Saying they can no longer ignore the rising prices of health care, some of the most influe

Saying they can no longer ignore the rising prices of health care, some of the most influential medical groups in the nation are recommending that doctors weigh the costs, not just the effectiveness of treatment, as they make decisions about patient care.

The shift, little noticed outside the medical establishment but already controversial inside it, suggests that doctors are starting to redefine their roles, from being concerned exclusively about individual patients to exerting influence on how healthcare dollars are spent.

In practical terms, the new guidelines being developed could result in doctors choosing one drug over another for cost reasons or even deciding that a particular treatment-at the end of life, for example-is too expensive. In the extreme, some critics have said that making treatment decisions based on cost is a form. of rationing.

Traditionally, guidelines have heavily influenced the practice of medicine, and the latest ones are expected to make doctors more conscious of the economic consequences of their decisions, even though there's no obligation to follow them. Medical society guidelines are also used by insurance companies to help determine reimbursement(报销)policies.

Some doctors see a potential conflict in trying to be both providers of patient care and financial overseers.

"There should be forces in society who should be concerned about the budget, but they shouldn't be functioning simultaneously as doctors," said Dr. Martin Samuels at a Boston hospital. He said doctors risked losing the trust of patients if they told patients, "I'm not going to do what I think is best for you because I think it's bad for the healthcare budget in Massachusetts."

Doctors can face some grim trade-offs. Studies have shown, for example, that two drugs are about equally effective in treating macular degeneration, an eye disease. But one costs $50 a dose and the other close to $2,000. Medicare could save hundreds of millions of dollars a year if everyone used the cheaper drug. Avastin, instead of the costlier one, Lucentis.

But the Food and Drug Administration has not approved Avastin for use in the eye, and using it rather than the alternative, Lucentis, might carry an additional, although slight, safety risk. Should doctors consider Medicare's budget in deciding what to use?

"I think ethically(在道德层面上)we are just worried about the patient in front of us and not trying to save money for the insurance industry or society as a whole," said Dr. Donald Jensen.

Still, some analysts say that there's a role for doctors to play in cost analysis because not many others are doing so. "In some ways," said Dr. Daniel Sulmasy, "it represents a failure of wider society to take up the issue."

57.What do some most influential medical groups recommend doctors do?

A.Reflect on the responsibilities they are supposed to take.

B.Pay more attention to the effectiveness of their treatments.

C.Take costs into account when making treatment decisions.

D.Readjust their practice in view of the cuts in health care.

58.What were doctors mainly concerned about in the past?

A.Specific medicines to be used.

B.Professional advancement.

C.Effects of medical treatment.

D.Patients' trust.

59.What may the new guidelines being developed lead to?

A.The redefining of doctors' roles.

B.Conflicts between doctors and patients.

C.Overuse of less effective medicines.

D.The prolonging of patients' suffering.

60.What risk do doctors see in their dual role as patient care providers and financial overseers?

A.They may be involved in a conflict of interest.

B.They may be forced to divide their attention.

C.They may have to use less effective drugs.

D.They may lose the respect of patients.

61.What do some experts say about doctors' involvement in medical cost analysis?

A.It may add to doctors' already heavy workloads.

B.It will help to save money for society as a whole.

C.It results from society's failure to tackle the problem.

D.It raises doctors' awareness of their social responsibilities.

Questions are based on the following passage．

Saying they can no longer ignore the rising prices of health care， some of the most influentialmedical groups in the nation are recommending that doctors weigh the costs， not just the effectiveness of treatments， as they make decisions about patient care．The shift， little noticed outside the medical establishment but already controversial inside it，suggests that doctors are starting to redefine their roles， from being concerned exclusively about individual patients to exerting influence on how healthcare dollars are spent．In practical terms， the new guidelines being developed could result in doctors choosing one drug over another for cost reasons or even deciding that a particular treatment—at the end of life， for example—is too expensive．In the extreme， some critics have said that making treatment decisionsbased on cost is a form. of rationing．Traditionally， guidelines have heavily influenced the practice of medicine， and the latest ones areexpected to make doctors more conscious of the economic consequences of their decisions， even though there"s no obligation to follow them．Medical society guidelines are also used by insurancecomoanies to help determine reimbursement （报销） policies．Some doctors see a potential conflict in trying to be both providers of patient care and fmancial

