A Report On Travel And Tourism Environment Tourism Essay

A Report On Travel And Tourism Environment Tourism Essay The purpose of this report is to survey the current state of the UK tourism market. This report examines the historical evolution of the travel and tourism industry in the UK, from ancient time to present in case of importance of being informed about, the history will lead us to understand the situation better and clearer and also it tries to clarify the current structure of the travel and tourism industry in the UK. Since we are facing many effects that economic policies have on different industries, the report also investigates the influence of both local and international agencies as well as global and national economic policy on tourism industry. The other section which has been explained in the current report is the effects of supply and demand on travel and tourism industry; its important to be discussed because of the clear vision itll give us in planning for the industry. Finally it should be noticed that all industries have some pros and cons and knowing them gives planners and managers to avoid making repetitive wrong decisions therefore I will describe what the positive and negative impacts are on local and the globe by tourism industry. History and structure of the travel and tourism industry History Since Persian king Darius the Great has made the first generation of roads and accommodation facilities for commuting, thousands of years has been past, its easy to find the footsteps of Egyptians and Romans as ancient travellers, Wikipedia (July 2010) comments that Wealthy people have always travelled to distant parts of the world, to see great buildings, works of art, learn new languages, experience new cultures and to taste different cuisines. Long ago, at the time of the Roman Republic, places such as Baiae were popular coastal resorts for the rich. However, we have different concept of travelling and tourism today. The word tourism was used by 1811 and tourist by 1780 also the word tour was used by 14th century (Merriam-Websters 11th collegiate dictionary). Nowadays based on UNWTO 1993, tourism is defined as: The activities of persons travelling to and staying in places outside their usual environment for not more than one consecutive year for leisure, business and other purposes. The UK was always one of the pathfinders in history of tourism industry, since many of new travelling system has founded or developed by the UK such as The Elizabethan traveller in the renaissance or the first-ever excursions by Thomas cook, Cox kings company. The industry revolution and economic growth formed todays tourism, as a result of social changes and massive demands for having leisure and recreation in the new born industrial societies. Wikipedia (July 2010) claims that: Leisure travel was associated with the Industrial Revolution in the United Kingdom the first European country to promote leisure time to the increasing industrial population. Initially, this applied to the owners of the machinery of production, the economic oligarchy, the factory owners and the traders. These comprised the new middle class. The need for services led the companies to be founded, 2008 marked the 250th anniversary of the foundation of Cox Kings, the longest established travel company in the world. Cox Kings (2010) In the other words, we were facing Democratization of Tourism which has been described by John Urry. How has it occurred? Sharply (2006) noted that: an historical analysis of tourism development identifies three main periods within which specific forms of tourism can be identified: 1600-1800: a period which witnessed the rise and fall of the Grand Tour, as well as the popularity of spas as the first example of resort-based tourism e.g. tourism in the Lake District which dates back to 1698, when many visitors travelled to the Lake District for the education and the pleasure of the journey. 1800-1900: during this period, seaside resorts emerged and grew rapidly. The latter half of the 19th century also saw the birth and development of the package tour, with Thomas Cook being widely considered as the originator of the concept. 1900 onwards: a period initially defined by increasing domestic tourism but, since the 1960s, by the rapid growth of international mass tourism. The world has experienced a noticeable fluctuation on almost every thing while World War II, the tourism wasnt apart and had major shifts; Industries have increasingly become global in the Post-World War II period. Infrastructures and transportation have faced fundamental changes, some of them are: Using motor couches Increase in car ownership Increase in leisure time More disposable income and paid holiday Jet aircrafts developed Computerized reservation systems Introduction of holiday camps Low cost airlines Long haul destinations Package holidays Social changes Political changes Nowadays tourism is affected mostly by new social attitude of government and people toward terrorism after 9/11, financial recession in 2009 and growth of the internet and Medias. Structure Travel and tourism industry is really complicated and usually is considered as umbrella industry, since its dependence on a lot of factors and sectors which are working together, therefore every section should work correctly in order to be successful. This industry encompasses transportation system, accommodations, tour operators, travel agencies, cruise lines, adventure companies, receptive operators, convention bureaus and so on. According to Rowe et al (2002), Travel and tourism is able to be discussed in several categories, but we basically classify it in these three types that are presented by Diagram1: Travel and Tourism Domestic Tourism Inbound Tourism Outbound Tourism Figure 1 Domestic tourism is when people from a country take holidays, short breaks and day trip in their own homeland. Like a couple who take a two days break to visit their relatives in their own country. Inbound tourism is when some people enter to another country form their home country. Like a business group which enter England in order to attend a conference. Outbound tourism this terms is used when the people travel form their own country to visit the other part of the world for leisure or baseness. Like an Iranian family who goes to The U.S just for leisure. In the chart below the number of both inbound and outbound tourism in the UK have been compared since 2008: National Statistic Online (2010) Figure2 Source: National Statistic Online There is also another model suggested by Leiper in 1990, according to Cooper et al, (2008) there are three basic elements of Leipers model: Tourists Tourists are different in what their goals are and what they are traveling for but they are the first ring of this chain. Geographical elements Traveler-generating region Tourist destination region Tourist route region The tourism sector Figure 3 Some of the tourism sector includes: International or national tourism organizations e.g.: UNWTO, Visitbritainà ¢Ã¢â€š ¬Ã‚ ¦ Transportation system e.g. airlines, rail system, ocean liners, rental cars, buses à ¢Ã¢â€š ¬Ã‚ ¦ Accommodations e.g. hotels, BBs, time share complex, campingà ¢Ã¢â€š ¬Ã‚ ¦ Tour operators, wholesalers, travel agencies, adventure companies, receptive operators, convention bureaus Visitors attractions e.g. museums, ancient monuments, landscapes Lets put Leipers model in practice with an example, a British young couple is traveling to Brazil in order to spend their honeymoon in Rio; Rio is famous for its great beaches. They fly by British Air Line, and booked a five star hotel at the beach through the internet. This package was designed by Travel to Heaven which is a wholesaler but they have bought it from a travel agency near their home in Sheffield. They are going to take the train to London since the flight is form Heathrow air port. A young couple is tourist. Geographical elements. Sheffield (England) is tourist generating region. Rio (Brazil) is tourist destination region. Taking the train from Sheffield and flying form Heathrow forms transit route region. Tourism elements are particularly Travel to Heaven, a small travel agency, a five star hotel, catering, national and international organizations, and so on. Tourism and travel Industry sometimes get impact of Integrations in companies which are an important occurrence; firstly we have to know that there are two kinds of integration, Horizontal and Vertical. According to Travel and Tourism Publishing (2010): Vertical integration in the travel industry is when a company has control over other companies that are at different levels in the chain of distribution or in different sectors for instance, TUI Travel UK owns Thomson and First Choice tour operating businesses, and the Thomson and First Choice travel agency chains. Thomas Cook AG (a German group) owns the Thomas Cook and MyTravel tour operating companies (including Airtours), plus the Thomas Cook and Going Places chains of travel agencies. Horizontal integration is when a company owns or has control over a number of companies at the same level in the distribution chain or the same industry sector for instance, many tour operating businesses that are now part of the big two were originally independent companies, e.g. Neilson and Club 18-30 (now part of the Thomas Cook Group), and Something Special and the Holiday Cottages Group (now merged with Thomson). These examples have made significant fluctuations in this industry both locally and globally. The influence of local and national governments and international agencies on the travel and tourism industry The nature of tourism industry as one of the worlds largest industries, employing approximately 235 million people and generating over 9.2 per cent of world GDP, due to its complex structure and its involvement in hundreds of different unit, cause it to be affected by the local and national governments as well as tourism organizations and agencies both domestically and globally. Figure 1 from Charles et al (2006) shows, all of these functions must be carried out with a high degree of cooperative interaction between the public and private sectors. Figure 4 Source: Tourism principle, practice and philosophies Organizations which lead tourism and travel industry are classified in four levels; some of these organizations are briefly described below, in addition it should be mentioned that Iran and Turkey have been selected as samples about national organizations. International organizations and agencies UNWTO: The World Tourism Organization (UNWTO/OMT) is a specialized agency of the united à ¢Ã¢â€š ¬Ã… ½nations and the leading international organization in the field of tourism. It serves as a à ¢Ã¢â€š ¬Ã… ½global forum for tourism policy issues and a practical source of tourism know-how.