Research Korner: Medicine

Legalizing Euthanasia: An Argument

The purpose of this paper is to argue about the subject of doctor assisted suicide. It will specifically argue with regards to the issue on the legalization of doctor assisted suicide for a terminally ill patient. This paper will also presents arguments and perspectives to defend the chosen position of the writer.             The legalization of doctor assisted suicide for the terminally ill are subjects of strong debates from all sectors of society in such countries as the United States, Canada and United Kingdom. It has become a hotly contested topic for special advocates groups and organizations that espouses a particular view or standpoint in life. This topic has touched and has been discussed and argued the fields of politics, sociology, medicine, medical ethics and moral creating factionalism and divisiveness inside a society on the legality or illegality of this practice. To better understand this practice and give further explanation to the people about this social and moral issue, it would upright to present both side of the fence, both sides of the argument. To facilitate ease of use and free flowing arguments, doctor assisted suicide in this paper will be equated to euthanasia.             Euthanasia can be defined as mercy killing or killing a person because of unbearable and incurable pain. To further expand, euthanasia can be committed indirectly or directly. Direct euthanasia refers to the act made by a person to finally ease and end his/her pain while indirect euthanasia is accomplished by a doctor who uses drugs, methods and operations that would kill the patient but would ease his/her pain (Wellie, 1992). A doctor who knowingly provides a patient with a drug or a prescription medicine in quantity that would induce death can be termed as  indirect euthanasia. Within the sphere of euthanasia, acts can be further classified as voluntary, involuntary and non-voluntary. Voluntary would mean that euthanasia has been performed because of the instruction and consent of the patient who is able to competently distinguish the results of his actions (Steinbock, 1994). In the non-voluntary procedure, the patient cannot give his/her direct consent with regards to a medical procedure that would end her sufferings. The unconscious state or the incapacity to make decisions for the patients and his/her guardian can be clearly applied to the situation that would involve non-voluntary euthanasia. In layman’s term, this kind of euthanasia can be called “pulling the plug” (Zucker, 1999).             Involuntary euthanasia meanwhile refers to the procedure that is both objected by the patient and his guardian (Prado, 1998). Although the patient or the guardian of the patient refuses to undergo euthanasia, the method is done anyway.             Religious, political, lobby and ethics groups have been debating and arguing about the legality and illegality of euthanasia. To clearly illustrate this point, it would be better to state the arguments and standpoints of these two contesting groups. In the negative side or the issue of legalizing doctor assisted suicide, arguments that concerns ethics, religion and morality are used. To these groups, euthanasia must not be implemented because this act is against the will of God. Although these groups argue that God gave man the power of free will, they stated that suicide and euthanasia are one of the acts that are considered to be wrong in the eyes of the Lord (Palmer, 2000). They further equate that although God gave man a free will, it does not mean that man can do all things and all acts that is desired by human beings and even though man has free will, there are things and actions that  are against the law of God and man. For instance, if man has a free will, it does not translate that he can rob, rape and injure other persons and properties without repercussions. To them, free will given by the Lord has some clearly defined lines and boundaries that must be crossed and one of these is the purposely ending or aiding a person to end his life (Donnelly, 1998).             Euthanasia argued by these groups also degrades and destroys the perception of society and its people towards life and its importance. Euthanasia, they argued would make the human perception on the value of life worthless and useless because each and every person who suffers from pain would be easily eased from his agonies by asking for euthanasia, whether voluntary or non-voluntary (Donnelly, 1998). The society and the people in it would be able to see the value of human life using pain, suffering and agonies as a benchmark thereby modifying their outlook and value with regards to the importance of human life. Euthanasia also serves as a social jurisprudence that would release inhibitions regarding the human life. If today, euthanasia is legalized, what assurance does the society has when men would in turn kill and exterminate persons who are considered degenerates, imbeciles and handicapped? If euthanasia is legalized, what prevents a person from committing a murder and then claiming that that act is an act that would free and ease the suffering of a person? If the society permits laws and public policies that in the short term would give beneficial effects like euthanasia, in the future, it cannot prevent the inclusion of policies and actions that would  harm individuals. If a society goes astray by legalizing euthanasia, it would never be in the right path.              The third argument raised by individuals and organizations that is against the legalization of euthanasia is that suffering and pain experienced by a person has a purpose or value. In a religious point of view, suffering would make the person realize the suffering made by Jesus Christ and this realization would of course translate to greater understanding of godliness and holiness (Palmer, 2000). Suffering and death also reminds us that this life is not permanent and that this life can be claimed at anytime by the Lord and in order to give meaning to this life, we must strive to use our life effectively in helping and caring for other people. Suffering and death reminds us not to concentrate on the worldly things and ways of this Earth but to focus our attention and strength to objects and things that would please God (Prado, 1998). Suffering for other individuals helps us to reflect and gain wisdom and a renewed perspective in life. By removing suffering and pain, these lessons of life cannot be totally understood by all men.             Euthanasia also touches some ethical dilemmas and arguments with regards to the importance of life. Groups and individuals who rally against the legalization of euthanasia says that euthanasia presents a mentality to the people that it is better to be dead than being sick or disabled. This mentality therefore would advocate for the elimination of all persons and individuals who are suffering or have some physical/mental disability as lower kinds of human beings that must be erased with or without their consent (Steinbock, 1994). This mentality degrades their status in society making other people look down at them while treating them with contempt and scorn. Society thinks therefore that disabled individuals and suffering patients are burdens to the community. Another argument related to this point of view is who is going to decide and who is going to undergo the non-voluntary euthanasia if patients are unconscious or incompetent in making decisions. Since all men are creatures that have built in with feelings, outlooks and thoughts, bias and prejudice cannot be excluded in the selection process. Since men are creatures that are exposed to the workings of society, doctors and other medical authorities will be inherently subjected in making decisions (Mcmahan, 2003). The medical profession, in implementing euthanasia, is playing as a God since they have the capacity to levy death or life even if the individual asked for it or not.  If checklists and standards will be used in classifying and determining who is going to undergo euthanasia and who is not, this condition would degrade the value of life into simple enumerations and checklists of present illnesses and symptoms experienced by a patient.             Euthanasia can also be contrary to the best interest of the patient asking for it. An argument against euthanasia with regards to this aspect clearly highlights the inability of a patient to critically make a decision and is a direct contradiction taken up in voluntary euthanasia. Anti-euthanasia groups advocate that critical and good judgment on the part of the patient cannot exist because he/she is in a state that can destabilize his/her decision making process. This inability to competently decide can be attributed to depression, medicinal side effects and psychological stability (Keown, 2002). The thought of ending one’s life through euthanasia is brought about by the perspective that the patient has been a burden to his/her relatives and that death will ease the burden that he/she is bringing to them (Keown, 2002).             To legalize euthanasia, opponents said that this move would entail the neglect on the research and development with regards to finding cures and treatment to illnesses such as AIDS and other prevalent diseases nowadays. In allowing euthanasia, the medical profession and the public in general will be forced to just kill and end the life of a person afflicted with an incurable disease (Mcmahan, 2003). Since euthanasia offers a comfortable way out, research and studies with regards to the specific incurable disease afflicted on a patient will not prosper. Euthanasia will be viewed as a risk free and financially stable option in treating patients who are gravely ill.             There are also arguments that support and defend the practice of euthanasia. Some nations and states government in the United States have legalized this practice but euthanasia is done with strict restrictions and conditions that must be complied upon (Dowbiggin, 2003). These conditions and restrictions regarding euthanasia are present in the governing laws and regulations on euthanasia practice in the Netherlands and in the state of Oregon in the United States. Advocates of euthanasia primarily advocate that euthanasia is beneficial because the patients are undergoing excruciating and painful feeling in his/her ordeal (Hillyard, 2001). This conception stem from the fact that people who have incurable and painful diseases suffer greatly and horribly when dying. They state therefore that in order to help and minimize the pain felt by the patient and the emotional trauma that is also felt by relatives and friends, euthanasia must be implemented. Other patient meanwhile state that they do not want to suffer and to experience a painful and humiliating death so they choose and order their doctors and guardians to facilitate euthanasia when they don’t have the capacity to decide anymore. This was the primary argument that was passed in the Terry Shiavo case.             In this legal and medical battle, a patient named Terry Shiavo has suffered from a brain damage and his husband wanted to remove the feeding tube that is inserted to his wife. This order as stated by the husband was specifically requested by Terry when she was still alive since she does not want to suffer and be a burden to the family. The parents of Terry meanwhile were strongly against the removal of the feeding tube countering that Terry was still alive since she was still responding to visual and auditory stimuli. A legal battle ensued between the husband and the parents of Terry dragging with the religious groups, conservative and liberal sectors of the American society. Different doctors and medical practitioners were summoned by the court but they all had conflicting and confused opinions regarding the case. In the end however, the arguments made by the husband won and the feeding tube was removed.             This argument that states that patients must be killed because they experience pain and suffering is a flimsy and weak standpoint. Since patients who request euthanasia have painful and incurable diseases, emotions and outlooks in life can have a great effect on the decision making process of an individual. Although they are asking for death, what they really want are compassion, care and love from their relatives and friends. There, a decision making process is also clouded by medication, pain and depression. In a study conducted by the state of New York in 1994 in a report entitled “When Death is Sought: Assisted Suicide and Euthanasia in the Medical Context”, it stated that patients with severe pain, disfigurement or disability do not wish to commit suicide and that patients who ask for euthanasia have major  symptoms of major depression (Zucker, 1999). The report further stated that patients who have experiences of pain and suffering felt hopelessness and depression and can wrongly see that death and the process of euthanasia is the only way that would end their ordeal (Zucker, 1999).             Another argument that is being pushed by pro-euthanasia groups is that each and every person has the moral and intrinsic right and autonomy to control and set the course of his/her destiny (Hillyard, 2001). This would mean that if a man or a woman decided to end his/her life, there are no legal and ethical hindrances that would prevent him/her for doing it so. Although this argument is accepted by some groups, they correctly said that euthanasia is not an individual action being undertaken by a patient. In order to commit euthanasia, there must be cooperation on the part of the attending doctor and hospital staff and when other persons and individuals are now involved, suicide and killing one’s self will now be in the realms of public interest and order since in most countries, the assistance and help offered by an individual in a suicide is classified as an offense in many states and countries (Donnelly, 1998).             For the sociologist, the issue on euthanasia can be a great opportunity to understand and to closely examine the mentality, outlook and consciousness of a particular society with regards to the subject of death. This study would not only elicit information regarding euthanasia practices in such societies but it would also answer prevailing questions like what are the factors that greatly hinders or advance the practices of euthanasia practices in an specific society?, does society exert pressure and influence when euthanasia is committed?. The field of sociology and sociologists therefore can clearly and adequately answer these questions by using research methods. Sociologists can provide an unbiased and unprejudiced opinion and examination to these emerging phenomena and hopefully, sociology can provide man and society with a way, a compromise in order to reconcile different opinions that are against and for euthanasia. Sociology can therefore be a bridge that will provide society with answers that would help us comprehend this particular issue.             I would say that euthanasia is a personal standpoint; it is a stand regarding a certain subject which is death. Euthanasia is a personal preference made by an individual but it will have negative and far reaching consequences to society. Although this thought can be relatively harmless when viewed at a glance, it can weaken and create confusion in the society because its effects are wide and encompass subjects such as religion, ethics, health care and psychology. This subject therefore creates tension and advocacy in terms of people and organizations who particularly advocates a certain topic or perspective. For me, I would agree and perfectly convinced on the arguments that support the move of not to legalize euthanasia or physician assisted suicide. Legalizing it would create societal conflict and discord because status quo and established mores, laws and customs with regards to death and the idea of death will completely be changed.

