CHANGES IN AIR
A A federal ban on ozone-depleting chlorofluorocarbons (CFCs), to conform with the Clean Air Act, is, ironically, affecting 22.9 million people in the U.S. who suffer from asthma. Generic inhaled albuterol, which is the most commonly prescribed short-acting asthma medication and requires CFCs to propel it into the lungs, will no longer be legally sold after December 31, 2008. Physicians and patients are questioning the wisdom of the ban, which will have an insignificant effect on ozone but a measurable impact on wallets: the reformulated brand-name alternatives can be three times as expensive, raising the cost to about $40 per inhaler. The issue is even more disconcerting considering that asthma disproportionately affects the poor and that, according to recent surveys, an estimated 20 percent of asthma patients are uninsured.
B “The decision to make the change was political, not medical or scientific,” says pharmacist Leslie Hendeles of the University of Florida, who co-authored a 2007 paper in the New England Journal of Medicine explaining the withdrawal and transition. In 1987 Congress signed on to the Montreal Protocol on Substances That Deplete the Ozone Layer, an international treaty requiring the phasing out of all nonessential uses of CFCs. At that time, medical inhalers were considered an essential use because no viable alternative propellant existed. In 1989 pharmaceutical companies banded together and eventually, in 1996, reformulated albuterol with hydrofluoroalkane.
C The transition began quietly, but as more patients see their prescriptions change and costs go up, many question why this ban must begin before generics become available. At least one member of the FDA advisory committee, Nicholas J. Gross of the Stritch-Loyola School of Medicine, has publicly regretted the decision, recanting his support and requesting that the ban be pushed back until 2010, when the first patent express.
D Gross notes that the decision had nothing to do with the environment. Albuterol inhalers contributed less than 0.1 percent of the CFCs released when the treaty was signed. “It’s a symbolic issue,” Gross remarks. Some skeptics instead point to the billions of dollars to be gained by the three companies holding the patents on the available HFA-albuterol inhalers, namely Glaxo-SmithKline, Schering-Plough and Teva. Although the FDA advisory committee recognized that the expenses would go up, Hendeles says, it also believed that the companies would help defray the added costs for individuals. Firms, for instance, had committed to donating a million HFA inhalers to clinics around the country. According to Hendeles, GlaxoSmithKline did not follow through, although Schering-Plough and Teva did. GlaxoSmithKline did not respond to requests for comment.
E The issue now, Hendeles says, is that pharmaceutical-grade CFCs are in short supply, and the public faces the risk of a shortage of albuterol inhalers if the FDA does not continue promoting the production of HFA inhalers. He posits that even costs of generics would go up as CFCs become scarcer. Gross disagrees, saying that the inhaler shortage and the closure of CFC manufacturing plants are a result of the ban.
F The HFA inhalers also have encountered resistance because some asthmatics insist that they do not work as well as the CFC variety. But, Hendeles says, the differences are in the mechanics and maintenance—unlike CFC inhalers, the HFA versions must be primed more diligently and rinsed to accommodate the stickier HFA formulation. They also run out suddenly without the warning with a CFC inhaler, that the device is running low. “Pharmacists may not tell people of these things, and the doctors don’t know,” Hendeles says.
G The main public health issue in this decision may be the side effects of the economics, not the drug chemistry. Multiple studies have shown that raising costs leads to poorer adherence to treatment. One study discovered that patients took 30 percent less antiasthma medication when thefr co-pay doubled. In the case of a chronic disease such as asthma, it is particularly difficult to get people to follow regular treatment plans. “Generally speaking, for any reason you don’t take medication, cost makes it more likely” that you do not, comments Michael Chemew, a health policy expert at Harvard Medical School.
H Such choices to forgo medication could affect more than just the patients themselves. “For example,” Hendeles points out, “in a pregnant mother with untreated asthma, less oxygen is delivered to the fetus, which can lead to congenital problems and premature birth.” And considering that the disease disproportionately strikes the poor, what seemed to be a good, responsible environmental decision might in the end exact an unexpected human toll.
