John Fitzgerald: a characterisiation of daisy in the great gatsby

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1. Introduction

In the last chapter Nick describes Daisy and Tom Buchanan as „careless people […] they smashed up things and creatures and then they retreated back into their money or their vast carelessness, or whatever it was that kept them together, and let other people clean up the mess they had made."

That shows that Nick thinks about Daisy and Tom that they have got the same characters. They are cruel and d they do not care about other people. They have got no real friends and whenever there is a problem they just flee and do not think about the consequences.

But don not know what happened between Daisy and Tom when they arrived home after the accident. Was it Daisy's own decision to move away or was she influenced by Tom?

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The scene in the hotel room when Tom and Gatsby fight about Daisy shows that Daisy is just a "ball" which is thrown between the two men. She did not really know what she wanted and changed her mind from one moment to the other just because of some sentences that were said. Daisy is a weak person in this scene.

The question that rises is Is Daisy Fay Buchanan really one of the careless characters or is she just a victim of Tom's superiority?

In the following text I am going to examine Daisy's behaviour before, during and after she met Jay Gatsby.

. Analysis of Daisy's character

. 1 Chapter I IV Before the reunion

In the first chapter Nick describes his first meeting with Daisy and Tom Buchanan.

Soon we learn about Tom's superiority and his arrogant character. Nick describes him not only as a powerful man but also as a "cruel" man

"Now he was a sturdy, straw haired man of thirty with rather hard mouth and a supercilious manner. Two shining, arrogant eyes had established dominance over his face and gave him the appearance of always leaning aggressively forward. Not even the effeminate swank of his riding clothes could hide the enormous power of that body he seemed to fill those glistening boots until he strained the top lacing and you could see a great pack of muscle shifting when his shoulder moved under his thin coat. It was a body capable of enormous leverage a cruel body."

Tom likes his power, and like the potentates of Eastern kingdom

When we follow the first meeting between Nick and Daisy Fay Buchanan Daisy seems to behave like a child. She laughed all the time and talked with an "excitement in her voice that men who had cared for her found difficult to forget" .

Daisy is described as a little stupid Lady in a white dress. When her husband Tom talked about his book he had read she did not understand a word and interrupted him just to be part of the conversation.

She repeated the sentences she had heard from Tom without knowing what she said "We've got to beat them down, whispered Daisy, winking ferociously toward the fervent sun" .

Later in the first chapter we learn that Daisy is not very happy with her life. Tom has got a mistress in New York and Daisy is almost helpless.

She tells Nick that she "had a very bad time" and that she is "cynical about everything"

When she told Nick about giving birth to her daughter we see how she feels about life "Well, she was less than an hour old and Tom was God knows where. I woke up out of the ether with an utterly abandoned feeling and asked the nurse right away if it was a boy or a girl. She told me it was a girl, and so I turned my head away and wept. `All right, I said, `I'm glad it's a girl. And I hope she'll be a fool that's the best thing a girl can be in this world, a beautiful little fool. `"

Daisy also behaves like a "beautiful little fool ". We get the idea that she doesn't understand things very well. When she says the sentence about her daughter it becomes clear that she is very cynically about life and that she behaves only like a fool because this can protect her from many hurts.

In the second chapter Daisy does not play an important role but we learn something about the selfishness of her husband Tom.

On the party in Myrtle Wilson's apartment Tom hits Myrtle because she annoys him by insisting that she can say "Daisy" any time she wants. Tom breaks her nose with his open hand. So this is what happens to those who become entangled with Tom Buchanan. Tom, we see, is strong and brutal and absolutely selfish.

Chapter four is the next chapter in the novel where we learn something about Daisy. We learn something about her youth and about the time she met Jay Gatsby.

