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Final Paper
Philosophy 2520 – 01 and 61S
Business Ethics
Please Note: This course will have a writing component. The
final exam will consist of a 7–10-
page research paper focusing on ethical dilemmas in
organizations. Your paper will be
due on May 6th, 2022, at 11:59pm.
Instructions
1. Choose one of the organizations listed in the case studies in
Part 5 (case studies) of your
textbook or may select one of your choosing.
2. You are required to write your research paper utilizing APA
(American Psychological
Association) format.
3. Your paper should contain the following information
a. Cover Page
b. Abstract
c. Content - Body of your paper
d. Conclusion
e. Reference Page
Scenario:
You are the new Compliance Officer at your organization. It is
your responsibility to review the
current compliance policies, procedures, and practices of your
organization. While reviewing and
auditing your organization, you discover there are several
ethical dilemmas within the
organization. You are to write a proposal to your Board of
Directors and the Executive Leadership
team within your organization. Your proposal should in include
the following:
(1) Identify 2-3 ethical dilemmas within the organization.
(2) Discuss the dilemmas buy providing background
information relating to each
dilemma.
(3) Describe what actions, processes, or compliant components
that the organization used
to address the dilemma in the past
(4) Discuss rather the dilemma was rectified or is the
organization still struggling with the
issue.
(5) As the new Compliance Officer, you are to create a
compliance plan to address the
issues/behaviors. Discuss what techniques or tools you would
implement to ensure
that these issues are addressed.
(6) Listed below are compliance models that you can use to
assist you.
Sample Resources for your compliance plan.
Compliance Model
Elements of an effective compliance program
Compliance programs are not one-size-fits-all. Although you
can follow the guidelines on how to
create a compliance program and what to include, you’ll need to
develop a plan that meets your
company’s specific needs.
When it comes to building a compliance program, there’s no
need to recreate the wheel.
The Affordable Care Act outlines seven key elements of an
effective compliance program.
1. Establish and adopt written policies, procedures, and
standards of conduct.
Having clear written policies and procedures in place that
describe compliance
expectations fosters uniformity within your company.
2. Create program oversight. Determine who will oversee,
monitor, and enforce the
compliance program and serve as your go-to company
“watchdog” with questions and
concerns.
3. Provide staff training and education. Employees at every
level need to understand
your compliance program expectations and standards to be able
to comply with them.
Implement a training program that clearly communicates your
company’s program
requirements, with an annual refresher course that reminds
employees of your code of
conduct and incorporates any changes.
4. Establish two-way communication at all levels. Set forth the
expectation that
employees should proactively communicate in a timely manner,
whether that means
asking compliance questions, reporting issues, or addressing
ethical concerns. Include a
https://www.cms.gov/Outreach-and-Education/Medicare-
Learning-Network-MLN/MLNEdWebGuide/Downloads/MLN-
Compliance-Webinar.pdf
way for employees to anonymously report compliance issues or
fraudulent or illegal
behavior without fear of retaliation.
5. Implement a monitoring and auditing system. You’ll need to
measure the
effectiveness of your corporate compliance program and
identify risks. To accomplish
this, develop a system of both internal and external monitoring,
including formal audits.
6. Enforce consistent discipline. Develop a plan to enforce
standards of conduct in a
timely manner, outlining appropriate disciplinary measures for
employees who fail to
comply with program requirements.
7. Take corrective action. When you identify vulnerabilities or
violations through
monitoring and auditing, take timely, consistent action to
correct the issue.
Keep in mind that this list is designed specifically for
healthcare facilities. However, it serves as
a solid guideline for any industry, touching on the key
components of an effective compliance
program. (Retrieved from https://www.powerdms.com/policy-
learning-center/how-to-create-
an-effective-compliance-program, 3/27/2022)
How you will be evaluated.
You will be evaluated on the following:
(1) Punctuation and grammar.
(2) APA format - Title Page, Abstract, running head, section
headings, citations
within the paper and reference page. (I have attached a sample
APA style
paper for your convenience.)
(3) Please note if you have references, you should have citations
in your paper.
Make sure that you cite your sources in the body of your paper!
(4) Turn it in – I will be using Turn-it- in to ensure the
academic integrity of your
paper. If your paper has a high percentage of plagiarism, it will
result in a
failing grade. Cite your sources! Please review the university
policy on
plagiarism.
(5) Please Note - Final Papers are due on the date specified.
There will be No
Extensions or Exceptions.
https://www.powerdms.com/policy-learning-center/how-to-
create-an-effective-compliance-program
https://www.powerdms.com/policy-learning-center/how-to-
create-an-effective-compliance-program
APA Research Paper (Mirano)
Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006).
This paper follows the style guidelines in the Publication
Manual of the American Psychological Association, 6th ed.
(2010).
Obesity in Children i
Can Medication Cure Obesity in Children?
A Review of the Literature
Luisa Mirano
Psychology 107, Section B
Professor Kang
October 31, 2004
Short title and
page number for
student papers.
Full title.
XXXX
Marginal annotations indicate APA-style formatting and
effective writing.
Obesity in Children 1
Writer’s name,
course, section
number, instructor’s
name, and date
(all centered).
Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006).
Abstract appears on
a separate page.
