The politics of coalition formation and democracy in lesotho

The politics of coalition formation and democracy in Lesotho
Motlamelle Anthony Kapa
Department of Political and Administrative Studies
National university of Lesotho
Abstract
That political party coalitions are becoming almost a permanent feature of pluralist democracies the world over is a fact beyond dispute. Although relatively new to the African continent for they began during the Third of wave democratization in the early 1990s, they are becoming deeply entrenched in Africa’s political systems as weapons through which political parties fight political battles. Lesotho’s experience of the phenomenon began in the run-up to the 2007 snap elections. Drawing from other countries which have a longer history than Lesotho with coalitions, this paper contributes to the current debate in Lesotho on the relevance of this phenomenon and its implications for the country’s nascent democracy. The paper argues that coalition formation in Lesotho has been caused, to large measure by the office-seeking motives of the political elite and the Mixed Member Proportional (MMP) electoral system. The paper concludes that Lesotho should establish ways and means of regulating coalition so that they work in way that preserves the spirit of the MMP. Introduction
Democratic government is party government: electoral competition is largely party competition; parliamentary politics are invariably party politics; and government is rarely anything but party government. For better or worse, political parties pervade all aspects of government and politics in democracies (Newton & Van Deth 2005:221) Although almost a permanent feature of most pluralist democracies of continental Europe, for their history goes as far back as 1945, ( see for example, Newton & Van Deth, 2005:228; Hague et al 1998:209; Levine 1993:177), political party coalitions are becoming common in Africa as well. For Newton & Van Deth (2005:228), the multi-party systems of Western Europe have been associated with coalition governments and these include Austria, Germany, Switzerland, Iceland, Luxembourg, Italy, France, and Norway. In Latin America, too, coalitions have been formed between parties of identical ideological orientations, such as in Chile where some centre-left parties formed a coalition - coalition of parties for Democracy, comprising among others the Christian Democracy, the Socialist Party, the Radical Party - in a bit to get rid of the dictatorial rule of General Augusto Pinochet. They have been successful as their coalition has won every presidential election since the military rule ended in 1990 (Wikipedia 2007). Africa as well has had its own history of coalitions and these have been classified into two by Oyugi. There are those he dubs ‘First generation coalitions’ and the ‘Second-generation coalitions’. The former are those that emerged on the eve of or immediately after independence while the latter refers to those, which came into being in the 1990s following the resurrection of multi-party politics in the continent (Oyugi 2006:56). True enough, the second-generation coalitions or alliances (which are the focus of this paper) have not been only a pervasive phenomenon in recent years but also one which has been instrumental, but of course to varying degree, in ousting different types of dictatorships and one- party systems in Africa. In Zambia, for example, the Movement of Multi-party Democracy (MMP) dislodged from state power the United Independence Party (UNIP) that had ruled the country since independence in 1964; the National Rainbow Coalition (NARC) defeated in the 2002 elections the Kenyan African National Union (KANU), which had been in power for almost four decades (ibid, 63, 65; Kadima 2006:179); and the United Democratic Front (UDF) broke the Malawi Congress Party’s (MCP) thirty years’ stranglehold on power in Malawi (Kadima 2006:11). In Mauritius, all its eight elections have been contested on the basis of all coalitions or alliances (ibid, 73). Thus, it seems that coalitions will be an important and indeed pervasive factor in African political systems. Lesotho’s political parties have since independence been reluctant to join forces and resources both prior to and after elections. This may be because the biggest of the country’s parties, initially the Basutoland Congress Party (BCP) and the Basotho National Party (BNP) (between 1993 and 1998) and later the Lesotho Congress for Democracy (LCD) and the (BNP) (1998-2002) each thought it could do well in elections and indeed in governing the country after winning elections without the support of others. The smaller parties too did not see a need to make coalitions among themselves or with the bigger ones. Instead of coalescing together the country witnessed incessant intra-party and inter-party conflict and feuding. The former often led to splits and the later to lack of cooperation even on matters of mutual interest and concern. However, following the introduction of the Mixed Member Proportional (MMP) electoral model after the reforms made on the country’s erstwhile discredited First-Past-The-Post (FPTP) electoral system, which have proved, in the case of Lesotho, to produce undesirable political outcomes – over rewarding the winners through making them over represented in parliament and unduly punishing the losers by denying them parliamentary representation, then fanning post-elections political instability and elections-related conflict - the parties have joint the trend taken by other