Separation of Powers between the Three Branches of Government Essay

Separation of Powers between the Three Branches of Government - Essay ExampleIt was, however, Charles Louis de Montesquieu who clearly defined the triplet branches of political science and laid down the rudiments of the concept of separation of powers. Some countries being underpinned by the concept of separation of powers, like the United States, have written constitutions that clearly laid out and allocated the variant powers and functions of the government to the different branches (Barnett pp. 105-106). This is non so in the United Kingdom. The UK Constitution does not consist of a single, written document but rather of motley uncodified laws scattered in several documents like statutes, court decisions and treaties and unwritten ones like customs and conventions. A strict separation of powers normally divides separate powers and functions and allows them to the three branches government the executive Parliament, and the judiciary. In the UK, the components of the three bran ches of governments usually share powers held by other branches in a mixed government fashion. Eric Barendt, however, author of the book Separation of Powers does not believe that the UK necessarily has a weaker constitution because of this disparity. He believes that the separation of powers should not be explained in terms of a strict distribution of functions between the three branches of government, but in terms of a network of rules and principles which ensure that power is not concentrated in the hands of one branch.The UK government, like other elected governments, has three major institutions, all exercising various functions and powers and sometimes sharing the powers of the other branches the executive, the legislative and the judiciary.The executive department is made up the Crown and the substitution government, the latter of which is composed of the Prime Minister and his/her Cabinet Ministers. The central government is accountable to Parliament, which can choose to d issolve it and force a new election of a new set of officials if it believes that circumstances warrant it.

Exploring of Teaching Strategies for Diversity Essay

Exploring of Teaching Strategies for Diversity - Essay ExampleThe efficiency of pedagogical intervention is differently designed for the teachers of low-income, multicultural and multilingual students who live in a big city with dissimilaritys in economic status, the students who live in large districts who have limited resources but last mobility rates and the teachers who travel to their schools. The instructional coaching intervention builds upon sociocultural theory. The mixed method study explores the efficacy of results of instructional coaching of urban teachers by using the data of focused group discussion and the data of quantitative pre and post-invention. Five standard interventions are discussed in the article. The trained teachers took part in a workshop of 30 hours while targeting the principles of learning based on research. It also discusses the standards for effective pedagogy in vagabond to teach the multicultural students. Pedagogical switch and outlines of sus tainability are demonstrated by the results of instructional coaching. The effects of the theory, its practice and research are acquired by the understanding of qualitative and quantitative results. A significant difference is indicated by the results. These results highlight the need of the continuing research that examines the influence of the composition of classroom based on the competency of cultural training in order to educate students. It helps new professionals to become culturally proficient and competent. The results show that the diversity in classroom composition affects the cultural competency.

Migrant Workers in North America Research Proposal

Migrant Workers in northward America - Research Proposal ExampleMigrant labor in unlike forms is found in North America, South Africa, India, Western Europe, and the Middle East. In both the Middle East and Europe, migrant labor habitually has been employed for urban instead of agricultural work and entails prolonged durations of residence (Foner, 2001). In contrast, in Northern America, migrant work is inclined for agricultural work, largely during times of harvest. The indispensability for agricultural migrant labor develops from the cyclic nature of yielding (Williams, 2004). Problem Statement The purpose of this study is to highlight the status of migrant workers in North America. Despites migrant labor patterns being present in different segmentations of the globe, non any can be compared with the magnitude and extent of the labor patterns in the United States. Migrant laborers may be move to their work areas by a contractor who is charged with the responsibility of supplyin g the farm owners with the required workers or the migrant laborers may go to the farms by themselves (Frum, 2000). Therefore, this study will investigate all aspects of migrant workers in North America (Hanson, 2006). Significance This study should be conducted so as to help people be decrease familiar with the topic of migrant workers on North America. ... Nevertheless, during the period of 18th and 19th centuries, when slaves were set apologise and the slave trade was outlawed, workers from the foreign areas galvaniseed to be recruited to compensate for the need for low-priced labor (Wright, 2003). In addition, there were a large number of sources for cheap workforce. Laborers from china were among the first people to be transported to North America in considerable numbers. Nevertheless, the federal administration restricted movement migration from this area with the 1882, Chinese Exclusion Act. During the start of the 20th century, individuals from the Philippines and Mexico started to enter North America to work in the farms as cheap laborers. In addition, different sources of low cost agricultural labor in this period came from untrained European migrants (Borjas, 2007)Unlike Philippine, Mexican, or Chinese laborers who came to North America purposefully to provide cheap labor in farms, European migrants did not come to North America to precisely work as laborers (Zimmermann, 2005). Nevertheless, they were employed as laborers in these farms. In addition, numerous a large number of Chinese, European, Philippine, and Mexican immigrants who moved to North America as laborers did so with the objective of finally buying their own lands and farms. Nonetheless, because of the complexity encountered in getting sufficient capital, this objective was frequently not attained. Literature Review In the Northern part, migrant labor travels regularly from south to north after the harvesting period, while in the Southern part migrant labor moves from north to south after harvest. The majority of agricultural laborers travel in well

Promoting Brand Loyalty at Abercrombie & Fitch Essay Example for Free

Promoting Brand Loyalty at Abercrombie Fitch EssayAbercrombie and Fitch is an American retailer that focuses on casual wear for consumers aged 18 to 22. It has over 300 locations in the United States, and is expanding inter studyly. The company also operates three offshoot brands Abercrombie, Hollister Co., and Gilly Hicks. The company operated a post-collegiate brand, Ruehl No.925, that closed in early 2010. The company operates 1,073 stores crosswise all four brands. The AF brand has 316 locations in the United States, four in Canada, one in London, one in Milan, one in Tokyo, one in Copenhagen, one in Madrid, one in Paris, one in Brussels, one in Dublin, and one in Hong Kong. AF stores range from 6,000 to 36,000 squ atomic spell 18 feet. The company focuses on providing high-quality product that compliments the casual classic American lifestyle. selling casual sportswear apparel, including knit and woven shirts, graphic t-shirts, fleece, jeans and woven pants, shorts, swea ters, outerwear, personal care products and accessories for men, women and kids under the Abercrombie Fitch, abercrombie kids, and Hollister brands.The union determines its operating segments on the same basis that it uses to evaluate performance internally. The operating segments identified by the smart set are Abercrombie Fitch, abercrombie kids, Hollister and Gilly Hicks. The operating segments have been aggregated and are reported as one reportable segment because they have similar economic characteristics and