Obesity in Children 2
Abstract
In recent years, policymakers and medical experts have
expressed alarm about the growing problem of childhood
obesity
in the United States. While most agree that the issue deserves
attention, consensus dissolves around how to respond to the
problem. This literature review examines one approach to
treating
childhood obesity: medication. The paper compares the
effectiveness for adolescents of the only two drugs approved by
the Food and Drug Administration (FDA) for longterm
treatment
of obesity, sibutrami ne and orlistat. This examination of
pharmacological treatments for obesity points out the
limitations
of medication and suggests the need for a comprehensive
solution
that combines medical, social, behavioral, and political
approaches
to this complex problem.
Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006).
Full title, centered.
The writer uses a
footnote to define
an essential term
that would be cum-
bersome to define
within the text.
The writer sets
up her organiza-
tion by posing four
questions.
The writer states
her thesis.
Obesity in Children 3
Can Medication Cure Obesity in Children?
A Review of the Literature
In March 2004, U.S. Surgeon General Richard Carmona
called attention to a health problem in the United States that,
until recently, has been overlooked: childhood obesity. Carmona
said that the “astounding” 15% child obesity rate constitutes
an “epidemic.” Since the early 1980s, that rate has “doubled in
children and tripled in adolescents.” Now more than nine
million
children are classified as obese.1 While the traditional response
to a medical epidemic is to hunt for a vaccine or a cure-all pill,
childhood obesity has proven more elusive. The lack of success
of recent initiatives suggests that medication might not be the
answer for the escalating problem. This literature review
considers
whether the use of medication is a promising approach for
solving
the childhood obesity problem by responding to the following
questions:
1. What are the implications of childhood obesity?
2. Is medication effective at treating childhood obesity?
3. Is medication safe for children?
4. Is medication the best solution?
Understanding the limitations of medical treatments for
children highlights the complexity of the childhood obesity
problem in the United States and underscores the need for
1Obesity is measured in terms of body-mass index (BMI):
weight in kilograms divided by square of height in meters. A
child
or an adolescent with a BMI in the 95th percentile for his or her
age and gender is considered obese.
Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006).
Headings, centered,
help readers follow
the organization.
In a signal phrase,
the word “and”
links the names of
two authors; the
date is given in
parentheses.
Because the
author (Carmona)
is not named in
the signal phrase,
his name and the
date appear in
parentheses.
Obesity in Children 4
physicians, advocacy groups, and policymakers to search for
other solutions.
What Are the Implications of Childhood Obesity?
Obesity can be a devastating problem from both an
individual and a societal perspective. Obesity puts children at
risk
for a number of medical complications, including type 2
diabetes,
hypertension, sleep apnea, and orthopedic problems (Henry J.
Kaiser Family Foundation, 2004, p. 1). Researchers Hoppin and
Taveras (2004) have noted that obesity is often associated with
psychological issues such as depression, anxiety, and binge
eating
(Table 4).
Obesity also poses serious problems for a society
struggling to cope with rising health care costs. The cost of
treating obesity currently totals $117 billion per year—a price,
according to the surgeon general, “second only to the cost of
[treating] tobacco use” (Carmona, 2004). And as the number of
children who suffer from obesity grows, long-term costs will
only increase.
Is Medication Effective at Treating Childhood Obesity?
The widening scope of the obesity problem has prompted
medical professionals to rethink old conceptions of the disorder
and its causes. As researchers Yanovski and Yanovski (2002)
have
explained, obesity was once considered “either a moral failing
or
evidence of underlying psychopathology” (p. 592). But this
view
has shifted: Many medical professionals now consider obesity a
biomedical rather than a moral condition, influenced by both
genetic and environmental factors. Yanovski and Yanovski have
Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006).
Ellipsis mark
indicates omitted
words.
An ampersand
links the names of
two authors in
parentheses.
The writer draws
attention to an
important article.
Obesity in Children 5
further noted that the development of weight-loss medications
in
the early 1990s showed that “obesity should be treated in the
same manner as any other chronic disease . . . through the
long-term use of medication” (p. 592).
The search for the right long-term medication has been
complicated. Many of the drugs authorized by the Food and
Drug Administration (FDA) in the early 1990s proved to be a
disappointment. Two of the medications—fenfluramine and
dexfenfluramine—were withdrawn from the market because of
severe side effects (Yanovski & Yanovski, 2002, p. 592), and
several others were classified by the Drug Enforcement
Administration as having the “potential for abuse” (Hoppin &
Taveras, 2004, Weight-Loss Drugs section, para. 6). Currently
only
two medications have been approved by the FDA for long-term
treatment of obesity: sibutramine (marketed as Meridia) and
orlistat (marketed as Xenical). This section compares studies on
the effectiveness of each.
Sibutramine suppresses appetite by blocking the reuptake
of the neurotransmitters serotonin and norepinephrine in the
brain. Though the drug won FDA approval in 1998, experiments
to test its effectiveness for younger patients came considerably
later. In 2003, University of Pennsylvania researchers
Berkowitz, Wadden, Tershakovec, and Cronquist released the
first double-blind placebo study testing the effect of
sibutramine
on adolescents, aged 13-17, over a 12-month period. Their
findings are summarized in Table 1.
