How to Earn Army Promotion Before BCT

The U.S. Armys Basic Combat Training (BCT) program is your portal into military service. Although youll be entering the service as a raw recruit, there are ways to earn a few stripes prior to entering BCT. These methods require varying levels of effort and dedication on your part while you are still a civilian, but these efforts are recognized by the Army and are often rewarded through early promotion.

Get your Eagle Scout Certificate or Girl Scout Gold Award.

Complete the Armys online Future Soldiers Training (FSTS) program. The FSTS gets you a step ahead of other candidates by acquainting you with the basics of Army life, as well as preparing you for what to expect during BCT.

Refer high school graduates or attendees. One referral must score 50 or higher on the ASVAB. You need to refer two or more candidates scoring between 31 and 49, or three candidates that meet qualifications but have not taken the test.

Earn 24 or more credit hours from an accredited university or other institution.

Earn the Quartermaster Award from the Naval Sea Cadet Program, or receive the Air Force Civil Air Patrols Billy Mitchell award.

Complete three or more years in a Junior Reserve Officers Training program at your high school, or one year of Senior ROTC.

Earn 48 or more college credits from an accredited university or other institution.

Complete a two-year certification program at a vocational or technical school.

Refer two high school graduates or attendees scoring higher than 50 on the ASVAB. Youll need to refer four or more if they score between 31 and 49, or six or more if they have not completed those requirements.

Complete your four-year college degree from an accredited college to enter BCT as an E-4, or Specialist. This is the highest enlisted rank you can earn prior to entering the military.

College credits earned at institutions not found on the American Council on Educations Accredited Institutions of Post-secondary Education or AIPE list will not count toward promotion credits.

David Lipscomb is a professional writer and public relations practitioner. Lipscomb brings more than a decade of experience in the consumer electronics and advertising industries. Lipscomb holds a degree in public relations from Webster University.

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Trailer (promotion

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Atrailer(also known as aprevieworcoming attraction) is a commercialadvertisementfor afeature filmthat will be exhibited in the future at acinema, the result of creative and technical work. The term trailer comes from their having originally been shown at the end of a feature film screening.1That practice did not last long, because patrons tended to leave the theater after the films ended, but the name has stuck. Trailers are now shown before the film begins.

Movie trailers have now become popular onDVDsandBlu-raydiscs, as well as on the Internet and mobile devices. Of some 10 billion videos watched online annually, film trailers rank third, after news and user-created video.2The trailer format has also been adopted as a promotional tool for television shows, video games, books, and theatrical events/concerts.

The first trailer shown in an American film theater was in November 1913, whenNils Granlund, the advertising manager for theMarcus Loewtheater chain, produced a short promotional film for the musicalThe Pleasure Seekers, opening at the Winter Garden Theatre on Broadway. As reported in a wire service story carried by theLincoln, NebraskaDaily Star, the practice which Loew adopted was described as an entirely new and unique stunt, and that moving pictures of the rehearsals and other incidents connected with the production will be sent out in advance of the show, to be presented to the Loews picture houses and will take the place of much of the bill board advertising.3Granlund was also first to introduce trailer material for an upcoming motion picture, using a slide technique to promote an upcoming film featuringCharlie Chaplinat Loews Seventh Avenue Theatre in Harlem in 1914.4

Trailers were initially shown after, or trailing, the feature film, and this led to their being called trailers. The practice was found to be somewhat ineffective, often ignored by audiences who left immediately after the feature. Later, exhibitors changed their practice so that trailers were only one part of the film program, which included cartoon shorts, newsreels, and serial adventure episodes. Today, more elaborate trailers and commercial advertisements have largely replaced other forms of pre-feature entertainment, and in major multiplex chains, about the first 20 minutes after the posted showtime is devoted to trailers.citation needed

Up until the late 1950s, trailers were mostly created byNational Screen Serviceand consisted of various key scenes from the film being advertised, often augmented with large, descriptive text describing the story, and an underscore generally pulled from studio music libraries. Most trailers had some form of narration, and those that did featuredstentorianvoices.citation needed

In the early 1960s, the face of motion picture trailers changed. Textless, montage trailers and quick-editing became popular, largely due to the arrival of the new Hollywood and techniques that were becoming increasingly popular in television. Among the trend setters wereStanley Kubrickwith his montage trailers forLolita(1962),Dr. Strangelove or: How I Learned to Stop Worrying and Love the Bomb(1964), and2001: A Space Odyssey(1968). Kubricks main inspiration for theDr. Strangelovetrailer was the short filmVery Nice, Very Nice(1961) by Canadian film visionaryArthur LipsettPablo Ferro, who pioneered the techniques Kubrick required as necessary elements for the success of his campaign, created theDr. Strangelovetrailer, as well as the award-winning trailer forA Clockwork Orange(1971).citation needed

Many home videos contain trailers for other movies produced by the same company scheduled to be available shortly after the legal release of the video, so as not to spend money advertising the videos on TV. MostVHStapes would play them at the beginning of the tape, but some VHS tapes contained previews at the end of the film or at both ends of the tape. VHS tapes that contained trailers at the end usually reminded the viewer to Stay tuned after the feature for more previews. WithDVDsandBlu-rays, trailers can operate as a bonus feature instead of having to watch through the trailers before the film.citation needed

Trailers consist of a series selected shots from the film being advertised. Since the purpose of the trailer is to attract an audience to the film, these excerpts are usually drawn from the most exciting, funny, or otherwise noteworthy parts of the film but in abbreviated form and usually without producingspoilers. For this purpose the scenes are not necessarily in the order in which they appear in the film. A trailer has to achieve that in less than 2 minutes and 30 seconds, the maximum length allowed by theMPAA. Each studio or distributor is allowed to exceed this time limit once a year, if they feel it is necessary for a particular film.5

In January 2014, the movie theater trade groupNational Association of Theatre Ownersissued an industry guideline asking that film distributors supply trailers that run no longer than 2 minutes, which is 30 second shorter than the prior norm.6The guideline is not mandatory, and also allows for limited exceptions of a select few movies having longer trailers. Film distributors reacted coolly to the announcement. There had been no visible disputes on trailer running time prior to the guideline, which surprised many.

