title: Ramallah

text: A large Christian village, of well-built stone houses, standing on a high ridge, with a view on the west extending to the sea. It stands amongst gardens and olive-yards, and has three springs to the south and one on the west; on the north there are three more, within a mile from the village. On the east there is a well. There are rock-cut tombs to the north-east with well-cut entrances, but completely blocked with rubbish. In the village is a Greek church, and on the east a Latin convent and a Protestant schoolhouse, all modern buildings. The village lands are Wakuf, or ecclesiastical property, belonging to the Haram of Jerusalem. About a quarter of the inhabitants are Roman Catholics, the rest Orthodox Greeks.


title: Ramallah

text: In the 21st century, a large community of people with direct descent from the Haddadins who founded Ramallah live in the United States. The town is now predominately Muslim, but still contains a Christian minority. The change in demographics is due mostly to new migration of Muslims to the area, and emigration of Christians from the area.


title: Ramallah

text: Ramallah grew dramatically throughout the 17th and 18th centuries as an agricultural village, attracting more (predominantly Christian) inhabitants from all around the region. In 1700, Yacoub Elias was the first Ramallah native to be ordained by the Eastern Greek Melkite Orthodox Church of Jerusalem, the Christian denomination that prevailed in the Holy Land at the time. In the early 19th century, the first Greek Melkite Jerusalemite Orthodox Christian church was built. Later, in 1852, the Greek Orthodox Church of Transfiguration, was built to replace it; it is the sole Orthodox Church in Ramallah today. There is also a Greek Catholic (Melkite) Church in Ramallah, built in 1895.


title: Ramallah

text: The Roman Catholic Church also established its presence in Ramallah the 19th century and constitutes today the second largest Christian denomination in the city. The Roman Catholic Church established the St. Joseph's Girls' School run by St. Joseph sisters, as well as the co-educational Al-Ahliyyah College high school runs by Rosary sisters. In 1913, construction of the Catholic Holy Family Church was started.


title: Ramallah

text: Currently, Ramallah also has a Coptic Church, an Evangelical Lutheran Church and an Episcopalian (Anglican) Church.


title: Ramallah

text: In the 19th century, the Religious Society of Friends (Quakers) established a presence in Ramallah and built the Ramallah Friends Schools, one for girls and later a boys' school, to alleviate the dearth of education for women and girls. Eli and Sybil Jones opened "The Girls Training Home of Ramallah" in 1869. A medical clinic was established in 1883, with Dr. George Hassenauer serving as the first doctor in Ramallah. In 1889, the girls academy became the Friends Girls School (FGS). As the FGS was also a boarding school, it attracted a number of girls from surrounding communities, including Jerusalem, Lydda, Jaffa, and Beirut. The Friends Boys School (FBS) was founded in 1901 and opened in 1918. The Quakers opened a Friends Meeting House for worship in the city center in 1910. According to the school's official website, most high school students choose to take the International Baccalaureate exams (IBE) instead of the traditional "Tawjihi" university exams.


title: Ramallah

text: The activity of foreign churches in Palestine in the late 19th century increased awareness of prosperity in the West. In Ramallah and Bethlehem, a few miles south, local residents began to seek economic opportunity overseas. In 1901, merchants from Ramallah emigrated to the United States and established import-export businesses, selling handmade rugs and other exotic wares across the Atlantic. Increased trade dramatically improved living standards for Ramallah's inhabitants. American cars, mechanized farming equipment, radios, and later televisions became attainable luxuries for upper-class families. As residents of Jaffa and Lod moved to Ramallah, the balance of Muslims and Christians began to change.


title: Ramallah

text: Ramallah was declared a modern city in 1908. It had an elected municipality as well as partnership projects with the adjacent town of al-Bireh. The Friends Boys School became a temporary hospital during World War I.


title: Ramallah

text: During World War I, the British Army captured and occupied Ramallah in December 1917. The city remained occupied until the designation of the Palestine Mandate in 1920, resulting in Ramallah falling under British Mandatory control until 1948. In the 1920s, the economy of Ramallah started to improve, resulting in the local Arab upper class (consisting primarily of landowners and merchants) ordering the construction of several multi-storied villas, many of which still stand today. In 1939, the Jerusalem Electric Company introduced electricity to Ramallah, and a majority of the city's homes became wired shortly thereafter. On the same year, the British Mandatory authorities inaugurated the state-owned Palestine Broadcasting Service in Ramallah, with BBC members training local radio staff to deliver daily broadcasts in Arabic, Hebrew, and English. The station was later renamed Jerusalem Calling.


title: Ramallah

text: In 1936, an Arab revolt against the British Mandate broke out in Palestine, and Ramallah soon became a center of insurgent activity. The rebels subsequently established a court near Ramallah, in order to provide legal alternatives to the courts of the British Mandate. One British schoolteacher noted that the Ramallah court judge began to produce "news sheets on typewriters and duplicators, aimed at publicizing the alternative rebel regime."


title: Ramallah

text: Following the creation of the State of Israel and the ensuing conflict, Jordan seized the part of Palestine they named the West Bank. This included Ramallah. The West Bank was relatively peaceful during the years of Jordanian rule between 1948 and 1967, with its residents enjoying freedom of movement between the West Bank, Jordan, Lebanon, and Syria. Jordan annexed the West Bank, applying its national law to the conquered territory. However, many Palestinians were jailed for being members of "illegal political parties", which included the Palestine Communist Party and other socialist and pro-independence groups. By 1953, Ramallah's population had doubled, but the economy and infrastructure could not accommodate the influx of poor villagers. Natives of Ramallah began to emigrate, primarily to the United States. By 1956, about one fourth of Ramallah's 6,000 natives had left, with Arabs from the surrounding towns and villages (particularly Hebron) buying the homes and land the émigrés left behind.


title: Ramallah

text: During the Six-Day War in 1967, Israel captured Ramallah from Jordan, imposing a military closure and conducting a census a few weeks later. Every person registered in the census was given an Israeli identity card which allowed the bearer to continue to reside there. Those who were abroad during the census lost their residency rights. For residents of Ramallah, the situation had now been reversed. For the first time in 19 years, residents could freely visit Israel and the Gaza Strip and engage in commerce there.


title: Ramallah

text: Unlike the Jordanians, Israel did not offer citizenship to the residents. Ramallah residents were issued permits to work in Israel, but did not gain the rights associated with Israeli citizenship. The city remained under Israeli military rule for more than four decades.


title: Ramallah

text: The Israeli Civil Administration (CA), established in 1981, was in charge of civilian and day-to-day services such as issuing permission to travel, build, export or import, and host relatives from abroad. The CA reprinted Jordanian textbooks for distribution in schools but did not update them. The CA was in charge of tax collection and land expropriation, which sometimes included Israeli seizure of olive groves that Arab villagers had tended for generations.


title: Ramallah

text: According to the Israeli Human Rights activists, the development of Jewish settlements in the Ramallah area, such as Beit El and Psagot, prevented the expansion of the city and cut it off from the surrounding Arab villages. As resistance increased, Ramallah residents who were members of the Palestine Liberation Organization were jailed or deported to neighboring countries. In December 1987, the popular uprising known as the Intifada erupted, protesting against the continued Israeli occupation.


title: Ramallah

text: Ramallah residents were among the early joiners of the First Intifada. The Intifada Unified Leadership, an umbrella organization of various Palestinian factions, distributed weekly bulletins on the streets of Ramallah with a schedule of the daily protests, strikes and action against Israeli patrols in the city. At the demonstrations, tires were burned in the street, and the crowds threw stones and Molotov cocktails. The IDF responded with tear gas and rubber bullets. Schools in Ramallah were forcibly shut down, and opened gradually for a few hours a day. The Israelis conducted house arrests, imposing curfews that restricted travel and exports in what Palestinians regarded as collective punishment. In response to the closure of schools, residents organized home schooling sessions to help students make up missed material; this became one of the few symbols of civil disobedience. The Intifada leadership organized "tree plantings" and resorted to the tactics used in pre-1948 Palestine, such as ordering general strikes in which no commercial businesses were allowed to open and no cars were allowed on the streets.


title: Ramallah

text: In 1991, the Palestinian delegation to the Madrid International Peace Conference included many notables from Ramallah. As the Intifada wound down and the peace process moved forward, normal life in Ramallah resumed. On September 13, 1993 Israeli Prime Minister Yitzhak Rabin and Palestinian Leader Yasser Arafat shook hands at a meeting at the White House. Schoolchildren in Ramallah handed out olive branches to Israeli soldiers patrolling the streets. In December 1995, in keeping with the Oslo Accords, the Israeli army abandoned the Mukataa and withdrew to the city outskirts. The newly established Palestinian Authority assumed civilian and security responsibility for the city, which was designated "Area A" under the accords.


title: Ramallah

text: The years between 1993 and 2000 (known locally as the "Oslo Years") brought relative prosperity to Ramallah. Ramallah and its immediate environs were classified as Area A in the Oslo Accords, under full civil and security control of the Palestinian Authority (PA) administration in September 1995. Many expatriates returned to establish businesses there, and the atmosphere was one of optimism. In 2000, unemployment began to rise and the economy of Ramallah declined. The Israel Defense Forces remained in control of the territories and its government did not restore the freedom of movement enjoyed by Ramallah residents prior to the first Intifada. Travel to Jerusalem required special permits. The number and size of Israeli settlements around Ramallah increased dramatically. A network of bypass roads for use of Israeli citizens only was built around Ramallah, and Israel expropriated land for settlements.


title: Ramallah

text: Many official documents previously handled by the Israeli Civil Administration were now handled by the Palestinian Authority but still required Israeli approval. A Palestinian passport issued to Ramallah residents was not valid unless the serial number was registered with the Israeli authorities, who controlled border crossings. The failure of the Camp David summit in July 2000 led to the outbreak of the Second Intifada (al-Aqsa Intifada) in September 2000.


title: Ramallah

text: Young Ramallah residents demonstrated daily against the Israeli army, with marches to the Israeli checkpoints at the outskirts of the city. Over time, the marches were replaced by sporadic use of live ammunition against Israeli soldiers; and various attacks targeting Jewish settlers, particularly on the Israeli-only bypass roads. Army checkpoints were established to restrict movement in and out of Ramallah.