Legalizing Euthanasia: An Argument

The purpose of this paper is to argue about the subject of doctor assisted suicide. It will specifically argue with regards to ...

Infant Visual Perception

Introduction Infant growth moves from the general to the specific. This is an important facet of human development It rests upon the principle of generalized movement by the infant directed toward more specific actions and precision as time passes. This can be seen readily in the infant whose movements are random at first when attempting an act, then becoming more exact and deliberate, from flailing arms to more specific hand control and finally finger coordination as the infant tries to "pick up" from a flat surface; this represents neuro-muscular maturation, reaching first with an entire limb in an awkward manner and then concluding with natural, self devised restrictions imposed on the arms facilitating more finite hand/finger aptitude. Time and genes allow for this kind of growth; external interferences can do little under this organic sequence. This paper will explain the different aspects of the perceptual growth of infants. What do Babies know about the Physical World? Perception is composed of both experiencing and interpreting the world that an infant live in this is according to some philosophers, psychologists, physiologists and physicists. The infant’s daily experiences increase his or her fascinating perceptual questions. Infants are responsive to binocular and kinetic information by 3 to 5 months of age except they may not be sensitive to static information until about 7 months of age. It is significant to point out, though, that infants younger than 3 months of age probably perceive depth. A child’s everyday experiences raise the following questions: How do our perceptions come to achieve stability amidst constant fluctuations in the environment? How do perceptions come to be invested with meaning? How are the individual features of things we perceive synthesized into organized wholes? How does the perceptual quality of “bitter” differ from that of “red”? How do we see a three-dimensional world when visual processing begins with a two-dimensional image in the eye? Perceptual development has served as a kind of battleground between nativists and empiricists, and to illustrate this some studies examine one exemplary skirmish in detail. It concerns the ways infants might come to perceive depth in space. They selected this example for several reasons. First, depth perception is crucial to determining the spatial layout of the environment, recognizing objects, and guiding motor action. Second, the study of depth perception addresses an interesting psychophysical question, namely how infants perceive the three dimensionality of the environment when the retina of the eye first codes information along only two dimensions. Third, debate on this question exemplifies the typical historical course: It began with hotly contested philosophical disputes that spanned the seventeenth to nineteenth centuries before prompting experimentation in the twentieth century. Throughout this time, philosophers and scientists consistently looked to infancy to help decide how depth perception develops. Experimental studies began to displace philosophical speculation; in fact, experimental psychology, which started only in the twentieth century, was at first specifically organized to address just such issues. Three lines of research exemplify how questions about the origins of depth perception have been addressed experimentally. All three are valuable because no one alone provides definitive information, but the three together converge to sketch how depth perception develops. The starting point for the first line of research was the following observation: Infants at the creeping and toddling stage are notoriously prone to falls from more or less high places . They must be kept from going over the brink by side panels on their cribs, gates on their stairways, and vigilance of adults. As their muscular coordination matures, they begin to avoid such accidents on their own. Common sense might suggest that the child learns to recognize falling-off places by experience—that is, by falling and hurting himself. But is experience really the teacher? Or is the ability to perceive and avoid a brink part of the child's original endowment? From these results, they concluded that depth perception must be present in infants as young as 6 months of age. By 6 months, however, children may already have had plenty of experience perceiving depth, the pre-crawling babies by monitoring heart rate when the babies were exposed to shallow and deep sides of the visual cliff. They found that babies as young as 2 months of age showed a decrease in heart rate when exposed to the deep side, indicating increased attention or interest. Thus, babies may perceive depth long before they locomote but show little fear of the drop at that age. The wariness of drops shown by older infants may result from the anxiety parents’ show when infants approach a drop, rather than from actual experience with falls. Infants “socially reference” their parents and use their parents' emotional cues to interpret ambiguous events .Visual cliff experiments represent one way investigators have sought to explore the infant’s  capacity to perceive depth. In actuality, three types of stimulus information specify depth, and thus organize this discussion of early depth perception around binocular, static, and kinetic cues. As Descartes and Kant argued, there are at least two bases for perceiving depth because infants are binocular (have two eyes). Because their two eyes receive slightly different images of the visual world, the convergence angle of the two and the disparity between the two images they yield provide some information about depth perception. Binocular convergence provides information only about close-up distances, but it may provide functional information about depth as early as 2 months of age. Depth perception experiments have demonstrated that infants are sensitive to binocular and kinetic information by 3 to 5 months of age but may not be sensitive to static information until about 7 months of age. It is important to point out, however, that infants younger than 3 months of age probably perceive depth. There may never be a final triumph for nativism or for empiricism. It can be argued that, no matter how early in life depth perception can be demonstrated, the ability still rests on some experience, and that no matter how late depth perception emerges, it can never be proved that only experience has mattered. Nevertheless, the nativism-empiricism debate remains pervasive in the developmental study of depth perception, as well as color, speech, and many other content topics in infant perceptual development. Physical objects or events arouse the infant’s sense-organs. As a causal result of this, they obtain instantaneous knowledge of their existence and their properties. By immediate knowledge is meant knowledge which is not inferred from, or suggested by, any further knowledge, or any ground or basis for knowledge. This knowledge is not necessarily verbalized knowledge, but it is always knowledge which it is logically possible to put verbally. It is propositional in form. And although such knowledge is immediate, in the sense just defined, it is not incorrigible knowledge. Conclusion As a result of  the stimulation of  the eye, infants  acquire immediate knowledge of  the size, shape, color and spatial relations of  the objects  around them; as a result of  the stimulation of  the skin, they obtain immediate knowledge of  the shape, size, temperature, spatial relations, and other properties of  the objects in our environment; as a result of the stimulation of  the nose, they acquire immediate knowledge of  the presence of smells; and so on. After they gain some knowledge of the physical world, this knowledge is accompanied by knowledge of the means by which this immediate knowledge was got (by the eyes, skin, nose, etc.). It is also regularly accompanied by characteristic sensations in the organs being used to acquire the immediate knowledge. The acquiring of immediate knowledge in this fashion is perception. It may be distinguished from more sophisticated forms of perception by being called immediate perception. But it must be emphasized that immediate perception is not immediate knowledge. It is the acquiring of immediate knowledge, and is therefore an event in the sense that an acquiring is an event. It is part of the concept of immediate perception that the knowledge acquired is knowledge of the state of affairs in the physical world contemporary with the acquiring of the knowledge. This logical necessity is built on the empirical fact that we never acquire any immediate knowledge of past states of affairs by means of the senses. The objects and properties of objects that are immediately perceived have an existence logically independent of their being perceived. They may be perceived or not perceived. There are objects and properties of objects that are never perceived, although it would always be logically possible for such unperceived things to be perceived. It is therefore REALISTIC. Studies prove that the quality of child care have a great impact to the growth and perceptual development of the child. Infants have diverse personalities and temperaments, they develop at different rates. Their self-esteem is an important aspect of their development, that is why parents and caregivers should give them constant praise and encouragement. The following points should be considered in order to help boost the development of a child: <ul type="disc" style="MARGIN-TOP: 0in; MARGIN-BOTTOM: 0in"><li class="MsoNormal" style="LINE-HEIGHT: 200%; TEXT-ALIGN: justify">Communicate to your offspring what needs to be done at that moment. </li> <li class="MsoNormal" style="LINE-HEIGHT: 200%; TEXT-ALIGN: justify">Redirect his or her attention or activity by using neutral or positive language. </li> <li class="MsoNormal" style="LINE-HEIGHT: 200%; TEXT-ALIGN: justify">Say no while maintaining love. </li> <li class="MsoNormal" style="LINE-HEIGHT: 200%; TEXT-ALIGN: justify">Explain the reason for your rule. </li> <li class="MsoNormal" style="LINE-HEIGHT: 200%; TEXT-ALIGN: justify">Give limited tasks and be specific in your request. </li> <li class="MsoNormal" style="LINE-HEIGHT: 200%; TEXT-ALIGN: justify">Acknowledge children's feelings, but set limits. </li> <li class="MsoNormal" style="LINE-HEIGHT: 200%; TEXT-ALIGN: justify">Help them understand how their actions affect others. </li> <li class="MsoNormal" style="LINE-HEIGHT: 200%; TEXT-ALIGN: justify">Help kids use words to communicate their frustrations. </li> <li class="MsoNormal" style="LINE-HEIGHT: 200%; TEXT-ALIGN: justify">Acknowledge positive behavior. </li></ul>

Infant Visual Perception

Introduction Infant growth moves from the general to the specific. This is an important facet of human development It re...

