There is even reason to think that pricing reforms may boost innovation. Britain and Germany are pioneering comparative reviews of drugs' effectiveness and cost-benefit analyses aimed at reimbursing firms for new drugs based on how well they perform. Janssen-Cilag persuaded Britain's health service to accept Velcade, its expensive cancer drug, by offering a money-back guarantee if it did not work as well as promised.

The American pharmaceutical lobby is violently opposed to making such an approach compulsory. Some suspect that its opposition stems from the fear that many expensive and profitable pills would be found to be of dubious value. But as Ms Danzon points out, “Comparative-effectiveness reviews are an indirect form of price control——but one that is consistent with encouraging innovation.”

注（1）：本文选自Economist；

注（2）：本文习题命题模仿的是2004年真题Text 1。

1. How does the new study mentioned in Paragraph 2 support government's health-care reform?

A) It says the government should impose exact price controls of drugs.

B) It claims that American drug companies should imitate their European counterparts.

C) It indicates that price control does not reduce the innovativeness of drug making.

D) It suggests that price control can promote the innovativeness of drug making.

2. Which of the following is NOT true concerning price control of drugs?

A) The measure has contributed to many free riders.

B) The measure is agreed upon by many rich countries.

C) The measure has encountered resistance from drug firms.

D) The measure has aroused a controversy that is yet to be settled.

3. The expression “by the same token”（Line 5, Paragraph 3) most probably means______.

A) in the same way

B) symbolically

C) by the same expression

D) in the same sense

4. Why does the author say that price control may promote innovation?

A) Because it works in Britain and Germany.

B) Because firms are encouraged by government to guarantee better performance.

C) Because firms will be reimbursed for new drugs based on how well they perform.

D) Because Britain's health service would like to try new drugs.

5. Which of the following is TRUE according to the text?

A) Medicare may reduce pharmaceutical firms' earning per share in future.

B) The price-control-for-innovation approach is not applicable to US.

C) The American pharmaceutical industry utilizes politics for its own benefit.

D) Comparative-effectiveness analysis is the best way to encourage innovation.





篇章剖析


本文主要讨论了药品价格管制对于药品行业，尤其是新药开发的影响。第一、二段分别提出了两个相反的观点，其中美国的药品公司认为价格管制会抑制药品创新，而莱特教授则持相反意见；第三段说明这场争论存在的问题，即人们过于注重药品源产地而忽视了当今的全球化趋势；第四段则分析了美国制药业的特殊情况；第五、六段说明了欧洲国家正在采取新的措施，而美国制药业反对这种强制措施。





词汇注释


patent /ˈpeɪtənt/ v. 给予…专利权；取得…的专利权

pharmaceutical /ˌfɑːməˈsjuːtɪkl/ adj. 制药的；药品的

trigger /ˈtrɪgə/ v. 引发，引起

denounce /dɪˈnaʊns/ v. 指责，谴责

tiff /tɪf/ n. 口角，争执；生气

fallacy /ˈfæləsi/ n. 错觉；误解；谬见

spectacle /ˈspektəkl/ n. 景象；奇观，壮观

token /ˈtəʊkən/ n. 标记；标志，象征

scenario /sɪˈnɑːrɪəʊ/ n. 方案；设想

reimburse /ˌriːɪmˈbɜːs/ v. 赔偿；偿还

lobby /ˈlɒbi/ n. 游说议员的团体





难句突破


That, says PhRMA, the industry's lobby based in Washington, D.C., is because price regulations seen in other rich countries “chill innovation, impede patients' access to the newest cutting-edge medicines, and trigger innovators to relocate to countries with more progressive public policy.”

主体句式：That, says PhRMA, …is because…

结构分析：本句有较多难点。首先主体句式是一个倒装结构，主语是PhRMA，其他内容都是says的宾语。第二个难点是间接引语和直接引语的交杂。PhRMA说的内容都是says的宾语，但这个宾语从句的主体结构是间接引语that is because…，而在price regulations seen in other countries 后面则加入了直接引语，注意引号里面是三个动词并列的结构，即chill… impede… and trigger…。

句子译文：设在华盛顿的制药行业游说团体美国药品研究与制造商协会（PhRMA）认为，因为其他富国采取的价格管制措施“阻碍创新，使病人无法使用最新药物，致使创新者不得不选择到公共政策更为宽松的国家去进行创新”。





题目分析


1. C 细节题。第二段提到“斯坦福大学客座教授唐纳德·莱特所做的最新研究指出，即使面临价格管制，欧洲医药企业的创新性也高于美国企业”，这说明价格管制并没有影响制药行业的创新性，因此C是正确选项。A和B文中并没有提到，故排除。原文并没有指出价格管制能够促进创新性的发展，故排除D。

