"Napsterizing" Pharmaceuticals: Access, Innovation, and Consumer Welfare

We analyze the effects on consumers of an extreme policy experiment -- Napsterizing' pharmaceuticals -- whereby all patent rights on branded prescription drugs are eliminated for both existing and future prescription drugs without compensation to the patent holders. The question of whether this policy maximizes consumer welfare cannot be resolved on an a priori basis due to an obvious tradeoff: While accelerating generic entry will yield substantial gains in consumer surplus associated with greater access to the current stock of pharmaceuticals, future consumers will be harmed by reducing the flow of new pharmaceuticals to the market. Our estimates of the consumer surpluses at stake are based on the stylized facts concerning how generic entry has affected prices, outputs, and market shares. We find that providing greater access to the current stock of prescription drugs yields large benefits to existing consumers. However, realizing those benefits has a substantially greater cost in terms of lost consumer benefits from reductions in the flow of new drugs. Specifically, the model yields the result that for every dollar in consumer benefit realized from providing greater access to the current stock, future consumers would be harmed at a rate of three dollars in present value terms from reduced future innovation. We obtain this result even accounting for the stylized fact that after generic entry branded drugs continue to earn significant price premia over generic products and hence recognizing that Napsterizing does not completely eliminate the incentives to innovate.

A New Template Family For The Detection Of Gravitational Waves From Comparable Mass Black Hole Binaries

In order to improve the phasing of the comparable-mass waveform as we approach the last stable orbit for a system, various re-summation methods have been used to improve the standard post-Newtonian waveforms. In this work we present a new family of templates for the detection of gravitational waves from the inspiral of two comparable-mass black hole binaries. These new adiabatic templates are based on re-expressing the derivative of the binding energy and the gravitational wave flux functions in terms of shifted Chebyshev polynomials. The Chebyshev polynomials are a useful tool in numerical methods as they display the fastest convergence of any of the orthogonal polynomials. In this case they are also particularly useful as they eliminate one of the features that plagues the post-Newtonian expansion. The Chebyshev binding energy now has information at all post-Newtonian orders, compared to the post-Newtonian templates which only have information at full integer orders. In this work, we compare both the post-Newtonian and Chebyshev templates against a fiducially exact waveform. This waveform is constructed from a hybrid method of using the test-mass results combined with the mass dependent parts of the post-Newtonian expansions for the binding energy and flux functions. Our results show that the Chebyshev templates achieve extremely high fitting factors at all PN orders and provide excellent parameter extraction. We also show that this new template family has a faster Cauchy convergence, gives a better prediction of the position of the Last Stable Orbit and in general recovers higher Signal-to-Noise ratios than the post-Newtonian templates.Comment: Final published version. Accepted for publication in Phys. Rev.

The differential impact of risk factors on mortality in hemodialysis and peritoneal dialysis

The differential impact of risk factors on mortality in hemodialysis and peritoneal dialysis.BackgroundWhile the survival ramifications of dialysis modality selection are still debated, it seems reasonable to postulate that outcome comparisons are not the same for all patients at all times. Trends in available data indicate the relative risk of death with hemodialysis (HD) compared to peritoneal dialysis (PD) varies by time on dialysis and the presence of various risk factors. This study was undertaken to identify key patient characteristics for which the risk of death differs by dialysis modality.MethodsAnalyses utilized incidence data from 398,940 United States Medicare patients initiating dialysis between 1995 and 2000. Proportional hazards regression identified the presence of diabetes, age, and the presence of comorbidity as factors that significantly interact with treatment modality. Stratifying by these factors, proportional and nonproportional hazards models were used to estimate relative risks of death [RR (HD:PD)].ResultsOf the 398,940 patients studied, 11.6% used PD as initial therapy, 45% had diabetes mellitus (DM), 51% were 65 years or older, and 55% had at least one comorbidity. Among the 178,693 (45%) patients with no baseline comorbidity, adjusted mortality rates in nondiabetic (non-DM) patients were significantly higher on HD than on PD [age 18–44: RR (95% CI) = 1.24 (1.07, 1.44); age 45–64: RR = 1.13 (1.02, 1.25); age 65+: RR = 1.13 (1.05, 1.21)]. Among diabetic (DM) patients with no comorbidity, HD was associated with a higher risk of death among younger patients [age 18–44: RR = 1.22(1.05, 1.42)] and a lower risk of death among older patients [age 45–64: RR = 0.92 (0.85, 1.00); age 65+: RR = 0.86 (0.79, 0.93)]. Within the group of 220,247 (55%) patients with baseline comorbidity, adjusted mortality rates were not different between HD and PD among non-DM patients [age 18–44: RR = 1.19 (0.94, 1.50); age 45–64: RR = 1.01 (0.92, 1.11); age 65+: RR = 0.96 (0.91, 1.01)] and younger DM patients [age 18–44: RR = 1.10 (0.92, 1.32)], but were lower with HD among older DM patients with baseline comorbidity [age 45–64: RR = 0.82 (0.77, 0.87); age 65+: RR = 0.80 (0.76, 0.85)].ConclusionValid mortality comparisons between HD and PD require patient stratification according to major risk factors known to interact with treatment modality. Survival differences between HD and PD are not constant, but vary substantially according to the underlying cause of ESRD, age, and level of baseline comorbidity. These results may help identify technical advances that will improve outcomes of patients on dialysis

