2012年医学博士外语真题试卷

Dear Dr. Benjamin,

Congratulations on your nomination as United States Surgeon General. Based on your extraordinary career and your commitment to【C1】______health disparities among underserved populations, no doubt your tenure will be marked by great progress toward the goal of improved health for all Americans.

Each United States Surgeon General has the unique opportunity to create his or her own lasting legacy. Dr. Koop focused on smoking prevention. Dr. Satcher, one of【C2】___mentors, released the first comprehensive report on mental health. We encourage you to build your own legacy【C3】concept of prevention through healthy lifestyles — a legacy that is both sustainable and cost-effective. This also is an important issue for Members of Congress, many of whom believe that【C4】___prevention and wellness initiatives will bring down costs and help people lead healthier lives. The American College of Sports Medicine(ACSM)would be honored to partner with you on such an initiative.

ACSM, the largest sports medicine and exercise science organization in the world,【C5】______ready to work with you to increase healthy behaviors — especially physical activity — throughout the life

span. During this crucial period of health system reform, we’ve been advocating for strategies that support preventive medicine not just through diagnostic testing,【C6】______promoting healthy, active behaviors that all Americans can achieve at little or no cost.

In fact, ACSM already has a working agreement with the Surgeon General’s office, focused on a series of healthy-lifestyle public service announcements for our Exercise Is Medicine^TMprogram, a program that【C7】___calls on doctors to encourage their patients to incorporate physical activity and exercise into their daily routine. As you are【C8】aware, physical activity can prevent and treat a host of chronic conditions — such as heart disease, type II diabetes, and obesity — that currently plague our country. Your example as【C9】___whose family has suffered from preventable disease and who demonstrates healthy lifestyles can be powerful indeed.

Anytime either before or after your appointment is confirmed, we would【C10】______the opportunity to meet with you and your staff to discuss how we, along with other leading health organizations, can enhance the prevention paradigm through physical activity.

Again, Dr, Benjamin, I extend our deepest congratulations and best wishes.

Sincerely,

James Pivarnik, Ph.D., FACSM

President, American College of Sports Medicine

As the defining epidemic of a modern age notable for overconsumption and excess, obesity is hard to beat. The increased availability of high-fat, high-sugar foods, along with more sedentary lifestyles, has helped push the number of obese people worldwide to beyond 400 million, and the number of overweight to more than 1.6 billion. By 2015, those figures are likely to grow to 700 million and 2.3 billion respectively, according to the World Health Organization. Given the health implications — increased risk of heart disease, stroke, diabetes and some cancers — anything that helps people avoid piling on the pounds must be a good thing, right?

Those who agree will no doubt welcome the growing success of researchers striving to develop “diet pills” that provide a technical fix for those incapable of losing weight any other way. Last week a study published in The Lancet showed that tesofensine, which works by inducing a sense of fullness, is twice as effective as any other drug at enabling patients to lose weight.

There is no question that advances such as this are good news for those with a strong genetic predisposition to obesity. But for the rest of us it is dangerous to see treatment as a more effective solution than prevention. There are several reasons for this. For a start, the traditional ways of maintaining a safe weight, such as limiting what you eat, increase consumption of fruit and vegetables and taking more exercise, are beneficial for our health in many ways.

Second, overindulgence in fatty foods has implications for the entire planet. Consider the deleterious environmental effects of the rising demand for meat. As demonstrated in our special issue on economic growth, technological fixes will not compensate for excessive consumption. Third, interfering with the brain circuits that control the desire for food can have an impact on other aspects of a person’s personality and their mental and physical health.

We need two approaches: more research into the genetics of obesity to understand why some people are more susceptible, and greater efforts to help people avoid eating their way to an early death. Cynics will say we’ve tried education and it hasn’t worked. That is defeatist: getting people to change their behavior takes time and effort, held back as we are by our biological tendency to eat more than we need, and by the food industry’s ruthless opportunism in exploiting that.

Drugs will be the saving of a few — as a last resort. But the global obesity problem is one of lifestyle, and the solution must be too.

An abandoned airfield near a former Nazi concentration tramp may soon feature pagodas and Tai Chi parks. A $700 million project aims to give Germany its own Chinatown 22 miles north of Berlin in the town of Oranienburg, housing 2,000 residents by 2010.

The investor group behind the scheme hopes the new Chinatown will attract tourists and business to rival the famed Chinatowns of San Francisco and New York by delivering an “authentic Chinese experience.” “You’ll be able to experience China, go out for a Chinese meal, and buy Chinese goods,” says Stefan Kunigam, managing director of Bandenburg-China-Project-Management GmbH.

