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The success of generic medicines in the worldwide pharmaceutical industry - Free Essay Example

Sample details Pages: 23 Words: 6882 Downloads: 1 Date added: 2017/06/26 Category Statistics Essay Did you like this example? Chapter 1 Executive Summary This research will look at the adoption of generic medicines in specific three countries in Europe (The Netherlands, Poland and Portugal). These three countries have a significant difference in adoption; the reasons for this adoption difference can be explained by several regulations which are implemented by these countries. In previous research it is proven that regulations have a direct effect on the adoption however, this research will have a closer look which regulations in specific are important to stimulate generic medicines in the market. Don’t waste time! Our writers will create an original "The success of generic medicines in the worldwide pharmaceutical industry" essay for you Create order Results show that too much regulation around the entry of generic medicines in the market will lead to slow growth adoption in the market compared to countries which adopt less regulation. Recommendations to stimulate the generic medicines in the market will be presented in the last chapter. The problem background A lot of research has been done on the introduction of generic medicines. Examples include the obstacles to generic substitution in Sweden (Anderesson et al. 2005) and the use of generic medicines and the implications for the pharmaceutical market (King Kanavos, 2002). However, there is limited cross-country research examining the relationship between the implementation of regulation, the effects of incentives given to pharmacies and physicians and consecutive adoption of generic medicines. The available research is limited to one of these elements, there has not been made a direct consideration between these elements which influence the adoption of generic medicines. In 1995 the European Medicine Evaluation Agency (EMEA) offers a EU- wide authorization process which replaced the ongoing single authorization process of each country separately, this means that regulation is harmonized regarding the entry of generic medicines The EMEA will approve the generic entry of a medicine before it can be presented on the European pharmaceutical market. This centralized procedure has decreased the approval delays for generic medicines in the EU resulting in the fact that patent regulation and approval procedures for medicines no longer have a large effect on the development of generics (Danzon, et al. 2003). National regulation still has an impact concerning price and reimbursement approval which has to be authorized by national authorities. Moreover, it is examined that generics have had more success in countries with more flexible pricing policies (Garattini Tediosi, 2000) and previous research has shown that the prescription of generic medicines is dependent on the incentives given to pharmacist, and other parties (Hellerstein, 1998). However, with recent reforms in the national regulation systems across European countries, flexible generic pricing policies and incentives given by the national governments are no longer the main determinants of successful entry of generics on the market. Obligatory generic substitution systems and other regulations implemented by European governments have become at dominant factor in explaining the adoption of generic medicines as a consequence that incentives for physicians, pharmacists and patient have decreased due to the obligatory system (Timonen, et al. 2009). This thesis gives an overview of the relation between the adoption of generic medicines and the regulation in three European countries: The Netherlands, Portugal and Poland. These countries are chosen because they have different implementations in regulation concerning generics and the adoption rate in these countries differs significantly. Recommendations for European countries and a conclusion about the most effective method to increase the use of generic medicines in relation with regulation will be exposed. The problem statement The differences among three countries; (The Netherlands, Portugal and Poland), concerning the adoption of generic medicines in relation with regulation and influencing incentives in these European countries. The motive to present these specific three countries is resulting from the fact that the adoption level of generic medicines differs significantly. Therefore a clear image can be provided between the differences of adoption connected with the accompanying regulation adopted in that country concerning generic medicines Dependent variable: adoption of generic medicines Independent variable 1: regulation of generics medicines Research Questions Research question 1: What are the differences in regulation about the use of generic medicines among the Netherlands, Portugal Poland? Research question 2: What is the role of these regulations on the adoption of generics? Relevance The thesis should give European countries and in particular public policy makers, a clear image on the effects incentives can have concerning the adoption of generic when prescribing these medicines, and which type of regulation is the most effective for the increase in adoption of generics. Managerial perspective The prescription of generic medicines is intensively regulated. This results in many implications for pharmaceutical companies especially, concerning the implementation of generic medicines in the market. Considering, the fact that the regulation of the prescription of generic medicines has a direct effect on the use of generic medicines. Therefore the adoption level for generic medicines is likely to change when the regulation changes. Pricing strategies for pharmaceutical companies have a diminishing effect due to the strict pricing regulation implemented by public policy makers. Branding strategies are also complicated to implement in the pharmaceutical industry because of the many regulations adopted. However, branding strategies are very important; they can strengthen the bond between the buyer and the seller (Blackett Robins, 2001). Pharmaceutical companies have to make important decisions regarding the implementation of the generic medicines in the market. They should be aware of all regulation to be able to compete in the pharmaceutical industry. Academic perspective Country-specific results have been presented in several papers how regulation influences the use and adoption of generic medicines. However, a cross-country research on the effects of regulations implemented, in relation to the adoption of generic medicines. More specifically, the effects of incentives, given by policy makers, to pharmaceutical companies and the accompanying marketing strategies implemented by pharmaceutical companies, have not been examined earlier. Overview of the Rest of the Chapters Chapter 2: This chapter gives an overview on the question: What are the differences in adoption of generic medicines between the Netherlands, Portugal and Poland? These three countries will be investigated carefully; previous literature studies will give a clear image about the actual adoption of generic medicines in these countries. Background information will be presented to understand the structure of the chosen countries and the differences in adoption. Chapter 3: Data will be gathered to come to an answer to the research question 1: What are the differences in regulation about the use of generic medicines among the Netherlands, Portugal Poland? Chapter 4: Chapter four will explain the role of regulation on the adoption rate of generic medicines (research question 2). Chapter5: Public policy makers are in general in favour of increasing the use of generic medicines, because of the market advantages. Chapter 5 will give an overview of the most effective policy which is used among the three countries presented earlier in the thesis. Further recommendation to the public policy makers and limitations of the research will be dealt with in this chapter. A conclusion of this research will be presented. Chapter 2: differences in adoption of generic medicines This chapter will give an answer to the differences concerning the adoption of generic medicines between the Netherlands, PortugalandPoland. The level of generic medicine adoption differs significantly across Europe. This chapter will have a look at these differences and the resulting factors that have lead to these differences in adoption. Other implications such as different policy regulations and incentives given to pharmacist by the policy makers will be dealt with in chapter 3. They will be dealt whit in a separate chapter because they are dominant factors in the adoption of generic medicines. A distinction can be made between mature generic markets and developing generic markets (Simoens, 2009). The level of adoption of generic medicines in these countries differs from less than 10 per cent to more than 40 per cent. The share value in the market for generic medicines is 8.8 per cent for the Portugal, 19.8 per cent in the Netherlands and Poland ranks the top with 65.2 per cent (A Review on the European, n.d.). Comparing these figures with