Ischemic Stroke Rates in Ireland - 678 Words

In Ireland there is a very high incidence of stroke with around 10,000 people a year having a stroke. Approximately 2,000 people die each year as a result and approximately 30,000 people within the Irish community are suffering with a disability as a result of stroke. (Irish Heart Foundation, 2011) This essay will discuss the topic of stroke, outlining the pathology of the disorder and discussing the recovery process. There are two major categories which stroke is divided into: Ischemic, which is the cause of 85% of strokes and Haemorrhagic, which causes 15%. In ischemic stroke, vascular occlusion and hypoperfusion occur, while in haemorrhagic stroke there is extravasation of blood into the brain or subarachnoid space. (Hinkle and Guanci, 2007). There are some similarities between the two, however differences exist in aetiology, pathophysiology and medical and surgical management. The causes and effects of each of the categories of stroke will be discussed and compared and the treatm ent and process of recovery will be described. An ischemic stroke is caused by the disruption of the supply of blood to part of the brain. Blood travels to the brain through arteries from the heart. In the case where an artery which supplies blood to the brain becomes narrowed or obstructed due to disease or other causes, blood flow to areas of the brain can become reduced. This reduces the supply of oxygen and glucose to the cells of the brain. According to Hickey (2003), 45% of ischemicShow MoreRelatedWith The Recent Shift In Our Country’S Political Climate1492 Words   |  6 Pagesfour major lifestyle behaviors, according to independent studies conducted by British scientists Janas Harrington and Phyo Myint. Myint’s longitudinal study aimed â€Å"to quantify the potential combined impact of four health behaviours on incidence of stroke in men and women living in the general community† (Myint, 2009). Subjects were categorized based on how many of the healthy lifestyle behaviors they participated in (or abstained from). The lifestyle behaviors are as follows: current non-smokingRead MorePatients Suffering From Acute Myocardial Infarction2550 Words   |  11 Pageswomen suffer heart attacks (62,000 men and 39,000 women) annually. This is juxtaposed with Scotland where 8,000 men and 5,000 women become heart attack patients annually. The gross figure for the UK yearly, when including Wales and Northern Ireland on a comparable rate to the UK is approximately 124,000 patients per year (British Heart Foundation 2010). For many years, pre-hospital primary intervention for this condition included high flow oxygen, as a matter of course based on anecdotal evidence andRead MoreHsc Level 5 Unit 534 Essay14626 Words   |  59 Pagesshows no obvious signs, whereas some cause significant functional impairments.A stroke occurs when the blood supply to part of the brain is suddenly interrupted or when a blood vessel in the brain bursts, spilling blood into the spaces surrounding brain cells. Brain cells die when they no longer receive oxygen and nutrients from the blood or there is sudden bleeding into or around the brain. The symptoms of a stroke include sudden numbness or weakness, especially on one side of the body; sudden confusionRead MoreNatural Dyes11205 Words   |  45 Pagesyellows, reds, browns, and bright pinks and purples. The lichen Rocella tinctoria was found along the Mediterranean Sea and was used by the ancient Phoenicians. In recent times, lichen dyes have been an important part of the d ye traditions of Wales, Ireland, Scotland, and among native peoples of the southwest and Intermontane Plateaus of the United States.[37] Scottish lichen dyes include cudbear (also called archil in England and litmus in Holland), and crottle.[45] [edit] Fungi Miriam C. Rice, (1918—2010)

Comparison of Pavlov vs Bandura. - 2096 Words

We use the term classical conditioning to describe one type of associative learning in which there is no contingency between response and reinforcer. This situation resembles most closely the experiment from Pavlov in the 1920s, where he trained his dogs to associate a bell ring with a food-reward (Ryle 1995). In such experiments, the subject initially shows weak or no response to a conditioned stimulus (CS, e.g. the bell), but a measurable unconditioned response (UCR, e.g. saliva production) to an unconditioned stimulus (UCS, e.g. food). In the course of the training, the CS is repeatedly presented together with the UCS; eventually the subject forms an association between the US and the CS. In a subsequent test-phase, the subject will†¦show more content†¦What Watson realized was that Albert was responding to the white beard Watson had at the time (Howard 2001). Thus, the fear evoked by the white, furry, rabbit had generalized to other white, furry things, like Watsons bear d. Behaviorism overall is a good scientific theory. It is simple and parsimonious, with the approach of cause-and-effect idea. Therefore, it is not necessary to invent hidden processes of learning (e.g.. Freud) to explain why behavior happens. The behaviorists believed that behavior is caused by environmental events (stimuli, reinforcers). With this idea, it cannot be controlled. Behaviorism is deterministic, as we do not control our own actions, and so therefore cannot be responsible for them. However, it becomes possible for others to control our behavior by manipulation of environmental events (Vancouver 2001). Behaviorism assumes that human behavior should be studied using the same methods applied in the physical sciences - that assuming psychology should restrict itself to studying only those things that can be studied directly. In this way, it means that anything that cannot be observed cannot be studied and that w cannot fully explain human behavior and the complications behind it. Williams (2002) added that although stimuli, response and reinforcement are essential in behaviorist explanation of behav ior, they areShow MoreRelatedInnate Theory : Innate Factors1258 Words   |  6 Pagesinnate factors need to be considered in order to explain our behaviour. Throughout the essay I will look at key branches of psychology which contribute to our behaviour. I will also compare and contrast both heritable and environmental factors, this comparison will enable me to uncover the level of importance within heritability. We are led to believe that one gene can contribute to a behavioural trait, most people are unaware of the extensive biological engineering of our genes ‘humans have 23 pairsRead MoreLearning Concepts and Research Approaches1337 Words   |  6 Pagesdraws the interest of psychologists who explore the prospect of reaping the greatest benefit from the human capacity to learn. This effort requires a description of the concept of learning, distinguishing between learning and performance, and a comparison/contrast of the conceptual approaches to the study of learning. Whereas learning affects behavior, understanding how people learn and adapt can enable productive learning and may facilitate enhanced lifespan development. Concept of Learning LearningRead MorePsychology14463 Words   |  58 Pagesresearch using constructs proposed to represent the operation of basic human needs, we instead review much more selectively the current state of theories about basic human needs, with a little historical context. We have chosen six theories for comparison. All of these theories have been given extensive explication and review elsewhere, so we will focus particularly on how these theories are structured and at what level of analysis they are designed to apply. We will find a little agreement but perhapsRead MoreCurriculum Development- Let Review9921 Words   |  40 Pagescontent of the curriculum are shown in its historical development . 3. PSYCHOLOGICAL FOUNDATIONS A. Behaviorist Psychology (20th century) – included the following behaviorists: Edward Thorndike Ivan Pavlov B.F. Skinner Albert Bandura Robert Gagne 5 learning outcomes: intellectual skills – knowing how Information or knowing what Cognitive strategies or learning skills Read MorePsychology Workbook Essay22836 Words   |  92 Pagescognitive processes. Exercises 1. Fill in the chart below. |School of Thought |Important Theorist(s) |Main Ideas | |Behaviorism |B.F Skinner, Ivan Pavlov, James B. |-Organisms repeat responses that lead to positive outcomes; | | |Watson |Freewill is just an illusion. | | |