Some trailers use special shoot footage, which is material that has been created specifically for advertising purposes and does not appear in the actual film. The most notable film to use this technique wasTerminator 2: Judgment Day, whose trailer featured an elaborate special effect scene of a T-800 Terminator being assembled in a factory that was never intended to be in the film itself.Dimension Filmsalso shot extra scenes for their 2006 horror remake,Black Christmas- these scenes were used in promotional footage for the film, but are similarly absent from the theatrical release. A trailer for the 2002 blockbusterSpider-Manhad an entire action sequence especially constructed that involved escaping bank robbers in a helicopter getting caught in a giant web between theWorld Trade Centers two towers. However, after theSeptember 11 attacksthe studio pulled it from theaters.

One of the most famous special shoot trailers is that used for the 1960s thrillerPsycho, which featured directorAlfred Hitchcockgiving viewers a guided tour of the Bates Motel, eventually arriving at the infamous shower. At this point, the soft-spoken Hitchcock suddenly throws the shower curtain back to revealVera Mileswith a blood-curdling scream. As the trailer, in fact, was made after completion of the film whenJanet Leighwas no longer available for filming, Hitchcock had Miles don a blonde wig for the fleeting sequence. Since the title, Psycho, instantly covers most of the screen, the switch went unnoticed by audiences for years until freeze-frame analysis clearly revealed that it was Vera Miles and not Janet Leigh in the shower during the trailer.

There are dozens of companies that specialize in the creation of film trailers in Los Angeles and New York. The trailer may be created at agencies (such as The Cimarron Group, MOJO, The Ant Farm, Ben Cain, Aspect Ratio, Flyer Entertainment, Trailer Park, Buddha Jones) while the film itself is being cut together at the studio. Since the edited film does not exist at this point, the trailereditorswork fromrushesordailies. Thus, the trailer may contain footage that is not in the final movie, or the trailer editor and the film editor may use differenttakesof a particular shot. Another common technique is including music on the trailer which does not appear on the movies soundtrack. This is nearly always a requirement, as trailers and teasers are created long before the composer has even been hired for the film scoresometimes as much as a year ahead of the movies release datewhile composers are usually the last creative people to work on the film.

Some trailers that incorporate material not in the film are particularly coveted by collectors, especially trailers for classic films. For example, in a trailer forCasablancathe character Rick Blaine says, OK, you asked for it! before shooting Major Strasser; this line of dialogue is not spoken in the final film.

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Over the years, there have been many instances where trailers give misleading representations of their films. They may give the impression that a celebrity who only has a minor part in the film is one of the main cast members, or advertising a film as being more action-packed than it is. These tricks are usually done to draw in a larger audience. Sometimes the trailers include footage not from the film itself. This could be an artistic choice, or because the trailer was put together before the films final cut, but at other times it is to give the audience a different impression of the movie. Then trailers could be misleading in a for the audiences own good kind of way, in that a general audience would not usually see such a film due to preconceptions, and bybait and switching, they can allow the audience to have a great viewing experience that they would not ordinarily have. However, the opposite is true too, with the promise of great trailers being let down by mediocre films.7An American woman sued the makers ofDrivebecause their film failed to live up to its promos promise,8910although her lawsuit was dismissed.1112In August 2016, an American lawyer attempted to sueSuicide Squadfor false advertising over lack of scenes includingJoker.13

Trailers tell the story of a film in a highly condensed fashion to have maximum appeal. In the decades since film marketing has become a large industry, trailers have become highly polished pieces of advertising, able to present even poor movies in an attractive light. Some of the elements common to many trailers are listed below. Trailers are typically made up of scenes from the film they are promoting, but sometimes containdeleted scenesfrom the film.

The key ambition in trailer-making is to impart an intriguing story that gets film audiences emotionally involved.14

Most trailers have athree-act structuresimilar to a feature-length film. They start with a beginning (act 1) that lays out the premise of the story. The middle (act 2) drives the story further and usually ends with a dramatic climax. Act 3 usually features a strong piece of signature music (either a recognizable song or a powerful, sweeping orchestral piece). This last act often consists of a visual montage of powerful and emotional moments of the film and may also contain a cast run if there are noteworthy stars that could help sell the movie.

Voice-overnarration is sometimes used to briefly set up the premise of the film and provide explanation when necessary, although this practice has declined in the years after the passing of voice-over artistDon LaFontaine. Since the trailer is a highly condensed format, voice-over is a useful tool to enhance the audiences understanding of the plot. Some of the best-known, modern-day trailer voice-over artists have been the aforementioned LaFontaine,Hal DouglasMark Elliott, John Leader,Corey BurtonGeorge DelHoyoPeter CullenMorgan FreemanAshton SmithJim Cummings, John Garry,Tom KaneNick SchatzkiBen Patrick Johnson, Tony Rodgers,Beau Weaver, andBrian Cummings. Classic voice-over artists in film trailers of the 1940s, 1950s and 1960s included Howard Strickling (for MGM), Lou Marcelle (for Warner Bros.), Art Gilmore, Knox Manning, Reed Hadley, Les Tremayne (for MGM), Fred Foy (for MGM), Karl Weber (for MGM) and Bob Marcato. Hollywood trailers of the classic film era were renowned for clichs such as Colossal!, Stupendous!, etc. Some trailers have used voice over clichs for satirical effect. This can be seen in trailers for films such as Jerry Seinfelds Comedian and Tenacious D in The Pick of Destiny.

Musichelps set thetoneand mood of the trailer. Usually the music used in the trailer is not from the film itself (thefilm scoremay not have been composed yet). The music used in the trailer may be:

Music from the score of other movies.

Popular or well-known music, often chosen for its tone, appropriateness of a lyric or lack thereof, or recognizability. The most often used of these is

as well as the works ofE.S. PosthumusandBeethoven. Popular music may be selected for its tone (i.e. hard rock for an action film, lighter pop for a romantic comedy), or to establish context (e.g. the trailer for a film set in the 1940s might use big band swing).

Library music previously composed specifically to be used in advertising by an independent composer. There are many trailer music library companies which producetrailer music, some of the best known areaudiomachineTwo Steps From HellImmediate MusicandX-Ray Dogor SFX and Music libraries like the ones from Moss Landing,Gerrit Kinkel ProductionsorredCola.