Critically evaluate the impact of the currently dominant scientific paradigm (Medical Model) in relation to the use and acceptability of acupuncture

Holistic Approaches to Health   Critically evaluate the impact of the currently dominant scientific paradigm (Medical Model) in relation to the use and acceptability of acupuncture     The impeding awareness and presence of therapeutic landscapes are places, settings and situations that encompass both the physical and psychological environments associated with treatment or healing, and the maintenance of health and well-being. Practices from holistic medicine, complementary medicine are used to illustrate specific humanistic concepts in further examining therapeutic landscapes and the understanding of holistic medicine. For acupuncture, the implying of alternative medicine has a major presence and persuasive attraction in the industrialized western world. The extent to which these practices have clinical efficacy according to biomedical criteria is a matter of ongoing research and debate. It may be that independent of any such efficacy, the attraction of alternative medicine is related to the power of its underlying shared beliefs and cultural assumptions. Discussion has focused on whether these practices have any biomedical efficacy and on potential adverse consequences. The shared cultural assumptions may provide vehicle for an enlarged sense of self and a renewed sense of morality and purpose, not meant to advocate or debunk alternative medicine but describes cultural dimensions of alternative medicine as overlooked.  Despite this diversity, much of alternative medicine shares important underlying assumptions and themes that have allowed these movements to form a significant coalition in their historical tug of war with conventional medicine (Cooter, 1988; Bynum and Porter, 1987; Rothstein, 1972; Gevitz, 1988). Thus, biomedicine suffers in this bifurcation because of its association with sophistication and technology as opposed to the perceived simplicity of undeveloped nature (Huxtable, 1992 p. 166). When people use alternative medicine, "the scientific enterprise" does not have to be abandoned. In fact, the label "science" in alternative medicine, as in biomedicine, is an important source of legitimating power, moral authority, and self-definition. Adding to the genuineness of the scientific label is the fact that training in alternative disciplines may involve years of study of complex knowledge bases and relations, intricate determinations of causality and empirical testing of practice (Cooper and Stoflet, 1996 p. 226). Thus, for instance in acupuncture, the biomedicine model may have assumptions that differ radically from those of alternative medicine (Gordon, 1988). The contemporary and alternative medicine's version of science lacks the adopted biomedical notion of clinical experiments carried out under the controlled conditions, exemplified by randomized trials (Kaptchuk, 1998; Lilienfeld, 1982). It can be that, the science of alternative medicine is ultimately "person friendly." Its language is one of solidarity, unity, and holism instead of the distant, statistical, and neutral conventions of normative science (Tambiah, 1990). For person-centered experience is the ultimate verification and reigns supreme in alternative science since, such acupuncture knowledge and simple observation are not deprecated, no placebo effect haunts and casts doubt on the validity of therapeutic outcomes (Kaptchuk, 1998 p. 1724; Sullivan, 1993 p. 215). The alternative medicine science has no radical skepticism. In fact, alternative medicine science sometimes takes on the appearance of proving deeply held beliefs by selectively appropriating normative scientific studies, for instance consumer infatuation with and hope in acupuncture use is unshakable as well as sustained by skewed attention to scientific knowledge as contrary to research evidence is being known at (Apple, 1996). Ideally, acupuncture had existed today not just in its Chinese origins but also in other parts of the world, even in the United Kingdom. The scientific paradigm adheres to the contemporary and alternative use and application of medicine and its therapies known about. The need to assume acupuncture research and such aspects of the medical model relating to its usage as well as acceptability into the UK society, and its impeding and growing health care systems and other processes deemed at. Recognizing acupuncture and how it works in the UK, from within research studies are to be discussed and analyzed critically along with some statistical examples of the acupuncture study, its safety assumptions in the UK and other relevant aspects and information of acupuncture in support of such resources from books, journals and articles linked from Google scholar, the guardian news archive/ the observer (Revill, 2005) and other academic related databases and some research points of reliability and validity of acupuncture effectiveness and practice respectively. Thus, truly known that in the United Kingdom, acupuncture is widely used in private institutions of care as well as in the National Health Society (NHS) practices, and noted in surveys of the use of complementary medicine, acupuncture is consistently cited among the most commonly used (Zollman and Vickers, 1999 p. 319). Indeed, there was about  seven percent of the adult population in England have received acupuncture, and that some of the acupuncture sessions are provided by specialist practitioners without other medical qualifications, of whom there are over 2200 in the UK (Thomas, Nicholl and Coleman, 2001 p. 4; British Acupuncture Council, 2001). Furthermore, the British Medical Acupuncture Society has among its members over 2000 doctors who use acupuncture in hospital or general practice, as one survey estimated that, NHS provided one million acupuncture treatments in England. The current estimated total cost to the NHS of nearly £26 million is equivalent to all other complementary therapies as ideally combined (British Medical Acupuncture Society, 2001; Thomas, Nicholl and Coleman, 2001) The process of acupuncture involves the stimulation of specific points on the skin, usually by the insertion of needles. In its original form acupuncture was based on the principles of traditional Chinese medicine. Traditional acupuncturists understand health in terms of energy which circulates between the organs along channels called meridians, as the energy must flow in the correct strength and quality through each of these meridians and organs for health to be maintained.  Many conventional healthcare professionals who practice acupuncture have dispensed with such concepts. Acupuncture points are thought to correspond to physiological and anatomical features such as peripheral nerve junctions, and diagnosis is made in purely conventional terms. One concept thought important by some practitioners is that of "trigger points" which they believe often correspond to acupuncture points, one area of increased sensitivity within a muscle which is said to cause a characteristic pattern of referred pain in a related segment of the body (Baldry, 1993).  Some research indicates that, “acupuncture and the complementary medical modalities that involve holistic principles challenge the dominant biomedical paradigm of mechanical reductionism and therefore are considered unconventional or alternative, two of which lie within the dominant scientific paradigm, and a third that is built upon frontier ideas at the edge of the new science of acupuncture paradigm as being capable of accommodating many puzzling features of acupuncture. In order to embody the latter, it appears that a new paradigm for the life sciences is needed to address the wholeness and integrity of the organism. Nonetheless, despite this pluralistic view, working toward a unity of Eastern and Western thought may lead to a more universal understanding of acupuncture in the future” (Rubik, 1995 p. 41). In addition, there success in examining better ways in which the “acupuncture phenomenon is translated into scientific language through the mobilization of functional magnetic resonance imaging. In doing so, it explores how differences between science and traditional medicine are bridged and negotiated through an open-ended tuning process among heterogeneous elements. By showing the constructive interaction between traditional medicine and science, conception of East Asian medicines as culturally bounded and to provide an interpretation of trans-cultural norm that emphasizes its diverse and hybrid formations. Particularly, in order to explain the scientific translation of acupuncture, the adopting of performance based perspective rather than representational one with regard to science, as the scientific interpretation of acupuncture as an interactive stabilization between the acupuncture phenomenon, theory and the material procedure there is” (Kim, 2006 p. 2960). It can be that, ideal understanding of acupuncture, Chinese medicine is limited by lack of inquiry into the dynamics of research and its underlying process, the holistic model of acupuncture assumes that, ‘whole being greater than the sum of the parts’, implications for service provision and research design. The paradigm model will require comprehensive evidence and assimilation of acupuncture dominance in the UK, in ample medical care and health domains. For many patients attracted to complementary medicine its safety has been one of its principal appeals. Complementary methods, including acupuncture, are seen as less invasive, more natural, and less liable to adverse effects than more orthodox forms of treatment. Critics of complementary medicine have, however, often castigated it as being dangerous, sometimes in the same breath as ridiculing complementary methods for their lack of effectiveness and scientific support (Vincent, 2001 p. 467). True, that no person will want unsafe medicine, safety is a given factor for care and acupuncture safety is also deemed to be a safe alternative as the UK carers are imbued with the importance of safe practice from the moment they start their training at the same time dislike the adverse publicity of medical accidents, the social and medical cultures, which focus on blame, are a major threat to safety in medicine. The impeachable need of a systems approach to the safe practice of acupuncture is possible, and involves making a careful and systematic assessment of every aspect of practice in a hierarchy that extends from the professional institution to factors in clinical practice and the patient, indeed, very necessary to provide positive evidence of the safety of acupuncture as such risks that acupuncture carries are the risk of traumatic injury to an internal organ, especially the pleura, by needle penetration, risk of causing bacterial infections in deep structures, though this seems to be small, probably because the needle tip is too small to carry infected material from the skin. The usual way to obtain an estimate of the frequency of adverse events is to conduct prospective surveys specifically for the purpose in the UK as reported. For example, safety of acupuncture treatment for osteoarthritis can be compared with that of non-steroidal anti-inflammatory drugs, as about 12% of these people will die, and it has been estimated that hemorrhage caused by NSAIDs are the cause of death in about 2000 people in the UK each year. The UK patients should be provided with