meet the required aggregation criteria. The troupe believes its operating segments may be aggregated for financial reporting purposes because they are similar in each(prenominal) of the following areas class of consumer, economic characteristics, nature of products, nature of production processes, and distribution methods. The Company views the customers in-store experience as the primary vehicle for communicating the spirit of each brand. The Company emphasizes the s enses of sight, sound, smell, touch and energy by utilizing visual origination of intersection, in-store marketing, music, fragrances, rich fabrics and its sales associates to reward the aspirational lifestyles represented by the brands.The Company considers the in-store experience to be its main form of marketing. The Company emphasizes the senses to reinforce the aspirational lifestyles represented by the brands. The Companys flagship stores represent the pinnacle of the Companys in-storebranding efforts. The Company also engages its customers through social media and mobile commerce in ways that reinforce the aspirational lifestyle of the brands. Flagship stores and social media both attract a substantial number of international consumers, and have evidentiaryly contributed to the Companys worldwide status as an iconic brand. The in-store marketing is designed to convey the principal elements and personality of each brand. The store design, furniture, fixtures and music are al l carefully planned and coordinated to construct a shopping experience that reflects the Abercrombie Fitch, abercrombie kids, Hollister or Gilly Hicks lifestyle.The Companys sales associates and managers are a central element in creating the atmosphere of the stores. In access to providing a high level of customer service, sales associates and managers reflect the casual, energetic and aspirational attitude of the brands. Every brand displays merchandise uniformly to ensure a reconciled store experience, regardless of location. Store managers receive detailed plans designating fixture and merchandise placement to ensure coordinated execution of the Company-wide merchandising strategy. In addition, standardization of each brands store design and merchandise presentation enables the Company to open wise stores efficiently. The Company had nett sales of $2.929 billion for the fifty-two weeks end January 30, 2010, down 15.9% from $3.484 billion for the fifty-two weeks ended Januar y 31, 2009. Operating income for Fiscal 2009 was $117.9 million, which was down from $498.3 million in Fiscal 2008.Net income from continuing trading operations was $79.0 million and net income per diluted share from continuing operations was $0.89 in Fiscal 2009, compared to net income from continuing operations of $308.2 million and net income per diluted share from continuing operations of $3.45 in Fiscal 2008. Net income per diluted share from continuing operations included non-cash, store-related asset impairment charges of $0.23 and $0.06 for Fiscal 2009 and Fiscal 2008, respectively. Net cash provided by operating activities, the Companys primary source of liquidity, was $402.2 million for Fiscal 2009. This source of cash was primarily driven by outgrowths from operations adjusted for non-cash items including derogation and amortization and impairment charges.The Company used $175.5 million of cash for capital expenditures and had proceeds from the sale of marketable secur ities of $77.5 million during Fiscal 2009. The Companys grocery store Share may beAdversely Impacted at any Time by a Significant Number of Competitors. The sale of apparel and personal care products is a highly competitive business with numerous participants, including individual and chain fashion specialty stores, as well as regional and national department stores.The Company faces a variety of competitive challenges, including maintaining favorable brand recognition and effectively marketing its products to consumers in several diverse demographic markets. And sourcing merchandise efficiently and countering the aggressive promotional activities of many of the Companys competitors without diminishing the aspirational nature of the Companys brands and brand equity. There can be no assurance that the Company will be able to compete successfully in the future.The science of the Deal Ch.7Genentech is a biotechnology corporation, founded in 1976 by back capitalist Robert A. Swanson a nd biochemist Dr. Herbert Boyer. Today, Genentech has the biggest market capitalization in biotech at US $88 billion, with an incredible reputation in drug development, especially in oncology, and a number of blockbuster drugs under its belt. Genentech has multiple products on the market for serious or life-threatening medical conditions. In March 2009, Genentech became a member of the Roche Group, and Genentech now serves as the headquarters for all Roche pharmaceutical operations in the United States. Accordingly, the list below includes products which were previously marketed as Roche products that are now being marketed by Genentech in the United States. Genentechs relationship with Roche Holding began in 1990, when the Swiss company bought a 60 percent stake in Genentech for $2.1 billion. As a result of additional stock purchases and sell offs, Roche owned about 56percent of Genentech in 2008.The success of Genentech as a biotechnology company is indeed in no modest part deriv ed from its strategy of forming alliances with smaller companies, whose proprietary drugs and technology platforms have the potential to become blockbusters. The commercialized drug, called Tarceva, is a drug used to treat non-small cell lung cancer, pancreatic cancer and several othertypes of cancer, which was released in 2004 and quickly acquired blockbuster status. It is marketed in the United States by Genentech and OSI Pharmaceuticals and elsewhere by Roche. In lung cancer, it extends life by an fair of 3.3 months at a cost of CDN$95,000. Historically, this approach has brought Genentech great rewards, particularly in the field of oncology, and now the company is hoping to achieve similar success in new therapeutic areas.To support small companies with promising technologies and/or drugs in development that are at too early a stage for licensing. In this way, Genentech has highly-developed a highly competitive approach, singling out small companies with enormous future potenti al and establishing mutually beneficial relationships at the earliest possible stage. A significant proportion of the Genentech pipeline has always consisted of proprietary technology platforms and drug candidates, and its brave approach to RD spending reflects this.In 2003, 24% of Genentechs revenues were directed into RD, to address the top-heavy couch of its pipeline at the time. To balance resource use with the strongest likelihood of success, Genentech continuously evaluates its pipeline products in order to determine which are the most promising projects to guide through the many phases of clinical testing. The pipeline includes both breakthrough innovations and new indications for existing, well understood products that may fight more than one disease or more than one form of a disease.

Review Article - Rheumatoid Arthritis & Il-6 Essay Example for Free

