Exercise 1-5

For example, you decide to consult the doctor in the first place because you feel unwell - this is personal knowledge about your own body.However, the doctor's expert diagnosis is based

1- The Power of Nothing

Want to devise a new form of alternative medicine? No problem Here is the recipe Be warm,sympathetic, reassuring and enthusiastic Your treatment should involve physical contact, and eachsession with your patients should last at least half an hour Encourage your patients to take an activepart in their treatment and understand how their disorders relate to the rest of their lives Tell themthat their own bodies possess the true power to heal Make them pay you out of their own pockets.Describe your treatment in familiar words, but embroidered with a hint of mysticism: energy fields,energy flows, energy blocks, meridians, forces, auras, rhythms and the like Refer to the K Jknowledge of an earlier age: wisdom carelessly swept aside by the rise and rise of blind,mechanistic science Oh, come off it, you are saying Something invented off the top of your headcould not possibly work, could it?

Well yes, it could – and often well enough to earn you living A good living if you are sufficientlyconvincing, or better still, really believe in your therapy Many illnesses get better on their own, soif you are lucky and administer your treatment at just the right time you will get the credit Butthat’s only part of it Some of the improvements really would be down to you Your healing powerwould be the outcome of a paradoxical force that conventional medicine recognizes but remainsoddly ambivalent about: the placebo effect

Placebos are treatments that have no direct effect on the body, yet still work because the patient hasfaith in their power to heal Most often the term refers to a dummy pill, but it applies just as much toany device or procedure, from a sticking plaster to a crystal to an operation The existence of theplacebo effect implies that even quackery may confer real benefits, which is why any mention ofplacebo is a touchy subject for many practitioners of complementary and alternative medicine, whoare likely to regard it as tantamount to a charge of charlatanism In fact, the placebo effect is apowerful part of all medical care, orthodox or otherwise, though its role is often neglected ormisunderstood

One of the great strengths of CAM may be its practitioners’ skill in deploying the placebo effect toaccomplish real healing “Complementary practitioners are miles better at producing non- specificeffects and good therapeutic relationships,” says Edzard Ernst, professor of CAM at ExeterUniversity The question is whether CAM could be integrated into conventional medicine, as somewould like, without losing much of this power

At one level, it should come as no surprise that our state of mind can influence our physiology:anger opens the superficial blood vessels of the face; sadness pumps the tear glands But exactlyhow placebos work their medical magic is still largely unknown Most of the scant research done sofar has focused on the control of pain, because it’s one of the commonest complaints and lends itselfto experimental study Here, attention has turned to the endorphins, morphine-like neurochemicalsknown to help control pain “Any of the neurochemicals involved in transmitting pain impulses ormodulating them might also be involved in generating the placebo response,” says Don Price, anoral surgeon at the University of Florida who studies the placebo effect in dental pain

“But endorphins are still out in front “That case has been strengthened by the recent work ofFabrizio Benedetti of the University of Turin, who showed that the placebo effect can be abolishedby a drug, naloxone, which blocks the effects of endorphins Benedetti induced pain in humanvolunteers by inflating a blood-pressure cuff on the forearm He did this several times a day for

several days, using morphine each time to control the pain On the final day, without sayinganything, he replaced the morphine with a saline solution This still relieved the subjects’ pain: aplacebo effect But when he added naloxone to the saline the pain relief disappeared Here wasdirect proof that placebo analgesia is mediated, at least in part, by these natural opiates.

Still, no one knows how belief triggers endorphin release, or why most people can’t achieve placebopain relief simply by willing it Though scientists don’t know exactly how placebos work, they haveaccumulated a fair bit of knowledge about how to trigger the effect A London rheumatologistfound, for example, that red dummy capsules made more effective painkillers than blue, green oryellow ones Research on American students revealed that blue pills make better sedatives thanpink, a color more suitable for stimulants Even branding can make a difference: if Aspro or Tylenolare what you like to take for a headache, their chemically identical generic equivalents may be lesseffective

It matters, too, how the treatment is delivered Decades ago, when the major tranquillizerchlorpromazine was being introduced, a doctor in Kansas categorized his colleagues according towhether they were keen on it， openly skeptical of its benefits or took a “let’s try and see” attitude.His conclusion: the more enthusiastic the doctor, the better the drug performed And this, year Ernstsurveyed published studies that compared doctors’ bedside manners The studies turned up oneconsistent finding: “Physicians who adopt a warm, friendly and reassuring manner,” he reported,“are more effective than those whose consultations are formal and do not offer reassurance”

