain disease does not remove an addict from their responsibility for their behavior it does explain why many addicts cannot stop using drugs by strength alone. References 1. Satel, S., & Goodwin, F.K. (1998). Is Drug Addiction a Brain Disease?, (9th edition). Upper Saddle River, N.J. Pearson Prentice Hall. Retrieved from http://www.eppc.org/publications/bookID.19,filterID./book_detail.asp 2. National Institute of Drug Abuse. (2007). Is Drug Addiction a Disease? Unknown. Retrieved from http://www.drugabuse.gov/publications/topics-in-brief/drugs-brains-behavior-science-addiction 3. Myers, D.G. (2011).Psychology. (10th edition). New York: Worth Publishers 4. International Narcotics Control Boars (2011). Report of the International Narcotics Control Board for 2011 Unknown. Retrieved from http://www.incb.org/incb/en/publications/annual-reports/annual-report-2011.html

The Black Death in the Middle Ages Research Paper

The Black Death in the Middle Ages - Research Paper Example The bacillus normally persists as a mild infection in the bloodstream of infected rats. The rat flea, or Xenopsylla cheopis, is the vector which transmits the bacillus to other rats. In unusual circumstances, such as the absence of an adequate rodent population, the flea may bite and infect humans. The human immune system is very vulnerable to the bacillus and the plague is usually fatal1. A study of the origin, spread, characteristics and significance of the Black Death in the Middle Ages shows that it was one of the greatest catastrophes in human history. The origin of the Black Death can be traced through historical accounts to Central Asia: â€Å"The earliest documented appearance --- occurred in 1346, in the Mongol territory called the Khanate of the Golden Horde† in present-day southern Russia2. The plague crossed biological barriers in Central Asia to attack and decimate the marmot population. These dead mammals were skinned by Asian trappers and the hides became a part of the merchandise which travelled down the famous ‘Silk Road’ from China, across Asia and to the Crimea.3 The outbreak is reported to have emerged after earthquakes and strange atmospheric conditions. The pestilence first ravaged the teeming populations of China and India, and moved to Persia, supposedly resulting in twenty-four million casualties in the East. There are accounts of horrendous casualties in China, India, Mesopotamia, Cairo, Syria and Cyprus. Gabriele de’ Mussis, a notary of Piacenza, writes that â€Å"In the year 1346, in eastern parts an immense number of Tartars and Saracens fell victims to a sudden and mysterious death.† ... Tartars and Saracens fell victims to a sudden and mysterious death.†5 The Tartars besieged the Black Sea port of Caffa (modern Feodosia), a Genoese settlement in the Crimea, where Italian merchants had taken refuge. The Tartars reportedly catapulted plague-infected corpses into Caffa, spreading the infection to the Genoese, who in turn carried it to Genoa. By 1348, the plague had moved from the seaports to reach the inland areas of Alexandria, Tunisia, Italy and France. It jumped across the seas to Britain, Ireland and Norway. It continued to spread until, â€Å"By 1350 virtually all of western and central Europe has been affected.†6 The plague moved eastwards to Poland and the Baltic lands the next year and then back to Central Asia in 1353, when it finally subsided. Historians currently estimate that, between 1346 –1353, the Black Death may have caused 50 million deaths in Europe. This constituted about 60 percent of the population. The characteristic symptoms o f the Black Death show it to have been a lethal combination of the Bubonic plague and the pneumonic plague. At the onset of the bacillus’ entry into the human bloodstream, the immune system responded with fever and the swelling of the lymph nodes in an attempt to flush out the contagion. These painful, swollen lymph nodes in the neck, armpits and groin, were called buboes: hence Bubonic plague. These swellings were referred to as the gavocciolo. Boccaccio states that some of these swellings â€Å"were egg-shaped while others were roughly the size of the common apple.†7 By the third day the victim experienced high fever, diarrhea and delirium and the skin showed dark splotches due to the rupture of blood capillaries and the clotting of blood beneath the epidermis. This darkening of the skin may be the