à ¢Ã¢â€š ¬Ã… ½ UNWTO (September 2010). WTTC: The World Travel Tourism Council (WTTC) is the forum for business leaders in the Travel Tourism industry. With Chief Executives of some one hundred of the worlds leading Travel Tourism companies as its Members, WTTC has a unique mandate and overview on all matters related to Travel Tourism. WTTC (September 2010). IATA: It is an international trade body, created over 60 years ago by a group of airlines. Today, IATA represents some 230 airlines comprising 93% of scheduled  international air traffic. The organization also represents leads and serves the airline industry in general.  IATA (September 2010)   Other organizations which have direct or indirect roles in tourism such as; WHO, IFC, IBRD, ICAO, UNESCO, OECD and so on Regional organizations PATA: The Pacific Asia Travel Association is a not-for-profit membership association dedicated to building responsible travel to, from and within the Pacific Asia Region. PATA (September 2010) ETC: The European Travel Commission (ETC) is an association of National Tourism Organizations (NTOs). It was created in 1948 to promote Europe as a destination to long-haul tourism markets. Visiteurope (September 2010) National organizations ICHTO: Iran Cultural Heritage and Tourism Organization is responsible for culture heritage, handy crafts and tourism. Museums, hospitality sectors, catering services. Managing private sectors encircle organization duties. KULTUR: Republic of Turkey Ministry of Culture and Tourism is a national organization which is in charge of tourism in Turkey. Local organizations GCHTO: Guilan Culture Heritage and Tourism Organization is a local organization that acts in Guilan province located in north of Iran. THA: Tehran Hotels Association, this association works to develop hotels and manage hospitality issues in Tehran the capital of Iran. Every province has its own association. These organizations are in charge of leading, managing, developing and making polices for expanding sustainable tourism criteria. Interrelate between these organizations is very crucial, since they are managing a massive industry. For example UNWTO is well-known for its unique statistics and surveys, also Charles et al (2006) declare that UNWTO has a central and decisive role in promoting the development of responsible, sustainable, and universally accessible tourism, with the aim of contributing to economic development, international understanding, peace, prosperity, and universal respect for and observance of human rights and fundamental freedoms. In pursuing this aim, WTO pays particular attention to the interests of the developing countries in the field of tourism. Its not only this organization involve in different regional projects, for instance the project of Silk road an ancient 12,000 Km form Asia to Europe. UNWTO is working on poverty soothing and omission through sustainable tourism, protecting children from sexual exploitation in tourism, crisis management, ecotourism, and safety and security. A good example for cooperation between all these organizations in different levels can be Rural Heritage Museum of Guilan this museum has been founded in 2005 with approximately four million dollars investment, its now in seventh phase. Its the first eco-museum in Iran. UNESCO, ICOM (international council of museum), university of Tehran, ICHTO, GCHTO, Financial sponsors and local communities involved in founding this museum as an unique experience in Iran. Here in this part of the report we are going to investigate what are the influences of these sectors on tourism; in addition the condition of these organizations and their effects will be examined in Iran. Naturally role of the government in totalitarian systems and communist regimes is more than the other sectors, because in these kinds of systems almost everything in all levels is controlled by the government. In addition finding suitable information based on reliable statistic is a troublesome action indeed. There are lots of outcomes can be identified in Iran during last few decades, for instance since Islamic revolution, Iran has faced fundamental fluctuations in politics, ideology, international relationship, economy and so on. All of these elements obviously influenced tourism industry, for example after the revolution many western countries werent interested to visit Iran mainly, because of the black face that the totalitarian regime of Iran had and also because of eight years war among Iran and Iraq which made the region unsafe, also partly because of limitation in social freedom for example in clothing or drinking. Political Issues and policies Sanctions after sanctions is what shows how bitter is the situation of Irans policy in international community; however in tourism destinations and attractions in the world ranking, Iran is in top twenties but in multi billion dollar tourism business its just near the finish line. Its hard to approve that you are not a terrorist as an ordinary citizen of Iran when you are preparing to travel to other countries; the process for getting visa is a pain due to political policy which Iran has and the feedback of the international community. Traveling to Iran form some countries is hard and sometimes impossible, for instance Israel and the United States. Political stability was threatened by 2009 presidential race and deception in the result which ends with Green Movement protests. This has decreased all domestic, outbound and inbound tourism, thus the investment in privet sector has declined. Economic Issues and policies The effect of economic issues is mostly touchable in domestic and outbound tourism not inbounds. Cutting taxes is an encouraging policy offered by government in order to increase privet sector role in tourism. Investing in tourism industry due to interest rate, inflation and economic stability ties with high risk, the interest rate in Iran is about 15% 25% and the inflation is usually more than 12% and mostly about 20%. Inbound tourism is benefiting with cheaper expenses thanks to the currency power, one $ US is about 10,000 IRR. Traveling by personal cars has been dramatically fall as a result of the policy of using Intelligent Fuel Cards that has been done by the government to reduce the petrol consumption in Iran. Other issues and policies Getting justification in order to run a business for private sector in Iran is a complicated and inexplicable process. A person who wants to invest in tourism fields should pass many filters and tests which arent necessarily relevant to the travel and tourism industry. There was a gradual rise in government employees travel by offering Expedition Cards from the government sector. People can use it to decrease their expenses while traveling. Educating and encouraging people to travel by advertising through the public Medias has made a fluctuation. Producing statistics and information is forgotten by authorities, and practically there isnt any reliable information about tourism industry. The new policy of government is to invest in health tourism thanks to Irans great infrastructure and substructure in this case. Investigate the effects of supply and demand on the travel and tourism industry Planning for enormous industries such tourism is much more vital today, so there should be a wise vision of what we have as facts and what is forecasted for the future. In addition analyzing supply and demand is a consequential procedure in a flourishing industry. As its been mentioned in the first task there are some models which illustrate structure of tourism, but it also can be defined with this two components; Cooper et al (2008) Demand-side definitions Supply-side definitions Since demand-side has an immense influence on supply-side, even we can say that supply is a function of demand, demand as a key factor of tourism industry will be discussed in this task. Indeed definition of demand is varying in the different subjects for example the explanation of demand in Economy may is differ with the definition in Psychology or Geography. But lets clarify according to Page (2007) tourism demand has been defined in numerous ways, including: The total number of persons who travel, or wish to travel, to use tourist facilities and services at places away from their places of work and residence; The relationship between individuals motivation [to travel] and their