information on the risks of acupuncture before giving consent to treatment. While the precise details and method of presentation will vary according to the circumstances and the needs of individual patients, as a minimum they should be informed of the risks of drowsiness, minor bleeding, and the aggravation of symptoms as well as fainting possibilities. For several acupuncture cases that works there are information effectively noted by the guardian news archive in the United Kingdom for one, there assumes that acupuncture relies on a different language and different tools from Western medicine, but however strange it seems at first, as controversy has raged for years over whether acupuncture has only a placebo effect that makes people feel psychologically and physically better but changes nothing physiologically. However, one study reveals for the first time that it provokes a specific response in the brain, shedding light on how it might affect the body's pain pathways. This helps to explain why both patients and health professionals trained in Western medicine are increasingly turning to this ancient form of Chinese healing. Aside, one study in the British Medical Journal showed that patients with osteoarthritis in the knee who received acupuncture a well as an anti-inflammatory painkiller suffered less pain and stiffness than those who received the drug plus sham acupuncture, where the needle did not penetrate the skin also, some children with hay fever and nasal allergies had fewer sneezing bouts and congestion after acupuncture compared with a placebo group, in research carried out in Hong Kong. Indeed, one particular research have indicated  the “conjunction of growing popularity, complementary and alternative medicine in the United Kingdom has witnessed increasing professionalization, as prompted by the landmark Parliamentary Inquiry during November of the year 2000. Professionalization has become significant strategy for practitioner associations and a key focus for the government, media, and patient groups, being driven by concern over the interests of patients and consumers, and in relation to the possible integration of certain forms of complementary and alternative medicine into publicly funded healthcare” (Clarke, Doel and Segrott, 2004 p. 330). There can be certain extent to which alternative therapies are being holistic as for instance, the acupuncture process in the UK, alternative medicine is contrasted with biomedical basis of orthodox medicine along with a critique of which there led to the development of contemporary notions of holistic acupuncture practice. The good background to the holistic health movement is then charted with reference to the rise of the medical profession, which has become increasingly unified around biomedicine from within largely holistic nature of alternative health care today is duly illustrated by some case studies of specific alternative therapies as well as their practice contextualization. However, it is argued that not every aspect of alternative medicine can be seen as holistic, nor should it be assumed that every elements of the known practice are non-holistic as health professionals become involved with alternative therapies in order to extend an ideal holistic approach to UK’s health care (Saks, 1997 p. 5).   For some acupuncture statistics found into the UK research context, there can linking evidence of certain conditions of research giving ample weight into the practice of acupuncture in the UK as such statistics coming from a particular investigation, meta analysis of practice and philosophy in acupuncture as it remain an issue within mainstream healthcare in the UK. In spite of the relative integration of acupuncture within orthodox medical practice, the lack of scientific paradigm conformity continues to divide traditional from Western approaches. This study sought to explore the perceptions and attitudes of existing acupuncture clinicians in the UK, from a range of professional backgrounds and affiliations, towards traditional acupuncture philosophy and practice. In doing so, it attempted to determine the extent to which traditional approaches were both regarded as legitimate and utilized in practice within mainstream healthcare. For stats, such response rates of 60.8% were being obtained, whereas 59% and 72% (Shao, Borthwick, Lewith and Hopwood, 2005) of respondents in BMAS and AACP groups used such known theory. Another point is placed at the acupuncture for such smoking cessation as the statistics research implied that acupuncture is promoted as a treatment for smoking cessation, and is believed to reduce withdrawal symptoms as there performed meta-analysis using a fixed effects model. For stats outcome, acupuncture was not superior to sham acupuncture in smoking cessation in any time point as odds ratio for early outcomes was 1.22 (95% confidence interval 0.99 to 1.49) (White, Rampes and Ernst, 2000 updated 2002), the odds ratio after 6 months was 1.38 (95% confidence interval 0.90 to 2.11) and after 12 months 1.02 (95% confidence interval 0.72 to 1.43) (White, Rampes and Ernst, 2000 updated 2002), when acupuncture was compared with other anti-smoking interventions, there were no differences in outcome at any time point and that there appeared to be superior to no intervention in the results but not duly sustained and have asserted that there has been no clear evidence that acupuncture is effective for smoking cessation. Therefore, the assimilation geared towards effective medical model of acupuncture usage and acceptance in the UK has assumptions that contemporary and alternative medication is a success as the British Medical Association had suggested the encompasses of treatments not taught in the medical curriculum as considerations of acupuncture is being evidently recognized. Thus, in UK, doctors who practise alternative medicine are practitioners, acting as mediators between the public demand for treatment and the evidence-based provision of medical services as inevitable that economic and social pressures will then encourage contemporary and alternative medicine development through the overall function stance of acupuncture areas in the UK, as well as in the determined practice environment as for acupuncture stature, some illnesses for which conventional medicine will be offering in adequate patterns of care and success in care path, the process has recently been completed in the United Kingdom (National Center for Complementary and Alternative Medicine, 2004) with the support of the Foundation for Integrated Medicine. Contemporary and alternative medicine is clearly known by UK and to some other Western nations but it may be a mistake to read too much into the use of any particular therapeutic intervention. Patients may be using contemporary and alternative medicine to empower themselves in the management of their chronic illnesses. Indeed, without adequate research funding and the establishment of high quality research network, as well as a critical and evaluative approach to education and practice of acupuncture, it will be impossible for UK health team to answer these vital questions about the increased use of contemporary and alternative medicine and its combined therapeutic efficacy, learning that contemporary and alternative medicine does incur positive desire for acupuncture ways to play vital role in the management of such diseases and illness points. References Apple RD. Vitamania: Vitamins in American Culture. New Brunswick, NJ: Rutgers Univ Pr; 1996. Baldry PE. Acupuncture, trigger points and musculoskeletal pain. London: Churchill Livingstone, 1993. British Acupuncture Council. www.acupuncture.org.uk (accessed 19 June 2001) British Medical Acupuncture Society. www.medical-acupuncture.co.uk (accessed 19 June 2001) British Medical Association. Complementary medicine: new approaches to good practice. Oxford: Oxford University Press, 1993. Bynum WF, Porter R, eds. Medical Fringe & Medical Orthodoxy, 1750-1850. London: Croom Helm; 1987. Clark, D. Doel, M. and Segrott, J. (2004), No alternative? The regulation and professionalization of complementary and alternative medicine in the United Kingdom. Health & Place Volume 10, Issue 4, December 2004, Pages 329-338. 2004 Elsevier Ltd Cooper RA, Stoflet SJ. Trends in the education and practice of alternative medicine clinicians. Health Aff (Millwood). 1996; 15:226-38. Cooter R, ed. Studies in the History of Alternative Medicine. New York: St. Martin's Pr; 1988. Gevitz N, ed. Other Healers: Unorthodox Medicine in America. Baltimore: Johns Hopkins Univ Pr; 1988. Gordon DR. Tenacious assumptions in western medicine. In: Lock MM, Gordon D, eds. Biomedicine Examined. Boston: Kluwer Academic; 1988. Huxtable RJ. The myth of beneficent nature: the risks of herbal preparation [Editorial]. Ann Intern Med. 1992; 117:165-6. Kaptchuk TJ. Powerful placebo: the dark side of the randomized controlled trial. Lancet. 1998; 351:1722-5. Kaptchuk TJ. Intentional ignorance: a history of blind assessment and placebo controls. Bull Hist Med. 1998; 72:389-433. Kim, J. (2006). Beyond paradigm: making transcultural connections in a scientific translation of acupuncture. Social Science Medicine Journal. Jun; 62(12):2960-72. Epub 2006 Jan 18, Elsevier University of Illinois at Urbana Lilienfeld AM. The Fielding H. Garrison Lecture: Ceteris paribus: the evolution of the clinical trial. Bull Hist Med. 1982; 56:1-18. National Center for Complementary and Alternative Medicine. Acupuncture. December 2004. Available at http://nccam.nih.gov/health/acupuncture (accessed on 2 September 2008) Paterson, C. and Britten, N. (2004). Acupuncture as a Complex Intervention: A Holistic Model.  The Journal of Alternative and Complementary Medicine. November 2004, 10(5): 791-801 Revill, J. (2005), It's official: acupuncture really works. Guardian, the Observer  Rubik, B. (1995), Can Western science provides a foundation for acupuncture? Alternative Therapy Health Medicine Journal. Sep; 1(4):41-7 Center for Frontier Sciences, Temple University Philadelphia Rothstein WG. American Physicians in the Nineteenth Century: From Sects to Science. Baltimore: Johns Hopkins Pr; 1972. Saks, M. (1997\), Alternative therapies: are they holistic?. Complementary Therapies in Nursing and Midwifery Volume 3, Issue 1, February 1997, Pages 4-8. 1997 Elsevier Ltd. Shao, J. Borthwick, A. Lewith, G. and Hopwood, V. (2005), Attitudes towards Traditional Acupuncture in the UK. Evidence-Based Integrative Medicine. 2(1):37-45 Sullivan MD. Placebo controls and epistemic control in orthodox medicine. J Med Philos. 1993; 18:213-31. Tambiah SJ. Magic, Science, Religion, and the Scope of Rationality. New York: Cambridge Univ Pr; 1990. Thomas KJ, Nicholl JP, Coleman P. Use and expenditure on complementary medicine in England: a population based survey. Complementary Therapies in Medicine 2001;9:2–11   Vincent, C. (2001),  The safety of acupuncture. BMJ 2001 323: 467-468.   White AR, Rampes H, Ernst E. Acupuncture for smoking cessation (Cochrane Review). In: The Cochrane Library. Issue 2. Oxford: Update Software, 2001   Zollman C, Vickers A. ABC of complementary medicine. Users and practitioners of complementary medicine. BMJ 1999;319:836–8

Critically evaluate the impact of the currently dominant scientific paradigm (Medical Model) in relation to the use and acceptability of acupuncture

Holistic Approaches to Health Critically evaluate the impact of the currently dominant scientific paradigm (Medical Model) in...

