Tổng hợp topic Health & Medicine IELTS READING (PDF)

Right and left-handedness in humans

Why do humans, virtually alone among all animal species, display a distinct left or right-handedness? Not even our closest relatives among the apes possess such decided lateral asymmetry, as psychologists call it. Yet about 90 percent of every human population that has ever lived appears to have been right-handed. Professor Bryan Turner at Deakin University has studied the research literature on left-handedness and found that handedness goes with sidedness. So nine out of ten people are right-handed and eight are right-footed. He noted that this distinctive asymmetry in the human population is itself systematic. “Humans think in categories: black and white, up and down, left and right. It's a system of signs that enables us to categorise phenomena that are essentially ambiguous.’

Research has shown that there is a genetic or inherited element to handedness. But while left-handedness tends to run in families, neither left nor right-handers will automatically produce offspring with the same handedness; in fact about 6 percent of children with two right-handed parents will be left-handed. However, among two left-handed parents, perhaps 40 percent of the children will also be left-handed. With one right and one left-handed parent, 15 to 20 percent of the offspring will be left handed. Even among identical twins who have exactly the same genes, one in six pairs will differ in their handedness.

What then makes people left-handed if it is not simply genetic? Other factors must be at work and researchers have turned to the brain for clues. In the 1860s the French surgeon and anthropologist, Dr Paul Broca, made the remarkable finding that patients who had lost their powers of speech as a result of a stroke (a blood clot in the brain) had paralysis of the right half of their body. He noted that since the left hemisphere of the brain controls the right half of the body, and vice versa, the brain damage must have been in the brain’s left hemisphere. Psychologists now believe that among right-handed people, probably 95 percent have their language centre in the left hemisphere, while 5 percent have right sided language. Left-handers, however, do not show the reverse pattern but instead a majority also have their language in the left hemisphere. Some 30 per cent have right hemisphere language.

Dr Brinkman, a brain researcher at the Australian National University in Canberra, has suggested that evolution of speech went with right-handed preference. According to Brinkman, as the brain evolved, one side became specialised for fine control of movement (necessary for producing speech) and along with this evolution came right-hand preference. According to Brinkman, most left-handers have left hemisphere dominance but also some capacity in the right hemisphere. She has observed that if a left-handed person is brain-damaged in the left hemisphere, the recovery of speech is quite often better and this is explained by the fact that left-handers have a more bilateral speech function.

In her studies of macaque monkeys, Brinkman has noticed that primates (monkeys) seem to learn a hand preference from their mother in the first year of life but this could be one hand or the other. In humans, however, the specialisation in (function of the two hemispheres results in anatomical differences: areas that are involved with the production of speech are usually larger on the left side than on the right. Since monkeys have not acquired the art of speech, one would not expect to see such a variation but Brinkman claims to have discovered a trend in monkeys towards the asymmetry that is evident in the human brain.

Two American researchers, Geschwind and Galaburda, studied the brains of human embryos and discovered that the left-right asymmetry exists before birth. But as the brain develops, a number of things can affect it. Every brain is initially female in its organisation and it only becomes a male brain when the male foetus begins to secrete hormones. Geschwind and Galaburda knew that different parts of the brain mature at different rates; the right hemisphere develops first, then the left. Moreover, a girl’s brain develops somewhat faster than that of a boy. So, if something happens to the brain’s development during pregnancy, it is more likely to be affected in a male and the hemisphere more likely to be involved is the left. The brain may become less lateralised and this, in turn, could result in left-handedness and the development of certain superior skills that have their origins in the left hemisphere such as logic, rationality and abstraction. It should be no surprise then that among mathematicians and architects, left-handers tend to be more common and there are more left-handed males than females.

The results of this research may be some consolation to left-handers who have for centuries lived in a world designed to suit right-handed people. However, what is alarming, according to Mr. Charles Moore, a writer and journalist, is the way the word “right” reinforces its own virtue. Subliminally he says, language tells people to think that anything on the right can be trusted while anything on the left is dangerous or even sinister. We speak of lefthanded compliments and according to Moore, “it is no coincidence that left-handed children, forced to use their right hand, often develop a stammer as they are robbed of their freedom of speech”. However, as more research is undertaken on the causes of left-handedness, attitudes towards left-handed people are gradually changing for the better. Indeed when the champion tennis player Ivan Lendl was asked what the single thing was that he would choose in order to improve his game, he said he would like to become a lefthander.

Geoff Maslen

Questions 1-7
Use the information in the text to match the people (listed A-E) with the opinions (listed 1-7) below. Write the appropriate letter (A-E) in boxes 1-7 on your answer sheet. Some people match more than one opinion.

A. Dr Broca
B. Dr Brinkman
C. Geschwind and Galaburda
D. Charles Moore
E. Professor Turner

Example: Monkeys do not show a species-specific preference for left or right-handedness. Answer: B

1. Human beings started to show a preference for right-handedness when they first developed language.
2. Society is prejudiced against left-handed people.
3. Boys are more likely to be left-handed.
4. After a stroke, left-handed people recover their speech more quickly than right handed people.
5. People who suffer strokes on the left side of the brain usually lose their power of speech.
6. The two sides of the brain develop different functions before birth.
7. Asymmetry is a common feature of the human body.

Questions 8-10
Using the information in the passage, complete the table below. Write your answers in boxes 8 10 on your answer sheet.

Questions 11-12
Choose the appropriate letters A-D and write them in boxes 11 and 12 on your answer sheet.

11. A study of monkeys has shown that
A. monkeys are not usually right-handed.
B. monkeys display a capacity for speech.
C. monkey brains are smaller than human brains.
D. monkey brains are asymmetric.

12. According to the writer, left-handed people
A. will often develop a stammer.
B. have undergone hardship for years.
C. are untrustworthy.
D. are good tennis players.

Questions 14-18
Reading passage 8 has six paragraphs B-F from the list of headings below. Choose the most suitable headings for paragraphs B-F from the list of headings below. Write the appropriate numbers (i-ix) in boxes 14-18 on your answer sheet.
NB There are more headings than paragraphs, so you will not use them all.
List of Headings
i) Ottawa International Conference on Health Promotion
ii) Holistic approach to health
iii) The primary importance of environmental factors
iv) Healthy lifestyles approach to health
v) Changes in concepts of health in Western society
vi) Prevention of diseases and illness
vii) Ottawa Charter for Health Promotion
viii) Definition of health in medical terms
ix) Socio-ecological view of health
14. Paragraph B
15. Paragraph C
16. Paragraph D
17. Paragraph E
18. Paragraph F

Changing Our Understanding of Health

A. The concept of health holds different meanings for different people and groups. These meanings of health have also changed over time. This change is no more evident than in Western society today, when notions of health and health promotion are being challenged and expanded in new ways.

B. For much of recent Western history, health has been viewed in the physical sense only. That is, good health has been connected to the smooth mechanical operation of the body, while ill health has been attributed to a breakdown in this machine. Health in this sense has been defined as the absence of disease or illness and is seen in medical terms. According to this view, creating health for people means providing medical care to treat or prevent disease and illness. During this period, there was an emphasis on providing clean water, improved sanitation and housing.

C. In the late 1940s the World Health Organisation challenged this physically and medically oriented view of health. They stated that ‘health is a complete state of physical, mental and social well-being and is not merely the absence of disease’ (WHO, 1946). Health and the person were seen more holistically (mind/body/spirit) and not just in physical terms.

D. The 1970s was a time of focusing on the prevention of disease and illness by emphasising the importance of the lifestyle and behaviour of the individual. Specific behaviours which were seen to increase the risk of diseases, such as smoking, lack of fitness and unhealthy eating habits, were targeted. Creating health meant providing not only medical health care, but health promotion programs and policies which would help people maintain healthy behaviours and lifestyles. While this individualistic healthy lifestyle approach to health worked for some (the wealthy members of society), people experiencing poverty, unemployment, underemployment or little control over the conditions of their daily lives benefited little from this approach. This was largely because both the healthy lifestyles approach and the medical approach to health largely ignored the social and environmental conditions affecting the health of people.

E. During 1980s and 1990s there has been a growing swing away from seeing lifestyle risks as the root cause of poor health. While lifestyle factors still remain important, health is being viewed also in terms of the social, economic and environmental contexts in which people live. This broad approach to health is called the socio-ecological view of health. The broad socio-ecological view of health was endorsed at the first International Conference of Health Promotion held in 1986, Ottawa, Canada, where people from 38 countries agreed and declared that:

• The fundamental conditions and resources for health are peace, shelter, education, food, a viable income, a stable eco-system, sustainable resources, social justice and equity. Improvement in health requires a secure foundation in these basic requirements. (WHO, 1986)

It is clear from this statement that the creation of health is about much more than encouraging healthy individual behaviours and lifestyles and providing appropriate medical care. Therefore, the creation of health must include addressing issues such as poverty, pollution, urbanisation, natural resource depletion, social alienation and poor working conditions. The social, economic and environmental contexts which contribute to the creation of health do not operate separately or independently of each other. Rather, they are interacting and interdependent, and it is the complex interrelationships between them which determine the conditions that promote health. A broad socio-ecological view of health suggests that the promotion of health must include a strong social, economic and environmental focus.