ability to do so; The schedule of the amount of any product or service which people are willing and able to buy at each specific price in a set of possible prices during a specified period of time. Each of these definitions in tourism has some elements according to cooper et al (2008) there are three elements in tourism demand: Demand elements Actual demand Suppressed demand No demand Figure 5 Effective or actual demand is the number of people participating in tourism, commonly expressed as the number of travelers. For instance thousands of people went to see World Cup in South Africa. Suppressed demand, which consists of the proportion of the population who are unable to travel because of, circumstances e.g. lack of purchasing power or lack of holidays. There were some people that liked to go and involve in World Cup but due to some circumstances like lack of money they couldnt make it. No demand includes those members of the population who have no desire to travel and those who are unable to travel due to family commitments or illness or they choose to spend their income on the other things rather than tourism. About the World Cup my brother is not interested in football at all so he should be in no demand category. Or may be some people are banded to enter South Africa so they are potentially categorized in no demand. As you can see all three elements can be explained in both geographical regions discussed by Leipers model. This may be an interesting question that: Why do people go on holiday? So lets see what motivations are, and what forms demand to travel. Knowing this is absolutely significant as a result of the importance of demand role in enhancement of tourism. Tourism demand determinants are different and a lot but most of the experts, despite of new determinants like globalization and environmentalism, believe that Uysel 1998 has explained these factors wisely. Figure 6 is his model in demand determinants. For better understanding lets have some examples, through these samples some of these determinants will be discussed, imagine an archeologist wants to visit Ancient Iran Museum to see Cyrus the great cylinder which is the first human right declaration that had kept in British museum beforehand. She wasnt able to go to Britain because it was not affordable for her for many reasons like: her disposable income wasnt enough, tourism price is high and exchange rate is dramatically upward but now she can easily see it (Economical determinants). Also if even she was able to pay for this travel she wasnt able to leave Iran, due to social and psychological reasons for example her father doesnt let her daughter leave Iran before she gets married, also she didnt have enough time for spending, and she is afraid of flying and so on (Social psychological determinants). Or think about an adventurous group interested in mount climbing and intend to go to Himalaya mountain range. Both Afghanistan and Nepal are good but due to war, terrorism, level of development in infrastructure and superstructure Nepals chance is more than Afghanistan (Exogenous determinants). Figure 6 Source: Reproduce form Tourism management managing for change Increasing tourism demand is led by two types of factors, Internal and External; external factors are those related to surrounding of person such as income and social condition. Internal factors are base on individual needs like health education and personal interests. In addition demand changes under many other circumstances through consumer behavior and decision process, cooper et al (2008) claim that decision making process as a system made up of four basic elements: Energizers of demand. These are the forces and influences that collectively create the motivation to travel or go on holiday. Effectors of demand. The information process and subsequent purchase decisions are influenced by the tourists knowledge and perceptions of particular places, destinations or experiences. These are the pull factors which lead the tourist to making particular travel choices. Roles and the decision-making process. Here, the important role is that of the family member who normally involved in the different stage of purchase process and the final resolution of decisions about when, where ad how the group will consume the tourism product. Determinants of demand. A variety of economic, social and psychological factors determine particular choices or filter out inappropriate products. These include tangible or descriptive demand factors, such as: à ¢Ã¢â€š ¬Ã‚ ¢ Mobility à ¢Ã¢â€š ¬Ã‚ ¢ Employment and income à ¢Ã¢â€š ¬Ã‚ ¢ Paid holiday entitlement à ¢Ã¢â€š ¬Ã‚ ¢ Education levels à ¢Ã¢â€š ¬Ã‚ ¢ Demographic variables: age, gender, race, stage in the family life cycle. In the other hand studying demand can clarify vital data which are main requirements for contriving future plans including: Number of visitors arrived Means of transportation Length of staying Type of accommodation Money expenditure and so on These data and lots of other details can be deriving by analyzing the demand statistics and information. Now that there is a very good perception of demand in tourism we have to see what direct and indirect influences it has on supply, or in the other word how supply changes to meet demand. Some examples will clarify how the system is. Globalization has changed the globe in many ways Medias, internet and satellites are playing a massive role in forming tourism demand these days and of course supply side used this as an opportunity. Internet booking, international ads, online packages and virtual tours are all important for demand side and tourists. Thanks to these changes, now there are lots of online sites which serve consumers before making a decision. These web sites and TV ads are very important to conceptualize tourists mind beforehand. Its significant since it influences consumer behavior based on determinants that we discussed in advance. The number of visitors during a year is different, for example during summer only a few people wants to visit Sahara desert or in the winter many people intend to go ski in Europe. Low season and High season are tow different concept which supply side should be aware of, the policies for these two occasions should be different, for example offering lower price services to attract people in low season may is one of the strategies. Also in the high season setting new flights can be helpful in order to cover all visitors. Environmentalism as a new issue has changed the world view of point about many things, for example hotels try to be greener in order to pull more customers toward. Or tour packages to North Pole have been established as a result of increasing pattern of demand to visit ice melting phenomenon and being informed of what is going on in reality. Tourism is a rapidly growing phenomenon and has become one of the largest industries in the world. The impact of tourism is extremely varied. On one hand, it plays an important and certainly positive role in the socio-economic and political development in destination countries by, for instance, offering new employment opportunities. Also, in certain instances, it may contribute to a broader cultural understanding by creating awareness, respecting the diversity of cultures and ways of life. On the other hand, as a tool to create jobs, it has not fulfilled its expectations. At the same time, complaints from tourist destinations concerning massive negative impacts upon environment, culture and residents ways of life have given rise to a demand for a more sustainable development in tourism. Different parties will have to be involved in the process of developing sustainable tourism. This section focuses on what the tourism industry itself can do in order to increase its sustainability, defines three major problems, and suggests possible tourism initiatives to help solve these problems. Other problems should also be included in the discussion for it to become exhaustive. Wikipedia (July 2010) (Merriam-Websters 11th collegiate dictionary) Word Tourism Organization 1993. Sharply (2006) Rowe et al (2002), National Statistic Online (2010) [online] http://www.statistics.gov.uk/cci/nugget.asp?id=352[Accessed: 20 July 2010] Cooper et al, 2008 Cox Kings (2010) Centuries of Experience [online]http://www.coxandkings.co.uk/aboutus-history.aspx, [Accessed: 20 July 2010] Travel and Tourism Publishing (2010) [online] www.tandtpublishing.co.uk/acatalog/pdf/unit12ppt.ppt [[Accessed: 27 July 2010] unwto (september2010) wttc (September 2010) IATA (September 2010)   PATA (September 2010) http://www.visiteurope.com/Footer/About-us Charles et al (2006) Task 5 Impact of tourism, UN PDF

Significance of Pharmacovigilance for Drug Safety