Review Article Rheumatoid Arthritis Il-6 EssayIntroductionRheumatoid arthritis (RA) is an instigative autoimmune condition principally do synovial joint firing and gristle erosion. The pathogenesis encompasses intricate cellular and humoural manifestations, and vascular reactions that result in the infiltration of the synovium by white blood cells, of which surrender incendiary mediators, inclusive of Interleukin-6 (IL-6). IL-6 blood serum levels of RA patients as shown by Capell et al. (1993) displayed a median of 55 IU/ml, as comp ard to that of healthy controls of 10 IU/ml.With a wide-ranging pleiotropy endorsed by both a membrane-bound (IL-6R) and soluble (sIL-6R) sensory receptor, and by the relative omnipresence of the trans-membrane protein gp130, IL-6 endorses a pro- inflammatory ready via its influence on many cell types and indicationling-pathways. As a result, heightened levels of IL-6 help in the promotion of osteitis, sequential joint disparage, pain/d iscomfort and impaired function in RA patients.Pleiotropy of IL-6Interleukin 6 exerts effects on numerous pathways contri scarceing to the pathophysiology of RA. IL-6 as it is called today has been known by several(prenominal) names that exemplify its pleiotropy for example, hepatocyte-stimulating factor known to cause the induction of C-reactive protein (CRP) due to IL-6 association with synovial fibril aggregation has been known as Amyloid protein a thrombopoietin both B-cell note and stimulating factor 2 plasmacytoma growth factor and cytotoxic T-cell differentiation factor. It also causes the differentiation of Th17 cells is a causative factor in adhesion molecule demonstration on the surface of endothelial cells, and is involved in the differentiation to mature from precursor osteoclasts cells (REF). IL-6Recptor bindingIL-6 implements its influence via a protein complex primarily comprised of a membrane bound IL-6R and a glycoprotein comprised of two intra-cytoplasmic transd ucer sub-units, gp130. When IL-6 binds to membrane bound IL-6R (mIL-6R) it causes homo-dimerisation of the gp130 sub-units, of which triggers intra-cytoplasmic manifestation transduction. Whilst expression of gp130 is relatively omnipresent upon the surface of the bodys cells (Akil, et al., 2008), IL-6R is most prominently located on hepatocytes, macrophages, monocytes, neutrophils and select lymphocytes. However, (sIL-6R) of which is systemic also binds IL-6, and just as mIL-6R, can also engage with gp130 for sIL-6-gp130 trans-signalling (REF).Synoviocytes, for example do not express mIL-6R tho do express gp130. Raised levels of IL-6 in the synovium is a feature film biomarker of RA (Attar, et al., 2010), and Kim, et al. (1996) states compound IL-6/sIL-6R in synovial fluid increased the risk of joint destruction, as IL-6 stimulates endothelial cells to express adhesion cytokines and other molecules of which attract inflammatory cells to synovial membrane (Romano, et al., 1997) thus could stomach to exemplifying the significance of sIL-6R in RA pathophysiology. sIL-6R is formed by either an incomplete proteolytic enzymic dissection of mIL-6R or alternative splicing of mRNA (REF).With the aforementioned ubiquitous nature of gp130, mIL-6R and systemic sIL-6R, increasing evidence REFERENCES SEE NOTES shows that a non-membrane bound, systemic, soluble gp130 (sgp130) found in higher circulative concentrations than that of sIL-6, also binds IL-6/sIL-6R, thus functioning as a redundency factor inhibiting the cytoplasmic signal-transducing potential of mgp130 REFERENCES SEE NOTES, (IL-6/IL-6 receptor system and its role) thus serving as a natural inhibitor of IL-6 signalling (IL-6/IL-6 receptor system and its role).Intracellular signallinggp130 dimerisation brings Janus Kinases (JAKS), a receptor-associated protein complex, into close proximity causing a trans-activation of the two molecule types. Auto-phosphorylation of JAKS occurs, of which causes intracellul ar signal transduction by recruiting signal-transducers and activators of transcriptions (STAT) that form either hetro or homo dimers and migrate to cell nucleus effecting target gene transcription of various physiological processes (REF). IL-6 can be detrimental to forgiving physiology (REF), thus expression of proteins known as the suppressors of cytokine signalling (SOCS) function as a negative-feedback system, and argon activated by STATs. The regulation of the JAK-STAT signalling pathway by SOCS is more specifically down-regulated by SOCS 3 (REF). SOCS 3 binds JAKs causing negative-regulation thus functioning as an auto-regulatory mechanism, by inhibiting JAK activity.IL-6 and the Adaptive insubordinate SystemThe trans-signalling of IL-6 is known to cause the induction of pre-B-cell-colony-stimulating factor (PBEF) in fibroblast cells of the synovium (Bryant, et al., 2006), and since PBEF upon its discovery was considered a B-cell differentiation cytokine(McNiece et al., 199 4), it could be considered plausible that IL-6- generate PBEF and the IL-6 maturation of B-cells, collectively brook to RA. It has been found the effect of IL-6 on plasmablasts indirectly induces the yield of B-cell antibodies by assisting elements of CD4+ T-cells (of which act upon activated B-cells) due to elevated IL-21 production (Bond, et al., 2009), thus IL-6 may potentially be a co-adjuvant to humoural immunity enhancement (Bond, et al., 2009). Enhanced levels of the RA associated Rheumatoid Factor argon located in the IgA, IgG and IgM isotypes (Ahmed, et al., 2010), and citruline antibodies located in serum and joints, can be linked to the plasmablast-induced antibody production of IL-6 (Ahmed, et al., 2010).IL-6 enhances T-cell proliferation where they bring forth been mitogen touch on (Mihara, et al., 2002). IL-6 also impacts T-cell development (Mihara, et al., 2002). Along with transforming growth factor (TGF)- , IL-6 contributes to Th 17 differentiation, an effector T cell with pro-inflammatory elements, and is further compounded by Th 17 production of the pro-inflammatory cytokine IL-17 (Bettelli, et al., 2007). Interestingly, without IL-6, TGF- induces Treg production, of which are Th 17 cell suppressors (Hirota, et al., 2008). CD4+ Th cells have been considered Th 1 and Th 2 based upon their cytokine-producing characteristics (Diehl and Rincon, 2002).Th 1 and Th 2 produce IFN- and IL-13 respectively, of which are both pro-inflammatory molecules, however whereas IL-6 bolsters IL-4 induced differentiation of Th 2, it causes the inhibition of IL-12 induced differentiation of Th 1 (Diehl and Rincon, 2002). Acosta-Rodriguez, et al. (2007) found that in vitro levels of IL-1 induced Th 17 polarisation of nave human CD4+ T-cells were heightened by IL-6 involvement. More research however, is required to make clear the full extent of IL-6 role in human Th 17 cell development, in vivo.During inflammation, neutrophils of which are essential inflammato ry mediators, systemically increase substantially, resulting in relative neutrophilia. Endothelial cells, macrophages and monocytes all emit IL-6. Neutrophils are directly affected by IL-6 due to the expression of IL-6R. Filer, et al. (2005) found that co-cultured endothelial cells and fibroblasts extracted from synovial fluid of RA patients caused an increase in IL-6 and neutrophil recruitment. Adhesion molecules, of which it has been shown in the run away of Woodfin et al. (2010) to be required in the transmigration of neutrophils, are augmented by IL-6 such as vascular cell adhesion molecule 1 (VCAM) and intracellular adhesion molecule 1 (ICAM) of which produce chemokine production. and so neutrophils being the most numerous and systemic of leucocytes have a strong initial synovial presence and is bolstered by the amplification of the inflammatory cascade, contributing to the inflammatory escalation during ague-phase response and findings from animal and human studies reveale d that the blockade of IL-6 caused a decrease in neutrophil levels at inflamed sites (Hashizume, et al., 2008), as well as a lessening in systemic neutrophil counts in RA patients (Deguchi, et al., 2003 and Broll, et al., 2006),thus indicating a prominent role for IL-6 in neutrophilia. IL-6 Acute to ChronicFarnarier, et al. (2003) suggests the transition from acute to chronic inflammation as emphasised by a shift of biomarker from neutrophil to monocyte, is influenced by IL-6. It was found that if stimulated for a number of hours by inflammatory cytokines, neutrophils switched from the production of IL-8 and transitioned to monocyte chemoattractant protein-1 (MCP-1) (Yamashiro, et al., 1999). sIL-6R is released from neutrophils of which in turn causes the chemokine release of endothelial cells, thus Romano, et al. (1997) suggests the IL-6 sIL6R complex contributes to the release of MCP-1 from endothelial cells.As earlier discussed, neutrophil-count was found to be directly associ ated with the blockade of IL-6R? and endothelial cells expressing the gp130 but not the IL-6R, thus reliant upon the IL-6 sIL6R complex for induction of MCP-1 release, i.e. the release of monocyte, not neutrophil specific chemo-attractants (Gres, et al., 2001), it would appear IL-6 tran-signalling plays an integral role in the transition from acute to chronic inflammation via neutrophil and endothelial cells. *CHART SHOWING CELLS THAT RELEASE IL-6*IL-6 induces a disintigrin and metalloproteinase with thrombospondin motifs (ADAMTS) and matrix metalloproteinase (MMP) proteinases of which are pivotal in the degradation of extracellular matrix. IL-6 more specifically, has been shown to induce ADAMTS-4 and MMPs 1, 2 and 13 production in cells lining the synovium and chondrocytes (Hashizume