F. At the Ottawa Conference in 1986, a charter was developed which outlined new directions for health promotion based on the socio-ecological view of health. This charter, known as the Ottawa Charter for Health Promotion, remains as the backbone of health action today. In exploring the scope of health promotion it states that:

• Good health is a major resource for social, economic and personal development and an important dimension of quality of life. Political, economic, social, cultural, environmental, behavioural and biological factors can all favour health or be harmful to it. (WHO, 1986)

The Ottawa Charter brings practical meaning and action to this broad notion of health promotion. It presents fundamental strategies and approaches in achieving health for all. The overall philosophy of health promotion which guides these fundamental strategies and approaches is one of ‘enabling people to increase control over and to improve their health’ (WHO, 1986).

Questions 19-22
Using NO MORE THAN THREE WORDS from the passage, answer the following questions. Write your answers in boxes 19-22 on your answer sheet.
19. In which year did the World Health Organization define health in terms of mental, physical and social well-being?
20. Which members of society benefited most from the healthy lifestyles approach to health?
21. Name the three broad areas which relate to people’s health, according to the socio-ecological view of health.
22. During which decade were lifestyle risks seen as the major contributors to poor health?
Questions 23-27
Do the following statements agree with the information in Reading Passage 8?
In boxes 23-27 on your answer sheet write
YES if the statement agrees with the information.
NO if the statement contradicts the information.
NOT GIVEN if there is no information on this in the passage.
23. Doctors have been instrumental in improving living standards in Western society.
24. The approach to health during the 1970s included the introduction of health awareness programs.
25. The socio-ecological view of health recognises that lifestyle habits and the provision of adequate health care are critical factors governing health.
26. The principles of the Ottawa Charter are considered to be out of date in the 1990s.
27. In recent years a number of additional countries have subscribed to the Ottawa Charter.

CHILDREN'S THINKING

One of the most eminent of psychologists, Clark Hull, claimed that the essence of reasoning lies in the putting together of two 'behaviour segments' in some novel way, never actually performed before, so as to reach a goal.

Two followers of Clark Hull, Howard and Tracey Kendler, devised a test for children that was explicitly based on Clark Hull's principles. The children were given the task of learning to operate a machine so as to get a toy. In order to succeed, they had to go through a two-stage sequence. The children were trained on each stage separately. The stages consisted merely of pressing the correct one of two buttons to get a marble; and of inserting the marble into a small hole to release the toy.

The Kendlers found that the children could learn the separate bits readily enough. Given the task of getting a marble by pressing the button they could get the marble; given the task of getting a toy when a marble was handed to them, they could use the marble. (All they had to do was put it in a hole.) But they did not for the most part 'integrate', to use the Kendlers' terminology. They did not press the button to get the marble and then proceed without further help to use the marble to get the toy. So the Kendlers concluded that they were incapable of deductive reasoning.

The mystery at first appears to deepen when we learn, from another psychologist, Michael Cole, and his colleagues, that adults in an African culture apparently cannot do the Kendlers' task either. But it lessens, on the other hand, when we learn that a task was devised which was strictly analogous to the Kendlers' one but much easier for the African males to handle.

Instead of the button-pressing machine, Cole used a locked box and two differently coloured matchboxes, one of which contained a key that would open the box. Notice that there are still two behaviour segments — 'open the right match-box to get the key' and 'use the key to open the box' - so the task seems formally to be the same. But psychologically it is quite different, Now the subject is dealing not with a strange machine but with familiar meaningful objects, and it is clear to him what he is meant to do. It then turns out that the difficulty of 'integration' is greatly reduced.

Recent work by Simon Hewson is of great interest here for it shows that, for young children, too, the difficulty lies not in the inferential processes which the task demands, but in certain perplexing features of the apparatus and the procedure. When these are changed in ways which do not at all affect the inferential nature of the problem, then five-year-old children solve the problem as well as college students did in the Kendlers' own experiments.

Hewson made two crucial changes. First, he replaced the button-pressing mechanism in the side panels by drawers in these panels which the child could open and shut. This took away the mystery from the first stage of training. Then he helped the child to understand that there was no 'magic' about the specific marble which, during the second stage of training, the experimenter handed to him so that he could pop it in the hole and get the reward.

A child understands nothing, after all, about how a marble put into a hole can open a little door. How is he to know that any other marble of similar size will do just as well? Yet he must assume that if he is to solve the problem. Hewson made the functional equivalence of different marbles clear by playing a 'swapping game' with the children. The two modifications together produced a jump in success rates from 30 percent to 90 percent for five-year, the olds and from 35 percent to 72.5 per cent for four-year-olds. For three-year olds, for reasons that are still in need of clarification, no improvement — rather a slight drop in performance - resulted from the change.

We may conclude, then, that children experience very real difficulty when faced with the Kendler apparatus; but this difficulty cannot be taken as proof that they are incapable of deductive reasoning.

Questions 28-35
Classify the following descriptions as a referring

Clark Hull CH
Howard and Tracy Kendler HTK
Micheal Cole and colleagues MC

Simon Hewson SH

Write the appropriate letters in boxes 28-35 on your answer sheet. NB You may use any answer more than once.

28) ......... is cited as famous in the field of psychology.

29) ......... demonstrated that the two-stage experiment involving button-pressing and inserting a marble into a hole poses problems for certain adults as well as children.

30) ......... devised an experiment that investigated deductive reasoning without the use of any marbles.

31) ......... appears to have proved that a change in the apparatus dramatically improves the performance of children of certain ages.

32) ......... used a machine to measure inductive reasoning that replaced button-pressing with drawer-opening.

33) ......... experimented with things that the subjects might have been expected to encounter in everyday life, rather than with a machine.

34) ......... compared the performance of five-year-olds with college students, using the same apparatus with both sets of subjects.

35) ......... is cited as having demonstrated that earlier experiments into children's ability to reason deductively may have led to the wrong conclusions.

Questions 36-40
Do the following statements agree with the information given in Reading Passage 3? In boxes 36-40 on your answer sheet, write :

YES if the statement agrees with the information
NO if the statement contradicts the information
NOT GIVEN if there is no information on this in the passage

36. Howard and Tracey Kendler studied under Clark Hull.

37. The Kendlers trained their subjects separately in the two stages of their experiment, but not in how to integrate the two actions.

38. Michael Cole and his colleagues demonstrated that adult performance on inductive reasoning tasks depends on features of the apparatus and procedure.

39. All Hewson's experiments used marbles of the same size.

40. Hewson's modifications resulted in a higher success rate for children of all ages.

The Risks of Cigarette Smoke

Discovered in the early 1800s and named ‘nicotianine’, the oily essence now called nicotine is the main active ingredient of tobacco. Nicotine, however, is only a small component of cigarette smoke, which contains more than 4,700 chemical compounds, including 43 cancer-causing substances. In recent times, scientific research has been providing evidence that years of cigarette smoking vastly increases the risk of developing fatal medical conditions.

In addition to being responsible for more than 85 per cent of lung cancers, smoking is associated with cancers of, amongst others, the mouth, stomach and kidneys, and is thought to cause about 14 per cent of leukemia and cervical cancers. In 1990, smoking caused more than 84,000 deaths, mainly resulting from such problems as pneumonia, bronchitis and influenza. Smoking, it is believed, is responsible for 30 per cent of all deaths from cancer and clearly represents the most important preventable cause of cancer in countries like the United States today.

Passive smoking, the breathing in of the side-stream smoke from the burning of tobacco between puffs or of the smoke exhaled by a smoker, also causes a serious health risk. A report published in 1992 by the US Environmental Protection Agency (EPA) emphasized the health dangers, especially from side-stream smoke. This type of smoke contains more smaller particles and is therefore more likely to be deposited deep in the lungs. On the basis of this report, the EPA has classified environmental tobacco smoke in the highest risk category for causing cancer.

As an illustration of the health risks, in the case of a married couple where one partner is a smoker and one a non-smoker, the latter is believed to have a 30 per cent higher risk of death from heart disease because of passive smoking. The risk of lung cancer also increases over the years of exposure and the figure jumps to 80 per cent if the spouse has been smoking four packs a day for 20 years. It has been calculated that 17 per cent of cases of lung cancer can be attributed to high levels of exposure to second-hand tobacco smoke during childhood and adolescence.

A more recent study by researchers at the University of California at San Francisco (UCSF) has shown that second-hand cigarette smoke does more harm to non-smokers than to smokers. Leaving aside the philosophical question of whether anyone should have to breathe someone else’s cigarette smoke, the report suggests that the smoke experienced by many people in their daily lives is enough to produce substantial adverse effects on a person’s heart and lungs.

The report, published in the Journal of the American Medical Association (AMA), was based on the researchers’ own earlier research but also includes a review of studies over the past few years. The American Medical Association represents about half of all US doctors and is a strong opponent of smoking. The study suggests that people who smoke cigarettes are continually damaging their cardiovascular system, which adapts in order to compensate for the effects of smoking. It further states that people who do not smoke do not have the benefit of their system adapting to the smoke inhalation. Consequently, the effects of passive smoking are far greater on non-smokers than on smokers.