Amazon Operational Management Strategies Term Paper

Amazon Operational Management Strategies - Term Paper Example Operations management is not confined to manufacturing alone but also encompasses services. Hence, operations management can be best defined as effective and efficient management of all operations of the organization that contribute to improving the systems that are aimed at creating and delivering quality products and services to the customers (Young, 2009). It involves designing, redesigning, overseeing, implementing, executing of the various business operations. Operations management has a twofold effect on the profit of an organization and hence it is vital for the overall success of an organization. Organization is benefitted from the improved effectiveness due to operations management and the created products and services are such that they meet the requirements and needs of the customers. In simple words, increased efficiency will result in increased revenue which results in a more competitive organization and increased efficiency will also reduce costs (Galloway, 1993). Follo wing are the 10 operational management strategies that an organization can apply: Product/ Service Design, Quality Management, Capacity Management, Location, Layout Design, Human Resources, Supply Chain Management, Inventory Management, Scheduling and Maintenance. This paper is aimed at analysing how Amazon.com has applied operational management strategies to succeed and gain competitive advantage in the market. Amazon.com Amazon.com is a multinational customer-centric American company. Headquartered in Seattle, Washington Amazon.com is an electronic commerce company and the largest online retailer in the world. It was founded by Jeffrey Bezos and incorporated in 1994. Even though it was incorporated in 1994, it went live in 1995. Started as an online book store, Amzon.com today has diversified and expanded its product and service line (Reuters, 2011). Today, Amzon.com sells numerous products from different categories. It not online sells books online but also sells computer softwar e, CDs, DVDs, food, furniture, video games, toys, electronic apparels, MP3 downloads, etc (Google Finance, 2011). Consumers, sellers and enterprises are three primary customer sets that the company serves. Apart from selling products online, the company also generates revenue from various other sources such as co-branded credit card agreements, third party selling, reselling and online advertising (Google Finance, 2011). For the following countries Amzon.com has separate websites: United States, United Kingdom, Canada, Italy, France, Germany, Spain, China and Japan (Amazon.com, 2011). Amazon has numerous software development centres, fulfilment and warehousing centres across the globe to meet the growing demands (Reuters, 2011). Amazon’s Product Categories: Books, DVDs, videotapes, music CDs, musical instruments, toys & games, software, consumer electronics, sporting goods, lawn and garden items, apparel, clothing, kitchen items, gourmet food, tools, baby products, beauty pro ducts, watches, jewellery, industrial & scientific supplies, groceries and health and personal-care items (Amazon.com, 2011). Amazon’s Services: Amazon Web Services, Amazon Publishing, Amazon Prime, AmazonBasics, Amazon.com exclusives, Amapedia, Subscribe & Save, AmazonLocal, Amazon Wireless, askville, Amazon Marketplace, Amazon Fresh, etc (Amazon.com, 2011

Review Discussion of Chris Hackley (2013), Marketing in Context Essay - 1

Review Discussion of Chris Hackley (2013), Marketing in Context - Essay Example According to Hackley, critics have been against marketing and its role because of the associated theories and techniques used in the business world in the name of marketing. The author is honest about the fact that the developed world has experienced some of the benefits associated with marketing. This is through increasing affluence. Despite the evident benefits of marketing, only a few people have a conscience understanding of the functioning of marketing. Many of the books seeking to elaborate the concepts of marketing have not succeeded in doing so in accordance with the views expressed by Hackley. Hackley has the conviction that marketing research and the findings recorded as well as the theories developed from such findings do not conform to the real life aspects of marketing. These reasons prompted Hackley to develop a text that can describe marketing concepts in the appropriate context. Hackley’s book succeeds in clarifying several marketing concepts, its role, and set ting a new scene that allows marketing to be understood in its appropriate context. This paper will present a critical review discussion of Chris Hackley’s introductory chapter and the conclusion he presents. The review is going to consider other chapters in the book, and describe how Hackley develops them to set a â€Å"marketing scene†. In the first chapter of the book, Hackley develops an introduction to his involving text. In this chapter, Hackley introduces the overgeneralization of concepts that has been happening in the marketing field. More specifically, he highlights that only a few people understand marketing in its appropriate context. The efforts of previous authors have not succeeded in enlightening readers on how to understand marketing. This is despite the fact that marketing is one of the fields with a remarkable economic contribution as well as a cultural presence with numerous effects on the society. In an effort to address