After 6 mos.:
loss of 3.2 kg
(7 lb)
After 12 mos.:
loss of 4.5 kg
(9.9 lb)
After 6 mos.:
loss of 7.8
kg (17.2 lb)
After 12 mos.:
loss of 7.0
kg (15.4 lb)
Gain of 0.67
kg (1.5 lb)
Loss of 1.3
kg (2.9 lb)
Table 1
Effectiveness of Sibutramine and Orlistat in Adolescents
Average
weight
Medication Subjects Treatmenta Side effects loss/gain
Sibutramine
Orlistat
Control
Medicated
Control
Medicated
0-6 mos.:
placebo
6-12 mos.:
sibutramine
0-12 mos.:
sibutramine
0-12 mos.:
placebo
0-12 mos.:
orlistat
Mos. 6-12:
increased
blood pressure;
increased pulse
rate
Increased
blood pressure;
increased pulse
rate
None
Oily spotting;
flatulence;
abdominal
discomfort
Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006).
The writer uses a
table to summa-
rize the findings
presented in two
sources.
A note gives the
source of the data.
A content note
explains data
common to
all subjects.
Note. The data on sibutramine are adapted from “Behavior
Therapy and
Sibutramine for the Treatment of Adolescent Obesity,” by R. I.
Berkowitz,
T. A. Wadden, A. M. Tershakovec, & J. L. Cronquist, 2003,
Journal of
the American Medical Association, 289, pp. 1807-1809. The
data on
orlistat are adapted from Xenical (Orlistat) Capsules: Complete
Product
Information, by Roche Laboratories, December 2003, retrieved
from
http://www.rocheusa.com/products/xenical/pi.pdf
aThe medication and/or placebo were combined with behavioral
therapy
in all groups over all time periods.
Obesity in Children 6
Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006).
When this article
was first cited, all
four authors were
named. In subse-
quent citations of
a work with three
to five authors,
“et al.” is used
after the first
author’s name.
Obesity in Children 7
After 6 months, the group receiving medication had lost
4.6 kg (about 10 pounds) more than the control group. But
during the second half of the study, when both groups received
sibutramine, the results were more ambiguous. In months 6-12,
the group that continued to take sibutramine gained an average
of 0.8 kg, or roughly 2 pounds; the control group, which
switched
from placebo to sibutramine, lost 1.3 kg, or roughly 3 pounds
(p. 1808). Both groups received behavioral therapy covering
diet,
exercise, and mental health.
These results paint a murky picture of the effectiveness
of the medication: While initial data seemed promising,
the results after one year raised questions about whether
medicationinduced weight loss could be sustained over time.
As Berkowitz et al. (2003) advised, “Until more extensive
safety and efficacy data are available, . . . weight-loss
medications should be used only on an experimental basis
for adolescents” (p. 1811).
A study testing the effectiveness of orlistat in adolescents
showed similarly ambiguous results. The FDA approved orlistat
in 1999 but did not authorize it for adolescents until December
2003. Roche Laboratories (2003), maker of orlistat, released
results of a one-year study testing the drug on 539 obese
adolescents, aged 12-16. The drug, which promotes weight loss
by
blocking fat absorption in the large intestine, showed some
effectiveness in adolescents: an average loss of 1.3 kg, or
roughly 3 pounds, for subjects taking orlistat for one year, as
opposed to an average gain of 0.67 kg, or 1.5 pounds, for the
control group (pp. 8-9). See Table 1.
Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006).
For a source with
six or more
authors, the first
author’s name
followed by “et al.”
is used for the first
and subsequent
references.
Obesity in Children 8
Short-term studies of orlistat have shown slightly more
dramatic results. Researchers at the National Institute of Child
Health and Human Development tested 20 adolescents, aged
12-16, over a three-month period and found that orlistat,
combined with behavioral therapy, produced an average weight
loss of 4.4 kg, or 9.7 pounds (McDuffie et al., 2002, p. 646).
The study was not controlled against a placebo group; therefore,
the relative effectiveness of orlistat in this case remains
unclear.
Is Medication Safe for Children?
While modest weight loss has been documented for both
medications, each carries risks of certain side effects.
Sibutramine has been observed to increase blood pressure and
pulse rate. In 2002, a consumer group claimed that the
medication was related to the deaths of 19 people and filed a
petition with the Department of Health and Human Services to
ban the medication (Hilts, 2002). The sibutramine study by
Berkowitz et al. (2003) noted elevated blood pressure as a side
effect, and dosages had to be reduced or the medicati on
discontinued in 19 of the 43 subjects in the first six months
(p. 1809).
The main side effects associated with orlistat were
abdominal discomfort, oily spotting, fecal incontinence, and
nausea (Roche Laboratories, 2003, p. 13). More serious for
long-term health is the concern that orlistat, being a fat-
blocker, would affect absorption of fat-soluble vitamins, such
as vitamin D. However, the study found that this side effect
can be minimized or eliminated if patients take vitamin
Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006).
The writer
develops the
paper’s thesis.
Obesity in Children 9
supplements two hours before or after administration of orlistat
(p. 10). With close monitoring of patients taking the
medication,
many of the risks can be reduced.
Is Medication the Best
Solution
?