countries in the Southern Africa sub-region and indeed other parts of the world to form coalitions. But what exactly are coalitions? What is the rationale for their formation and with what kind of political outcomes in terms confusing the electorate in their voting decisions? What is the relationship between coalitions and democracy? Are they antithetical to democracy? What influence do they have on countries’ politics in general? Drawing examples from other parts of the world, this paper will attempt to broach these questions in the context of Lesotho’s recent experience with political parties’ coalitions in the run-up to the 17th February 2007 parliamentary elections. It is in order to declare that the coalitions’ formation in Lesotho has generated controversies and intense debates in different public fora and the mass media, and as such, this paper is only a contribution in this debate. Conceptual/theoretical framework
Political parties, and indeed coalitions of them, are formed and take their political place in pluralist democratic systems and operate within this framework. According to Newton & Van Deth (2005:176), pluralist democracies are characterized among other features by plurality of competing groups with unequal access to resources to fight political battles; different configurations of shifting coalitions and power according to issues and circumstances so that today’s winners become tomorrows losers and vice versa; groups looking for political allies through compromises and cooperation. Since this paper is about coalitions of political parties, it follows logically that the two concepts have to be defined before they can be invoked. But an important caveat is in order here. This is that as a general rule in social sciences, there is no agreement among scholars on the definitions of concepts largely because their usage is both circumstantial and contextual. This applies also to political parties and coalitions. Political parties have been defined as “organizations of politically like-minded people who seek power and public office in order to realize their policies” (Newton & Van Deth 2005:221). For Hague et al. (1998:131), “political parties are permanent organizations which contest elections, usually because they seek to occupy decisive positions of authority within a state”. In other words, they are different from other social formations such as pressure or interest groups in that they vie for political power. One the other hand, the concept of coalition has been defined differently by different authors. For Gamsan (1961:374), “coalitions are temporary, means oriented, alliances among individuals or groups which differ in goals”. More specifically and also relevant to this paper, Altman defines coalitions as: Temporary combination of groups or individuals formed to pursue specific objectives through joint action. Specifically it is a set of parliamentary political parties that agree to pursue a common goal or a set of common goals; pool their resources together in pursuit of this goal; communicate and form building commitments concerning their goals;(and) agree on the distribution of pay-offs to be received on obtaining their goal (Altman 2000) Although largely useful in proving this instrumentalist definition, which defines coalitions as goal- oriented entities and in particular focusing on political parties, Oyugi is accurate to spot its weakness. This is that it sees coalitions as post-elections phenomenon, when in fact they are also formed in the pre-elections periods (Oyugi, ibid). Taken together, all these definitions suffice and constitute the conceptual framework of this paper. In other words although they may form a coalition, political parties are themselves relatively permanent entities which do not detract from their key objective of seeking power through the competitive process nor do they lose their distinct identities unless they lead to a merger, which is a different case. Thus this is how they must be understood. Another key issue which comes out of the Altman’s definition is that coalitions may be a transient phenomenon with short lifespan. But it is important also to note that they may endure over a relatively longer time to pursue specific predetermined goals and objectives stipulated in their constitutive agreements. Some coalitions are, to borrow from Makoa “loose and narrow in their focus, while others are tightly knit with an identifiable authority and broad but clearly defined functions (ibid, 5).” So, if political parties are entities vying for state power, using all sorts of strategies including intimidation of their opponents, vote buying, manipulation of the rules of the electoral game, even violence, then why do they cooperate with their otherwise competitors or even arch rivals? The next section dwells on this question. The rationale for coalition formation