The story about Gatsby and Daisy sounds like a fairytale. The princess in this case is Daisy Fay, an eighteen-year-old beauty, the most popular girl in Louisville, Kentucky. All the officers from nearby Camp Taylor are competing for the honor of her company. On this particular day, she is sitting in her white dress in her white roadster with a young lieutenant who is speaking to her with the kind of romantic intensity that princesses adore. His name is Jay Gatsby. Daisy apparently loves him as much as he loves her, for she' s ready to go to New York to say good-bye to him when he' s sent overseas

We get the feeling that Daisy enjoyed it very much that all the officers fell in love with her and that she could get from them whatever she wanted.

I think that she did not really love the men she was together with. She just enjoyed the feeling that she was loved by everybody and she did not have to do very much for this.

When she met Tom Buchanan she realized that all his money and his "pomp and circumstances" would perfectly fit to a white princess as she was. I think that this was the only reason she married Tom Buchanan. He was rich and she wanted to marry someone who was rich and could give her the standard of living she wanted to have.

It was not until she got the letter from Gatsby that she thought of him. When she received the letter before her wedding she drank herself into a state of near stupor. That shows that this was the first time she really thought about her decision. It came to her mind that maybe she missed the love that Jay Gatsby had given her and that Tom could never give this to her.

But her decision was to marry money and not love.

Tom had an affair even a short while after his wedding. Since we already know that Tom is having an affair with Myrtle Wilson, it does not surprise us that Tom has been unfaithful before.

Daisy realized that Tom was unfaithful but she did not do anything against it. What the reader may think is that it did not hurt her that much because she still loved Gatsby but as Jordan describes it, Daisy has not given Gatsby a thought until the mention of his name jarred her memory.

The story about Daisy's youth has shown that she is a very superficial person. She did not care about the feelings of other people and married Tom Buchanan just because he fitted into her small "princess world".

Even when Tom Buchanan was unfaithful she did not leave him.

Her behaviour in the first chapters shows that she is not happy with her life. But on the other side she does not change anything.

Her husbands behaviour and his superiority lead us to the assumption that she is inferior to Tom.

She has never learned to lead her own life and is so far dependent on her husband.

. The reunion love or just romanticism?

In chapter five the reunion between Daisy and Gatsby takes place. Nick agrees to invite Daisy over.

When the day arrives Gatsby is so nervous that ha can hardly function.

Daisy looks absolutely beautiful in a three-cornered lavender hat, "with a bright, ecstatic smile" . She is dying to know why Nick has invited her over.

After Gatsby came in and shook hands with Daisy they drink tea together. They try to make conversation and after a while Nick excuses himself.

When Nick returns, the rain has stopped, the sun is out, and Daisy and Gatsby are radiantly happy. Nick can see that "Daisy's face was smeared with tears" .

We already know that Daisy is crying whenever she is overwhelmed by a situation and she can' t deal with it. It is her way to protect herself.

After tea Gatsby walks Daisy and Nick over to his house and shows them his possessions. When he shows daisy his shirts and throws them around in his room Daisy is overwhelmed and starts to cry again. Daisy admires the house, the gardens the gigantic rooms, the colours of pink and lavender, the sunken baths. The princess is astounded. Gatsby overwhelms her with these tangible signs of affection.

I think that Daisy is not only impressed by Gatsby' s possessions because she has got money herself. She is impressed by Gatsby's extraordinary dedication to his dream. She realizes that Gatsby just bought the house and all this possessions because of her. It is the first time in her life that somebody has done such a great thing for her. Tom also has got many possessions but for Tom she is part of the possessions. Gatsby has bought his possessions just for her. She is overwhelmed and moved to tears because she finds herself the object of so much adoration.

