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Part 1
Read the text and answer questions 1–13.
Doctoring sales
Pharmaceuticals is one of the most profitable industries in North America. But do the drugs industry’s sales and marketing strategies go too far?
A few months ago Kim Schaefer, sales representative of a major global pharmaceutical company, walked into a medical center in New York to bring information and free samples of her company's latest products. That day she was lucky - a doctor was available to see her. ‘The last rep offered me a trip to Florida.What do you have?' the physician asked. He was only half joking.
B What was on offer that day was a pair of tickets for a New York musical. But on any given day, what Schaefer can offer is typical for today's drugs rep - a car trunk full of promotional gifts and gadgets, a budget that could buy lunches and dinners for a small country, hundreds of free drug samples and the freedom to give a physician $200 to prescribe her new product to the next six patients who fit the drug's profile. And she also has a few $1,000 honoraria to offer in exchange for doctors' attendance at her company's next educational lecture.
C Selling pharmaceuticals is a daily exercise in ethical judgement. Salespeople like Schaefer walk the line between the common practice of buying a prospect's time with a free meal, and bribing doctors to prescribe their drugs. They work in an industry highly criticized for its sales and marketing practices, but find themselves in the middle of the age-old chicken-or-egg question - businesses won't use strategies that don't work, so are doctors to blame for the escalating extravagance of pharmaceutical marketing? Or is it the industry's responsibility to decide the boundaries?.
D The explosion in the sheer number of salespeople in the field - and the amount of funding used to promote their causes - forces close examination of the pressures, influences and relationships between drug reps and doctors. Salespeople provide much-needed information and education to physicians. In many cases the glossy brochures, article reprints and prescriptions they deliver are primary sources of drug education for healthcare givers. With the huge investment the industry has placed in face-to-face selling, salespeople have essentially become specialists in one drug or group of drugs - a tremendous advantage in getting the attention of busy doctors in need of quick information.
E But the sales push rarely stops in the office. The flashy brochures and pamphlets left by the sales reps are often followed up with meals at expensive restaurants, meetings in warm and sunny places, and an inundation of promotional gadgets. Rarely do patients watch a doctor write with a pen that isn't emblazoned with a drug's name, or see a nurse use a tablet not bearing a pharmaceutical company's logo. Millions of dollars are spent by pharmaceutical companies on promotional products like coffee mugs, shirts, umbrellas, and golf balls. Money well spent? It's hard to tell. 'I've been the recipient of golf balls from one company and I use them, but it doesn't make me prescribe their medicine,' says one doctor. 'I tend to think I'm not influenced by what they give me.
F Free samples of new and expensive drugs might be the single most effective way of getting doctors and patients to become loyal to a product. Salespeople hand out hundreds of dollars' worth of samples each week- $7.2 billion worth of them in one year. 2 billion worth of them in one year. Though few comprehensive studies have been conducted, one by the University of Washington investigated how drug sample availability affected what physicians prescribe. A total of 131 doctors self-reported their prescribing patterns - the conclusion was that the availability of samples led them to dispense and prescribe drugs that differed from their preferred drug choice.
G The bottom line is that pharmaceutical companies as a whole invest more in marketing than they do in research and development. And patients are the ones who pay - in the form of sky-rocketing prescription prices - for every pen that's handed out, every free theatre ticket, and every steak dinner eaten. In the end the fact remains that pharmaceutical companies have every right to make a profit and will continue to find new ways to increase sales. But as the medical world continues to grapple with what's acceptable and what's not, it is clear that companies must continue to be heavily scrutinized for their sales and marketing strategies.
Part 2
Read the text and answer questions 14–27.
A
The Lumière Brothers opened their Cinematographe, at 14 Boulevard des Capucines in Paris, to 100 paying customers over 100 years ago, on December 8, 1895.
Before the eyes of the stunned, thrilled audience, photographs came to life and moved across a flat screen.
B So ordinary and routine has this become to us that it takes a determined leap of the imagination to grasp the impact of those first moving images.
But it is worth trying, for to understand the initial shock of those images is to understand the extraordinary power and magic of cinema, the unique, hypnotic quality that has made film the most dynamic, effective art form of the 20th century.
C One of the Lumière Brothers' earliest films was a 30-second piece which showed a section of a railway platform flooded with sunshine.
A train appears and heads straight for the camera.
And that is all that happens.
Yet the Russian director Andrei Tarkovsky, one of the greatest of all film artists, described the film as a 'work of genius'.
'As the train approached,' wrote Tarkovsky, 'panic started in the theatre: people jumped and ran away.
That was the moment when cinema was born.
The frightened audience could not accept that they were watching a mere picture.
Pictures were still, only reality moved; this must, therefore, be reality.
In their confusion, they feared that a real train was about to crush them.
D Early cinema audiences often experienced the same contusion.
In time, the idea of film became familiar, the magic was accepted -but it never stopped being magic.
Film has never lost its unique power to embrace its audiences and transport them to a different world.
For Tarkovsky, the key to that magic was the way in which cinema created a dynamic image of the real flow of events.
A still picture could only imply the existence of time, while time in a novel passed at the whim of the reader. But in cinema, the real, objective flow of time was captured.
E One effect of this realism was to educate the world about itself.
For cinema makes the world smaller.
Long before people travelled to America or anywhere else, they knew what other places looked like; they knew how other people worked and lived.
Overwhelmingly, the lives recorded - at least in film fiction - have been American.