To be sure, coalition formation is a process that has both costs and benefits. In this process those involved make rational calculations and weigh the costs and benefits. If the benefits outweigh the costs, then they start the process. I have already indicated that coalitions can be formed before or after election. In the former case and in line with the coalition theories associated with the works of theorists such as William Riker in his The theory of political coalitions (1962), politicians would form coalitions just big enough to ensure a majority in parliament, but no bigger or smaller. They are motivated primarily by a desire for power or prestige in which case there was no sense in sharing cabinet posts among more parties than was necessary - hence the concept of minimum winning coalition (Newton & Van Deth 2005:234).These forms of coalitions often occur in presidential systems using proportional representation model and requiring at least 51 percent of the total vote (Sithanen 2003:2). The theory is also called office-seeking or office-oriented (Kadima 2006:5). In line with the office-seeking theory, Oyigi captures the rationale for the formation of If coalition formation “involves a process which leads to sharing power as well as the material benefits that go with it, then coalition formation is a process which normally occurs because neither or none of the co-operating parties can manage to win an election and govern on its own. It is therefore a necessary evil - an evil in the sense that normally no party ever coalesces except in circumstances in which not to do so would deprive it of the chance to exercise power (Oyugi 2006:54) The theory applies, in most cases, in situations where political parties have closer or convergent ideological orientations. But this is not a blanket rule, for in his study of the five African countries – Kenya, Malawi, Mauritius, Mozambique, and South Africa - Kadima (2006:228), finds that ideological proximity has not been a factor in determining coalition formation. Instead, for him, the formation of coalitions in South Africa and Mauritius has led to ideological harmony between the ANC and the Democratic Alliance (DA). For him, in both the Mauritian and South African case, “ all the main parties have embraced neo-liberal ideology, thus shifting to the centre” (ibid, p. 233) Sithanen (2003:7) argues that “in Mauritius, coalition formation and governance has been influenced by office - seeking strategy” other than other considerations such as ideological convergence. This was a time in the country’s history when the Mouvement Militant Mauricien (MMM) and the Mouvement Socialiste Mauricien (MSM) joined forces to govern the country, which they did, albeit for only nine months (Kadima 2006:78). The MMM again formed a coalition with the movement Socialiste Mauricien (MSM) in order to guarantee its electoral victory in 2000 (ibid, p. Political parties also form coalitions not exclusively to seek power, but to influence public policy. Thus, when they are aware that they do not stand a chance of winning elections, politicians form coalitions to at least be in parliament so that they can influence policy-making in their favour (Van Deth 2005:234). They would then support a minority government as long as this is responsive to their interests. The outcome of such a coalition would in most cases be to enhance democratic Furthermore, coalitions are formed especially after elections to form a government or to produce a countervailing force to the governing party. According to Hague et al. (1998:207), coalition parties have been a defining feature of politics throughout Western Europe. This has been the case in Italy, Belgium, Sweden, Portugal, Finland, Denmark, Netherlands, Norway, Ireland, Spain, to name but a few. In most cases, the phenomenon is a result of the electoral systems used in these countries that fail to produce clear winners. Such governments become unstable in most but not all cases. The German coalition governments have been more durable than in Italy. In the latter, these lasted for a few months (ibid, 207-208; Newton & Van Deth 2005:231). In New Zealand also, following the change of the electoral model from FPTP to the MMP, the New Zealand First Political Party and the New Zealand National Party signed a coalition agreement in December 1996. The purpose of this move was to “provide sound and stable government for New Zealand for a three year term concluding with the 1999 general elections.” (Government of New Zealand Lastly, political parties enter into coalition agreements for purposes of resolving political conflicts and contributing to the process of nation-building. This is common in countries characterized by ethnic, racial, and religious divisions. This has been the case in South Africa following the demise of the Apartheid system and in Mauritius since independence. Kadima (2006:233) finds that in Mauritius, coalitions have been formed between the Labour Party (LP) and its rival, the Parti Mauricien Socialiste Democrate (PMSD) to help nation-building and reconcile the majority Hindu represented by the former and the mainly Creole people represented by the latter. This point is corroborated by Sithanen (2003:9). For him, coalition governments in Mauritius have become important instruments for ensuring integration, participation in decision-making and empowerment, thus promoting national unity, these are achieved by conscious action of selecting a prime minister from one ethnic group and the deputy from another and distribution of ministerial and other important positions in manner reflective of the composition of the population. In South Africa as well, the national unity government consisting of the African National Congress (ANC), the National Party (NP), and the Inkatha Freedom party (IFP),was formed for the purposes of nation-building in the then racially divided country (ibid). He goes on to show that in the Kwazulu Natal Province, which was characterized by violence between the supporters of the ANC and the IFP the parties formed a coalition to put this to an end. Political party coalition-making in Lesotho: Ideology, office-seeking, policy influence, or
nation-building?