title: Ramallah

text: On October 12, 2000, two Israeli army reservists, Vadim Norzhich and Yosef Avrahami were lynched in Ramallah. They had taken a wrong turn, and were set upon by a mob, enraged in particular by the Muhammad al-Durrah incident in Gaza. A frenzied crowd killed the two IDF reservists, mutilated their bodies, and dragged them through the streets. Later that afternoon, the Israeli army carried out an air strike on Ramallah, demolishing the police station. Israel later succeeded in capturing and prosecuting some of those involved in the deaths of the reservists.


title: Ramallah

text: The IDF has occasionally operated inside Ramallah, in breach of the 1995 Oslo Accords. The first and largest incursion was the 2002 Operation Defensive Shield, with a more recent intervention coming in March 2017 while attempting to arrest a suspected terrorist. In 2002, the army imposed curfews, electricity cuts, school closures and disruptions of commercial life. Many Ramallah institutions, including government ministries, were vandalized, and equipment was destroyed or stolen. The IDF took over local Ramallah television stations, and social and economic conditions deteriorated. Many expatriates left, as did many other Palestinians who complained that the living conditions had become intolerable. Construction of the Israeli West Bank barrier has added to Ramallah's isolation.


title: Ramallah

text: Yasser Arafat established his West Bank headquarters, the Mukataa, in Ramallah. Although considered an interim solution, Ramallah became the "de facto" capital of the Palestinian Authority, now officially known as the State of Palestine. It hosts almost all governmental headquarters. In December 2001, Arafat held meetings at the Mukataa, but lived with his wife and daughter in Gaza City. After suicide bombings in Haifa, Arafat was confined to the Ramallah compound. In 2002, the compound was partly demolished by the Israeli Defense Forces and Arafat's building was cut off from the rest of the compound.


title: Ramallah

text: On November 11, 2004 Arafat died at the Percy training hospital of the Armies near Paris. He was buried in the courtyard of the Mukataa on November 12, 2004. The site still serves as the Ramallah headquarters of the Palestinian Authority, as well the official West Bank office of Mahmoud Abbas. Throughout 2005, while the Disengagement Plan was underway, some US government officials suggested to the Palestinian leadership to move the provisional capital back to Gaza, where it had been when the Palestinian Authority was first established in 1994. President Abbas, however, refrained from doing so, arguing that at this point, it was important to keep the administrative center in the West Bank in order to remind the international community that the West Bank was still awaiting a territorial solution.


title: Ramallah

text: In December 2005, local elections were held in Ramallah in which candidates from three different factions competed for the 15-seat municipal council for a four-year term. The council elected Janet Mikhail as mayor, the first woman to hold the post.


title: Ramallah

text: Munir Hamdan, a member of Fatah and a Ramallah businessman, discussed the concentration of government offices with a journalist. He said, "The president and prime minister have their offices here. So do the parliament and all the government ministries", representing a "collusion" between the Palestinian Authority and Israel to turn Ramallah into the political as well as the financial capital of the Palestinians. He is particularly worried by the construction of a large new governmental complex by the PA. Hatem Abdel Kader, a Jerusalem resident, Fatah legislator and former Minister for Jerusalem Affairs, complained that "If they are building a new government compound here, that means they have no plans to be based in Jerusalem... Unfortunately, the Palestinian government of Salam Fayyad has abandoned Jerusalem in favor of Ramallah."


title: Ramallah

text: Many foreign nations have located their diplomatic missions to the Palestinian Authority in Ramallah, including, , Argentina, Australia, Austria, Korea, South Africa, Norway, Sri Lanka, Switzerland, China, Poland, Portugal, The Netherlands, Russia, Jordan, Brazil, Finland, Denmark, Ireland, Germany, India, Japan, the Czech Republic, Canada and Mexico.


title: Ramallah

text: This area enjoys a Mediterranean climate of a dry summer and mild, rainy winter with occasional snowfall. The recorded average of Ramallah's rainfall is about and minimum rainfall is and maximum rainfall is .


title: Ramallah

text: The Köppen climate classification places Ramallah in the Csa category. Climates of this class generally occur on the western sides of continents between the latitudes of 30° and 45°. These climates are in the polar front region in winter, and thus have moderate temperatures and changeable, rainy weather. Summers are hot and dry, due to the domination of the subtropical high pressure systems, except in the immediate coastal areas, where summers are milder due to the nearby presence of cold ocean currents that may bring fog but prevent rain.


title: Ramallah

text: Ramallah has been described as the seat of power of the Palestinian Authority and serves as the headquarters for most international NGOs and embassies. Hundreds of millions of dollars in aid flowing into the city have boosted Ramallah's economy greatly since the end of the Second Intifada.


title: Ramallah

text: The Ramallah construction boom is one of the most obvious signs of West Bank economic growth, estimated at an annual rate of 8 percent. This has been attributed to relative stability and Western donor support to the Palestinian Authority. Ramallah's buoyant economy continues to draw Palestinians from other West Bank towns where jobs are fewer. The built-up area has grown fivefold since 2002.


title: Ramallah

text: By 2010, Ramallah had become the leading center of economic and political activity in the territories under the control of the Palestinian Authority. During a building boom in the early years of the 21st century, apartment buildings and "five-star" hotels were erected, particularly in the Al-Masyoun neighborhood. In 2010, "more than one hundred" Palestinian businesses were reported to have moved to Ramallah from East Jerusalem, because "Here they pay less taxes and have more customers." One local boasted to a journalist that "Ramallah is becoming the de facto capital of Palestine." This boast was seconded by "The New York Times" which, in 2010, called Ramallah the "de facto capital of the West Bank. According to Sani Meo, the publisher of "This Week in Palestine," "Capital or no capital, Ramallah has done well and Palestine is proud of its achievements." Some Palestinians allege that Ramallah's prosperity is part of an Israeli "conspiracy" to make Ramallah the capital of a Palestinian state, instead of Jerusalem.


title: Ramallah

text: ASAL technologies, an information technology company in Ramallah, has 120 employees and is looking forward to "exponential growth".


title: Ramallah

text: An Ottoman village list of about 1870 showed that Ramallah had 249 houses and a population of 635, though the population count included men only. The village was described as being in the "Bire" area,"north of Mikhmas, on a rocky hill."


title: Ramallah

text: In the 1922 census of Palestine conducted by the British Mandate authorities, Ramallah had a population of 3,104; 2,972 Christians, 125 Muslims, and 10 Jews, where the Christians were 2,162 Orthodox, 1 Syriac Orthodox (Jacobite), 332 Roman Catholics, 144 Greek Catholic (Melkite Catholic), 211 Church of England, and 122 "other". The population increased at the time of the 1931 census to 4,286, with 3,766 Christians, 519 Muslims and 1 Jew, in a total of 1014 houses.


title: Ramallah

text: In the 1945 statistics, the population stood at 5,080, with Christians forming the majority of the population. However, the demographic makeup of the town changed drastically between 1948 and 1967, when considerable emigration of Christians took place. Slightly more than half of the city's 12,134 inhabitants were Christian by 1967, the other half Muslim.


title: Ramallah

text: Ramallah's population drastically decreased in the late 20th century from 24,722 inhabitants in 1987 to 17,851 in 1997. In the Palestinian Central Bureau of Statistics (PCBS) census in 1997, Palestinian refugees accounted for 60.3% of the population, which was 17,851. There were 8,622 males and 9,229 females. People younger than 20 years of age made up 45.9% of the population, while those aged between 20 and 64 were 45.4%, and residents aged over 64 constituted 4.7%.


title: Ramallah

text: Only in 2005 did the population reach more than 24,000. In a PCBS projection in 2006, Ramallah had a population of 25,467 inhabitants. In the 2007 PCBS census, there were 27,460 people living in the city. Sources vary about the current Christian population in the city, ranging around 25%.


title: Ramallah

text: In the aftermath of the 1936–39 Arab revolt, the Ramallah Hospital Foundation was established and registered as a tax exempt organization in New York in 1944. It bought large pieces of land in the south-eastern fringes of the city dedicated for the future hospital. In 1963 a hospital was opened. The present Ramallah Government Hospital and the Palestine Medical Centered are located on the land purchased by the Foundation. In January 1987 the first open-heart surgery was performed at the Hospital under the direction of Dr. Shehadeh (Shawki) Harb, a Palestinian surgeon trained in the United States.


title: Ramallah

text: The Jamal Abdel Nasser Mosque is one of the city's largest. The Orthodox Church of Ramallah, an Orthodox Christian convent, Melkite Catholic Church, Evangelical Lutheran Church, Arab Episcopal (Anglican) Church, Ramallah Local Church (Evangelical\Born Again) and Ramallah Baptist Church all operate schools in the city. A large new church has been built on top of one of the highest hills of Ramallah, belonging to the Coptic Orthodox Church. A small group of Jehovah Witnesses are present in the area as well and others.


title: Ramallah

text: During the annual "Saturday of Light" religious festival (which occurs on the Saturday between Good Friday and Easter Sunday to commemorate the light that tradition holds shone from the tomb of Jesus), the scouts hold a parade through the city streets to receive the flame from Jerusalem. (The flame is ignited in Jerusalem's Church of the Holy Sepulchre and is passed on through candles and lanterns to regional churches.) A variety of mosques and churches of different denominations dot the landscape.


title: Ramallah

text: Ramallah is generally considered the most affluent and cultural, as well as the most liberal, of all Palestinian cities, and is home to a number of popular Palestinian activists, poets, artists, and musicians. It boasts a lively nightlife, with many restaurants including the Stars and Bucks Cafe, a branch of the Tche Tche Cafe and the Orjuwan Lounge, described in 2010 as two among the "dozens of fancy restaurants, bars and discotheques that have cropped up in Ramallah in the last three years".


title: Ramallah

text: One hallmark of Ramallah is Rukab's Ice Cream, which is based on the resin of chewing gum and thus has a distinctive taste. Another is the First Ramallah Group, a boy- and girl-scout club that also holds a number of traditional dance (Dabka) performances and is also home to men's and women's basketball teams that compete regionally. International music and dance troupes occasionally make a stop in Ramallah, and the renowned Argentinian-Israeli pianist Daniel Barenboim performs there often. The Khalil Sakakini Cultural Center, founded in 1996, is a popular venue for such events. The Al-Kasaba Theatre is a venue for plays and movies. In 2004, the state-of-the art Ramallah Cultural Palace opened in the city. The only cultural center of its kind in the Palestinian-governed areas, it houses a 736-seat auditorium, as well as conference rooms, exhibit halls, and movie-screening rooms. It was a joint venture of the Palestinian Authority, the United Nations Development Programme (UNDP), and the Japanese government. Ramallah hosted its first annual international film festival in 2004.