Oceanography As Viewed From Space Essay Example For Students

Oceanography As Viewed From Space Essay Oceanography as Viewed from SpaceIntroductionAt first thought, studying the oceans from space seems to be a bizarre idea. Space observation helps oceanographers do research with manned and unmanned space systems. The space systems can be satellites and/or space shuttles that observe various features of the ocean such as sea-surface winds, sea-surface temperatures, waves, ocean currents, frontal regions, and sea color. Technological advances have greatly improved the ability of oceanographers to gather and use information that is received. Oceanography as viewed from space has and will become more and more valuable as we begin to understand more of the worlds oceans. ProjectsSpace oceanography uses a number of different sciences to research the oceans that include physics, geology, biology, chemistry, and engineering (Cracknell 13). This is evident in the projects that send satellites into space for observation of our oceans. In 1992, the Topex/Poseidon project was launched to observe the interaction between the ocean and the atmosphere (Cracknell 17). The Topex/Poseidon mission is to gather information about sea level heights and ocean currents (Cracknell 17). The Topex/Poseidon orbits above the earth at 840 miles and has a 10-day repeating cycle in which it takes pictures of all of the earth (Cracknell 17). Information about the how the sea level changes can tell scientists that there are changes in ocean currents and in climate patterns (Cracknell 25). This information is valuable to both oceanographers and meteorologists because it gives information about the phenomena, El Nino. Figure 1 is a picture of how the Topex/Poseidon works. Figure 1(NASA)The Topex/Poseidon receives information as to what it is supposed to do from a beacon on earth. The satellite then gathers the information it is supposed to gather and then sends it to the beacon on earth. The beacon on earth processes this information so that scientists can use it. As the Topex/Poseidon nears the end of observation new developments are being made to continue with similar work. Jason 1 is an observation satellite that will look at extending research about the interaction of oceans with the atmosphere, improving predictions about the climate, continue to monitor El Nino, and observe ocean eddies (Cracknell 26). These satellites are leading the way to a better understanding of our oceans as well as weather on planet earth. HistoryObservations of oceanographic features with pictures were first realized with the invention of the camera (Pinet 181). Soon after the invention of the Camera, hot air balloons were used to take high altitude pictures of the land and sea, for mapping purposes (Pinet 181). In World War II, pilots took pictures of large areas of land that were used to develop strategies in the war (Pinet 181). At the beginning of the space age, just after World War II, rockets (although never in orbit) used movie cameras to photograph the surface (Pinet 182). The first manned shuttles took pictures of Earth and realized there were many observations of the oceans to be made (Pinet 182). Soon remote sensing came into action as satellites were sent into orbit (Pinet 182). Process of Remote SensingRemote Sensing involves two types of instruments, passive and active (Gautier 58). Passive instruments detect natural energy that is reflected or emitted from the Sun (Gautier 59). Scientists use a variety of passive remote sensors such as a radiometer, imaging radiometer, and spectrometer. A radiometer measures the intensity of electromagnetic radiation in a band of wavelengths in the spectrum (Gautier 59). The spectrum is a measure of the visible, infrared (heat), and microwaves emitted from the Earth (Gautier 60). An imaging radiometer has the capability to scan an area and provide pixels of an area giving more detailed images of the surface than a radiometer (Gautier 60). A spectrometer detects, measures, and analyzes the wavelengths of the spectrum using prisms to separate the colors (Gautier 61). .uc5cbadf9e3d559f289ec6cbf0fff14ac , .uc5cbadf9e3d559f289ec6cbf0fff14ac .postImageUrl , .uc5cbadf9e3d559f289ec6cbf0fff14ac .centered-text-area { min-height: 80px; position: relative; } .uc5cbadf9e3d559f289ec6cbf0fff14ac , .uc5cbadf9e3d559f289ec6cbf0fff14ac:hover , .uc5cbadf9e3d559f289ec6cbf0fff14ac:visited , .uc5cbadf9e3d559f289ec6cbf0fff14ac:active { border:0!important; } .uc5cbadf9e3d559f289ec6cbf0fff14ac .clearfix:after { content: ""; display: table; clear: both; } .uc5cbadf9e3d559f289ec6cbf0fff14ac { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .uc5cbadf9e3d559f289ec6cbf0fff14ac:active , .uc5cbadf9e3d559f289ec6cbf0fff14ac:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .uc5cbadf9e3d559f289ec6cbf0fff14ac .centered-text-area { width: 100%; position: relative ; } .uc5cbadf9e3d559f289ec6cbf0fff14ac .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .uc5cbadf9e3d559f289ec6cbf0fff14ac .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .uc5cbadf9e3d559f289ec6cbf0fff14ac .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .uc5cbadf9e3d559f289ec6cbf0fff14ac:hover .ctaButton { background-color: #34495E!important; } .uc5cbadf9e3d559f289ec6cbf0fff14ac .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .uc5cbadf9e3d559f289ec6cbf0fff14ac .uc5cbadf9e3d559f289ec6cbf0fff14ac-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .uc5cbadf9e3d559f289ec6cbf0fff14ac:after { content: ""; display: block; clear: both; } READ: Anne Frank EssayActive instruments provide electromagnetic radiation to observe an object (Gautier 69). Satellites that use active instruments send a pulse of energy towards the object being observed, then wait for the energy to be reflected (Gautier 69). This energy is then picked up as weaker or stronger in areas, which can define what features the satellite is looking at (Gautier 70). Some active instruments are radar, scatterometer, and lidar (Gautier 71). Radar uses radio or microwaves to emit electromagnetic radiation upon an object and record the time between when the energy leaves and comes back (Gautier71). A scatterometer uses microwaves the same way as radar, bu t it can measure wind speed and direction (Gautier71). Lidar uses lasers to transmit a light source on the object being observed, they can calculate a number of elements in the atmosphere (Gautier 71). With all of this scientists are able to determine the heights of the oceans, able to predict weather patterns and the effects on the ocean. FutureUnmanned space systems are the most cost-effective way to observe the planet (Victorov 109). The human eye however, has the best ability to observe the earth in a visual perspective (Victorov 110). Humans in space play a valuable role in the observation of oceans (Victorov 111). In the future people will be permanently stationed in space stations to observe and research the earth (Victorov 111). How the satellites workSatellites that observe the surface of the earth rotate at the same speed as the earth, this enables them to take pictures from pole to pole (Victorov 123). Figure 2 is a diagram of a Geostationary Operational Environmental Satellite (GOES). Figure 2(NASA)A GOES satellite rotates above the earth at 22,000 miles. The camera on the satellite sends photographs back to earth through its antenna (Robinson 34). Solar panels use the sun to produce energy, and the solar sail and trim tab keep the satellite from spinning out of orbit when the solar wind hits the satellite (Robinson 34). Ocean color can indicate a number of things to an oceanographer, such as amount of plankton, and amount of vegetation (Gautier 117). The color of the ocean changes slightly, from a bright blue to a dark blue or black (Robinson 118). These changes in color happen when plankton float freely and concentrate in areas (Robinson 119). These concentrations are called blooms and are shown off the coast of Angola in Figure 3. Figure 3The ocean color can also turn into a blue-green because of the presence of large amounts of vegetation (Robinson 124). Together, these colors can indicate to scientists the productivity of the oceans and potential for greater amounts to wildlife (Robinson 125). Figure 4 is a false color image that shows the amount of plankton in the ocean. Figure 4The microscopic plankton are the basis of the marine food web, without plankton all marine life would suffer. Thus, the importance of the information from the false color images of plankton on the earth becomes more valuable. ConclusionOceanography is a new science that will unleash a lot of new information to us on how planet earth works. Oceanography from space will be a tool for find out more about our oceans, but there are limited things it can do. It is expected that few major developments in oceanography will occur with satellites. The development of satellite oceanography will bring together ideas from all sciences to an overall understanding about oceans and earth as a whole. Science