Mexican Americans Essay Example | Topics and Well Written Essays - 750 words

Mexican Americans - Essay Example While the author describes the grandmother as an â€Å"awful grandmother† because of her persistent desire to maintain the traditional church doctrines, the rest of her significant others and other younger generations are embracing a new way of life that is more liberal. This conflict of traditional and modern ways puts the religious grandmother and her grandchildren into constant conflicts. In the story, the grandmother maintains the ways of the church, observing the doctrines of the Catholic Church to the latter. First, the grandmother maintains the use of light candles and use of rosaries when praying for the her family, while the daughter never attends the mass as would be desired by the grandmother. The grandmother maintains the traditional church ways, and use her prayer times to pray for the entire family who are seemingly drifting away from the church and embracing the more liberal approach to life. According to the grandmother’s designated way of life, which ex emplified the conservative ways, there are specific material things that are supposed to be completely shunned. First, the people should shun eating fast foods such as fries, should not spend money on comic books, and should not stay anywhere else other than near the church. The desire to maintain ‘purity’, according to the traditional church doctrines, led to strict ways of life that only matched grandmother’s standards and not any other members of the family. For instance, the son is noncommittal on matters church, and the grandchildren are busy Americanizing their lives from language to general behaviors. It is apparent that the subject family in the story is natives of Spain. However, while only the grandmother is able to speak and understand Spanish, her grandchildren struggles with the native Spanish language, thereby causing some sort of barrier to communication. This exposes the fact that there is an adoption of a different culture from that of the native Spain. The successive generations struggle with the native language, a fact that the older generations understand quite well. While the grandmother's generation lived within the church doctrines, their goals focused into the price that is of a society that is prayerful and bent on defending the outright ways of the church, the changing American society of the younger generation do not mind doing things that are outside the realm of church teachings. For example, the young boy challenges the status quo that he sees as against his good. By telling the sister he is the Flash Gordon, and that the sister is â€Å"Ming the Merciless and the Mud People†, the young boy is trying to spate his ability from that of the sister, portraying himself as the strong righteous one. The younger generations, as represented by the young boy, challenges the role of church rituals such as buring of the candles, kneeling down when praying, and taking of the holy water. To the younger generation, suc h rituals never changed anything as far as reduction of human suffering is concerned. The constant church rituals did not stop people from getting sick from worms and life threatening problems such as depression. The society has played a role in the changes in the attitudes of the young generation. For example, the narrator’s little brother is claiming to want to be a flying feather dancer, but in the process somehow subconsciously expresses what he has seen the surrounding, the second world war

Poem explanation for Rumi Essay Example | Topics and Well Written Essays - 500 words

Poem explanation for Rumi - Essay Example The poem’s form is very loose, rhyme free, almost like a flow of free thought from the heart, a confession of a soul not confused any more, but illuminated and free. Its haunting aura of deep simplicity almost borders on atheism: â€Å"Not Christian or Jew or Muslim, not Hindu, Buddhist, sufi, or zen. Not any religion†¦Ã¢â‚¬  Man is the bedrock of all religious and cultural systems, but he is always taught what to believe in and what to feel, while in fact, he should believe in what he feels. For Rumi, religion is a highly personal experience, not necessarily limited to logical arguments or perceptions of the senses, and in this particular poem, he disregards the importance of outward religious observance. Faith and love, just like breath, are invisible, yet inextricably present, and he truly believes that people of all religions and backgrounds can live together in ecumenical peace and harmony. His words come from the heart and ache to explain the often perplexing worl d of personal, spiritual growth, and are aimed at everyone, every single human being on earth. He continues to list contrasting worlds of â€Å"the East or the West†¦ the ocean or†¦ the ground, not natural or ethereal† pushing his existence away from all those cultural and natural systems. He is neither, yet he is all of them.

