A look at how drug companies sell to doctors: free samples, gifts, meals and cash incentives from sales reps. The writer weighs the useful information reps bring against the ethical problems, cites a study showing samples change prescriptions, and points out that patients end up paying.
How to attack this block: Ten headings for seven paragraphs, and three are spare. A and B are a pair: a doctor's expectation, then the list of offers including cash. E ends on a doctor who isn't persuaded, while F has the study showing samples do work. G mentions research spending, but its point is who pays.
Question 1
Answer: vParagraph A, last three sentences
Which heading fits paragraph A?
'The last rep offered me a trip to Florida. What do you have?' the physician asked. He was only half joking.
Question says → Passage says
An exampleA few months ago Kim Schaefer… walked into a medical center in New York
what doctors expect from drug companiesThe last rep offered me a trip to Florida. What do you have?
Why: A is one scene: a doctor openly asks the rep what she's offering, because the last one offered a trip. 'Only half joking' shows doctors really do expect gifts. One scene showing that expectation is heading v.
The trap: Heading ii (choosing the best offers) tempts because the doctor is comparing offers. But nobody chooses anything in A. The point is that the doctor expects something.
Question 2
Answer: viParagraph B, second and third sentences
Which heading fits paragraph B?
the freedom to give a physician $200 to prescribe her new product to the next six patients who fit the drug's profile
Question says → Passage says
Giftspromotional gifts and gadgets / a pair of tickets for a New York musical
financial incentivesgive a physician $200 / a few $1,000 honoraria
Why: B lists what reps hand out: tickets, gadgets, meals, samples, and then actual money, $200 per six prescriptions and $1,000 honoraria. The cash is what makes heading vi fit better than a general 'gifts' idea.
The trap: Heading v fits A, which has the doctor's question. B is the answer to it, a list of what's on offer, and the money is the detail the heading points to.
Question 3
Answer: iiiParagraph C, last two sentences
Which heading fits paragraph C?
so are doctors to blame for the escalating extravagance of pharmaceutical marketing? Or is it the industry's responsibility to decide the boundaries?
Question says → Passage says
Who is responsibleare doctors to blame… Or is it the industry's responsibility
the increase in promotionsthe escalating extravagance of pharmaceutical marketing
Why: C ends with the chicken-or-egg question: doctors or the industry? 'Escalating extravagance' is the increase in promotions, and 'to blame' and 'responsibility' match 'who is responsible'. Heading iii.
The trap: Heading x (who really pays) is also a 'who' question, but it's about money and patients, which is G. C is about who's to blame.
Question 4
Answer: ixParagraph D, second and third sentences
Which heading fits paragraph D?
Salespeople provide much-needed information and education to physicians.
Question says → Passage says
The positive sidemuch-needed / a tremendous advantage
of drugs promotionthe glossy brochures, article reprints and prescriptions they deliver
Why: After criticism in B and C, D gives the other side: reps bring doctors useful information, are often their main source of drug education, and save busy doctors time. That's heading ix.
The trap: Heading viii (the high costs of research) tempts because D mentions a 'huge investment'. That investment is in face-to-face selling, not research.
Question 5
Answer: iParagraph E, last three sentences
Which heading fits paragraph E?
I've been the recipient of golf balls from one company and I use them, but it doesn't make me prescribe their medicine
Question says → Passage says
Not all doctorssays one doctor
are persuadedit doesn't make me prescribe their medicine / I'm not influenced by what they give me
Why: E describes the flood of branded gadgets, asks whether it's money well spent, and ends with a doctor saying the gifts don't change what he prescribes. The paragraph lands on that doctor, so heading i.
The trap: Heading vii (research shows promotion works) is the opposite conclusion. E says 'It's hard to tell', and the research that shows promotion working is in F.
Question 6
Answer: viiParagraph F, last two sentences
Which heading fits paragraph F?
the conclusion was that the availability of samples led them to dispense and prescribe drugs that differed from their preferred drug choice
Question says → Passage says
Research showsone by the University of Washington investigated
promotion worksthe availability of samples led them to dispense and prescribe drugs that differed from their preferred drug choice
Why: The University of Washington study found that free samples changed what doctors prescribed. A study showing that a promotion changes behaviour is heading vii.
The trap: Heading i (not all doctors are persuaded) was E's. F's study says the opposite: samples did change what doctors chose.
Question 7
Answer: xParagraph G, second sentence
Which heading fits paragraph G?
And patients are the ones who pay - in the form of sky-rocketing prescription prices - for every pen that's handed out
Question says → Passage says
Who really payspatients are the ones who pay
doctors' free giftsevery pen that's handed out, every free theatre ticket, and every steak dinner eaten
Why: G answers the question in heading x directly: patients pay, through higher prices, for every pen, ticket and dinner.
The trap: Heading viii (the high costs of research) picks up 'research and development' in G's first sentence. But G says companies spend more on marketing than on research, so research costs aren't the point.
