The Competitive Effects of Drug Withdrawals

In September 1997, the anti-obesity drugs Pondimin and Redux, ingredients in the popular drug combination fen-phen, were withdrawn from the market for causing potentially fatal side effects. That event provides an opportunity for studying how consumers respond to drug withdrawals. In theory, remaining drugs in the therapeutic class could enjoy competitive benefits, or suffer negative spillovers, from the withdrawal of a competing drug. Our findings suggest that, while the withdrawal of a rival drug may impose negative spillovers in the form of higher patient quit rates, on the whole non-withdrawn drugs in the same therapeutic class enjoy competitive benefits in the form of higher utilization.

The Other Side of the Trade Imbalance: What Will Japan Do?

With the mounting U.S. trade deficit, much attention has centered on the role of U.S. macroeconomic policy and economic structure as contributing factors. This paper contends that the economic structure and policies of Japan have also done much to contribute to the trade imbalance. Institutional features of Japan's macroeconomy and industrial structure which have promoted her large trade surplus are discussed and industrial policies evaluated. Given the nature and magnitude of the role played by Japan in causing the bilateral trade imbalance, the next question the paper addresses is how Japan might best act to alleviate this imbalance. This section of the paper examines fiscal, monetary and other policy initiatives Japan might take to reduce the trade imbalance. The evidence stresses the desirability of expanding Japan's services industries, particularly leisure-related services.

Generic Scrip Share and the Price of Brand-Name Drugs: The Role of the Consumer

Generic drug utilization has risen dramatically, from 19% of scrips in 1984 to 47% in 2001, thus bringing significant direct dollar savings. Generic drug use may also yield indirect savings if it lowers the average price of those brand-name drugs that are still purchased. Prior work indicates - and we confirm - that generic competition does not induce brand-name producers to lower prices. However, consumer choices between generic and brand-name drugs could affect the average price of those brand-name drugs that are purchased. We use nationally representative panel data on drug utilization and costs for the years 1996-2001 to examine how the share of an individual's prescriptions filled by generics affects his average out-of-pocket cost for brand-name drugs. Our principal finding is that a higher generic scrip share lowers average brand-name prices to consumers, presumably because consumers are more likely to substitute generics when the price gap is great. This effect is substantial: a 10% increase in the consumer's generic scrip share is associated with a 15.6% decline in the average price he pays for brand-name drugs.

Female Employment and Fertility in Rural China

Data on 2,288 married women from the 2006 China Health and Nutrition Survey are deployed to study how off-farm female employment affects fertility. Such employment reduces a married woman's actual number of children by 0.64, her preferred number by 0.48, and her probability of having more than one child by 54.8 percent. Causality flows in both directions; hence, we use well validated instrumental variables to estimate employment status. China has deep concerns with both female employment and population size. Moreover, female employment is growing quickly. Hence, its implications for fertility must be understood. Ramifications for China's one-child policy are discussed.

Understanding the Medical and Nonmedical Value of Diagnostic Testing

ABSTRACTObjectivesTo develop a framework for defining the potential value of diagnostic testing, and discuss its implications for the health-care delivery system.MethodsWe reviewed the conceptual and empirical literature related to the valuing of diagnostic tests, and used this information to create a framework for characterizing their value. We then made inferences about the impact of this framework on health insurance coverage, health technology assessment, physician–patient relationships, and public health policy.ResultsThree dimensions can effectively classify the potential value created by diagnostic tests: 1) medical value (impact on treatment decisions); 2) planning value (affect on patients' ability to make better life decisions); and 3) psychic value (how test information affects patients' sense of self). This comprehensive framework for valuing diagnostics suggests that existing health technology assessments may systematically under- or overvalue diagnostics, leading to potentially incorrect conclusions about cost-effectiveness. Further, failure to account for all value dimensions may lead to distorted payments under a value-based health-care system.ConclusionsThe potential value created by medical diagnostics incorporates medical value as well as value associated with well-being and planning. Consideration of all three dimensions has important implications for technology assessment and value-based payment

Penetrating ulcer of the thoracic aorta: What is it? How do we recognize it? How do we manage it?

