Day reading Passage (Australian culture and culture shock)

To falter (v) 
- to lose strength or purpose and stop, or almost stop.

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11 
To baffle (v) 
- to cause someone to be unable to understand or explain something. 
Example: Even his friends were baffled by his behavior
12 
To overlook (v) (C2) 
- to fail to notice or consider something or someone.
Example: I think there is one key fact that you have overlooked.
13 
To comb (v) 
- to search a place or an area very carefully in order to find something. 
Example: The police combed the whole area for evidence.
14 
Assumption (n) (C1) 
- something that you accept as true without question or proof.
Example: These calculations are based on the assumption that prices will continue to
rise.
15 
Coercion (n) 
- the practice of persuading someone to do something by using force 
or threats.
Example: Our problem cannot be solved by any form o f coercion but only by
agreement.
Example: His career began to falter

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Day 21
You should spend about 20 minutes on Questions 27-40, which are based on Reading
Passage 3 below.
Examining the placebo effect
BY STEVE SILBERMAN
The fact that taking a fake drug can powerfully improve some people’s health - the
so-called placebo effect
-
was long considered an embarrassment to the serious practice
o f pharmacology, but now things have changed.
Several years ago, Merck, a global 
pharmaceutical company, was 
falling behind its rivals in sales. To 
make matters worse, patents on five 
blockbuster drugs were about to 
expire, which would allow cheaper 
generic products to flood the market.
In interviews with the press, Edward 
Scolnick, Merck’s Research Director, 
presented his plan to restore the firm to 
pre-eminence. Key to his strategy was 
expanding the com pany’s reach into the 
anti-depressant market, where Merck 
had trailed behind, while competitors like 
Pfizer and GlaxoSmithKline had created 
some of the best-selling drugs in the 
world. “To remain dominant in the future,” 
he told one media company, “we need to 
dominate the central nervous system.”
His plan hinged on the success of an 
experimental anti-depressant codenamed 
MK-869. Still in clinical trials, it was a 
new kind of medication that exploited 
brain chemistry in innovative ways to 
promote feelings of well-being. The 
drug tested extremely well early on, with 
minimal side effects. Behind the scenes, 
however, MK-869 was starting to unravel. 
True, many test subjects treated with the 
medication felt their hopelessness and
anxiety lift. But so did nearly the same 
number who took a placebo, a look-alike 
pill made of milk sugar or another inert 
substance given to groups of volunteers 
in subsequent clinical trials to gauge 
the effectiveness of the real drug by 
comparison Ultimately, Merck’s venture 
into the anti-depressant market failed.
In the jargon of the industry, the trials 
crossed the “futility boundary” .
MK-869 has not been the only 
much-awaited medical breakthrough 
to be undone in recent years by the 
placebo effect. And it’s not only trials of 
new drugs that are crossing the futility 
boundary. Some products that have been 
on the market for decades are faltering in 
more recent follow-up tests. It’s not that 
the old medications are getting weaker, 
drug developers say. It’s as if the placebo 
effect is som ehow getting stronger.
The fact that an increasing number of 
medications are unable to beat sugar 
pills has thrown the industry into crisis. 
The stakes could hardly be higher. To win 
FDA approval, a new medication must 
beat placebo in at least two authenticated 
trials. In today’s economy, the fate of a 
well-established company can hang on 
the outcome of a handful of tests.

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Reading Passage 3
W hy are fake pills suddenly 
overwhelming promising new drugs 
and established medicines alike? The 
reasons are only just beginning to be 
understood. A network of independent 
researchers is doggedly uncovering the 
inner workings and potential applications 
of the placebo effect.
A psychiatrist, William Potter, who knew 
that some patients really do seem to get 
healthier for reasons that have more to 
do with a doctor’s empathy than with the 
contents of a pill, was baffled by the fact 
that drugs he had been prescribing for 
years seemed to be struggling to prove 
their effectiveness. Thinking that a crucial 
factor may have been overlooked, Potter 
combed through his com pany’s database 
of published and unpublished trials 
including those that had been kept secret 
because of high placebo response.
His team aggregated the findings from 
decades of anti-depressant trials, looking 
for patterns and trying to see what was 
changing over time. W hat they found 
challenged some of the industry’s basic 
assumptions about its drug-vetting 
process.
Assumption number one was that if a trial 
were managed correctly, a medication 
would perform as well or badly in a 
Phoenix hospital as in a Bangalore 
clinic. Potter discovered, however, 
that geographic location alone could 
determine the outcome. By the late 
1990s, for example, the anti-anxiety drug 
Diazepam was still beating placebo in 
France and Belgium But when the drug 
was tested in the U.S., it was likely to 
fail. Conversely, a similar drug, Prozac, 
performed better in America than it did in 
Western Europe and South Africa. It was 
an unsettling prospect: FDA approval 
could hinge on where the company 
chose to conduct a trial.
Mistaken assumption number two was 
that the standard tests used to gauge 
volunteers’ improvement in trials yielded 
consistent results. Potter and his 
colleagues discovered that ratings by trial 
observers varied significantly from one 
testing site to another. It was like finding 
out that the judges in a tight race each 
had a different idea about the placement 
of the finish line.
A fter some coercion by Potter and 
others, the National Institute of Health 
(NIH) focused on the issue in 2000, 
hosting a three-day conference in 
Washington, and this conference 
launched a new wave of placebo 
research in academ ic laboratories in the 
U.S. and Italy that would make significant 
progress toward solving the mystery of 
w hat was happening in clinical trials.
In one study last year, Harvard Medical 
School researcher Ted Kaptchuk 
devised a clever strategy for testing his 
volunteers’ response to varying levels of 
therapeutic ritual. The study focused on 
a common but painful medical condition 
that costs more than $40 billion a year 
worldwide to treat. First, the volunteers 
were placed randomly in one of three 
groups. One group was simply put on 
a waiting list, researchers know that 
some patients get better just because 
they sign up for a trial. Another group 
received placebo treatment from a 
clinician who declined to engage in small 
talk. Volunteers in the third group got the 
same fake treatment from a clinician who 
asked them questions about symptoms, 
outlined the causes of the illness, and 
displayed optimism about their condition.
Not surprisingly, the health of those in the 
third group improved most. In fact, just 
by participating in the trial, volunteers in 
this high-interaction group got as much

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Day 21
relief as did people taking the two leading 
prescription drugs for the condition.
And the benefits of their “bogus” 
treatment persisted for weeks afterward, 
contrary to the belief-widespread in the 
pharmaceutical industry that the placebo 
response is short-lived.
Studies like this open the door to hybrid 
treatment strategies that exploit the 
placebo effect to make real drugs safer 
and more effective. As Potter says, “To 
really do the best for your patients, you 
w ant the best placebo response plus the 
best drug response.”

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Reading Passage 3
In boxes 27-31 on your answer sheet, write