and Mihara, 2009 Hashizume, et al., 2010 2012). However, it has been suggested the IL-6 sIL-6R complex has bearing on the extracellular matrix turnover, as it causes generation of tissue inhibitors o f MMPs (TIMPs) in synovium fibroblasts and chondrocytes (Dayer, et al., 1998 and Hashizume, et al., 2012). The drug tocilizumab (TCZ), an IL-6 inhibitor reduces MMP-3 blood serum levels of RA patients (Garnero, et al., 2010), and has been show to restore biomarkers associated with cartilage turnover (Dayer, et al., 1998).Thus, in RA patients the lessening of IL-6 activity appears to be a mediatory factor in sustainment of healthy joint cartilage. Angiogenesis is a primeval process in the local inflammatory process. Neovascularisation of the synovium and other angiogenic processes such as hyperplasia of synovial cells and permeation by inflammatory cells are characteristic processes in pannus development and RA pathology (Ballara et al., 2001). In extension to notable constituents of the inflammatory process such as monocytes and T cells, both of which as stated previously have affiliations with IL-6 expression (CITATION OF A FEW), levels of a key angiogenic specific growth factor Vascular Endothelial Growth Factor (VEGF) has also been associated with systemic levels of IL-6, as demonstrated in the work of Hasizume, et al., 2009 and Hagihara, et al., 2003 revealing IL-6 induces VEGF production from synovial cells.VEGF induces proteins that contribute to the breakdown of endothelial basement membrane, including MMPs, of which increases the permeability of blood vessels, thus allowing enhanced infiltration of inflammatory constituents (Delisle, et al., 2010). VEGF levels accordingly, have been shown to coincide with the articular tartness of RA (Hagihana, et al., 2003), and has shown a reduction in response to TCZ (Hagihana, et al., 2003), of which correlates with findings of a semi-quantitative assessment by Akoi, et al. (2011) using ultrasonography that found TCZ responsible for a marked reduction in RA neovascularisation.Bone RemodellingBone remodelling is a highly regulated process in which mature bone tissue is removed by osteoclasts and physical compos ition by osteoblasts. The pathogenesis of RA favours bone loss ( reabsorption) via the excessive production of osteoclasts. Anecdotal evidence by Kazuto et al. (1996) revealed synovial fluid highly +ve for IL-6 sIL6R complex from RA patients, stimulated increased formation of osteoclasts in mouse co-culture of osteoblast and bone marrow cells. This study coincides with research by Balena, et al. (1994) of which indicated that mice deficient in IL-6 displayed no significant changes in gross or trabecular bone structure.In human studies, biopsies of RA patients revealed that peri-articular bone loss was found to correlate with local excessive presence of IL-6 (Sugiyama, 2001), and work by Garnero et al. (2009) showed the administration of TCZ to RA patients in a multi-centre double-blind placebo-controlled study yielded an increase in bone-formation markers, with a decrease in bone-resorption markers. Collectively, research suggests IL-6 has a negative effect on bone mass.Acute-phase responseAcute-phase response is an innate immune reaction in which IL-6 is notably involved via the stimulation of hepatocytes, and is a key inducer of the acute-phase protein CRP. CRP is considered a dependable biomarker of inflammation and RA activity as serum half-life remains constant due to its inflammatory-induced, hepatic-stimulated production being the exclusive systemic epitope and due to its noted increase in RA serum levels (Hirshfield and Pepys, 2003).AnaemiaApproximately 1-in-4 RA patients will suffer symptoms of anemia within the first socio-economic class (Figenschau, Nikolaisen and Nossent, 2008). The hormone hepcidin, produced in the liver and integral in stemming the metabolism of iron, has been shown in vitro to increase in presence due to IL-6 stimulation of hepatoma cells (Ganz, 2003). This study correlates with Gabayan et al. (2004) in which IL-6 induced patients experienced a 7.5 fold increase in hepcidin production. Anaemia in RA patients, as a result of a hepcidin-IL-6 axis, has limited but supported credence. Osteoporosis has also shown a correlation with IL-6.As mentioned earlier, healthy bone metabolism requires adequate regulation of osteoclasts and osteoblasts, in which excessive IL-6 expression and the Th17 derived IL-17 (Gillespie, et al., 1999) both contribute to excessive osteoclast formation (Campbell et al., 2005). This has also been found to be the case in transgenic mice (De et al., 2006 and Choy and Dayer, 2009) in which bone formation was reduced, and negative ossification was reported. As shown, there are comparable cross-over aspects of IL-6 pathology between RA and osteoporosis.TreatmentAs highlighted throughout this review, IL-6 plays a pleiotropic pathophysiological role in RA, thus would make an ideal therapeutic target. The most promise and note-worthy of treatments at present, TCZ interrupts IL-6 induced trans-signalling. Numerous studies have shown promising results including a phase III clinical trial in 200 5 using the ACR (American College of Rheumatology)* RA activity measure, which had rise measures of 89, 70 and 47% at ACRs of 20, 50 and 70 respectively at 52 weeks, in patients treated with TCZ. This multicentre, double-blind placebo-controlled trial by Hashimoto et al. (2004) showed bone resorption and joint destruction could potentially be all in all prevented (Kishimoto, 2010), as exemplified when a culture of patient synovial and peripheral mononuclear cells, extracted from the same patients showed that osteoclast generation was completely prevented (Hashimoto et al., 2004 Kishimoto, 2010).At 6 weeks within this study, it was also found that IgG, CRP and serum amyloid A levels all normalised. It has also been suggested that TCZ aids in Th17 differentiation, hence IL-17 production, thus aids in the improvement of RA symptoms (Kimura and Kishimoto, 2010). Other notable studies such as the SAMURAI (Study of Active controlled Monotherapy Used for RA, an IL-6 Inhibitor) and LITHE ( TociLIzumab safety and THE prevention of structural joint damage trial) served to enhance conscensus. This humanised, monoclonal antibody has now been approved in many countries. 286 With a wide-ranging pleitropy, IL-6 has the most profuse SF and systemic cytokine presence in RA pathophysiology, and coincides with cartilage erosion and disease activity.It has a role in elements of B-cell differentiation and increasing evidence suggests a definite yet ambiguous role in Th17 differentiation. IL-6 has several key positions in immune and inflammatory processes (recruitment, permeation and adhesion of inflammatory elements), and bone and joint degradation, of which over-expression causes adversity, such as release of hepcidin and CRP from the liver contributing to anaemia and inflammation, osteoporosis and pannus development.It plays a key role in the cross-over from acute-to-chronic disease. TCZ has shown much promise in RA therapy by inhibiting IL-6 expression. *ACR 20, 50 and 70 = imp rovements of 20%, 50% and 70% in disease activity, respectively. Disease Modifying Anti Rheumatic Drugs. Japan , April 2008, Europe, January 2009 and USA, January 2010. PUT IN ABSTRACT The IL-6R, sIL-6R and gp130 system is known as IL-6 trans-signallingReferencesCapell, H. A., Crilly, A., Madhok, R., Watson, J., 1993. Serum interleukin 6 levels in woebegone arthritis correlations with clinical and laboratory indices of disease activity. 52 (3) 232 Annals of the Rheumatic Diseases. 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Potential novel biomarkers of disease activity in derelict arthritis patients CXCL13, CCL23, transforming growth factor alpha, tumor necrosis factor receptor superfamily member 9, and macrophagecolony-stimulating factor. Arthritis Rheumatology, 58, pp. 22572267. Attar, M., Cuzzocrea, S., Mirshafiey, A., Di Paola, R., Saadat, F., 2010. curative Efficacy of Artesunate in Experimental Model of Rheumatoid Arthritis. Oxford Journals, PP-037-09. Available at http//intimmabs.oxfordjournals.org/content/22/Suppl_1_Pt_2/ii105.short. Accessed 01 January 2013. Kashiwazaki, S., Kishimoto, T Kim KJ, Kotake S, Nakamura, I., Sato K, Suda, T.,takahashi, N., Udagawa, N., Yamaguchi, A., 1996. Interleukin-6 and soluble interleukin-6 receptors in the synovial fluids from rheumatoid arthritis patients are responsible for osteoclast-like cell formation. Journal of Bone and Mineral Research. 