Medical Supply Contracting

Introduction: The development of the pharmaceutical industry since World War II led to the discovery and use of new and effective drug substances. It also changed the role of the pharmacist. The scope for extemporaneous compounding of medicines was much diminished and with it the need for the manipulative skills that were previously applied by the pharmacist to the preparation of bougies, cachets, pills, plasters, and potions. The pharmacist continues, however, to fulfill the prescriber's intentions by providing advice and information; by formulating, storing, and providing correct dosage forms; and by assuring the efficacy and quality of the dispensed or supplied medicinal product. The evolving nature of the chain drug industry may seem to favor large chains, but the foundation of the business remains the same, according to Brooks Pharmacy senior vice president of operations Bill Welsh. "It's all about the connection each store makes with its customers," he notes. The changes in the industry have forced us to alter many of the ways we do business, but the true fundamentals of the drug store business remain the same. There may be fewer drug chains than there were a few years ago, but not a smaller number of drug stores. Certainly, the demand for the products and services offered by drug stores have not declined (Warwick, 1997). According to the Chain Drug Review, the pharmacy automation market in the United States, which traces its origin to the introduction of pill-counting machines in the 1970s, is on pace to reach nearly $2.5 billion within the next five years (2004). The continually increasing demand for accuracy, safety, industry standards and competency in the pharmacy environment by regulatory authorities, manufacturers, health care professionals and consumers has spurred the growth of this market, asserts Business Communications Co. Products in the outpatient market include automated dispensing systems, packaging equipment, and samples management and automated counting machines. The packaging equipment component is the most successful market sector in the outpatient pharmacy automation market with over 55% of sales, followed by automated dispensing systems at nearly 30%. A pharmaceutical company (or drug company) is a company licensed to discover, develop, market and distribute drugs.  Drug Development is considered a costly and intensive process.  The cost of a new drug (new chemical entity) is estimated be about 1 billion USD. Apart from that, a company may apply and be granted a patent for the drug or the process of producing the drug about for about 20 years. Only after rigorous study and testing, which can take as long as 12 years, will governmental authorities grant permission for the company to market and sell the drug. Patent protection allows the owner of the patent to charge high margins for the branded drug. When the patent fro the drug runs out, a generic drug is usually created by a competing company and released, causing the price to drop markedly. The generic industry was also granted new benefits. The manufacturers no longer need to duplicate expensive research to bring their generic copies to the market when the innovator's patent runs out. In some circumstances, a generic drug can even be marketed before the patent's expiration. Hatch-Waxman was a statute designed for balance, and on the whole, it has performed as intended: both innovator and generic firms in general have prospered and increased their productivity (Crawford, 2005) Some medication only show to have safety issues after they are marketed, as clinical trials are of limited size, such as the 3,000 test subjects required by the FDA. The over – arching of FDA is to regulate the multitude of medicinal products in a manner that ensures the safety of the American public and the effectiveness of marketed drugs. The FDA’s budget for approving, labeling and monitoring drugs is roughly $290 million per year. “Review Teams” employ around 1,300 employees to approve new drugs. Te “safety team” has 72 employees to determine whether new drugs are unsafe or present risks not disclosed in the product’s labeling. The safety team monitors the effects of more than 3,000 prescription drugs on 200 million people with a budget of about $15 million a year. The FDA requires a four-phased series of clinical trials (synonymous for clinical studies, research protocols, medical research is a research study) with phase three being the largest and usually requiring 1,000 – 3,000 patients. Post – marketing surveillance ensures that are after marketing the safety of a drug is monitored closely. In certain instances, its indication may need to be limited to particular patient groups, and in others the substance is withdrawn from the market completely. Post market studies test a marketed drug in new age groups or patient types. Some studies focus on previously unknown side effects related risk factors. As with all stages of drug development testing, the purpose is to ensure the safety and effectiveness of the marketed drugs. Pharmaceutical marketing (Wikipedia, 2006) is the business of selling pharmaceuticals or drugs. Physicians control the choice of many drugs through prescription writing. They are considered the vital players in the complex subject of pharmaceutical marketing where in they determine the drugs that will be used by the patients whether patented or the generic drug. Direct marketing applies that is when pharmaceutical companies sends medical or sales representatives providing medication information and they bring along with them drug samples to be given to the physicians so, in return they would influence their patients. Pharmaceutical companies are developing new innovations or different approach that now centers on influencing the people who influence the physicians. There are several channels by which a physician may be influenced, including self – influence through research, peer influence, direct interaction with pharmaceutical companies, patients and public or private insurance companies. Physicians could get pharmaceutical information through the PDR (Physician’s Desk Reference), which is a commercially published compilation of manufacturers’ prescribing information on prescription drugs, updated manually. Another way would be an online source, Epocrates. Physicians would also rely on pharmaceutical branded e-detailing sites, pharmaceutical sales and non – sales representatives, and scholarly literatures in the form of medical journal article reprints. Peer influence could either be key opinion leaders who influenced physicians through their professional status, including but not limited to prescribing behavior. Pharmaceutical companies generally engage key opinion leaders early in the drug development process to provide advocacy activity and key marketing feedback (Developing Win – Win Key Opinion Leaders, 2003). Physicians also acquire information through informal contacts such as their colleagues. According to the Teredata Magazine, currently, there are approximately 100,000 pharmaceutical sales reps in the United States pursuing some 120,000 pharmaceutical prescribers. As a result, what used to be 15-20 minutes of face time with physicians has been reduced to competing with other reps for one or two minutes of time, according to Sheryl Kingstone, an analyst with The Yankee Group. Because of the large size of the pharmaceutical sales force; organization, management, and measurement of the effectiveness of the sales force are large business challenges. Management tasks are usually broken down into the areas of physician targeting, sales force size and structure, sales force optimization, call planning, and sales forces effectiveness. The role of the patients in the pharmaceutical marketing is influenced greatly by mass media advertisements for pharmaceuticals. Expenditures on direct-to-consumer (DTC pharmaceutical advertising) have more than quintupled in the last seven years since the FDA changed the guidelines, from $700 million in 1997 to more than $4 billion in 2004 (Wikipedia, 2006). Public and private insurers affect the writing of prescriptions by physicians through formularies that restrict the number and types of drugs that the insurer will cover. In January 2006, the U.S. instituted a new public prescription drug plan through its Medicare program (Huntoon, R. 2004) Known as Medicare Part D, this program engages private insurers to negotiate with pharmaceutical companies for the placement of drugs on tiered formularies. Conclusion:             The pharmaceutical industry is usually characterized as elite in terms of outsized rewards and excessive profits. Overall global industry growth has slowed to single digit rates: 2004 global dollar volume was $550 billion, a 7 percent increase over 2003—which in turn represented a 9 percent increase over 2002. US sales grew to $235.4 billion, a growth rate of 8.3 percent compared with 11.5 percent growth from 2002 to 2003 (Trombetta, 2005). The U.S. comprises roughly 45% of the pharmaceutical market worldwide, while Europe comprises about 25% (AMR Research). The pharmaceutical industry, intimately linked with healthcare, is feeling healthcare's pains—and some of its own as well (Ebisch, 2005). According to the Teradata Magazine (2005), By 2007, $40 billion in U.S. sales will be lost at the top 10 pharma companies as a result of the slowdown in R&D innovation and the expiry of patents on major products," predict Ian Brodie, executive consultant, and Michelle Palmer, managing consultant, Capgemini. "Taking a broader look across the industry, no fewer than 19 blockbuster drugs are expected to hit patent crisis by 2008. Analysis suggests that 150 mid-sized new compounds will be needed by 2007-2008 in the U.S. alone to plug this gap."  This is one of the many reasons why many Americans would suggest for import drugs from other countries where it would be cheap and totally affordable. However, "FDA has found that the importation of prescription drugs from foreign sources is not safe medical practice and our position regarding importation is based on FDA's concern surrounding the strength, quality and purity of these medications," said Thomas J. McGinnis, R.Ph. Director of Pharmacy Affairs in the Office of Policy at FDA. "The 'Looks Can Be Deceiving' campaign is an outreach effort designed to educate people about the potential risks importation poses to their health and our nation's drug supply. As it is the responsibility of FDA to safeguard public health, we must do everything in our power to inform the American people about the proliferation of importing prescription drugs. This is precisely why FDA has partnered with the CPA to launch this campaign in Connecticut." [Cited in PR Newswire, 2004]. Due to this, new savings programs are designed to offset the rising cost of prescription drugs and other medical supplies that will only increase as the baby boomer generation begins aging. These programs may reduce prescription drug costs by more, on average, than any imported drug could. Many Americans remain unaware of the benefits available through prescription drug savings programs, which help eligible patients, receive prescription name brand medications at a reduced cost or even for free (Miami Times, 2005). To deal with the 90 percent of health care costs not related to drug prices, experts say that stress the importance on prevention, which can radically reduce costs later on. Prevention can take in many forms: (1) buying the appropriate medicine (2) right dosage (3) right timing and lastly, (4) patient’s compliance.  This can, not only help sustain ones health but at the same time, self – reliance is established. Future innovations are something that keeps an industry booming in spite of strict competition. There are numerous ways of keeping the industry alive. One of which is found in China. Biological Pharmacy might not be new to other western countries but for china, it is some risk worth taking. This particular risk would even help other entrepreneurs of same market strategy boost sales if taken further considerations. The biological pharmacy is a new increasing point for North China Pharmacy Group. There are 2 reasons for North China Pharmacy Group to enter into the biological medicine scope. One is the market reason, that's to say the clinic demand is enlarging. The other is that North China Pharmacy Group has the base and advantage to make biological medicines. In the layout of North China Pharmacy Group, the biological medicines will become an important part in the product frame in future. According to the present rate of progress, the sales sum of the annual biological medicines will reach about 0.15-0.2 billion Yuan in 3-5 years, and the profit will be about 20-30 million Yuan. In 2015 the sales sum and profits will take up 1/3 of North China Pharmacy Group. According to the present operative ability, the sales sum of North China Pharmacy Group will be over 1.5 billion Yuan on the occasion (AsiaInfo Services, 2001). To bridge the barrier between imported drugs to cater the needs of the American society, the Pr Newswire reported, Available online at http://www.ciparx.ca/cipa_pharmacies.html, CIPA's "Safe List" serves as a central referral source. Patients can shop for medications with peace of mind because the list only links to licensed, CIPA- certified Canadian (2004). There must be objectives that should be met in order to keep tract of the pit falls or back logs and therefore, one can make accurate if not better proposition to maneuver or compromise with the current situation. It is always important to have a strategy and a contingency plan while observing the economic boost for these are the underlying trends not just the advancement in the quality of drugs for long-term maintenance conditions. Consumer attitudes, perceptions and behavior continually evolve and form new trends and countertrends, and these key trends will help one learn on what's affecting the changing moods of the customers right now. What types of perks, benefits that the company can offer the customer? That is why the advent of retail industry came to being. The future of retail pharmacy, in the course of that discussion Bernauer described how Walgreens is taking the lead in modifying the current industry practice on long-term maintenance drug refills, while providing a succinct primer on meaningful financial metrics for investment professionals with little knowledge of the retail pharmacy business (Chain Drug Review, 2004). The program allows patients with 90-day prescriptions to have them filled either through mail order or at a retail pharmacy. Bernauer said that further research is needed to fully analyze the reasons for the retail price performance, but he offered a tentative explanation. When a patient walks into a community pharmacy with a prescription that requires a $50 co-pay, he suggested, the pharmacist, being well acquainted with the generic options available (unlike the physician), is in a position to call the patient's doctor and get approval for a generic substitute with a co-pay of perhaps one-third that of the original prescription. In particular, this paper will tells us that one must have key strategy divided into individual strategy for short term and long term goals at the same time identifying and evaluating factors that drive strategic choices for each strategy element. In regards to this, one must choose strategic element that best suits the driving factors that will mitigate risk factors.