title: Ramallah

text: Ramallah, like most Palestinian areas, has a rich folklore of song and dance. Songs accompanied people in every occasion whether it was the harvest season, roofing a house, traveling, coming back from travel, engagement, wedding, or even death. Most of the songs were sung by the women with the exception of Zaffeh and Mal'ab which are sung by the men at wedding celebrations. Palestinian educator Bahia Khalil's book "Ramallah Folklore Songs and Traditions" documents to a great extent this oral tradition inherited from one generation to another. The second edition of the book was published in 2002 by the American Federation of Ramallah, Palestine, an organization for Palestinian-Americans from the Ramallah region living in the United States.


title: Ramallah

text: Foreign travelers to Palestine in late 19th and early 20th centuries often commented on the rich variety of costumes among the Palestinian people, and particularly among the fellaheen or village women. Until the 1940s, a woman's economic status, whether married or single, and the town or area they were from could be deciphered by most Palestinian women by the type of cloth, colors, cut, and embroidery motifs, or lack thereof, used for the robe-like dress or "thoub" in Arabic


title: Ramallah

text: Though experts in the field trace the origins of Palestinian costumes to ancient times, there are no surviving clothing artifacts from this early period against which the modern items might be definitively compared. Influences from the various empires to have ruled Palestine, such as Ancient Egypt, Ancient Rome, Byzantine empire, and Ayyubids, among others, have been documented by scholars largely based on the depictions in art and descriptions in literature of costumes produced during these times.


title: Ramallah

text: Hanan Munayyer, collector and researcher of Palestinian clothing, sees examples of proto-Palestinian attire in artifacts from the Canaanite period (1500 BCE) such as Egyptian paintings depicting Canaanites in A-shaped garments. Munayyer says that from 1200 BC to 1940 AD, all Palestinian dresses were cut from natural fabrics in a similar A-line shape with triangular sleeves. This shape is known to archaeologists as the "Syrian tunic" and appears in artifacts such as an ivory engraving from Megiddo dating to 1200 BC.


title: Ramallah

text: Until the 1940s, traditional Palestinian costumes reflected a woman's economic and marital status and her town or district of origin, with knowledgeable observers discerning this information from the fabric, colours, cut, and embroidery motifs (or lack thereof) used in the apparel.


title: Ramallah

text: Due to the difficulty of travel in the 19th century, villages in Palestine remained isolated. As a result, clothing and accessories became a statement of region. In Ramallah, the back panels of dresses often incorporated a palm tree motif embroidered in cross-stitch. Ramallah women were famous for their distinctive dress of white linen fabric embroidered with red silk thread. The headdress or "smadeh" worn in Ramallah was common throughout northern Palestine: a small roundish cap, padded and stiffened, with gold and silver coins set in a fringe with a long veil pinned to the back, sometimes of silk and sometimes embroidered.


title: Disappearance of Etan Patz

text: Etan Kalil Patz (; October 9, 1972 – May 25, 1979) was an American boy who was six years old on May 25, 1979, when he disappeared on his way to his school bus stop in the SoHo neighborhood of Lower Manhattan. His disappearance helped launch the missing children movement, which included new legislation and new methods for tracking down missing children. Several years after he disappeared, Patz was one of the first children to be profiled on the "photo on a milk carton" campaigns of the early 1980s. In 1983, President Ronald Reagan designated May 25—the anniversary of Etan's disappearance—as National Missing Children's Day in the United States.


title: Disappearance of Etan Patz

text: Decades later, it was determined that Patz had been abducted and murdered the same day that he went missing. The case was reopened in 2010 by the Manhattan District Attorney's office. In 2012, the FBI excavated the basement of the alleged crime scene near the Patz residence but discovered no new evidence. Pedro Hernandez—a suspect who confessed—was charged and indicted later that year on charges of second-degree murder and first-degree kidnapping. In 2014, the case went through a series of hearings to determine whether or not Hernandez's statements before he received his Miranda rights were legally admissible at trial. His trial began in January 2015 and it ended with a mistrial that May, when 1 of the 12 jurors held out. The retrial began on October 19, 2016, and it was concluded on February 14, 2017, after nine days of deliberations, when the jury found Hernandez guilty of murder and kidnapping. Hernandez was sentenced to 25-years-to-life in prison on April 18, 2017. Hernandez will not be eligible for parole for 25 years.


title: Disappearance of Etan Patz

text: On the morning of May 25, 1979, Etan left his SoHo apartment at 113 Prince Street by himself for the first time, planning to walk two blocks to board a school bus at West Broadway and Prince Street. He was wearing a black "Future Flight Captain" pilot cap, a blue corduroy jacket, blue jeans and blue sneakers with fluorescent stripes. He never got on the bus.


title: Disappearance of Etan Patz

text: At school, Etan's teacher noticed his absence but did not report it to the principal. When Etan did not return home after school, his mother Julie called the police. At first, detectives considered the Patzes to be possible suspects but quickly determined they had no involvement. An intense search began that evening, using nearly 100 police officers and a team of bloodhounds. The search continued for weeks. Neighbors and police canvassed the city and placed missing-child posters featuring Etan's portrait, but this resulted in few leads.


title: Disappearance of Etan Patz

text: Etan's father Stanley was a professional photographer and had a collection of photographs he had taken of his son. His photos of Etan were printed on countless missing-child posters and milk cartons. They were also projected on screens in Times Square.


title: Disappearance of Etan Patz

text: Assistant United States Attorney Stuart R. GraBois received the case in 1985 and identified Jose Antonio Ramos, a convicted child sexual abuser who had been a friend of Etan's former babysitters, as the primary suspect. In 1982, multiple boys had accused Ramos of trying to lure them into a drain pipe in the area where Ramos was living. When police searched the drain pipe, they found photographs of Ramos and young boys who resembled Ethan. GraBois eventually found out that Ramos had been in custody in Pennsylvania in connection with an unrelated child molestation case. In 1990, GraBois was deputized as a deputy state attorney general in Pennsylvania to help prosecute a case against Ramos for sexually abusing children and to obtain further information about Etan's case. When first questioned by GraBois, Ramos stated that, on the day when Etan disappeared, he had taken a young boy back to his apartment to rape him. Ramos said that he was "90 percent sure" it was the boy whom he later saw on television. However, Ramos did not use Etan's name. He also claimed he had put the boy on a subway going uptown.


title: Disappearance of Etan Patz

text: In 1991, while Ramos was incarcerated, a jailhouse informant told GraBois and FBI agent Mary Galligan that Ramos had told him he knew what had happened to Etan. Ramos even drew a map of Etan's school bus route, indicating that he knew that Etan's bus stop was the third one on the route. In a special feature on missing children, the "New York Post" reported on October 21, 1999 that Ramos was the prime suspect in Etan's disappearance. Ramos had been known by the Patz family and was the prime suspect all along, but in the early 1980s authorities were unable to prosecute Ramos.


title: Disappearance of Etan Patz

text: Etan's body was never found, and he was declared legally dead on June 19, 2001. Stan and Julie Patz pursued and won a civil case against Ramos in 2004. They were awarded a symbolic sum of $2 million, which they have never collected. Ramos has never been criminally prosecuted for the murder of Etan. Every year, on Etan's birthday and the anniversary of his disappearance, Stan Patz sent Ramos a copy of his son's missing-child poster. On the back, he typed the same message: "What did you do to my little boy?"


title: Disappearance of Etan Patz

text: Ramos has denied that he killed Etan. Ramos served a 20-year prison sentence in the State Correctional Institution in Dallas, Pennsylvania, for child molestation. He was released from prison on November 7, 2012. Soon after his release he was arrested on a Megan's Law violation.


title: Disappearance of Etan Patz

text: Stan and Julie Patz had the 2004 judgment against Ramos dismissed after the 2015 trial of Pedro Hernandez convinced them that Ramos was not responsible for their son's death.


title: Disappearance of Etan Patz

text: Manhattan district attorney Cyrus Vance, Jr. officially reopened the case on May 25, 2010. On April 19, 2012, Federal Bureau of Investigation (FBI) and New York City Police Department (NYPD) investigators began excavating the SoHo basement of 127-B Prince Street, near the Patz home. This residence had been newly refurbished shortly after Etan's disappearance in 1979, and the basement had been the workshop and storage space of a handyman. After a four-day search, investigators announced that there was "nothing conclusive found."


title: Disappearance of Etan Patz

text: On May 24, 2012, New York police commissioner Raymond Kelly announced that a man was in custody who had implicated himself in Etan's disappearance. A law enforcement official identified the man as 51-year-old Pedro Hernandez of Maple Shade, New Jersey and said that Hernandez had confessed to strangling the child. Hernandez stated in his written confession to police, "I’m sorry, I shoke [sic] him." According to a 2009 book about the case, "After Etan", Etan had a dollar and had told his parents that he planned to buy a soda to drink with his lunch. At the time of Etan's disappearance, Hernandez was an 18-year-old convenience store worker in a neighborhood bodega. Hernandez said that he later threw Etan's remains into the garbage. Hernandez was charged with second-degree murder. According to a "New York Times" report from May 25, 2012, the police at that time had no physical evidence to corroborate his confession.


title: Disappearance of Etan Patz

text: In 2012 Jose Lopez, a man from New Jersey, reached out to investigators because he believed that Hernandez, Lopez's brother-in-law, was responsible for Etan's disappearance. Statements by Hernandez's sister, Nina Hernandez, and Tomas Rivera, leader of a Charismatic Christianity group at St. Anthony of Padua, a Roman Catholic church in Camden, New Jersey, indicated that Hernandez may have publicly confessed in the presence of fellow parishioners in the early 1980s to have murdered Etan. According to Hernandez's sister, it was an "open family secret that he had confessed in the church."


title: Disappearance of Etan Patz

text: A New York grand jury indicted Hernandez on November 14, 2012 on charges of second-degree murder and first-degree kidnapping. His lawyer has stated that Hernandez was diagnosed with schizotypal personality disorder, which includes hallucinations. The lawyer has also said that Hernandez has a low intelligence quotient (IQ) of around 70, "at the border of intellectual disability."