The project has attracted investors in both Germany and China, reports Christoph Lang of Berlin’s Trade and Industry promotion Office. “Chinese investors have already asked if we have a Chinatown here.” He says. “The cultural environment is very important for them. You cannot build a synthetic Chinatown.”

Germany is home to about 72,000 Chinese migrants(2002 Federal Statistical Office figures), but the country has not had a Chinatown since the early 1930s in Hamburg, when most of the city’s 2,000 Chinese residents fled or were arrested by the Nazis.

German’s more-recent history with anti-foreigner extremism remains a problem even within the government, reports Deutsche Welle(DW), Germany’s international broadcaster. DW notes that National Democratic Party lawmaker Holger Apfel’s xenophobic(恐外的)comments about “state-subsidized Oriental mega-families” at first went largely uncriticized.

“Every fourth German harbors anti-foreigner sentiments,” DW quotes Miriam Grass, a Free Democratic Party parliamentarian. “Right-wing extremism is clearly rooted in the middle of society. It’s not a minor phenomenon.” The German government initiated a special youth for Democracy and Tolerance program in January 2007 as part of its tolerance-building efforts.

While it is not clear how many Chinese migrants will ultimately settle in the new German Chinatown, developers hope the project will increase Germans’ understanding for China and Chinese culture.

The American research university is a remarkable institution, long a source of admiration and wonder. The idyllic(田园诗的), wooded campuses, the diversity and energy of the student populations, and, most of all, the sheer volume of public and private resources available to run them, have made them the envy of the world.

Seen from the inside, however, everything is not quite so rosy. Setting aside the habitual complexity of medical schools, which have separate healthcare and finance issues, the structure of these institutions is straightforward and consistent. The bedrock of each university is a system of discipline-specific departments. The strength of these departments determines the success and prestige of the institution as a whole.

This structure raises a few obvious questions. One is the relevance of the department-based structure to the way scientific research is done. Many argue that in a host of areas — ranging from computational biology and materials science to pharmacology and climate science — much of the most important research is now interdisciplinary in nature. And there is a sense that, notwithstanding years of efforts to adapt to this change by encouraging interdisciplinary collaboration, the department-based structure of the university is essentially at odds with such collaboration.

A second set of issues surrounds the almost static nature of the departmental system. In a country where most things are highly fluid, the fields covered by departments, as well as the pecking order(权势等级)between them, have remained largely unchanged for many years. As people and money have flowed, particularly over the past twenty years, to the south and the southwest, the strongest US universities and departments remain embedded in the northeast and in California. League tables drawn up by the National Academy of Sciences and others show little movement in this pecking order, even over several decades.

Another, perhaps more contentious, issue concerns the relevance of the modern research university to the community it serves. The established model, whatever else its strengths and weaknesses, reflects the desire of the middle classes for undergraduate training that prepares their offspring for a stable career. But how does it serve a society in which people may have to retrain and recreate their careers throughout their adult lives?

Science and politics make uncomfortable bedfellows. Rarely is this more true than in the case of climate change, where it is now time for emergency counseling. One point repeatedly made at last week’s climate change congress in Copenhagen was that formulating an action plan to curb climate change is not a job of scientists.

Politicians may be left scratching their heads over what to do, but at this stage climate scientists cannot provide more guidance than they did in the 2007 report from the Intergovernmental Panel on Climate Change, for two reasons.

First, models will never provide a straightforward prediction of how the climate will change. As one Copenhagen delegate put it: “Tell me what the stock market will do in 100 years and I will tell you what the climate will do.” Second as most climate scientists will agree, their role is not to formulate policy. They can provide more or less apocalyptic(大灾预测的)scenarios of what will happen if emissions hit certain thresholds, from burning forests to disappearing islands. But when politicians ask what is the absolute maximum amount of carbon dioxide we should allow to be pumped out, the answer is, invariably, how much risk do you want to take?

There are ways out of the deadlock. As the major climate negotiations in December approach, scientists need to be able to take off their labcoats sometimes and speak as concerned citizens. Some may feel uncomfortable with blurring the line between science and activism, but they should be aware that no one understands the risks better than they do and no one is better placed to give informed opinions.

Politicians, for their part, should stop begging climatologists for easy answers. What they need instead is a new breed of advisers to descend from the ivory towers of academia and join the climate fray — people who are willing and able to weight up the risks, costs and benefits of various degrees of action.