American History Essay Example | Topics and Well Written Essays - 250 words - 4

American History - Essay Example The author writes in this context as a response to the augments made by these writers and in his view the most important efforts were done by Richard Powers (1994) and Ellen Shrecker. The political and cultural sitting at the time of the writing of the paper includes the fall of the Soviet Union and the collapse of international communism prompting. The writing of the article was also prompted by the reevaluation of the cold war era in America by different writers prompting the author to present the most important writers. The intended audiences for the article are students, scholars, and the public. The article is aimed at this audience as a measure of augmenting the understanding aspects of cold war era and demonstrating the various issues at play during the time. The article’s thesis is making a combination of two perspectives on anticommunism with the aim of seeking an evaluation of consequences of anticommunism and the mix of responsible and extremist elements. The study’s objective is achieved through an examination of the investigations by the House Committee on Un-American Activities (HUAC) on the activities undertaken by the Communist Party of Maryland. In summary the article provides the controversies associated with the communism in the writings of Power and Shrecker but makes a point in showing that the two writers had some similarities in their view of the period. The similarity is that the two writers acknowledged that anticommunist protests were waged against mainly members and organizations tied to the Communist Party USA (CPUSA). Some of the arguments in the article include the fact that Power’s states the nature of anticommunism as complex, pluralist movement containing elements of responsible, principled, and conspiracy-based extremists1. On the other hand, Shrecker considers McCarthyism as having caused setbacks for labor, restriction of

Research Continuous Quality Assurance efforts in a school clinic Essay

Research Continuous Quality Assurance efforts in a school clinic - Essay Example For any treatment to bear fruit, a patient is required to admit the fact that he or she is sick and that they are open to the treatment they are being given. School going children are mostly encountered with psychological challenges that got to do with growth and transition. They are surrounded by various options that a largely influenced by their peers and guardians. They, therefore, need somebody they can trust with their psychological thoughts. Due to the various growth transitions that they go through, most of them tend to shy away from adults and instead choose to trust their peers. It is, therefore, vital for a healthcare provider to reassure them of their loyalty and trust.As stated earlier, quality healthcare is not just about physical illness but also psychological issues. It may not be easy for school going children to acknowledge the fact that emotional disturbance may be a form of a health care issue that requires intervention. It is hence important for school physicians to create awareness among pupils and students about their psychological health. Healthcare providers need to organize meetings to create such awareness and even help the children to know how to overcome some of the issues they are encountered with. There are questions such as relationships and drugs that are synonymous with certain age groups. A healthcare provider can organize meetings with children of particular age groups and ensure that they open up on some of the challenges they face and how best to handle them.

Packaging Design Essay Example | Topics and Well Written Essays - 4000 words

Packaging Design - Essay Example Protection from foreign particles entry; the products are protected from entry of oxygen, dust, bacterial, viruses, water, chemicals and other harmful agents that may destroy or degrade the working parts. Agglomeration: through packaging, small objects are grouped together to form one package. Packaging eases the process of transport, warehousing and distribution. Products like liquids, powders, air and chemicals are easily handled when packaged. There are many types of packaging materials that are commonly used. These materials differ from product to product and are also affected by the mode of transportation, costs, warehousing, customer's demands and many other factors. In the recent past, great concerns have been put forward by the environmentalist regarding the pollution by packaging materials. Most packaging materials are discarded once the product reaches the customer. This has significant effects on the dumping and pollution especially if the packaging material is made of plastic or glass or any other non degradable material. This has resulted to the introduction of recyclable packaging materials, materials reuse and use of biodegradable plastics. Consequently, symbols of quality, recycling symbol, the green dot symbol have all be introduced on the packaging materials. ... Consequently, symbols of quality, recycling symbol, the green dot symbol have all be introduced on the packaging materials. This papers studies packaging materials for lighting applications, their effects to the environments and also studies which of the materials are recyclable and environmentally friendly as well as the current techniques used to improve packaging to prevent dumping and accumulation of these materials in landfills. Types of lighting application There are many types of lighting applications these include; Incandescent bulbs Fluorescent lights Compact fluorescent lights (CFL) Metal halide bulbs Light emitting diodes (LED) Special lights (infra-red lights and X ray lights ) Lighting accessories such as sockets, switches and lamp bases There are various packaging materials for these different lighting. Incandescent bulb The incandescent bulb has several packaging materials. These materials include the glass bulb, that houses the internal parts of the bulb that is, the filament, the metallic base that aids in the connecting the bulb to the electrical supply. The outside packaging of the bulb includes a carton that carries the bulb. The outer carton varies from one manufacturer to another; some types of packaging are illustrated below. Single bulb color box packing that is used to house one bulb Figure 1: Carton for packaging a single bulb and double pack bulb packaging: (source: QML. 2009. Incandescent bulb. http://www.alibaba.com/product-gs/200800532/Incandescent_Bulb.html) After packaging the bulb in individual small cartons, the bulbs are then packaged into a large carton for transportation. Large carton where incandescent bulbs are packaged Figure 2: large Carton for packaging