VOLATILITY KILLS
A. Despite gun battles in the capital of Chad, rioting in Kenya, and Galloping inflation in Zimbabwe, the economies of sub-Saharan Africa are, as a whole, in better shape than they were a few years ago. The World Bank has reported recently that this part of the continent experienced a respectable growth rate of 5.6 percent in 2006 and a higher rate from 1995 to 2005 than in previous decades. The bank has given a cautions assessment that the region may have reached a turning point. An overriding question for developmental economists remains whether the upswing will continue so Africans can grow their way out of poverty that relegates some 40 percent of the nearly 744 million in that region to living on less than a dollar a day. The optimism, when inspected more closely, maybe short-lived because of the persistence of a devastating pattern of economic volatility that has lingered for decades.
B. “In reality, African countries grow as fast as Asian countries and other developing countries during the good times, but afterward they see growth collapses,” comments Jorge Arbache, a senior World Bank economist. “How to prevent collapses may be as important as promoting growth.” If these collapses had not occurred, he observes, the level of gross domestic product for each citizen of the 48 nations of sub -Saharan Africa would have been third higher.
C. the prerequisites to prevent the next crash are not in place, according to a World Bank study issued in January, Is Africa’s Recent Growth Robust? The growth period that began in 1995, driven by a commodities boom spurred in particular by demand from China, may not be sustainable, because the economic fundamentals- new investment and the ability to stave off inflation, among other factors-are absent. The region lacks the necessary infrastructure that would encourage investors to look to Africa to find the next Bengaluru (Bangalore) or Shenzhen, a November report from the bank concludes. For sub–Saharan countries rich in oil and other resources, a boom period may even undermine efforts to institute sound economic practices. From 1996 to 2005, with growth accelerating, measures of governance– factors such as political stability, rule of law, and control of corruption- actually worsened, especially for countries endowed with abundant mineral resources, the January report notes.
D. Perhaps the most incisive analysis of the volatility question comes from Paul Collier, a longtime specialist in African economics at the University of Oxford and author of the recent book The Bottom Billion. He advocates a range of options that the U.S. and other nations could adopt when formulating policy toward African countries. They include revamped trade measures, better-apportioned aid, and sustained military intervention in certain instances, to avert what he sees as a rapidly accelerating divergence of the world’s poorest, primarily in Africa, from the rest of the world, even other developing nations such India and China.
E. Collier finds that bad governance is the main reason countries fail to take advantage of the revenue bonanza that results from a boom. moreover, a democratic government, he adds, often makes the aftermath of a boom worse. “Instead of democracy disciplining governments to manage these resource booms well, what happens is that the resource revenues corrupt the normal functioning of democracy-unless you stop (them from) corrupting the normal function of democracy with sufficient checks and balances”, he said at a talk ion January at the Carnegie Council in New York City.
F. Collier advocates that African nations institute an array of standards and codes to bolster governments, one of which would substitute auctions for bribes in apportioning mineral rights and another of which would tax export revenues adequately. He cites the Democratic Republic of the Congo, which took in $200 million from mineral exports in 2006 yet collected only $86000 in royalties for its treasury. “If a nation gets these points right,” he argues, “It’s going to develop. I f it gets them wrong, it won’t.”
G. To encourage reform, Collier recommends that the G8 nations agree to accept these measures as voluntary guidelines for multinationals doing business in Africa- companies, for instance, would only enter new contracts through auctions monitored by an international verification group. Such an agreement would follow the examples of the so-called Kimberley Process, which has effectively undercut the trade in blood diamonds, and the Extractive Industries Transparency Initiative, in which a government must report to its citizens the revenues it receives from sales of natural resources.
H. These measures, he says, are more important than elevating aid levels, an approach emphasized by economist Jeffrey D. Sachs of Columbia University and celebrity activists such as Bono. Collier insists that first Angola receives tens of billions of dollars in oil revenue and whether it gets a few hundred million more or less in aid is really second-order.