This report emphasizes that cancer is not caused by a single element in cigarette smoke; harmful effects to health are caused by many components. Carbon monoxide, for example, competes with oxygen in red blood cells and interferes with the blood’s ability to deliver life-giving oxygen to the heart. Nicotine and other toxins in cigarette smoke activate small blood cells called platelets, which increases the likelihood of blood clots, thereby affecting blood circulation throughout the body.

The researchers criticize the practice of some scientific consultants who work with the tobacco industry for assuming that cigarette smoke has the same impact on smokers as it does on non-smokers. They argue that those scientists are underestimating the damage done by passive smoking and, in support of their recent findings, cite some previous research which points to passive smoking as the cause for between 30,000 and 60,000 deaths from heart attacks each year in the United States. This means that passive smoking is the third most preventable cause of death after active smoking and alcohol-related diseases.

The study argues that the type of action needed against passive smoking should be similar to that being taken against illegal drugs and AIDS (SIDA). The UCSF researchers maintain that the simplest and most cost-effective action is to establish smoke-free work places, schools and public places.

Questions 15-17

Choose the appropriate letters A-D and write them in boxes 15-17 on your answer sheet.

15. According to information in the text, leukaemia and pneumonia
A. are responsible for 84,000 deaths each year.
B. are strongly linked to cigarette smoking.
C. are strongly linked to lung cancer.
D. result in 30 per cent of deaths per year.

16. According to information in the text, intake of carbon monoxide
A. inhibits the flow of oxygen to the heart.
B. increases absorption of other smoke particles.
C. inhibits red blood cell formation.
D. promotes nicotine absorption.

17. According to information in the text, intake of nicotine encourages
A. blood circulation through the body.
B. activity of other toxins in the blood.
C. formation of blood clots.
D. an increase of platelets in the blood.
Questions 18-21

Do the following statements reflect the claims of the writer in Reading Passage 2? In boxes 18-21 on your answer sheet, write:

YES if the statement reflects the claims of the writer
NO if the statement contradicts the claims of the writer
NOT GIVEN if it is impossible to say what the writer thinks about this

18. Thirty per cent of deaths in the United States are caused by smoking-related diseases.
19. If one partner in a marriage smokes, the other is likely to take up smoking.
20. Teenagers whose parents smoke are at risk of getting lung cancer at some time during their lives.
21. Opponents of smoking financed the UCSF study.
Questions 22-24

Choose ONE phrase from the list of phrases A-J below to complete each of the following sentences (Questions 22-24). Write the appropriate letters in boxes 22-24 on your answer sheet.

22. Passive smoking .................... .
23. Compared with a non-smoker, a smoker .................... .
24. The American Medical Association .................... .
A. includes reviews of studies in its reports.
B. argues for stronger action against smoking in public places.
C. is one of the two most preventable causes of death.
D. is more likely to be at risk from passive smoking diseases.
E. is more harmful to non-smokers than to smokers.
F. is less likely to be at risk of contracting lung cancer.
G. is more likely to be at risk of contracting various cancers.
H. opposes smoking and publishes research on the subject.
I. is just as harmful to smokers as it is to non-smokers.
J. reduces the quantity of blood flowing around the body.
Questions 25-28

Classify the following statements as being

A a finding of the UCSF study
B an opinion of the UCSF study
C a finding of the EPA report
D an assumption of consultants to the tobacco industry
Write the appropriate letters A-D in boxes 25-28 on your answer sheet.

NB You may use any letter more than once.

25. Smokers’ cardiovascular systems adapt to the intake of environmental smoke.
26. There is a philosophical question as to whether people should have to inhale others’ smoke.
27. Smoke-free public places offer the best solution.
28. The intake of side-stream smoke is more harmful than smoke exhaled by a smoker.

Highs & Lows

Hormone levels - and hence our moods –may be affected by the weather. Gloomy weather can cause depression, but sunshine appears to raise the spirits. In Britain, for example, the dull weather of winter drastically cuts down the amount of sunlight that is experienced which strongly affects some people. They become so depressed and lacking in energy that their work and social life are affected. This condition has been given the name SAD (Seasonal Affective Disorder). Sufferers can fight back by making the most of any sunlight in winter and by spending a few hours each day under special, full-spectrum lamps. These provide more ultraviolet and blue-green light than ordinary fluorescent and tungsten lights. Some Russian scientists claim that children learn better after being exposed to ultraviolet light. In warm countries, hours of work are often arranged so that workers can take a break, or even a siesta, during the hottest part of the day. Scientists are working to discover the links between the weather and human beings’ moods and performance.

It is generally believed that tempers grow shorter in hot, muggy weather. There is no doubt that ‘crimes against the person’ rise in the summer, when the weather is hotter and fall in the winter when the weather is colder. Research in the United States has shown a relationship between temperature and street riots. The frequency of riots rises dramatically as the weather gets warmer, hitting a peak around 27-30°C. But is this effect really due to a mood change caused by the heat? Some scientists argue that trouble starts more often in hot weather merely because there are more people in the street when the weather is good.

Psychologists have also studied how being cold affects performance. Researchers compared divers working in icy cold water at 5°C with others in water at 20°C (about swimming pool temperature). The colder water made the divers worse at simple arithmetic and other mental tasks. But significantly, their performance was impaired as soon as they were put into the cold water – before their bodies had time to cool down. This suggests that the low temperature did not slow down mental functioning directly, but the feeling of cold distracted the divers from their tasks.

Psychologists have conducted studies showing that people become less skeptical and more optimistic when the weather is sunny However, this apparently does not just depend on the temperature. An American psychologist studied customers in a temperature-controlled restaurant. They gave bigger tips when the sun was shining and smaller tips when it wasn’t, even though the temperature in the restaurant was the same. A link between weather and mood is made believable by the evidence for a connection between behavior and the length of the daylight hours. This, in turn, might involve the level of a hormone called melatonin, produced in the pineal gland in the brain. The amount of melatonin falls with greater exposure to daylight. Research shows that melatonin plays an important part in the seasonal behavior of certain animals. For example, food consumption of stags increases during the winter, reaching a peak in February/ March. It falls again to a low point in May, then rises to a peak in September, before dropping to another minimum in November. These changes seem to be triggered by varying melatonin levels.

In the laboratory, hamsters put on more weight when the nights are getting shorter and their melatonin levels are falling. On the other hand, if they are given injections of melatonin, they will stop eating altogether. It seems that time cues provided by the changing lengths of day and night trigger changes in animals’ behavior - changes that are needed to cope with the cycle of the seasons. People’s moods too, have been shown to react to the length of the daylight hours. Skeptics might say that longer exposure to sunshine puts people in a better mood because they associate it with the happy feelings of holidays and freedom from responsibility. However, the belief that rain and murky weather make people more unhappy is borne out by a study in Belgium, which showed that a telephone counseling service gets more telephone calls from people with suicidal feelings when it rains.

When there is a thunderstorm brewing, some people complain of the air being ‘heavy’ and of feeling irritable, moody and on edge. They may be reacting to the fact that the air can become slightly positively charged when large thunderclouds are generating the intense electrical fields that cause lightning flashes. The positive charge increases the levels of serotonin (a chemical involved in sending signals in the nervous system). High levels of serotonin in certain areas of the nervous system make people more active and reactive and, possibly, more aggressive. When certain winds are blowing, such as the Mistral in southern France and the Fohn in southern Germany, mood can be affected - and the number of traffic accidents rises. It may be significant that the concentration of positively charged particles is greater than normal in these winds. In the United Kingdom, 400,000 ionizers are sold every year. These small machines raise the number of negative ions in the air in a room. Many people claim they feel better in negatively charged air.

Questions 26-28
Choose the appropriate letters A—D and write them in boxes 26—28 on your answer sheet.

26. Why did the divers perform less well in colder conditions?
A. They were less able to concentrate.
B. Their body temperature fell too quickly.
C. Their mental functions were immediately affected by the cold.
D. They were used to swimming pool conditions.

27. The number of daylight hours
A. affects the performance of workers in restaurants.
B. influences animal feeding habits.
C. makes animals like hamsters more active.
D. prepares humans for having greater leisure time.

28. Human irritability may be influenced by
A. how nervous and aggressive people are.
B. reaction to certain weather phenomena.
C. the number of ions being generated by machines.
D. the attitude of people to thunderstorms.

Questions 29-34
Do the following statements agree with the information in Reading Passage 3? In boxes 29-34 on your answer sheet write:

TRUE if the statement is true according to the passage
FALSE if the statement is false according to the passage
NOT GIVEN if the information is not given in the passage

29. Seasonal Affective Disorder is disrupting children’s education in Russia.
30. Serotonin is an essential cause of human aggression.
31. Scientific evidence links ‘happy associations with weather’ to human mood.
32. A link between depression and the time of year has been established.
33. Melatonin levels increase at certain times of the year.
34. Positively charged ions can influence eating habits.

Questions 35-37

Choose THREE letters A—G and write them in boxes 35—37 on your answer sheet.
According to the text which THREE of the following conditions have been scientifically proved to have a psychological effect on humans?