other European countries, Portugal falls in the lower range of adoption and Poland is situated in the upper range of the adoption level of generic medicines in their market. According to Simoens and Coster, (2006), Poland and the Netherlands are seen as mature generic markets in Europe, while Portugal is seen as a developing market. There are several factors (historical background and cultural elements), which have influenced the adoption rate of generic medicines in these countries. Clarifications of these elements are stated below. Historical background An explanation for the differences in adoption of generic medicines can partially be explained by the historical differences between the Netherlands, Portugal and Poland. In Western Europe, pricing and reimbursement policies naturally developed as an evolutionary economic process. However, this was not the case for Central and Eastern Europe states (CEE) which are now members of the EU. These CEE countries used to have a socialistic type of economy, and after the fall of the Berlin wall (1989) many of those countries faced political and economic bankruptcy. Large-scale reform was necessary in every single sector to guarantee their economical and political well being. The health care system was also a part of this sector and even today, ongoing reforms are taking place. There is still a lot that has to be done in the CEE countries, specifically within the health care system. Hospital decentralization, modernization and privatization and pricing and reimbursement policies are some examples of areas where further development is preferred (Kazakov, 2007). These necessary reforms and changes are also applicable to Poland. The Netherlands and Portugal do not suffer from these reforms, due to fact of not having a communistic history. Another implication of this socialist history is the fact that Poland was already used to adopt generic medicines, as brand medicines were not available in these countries due the absence of product patents until early 1990s (Simoens de Coster, 2006). Cultural elements Cultural sensitivity is one of the most widely accepted principles among public health (Resnicow, et all. 2000). According to Resnicow (2000), cultural sensitivity indicates The extent to which ethnic/cultural characteristics, experiences, norms, values, behavioral patterns, and beliefs of a target population as well as relevant historical, environmental, and social forces are incorporated in the design, delivery, and evaluation of targeted health promotion materials and programs (page 272). The relation between the pharmacist and the pharmaceutical representative can have a huge impact on the prescription of medicines and therefore on the adoption of generic medicines. Historical developments in Poland have created a positive attitude towards prescribing generic medicines, as prescribing generic medicines has been a common practice in Poland until the early 1990s. In the Netherlands, on the other hand, generic substitution is more driven by the pharmacist (Simoens de Coster, 2006). On average a pharmaceutical company will spend twice as much on marketing to the pharmacist and the public than on research and development (Zipkin, et all. 2005). A more detailed view about the adoption rate of generic medicines concerned the three countries (the Netherlands, Poland and Portugal) are presented below: The Netherlands The Dutch generic market has grown rapidly over time; public expenditure has increased from 185 million euro in 1994, resulting in a market share value of 8.5 per cent. In 2004 the market share has increased to 17.7 per cent; this means that the value has almost doubled. The market share increased also dramatically from 19.9 per cent in 1994 to 44.3 percent in 2004 (Simoens de Coster, 2006). Results from an EGA survey conducted in 2007; show that the market share of generic medicines has increased to more than 50 per cent (see figure 2 and 3 in appendix B). Poland Due to historical implications mentioned before, Poland has a very mature generic market. In 2006 the market shares of Poland were 60 per cent by value and close to 80 per cent by volume (see figure 2 and 3 in appendix B). Portugal In the 1990s the generic medicines adoption in Portugal did not exceed more than 1 per cent. An introduction in the generic policy in the year 2000 caused for an increase in market share of 8 per cent measured until 2004. An explanation of the generic policy will be provided in chapter 3 (Simoens de Coster, 2006). Recent results from an EGA survey implemented in 2007 show that the market share has slightly increased to almost 10 per cent (see figure 2 and 3 in appendix B). Chapter 3: differences in regulation about the use of generic medicines What are the differences in regulation about the use of generic medicines among the Netherlands, Portugal Poland? There are several domains in regulation which will eventually influence the structure of the market and determine how the pharmaceutical companies can operate most effectively in this pharmaceutical market. This thesis presents the most important domains where regulations are implemented; market authorisation, pricing, incentives, and marketing implications. Market authorisation In Europe, the process regarding market authorisation is very complex. Market access for generic medicines may differ from country to country; this holds there is little transparency regarding the entry of generic medicines in Europe. A pharmaceutical company may receive market authorisation to enter the market in a specific country. However, other regulations regarding the reimbursement and price of the generic product still need to be determined by the government. This means the process, concerning the entry of the generic medicine, can be delayed up to three times (A Review on the European Generic Pharmaceutical Market in 2005, n.d.). The EU directive was introduced to create a better system regarding the entry of generic medicines in Europe. There is a transparency directive, 89/105/EEC, which specifies that there is a 90 day limit regarding the reimbursement and pricing decision. However, the time delays vary from country to country (Garattini Tediosi, 2000). The table below (A Review on the European Generic Pharmaceutical Market in 2005, n.d.) gives an overview of the times delays per country for price approval to enter the market. With respect to the countries in this thesis, the table above (A Review on the European Generic Pharmaceutical Market in 2005, n.d.). shows the following: Poland does not have a time delay because the pricing and reimbursement approvals are granted together with the market authorisation of the generic medicines. In the Netherlands, we can see a delay of between 10 and 15 days which could be defined as a relatively efficient time to approval compared to other countries in Europe. Portugal is very inefficient with the entry of the generic medicines, the status of pricing and reimbursement will only be given after a 90-day delay (A Review on the European, n.d.). Pricing Price regulations are only applicable when the generic medicines will be reimbursed. The most effective regulation is a price restriction on the maximum reimbursement of that specific medicine or a maximum price that pharmaceutical companies may charge the medicine users (Danzon Keuffel, 2007). Most European countries, including the countries in this study, have introduced a reference price system. A reference price system entails that there are regulations which will restrict the reimbursement level of generic medicines, but that the price of the generic medicines itself will be uncontrolled. Under the reference price system, groups are clustered into certain reimbursement level, based either on the same compound or different compounds but with the same mode of action or with a similar name. All products that are placed in the same group are reimbursed at the same price per daily dose, which is also called the reference price. In general, the reference price in a group will be set at the level of the cheapest medicine or the median in that group. If pharmaceutical manufacturers price their product above the reference price, the user of the generic medicines needs to pay the outstanding amount above the reference price. There are two different pricing systems in Europe: a generic free pricing system and a generic price-regulated system. Both systems determine the degree of adoption of generic medicines. In a generic free pricing system companies can decide on the height of the price of a new generic medicine introduced in the market themselves, in contrary to a price regulated system (Simoens, 2010). The reference pricing system has three levels of implementation, the higher the level of the system is, the more the prices are regulated. Poland has a low reference pricing system, the Netherlands could be defined as a medium reference pricing system and Portugal uses a high reference pricing system. As presented in the table below (Bongers Carradinha, 2009), one can see which European countries fall in a regulated price system and have no free pricing system. Consumer implications The patients themselves (the demand side) play an important role in the prescription of generic medicines. Physicians and pharmacists