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Compariso Essay

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Comparison Essay

By: Xavier

College vs. University When you graduate high school you have your choice of what kind of an education you want to get. You have your choice of going to a 4-year university, or a 2-year college. In order to decide you will compare the two and use the comparisons to come up with your final decision. Questions to ask yourself would be, what are you looking for in college, how do you want to learn, and how much money do you have to work with. Comparing University and Community college the first thing that comes to mind is the difference in price. Certain Universities are more expensive than others. The difference in price is because of the difference in price and size, also because of the difference in the educational program they have. The price for a University can also differ with whether or not you are going to live there. With a Community college the price will differ significantly. The difference in price strands for the difference in size, teaching and living. At a Community college you have a smaller campus, the curriculum is different and you do not have the option of living there. When choosing you have to think of what you are looking for out of college. Some of you go to college go to play a sport for that college, in which case you would go to a University. At the time of graduation you are usually around 17 to 19, at this point in your life you have to think if you are ready to move out of your parents house and be on your own, and many do, again you would choose a University. There are some of you who want to stay under mom and dad's roof and just want to go to college to see what living by yourself is like, to see if you will like it. In this case you would choose a Community college. For some this can be one of the harder decisions to make. Another difference of a University and Community college is the size. Not just the size of the campus, but the size of the classes and workload that you will be facing. With a University you have a large campus with numerous class buildings and dorms. At a Community college you will usually have only one building and all that this building contains is classrooms for learning. Sizes of most University classes are over 30 of you to a class; sometimes that number can be as high as 100 students to a class. When you are a student at a Community college you are usually one out of twenty. The most you will probably find in a classroom of a Community college will be around thirty. Then there is always the size of the workload. When you go to a University you are usually expected to have to spend about 3 to 4 hours out of the classroom on your work, and that is for each class. That is why a large number of you that attend a University do not have jobs and if they do it is only part time. When attending a Community college you are expected to spend about 2 hours of time on work outside of the classroom, for each class. It may not seem as that much of a difference, but it is when a full course load at a University is 5 classes and a full class load at a Community school is 4 classes. Most of you who attend Community college have part or full time jobs. As you can see there are many differences when comparing University to Community college. It all depends on what you want out of college and what you can afford. For most there is one difference that is more significant then the other, that difference is usually what makes or breaks your decision.

Order essays on Compariso Essay and other topics

These are three characteristics of Oedipus personality. There are more but I think that the great idea he had for himself, the thirst he had for truth and his afraid of conspiracies were the most characteristics points of his personality in this play.

jealousy with Gene as Gene does with Finny. He never thinks of their relationship as a competition, but

Gene still feels overshadowed and controlled.

The inner war that Gene holds with Finny is what ultimately leads to Finny's crippling and death.

Before the accident Finny asks Gene to come watch Leper jump out of the tree for the Super Suicide

Society. Gene feels that Finny is trying to intentionally make him do poorly in his classes. Gene tells

Finny that if he goes it will ruin his grades. Finny is honest and says he never knew that Gene had to

study to get good grades. Gene realizes that Finny had made a parallel between his athletics and

Gene's studies; Finny thought that Gene's knowledge simply came to him. All at once Gene's

rationalization of Finny is destroyed, understanding that he and Finny are not really alike at all. Finny is a

good person free of envy and Gene is inferior. Gene feels once again, insignificant and secondary, and

releases his frustration by pushing Finny out of the tree. Even though the action was done on blind

impulse Gene still feels a sense of joy to have defeated someone who he considers an enemy and threat.

This entire accident was all a result of competition. After the accident Gene feels superior to

Finny and therefore, can be his friend not his rival. Gene is happy that Finny will never be as great as he

was. He will never be able to participate in sports or even walk as smoothly as he did. Gene feels he

has finally won the inner war he had with Finny and no longer has to compete against his best friend.

In "Bless the Beasts and Children" competition is also an substantial part of the theme. Box

Canyon Boys Camp is centered around competitions. Boys were not assigned cabins to stay in but

instead they found a group and cabin to be in. Competition separated the popular kids from the social

rejects and the winners from the losers. The Lally brothers, Teft, Goodenow and Shrecker were misfits.

They were wealthy, emotionally disturbed boys. They wet the bed, sucked their thumbs, and had

nightmares. No one wanted them in their cabin. Only one "normal kid", Cotton would tolerate and lead

the misfits.