Significance of Pharmacovigilance for Drug Safety AIM: To present an overview on the pharmacovigilance practice and realize the significance of pharmacovigilance in envisaging drug safety and efficacy To decisively appraise the pharmacovigilance findings of the anti-diabetic drug Avandia INTRODUCTION AND BACKGROUND INFORMATION: The World Health Organization defines pharmacovigilance as â€Å"The science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug-related problem†.9 THE NEED FOR PHARMACOVIGILANCE: Primarily let us understand the need for pharmacovigilance. It has been long debated that the data from animal experiments is not completely worth of extrapolation. The differences in their metabolic pathways, resistance to drugs and various other factors, the pharmacokinetics and dynamics of drugs tend to vary within species to species as well. Extrapolating such statistics from animals to humans though necessary is not foolproof. Additionally, the clinical trial environment is extremely controlled. The patient population, however large, is not a good representative of the general global population. The number of patients is limited. Owing to these facts, an adverse effect, which would occur in one in ten thousand or so, is very unlikely to arise within the restrictions of the clinical trial atmosphere. Moreover, in a real life situation the patients using the drug are likely to have other diseases, consuming other drugs and with different genetic make-ups. Accordingly arises the urgent need for better pharmacovigilance practices. The importance of identifying rare and serious adverse effects of drugs that have remained secret during the course of the clinical trial cannot be ignored. THE STEPS IN PHARMACOVIGILANCE: Spontaneous reporting and prescription event monitoring: Spontaneous reports and prescription event monitoring include reports of adverse effects of drugs to sponsors, CROs or regulatory authorities, reported by patients, nurses, doctors and other healthcare professionals and consumers. The above process is streamlined with the help of global and countrywide structured programs to accelerate the practice and facilitate consumers to testify an adverse effect. Example: the National Pharmacovigilance Program in India. All events that are serious (as defined in ICH-GCP), unexpected, unlabeled, additional efficacy and lack of efficacy should be promptly reported. An incoming report is called as a case report. FDA has defined certain characteristics of a good case report. They are as follows: â€Å"1. Description of the adverse events or disease experience, including time to onset of signs or symptoms; 2. Suspected and concomitant product therapy details (i.e., dose, lot number, schedule, dates, duration), including over-the-counter medications, dietary supplements, and recently discontinued medications; 3. Patient characteristics, including demographic information (e.g., age, race, sex), baseline medical condition prior to product therapy, co-morbid conditions, use of concomitant medications, relevant family history of disease, and presence of other risk factors; 4. Documentation of the diagnosis of the events, including methods used to make the diagnosis; 5. Clinical course of the event and patient outcomes (e.g., hospitalization or death);5 6. Relevant therapeutic measures and laboratory data at baseline, during therapy, and subsequent to therapy, including blood levels, as appropriate; 7. Information about response to dechallenge and rechallenge; and 8. Any other relevant information (e.g., other details relating to the event or information on benefits received by the patient, if important to the assessment of the event).†6 Signal generation: A signal is reported information of the possible causal relationship between an adverse event and the drug, which has been reported more than once. The frequency of reports to generate a signal depends on the seriousness of the event, drug class, disease status, authenticity of the reporter etc. Signal follow-up and strengthening: Signal follow-up and strengthening consists of identifying similar cases in different countries, mining the literature for evidence to support the hypothesis, pre-clinical information and patient follow-up. The prospective analysis of reports of interests is crucial for a signal to generate any action. Careful scrutiny has to be done in order to assess the ingenuity of the signal. The report could have been due to the patients illness history, concomitant medication, disease state or any other reason not related to the use of drug. Even then, such confounded reports should be analyzed promptly. Signal follow-up ensures authenticity of the reports. Causality assessment: Determining whether the adverse event has a causal relationship with the drug or not, and if it has, the degree to which the association exists is called as causality assessment. The WHO has defined six degrees of relationship, namely: certain, probable, possible, unlikely, conditional/unclassified and unassessable/unclassifiable with lowering intensity of causality. Action: Action is taken once it is well established that there exists a causal relationship in between the drug and the adverse event. Depending on the severity of the adverse event, action taken can be in the form of withdrawal of marketing approval, change in package insert, additional trials to confirm causality and dissemination of information globally. THE PRACTICAL ASPECT: Consider the story of the blockbuster drug Avandia (rosiglitazone), used to treat patients with type II diabetes mellitus. â€Å"Rosiglitazone (Avandia ®) is a thiazolidinedione indicated in the treatment of type 2 diabetes mellitus: as monotherapy in patients (particularly overweight patients) inadequately controlled by diet and exercise for whom metformin is inappropriate because of contraindications or intolerance as dual oral therapy in combination with metformin, in patients (particularly overweight patients) with insufficient glycaemic control despite maximal tolerated dose of monotherapy with metformin a sulphonylurea, only in patients who show intolerance to metformin or for whom metformin is contraindicated, with insufficient glycaemic control despite monotherapy with a sulphonylurea as triple oral therapy in combination with metformin and a sulphonylurea, in patients (particularly overweight patients) with insufficient glycaemic control despite dual oral therapy†4 Little did the world know that a boon was in fact a bane for a certain group of people with a history of cardiovascular illnesses. A meta-analysis by Nissen and Wolski et al. provided evidence that â€Å"rosiglitazone was associated with a significant increase in the risk of (MI)myocardial infarction (odds ratio, 1.43; 95% confidence interval [CI], 1.03 to 1.98; P = 0.03) and a borderline-significant finding for death from cardiovascular causes (odds ratio, 1.64; 95% CI, 0.98 to 2.74; P = 0.06).†2 Though the meta-analysis study had quite a few numbers of weaknesses, the increased risk of MI in patients consuming rosiglitazone has come as a rude shock to the sponsors as well as the patient community. Something, which could not be unveiled during the clinical trial process. Another study (called Antipsychotic drugs and heart muscle disorder in international pharmacovigilance: data mining study) by David Coulter et al. used a Bayesian confidence propagation network to analyze the correlation between anti-psychotic drugs and occurrences of cardiomyopathy and myocarditis. Though the study did not prove much, it did bring up an association between use of clozapine and incidences of heart disorders. It also scanned the WHO database and concluded that as compared to other anti-psychotic drugs, clozapine is more widely reported. A French pharmacovigilance study (called Reports of hypoglycemia associated with the use ACE inhibitors and other drugs: a case/non-case study in the French pharmacovigilance system database) by Nicholas Moore et al. set out to find any association between use of ACE inhibitors and incidences of hypoglycemia. The results attested that in fact there was no significant increase in the occurrences of hypoglycemia in patients on ACE inhibi tors. Such pharmacovigilance approaches add to the knowledge base of drugs and related Adverse Drug Reactions. Pharmacovigilance is a vital tool. There are various advances and approaches to good pharmacovigilance practices ranging from data mining studies to conducting global clinical trials. What approach is deemed best to yield the right results, only time will tell. CASE STUDY: THE CHRONICLE OF DIABETES MELLITUS TYPE II, AVANDIA, HOPE AND DEATH! Early in august 2006, Vivians mother had gone to the hospital for some routine cancer tests. However, what was supposed to be routine, did not turn out to be. The doctors found the left side of the patients body swollen. She was admitted immediately. On admission, the doctors found her heart swollen as well. Her heart was racing. Every trick in the trade was tried to get Vivians mother under control, but nothing seemed to work. Just a few days into her admission, she died, of cardiac arrest. Till the end, the doctors failed to find out the root cause for her death. However strange it may seem, the drug which she was taking for the past eight years, to control her blood sugar level has been the prime suspect and the causative agent of edema and myocardial infarction. The name, Avandia; generically known as Rosiglitazone. Vivians mother was put on Avandia since 1999, the drugs approval year. Her death occurred in august 2006. Precisely eight years of Avandia, took her life. Then in May 2007, came to light a stunning NEJM study which spilled the beans for GlaxoSmithKline. They found â€Å"a significant increase 43 percentin the risk for myocardial infarction -with rosiglitazone. They also found a 64 percent increased risk for death from other cardiovascular causes in people taking the drug. These findings were based on analyses of 42 clinical trials of the drug.†10 As a response to this, but probably too late for Vivian and her mother, FDA issued a public warning about the findings of the Avandia pharmacovigilance study. Patients with a bad cardiovascular history were now said to revise their use of Avandia. Either stop it, or lower the dose. The information directly applies to Vivians mother death. Vivian said â€Å"At the time I didnt realize that she had any cardiac problems. But there is a history of heart problems in my mothers family, including a history of heart murmurs. And my brother has a congenital heart defect, my mother was also on at least 13 drugs at the time she went to hospital.