A. lack of negative ions
B. rainy weather
C. food consumption
D. high serotonin levels
E. sunny weather
F. freedom from worry
G. lack of counselling facilities

Questions 38-40
Complete each of the following statements with the best ending from the box below. Write the appropriate letters A-G in boxes 38—40 on your answer sheet.

38. It has been established that social tension increases significantly in the United States during .......
39. Research has shown that a hamster’s bodyweight increases according to its exposure to.......
40. Animals cope with changing weather and food availability because they are influenced by.......

A. daylight
B. hot weather
C. melatonin
D. moderate temperatures
E. poor co-ordination
F. time cues
G. impaired performance

Alternative Medicine in Australia

The first students to study alternative medicine at university level in Australia began their four-year, full-time course at the University of Technology, Sydney, in early 1994. Their course covered, among other therapies, acupuncture. The theory they learnt is based on the traditional Chinese explanation of this ancient healing art: that it can regulate the flow of ‘Qi’ or energy through pathways in the body. This course reflects how far some alternative therapies have come in their struggle for acceptance by the medical establishment.

Australia has been unusual in the Western world in having a very conservative attitude to natural or alternative therapies, according to Dr Paul Laver, a lecturer in Public Health at the University of Sydney. ‘We’ve had a tradition of doctors being fairly powerful and I guess they are pretty loath to allow any pretenders to their position to come into it.’ In many other industrialized countries, orthodox and alternative medicines have worked ‘hand in glove’ for years. In Europe, only orthodox doctors can prescribe herbal medicine. In Germany, plant remedies account for 10% of the national turnover of pharmaceutical. Americans made more visits to alternative therapist than to orthodox doctors in 1990, and each year they spend about $US 12 billion on the therapies that have not been scientifically tested.

Disenchantment with orthodox medicine has seen the popularity of alternative therapies in Australia climb steadily during the past 20 years. In a 1983 national health survey, 1.9% of people said they had contacted a chiropractor, naturopath, osteopath, acupuncturist or herbalist in the two weeks prior to the survey. By 1990, this figure had risen to 2.6% of the population. The 550,000 consultations with alternative therapists reported in the 1990 survey represented about an eighth of the total number of consultations with medically qualified personnel covered by the survey, according to Dr Laver and colleagues writing in the Australian Journal of Public Health in 1993. ‘A better educated and less accepting public has become disillusion with the experts in general and increasingly skeptical about science and empirically based knowledge,’ they said. ‘The high standing of professionals, including doctors, has been eroded as a consequence.’

Rather than resisting or criticizing this trend, increasing numbers of Australian doctors, particularly younger ones, are forming group practices with alternative therapists or taking courses themselves, particularly in acupuncture and herbalism. Part of the incentive was financial, Dr Laver said. ‘The bottom line is that most general practitioners are business people. If they see potential clientele going elsewhere, they might want to be able to offer a similar service.’

In 1993, Dr Laver and his colleagues published a survey of 289 Sydney people who attended eight alternative therapists’ practices in Sydney. These practices offered a wide range of alternative therapies from 25 therapists. Those surveyed had experience chronic illnesses, for which orthodox medicine had been able to provide little relief. They commented that they liked the holistic approach of their alternative therapists and the friendly, concerned and detailed attention they had received. The cold, impersonal manner of orthodox doctors featured in the survey. An increasing exodus from their clinics, coupled with this and a number of other relevant surveys carried out in Australia, all pointing to orthodox doctors’ inadequacies, have led mainstream doctors themselves to begin to admit they could learn from the personal style of alternative therapists. Dr Patrick Store, President of the Royal College of General Practitioners, concurs that orthodox doctors could learn a lot about besides manner and advising patients on preventative health from alternative therapists.

According to the Australian Journal of Public Health, 18% of patients visiting alternative therapists do so because they suffer from musculo-skeletal complaints; 12% suffer from digestive problems, which is only 1% more than those suffering from emotional problems. Those suffering from respiratory complaints represent 7% of their patients, and candida sufferers represent an equal percentage. Headache sufferers and those complaining of general ill health represent 6% and 5% of patients respectively, and a further 4% see therapists for general health maintenance.

The survey suggested that complementary medicine is probably a better term than alternative medicine. Alternative medicine appears to be an adjunct, sought in times of disenchantment when conventional medicine seems not to offer the answer.

Question 14 and 15
Choose the correct letter, A, B, C or D. Write your answers in boxes 14 and 15 on your answer sheet.

14. Traditionally, how have Australian doctors differed from doctors in many Western countries?
A They have worked closely with pharmaceutical companies.
B They have often worked alongside other therapists.
C They have been reluctant to accept alternative therapists.
D They have regularly prescribed alternative remedies.

15. In 1990, Americans
A were prescribed more herbal medicines than in previous years.
B consulted alternative therapists more often than doctors.
C spent more on natural therapies than orthodox medicines.
D made more complaints about doctors than in previous years.

Questions 16-23
Do the following statements agree with the views of the writer in Reading Passage 2? In boxes 16-23 on your answer sheet, write:

YES if the statement agrees with the views of the writer
NO if the statements contradicts the views of the writer
NOT GIVEN if it is impossible to say what the writer thinks about this

16. Australians have been turning to alternative therapies in increasing numbers over the past 20 years.
17. Between 1983 and 1990 the numbers of patients visiting alternative therapists rose to include a further 8% of the population.
18. The 1990 survey related to 550,000 consultations with alternative therapists.
19. In the past, Australians had a higher opinion of doctors than they do today.
20. Some Australian doctors are retraining in alternative therapies.
21. Alternative therapists earn higher salaries than doctors.
22. The 1993 Sydney survey involved 289 patients who visited alternative therapists for acupuncture treatment.
23. All the patients in the 1993 Sydney survey had long-term medical complaints.

Questions 24 -26
Complete the vertical axis on the table below. Choose NO MORE THAN THREE WORDS from the Reading Passage 2 for each answer. Write your answer in boxes 24-26 on your answer sheet.

How much higher? How much faster?

— Limits to human sporting performance are not yet in sight —

Since the early years of the twentieth century, when the International Athletic Federation began keeping records, there has been a steady improvement in how fast athletes run, how high they jump and how far they are bale to hurl massive objects, themselves included, through space. For the so-called power events –that require a relatively brief, explosive release of energy, like the 100-metre sprint and the long jump-times and distances have improved ten to twenty percent. In the endurance events the results have been more dramatic. At the 1908 Olympics, John Hayes of the U.S. team ran to marathon in a time of 2:55:18. In 1999, Morocco’s Khalid Khannouchi set a new world record of 2:05:42, almost thirty percent faster.

No one theory can explain improvements in performance, but the most important factor has been genetics. ‘The athlete must choose his parents carefully,’ says Jesus Dapena, a sports scientist at Indiana University, invoking an oftcited adage. Over the past century, the composition of the human gene pool has not changed appreciably, but with increasing global participation in athletics-and greater rewards to tempt athletes-it is more likely that individuals possessing the unique complement of genes for athletic performance can be identified early. ‘Was there someone like [sprinter] Michael Johnson in the 1920s?’ Dapena asks. ‘I’m sure there was, but his talent was probably never realized.’

Identifying genetically talented individuals is only the first step. Michael Yessis, an emeritus professor of Sports Science at California State University at Fullerton, maintains that ‘genetics only determines about one third of what an athlete can do. But with the right training we can go much further with that one third than we’ve been going.’ Yesis believes that U.S. runners, despite their impressive achievements, are ‘running on their genetics’. By applying more scientific methods, ‘they’re going to go much faster’. These methods include strength training that duplicates what they are doing in their running events as well as plyometrics, a technique pioneered in the former Soviet Union.

Whereas most exercises are designed to build up strength or endurance, plyometrics focuses on increasing power-the rate at which an athlete can expend energy. When a sprinter runs, Yesis explains, her foot stays in contact with the ground for just under a tenth of a second, half of which is devoted to landing and the other half to pushing off. Plyometric exercises help athletes make the best use of this brief interval.

Nutrition is another area that sports trainers have failed to address adequately. ‘Many athletes are not getting the best nutrition, even through supplements,’ Yessis insists. Each activity has its own nutritional needs. Few coaches, for instance, understand how deficiencies in trace minerals can lead to injuries.
Focused training will also play a role in enabling records to be broken. ‘If we applied the Russian training model to some of the outstanding runners we have in this country,’ Yessis asserts, ‘they would be breaking records left and right.’ He will not predict by how much, however: ‘Exactly what the limits are it’s hard to say, but there will be increases even if only by hundredths of a second, as long as our training continues to improve.’

One of the most important new methodologies is biomechanics, the study of the body in motion. A biomechanic films an athlete in action and then digitizes her performance, recording the motion of every joint and limb in three dimensions. By applying Newton’s law to these motions, ‘we can say that this athlete’s run is not fast enough; that this one is not using his arms strongly enough during take-off,’ says Dapena, who uses these methods to help high jumpers. To date, however, biomechanics has made only a small difference to athletic performance.