and other contributing parties will prescribe generic medicines to reduce the costs for the payer, which is in this case the consumer of the medicine. Patient co-payment Pricing and reimbursement systems play a role for the patient. The patient will contribute to the financing of the health care system, in particular with the co-payment arrangement. This is a common practice in all European countries (with the exception of Malta), but the implementation of co-payment differs significantly across countries. Nevertheless, in all countries that employ a co-payment arrangement a financial contribution is made by the medicine user. Patient co-payment arrangements can strongly influence the end decision of the patient on which medicines to take (A Review on the European Generic Pharmaceutical Market in 2005, n.d.). The reimbursement of generic medicines is taken care of through an insurance model; however the co-payment arrangement is based on a percentage of the cost of the medicine (Kazakov, 2007). Pricing regulation related to the countries in the thesis; The Netherlands uses an enforcing pricing regulation, which sets a maximum for the pricing of medicines. In 1996, this system was implemented. In general, it led to a decrease of 15 per cent of the average medicine price in the market (Simoens de Coster, 2006). However, the prices of generic medicines in the Netherlands still tended to be higher compared to other EU countries. Mediation in short-term pricing strategies such as implementing similar pricing systems, have increased and stimulated the share in the markets for generic medicines, where competition already existed (Bongers Carradinha, 2009). Polish medicine prices tend to be lower compared to other EU countries. They work with a price regulated system for generic medicines. The pharmaceutical companies want to be absorbed in the reimbursement list for medicines. The reference price in Poland is set just below or just above the cheapest generic medicines in the Polish market (Simoens, 2009). Pharmaceutical companies may price their product above the reference price, taking into account that as a result they will not be placed on the reimbursement list (Kazakov, 2007). Portugal established a regulation which says that the minimum price difference of generic medicines and brand medicines should be a least 35 per cent in 2001. In 2005 Portugal agreed to reduce the overall medicine prices by 6 per cent. Of that 6 per cent 4.17 per cent had to be reduced by the pharmaceutical company and the other 1.93 per cent had to be reduced by the wholesalers and pharmacists. The reference price system was introduced in 2003 where the reference price was set at the level of the most expensive generic medicine (Simoens de Coster, 2006). Despite the fact Portugal has a developed market, the market share concerning generic medicines is still relatively low compared to other countries in Europe. Regardless, of the fact that companies producing generic medicines provide affordable treatments to patients, other savings can only be achieved if government supply side policy initiatives are designed to increase the competitiveness of generic medicines in the market (Bongers Carradinha, 2009). Incentives To establish a generic medicine market, the supply side (pricing system) needs to be supplemented by demand side policies which create incentives for physicians, pharmacists, and patients to use generic medicines (Simoens de Coster, 2006). The Netherlands Instruments to promote generic medicines have been in place for a long time and have been widely accepted in the Netherlands (Vogler Schmickl, 2010). Incentives for physicians The Dutch government has stimulated physicians to prescribe generic medicines, which is supported by an electronic prescription system. In the Netherlands it is customary to develop and implement guidelines and treatment protocols on how to prescribe generic medicines in order to efficiently increase the adoption of generic medicines. An important feature is that there are no sanctions for physicians who do not prescribe generic medicines (Simoens de Coster, 2006). Incentives for pharmacists Generic substitution is allowed for the pharmacist when the physician and the patient agree with it, however, it could be indicated by the physician that generic substitution is not permitted due to health reasons. This means that when a branded drugs patent has expired pharmacists are allowed to distribute a generic substitution unless indicated otherwise by the physician. Health insurers have also agreed upon several targets for the pharmacist in distributing generic medicines (Simoens de Coster, 2006). Generic substitution has been connected to financial incentives for the pharmacist for a long time, however these incentives have been abolished since 2004. Nevertheless, the adoption in the market of generic substitution has not decreased (Vogler Schmickl, 2010). Incentives for the patients In the Netherlands the patients do not have a financial incentive to buy generic medicines because there are no patient co-payments arrangements. Nevertheless, patients do have to pay the outstanding amount when the price of the medicines is above the reference price, which is set by the government (Simoens de Coster, 2006). Poland Incentives for physicians Physicians are not intensively encouraged to prescribe generic medicines. Due to the historical background physicians are already accustomed with the use and prescription of generic medicines (Simoens de Coster, 2006). Incentives for pharmacist Generic substitution is allowed by pharmacists; whenever a branded drug is prescribed a pharmacist may replace this by a generic substitution. Pharmacists are obliged to inform the patients about the generic substitution. Price reductions implemented by pharmaceutical companies encourage pharmacists to prescribe generic medicines (Simoens, 2009). Incentives for the patient There are four levels of reimbursement for the patient. The first level includes a fixed amount per prescription which will be reimbursed when these are essential medicines. The second and third level consist of supplementary medicines which will be charged to the patient through the co-patient system. The patients have to pay 30 to 50 per cent themselves. The fourth level holds that other prescribed medicines which are not on the reimbursement list will be fully paid by the medicine user (the patient). However, initiatives to inform the patients about generic medicines have not been presented (Simoens de Coster, 2006). Portugal Incentives for physicians In 2002, a regulation was implemented in Portugal which formulated that from that moment on physicians would be obliged to prescribe a generic medicine if possible. However, physicians and pharmacists are free to add brand medicines to prescriptions that include more than one medicine, of which at least one is generic. The physicians are to inform the patient about other generic medicines and the accompanying price differences. Even though guidelines are available, the system has not been fully implemented. An explanation for this is that the physicians and the pharmacists are neither being rewarded for prescribing, nor being punished when not prescribing generic medicines (Simoens de Coster, 2006). Incentives for pharmacists Physicians can indicate whether they permit generic substitution on the prescription form. In the cases that generic substitution is allowed by the physician, the pharmacists have to prescribe the cheapest generic medicines available. Pharmacists do not have any financial incentive to prescribe generic medicines as the generic margins for pharmacists have been dramatically low since the introduction of the regulation in 2005 (the overall reduction of generic medicines prices) (Simoens de Coster, 2006). Incentives for patients Portugal has 5 different levels of reimbursement. In the first level 100 per cent of the medicine will be reimbursed when they are classified as life saving. The second level holds that 95 per cent of the medicines will be reimbursed, the third level holds 70 per cent, the fourth level 40 per cent, and the fifth level holds a percentage of 20 per cent. Patients with a low income will receive a 15 per cent additional compensation on the stated reimbursement level. Until 2005, patients were rewarded with a 10 per cent additional reimbursement when they asked for a generic substitution. However, with the abolishment of the reward system of 10 per cent, the patient will now only receive a price reduction of 6 per cent for the use of generic medicines. The patient does not have an incentive but rather a discouraging effect to use generic medicines. Nevertheless, pro-generic campaigns have been introduced by the government since 2006; the effects of these campaigns are not yet clear (Simoens de Coster, 2006). Previous research shows that the patient co-payment arrangement in Poland and Portugal plays a visible role in stimulating the use and adoption for generic medicines (Simoens de Coster, 2006). For an overall overview of the regulation implemented across these three countries a table is presented below. Poland The Netherlands Portugal pricing Reference pricing low Medium high Patient co-payment yes no yes reimbursement 4 