The data on the safety and efficacy of pharmacological
treatments of childhood obesity raise the question of whether
medication is the best solution for the problem. The
treatments have clear costs for individual patients, including
unpleasant side effects, little information about long-term use,
and uncertainty that they will yield significant weight loss.
In purely financial terms, the drugs cost more than $3 a
day on average (Duenwald, 2004). In each of the clinical trials,
use of medication was accompanied by an expensive regime
of behavioral therapies, including counseling, nutritional
education, fitness advising, and monitoring. As journalist Greg
Critser (2003) noted in his book Fat Land, use of weight-loss
drugs is unlikely to have an effect without the proper “support
system”—one that includes doctors, facilities, time, and
money (p. 3). For some, this level of care is prohibitively
expensive.
A third complication is that the studies focused on
adolescents aged 12-16, but obesity can begin at a much
younger
age. Little data exist to establish the safety or efficacy of
medication for treating very young children.
While the scientific data on the concrete effects of these
medications in children remain somewhat unclear, medication
is not the only avenue for addressing the crisis. Both medical
experts and policymakers recognize that solutions might come
Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006).
Brackets indicate
a word not in the
original source.
A quotation longer
than 40 words is
indented without
quotation marks.
The writer inter-
prets the evidence;
she doesn’t just
report it.
The tone of the
conclusion is
objective.
Obesity in Children 10
not only from a laboratory but also from policy, education, and
advocacy. Indeed, a handbook designed to educate doctors on
obesity recommended a notably nonmedical course of action,
calling for “major changes in some aspects of western culture”
(Hoppin & Taveras, 2004, Conclusion section, para. 1). Cultural
change may not be the typical realm of medical professionals,
but the handbook urged doctors to be proactive and “focus
[their] energy on public policies and interventions” (Conclus ion
section, para. 1).
The solutions proposed by a number of advocacy groups
underscore this interest in political and cultural change. A
report
by the Henry 3. Kaiser Family Foundation (2004) outlined
trends
that may have contributed to the childhood obesity crisis,
including food advertising for children as well as
a reduction in physical education classes and after-school
athletic programs, an increase in the availability of sodas
and snacks in public schools, the growth in the number of
fast-food outlets . . . , and the increasing number of
highly processed high-calorie and high-fat grocery
products. (p. 1)
Addressing each of these areas requires more than a doctor
armed with a prescription pad; it requires a broad mobilization
not just of doctors and concerned parents but of educators,
food industry executives, advertisers, and media
representatives.
The barrage of possible approaches to combating childhood
obesity—from scientific research to political lobbying—
indicates both the severity and the complexity of the problem.
Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006).
Obesity in Children 11
While none of the medications currently available is a miracle
drug for curing the nation’s nine million obese children,
research
has illuminated some of the underlying factors that affect
obesity and has shown the need for a comprehensive approach
to the problem that includes behavioral, medical, social, and
political change.
Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006).
List of references
begins on a new
page. Heading is
centered.
List is alphabet-
ized by authors’
last names. All
authors’ names
are inverted.
The first line of
an entry is at
the left margin;
subsequent
lines indent 1⁄2''.
Double-spacing is
used throughout.
Obesity in Children 12
References
Berkowitz, R. I., Wadden, T. A., Tershakovec, A. M., &
Cronquist,
J. L. (2003). Behavior therapy and sibutramine for the
treatment of adolescent obesity. Journal of the American
Medical Association, 289, 1805-1812.
Carmona, R. H. (2004, March 2). The growing epidemic of
childhood obesity. Testimony before the Subcommittee on
Competition, Foreign Commerce, and Infrastructure of
the U.S. Senate Committee on Commerce, Science, and
Transportation. Retrieved from http://www.hhs.gov/asl
/testify/t040302. html
Critser, G. (2003). Fat land. Boston, MA: Houghton Mifflin.
Duenwald, M. (2004, January 6). Slim pickings: Looking
beyond ephedra. The New York Times, p. F1. Retrieved from
http://nytimes.com/
Henry J. Kaiser Family Foundation. (2004, February). The role
of media in childhood obesity. Retrieved from http://www
.kff.org/entmedia/7030.cfm
Hilts, P. J. (2002, March 20). Petition asks for removal of diet
drug from market. The New York Times, p. A26. Retrieved
from http://nytimes.com/
Hoppin, A. G., & Taveras, E. M. (2004, June 25). Assessment
and management of childhood and adolescent obesity.
Clinical Update. Retrieved from http://www.medscape
.com/viewarticle/481633
McDuffie, J. R., Calis, K. A., Uwaifo, G. I., Sebring, N. G.,
Fallon, E. M., Hubbard, V. S., & Yanovski, J. A. (2002).
Three month tolerability of orlistat in adolescents with
Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006).
Obesity in Children 13
obesity-related comorbid conditions. Obesity Research,
10, 642-650.
Roche Laboratories. (2003, December). Xenical (orlistat)
capsules: Complete product information. Retrieved from
http://www.rocheusa.com/products/xenical/pi.pdf
Yanovski, S. Z., & Yanovski, J. A. (2002). Drug therapy:
Obesity.
The New England Journal of Medicine, 346, 591-602.