Specially composed music. One of the most famous Hollywood trailer music composers, credited with creating the musical voice of contemporary trailers, isJohn Beal, who began scoring trailers in the 1970s and, in the course of a thirty-year career, created original music for over 2,000 film trailer projects,

including 40 of the top-grossing films of all time, such as

Acast runis a list of thestarsthat appear in the movie. If thedirectororproduceris well-known or has made other popular movies, they often warrant a mention as well. Most trailers conclude with abillingblock, which is a list of the principalcastandcrew. It is the same list that appears on posters and print publicity materials, and also usually appears on-screen at the beginning (or end) of the movie. Studioproduction logosare usually featured near the beginning of the trailer. Until the late 1970s, they were put only at the end of the trailer or not used at all; however,Paramount Pictureswas the first studio to use its actual studio logo at the beginning of its trailers in the 1940s. Often there will be logos for both theproduction companyanddistributorof the film.

Many trailers aremixedin Dolby Digital or any other multichannel sound mix. Scenes including sound effects and music that are enhanced by stereophonic sound are therefore the focus point of many modern trailers.

Trailers preceding feature films are generally presented in the same format as the feature, being either 35mm film or a digital format. High bandwidth internet connections allow for trailers to be distributed online at any resolution. Since the advent ofDigital 3D, it has become common for a 3‑D feature film to be preceded by one or more trailers that are also presented in 3‑D.

National Screen Service contracts required that trailers be returned (at the cinemas expense) or destroyed, however it required no proof of destruction and depositing them in a waste bin counted. A market for trailers evolved as it became clear that some had a commercial value to collectors. Many of the trailers for films like theStar Warsseries reported as destroyed were taken back out of the bin and sold by cinema staff. As they cost about $60 each to make (1981 estimate) and were hired to the cinema for $10, such losses led to NSS increasing its rental charges, which led to a decrease in the number of trailers rented and shown to audiences.17

Some cinemas also began to show trailer trash programs of trailers without a main feature. Similarly, several DVDs containing nothing but trailers for films, typically from exploitation film genres, have been produced for sale.

Beginning in the late 1990s to early 2000s, and along with the development of the Internet and sites such asYouTubeas well as animation techniques, more types of trailers began to be created due to easier and cheaper costs to produce and show trailers.

Beginning in the late 1990s to early 2000s, video game trailers began to be produced as they became more mainstream. Used to entice viewers to go out and play the game, game trailers are very useful. The content and production process is similar to that for movies, complicated by the need to convey the way the game plays. The trailer for Aliens: Colonial Marines, for example, featured graphics that were of a higher standard than the game that was eventually sold.18Hideo Kojima, a game creator strongly influenced by Hollywood movies, edits the elaborate trailers for his own games from a special studio in his office.19

TV spots are trailers for movies shown on television that are often shortened to 3060 seconds. These trailers are similar to green band trailers and have content appropriate for the channel.

TV showtrailers are trailers advertising a new TV series, episode, event or marathon premiering on television. Trailers for the next episode of a TV series are often shown during or following the closing credits of the show.

Abook traileris avideoadvertisement for abookwhich employs techniques similar to those ofmovie trailersto promote books and encourage readers.20These trailers can also be referred to as video-podcasts, with higher quality trailers being called cinematic book trailers.21They are circulated on television and online in most common digital video formats.22Common formats of book trailers include actors performing scenes from the book akin to a movie trailer, full production trailers, flash videos, animation or simple still photos set to music with text conveying the story.23This differs from author readings and interviews, which consist of video footage of the author narrating a portion of their writing or being interviewed.24Early book trailers consisted mostly of still images of the book, with some videos incorporating actors,25withJohn Farrissbook trailer for his 1986 novelWildwoodincorporating images from the book cover along with actors such asJohn Zacherle.26

In September 2007, theSchool Library Journalestablished the Trailie Award for the best book trailers. There are three categories: author/publisher created, student created and librarian/adult created. The award was announced at theSchool Library JournalLeadership Summit on the Future of Reading on October 22, 2010 in Chicago.27

In 2014, Dan Rosen and CV Herst established BookReels, a website dedicated to allowing publishers and authors to post book trailers and other multimedia, culminating in the annual BookReels Awards. BookReels lets readers browse and rate trailers, post comments and reviews, join discussion groups, and share BookReel discoveries.28

For popular movies, fans often make trailers on their own. These are unofficial videos by fans utilizing audio or video of a movie, studio trailer, animation techniques or fan-acted scenes replacing the video of the official trailer.

TheMotion Picture Association of America(MPAA) mandates that theatrical trailers be no longer than two minutes and thirty seconds. Each major studioclarification neededis given one exception to this rule per year.citation neededInternet or home-video trailers have no time restrictions.Rating cardsappear at the head of trailers in the United States which indicate how closely the trailer adheres to the MPAAs standards.citation needed

Agreen bandis an all-green graphic at the beginning of the trailer. Until April 2009, these cards indicated that they had been approved for all audiences and often included the moviesMPAA rating. This signified that the trailer adheres to the standards for motion picture advertising outlined by the MPAA, which include limitations on foul language and violent, sexual, or otherwise objectionable imagery. In April 2009, the MPAA began to permit the green band language to say that a trailer had been approved for appropriate audiences, meaning that the material would be appropriate for audiences in theaters, based on the content of the film they had come to see. In May 2013, the MPAA changed the trailer approval band from for appropriate audiences to to accompany this feature, but only when accompanying a feature film; for bands not accompanying a feature film, the text of the band remained the same. The font and style of the text on the graphic bands (green and red) was also changed at the time the green band was revised in 2013.citation needed

Trailers which do not adhere to these guidelines may be issued ared band, which indicates approval for only restricted or mature audiences. These trailers may only be shown theatrically before R-rated, NC-17-rated, or unrated moviescitation needed(only films that are released in theaters rated R and not in theatersclarification neededrated PG-13). These trailers may include nudity, profanity, or other material deemed inappropriate for children.29

Additionally, yellow band trailers were introduced around 2007 to indicate restricted content, only for distribution on the Internet. Although official, this practice appears to have never been widespread (although occasional yellow band trailers are created). A notable example is the yellow band trailer for Rob ZombiesHalloween(2007).30

Every year there are two main events that give awards to outstanding film trailers: TheKey Art Awards, presented byThe Hollywood Reporter, and theGolden Trailer Awards. The Golden Trailer Awards and the Key Art Awards pick winners in all creative parts of film advertising, from trailers and TV spots to posters and print ads. The Golden Trailer Awards are currently expanding to add a sister event, The World Trailer Awards, to be a kickoff to the Cannes Film Festival in France, 2013. The yearly Key Art Awards ceremony is often held at theDolby Theaterin Hollywood.The Film Informantalso recognizes movie marketing media and held the first annual TFI Awards in early January 2012.31The site is the first to officially start recognizing and rating movie marketing media on a daily basis.