levels Pay excess when Above RP 5 levels Adoption level Very high mature market Medium mature market Low developing market Incentives Physician Not encouraged but accustomed to prescribe Stimulate to prescribe obligated pharmacist Allowed and have financial incentive Allowed unless indicated else Allowed but no financial incentive patient Financial incentive No financial incentive No financial incentive Marketing implications A generic medicine should appear under the international non-proprietary name (INN). This entails, that a generic medicine should be marketed without a commercial brand name but in fact, three categories there can be distinguished; branded generics (copies of generic medicines with their own brand name), semi-branded generics (products marketed under the INN following the name of the manufacturer of the medicines) and medicines marketed under INN (Garattini Tediosi, 2000). The EU directive 65/65/EEC was established, to approve marketing of a drug. An allowance for introducing a generic medicine and detailing these medicines should be supported by several data available of the generic medicines (for example clinical data.) There are a lot of restrictions concerning advertisements and promotion activities of pharmaceutical products. These are presented by the The European Parliament and the Council of the European Union (2004) .Together with price regulation, advertising plays an important role in the pharmaceutical market. In general patients are uninformed about the most effective and available treatments, they depend on the diagnosis and treatment suggestion from the physician. Since the physician will prescribe the medicine it can be stated that they will directly affect the extent of competition between different treatments and medicines available. Therefore it not remarkable that the physician is the target of huge advertisement campaigns and that detailing in the pharmaceutical industry is mainly focused on physicians (Knigbauer, 2006). The volume of detailing in the pharmaceutical market depends on several factors such as: the prevalence of the disease, the amount of competition for the medicine, the number of physicians who might prescribe the generic medicines, and like any other product in a market, taking into account the product life cycle of the product (Berndt, et al 2007). Chapter 4 What is the role of these regulations on the adoption of generics? Market authorisation Approval of generic medicines The success of a generic medicine depends on several factors including; patent, approval to the market, pricing and reimbursement. These factors eventually lead to successful product life cycle of a generic medicine. The generic medicines can be approved after the patent of the originator medicine is expired (Frequently asked questions about generic medicines, n.d.). Approval to the market will be regulated by the coordinating organization EMEA; they will approve a generic medicine, resulting in the fact that it can be launched on the EU market. The National authority of the EU countries will eventually approve the price and reimbursement authorization. These separated approvals can cause delays in the approval of a generic medicine in a country, while price and promotion regulation also affect the success of a product life cycle regarding a generic medicine (Danzon, 2003). Decrease in national medicine expenditure The national governments and the EMEA, which approve the market authorization for generic medicines, create a decrease in national medicine expenditure. A good regulation for generic medicines will increase the adoption level of generic medicines. The low development of new medicines and the increasing expiry dates of patent medicines has lead to a competitive generic market, the involving regulations (e.g: price regulations) will stimulate the adoption in the EU market (Garattini Tediosi, 2000). The ageing population in Europe, with its coherent prevalence age-diseases and the need for more specialized and individualised care treatments in Europe, will result in a considerable increase in pharmaceutical costs in the future. (see appendix figure 6) Pricing Introducing a controlling price system is a way to control supplier moral hazard. It applies to all services; this is also the case for the pharmaceutical industry. Consistent with this view of pharmaceutical price regulation, it can be seen that it has become a fundamental strategy for insurances to control the supplier moral hazard. In general it can be stated that price controls, in most countries, apply only when medicines are reimbursed by the public health insurance (Danzon Keuffel, 2007). Policy implications The reference pricing system which is implemented by the European countries plays a role in the economic pharmaceutical market. This means that the European countries influence the market entry of generic medicines and the price level of generic medicines on the supply side (Simoens de Coster, 2006). Subsequently, the reference price system will cause that pharmaceutical companies will decrease their prices, assuming that the demand for the generic medicine will become inelastic when pricing the product above the reference price (Danzon Keuffel, 2007). However, it is important to notice that the primary objective of a reference price system is to control the pharmaceutical expenditure by controlling the reimbursement level of medicines. The objective is not to stimulate generic use (Simoens de Coster, 2006). This means that countries in favour of free market pricing generally have higher medicine prices. High medicine prices stimulate generic market entry, in contrary to regulated price systems (e.g. Portugal) where regulation prices drive down the originator price over the life cycle of the medicine. This lowers the potential profit margin for a generic company and discourages market entry (Simoens de Coster, 2006). According to the internal EGA survey, in the case of compulsory prescriptions, doctors are encouraged to prescribe generics in 56 per cent more cases than when it is not compulsory. Only 11 per cent of European countries implement a compulsory subscription system. There are guidelines to inform doctors about the prescription and assist them in the procedure of prescribing (A Review on the European Generic Pharmaceutical Market in 2005, n.d) Incentives The consumer is not only responsible for the adoption of generic medicines in the market. The physician also plays an important role in the prescription of generic medicines. The physician will determine which specific medicines a patient will use and in which therapeutic class the medicines will be used. The therapeutic class will be determined from the input of the physicians and the patient together. Therefore it can be stated that this relationship is not only a principle agent relationship but that the patient- physician relationship can also be seen as a partnership due to the interaction of both parties (McCarthy, 2010). Overall, it can be stated that incentives given to physicians, pharmacists and patients have limited focus, in accordance with the improvability of regulation system incentives can stimulate an increase in adoption. Marketing implications Persuasive advertising namely, product differentiation stimulates generic medicines in the market. This will cause for lower prices of the medicines in specific after the patent is expired. The advantages of these lower prices have been explained earlier, in this chapter. Brand- name advertising will decrease the adoption in the market for generic medicines because price elasticity of demand in the pharmaceutical will decrease due to the fact that brand loyalty has increased (Knigbauer, 2007). Important to notice is that the regulations cannot affect the incumbent level of advertisement nor can they control the pharmaceutical firms whether they enter the market with generic medicines. However, regulations can manipulate the conditions under which the incumbent chooses to the profit maximization level. In addition health authorities can guide the extent physicians are allowed to accept gifts or sponsored reference trips to reduce the obligation of the physician to prescribe a specific brand or product. Detailing is generally allowed under strict condition concerning advertisement. It is assumed that detailing is mainly used to inform the physician or patient. Lenient price regulation will strengthen the advertisement advantages by allowing generic medicines in the market and restricting high patent prices (Knigbauer 2007). Chapter 5 Recommendations: General recommendations Time is an important factor when concerning the approval of generic medicines for the market. It can give a significant value to different patient groups, and therefore a reduction in the delay in approval for in the market of a generic medicine is crucial (Kazakov, 2007). This can be accomplished by a more transparent system. Considering the restrictions regarding promotion and advertisement of medicines, pharmaceutical companies have to find ways to introduce the product to the prescriber and the user of the generic medicine. Price competition also limits the revenue for pharmaceutical companies, this leads to a very competitive even rivalry pharmaceutical market. As a