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The industry defends the price on the grounds that it’s cheaper than a $500,000 liver transplant. But most people with untreated Hepatitis C never need a transplant; even after 20 years, the savings from not having to treat the disease’s worst effects would offset only about 75 percent of Sovaldi’s up-front costs, research suggests. Meanwhile, it would add $600 per person to the annual cost of a group health plan.

Outrage № 3: Pushing the new and flashy

One way for hospitals and medical practices to make gobs of money is to push a new, trendy procedure – even if it’s no better than an older one. Prime example: prostate cancer surgery. Medical science still has little idea which treatments work best for the disease, or even who really needs to be treated, because many patients have cancer so indolent that they will die of something else long before it kills them.

None of that has stopped medical marketers from persuading hospitals to spend ever larger sums of money on so-called cutting-edge prostate cancer treatments to lure patients away from competitors.

The poster child for the phenomenon is robotic surgery, which your local hospital has probably bragged about.

First introduced for prostate cancer surgery in 2001, the $2 million machine – a collection of laparoscopic instruments operated remotely – went from being used for 6 percent of prostatectomies in 2004 to 83 percent in 2014, despite little evidence that it is better than other types of surgery even though it comes with a higher price tag. “There’s marketing value in a very

expensive piece of technology, such as a robot, even if it doesn’t work better,” says Jeffrey C. Lerner, president of the ECRI Institute, a nonprofit health technology evaluation organization. “Nobody’s ever going to put up a billboard about having the best bandage.”

3 ways you can help rein in expenses

1. Find out the real cost of your treatment More and more insurers are disclos-

ing at least some negotiated prices to members who register with their websites. Take advantage of that feature if your health plan offers it, especially for things you can plan in advance, such as imaging tests. In a recent experiment, people scheduled for CT scans or MRIs were called and told about cheaper alternatives of equal quality; they ended up saving par-

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ticipating insurers an average of $220 per scan – and prompted more expensive providers to cut their prices.

2. If you want the celeb doctor, pay extra

“Reference pricing” is when an insurer analyzes its past claims to set a reasonable price for a good-quality routine test or procedure and tells its customers that if they want to go to a higher-cost in-network provider, they can – but will be responsible for the difference between the reference price and the provider’s price.

CalPERS, which buys health insurance for 1.3 million California state employees and retirees, set a reference price of $30,000 for routine hip and knee replacements after discovering it was paying as much as $110,000 for those procedures. In the first year, savings averaged $7,000 per patient – and several high-cost hospitals suddenly discovered that they, too, could offer $30,000 joint replacements. One caveat: This fix needs to be done carefully to make sure that quality stays high and consumers aren’t caught by surprise.

3. Seek out a smaller medical network

You can save about 20 percent on premiums by signing up with a plan that has fewer providers than customary. Providers give the insurer a price break in exchange for fewer competitors. But before signing on, make sure that the network includes the doctors, hospitals, labs, and other services you need within a reasonable distance from your home and that they accept new patients. Subscribers to our website can see how hospitals compare in quality.

(from http://www.consumerreports.org, published: September 2014, photo: Benjamin Bouchet)

1.Get health insurance rankings. Surf the Internet and find information about insurance companies in your country or the country you’d like to go to. Choose two companies.

Customize your search to compare plans’ scores and their performance in measures such as consumer satisfaction and providing preventive services.

2. Have a class feedback.

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FOCUS ON LISTENING

I. You are going to listen to two friends completing a health and fitness quiz. (Listening Extra, Unit 11.3, CD 2 tr. 10)

1.What are Healthy habits and Unhealthy habits? Discuss in pairs. Have a class feedback.

2.Brainstorm the words and expressions connected with Health and fitness.

3.Listen and write down the questions. One of you writes all the evennumbered questions, the other – all the odd-numbered questions.

HOW HEALTHY ARE YOU?

Answer the questions, then check your score

To find you health and fitness level, add your score for each question

58–71 You have excellent health habits. But be carefull – you might be obsessed with health. You’ll live longer. But what’s the point?

40–57 You have good health habits. Well done!

24–39 Your lifestyle is a bit unhealthy. Perhaps try to make some changes. 23 or below is terrible! You are a real slob. Watch out, or you’ll soon have problems.

4.Listen again. Make a note of Bob’s answers that Julia puts on the form. Work out his total score.

5.Work in pairs. Discuss the statement “Good health is the most important thing of all”. Have a class feedback.