Everything at the camp revolved around competition. Each cabin was a team. Each team

competed in riding, archery, riflery, crafts, swimming and field sports. All of the competitions were

scored. The teams would be ranked in order from highest to lowest and given Indian tribe names

according to their ranking. The highest ranked team was the Apaches, followed by the Sioux,

Comanches, Cheyenne, Navajo and the last place team was the "bedwetters". No one wanted to be the

"bedwetters". It was a shame and an embarrassment and that team was teased, tormented, and

taunted. While the Apaches acquired a head of a buffalo bull, the "bedwetters" received a large white

chamber pot. Cotton and his crew always were the "bedwetters". This caused them all feel very badly

about themselves. They all felt that they weren't anybody, useless and ineffectual. This feeling of

rejection caused and originated the mission to save the buffalo. They felt instant empathy when they saw

the defenseless, innocent animals slaughtered. Ironically the feelings of the animals was parallel with the

feeling of the young men. They knew the feeling of uselessness. The freeing of the buffalo symbolizes

the freeing of themselves, their own self-discovery and their maturation into

Many women and men are looking into human cloning because they

are infertile. But, the problem is that the U.S. congress is considering human

cloning for reproductive purposes to be a criminal act (Lampman 1). They

will have to wait a while if they want to have their child by cloning.

Another way to have a child is by vitro-fertilization, which allows the ability

to start a life outside of the womb (British 2).

Creating a human clone would have many birth defects because of all

the genes. There are over 30,000 genes in a body. There is no way they

could test over 30,000 genes. There would probably be mutations and such

in the genetic code of the body. There is a high risk of change in the genetic

code (Drlica 147).

In conclusion there should not be human clones until further research

is done on the subject. Before scientists start making human clones

scientists should get the success rate of animal clones up much more than

three percent. It could be beneficial but it will take a lot of research

and testing. Human cloning may be playing god but eventually someone

will make a human clone, whether it is in a year or one hundred years.

Works Cited

Gibbs, Nancy. "Cloning: Where Do You Draw the Line?" Time 13

Feb. 2001: 18-21

Gorman, Christine. "Cloning: Humans May Have It Easier." Time 27

Feb. 2001: 56-57

Lampman, Jane. "Transcript of our live event with Jane Lampman."

Yahoo.

http://www.csmonitor.com/monitortalk/events/pastevents/0628chatLo

g.html (6 Nov. 2001).

"British Government Panel Approves Human Cloning for Cell Research."

Yahoo.

http://www.cnn.com/2000/HEALTH/08/16/embryo.cloning.02/

(6 Nov. 2001).

Cole-Turner, Ronald. Human Cloning: Religious Responses. Los Angeles:

Westminister John Knox Press, 1997.

Drlica, Karl. Understanding DNA and Gene Cloning. New York: Jon

Wiley & Sons inc, 1984.

Gibbs, Nancy. "Baby It's You! And You, And You…" Time 19 February

2001: 46-57.

Goodman, Steve. "Should There Be Human Clones?" Faces: People, Places,

and ures. 16 January 2000: 6-11.

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Swimming lessons

If you order your research paper from our custom writing service you will receive a perfectly written assignment on swimming lessons. What we need from you is to provide us with your detailed paper instructions for our experienced writers to follow all of your specific writing requirements. Specify your order details, state the exact number of pages required and our custom writing professionals will deliver the best quality swimming lessons paper right on time.

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Welcome to The Peak swimming lessons. We are very excited to be teaching your children.

Some tips to make your child's swimming experience positive.

Please be on time and have your children use the restroom before class.

All girls need to have hair pulled back in one ponytail (if to short please pull out of face)

Custom writing offers papers on swimming lessons

Parents are welcome to sit on the north side of the pool, however if it becomes distractive to student the staff may ask parent to wait in the building.

Absolutely no unattended children on the deck.