result, pharmaceutical companies have to respond to regulation in such way; they make a profit out of the regulation for their own interest. This complies with an ongoing regulation changes that have to be induced (Richard Frank, 2007). Another implication with price regulation can arise, when the price of generic medicines is too regulated. Resulting in a low percentage of competitive medicines available, causing a higher (monopolistic) price (Knigbauer, 2006). In other words, in a flexible pricing system, a pharmaceutical company has the opportunity to compete with other companies using pricing strategies taking into account the restrictions enforced by the national regulation in specific taken into account reference price. Therefore a flexible pricing system is recommended over a strictly regulated system (for example: Portugal). Other measures recommended are Pro generic measures. In particular, the areas of pricing and reimbursement mechanisms should be improved and be more transparent. Governments should also try to increase the knowledge of patients by informing them about generic medicines. This can be done through the channels of physicians and pharmacists (A Review on the European Generic Pharmaceutical Market in 2005, n.d.). Although there is no concrete or well defined policy concerning the encouragement of the physician in the countries where measures exist toward the encouragement of prescription of generic medicines by the physician have a higher adoption level compared to countries who do not adopt such measures. Therefore measures encouraging physicians to prescribe generic medicines (example: budgetary incentives or prescription monitoring) are recommendable for all European countries (Bongers Carradinha, 2009). Finally, it remains difficult to recommend one best fitting regulation to implement for all European countries due to the fact that the adoption level concerning generic medicines differs significantly across European countries and not all regulations fit when there is a difference in the maturity of the market. Therefore one strategy will not be compliable anymore for all European countries. However a more transparent and central European regulation model should guide all European counties into one direction. Specific recommendation for the Netherlands, Poland and Portugal Given, that the adoption rate of generic medicines in the three concerning countries presented in the thesis have a significant difference and taking into account the different regulation presented above. There can be made several recommendations for the concerning policy makers in the specific countries. The Netherlands As mentioned earlier in the thesis, generics have a better adoption rate when the country has introduced a flexible pricing system, however, it does result in a higher medicines price compared to other EU countries (Garattini Tediosi, 2000). The Netherlands has developed an electronic subscription system however this is not completely introduced yet; a complete implementation of this system together with better transparency concerning pricing should create a competitive generic market. Poland Poland has chosen for a low Reference Pricing system by putting the reimbursement level on the cheapest generic medicine. When Poland switches to a flexible pricing system the adoption rate can increase, this is examined in previous research (Garattini Tediosi, 2000). However Poland should take in account that medicine prices will increase. Portugal As presented earlier in chapter 3, regulated pricing system drive down the price of generic medicines; resulting in a discouraging entry for generic medicines. Therefore it would be recommended to abolish the regulated pricing system and implement a flexible pricing system. This encourages pharmaceutical companies to adopt in de Portuguese market. In general Portugal should create proper regulations and conditions that increase the competitiveness and stimulate the entry of generic medicines (Bongers Carradinha, 2009). Limitations The research presented above is focused on three chosen countries (The Netherlands, Poland and Portugal). Due to the different national policies and regulations some regulations applicable specific for the countries presented in the thesis may not be declared applicable to other European countries. Therefore assumptions and conclusions for all European countries cannot be made or are not representative. However, it is possible to present European countries a guideline what a favourable policy or regulation would be considering the outcomes of these countries. Further comparisons between European countries should be made. A better insight of the ultimate adoption of generic medicine can be investigated; this can be done by comparing all developed generic markets in Europe. A more detailed insight should be presented of the European countries concerning several strategies and temporary policy agreements to explain particular increases in a specific period of time in relation with the adoption of generic medicines in the market. In extension of this further research and more detailed and concentrated adoption results of generic medicines in the market should be retrieved. Policies and regulations concerning a further increase of generic medicines in the markets have not been investigated. Therefore developed generic markets should try to find new short-term strategies or regulations which can increase the total adoption in the market for generic medicines, this to prevent that the increase of adoption concerning generic medicines will stop. Perception of neither the physicians nor the patients is included as a mediating variable. Research is conducted about the perception of generic medicines concerning these parties, as mentioned previous in the research the patients can play an influencing role in the prescription of the drugs. This can have consequences when taking in account that European countries have different cultures and therefore different perceptions regarding generic medicines. Conclusion It can be concluded that countries which do not have a long-term or consistent generic medicine regulation implemented, are in general countries that have the smallest market volume in the generic medicine market (see figure 7 appendix). These countries are creating little awareness and economic benefits for the healthcare system. Savings for governments and affordable prices for patients are minimal (Bongers Carradinha, 2009). Regulations implemented in a country, have a direct effect on the adoption of generics medicines in the pharmaceutical market. Flexible pricing systems are favored above strict price regulations, it encourages the pharmaceutical industry to develop and establish a better generic market in the concerning country, competitiveness among pharmaceutical companies will increase. Moreover pharmacists, patients and physicians are also encouraged to use and prescribe generic medicines. A flexible pricing system results in increasing adoption of generic medicines in the market (example the Netherlands). In general, we can conclude that regulations concerning generic medicines can constraint or provide the adoption of generic medicines in the pharmaceutical market. The Highest market share concerning generic medicines is found in countries where the industry had historically the greatest pricing freedom among which The Netherlands (Lofgren, 2002). Too much regulation will cause no flexibility for the pharmaceutical industry to develop (example Portugal). Hence, cultural and historical aspects also remain an important factor that influences the adoption in the generics industry (example Poland). Marketing implications concerning generic medicines constrain the development of generic medicines. Pharmaceutical industries are very limited regarding advertisements and branding of the medicines, other regulations such as price and reimbursement regulations make the possibilities to enter the pharmaceutical market inflexible therefore, policies makers should take that in account and mainly consider flexible policies. Transparency of generic medicines in the pharmaceutical market is also an important factor is; it can reduce delays for an approval on the European market. Another increasing concern of the European governments is the sustainability of the healthcare system. The expenditure on pharmaceutical products is a significant component of the healthcare system. Generic medicines contribute to a sustainable healthcare system partly due to the reduction in costs (Bongers Carradinha, 2009). The importance of a sustainable healthcare system is acknowledged. However, the implementation of these sustainable healthcare systems can be implemented by balanced policies and regulations. On the one hand, the policies and regulations will take care of affordable prices for healthcare systems in general, which extends to affordable prices for the patients. But on the other hand, the generic medicines sector provides a continuous source of cost effective medicine treatments and generates yearly savings of more than 25 billion Euros for the European healthcare system. In addition generic medicines will create a competitive market resulting in a decrease of medicine prices (Bongers Carradinha, 2009).