Warm, friendly and reassuring are precisely CAM， s strong suits, of course Many of theingredients of that opening recipe — the physical contact, the generous swathes of time, the stronghints of supernormal healing power 一 are just the kind of thing likely to impress patients It’shardly surprising, then, that complementary practitioners are generally best at mobilizing theplacebo effect, says Arthur Kleinman, professor of social anthropology at Harvard University

29 An alternative practitioner who has faith in what30 The illness of patients convinced of alternative practice31 Improvements of patients receiving alternative practice32 Conventional medical doctors (who is aware of placebo)

Questions 33-35

Choose the correct letter, A, B, C or D.Write your answers in boxes 33-35 on your answer sheet.,

33 In the fifth paragraph, the writer uses the example of anger and sadness to illustrate that:

A People’s feeling could affect their physical behaviorB Scientists don’t understand how the mind influences the body.C Research on the placebo effect is very limited

D How the placebo achieves its effect is yet to be understood

34 Research on pain control attracts most of the attention because

A Scientists have discovered that endorphins can help to reduce pain.B Only a limited number of researchers gain relevant experienceC Pain reducing agents might also be involved in the placebo effect.D Patients often experience pain and like to complain about it35 Fabrizio Benedettfs research on endorphins indicates that

A They are widely used to regulate pain.B They can be produced by willful thoughts.C They can be neutralized by introducing naloxone.D Their pain-relieving effects do not last long enough

Questions 36-40

Do the following statements agree with the information given in Reading Passage 3? In boxes 36-40on your answer sheet, write

TRUE if the statement is true

FALSE if the statement is false

NOT GIVEN if the information is not given in the passage

36 There is enough information for scientists to fully understand the placebo effect.37 A London based researcher discovered that red pills should be taken off the market.38 People’s preference for brands would also have an effect on their healing

39 Medical doctors have a range of views of the newly introduced drug of chlorpromazine.40 Alternative practitioners are seldom known for applying the placebo effect

Exercise 2: Source of KnowledgeA What counts as knowledge? What do we mean when we say that we know some-thing? What is

the status of different kinds of knowledge? In order to explore those questions we are going tofocus on one particular area of knowledge medicine

B How do you know when you are ill? This may seem to be an absurd question You know you are

ill because you feel ill; your body tells you that you are ill You may know that you feel pain ordiscomfort Iml knowing you are ill is a bit more complex At times, people experience thesymptoms of illness, but in tact they are simply tired or over-worked or they may just have ahangover At other limes, people may be suffering from a disease and fail to be aware of the illnessuntil it has reached a late stage in its development So how do we know we are ill, and what countsas knowledge?

C Think about this example You feel unwell You have a bad cough and always seem to be tired.

Perhaps it could be stress at work, or maybe you should give up smoking You tool worse You visitthe doctor who listens to your chest and heart, takes your temperature and blood pressure, and thenfinally prescribes antibiotics for your cough

D Things do not improve but you struggle on thinking you should pull yourself together, perhaps

things will ease off at work soon A return visit to your doctor shocks you This time the doctor,drawing on yours of training and experience, diagnoses pneumonia This means that you will needbed rest and a consider able time off work The scenario is transformed Although you still have thesame symptoms, you no longer think that these are caused by pressure at work You now have proofthat you are ill This is the result of the combination of your own subjective experience and thediagnosis of someone who has the status of a medical expert You have a medically authenticateddiagnosis and it appears that you are seriously ill; you know you are ill and have evidence uponwhich to base this knowledge

E This scenario shows many different sources of knowledge For example, you decide to consult the

doctor in the first place because you feel unwell - this is personal knowledge about your own body.However, the doctor's expert diagnosis is based on experience and training, with sources ofknowledge as diverse as other experts, laboratory reports, medical textbooks and years ofexperience

F One source of knowledge is the experience of our own bodies; the personal knowledge we have of

change's that might be significant, as well as the subjective experience of pain and physical distress.These experiences are mediated by other forms of knowledge such as the words we have availableto describe our experience and the common sense of our families and friends as well as that drawnfrom popular culture Over the post decade, for example, Western culture has seen a significantemphasis on stress-related illness in the media Reference to being ‘stressed end' has become acommon response in daily exchanges in the workplace and has become port of popular common-sense knowledge It is thus not surprising that we might seek such an explanation of physicalsymptoms of discomfort