List of most viewed online trailers in the first 24 hours

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AWFJ Opinion Poll: All About Movie Trailers. AWFJ. 2008-05-09.

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Trailer music. SoundtrackNet, LLC. 30 April 2009.

Theaters Advocate Shorter Movie Trailers. . 2014-01-28.

10 Movie Trailers That Are Nothing Like The Actual Movie. m

Hardie, Giles (October 11, 2011).Misleading trailer leads to law suit.

Child, Ben (10 October 2011).Woman sues to stop Drive getting away with a misleading trailer.

10/08/11 3:02pm 10/08/11 3:02pm.Woman Files Lawsuit Over Misleading Trailer for Drive. Gawker.com

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Suicide Squad fan suing for false advertising over the lack of Joker scenes.

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(3rd ed.). Southern Illinois University Press. pp.642.

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Daily Variety: Razor-thin copyright line.

Coming Soon to a Theatre Near You – Maybe in Ares 8, Schow, DJ; Simulations Publications, NY 1981, Page 33

Sega Admits Aliens: Colonial Marines Trailer Was Misleading. Forbes

Matulef, Jeffrey (2014-03-14).War has changed. But has Hideo Kojima? • Articles • PlayStation 4 •. Eurogamer.net

Chmielewski, Dawn (November 4, 2006).YouTube video sets stage for novel.

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Metz, Nina.Super Sad Book Trailers. Chicago Tribune.

Fitton, Akira.TOR Books WILDWOOD promo

SLJs Trailie Awards Asks Readers to Vote for Their Favorite Book Trailer. School Library Journal

BookReels, an MTV for Books?. Publishers Weekly

Barnes, Brooks (February 23, 2010).Cat-and-Mouse for a Trashy Trailer. New York Times

Halbfinger, David M. (13 June 2007).Attention, Web Surfers: The Following Film Trailer May Be Racy or Graphic.

. The Film Informant. Archived fromthe originalon 17 July 2012

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Employee Promotion Policy Guide

Basing promotions on performance prevents accusations of discrimination.

Unclear promotion policies can create conflicts and high turnover rates among employees who dont understand why co-workers received a promotion instead of them. Problems may not end there if vague promotion procedures also appear discriminatory. Employers can avoid such difficulties by creating a transparent promotion policy and consistently applying that policys standards to each employee seeking advancement.

An effective promotion policy focuses on advancing employees based on their skills and performance, not favoritism. Companies risk putting people in jobs they cant handle when promotions arent based on workers abilities. Moreover, employers who dont base employee advancement on job performance could face lawsuits if workers assert that the promotion process is discriminatory. In such cases, workers would have to show that an employer violated Title VII of the Civil Rights Act. The legislation prohibits companies from denying job promotions based on workers age, gender, race or other characteristics.

Its important to determine the minimum criteria for advancement and make employees aware of the standards they need to meet to earn promotions. For example, employees may need to work with a company for at least two years before theyre eligible for any type of promotion, or meet certain quotas to advance within a company. Salespeople, for instance, may need to meet monthly sales goals to be considered for promotions. Employers can bolster motivation among employees by encouraging the advancement of qualified workers to higher positions before hiring from outside the company to fill such jobs.

Make posting all job openings in the workplace part of your promotion policy so advancement opportunities are open to all qualified candidates. In 2007, the 6th U.S. Circuit Court of Appeals determined that an employee could sue an employer for not posting job openings. The decision resulted from a case involving a 50-year-old Tractor Supply Company employee who asserted he wasnt considered for a promotion to an unadvertised position because of his age. The court determined the company wasnt guilty of age discrimination. Nonetheless, the company could have avoided the lawsuit and expensive legal fees if it had posted the job so that all qualified employees could have applied for it.

Assess all qualified employees for a promotion in the same manner to avoid the appearance of favoritism or discrimination. For example, ensure a hiring manager examines performance appraisals and uses them to select the top candidates for a promotion. Keep the application review process consistent by determining the importance of various qualifications and judging all candidates on those factors. For instance, consider whether candidates job-related experience is more important than their educational background. Document the application review process for each candidate in case there are questions about whether the promotion policy is biased. Note in employees files why they were or werent promoted.

Equal Employment Opportunity Commission: Equal Employment Opportunity is the Law

HR Specialist: Michigan Employment Law: Dont Post Promotion Opportunities? Its Time to Reconsider

Harvard Business Review: When to Reward Employees with More Responsibility and Money

Frances Burks has more than 15 years experience in writing positions, including work as a news analyst for executive briefings and as an Associated Press journalist. Burks has banking and business development experience, and she has written numerous articles on consumer issues and home improvement. Burks holds a bachelors degree in political science from the University of Michigan.

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Burks, Frances. (n.d.). Employee Promotion Policy Guide.

Burks, Frances. Employee Promotion Policy Guide accessed August 11, 2018.

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Examples of BusinessJustificationsfor Promotions

The Effects ofMerit-Based Promotion Vs. Seniority

Examples of Company Policies &Procedures

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Im a board-certified anatomic and clinical pathologist and operator of the largest one-person medical information site on the web. As a pathologist, its my job (among others) to examine tissue, tell whats the matter, and predict the behavior of the disease and response to therapy. Like most other pathologists, Im extremely successful at this. Like most other pathologists, I take a lot of pride in this. (Call us arrogant if you like. I am an honest physician who engages in public debates. When I catch somebody deliberately deceiving the public, they never defend their cases on the facts, but almost always call me arrogant or elitist and claim I am secretly in the pay of the wicked pharmaceutical companies.) And if I screw up even once, Im in MAJOR trouble.