title: Disappearance of Etan Patz

text: On December 12, 2012, Hernandez pled not guilty to two counts of murder and one count of kidnapping in a New York court. In April 2013, Harvey Fishbein, Hernandez's legal-aid criminal-defense lawyer, filed a motion to dismiss the case, citing that Hernandez's "confession in one of the nation's most notorious child disappearances was false, peppered with questionable claims and made after almost seven hours of police questioning." The next month, New York Supreme Court justice Maxwell Wiley ruled that the evidence was "legally sufficient to support the charges" and that the case could move forward. He also ordered a hearing to determine whether the defendant's statements could be used at trial.


title: Disappearance of Etan Patz

text: A September 2014 hearing was conducted to determine whether Hernandez's statements that were made before the police had read the Miranda rights to him were legally admissible at trial. This would be influenced by whether he felt free to leave during the time before which he was Mirandized. The hearing also sought to determine whether Hernandez understood the significance of his Miranda rights and was competent to waive them when he did so. This was significant because it would decide whether any statements made after that point by Hernandez were legally admissible at trial. The actual truth or falsehood of the statements was not the focus of the hearing; rather, the question of the statements' truthfulness was to be discussed at trial, which began on January 5, 2015.


title: Disappearance of Etan Patz

text: The case resulted in a mistrial in May 2015 because of a hung jury that was deadlocked 11 against 1 for conviction. A retrial began on October 19, 2016 in a New York City court, with jury deliberations in February 2017. On February 14, 2017, Hernandez was found guilty of kidnapping and felony murder. Sentencing was scheduled on February 28, with Hernandez facing 25 years to life in prison. However, Hernandez's attorneys were granted a delay in order to challenge the verdict, and no new sentencing date was set.


title: Disappearance of Etan Patz

text: On April 18, 2017, Hernandez was sentenced to life in prison with the possibility of parole after serving at least 25 years.


title: Disappearance of Etan Patz

text: In 1983, the May 25 anniversary of Etan Patz's disappearance was designated National Missing Children's Day in the United States. In 2001, the tribute spread worldwide. The International Centre for Missing & Exploited Children (ICMEC) coordinates the "Help Bring Them Home" campaign in 22 countries in conjunction with International Missing Children's Day.


title: Disappearance of Etan Patz

text: The extensive media attention attracted by the case of Patz's disappearance has been credited with increasing public awareness of the problem of child abduction. As a result, fewer parents are willing to allow their children to walk to school, photos of missing children have been more widely distributed (for example, on milk cartons) and the concept of "stranger danger" has been promoted, the idea that all adults not known to the child must be regarded as potential sources of danger.


title: Epic Systems

text: Epic Systems Corporation, or Epic, is an American privately held healthcare software company. According to the company, hospitals that use its software held medical records of 78% of patients in the United States and over 3% of patients worldwide in 2022.


title: Epic Systems

text: Epic was founded in 1979 by Judith R. Faulkner with a $70,000 investment (). Originally headquartered in Madison, Wisconsin, Epic moved its headquarters to a large campus in the suburb of Verona, Wisconsin in 2005, where it employs 10,000 people as of 2019. The campus has themed areas/buildings, such as a castle-like structure, a "Wizard Campus" that appears to be inspired by J.K. Rowling's "Harry Potter", and a dining facility designed to mimic a train station.


title: Epic Systems

text: As of 2015, the company was in the fifth phase of campus expansion with five new buildings each planned to be around 100,000 square feet. The company also has offices in Bristol, UK; , Netherlands; Dubai, United Arab Emirates; Dhahran, Saudi Arabia; Helsinki, Finland; Melbourne, Australia; Singapore; Trondheim, Norway; and Søborg, Denmark.


title: Epic Systems

text: Epic primarily develops, manufactures, licenses, supports, and sells a proprietary electronic medical record software application, known in whole as 'Epic' or an Epic EMR. The company's healthcare software is centered on its Chronicles database management system. Epic's applications support functions related to patient care, including registration and scheduling; clinical systems for doctors, nurses, emergency personnel, and other care providers; systems for lab technologists, pharmacists, and radiologists; and billing systems for insurers. MyChart is used in the USA and other countries to access doctors’ records and for billing purposes. It is used by 150 million patients across the US.


title: Epic Systems

text: Epic also offers cloud hosting for customers that do not wish to maintain their own servers; and short-term optimization and implementation consultants through their wholly-owned subsidiary Boost, Inc..


title: Epic Systems

text: The company's competitors include Cerner, MEDITECH, Allscripts, athenahealth, and units of IBM, McKesson, and Siemens.


title: Epic Systems

text: The majority of U.S. News & World Report's top-ranked hospitals and medical schools use Epic. In 2003, Kaiser Permanente began using Epic for its electronic records system. Among many others, Epic provides electronic record systems for Cedars-Sinai Medical Center in Los Angeles, the Cleveland Clinic, Johns Hopkins Hospital, UC Davis Medical Center in Sacramento, and all Mayo Clinic campuses. Partners HealthCare began adopting Epic in 2015 in a project initially reported to cost $1.2 billion, which critics decried and which is greater than the cost of its buildings. By 2018, the total expenses for the project were $1.6 billion, with payments for the software itself amounting to less than $100 million and the majority of the costs caused by lost patient revenues, tech support and other implementation work.


title: Epic Systems

text: In 2022 Emory Healthcare, Baptist Health and Memorial Hermann Health System all switched to Epic from Cerner. Epic seems to be preferred in large systems.


title: Epic Systems

text: Care Everywhere is Epic's health information exchange software, which comes with its electronic health record (EHR, or EMR) system. A 2014 article in "The New York Times" interviews two doctors who said that their Epic systems wouldn't allow them to share data with users of competitors' software in a way that will satisfy the Meaningful Use requirements of the HITECH Act. At first, Epic charged a fee to send data to some non-Epic systems. Epic said the yearly cost for an average-sized hospital was around $5,000 a year. However, after Congressional hearings, Epic and other major software vendors announced that they would suspend per-transaction sharing fees. Epic customers must still pay for one-time costs of linking Epic to each individual non-Epic system with which they wish to exchange data; in contrast, Epic's competitors have formed the CommonWell Health Alliance which set a common Interoperability Software standard for electronic health records. A 2014 report by the RAND Corporation described Epic as a "closed" platform that made it "challenging and costly for hospitals" to interconnect with the clinical or billing software of other companies. The report also cited other research showing that Epic's implementation in the Kaiser Permanente system led to efficiency losses.


title: Epic Systems

text: In September 2017, Epic announced Share Everywhere, which allows patients to authorize any provider who has internet access to view their record in Epic and to send progress notes back. Share Everywhere was named Healthcare Dive's "Health IT Development of the Year" in 2017.


title: Epic Systems

text: An Epic electronic health record system costing £200 million was installed at Cambridge University Hospitals NHS Foundation Trust in October 2014, the first installation of an Epic system in the UK.


title: Epic Systems

text: After 2.1 million records were transferred to it, it developed serious problems and the system became unstable. Ambulances were diverted to other hospitals for five hours and hospital consultants noted issues with blood transfusion and pathology services. Other problems included delays to emergency care and appointments, and problems with discharge letters, clinical letters and pathology test results. Chief information officer, Afzal Chaudhry, said "well over 90% of implementation proceeded successfully".


title: Epic Systems

text: In July 2015, the BBC reported that the hospital's finances were being investigated. In September 2015, both the CEO and CFO of the hospital resigned. Problems with the clinical-records system, which were said to have compromised the "ability to report, highlight and take action on data" and to prescribe medication properly, were held to be contributory factors in the organization's sudden failure. In February 2016, digitalhealth.net reported that Clare Marx, president of the Royal College of Surgeons of England and member of the NHS National Information Board, found that at the time of implementation, "staff, patients and management rapidly and catastrophically lost confidence in the system. That took months and a huge amount of effort to rebuild."


title: Epic Systems

text: In 2016, Danish health authorities spent 2.8 billion DKK on the implementation of Epic in 18 hospitals in a region with 2.8 million residents. On May 20, Epic went live in the first hospital. Doctors and nurses reported chaos in the hospital and complained of severe under preparation and training. Epic and its Danish partners insisted that normal testing and training were carried out.


title: Epic Systems

text: Since some elements of the Epic system were not properly translated from English to Danish, physicians resorted to Google Translate. As one example, when inputting information about a patient's condition, physicians were given the option to report between the left and the "correct" leg, not the left and right legs. As of 2019, Epic had still not been fully integrated with Denmark's national medical record system, which is meant to be accessed every time a patient is seen. Danish anesthesiologist and computer architect Gert Galster worked to adapt the system. According to Galster, these Epic systems were designed specifically to fit the U.S. health care system, and could not be disentangled for use in Denmark.


title: Epic Systems

text: An audit of the implementation that voiced concerns was published in June 2018. At the end of 2018, 62% of physicians expressed they were not satisfied with the system and 71 physicians signed a petition calling for the system to be removed.


title: Epic Systems

text: In 2012, the Hospital District of Helsinki and Uusimaa (HUS) decided to replace several smaller health record systems with one district-wide system created by Epic. It was called Apotti and would be used by healthcare and social services for the 2.2 million residents in the HUS area. The Apotti system was selected as the provider in 2015 and implementation started in 2018. By November 2022, the Apotti system had cost 625 million euros.


title: Epic Systems

text: After the implementation, complaints from healthcare workers, especially from doctors, started accumulating. The system was accused of being too complicated and that its convoluted UI was endangering patient safety. For example, one patient was administered the wrong chemotherapeutic drug due to an unclear selection menu in the system.


title: Epic Systems

text: In July 2022, a formal complaint demanding that the issues in the system be fixed or the system be removed entirely was sent to the Finnish health care supervising body Valvira. The complaint was signed by 619 doctors that use Apotti.


title: Epic Systems

text: In 2020, the novel coronavirus pandemic spread in the United States. Epic Systems faced considerable criticism for their initial plan to have their 10,000 employees return to work on-campus. Employees expressed concern about returning to the office, with the first group being required to return as early as August 10 while the pandemic continued to spread. This plan was abandoned, and as of December 2020, employees were still able to work from home. The plan had come about despite a Dane County public health order requiring remote work "to the greatest extent possible." Criticism revolved in particular around the fact that employees were being ordered back to preserve the company "culture," despite CEO Judy Faulkner's admission that work was getting done remotely. According to The Capital Times, who interviewed 26 Epic employees about the plan, "13 [employees] said they have knowledge of managers being demoted for expressing concern about the company’s plans to bring its nearly 10,000 workers back" to on-campus work, and all requested anonymity for fear of employer retribution.