2. A 细节题。本题可以采用排除法。 B选项对应于文章第一段提到的信息“很多富国已经采取措施来控制价格”，因此是正确的表述。文章第一段和最后一段都提到美国的制药行业游说团体反对价格控制措施，对其进行抵制，所以C选项的表述也是正确的。文章对实施价格控制措施进行了讨论，但是没有给出定论，所以D的表述也是正确的。尽管文章第一段提到“采取价格控制措施的欧洲则坐享其成”，但第三段的研究结果则表明那些欧洲的制药公司并不是所谓的“free riders”，所以A选项的表述不够准确。

3. D 语义题。从文章第三段我们可以发现，沃顿商学院的帕特里夏·当宗认为这一观点没什么说服力，因为大部分医药巨头都在多个国家设有实验室，而且经常从其他国家的生物公司获取开发中的药品，而斯坦福大学的艾伦·加伯发现，企业不仅为本地市场开发药品，更要面对全球市场，两位专家所持观点的基本立场是相同的，也就是现在的医药开发都是全球化运作，因此可以推出连接二者观点的“by the same token”意为“同样意义上”，因此D是正确答案。

4. B 细节题。本题对应于文章的倒数第二段，该段第一句话就提出“我们甚至还有理由认为价格改革可能会促进创新”，后面举例来说明这一点。A、D两项显然是错误的，关键是B、C两项，其内容表述都是正确的。但是C选项的表述只是这些政府推出的做法，并不是原因，而B选项则是更好地说明了原因，即政府通过价格管制能够鼓励企业更好地保证新产品质量，从而也就是鼓励了创新。

5. C 细节题。本题主要对应于文章最后三段。倒数第三段中提到了Medicare，但是这里只是用于举例说明的一个假设，与A选项的描述并不相符，因此A不正确。倒数第三段开头提出“当然美国是个例外”，但是后面又指出“根据斯坦福伯恩斯坦金融研究公司的结论，在改革方案和措施不是很激进的情况下，价格改革不会抹杀创新”，这说明价格管制促进创新这个观点在美国是否适用还没有定论，因此B也不正确。文章最后一句话指出“对比较疗效的评价是一种间接的价格控制——但同样可以鼓励创新”，但这里并不是说疗效比较分析就是鼓励创新的最好方法，所以D也不正确。文章第一段就提到了设在华盛顿的行业游说团体PhRMA，最后一段又提到美国医药企业游说团体，说明美国医药行业充分通过政治手段来维护自己的利益，所以C是正确的说法。





参考译文


全球的政府都在想尽办法来对付不断上涨的医疗费用，尤其是药品价格。很多富国已经采取措施来控制价格，一些美国左翼人士也对此表现出积极支持的态度。但是美国的制药公司却认为，正是因为美国的制药公司拥有为其专利药品定价的自由，因此美国才能成为世界新药研发的生力军。而相比之下，采取价格控制措施的欧洲则坐享其成。设在华盛顿的制药行业游说团体美国药品研究与制造商协会（PhRMA）认为，因为其他富国采取的价格管制措施“阻碍创新，使病人无法使用最新药物，致使创新者不得不选择到公共政策更为宽松的国家去进行创新”。

斯坦福大学客座教授唐纳德·莱特所做的最新研究指出，即使面临价格管制，欧洲医药企业的创新性也高于美国企业。这种观点与2006年同一本期刊的另一篇较有影响力的文章正好相反，该文章检验了1982年至2003年注册药品的地理来源，结论是，有利的公共政策确实帮助美国成为了第一大医药国家。PhRMA迅速反驳了莱特先生的研究，坚持认为莱特的研究曲解和低估了美国国内创新的影响。

这场争论暴露了从国家的角度来看全球化药业时容易产生的两个误解。双方都把新药的产生归结于特定的源头国家（即那些最先开发出新药的公司的总部所在地）。但是沃顿商学院的帕特里夏·当宗认为这一观点没什么说服力，因为大部分医药巨头都在多个国家同时拥有实验室，而且经常从其他国家的生物科技公司获取正在开发的药品。同样，斯坦福大学的艾伦·加伯发现，企业不仅为本地市场开发药品，更是着眼全球市场。所以由于出口的诱惑，特定国家的价格管制不会阻碍当地的创新。

当然美国是个例外，其药品销量占到全球的40%以上。如果美国国会实行价格管制，那么会产生怎样的影响？如果下降幅度较大，世界其他地方新药研发者的获利也将减少。但是根据斯坦福伯恩斯坦金融研究公司的结论，在改革方案和措施不是很激进的情况下，价格改革不会抹杀创新。报告分析了如果政府针对老年人的医保计划Medicare中药品的价格降低20%可能会产生的影响，其结论是大型医药企业每股收益将因此下降3%~8%。