Foul weather days will be made up, determined by staff.

All children under four years must wear a swim diaper.

Most important we want this to be a positive experience for your children and to see progression in their swimming, if you have any questions or concerns please discuss them with the staff.

Thank you Swimming Staff

Welcome to The Peak swimming lessons. We are very excited to be teaching your children.

Some tips to make your child's swimming experience positive.

Please be on time and have your children use the restroom before class.

All girls need to have hair pulled back in one ponytail (if to short please pull out of face)

Parents are welcome to sit on the north side of the pool, however if it becomes distractive to student the staff may ask parent to wait in the building.

Absolutely no unattended children on the deck.

Foul weather days will be made up, determined by staff.

All children under four years must wear a swim diaper.

Most important we want this to be a positive experience for your children and to see progression in their swimming, if you have any questions or concerns please discuss them with the staff.

Thank you Swimming Staff

Welcome to The Peak swimming lessons. We are very excited to be teaching your children.

Some tips to make your child's swimming experience positive.

Please be on time and have your children use the restroom before class.

All girls need to have hair pulled back in one ponytail (if to short please pull out of face)

Parents are welcome to sit on the north side of the pool, however if it becomes distractive to student the staff may ask parent to wait in the building.

Absolutely no unattended children on the deck.

Foul weather days will be made up, determined by staff.

All children under four years must wear a swim diaper.

Most important we want this to be a positive experience for your children and to see progression in their swimming, if you have any questions or concerns please discuss them with the staff.

Thank you Swimming Staff

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A multicultural Nation

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AUSTRALIA A MULTICULTURAL NATION

THE TOP O COUNTRIES FROM WHICH PEOPLE HAVE MIGRATED TO AUSTRALIA, plus THE PERCENTAGE OF THE AUSTRALIAN POPULATION IN JANUARY 188.

England 44% Ireland 17% Scotland 1% Italy 4% Germany 4%

Greece % Netherlands 1.5% China 1.% Croatia 1% Poland 0.8%

Malta 0.8% Lebanon 0.7% Spain 0.6% Sri Lanka 0.6% Vietnam 0.5%

France 0.5% Yugoslavia 0.5% Denmark 0.4% India 0.4% Hungary 0.%

see graph and world map on following pages.

ITALIAN AUSTRALIANS

There are more than 1 million people of Italian background in Australia. Italian Australians are the now the third largest ethic group in Australia.

Italians have been migrating to Australia for 00 years. The largest number came in the years following World War II.

SPECIAL FESTIVALS.

Most Italians are Roman Catholics and many festivals are linked to religious events. Christmas, Easter and Lent are important festivals for Catholics. Lent is 40 days of self-denial with one final indulgence of food and partying, Carnevale. Many Italians are named after saints, and people celebrate their saint's day as well as their birthday's.

The Italians are famous for having very close families. One festival they take very seriously is Festa dei Morti, a day when they pay their respects to any of their relatives who have died

.

Other main events in the Italian community are weddings, christenings and funerals. The celebrations at a wedding included a lavish meal of several courses, with different wines. The tradition was to invite the whole town but costs have become too great.

Farming families would also get together to make wine, salami, pasta and bread. Another custom was to get together to distil a spirit known as grappa.

Thousands of people from Sydney and different parts of New South Wales attend the Brookvale annual festival of Italian song and entertainment.

Every year, an Italian festival is held in Lygon Street, Carlton, Melbourne. Along this street, there are Italian restaurants. A street procession is held , along with all-night pavement parties.

TRADITIONAL FOODS.

Italian immigrants were among the pioneers of irrigation, grape, sugar and tobacco growing and the fishing industry. They are major producers of fruit and vegetables in Australia. They introduced new crops such as olives.

Italian food is very popular in Australia. When Australians eat at a restaurant, the dish they most commonly order is pasta. There are many kinds of pasta, including spaghetti, fettuccine, vermicelli, lasagne and cannelloni. Another famous Italian food is pizza. Pizza originally came from Naples, in the south of Italy. Nearly every town in Australia has a caf that sells pizza.

