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                                                                  EXHIBIT 10.178

                                SECOND AMENDMENT

         THIS SECOND AMENDMENT (this "Amendment") dated as of December 30, 2001,
                                      ---------
to the Loan Agreement referenced below, is by and among Spotlight Health, Inc.,
a Delaware corporation (the "Borrower"), Pharmaceutical Product Development,
                             --------
Inc., a North Carolina corporation (the "Company"), and First Union National
Bank (the "Bank"). Terms used herein but not otherwise defined herein shall have
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the meanings provided to such terms in the Loan Agreement.

                               W I T N E S S E T H

         WHEREAS, a $2 million credit facility has been established in favor of
the Borrower pursuant to the terms of that Loan Agreement dated as of January
24, 2001 (as amended and modified from time to time, the "Loan Agreement") among
                                                          --------------
the Borrower, the Company and the Bank;

         WHEREAS, the Borrower has requested certain modifications to Loan
Agreement; and

         WHEREAS, the Bank has agreed to the modifications on the terms and
conditions set forth herein.

         NOW, THEREFORE, IN CONSIDERATION of the premises and other good and
valuable consideration, the receipt and sufficiency of which are hereby
acknowledged, the parties hereto agree as follows:

         1.     The Loan Agreement is amended in the following respects:

                (a)  In Section 1.1 of the Loan Agreement, the definition of
         "Termination Date" is amended to read as follows:

                     "Termination Date" means June 30, 2002, or such later
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                     date as to which the Bank may agree in its sole
                     discretion.

         2.     This Amendment shall be effective upon satisfaction of the
         following conditions precedent:

                (a)  execution of this Amendment by the Borrower, the
         Company and the Bank; and

                (b)  receipt by the Bank of certified resolutions of the
         Company approving this Amendment and the terms hereof.

         3.     Except as expressly modified hereby, all of the terms and
provisions of the Loan Documents (including schedules and exhibits thereto)
shall remain in full force and effect.

         4.     The Borrower agree to pay all reasonable costs and expenses of
the Bank in connection with the preparation, execution and delivery of this
Amendment, including without limitation the reasonable fees and expenses of
Moore & Van Allen, PLLC.

         5.     This Amendment may be executed in any number of counterparts,
each of which when so executed and delivered shall be deemed an original and it
shall not be necessary in making proof of this Amendment to produce or account
for more than one such counterpart.

         6.     This Amendment shall be deemed to be a contract made under, and
for all purposes shall be construed in accordance with, the laws of the State of
North Carolina.

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         IN WITNESS WHEREOF, each of the parties hereto has caused a counterpart
of this Amendment to be duly executed and delivered as of the date first above
written.

BORROWER:                           SPOTLIGHT HEALTH, INC.,
                                    a Delaware corporation

                                    By:  /s/Tyler J. Spring
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                                    Name:  Tyler J. Spring
                                    Title:  Chief Financial Officer/Treasurer

COMPANY:                            PHARMACEUTICAL PRODUCT DEVELOPMENT, INC.,
                                    a North Carolina corporation

                                    By:  /s/Fred B. Davenport, Jr.
                                        --------------------------
                                    Name:  Fred B. Davenport, Jr.
                                    Title:  Executive Vice President

BANK:                               FIRST UNION NATIONAL BANK

                                    By:  /s/Douglas T. Davis
                                        --------------------
                                    Name:  Douglas T. Davis
                                    Title:  Senior Vice President