11 8895. Ahmaed, M. M., Obaid, A. K. A., Mohammed, S. H., 2010. Evaluation of the rheumatoid factors of the IgG, IgM and IgA isotypes as prognostic parameters for rheumatoid arthritis among Iraki patients. Indian Journal of Pathology and Microbiology, online Available at http//www.ncbi.nlm.nih.gov/pubmed/20699498. Accessed 01 January 2013. Bond, J. P., Briso, E. M., Charland, C., Ciliberto, G., Dienz, O., Eaton, S. M., Haynes, L., Leonard, W. J., Moquin, D., Neveu, W., Rincon, M., 2009. The induction of antibody production by IL-6 is indirectly mediated by IL-21 produced by CD4+ T cells, Journal of Experimental Medicine, ONLINE Available at http//www.ncbi.nlm.nih.gov/pmc/articles/PMC2626667/. Accessed 01 January 2013. Hashizume, M., Higuchi, Y., Miha ra, M., Uchiyama, Y., 2011. IL-6 plays an essential role in neutrophilia under inflammation, Cytokine, ONLINE Available athttp//www.sciencedirect.com/science/article/pii/S1043466611000081. Accessed 01 January 2013. Bryant-Greenwood, G., Fielding, C. A., Jones, S. A., Nowell, M. A., Ognjanovic, S., Richards, P. J., Topley, N., Williams, A. S., 2006. Regulation of pre-B cell colony-enhancing factor by STAT-3-dependent interleukin-6 trans-signaling implications in the pathogenesis of rheumatoid arthritis, Arthritis Rheumatism, ONLINE Available at http//www.ncbi.nlm.nih.gov/pubmed/16802343. Accessed 10 January 2013.(McNiece et al., 1994)http//europepmc.org/articles/PMC358498/pdf/molcellb00002-0573.pdf(Mihira et al., 2002)http//www.sciencedirect.com/science/article/pii/S016524780200202X(Bettelli et al., 2009)http//europepmc.org/articles/PMC2839934/(Diehl and Rincon, 2002)http//www.sciencedirect.com/science/article/pii/S0161589002002109(Acosta-Rodriguez, E. V., Lanzavecchia, A., Napolita ni, G., Sallusto, F., 2007. Interleukins 1b and 6 but not transforming growth factor-b are essential for the differentiation of interleukin 17producing human T helper cells, Nature Immunology, online Available at http//kp5us7vu4a.search.serialssolutions.com/?ctx_ver=Z39.88-2004ctx_enc=infoofi/encUTF-8rfr_id=infosid/ProQ%3Arft_val_fmt=infoofi/fmtkevmtxjournalrft.genre=articlerft.jtitle=Nature+immunologyrft.atitle=Interleukins+1beta+and+6+but+not+transforming+growth+factor-beta+are+essential+for+the+differentiation+of+interleukin+17-producing+human+T+helper+cells.rft.au=Acosta-Rodriguez%2C+Eva+V+EV%3BNapolitani%2C+Giorgio+G%3BLanzavecchia%2C+Antonio+A%3BSallusto%2C+Federica+Frft.aulast=Acosta-Rodriguezrft.aufirst=Eva+Vrft.date=2007-09-01rft.volume=8rft.issue=9rft.spage=942rft.isbn=rft.btitle=rft.title=Nature+immunologyrft.issn=15292908. Accessed 02 January 2013.Buer, J., Dumoutier, L., Hirota, K., Renauld, J. C., Stockinger, B., Veldhoen, M., Westendorf, A. M., 2008. The aryl hydrocar bon receptor links TH17-cell-mediated autoimmunity to environmental toxins, Nature, online Available at http//europepmc.org/ pluck/MED/18362914. Accessed 01 January 2013.(flier, et al., 2005)http//europepmc.org/articles/PMC3119436/Woodfin, A., Nourshargh, S., Voisin, M., 2010. Recent developments and complexities in neutrophil transmigration, Current Opinion in Hematology, online Available at http//www.ncbi.nlm.nih.gov/pmc/articles/PMC2882030/. Accessed 01 january 2013.Hashizume, M., Mihara, M., Moriya, Y., Yorozu, K., Uchiyama, Y., 2008. Tocilizumab, a humanized anti-interleukin-6 receptor antibody, amelioratesjoint swelling in conventional monkey collagen-induced arthritis, Biological and Pharmaceutical bulletin, online Available at http//europepmc.org/abstract/MED/18520048. Accessed 02 January 2013.Deguchi H, Imai N, Kakehi T, Kishimoto T, Kuritani T, Maeda K, Nishimoto N, Sato B, Suemura M, Takagi N, Yoshizaki K, 2010. Toxicity, pharmacokinetics, and dose-finding study of repeti tive treatment with the humanized anti-interleukin 6 receptor antibody MRA in rheumatoid arthritis. Phase I/II clinical study, Journal of Rheumatology, online Available at http//onlinelibrary.wiley.com/doi/10.1002/eji.201040391/full. Accessed 01 January 2013.Balint, G., Broll, J., Emery, P. Kishimoto, T., Pavelka, K., Peterson, J., Maini, R. N., Raemen, F., Smolen, Szechinski, J., K., Taylor, J., Thompson, D., 2006. Doubleblind randomized controlled clinical trial of the interleukin6 receptor antagonist, tocilizumab, in European patients with rheumatoid arthritis who had an incomplete response to methotrexate, Arthritis Rheumatism Wiley Online Library, ONLINE Available at http//onlinelibrary.wiley.com/doi/10.1002/art.22033/pdf. Accessed 01 January 2013.Farnarier, C., Kaplanski, G., Mantovani, A., Marin, V., Montero-Julien, F., 2003. IL-6 a regulator of the transition from neutrophil to monocyte recruitment during inflammation, Trends in immunology, online Available at http//www.sc iencedirect.com/science/article/pii/S1471490602000133. Accessed 01 January 2013.Hashizume and Mirhara, 2009. Desirable effect of combination therapy with high molecular weight hyaluronate and NSAIDs on MMP production, Osteoarthritis and Cartilage, 17(11) Pp 1513-1518. online Available at http//www.sciencedirect.com/science/article/pii/S1063458409001320. Accessed 01 January 2010.(Hashizume, M., Mihara, M., Shiina, M., Suzuki, M., Yoshida, H., 2010. IL-6 and IL-1 synergistically enhanced the production of MMPs from synovial cellsby up-regulating IL-6 production and IL-1 receptor I expression, Cytokine, online Available at http//europepmc.org/abstract/MED/20403707. Accessed 01 January 2013.(Hashizume, M., Mihara, M., Shiina, M., Suzuki, M., Yoshida, H., 2012. IL-6/IL-6 receptor system and its role in physiological and ghoulish conditions, clinical Science, online Available at http//submit.clinsci.org/cs/122/0143/1220143.pdf. Accessed 01 January 2013.Ballara, S., Feldmann, M., Maini, R . N., Marme, D., Paleolog, E. M., Reusch, P., Taylor, P. C., et al., 2001. Raised serum vascular endothelial growth factor levels are associated with destructive change in inflammatory arthritis, Arthritis Rheumatology, online Available at http//europepmc.org/abstract/MED/11592367. Accessed 01 January 2013.(Hashizume et al., 2009)http//europepmc.org/abstract/MED/20039425(Hagihara et al., 2003)http//europepmc.org/abstract/MED/12794819(Delisle, C., Faubert, D., Gratton, J., Oubaha, M., Rautureau, Y., Thibeault, S., Wilkes, B. C., 2010. S-Nitrosylation of -Catenin by eNOS-Derived NO Promotes VEGF-Induced Endothelial Cell Permeability, Molecular cell. online Available at http//www.sciencedirect.com/science/article/pii/S1097276510005356, Accessed 01 January 2013.(Akoi et al., 2011)http//europepmc.org/abstract/MED/21076827(Koishihara et al., 1993)http//www.pnas.org/content/90/24/11924.full.pdf(Fuller et al., 2001)http//www.fasebj.org/content/15/1/43.full(Kazuto et al., 1996)http//online library.wiley.com/doi/10.1002/jbmr.5650110113/abstractBalena et al. (1994)http//www.ncbi.nlm.nih.gov/pmc/articles/PMC394928/pdf/emboj00053-0197.pdf(Garnero et al 2009)http//onlinelibrary.wiley.com/doi/10.1002/art.25053/fullHirschfield, G.M. and Pepys, M.B., 2003. C-reactive protein a critical update. Journal of Clinical Investigations. 111, pp. 1805-1812. online Available at http//www.jci.org/articles/view/18921. Accessed 01 January 2013.Figenschau Y, Nikolaisen C, Nossent JC., 2008. Anemia in early rheumatoid arthritis is associated with interleukin 6-mediated bone marrow suppression, but has no effect on disease data track or mortality. Journal of Rheumatology. 200835 3806.Ganz, 2003. Hepcidin, a key regulator of iron metabolism and mediator of anemia of inflammation. Blood, 1027838. online Available at http//bloodjournal.hematologylibrary.org/content/102/3/783.long Accessed 02 January 2013.Gillespie, M. T., Inoue, K., Itoh, K., Ishiyama, S., Kotake, S., Martin, T., J., Matsuzaki , K., Saito, S., Suda, T., Takahashi, N., Udagawa, N., 1999. IL-17 in synovial fluids from patients with rheumatoid arthritis is a potent stimulator of osteoclastogenesis. Journal of Clinical Investigations, 103 13451352. online Available at http//www.ncbi.nlm.nih.gov/pmc/articles/PMC408356/ Accessed 02 January 2013.Campbell, I. K., Nieuwenhuize, A. V., Quinn, J. M. W., Sims, N. A., Wicks, I. P., Wong, P. K. K., 2006. Interleukin-6 modulates production of T lymphocytederived cytokines in antigen-induced arthritis and drives inflammation-induced osteoclastogenesis. Arthritis Rheumatism, 54 (1) 158-168. online Available at http//onlinelibrary.wiley.com/doi/10.1002/art.21537/pdf Accessed 02 January 2013.