†10 A CRITICAL ANALYSIS Thats the tale of one drug and one death. But there have been many. And no noise is being made about it. What approach is the right approach for pharmacovigilance is still to be stereotyped. But so far, the structured ADR reporting systems and data mining seems to have turned the fortunes for Avandia. But for the time being lets spare Avandia, and concentrate our resources towards analyzing the situation of global pharmacovigilance. Does it really happen? What constitutes good pharmacovigilance practice? But one things for sure, the mindsets of sponsors and regulatory authorities needs to change. Things need to get crystallized. Vigilance should be policed. Conditional approval to market the drug should follow stringent laws. The two core issues surrounding pharmacovigilance are drug safety and the reputation of pharmaceuticals. Which one of those needs to be sacrificed does the time arise, is a million dollar question. The reputation, it should be. Compromising drug safety puts millions of patients at risk. Reputation can be back, but life, once gone, never returns, and so is Vivians mother. Even then, the reputation of GSK seems to be untouched. Vivians mother did have a history of cardiovascular illnesses, but still she was on the death drug for over eight years. Such an issue was never raised during any of the trials of Avandia. It is thanks to pharmacovigilance that the root cause analysis was performed and the association between Avandia and edema and myocardial infarction was established. If not completely, at least it has rung the bells at the FDA. It was no doubt too late for Vivians mother, but the information has the potential to save millions of life, now that the correlation has been ascertai ned. However, some issues in the meta-analysis also need to be addressed. The study combined data of 42 different clinical trials. Trials with different outcomes, disease states, patients, duration and many other differentiating factors have been combined to pool in the data. The data from varying trials can be sometimes conflicting. GSK argues, the most reliable way to assess the long-term safety of the trial is to conduct a long-term safety trial. Three long-term safety trials of Avandia have been conducted by GSK. Namely; ADOPT (A Diabetes Outcome Progression Trial), DREAM and RECORD. The studies back Avandias safety profile. No more than a minimalist increase in risk has been noted in one of the studies. Again, as Avandia is known to control the blood sugar level for a longer time, it said to have benefits outweighing the risks. The conflict will always remain. However, in such a scenario, the safety of patients should not in any way take a back seat. Sponsors and regulatory authorities along with consumers and healthcare professionals equal should take serious and committed steps to improve pharmacovigilance. The authenticity of the safety profile of Avandia will be demonstrated over time. But in any case, the death of Vivians mother cannot be reversed, not by me, nor by GSK nor by the FDA. CONCLUSION The coming years are bound to be very interesting on the pharmacovigilance front. The techniques regulatory agencies mandate to make PV more stringent will be worth waiting for. Sponsors will have to invest more money to establish the safety profile of the drug. Awareness among patients has to be created for better reporting of ADRs. The current approach to drug development focuses an intensive, strong and time-consuming pre approval process, but a similar standing is required post approval also. The transition from research to marketing has to be more governed with the research step not stopping at the marketing juncture. BIBLIOGRAPHY: Dhruv Kazi, Rosiglitazone and implications for pharmacovigilance, BMJ 2007;334:1233-1234 (16 June), doi:10.1136/bmj.39245.502546.BE Steven E. Nissen, M.D., and Kathy Wolski, M.P.H., Effect of Rosiglitazone on the Risk of Myocardial Infarction and Death from Cardiovascular Causes, n engl j med 356;24, vol. 356 no. 24 Bruce M. Psaty, M.D., Ph.D., and Curt D. Furberg, M.D., Ph.D., Rosiglitazone and Cardiovascular Risk, n engl j med 356;24 Overview of cardiac adverse drug reactions reported in association with rosiglitazone, Nederlands Bijwerkingen Centrum Lareb November 2007 V. Thawani1, S. Sharma2, K. Gharpure1, Pharmacovigilance: Is it possible if bannable medicines are available over the counter?, Indian J Pharmacol | June 2005 | Vol 37 | Issue 3 Guidance for Industry, Good Pharmacovigilance Practices and Pharmacoepidemiologic Assessment, U.S. Department of Health and Human Services, Food and Drug Administration, Center for Drug Evaluation and Research (CDER), Center for Biologics Evaluation and Research (CBER), March 2005, Clinical Medical David M Coulter, Andrew Bate, Ronald H B Meyboom, Marie Lindquist, I Ralph Edwards, Antipsychotic drugs and heart muscle disorder in international pharmacovigilance: data mining study, BMJ VOLUME 322 19 MAY 2001, BMJ 2001;322:1207-9 Nicholas Moore et al., Reports of hypoglycemia associated with the use of ACE inhibitors and other drugs: a case/non-case study in French pharmacovigilance sysyem database, Br J Clin Pharmacol1997;44: 513-518, 1997 Blackwell Science Ltd. Data Assessment in Pharmacovigilance (powerpoint presentation), R.H.B. Meyboom Avandia: Meant to Help but Killed Instead March 30, 2008. By Lucy Campbell, Seed Newsvine

henry clays american system Essays -- essays research papers

Henry Clay’s American System 1832 Background: Following the War of 1812, Henry Clay, John C. Calhoun, and John Quincy Adams helped form a new political agenda, which promised to meet the needs of America. It was a new nationalist United States. Henry Clay's "American System" was a neofederalist program of a national bank, a tariff to promote and protect industry’s, and financial improvements. Parties Involved: Henry Clays started as lawyer In Richmond, Virginia. In 1797 he quickly acquired a reputation and a lucrative income from his law practice. At the age of twenty-two, he was elected to a constitutional convention in Kentucky; at twenty-nine, while yet under the age limit of the United States Constitution, he was appointed to an unexpired term during 1806 and 1807 in the ... henry clays american system Essays -- essays research papers Henry Clay’s American System 1832 Background: Following the War of 1812, Henry Clay, John C. Calhoun, and John Quincy Adams helped form a new political agenda, which promised to meet the needs of America. It was a new nationalist United States. Henry Clay's "American System" was a neofederalist program of a national bank, a tariff to promote and protect industry’s, and financial improvements. Parties Involved: Henry Clays started as lawyer In Richmond, Virginia. In 1797 he quickly acquired a reputation and a lucrative income from his law practice. At the age of twenty-two, he was elected to a constitutional convention in Kentucky; at twenty-nine, while yet under the age limit of the United States Constitution, he was appointed to an unexpired term during 1806 and 1807 in the ...

I Took the Road More Traveled :: Personal Narrative Essay Example

I Took the Road More Traveled The great oak table stood in the middle of the room, warped by heat from an old wood stove in the corner.   Its dark brown finish had boiled up in the center into little pockets of wax and cure, and that was its grand history--a hundred years or more of Christmas dinners and knives hammered thoughtlessly into the wood.   The leaves and edges drooped down, worn under the weight of rough, uncultured elbows and wood bundles for the stove.   Underneath, the modest planks gave way to the graceful arch of the leg, terminating in the vicious paw of a huge dog, polished claws gleaming on the drab floor. At night the legs tapped their way upstairs, past the rooms of sleeping adults, stopping at the unfamiliar bed in which I slept.   The moonlight illuminated every glistening nail slathered in dew and blood with fierce intensity.   That evil table, with hairy paws like a dog, a lion, a monster, came to devil with the shifting patterns of blue, playing on my coverlet and left again before the silvery, delicate cicadas pealed their morning mass. And I was afraid. At the table, my chin barely reached my cereal bowl and my legs dangled wildly above the floor.   I eyed the strange woman who stood at the kitchen counter and gazed out at the morning.  Ã‚   "Miz Edna," I said, "Where'd ya get this table?" "Well now child, I don't rightly recall.   It came from my grandmother, I reckon." I couldn't imagine Edna's grandmother.   My grandmother was already very old and very wrinkled.   She stooped when she walked, and shuffled along the floor with a cane.   Edna looked like that, and she said her heart hurt when she looked at pictures of her children.   That was an affliction which plagued old people; sometimes I had heard they died of it in a shocking and abrupt manner.   Edna's grandmother must have been very old, even older than mine. "How old is your grandma, Miz Edna?" "She's dead now, child.   She died afore I was born. You hurry up with your cereal and run outside and play." "Yes ma'am.   One thing I can't figure though," I said.  Ã‚   "What's that?" "How did you get this table if your grandmother was dead afore you were born?" "I tol' you, child, hurry up.   Your ma and I're going down to the store, and I've got to get these here dishes scrubbed.