The Death of Newspapers free essay sample

Since the turn of the new century, newspapers have always been the main source of our news. For years, it started the day for millions. Along with a cup of coffee, maybe even some breakfast, the arrival of the morning paper meant the beginning to the daily grind. Nowadays the evening paper is long extinct, especially in large cities. With Internet so available to the masses and, for the most part, providing free news, the newspaper is no longer a necessity. The newspaper becoming extinct is beneficial because it is more environmentally friendly, is more of a convenience, and has given voice to countless talented people who would otherwise have no platform. Lets take a look at the newspaper from an environmental point of view. Nearly four billion trees worldwide are cut down annually for paper alone, representing about thirty-five percent of all harvested trees (Lukenbill 1). Each person alone in the United States uses almost eight hundred pounds of paper per year that adds up to almost two hundred billion pounds per year for our entire population. We will write a custom essay sample on The Death of Newspapers or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page World paper consumption has grown four hundred percent in the last forty years. With the newspaper industry consuming almost ten percent of all trees the downfall of newspapers would be very environmentally friendly (Lukenbill 2). The United States Toxic Release Inventory Report released by the EPA states that pulp and paper mills are among the worst polluters to air, water, and land of any industry in the country. Not only do the mills pollute but also distributing all the newspaper copies to newsstands and homes, then trucking them back to recycling center or landfills creates even more. The end result, according to a 2006 report, sates newspaper sales account for almost sixteen percent of all carbon emissions (Koerner 1). Not only does the downfall of newspapers save trees but also creates less pollution. Some may try to argue the fact that the servers and desktops used to make online newspapers possible are on par with the pollution newspapers create. This would be true only if over sixty-five percent of all newspapers were recycled. Close to forty percent of newsprint comes from recycled material making this counterargument fictional (Koerner 1). This isn’t just about pollution, though, and we know it. Our world today is about convenience. The sooner and the cheaper we can access anything, the better. Nowadays things are faster paced and people just don’t have the time or luxury to read over the newspaper. The number of people employed by the industry fell by eighteen percent between 1990 and 2004 (Weeks 1). The Internet provides outlets for anyone with an opinion, and the ability to have a voice is very attractive. Blogging has also become a huge hit on the web scene, and with it, more opinions, leading readers to question authority and other â€Å"facts† of media. Most large-circulations papers have created strong websites. With advertising dollars providing more revenue, these online versions of the paper can attain extra readers, generate more talk, and lead to more hits and higher numbers. Young teenagers now don’t even remember a time without the Internet, and reading a newspaper would be something unheard of. Going through a newspaper, while trying to find a relevant topic and ending up with ink all over your hands is much less appealing than typing in what you’re trying to find in a search engine and getting a thousand hits in less than a second. Also with the Internet there are websites such as Craig’s List or EBay arising, there is no longer a need to pay for an add in the newspaper when you can sell your item for free. We need to stop holding onto the past and let ourselves evolve into a more technological generation. So far, the Internet media revolution has been a huge net plus for journalism and blogging. It has greatly increased the quantity and even the quality of available opinion and news. Trying to figure out the truth of a given subject means reading about it from as many perspectives as possible, and now with the Internet there are more perspectives accessible. The Internet has given voice to countless talented and informed people who would of otherwise have no platform. It has created a surplus of bloggers who provide fact checking and criticism of the press, and provides powerful counterarguments to many respectable medias (Kamiya 1). Bloggers are often valuable reporters. Some bloggers have done significant research, reporting, and even digging through documents to unearth secrets. The newspaper has not always done a sufficient job of capturing reality. Too often hidden corporations and agendas have driven it. The press’s failure to question the Bush administration’s case for war in Iraq is the most glaring recent example (Kamiya 1). With the Internet we are able to address these problems as a whole instead of separate corporations controlling our media. What appears in the newspapers is a result of editorial whim and financial pressures. This limited information is preferable to only a few self-selected individuals. The Internet allows people to vent their opinions and always expand on a certain topic. Some may argue that in a newspaper it is much easier to consume unfamiliar information than on the Internet, and it stimulates parts of our brain that would otherwise atrophy. The physical layout of a newspaper does make it easier to consume unfamiliar information, however online media is created to respond to our desires. We want our information precise and quick and the Internet provides this for us. There has also been the statement that if newspaper reporting dies out, the global consequences would be dire. Little things would go under the radar; regimes would feel free to commit crime without consequences (Gapper 1). This is not true though, major reporting companies working for websites on the Internet such as Yahoo, CNN, or even FOX News have coverage of almost more than the newspaper. The Internet gives readers what they need; newspapers are just redundant and wasteful. With the Internet becoming faster and more powerful every day the newspaper is beginning to decline in profit. Internet is now provided to the masses; almost all news can be accessed for free. This is beneficial because it is more environmentally friendly, is more of a convenience, and given voice to countless talented people who would otherwise have no platform. We need to stop holding onto the past, newspapers have died out and we need to embrace our new forms of media.

American Government, Its Functions and Branches

Mary Whiton Calkins essays

Mary Whiton Calkins essays Mary Whiton Calkins was born on March 30, 1863 in Hartford, Connecticut, but spent most of her childhood in Buffalo, New York. Mary was the oldest of five children born to her Puritan mother and minister father. According to some sources, Calkins father had a great distrust of public education, and preferred educating his children by boarding them with French and German families. It is recorded, though, that Mary Calkins graduated from an established high school in Newton, Massachusetts. Calkins indicated her interest in philosophy in high school by writing a graduation essay entitled "The Apology Plato should have written: a vindication of the character Xantippi." Johnson, 1997 Calkins entered Smith College in 1882 as a sophomore, but left the following spring when her sister became ill and died. She remained home the following academic year, studying Greek and tutoring two of her younger brothers. Calkins re-entered Smith College in the fall of 1984 with senior standing and graduated the following spring with a degree concentrated in classics and philosophy. (Johnson, 1997) After Calkins graduation from Smith, she spent a year studying social and economic issues with a womens organization called the Newton Social Science Club. Calkins researched her first paper entitled Sharing the Profits (1888), during this period (Johnson, 1997). The following year, Calkins, and her family went on a journey to Europe where Calkins attended Leipzig University for a short while and studied with Wilhelm Wundt. (McHenry, 1995). The Calkins family traveled on to Greece where Mary studied Modern Greek (Johnson, 1997). Calkins began her career in academia immediately upon her return when she was offered a position as a Greek teacher at Wellesley College. During her time at Wellesley, Calkins made her interests in philosophy known and she was recommended to fulfill the position of teaching courses i...

Assigment 5 Essay Example | Topics and Well Written Essays - 750 words

Assigment 5 - Essay Example The web studio 5.0 is one of the most recent and reliable Web Design Software (Fowler and Victor 5). The program is a creation of the Back To The Beach Software Company. The program also offers 30 days trail for interested customers. The 30 days trail involves full web design operation and function, free website hosting and technology support. Despite being cheaper, the program has numerous useful applications. Net Objects Fusion Essentials is also another useful website program. The program also offers free services for individuals who are interested in using website services. Some of the basic features of the program entail ecommerce tools, photo gallery, quick times, flash builder, and rollover images. The Trendy Flash Site Builder is one of the most effective and reliable web design software. By using this program, an individual has the capability of creating SEO optimized website that has stunning tools and graphics. The programs also has other reliable features that include unl imited customizations, music library, text effects, pay pal integration as well as premade web site design. Compared to other programs, the Trendy Flash Site Builder is relatively cheap and affordable. Apache web server software is also reliable and effective web design software. ... Despite offering better services to its customers the programs is also cheap to learn and maintain. FrontPage Web Design Program is also reliable web design software. In order to use the program, the user needs to pay for the services and secure a license of using its services. This program is also created and supported by companies that have he will of making huge amount of profit. Huge number people can also use the services of this program at one specific time. The program also has a support team that offers 24 hours services to its customers (Plumley and Warren 67). Paint.NET is also reliable web design software that is accessible to huge number of website users. This web design software is copyrighted software that is available for both personal use and for downloading importance programs from the website. This program is free but the frequent users of the programs are requested to pay small contribution for the maintenance of the program. After paying the required registration fee, an individual become a permanent member with the authority of effectively using the program. Among the six common webs design software, the Web Studio 5.0 is one of the most reliable web design software. This is owing to the fact that the program is easy to learn and manage. The maintenance cost of the program is also friend among all website users. The programs also has drag interface and it is easy to drop. The program is also fasters and facilitate easy creation of professionals website. This web design software has various features such as video tutorial, menu maker and PayPal shopping cart. However, despite being one of the most reliable web design software, the program is relatively expensive compared to other programs. In addition, the process of acquiring the programs