Pacific Healthcare Essay Example for Free

Pacific Healthcargon EssayHe now has the probability to authorize the use of any X radiate photo other than Kodak. An investigation was complete in where Mr. Rubble had a reason to believe that the up-to-the-minute Kodak price was above that of possible competition. There was an existing agreement with Kodak calls for furnishing X beam of light equipment along with maintenance and service, at a considerable discount for exploitation Kodak as a single supplier of the X irradiation painting. Kodak refused to provide those services if they were not their still source for X ray film. II. Major occupation Kodak has been Pacific HealthC ares main supplier for X ray film. Now that Mr.Ho hearty has pasted it is Mr. Rubbles responsibility to either decide to keep the Kodak for the X ray film or change to a unlike X ray film supplier. What leads to be kept in mind is that Kodak was also pass Pacific Healthcare discounts for furnishing X ray equipment along with maintenance and service. This was all because they were their only X ray film supplier. If Pacific Healthcare switches to a different X ray film supplier they will lose those discounts. Obtaining the highest quality with the best service at the last-place price is Pacific Healthcares supply strategy for medical supplies.Their objective is to find a single source supplier for a one year contract. III. Possible Solutions A. There are four other companies that make X ray films DuPont, Agfa, Fugi, and 3M. The quality of DuPont and Agfa are concordant with Kodak. Mr. Rubble can choose to go with DuPont since it holds the standard of Kodak and cost less(prenominal) than Agfa. The price of DuPont $1. 50 per sheet of X ray film. B. There are four other companies that make X ray films DuPont, Agfa, Fugi, and 3M. The quality of DuPont and Agfa are consistent with Kodak. Mr. Rubble can choose to go with Agfa since it holds the standard of Kodak.The only real issue I see here is that there is another family that makes the analogous quality of X ray film than both Kodak and Agfa. DuPont make the aforesaid(prenominal) quality of film for a lower price. The price of Agfa is $1. 58 per sheet of X ray film and DuPont offers it for $1. 50 per sheet. C. Mr. Rubbles can choose to stay with Kodak. The price for Kodak is higher than the other competition but they give Pacific Healthcare discounts on other services. Kodak furnishes Pacific Healthcare with X ray equipment, along with maintenance and services at a substantial discount for using Kodak as a single supplier for X ray film.I confuse found three issues with this possible solution. One, I do not know how much of a discount they are getting for the X ray equipment, along with the maintenance and services they are receiving from Kodak. With that I also need to know how much the competitors are willing to give Pacific Healthcare for those additional services that Kodak is offering to them. Last, but not least there are other competitor s that are at a lower price range with the same quality as Kodak. DuPont offers their X ray film for $1. 50 per sheet and Agfa offers theirs at $1. 8 per sheet. Kodak is charging Pacific Healthcare $1. 80 per sheet of X ray film. With this solution we have to keep in mind that Pacific Healthcare uses approximately 1,500 sheets of X ray film per day. That is approximately $2,700 per day. If Mr. Rubbles chooses to go with DuPont which is the same quality as Kodak that would be approximately $2,250 per day. By choosing DuPont Pacific Healthcare with be saving about $450 a day. That is $3,150 per week and $12,600 a month by switching to DuPont. That is a huge saving for Pacific Healthcare.Pacific Healthcare can save money as well as keeping the same high quality as Kodak. IV. Choice and Rationale After reviewing all of the possible superiors I chose to go with choice A. I chose A, because it saves Pacific Healthcare a lot of money as discussed in choice C. By choosing DuPont the compa ny would save $450 a day compared to Kodak. That is $3,150 per week of savings and $12,600 a month by switching to DuPont. Also in choosing Agfa which is the same quality as Kodak, Pacific Healthcare would save $330. Keep in mind that Agfa and DuPont have the same quality as Kodak.Why choose Agfa over DuPont if they have the same quality of X ray film? That is why I chose DuPont. It is a smart solution, because it saves Pacific Healthcare money while also keeping the same quality as Kodak. Moving on deuce the other choices Mr. Rubble has. In the beginning I mentioned that there were four competitors that offered X ray films at a much lower rate than Kodak. The competitors were Agfa, DuPont, Fugi, and 3M. I have discussed Agfa and DuPont. The reason for not adding Fugi and 3M to my possible solutions is because Pacific Health care wanted to keep the same high quality in X ray film.Even though Fugi and 3M met minimum requirement they were thought of as having lower quality. Pacific He althcare was looking for obtaining the highest quality with the best service at the lowest overall cost. To me they did not meet the requirement of Pacific HealthCares goal. V. Implementation I would let Pacific Healthcare know of my overall decision. In this brief, I would brief all my possible choices I had and why I chose to go with my choice. If we are in agreement my next step would be to concussion DuPont and request their service for X ray film.From there I would let Kodak know that we appreciate their business, but we no longer are in need of their X ray film service. Of course I would make sure that DuPont has agree to be our single source supplier for X ray film prior to finishing the contract with Kodak. Appendix A What alternatives should Barney Rubbles consider when addressing the problem? Barry Rubbles should consider the high quality that Pacific Healthcare would like to keep as well as the best service with overall lower cost. He should consider which one would give the overall high quality as well as trying to save money.Should Pacifics supply policies allow for any medical staff personnel to control sourcing decisions? In my personal conviction no, because they may not have the proper training or know what the companies needs are. I would like the professionals handle that. This case does not show a good example, because Mr. Howell chose the highest competitor. I would definitely have had both Mr. Howell and Mr. Rubbles work together. Sometimes one may come up with a different solution. What are the advantages and disadvantages of staying with Kodakor changing suppliers?How would you evaluate these? If the Pacific Healthcare would stay with Kodak they could keep receiving their discount for the other services that Kodak provides. This includes the X ray equipment, maintenance and, service for being their only source for X ray film. Like previously stated, I am not sure exactly how much that discount was. Nor did I know how much the competit ors were willing to give those services to Pacific Healthcare. With changing suppliers Pacific Healthcare would definitely save a lot of money. This would include changing to DuPont or Agfa.With DuPont the company would save $450 a day and by switching to Agfa the company would save $330 a day. Mr. Rubble has to keep in mind that both have the same quality of X ray film as Kodak. What action could Mr. Rubble have taken prior to Mr. Howells death to obtain reduced film prices? Mr. Rubble should have conducted a research just like he did when they put him in charge of the X ray film ordering. He should have presented this information to Mr. Howell and if he had disagreed Mr. Rubble should have taken it up to the company.

