Uncertainty and choice: the challenges of pharmaceutical efficacy, safety, and cost

This paper addresses the role of uncertainty in challenges confronting the US pharmaceutical industry and its regulators. It begins with a macroeconomic overview, showing how rising health care costs, including rising ethical drug costs, squeeze the wage and salary share of national income. It addresses the claim that pharmaceutical companies' new drug pipelines are drying up. Taking a stochastic approach, it shows that both the trend of new medical entity approvals and the trend of pharmaceutical company gross margins can be explained as random walks-the latter as a result of sampling from a highly skew distribution. It then focuses on problems of ascertaining efficacy and especially low-probability adverse effects from clinical trial samples of acceptable size. Noting the need for post-NDA surveillance of adverse effects and observing the incentive failures that occur at that stage, it proposes two new approaches to identifying adverse reactions. Copyright © 2007 John Wiley & Sons, Ltd.

The Direction of Union Mergers in the United States : The Rise of Conglomerate Unionism

Trade union mergers have become common throughout the industrial world. In the United States, since the late 1970s, these have become increasingly multi-jurisdictional. Beginning in the 1990s, the trend has been dominated by five 'conglomerate' unions, who have embraced this as a strategy for growth and increased effectiveness. This article will examine the roots of this 'conglomerate' direction and quantitatively assess the claims for greater effectiveness in finances, organizing, and collective bargaining. The tentative conclusion is that while resources and policy matter, the conglomerate merger strategy of these unions has not improved any of these functions either over time or in comparison to other unions that have put less emphasis on multi-jurisdictional mergers.Peer reviewe