Chapter 7
Uber Collides with Controversy
· Introduction
· 7-2Global Expansion Challenges
· 7-3Threats to the Sharing Economy
· 7-4Controversy
· 7-5A Global Pandemic
· 7-6Other Business Segments
· 7-6aFood Delivery
· 7-6bFreight
· 7-6cOther Bets
· 7-6dThe Future
· 7-7Uber Becomes a Public Company
· 7-8Conclusion
· 7-9Chapter Review
· 7-9aQuestions for Discussion
· 7-9bSources
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Final Paper Philosophy 2520 – 01 and 61S Business Et

  • 1. Final Paper Philosophy 2520 – 01 and 61S Business Ethics Please Note: This course will have a writing component. The final exam will consist of a 7–10- page research paper focusing on ethical dilemmas in organizations. Your paper will be due on May 6th, 2022, at 11:59pm. Instructions 1. Choose one of the organizations listed in the case studies in Part 5 (case studies) of your textbook or may select one of your choosing. 2. You are required to write your research paper utilizing APA (American Psychological Association) format. 3. Your paper should contain the following information a. Cover Page b. Abstract
  • 2. c. Content - Body of your paper d. Conclusion e. Reference Page Scenario: You are the new Compliance Officer at your organization. It is your responsibility to review the current compliance policies, procedures, and practices of your organization. While reviewing and auditing your organization, you discover there are several ethical dilemmas within the organization. You are to write a proposal to your Board of Directors and the Executive Leadership team within your organization. Your proposal should in include the following: (1) Identify 2-3 ethical dilemmas within the organization. (2) Discuss the dilemmas buy providing background information relating to each dilemma. (3) Describe what actions, processes, or compliant components that the organization used to address the dilemma in the past (4) Discuss rather the dilemma was rectified or is the
  • 3. organization still struggling with the issue. (5) As the new Compliance Officer, you are to create a compliance plan to address the issues/behaviors. Discuss what techniques or tools you would implement to ensure that these issues are addressed. (6) Listed below are compliance models that you can use to assist you. Sample Resources for your compliance plan. Compliance Model Elements of an effective compliance program Compliance programs are not one-size-fits-all. Although you can follow the guidelines on how to create a compliance program and what to include, you’ll need to develop a plan that meets your company’s specific needs. When it comes to building a compliance program, there’s no need to recreate the wheel. The Affordable Care Act outlines seven key elements of an
  • 4. effective compliance program. 1. Establish and adopt written policies, procedures, and standards of conduct. Having clear written policies and procedures in place that describe compliance expectations fosters uniformity within your company. 2. Create program oversight. Determine who will oversee, monitor, and enforce the compliance program and serve as your go-to company “watchdog” with questions and concerns. 3. Provide staff training and education. Employees at every level need to understand your compliance program expectations and standards to be able to comply with them. Implement a training program that clearly communicates your company’s program requirements, with an annual refresher course that reminds employees of your code of conduct and incorporates any changes. 4. Establish two-way communication at all levels. Set forth the expectation that employees should proactively communicate in a timely manner, whether that means asking compliance questions, reporting issues, or addressing ethical concerns. Include a https://www.cms.gov/Outreach-and-Education/Medicare- Learning-Network-MLN/MLNEdWebGuide/Downloads/MLN- Compliance-Webinar.pdf
  • 5. way for employees to anonymously report compliance issues or fraudulent or illegal behavior without fear of retaliation. 5. Implement a monitoring and auditing system. You’ll need to measure the effectiveness of your corporate compliance program and identify risks. To accomplish this, develop a system of both internal and external monitoring, including formal audits. 6. Enforce consistent discipline. Develop a plan to enforce standards of conduct in a timely manner, outlining appropriate disciplinary measures for employees who fail to comply with program requirements. 7. Take corrective action. When you identify vulnerabilities or violations through monitoring and auditing, take timely, consistent action to correct the issue. Keep in mind that this list is designed specifically for healthcare facilities. However, it serves as a solid guideline for any industry, touching on the key components of an effective compliance program. (Retrieved from https://www.powerdms.com/policy- learning-center/how-to-create- an-effective-compliance-program, 3/27/2022) How you will be evaluated. You will be evaluated on the following: (1) Punctuation and grammar.