Ethical Marketing Strategies in the Pharmaceutical Industry

Ethical ticktocketing Strategies in the Pharmaceutical IndustryEthical merchandise refers to the application of selling ethics into the marketing fulfil. Ethical marketing generally results in a much socially responsible and culturally sensitive business community. The establishment of marketing ethics has the potential to benefit golf-club as a whole, both in the short- and long-term. Ethical marketing should be part of business ethics in the sense that marketing forms a fundamental part of any business model. Marketing strategy apprise be arranged into five categories, (1) Physicians-targeted promotions, (2) indicate-to-consumer advertising, (3) wrong recruitment of physicians, (4) interrogationers conflicts of interest, and (5) data manipulation in clinical trials. Drug companies promotions subconsciously work out physicians prescription patterns. Heavy advertising to consumers results in more prescriptions being scripted, whether or not the new drug is in the bette r(p) interests of patients, and therefore powerfully correlates with sales increases for the promoted new drug.It has been estimated that pharmaceutic companies spend Rs.7 Billions each year prompting their product to Physician in Pakistan. Although pharmaceutical marketing strategies are primarily directed toward practicing physicians and residents, medical student are targeted as well. The goal of this deliberate is to asses the importance of ethical marketing strategies of pharmaceutical industriousness in Pakistan. A questionnaire is design to assess the attitudes of Doctors and pharmaceutical captains about pharmaceutical promotion, including the acceptableness of receiving various gifts, foreign and local sponsorships, and incentives. In this study, Pharmaceutical market pull up stakes be direct variable, marketing strategies bequeath be indirect variable where as doctors and Pharmaceutical representatives will be nation. The scale will use from strongly agree to st rongly disagree. Total 180 Questionnaire will be distributed by the researcher. Rresearcher will elaborate here the contrastive choices of methodology that have been adopted in this research paper.enquiry-findings ground on data analysis will be discussed in general and exclusively. Finally conclusions and recommendations will be do accordingly.Problem and Its BackgroundIntroductionMark Twain once remarked Always try to do the right thing. It will surprise a lot of people. And it will astonish the rest. at that place has long been a close relationship between physicians and the pharmaceutical attention. It has been estimated that 85-90% of doctors in Pakistan see to pharmaceutical representative. These representatives often visit physician offices to discuss their products, provides free samples, and offer gifts. According to attention estimates, pharmaceutical promotional expenditure in Pakistan amounted to Rs.7 Billions in 2009. Approximately 25% of this amount was spend on d etailing to doctors, 4% on hospital detailing, 2% on journal ads, 56% on samples, and 12.5% on direct-to-consumer advertisement.The precision and the worth of drug advertisements has been the subject of debate for more than a century now. According to man Health Organizations (WHO) criteria for medicinal drug promotion, promotion refers to all the schoolingal and convincing activities of manufacturers and distributors, the effect of which is to encourage the prescription, supply, purchase and / or use of medicinal drugs. Drug promotion and marketing make up a very large part of the activities of pharmaceutical companies in Pakistan. For the drug promotion, in addition to other activities, companies usually use the written material supposedly showing all the good and bad aspects about the concerned drug. These advertisements can be highly informative as long as they are critically appraised. However, when these are accepted without any question, can contribute to illogical prescri bing. Ideally, drug promotional literature should provide health care professionals with bulky information. However, the information contained in promotional material may be inadequate or altogether inaccurate Undoubtedly, the pharmaceutical promotional activities have powerful works on prescribing behaviour of the doctors although this influence may be more hidden rather than explicit.Being a member state of the United Nations Organization, efforts to regulate drug promotions in Pakistan were as well as initiated with the proliferation of the Drug Licensing, Registering and Advertising Rules by the Ministry of Health, Government of Pakistan. However, there is no mechanism to monitor the drug promotional campaign by pharmaceutical industriousness in Pakistan despite the fact that there is enough evidence that logical drug utilization problems are increasingly encountered even in developed countries ascribable to unethical practices of pharmaceutical promotion. Since promotional activities influence the prescribing behaviour of the health care providers, it is of utmost importance to critically analyze the claims made in the promotional material of the drugs. transnationally, aspects of contents in pharmaceutical advertising pertinent to evidence based decision-making have been studied. The extent to which pharmaceutical companies promote the merits of their products and whether such claims are supported by evidence, has not been studied in Pakistan. The results of the present analytical study show that unethical and biased claims regarding the medicinal products are uncontrolled in Pakistan. These drug promotions influence the prescribing behaviour of the General Practitioners, Consultants thus accounting for one of the potentially major causes of illogical prescription.Pakistan Medical Association has developed Ethical encipher of conduct for Doctors and pharmaceutical governings but are not followed by National companies. All Multinational organizatio ns in Pakistan are following the Pakistan Medical Association (PMA) code of conduct and International Federation of Pharmaceutical Manufacturers Associations (IFPMA) code of conduct. The International Federation of Pharmaceutical Manufacturers Associations is the global nonprofit NGO representing the research-based pharmaceutical, biotech and vaccine sectors. All the Multinational pharmaceuticals companies running in Pakistan are members of this NGO and bound to follow the code of ethics.Definition of ConstructEthical Marketing Strategies in pharmaceutical industry are the tools and proficiencys to sell medicines ethically. The strategy must be such that it doesnt not influence the decision making criteria of doctors.Background InformationThe researcher is working as Field Manger in Roche Pakistan Ltd since coda three and half years. Roche Pakistan Ltd is a member of Halfman La Roche Basel, a Switzerland research based multinational organization that is running its businesses in more than 70 countries of 6 continents of the world. Halfman La Roche started it business in 1886 from Basel Switzerland from multivitamins medicines to new innovative biotechnology products. In 1946 they discovered metabolic and antibiotics product. In 1980, they discovered anxiolitic and psychiatric medicines. In 1990s, they discovered crabby person and hepatitis medicines. Now Halfman La Roche Basel has discovered 100 more molecules that are in variant phases of clinical trails for different diseases. Roche Pakistan Ltd started its operation in Pakistan in 1982. Initially they trade their products and sell in the Pakistan Market but they started their manufacturing in Pakistan in 2001. Now Roche Pakistan Ltd selling its product in 8 sections in Pakistani pharmaceutical market that areHepatitisCancerTransplantAnaemiaAntibioticsAntihypertensiveMetabolic DiseasesDiagnosticHalfman La Roche is at 4th ranking world wide in pharmaceutical industry and is Market leader in Hepatitis, Cancer, Transplant and Anaemia, Metabolic diseases and Diagnostic. The yearly sale is CHF. 49051 Millions grew by 10% and operating profit in 2009 was 15012 Millions that grew by 6%. Roche is invested CHF. 9874 Millions on RD in 2009. The free cash flow in 2009 was 8893 that was 79% more than 2008. The total employee of Roche are 81507. Out of them 80115 are permanent.The Sales contribution is more from US that is 38% than West Europe that is 28%.Since pharmaceutical marketing activities influence the prescribing behaviour of doctors, it is of utmost importance to critically analyze the claims made in the promotional material of the drugs. The extent to which pharmaceutical companies promote the merits of their products and relevant clinical trails provide to doctors are not studied in Pakistan. The results of the present analytical study show that unethical and biased claims regarding the pharmaceutical products are uncontrolled in Pakistan. These drug promotions influence the pre scribing behaviour of the General Practitioners, Consultants thus accounting for one of the potentially major causes of illogical prescription.Roche Pakistan Ltd is a Member of IFPMA and PMA and follow their ethical business guidelines to sell its products. Roche Paksitan Ltd is at 6th ranking in Pakistan