The Italians brought espresso coffee to Australia. Caf s everywhere serve Italian-style coffees. These include cappuccino, caffe latte and macchiato. Cappuccino is the most popular non-alcoholic drink in Australia.

Gelato is a kind of ice-cream with fruit or nut flavouring. This is another Italian food that is now an Australian food.

MULTICULTURALISM

In Australia, immigration has largely been encouraged as a means of expanding our economy and population. The numbers rise and fall depending on whether or not we think the economy can cope with the increased numbers.

Immigration has been an issue in Australia for many years. It was one of the main reasons put forward in favour of Federation. It was hoped that a federal government would control immigration, so 'undesirable' immigrants could not enter Australia. An 'undesirable immigrant was any person not of the 'British race'. This meant that only white people were welcome in Australia, and that those white people should come from the British Isles or some other British colony or ex-colony.

There were three reasons for this preference. The first was the concern that 'coloured' immigrants would work for lower wages than people in Australia, and so would take all the jobs. Secondly, it was feared that the existence of another large racial group would lead to violence. The third reason was pure racism - prejudice based on the belief that one race of people is superior to another. A hundred years ago it was not considered wrong to think of your own race as superior to others, or to think of other people as inferior simply because of their skin colour. The 'White Australian Policy' was the term used to describe the Australian immigration policy. To be eligible to migrate to Australia people had to pass a language test. Those consider 'undesirable' were given a test in a language they couldn't speak. This term 'White Australia' was used for many years and was not officially abandoned until 174.

In our society today, these ideas are cruel and wrong. Now people of many races, cultures and religions are accepted as Australians.

After wold war II, many refugees and displaced persons migrated to Australia from Europe and other places, where they had endured great hardship and suffering. They, and the migrants who came after them, wanted to make a better life in a new country .

After the war, Australia needed more workers, for example on the Snowy Mountains Hydro Electric Scheme. To provide the workers needed, the government aimed to bring in 70 000 migrants a year, mainly from the United Kingdom and other European counties.

In the 0 years after world war II, Australia's population doubled to 14 million. Immigrants and their children made up much of the increase.

In the 170s, refugees again began coming to Australia, this time from South East Asia. The Vietnam War ended in 175. Between 175 and 18, almost million Indochinese people fled their countries. During these years, almost 65 000 Indochinese refugees arrived in Australia. By 17, the Australian population consisted of about 00 different ethnicities, in addition to the Australian Aboriginal peoples. In that year, the Australian Government officially recognised the contributions made by all the different cultures to Australian society, and began to encourage all Australians to be proud of their origins. This belief that it is good for Australian society to be made up of many different cultures is called multiculturalism.

In the early 10s there was an increased emphasis on immigration and refugees from Asia. There has always been some controversy about accepting refugees. However, it was not until the arrival of 'boat people', refugees from Vietnam, Laos and Cambodia, and more recently asylum seekers from Afghanistan, that the Australia's refugee program came under the 'national and international eye'. As a member of the United Nations, Australia has an obligation to accept a reasonable number of refugees under the Universal Declaration of Human Rights.

The birthplace of overseas-born residents gives some indication of the diversity of ethnicity of a population. When Australian born residents with one or both parents born overseas are combined with overseas born a fuller picture of cultural diversity emerges.

The following data is derived from the 16 Census.

% of Australians were born overseas.

1.1% of Australians have at least one parent born overseas.

Around 70% of Australian born people with a least one parent born overseas live in NSW and Victoria.

Over 70% of Australian born people had both parents born in Australia.

Over 0% of Australian born people had at least one parent born in a non-English speaking country.

The major birthplaces of the overseas born population in 16 were England, New Zealand, Italy, Vietnam, Scotland, Greece, China, Germany, Philippines, and Netherlands.