G We might also rely on the observations of others who know us Comments from friends and

family such as ‘you do look ill' or 'that's a bad cough' might be another source of knowledge.Complementary health practices, such as holistic medicine, produce their own sets of knowledgeupon which we might also draw in deciding the nature and degree of our ill health and aboutpossible treatments

H Perhaps the most influential and authoritative source of knowledge is the medical knowledge

provided by the general practitioner We expect the doctor to have access to expert knowledge Thisis socially sanctioned It would not be acceptable to notify our employer that we simply felt toounwell to turn up for work or that our faith healer, astrologer, therapist or even our priest thought itwas not a good idea We need an expert medical diagnosis in order to obtain the necessarycertificate it we need to be off work for more than the statutory self-certificaion period Theknowledge of the medical sciences is privileged in this respect in contemporary Western culture.Medical practitioners are also seen as having the required expert knowledge that permits thenlegally to prescribe drugs and treatment to which patients would not otherwise have access.However there is a rauge of different knowledge upon which we draw when making decisions aboutour own state of health

I However, there is more than existing knowledge in this little story; new knowledge is constructed

within it Given the doctor's medical training and background, she may hypothesize 'is this nowpneumonia?' and then proceed to look for eevidence about it She will use observations andinstruments to assess the evidence and-critically-interpret it in the light of her training and newexperience both for you and for the doctor This will then be added to the doctor's medicalknowledge and may help in future diagnosis of pneumonia

Scientific evidence

Medical knowledge from the general (30)………

e.g doctor’s medical (31)………Examine the medical hypothesis with the previous drill and(32) ………

Question 33-40The reading Passage has nine paragraphs A-IWhich paragraph contains the following information?Write the correct letter A-I, in boxes 33-40 on your answer sheet.

33 the contrast between the nature of personal judgment and the nature of doctor’s diagnosis34 a reference of culture about pressure

35 sick leave will not be permitted without the professional diagnosis36 how doctors’ opinions are regarded in the society

37 the illness of patients can become part of new knowledge38 a description of knowledge drawn from non-specialized sources other than personal knowledge

39 an example of collective judgment from personal experience and professional doctor40 a reference that some people do not realize they are ill

Exercise 3: The power of play

Virtually every child, the world over, plays The drive to play is so intense that children will do soin any circumstances, for instance when they have no real toys, or when parents do not activelyencourage the behavior In the eyes of a young child, running, pretending, and building are fun.Researchers and educators know that these playful activities benefit the development of the wholechild across social, cognitive, physical, and emotional domains Indeed, play is such an instrumentalcomponent to healthy child development that the United Nation High Commission on HumanRights (1989) recognized play as a fundamental right of every child

Yet, while experts continue to expound a powerful argument for the importance of play inchildren’s lives, the actual time children spend playing continues to decrease Today, children playeight hours less each week than their counterparts did two decades ago (Elkind 2008) Underpressure of rising academic standards, play is being replaced by test preparation in kindergartensand grade schools, and parents who aim to give their preschoolers a leg up are led to believe thatflashcards and educational ‘toys’ are the path to success Our society has created a false dichotomybetween play and learning

Through play, children learn to regulate their behavior, lay the foundations for later learning inscience and mathematics, figure out the complex negotiations of social relationships, build arepertoire of creative problem-solving skills, and so much more There is also an important role foradults in guiding children through playful learning opportunities

Full consensus on a formal definition of play continues to elude the researchers and theorists whostudy it Definitions range from discrete descriptions of various types of play such as physical,construction, language, or symbolic play (Miler & Almon 2009), to lists of broad criteria, based onobservations and attitudes, that are meant to capture the essence of all play behaviors (e.g Rubin etal 1983)

A majority of the contemporary definitions of play focus on several key criteria The founder of theNational Institute for Play, Stuart Brown, has described play as ‘anything that spontaneously is donefor its own sake’ More specifically, he says it ‘appears purposeless, produces pleasure and joy,[and] leads one to the next stage of mastery’ (as quoted in Tippett 2008) Similarly, Miller andAlmon (2009) say that play includes ‘activities that are freely chosen and directed by children andarise from intrinsic motivation’ Often, play is defined along a continuum as more or less playfulusing the following set of behavioral and dispositional criteria (e.g Rubin et al 1983)