Two Variable Inequality Essay Example for Free

Two Variable Inequality Essay a) Let ‘c’ be the number of classic maple rocking chairs and ‘m’ be the number of classic maple rocking chairs that Ozark Furniture Company make. b) Here we have given that a classic maple rocker requires 15 board feet of maple, and a modern rocker requires 12 board feet of maple. We have ‘c’ classic maple rocker, so total maple required for classic maple rocker chair = 15c board feet. And we have ‘m’ modern maple rocker, so total maple required for classic maple rocker chair = 12m board feet. We have total maple available is 3000 board feet. Hence we can show this condition as: 15c + 12m ≠¤ 3000. This is the inequality which is showing the given situation. c) Graph for this inequality: d) Here this is a less than and equal to inequality, so we need to take the area which is below to the line 15c + 12m = 3000 and this will be a solid line on the boundaries. The region lies between origin to x and y – intercepts. Each point which is in the first quadrant and under the shaded area is a solution for the given inequality. So, if (x, y) is a point in the shaded region then Ozark Furniture Company can obtain x number of classic and y number of modern maple rocking chairs. So, x – axis is showing number of classic maple rocking chairs and y – axis is showing the number of modern maple rocking chairs. i) Consider the point (50, 100). This point is indicating that company is making 50 classic and 100 modern maple rocking chairs. So, c = 50 and m = 100. So, 15c + 12m = 15(50) + 12(100) = 750 + 1200 = 1950. Total board maple available = 3000 board feet. Hence, total remaining maple = 3000 – 1950 = 1050 board feet. So, (50, 100) point, which is within the region showing that the company is making 50 classic and 100 modern maple rocking chairs and using 1950 board feet of maple. In this case total waste of maple is 1050 board feet. So, the company can fill the order easily. ii) Consider the point (200, 100). This point is indicating that the company is making 200 classic and 100 modern maple rocking chairs. So, c = 200 and m = 100. So, 15c + 12m = 15(200) + 12(100) = 3000 + 1200 = 4200. Total board maple available = 3000 board feet. Hence, extra maple required = 4200 – 3000 = 1200 board feet. So, (200, 100) point, which is out of the region showing that the company is making 200 classic and 100 modern maple rocking chairs and need 4200 board feet of maple. In this case the company needs 1200 board feet of maple. So, company cannot fill this order with the available maple. iii) Consider the point (100, 125). This point is indicating that the company is making 100 classic and 125 modern maple rocking chairs. So, c = 100 and m = 125. So, 15c + 12m = 15(100) + 12(125) = 1500 + 1500 = 3000. Total board maple available = 3000 board feet. So, here the company has exact amount of required maple. So, (100, 125) point, which is exactly on the line showing that the company is making 100 classic and 125 modern maple rocking chairs and need to be very careful because company has exact amount of maple available to complete this order. So, company can complete the order. f) Here the order is of 125 classic rocking chairs and 175 modern rocking chairs. In terms of point we can show this condition as (125, 175). So, we have c = 125 and m = 175. So, 15c + 12m = 15(125) + 12(175) = 1875 + 2100 = 3975 board feet. Total maple available = 3000 board feet. So, Ozark Furniture will need 3975 – 3000 = 975 board feet of lumber. So, Ozark Furniture is not able to fill this order because the point is outside of the shaded area and company will need 975 board feet of lumber to fill the order. Conclusion: This was a real life example that how to use inequalities in our business. By the use of this we got to know that we will able to fill any order or not and if not then how much more raw-material we need to complete the order. This was very interesting question and we discussed all the 3 possible cases in this. References Dugopolski, M. (2012). Elementary and intermediate algebra (4th ed.). New York, NY: McGraw-Hill Publishing.