THE SENSE OF FLAVOUR
Scientists now believe that human beings acquired the sense of taste as a way to avoid being poisoned. Edible plants generally taste sweet; deadly ones, bitter. Taste is supposed to help us differentiate food that’s good for us from food that’s not. The taste buds on our tongues can detect the presence of half a dozen or so basic tastes, including sweet, sour, bitter, salty, and umami (a taste discovered by Japanese researchers, a rich and full sense of deliciousness triggered by amino acids in foods such as shellfish, mushrooms, potatoes, and seaweed).
Taste buds offers a limited means of detection, however, compared with the human olfactory system, which can perceive thousands of different chemical aromas. Indeed, ‘flavor’ is primarily the smell of gases being released by the chemicals you’ve just put in your mouth. The aroma of food can be responsible for as much as 90% of its flavor.
The act of drinking, sucking or chewing a substance releases its volatile gases. They flow out of the mouth and up the nostrils, or up the passageway at the back of the mouth, to a thin layer of nerve cells called the olfactory epithelium, located at the base of the nose, right between the eyes. The brain combines the complex smell signals from the epithelium with the simple taste signals from the tongue, assigns a flavor to what’s in your mouth, and decides if it’s something you want to eat.
Babies like sweet tastes and reject bitter ones; we know this because scientists have rubbed various flavors inside the mouths of infants and then recorded their facial reactions. A person’s food preferences, like his or her personality, are formed during the first few years of life, through a process of socialization. Toddlers can learn to enjoy hot and spicy food, bland health food, or fast food, depending upon what the people around them eat. The human sense of smell is still not fully understood. It is greatly affected by psychological factors and expectations. The mind filters out the overwhelming majority of chemical aromas that surround us, focusing intently on some, ignoring others. People can grow accustomed to bad smells or good smells; they stop noticing what once seemed overpowering.
Aroma and memory are somehow inextricably linked. A smell can suddenly evoke a long- forgotten moment. The flavours of childhood foods seem to leave an indelible mark, and adults often return to them, without always knowing why. These ‘comfort foods’ become a source of pleasure and reassurance a fact that fast-food chains work hard to promote Childhood memories of Happy Meals can translate into frequent adult visits to McDonald’s’, like those of the chain’s ‘heavy users’, the customers who eat there four or five times a week.
The human craving for flavour has been a large unacknowledged and unexamined force in history. Royal empires have been built, unexplored lands have been traversed, great religions and philosophies have been forever changed by the spice trade. In 1492, Christopher Columbus set sail in order to try to find new seasonings and thus to make his fortune with this most desired commodity of that time. Today, the influence of flavour in the world marketplace is no less decisive. The rise and fall of corporate empires – soft-drink companies, snack-food companies, and fast-food chains – is frequently determined by how their products taste.
The flavor industry emerged in the mid-1800s, as processed foods began to be manufactured on a large scale. Recognizing the need for flavor additives, the early food processors turned to perfume companies that had years of experience working with essential oils and volatile aromas. The great perfume houses of England, France, and the Netherlands produced many of the first flavor compounds. In the early part of the 20th century, Germany’s powerful chemical industry assumed the lead in flavour production. Legend has it that a German scientist discovered methyl anthranilate, one of the first artificial flavours, by accident while mixing chemicals in his laboratory. Suddenly, the lab was filled with the sweet smell of grapes. Methyl anthranilate later became the chief flavoring compound of manufactured grape juice.
The quality that people seek most of all in a food, its flavour, is usually present in a quantity too infinitesimal to be measured by any traditional culinary terms such as ounces or teaspoons. Today’s sophisticated spectrometers, gas chromatograph, and headspace vapor analyzers provide a detailed map of a food’s flavour components, detecting chemical aromas in amounts as low as one part per billion. The human nose, however, is still more sensitive than any machine yet invented. A nose can detect aromas present in quantities of a few parts per trillion. Complex aromas, such as those of coffee or roasted meat, may be composed of gases from nearly a thousand different chemicals. The chemical that provides the dominant flavour of bell pepper can be tasted in amounts as low as 0.02 parts per billion; one drop is sufficient to add flavour to the amount of water needed to fill five average-sized swimming pools
Part 1
Questions 1-5
Use the information in the passage to match the people (listed A-C) with opinions or deeds below.