Comparing Todays Media and the Chorus of Sophocles play, Antigone Ess

Comparing Today's Media and the Chorus of Sophocles' play, Antigone When you think of ancient Greece, what do you think of? Do you think of outrageous myths and impossible art? Do you think ancient Greek culture has absolutely no effect on today? What many people don't realize is that the ancient Greeks have immensely affected the world today. The chorus in Sophocles' play, Antigone greatly relates to Daniel McGinn's article, "Guilt Free TV." Antigone is a girl who wants to obey the gods and give her deceased brother a proper burial even though her uncle, Creon, King of Thebes, forbids it by law. The article and the play may seem very different but the media today is very similar to the chorus of the ancient Greek play, Antigone in many ways by informing, interpreting and making connections to today. Just as Newsweek, a form of media today informs the public about whether TV is good or bad for children, the chorus informs the audience about the play, Antigone. In the play, the chorus narrates the play and tells the audience what's happening. "These two only, brothers in blood, face to face in matchless rage, mirroring each the other's death, clashed in long combat" (Sophocles 314). The chorus gives background information such as this to better understand the plot of the play. The chorus is like a reporter on the news or a writer of this article. The chorus in Antigone interacts with the characters by asking questions just as a journalist would do in an article or interview. "But now at last our new King is coming: Creon of Thebes, Menoikeus son. In this auspicious dawn of his reign what are the new complexities that shifting Fate has woven for him? What is his counsel? Why has he summoned the old men to hear him?... ... media such as newspapers, TV, magazines, the Internet, and the radio. These are all similar to the chorus and choragos in Antigone, because they all inform the audience/public about the current events taking place. Without the media, no one would be notified about political events, world events, or even local events. Likewise, without the chorus, the audience would not be able to value the play as well. So next time you come across something from ancient Greece, don't quickly glance at it, but really take a look. Maybe you'll realize that a lot of ideas and culture that we have today were taken from the Greeks. Works Cited McGinn, Daniel. "Guilt Free TV." Newsweek November 11,2002: 52-59. Sophocles. Antigone. Trans. Dudley Fitts and Robert Fitzgerald. Prentice Hall Literature, Platinum. Eds. Eileen Thompson, et al. Englewood Cliffs: Simon and Schuster, 1991.

Healthcare System in Cuba

8)  Sources †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 16 )  HISTORY Modern Western medicine has been practiced in Cuba by formally trained  doctors  since at least the beginning of the 19th century and the first surgical clinic was established in 1823. Cuba has had many world class doctors, including  Carlos Finlay, whose mosquito-based theory of  yellow fever  transmission was given its final proof under the direction of  Walter Reed,  James Carroll, and  Aristides Agramonte. During the period of U. S presence (1898–1902) yellow fever was essentially eliminated due to the efforts of  Clara Maass  and surgeon Jesse W. Lazear.In 1976, Cuba's healthcare program was enshrined in Article 50 of the revised  Cuban constitution  which states â€Å"Everyone has the right to health protection and care. The state guarantees this righ t by providing free medical and hospital care by means of the installations of the rural medical service network, polyclinics, hospitals, preventative and specialized treatment centers; by providing free dental care; by promoting the health publicity campaigns, health education, regular medical examinations, general vaccinations and other measures to prevent the outbreak of disease.All the population cooperates in these activities and plans through the social and mass organizations. Cuba's doctor to patient ratio grew significantly in the latter half of the 20th century, from 9. 2 doctors per 10,000 inhabitants in 1958, to 58. 2 per 10,000 in 1999. In the 1960s the government implemented a program of almost universal  vaccinations. This helped eradicate many contagious diseases including  polio  and  rubella, though some diseases increased during the period of economic hardship of the 1990s, such as  tuberculosis,  hepatitis  and  chicken pox.Other campaigns included a program to reduce the infant mortality rate in 1970 directed at maternal and prenatal care. 1. POST-SOVIET UNION The loss of Soviet subsidies brought famine to Cuba in the early 1990s. In 2007, Cuba announced that it has undertaken computerizing and creating national networks in Blood Banks, Nephrology and Medical Images. Cuba is the second country in the world with such a product, only preceded by France.Cuba is preparing a Computerized Health Register, Hospital Management System, Primary Health Care, Academic Affairs, Medical Genetic Projects, Neurosciences, and Educational Software. The aim is to maintain quality health service free for the Cuban people, increase exchange among experts and boost research-development projects. An important link in wiring process is to guarantee access to Cuba's Data Transmission Network and Health Website (INFOMED) to all units and workers of the national health ystem. 2)  PRESENT | | | | |WHO  health statistics for Cuba | |[Source:  WHO country page on Cuba] | |Life expectancy at birth m/f: |76. 0/80. (years) | |Healthy life expectancy at birth m/f: |67. 1/69. 5 (years) | |Child mortality m/f: |8/7 (per 1000) | |Adult mortality m/f: |131/85 (per 1000) | |Total health expenditure per capita: |$251 | |Total health expenditure as  % of GDP: |7. 3 | Rank |Countries | |Statistic |Date of | | |surveyed | | |Information | |125 |167 |HIV/AIDS adult prevalence rate |0. 10% |2003 est. | |162 |175 |Fertility rate |1. 66 (children/woman) |2006. | |153 |224 |Birth rate |11. 9 (births/1,000 population) |2006 est. | |168 |226 |Infant mortality rate |6. 04 (deaths/1,000 live births) |2006. | |129 |224 |Death rate |6. 33 (deaths/1,000 population) |2005. | |37 |225 |Life expectancy at birth |77. 23 (years) |2006. est | |17 |99 |Suicide rate |18. 3 per 100,000 people per year |1996. | 3)  COMPARISON OF PRE- AND POST-REVOLUTIONARY INDICES |Cuba: Public health 1950-2005 | |   |Years | | | 1. HEALTH INDICATORS AND ISSUES Cuba bega n a food rationing program in 1962 to guarantee all citizens a low-priced basket of basic foods.As of 2007, the government was spending about $1 billion annually to subsidise the food ration. The ration would cost about $50 at an average grocery store in the United States, but the Cuban citizen pays only $1. 20 for it. The ration includes rice, legumes, potatoes, bread, eggs, and a small amount of meat. It provides about 30 to 70 percent of the 3,300 kilocalories that the average Cuban consumes daily. The people obtain the rest of their food from government stores (Tiendas), free market stores and cooperatives, barter, their own gardens, and the black market.According to the Pan American Health Organization, daily caloric intake per person in various places in 2003 were as follows (unit is kilocalories): Cuba, 3,286; America, 3,205; Latin America and the Caribbean, 2,875; Latin Caribbean countries, 2,593; United States, 3,754. The table below shows the relative seriousness of commun icable diseases, non-communicable diseases (e. g. , heart disease and cancer) and injuries, in various parts of the world. Data is from the World Health Organisation and is for year 2004. Distribution of years of life lost by cause (%) | |Place |Communicable |Non-communicable |Injuries | |Cuba |9 |75 |16 | |World |51 |34 |14 | |High income countries |8 |77 |15 | |United States |9 |73 |18 | |Low income countries |68 |21 |10 | | | |Source: World Health Organisation. World Health Statistics 2009, Table 2, â€Å"Cause-specific | |mortality and morbidity†. | Like the rest of the  Cuban economy, numerous reports have shown that Cuban medical care has long suffered from severe material shortages caused by the  US embargo. The ending of Soviet subsidies in the early 1990s has also affected it. While  preventive medical care,  diagnostic tests  and  medication  for hospitalized patients are free, some aspects of healthcare are paid for by the patient.Items which are paid by patients who can afford it are: drugs prescribed on an  outpatient  basis, hearing,  dental, and  orthopedic  processes,  wheelchairs  and  crutches. When a patient can obtain these items at state stores, prices tend to be low as these items are subsidized by the state. For patients on a low-income, these items are free of charge. 2. SEXUAL HEALTH †¢ According to the  UNAIDS  report of 2003 there were an estimated 3,300 Cubans living with  HIV/AIDS  (approx 0. 05% of the population). In the mid-1980s, when little was known about the virus, Cuba compulsorily tested thousands of its citizens for  HIV. Those who tested positive were taken toLos Cocos and were not allowed to leave. The policy drew criticism from the United Nations  and was discontinued in the 1990s. Since 1996 Cuba began the production of generic  anti-retroviral  drugs reducing the costs to well below that of developing countries. This has been made possible through the substant ial government subsidies to treatment. †¢ In 2003 Cuba had the lowest HIV prevalence in the Americas and one of the lowest in the world. The  UNAIDS  reported that HIV infection rates for Cuba were 0. 