Revolutionary ideas still come from the athletes themselves. For example, during the 1968 Olympics in Mexico City, a relatively unknown high jumper named Dick Fosbury won the gold by going over the bar backwards, in complete contradiction of all the received high-jumping wisdom, a move instantly dubbed the Fosbury flop. Fosbury himself did not know what he was doing. That understanding took the later analysis of biomechanics specialists. who put their minds to comprehending something that was too complex and unorthodox ever to have been invented through their own mathematical simulations. Fosbury also required another element that lies behind many improvements in athletic performance: an innovation in athletic equipment. In Fosbury’s case, it was the cushions that jumpers land on. Traditionally, high jumpers would land in pits filled with sawdust. But by Fosbury’s time, sawdust pits had been replaced by soft foam cushions, ideal for flopping.

In the end, most people who examine human performance are humbled by the resourcefulness of athletes and the powers of the human body. ‘Once you study athletics, you learn that it’s a vexingly complex issue,’ says John S.Raglin, a sports psychologist at Indiana University. ‘Core performance is not a simple or mundane thing of higher, faster, longer. So many variables enter into the equation, and our understanding in many cases is fundamental. We’re got a long way to go.’ For the foreseeable future, records will be made to be broken.

Questions 1-6
Do the following statements agree with the information given in Reading Passage? In boxes 1-6 on your answer sheet write:

TRUE if the statement agrees with the information

FALSE if the statement contradicts the information

NOT GIVEN if there is no information on this

1. Modern official athletic records date from about 1900.

2. There was little improvement in athletic performance before the twentieth century.

3. Performance has improved most greatly in events requiring an intensive burst of energy.

4. Improvements in athletic performance can be fully explained by genetics.

5. The parents of top athletes have often been successful athletes themselves.

6. The growing international importance of athletics means that gifted athletes can be recognised at a younger age.

Questions 7-10
Complete the sentences below with words taken from Reading Passage. Use ONE WORD for each answer. Write your answers in boxes 7-10 on your answer sheet.

7. According to Professor Yessis, American runners are relying for their current success on ...............

8. Yessis describes a training approach from the former Soviet Union that aims to develop an athlete’s ..............

9. Yessis links an inadequate diet to ...................

10. Yessis claims that the key to setting new records is better ................

Questions 11-13
Choose the correct letter, A, B, C or D. Write your answers in boxes 11-13 on your answer sheet.

11. Biomechanics films are proving particularly useful because they enable trainers to

A. highlight areas for improvement in athletes.

B. assess the fitness levels of athletes.

C. select top athletes.

D. predict the success of athletes.

12. Biomechanics specialists used theoretical models to

A. soften the Fosbury flop.

B. create the Fosbury flop.

C. correct the Fosbury flop.

D. explain the Fosbury flop.

13. John S. Raglin believes our current knowledge of athletics is

A. mistaken.

B. basic.

C. diverse.

D. theoretical.

Questions 28-31
Reading Passage 3 has five sections A-E. Choose the correct heading for section A and C-E from the list of headings below. Write the correct number i-viii in boxes 28-31 on your answer sheet.

List of Headings

i. The connection between health-care and other human rights
ii. The development of market-based health systems.
iii. The role of the state in health-care
iv. A problem shared by every economically developed country
v. The impact of recent change
vi. The views of the medical establishment
vii. The end of an illusion
viii. Sustainable economic development

28. Section A

Example: Section B. Answer: viii

29 Section C
30 Section D
31 Section E

The Problem of Scarce Resources

Section A
The problem of how health-care resources should be allocated or apportioned so that they are distributed in both the "most just" and "most efficient" way, is not a new one. Every health system in an economically developed society is faced with the need to decide (either formally or informally) what proportion of the community’s total resources should be spent on health-care; how resources are to be apportioned; what diseases and disabilities and which forms of treatment are to be given priority; which members of the community are to be given special consideration in respect of their health needs; and which forms of treatment are the most cost-effective.
Section B
What is new is that, from the 1950s onwards, there have been certain general changes in outlook about the finitude of resources as a whole and of health-care resources in particular, as well as more specific changes regarding the clientele of health-care resources and the cost to the community of those resources. Thus, in the 1950s and 1960s, there emerged an awareness in Western societies that resources for the provision of fossil fuel energy were finite and exhaustible and that the capacity of nature or the environment to sustain economic development and population was also finite. In other words, we became aware of the obvious fact that there were ‘limits to growth’. The new consciousness that there were also severe limits to health-care resources was part of this general revelation of the obvious. Looking back, it now seems quite incredible that in the national health systems that emerged in many countries in the years immediately after the 1939-45 World War, it was assumed without question that all the basic health needs of any community could be satisfied, at least in principle; the ‘invisible hand’ of economic progress would provide.

Section C
However, at exactly the same time as this new realization of the finite character of health-care resources was sinking in, an awareness of a contrary kind was developing in Western societies: that people have a basic right to health-care as a necessary condition of a proper human life. Like education, political and legal processes and institutions, public order, communication, transport and money supply, health-care came to be seen as one of the fundamental social facilities necessary for people to exercise their other rights as autonomous human beings. People are not in a position to exercise personal liberty and to be self-determining if they are poverty-stricken, or deprived of basic education, or do not live within a context of law and order. In the same way, basic health-care is a condition of the exercise of autonomy.

Section D
Although the language of ‘rights’ sometimes leads to confusion, by the late 1970s it was recognized in most societies that people have a right to health-care (though there has been considerable resistance in the United Sates to the idea that there is a formal right to health-care). It is also accepted that this right generates an obligation or duty for the state to ensure that adequate health-care resources are provided out of the public purse. The state has no obligation to provide a health-care system itself, but to ensure that such a system is provided. Put another way, basic health-care is now recognized as a ‘public good’, rather than a ‘private good’ that one is expected to buy for oneself. As the 1976 declaration of the World Health Organisation put it: ‘The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition’. As has just been remarked, in a liberal society basic health is seen as one of the indispensable conditions for the exercise of personal autonomy.

Section E
Just at the time when it became obvious that health-care resources could not possibly meet the demands being made upon them, people were demanding that their fundamental right to health-care be satisfied by the state. The second set of more specific changes that have led to the present concern about the distribution of health-care resources stems from the dramatic rise in health costs in most OECD countries, accompanied by large-scale demographic and social changes which have meant, to take one example, that elderly people are now major (and relatively very expensive) consumers of health-care resources. Thus in OECD countries as a whole, health costs increased from 3.8% of GDP in 1960 to 7% of GDP in 1980, and it has been predicted that the proportion of health costs to GDP will continue to increase. (In the US the current figure is about 12% of GDP, and in Australia about 7.8% of GDP.)

As a consequence, during the 1980s a kind of doomsday scenario (analogous to similar doomsday extrapolations about energy needs and fossil fuels or about population increases) was projected by health administrators, economists and politicians. In this scenario, ever-rising health costs were matched against static or declining resources.

Note
OECD: Organisation for Economic Cooperation and Development
GDP: Gross Domestic Products

Questions 32-35
Classify the following as first occurring

A between 1945 and 1950
B between 1950 and 1980
C after 1980

Write the correct letter A, B or C in boxes 32-35 on your answer sheet.

32. the realisation that the resources of the national health system were limited
33. a sharp rise in the cost of health-care.
34. a belief that all the health-care resources the community needed would be produced by economic growth
35. an acceptance of the role of the state in guaranteeing the provision of health-care.

Questions 36-40
Do the following statements agree with the view of the writer in Reading Passage 3? In boxes 136-40 on your answer sheet, write:

YES if the statement agrees with the views of the writer
NO if the statement contradicts the views of the writer
NOT GIVEN if it is impossible to say what the writer thinks about this

36. Personal liberty and independence have never been regarded as directly linked to health-care.
37. Health-care came to be seen as a right at about the same time that the limits of health-care resources became evident.
38. IN OECD countries population changes have had an impact on health-care costs in recent years.
39. OECD governments have consistently underestimated the level of health-care provision needed.
40. In most economically developed countries the elderly will to make special provision for their health-care in the future.

What's so funny?

John McCrone reviews recent research on humour.
The joke comes over the headphones: ' Which side of a dog has the most hair? The left.' No, not funny. Try again. ' Which side of a dog has the most hair? The outside.' Hah! The punchline is silly yet fitting, tempting a smile, even a laugh. Laughter has always struck people as deeply mysterious, perhaps pointless. The writer Arthur Koestler dubbed it the luxury reflex: 'unique in that it serves no apparent biological purpose'.

Theories about humour have an ancient pedigree. Plato expressed the idea that humour is simply a delighted feeling of superiority over others. Kant and Freud felt that joke-telling relies on building up a psychic tension which is safely punctured by the ludicrousness of the punchline. But most modern humour theorists have settled on some version of Aristotle's belief that jokes are based on a reaction to or resolution of incongruity, when the punchline is either a nonsense or, though appearing silly, has a clever second meaning.

Graeme Ritchie, a computational linguist in Edinburgh, studies the linguistic structure of jokes in order to understand not only humour but language understanding and reasoning in machines. He says that while there is no single format for jokes, many revolve around a sudden and surprising conceptual shift. A comedian will present a situation followed by an unexpected interpretation that is also apt.