Unlike many M.D.s, Im open-minded about whats known as alternative medicine, i.e., therapies that are not recognized by mainstream medicine.During the 1980s, I reviewed alternative medicine and found there was little to recommend. As the alternative medical community has responded to pressure to defend its claims by the usual methods of science, some areas have improved.

This site aims to let the public know what empirical evidence is available for various alternative remedies, especially studies published in refereed journals. This will enable people who must make decisions to rely on more than anecdotes and advertising.

This site will always be under intensive construction. Only a fool pretends to know everything. I cannot buy or read a book, but I am interested in your personal experiences (anecdotes), and especially in real work by real scientists (i.e., people taking serious precautions against self-deception.) Unless you specify otherwise, Ill feel free to quote you.

I would be remiss without placing links toQuackwatch. The fact that I am less likely than some members to dismiss alternative claims out-of-hand probably reflects our differing life experience. Remember there are plenty of bad doctors in both mainstream medicine and alternative medicine.

Heres the ranking system that this site will use:

The remedy has a plausable mechanism and has been given some basic tests, and/or has solidly passed two good, clear, controlled studies

The remedy makes sense pathophysiologically, and there is at least impressive anecdotal evidence

The anecdotal evidence seemed interesting to me, but thats all there was.

I can see why somebody might have thought of this. But if this actually works better than a placebo and a little human kindness, we are all going to have to make some major readjustments in how we think about health and disease. Dont spend too much money, or get your hopes up.

Boldindicates the remedy has passed a controlled, reasonable-sounding study for this use.Underliningmeans it failed. Claims that lack substantial testing are unmarked.

Here are some things that are NOT alternative medicine.

Taking time with patients, getting to know them, communicating with them, showing some (real or pretended) interest, and being polite. The less that scientific physicians do this, the more we push patients toward the sweet-talking bunko artists.

Being aware of iatrogenic disease, which is inevitable nowadays. Today we have powerful surgical and pharmacological interventions. Surgery is surgery, and all effective drugs except the vitamins and hormones are at least semi-poisons. Hippocrates had no specific therapy for any specific disease. No longer can his dictim, First Do No Harm, be anything more than our wish for the distant future.

Being angry about the mainstream health-care systemand its wanton misuse to maximize personal or corporate gain in a system filled with perverse incentives for everyone involved. You should hear how we autopsy pathologists talk among ourselves after-hours.

I teach my students to treat patients holistically. Ask one of them whether Ive been successful.

Heres how to evaluate an alternative claim.The key is finding out whether anyone has tested the claim using controls.

For example, if you want to know what effect shark cartilage by mouth has on tumors in rats, you need to give some cancer-ridden rats cartilage tablets, and other cancer-ridden rats tablets that look the same but that do not contain cartilage or any other ingredient that is likely to be active (placebo). You have somebody else decide which rats get which tablets, by flipping a coin. When youve examined the rats (how long did they live, or what did the tumors look like at biopsy/autopsy, or whatever), describe each one. Only then do you, yourself, find which rat was in which group. If shark cartilage really works, the treated rats will live longer and/or be distinguishable in some other way from the sham-treated (control) rats.

People who believe their own claims will make every effort to do controlled studies.If their therapy works, it should pass some controlled study sooner or later. If positive results are obtained, some other scientist will always try to duplicate the work. If this succeeds, the claim is reproduced, and you can present a truthful, honest claim to the public.People who dont believe their own claims will start complaining about lack of funding, the Heisenberg uncertainty principle, placebos are valuable and ethical too, politics in science, social causation, you create your own reality, Thomas Kuhn, closed-minded medical establishment, persecuted geniuses, we will NEVER treat individual whole-persons as statistics, etc., etc.

Another very popular claim by charlatans, who admit they have no placebo-controlled studies, is to observe that the vast majority of todays therapies have not been placebo-controlled. These people either dont understand or are lying about the central model of a modern medical study –clinical equipoise. The control group isnt people receiving no treatment. It is people receiving the most popular standard treatment. To be ethical, there must also be a reason to think the treatment will be superior.

The Beautiful Truth / Dying to have known: In Max Gersons era, no child was ever cured of leukemia. To demand that in 2009 we randomize children with leukemia between the modern therapy that cures that vast majority, and a treatment group getting only a magic raw-liver-and-vegetable-based diet and coffee enemas, without even an animal model, would be a crime against humanity. Go ahead and call me an unspiritual corrupt brainwashed bigot if you want — Ive stopped answering my crank mail.

When lives are at stake, I dont think asking for a controlled study is asking too much. Do you?

If there are published, controlled studies, find out what they showed.

If the statistical effect is pronounced and reproducible, you can be confident we have something real. If it is not reproduced, there may have been some intentional or unintentional bias in the original lab.

CAUTION: As charlatans become more sophisticated, you occasionally find books that list refereed journal publications by the dozen. For example, somebody promoting oral superoxide dismutase to prevent aging will cite references to the substances activities in the body, the harmful effects of free radicals, and so forth. This is the old salesmans technique of telling a bunch of truths, so you wont notice the lies… (1) Superoxide dismutase isnt going to make it from your stomach into your cells, but will be destroyed; (2) free radicals may contribute to degenerative disease, but they do not cause aging; (3) animals that produce huge amounts of superoxide dismutase age as fast as others. If youre in doubt, feel free to phone the authors of the papers that are cited in the dubious book… Ive done so occasionally, and they have been VERY unhappy to learn that…

If there are NOT published, controlled studies, ask Why not?

Possibility 1: There is no reason to think it works.Either the therapymakes no sense biologically, or itfailed a pilot study(i.e., a tiny, no-cost study that a high-school kid could do as a science project), or the remedy is promoted byan individual who has failed to present a pilot study.

Possibility 2: Everybody knows it works.Id like to illustrate this with an example. I like working out, and in the late 1980s, I obtained an EMS unit that Id heard could accelerate my muscle growth. The anti-quackery literature listed this as fraudulent, but it made sense biologically, and I decided to do a pilot study, using the EMS unit only on the right side of my body. The end-point would be three people telling me (without my asking) that I was asymmetric. This took about a month. I decided to report my study in a letter to the JAMA, but first I went again to the refereed literature and I discovered an article that described EMS as generally known to be effective in accelerating muscle hypertrophy.