Medical Supply Contracting

Introduction: The development of the pharmaceutical industry since World War II led to the discovery and use of new and effective drug s...

A Sample Theoretical Framework : Input-Process-Output Model

Chapter 3 Methodology             Methodologies are outlooks on research; they set out an image for what research is and how it should be carried out. Basically, axioms and methods are connected to each other. Methods are tools or techniques of gathering of data, techniques of analysis, and techniques of writing. Since it is a tool, then a scrupulous method can often be used by many different methodologies (both qualitative and quantitative). Therefore, methodologies are at a more abstract (or general) level than are methods. Apparently, www.encyclopedia.com defined ‘methodology’ as a strategy or plan for achieving some goal. In contrast to this, methods are the tactics that can be used to service the goals of the methodology. In essence, methodologies provide the blueprints that prescribe how the tools should be used. Those prescriptions can be traced to the axioms -- beliefs about how research should be conducted. According to Saunders, Mark; Lewis, Philip & Thornhill, Adrian (2004), all research will possibly involve categorical or numerical data or data that can be use for analysis to help the researcher answer the research questions.  In connection to this, Saunders, Mark; Lewis, Philip & Thornhill, Adrian (2004; p.327) defined quantitative as a type of empirical knowledge. Actually, qualitative data are described in expressions of quality. Qualitative is the converse of quantitative, which more precisely describes data in terms of quantity (that is, using 'formal' numerical measurement).             In connection to this, this chapter will discuss the research design, significance of the study, conceptual framework, participants & the methods course, data sources, historical thinking skills, data collection, data analysis, validation of the data, ethical consideration and summary of the chapter. The Research Design             In order to come up with the most suitable research approaches and strategies for this study, the research process “onion” is undertaken. This is because conducting a research is like peeling the back layers of an onion—in order to come to the central issue of how to collect the necessary data needed to answer the research questions and objectives, important layers should be first peeled away. With the said process, the researcher was able to create an outline on what measures are most appropriate to be applied in the study. Saunders et al (2004) said that while it is not unusual for a researcher to first think of his research undertaking by considering whether one should, for instance, administer a questionnaire or conduct interviews, thoughts on this question should belong to the centre of the research ‘onion’. That is, in order to come to the central issue of how to collect the data needed to answer one’s research questions, there are important layers of the onion that need to be peeled away: the first layer raises the question of the research philosophy to adopt, the second considers the subject of research approach that flows from the research philosophy, the third examines the research strategy most applicable, the fourth layer refers to the time horizon a researcher applies to his research, and the fifth layer is the data collection methods to be used. Figure 1 shows how the researcher conceptualised the research approach to be applied in this study by Saunder, Lewis, and Thornhill (2003), in order to come up with the pertinent data needed to answer the research questions stated in the first chapter, as well as to arrive to the fulfilment of this research undertaking’s objectives. As shown in Figure 1, the research philosophy that is reflected in this study is positivism. With this research philosophy, a researcher prefers to work with an observable social reality in order to come up with law-like generalisations similar to those produced by the physical and natural scientists (Remenyi et al, 1998), and in this tradition, the researcher becomes an objective analyst, coolly making detached interpretations about those data that have been collected in an apparently value-free manner (Saunders et al, 2004). Meanwhile, the second layer shows that this study has undertaken a deductive approach. Accordingly, this approach has five sequential stages: deducing a hypothesis; expressing the hypothesis in operational terms; testing this operational hypothesis; examining the specific outcome of the inquiry to either confirm the theory or indicate the need for its modification; and finally, modifying the theory in the light of the findings (if necessary) (Robson, 1993, p. 19). Significance of the study In recent years, historians and history educators have concluded that historical literacy requires children in grades four through twelve learn and refine historical thinking skills (National Standards for History in School, 1996; National Council for the Social Studies Standards, 1994). Therefore, young people in high school history classes should become increasingly adept at analyzing and interpreting primary sources such as diaries, old photographs, government documents, and other artifacts from the past. Furthermore, students should demonstrate increased historical literacy. They should be able to compose more refined and coherent narratives of what happened and why. To demonstrate historical literacy, students must also be able to properly cite evidence on which they base their historical narratives and interpretations. The requirement of documenting claims about the past, in part, distinguishes historical literacy from other kinds of literacy skills. History teachers could help students improve the above skills by helping students comprehend broad historical themes. They could help them to weave historical materials from various historical sources into coherent historical narratives (Fehn & Koeppen, 1998). This could be done because effective history teachers have a deep understanding of how historians investigate and reconstruct the past and understand that historical knowledge is always open to revision and interpretation (Yeager & Davis, 1994; Wineburg, 1991, 2001). These teachers are comfortable with the ambiguity of conflicting evidence and are aware of the sources of bias in historical documents. History teachers who possessed a deep understanding of history and the historiograghic principles are the ones who will become successful teachers of history (National Standards for History in the Schools 1996).                          This study joined the  lines of research that have investigated the nature of historical thinking skills among professional historians, secondary social studies teachers, elementary school teachers, high school students and elementary school students (Yeager & Wilson, 1997; Fehn & Koeppen 1998; Wunder, 2002; Wineburg, 1991 & 2001.) It explores the historical thinking skills of pre service teachers so far neglected by previous researchers (Wunder, 2002; Seixas, 1998). In order to do so, this study investigated the historical thinking skills exhibited by five would-be history teachers in a, mid western public university in the United States and how they planned their teaching strategies to teach the thinking skills. This study shed some understanding on the similarities and differences between these individuals. This study managed to identify, describe and compare the historical thinking skills of the participants and described and analyzed the instructional strategies that they utilized to teach historical thinking skills. Theoretical/Conceptual Framework The theoretical framework that will be used in the study is the Input-Process-Output Model. In the IPO model, a process is viewed as a series of boxes (processing elements) connected by inputs and outputs. Information or material objects flow through a series of tasks or activities based on a set of rules or decision points. (Harris & Taylor, 1997) Flow charts and process diagrams are often used to represent the process. (Harris & Taylor, 1997) What goes in is the input; what causes the change is the process; what comes out is the output. (Armstrong, 2001) Figure 1.1 illustrates the basic IPO model:                      The IPO model will provide the general structure and guide for the direction of the study. Substituting the variables of this study on the IPO model, the researcher came up with the following: Participants and The Methods Course             The researcher enlisted five would be secondary education social studies teachers in a mid western public university in the United States. The participants were going through the social studies methods course when they were enlisted, and they volunteered to take part in this study. Data Sources The data sources consisted of five historical documents and the lesson plans that were developed by the participants. Historical Thinking Skills             To elicit and detect historical thinking skills, the researcher presented the participants with five different categories of historical documents. They depicted an overarching theme of slavery. Those documents were: a.                  an etching from the 1700s illustrating a coffle of slaves in Africa marching under guard towards the sea, b.                  a painting of the “Amistad” depicting a slave revolt at sea (based upon an actual event), c.                  an excerpt from the 1852 Alabama Slave Code, d.                  a letter from James Henry Hammond, and e.                  a photograph of armed African American in the Union army uniform in front of a barrack.              The documents were selected to simulate a professional historian’s task of weaving together a coherent historical narrative from a mix of historical sources: a painting, an etching, a photograph, a letter, and printed documents. This mix of historical materials offered the participants opportunities to interpret non-written materials as well as written materials. Both type of materials are essential in elucidating historical thinking abilities (Wineburg, 2001 and Levstik & Barton, 2001). The task given to the participants potentially enabled inter-textual comparisons between historical sources. On the back of each source was printed the author of the source and the date it was produced. If the respondents checked the date and source of the document, they would exhibit their historical heuristic skills which is to evaluate the attribution of the source, assess the author’s stance and its truthfulness by examining the date and source of the documents, relate it to the historical background that represents that period, and assess the truth of the author’s biases and intentions (Wineburg, 1991). The five historical sources provided the participants the chance to reconstruct a rich portrait of slavery in the United States. Each of the five selected historical sources for this study was chosen for specific reasons: <ul type="disc" style="MARGIN-TOP: 0in; MARGIN-BOTTOM: 0in"><li class="MsoNormal" style="LINE-HEIGHT: 200%; TEXT-ALIGN: justify">Slave coffle (1700). This etching is an indication that slavery was a terrible system of exploitation. Together with the other sources, the etching could suggest an overarching theme of exploitation and oppression that the respondent could narrate in their story. This generalization would cohere with the respondent’s previous understanding about slavery (Fehn, et.al.1997). The etching, through the subtext, also could direct the participant’s attention to the fact that Africans were implicated in the enslavement of other Africans, portraying a complex view of slavery. It shows that slavery happened everywhere and the researcher intends to discern whether the participants will include these notions in their narratives. Furthermore, the researcher wanted to detect if the participants evaluate etching as more or less reliable historical evidence than other types of historical sources, thus displaying their sourcing heuristic skills described above.