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II. Listen to five people talking about health problems. (Upstream advanced, Unit 7)

1.Put the number of the speaker by each health problem. Then, match the health problems with the treatment(s) they tried and say which ones were

successful. Speaker

2.Now listen again and say how each person felt about their medical problem and why? Choose from the list: frustrated / gloomy / embarrassed / worried / desperate (Upstream advanced, Unit 7)

III. You are going to listen to two friends. One of them is talking about some recent experiences at the doctor’s. Cover the conversation below. (Innovations Intermediate, p. 141)

1.As you listen, answer these questions: What health problems does Ken mention?

How did the doctor deal with these problems?

At the doctor’s

sleep, I (3) ______ all through the night, and I’d get up in the morning and my whole body would be stiff and aching. It was terrible. I thought I (4) ______ die. Honestly, it was awful.

this Tuesday, so I said ,”What good is that? I’ll probably be better by then – or dead!” So he said, “Well, you (6)______ see me, then.” And put the phone down. I couldn’t believe it. Doctors these days are just so unhelpful.

David: Yeah.

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Ken: You know my mum… she’s seventy and the other day she was coming home from the shops and she slipped and fell over and when she woke up the next day, she had a really sore back. She could (7) _______ . She rang the doctor and asked him to come out, but he wouldn’t, so then she had to go all way to the surgery (8) ______ . Then, when she got there, she had to wait around for about an hour with all these really ill people coughing and sneezing and spreading their germs. When she finally saw the doctor, he (9) ______ for about ten seconds and just told her to go home and lie down for a few days. That was it! No pain-killers, no physiotherapy, nothing! And then (10)______ he told her she should may be lose some weight.

which she probably picked up in the waiting room, so she went back and this time he just told her to (11)______ and drink lots of water. She wanted some kind of medicine, but he said it wouldn’t work for some reason. I don’t know! It seems as if we pay all these taxes so we can have a free service, but all we really get from them is advice about giving up smoking, getting more exercise, (12)______ fatty food and anything else which makes life worth living. Doctors? They treat you as if you are two years old.

one last one!

2.Listen again and complete the gaps.

3.Work in pairs or groups. Do you think the doctors who spoke to Ken and his mum were right? Why/why not? Is your own experience of doctors positive or negative?

4.Make sentences that give typical pieces of doctor’s advice by matching the beginnings 1–10 to the endings a–j. What problems do you think the patients had?

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IV. This is a success story for medicine – but lots more problems remain

1. Look at the pictures and tell the story. Here are some words to help you: discover (1), to vaccinate (4), outbreaks of disease (5), vaccination campaign (6), stores (8)

2. Listen to the story and check your answers. (Timesaver Storyboard.

P. 44–45, tr. 39–40)

3.Listen to the interview with a doctor in Africa. What does/doesn’t he like about his the work?

4.Work in pairs. Make up an interview with a villager. Ask questions like

“How does the doctor help people I your village? What other things does the village need to make life easier?”

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5. Work in pairs or groups. Discuss the questions. Use the Notes given below:

How much of a problem is AIDS in your country? Do you think they are doing enough to combat it?

How worried do you feel about things like SARS and Avian bird flu? Would you go on holiday to a country that had had an outbreak of one of these kinds of diseases?

Have there been any outbreaks of BSE in your country? Did mad cow disease make you think twice about eating meat?

Have you ever heard of MRSA? Do you have similar problems in your hospitals?

Notes:

AIDS (pronounced as one word) – acquired immunity deficiency syndrome, disease which destroys the body’s natural protection from infection.

SARS (pronounced as one word) – severe acute respiratory syndrome, serious illness which causes difficulty in breathing and sometimes death.

BSE (pronounced as individual letters) – bavine spongiform encephalopathy (often called mad cow disease), a disease which affects the central nervous system of cattle.

MRSA (pronounced as individual letters) – methicillin resistant staphyllococcuc aureas, a type of bacterium that cannot be treated by most antibiotics.

6.Work in small groups. You are the Government Minister for Health. You can introduce five laws to raise the general level of physical and mental health. What will you introduce? Compare your list with the “laws” from other groups.

V. You will hear a talk from BBC Learning English “The cost of life saving vaccines”

1.The price of vaccines has escalated and some poor countries are struggling prevent children from catching certain life-threatening diseases. The warning comes from the organisation Medecins Sans Frontieres. It criticises the drug companies which reply that they can’t make such complex medicine cheaper than they already do. Discuss in pairs what the talk may be about. Do you know anything on the topic?

2.Listen and write down this week’s question.

