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UNIVERSITI TEKNOLOGI MARA

FINAL EXAMINATION

COURSE

ENGLISH FOR CRITICAL ACADEMIC READING

COURSE CODE

ELC501

EXAMINATION

DECEMBER

TIME

2 HOURS

2015

INSTRUCTIONS TO CANDIDATES
1.

This question paper consists of one passage with seventeen (17) questions.

2.

Answer ALL questions in the Question Paper.

3.

Fill in the details below :

UiTM STUDENT CARD NO

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PROGRAMME / CODE

__________________________________

PART

__________________________________

ENGLISH LANGUAGE GROUP

__________________________________

NAME OF LECTURER

__________________________________

4.

You are allowed to refer to a print English-English dictionary.

5.

Please check to make sure that this examination pack consists of :

i) the Question Paper

DO NOT TURN THIS PAGE UNTIL YOU ARE TOLD TO DO SO

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This examination paper consists of 12 printed pages

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TOTAL : 40 MARKS
Read the following article and answer ALL the questions that follow.
Drug Shortage: The Scary Reality of a World Without Medication
I

Imagine surgeons running out of anaesthetic drugs, cancer patients who

cannot get lifesaving chemotherapy, and doctors scrambling for the most basic
antibiotics. We are already there. It seems unfathomable in our high-tech
medical system, but in 2007, 154 drugs were in shortage. This number almost
tripled to 456 in 2012, according to the U.S. Government Accountability Office.

Regardless of the reasons justifying the shortage, there should be proactive

roles taken to end this nightmare affecting the lives of many people.
II

Threatening medical-care options and patients lives, drug shortages have

occurred in almost every pharmaceutical category. Antibiotics, cancer drugs,
anaesthesia, pain control, reproductive and gynaecological drugs, cardiac

10

medicine, psychiatric drugs, and intravenous-feeding solutions have all been

in varying degrees of short supply or not available at all. Recently,
nitroglycerin, an emergency room staple used to treat heart attack patients,
has been in such severe scarcity that its sole U.S. manufacturer has restricted
hospitals to 40 per cent of their usual orders.
III

15

A study published this March in the Mayo Clinic Proceedings attributed more
than 15 documented deaths since 2010 to either lack of treatment or the
switch to an inferior drug as a result of medication shortages. Though the
Food and Drug Administration (FDA) has scrambled to alleviate the crisis and
physicians have become deft at juggling or substituting treatments, there is no

20

comprehensive solution to this drug-supply breakdown, which has persisted

for a complex array of reasons.
IV

The first reason is all about money. As generic drug prices have dropped, so
have manufacturers profits. As a result, some manufacturers have failed to
invest in infrastructure and quality control. Therefore, the FDA has taken

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regulatory actions to ensure quality control. This, however, has halted supplies
of certain drugs. Sterile injectable drugs, such as pain medication and
chemotherapy, dominate the shortage list. Furthermore, the business model of
just-in-time manufacturing, in which companies make drugs as patients need
them but do not stockpile extra, leaves no margin for unexpected events.
V

30

Another reason could be that of less-than-honourable motives of the drugmakers. Noting that there are no shortages of big profit-generators, like
Viagra, many practitioners and patients suspect stealth motives by these drug
manufacturers. Some experts suggest that these manufacturers may have a
financial motive to temporarily stop production of a drug. Medicare reform

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imposed certain price controls on generic drugs, but due to a loophole, these
controls are lifted if a manufacturer stops making the drug for six months.
Such a practice causes a shortage of supplies leading to a price increase of
those drugs. In other words, the manufacturers are still at a winning end.
VI

Limited manufacturing capacity is an important factor too. Over half the drugs

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on the FDA shortage list had only one or two manufacturers, according to a
report by the IMS Institute for Healthcare Informatics. Some blame hospital
buying groups, or wholesalers. Others blame middlemen who purchase drugs
and supplies for many of the nations hospitals, which have awarded contracts
to some manufacturers and not others, thereby suppressing competition and

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innovation. The result is that for any given drug, there may be only one or two
generic manufacturers left to produce it, which can lead to shortages.
VII

Predatory middlemen are making the situation even worse. A congressional

investigation led by Elijah Cummings, a Baltimore Democrat, has found that
shady secondary wholesalers buy up drugs in shortage and resell them, often

50

at exorbitant prices. This explains, in part, the haphazard ebb and flow of the
shortages that makes the situation particularly hard to handle. One day the
medicine is just gone, but there is plenty the next.