So even if a punchline sounds silly, the listener can see there is a clever semantic fit and that sudden mental 'Aha!' is the buzz that makes us laugh. Viewed from this angle, humour is just a form of creative insight, a sudden leap to a new perspective.

However, there is another type of laughter, the laughter of social appeasement and it is important to understand this too. Play is a crucial part of development in most young mammals. Rats produce ultrasonic squeaks to prevent their scuffles turning nasty. Chimpanzees have a 'play-face' - a gaping expression accompanied by a panting 'ah, ah' noise. In humans, these signals have mutated into smiles and laughs. Researchers believe social situations, rather than cognitive events such as jokes, trigger these instinctual markers of play or appeasement. People laugh on fairground rides or when tickled to flag a play situation, whether they feel amused or not.

Both social and cognitive types of laughter tap into the same expressive machinery in our brains, the emotion and motor circuits that produce smiles and excited vocalisations. However, if cognitive laughter is the product of more general thought processes, it should result from more expansive brain activity.

Psychologist Vinod Goel investigated humour using the new technique of 'single event' functional magnetic resonance imaging (fMRl). An MRI scanner uses magnetic fields and radio waves to track the changes in oxygenated blood that accompany mental activity. Until recently, MRI scanners needed several minutes of activity and so could not be used to track rapid thought processes such as comprehending a joke. New developments now allow half-second 'snapshots' of all sorts of reasoning and problem-solving activities.

Although Goel felt being inside a brain scanner was hardly the ideal place for appreciating a joke, he found evidence that understanding a joke involves a widespread mental shift. His scans showed that at the beginning of a joke the listener'$ prefrontal cortex lit up, particularly the right prefrontal believed to be critical for problem solving. But there was also activity in the temporal lobes at the side of the head (consistent with attempts to rouse stored knowledge) and in many other brain areas. Then when the punchline arrived, a new area sprang to life -the orbital prefrontal cortex. This patch of brain tucked behind the orbits of the eyes is associated with evaluating information.

Making a rapid emotional assessment of the events of the moment is an extremely demanding job for the brain, animal or human. Energy and arousal levels may need, to be retuned in the blink of an eye. These abrupt changes will produce either positive or negative feelings. The orbital cortex, the region that becomes active in Goel's experiment, seems the best candidate for the site that feeds such feelings into higher-level thought processes, with its close connections to the brain's sub-cortical arousal apparatus and centres of metabolic control.

All warm-blooded animals make constant tiny adjustments in arousal in response to external events, but humans, who have developed a much more complicated internal life as a result of language, respond emotionally not only to their surroundings, but to their own thoughts. Whenever a sought-for answer snaps into place, there is a shudder of pleased recognition. Creative discovery being pleasurable, humans have learned to find ways of milking this natural response. The fact that jokes tap into our general evaluative machinery explains why the line between funny and disgusting, or funny and frightening, can be so fine. Whether a joke gives pleasure or pain depends on a person's outlook.

Humour may be a luxury, but the mechanism behind it is no evolutionary accident. As Peter Derks, a psychologist at William and Mary College in Virginia, says: 'I like to think of humour as the distorted mirror of the mind. It's creative, perceptual, analytical and lingual. If we can figure out how the mind processes humour, then we'll have a pretty good handle on how it works in general.

Questions 14-20
Do the following statements agree with the information given in Reading Passage 2? In boxes 14-20 on your answer sheet, write:

TRUE if the statement agrees with the information
FALSE if the statement contradicts the information
NOT GIVEN if there is no information on this

14. Arthur Koestler considered laughter biologically important in several ways.
15. Plato believed humour to be a sign of above-average intelligence.
16. Kant believed that a successful joke involves the controlled release of nervous energy.
17. Current thinking on humour has largely ignored Aristotle's view on the subject.
18. Graeme Ritchie's work links jokes to artificial intelligence.
19. Most comedians use personal situations as a source of humour.
20. Chimpanzees make particular noises when they are playing.

Questions 21-23
The diagram below shows the areas of the brain activated by jokes.
Label the diagram. Choose NO MORE THAN TWO WORDS from the passage for each answer. Write your answers in boxes 11-23 on your answer sheet

Questions 24-27
Complete each sentence with the correct ending A-G below. Write the correct letter A-G in boxes 24-27 on your answer sheet.

24. One of the brain's most difficult tasks is to
25. Because of the language they have developed, humans
26. Individual responses to humour
27. Peter Derks believes that humour

A. react to their own thoughts.
B. helped create language in humans.
C. respond instantly to whatever is happening.
D. may provide valuable information about the operation of the brain.
E. cope with difficult situations.
F. relate to a person's subjective views.
G. led our ancestors to smile and then laugh.

Lack of sleep

Section A
It is estimated that the average man or woman needs between seven-and-a-half and eight hours' sleep a night. Some can manage on a lot less. Baroness Thatcher, for example, was reported to be able to get by on four hours' sleep a night when she was Prime Minister of Britain. Dr Jill Wilkinson, senior lecturer in psychology at Surrey University and co-author of 'Psychology in Counselling and Therapeutic Practice', states that healthy individuals sleeping less than five hours or even as little as two hours in every 24 hours are rare, but represent a sizeable minority.

Section B
The latest beliefs are that the main purposes of sleep are to enable the body to rest and replenish, allowing time for repairs to take place and for tissue to be regenerated. One supporting piece of evidence for this rest-and-repair theory is that production of the growth hormone somatotropin, which helps tissue to regenerate, peaks while we are asleep. Lack of sleep, however, can compromise the immune system, muddle thinking, cause depression, promote anxiety and encourage irritability.

Section C
Researchers in San Diego deprived a group of men of sleep between 1am and 5am on just one night, and found that levels of their bodies' natural defences against viral infections had fallen significantly when measured the following morning. 'Sleep is essential for our physical and emotional well-being and there are few aspects of daily living that are not disrupted by the lack of it', says Professor William Regelson of Virginia University, a specialist in insomnia. 'Because it can seriously undermine the functioning of the immune system, sufferers are vulnerable to infection.'

Section D
For many people, lack of sleep is rarely a matter of choice. Some have problems getting to sleep, others with staying asleep until the morning. Despite popular belief that sleep is one long event, research shows that, in an average night, there are five stages of sleep and four cycles, during which the sequence of stages is repeated.

In the first light phase, the heart rate and blood pressure go down and the muscles relax. In the next two stages, sleep gets progressively deeper. In stage four, usually reached after an hour, the slumber is so deep that, if awoken, the sleeper would be confused and disorientated. It is in this phase that sleep-walking can occur, with an average episode lasting no more than 15 minutes.

In the fifth stage, the rapid eye movement (REM) stage, the heartbeat quickly gets back to normal levels, brain activity accelerates to daytime heights and above and the eyes move constantly beneath closed lids as if the sleeper is looking at something. During this stage, the body is almost paralysed. This REM phase is also the time when we dream.

Section E
Sleeping patterns change with age, which is why many people over 60 develop insomnia. In America, that age group consumes almost half the sleep medication on the market. One theory for the age-related change is that it is due to hormonal changes. The temperature General Training: Reading and Writing rise occurs at daybreak in the young, but at three or four in the morning in the elderly. Age aside, it is estimated that roughly one in three people suffer some kind of sleep disturbance. Causes can be anything from pregnancy and stress to alcohol and heart disease. Smoking is a known handicap to sleep, with one survey showing that ex-smokers got to sleep in 18 minutes rather than their earlier average of 52 minutes.

Section F
Apart from self-help therapy such as regular exercise, there are psychological treatments, including relaxation training and therapy aimed at getting rid of pre-sleep worries and anxieties. There is also sleep reduction therapy, where the aim is to improve sleep quality by strictly regulating the time people go to bed and when they get up. Medication is regarded by many as a last resort and often takes the form of sleeping pills, normally benzodiazepines, which are minor tranquillisers.

Section G
Professor Regelson advocates the use of melatonin for treating sleep disorders. Melatonin is a naturally secreted hormone, located in the pineal gland deep inside the brain. The main function of the hormone is to control the body's biological clock, so we know when to sleep and when to wake. The gland detects light reaching it through the eye; when there is no light, it secretes the melatonin into the bloodstream, lowering the body temperature and helping to induce sleep. Melatonin pills contain a synthetic version of the hormone and are commonly used for jet lag as well as for sleep disturbance. John Nicholls, sales manager of one of America's largest health food shops, claims that sales of the pill have increased dramatically. He explains that it is sold in capsules, tablets, lozenges and mixed with herbs. It is not effective for all insomniacs, but many users have weaned themselves off sleeping tablets as a result of its application.

Questions 28-35
The passage has seven sections labelled A-G. Write the correct letter A-G in boxes 28-35 on your answer sheet.

NB You may use any letter more than once.

Which section contains the following information?