3.Complete the extracts from the talk using the words and phrases given: to

immunise / charity / transparency / out of proportion / to verify / discount / to make a profit. Listen again and check.

Medecins Sans Frontieres is a well-known ______.

They should simply submit to some sort of audit to ensure that we can

______ the cost of production.

They argue that they already sell these vaccines at a ______, in other words, at a reduced price.

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It’s a black box in terms of the price they are charging to most countries around the world so they’re often charging prices that are wildly ______

with their ability to pay.

On one hand, vaccines take many years of research and these companies want ______, which means to sell the product for more than it costs to make it.

That’s what Medecins Sans Frontieres says, and they’re asking for more

______ around prices.

Some of the world’s poorer countries are struggling ______ children.

4. Work in pairs or groups. Reconstruct the talk.

VI. You will hear a talk from BBC Learning English “Penicillin: breaking the mould”

1.Alice and Neil discuss penicillin, the so-called wonder drug discovered in 1928 by Alexander Fleming. Discuss in pairs what the talk may be about. Do you know anything on the topic?

2.Listen and write down this week’s question and the summary of their talk.

3.Complete the extracts from the talk using the words and phrases given: an-

tibiotic / halo / mould / suppress / immune system / pave the way / resistance / corpses. Listen again and check.

And it was discovered in 1928 by a Scottish scientist called Alexander Fleming who noticed some mould growing on a petri dish of bacteria in his lab, which had a ______ – or circle – around it where no bacteria were growing.

Now, penicillin is a common ______ – or substance that kills microorganisms – that acts very effectively against certain bacteria.

The ______ is our body’s defence against infection and disease.

This bacterium was sensitive to penicillin but has developed a ______ to it, and to other antibiotics, meaning the drugs can’t harm it any more.

______ is a chemical treatment used to kill cancer cells that also ______ – or stops – the body’s immune system from working.

So the discovery of penicillin ______ for chemotherapy and other types of medical treatment.

And scientists have been able to test bacteria present in very old ______.

4. Work in pairs or groups. Reconstruct the talk.

VII. You will hear a talk from BBC Learning English “Diabetes”

1.Why is the disease diabetes on the rise? Discuss in pairs what the talk may be about. Do you know anything on the topic?

2.Listen and write down this week’s question.

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3. Complete the extracts from the talk using the words and phrases given: diabetes / glucose / on the rise / obesity / processed food / urbanisation / continuum / tipping point. Listen again and check.

Diabetes is ______ all over the world.

Diabetes is a kind of ______, something that changes slowly over time.

______ is a condition where the body can’t control the amount of ______ in the blood.

______, by the way, is food that’s been changed from its natural state, for example, by freezing or re-hydrating it, or by adding ingredients to it such as sugar, salt or fat.

And particularly type 2 diabetes where risk factors include ______, unhealthy diet and lack of physical exercise.

With increasing ______ people are no longer doing jobs that involve as much physical activity.

And having a high blood-sugar level may reach a ______ and you develop diabetes.

4. Work in pairs or groups. Reconstruct the talk.

VIII. You are going to listen to four short conversations in which people talk about health and medicine. (Innovations Advanced, p. 93)

1. Listen and match two of the sentences with each conversation.

a.Someone thinks they should have done something earlier.

b.Someone is overweight.

c.Someone thinks their friend got the wrong end of the stick.

d.Someone has been getting withdrawal symptoms.

e.Someone gets recommended quite a lot.

f.Someone is cautious about expressing too much optimism.

g.Someone practices complementary therapies.

h.Someone completely hit the roof.

2.Listen again and check your answers.

3.Discuss these questions with your partner.

Have you ever tried any complementary therapies like shiatsu, aromatherapy or acupuncture? When? Why?

Do you think it’s true that dieting can be unhealthy?

Have you ever taken sleeping pills? Do you ever take anything in these situations: to calm you down, to help you stay awake, for headaches, when you have a cold?

Do you take any other kinds supplements? Why?

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IX. You will hear a woman telling a story. Put the pictures in the correct order

1.What is Alternative medicine? Think of various types of alternative medicine. Discuss in pairs. Have a class feedback. (Listening Extra, Unit 11.2, CD 2 tr. 9)

2.Predict the order of the pictures.

3.Listen to the story and check your answers.

4.Reproduce the story using the pictures as a guide.

5.Think about a story that happened to you about a health problem you once had. You can choose a true story, or you can make one up. Note down ten key words on a piece of paper, exchange papers with your partner and try to guess your partner’s story using the words as a guide. Tell your story. Your partner should say if they think the story is true or false.

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