Education Theatre Essay Example for Free

Education Theatre Essay â€Å"CAN you still remember your Grade I teacher? † This was once the by-line of an advertisement of one financial institution. This is also the base concept of the play â€Å"Ang Guro† staged by Stairs Production and Imagination Beyond Events Philippines at West Negros University Gym last Saturday, January 21. The musical play was written by occupational therapist Paul Ballano. This is his form of loving tribute to his Grade I school teacher, Mrs. Cecilia Resontoc, who was instrumental in making him pursue, work and reach his goals, despite all odds. As Paul fondly recalled after the curtain call, Mrs. Resontoc made him believe in what he can do, what he can achieve, and what he can become. The soft–spoken yet talented singer Karel Marquez performed the lead role perfectly. Comely, gentle yet versatile, Karel took in the part of Ms. Amelia Resontoc, a young high school teacher who has the knack of understanding and motivating her students. With her strong convictions, she encouraged her students to keep on going by singing â€Å"The Climb†, as she accepted each of their individual differences in â€Å"True Colors. † Izzy Trazona, one of the Sex Bomb Dancers, showed off her acting and dancing prowess as one of the talented yet late bloomer students of Ms. Resontoc. Sheila Asuncion, who plays the mother of Karel, not only played her role well but also belted out one powerful, heart–rending rendition of â€Å"The Prayer† together with the lead singer. Together with Charina Ramirez, Kath Jarabelo, Zac Celadania, Yab Aragones, Jake Duquiatan, Vida Masakayan, Jess Ibasco, Juddie Fe Suarez, Ahmee Galguerra, Owen Siy, Sweet Reyes, Jen Galope, Kiana Rodriguez, Armand Go, and playwright Paul, they composed the powerhouse of a cast which made the play a natural success. Moreover, the play’s universal theme on the crucial role that teachers play in the molding of the country’s young minds and the nobility of the teaching profession are great ideas which need to be brought to light. No wonder why the Department of Education and the West Negros University supported the staging of the musicale. The stage set and backdrop were to the minimum. Same with the costumes. But the plot thickens with almost real-life dialogues and scenes which every teacher and student or school administrator in the audience could easily identify with. The different personalities of teacher and students, and the varied circumstances which caught each web of each other lives provided the audience with hearty laughs, and flowing tears. The end of the play may have been tragic, but all good works do not go in vain. Especially that of the noble teacher Ms. Amelia Resontoc. Directed by Sweet Grace Ballano, â€Å"Ang Guro† may still have to undergo some minor refinements in stage blocking, but it has carved a better niche for itself in the world of stage plays. The cameo roles which some WNU dancers and students did in the play are also worth mentioning. But because the play is conceptualized and brought to different schools all over the country with no thought of a bigger profit, except to fulfill the writer’s dream and to bring forth the messages of acceptance, honor, love and understanding. It’s just quite sad to note that not everybody in the teaching profession or those who are enrolled in education courses have watched the play. But still, like a good book, or a worthy movie, the musicale â€Å"Ang Guro† has touched hearts and minds. And if all the student-members in the audience took leave of their seats to go thank their teachers in the audience and give each a warm hug, such is indicative that the musicale has brought its message across its audience’s hearts. Thus, warm kudos to the members of production and the cast of â€Å"Ang Guro† and to the wonderful people and sponsors in Bacolod who brought the musicale here. Well, what or who then is the â€Å"guro†? Probably they could be as specific as Socrates, Anne Sullivan, Marva Collins, Mary McCloud Bethune, Bel Kaufman or, from the namesake of the lead player in the musicale, Mrs. Cecilia Resontoc all of them having one thing in common: they were all teachers in their own time. Or in generics, a â€Å"guro† can just be a â€Å"he† or a â€Å"she† nameless or faceless yet gentle and wonderful beings who have long been forgotten but whose valuable lessons and strength in character will always be remembered by their students. So, at this point, can you now recall your Grade 1 teacher? Or even your other teachers? I hope you can. I would like to end with a part of a speech of John Schlatter of Cypress, California which I adapted. â€Å"Throughout the course of the day I have been called upon to be an actor, friend, nurse and doctor, coach, finder of the lost article, money lender, psychologist, substitute parent, and a keeper of faith†¦ I am allowed to see that life is reborn each day with new questions, burst of ideas and young friendships†¦ I know that if I build with love and trust, what I build will last forever†¦ I am a warrior, daily doing battle against peer pressure, negativity, fear, conformity, prejudice, ignorance, and apathy. But I have great allies: curiosity, intelligence, creativity, faith, love and laughter which all rush to my banner with indomitable support†¦ I AM A TEACHER. † Dear teachers, our hats off you. GOD BLESS.