1%, and for other countries in the Caribbean between 1 – 4%. Education in Cuba concerning issues of HIV infection and AIDS is implemented by the  Cuban National Center for Sex Education. According to  Avert, an international  AIDS  charity, â€Å"Cuba’s epidemic remains by far the smallest in the Caribbean. †Ã‚  They add however that †¦ new HIV infections are on the rise, and Cuba’s preventive measures appear not to be keeping pace with conditions that favour the spread of HIV, including widening income inequalities and a growing sex industry. At the same time, Cuba’s prevention of mother-to-child transmission programme remains highly effective. All pregnant women are tested for HIV, and those testing positive receive antiretrovi ral drugs. †¢ In recent years because of the rise in  prostitution  due to  tourism,  STDs  have increased. 3. 3 EMBARGODuring the 90s the ongoing  United States embargo against Cuba  caused problems due to restrictions on the export of medicines from the US to Cuba. In 1992 the US embargo was made more stringent with the passage of the  Cuban Democracy Act  resulting in all U. S. subsidiary trade, including trade in food and medicines, being prohibited. The legislation did not state that Cuba cannot purchase medicines from U. S. companies or their foreign subsidiaries; however, such license requests have been routinely denied. In 1995 the  Inter-American Commission on Human Rights  of the Organization of American States informed the U. S. Government that such activities violate international law and has requested that the U. S. ake immediate steps to exempt medicine from the embargo. The Lancet  and the  British Medical Journal  also condemned the e mbargo in the 90s. A 1997 report prepared by  Oxfam  America and the  Washington Office on Latin America,  Myths And Facts About The U. S. Embargo On Medicine And Medical Supplies, concluded that the embargo forced Cuba to use more of its limited resources on medical imports, both because equipment and drugs from foreign subsidiaries of U. S. firms or from non-U. S. sources tend to be higher priced and because shipping costs are greater. The Democracy Act of 1992 further exacerbated the problems in Cuba's medical system. It prohibited foreign subsidiaries of U. S. orporations from selling to Cuba, thus further limiting Cuba's access to medicine and equipment, and raising prices. In addition, the act forbids ships that dock in Cuban ports from docking in U. S. ports for six months. This drastically restricts shipping, and increases shipping cost some 30%. 3. 4 MEDICAL STAFF IN CUBA According to the World Health Organization, Cuba provides a doctor for every 170 residents, and has the second highest doctor to patient ratio in the world after Italy. Medical professionals are not paid high salaries by international standards. In 2002 the mean monthly salary was 261 pesos, 1. 5 times the national mean. A doctor’s salary in the late 1990s was equivalent to about US$15–20 per month in purchasing power.Therefore, some prefer to work in different occupations, for example in the lucrative tourist industry where earnings can be much higher. The  San Francisco Chronicle, the  Washington Post, and  National Public Radio  have all reported on Cuban doctors defecting to other countries. 3. 5  BLACK MARKET HEALTHCARE The difficulty in gaining access to certain medicines and treatments has led to healthcare playing an increasing role in Cuba's burgeoning  black market  economy, sometimes termed â€Å"sociolismo†. According to former leading Cuban  neurosurgeon  and  dissident  Dr  Hilda Molina, â€Å"The doctors in the hosp itals are charging patients under the table for better or quicker service. † Prices for out-of-surgery X-rays have been quoted at $50 to $60.Such â€Å"under-the-table payments† reportedly date back to the 1970s, when Cubans used gifts and tips in order to get health benefits. The harsh economic downturn known as the â€Å"Special Period† in the 1990s aggravated these payments. The advent of the â€Å"dollar economy†, a temporary legalization of the dollar which led some Cubans to receive dollars from their relatives outside of Cuba, meant that a class of Cubans was able to obtain medications and health services that would not be available to them otherwise. 4)  CUBA AND INTERNATIONAL HEALTHCARE In the 1970s, the Cuban state initiated bilateral service contracts and various money-making strategies.Cuba has entered into agreements with  United Nations  agencies specializing in health:  PAHO/WHO,  UNICEF, the  United Nations Food and Agriculture Organization  (FAO), the  United Nations Population Fund  (UNFPA), and the  United Nations Development Fund (UNDP). Since 1989, this collaboration has played a very important role in that Cuba, in addition to obtaining the benefits of being a member country, has strengthened its relations with institutions of excellence and has been able to disseminate some of its own advances and technologies Cuba currently exports considerable health services and personnel to Venezuela in exchange for subsidized  oil. Cuban doctors play a primary role in the  Mission Barrio Adentro (Spanish: â€Å"Mission Into the Neighborhood†) social welfare program established in Venezuela under current Venezuelan president  Hugo Chavez.The program, which is popular among Venezuela's poor and is intended to bring doctors and other medical services to the most remote slums of Venezuela,  has not been without its detractors. Operacion Milagro (Operation Miracle) is a joint health program be tween Cuba and Venezuela, set up in 2005. Human Rights Watch  complains that the government â€Å"bars citizens engaged in authorized travel from taking their children with them overseas, essentially holding the children hostage to guarantee the parents' return. Given the widespread fear of forced family separation, these travel restrictions provide the Cuban government with a powerful tool for punishing defectors and silencing critics. †Ã‚  Doctors are reported to be monitored by â€Å"minders† and subject to curfew.The Cuban government uses relatives as hostages to prevent doctors from defecting. According to a paper published in  The Lancet  medical journal, â€Å"growing numbers of Cuban doctors sent overseas to work are defecting to the USA†, some via Colombia, where they have sought temporary asylum. Cuban doctors have been part of a large-scale plan by the Cuban state to provide free medical aid and services to the international community (especiall y third world countries) following natural disasters. Currently dozens of American medical students are trained to assist in these donations at the Escuela Latino Americana de Medecina (ELAM) in Cuba. 4. 1  HEALTH TOURISM AND PHARMACEUTICSCuba attracts about 20,000  paying  health tourists, generating revenues of around $40 million a year for the Cuban economy. Cuba has been serving health tourists from around the world for more than 20 years. The country operates a special division of hospitals specifically for the treatment of foreigners and diplomats. Foreign patients travel to Cuba for a wide range of treatments including  eye-surgery,  neurological  disorders such as  multiple sclerosis  and  Parkinson’s disease,  cosmetic surgery, addictions treatment,  retinitis pigmentosa  and orthopaedics. Most patients are from Latin America, Europe and Canada, and a growing number of Americans also are coming.Cuba also successfully exports many medical produ cts, such as  vaccines. By 1998, according to the Economic Commission for Latin America and the Caribbean, the Cuban health sector had risen to occupy around two percent of total tourism. Some of these revenues are in turn transferred to health care for ordinary Cubans, although the size and importance of these transfers is both unknown and controversial. At one nationally prominent hospital/research institute, hard currency payments by foreigners have financed the construction of a new bathroom in the splanic surgery wing; anecdotal evidence suggests that this pattern is common in Cuban hospitals. 5)  ALTERNATIVE HEALTHCAREEconomic constraints and restrictions on medicines have forced the Cuban health system to incorporate  alternative  and  herbal  solutions to healthcare issues, which can be more accessible and affordable to a broader population. In the 1990s, the Cuban Ministry of Public Health officially recognized natural and  traditional medicine  and began it s integration into the already well established Western medicine model. Examples of alternative techniques used by the clinics and hospitals include:  flower essence, neural and hydromineral therapies,  homeopathy,  traditional Chinese medicine  (i. e. acupunctural  anesthesia for surgery), natural dietary supplements,  yoga, electromagnetic and laser devices.Cuban biochemists have produced a number of new alternative medicines, including PPG (policosanol), a natural product derived from sugarcane wax that is effective at reducing total cholesterol and LDL levels, and Vimang a natural product derived from the bark of  mango trees. 