title: Epic Systems

text: In a survey of over 400 Epic employees, 89% of respondents expressed dissatisfaction with how Epic was handling the pandemic.


title: Humility

text: Humility is the quality of being humble. Dictionary definitions accentuate humility as a low self-regard and sense of unworthiness. In a religious context humility can mean a recognition of self in relation to a deity (i.e. God), and subsequent submission to that deity as a member of that religion. Outside of a religious context, humility is defined as being "unselved", a liberation from consciousness of self, a form of temperance that is neither having pride (or haughtiness) nor indulging in self-deprecation.


title: Humility

text: Humility is an outward expression of an appropriate inner, or self regard, and is contrasted with humiliation which is an imposition, often external, of shame upon a person. Humility may be misappropriated as ability to suffer humiliation through self-denouncements which in itself remains focused on self rather than low self-focus.


title: Humility

text: Humility, in various interpretations, is widely seen as a virtue which centers on low self-preoccupation, or unwillingness to put oneself forward, so it is in many religious and philosophical traditions, it contrasts with narcissism, hubris and other forms of pride and is an idealistic and rare intrinsic construct that has an extrinsic side.


title: Humility

text: The term "humility" comes from the Latin word "humilitas", a noun related to the adjective ', which may be translated as "humble", but also as "grounded", or "from the earth", since it derives from ' (earth). See the English "humus".


title: Humility

text: The word "humble" may be related to feudal England where the lowest cuts of meat, or 'umbles',' that is to say whatever was left over when the upper classes had taken their parts, were provided to the lowest class of citizen.


title: Humility

text: Aidos, in Greek mythology, was the "daimona" (goddess) of shyness, shame, and humility. She was the quality that restrained human beings from wrong.


title: Humility

text: Rabbi Lord Jonathan Sacks states that in Judaism humility is an appreciation of oneself, one's talents, skills, and virtues. It is not meekness or self-deprecating thought, but the effacing of oneself to something higher. Humility is not to think lowly of oneself, but to appreciate the self one has received. In recognition of the mysteries and complexities of life, one becomes humbled to the awesomeness of what one is and what one can achieve. Rabbi Pini Dunner discusses that humility is to place others first; it is to appreciate others' worth as important. In recognizing our worth as people, Rabbi Dunner shows that looking into the zillions of stars in the sky, and in the length and history of time, you and I are insignificant, like dust. Rabbi Dunner states that Moses wrote in the Torah, "And Moses was exceedingly humble, more than any man on the face of the earth." How is it possible to be humble and write you are the most humble? The conclusion is that Moses knew he was humble. It is not in denial of your talents and gifts but to recognize them and live up to your worth and something greater. It is in the service to others that is the greatest form of humility.


title: Humility

text: As illustrated in the person of Moses, who leads the nation of Hebrews out of slavery in Egypt and to the "Promised Land", humility is a sign of Godly strength and purpose, not weakness. Of this great leader, the Bible states, "For Moses was a man exceeding meek above all men that dwelt upon earth" (). Moses is venerated by Jewish, Christian and Muslim adherents alike.


title: Humility

text: Amongst the benefits of humility described in the Hebrew Bible, that is shared by many faiths, are honor, wisdom, prosperity, the protection of the Lord and peace. In addition, "God opposes the proud but gives grace to the humble" ()


title: Humility

text: New Testament exhortations to humility are found in many places, for example "Blessed are the meek" (), "He who exalts himself will be humbled and he who humbles himself will be exalted" (), as well as () and throughout the Book of James. Also in Jesus Christ's behavior in general and submission to unjust torture and execution in particular, are held up as examples of righteous humility: "Who, when he was reviled, did not revile: when he suffered, he threatened not: but delivered himself to him that judged him justly.",


title: Humility

text: C.S. Lewis writes, in "Mere Christianity", that pride is the "anti-God" state, the position in which the ego and the self are directly opposed to God: "Unchastity, anger, greed, drunkenness, and all that, are mere fleabites in comparison: it was through Pride that the devil became the devil: Pride leads to every other vice: it is the complete anti-God state of mind." In contrast, Lewis contends that, in Christian moral teaching, the opposite of pride is humility. This is popularly illustrated by a phrase wrongly attributed to Lewis, "Humility is not thinking less of yourself, but thinking of yourself less." This is an apparent paraphrase, by Rick Warren in "The Purpose Driven Life", of a passage found in "Mere Christianity": Lewis writes, regarding the truly humble man,


title: Humility

text: St. Augustine stresses the importance of humility in the study of the Bible, with the exemplars of a barbarian Christian slave, the apostle Paul, and the Ethiopian eunuch in Acts 8 ("De Doctrina Christiana", prooem. 4–7 [hereafter "DDC"]). Both learner and teacher need to be humble, because they learn and teach what ultimately belongs to God ("DDC", prooem. 7–8; 1 Cor. 4:7). Humility is a basic disposition of the interpreter of the Bible. The confidence of the exegete and preacher arises from the conviction that his or her mind depends on God absolutely ("DDC", 1.1.1). Augustine argues that the interpreter of the Bible should proceed with humility, because only a humble person can grasp the truth of Scripture ("DDC", 2.41.62).


title: Humility

text: Humility is said to be a fit recipient of grace; according to the words of St. James, "God opposes the proud but gives grace to the humble" (, .)


title: Humility

text: "True humility" is distinctly different from "false humility" which consists of deprecating one's own sanctity, gifts, talents, and accomplishments for the sake of receiving praise or adulation from others, as personified by the fictional character Uriah Heep created by Charles Dickens. In this context legitimate humility comprises the following behaviors and attitudes:


title: Humility

text: Catholic texts view humility as annexed to the cardinal virtue of temperance. It is viewed as a potential part of temperance because temperance includes all those virtues that restrain or express the inordinate movements of our desires or appetites.


title: Humility

text: St. Bernard defines it as, "A virtue by which a man knowing himself as he truly is, abases himself. Jesus Christ is the ultimate definition of Humility."


title: Humility

text: Humility was a virtue extolled by Saint Francis of Assisi, and this form of Franciscan piety led to the artistic development of the "Madonna of humility" first used by them for contemplation. The Virgin of humility sits on the ground, or upon a low cushion, unlike the "Enthroned Madonna" representations. This style of painting spread quickly through Italy and by 1375 examples began to appear in Spain, France and Germany and it became the most popular among the styles of the early Trecento artistic period.


title: Humility

text: St. Thomas Aquinas, a 13th-century philosopher and theologian in the Scholastic tradition, defines humility similarly as "the virtue of humility" that "consists in keeping oneself within one's own bounds, not reaching out to things above one, but submitting to one's superior" (Summa Contra Gent., bk. IV, ch. lv, tr. Joseph Rickaby).


title: Humility

text: In the Qur'an, various Arabic words conveying the meaning of "humility" are used. The very term "Islam" can be interpreted as "surrender (to God), humility", from the triconsonantal root S-L-M; other words used are "tawadu" and "khoshou":


title: Humility

text: Buddhism is a religion of self-examination. The natural aim of the Buddhist life is the state of enlightenment, gradually cultivated through meditation and other spiritual practices. Humility, in this context, is a characteristic that is both an essential part of the spiritual practice, and a result of it. As a quality to be developed, it is deeply connected with the practice of Four Abodes (Brahmavihara): love-kindness, compassion, empathetic joy and equanimity. As a result of the practice, this cultivated humility is expanded by the wisdom acquired by the experience of ultimate emptiness (Śūnyatā) and non-self (Anatta). Humility, compassion, and wisdom are intrinsic parts of the state of enlightenment. On the other hand, not being humble is an obstacle on the path of enlightenment which needs to be overcome. In the Tipitaka (the Buddhist scriptures), criticizing others and praising oneself is considered a vice; but criticizing oneself and praising others is considered a virtue. Attachment to the self, apart from being a vice in itself, also leads to other evil states, that create suffering.


title: Humility

text: In the Tipitaka, in the widely known ""Mangala Sutta"", humility ("", literally: 'without air') is mentioned as one of the thirty-eight blessings in life. In the Pāli Canon, examples of humility that are often raised are the monk Sariputta Thera, a leading disciple of the Buddha, and Hatthaka, a leading lay disciple. In later Pali texts and Commentaries, Sariputta Thera is depicted as a forgiving person, who is quick to apologize and accepting of criticism. In the "suttas" (discourses of the Buddha) Hatthaka is praised by the Buddha when he was unwilling to let other people know his good qualities.


title: Humility

text: In Buddhist practice, humility is practiced in a variety of ways. For example, Japanese Soto Zen monks bow and chant in honor of their robes before they don them. This serves to remind them of the connection of the monk's robes with enlightenment. Buddhist monks in all traditions are dependent on the generosity of laypeople, through whom they receive their necessities. This in itself is a practice of humility.


title: Humility

text: In Sanskrit literature, the virtue of humility is explained with many terms, some of which use the root word, . comes from . Related words include , , and the concept "amanitvam", listed as the first virtue in the Bhagwad Gita. "Amanitvam" is a fusion word for "pridelessness" and the virtue of "humility". Other related concepts are "namrata" (नम्रता), which means "modest and humble behavior".


title: Humility

text: Different scholars have varying interpretations for the concept of "amanitvam", humility, as virtue in the Bhagwad Gita. For example, Prabhupada explains humility to mean one should not be anxious to have the satisfaction of being honored by others. The material conception of life makes us very eager to receive honor from others, but from the point of view of a man in perfect knowledge—who knows that he is not this body—anything, honor or dishonor, pertaining to this body is useless. Jopson explains "amanitvam", humility, as lack of arrogance and pride, and one of twenty-six virtues in a human being that if perfected, leads one to a divine state of living and the ultimate truth. Eknath Easwaran writes that the Gita's subject is "the war within, the struggle for self-mastery that every human being must wage if he or she is to emerge from life victorious", and "The language of battle is often found in the scriptures, for it conveys the strenuous, long, drawn-out campaign we must wage to free ourselves from the tyranny of the ego, the cause of all our suffering and sorrow". To get in touch with your true self, whether you call that God, Brahman, etc., one has to let go of the ego. The Sanskrit word Ahamkara literally translates into The-sound-of-I, or quite simply the sense of the self or ego.