  • 6. (2) APA format - Title Page, Abstract, running head, section headings, citations within the paper and reference page. (I have attached a sample APA style paper for your convenience.) (3) Please note if you have references, you should have citations in your paper. Make sure that you cite your sources in the body of your paper! (4) Turn it in – I will be using Turn-it- in to ensure the academic integrity of your paper. If your paper has a high percentage of plagiarism, it will result in a failing grade. Cite your sources! Please review the university policy on plagiarism. (5) Please Note - Final Papers are due on the date specified. There will be No Extensions or Exceptions. https://www.powerdms.com/policy-learning-center/how-to- create-an-effective-compliance-program https://www.powerdms.com/policy-learning-center/how-to- create-an-effective-compliance-program
  • 7. APA Research Paper (Mirano) Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006). This paper follows the style guidelines in the Publication Manual of the American Psychological Association, 6th ed. (2010). Obesity in Children i Can Medication Cure Obesity in Children? A Review of the Literature Luisa Mirano Psychology 107, Section B Professor Kang October 31, 2004 Short title and page number for student papers. Full title. XXXX Marginal annotations indicate APA-style formatting and effective writing. Obesity in Children 1 Writer’s name, course, section
  • 8. number, instructor’s name, and date (all centered). Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006). Abstract appears on a separate page. Obesity in Children 2 Abstract In recent years, policymakers and medical experts have expressed alarm about the growing problem of childhood obesity in the United States. While most agree that the issue deserves attention, consensus dissolves around how to respond to the problem. This literature review examines one approach to treating childhood obesity: medication. The paper compares the effectiveness for adolescents of the only two drugs approved by the Food and Drug Administration (FDA) for longterm treatment of obesity, sibutrami ne and orlistat. This examination of
  • 9. pharmacological treatments for obesity points out the limitations of medication and suggests the need for a comprehensive solution that combines medical, social, behavioral, and political approaches to this complex problem. Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006). Full title, centered. The writer uses a footnote to define an essential term that would be cum- bersome to define within the text. The writer sets up her organiza- tion by posing four questions. The writer states her thesis. Obesity in Children 3 Can Medication Cure Obesity in Children?
  • 10. A Review of the Literature In March 2004, U.S. Surgeon General Richard Carmona called attention to a health problem in the United States that, until recently, has been overlooked: childhood obesity. Carmona said that the “astounding” 15% child obesity rate constitutes an “epidemic.” Since the early 1980s, that rate has “doubled in children and tripled in adolescents.” Now more than nine million children are classified as obese.1 While the traditional response to a medical epidemic is to hunt for a vaccine or a cure-all pill, childhood obesity has proven more elusive. The lack of success of recent initiatives suggests that medication might not be the answer for the escalating problem. This literature review considers whether the use of medication is a promising approach for solving the childhood obesity problem by responding to the following questions: 1. What are the implications of childhood obesity? 2. Is medication effective at treating childhood obesity?
  • 11. 3. Is medication safe for children? 4. Is medication the best solution? Understanding the limitations of medical treatments for children highlights the complexity of the childhood obesity problem in the United States and underscores the need for 1Obesity is measured in terms of body-mass index (BMI): weight in kilograms divided by square of height in meters. A child or an adolescent with a BMI in the 95th percentile for his or her age and gender is considered obese. Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006). Headings, centered, help readers follow the organization. In a signal phrase, the word “and” links the names of two authors; the date is given in parentheses. Because the author (Carmona) is not named in the signal phrase,
  • 12. his name and the date appear in parentheses. Obesity in Children 4 physicians, advocacy groups, and policymakers to search for other solutions. What Are the Implications of Childhood Obesity? Obesity can be a devastating problem from both an individual and a societal perspective. Obesity puts children at risk for a number of medical complications, including type 2 diabetes, hypertension, sleep apnea, and orthopedic problems (Henry J. Kaiser Family Foundation, 2004, p. 1). Researchers Hoppin and Taveras (2004) have noted that obesity is often associated with psychological issues such as depression, anxiety, and binge eating (Table 4). Obesity also poses serious problems for a society struggling to cope with rising health care costs. The cost of treating obesity currently totals $117 billion per year—a price,
  • 13. according to the surgeon general, “second only to the cost of [treating] tobacco use” (Carmona, 2004). And as the number of children who suffer from obesity grows, long-term costs will only increase. Is Medication Effective at Treating Childhood Obesity? The widening scope of the obesity problem has prompted medical professionals to rethink old conceptions of the disorder and its causes. As researchers Yanovski and Yanovski (2002) have explained, obesity was once considered “either a moral failing or evidence of underlying psychopathology” (p. 592). But this view has shifted: Many medical professionals now consider obesity a biomedical rather than a moral condition, influenced by both genetic and environmental factors. Yanovski and Yanovski have Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006). Ellipsis mark indicates omitted