Overseers．"There should be forces in society who should be concerned about the budget， but they shouldn"t be functioning simultaneously as doctors，" said Dr．Martin Samuels at a Boston hospital．He said doctors risked losing the trust of patients if they told patients， "I"m not going to do what I think is best for you because I think it"s bad for the healthcare budget in Massachusetts．" Doctors can face some grim trade—offs．Studies have shown， for example， that two drugs are about

equally effective in treating macular degeneration， and eye disease．But one costs $ 50 a dose and the other close to $ 2，000．Medicare could save hundreds of millions of dollars a year if everyone used the cheaper drug， Avastin， instead of the costlier one， Lucentis．But the Food and Drug Administration has not approved Avastin for use in the eye．and using it rather than the alternative， Lucentis， might carry an additional， although slight， safety risk．Should doctors consider Medicare"s budget in deciding what to use?"I think ethically （在道德层面上） we are just worried about the patient in front of us and not trying to save money for the insurance industry or society as a whole，" said Dr．Donald Jensen．Still， some analysts say that there"s a role for doctors to play in cost analysis because not many others are doing so．"In some ways，" said Dr．Daniel Sulmasy， "it represents a failure of wider society

to take up the issue．"

What do some most influential medical groups recommend doctors do? 查看材料

A.Reflect on the responsibilities they are supposed to take．

B.Pay more attention to the effectiveness of their treatments．

C.Take costs into account when making treatment decisions．

D.Readjust their practice in view of the cuts in health care．

听力原文： Rats are the enemy of human beings. They eat or spoil crops of grain and rice before they can be harvested, or while they are in storage. In India, where millions of people go hungry, there are ten times as many rats as people. Rats devour half of the available food. Rats will also attack birds and animals, from frogs and chicks to geese and young calves. They have even destroyed dams and buildings by making holes through or under them, and have started fires by chewing on electrical wiring.

The most terrible destruction caused by rats, however, has come from the diseases they carry. In the fourteenth century, rats caused the death of one-third of the world's population by transmitting the dreadful Black Plague that mined Europe.

Ironically, it is in fighting diseases that rats have been most useful to humanity. Thousands of specially bred rats are used in research laboratories every year to test medicines which can possibly be used to prolong and improve human life. Some laboratory rats are even used to test new methods of eliminating their cousins, the wild rats.

(23)

A．The Black Plague.

B．Enemy of Humanity.

C．Common Animal pests.

D．Causes of World Hunger.

 Questions 1 to 5 are based on the following passage.

Some of the world's most sign significant problems hit headlines. One example comes from agriculture. Food riots and hunger make news. But the trend lying behind these matters is rarely talked about. This is the decline in the growth in yields of some of the world's major crops. A new study by the University of Minnesota and McGill University in Montreal looks at where, and how far, this decline is occurring.

The authors take a vast number of data points for the four most important crops: rice, wheat, corn and soyabeans(大豆). They find that on between 24% and 39% of all harvested areas, the improvement in yields that took place before the 1980s slowed down in the 1990s and 2000s.

There are two worrying features of the slowdown. One is that it has been particularly sharp in the world's most populous(人口多的)countries, India and China. Their ability to feed themselves has been an important source of relative stability both within the countries and on world food markets. That self-sufficiency cannot be taken for granted if yields continue to slow down or reverse.

Second,yield growth has been lower in wheat and rice than in corn and soyabeans. This is problematic because wheat and rice are more important as foods, accounting for around half of all calories consumed. Corn and soyabeans are more important as feed grains. The authors note that "we have preferentially focused our crop improvement efforts on feeding animals and cars rather than on crops that feed people and are the basis of food security in much of the world."

The report qualifies the more optimistic findings of another new paper which suggests that the world will not have to dig up a lot more land for farming in order to feed 9 billion people in 2050, as the Food and Agriculture Organisation has argued.

Instead, it says, thanks to slowing population growth, land currently ploughed up for crops might be able to revert(回返)to forest or wilderness. This could happen. The trouble is that the forecast assumes continued improvements in yields, which may not actually happen.

1.What does the author try to draw attention to?

A.Food riots and hunger in the world.

B.The decline of the grain yield growth.

C.News headlines in the leading media.

D.The food supply in populous countries.

2.Why does the author mention India and China in particular?

A.Their self-sufficiency is vital to the stability of world food markets.

B.Their food yields have begun to decrease sharply in recent years.

C.Their big populations are causing worldwide concerns.

D.Their food self-sufficiency has been taken for granted.

3.What does the new study by the two universities say about recent crop improvement efforts?

A.They fail to produce the same remarkable results as before the 1980s.

B.They contribute a lot to the improvement of human food production.

C.They play a major role in guaranteeing the food security of the world.

D.they focus more on the increase of animal feed than human food grains.

4.What does the Food and Agriculture Organisation say about world food production in the coming decades?

A.The growing population will greatly increase the pressure on world food supplies.

B.The optimistic prediction about food production should be viewed with caution.

C.The slowdown of the growth in yields of major food crops will be reversed.

D.The world will be able to feed its population without increasing farmland.

5.How does the author view the argument of the Food and Agriculture Organisation?

A.It is built on the findings of a new study.

B.It is based on a doubtful assumption.

C.It is backed by strong evidence.

D.It is open to further discussion.

In which of the following types of contracts is it most important for the contractor to maintain control of cost, schedule and scope changes.

A unit price

B cost plus incentive fee

C cost plus fixed fee

D firm fixed price

E B and D only