If all else fails, there may still be the safety net of geoengineering. As we have said on several occasions, this option can no longer be dismissed as fantasy. Reputable scientists are discussing options among themselves and with policy-makers, but the fact that we are even considering it should spur governments to cut emissions, cut them deeply and cut them fast. Geoengineering is no get-out-of-jail-free card; it has dangers of its own. The military are already taking an interest, raising the spectre of climate weapons able to divert rainfall and bring drought. That is the last thing we want.

You are what you eat notwithstanding, it is only recently that most consumers have become interested in the technical details of their food’s composition, production and transport. With obesity and climate change now major concerns, and “localvore” and “food miles” entering the lexicon, shoppers are clamoring for information. And many food companies are happy to supply it, resulting in a dizzying array of multicolored labels and claims.

But not everyone is happy. A proposed law in Indiana is the latest attempt in the United States to ban milk labels proclaiming that the cows from whence the milk came were not treated with recombinant bovine growth hormone(rBGH, also called recombinant bovine somatotropin or rbST). This hormone, produced by engineered bacteria, is virtually identical to the cow’s own and can increase milk production by 10-15%.

There are two bad arguments for banning such labels. The first — that it is impossible to determine from the milk whether the cow was injected with rBGH — is the reason cited in the bill language. The second — that proliferation of “no rBGH” labels will train consumers to distrust the product — is the real motivation.

The first argument can be disposed of easily: it is already illegal to make false claims about a product. The second argument may seem more convincing. There is no firm scientific evidence that injecting cows with rBGH affects human health in any way, but prevalent labeling touting the absence of rBGH would suggest to consumers that there are some differences. The mandating(颁布)of an additional phrase such as that agreed last month in Pennsylvania — “No significant difference has been shown between milk derived from rbST-treated and non-rbST-treated cows” — ameliorates(减轻)this problem.

There are good reasons not to ban accurate labels. More information means that consumers can be more discerning, and not just about their own health. They can vote with their purchases for farming practices they prefer. And if a company wants to use a technology with a bad reputation, it is the firm’s responsibility to educate the consumer about why it is beneficial. If consumers choose irrationally to reject it, that is their prerogative(特权). Capitalism thrives on the irrationality of consumers, from their noted fear of smelling bad, to their preference for redness in apples, farmed salmon and fast-food signage(标记).

Indeed, if consumers were suddenly to become rational, an economic cataclysm(大灾难)would result, as households in all the rich nations would cut their consumption to only what they really needed. Such a crash would no doubt make the current economic doldrums(萧条)look like the mildest hiccup(打嗝).

There may be a link between creativity and mental disorders, but it is probably not in the way that you think. There is a widespread highly romanticized belief that madness somehow heightens creative genius among artists, writers, and musicians. And that may be because we romanticize the idea of artistic inspiration.

As with mental disorders, there is something mysterious and unexplainable about the creative process.

But all significant creative leaps have two very important components: talent and technique. By far the most universal and necessary aspect of technique is dogged persistence, which is anything but romantic.

Mihaly Csikszentmihalyi, best known psychologist for his work on flow, says despite the carefree air that many creative people effect, most of them work late into the night and persist when less driven individuals would not. Even acknowledged creative geniuses find that endurance must follow intuition. Follow-through is critical to the realization of an idea. Robert Root-Bernstein, another observer of the creative process, points out: “If the writer doesn’t sit at the computer every day, the muse is not going to visit.” Even having ideas can take a great deal of discipline. Discipline is not a hallmark of minds in the throes of emotional distress.

Nevertheless, depression strikes artists ten times more often than it does the general population. The link, however, is not creativity. Artists are more likely to be self-reflective and to think things through. And that thinking style— as opposed to creativity itself— is a hallmark of depression and commonly leads to it.

Evidence that madness does nothing to heighten creative genius comes from a study done by psychologist Robert Weisberg. He studied in detail Robert Schumann, the great composer, who was known to endure bouts of manic depression that drove him to attempt suicide. Indeed, Schumann wrote a great deal of music during his manic intervals. But quantity is one thing and quality is another. Weisberg found that Schumann’s compositional output indeed swelled during his manic years, but the average quality of his efforts did not change. Mania “jacks up the energy level,” Weisberg points out, “but it doesn’t give the person access to ideas that he or she wouldn’t have had otherwise.”

It’s entirely possible, Weisberg notes, that the elevated rates of mental disorders among artistic geniuses result from their creative lifestyle, which hardly provides emotional stability. Many artists struggle against poverty and public indifference in their lifetime. And if they do indeed produce works that are acclaimed, they could succumb to the overwhelming pressure to live up to their earlier successes.