  • 14. words. An ampersand links the names of two authors in parentheses. The writer draws attention to an important article. Obesity in Children 5 further noted that the development of weight-loss medications in the early 1990s showed that “obesity should be treated in the same manner as any other chronic disease . . . through the long-term use of medication” (p. 592). The search for the right long-term medication has been complicated. Many of the drugs authorized by the Food and Drug Administration (FDA) in the early 1990s proved to be a disappointment. Two of the medications—fenfluramine and dexfenfluramine—were withdrawn from the market because of severe side effects (Yanovski & Yanovski, 2002, p. 592), and several others were classified by the Drug Enforcement
  • 15. Administration as having the “potential for abuse” (Hoppin & Taveras, 2004, Weight-Loss Drugs section, para. 6). Currently only two medications have been approved by the FDA for long-term treatment of obesity: sibutramine (marketed as Meridia) and orlistat (marketed as Xenical). This section compares studies on the effectiveness of each. Sibutramine suppresses appetite by blocking the reuptake of the neurotransmitters serotonin and norepinephrine in the brain. Though the drug won FDA approval in 1998, experiments to test its effectiveness for younger patients came considerably later. In 2003, University of Pennsylvania researchers Berkowitz, Wadden, Tershakovec, and Cronquist released the first double-blind placebo study testing the effect of sibutramine on adolescents, aged 13-17, over a 12-month period. Their findings are summarized in Table 1. After 6 mos.: loss of 3.2 kg
  • 16. (7 lb) After 12 mos.: loss of 4.5 kg (9.9 lb) After 6 mos.: loss of 7.8 kg (17.2 lb) After 12 mos.: loss of 7.0 kg (15.4 lb) Gain of 0.67 kg (1.5 lb) Loss of 1.3 kg (2.9 lb) Table 1 Effectiveness of Sibutramine and Orlistat in Adolescents Average weight Medication Subjects Treatmenta Side effects loss/gain Sibutramine Orlistat Control Medicated
  • 17. Control Medicated 0-6 mos.: placebo 6-12 mos.: sibutramine 0-12 mos.: sibutramine 0-12 mos.: placebo 0-12 mos.: orlistat Mos. 6-12: increased blood pressure; increased pulse rate Increased blood pressure; increased pulse rate None Oily spotting; flatulence; abdominal discomfort
  • 18. Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006). The writer uses a table to summa- rize the findings presented in two sources. A note gives the source of the data. A content note explains data common to all subjects. Note. The data on sibutramine are adapted from “Behavior Therapy and Sibutramine for the Treatment of Adolescent Obesity,” by R. I. Berkowitz, T. A. Wadden, A. M. Tershakovec, & J. L. Cronquist, 2003, Journal of the American Medical Association, 289, pp. 1807-1809. The data on orlistat are adapted from Xenical (Orlistat) Capsules: Complete Product Information, by Roche Laboratories, December 2003, retrieved from http://www.rocheusa.com/products/xenical/pi.pdf
  • 19. aThe medication and/or placebo were combined with behavioral therapy in all groups over all time periods. Obesity in Children 6 Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006). When this article was first cited, all four authors were named. In subse- quent citations of a work with three to five authors, “et al.” is used after the first author’s name. Obesity in Children 7 After 6 months, the group receiving medication had lost 4.6 kg (about 10 pounds) more than the control group. But during the second half of the study, when both groups received sibutramine, the results were more ambiguous. In months 6-12, the group that continued to take sibutramine gained an average of 0.8 kg, or roughly 2 pounds; the control group, which
  • 20. switched from placebo to sibutramine, lost 1.3 kg, or roughly 3 pounds (p. 1808). Both groups received behavioral therapy covering diet, exercise, and mental health. These results paint a murky picture of the effectiveness of the medication: While initial data seemed promising, the results after one year raised questions about whether medicationinduced weight loss could be sustained over time. As Berkowitz et al. (2003) advised, “Until more extensive safety and efficacy data are available, . . . weight-loss medications should be used only on an experimental basis for adolescents” (p. 1811). A study testing the effectiveness of orlistat in adolescents showed similarly ambiguous results. The FDA approved orlistat in 1999 but did not authorize it for adolescents until December 2003. Roche Laboratories (2003), maker of orlistat, released results of a one-year study testing the drug on 539 obese adolescents, aged 12-16. The drug, which promotes weight loss
  • 21. by blocking fat absorption in the large intestine, showed some effectiveness in adolescents: an average loss of 1.3 kg, or roughly 3 pounds, for subjects taking orlistat for one year, as opposed to an average gain of 0.67 kg, or 1.5 pounds, for the control group (pp. 8-9). See Table 1. Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006). For a source with six or more authors, the first author’s name followed by “et al.” is used for the first and subsequent references. Obesity in Children 8 Short-term studies of orlistat have shown slightly more dramatic results. Researchers at the National Institute of Child Health and Human Development tested 20 adolescents, aged 12-16, over a three-month period and found that orlistat, combined with behavioral therapy, produced an average weight
  • 22. loss of 4.4 kg, or 9.7 pounds (McDuffie et al., 2002, p. 646). The study was not controlled against a placebo group; therefore, the relative effectiveness of orlistat in this case remains unclear. Is Medication Safe for Children? While modest weight loss has been documented for both medications, each carries risks of certain side effects. Sibutramine has been observed to increase blood pressure and pulse rate. In 2002, a consumer group claimed that the medication was related to the deaths of 19 people and filed a petition with the Department of Health and Human Services to ban the medication (Hilts, 2002). The sibutramine study by Berkowitz et al. (2003) noted elevated blood pressure as a side effect, and dosages had to be reduced or the medicati on discontinued in 19 of the 43 subjects in the first six months (p. 1809). The main side effects associated with orlistat were abdominal discomfort, oily spotting, fecal incontinence, and
  • 23. nausea (Roche Laboratories, 2003, p. 13). More serious for long-term health is the concern that orlistat, being a fat- blocker, would affect absorption of fat-soluble vitamins, such as vitamin D. However, the study found that this side effect can be minimized or eliminated if patients take vitamin Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006). The writer develops the paper’s thesis. Obesity in Children 9 supplements two hours before or after administration of orlistat (p. 10). With close monitoring of patients taking the medication, many of the risks can be reduced. Is Medication the Best Solution