title: Humility

text: Mahatma Gandhi interprets the concept of "humility" in Hindu Dharma much more broadly, where humility is an essential virtue that must exist in a person for other virtues to emerge. To Mahatma Gandhi, Truth can be cultivated, as well as Love, but Humility cannot be cultivated. Humility has to be one of the starting points. He states, "Humility cannot be an observance by itself. For it does not lend itself to being practiced. It is however an indispensable test of ahimsa (non-violence)." Humility must not be confused with mere manners; a man may prostrate himself before another, but if his heart is full of bitterness for the other, it is not humility. Sincere humility is how one feels inside, it's a state of mind. A humble person is not himself conscious of his humility, states Mahatma Gandhi.


title: Humility

text: Swami Vivekananda, one of the scholars of Hindu Dharma in the 19th century, argues that the concept of humility does not mean "crawling on all fours and calling oneself a sinner." In Vivekananda's Hindu Dharma, each human being the Universal, recognizing and feeling oneness with everyone and everything else in the universe, without inferiority or superiority or any other bias, is the mark of humility. To Dr. S Radhakrishnan, humility in Hindu Dharma is the non-judgmental state of mind when we are best able to learn, contemplate and understand everyone and everything else.


title: Humility

text: Baba Nand Singh Ji Maharaj said about Guru Nanak that Garibi, Nimrata, Humility is the Divine Flavour, the most wonderful fragrance of the Lotus Feet of Lord Guru Nanak. There is no place for Ego (referred to in Sikhism as Haumain) in the sphere of Divine Love, in the sphere of true Prema Bhagti. That is why in the House of Guru Nanak one finds Garibi, Nimrata, Humility reigning supreme. Guru Nanak was an Incarnation of Divine Love and a Prophet of True Humility.


title: Humility

text: According to Sikhism all people, equally, have to bow before God so there ought to be no hierarchies among or between people. According to Nanak the supreme purpose of human life is to reconnect with Akal (The Timeless One), however, egotism is the biggest barrier in doing this. Using the guru's teaching remembrance of "nām" (the divine Word) leads to the end of egotism. The immediate fruit of humility is intuitive peace and pleasure. With humility they continue to meditate on the Lord, the treasure of excellence. The God-conscious being is steeped in humility. One whose heart is mercifully blessed with abiding humility. Sikhism treats humility as a begging bowl before the god.


title: Humility

text: Sikhs extend this belief in equality, and thus humility, towards all faith: "all religious traditions are equally valid and capable of enlightening their followers". In addition to sharing with others Guru Nanak inspired people to earn an honest living without exploitation and also the need for remembrance of the divine name (God). Guru Nanak described living an "active, creative, and practical life" of "truthfulness, fidelity, self-control and purity" as being higher than a purely contemplative life.


title: Humility

text: Baba Nand Singh Sahib is renowned as the most humble Sikh Saint in the history of Sikhism. Once the disciples of Baba Harnam Singh Ji, the spiritual preceptor of Baba Nand Singh Ji Maharaj asked him how much power He had transmitted to Baba Nand Singh Ji Maharaj to which He replied


title: Humility

text: Baba Nand Singh Ji Maharaj was humbler than the humblest in spirit and He outshines everyone at the pinnacle of all spiritual glory.


title: Humility

text: The spiritual teacher Meher Baba held that humility is one of the foundations of devotional life: "Upon the altar of humility we must offer our prayers to God." Baba also described the power of humility to overcome hostility: "True humility is strength, not weakness. It disarms antagonism and ultimately conquers it." Finally, Baba emphasized the importance of being humble when serving others: ""One of the most difficult things to learn is to render service without bossing, without making a fuss about it and without any consciousness of high and low. In the world of spirituality, humility counts at least as much as utility"."


title: Humility

text: Humility, in Taoism, is defined as a refusal to assert authority or a refusal to be first in anything and that the act of daring, in itself, is a refusal of wisdom and a rush to enjoin circumstances before you are ready. Along with compassion and frugality, humility is one of the three treasures (virtues) in the possession of those who follow the Tao.


title: Humility

text: The treasure of humility, in Chinese is a six-character phrase instead of a single word: "not dare to be first/ahead in the world". Ellen Chen notes that:


title: Humility

text: The third treasure, daring not be at the world's front, is the Taoist way to avoid premature death. To be at the world's front is to expose oneself, to render oneself vulnerable to the world's destructive forces, while to remain behind and to be humble is to allow oneself time to fully ripen and bear fruit. This is a treasure whose secret spring is the fear of losing one's life before one's time. This fear of death, out of a love for life, is indeed the key to Taoist wisdom.


title: Humility

text: Furthermore, also according to the Tao Te Ching (77.4) a wise person acts without claiming the results as his; he achieves his merit and does not rest (arrogantly) in it: – he does not wish to display his superiority.


title: Humility

text: In the numerous traditions of initiatory Wicca, called in the U.S.A. British Traditional Wicca, four paired & balanced qualities are recommended in liturgical texts as having come from the Wiccan Goddess:


title: Humility

text: In the matter of humility, this deific instruction appropriately pairs being honorable with being humble. Characteristically, this Wiccan "virtue" is balanced by its partner virtue.


title: Humility

text: Kant's view of humility has been defined as "that meta-attitude that constitutes the moral agent's proper perspective on himself as a dependent and corrupt but capable and dignified rational agent". Kant's notion of humility relies on the centrality of truth and rational thought leading to proper perspective and can therefore be seen as emergent.


title: Humility

text: Mahatma Gandhi is attributed as suggesting that attempting to sustain truth without humility is doomed to become an "arrogant caricature" of truth.


title: Humility

text: While many religions and philosophers view humility as a virtue, some have been critical of it, seeing it as opposed to individualism.


title: Humility

text: Nietzsche views humility as a strategy used by the weak to avoid being destroyed by the strong. In "Twilight of the Idols" he writes: "When stepped on, a worm doubles up. That is clever. In that way he lessens the probability of being stepped on again. In the language of morality: humility." He believed that his idealized Übermensch would be more apt to roam around unfettered by pretensions of humility, proud of his stature and power, but not reveling idly in it, and certainly not displaying hubris. But, if so, this would mean the pretension aspect of this kind of humility is more akin to obsequiousness and to other kinds of pretentious humility.


title: Humility

text: Recent research suggests that humility is a quality of certain types of leaders. For example, Jim Collins and his colleagues found that a certain type of leader, whom they term "level 5", possesses humility and fierce resolve. Humility is being studied as a trait that can enhance leadership effectiveness. The research suggests that humility is multi-dimensional and includes self-understanding and awareness, openness, and perspective taking.


title: Bianca Kajlich

text: Bianca Maria Kajlich ( ; born March 26, 1977) is an American actress. Kajlich has had starring and supporting roles in television and film including the role of Jennifer on the CBS comedy "Rules of Engagement" (2007–2013). Kajlich was an actress on "Bosch" as Christina Henry during Season 5 of the Amazon Prime series.


title: Bianca Kajlich

text: Kajlich was born in Seattle, Washington, the daughter of Patti (née Campana) and Dr. Aurel Jan "Relo" Kajlich. Her father was Slovak and her mother is of Italian descent. She is a graduate of Bishop Blanchet High School in Seattle, Washington, and attended Washington State University in Pullman, Washington.


title: Bianca Kajlich

text: Kajlich began her career with the Olympic Ballet Theater as a ballet dancer in Edmonds, Washington. After seven years, she decided to try acting. By that time, she had already performed lead roles in "The River", "Swan Lake", and "The Nutcracker". Kajlich's first acting part was in an advertisement for Kragen Auto Parts. She has since appeared in the films "Bring It On", "10 Things I Hate About You", "", and "30 Minutes Or Less". Kajlich also had recurring roles in the television series "Boston Public" as Lisa Grier and in "Dawson's Creek" as Natasha Kelly, as well as roles in UPN's "Rock Me Baby" and the Fox drama "Vanished".


title: Bianca Kajlich

text: Kajlich appeared in an episode of the USA Network's "Psych" entitled "Psy vs. Psy" as a psychic FBI agent who ends up not being who she appears to be. She appeared as a major character in an episode of Fox's short-lived action TV show, "Fastlane", as a prostitute named Bree whose pimp wants her dead. Kajlich had a quick appearance as a punk nose-piercing girl in an episode of "Freaks and Geeks", and she played Jennifer on the CBS comedy "Rules of Engagement". She was ranked No. 74 on the "Maxim" "Hot 100 Women of 2004" and No. 63 on the "Maxim" "Hot 100 Women of 2007".


title: Bianca Kajlich

text: In March 2013, Kajlich was cast as a main character in the NBC sitcom "Undateable", which premiered on May 29, 2014 and ended January 29, 2016.


title: Bianca Kajlich

text: In October 2017, she appeared as Paula, a prostitute befriended with sartorial advice by Larry David in HBO's "Curb Your Enthusiasm".


title: Bianca Kajlich

text: She starred in the Amazon Prime series Bosch as Christina Henry, which completed on June 25, 2021 with its seventh and final season.


title: Bianca Kajlich

text: Kajlich married soccer player Landon Donovan on December 31, 2006. The couple separated in late 2009 and Donovan filed for divorce on December 23, 2010. On December 16, 2012, she married radio personality Michael Catherwood. Kajlich gave birth to the couple's first child, Magnolia, in April 2014.


title: Dua

text: In Islam, (  , plural: ""  ) is a prayer of invocation, supplication or request, even asking help or assistance from God.


title: Dua

text: Muslims regard this as a profound act of worship. Muhammad is reported to have said, "Dua is itself a worship."


title: Dua

text: There is a special emphasis on du'a in Muslim spirituality and early Muslims took great care to record the supplications of Muhammad and his family and transmit them to subsequent generations. These traditions precipitated new genres of literature in which prophetic supplications were gathered together in single volumes that were memorized and taught. Collections such as al-Nawawi's "Kitab al-Adhkar" and Shams al-Din al-Jazari's "al-Hisn al-Hasin" exemplify this literary trend and gained significant currency among Muslim devotees keen to learn how Muhammad supplicated to God.