Saturday, December 21, 2019

Should Medical Marijuana Be Legalized - 1551 Words

Legalization of Medical Marijuana Marijuana is not like other helpful drugs that have amazing medical benefits. It is not made available to thousands of patients that could gain quality of live from it. Many Americans are forced to use second rate drugs to help them deal with conditions such as nausea, glaucoma, chronic pain, and multiple sclerosis. Why does the â€Å"world’s best health care system† use drugs that are not as effective as marijuana, but have more side effects? The United States Federal Government is going on a personal crusade to ban legalized marijuana. Before the government makes a decision about the legality of the medical use of marijuana, they should weigh the influences that marijuana has on society in†¦show more content†¦It has recently legislated to provide cannabis on medical prescription to registered patients, but this method has not been implemented so far. Some advocates argue that legalizing cannabis is the only way to ensure that patients can use it legally medical purposes. However, this would be contrary to international drug control treaties and is electorally unpopular. The best prospects for the medical use of cannabinoids lies in finding ways to deliver THC that do not involve smoking and in developing synthetic cannabinoids that produce therapeutic effects with a minimum of psychoactive effects. While awaiting these developments, patients with specified medical conditions suffer. While the issue is in debate , the government could give patients exemptions from criminal prosecution to grow cannabis for their own use, at their own risk. While the government of Great Britain seems to support a public health approach by lowering cannabis to a class C drug (lowest priority for law enforcement); the United State’s war on drugs heavily supports a criminal/moral approach to the drug problem and marijuana users are the biggest target. Slogans such as ‘Just Say No’ and ‘Zero Tolerance’ blatantly send the message that any use of illegal drugs is wrong and drug users will be punished. The clinician needs to assess each patient’s perception of his/her use. For some patients, cannabis provides much relief for chronic symptoms;Show MoreRelatedShould Medical Marijuana Be Legalized?1915 Words   |  8 PagesAll States Should Have Legalized Medical Marijuana Dispensaries Hot of the press for the State of Hawaii†¦ on July 15, 2015 Governor Ige signed HB 321 which became Act 241 establishing a system for licensing Medical Marijuana dispensaries throughout the state. He is quoted as saying, â€Å"I support the establishment of dispensaries to ensure that qualified patients can legally and safely access medical marijuana† (1). Hawaii legalized the use of medical marijuana in 2000 through Act 228, fifteen yearsRead MoreShould Medical Marijuana Be Legalized?1515 Words   |  7 PagesShould Medical Marijuana Be Legalized In The United States? Marijuana is a controversy that has been argued over for years now and it has many people questioning its benefits and defaults. Whether or not marijuana is a drug this is a subject that is very misunderstood by most people who argue over it today. Marijuana has been outlawed in the United States for almost a hundred years now, Hemp first was encouraged to be sold during the 1600’s to 1890’s by the government of the United States in orderRead MoreShould Medical Marijuana Be Legalized?1129 Words   |  5 PagesMarijuana goes by many names such as cannabis, weed, and molly just to name a few. It is often seen as a stress reliever, and an escape from reality type of drug. Some use it for recreational purposes, or medical purposes. Marijuana comes in many forms such as an oil, a pill, or hemp which was used for a lot of economical purposes. I’m going to be focusing on the medical benefits of this drug, in order to give you good reasons as to why it should be legalized. This drug has been found to help patientsRead MoreShould Medical Marijuana Be Legalized?2024 Words   |  9 PagesMarlyn Brillantes Mr. Tariq Jawhar ENG 111 April 24, 2016 Should Medical Marijuana be Legalized? Marijuana is a controversial drug because it can be both beneficial as well as harmful to the user. The marijuana plant can be utilized as an effective medicine to diagnose a number of issues. According to Business Insider, marijuana can treat glaucoma, improve lung health, control seizures of epileptic patients, decrease the symptoms of Dravet’s Syndrome, prevent cancer from spreading, and can contributeRead MoreWhy Medical Marijuana Should Be Legalized1245 Words   |  5 PagesWhy Medical Marijuana should be legalized all over all the United States. In today’s society, debates regarding legalizing Medical Marijuana occur frequently. The discussions arise in almost every state. Both sides bring solid arguments; however, opponents of the approval are facing the fact, which is very hard to ignore. Medical Marijuana has proven to cure people with life-threatening diseases much more effectively than official treatments; to have second-to-none side effects; and to be aRead MoreShould Marijuana Be Legalized For Medical Purposes?1735 Words   |  7 Pagessurveys, about 25 million Americans have smoked marijuana in the past year. More than 14 million do it regularly. (NORML: Working to Reform Marijuana Laws, 2015) Marijuana has been the topic of much discussion these past decades. The main factor of discussion is whether or not to legalize it and the outcome it would have on the states. Some states have already legalized but for medicinal purposes only. Much research has come out in this decade that marijuana just isnâ€⠄¢t for your average drug junkie butRead MoreMedical Marijuana Should be Legalized Essay1973 Words   |  8 Pages Marijuana has been in the news lately since two states, Colorado and Washington, have voted to legalize recreational marijuana. Currently they are the only two states to legalize recreational marijuana. Twenty states and the District of Columbia have legalized medical marijuana. Iowa, at this time, has decided not to legalize medical marijuana in spite of many Iowa citizens advocating for the legalization of the drug. Iowa is taking a cautious approach to medical marijuana. Medical marijuanaRead MoreMarijuana Should Be Legalized for Medical Purposes2770 Words   |  11 Pageswere told that she might benefit from marijuana. After much difficulty they were finally able to get it for her in oil form. After taking the medical marijuana for just one day, the seizures basically stopped. Now she only experiences one to two seizures a month! She was on the brink of dying and now she is living a relatively healthy normal life. Medical marijuana literally saved this little girl’ s life. (Gupta). Marijuana should be legalized for medical purposes because it is saving lives andRead MoreShould Marijuana Be Legalized Medical Marijuana?1465 Words   |  6 Pagesand some for the bad. In this paper we be discussing whether to continue the federal prosecution of medical marijuana patients and their providers under the accordance with the federal controlled substance Act. There are so many opinions that people have on this issues. Some people may disagree with congress for passing this law and they may feel that it’s giving people the right to smoke marijuana freely and then you have some people that agree with this law being pass. Because they may feel thatRead MoreShould Medical Marijuana Be Legalized?967 Words   |  4 PagesLegalization of Marijuana There are many topics nowadays that people in America agree on and there are also many topics American’s disagree on. One main topic that the states are trying to figure out whether to legalize or not is medical and recreational marijuana. Many look at cannabis or marijuana as a gateway drug and many look at it as another tobacco product. I personally don’t see marijuana as a bad thing for the states to legalize. People look down on marijuana because of it only being legal