Space Warps II. New Gravitational Lens Candidates from the CFHTLS Discovered through Citizen Science

We report the discovery of 29 promising (and 59 total) new lens candidates from the CFHT Legacy Survey (CFHTLS) based on about 11 million classifications performed by citizen scientists as part of the first Space Warps lens search. The goal of the blind lens search was to identify lens candidates missed by robots (the RingFinder on galaxy scales and ArcFinder on group/cluster scales) which had been previously used to mine the CFHTLS for lenses. We compare some properties of the samples detected by these algorithms to the Space Warps sample and find them to be broadly similar. The image separation distribution calculated from the Space Warps sample shows that previous constraints on the average density profile of lens galaxies are robust. SpaceWarps recovers about 65% of known lenses, while the new candidates show a richer variety compared to those found by the two robots. This detection rate could be increased to 80% by only using classifications performed by expert volunteers (albeit at the cost of a lower purity), indicating that the training and performance calibration of the citizen scientists is very important for the success of Space Warps. In this work we present the SIMCT pipeline, used for generating in situ a sample of realistic simulated lensed images. This training sample, along with the false positives identified during the search, has a legacy value for testing future lens finding algorithms. We make the pipeline and the training set publicly available.Comment: 23 pages, 12 figures, MNRAS accepted, minor to moderate changes in this versio

Effects of Age and Sex on Weight-Loss Dynamics in Obese Patients Undergoing Very Low Calorie Treatment

Background and Significance: Although known to effectively provoke large scaled weight-loss, less is known regarding age- and sex-related influences on treatment outcomes of bariatric patients treated with a very-low calorie diet (VLCD) program. Purpose: This study retrospectively examined body composition and metabolic changes induced by a 12-wk proprietary VLCD treatment in obese patients while assessing age and sex differences. Methods: Male (n=16) and female (n=16) patients underwent 12 weeks of VLCD under standard medical care. Results: Older patients exhibited a greater relative loss of FFM compared to younger patients (p=0.004). Older patients also lost a greater proportion of total weight-loss as FFM (p=0.003) and lower proportion as FM (p=0.003) compared to the young group. This age-specific difference in weight-loss composition was driven by the older males. Conclusion: The results demonstrate the need for special clinical considerations for VLCD treated patients, such as older adults and perhaps older males specifically, who demonstrate a reduced quality of weight-loss compared to their younger counterpart

Space Warps: I. Crowd-sourcing the Discovery of Gravitational Lenses

We describe Space Warps, a novel gravitational lens discovery service that yields samples of high purity and completeness through crowd-sourced visual inspection. Carefully produced colour composite images are displayed to volunteers via a web- based classification interface, which records their estimates of the positions of candidate lensed features. Images of simulated lenses, as well as real images which lack lenses, are inserted into the image stream at random intervals; this training set is used to give the volunteers instantaneous feedback on their performance, as well as to calibrate a model of the system that provides dynamical updates to the probability that a classified image contains a lens. Low probability systems are retired from the site periodically, concentrating the sample towards a set of lens candidates. Having divided 160 square degrees of Canada-France-Hawaii Telescope Legacy Survey (CFHTLS) imaging into some 430,000 overlapping 82 by 82 arcsecond tiles and displaying them on the site, we were joined by around 37,000 volunteers who contributed 11 million image classifications over the course of 8 months. This Stage 1 search reduced the sample to 3381 images containing candidates; these were then refined in Stage 2 to yield a sample that we expect to be over 90% complete and 30% pure, based on our analysis of the volunteers performance on training images. We comment on the scalability of the SpaceWarps system to the wide field survey era, based on our projection that searches of 10$^5$ images could be performed by a crowd of 10$^5$ volunteers in 6 days.Comment: 21 pages, 13 figures, MNRAS accepted, minor to moderate changes in this versio