28. the different amounts of sleep that people require
29. an investigation into the results of sleep deprivation
30. some reasons why people may suffer from sleep disorders
31. lifestyle changes which can help overcome sleep-related problems
32. a process by which sleep helps us to remain mentally and physically healthy
33. claims about a commercialised man-made product for sleeplessness
34. the role of physical changes in sleeping habits
35. the processes involved during sleep
Questions 36-40
Do the following statements agree with the information given in the passage? In boxes 9-13 on your answer sheet, write:

TRUE if the statement agrees with the information
FALSE if the statement contradicts the information
NOT GIVEN if there is no information on this
36. Sleep can cure some illnesses.
37. The various stages of sleep occur more than once a night.
38. Dreaming and sleep-walking occur at similar stages of sleep.
39. Sleepers move around a lot during the REM stage of sleep.
40. The body temperature rises relatively early in elderly people.

Australia's Sporting Success

A. They play hard, they play often, and they play to win. Australian sports teams win more than their fair share of titles, demolishing rivals with seeming ease. How do they do it? A big part of the secret is an extensive and expensive network of sporting academies underpinned by science and medicine. At the Australian Institute of Sport (AIS), hundreds of youngsters and pros live and train under the eyes of coaches. Another body, the Australian Sports Commission (ASC), finances programmes of excellence in a total of 96 sports for thousands of sportsmen and women. Both provide intensive coaching, training facilities and nutritional advice.

B. Inside the academies, science takes centre stage. The AIS employs more than 100 sports scientists and doctors, and collaborates with scores of others in universities and research centres. AIS scientists work across a number of sports, applying skills learned in one - such as building muscle strength in golfers - to others, such as swimming and squash. They are backed up by technicians who design instruments to collect data from athletes. They all focus on one aim: winning. 'We can't waste our time looking at ethereal scientific questions that don't help the coach work with an athlete and improve performance.' says Peter Fricker, chief of science at AIS.

C. A lot of their work comes down to measurement - everything from the exact angle of a swimmers dive to the second-by-second power output of a cyclist. This data is used to wring improvements out of athletes. The focus is on individuals, tweaking performances to squeeze an extra hundredth of a second here, an extra millimetre there. No gain is too slight to bother with. It's the tiny, gradual improvements that add up to world-beating results. To demonstrate how the system works, Bruce Mason at AIS shows off the prototype of a 3D analysis tool for studying swimmers. A wire-frame model of a champion swimmer slices through the water, her arms moving in slow motion. Looking side-on, Mason measures the distance between strokes. From above, he analyses how her spine swivels. When fully developed, this system will enable him to build a biomechanical profile for coaches to use to help budding swimmers. Mason's contribution to sport also includes the development of the SWAN (SWimming ANalysis) system now used in Australian national competitions. It collects images from digital cameras running at 50 frames a second and breaks down each part of a swimmers performance into factors that can be analysed individually - stroke length, stroke frequency, the average duration of each stroke, velocity, start, lap and finish times, and so on. At the end of each race, SWAN spits out data on each swimmer.

D. 'Take a look.' says Mason, pulling out a sheet of data. He points out the data on the swimmers in second and third place, which shows that the one who finished third actually swam faster. So why did he finish 35 hundredths of a second down? 'His turn times were 44 hundredths of a second behind the other guy.' says Mason. 'If he can improve on his turns, he can do much better.' This is the kind of accuracy that AIS scientists' research is bringing to a range of sports. With the Cooperative Research Centre for Micro Technology in Melbourne, they are developing unobtrusive sensors that will be embedded in an athlete's clothes or running shoes to monitor heart rate, sweating, heat production or any other factor that might have an impact on an athlete's ability to run. There's more to it than simply measuring performance. Fricker gives the example of athletes who may be down with coughs and colds 11 or 12 times a year. After years of experimentation, AIS and the University of Newcastle in New South Wales developed a test that measures how much of the immune-system protein immunoglobulin A is present in athletes' saliva. If IgA levels suddenly fall below a certain level, training is eased or dropped altogether. Soon, IgA levels start rising again, and the danger passes. Since the tests were introduced, AIS athletes in all sports have been remarkably successful at staying healthy.

E. Using data is a complex business. Well before a championship, sports scientists and coaches start to prepare the athlete by developing a 'competition model', based on what they expect will be the winning times. 'You design the model to make that time.' says Mason. 'A start of this much, each free-swimming period has to be this fast, with a certain stroke frequency and stroke length, with turns done in these times'. All the training is then geared towards making the athlete hit those targets, both overall and for each segment of the race. Techniques like these have transformed Australia into arguably the world's most successful sporting nation.

F. Of course, there's nothing to stop other countries copying - and many have tried. Some years ago, the AIS unveiled coolant-lined jackets for endurance athletes. At the Atlanta Olympic Games in 1996, these sliced as much as two per cent off cyclists' and rowers times. Now everyone uses them. The same has happened to the altitude tent', developed by AIS to replicate the effect of altitude training at sea level. But Australia's success story is about more than easily copied technological fixes, and up to now no nation has replicated its all-encompassing system.

Questions 1-7
Reading Passage 1 has six paragraphs, A-F. Write the correct letter A-F in boxes 1-7 on your answer sheet.

NB You may use any letter more than once

Which paragraph contains the following information?

1. a reference to the exchange of expertise between different sports
2. an explanation of how visual imaging is employed in investigations
3. a reason for narrowing the scope of research activity
4. how some AIS ideas have been reproduced
5. how obstacles to optimum achievement can be investigated
6. an overview of the funded support of athletes
7. how performance requirements are calculated before an event

Questions 8-11
Classify the following techniques according to whether the writer states they
A. are currently exclusively used by Australians
B. will be used in the future by Australians
C. are currently used by both Australians and their rivals

Write the correct letter A, B, C or D in boxes 8-11 on your answer sheet.
8. cameras
9. sensors
10. protein tests
11. altitude tents

Questions 12 and 13
Choose NO MORE THAN THREE WORDS AND/OR A NUMBER from the Reading Passage for each answer. Write your answers in boxes 12 and 13 on your answer sheet.

12. What is produced to help an athlete plan their performance in an event?
13. By how much did some cyclists' performance improve at the 1996 Olympic Games?

Greying Population Stays in the Pink

Elderly people are growing healthier, happier and more independent, say American scientists. The results of a 14-year study to be announced later this month reveal that the diseases associated with old age are afflicting fewer and fewer people and when they do strike, it is much later in life.
In the last 14 years, the National Long-term Health Care Survey has gathered data on the health and lifestyles of more than 20,000 men and women over 65. Researchers, now analysing the results of data gathered in 1994, say arthritis, high blood pressure and circulation problems - the major medical complaints in this age group - are troubling a smaller proportion every year. And the data confirms that the rate at which these diseases are declining continues to accelerate. Other diseases of old age - dementia, stroke, arteriosclerosis and emphysema - are also troubling fewer and fewer people.
'It really raises the question of what should be considered normal ageing,' says Kenneth Manton, a demographer from Duke University in North Carolina. He says the problems doctors accepted as normal in a 65-year-old in 1982 are often not appearing until people are 70 or 75.
Clearly, certain diseases are beating a retreat in the face of medical advances. But there may be other contributing factors. Improvements in childhood nutrition in the first quarter of the twentieth century, for example, gave today's elderly people a better start in life than their predecessors.
On the downside, the data also reveals failures in public health that have caused surges in some illnesses. An increase in some cancers and bronchitis may reflect changing smoking habits and poorer air quality, say the researchers. 'These may be subtle influences,' says Manton, 'but our subjects have been exposed to worse and worse pollution for over 60 years. It's not surprising we see some effect.'
One interesting correlation Manton uncovered is that better-educated people are likely to live longer. For example, 65-year-old women with fewer than eight years of schooling are expected, on average, to live to 82. Those who continued their education live an extra seven years. Although some of this can be attributed to a higher income, Manton believes it is mainly because educated people seek more medical attention.
The survey also assessed how independent people over 65 were, and again found a striking trend. Almost 80% of those in the 1994 survey could complete everyday activities ranging from eating and dressing unaided to complex tasks such as cooking and managing their finances. That represents a significant drop in the number of disabled old people in the population. If the trends apparent in the United States 14 years ago had continued, researchers calculate there would be an additional one million disabled elderly people in today's population. According to Manton, slowing the trend has saved the United States government's Medicare system more than $200 billion, suggesting that the greying of America's population may prove less of a financial burden than expected.
The increasing self-reliance of many elderly people is probably linked to a massive increase in the use of simple home medical aids. For instance, the use of raised toilet seats has more than doubled since the start of the study, and the use of bath seats has grown by more than 50%. These developments also bring some health benefits, according to a report from the MacArthur Foundation's research group on successful ageing. The group found that those elderly people who were able to retain a sense of independence were more likely to stay healthy in old age.
Maintaining a level of daily physical activity may help mental functioning, says Carl Cotman, a neuroscientist at the University of California at Irvine. He found that rats that exercise on a treadmill have raised levels of brain-derived neurotrophic factor coursing through their brains. Cotman believes this hormone, which keeps neurons functioning, may prevent the brains of active humans from deteriorating.
As part of the same study, Teresa Seeman, a social epidemiologist at the University of Southern California in Los Angeles, found a connection between self-esteem and stress in people over 70. In laboratory simulations of challenging activities such as driving, those who felt in control of their lives pumped out lower levels of stress hormones such as cortisol. Chronically high levels of these hormones have been linked to heart disease.
But independence can have drawbacks. Seeman found that elderly people who felt emotionally isolated maintained higher levels of stress hormones even when asleep. The research suggests that older people fare best when they feel independent but know they can get help when they need it.
'Like much research into ageing, these results support common sense,' says Seeman. They also show that we may be underestimating the impact of these simple factors. 'The sort of thing that your grandmother always told you turns out to be right on target,' she says.