</li> <li class="MsoNormal" style="LINE-HEIGHT: 200%; TEXT-ALIGN: justify">Amistad (1841). The painting was selected to see whether the participants are aware that slaves rebelled violently against their captors. The painting should motivate the participants to explore the theme of slave resistance and detect whether they can weave the theme of resistance into a more complex history of slavery. The Armistad tested the sourcing heuristic skills of the participants by inviting them to ponder its validity since it was painted more than a hundred years after the actual rebellion (Fehn, et. Al. 1997).</li> <li class="MsoNormal" style="LINE-HEIGHT: 200%; TEXT-ALIGN: justify">Alabama Slave Code (1852). The excerpts from the code gave the opportunity to the participants to form diverse possibilities of interpretations and to an overarching theme of a legally sanctioned and rigid system of slave control. The code provided specific evidence portraying restricted lives experienced by the slaves. This document allowed the participants to identify a “subtext” an inference that slaves tended to rebel or flee for their freedom. </li> <li class="MsoNormal" style="LINE-HEIGHT: 200%; TEXT-ALIGN: justify">James Hammond’s Letter. James Hammond’s Letter provided the participants the opportunity to analyze the thoughts of a slave owner justifying slavery to an English abolitionist staying in England. The researcher could detect whether the participants provided valid interpretations about the thoughts of the slave owner in the context of the period the letter was written, particularly with regards to the other sources that were presented to them. With hope, the participants will evaluated the letter in terms of its reliability as a historical source (Fehn, et.al. 1997).</li> <li class="MsoNormal" style="LINE-HEIGHT: 200%; TEXT-ALIGN: justify">African-American Soldiers (1864).  A photograph of Civil War soldiers will be included to elucidate the theme of resistance in the narrative of the respondents. The researcher wanted to know if the respondents could weave a narration from the photo to include discussions about the slaves’ participation in their own liberation through armed struggle. The researcher also wanted to see if the participants regarded photograph as a reliable historical event. </li></ul>             Lesson Plan. On the other hand, the lesson plan of the participants was chosen to identify the ability of the participants to develop effective lessons for teaching historical thinking skills. Each participant was required to develop a lesson plan using primary sources as part of the course requirement. The teachers’ lesson plans were collected and photocopied as a data source for this study since the purpose of this study is also to describe the instructional strategies that the participants developed. The content of the lesson plans were viewed, analyzed, and coded for characteristics of an effective history lesson.             Furthermore, lesson plans were chosen to analyze effective history teaching strategies because lesson plans revealed information such as teacher activities and how they communicated with the students. Generally an effective lesson plan has an introduction, body, opportunity for questions, and summary. These components are bound together with time cues, media cues and practice (Toney, 1991).             According to Cramer, R. & Schwartz, R., (1989), lesson planning can be divided into three types; content, process, and context. Each type helps to organize classroom activities, and together they establish the ambiance of the learners’ learning process. Content plans focus on information students should know. Instructional strategies designed to introduce or elaborate the content should be included in the plan.             Apparently, process plans help student learn how to perform cognitive skills or procedures. Process skills include procedural knowledge that supports independent learning. Context plans set the larger framework in which content and process lessons occur. Context plan can include decisions about grouping, discipline, and grading. The lesson planner can develop process lesson plans in six steps: a) decide what process would improve student performance, b) help student understand the purpose of the lesson, c) help students connect prior knowledge to process new information, d) break instruction into incremental steps to help students develop their performance theory, e) provide meaningful practice in the process, f) extend the lesson by making applications to other areas (Cramer &Schwartz, 1989).  Well structured content plans and process plans will help insure that all students make progress in acquiring the knowledge and skills set by the lesson objectives (Cramer, & Schwartz, 1989). Data Collection The Interview For the face-to-face interview part, open-ended questions will be used to obtain as much information as possible about how the interviewees feel about the research topic. The researcher will interview 5 purposively selected individuals. The researcher will design a semi-structured interview. Using this type of interview enables the researcher/interviewer probe deeper on the issues of biracial identity development. Unlike structured interviews which are standardised and do not allow the interviewer to deviate from the questions (Saunders, Lewis, and Thornhill, 2004), this type of interview does not limit response of the interviewees. Open questioning, in addition, will help me explore the topic and produce a fuller account. In this case, interviewees are encouraged to clarify vague statements and to further elaborate on brief comments. The researcher will not also share her own beliefs and opinions so as not to influence the answer of the interviewee. Importantly, the researcher will avoid leading questions and showing personal bias as these may result to interviewee or response bias (Saunders, Lewis, and Thornhill, 2004). In the face-to-face interview, the distribution and collation methods that will be used to manage the process will ensure anonymity. A cover letter will explain to them what the research is all about and how the researcher intends to regard the survey with high confidentiality. The results from the interview will be given in question and answer format. Moreover, content analysis will be drawn from the interviews to identify the development of biracial identity. Actually, the best way to understand a respondent’s past experience, thoughts, and attitudes are through interviews and document analysis (Guba & Lincoln, (1981). Data was gathered and recorded through one 30 minute semi-structured interview session with each participant. Semi-structured interviews allow for flexibility, therefore obtaining optimum information regarding a topic from the participant, and they are more likely than other forms of inquiry to provide a complete picture (Guba and Lincoln, 1981). The recorded interviews were transcribed by the researcher and the content was analyzed for the presence of historical thinking skills. The member check procedure was used to validate the accuracy. The participants were given the transcript to confirm the authenticity of its content. The interview began with a warm up phase to familiarize the participants with the exercise. The participants were shown the photograph of a slave with horrendous whipping scars on his back and were asked questions about this photograph stands out to you? What grabs your attention?” These questions elicited from the respondents what they considered the central elements that provide an overarching theme for the documents or sources. Then they were asked, “What does the photograph convey to you about slavery? What was slavery like?” These questions guided the respondents to initiate reconstruction of historical narratives with regard to slavery. Then the participants’ attention was directed towards the reverse side of the photograph that was printed with the photograph’s title, the person who took it and when it was taken. This procedure encouraged them to exhibit their sourcing heuristic capability. The warm up phase usually lasted about five minutes. After the warm-up session, the participants were presented with the five historical sources mentioned before. The participants were instructed to examine the five sources and were asked the same questions as during the warm-up session. Following that, the participants were asked to tell a narrative that tied all the sources together while emphasizing that there is no right or wrong answers. The participants were encouraged to take notes and make an outline of the narrative. The participants were allowed to refer to their notes while voicing their narratives to the researcher but none of them did. After examining the sources, the participants shared their narratives with the researcher without any interruption. Then, the participants were asked to identify the most important source for their narrative and the reasons they considered the source importance. Subsequently, the participant’s historical heuristic ability was assessed by asking the following questions: “Which documents are the best ones for writing an accurate history of slavery? Which document is the best source of information? Which is the least reliable source of information?”  This phase lasted for about 15 minutes. Throughout each session, the researcher acted as a naïve listener and accepting anything the participants said and declining to interpret any responses. The researcher from time to time however offered clarification or prodded the participants to elaborate on a comment or observation they had made. Lesson Plan The lesson plans that the participants developed were collected over duration of the course and analyzed to detect characteristics of effective history teaching. Data Analysis The qualitative method of data analysis utilized in this study consist of making sense of raw data by identifying sign posts that determine the presence of characteristics of historical thinking skills and effective teaching strategies to teach those skills. The content was analyzed in order to make sense out of a phenomenon. In this study the phenomenon was historical thinking skills and effective teaching strategies to teach these skills. The data allowed the researcher to describe historical thinking skills and effective teaching strategies after analyzing interview transcripts and the lesson plans. These characteristics were explicitly analyzed to detect sign posts of historical thinking skills and of effective teaching strategies. Basically, Mays & Pope, (2000) believes that qualitative research uses explanatory methods in describing the variables wherein the data, situations, or other facts collected will be explained or correlated with other data. According to them qualitative research methods are useful when conducting a study wherein the data are immeasurable, such as feelings, beliefs, thoughts, and others. Moreover, Yin (1984) stated that qualitative methods is important to management analysis, organisation studies and even to business development since it assist the researchers