As already averred, the phenomenon of coalition, at least in the form of what Oyugi (2006:56)
terms the ‘second-generation coalitions’, is a novelty in Lesotho’s politics. The coalition formation in Lesotho is an outcome of the constitutional and electoral reforms that were instituted prior to the 2002 elections, and more specifically the Mixed Member Proportional (MMP) electoral system. it has been established that there is a positive relationship between the Proportional Representatio9n model and coalition formation. Thus, “it has been suggested that coalition formation is more common in countries operating PR” (Oyugi 2006:56). The introduction of the MMP was a deliberate innovation to solve Lesotho’s incessant post-elections conflict occasioned by lack of ‘inclusivity’ of the erstwhile FPTP electoral model. The MMP was expected to make the National Assembly more inclusive by ensuring, through its proportional element, that political parties with some degree of following among the population have parliamentary representation, and compensating the losers in the electoral contest, thereby leading to political stability in the country. The model did deliver as expected, and for the first time in the country’s political history, at least ten (10) of the countries nineteen (19) political parties got seats in Parliament. This said, however, the MMP model did not break the dominance of the ruling Lesotho Congress for Democracy (LCD) for this won, as has been the case before, seventy-nine (79) of the country’s (80) electoral constituencies. History was also made when the split in October 2006 of the governing LCD and the formation of the All Basotho Convention (ABC) by the then Minister of Communication, Science and Technology, Mr. Thomas Motsoahae Thabane, and 17 other former LCD’s Members of Parliament occurred and the party winning ten 10 constituencies in the country’s urban areas . Even before this split, the LCD is known to have preferred a Mixed Member Parallel system to the MMP and made its position on this known during the 12 parties negotiations in the then Interim Political Authority (IPA) - a structure that was tasked, among others, to review the country’s FPTP system. The parallel model would ensure the LCD parliamentary majority of about two-thirds if its performance under the FPTP system could not change. This is because although it is similar to the MMP for “they use the plurality-majority system together with a PR system, but unlike the MMP the PR system does not compensate for any disproportionality resulting from the plurality-majority system” (Newton & Van Deth 2005:205). That is, it does not stress proportionality in the process of converting the PR seats into parliamentary seats. The introduction of the MMP model encouraged the formation of parties’ coalitions as parties saw the opportunity, through the PR component of the MMP, to increase their majority in parliament or at least not to lose the seats they already had. Thus, for the first time in Lesotho’s electoral history there has been pre-elections coalition or electoral pacts in the run up to the 2007 polls formed by at least nine of these parties, namely, All Basotho Convention/Lesotho Workers Party (ABC/LWP), Basotho National Party/National Progressive Party (BNP/NNP), Alliance of Congress Parties (ACP) - comprising the Basutoland African Congress, Lesotho People’s Congress, and one faction of the Basutoland Congress Party and finally the Lesotho Congress for Democracy/National Independent Party (LCD/NIP). How then can the formation of these alliances be explained? We have seen in this paper that there are several theories that attempt to explicate coalitions’ formation and I attempt at this juncture to apply some of these theories in order to understand the coalition phenomenon in Lesotho’s politics. I suggest that the phenomenon cannot be explained in terms of any of the three motivations, namely, ideology, policy-influence, and nation-building. This is because Lesotho’s political parties do not really have divergence in their ideological orientations. They all seem to embrace, to a large measure, the now reigning hegemonic world’s neo-liberal ideology, which is marked by among others free market system and political pluralism. None of them reflects any other ideology in their manifestos. Interestingly, this seems to be the case in other neighbouring countries as reflected in Kadima’s work referred to above. The Policy-influence thesis also seem, I would argue, to be irrelevant in Lesotho’s context. This is because none of the political parties that have been in Parliament before the February 17th elections provided a markedly differing policy to that of the ruling LCD. Even the leadership of new ABC only cited poor service delivery by the LCD as its reason for breaking away from the former. Besides, Lesotho’s political parties are known to have maintained and sustained a posture of adversarial relations (Makoa 2005) with very limited if any propensities to cooperate. The Nation-building argument, as well, falls off as an explanatory tool in coalition formation in Lesotho. This is because unlike in countries with ethnic, religious, and racial diversity such as Mauritius and South Africa, Lesotho is a homogenous society with no problem of ethnic or racial conflict. The conflict that the country has had is of different a nature, Thus, I suggest that coalition formation in Lesotho can, to a large measure, be explained in terms of the office-seeking theory. The political elites both within the ruling party and opposition alike were motivated by the desire to have access to public office, and not purely for that, but more crucially to have access to the lucrative salaries and the controversial benefits including among others interest free loans worth up to M400,000 (Lesotho government Gazette Extraordinary, 2006). It is not difficult to understand this kind of elite behaviour for Lesotho exemplifies a typical neopatrimonial system common in most African countries. Under the neopatrimonial system the elites use public