Possibility 3: Nobody stands to make a buck. Nowadays I really doubt it. The unpatentable alternative remedies that obviously work (melatonin, DHEA, creatine, St. Johns wort, strontium for osteoporosis) are widely marketed, presumably for just a modest profit.

In addition, ask whether the therapy makes sense

Scientific knowledge is always tentative (and thankfully, science is self-correcting in the long run.) But our current thinking about how the body works has shown great predictive power, not the least in my own success in predicting the course of disease from looking at tissue sections.

Any proposed mechanism of action can be wrong.For example, I was taught totally-wrong mechanisms of action for bismuth anti-ulcer remedies, dandruff shapoos, nitroglycerine for angina, and nitroprusside for hypertension. (I congratulate myself for having been skeptical as a student.) So if a proposed mechanism for an alternative remedy sounds wrong or even silly, dont dismiss the remedy out-of-hand.

Be skeptical about remedies that cannot work by any means presently known to science or religion.Im open to the reality of the supernatural — in fact, as a Christian, Im committed to it (though not necessarily to the effectiveness of intercessory prayer or laying-on-of-hands.) Enough of this for now.

I am not going to consideralternative systems of diagnosis. As a pathologist, I remain open-minded on the subject. If you know of any that show predictive value (i.e., you can predict which people in the community will and will not come down with XYZ better than I can), please let me know.

The fruit of the acai palm tree, which like everything else contains some biologically active molecules, was presented as a multi-level marketing scheme in 2004. Claims included weight loss and cleansing. The shady work of the marketers is now history, as is Oprahs successful lawsuit against them. A pilot study of acai for weight loss was a miserable and total failure (Nutr. J.10: 45, 2011). At least the juice seems not to be toxic or carcinogenic (Toxicology278: 46, 2010. There junk journal claims (adding it to cigarets prevents emphysma in mice), etc., etc.

Many people who have experienced acupuncture treatment believe that it caused physiologic changes beyond just suggestion and relaxation. As acupuncture moves from folk medicine into real scientific therapeutics, physicians will insist on sorting out the placebo effect and the cultural overlay.

Acupuncture appears to have effects on neurally-mediated reflexes. Because the reflexes are so subtle, studies will remain empirical for a long time to come. Positive studies will need to be replicated, especially since the strong feelings that some people have in favor of acupuncture may introduce bias. This will probably happen soon, but to date, there are no findings of effectiveness (i.e., this particular acupuncture procedure works in this particular situation) that are robust after being replicated in several different series.

Serious studies of whether traditional acupuncture is actually more effective than placebo now use sham acupuncture as the control. In sham acupuncture, the operator deliberately needles the wrong points. This isnt double-blind, but its a start. There are positive results (i.e., real acupuncture is significantly more effective than sham acupuncture) for nausea and vomiting after gynecologic surgery (weak), epicondylitis, anxiety in the emergency pre-hospital care setting, and even parental anxiety during anesthesia induction in a child. In one study of nausea and vomiting after tonsillectomy, the control group did better and the sham group did worse than those not treated at all.

In a few instances, acupuncture has proved superior to a standard medication. One example is an electrical technique for post-operative nausea and vomiting after cosmetic surgery. In another instance, stimulation of a particular needle-point proved as effective as a standard anti-emetic for post-operative nausea and vomiting in children. Another study obtained a similar result for children undergoing anesthesia in the dentists office.

In the anesthetized patient, the placebo phenomenon is less likely to be operating. Electro-acupuncture is now widely used in Europe to reduce the need for anesthetic agents, and the effect was strongly significant in a US double-blind study.

There are also numerous negative studies, in which particular techniques applied to particular clinical problems showed no significant effect. This is in spite of the fact that acupuncture proponents might be reluctant to share a negative study. An electrical technique failed for low back pain. Another electrical technique failed to reduce the need for anesthetics. A major study showed no effect for asthma. Urologists were unable to obtain any benefits by needling the kidney-ureter-bladder meridian. Minute sphere acupuncture failed to help postoperative pain or morphine use. Despite an apparent effect in one study of e addicts, acupuncture did not outperform relaxation or sham treatment for e addiction in a second study. Unlike some other complementary therapies, acupuncture did not show an effect in a major study of chronic low back pain. Although two non-blinded studies of acupuncture for tinnitus suggested an effect, four blinded ones showed no significant effect.

Some large studies have actually not included a sham-acupuncture group when it would be easy to do so. These do help make it clear that acupuncture is relatively safe. Recent studies without a sham control but with positive results compared to no-acupuncture include one for low back pain in the elderly, another for nausea and vomiting during cyclophosphamide infusion for rheumatic disease, another for wheelchair-users shoulder, another for childhood constipation, and another for labor pain. Two British studies found that a trip to the acupuncturist gave good results for chronic headache patients at relatively low cost to the health care system. The question was, Is this worth the money? rather than Is this anything more than a placebo? The authors characterized their own approach as pragmatic. In turn, there are ethical questions involved in placebo treatment, even to make people feel good.

Some studies of electroacupuncture claiming to show a benefit (i.e., for low back pain, nausea and vomiting of pregnancy, nausea and vomiting of myeloablative chemotherapy) have used as controls a non-electrical apparatus, which is not really blinding.

Physiologists are starting to characterize the reflexes involved in needle insertion. One surprising finding, awaiting confirmation, is the induction of mirror-image electrical activity when a myofascial trigger point is stimulated. Controlled studies showing no clinical benefit (for example, post-stroke leg spasticity) still showed curious reflex effects from treatment. Animals have reflexes in response to acupuncture treatment that may be abolished by certain medications.

Despite the training they receive, several acupuncturists examining the same patient are likely to recommend widely different needle placements. This was demonstrated in a test using a low-back- pain patient, and perhaps this is no different from other physicians. Practice is likely to become more standardized as the scientific work continues. Acupuncturists will need to decide how much to retain of the cultural trappings and imaginative physiology. We can expect that most will regard the theory as something to be treasured as a bygone ages attempt to understand the riddles of the body. Instead, its practitioners will recognize that the effects are really mediated by subtle reflexes that are not fundamentally unlike the other processes by which the body maintains its health.