Play is pleasurable: Children must enjoy the activity or it is not play It is intrinsically motivated:Children engage in play simply for the satisfaction the behavior itself brings It has no extrinsicallymotivated function or goal Play is process oriented: When children play, the means are moreimportant than the ends It is freely chosen, spontaneous and voluntary If a child is pressured, theywill likely not think of the activity as play Play is actively engaged: Players must be physically and/or mentally involved in the activity Play is non-literal It involves make- believe

According to this view, children’s playful behaviors can range in degree from 0% to 100% playful.Rubin and colleagues did not assign greater weight to any one dimension in determiningplayfulness; however, other researchers have suggested that process orientation and a lack ofobvious functional purpose may be the most important aspects of play (e.g Pellegrini 2009)

From the perspective of a continuum, play can thus blend with other motives and attitudes that areless playful, such as work Unlike play, work is typically not viewed as enjoyable and it isextrinsically motivated (i.e it is goal oriented) Researcher Joan Goodman (1994) suggested thathybrid forms of work and play are not a detriment to learning; rather, they can provide optimalcontexts for learning For example, a child may be engaged in a difficult, goal-directed activity setup by their teacher, but they may still be actively engaged and intrinsically motivated At this mid-point between play and work, the child’s motivation, coupled with guidance from an adult, cancreate robust opportunities for playful learning.

Critically, recent research supports the idea that adults can facilitate children’s learning whilemaintaining a playful approach in interactions known as ‘guided play’ (Fisher et al 2011) Theadult’s role in play varies as a function of their educational goals and the child’s developmentallevel (Hirsch-Pasek et al 2009)

Guided play takes two forms At a very basic level, adults can enrich the child’s environment byproviding objects or experiences that promote aspects of a curriculum In the more direct form ofguided play, parents or other adults can support children’s play by joining in the fun as a co- player,raising thoughtful questions, commenting on children’s discoveries, or encouraging furtherexploration or new facets to the child’s activity Although playful learning can be somewhatstructured, it must also be child-centered (Nicolopolou et al 2006) Play should stem from thechild’s own desire

Both free and guided play are essential elements in a child-centered approach to playful learning.Intrinsically motivated free play provides the child with true autonomy, while guided play is anavenue through which parents and educators can provide more targeted learning experiences Ineither case, play should be actively engaged, it should be predominantly child-directed, and it mustbe fun

Questions 27-31Look at the following statements (Questions 27-31) and the list of researchers below.Match each statement with the correct researcher, A-G.

Write the correct letter, A-G, in boxes 27-31 on your answer sheet.

27 Play can be divided into a number of separate categories.28 Adults’ intended goals affect how they play with children.29 Combining work with play may be the best way for children to learn.30 Certain elements of play are more significant than others.

31 Activities can be classified on a scale of playfulness.List of Researchers

A ElkindB Miller & AlmonC Rubin et al

D Stuart BrownE PellegriniF Joan GoodmanG Girsch-Pasek et al.

Questions 32-36

Do the following statements agree with the claims of the writer in Reading Passage 3? In

boxes 32-36 on your answer sheet, writeYES if the statement agrees with the claims of the winter

NO if the statement contradicts the claims of the writer

NOT GIVEN if it is impossible to say what the writer thinks about this

32 Children need toys in order to play.33 It is a mistake to treat play and learning as separate types of activities.34 Play helps children to develop their artistic talents.

35 Researchers have agreed on a definition of play.36 Work and play differ in terms of whether or not they have a target.Questions 37-40

Complete the summary below

Choose ONE WORD ONLY from the passage for each answer.

Write your answers in boxes 37-40 on your answer sheet.

Guided play

In the simplest form of guided play, an adult contributes to the environment in which the child isplaying Alternatively, an adult can play with a child and develop the play, for instance by

37……… the child to investigate different aspects of their game Adults can help

children to learn through play, and may make the activity rather structured, but it should still be

based on the child’s 38 to play.Play without the intervention of adults gives children real 39……….; with adults,play can be 40……… at particular goals However, all forms of play should be an

opportunity for children to have fun