The Most Appropriate Way of Analyzing and Representing Data Article

The Most Appropriate Way of Analyzing and Representing Data - Article Example This is meant to make a researcher come up with a simpler way of data analysis without following the rigid linear method. A major problem existed when it came to coding and five major approaches were unearthed for the purpose of data analysis as discussed below. For the purposes of chronology, the steps involved in this case is organizing data files, the creation of initial codes, description, interpretation, and presentation of this data. As such, this method can be said to be used appropriately for qualitative research. However, all aspects of the data analysis methods were not justified clearly shown by Cresswell. The accumulation of other elements such as beginning scrutiny by focusing on a distinct element. This could have also made the method more effective. The grounded theory is also known as constant equation theory whose stages are more detailed and include; organizing the data, getting to know the data, open coding, axial coding and checking the results of the analysis. This method has been effectively used to study recovery from child abuse according to the text thus it has been used appropriately for research analysis. Creswell clearly gives a step to step process before a hypothesis is made. However, the results of the analysis were not presented in the study above and thus all processes were not justified. The best way to correct this according to Miles and Huberman would be to present sub-stages in the presentation of analysis. Used successfully for analyzing personal experiences, the structured steps include; description of the experience, stating significant statements, grouping significant statements, answering the questions what and how and lastly writing a description of the phenomenon.