我们甚至还有理由认为价格改革可能会促进创新。英国和德国正在率先开展对药品疗效的比较和成本——收益分析，目的是以企业表现来决定对新药的资助力度。杨森药厂说服英国健康服务部门接受其昂贵的抗癌药物万珂，同时承诺若药品达不到预期疗效，将予以退款。

美国医药企业游说团体强烈反对强制推行类似的方法。一些人猜测，美国医药界反对的原因是害怕很多价格昂贵且获利丰厚的新药被发现物非所值。但是就像当宗女士所指出的那样：“对比较疗效的评价是一种间接的价格控制——但同样可以鼓励创新。”





Unit 89


Sleep is a funny thing. We're taught that we should get seven or eight hours a night, but a lot of us get by just fine on less, and some of us actually sleep too much. ① A study out of the University of Buffalo last month reported that people who routinely sleep more than eight hours a day and are still tired are nearly three times as likely to die of stroke——probably as a result of an underlying disorder that keeps them from snoozing soundly.

Doctors have their own special sleep problems. Residents are famously sleep deprived. When I was training to become a neurosurgeon, it was not unusual to work 40 hours in a row without rest. Most of us took it in stride, confident we could still deliver the highest quality of medical care. Maybe we shouldn't have been so sure of ourselves. An article in the Journal of the American Medical Association points out that in the morning after 24 hours of sleeplessness, a person's motor performance is comparable to that of someone who is legally intoxicated. ② Curiously, surgeons who believe that operating under the influence is the reason for dismissal often don't think twice about operating without enough sleep.

“I could tell you horror stories,”says Jaya Agrawal, president of the American Medical Student Association, which runs a website where residents can post anonymous anecdotes. Some are terrifying. “I was operating after being up for over 36 hours,”one writes. “I literally fell asleep standing up and nearly face planted into the wound.”

“Practically every surgical resident I know has fallen asleep at the wheel driving home from work,”writes another. “I know of three who have hit parked cars. Another hit a ‘Jersey barrier' on the New Jersey Turnpike, going 65 m. p. h.”“Your own patients have become the enemy,”writes a third, because they are “the one thing that stands between you and a few hours of sleep.”

Agrawal's organization is supporting the Patient and Physician Safety and Protection Act of 2001, introduced last November by Representative John Conyers Jr. of Michigan. Its key provisions, modeled on New York State's regulations, include an 80-hour workweek and a 24-hour work-shift limit. Most doctors, however, resist such interference. Dr. Charles Binkley, a senior surgery resident at the University of Michigan, agrees that something needs to be done but believes “doctors should be bound by their conscience, not by the government.”

The U.S. controls the hours of pilots and truck drivers. But until such a system is in place for doctors, patients are on their own. If you're worried about the people treating you or a loved one, you should feel free to ask how many hours of sleep they have had and if more-rested staffers are available. Doctors, for their part, have to give up their pose of infallibility and get the rest they need.

注（1）：本文选自Time；

注（2）：本文习题命题模仿对象：第1、2题分别模仿1999年真题Text 4第1题和Text 2第2题；第3题模仿1998年真题Text 3第2题；第4、5题分别模仿2004年真题Text 2第3题和Text 3第5题。

1. We can learn from the first paragraph that______.

A) people who sleep less than 8 hours a day are more prone to illness

B) poor sleep quality may be a sign of physical disorder

C) stroke is often associated with sleep

D) too much sleep can be as harmful as lack of sleep

2. Speaking of the sleep problems doctors face, the author implies that______.

A) doctors often need little sleep to keep them energetic

B) doctors' sleep is deprived by residents

C) doctors tend to neglect their own sleep problems

D) sleep-deprived doctors are intoxicated

3. Paragraphs 3 and 4 are written to______.

A) entertain the audience with some anecdotes

B) discuss the cause of doctors' sleep problems

C) show the hostility doctors harbor against their patients

D) exemplify the danger doctors face caused by lack of sleep

4.

By “doctors should be bound by their conscience, not by the government”（Lines 5~6, Paragraph 5), Dr. Charles Binkley means that______.

A) doctors should not abide by government's regulations

B) the government is interfering too much

C) the regulations about workweek and work shift are too specific

D) law cannot force a doctor to sleep while his conscience can

5. To which of the following is the author likely to agree?

A) Patients should control the working hours of their doctors.

B) Pilots and truck drivers work in safer environments than that of doctors'.

C) Patients are facing more risks if their doctors are not adequately-rested.

D) People concerned have the right to remove their doctors from their positions.