title: Dua

text: However, Du'a literature is not restricted to prophetic supplications; many later Muslim scholars and sages composed their own supplications, often in elaborate rhyming prose that would be recited by their disciples. Popular du'as would include Muhammad al-Jazuli's "Dala'il al-Khayrat", which at its peak spread throughout the Muslim world, and Abul Hasan ash-Shadhili's "Hizb al-Bahr" which also had widespread appeal. Du'a literature reaches its most lyrical form in the "Munajat", or 'whispered intimate prayers' such as those of Ibn Ata Allah. Among the Shia schools, the "Al-Sahifa al-Sajjadiyya" records du'as attributed to Ali and his grandson, Ali ibn Husayn Zayn al-Abidin.


title: Dua

text: Type I: "Du'ā al-mas'alah" (دُعَاءُ الْمَسْأَلَة "du‘ā’u ’l-mas‘alah"), or the 'du'a of asking.' This type of du'a is when one asks for the fulfillment of a need, or that some harm be removed from him/her. An example would be when a person asks, "O God! Grant me good in this world, and good in the next life!"


title: Dua

text: Type II: "Du'ā al-'ibadah" (دُعَاءُ الْعِبَادَة "du‘ā’u ’l-‘ibādah"), or the 'du'a of worship.' This type of du'a includes every single act of worship. Examples would include when a Muslim prays or gives "zakāt" or fasts.


title: Dua

text: The salat is the obligatory prayer recited five times a day, as described in the Quran: "And establish regular prayers at the two ends of the day and at the approaches of the night: For those things, that are good remove those that are evil: Be that the word of remembrance to those who remember (their Lord):"[Quran 11:114] Salat is generally read in the Arabic language; however Imam Abu Hanifah, for whom the Hanafi school is named after, proclaimed that prayer could be said in any language unconditionally. His two students who created the school: Abu Yusuf and Muhammad al-Shaybani, however, did not agree and believed that prayers could only be done in languages other than Arabic if the supplicant can not speak Arabic. Some traditions hold that Abu Hanifa later agreed with them and changed his decision; however there has never been any evidence of this. Hanbali theologian Ibn Taymiyah issued a "fatwa" proclaiming the same. Until the 1950s, Ismailis from India and Pakistan performed the prayer the language of the local "Jama'at Khana".


title: Dua

text: Ali ibn al-Husayn Zayn al-'Abidin conveyed his understanding of the relationship between human and God by the prayers and supplications that he offered God during his extensive nighttime vigils in the Al-Masjid an-Nabawi (Mosque of the Prophet) in Medina. These prayers and supplications were written down and then disseminated by his sons and the subsequent generations. Among them is the "Al-Sahifa al-Sajjadiyya", which is known as the Psalms of the Household of Muhammad.


title: Dua

text: Every Muslim is required to offer prayers for 5 times, Allah is remembered through prayers. In Islam a Muslim prays to God alone.


title: Dua

text: In Islam, to be hasty in du'a is said to be a cause of rejection of du'a. The type of hastiness that is forbidden in Islam is that a person leaves du'a, thinking that God will not respond to it. In Islam, Muslims are instructed not to give up du'a because they do not see a response immediately.


title: Dua

text: In Islam, in order for a person's du'a to be accepted by God, it must be for something pure and reasonable.


title: Dua

text: In Islam it is imperative that a person making du'a have the best of intentions for whatever he or she is asking. An example would be if someone asks for an increase in wealth, they should intend with that increase in wealth to spend more on the poor and on their relatives.


title: Dua

text: A Muslim is instructed to make du'a with an attentive heart. A Muslim should be aware of what he is saying and should believe in his or her heart that their du'a will be responded to by God.


title: Dua

text: A similar version in Hadith reported by Ahmad, Muslim, and al-Tirmidhi from Abu Hurayrah, as mentioned in sahih al-Jami #2744.


title: Dua

text: Praying or Du'a in Shia has an important place as Muhammad described it as a weapon of the believer. Du'a is considered a feature of Shia community in a sense. Performing Du'a in Shia has a special ritual. Because of this, there are many books written on the conditions of praying among Shia. Most of ad'ayieh transferred from the household of Muhammad and then by many books in which we can observe teachings of Muhammad and his household according to Shia. The leaderships of Shia always invited their followers to recite Du'a. For instance, Ali has considered with the subject of Du'a because of his leadership in monotheism.


title: Dua

text: Shia believe that Dua is possible both in terms of philosophy and from other religion. Some philosophers likes Avicenna, however refers to the importance and possibility but reality of dua. He says that if one heard that someone got health by the Mystic or some problem has been resolved by Bua then do not deny them without reflection suddenly since that may there is a wisdom and mystery. Certainly mystic is one who has connection with Trans physic. Therefore, no one of Islamic sages denied the affection of dua.


title: Dua

text: Among believers there are three groups on Dua. One group is radical such a way that they believe that there is no role for dua in life of believer. Second group believe that at least some of Dua are of affection but many of them don't have any affection. Third group are of moderate attitude on Dua. They believe that Dua is of condition and there are preliminaries for fulfillment of Dua.


title: Dua

text: According to Mutahhari, Dua is both premises and conclusion, both means and end. Mutahhari knows Dua as disposition and innate desire within human.


title: Dua

text: There are various other optional techniques and etiquettes in the Quran and Sunnah for Du'a. Listed here are a limited few and just a fraction of the etiquettes of du'a that scholars have found in reference to in the Quran and Sunnah.


title: Dua

text: Raising one's hands is an encouraged option. There are many hadith that describe how Muhammad raised his hands during du'a. Some hadith describe him having raised his hands to or above head-level in dire circumstances. Many scholars agree that aside from times of exceptionally great need, Muhammad did not raise his hands above his head. Under any other conditions, a common practice is to raise the hands to shoulder-height with palms placed together.


title: Dua

text: Scholars however agree that there are two authentic ways of raising one's hands: when not in drastic conditions the palms of one's hands should be turned up facing the skies, whilst the back of one's hands are facing the ground, then the du'a can be "recited". One must also make sure to face the Qibla (direction of prayer), whilst making du'a.


title: Dua

text: The second way agreed upon by scholars is to have the palms facing one's face; once again one must face the Qibla, but this time the back of one's hands should also face the Qibla.


title: Dua

text: There are also Sahih hadith which narrate that it is forbidden to lift one's eyes towards the sky in prayer.


title: Dua

text: Once the du'a has been completed, it is most common for the supplicant to wipe their face with their hands, and this act signals the end of the du'a.


title: Generic drug

text: A generic drug is a pharmaceutical drug that contains the same chemical substance as a drug that was originally protected by chemical patents. Generic drugs are allowed for sale after the patents on the original drugs expire. Because the active chemical substance is the same, the medical profile of generics is equivalent in performance. A generic drug has the same active pharmaceutical ingredient (API) as the original, but it may differ in some characteristics such as the manufacturing process, formulation, excipients, color, taste, and packaging.


title: Generic drug

text: Although they may not be associated with a particular company, generic drugs are usually subject to government regulations in the countries in which they are dispensed. They are labeled with the name of the manufacturer and a generic non-proprietary name such as the United States Adopted Name (USAN) or International Nonproprietary Name (INN) of the drug. A generic drug must contain the same active ingredients as the original brand-name formulation. The U.S. Food and Drug Administration (FDA) requires generics to be identical to or within an acceptable bioequivalent range of their brand-name counterparts, with respect to pharmacokinetic and pharmacodynamic properties. (The FDA's use of the word "identical" is a legal interpretation, not literal.)


title: Generic drug

text: Biopharmaceuticals, such as monoclonal antibodies, differ biologically from small-molecule drugs. Biosimilars have active pharmaceutical ingredients that are almost identical to the original product and are typically regulated under an extended set of rules, but they are not the same as generic drugs as the active ingredients are not the same as those of their reference products.


title: Generic drug

text: In most cases, generic products become available after the patent protections afforded to the drug's original developer expire. Once generic drugs enter the market, competition often leads to substantially lower prices for both the original brand-name product and its generic equivalents. In most countries, patents give 20 years of protection. However, many countries and regions, such as the European Union and the United States, may grant up to five years of additional protection ("patent term restoration") if manufacturers meet specific goals, such as conducting clinical trials for pediatric patients.


title: Generic drug

text: Manufacturers, wholesalers, insurers, and drugstores can all increase prices at various stages of production and distribution.


title: Generic drug

text: In 2014, according to an analysis by the Generic Pharmaceutical Association, generic drugs accounted for 88 percent of the 4.3 billion prescriptions filled in the United States.


title: Generic drug

text: "Branded generics" on the other hand are defined by the FDA and National Health Service as "products that are (a) either novel dosage forms of off-patent products produced by a manufacturer that is not the originator of the molecule, or (b) a molecule copy of an off-patent product with a trade name." Since the company making branded generics can spend little on research and development, it is able to spend on marketing alone, thus earning higher profits and driving costs down. For example, the largest revenues of Ranbaxy, now owned by Sun Pharma, came from branded generics.


title: Generic drug

text: Generic drug names are constructed using standardized affixes that distinguish drugs between and within classes and suggest their action.


title: Generic drug

text: When a pharmaceutical company first markets a drug, it is usually under a patent that, until it expires, the company can use to exclude competitors by suing them for patent infringement. Pharmaceutical companies that develop new drugs generally only invest in drug candidates with strong patent protection as a strategy to recoup their costs of drug development (including the costs of the drug candidates that fail) and to make a profit. The average cost to a brand-name company of discovering, testing, and obtaining regulatory approval for a new drug, with a new chemical entity, was estimated to be as much as US$800 million in 2003 and US$2.6 billion in 2014. Drug companies that bring new products have several product line extension strategies they use to extend their exclusivity, some of which are seen as gaming the system and labeled "evergreening" by critics, but at some point there is no patent protection available. For as long as a drug patent lasts, a brand-name company enjoys a period of market exclusivity, or monopoly, in which the company is able to set the price of the drug at a level that maximizes profit. This profit often greatly exceeds the development and production costs of the drug, allowing the company to offset the cost of research and development of other drugs that are not profitable or do not pass clinical trials. The impact of loss of patent exclusivity on pharmaceutical products varies significantly across different product classes (e.g., biologics vs. small molecules), largely due to regulatory, legal and manufacturing hurdles associated with such products. Indeed, the greater degree of 'brand-brand' competitive dynamics seen in the biologics and complex generics space allows manufacturers of originators to better protect market share following loss of patent exclusivity.