The United Kingdom and Ireland account for about 78% of the overseas born population in 111 and only % in 16.

Nearly three quarters of the children of migrants (people born in Australia with one or both immigrant parents) marry people of different cultural background to themselves.

One in six families in Australia involves a marriage between an overseas-born and an Australian-born partner.

Everyone is entitled to an opinion on immigration, but it should be remembered that there are equally good arguments on all sides of debate. What is important is that people's arguments are based on reason and fact, not simply on emotions. I am for the continuation of immigration for those who are unable to live in their country safely.

There is probably no longer a need to increase Australia's population and expand the economy, But there is a humanitarian need to provide a stable home for people who, if they stay in their own homeland will die.

Detention camps are an unsatisfactory way to treat refugees, but I believe something similar is necessary in order to ascertain who is genuine.

Australia is a large country with much open space. We should be able to think globally and creatively to accommodate people in need.

This is a problem that will only get worse with the looming war in Iraq. Many Australians have little idea of life in a war torn country or living in a undemocratic society.

But if we ask ourselves the question, would we want another country to help us if we could no longer live safely in Australia?

Wouldn't our answer be yes!

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Improving Patient Outcomes The Role of Medicines and the

Innovative Pharmaceutical Industry in An Integrated Health System

Speech by Jean-François Leprince, President, Aventis Pharma, Chairman, Canadas Research-Based Pharmaceutical Companies, (Rx&D)

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OTTAWA (April 4, 00) Thank you Commissioner Romanow (and members of the Commission?) for allowing us to present our views on the future of health care in Canada. My name is Jean-François Leprince and I am President of Aventis Pharma and Chair of the Board of Directors of Rx&D. With me today is Murray Elston, President of Rx&D, the national association representing over 1,000 employees who work for Canadas 6 research-based pharmaceutical companies.

While several proposals are being put forth on the future of health care in this country, we are of the firm opinion that patient health outcomes should be the paramount consideration in the development of government health policy and the delivery of health services. We also believe that an effective solution to the issues facing our health care system in Canada must include measures to ensure that effective medications are accessible to patients and then used appropriately to achieve optimal health outcomes.

Innovative medications, when used appropriately, have been proven to prevent illness, effectively treat disease, improve quality of life and manage patient care outside of institutional settings. It is often the case that innovative pharmaceuticals help avoid hospital admissions and shorten hospital stays. Once patients are moved out of hospitals, however, their medication costs become an expense to either an insurer or themselves. This interface between hospital and community care can be problematic for patients, from both a clinical and an economic perspective. We believe there should be a seamless continuation of pharmaceutical therapy between these care settings, as unnecessary changes in treatment, often due to drug plan restrictions, can result in adverse health consequences for patients, and avoidable costs for the health care system.

Given the importance of medications, Rx&D believes that they should be considered a medically necessary component of the health system. There should be adequate coverage programs in place to ensure all Canadians have access to necessary innovative prescription medicines. This access should not be dependent on geographic location, age, gender or wealth. It should be up to health service providers, in discussion with patients and on a case-by-case basis, to determine whether pharmaceutical treatment is medically necessary. It is important to bear in mind that an individuals response to medications is unique in terms of effectiveness, side effects, compliance, and other measures. While it is a fact that large studies are undertaken to demonstrate the relative safety and efficacy of innovative medicines, the real test occurs when the individual is receiving the therapy. For those who do not respond as anticipated, it is imperative that other therapeutic options are available.

Advances in pharmaceutical therapy have a direct and measurable effect on the health of individuals and populations. New medications are approved for use in Canada only once they have been proven safe and efficacious. We must all commit to improving the use of these approved medications in patients that will benefit from them. The over-, or under-use of proven therapies has undesirable health and economic consequences and compromises our ability to achieve their full potential value. We refer you to the compelling examples of asthma and cardiovascular disease cited in our written submission to the Commission. Integrated efforts must be undertaken to promote and assure optimal drug therapy, including the involvement of physicians, pharmacists, other health professionals, payers, innovative pharmaceutical companies and, of course, patients themselves.