AbstractBackground: Although classic type A and B aortic dissections have been well described, less is known about the natural history of penetrating atherosclerotic ulcers of the thoracic aorta. This study differentiates penetrating ulcer from aortic dissection, determines the clinical features and natural history of these ulcers, and establishes appropriate correlates regarding optimal treatment. Methods: A retrospective review of patient records and imaging studies was conducted with 198 patients with initial diagnoses of aortic dissection (86 type A, 112 type B) at our institution from 1985 to 1997. Results: Of the 198 patients, 15 (7.6%) were found to have a penetrating aortic ulcer on re-review of computed tomographic scans, magnetic resonance images, angiograms, echocardiograms, intraoperative findings, or pathology reports. Two ulcers (13.3%) were located in the ascending aorta; the other 13 (86.7%) were in the descending aorta. In comparison with those with type A or B aortic dissection, patients with penetrating ulcer were older (mean age 76.6 years, p = 0.018); had larger aortic diameters (mean diameter 6.5 cm); had ulcers primarily in the descending aorta (13 of 15 patients, 86.7%); and more often had ulcers associated with a prior diagnosed or managed AAA (6 of 15 patients, 40.0%; p = 0.0001). Risk for aortic rupture was higher among patients with penetrating ulcers (40.0%) than patients with type A (7.0%) or type B (3.6%) aortic dissection (p = 0.0001). Conclusions: Accurate recognition and differentiation of penetrating ulcers from classic aortic dissection at initial presentation is critical for optimal treatment of these patients. For penetrating ulcer, the prognosis may be more serious than with classic type A or B aortic dissection. Surgical management is advocated for penetrating ulcers in the ascending aorta and for penetrating ulcers in the descending aorta that exhibit early clinical or radiologic signs of deterioration. (J Vasc Surg 1998;27:1006-16.

Supersymmetry Without Prejudice at the 7 TeV LHC

We investigate the model independent nature of the Supersymmetry search strategies at the 7 TeV LHC. To this end, we study the missing-transverse-energy-based searches developed by the ATLAS Collaboration that were essentially designed for mSUGRA. We simulate the signals for ~71k models in the 19-dimensional parameter space of the pMSSM. These models have been found to satisfy existing experimental and theoretical constraints and provide insight into general features of the MSSM without reference to a particular SUSY breaking scenario or any other assumptions at the GUT scale. Using backgrounds generated by ATLAS, we find that imprecise knowledge of these estimated backgrounds is a limiting factor in the potential discovery of these models and that some channels become systematics-limited at larger luminosities. As this systematic error is varied between 20-100%, roughly half to 90% of this model sample is observable with significance S>5 for 1 fb^{-1} of integrated luminosity. We then examine the model characteristics for the cases which cannot be discovered and find several contributing factors. We find that a blanket statement that squarks and gluinos are excluded with masses below a specific value cannot be made. We next explore possible modifications to the kinematic cuts in these analyses that may improve the pMSSM model coverage. Lastly, we examine the implications of a null search at the 7 TeV LHC in terms of the degree of fine-tuning that would be present in this model set and for sparticle production at the 500 GeV and 1 TeV Linear Collider.Comment: 51 pages, 26 figure

Female Employment and Fertility in Rural China

Data on 2,288 married women from the 2006 China Health and Nutrition Survey are deployed to study how off-farm female employment affects fertility. Such employment reduces a married woman’s actual number of children by 0.64, her preferred number by 0.48, and her probability of having more than one child by 54.8 percent. Causality flows in both directions; hence, we use well validated instrumental variables to estimate employment status. China has deep concerns with both female employment and population size. Moreover, female employment is growing quickly. Hence, its implications for fertility must be understood. Ramifications for China’s one-child policy are discussed

Jobs and Kids: Female Employment and Fertility in China

Data on 2,355 married women from the 2006 China Health and Nutrition Survey are used to study how female employment affects fertility in China. China has deep concerns with both population size and female employment, so the relationship between the two should be better understood. Causality flows in both directions. A conceptual model shows how employment prospects affect fertility. Then a well-validated instrumental variable isolates this effect. Female employment reduces a married woman’s preferred number of children by 0.35 on average and her actual number by 0.50. Ramifications for China’s one-child policy are discussed

Gaugephobic Higgs Signals at the LHC

The Gaugephobic Higgs model provides an interpolation between three different models of electroweak symmetry breaking: Higgsless models, Randall-Sundrum models, and the Standard Model. At parameter points between the extremes, Standard Model Higgs signals are present at reduced rates, and Higgsless Kaluza-Klein excitations are present with shifted masses and couplings, as well as signals from exotic quarks necessary to protect the Zbb coupling. Using a new implementation of the model in SHERPA, we show the LHC signals which differentiate the generic Gaugephobic Higgs model from its limiting cases. These are all signals involving a Higgs coupling to a Kaluza-Klein gauge boson or quark. We identify the clean signal $p p \to W^(i) \to W H$ mediated by a Kaluza-Klein W, which can be present at large rates and is enhanced for even Kaluza-Klein numbers. Due to the very hard lepton coming from the W decay, this signature has little background, and provides a better discovery channel for the Higgs than any of the Standard Model modes, over its entire mass range. A Higgs radiated from new heavy quarks also has large rates, but is much less promising due to very high multiplicity final states.Comment: 16 pages, 8 figure