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But as experts debate the cause of the shortages, there is no disagreement

over their devastating impact. These shortages have turned pharmacists into

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professional beggars and have forced doctors to change treatment protocols

casually whereby in some cases, turning routine care into a roll of the dice.
Such shortages have also resulted in clinical trials being stopped and have
even led to the suspension of the death penalty in some states that use lethal
injection.
IX

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Shortages are leading hospitals and patients to get drugs from less regulated
and potentially less safe sources. They turn to drug compounders who are
specialty pharmacies that mix medications for individual patients. Some
compounding pharmacies, which are not subject to regulation as stringent as
that for drug manufacturers, have taken advantage of this and started

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churning out large volumes of drugs. This act has led to safety issues. Such
dangers became vividly clear in 2012, after contaminated steroids from the
New England Compounding Center led to an outbreak of meningitis that killed
64 patients. A 2013 report by the Health and Human Services Inspector
General found that drug shortages have led 68 per cent of U.S. hospitals to

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turn to compounders to make versions of medicine in short supply.

X

Patients today have to cope not only with being sick or choosing between
treatment options, but also with the possibility that the drug they need may be
available solely from a risky source, or not at all. In a recent study by the
University of Pennsylvania which was presented at the 2013 annual meeting

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of the American Society of Clinical Oncology, 83 per cent of oncologists and

haematologists said that they had faced cancer drug shortages, and of those,
nearly all claimed that their patients treatment had been affected by drug
shortages.
XI

At the Ohio State University Comprehensive Cancer Center in Columbus,

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Ohio, Ryan Forrey, Associate Director for Pharmacy and Infusion Services,
states that in 2012, of the 60,000 doses of chemotherapy administered
intravenously at his facility, almost 35 per cent were affected by shortages.

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Treatment was interrupted or cancelled, patients were switched to alternative

drugs, or an alternative supply for the needed drug had to be found. In short,

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the staff were forced to beg, borrow and plead for drugs that were in shortage.
XII

In July 2012, Congress passed the Food and Drug Administration Safety and
Innovation Act, which included provisions originally spearheaded by Senator
Amy Klobuchar. The act requires that drug-makers give the FDA early
notification of any manufacturing issues or business decisions that may lead to

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shortages. It requires the FDA to expedite inspections and reviews of

manufacturing sites that could help resolve shortages.
XIII

Companies are not penalised for drug shortages nor incentivised to prevent
them, experts say. A number of healthcare professionals believe that the only
real solution is to require drug manufacturers to stockpile medicine and to

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ensure that more than one drug-maker produces it. There needs to be a way
to obligate multiple manufacturers to make these lifesaving medications, says
Forrey.
XI

As such the predicament ensues; we are left in disbelief that such a condition

would result in endangering the life of people who are dependent on these

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drugs. Patients lament that drug-makers have forced them into unacceptable
treatment due to the unavailability or shortage of these drugs. In fact, there
was a lawsuit against the FDA on behalf of patients affected by drug
shortages, which alleged that by allowing the drug companies to stop making
a drug, the FDA has effectively allowed them to make life-or-death decisions

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for patients. Nonetheless, this lawsuit was dismissed with the FDA stating that
they themselves lack the authority to address potential and actual drug
shortages. It is ironic that despite all the technological advancements, we still
have to face this problem of drug shortages. Therein is the harsh reality of a
world without medication.
Adapted from Drug Shortages: The Scary Reality of a World Without Meds
http://www.rd.com/health/healthcare/drug-shortages/

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QUESTION 1
Explain the meaning of the following words as they are used in the article.
a)
b)
c)
d)

unfathomable (line 3)
suppressing (line 45)
spearheaded (line 88)
predicament (line 99)

: __________________________
:___________________________
:___________________________
:___________________________
(4 marks)

QUESTION 2
Identify the main issue discussed in the article.
_________________________________________________________________________
_________________________________________________________________________
(2 marks)
QUESTION 3
Explain the authors position on the issue presented in the article.
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(2 marks)
QUESTION 4
Explain what the writer is implying by the statement:
A study published this March in the Mayo Clinic Proceedings attributed more than 15
documented deaths since 2010 to either lack of treatment or the switch to an inferior drug as
a result of medication shortages (lines 16-18).
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
(2 marks)