Acupuncture seems to be safe overall. One acupuncturist perforated the right ventricle of the heart causing hemopericardium, and there have been several instances of pneumothorax. I have been pleasantly surprised with how few other complications have been reported during the last few years. My friends in oriental medicine asked me to mention that its now standard to use single-use, presterilized, disposable needles.

The anti-malarial drug artemisinin and its relatives are being promoted by the alternative-medicine community for cancer in general. There is some interest in their possible anti-cancer properties, and a few decent papers, mostly focusing on which patterns of gene expression predict that the drug will kill cells in tissue culture (Pharmacogenetics Journal6: 269, 2006). Theyre well-known to do this, because they are poisons, and the fact that they kill cancer cells (J. Med. Chem.49: 2731, 2006, from the Hop) should come as no surprise. Especially, they may have activity as angiogenesis blockers.

The foremost proponent in the US seems to be Dr. Henry Lai, whose professional degree is in psychology and who teaches in the department of bioengineering at U. Wash. His focus on the effects of non-ionizing fields on humans seems to have led him into fringe medicine, and he has been writing papers about artemisinin as an anti-cancer agent since 1995. He notes that breast cancer cells reportedly (a few old papers in obscure journals) tend to have more surface transferrin (iron-binder) than their benign counterparts. So artemisinin (which generates toxic free radicals when exposed to iron) could induce apoptosis selectively in breast cancer. He managed to demonstrate this effect in a culture of breast cancer cells awash in iron-binder (Life Sciences70: 49, 2001). Artemisinin alone was a dismal failure. At least hes honest. It sounds to me as if the breast cancer cells simply were more adherent for the iron-binder; the experiment does not support the claim that they have greatly increased transferrin surface levels. However, around this time, Dr. Lai speculated about how one could saturate the allegedly-increased transferrin molecules with enough iron, not mentioning that flooding the body with iron is itself dangerous. The iron-bearing pigment that accumulates in malaria is orders-of-magnitude richer in iron than one could possibly accumulate simply from having extra surface transferrin. (At least, both are ferric.)

Readers should know that there are no reports to date (despite ten years of interest, especially by Dr. Lai) of artemisinin inducing even a partial remission of any cancer in any animal system. The claim that there are 350 papers showing an effect on cancer is just another lie. The 88 that I found were mostly cell-culture studies without benign cells as controls. Conspiracy buffs who assume that the drug companies have shunned artemisinin since its a naturally-occurring substance and therefore less profitable should note that taxol (a similar case) became part of mainstream breast cancer therapy as soon as it proved to work.

There just might be an effect. Dr. Lai actually got a chance to try it as a breast cancer preventative in mice in 2006 (Cancer Letters231: 43, 2006). This was the only in vivo study I could find. He claimed an effect with p336: 1328, 1997). Thankfully, her illness subsided when her artemisinin was discontinued. Cause and effect? We cant prove it, but its worrisome.

If you want to try artermisinin for cancer prevention or treatment, its your decision.

UPDATE: 2011. The discussion continues. A correspondent who believes herself to have been cured of breast cancer entirely by artemisinin brought to my attention a very lively ongoing discussion as to whether the substance produces neurotoxicity (see Clin. Inf. Dis.43: 1618, 2006.) This actually does not reference the index case. Dr. Lai continues to publish both on animals and cell culture and has findings that are interesting. There are still no reports of cancer regression in an animal system, but Cancer Letters231: 43, 2006 (which is an elite journal) published the results of a model in which the treated animals got fewer / smaller tumors after treatment with a carcinogen (anti-cancer effect, altered carcinogen metabolism, or someting else?) Im going to stand by my statement, There just might be an effect, and wait with hope for the success of i, an investigator who is obviously a sincere and decent person.

Beta-mannan to reverse dysplasia of the cervix

Beta-mannans are presently being promoted by one individual as able to reverse most cases of dysplasia (pre-cancer) of the cervix. The principal promoter bases his claim on anecdotal evidence, but does claim 95% success.

Mannans are found in tomatoes and may have something to do with their empirical link to a lower rate of some cancers. They may prevent some of the mutations that accumulate to cause cancers. Its harder to see how they would reverse the mutations once they have happened. (Thatd be like reversing loss of virginity.) The promoter claims instead that beta-mannan stimulates the immune system, which is weak in Americans because of our alleged poor diet and smoking habits.

To his credit, the principal proponent has a side-note that urges women with frank cancer to get the required surgery.

People considering this complementary remedy need to know the facts.

The website list of the authors publications does not list a single publication in a refereed scientific journal. It lists only the Phantom Notes.

I searched the medical literature database from the NIH and there is exactly nothing to support the claim from ANY author, not even in the junk journals.

The authors page about Medical Opinions about Beta-Mannan does not even have anecdotal support from another physician, and admits there is exactly nothing published in the scientific literature to support his claim. For this reason, he compares himself to Alexander Fleming, who discovered penicillin about a decade before it came into widespread use.

Until I see a publication, Ill reserve final judgement. But Im very much afraid this one wont work out.

The principal promoter of this complementary remedy is none other than the author of the old Phantom Notes, which I found very helpful when I was on my surgery rotation. They were a superb resource; curiously, we had to send away for them and get them delived to us by mail. A few months later, a sheaf of Bible Prophecy stuff that proved the truth of the Christian religion was mailed to our PO boxes from The Phantom. My Jewish friends especially did not appreciate this. Bible Prophecy still appears on the beta mannan for cervical dysplasia site. Again, youll need to draw your own conclusions. In September 2003, a correspondent shared with me the court decision in a lawsuit against Dr. _______ for plagairism in connection with the Phantom notes. The judge had some very harsh things to say about him even back in the 1970s.

Anti-Malignin Antibody Test for Cancer

See mynotes. This allegedly is an extremely sensitive and specific way of determining whether cancer is present in the body, and its proponents talk about its making pap smears, mammograms, and so forth obsolete. But after more than 20 years, only the original discoverer has described this substance as really existing. In a short (unrefereed) letter in Lancet announcing that his serum stains three different kinds of cancer cells, the discoverer failed to mention any control using any benign cells. (If the fundamental idea is correct, benign cells would be unstained.) Im ready to draw the obvious conclusion. To the labs credit, there is no talk of conspiracies or cover-ups or persecution.