NB you may use any letter more than once
A. Nicolas J Gross
B. Michael Chernew
C. Leslie Hendeles
1. Put forward that the increase in the price of drugs would contribute to the patients’
negative decision on the treatment. 1
2. Spoke out a secret that the druggists try to hold back. 2
3. Pointed out that the protocol itself is not concerning the environment. 3
4. Demonstrated that the stop of providing alternatives for CFCs would worsen rather than help with the situation. 4
5. In public repented of his previous backing up of the prohibition proposal. 5
Questions 6-9
Do the following statements agree with the information given in Reading Passage? write
TRUE if the statement is true
FALSE if the statement is false
NOT GIVEN if the information is not given in the passage
6 It took almost a decade before the replacement drug for the asthma therapy was ultimately
developed by the joint effort of several drug companies. 6
7 One of the FDA committee members had a decisive impact on the implementation of the ban on
chlorofluorocarbons. 7
8 as a matter of fact, the emitted chlorofluorocarbons in asthma treatment took up quite an
insignificant amount at the time when the pact was reached. 8
9 The HFA and CFC inhalers have something different regarding the therapeutic effect. 9
Questions 10-14
Complete the following summary,
Use No More than Three words from the Reading Passage for each answer.
American people with asthma would be impacted by 10 10 about chlorofluorocarbons which would consume the ozone layer. The usually used 11 11 would be considered illegal because it needs the propelment of 12 12 . The 13 13 would cost the patients considerably more money. Impoverished people are far more likely to suffer from asthma and what makes it even worse is that some of them are in 14 14 condition.
Part 2
Questions 15-19
Do the following statements agree with the information given in the Reading Passage 2? write
TRUE if the statement is true
FALSE if the statement is false
NOT GIVEN if the information is not given in the passage
19. The instability in an economy in some African countries might negatively impact their continuing
growth after a certain level has been reached. 15
20. Collier is the most influential scholar in the study of the volatility problem. 16
21. Certain African governments levy considerable taxes on people profiting greatly from exportation. 17
22. Some African nation’s decisions on addressing specific existing problems are directly related to the
future of their economic trends. 18
23. Collier regards Jeffrey D. Sachs recommended a way of evaluating of title importance. 19
Questions 20-23
Complete the following summary,
Use No More than Three words from the Reading Passage Volatility Kills for each answer.
According to one research carried by the world bank, some countries in Africa may suffer from 24 20 due to the lack of according preconditions. they experienced a growth stimulated by 25 21 , but according to another study, they may not keep this trend stable because they don’t have 26 22 which would attract investors. to some countries with abundant resources, this fast- growth period might even mean something devastating to their endeavor. during one specific decade accompanied by 27 23 as a matter of fact, the governing saw a deterioration.
Part 3
Questions 24-28
Do the following statements agree with the information given in The Passage? write
TRUE if the statement is True
FALSE if the statement is false
NOT GIVEN If the information is not given in the passage
28. The brain determines which aromas we are aware of. 24
29. The sense of taste is as efficient as the sense of smell. 25
30. Personal tastes in food are developed in infancy. 26
31. Christopher Columbus found many different spices on his travels. 27
32. In the mid-1880s, man-made flavors were originally invented on purpose. 28
Questions 29-34
Complete the sentence below. Choose ONE word from The Passage for each answer.
It is thought that the sense of taste was 33 29 in order to 34 30 the foods which are harmless to us from those that are not 35 31 . The sense of smell, which gives us the flavour we detect in our food, helps us to take pleasure in our food. Indeed this 36 32 for flavour was, in the past, the reason why so many explorers ventured to distant lands to bring back new 37 33 which were greatly sought after in Europe. Here they were used in cooking to enhance the usual 38 34 and unappetizing dishes eaten by rich and poor alike.
Questions 35-36
Write NO MORE THAN TWO WORDS from Reading Passage 1 for each answer.
39. We associate certain smells with the past as they are 35
40. Modern technology is able to help determine the minute quantities of
found in food. 36