Pharmaceutical Market and its annual sale is Rs. 5.2 Billions in 2009 in Pakistan.Problem StatementUnethical Marketing strategies effect the prescribing habit of doctors that can lead to serious life threatening results for patients. investigate QuestionsResearch Q 1 What Ethical Marketing Strategies formulated for business in pharmaceutical industry?Research Q 2 What type of studies should be formulated?Research Q 3 what are the Marketing strategies that effect the decision making criteria of doctors.?1.6 Research ObjectivesTo find out the problem associated with unethical marketing strategies in pharmaceutical industry.To pursue the ethical strategies that will not effect the de cision making criteria of doctors.HypothesisHo There is no relationship between ethical marketing strategies and unethical marketing strategies.H1 There is relationship between ethical marketing strategies and unethical marketing strategies.Scope and Limitations of StudyScope of the researchAs this research will be carried out with in single organization that is Roche Pakistan Ltd, based on the population from the different pharmaceuticals representative and doctors so the targeted low population narrows down the mountain range of the study.LimitationsFollowing limitation may also be observed during the research procedure and methodology adopted in collection of data from the resources within the organizationData will be peaceful only from those respondent who directly and indirectly involved in the decision making process at different levels.Researcher may lave limited access to all authorities in respondent.answerer may not responded answer due to tight registerRespondent may n ot have proper information about variable and their relationship.respondent personal liking and disliking may create some biasness.Respondent may feel hesitation while attempting to questionsRespondent may have personal reservations in responding to some questions relevant to their field or job.As the population under study is lessened to 132 respondent only, hence the scale of the study is restricted.Due to inadequate time, Research may cover and pass influential information onlyData will be collected by the researcher himself.It is not possible to cover all variables.Significance of the researchThe study will explore that how the marketing strategies effect the decision making process of healthcare professionals. This research will also helpful to understand the importance of ethical marketing strategies. It will elaborate the impact of ethical marketing strategies on patients life.Moreover another aspect of this study is to elaborate the significance of ethical pharmaceutical str ategies for doctor, pharmaceuticals industry and patients.It will assist to confirm that following the ethical marketing codes in pharmaceutical industry not only save the cost of patients but also life. It will also increase the moral and dignity of doctors also.CHAPTER 2Literature ReviewEthical marketing is the application of marketing ethics into the marketing process (Patrick, 2005).Ethical marketing generally results in a more socially responsible and culturally responsive business community (Eugene, 1978).Pharmaceutical strategy can be arranged into five categories (Brownlee, April 2004).Heavy pharmaceuticfal promotional activities to doctors results in more prescriptions being written (Elliott, Oct 2004).It has been estimated that 85-90% of doctors in Pakistan see to pharmaceutical representative (Gutknecht, 2001).pharmaceutical promotional expenditure in Pakistan amounted to Rs.7 Billions in 2009 (Gutknecht, 2001).(WHO) criteria for medicinal drug promotion, Marketing Strate gies by Pharmaceutical companies is to encourage the prescription, supply, purchase and / or use of medical drugs, (WHO 33rd human beings Health Assembly, May 1986).The pharmaceutical promotional activities have powerful influences on prescribing behaviour of the doctors although this influence may be more hidden rather than explicit. (Lexchin, 1999).There is no mechanism to monitor the drug promotional campaign by pharmaceutical industry in Pakistan (Lober, 1993).Pakistan Medical Association has developed Ethical Code of conduct for Doctors and pharmaceutical organizations (www.jpma.gov.pk).International Federation of Pharmaceutical Manufacturers Associations (IFPMA) has developed code of conduct for pharmaceutical organizations. (www.ifpma.org).The strategy must be such that it doesnt not influence the decision making criteria of doctors. (Lober, 1993).Roche Pakistan Ltd is a member of Halfman La Roche Basel (www.roche.com).The annual sale of Roche is CHF. 49051 Millions and ope rating profit in 2009 was 15012 Millions. Roche is invested CHF. 9874 Millions on RD in 2009. (www.roche.com).In 2002, the pharmaceutical industry spent $15.63 billion on promotions, which include free office supplies, all-expenses-paid events, sales representatives, and awards to physicians (Parker, 2003).A 10-year study of internists at seven university hospitals, published in 1990, found that familiar contact with sales representatives also changed prescription practice (Israel, 2003).New drugs are not time tested their long-term effects are unknown many a(prenominal) patients who can be just as effectively treated with less expensive, older drugs are risking their health when using newer drugs (Elliott, 2004).Dr. Drummond Rennie, Deputy Editor of the Journal of the American Medical Association, stated, I suppose I had about 20 at one time (Spears, 2003,).Brett and Colleagues found that physicians make distinction about the ethical acceptability of drug company gifts ( Brett, 2 003).Drug information provided by pharmaceutical representative and drug advertisements are inaccurate ( Wilkes, 1992).Medical practitioners are dependent on the pharmaceutical industry for much of their drug information in Pakistan (Ahmad,1990).Unethical practices regarding the medicinal drug promotion are uncontrolled in Pakistan and it is suggested that physicians should be careful and vital in assessment of advertised claims of greater efficacy, safety or convenience made by the pharmaceutical companies (Ahmad, 1990).GiftsDinnerNetwork DiagramSamplesPharmaceuticalMarketDoctorsInternational blow upClinical TrailsCashChapter 3Research MethodologyIn regularize to answer the research questions mentioned in chapter 1, researcher will elaborate here the different choices of methodology that have been adopted in this research paper.For historical viewpoint, I will conduct a Qualitative (content based) study of the previous researches on the spot ethical marketing strategies in phar maceutical industry. For present view, I will conduct a Quantitative (based on survey) analysis.3.1 PopulationIn the given research study, the population will be all employees of Roche Pakistan Ltd, Doctors of Medical Unit Sir Gangaram Hospital Lahore.3.2 SampleThe sample will consist of both males and females, Seniors and Juniors Doctors, pharmaceutical representative. According to the designations of the respondents their qualifications, professional experience, age will vary.3.3 Sampling Technique/StrategyIn order to select the sample from the target population i.e. Roche Pakistan Ltd, Sir Gangaram Hospital Lahore, Non-Probability Convenience (purposive) sampling technique will be used.3.4 Sample SizeFor the present study sample size will consist of 132 respondents (Pharmaceutical Representative, Doctors and Chemist).3.5 Survey InstrumentA questionnaire (English language) will be designed to collect the required Information. All the questions will be close-ended. A Cover letter t o highlight the purpose of the study and instructions to fill the questionnaire, and a Demographic Data Sheet will be prepared and attached with the Questionnaire as well.3.6 Data CollectionThe data for the proposed study will be collected through sell-structured questionnaire. The questionnaire will be circulated, explained and collected by the researcher himself. The questionnaire will be based on Likert Scale and will have five levels of responses against every question from the respondent. Since the company contains different hierarchies of employees and management so the respondents will be categories and manipulated accordingly. The five levels ofresponses will be1. Strongly Agree2. Agree3. Undecided/ neutral4. Disagree5. Strongly Disagree3.7 Pre-TestingBefore the full scale administration of the questionnaire it will also be pre-tested on avery small segment of the population (10-15 respondents) so that any ambiguity inany question/s can be dealt with.CHAPTER 4Data Analysis and Interpretation getable research soft ware for social sciences i.e. SPSS. Will be uses for analysis on Data collected for the proposed research study. Statistical and Arithmetical formulae Correlation or Regression will be applied as per demand and need of the study. Statistical tables and graphs / figures will also be obtained / drawn if needed.CHAPTER 5Findings, Conclusions and RecommendationsIn order to achieve the basic purposes and objectives of the proposed research study, research-findings based on data analysis will be discussed in general and exclusively. Finally conclusions and recommendations will be made accordingly.