Friday, December 13, 2019

Mra Media Group Company Visit Free Essays

Company Visit Cosmo Girl ditujukan utk ank SMP SMA (girl) Deadline tulisan, iklan, atau graphic ,sangat ketat connected with the printing department. Setiap Majalah pnya marketing strategy sndiri have premium Magazine[1] and they have own business development. Some company send their proposal to them, usually a big event plan, but it also help to make people more aware towards their brands, MRA is more to sampling and branding. We will write a custom essay sample on Mra Media Group Company Visit or any similar topic only for you Order Now Web profiles yg masuk, jg bnyak and help to improve the branding also. Redaksi ngurus content, % of ads.. There is 3 local magazine in MRACosmo girl have 90% local issues but, there is also pictures from US, etc. Different departments in MRA usually meet together in advertorial part. advertise + editorial = advertorial Ada jg dept of media n Business relation or MBR Market strategy applied ; Soft Cell or pull strategy cth : â€Å"Swift† ,iklan mobil di cosmogirl! Tapi dy jg represent model dgn latest fashion trends, and promote fashion brands also. MRA is more to soft sell than hard sell, ttpi smua depends on the client Media Value : client yg punya barang, dy maw kasi reader voucher, blackberry, prodksi itu client pnya bias any mlalui promo quiz d majalah MRA. Client pnya company, popularityny naek, awareness of the magazine jg slain itu, klo langganan, bias any d twarkan souvenir ato harga yg jauh lbih murah. MRA also have membership card, yg d dpet klo berlangganan, bisa dpet diskon ,(bias any 10%) dan bisa d pkai d hard rock, fun world, etc Cosmo girl n MRA bkn acara which give out free magazines, also cooperate with talkshow brands, radio, company, or roadshow Bentuk market segment : musi d liat, worthed atau gak, di Indo, kalo mau bli franchise mjlah luar.. almost all look like, but the diff is in the positioning, and angle.They also do market research for good positioning There is als merchandising dept. bias any audit free merchandise sesuaikan dgn trend† di Indo. Dari thun lalu bias any ud d planning. Hadiah special d berikan bias any pas anniversary edition magazines. utk budget, bias any ad percentage utk iklan, gossip plg baru, dll wktu itu jg ad mother baby affair, bazaar concerto (annual event), cosmo girl of the year (yg mlihat karakter suatu cwe, bkn hnya looksny) Distribusi dept. / CDM responsibleutk distribution majalah returBeda Gogirl n cosmo, Cosmo lbih mendkung remaja utk pnya karakter kuat, mengenal potensi mereka, tpi gogirl lbih k trend fashion. Ada rapat redaksi jg per bulan. Vision cosmo girl : Guide utk remaja, mengembngkan personality mreka, to have strong character, update to fashion trends, bkn hnya ttg beauty, tpi jg utk mncari potensi n bakat mereka Cosmogirl. co. id hairideas. co. id Mra. co. id Cosmopolitan ad franchise prtma MRA, Mother n Baby plg laku d genreny.. Slain ttg mother n baby, bias any jg ad resep† utk bayi, artikel konsultasi dgn dokter, dllHarga majlah tergantung dgn tebal n bonus sbuah mjalah. Skrg cosmo ad yg mini size spnya lbih mudah d bwa. Ada juga SPOT UV di cover, utk edisi special, or birthday issue There is also link in agent in every part of Jakarta, west, south, etc. CDm berhungn dgn outlet, kinokuniya, periplus, n gramed. AIDA (Interest, desire, action, )= tempel billboard, frame di mall, escalator sency, free magazine distributed at bndaran HI. Mjalah plg baru mreka = HELLO Kalo ad sisa yg tdk terjual bias any utk sampling pas ad event†, skaligus branding .MRA bkn event spt : Disney ice, song nation, n deals with ppl with diff character. Klbihan mjalah, bsa d gnting n d bkn scrapbook.. ga kyk radio, or TV dy jg pernh ksi kertas yg d slipin d majalah, kek survey, (what is ur recommendation, rating iklan n artikel) for market research. Bias any demography, age, positioning utk mjalah hrus jelas.. MRA jg pnrh broadcast in radio, radiony d ksi iklan gratis di magazine. Which also promte a client’s radio in magazine. ———————– [1] Coreny MRA Group How to cite Mra Media Group Company Visit, Papers

Thursday, December 5, 2019

Shakespeares Presentation of Isabella in Act 5 of the Play Essay Example For Students

Shakespeares Presentation of Isabella in Act 5 of the Play Essay Isabella is one of the most important characters in Measure for Measure, along with Angelo and the Duke. Before Act 5 we have a good idea as to her character, we know that she remains by her principles and is not easily influenced by people, even close family. She wanted the rules at the convent to be stricter, which shows her very apparent free will, and determination to do things right. She has already stood up to Angelo when he propositioned her to sleep with him in return for Claudios life, and when she relayed this information to Claudio she stood up to even him. All of this shows us just how much Isabella values her morals and religion, she is being extremely intransigent. At the beginning of Act 5 Isabella is to participate in the plan put forth by the Duke, she is not to accuse Angelo and if the Duke acts harshly to her then it is all part of the plan. She is not very pleased at this, in Act 4, Scene 6 she says To speak so indirectly I am so loth, this basically means that she hates the idea of not accusing Angelo in person. I would say that she play a very major part in the Act, most main characters do in fact, except maybe Claudio who says nothing. She exposes Angelo for the murder, liar and adulterer that he is, and when no one believes her she speaks very passionately about how he broke his bargain. She then, near the end of the Act begs the Duke to spare Angelos life for the sake of Isabella; this is indeed a test of just how strong her convictions are. She takes part in the fist and one of the most important sections of the Act, when she exposes Angelo and is then called mad by the Duke. In her fist speech she claims that she seeks justice for the crimes committed to her, she really emphasises this point by repetition, given me justice! Justice! Justice! Justice! this shows her desperation to see justice carried out. When the Duke tells her to reveal this scandal to Angelo she is shocked and appalled, You bid me seek redemption of the devil. Obviously saying that to tell Angelo the news would be like confessing to the Devil, which is altogether wrong. Angelo then tries to say that she is mad, she lists all of his crimes and playing along with the plan, the Duke sends her away. Despite the Duke apparently not believing her she continues with her convincing speech, saying may Angelo, in all his dressings, caracts, titles, forms, be an arch-villain. This does indeed interest the Duke, as he says that if she is indeed mad then she seems to be making sense. She continues in this manner until finally the Duke gets irritated and arrests her for making false accusations. Throughout this whole conversation Isabella kept her composure, and kept up a structured and legitimate argument, even against the Duke who is the leader of her city. The Duke having her arrested must have been quite a blow to Isabellas self esteem, as she thought he would be the perfect person to help her. Isabella does not appear again until after the Duke has been de-robed, she asks for his pardon as she says she has employed and pained your unknown sovereignty he pardons her. The Duke then asks her to pardon him for not revealing himself sooner and saving her brothers life, he claims that it was the swift celerity of his death , which I did think with slower foot came on Isabella then pardons him, though why I do not know, she should surely be disappointed at him for letting Claudio die. .ub864b3a7fe86757dc4c87cd8b60c8cb4 , .ub864b3a7fe86757dc4c87cd8b60c8cb4 .postImageUrl , .ub864b3a7fe86757dc4c87cd8b60c8cb4 .centered-text-area { min-height: 80px; position: relative; } .ub864b3a7fe86757dc4c87cd8b60c8cb4 , .ub864b3a7fe86757dc4c87cd8b60c8cb4:hover , .ub864b3a7fe86757dc4c87cd8b60c8cb4:visited , .ub864b3a7fe86757dc4c87cd8b60c8cb4:active { border:0!important; } .ub864b3a7fe86757dc4c87cd8b60c8cb4 .clearfix:after { content: ""; display: table; clear: both; } .ub864b3a7fe86757dc4c87cd8b60c8cb4 { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .ub864b3a7fe86757dc4c87cd8b60c8cb4:active , .ub864b3a7fe86757dc4c87cd8b60c8cb4:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .ub864b3a7fe86757dc4c87cd8b60c8cb4 .centered-text-area { width: 100%; position: relative ; } .ub864b3a7fe86757dc4c87cd8b60c8cb4 .