6)  MEDICAL RESEARCH IN CUBA The Cuban Ministry of Health produces a number of  medical journals  including the  ACIMED, the  Cuban Journal of Surgery  and the  Cuban Journal of Tropical Medicine. Because the U. S. government restricts investments in Cuba by U. S. companies and their affiliates, Cuban institutions have been limi ted in their ability to enter into research and development partnerships, although exceptions have been made for significant drugs. In April 2007, the Cuba IPV Study Collaborative Group reported in the  NewEngland Journal of Medicine  that inactivated (killed) poliovirus vaccine was effective in vaccinating children in tropical conditions. The Collaborative Group consisted of the Cuban Ministry of Public Health, Kouri Institute, U. S. Centers for Disease Control and Prevention, Pan American Health Organization, and the World Health Organization. This is important because countries with high incidence of polio are now using live oral poliovirus vaccine. When polio is eliminated in a country, they must stop using the live vaccine, because it has a slight risk of reverting to the dangerous form of polio. The collaborative group found that when polio is eliminated in a population, they could safely switch to killed vaccine and be protected from recurrent epidemics.Cuba has been free of polio since 1963, but continues with mass immunization campaigns. In the 1980s, Cuban scientists developed a vaccine against a strain of bacterial meningitis B, which eliminated what had been a serious disease on the island. The Cuban vaccine is used throughout Latin America. After outbreaks of meningitis B in the United States, the U. S. Treasury Department granted a license in 1999 to an American subsidiary of the pharmaceutical company SmithKline Beecham to enter into a deal to develop the vaccine for use in the U. S. and elsewhere. 7)  ANALYSIS In 2006,  BBC  flagship news programme  Newsnight  featured Cuba's Healthcare system as part of a series identifying â€Å"the world's best public services†.The report noted that â€Å"Thanks chiefly to the American economic blockade, but partly also to the web of strange rules and regulations that constrict Cuban life, the economy is in a terrible mess: national income per head is minuscule, and resources are amazin gly tight. Healthcare, however, is a top national priority† The report stated that life expectancy and infant mortality rates are nearly the same as the USA's. Its doctor-to-patient ratios stand comparison to any country in Western Europe. Its annual total health spend per head, however, comes in at $251; just over a tenth of the UK's. The report concluded that the population's admirable health is one of the key reasons why Castro is still in power.A 2006 poll carried out by  the Gallup Organization's Costa Rican affiliate — Consultoria Interdisciplinaria en Desarrollo (CID) — found that about three-quarters of urban Cubans responded positively to the question â€Å"do you have confidence to your country's health care system†. In 2001, members of the  UK  House of Commons  Health  Select Committee  travelled to Cuba and issued a report that paid tribute to â€Å"the success of the Cuban healthcare system†, based on its â€Å"strong emph asis on disease prevention† and â€Å"commitment to the practice of medicine in a community†. CUBA’S COMPREHENSIVE HEALTH PROGRAM: 1. Confronting the Real Disaster †¢ Direct long-term medical care †¢ Applying lessons from Cuban experience On-the-ground training of local personnel †¢ Development and sharing of research †¢ Academic training for Cubans at international sites †¢ Trilateral cooperation †¢ Scholarships for medical education †¢ 29 countries involved (21 in Africa) 2. Direct Medical Services – Strengthening Health Systems †¢ Bilateral government accords, identify needs †¢ Bolster public health infrastructure, capabilities †¢ Shared financial responsibility †¢ Mainly remote, rural postings †¢ Individual commitment/institutional commitment †¢ Numbers of professionals enough to make a difference 3. Challenges and Opportunities – Bolstering Local Public Health Systems Opportunitie sChallenges ___________________________________________________________________ SustainabilityFrustration with local infrastructure Increase understanding locallyBend to local opinions Long-range perspective, understandingVulnerable to govt changes, political will Horizontal model, broad presenceIntegrate vertical programs Increase staffing for health systemCreate felt need in population Broad skill setMismatched, narrow skill set 4. Training Professionals for Global Health †¢ At least 100,000 new doctors by 2015 †¢ Second Latin American Medical School †¢ Cuba has founded 11 medical schools and 2 nursing schools abroad †¢ Cuban professors teach in a dozen others 5. Health Equity & Cooperation: Challenges They Face $$ Resources |Lacking |Wise use (still lacking†¦) | |Goals |Disease driven |Healthy people driven | |Programs |Silos |Blankets | |Models |Stand-alone |Building health systems | |Priorities |Donor driven |Effective local leadership | |Investments |I n buildings |In people | |Reach |Pilot programs |Scaling Up | |Way |Independent |Real cooperation | |Movement |Band aids |Change | 8)  SOURCES †¢ The World Health Organisation, and its regional branch, the Pan American Health Organization, publish regular reports as well as making data available on the web. †¢ World Health Organisation,  World Health Statistics 2009  consists mostly of tables (. df format) of health indicators, for most countries, for selected years between 1990 and 2008. World Health Organisation,  National Accounts Series  consists of statistics on the financing of health care in various countries. Cuba tables covers years 1995-2007. †¢ Pan American Health Organisation,  Health situation in the Americas: Basic Indicators 2008. Table of health indicators for countries, one datum from a recent year (2000-2008) for each indicator. Pan American Health Organisation,  Health in the Americas 2007  is primarily a text report; also contains t ables. First section is on the region as a whole, second section is reports on individual countries, including Cuba.

Global Warming Issues Facing the U.S. Today Essay

Throughout history, the fastest increase rate in the average global temperature has been recorded during the past 50 years, and experts further believe that the trend is alarmingly accelerating. Global warming is a complex phenomenon, and its full-blown consequences are difficult to foresee ahead of time. Nevertheless, every year scientists gain more knowledge of how global warming is upsetting the planet, and many have the same opinion that definite outcomes are expected to take place if present trends persist. Unless Americans reduce global warming emissions, distressing and almost irreversible impact on the country, planet and its life will be greatly expected in the near future. United States Issues Air pollutants, particularly carbon dioxide that is accumulating in the atmosphere is condensing extensively, trapping the heat of the sun and causing the earth to warm up. Despite the fact that Americans make up merely 4 percent of the world’s inhabitants, yet through fossil-fuel burning, they generate roughly 25 percent of the worldwide carbon dioxide pollution, which is considerably the largest share of any nation (â€Å"Global Warming Basics†). In the United States, the largest sources of carbon dioxide are the coal-burning power plants, producing 2. 5 billion tons annually; while automobiles running throughout the country’s streets are the second largest source, producing almost 1. 5 billion tons each year (â€Å"Global Warming Basics†). In the United States, global warming is already causing damage in its numerous regions. In June 2006, a panel organized by the United States National Research Council, the leading science policy body of the country, expressed confidence that the planet is the hottest it has been in at least four centuries, and probably even the last 20 centuries (â€Å"Global Warming†). Snow buildup in the United States has declined by almost 60 percent and winter seasons have abridged in a number of regions of the Cascade Range in Washington and Oregon since the early 1950s (â€Å"Global Warming Basics†). Oregon, Arizona and Colorado suffered their most terrible wildlife seasons, and drought produced relentless dust storms in Kansas, Colorado and Montana, and floods caused hundreds of millions of dollars in destruction in North Dakota, Kansas, Colorado and Montana. All the same, by the last part of the century, global warming is expected to further elevate the typical temperatures of the United States to three to nine degrees, which is expected to affect more of the country’s species and wildlife that cannot endure warmer environments. Americans wellbeing is as well in jeopardy, as abnormal climate changes may bring about the spread of certain illnesses, a greater possibility of heat stroke, poor air quality, and the flooding of the country’s foremost cities. Conclusion America must take a leadership function in solving the global warming crisis. Technologies exist today that make power plants produce electricity from nonpolluting sources, cars burn less gas and run cleaner, and electricity consumption lower and more efficient. Americans can take the initial move in seriously campaigning for energy conservation and manufacturing of more efficient appliances, as well as increase their reliance on renewable energy sources such as geothermal, sun and wind. Currently, the challenge for the country is to be certain that these solutions are implemented. Unfortunately, while the technologies are present, the country’s political and corporate will to put them into extensive exploitation are waning. Without doubt, every Americans must demand for it if development and environmental sustainability are desired to be achieved. Works Cited â€Å"Global Warming. † 2008. Standford SOLAR Center. 16 March 2009 . â€Å"Global Warming Basics. † 18 October 2005. Natural Resources Defense Council. 16 March 2009 .