office to appropriate for themselves state-generated benefits (for more discussion on the issue, see Kapa 2006). Access to state power and by extension to the benefits that go with it, in an environment where there are limited if any alternatives to wealth accumulation, is a means for elite survival in a political economy characterized by extreme poverty and limited options. All parliamentary parties’ leadership was desperate not to lose their seats in parliament, and in order to achieve this goal, they formed coalitions. With regard to post-election coalition formed by the now so called ‘Big Five’, consisting of the ABC/LWP, BNP, MFP, and ACP the motivation was to allow them to elect an official leader of opposition so that the position does not go the deputy leader of the NIP who is working with the ruling LCD. This reflects the office-seeking motives of these parties, for they were aware that none of them would qualify for the position, which requires at least 25% of the National Assembly seats for a party or a coalition of parties to claim the position. Although they have a total of 21 seats – 10 won by the ABC in under the FPTP and 11 others under the banner of the LWP through the PR system, the ABC/LWP could not make the 30 seats or 25% of the total parliamentary seats required to be an official opposition. Thus they formed a post-elections coalition with others shown above and nominated the ABC leader to be the leader of official opposition. But this move was quelled by the Speaker of the National Assembly when she ruled that coalitions had no legal standing. This decision caused a lot of disquiet among the opposition ranks and justifiably so for the Speaker quoted in her ruling on the same matter Section 3 of the Members of Parliament Salaries Act of 1998, which does not only define the official leader of opposition but actually Conclusion
While it has been a feature of Western democratic systems since the end of the Second World War, as shown in this paper, political party coalitions are increasingly becoming common as instruments of fighting political battles in other regions of the globe including Africa, and Lesotho. The motivation of political leaders to form coalitions have been explained invoking different theories including, ideological proximity of parties, policy-influence, nation-building, and office-seeking. The explanatory power of these differs depending on the context and political economy of countries where they are applied, but I have argued that the office-seeking theory explains Lesotho’s situation better. This is because of the nature of the country’s political economy in which the state is the main source of wealth accumulation and indeed survival for the country’s elite. Whether or not the Lesotho coalitions will endure is debatable for it appears for them the main issue was either retain power (especially for the ruling party) or political survival of the opposition. If coalition arrangements can be seen by them as ways of maintaining the status quo, the parties may make As a last word, what is the relationship between coalitions and the democracy? The quotation at the beginning of this paper fully answers the question. If there cannot be democracy without political parties as single entities, it follows logically that coalitions of parties should, if anything, add more value to democracy rather than being its antithesis. As such, formation of coalitions in the run-up to Lesotho’s 17th February general elections and contesting of these in the elections should be hailed as a positive development for the country’s democratization. Coalitions have ensured that some parties’ survived while at the same time they have, resolved partly, the ruling party’s problem of rebelling MPs. Through its coalition with the NIP, the ruling party is assured of parliamentary majority, if and only if, there will be no more defectors from its FPTP MPs. In fact the coalition has ensured the survival of the very government of the LCD, for without, as has been argued elsewhere, the government could have collapsed because of loss of its parliamentary majority. The have also re-drawn Lesotho’s political map by dissipating effectively the one-party-dominant system that was about to entrench itself. Following the ABC’s split, the LCD had only sixty-one parliamentary majority as a result of the death of its MP for Mekaling constituency. Desperate to prevent the collapse of its government, it formed and alliance with NIP the product of which has been the current coalition government (Makoa 2007:13-14). Coalitions in and of themselves, therefore, should not be viewed in any other light than this. More importantly, although coalitions were formed within a short time, Basotho voters seem to have understood how coalitions work for they voted as expected. This is because there have not been large amounts of spoiled ballots, at least large enough to cause concern and in relation to the last elections. This is probably because despite time constraints, political parties made effective voter education. These said, however, the problem which led to the current impasse between the ruling party, the Independent Electoral Commission (IEC), and the major opposition parties originates in the manner in which the coalitions were formed and the silence of the electoral law on the regulation of coalitions. The problem lies with the countries political elite’s deliberate move to undermine the spirit of the country’s hard fought for MMP model through coalitions. This calls for an urgent need to find appropriate mechanisms to protect jealously the MMP model lest the country reverts back to its dark history of political violence reminiscent of that of 1998. Although a positive development for Lesotho’s politics as I have indicated, the big challenge facing coalitions is to endure and assist the opposition to cooperate in matters of common, and crucially, national interest to hold the ruling Selected Bibliography
Elklit (2002) ‘ Lesotho 2002: Africa’s first MMP elections’. Journal of African Elections Vol.1. no.