篇章剖析


本篇文章采用提出问题——分析问题——解决问题的模式指出了医生睡眠不足会带来的危害以及解决办法。第一段说明了睡眠对人的影响；第二段指出了医生睡眠不足的问题以及医生对此的态度；第三段至第四段以两个事例说明医生睡眠不足可能带来的危害；第四段介绍了政府针对这一问题所采取的措施以及医生对此的反应；最后一段分别对病人、相关人员及医生提出建议。





词汇注释


underlying /ˈʌndəˈlaɪɪŋ/ adj. 潜在的，隐晦的

resident /ˈrezɪdənt/ n. 住院医生

deprived /dɪˈpraɪvd/ adj. 缺乏的，不足的

neurosurgeon /ˌnjʊərəʊˈsɜːdʒən/ n. 神经外科医生

intoxicated /ɪnˈtɒksɪkeɪtɪd/ adj. 醉酒的

dismissal /dɪsˈmɪsəl/ n. 免职，解雇

anonymous /əˈnɒnɪməs/ adj. 匿名的

Turnpike /ˈtɜːnˌpaɪk/ n. 〈美〉 收费公路，收通行税的公路

provision /prəˈvɪʒən/ n. 规定；条款

staffer /ˈstɑːfə/ n. 职员

infallibility /ɪnˌfæləˈbɪlɪti/ n. 绝无错误，绝对可靠





难句突破


① A study out of the University of Buffalo last month reported that people who routinely sleep more than eight hours a day and are still tired are nearly three times as likely to die of stroke——probably as a result of an underlying disorder that keeps them from snoozing soundly.

主体句式：A study reported that…

结构分析：本句是个复杂长句，包含一个宾语从句（reported之后由that引导），两个定语从句（who引导的修饰people的从句和that引导的修饰disorder的从句），一个比较结构的省略形式（three times as likely to…）和一个容易理解错误的动词短语keep… from…。

句子译文：上个月由布法罗大学所做的一项研究显示那些每天习惯睡八个小时以上但仍然感觉疲劳的人死于中风的危险是普通人的近三倍——也许这是一种潜在的紊乱导致的结果，正是这种紊乱才让他们难以安睡。

② Curiously, surgeons who believe that operating under the influence is the reason for dismissal often don't think twice about operating without enough sleep.

主体句式：Surgeons don't think twice.

结构分析：本句涉及定语从句（who引导的修饰surgeons的从句），宾语从句（believe后面由that引导的从句），和一个英语习语think twice about something以及容易引起歧义的介词without。

句子译文：令人好奇的是，那些认为酒后作业应该被免职的外科医生却很少认真思考在睡眠不足的情况下操刀手术的后果。





题目分析


1. B 推理题。从第一段最后一句话中的“probably as a result of an underlying disorder that keeps them from snoozing soundly”可以看出潜在的紊乱可能导致人们睡眠质量不高，虽然睡眠时间长，但仍然感到疲惫。因此B项是正确的。

2. C 推理题。文章第二段最后一句话说医生们虽然认为醉酒后给病人做手术应该受到严惩，但对于在睡眠不足的情况下做手术却并不“think twice”。由此可见C是正确的。

3. D 细节题。文章第二段指出医生睡眠不足以及医生对此缺乏重视的问题，紧接着就在第三、四段里举了几个例子：医生的脸差点碰到伤口，医生开车时趴在方向盘上睡着、撞车或撞到公路收费站栏杆等。可见这些例子是要说明睡眠不足可能带来的危害。

4. B 语义题。对于政府制定法规解决医生睡眠不足的问题，文章第五段第三句说“Most doctors, however, resist such interference”，并进一步引用Charles Binkley医生的话进行论证，可见Charles Binkley也认为政府干预过多了。所以应该选择B。

5. C 细节题。文章在最后给医生提出建议，认为医生应该改正认为他们绝不出错的态度，得到充足的休息，否则“patients are on their own”，病人就只能听天由命了。由此可见C是正确答案。





参考译文


睡眠是一件有趣的事情。我们被教导每晚要睡七八个小时，但我们很多人并没有睡够这个时间却依然身体健康，而我们中的一些人实际上睡得过多。上个月由布法罗大学所做的一项研究显示，那些每天习惯睡八个小时以上但仍然感觉疲劳的人死于中风的危险是普通人的近三倍——也许这是一种潜在的紊乱导致的结果，正是这种紊乱才让他们难以安睡。

医生们也有自己特殊的睡眠问题。住院医生以缺少睡眠而著称。我在受训成为一名神经外科医生的时候，时常会连续工作40个小时。我们大多数人对此不以为意，自信我们仍然能够给病人提供最高质量的医疗护理。也许我们不应该对自己这么自信。《美国医学会杂志》上刊登的一篇文章指出，一个人如果连续24小时不睡，那么到了早晨，他的运动能力就和那些饮酒后酒精浓度超标的人差不多。令人好奇的是，那些认为醉酒后做手术应该被免职的外科医生却很少认真思考在睡眠不足的情况下操刀手术的后果。