  • 24. ? The data on the safety and efficacy of pharmacological treatments of childhood obesity raise the question of whether medication is the best solution for the problem. The treatments have clear costs for individual patients, including unpleasant side effects, little information about long-term use, and uncertainty that they will yield significant weight loss. In purely financial terms, the drugs cost more than $3 a day on average (Duenwald, 2004). In each of the clinical trials, use of medication was accompanied by an expensive regime of behavioral therapies, including counseling, nutritional education, fitness advising, and monitoring. As journalist Greg Critser (2003) noted in his book Fat Land, use of weight-loss
  • 25. drugs is unlikely to have an effect without the proper “support system”—one that includes doctors, facilities, time, and money (p. 3). For some, this level of care is prohibitively expensive. A third complication is that the studies focused on adolescents aged 12-16, but obesity can begin at a much younger age. Little data exist to establish the safety or efficacy of medication for treating very young children. While the scientific data on the concrete effects of these medications in children remain somewhat unclear, medication is not the only avenue for addressing the crisis. Both medical experts and policymakers recognize that solutions might come
  • 26. Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006). Brackets indicate a word not in the original source. A quotation longer than 40 words is indented without quotation marks. The writer inter- prets the evidence; she doesn’t just report it. The tone of the conclusion is objective. Obesity in Children 10
  • 27. not only from a laboratory but also from policy, education, and advocacy. Indeed, a handbook designed to educate doctors on obesity recommended a notably nonmedical course of action, calling for “major changes in some aspects of western culture” (Hoppin & Taveras, 2004, Conclusion section, para. 1). Cultural change may not be the typical realm of medical professionals, but the handbook urged doctors to be proactive and “focus [their] energy on public policies and interventions” (Conclus ion section, para. 1). The solutions proposed by a number of advocacy groups underscore this interest in political and cultural change. A report by the Henry 3. Kaiser Family Foundation (2004) outlined trends
  • 28. that may have contributed to the childhood obesity crisis, including food advertising for children as well as a reduction in physical education classes and after-school athletic programs, an increase in the availability of sodas and snacks in public schools, the growth in the number of fast-food outlets . . . , and the increasing number of highly processed high-calorie and high-fat grocery products. (p. 1) Addressing each of these areas requires more than a doctor armed with a prescription pad; it requires a broad mobilization not just of doctors and concerned parents but of educators, food industry executives, advertisers, and media
  • 29. representatives. The barrage of possible approaches to combating childhood obesity—from scientific research to political lobbying— indicates both the severity and the complexity of the problem. Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006). Obesity in Children 11 While none of the medications currently available is a miracle drug for curing the nation’s nine million obese children, research has illuminated some of the underlying factors that affect obesity and has shown the need for a comprehensive approach to the problem that includes behavioral, medical, social, and
  • 30. political change. Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006). List of references begins on a new page. Heading is centered. List is alphabet- ized by authors’ last names. All authors’ names are inverted. The first line of an entry is at the left margin; subsequent lines indent 1⁄2''. Double-spacing is used throughout.
  • 31. Obesity in Children 12 References Berkowitz, R. I., Wadden, T. A., Tershakovec, A. M., & Cronquist, J. L. (2003). Behavior therapy and sibutramine for the treatment of adolescent obesity. Journal of the American Medical Association, 289, 1805-1812. Carmona, R. H. (2004, March 2). The growing epidemic of childhood obesity. Testimony before the Subcommittee on Competition, Foreign Commerce, and Infrastructure of the U.S. Senate Committee on Commerce, Science, and Transportation. Retrieved from http://www.hhs.gov/asl /testify/t040302. html
  • 32. Critser, G. (2003). Fat land. Boston, MA: Houghton Mifflin. Duenwald, M. (2004, January 6). Slim pickings: Looking beyond ephedra. The New York Times, p. F1. Retrieved from http://nytimes.com/ Henry J. Kaiser Family Foundation. (2004, February). The role of media in childhood obesity. Retrieved from http://www .kff.org/entmedia/7030.cfm Hilts, P. J. (2002, March 20). Petition asks for removal of diet drug from market. The New York Times, p. A26. Retrieved from http://nytimes.com/ Hoppin, A. G., & Taveras, E. M. (2004, June 25). Assessment and management of childhood and adolescent obesity.
  • 33. Clinical Update. Retrieved from http://www.medscape .com/viewarticle/481633 McDuffie, J. R., Calis, K. A., Uwaifo, G. I., Sebring, N. G., Fallon, E. M., Hubbard, V. S., & Yanovski, J. A. (2002). Three month tolerability of orlistat in adolescents with Source: Diana Hacker (Boston: Bedford/St. Martin’s, 2006). Obesity in Children 13 obesity-related comorbid conditions. Obesity Research, 10, 642-650. Roche Laboratories. (2003, December). Xenical (orlistat) capsules: Complete product information. Retrieved from http://www.rocheusa.com/products/xenical/pi.pdf
  • 34. Yanovski, S. Z., & Yanovski, J. A. (2002). Drug therapy: Obesity. The New England Journal of Medicine, 346, 591-602. Chapter 7 Uber Collides with Controversy · Introduction · 7-2Global Expansion Challenges · 7-3Threats to the Sharing Economy · 7-4Controversy · 7-5A Global Pandemic · 7-6Other Business Segments · 7-6aFood Delivery · 7-6bFreight · 7-6cOther Bets · 7-6dThe Future · 7-7Uber Becomes a Public Company · 7-8Conclusion · 7-9Chapter Review · 7-9aQuestions for Discussion · 7-9bSources