最新雅思阅读考试特别训练文档格式.docx
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最新雅思阅读考试特别训练文档格式.docx
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ChangesinAir
A
Afederalbanonozone-depletingchlorofluorocarbons(CFCs),toconformwiththeCleanAirAct,is,ironically,affecting22.9millionpeopleintheU.S.whosufferfromasthma,Geneticinhaledalbuterol,whichisthemostcommonlyprescribedshort-actingasthmamedicationandrequiresCFCstopropelitintothelungs,willnolongerbelegallysoldafterDecember31,2008.Physiciansandpatientsarequestioningthewisdomoftheban,whichwillhaveaninsignificanteffectonozonebutameasurableimpactonwallets:
thereformulatedbrand-namealternativescanbethreetimesasexpensive,raisingthecosttoabout$40perinhaler.Theissueisevenmoredisconcertingconsideringthatasthmadisproportionatelyaffectsthepoorandthataccordingtorecentsurveys,anestimated20percentofasthmapatientsareuninsured.
B
Thedecisiontomakethechangewaspolitical,notmedicalorscientific,sayspharmacistLeslieHendelesoftheUniversityofFlorida,whoco-authoreda2007paperintheNewEnglandJournalofMedicineexplainingthewithdrawalandtransition.In1987CongresssignedontotheMontrealProtocolonSubstancesThatDepletetheOzoneLayer,aninternationaltreatyrequiringthephasingoutofallnonessentialusesofCFCs.Atthattime,medicalinhalerswereconsideredanessentialusebecausenoviablealternativepropellantexisted.In1989pharmaceuticalcompaniesbandedtogetherandeventually,in1996,reformulatedalbuterolwithhydrofluoroalkane.
C
Thetransitionbeganquietly,butasmorepatientsseetheirprescriptionschangeandcostsgoup,manyquestionwhythisbailmustbeginbeforegenericsbecomeavailable.AtleastonememberoftheFDAadvisorycommittee,NicholasJ.GrossoftheStritch-LoyolaSchoolofMedicine,haspubliclyregrettedthedecision,recantinghissupportandrequestingthatthebanbepushedbackuntil2010,whenthefirstpatentexpires.
D
GrossnotesthatthedecisionhadnothingtodowiththeenvironmentAlbuterolinhalerscontributedlessthan0.1percentoftheCFCsreleasedwhenthetreatywassigned.Lt&
#39;
sasymbolicissueGrossremarks.SomeskepticsinsteadpointtothebillionsofdollarstobegainedbythethreecompaniesholdingthepatentsontheavailableHFA-albuterolinhalers,namelyGlaxo-SmithKline,Schering-PloughandTeva.AlthoughtheFDAadvisorycommitteerecognizedthattheexpenseswouldgoup,Hendelessays,italsobelievedthatthecompanieswouldhelpdefraytheaddedcostsforindividuals,Firms,forinstance,hadcommittedtodonatingamillionHFAinhalerstoclinicsaroundthecountry.AccordingtoHendeles,GlaxoSmithKlinedidnotfollowthrough,althoughSchering-PloughandTevadid.GlaxoSmithKlinedidnotrespondtorequestsforcomment.
E
Theissuenow,Hendelessays,isthatpharmaceutical-gradeCFCsareinshortsupply,andthepublicfacestheriskofashortageofalbuterolinhalersiftheFDAdoesnotcontinuepromotingtheproductionofHFAinhalers.HepositsthatevencostsofgenericswouldgoupasCFCsbecomescarcer.Grossdisagrees,sayingthattheinhalershortageandtheclosureofCFCmanufacturingplantsarearesultoftheban.
F
TheHFAinhalersalsohaveencounteredresistancebecausesomeasthmaticsinsistthattheydonotworkaswellastheCFCvariety.But,Hendelessays,thedifferencesareinthemechanicsandmaintenance&
mdash;
unlikeCFCinhalers,theHFAversionsmustbeprimedmorediligentlyandrinsedtoaccommodatethestickierHFAformulation.TheyalsorunoutsuddenlywithoutthewarningwithaCFCinhaler,thatthedeviceisrunninglow.Pharmacistsmaynottellpeopleofthesethings,andthedoctorsdon&
tknow,Hendelessays.
G
Themainpublichealthissueinthisdecisionmaybethesideeffectsoftheeconomics,notthedrugchemistry.Multiplestudieshaveshownthatraisingcostsleadstopooreradherencetotreatment.Onestudydiscoveredthatpatientstook30percentlessamtiasthmamedicationwhentheirco-paydoubled.Intheeaseofachronicdiseasesuchasasthma,itisparticularlydifficulttogetpeopletofollowregulartreatmentplans.Generallyspeaking,foranyreasonyoudon&
rsquo;
ttakemedication,costmakesitmorelikely&
rdquo;
thatyoudonot,commentsMichaelChernew,ahealthpolicyexpertatHarvardMedicalSchool.
H
Suchchoicestoforgomedicationcouldaffectmorethanjustthepatientsthemselves.Forexample,Hendelespointsout,inapregnantmotherwithuntreatedasthma,lessoxygenisdeliveredtothefetus,whichcanleadtocongenitalproblemsandprematurebirth.Andconsideringthatthediseasedisproportionatelystrikesthepoor,whatseemedtobeagood,responsibleenvironmentalde
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