From the earliest days of the industry, Hollywood has dominated the world film market.
American imagery - the cars, the cities, the cowboys - became the primary imagery of film.
Film carried American life and values around the globe.
F And, thanks to film, future generations will know the 20th century more intimately than any other period.
We can only imagine what life was like in the 14th century or in classical Greece.
But the life of the modern world has been recorded on film in massive, encyclopaedic detail.
We shall be known better than any preceding generations.
G The 'star' was another natural consequence of cinema.
The cinema star was effectively born in 1910.
Film personalities have such an immediate presence that, inevitably, they become super-real.
Because we watch them so closely and because everybody in the world seems to know who they are, they appear more real to us than we do ourselves.
The star as magnified human self is one of cinema's most strange and enduring legacies.
H Cinema has also given a new lease of life to the idea of the story.
When the Lumière Brothers and other pioneers began showing off this new invention, it was by no means obvious how it would be used.
All that mattered at first was the wonder of movement.
Indeed, some said that, once this novelty had worn off, cinema would fade away.
It was no more than a passing gimmick, a fairground attraction.
I Cinema might, for example, have become primarily a documentary form.
Or it might have developed like television - as a strange, noisy transfer of music, information and narrative.
But what happened was that it became, overwhelmingly, a medium for telling stories.
Originally these were conceived as short stories - early producers doubted the ability of audiences to concentrate for more than the length of a reel.
Then, in 1912, an Italian 2-hour film was hugely successful, and Hollywood settled upon the novel-length narrative that remains the dominant cinematic convention of today.
J And it has all happened so quickly.
Almost unbelievably, it is a mere 100 years since that train arrived and the audience screamed and fled, convinced by the dangerous reality of what they saw, and, perhaps, suddenly aware that the world could never be the same again - that, maybe, it could be better, brighter, more astonishing, more real than reality.
Before the eyes of the stunned, thrilled audience, photographs came to life and moved across a flat screen.
B So ordinary and routine has this become to us that it takes a determined leap of the imagination to grasp the impact of those first moving images.
But it is worth trying, for to understand the initial shock of those images is to understand the extraordinary power and magic of cinema, the unique, hypnotic quality that has made film the most dynamic, effective art form of the 20th century.
C One of the Lumière Brothers' earliest films was a 30-second piece which showed a section of a railway platform flooded with sunshine.
A train appears and heads straight for the camera.
And that is all that happens.
Yet the Russian director Andrei Tarkovsky, one of the greatest of all film artists, described the film as a 'work of genius'.
'As the train approached,' wrote Tarkovsky, 'panic started in the theatre: people jumped and ran away.
That was the moment when cinema was born.
The frightened audience could not accept that they were watching a mere picture.
Pictures were still, only reality moved; this must, therefore, be reality.
In their confusion, they feared that a real train was about to crush them.
D Early cinema audiences often experienced the same contusion.
In time, the idea of film became familiar, the magic was accepted -but it never stopped being magic.
Film has never lost its unique power to embrace its audiences and transport them to a different world.
For Tarkovsky, the key to that magic was the way in which cinema created a dynamic image of the real flow of events.
A still picture could only imply the existence of time, while time in a novel passed at the whim of the reader. But in cinema, the real, objective flow of time was captured.
E One effect of this realism was to educate the world about itself.
For cinema makes the world smaller.
Long before people travelled to America or anywhere else, they knew what other places looked like; they knew how other people worked and lived.
Overwhelmingly, the lives recorded - at least in film fiction - have been American.
From the earliest days of the industry, Hollywood has dominated the world film market.
American imagery - the cars, the cities, the cowboys - became the primary imagery of film.
Film carried American life and values around the globe.
F And, thanks to film, future generations will know the 20th century more intimately than any other period.
We can only imagine what life was like in the 14th century or in classical Greece.
But the life of the modern world has been recorded on film in massive, encyclopaedic detail.
We shall be known better than any preceding generations.
G The 'star' was another natural consequence of cinema.
The cinema star was effectively born in 1910.
Film personalities have such an immediate presence that, inevitably, they become super-real.
Because we watch them so closely and because everybody in the world seems to know who they are, they appear more real to us than we do ourselves.
The star as magnified human self is one of cinema's most strange and enduring legacies.
H Cinema has also given a new lease of life to the idea of the story.
When the Lumière Brothers and other pioneers began showing off this new invention, it was by no means obvious how it would be used.
All that mattered at first was the wonder of movement.
Indeed, some said that, once this novelty had worn off, cinema would fade away.
It was no more than a passing gimmick, a fairground attraction.
I Cinema might, for example, have become primarily a documentary form.
Or it might have developed like television - as a strange, noisy transfer of music, information and narrative.
But what happened was that it became, overwhelmingly, a medium for telling stories.
Originally these were conceived as short stories - early producers doubted the ability of audiences to concentrate for more than the length of a reel.
Then, in 1912, an Italian 2-hour film was hugely successful, and Hollywood settled upon the novel-length narrative that remains the dominant cinematic convention of today.
J And it has all happened so quickly.
Almost unbelievably, it is a mere 100 years since that train arrived and the audience screamed and fled, convinced by the dangerous reality of what they saw, and, perhaps, suddenly aware that the world could never be the same again - that, maybe, it could be better, brighter, more astonishing, more real than reality.
Part 3
Read the text and answer questions 28–40.
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