who desire to understand complex social phenomena. They are appropriate when seeking knowledge about the fundamental characteristics of a phenomenon being studied before theorising about it. This knowledge often surfaces through close contact with subjects of a study, allowing the researcher to understand their points of view about and experiences with the phenomenon. Researchers even disagree on the definition of "qualitative." For example, some researchers use terms such as naturalistic and descriptive, as well as field, product, and case study. Perhaps the best way to clear up some of the confusion about qualitative research is to examine some its most accepted methodologies and characteristics. On the other hand, Wolcott (1992) proposes that there are but three general types of data-gathering techniques in qualitative studies: experiencing, enquiring, and examining. These three techniques are used, Wolcott argues, in such diverse qualitative approaches as case studies, non-participant observed studies, interviews, participant observation, phenomenology, ethnomethodology, enography, and ethnology. As Wolcott (1992) notes, most qualitative research is based on a case study that uses one or several of these qualitative techniques, enabling researchers to immerse themselves within a culture or a context and producing questions to pursue for further research and understanding of phenomena. As an extension of the qualitative technique of interviewing, Byers and Wolcott, H. F. (1992) proposed that focus groups offer researchers a rich source in which to gather genuine information about participants' perceptions, experiences, and attitudes which provide a basis from which to build theory. Another variation of interviewing techniques proposed by Martin and Chaney (1992) is the Delphi technique, which can be valuable in gathering data on a subject from a panel of experts. In connection to this, the collected and analyzed data were checked for accuracy by a social studies professor who teaches social studies methods course. He was selected because of his knowledge and familiarity with conducting similar research on a similar topic and similarity in reporting such research. This expertise is necessary so that he is able conduct an informal examination of the data. The expert examined the raw data, transcripts, data that have been coded and analyzed, and reconstructed and synthesized items. For this study, a participant was considered to exhibit interpretive skills if he or she focused on aspects of a historical source in deriving meanings about slavery or slave owners. As part of the analysis, the participants were assessed for whether or not they provided elaborate or circumscribed interpretations of the sources. Numerous possible interpretations and detailed analysis of the sources indicated a higher level of interpretation skill (Wineburg, 1991, 2001; Fehn, 1997).  The researcher also checked the ability of the participants to recognize overarching themes or generalizations to provide a coherent relationship among the sources. The participants’ ability to construct a sophisticated narrative, such as the ability to weave the themes of oppression and resistance in their narrative, was also assessed.  The researcher assessed if and how the participant used all or a few of the sources as authentic evidence in support of his or her generalization or theme. Finally the researcher analyzed interview transcripts to determine the usage of historical heuristic as the participants narrated their stories. Historical heuristic is the ability of the participants to critically evaluate and distinguish between a more reliable source and less reliable source with substantive arguments or reasons (Wineburg, 1991, 2001 ; Fehn, 1997). The researcher compared the similarities and differences between the participants because the individual differences affect an individual teacher’s perception of historical thinking and learning (Larsson, 1998). In identifying effective teaching strategies for teaching historical thinking skills the researcher analyzed and evaluated the lesson plan based on three principles derived from the literature review on chapter three with regard to teaching and learning history. The principles are; (a) history is interpretive and is explained through narratives; (b) learning history is through in depth understanding; (c) history is learned through disciplined inquiry. History is interpretive and is explained through narratives suggested that a single historical account is not entirely objective. The historical events were over and cannot be directly observed. The only way to find out what happened is through using primary sources and artifacts which students can interpret and develop into narratives of what might have happened. In other words, an effective history lesson should utilize historical documents and artifacts that are relevant to the topic and objectives of the lesson. Learning history through in depth understanding means that students should know how to interpret history and write narratives about history. Just knowing historical facts such as dates, events, and people does not mean greater historical understanding. To attain in depth understanding, teachers should use teaching strategies that help students to organize ideas and engage them in sustained activities so they have enough time to understand and reflect on the meaning and significance of what they are studying.  This could be achieved by encouraging students to interrogate the primary sources, collecting data, questioning, interpreting, explaining, developing historical narratives and organizing a community of critical learners History learned through discipline inquiry means that students should learn history through a process of systematic inquiry that is specifically historical.  They should be taught the historian’s craft of interrogating primary sources. They have to learn how to evaluate sources, how to reconcile and explain conflicting accounts, and how to properly narrate their own account of historical events. In conclusion, this chapter provides the explanation on the methodical procedures that the researcher followed to collect, analyze and validate the data for this study.  The findings, conclusions, and recommendations of this study were derived from the guidelines presented in this chapter for the purpose of producing a responsible and thrust worthy research findings. Validation of the Data According to Stewart and Kamins (1993), the use of secondary data is advantageous for a researcher since one can already evaluate the suitability of a data as it is already in existence, thus, much time can be saved. Needless to say, an evaluation of potential secondary data is very important before one incorporates it in his/her study. In this study, the researcher adopted the three-stage process devised by Saunders et al (2004, p. 205): The first stage is assessing the overall suitability of data to research questions and objectives. During this stage, the researcher paid particular attention to measurement validity (measuring / estimating whether the secondary data will result to a valid answer to the research questions and objectives) and coverage (this includes ensuring whether or not the data is wanted and can be included, as well as making sure that sufficient data remain for analyses to be undertaken once unwanted data have been excluded). The second stage is evaluating precisely the suitability of data for analyses needed to answer and meet the research questions and objectives. In this stage, the researcher made sure of the validity and reliability of the secondary data by assessing how it was previously gathered, who are its sources, and the likes. Also, the researcher was cautious not to commit measurement bias (which can occur due to deliberate distortion of data or changes in the way data are collected) had been paid close attention. Finally, the researcher judged whether to use data based on an assessment of costs and benefits in comparison with alternative sources. Ethical Consideration The data generated will be used solely to understand the development of teaching and learning theories. The researcher is solely responsible for conducting the whole research process and shall abide all the policies regarding the organization as well as the university. The data will not be transferable for any means in person or organization. The research is being done according to the guidelines and rules and regulations of the university. The researcher does not belong to any professional bodies to share the outcome of the research results. The four stages of ethics in doing research are followed by the way of a good design, modes of data collection, analysis of data and for proper dissemination. Both confidentiality and anonymity will be maintained of the informants who have participated or shared information in the research. There will be no Coercion or force to take advantage from the informants. Full voluntary guarantee will be taken from the informants. Due consideration and approval will be taken from the organization which is being studied. Prior objectives and motive of the research will be intimated. There shall be no misrepresentation or misuse of the data collected from the organization. Strict confidentiality shall be maintained. Finally, the university for dissemination of academic purposes might take the data collected. Summary             As stated in this chapter, the researcher will undergo stages. In the research design, the researcher will collect secondary data and will formulate and develop an interview. In this stage, this instrument will be subjected to approval and validation. During the data collection, the researcher will collate and summarize the data obtained from the literatures and survey. The researcher will then analyze these data and from these, findings and recommendations will be presented. In summary, the researcher will have taken four major phases to complete the study. Phase 1: Problem Identification for Research             In the first phase, the researcher identifies the specific focus of the problem to be researched. This involves reviewing existing theory, research, and practices from professional literature. This process helps me integrate theoretical perspectives and empirical findings with my own understanding of the problem, and discern the aspect of the problem the researcher want to research and learn more about. Phase 2: Administration of the Instrument             After reviewing literature, the researcher formulates questions for the survey and makes a set of guide questionnaires for the interview. These are then presented to the advisor for validation purposes. Phase 3: Data Collection and Analysis             In the third phase, the researcher will collect and analyse data for the purposes of identifying critical variables specific to their setting. These data will enable me to achieve a specific understanding of the problem. Phase 4: Data Synthesis and Generation of Recommendations             In the fourth phase, the researcher will synthesise findings from the previous phases and relevant previous research. The focus of this stage is to synthesise these data to modify existing hypotheses and account for different factors, as well as generating recommendations based on new understandings. During this phase, research-based, culture-specific recommendations for action will be generated.

A Sample Theoretical Framework : Input-Process-Output Model

Chapter 3 Methodology Methodologies are outlooks on research; they set out an image for what research is...