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .ub864b3a7fe86757dc4c87cd8b60c8cb4 .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .ub864b3a7fe86757dc4c87cd8b60c8cb4 .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .ub864b3a7fe86757dc4c87cd8b60c8cb4:hover .ctaButton { background-color: #34495E!important; } .ub864b3a7fe86757dc4c87cd8b60c8cb4 .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .ub864b3a7fe86757dc4c87cd8b60c8cb4 .ub864b3a7fe86757dc4c87cd8b60c8cb4-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .ub864b3a7fe86757dc4c87cd8b60c8cb4:after { content: ""; display: block; clear: both; } READ: Othello Shakespeare EssayHowever it is apparent that people (except Lucio) hold a lot of respect for the Duke in Measure for Measure, so she might have to forgive him out of respect and compliance with him as an authority figure. The next event is one that I feel is key in determining Isabellas true character. This shows just how far she will go to stand by her faith and morals, despite what has previously happened. The Duke has sentenced Angelo to death for killing Claudio, Mariana pleads with the Duke not to do it but he says that it is necessary to avenge Claudios death. Mariana pleads with Isabella to support her, sweet Isabel, take my part; lend me your knees and all my life to come, Ill lend you all my life to do you service. And if she does so then she will be forever in her debt. Isabella here does something that I doubt many people would do, she kneels next to Mariana and pleads for Angelos life. At this point in the play she does not know that Claudio is alive, yet she still begs for mercy on behalf of Angelo. Her argument says that although Angelo thought he had committed a crime he actually had not, and it is ultimately Claudio that is the guilty party. I would imagine that this is very hard for Isabella; after all of the things she has gone through with Angelo, to now forgive him and save his life, this shows great strength of character. Isabella is left at the end of Measure for Measure with a life changing decision to make; does she marry the Duke or go to life in the convent as originally planned? I am not sure what her decision would be. Based on the events of the play, she is seen as being very set in her ways and unmovable, so on that basis she would probably go to the convent. However in that time (1600s) it was really the womans goal in life to land herself a good husband, therefore on that basis she would marry the Duke. The audiences view of Isabella I think will be constantly changing throughout the play. At the start they may think she is far too set in her ways and is a bit cold-hearted, to let her brother die for the sake of her virginity. But in Act 5 I think that we see another side of her morality that is more human, she goes against her true feelings for a man (Angelo) to help another woman (Mariana). I think that the audience would respect her for that noble deed. She would also be felt sympathy for, as she is being messed around by the Duke a great deal. The way he pretends that Claudio is dead and how he couldnt do anything about it should make her extremely resentful towards her, and the audience feel exceedingly sorry for her. Overall I think that Shakespeare has portrayed Isabella as a very strong female character in a male dominated play, she is the only woman to really have her own say and individuality. Mariana is only interested in getting her husband back; Mistress Overdone is hardly a good, strong, upright member of the community. Isabella may even be the most just and un-corrupt character in Measure for Measure. Because while most of the other main characters have major flaws or ulterior motives, she seems to wear her thoughts on her sleeve so to speak. Even though Measure for Measure is a comedy, it is apparent that it was one of the later plays (first performed in 1604), because of the mature themes dealt with like power, corruption and justice. .u5ca818f0070911bfc801bccb974ae80a , .u5ca818f0070911bfc801bccb974ae80a .postImageUrl , .u5ca818f0070911bfc801bccb974ae80a .centered-text-area { min-height: 80px; position: relative; } .u5ca818f0070911bfc801bccb974ae80a , .u5ca818f0070911bfc801bccb974ae80a:hover , .u5ca818f0070911bfc801bccb974ae80a:visited , .u5ca818f0070911bfc801bccb974ae80a:active { border:0!important; } .u5ca818f0070911bfc801bccb974ae80a .clearfix:after { content: ""; display: table; clear: both; } .u5ca818f0070911bfc801bccb974ae80a { display: block; transition: background-color 250ms; webkit-transition: background-color 250ms; width: 100%; opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #95A5A6; } .u5ca818f0070911bfc801bccb974ae80a:active , .u5ca818f0070911bfc801bccb974ae80a:hover { opacity: 1; transition: opacity 250ms; webkit-transition: opacity 250ms; background-color: #2C3E50; } .u5ca818f0070911bfc801bccb974ae80a .centered-text-area { width: 100%; position: relative ; } .u5ca818f0070911bfc801bccb974ae80a .ctaText { border-bottom: 0 solid #fff; color: #2980B9; font-size: 16px; font-weight: bold; margin: 0; padding: 0; text-decoration: underline; } .u5ca818f0070911bfc801bccb974ae80a .postTitle { color: #FFFFFF; font-size: 16px; font-weight: 600; margin: 0; padding: 0; width: 100%; } .u5ca818f0070911bfc801bccb974ae80a .ctaButton { background-color: #7F8C8D!important; color: #2980B9; border: none; border-radius: 3px; box-shadow: none; font-size: 14px; font-weight: bold; line-height: 26px; moz-border-radius: 3px; text-align: center; text-decoration: none; text-shadow: none; width: 80px; min-height: 80px; background: url(https://artscolumbia.org/wp-content/plugins/intelly-related-posts/assets/images/simple-arrow.png)no-repeat; position: absolute; right: 0; top: 0; } .u5ca818f0070911bfc801bccb974ae80a:hover .ctaButton { background-color: #34495E!important; } .u5ca818f0070911bfc801bccb974ae80a .centered-text { display: table; height: 80px; padding-left : 18px; top: 0; } .u5ca818f0070911bfc801bccb974ae80a .u5ca818f0070911bfc801bccb974ae80a-content { display: table-cell; margin: 0; padding: 0; padding-right: 108px; position: relative; vertical-align: middle; width: 100%; } .u5ca818f0070911bfc801bccb974ae80a:after { content: ""; display: block; clear: both; } READ: "To his Coy Mistress", By Andrew Marvell, "Sonnet", By Elizabeth Barrett Browning and "Sonnet 138", By William Shakespeare EssayI think that Shakespeare put Isabella in the play to create a balance between the characters, she gives some much needed morality and common sense to a lot of the play. The audience can relate to Isabella in such a way that they initially feel some anger at her intransigence, but they inevitably later on are sympathetic of her position. At the start of the play I did not take to Isabella much, but now I believe that she is the most interesting character and defiantly my favourite in Measure for Measure.