Questions 14-22
Complete the summary using the list of words, A-Q below. Write the correct letter, A-Q, in boxes 14-22 on your answer sheet.

Research carried out by scientists in the United States has shown that the proportion of people over 65 suffering from the most common age-related medical problems is 14 ....................... and that the speed of this change is 15............................. It also seems that these diseases ere affecting people 16 .......................... in life than they did in the past. This is largely due to developments in 17 ......................... , but other factors such as improved 18 ........................ may also be playing a part. Increases in some other illnesses may be due to changes in personal habits and to 19 ............................ The research establishes a link between levels of 20 ......................... and life expectancy. It also shows that there has been a considerable reduction in the number of elderly people who are 21 .......................... which means that the 22 ........................ involved in supporting this section of the population may be less than previously predicted.

A. cost

B. falling

C. technology
D. undernourished

E. earlier

F. later
G. disabled

H. more

I. Increasing
J. nutrition

K. education

L. constant
M. medicine

N. pollution

O. environmental
P. health

Q. independent

Questions 23-26
Complete each sentence with the correct ending, A-H, below. Write the correct letter, A-H, in boxes 23-26 on your answer sheet.

23. Home medical aids
24. Regular amounts or exercise
25. Feelings of control over life
26. Feelings of loneliness

A. may cause heart disease.
B. can be helped by hormone treatment.
C. may cause rises in levels of stress hormones.
D. have cost the United States government more than $200 billion.
E. may help prevent mental decline.
F. may get stronger at night.
G. allow old people to be more independent.
H. can reduce stress in difficult situations.

The Search for the Anti-aging Pill

In government laboratories and elsewhere, scientists are seeking a drug able to prolong life and youthful vigor. Studies of caloric restriction are showing the way.

As researchers on aging noted recently, no treatment on the market today has been proved to slow human aging- the build-up of molecular and cellular damage that increases vulnerability to infirmity as we grow older. But one intervention, consumption of a low-calorie* yet nutritionally balanced diet, works incredibly well in a broad range of animals, increasing longevity and prolonging good health. Those findings suggest that caloric restriction could delay aging and increase longevity in humans, too.

Unfortunately, for maximum benefit, people would probably have to reduce their caloric intake by roughly thirty percent, equivalent to dropping from 2,500 calories a day to 1, 750. Few mortals could stick to that harsh a regimen, especially for years on end. But what if someone could create a pill that mimicked the physiological effects of eating less without actually forcing people to eat less? Could such a 'caloric-restriction mimetic', as we call it, enable people to stay healthy longer, postponing age-related disorders (such as diabetes, arteriosclerosis, heart disease and cancer) until very lace in life? Scientists first posed this question in the mid-1990s, after researchers came upon a chemical agent that in rodents seemed to reproduce many of caloric restriction's benefits. No compound that would safely achieve the same feat in people has been found yet, but the search has been informative and has fanned hope that caloric-restriction (CR) mimetics can indeed be developed eventually.

The benefits of caloric restriction
The hunt for CR mimetics grew out of a desire to better understand caloric restriction's many effects on the body. Scientists first recognized the value of the practice more than 60 years ago, when they found that rats fed a low-calorie diet lived longer on average than free-feeding rats and also had a reduced incidence of conditions that become increasingly common in old age. What is more, some of the treated animals survived longer than the oldest-living animals in the control group, which means that the maximum lifespan (the oldest attainable age), not merely the normal lifespan, increased. Various interventions, such as infection-fighting drugs, can increase a population's average survival time, but only approaches that slow the body's rate of aging will increase the maximum lifespan.

The rat findings have been replicated many times and extended to creatures ranging from yeast to fruit flies, worms, fish, spiders, mice and hamsters. Until fairly recently, the studies were limited short-lived creatures genetically distant from humans. But caloric-restriction projects underway in two species more closely related to humans- rhesus and squirrel monkeys- have scientists optimistic that CR mimetics could help people.

The monkey projects demonstrate that compared with control animals that eat normally. caloric-restricted monkeys have lower body temperatures and levels of the pancreatic hormone insulin, and they retain more youthful levels of certain hormones that tend to fall with age.

The caloric-restricted animals also look better on indicators of risk for age-related diseases. For example, they have lower blood pressure and triglyceride levels (signifying a decreased likelihood of heart disease) and they have more normal blood glucose levels (pointing to a reduced risk for diabetes, which is marked by unusually high blood glucose levels). Further, it has recently been shown that rhesus monkeys kept on caloric-restricted diets for an extended time (nearly 15 years) have less chronic disease. They and the other monkeys must be followed still longer, however, to know whether low-calorie intake can increase both average and maximum lifespans in monkeys. Unlike the multitude of elixirs being touted as the latest anti-aging cure, CR mimetics would alter fundamental processes that underlie aging. We aim to develop compounds that fool cells into activating maintenance and repair.

How a prototype caloric-restriction mimetic works
The best-studied candidate for a caloric-restriction mimetic, 2DG (2-deoxy-D-glucose), works by interfering with the way cells process glucose, it has proved toxic at some doses in animals and so cannot be used in humans. But it has demonstrated that chemicals can replicate the effects of caloric restriction; the trick is finding the right one.

Cells use the glucose from food to generate ATP (adenosine triphosphate), the molecule that powers many activities in the body. By limiting food intake, caloric restriction minimizes the amount of glucose entering cells and decreases ATP generation. When 2DG is administered to animals that eat normally, glucose reaches cells in abundance but the drug prevents most of it from being processed and thus reduces ATP synthesis. Researchers have proposed several explanations for why interruption of glucose processing and ATP production might retard aging. One possibility relates to the ATP-making machinery's emission of free radicals, which are thought to contribute to aging and t such age-related diseases as cancer by damaging cells. Reduced operation of the machinery should limit their production and thereby constrain the damage. Another hypothesis suggests that decreased processing of glucose could indicate to cells that food is scarce (even if it isn't) and induce them to shift into an anti-aging mode that emphasizes preservation of the organism over such 'luxuries' as growth and reproduction.

calorie: a measure of the energy value of food.

Questions 28-32
Do the following statements agree with the claims of the writer in Reading Passage 3? In boxes 28-32 on your answer sheet, write:

YES if the statement t agrees with the claims of the writer
NO if the statement contradicts the claims of the writer
NOT GIVEN if it is impossible to say what the writer thinks about this

28. Studies show drugs available today can delay the process of growing old.
29. There is scientific evidence that eating fewer calories may extend human life.
30. Not many people are likely to find a caloric-restricted diet attractive.
31. Diet-related diseases are common in older people.
32. In experiments, rats who ate what they wanted to lead shorter lives than rats on a low calorie diet.

Questions 33-37
Classify the following descriptions as relating to:

A. caloric-restricted mimetic
B. control monkeys
C. neither caloric-restricted monkeys nor control monkeys

Write the correct letter, A, B or C, in boxes 33-37 on your answer sheet.

33. Monkeys were less likely to become diabetic.
34. Monkeys experienced more chronic disease.
35. Monkeys have been shown to experience a longer than average life span.
36. Monkeys enjoyed a reduced chance of heart disease.
37. Monkeys produced greater quantities of insulin.

Questions 38-40
Complete the flow chart below. Choose NO MORE THAN TWO WORDS from the passage for each answer. Write your answers in boxes 38-40 on your answer sheet.

Questions 1-7
Reading Passage 1 has seven paragraphs, A-G. Choose the correct heading for each paragraph from the list of headings below. Write the correct number, i-x, in boxes 1-7 on your answer sheet.

List of Headings

i. Not all doctors are persuaded

ii. Choosing the best offers

iii. Who is responsible for the increase in promotions?

iv. Fighting the drug companies

v. An example of what doctors expect from drug companies

vi. Gifts include financial incentives

vii. Research shows that promotion works

viii. The high costs of research

ix. The positive side of drugs promotion

x. Who really pays for doctors’ free gifts?

1. Paragraph A

2. Paragraph B

3. Paragraph C

4. Paragraph D

5. Paragraph E

6. Paragraph F

7. Paragraph G

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. A few months ago Kim Schaefer, sales representative of a minor 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 county 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 judgment. 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 Reid- 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, sales people 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. 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.

Questions 8-13
Do the following statements agree with the views of the writer in Reading Passage 1? In boxes 8-13 on your answer sheet, write:

YES if the statement agrees with the views of the writer
NO if the statement contradicts the views of the writer
NOT GIVEN if it is impossible to say what the writer thinks

8. Sales representatives like Kim Schaefer work to a very limited budget.
9. Kim Schaefer's marketing technique may be open to criticism on moral grounds.
10. The information provided by drug companies is of little use to doctors.
11. Evidence of drug promotion is clearly visible in the healthcare environment.
12. The drug companies may give free drug samples to patients without doctors' prescriptions
13. It is legitimate for drug companies to make money.

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