Homosexuality Defaces the Bible Essay Example for Free

Homosexuality Defaces the Bible Essay Alright, I’d just like to start by saying thank you to everybody for coming tonight – I really appreciate it – and for being interested in learning more about this subject. I also want to thank College Hill United Methodist for graciously agreeing to host the event. My name is Matthew Vines, I’m 21 years old, and I’m currently a student in college, although I’ve been on leave for most of the last two years in order to study the material that I’ll be presenting tonight. I was born and raised here in Wichita, in a loving Christian home and in a church community that holds to the traditional interpretation of Scripture on this subject. Just to offer a brief outline for this presentation: I’ll start by considering some of the broader issues and divisions that are behind this debate; and then I’ll move to a closer examination of the main biblical texts that are involved in it; and then I’ll offer some concluding remarks. The issue of homosexuality, of the ordination of gay clergy and of the blessing of same-sex unions, has caused tremendous divisions in the church in recent decades, and the church remains substantially divided over the issue today. On the one hand, the most common themes voiced by those who support changing traditional church teaching on homosexuality are those of acceptance, inclusion, and love, while on the other hand, those who oppose these changes express concerns about sexual purity, holiness, and most fundamentally, the place of Scripture in our communities. Are we continuing to uphold the Bible as authoritative, and are we taking biblical teachings seriously, even if they make us uncomfortable? I want to begin tonight by considering the traditional interpretation of Scripture on this subject, in part because its conclusions have a much longer history within the church, and also because I think that many who adhere to that position feel that those who are arguing for a new position haven’t yet put forth theological arguments that are as well-grounded in Scripture as their own, in which case the most biblically sound position should prevail. The traditional interpretation, in summary form, is this: There are six passages in the Bible that refer in some way to same-sex behavior, and they are all negative. Three of them are direct and clear. In the Old Testament, in Leviticus, male same-sex relations are prohibited, and labeled an â€Å"abomination. † And in the New Testament, in Romans, Paul speaks of women â€Å"exchanging natural relations for unnatural ones,† and of men abandoning â€Å"natural relations with women and committing shameful acts with other men. † And so according to the traditional interpretation, both the Old and the New Testament are consistent in their rejection of same-sex relationships. But it’s not just those three verses, as well as three others that I’ll come to later. It’s true that 6 verses isn’t all that many out of Scripture’s 31,000. But not only are they all negative, from the traditional viewpoint, they gain broader meaning and coherence from the opening chapters of Genesis, in which God creates Adam and Eve, male and female. That was the original creation – before the fall, before sin entered the world. That was the way that things were supposed to be. And so according to this view, if someone is gay, then their sexual orientation is a sign of the fall, a sign of human fallenness and brokenness. That was not the way that things were supposed to be. And while having a same-sex orientation is not in and of itself a sin, according to the traditional interpretation, acting upon it is, because the Bible is clear, both in what it negatively prohibits and in what it positively approves. Christians who are gay – those who are only attracted to members of the same sex – are thus called to refrain from acting on those attractions, to deny themselves, to take up their crosses and to follow Christ. And though it may not seem fair to us, God’s ways are higher than our own, and it’s not our role to question, but to obey. Within this framework, gay people have a problem, and that is that they want to have sex with the wrong people. They tend to be viewed as essentially lustful, sexual beings. So while straight people fall in love, get married, and start families, gay people just have sex. But everyone has a sexual orientation – and it isn’t just about sex. Straight people are never really forced to think about their sexual orientation as a distinctive characteristic, but it’s still a part of them, and it affects an enormous amount of their lives. What sexual orientation is for straight people is their capacity for romantic love and self-giving. It’s not just about sexual attraction and behavior. It’s because we have a sexual orientation that we’re able to fall in love with someone, to build a long-term, committed relationship with them, and to form a family. Family is not about sex, but for so many of us, it still depends upon having a companion, a spouse. And that’s true for gay people as well as for straight people. That is what sexual orientation means for them, too. Gay people have the very same capacity for romantic love and self-giving that straight people do. The emotional bond that gay couples share, the quality of love, is identical to that of straight couples. Gay people, like almost all of us, come from families, and they, too, long to build one of their own. But the consequence of the traditional interpretation of the Bible is that, while straight people are told to avoid lust, casual relationships, and promiscuity, gay people are told to avoid romantic relationships entirely. Straight people’s sexuality is seen as a fundamentally good thing, as a gift. It can be used in sinful or irresponsible ways, but it can also be harnessed and oriented toward a loving marriage relationship that will be blessed and celebrated by their community. But gay people, though they are capable of and desire loving relationships that are just as important to them, are told that, for them, even lifelong, committed relationships would be sinful, because their sexual orientation is completely broken. It’s not an issue of lust versus love, or of casual versus committed relationships, because same-sex relationships are intrinsically sinful, no matter the quality and no matter the context. Gay people’s sexual orientation is so broken, so messed up that nothing good can come from it – no morally good, godly relationship could ever come from it. And so they are told that they will never have a romantic bond that will be celebrated by their community; they are told that they will never have a family. Philippians 2:4 tells us to look not only to our own interests, but also to the interests of others. And in Matthew 5, Jesus instructs that if someone makes you go one mile, go with them two miles. And so I’m going to ask you: Would you step into my shoes for a moment, and walk with me just one mile, even if it makes you a bit uncomfortable? I am gay. I didn’t choose to be gay. It’s not something that I would have chosen, not because it’s necessarily a bad thing to be, but because it’s extremely inconvenient, it’s stressful, it’s difficult, and it can often be isolating and lonely – to be different, to feel not understood, to feel not accepted. I grew up in as loving and stable of a family and home as I can imagine. I love my parents, and I have strong