Education is a critical component of optimal medication use, as are monitoring systems to provide information and feedback on the effectiveness of treatment. Rx&D believes that to improve decision-making and to achieve an accountable, integrated health system, the government needs to encourage a disease management concept that relies on evidence-based, outcome-oriented performance indicators.

Less attention should be paid to administrative barriers such as reference-based pricing that are implemented solely to control drug plan costs rather than ensure optimal patient care. Evidence from reference-based pricing studies in Europe indicates that such policies do not control pharmaceutical costs over the long term. Norway abandoned the practice after concluding that the cost of running the program exceeded the savings on medicines. We include numerous examples, in our written submission, of peer-reviewed studies on reference-based pricing that clearly state the pressing need for more research to understand the full impact of such programs. To summarize, the effects of reference-based pricing on the use and cost of other health services, the administrative burden to physicians and pharmacists, and most importantly, the health outcomes of patients, have yet to be adequately analyzed. A systematic evaluation of reference-based pricing is therefore essential before such a policy is further endorsed.

Disease management programs have been shown to be effective strategies for optimizing patient care, and hold promise as one of the keys to ensuring the sustainability of our health care system. Such programs take a broad view of health management with a view to improving patient health outcomes while, at the same time, reducing the economic burden on society as a whole. They are centered around multidisciplinary, patient-focused approaches to implement best practices in the prevention, diagnosis and treatment of disease, and can result in significant benefits for individual patients and society at large. Such health management programs cannot be successfully approached in a piecemeal fashion, but must include the committed participation of all key stakeholders. We refer you to our written submission for examples of such programs, and studies demonstrating their benefits.

The Commission has seen evidence that medications are a growing portion of total health care costs. However, it is important for the Commission to recognize that patented prescription medicine costs account for less than 6 cents for every dollar spent on national healthcare. And though spending on pharmaceuticals is increasing, it is also important to understand that it is the utilization of medications and the aging of the population that is behind this trend. Provincial governments currently spend two-thirds of their drug budgets on patients over 65 years of age. And the governments own studies have shown that annual price changes of medications do not play a significant role in driving expenditures. In fact, prices of patented medicines have shown an average annual decrease since 188.

We must all recognize the global natures of the economy and health. The innovative pharmaceutical industry operates within a world market, and makes a substantial contribution to both health and the economy. With current Canadian government initiatives focused on both health and innovation, Rx&D is in a key strategic position to contribute to both agendas. The private business sector remains the largest single contributor to health-related research and development investment in Canada. We employ a highly educated workforce and support nearly 5,000 direct academic positions. Our companies invested approximately $1 billion in research and development in Canada in 001.

The Canadian and provincial governments, as well as our citizens, will continue to benefit from the contributions of the pharmaceutical industry so long as government policies take into account the interrelationship between industrial and health policy.

As we move forward, cooperation and partnerships to encourage the development and use of medications that will enhance the lives of Canadians must be sought. The human genome project promises to unlock a myriad of secrets about disease, prevention and treatment, and we should pursue this knowledge in a cooperative venture to ensure the information is used ethically and wisely.

Rx&D is fully prepared to partner with the federal, provincial and territorial governments, as well as other health care stakeholders, to implement the necessary reform and create the best health care system for Canadians. In doing so, we need to be turning our collective attention to supporting the development of new innovative medicines and ensuring their appropriate use to achieve the best possible patient outcomes. Encouraging innovation, removing access barriers to proven therapies, monitoring the outcomes of medication use, and keeping the patient at the focus of all these efforts are all principles worth pursuing in our quest to provide the best health care for the most people at the best cost, and ensure a bright future for health care in Canada.

Thank you Commissioner Romanow and members of the Commission for your attention. We would be pleased to answer any questions you may have.

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