Should Xenotransplantation Be Allowed?

Should Xenotransplantation Be Allowed? Xenotransplants have a long history in modern medicine. In late 1963 and early 1964, a team from Tulane University led by Keith Reemtsma, MD, did kidney transplants from chimpanzees into six patients, and one of them survived for nine months subsequent to the transplant. By 1974, including investigational surgeries performed by Thomas Starzl, MD, of University of Pittsburgh, around 20 patients had received xenotransplants. In this essay, I will examine if xenotransplantation should be allowed. Xenotransplantation is the removal of cells, tissue or organs from one organism and then implanted into another organism (Nuffield, 1996). A xenograft is a surgical graft of tissue between different species. The most liable source of transplantable organs is currently the pig. A modern technique from molecular biology that is now used to alter a donor organ is referred as gene knockout technology. Specific genes are inactivated through this way. Hypothetically, gene knockout technique can eliminate genes for antigens or other factors that induces rejection from animal organs and tissues permanently. Scientists are trying to make the human immune system accept transplants of pig organs by genetic engineering to modify the pig. Research teams are trying to delete specific pig genes or inserting human genes to modify pig cells into a less foreign matter to the immune system by accessible laboratory techniques. The manufacture of transgenic organs is an approach to shield animal organs f rom rejection by humans without need for immunosuppression. With the aid of transgenic technology, genes that can prevent rejection are added. In transgenic modification, either all the animal cells that contain the foreign gene which is incorporated firmly into their genome expressing the protein, or only chosen cells contain these genes due to the presence of promoters that are precise for a single cell type (Levinsky, 1996). There is an increase in number of patients with organ failures but an insufficient supply of organs, creating a gap between organ supply and demand (Uncaged, 1999). Considering that this imbalance has resulted in rising waiting times and number of deaths of patients on waiting lists, xenotransplants should be allowed. (Levinsky, 1996) Other than that, researchers also have studied transplanting animal cells for therapeutic effect. Suzanne Ildstad, who is the director of Institute for Cellular Therapeutics in Louisville, Kentucky does bone-marrow transplantation research. In year 1995, she performed a baboon bone-marrow transplant into Jeff Getty, a man infected with HIV and therefore has AIDS. Bone marrow makes immune system cells. The main aim was to shield Getty from infection by replacing his collapsing immune system with a HIV-proof baboon immune system. Getty is still alive even though the baboon cells functioned for merely two weeks (Agnew, 1999). Besides that, enough animals could be reared to supply sufficient organs and tissue to surmount the current shortage of human organs and tissue for transplantation. Pigs are the considered the liable candidates because they are highly tamed, have large amount of litters, grow rapidly to maturity and their organs are the correct size. They can be bred in sterile environments, and this decreases the chances of transmission of certain pig diseases to humans. Successful xenotransplantation of genetically modified organs and tissue would eradicate the need for the careful matching of the organ or tissue with the recipient, necessary in transplants between human beings in order to lessen rejection by the immune system. This predominantly benefits people who have difficulties finding compatible organs and tissue (Nuffield, 1996). The potential benefits are obvious, but the harm that it also brings cannot be overlooked. The human immune system consists of an intricate network of defense against disease and other foreign substances. When an organ from an animal that is evolutionarily remote is introduced, the human immune system shows a violent response. In hyperacute rejection, antibodies that appear pre-primed to attack tissues of another species convene the complement cascade, a range of proteins in the blood which attacks the interior walls of the transplants blood vessels, causing organ rejection within hours or even minutes. Patients died either due to graft rejection or because of infections resulting from the use of large doses of immunosuppressive drugs (Agnew, 1999). Animal organs may come with unwanted viruses or infectious organisms. The foremost concern involves porcine endogenous retroviruses (PERVs) because they are able to infect human cells in-vitro and cannot be eliminated from the source animals genome. In the more notable research projects, three classes of infectious type C PERVs have displayed its ability of infecting human cells. PERVs can infect both pig and human cell lines. This shows that PERVs is most likely to replicate in pig transplants and human cells in immunosuppressed xenograft recipients. Scientists believe that there is an intolerable threat to public health related with xenotransplantation because of the lack of alternatives to counter risks posed by PERVs (Uncaged, 1999). Moreover, there is a possibility of initiating a human epidemic. Zoonotic infections have the potential to expand beyond the individual and into the public. The likelihood for xenogeneic infections to be transmitted through human populations poses a public health concern. Furthermore, the risk for health care workers who interacts with the xenograft recipient is higher than for the community at large (Uncaged, 1999). Finally, the use of animals as a source of xenotransplant organs will raise an ethical storm. The main concerns of bioethicists and animal-rights advocates are whether humans have the moral right to exploit animal organs to save human lives. The debate is further strengthened when we consider the suffering, exploitation and annihilation of animals (Nuffield, 1996). In conclusion, xenotransplantation can solve the shortage of organ supply, minimise the need for careful matching of the organ or tissue with the recipient and also has therapeutic effect. On the contrary, it might be potentially harmful to patients through infection or rejection. Risks for zoonotic infections that can spread to the community are high and ethical issues such as exploitation of animals would be raised. (1000 words)