relationships with them both. No one ever molested or abused me growing up, and I couldn’t have asked for a more supportive and nurturing childhood than the one that I had. I’ve never been in a relationship, and I’ve always believed in abstinence until marriage. But I also have a deeply-rooted desire to one day be married, to share my life with someone, and to build a family of my own. But according to the traditional interpretation of Scripture, as a Christian, I am uniquely excluded from that possibility for love, for companionship, and for family. But unlike someone who senses a calling from God to celibacy, or unlike a straight person who just can’t find the right partner, I don’t sense a special calling to celibacy, and I may well find someone I grow to love and would like to spend the rest of my life with. But if that were to happen, following the traditional interpretation, if I were to fall in love with someone, and if those feelings were reciprocated, my only choice would be to walk away, to break my heart, and retreat into isolation, alone. And this wouldn’t be just a one-time heartbreak. It would continue throughout my entire life. Whenever I came to know someone whose company I really enjoyed, I would always fear that I might come to like them too much, that I might come to love them. And within the traditional interpretation of Scripture, falling in love is one of the worst things that could happen to a gay person. Because you will necessarily be heartbroken, you will have to run away, and that will happen every single time that you come to care about someone else too much. So while you watch your friends fall in love, get married, and start families, you will always be left out. You will never share in those joys yourself – of a spouse and of children of your own. You will always be alone. Well, that’s certainly sad, some might say, and I’m sorry for that. But you cannot elevate your experience over the authority of Scripture in order to be happy. Christianity isn’t about you being happy. It’s not about your personal fulfillment. Sacrifice and suffering were integral to the life of Christ, and as Christians, we’re called to deny ourselves, to take up our crosses, and to follow Him. This is true. But it assumes that there’s no doubt about the correctness of the traditional interpretation of Scripture on this subject, which I’m about to explore. And already, two major problems have presented themselves with that interpretation. The first problem is this: In Matthew 7, in the Sermon on the Mount, Jesus warns against false teachers, and he offers a principle that can be used to test good teaching from bad teaching. By their fruit, you will recognize them, he says. Every good tree bears good fruit, but a bad tree bears bad fruit. A good tree cannot bear bad fruit, and a bad tree cannot bear good fruit. Good teachings, according to Jesus, have good consequences. That doesn’t mean that following Christian teaching will or should be easy, and in fact, many of Jesus’s commands are not easy at all – turning the other cheek, loving your enemies, laying down your life for your friends. But those are all profound acts of love that both reflect God’s love for us and that powerfully affirm the dignity and worth of human life and of human beings. Good teachings, even when they are very difficult, are not destructive to human dignity. They don’t lead to emotional and spiritual devastation, and to the loss of self-esteem and self-worth. But those have been the consequences for gay people of the traditional teaching on homosexuality. It has not borne good fruit in their lives, and it’s caused them incalculable pain and suffering. If we’re taking Jesus seriously that bad fruit cannot come from a good tree, then that should cause us to question whether the traditional teaching is correct. The second problem that has already presented itself with the traditional interpretation comes from the opening chapters of Genesis, from the account of the creation of Adam and Eve. This story is often cited to argue against the blessing of same-sex unions: in the beginning, God created a man and a woman, and two men or two women would be a deviation from that design. But this biblical story deserves closer attention. In the first two chapters of Genesis, God creates the heavens and the earth, plants, animals, man, and everything in the earth. And He declares everything in creation to be either good or very good – except for one thing. In Genesis 2:18, God says, â€Å"It is not good for the man to be alone. I will make a helper suitable for him. † And yes, the suitable helper or partner that God makes for Adam is Eve, a woman. And a woman is a suitable partner for the vast majority of men – for straight men. But for gay men, that isn’t the case. For them, a woman is not a suitable partner. And in all of the ways that a woman is a suitable partner for straight men—for gay men, it’s another gay man who is a suitable partner. And the same is true for lesbian women. For them, it is another lesbian woman who is a suitable partner. But the necessary consequence of the traditional teaching on homosexuality is that, even though gay people have suitable partners, they must reject them, and they must live alone for their whole lives, without a spouse or a family of their own. We are now declaring good the very first thing in Scripture that God declared not good: for the man to be forced to be alone. And the fruit that this teaching has borne has been deeply wounding and destructive. This is a major problem. By holding to the traditional interpretation, we are now contradicting the Bible’s own teachings: the Bible teaches that it is not good for the man to be forced to be alone, and yet now, we are teaching that it is. Scripture says that good teachings will bear good fruit, but now, the reverse is occurring, and we say it’s not a problem. Something here is off; something is out of place. And it’s because of these problems and these contradictions that more and more Christians have been going back to Scripture and re-examining the 6 verses that have formed the basis for an absolute condemnation of same-sex relationships. Can we go back, can we take a closer look at these verses, and see what we can learn from further study of them? What are these 6 verses? There are three in the Old Testament and three in the New Testament, so I’ll go in order of their appearance in Scripture. In the Old Testament, we have the story of the destruction of Sodom and Gomorrah in Genesis 19 as well as two prohibitions in Leviticus 18 and 20. And in the New Testament, we have a passage by Paul in Romans 1, as well as two Greek terms in 1 Corinthians 6 and 1 Timothy 1. To begin, let’s look at Genesis 19, the destruction of Sodom and Gomorrah. In Genesis 18, God and two angels come in the form of men to visit Abraham and Sarah at their tent alongside the Dead Sea. Abraham and Sarah do not yet realize who they are, but they show them lavish hospitality nonetheless. Halfway through the chapter, God – now beginning to be recognized by Abraham – tells him â€Å"[t]he outcry against Sodom and Gomorrah is so great and their sin so grievous that I will go down and see if what they have done is as bad as the outcry that has reached me. † Abraham’s nephew, Lot, and Lot’s family, live in Sodom, and so Abraham bargains with God, and gets Him to agree not to destroy the city if He finds even 10 righteous people there.