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QUESTION 5
Write out the implied main idea of paragraph IX and provide ONE MAJOR supporting detail
used to support this main idea.
a) Implied main idea:
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b) Major supporting detail:

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(3 marks)
QUESTION 6
Identify the stated main idea of paragraph VIII.
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(1 mark)
QUESTION 7
Read each of the following statements. Decide whether each statement is a Fact or an
Opinion and explain why. Write your answer in the space provided.
a) Recently, nitroglycerin, an emergency room staple used to treat heart attack patients,
has been in such severe scarcity that its sole U.S. manufacturer has restricted hospitals
to 40 per cent of their usual orders.(Paragraph II)
______________________________________________________________________
______________________________________________________________________
b) Some experts suggest that manufacturers may have a financial motive to temporarily
stop production of a drug.(Paragraph V)
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______________________________________________________________________
______________________________________________________________________
c) Such dangers became vividly clear in 2012, after contaminated steroids from the New
England Compounding Center led to an outbreak of meningitis that killed 64 patients.
(Paragraph IX)
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______________________________________________________________________
(6 marks)
QUESTION 8
Identify the type of support for each of the supporting details based on the following options.
Use each option only ONCE.
Law
Explanation

Personal Observation
Historical Data

Research Findings
Expert Opinion

Supporting Detail
a)

It seems unfathomable in our high-tech medical

system, but in 2007, 154 drugs were in shortage, a
number that almost tripled to 456 in 2012, according to
the U.S. Government Accountability Office. (Paragraph
I)

b)

A congressional investigation led by Elijah Cummings,

a Baltimore Democrat, has found that shady secondary
wholesalers buy up drugs in shortage and resell them,
often at exorbitant prices. (Paragraph VII )

c)

The act requires that drug-makers give the FDA early

notification of any manufacturing issues or business
decisions that may lead to shortages.(Paragraph XII)

d)

There needs to be a way to obligate multiple

manufacturers to make these lifesaving medications,
says Forrey. (Paragraph XIII)

Type of
Support

(4 marks)

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QUESTION 9
Referring to paragraph X, identify two (2) inferences that can be made about the effects of
drug shortage. Indicate your answer by circling the appropriate options.
a)
b)
c)
d)

Patients are the ones who will eventually suffer from drug shortages.
Patients have to deal with risks, limited choices and questionable source of drugs.
Drug shortages can compromise the quality of hospital treatments.
Patients and hospitals are facing risky sources of drugs for treatments.
(2 marks)

QUESTION 10
Explain why Congressmen should be among the target audience.
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_________________________________________________________________________
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(1 mark)
QUESTION 11
Identify which of the following best describes the tone of the author.
a)
b)
c)
d)

Pleading
Concerned
Dispassionate
Righteous
(1 mark)

QUESTION 12
Determine the authors purpose for writing such an article.
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_________________________________________________________________________
(1 mark)
QUESTION 13

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Determine in what way the writers feelings towards the middlemen is different from his or
her feelings towards patients. Support your answer with four examples of language use that
reflect the writers feelings.
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(3 marks)

QUESTION 14
Draw a possible conclusion based on the reasoning in the given text:
At the Ohio State University Comprehensive Cancer Center in Columbus, Ohio, Ryan
Forrey, Associate Director for Pharmacy and Infusion Services, stated that in 2012, of the
60,000 doses of chemotherapy administered intravenously at his facility, almost 35 per cent
were affected by shortages. Treatment was interrupted or cancelled, patients were switched
to alternative drugs, or an alternative supply for the needed drug had to be found. (lines 8085)
_________________________________________________________________________
_________________________________________________________________________
(1 mark)

QUESTION 15
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Draw a possible conclusion based on the reasoning in the given text:

Companies are not penalised for drug shortages nor incentivised to prevent them, experts
say. A number of healthcare professionals believe that the only real solution is to require
drug manufacturers to stockpile medicine and to ensure that more than one drug-maker
produces it. There needs to be a way to obligate multiple manufacturers to make these
lifesaving medications, says Forrey. (lines 93-98)
_________________________________________________________________________
_________________________________________________________________________
(1 mark)

QUESTION 16
Evaluate whether the authors argument is valid. Justify your answer with evidence from the
article.
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_________________________________________________________________________
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_________________________________________________________________________
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(3 marks)
QUESTION 17
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Explain whether the argument forwarded by the author is complete. Justify your answer with
evidence from the article.
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_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
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_________________________________________________________________________

(3 marks)

END OF QUESTION PAPER

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