Advancement in Technology: How it has Lead to a Decrease in Writing Sk

Advancement in Technology: How it has Lead to a Decrease in Writing Skills It’s the 21st century, and technology is rapidly moving more into people's everyday lives, especially as the interest in computers grow. The advancement with computers alone has increased drastically, faster than some would have ever imagined. For the most part, this advancement in computer technology has skyrocketed businesses and eased our lives as a whole in society. However, technology doesn’t always have a positive influence on our lives. In fact, it has the potential to harm a major area of our communication skills if not used carefully. It has been shown that technology is one of the factors as to why writing skills have decreased in the past years. With our nation’s writing skills in a slump, it’s important to note the reasons as to why this trend has started and put an end to it as soon as possible. Computers should be used as a language-learning tool in the classroom, just as any other piece of equipment like a tape recorder or VCR. No one can argue that the computer is one of the most influential tools developed in education. However, in school especially, it seems as if the use of computers has become the center of attention in class lessons, which is where the problem comes in. If for instance, there is a situation when activities at the computer could become the center of attention, teachers should be using more discretion in this area than they currently are today. Relying on computers for every aspect of a lesson will greatly have an effect on a student’s writing capabilities, and it isn’t a positive one. When students are interacting with a computer, they are also using motor skills as well. These motor sk... ... 3e/students/rcd/rcd_ch05.html Haney, W. & Russell, M. (1997). Testing writing on computers. Education Policy Analysis Archives, 5(3), Retrieved October 17, 2004, from Peer-Reviewed Scholarly Electronic Journal database. Jones, Rebecca (Oct1995). Education Digest. Writing Wrongs, Volume 61, page 63. Poor Writing Blamed on Little Practice, Poor Instruction (July 10,2003). Retrieved October 17, 2004, from http://abclocal.go.com/wabc/news/wabc_ourschools_071003writing.html Toner, Erin (1997). Graduates lack computer, writing skills. Resources from state news staff. Retrieved October 17, 2004 from http://www.statenews.com/editionsfall97/082997/p1_study.html Using Technology to Enhance the Writing Processes of Students with Learning Disabilities (1996, July). Retrieved October 17, 2004, from http://www.ldonline.org/ld_indepth/technology/tech_writing.html