There is presently an online promotion of a secret natural remedy for both type I and type II diabetes. Youll have to find the site yourself, but the claims are obviously bogus.

A supposed scientific article is appended to the site. It is clear that this was not accepted for publication, even by a non-refereed junk journal. For starters, the composition of the remedy is not given. Second, the authors mention at least three previous studies but do not cite references. Third, there are no controls. There are also illiterate expressions. (There is a remarkable phenotypic difference in Type 2 Diabetes. The connective importance of the genetic and environment causes of type 2 diabetes varies between people.) These people claim, in their ad, to make pancreatic islands regrow, but there are no tissue studies in the article. This is a sensational claim, and if there were any reason to think it were true, some scientific journal would have grabbed up the evidence. The shabby quality of the work is shown by the ad page, which states The clinical study further concluded, … treatment with _____ partially brought about a regenerative capability for the damaged endocrine tissues as evidenced by increased islet cell numbers and resulted in restoration of near normal architecture of pancreatic islet(sic.). Anyone who reads the fine print will see that this is simply untrue. The study cited shows nothing of the sort, but simply makes this statement about a second, unreferenced study. Even the name of the independent lab that supposedly did the tests is concealed from the reader.

If you want to send these people a few hundred dollars for their secret mix, that is your business.

Right now (2005), current articles in the genuine scientific literature on the use of natural remedies for diabetes are conspicuous by their absence. For a review of how herbalists design complementary therapy for diabetics, see Acta. Diab.41: 91, 2004. The ten most frequently suggested herbal remedies were gymnema, psyllium, funagreek, bilberry, garlic, Chinese ginseng, dandelion, burdock, prickly pear cactus, and bitter melon. The ten most frequently recommended dietary supplements were biotin, vanadium, chromium, vitamin B6, vitamin C, vitamin E, zinc, selenium, alpha-lipoic acid, and fructo-oligosaccharides. The reviewers felt some of these might help at least some. This is far from the grandiose claims made by the current promotion.

Bromelain / pineapple for goiter and so forth

Bromelain is an enzyme in pineapple that, as it happens, pathologists use in blood bank testing. In July 2010 I was alerted to promotion of magic pineapple juice, especially as a treatment for goiter (enlarged thyroid gland). This is very, very surprising. If enough bromelain were to get through your gut mucosa to have any effect, it would start by gravely altering your red cell antigens, like it does in lab.

Just to be sure, I ran a check of the NIH database that would find any study — even a mouse study in a bottom-class junk journal — on bromelain / pineapple and thyroid disease. Exactly nothing.

Various plants contain various chemicals that can enlarge thyroid glands. There may perhaps be something in some plant that has as as-yet-unknown effect on thyroid glands. The burden of proof is on the person trying to sell you the magic pineapple extract. Its your money.

If you have a goiter, the most important thing to find out is Why? Common nodular goiter often responds well to conventional treatment with thyroid supplementation. Medical disease of the thyroid is likely to kill if not diagnosed properly. And of course theres plenty of thyroid cancer. Its your life.

Follow-up: When I originally heard of the claim, I did not believe that

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Do we need different types of tenure? On Adam Grant in

Give and Take: A Revolutionary Approach to Success), examines the current tenure system in American universities and the skewed incentives they provide for continued work after tenure:

Its no secret that tenured professors cause problems in universities. Some choose to rest on their laurels, allowing their productivity to dwindle. Others develop tunnel vision about research, inflicting misery on students who suffer through their classes.

Instead of abolishing tenure, what if we restructured it? The heart of the problem is that weve combined two separate skill sets into a single job. We ask researchers to teach, and teachers to do research, even though these two capabilities have surprisingly little to do with each other.

Later in the piece he recommends three different kinds of tenure: research-only, teaching-only, and research-and-teaching, each tailored to a professors talents and drives.

Some universities currently have similar positions: some haveresearch professors, for instance, and most have some version of alecturer. As far as Im aware, however, the lecturer position, while it may carry some form of tenure, is rarely considered equivalent to professor positions, which demeans the devotion of ones time primarily to teaching. So Grants proposal would certainly be an improvement over the status quo in this regard.

Having three types of tenure would allow for more delineation of job responsibilities, improve the targeting motivation (as Grant argues), and provide more precise guidance to committees charged with granting reappointment, tenure, and promotion. (As chair of my department I serve on such a committee at my college.)

Ideally, however, a scheme like this would not be necessary. Since evaluation occurs at the level of departmental and college-wide tenure-and-promotion committees, they can lead in reforming this process (with changes in motivation flowing down from there). They should allow for faculty to have different orientations regarding teaching, research,andservice (the often-forgotten aspect of a professors job). They should be willing to assess each faculty member according to his or her particular mix, as long as they remained productive in whatever way they chose to further the mission of the college or university. Fantastic instructors should be valued as much as prolific and acclaimed researchers, as well as active campus citizensandthe faculty members who successfully combine two or even all three of these roles.

As I advocate for in my committee, all three roles are essential to a flourishing universitybut not every faculty member should be expected to excel in all. As economists know, there can be enormous benefits to specialization of labor, and I would like to think these benefits can be realized without creating additional bureaucracy and proliferation of tenure-tracks. While I agree with Grants concerns, I would prefer to encourage pluralitywithinthe existing tenure system rather than making it more complicated. But this relies on those responsible for making personnel decisions to adopt this pluralistic mindsetand if they cant (or wont), then multiple tenure tracks may be the next best option.

(By the way, for a humorous look at this topic, seeThe Onions recent post here.)

Posted byMark D. Whiteon February 6, 2014 at 08:26 AM inAcademiaEducationNewspapersOp-edsPosts by Mark D. WhitePermalink

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I entirely agree. Pluralism within the existing tenure system addresses several concerns. One is the life cycle. When I was starting out my university was mostly teaching oriented. I taught many different sections each year. I also had an enormous service load. After getting tenure my research took off as the university was willing to lower loads on those doing research. Faculty negotiate what they think their contribution can be, and get different teaching loads and different performance evaluations, accordingly. A good mix of teachers and scholars can result, but one does not have to be locked into just one role over ones career.

One size does not fit all. At the same time, I dont like a two- or three- tier system in which faculty members are accorded different status. This degrades the system of self governance.

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