YES / NO / NOT GIVEN
Questions 8-13
How to attack this block: Watch for exaggeration and double negatives: a budget that could feed a small country is huge, and 'rarely… isn't' means almost always. The writer criticises the methods but accepts the profits. The NOT GIVEN is about how samples reach patients, which the passage never explains.
Question 8
Answer: NOParagraph B, second sentence
Do reps like Schaefer have to work with very little money?
a budget that could buy lunches and dinners for a small country
Question says → Passage says
a very limited budgeta budget that could buy lunches and dinners for a small country
Why: Feeding a small country is a joke about how huge the budget is. A huge budget contradicts 'very limited', so NO.
The trap: If you miss the exaggeration and read it literally, it can seem like NOT GIVEN. Writers use 'could feed a small country' to mean enormous.
Question 9
Answer: YESParagraph C, first two sentences
Could Schaefer's way of marketing be criticised as unethical?
Selling pharmaceuticals is a daily exercise in ethical judgement. Salespeople like Schaefer walk the line between the common practice of buying a prospect's time with a free meal, and bribing doctors
Question says → Passage says
open to criticism on moral groundsa daily exercise in ethical judgement / walk the line between… and bribing doctors
Kim Schaefer's marketing techniqueSalespeople like Schaefer
Why: 'Ethical' means moral. Reps like Schaefer walk a line close to bribery, in an industry 'highly criticized' for its sales practices. 'May be open to criticism' is a cautious claim, and the writer supports it. YES.
The trap: The writer never says Schaefer herself does anything wrong, which tempts NO or NOT GIVEN. But the statement only says 'may be open to criticism', not that she is guilty.
Question 10
Answer: NOParagraph D, second and third sentences
Is the information from drug companies of little use to doctors?
Salespeople provide much-needed information and education to physicians. In many cases the glossy brochures, article reprints and prescriptions they deliver are primary sources of drug education
Question says → Passage says
of little usemuch-needed / primary sources of drug education
Why: 'Much-needed' and 'primary sources' mean the information is very useful. The statement says the opposite, so NO.
The trap: E calls the brochures 'flashy', which sounds dismissive, but the writer's direct comment on their value is in D.
Question 11
Answer: YESParagraph E, third sentence
Can you clearly see drug promotion in places where healthcare happens?
Rarely do patients watch a doctor write with a pen that isn't emblazoned with a drug's name
Question says → Passage says
clearly visibleRarely do patients watch… that isn't emblazoned with a drug's name
in the healthcare environmenta doctor… a nurse use a tablet not bearing a pharmaceutical company's logo
Why: Patients almost always see branded pens and tablets in doctors' and nurses' hands. If patients can see it, it's clearly visible. YES.
The trap: The 'rarely… isn't' double negative trips people up. 'Rarely is it unbranded' means 'almost always branded'.
Question 12
Answer: NOT GIVENParagraph F, first two sentences
Might drug companies give patients free samples without a doctor's prescription?
Free samples of new and expensive drugs might be the single most effective way of getting doctors and patients to become loyal to a product.
Question says → Passage says
free drug samplesFree samples of new and expensive drugs
patientsgetting doctors and patients to become loyal
Why: Samples go from reps to doctors, and patients become loyal through them. The passage never says how patients get samples, or whether companies hand them over directly. NOT GIVEN.
The trap: 'Patients' and 'samples' sit in the same sentence, so it's tempting to assume patients receive them directly (YES) or never could (NO). The passage doesn't cover it.
Question 13
Answer: YESParagraph G, third sentence
Is it acceptable for drug companies to make money?
In the end the fact remains that pharmaceutical companies have every right to make a profit
Question says → Passage says
legitimatehave every right
make moneymake a profit
Why: 'Every right' means it's fully legitimate, and 'a profit' is money. YES.
The trap: The rest of G is critical of the companies, which can push people towards NO. The writer criticises how they sell, not their right to make money.
YES. The statement only says 'may be open to criticism', and C puts reps like Schaefer near the line of bribery.
Words from this passage worth keeping
honoraria(B)
payments for a professional service, such as giving a talk
escalating(C)
rising quickly
extravagance(C)
spending far too much
sheer(D)
used to stress how large something is
inundation(E)
a flood of something, too much to deal with
emblazoned(E)
clearly printed or decorated with
grapple with(G)
struggle to deal with a difficult problem
scrutinized(G)
examined very carefully
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The full Cambridge 6 Test 4 reading paper: all three passages, 60 minutes, marked the second you finish with a review of every answer. Already done it? Take it again and see if the same traps still get you.
Cambridge IELTS 6, Test 4, Reading Passage 1. The passage and questions belong to Cambridge University Press and are not reproduced here. We quote short extracts only as evidence for our own commentary, and the answers are published for self-marking. Get the book for the full text, or sit the test on Langujet.