Reducing prejudice in society

Reducing prejudice in society A major problem still occurring in todays society is prejudice. We can observe this in the wide ranges of evidence available. . It is still reported to be in any institution such as school or work and can be learnt from how we see others. The current paper intends to explore and revise the literature that can be found surrounding the topic. Prejudice and discrimination are a reflection of how others respond to people of another group and reflect their affective, behavioural and cognitive reactions to the people within these different groups. The literature surrounding this topic is vast, so this review will focus on a specific strand gathered from the literature surrounding prejudice and concentrate on prejudice reduction within society. Where does it start? There is a negative thought pattern that occurs in early childhood as according to Klein (1992.) Media and books contain stereotyping and thus it is this that creates the foundation for prejudicing occurring in adults. Degner and Wentura (2010) carried out a study that looked at the automatic activation of prejudice in children and adolescents (9 years to 15 years.) There was a continuous pattern suggesting a linear developmental increase of automatic prejudice with significant effects of outgroup negativity which only appeared surrounding 12 to 13 year olds. However, results of younger children showed no indication of automatic prejudice activation. These results suggest that although children are assumed to acquire prejudice at much younger ages, automatization of negative attitudes may well be related to developmental processes in early adolescence. What society views as beautiful is controlled by the media through magazines etc. An article called Preventing Prejudice: A Guide for Counsellors, Educators, and Parents, written by Ponterotto, Utsey, and Pedersen (2006) gave a very useful insight. This piece of literature covers a range of topics on reducing prejudice, one being the roles and responsibilities of those in a position to reduce prejudice; such as teachers and counsellors etc. This is a view which is also shared by many others, who agree that the classroom is where the early signs of prejudice are seen and it is there that they should be alleviated. This would be a direct approach by the teacher. Pate (1995) believed that the teacher should instruct the students to take part in anti-prejudice programs by reading informative books on the topic, integrating a weekly class to enlighten the students and such other activities. However Pate did admit this was not a successful tactic as students may begrudge the instructions and thus strengthening a prejudice therefore, delayed measures are the only resolut ion to create an attitude change with the direct approach being used in the long-run. Teachers have the power and means to implement prejudice reduction techniques. This is a statement many claim, such as Dessel (2010), and could be perceived as being straight forward and true. However, there is still a lack of demonstration of this in action as something which can be repeated in any school. Again other literature from Pate indicates that the cognitive approachs principle is that people can reduce prejudice if they know more about other groups and think more clearly. Pate (1995) stated that various intervention efforts which include; empathy as well as an increase in knowledge and consideration of other groups, different in several ways from the students, are effective. Other studies also share this view about the effectiveness of the cognitive approach in prejudice reduction. For instance, Katz and Zalk (1978) found the ability to recognize and accept differences amongst member groups could promote prejudice reduction. Other classroom approaches might also work in re ducing prejudice. Some examples of this alternative are; semantics, counter-stereotype approach, cultural immersion, the study of cultural anthropology, developing instructional materials and value clarification (Pate, 1995). The common problem is still a lack of evidence and design flaws. Bigler (1999) noted that prejudice reduction research has encountered limitations due to problems with the design of many studies. Some of these include an overly simplistic model, bias in the measuring of attitudes and a want for longitudinal studies in order to ascertain if there are any sustainable effects from the reduction strategies. Some studies in the literature have actually reported that, even though strategies are implemented for reducing prejudice, there are troubling effects . . . of increased racial bias among children (Bigler 1999.) Copious amounts of literature display programs and schemes of how they can theoretically reduce prejudice from an early age such as Weston (1990.) The study claimed that carefully chosen reduction tactics incorporated into the current curriculum can reduce prejudice. This however is claimed by many theorists in different ways, although the study didnt prove to have any valid e vidence to back up the theory. Other researchers have admitted there is a repetition in the guidelines as to how we can reduce prejudice. Work carried out by Parrens (2007) does give a good background on prejudice and is insightful stating that the reduction of malignant prejudice is the responsibility of society. However this investigation lacks the presence of new research, as much already exists in the vast amount of literature available. Even so, it does highlight some factors which have been brought up before to reduce prejudice but underlines a new importance of these factors where they had previously not been counted as substantially important and discusses them further. The focus in much of the literature was on intervention in early children to eradicate prejudice; however this focus has been modified to ensure the inclusion of how social motivational processes and other aspects of a childs social interactions can influence them in their attitude towards prejudice. (Social Identity Development Theory (SID T), (Davis et al 2007). Much of the literature includes theories to reduce prejudice; however Dovidio Gaertner (1993) found that the traditional methods and techniques included in such literature