2

Gamson W. (1961) ‘ A theory of coalition formation’ American Sociological Review . Vol.6, No.3.
pp 373-382
Government of New Zealand official website 2000. Available at http//www.executive.govt.nz/96- 99/coalition/coalit.htm. Accessed 10/10/2007 Hague R., M. Harrop, & S. Breslin (1998) Political Science: A comparative introduction. New
York: Worth Publishers
Kadima D. (ed) (2006). The politics of party coalitions in Africa. Johannesburg: EISA
Kapa M.A. (2006). ‘The Lesotho textile and clothing industry and the United States Africa Growth and Opportunity Act: A long term development and poverty reduction scheme?’ Lesotho Social
Sciences Review
, Vol. 10. pp.58-75
Levine H.M (1993). Political issues debated: An introduction to politics. Englewood Cliffe:
Prentice Hall
Makoa F.K. (2005). ‘Strengthening parliamentary democracy in Southern Africa: Lesotho country case’ South African Journal of international Affairs. Vol 12 no.1. pp 61-76
----------------(2007). ‘Political party alliances and coalitions during the 2007 general elections in
Lesotho. A paper presented at the Electoral Institute of Southern Africa and the Lesotho National Council of Non-governmental Organizations Conference on : Lesotho’s 2007 General Election: Towards a constructive management of post-election disputes, Maseru sun Cabanas Hotel, 25-27 September 2007.
Newton K. & J. W. Van Deth (2005). Foundations of comparative politics. Cambridge:
Cambridge University Press.
Oyugi. O. W. (2006) ‘Coalition politics and coalition governments in Africa’ Journal of
Contemporary African Studies
, Vol.24, No. 1
Sithnen R. (2003). ‘Coalition politics under the tropics: office seekers, power makers, nation
building: A cases of Mauritius’. A paper presented at an EISA Roundtable on Political party
coalitions – Strengthening democracy through party coalition building, Vineyard Hotel, Claremont, Cape Town, 19 June 2003. Wekipedia (2007) Coalition of parties for democracy, Available form: http//en.wikipedia.org/wiki/Coalition_of_Parties_for_Democracy [Accessed 10/10/2007

Source: http://trc.org.ls/wp-content/uploads/2013/04/Kapa_Presentation.pdf

vilafranca.org

ACTA DE SESSIÓ DEL PLE DE L'AJUNTAMENT Identificació de la sessió Núm. : 04/2004 Caràcter : ordinari Data : 16 de març de 2004 Horari : de 20,04 a 23,15 hores Lloc : saló de sessions de la casa de la vila Hi assisteixen : ALCALDE-PRESIDENT: Il.lm. Sr. Marcel Esteve i Robert REGIDORS I REGIDORES (per ordre alfabètic): - Àngela Agramunt i Andreu - Francisco Álvarez

Effects of pioglitazone on menstrual frequency, hyperandrogenism and insulin resistance in adoloscents and young adults with polycystic ovary syndrome

J Pediatr Adolesc Gynecol (2008) 22:91e95Effects of Pioglitazone on Menstrual Frequency,Hyperandrogenism and Insulin Resistance in Adoloscents andYoung Adults with Polycystic Ovary SyndromeLaddiperla Narsing Rao, MD, Jubbin Jagan Jacob, MD, Thomas V. Paul, MD, Simon Rajarathinam, MD,Nihal Thomas, MD, and Mandalam S. Seshadri, MDDepartment of Endocrinology, Christian Medical College and Hospital,

Copyright © 2010-2014 Medical Articles