title: Generic drug

text: Large pharmaceutical companies often spend millions protecting their patents from generic competition. Apart from litigation, they may reformulate a drug or license a subsidiary (or another company) to sell generics under the original patent. Generics sold under license from the patent holder are known as authorized generics.


title: Generic drug

text: Generic drugs are usually sold for significantly lower prices than their branded equivalents and at lower profit margins. One reason for this is that competition increases among producers when a drug is no longer protected by patents. Generic companies incur fewer costs in creating generic drugs—only the cost of manufacturing, without the costs of drug discovery and drug development—and are therefore able to maintain profitability at a lower price. The prices are often low enough for users in less-prosperous countries to afford them. For example, Thailand has imported millions of doses of a generic version of the blood-thinning drug Plavix (used to help prevent heart attacks) from India, the leading manufacturer of generic drugs, at a cost of US$0.03 per dose.


title: Generic drug

text: Generic drug companies may also receive the benefit of the previous marketing efforts of the brand-name company, including advertising, presentations by drug representatives, and distribution of free samples. Many drugs introduced by generic manufacturers have already been on the market for a decade or more and may already be well known to patients and providers, although often under their branded name.


title: Generic drug

text: India is a leading country in the world's generic drugs market, exporting US$20.0 billion worth of drugs in the 2019–20 (April–March) year. India exports generic drugs to the United States and the European Union. also the according to market research community the Global Generic Drugs Market was evaluated US$465.96 million in 2021 and is expected to rise with a CAGR of 5.5% from 2022- 2028 during the forecast period.


title: Generic drug

text: In the United Kingdom, generic drug pricing is controlled by the government's reimbursement rate. The price paid by pharmacists and doctors is determined mainly by the number of license holders, the sales value of the original brand, and the ease of manufacture. A typical price decay graph will show a "scalloped" curve, which usually starts at the brand-name price on the day of generic launch and then falls as competition intensifies. After some years, the graph typically flattens out at approximately 20% of the original brand price. In about 20% of cases, the price "bounces": Some license holders withdraw from the market when the selling price dips below their cost of goods, and the price then rises for a while until the license holders re-enter the market with new stock. The NHS spent about £4.3 billion on generic medicines in 2016–17.


title: Generic drug

text: In 2012, 84 percent of prescriptions in the US were filled with generic drugs, and in 2014, the use of generic drugs in the United States led to US$254 billion in health care savings.


title: Generic drug

text: In the mid-2010s the generics industry began transitioning to the end of an era of giant patent cliffs in the pharmaceutical industry; patented drugs with sales of around US$28 billion were set to come off patent in 2018, but in 2019 only about US$10 billion in revenue was set to open for competition, and less the next year. Companies in the industry have responded with consolidation or turning to try to generate new drugs.


title: Generic drug

text: Most developed nations require generic drug manufacturers to prove that their formulations are bioequivalent to their brand-name counterparts.


title: Generic drug

text: Bioequivalence does not mean generic drugs must be exactly the same as the brand-name product ("pharmaceutical equivalent"). Chemical differences may exist; a different salt or ester may be used, for instance. Different inactive ingredients means that the generic may look different from the originator brand. However, the therapeutic effect of the drug must be the same ("pharmaceutical alternative"). Most small molecule drugs are accepted as bioequivalent if their pharmacokinetic parameters of area under the curve (AUC) and maximum concentration (C) are within a 90% confidence interval of 80–125%; most approved generics in the US are well within this limit. For more complex products—such as inhalers, patch delivery systems, liposomal preparations, or biosimilar drugs—demonstrating pharmacodynamic or clinical equivalence is more challenging.


title: Generic drug

text: Enacted in 1984, the Drug Price Competition and Patent Term Restoration Act, informally known as the Hatch–Waxman Act, standardized procedures for recognition of generic drugs. In 2007, the FDA launched the Generic Initiative for Value and Efficiency (GIVE): an effort to modernize and streamline the generic drug approval process, and to increase the number and variety of generic products available.


title: Generic drug

text: Before a company can market a generic drug, it needs to file an Abbreviated New Drug Application (ANDA) with the Food and Drug Administration, seeking to demonstrate therapeutic equivalence to a previously approved "reference-listed drug" and proving that it can manufacture the drug safely and consistently. For an ANDA to be approved, the FDA requires that the 90% confidence interval of the geometric mean test/reference ratios for the total drug exposure (represented by the area under the curve or AUC) and the maximum plasma concentration (Cmax) should fall within limits of 80–125%. (This range is part of a statistical calculation, and does not mean that generic drugs are allowed to differ from their brand-name counterparts by up to 25 percent.) The FDA evaluated 2,070 studies conducted between 1996 and 2007 that compared the absorption of brand-name and generic drugs into a person's body. The average difference in absorption between the generic and the brand-name drug was 3.5 percent, comparable to the difference between two batches of a brand-name drug. Non-innovator versions of biologic drugs, or biosimilars, require clinical trials for immunogenicity in addition to tests establishing bioequivalency. These products cannot be entirely identical because of batch-to-batch variability and their biological nature, and they are subject to extra rules.


title: Generic drug

text: When an application is approved, the FDA adds the generic drug to its Approved Drug Products with Therapeutic Equivalence Evaluations list and annotates the list to show the equivalence between the reference-listed drug and the generic. The FDA also recognizes drugs that use the same ingredients with different bioavailability and divides them into therapeutic equivalence groups. For example, as of 2006, diltiazem hydrochloride had four equivalence groups, all using the same active ingredient, but considered equivalent only within each group.


title: Generic drug

text: In order to start selling a drug promptly after the patent on innovator drug expires, a generic company has to file its ANDA well before the patent expires. This puts the generic company at risk of being sued for patent infringement, since the act of filing the ANDA is considered "constructive infringement" of the patent. In order to incentivize generic companies to take that risk the Hatch-Waxman act granted a 180-day administrative exclusivity period to generic drug manufacturers who are the first to file an ANDA.


title: Generic drug

text: When faced with patent litigation from the drug innovator or patent holder, generic companies will often counter-sue, challenging the validity of the patent. Like any litigation between private parties, the innovator and generic companies may choose to settle the litigation. Some of these settlement agreements have been struck down by courts when they took the form of reverse payment patent settlement agreements, in which the generic company basically accepts a payment to drop the litigation, delaying the introduction of the generic product and frustrating the purpose of the Hatch–Waxman Act.


title: Generic drug

text: Innovator companies sometimes try to maintain some of the revenue from their drug after patents expire by allowing another company to sell an authorized generic; a 2011 FTC report found that consumers benefitted from lower costs when an authorized generic was introduced during the 180 day exclusivity period, as it created competition.


title: Generic drug

text: Innovator companies may also present arguments to the FDA that the ANDA should not be accepted by filing an FDA citizen petition. The right of individuals or organizations to petition the federal government is guaranteed by the First Amendment to the United States Constitution. For this reason, the FDA has promulgated regulations that provide, among other things, that at any time, any "interested person" can request that the FDA "issue, amend, or revoke a regulation or order," and set forth a procedure for doing so.


title: Generic drug

text: Some generic drugs are viewed with suspicion by doctors. For example, warfarin (Coumadin) has a narrow therapeutic window and requires frequent blood tests to make sure patients do not have a subtherapeutic or a toxic level. A study performed in Ontario showed that replacing Coumadin with generic warfarin was safe, but many physicians are not comfortable with their patients taking branded generic equivalents. In some countries (for example, Australia) where a drug is prescribed under more than one brand name, doctors may choose not to allow pharmacists to substitute a brand different from the one prescribed unless the consumer requests it.


title: Generic drug

text: A series of scandals around the approval of generic drugs in the late 1980s shook public confidence in generic drugs; there were several instances in which companies obtained bioequivalence data fraudulently, by using the branded drug in their tests instead of their own product, and a congressional investigation found corruption at the FDA, where employees were accepting bribes to approve some generic companies' applications and delaying or denying others.


title: Generic drug

text: In 2007, North Carolina Public Radio's "The People's Pharmacy" began reporting on consumers' complaints that generic versions of bupropion (Wellbutrin) were yielding unexpected effects. Subsequently, Impax Laboratories's 300 mg extended-release tablets, marketed by Teva Pharmaceutical Industries, were withdrawn from the US market after the FDA determined in 2012 that they were not bioequivalent.


title: Generic drug

text: Problems with the quality of generic drugs – especially those produced outside the United States – are widespread as of 2019. The FDA does infrequent – less than annual – inspections of production sites outside the United States. The FDA normally gives advance notice of inspections, which can lead to cover-ups of problems before inspectors arrive; inspections performed with little or no advance notice have produced evidence of serious problems at a majority of generic drug manufacturing sites in India and China.


title: Generic drug

text: Two women, each claiming to have suffered severe medical complications from a generic version of metoclopramide, lost their Supreme Court appeal on June 23, 2011. In a 5–4 ruling in "PLIVA, Inc. v. Mensing", the court held that generic companies cannot be held liable for information, or the lack of information, on the originator's label.


title: Generic drug

text: The Indian government began encouraging more drug manufacturing by Indian companies in the early 1960s, and with the Patents Act in 1970. The Patents Act removed composition patents for foods and drugs, and though it kept process patents, these were shortened to a period of five to seven years. The resulting lack of patent protection created a niche in both the Indian and global markets that Indian companies filled by reverse-engineering new processes for manufacturing low-cost drugs. The code of ethics issued by the Medical Council of India in 2002 calls for physicians to prescribe drugs by their generic names only. India is a leading country in the world's generic drugs market, with Sun Pharmaceuticals being the largest pharmaceutical company in India. Indian generics companies exported US$17.3 billion worth of drugs in the 2017–18 (April–March) year.


title: Generic drug

text: In 1945–2017, bioequivalence studies were only required for generics of drugs that are less than four years old. Since 2017, all generic drugs of certain classes, irrespective of age, require bioequivalence to be approved.


title: Generic drug

text: Generic drug production is a large part of the pharmaceutical industry in China. Western observers have said that China lacks administrative protection for patents. However, entry to the World Trade Organization has brought a stronger patent system. China remains the largest exporter of active pharmaceutical ingredients, accounting for 40% of the world market per an 2017 estimate.