may not actually be very effective in reducing prejudice. As indicated by the material available in psychology, intergroup contact seems to be an essential means of reducing prejudice. Allports (1954) contact theory argues that four major conditions must be met to effectively reduce prejudice. Pettigrew (1998) expanded on Allports theory in his intergroup contact theory by adding another condition of friendship potential. Optimal intergroup contact requires time for cross-group friendships to develop (Pettigrew, 1998) A study was conducted to examine the conflict and prejudice between Israelis and Palestinians. The existing prejudice here was reported to have furthered the development and preservation of two major groups living in direct resistance and antagonism. Stephen et al (2004) conducted such studies. Although the research seems promising in its effort to attempt to discourage and remove prejudicial stereotyping in small groups, literature has several limitations which need to be taken into account. It focused primarily on reducing prejudice between Israelis and Palestinians. This therefore evokes concern as to whether or not there can be a generalization towards conflict in other populations. Each population is different and different underlying issues exist, therefore the mentioned interventions may not necessarily be appropriate to all populations, leading to a possible requirement for adjusting according to the population. The literature also faltered in its lack of longitudinal researc h. From the study the results indicated desired effects; however these could very well only be short term. Bargal (2008) reasoned for adopting a long-range research design, monitoring the study over time, as opposed to it being a short-term intervention. Evidently, more research is required in this area in order to determine whether or not these interventions discussed, offer long lasting effects in terms of conflict resolution and reducing stereotypes and prejudice effectively. Conclusion Most of the literature informs us that the classroom is the best place to reduce prejudice due to the earliness of which it is recognized and can be manipulated. This then proposes that the students can learn empathy and other desirable emotions towards those who are different to them which could lead to unnecessary feelings of us versus them,a classic in-group versus out-group situation. According to literature, by the age of 10 a child may quickly develop a prejudiced attitude due to this becoming autonomous (Yee and Brown (1992), Rutland (1999) and Rutland et al (2005.) However, to validate this claim, more research should be conducted with a certain concentration on the age differences and the environment at home, which may breed hostile attitudes, in turn strengthening a prejudice tendency. The literature should use more of a qualitative based method and data, as opposed to the vast amount of quantitative data, to determine if the results reinforce the existing records. Again since the main reduction strategies are poorly supported by valid studies, they are merely suggestions, insufficiently backed up by research. The studies on these strategies are vague, lacking needed specifics on certain focuses such as gender, age and individual background. Future studies should aim to include a larger focus on strategies involving education and eliciting self-control and should particularly attempt to refer to different types of race and ethnicity. One such piece of literature seemed to demonstrate the best understanding of prejudice reduction tactics by offering field tested tools to determine ways to reduce it. This was written by Ponterotto et al (2006) as discussed above. However since this is one piece of literature, more needs to be focused on not just what prejudice is and the fact that it can be overcome, but to actually display studies of these reductions in action.

Edmee Ferrer Essay

Professor Anderson Listening to the Women’s Rights was very moving and it really touched me and I learned a lot about what women had to go through and are still going through. I learned about Elizabeth Cady Stanton and what an amazing and powerful woman she was. Stanton was born in November. 12, 1815 and died in October. 26, 1902. She was an American Social Activist, abolitionist, and leading figure of the early Women’s Rights Movement. Besides focusing on Women’s Rights she also addressed issues pertaining to voting rights, women’s parental and custody rights, property rights, employment and income rights, divorce, the economic health of the family and birth control. She was also an outspoken supporter of the 19th century temperance movement. In 1920 women gained the right to vote, right of citizens of United States to vote shall not be denied by the United States or any state on account of sex. In the 1940’s and the 1950’s men had to go out to war so it left women to depend on themselves and started working to provide for their family. I also learned about the first-wave feminism and the second-wave feminism. The first-wave feminism focused more on suffrage and overturning legal obstacles to gender equality, voting rights, and property rights. The second-wave feminism broadened the debate to a wide range of issues like sexuality, family, the work place, reproductive rights, and official legal inequalities. The second-wave feminism also focused on domestic violence and marital rape issues, establishment of rape crisis and battered women’s shelter, also changes in custody and divorce law. I can say that I am very proud to be a woman, we have had to go through many challenges, having to be slaves of our life as wife’s and mother’s and home makers. Being sex slaves to our husbands, looked down at or feel less than a man. Not able to work or feel independent. We women are powerful and strong and capable of changing the world forever, capable of showing how we can be as amazing as any man can. Women now have as many rights as any man have. An example of these rights are: the right to vote, to hold public office, to work, to fair wages or equal pay, to own property, to education, to serve in the military, ent er into legal contracts, and to have marital and parental rights.

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).