Research

Abstract: We analyze how common market failures---market power and choice frictions---shape the welfare effects of a large-scale pharmaceutical price control policy in India. The policy reduced regulated product prices by 24% and increased sales by 36%, with little impact on entry and exit. Standard welfare analysis shows significant consumer and social welfare gains, as price caps correct monopoly distortions. However, using a survey of doctors' drug choices, we show that consumers overvalue regulated products, implying 30% lower true consumer surplus gains and a decline in social welfare. We assess alternative price and non-price regulations that address both market failures. 

Abstract:  We study the role of political ideology in the diffusion of scientific knowledge by media outlets. We document, using a novel measure of scientist ideology that spans more than 600,000 papers, that outlets are statistically significantly more likely to cover scientists with similar ideology. However, the role of scientist ideology is small in magnitude when compared to the role of scientific quality, as measured by academic citations, journal quality, and research funding, in media coverage of science. On average, outlets are more likely to cover high-quality research written by misaligned scientists than low-quality research written by ideologically aligned scientists.

This article examines the consequences and causes of low enrollment of Black patients in clinical trials. We develop a simple model of similarity-based extrapolation that predicts that evidence is more relevant for decision-making by physicians and patients when it is more representative of the group being treated. This generates the key result that the perceived benefit of a medicine for a group depends not only on the average benefit from a trial but also on the share of patients from that group who were enrolled in the trial. In survey experiments, we find that physicians who care for Black patients are more willing to prescribe drugs tested in representative samples, an effect substantial enough to close observed gaps in the prescribing rates of new medicines. Black patients update more on drug efficacy when the sample that the drug is tested on is more representative, reducing Black-white patient gaps in beliefs about whether the drug will work as described. Despite these benefits of representative data, our framework and evidence suggest that those who have benefited more from past medical breakthroughs are less costly to enroll in the present, leading to persistence in who is represented in the evidence base.

Abstract:  

Importance  Inequity in clinical trial enrollment, particularly the underenrollment of women, is an ongoing concern in biomedical sciences. The extent to which increasing gender diversity among research teams, particularly, study principal investigators, could address this inequity is unclear.

Objective  To assess the association between principal investigator gender and the proportion of women participants in clinical trials.

Design, Setting, and Participants  This cross-sectional analysis used clinical trials registered on ClinicalTrials.gov that started enrollment after January 1, 2007, and completed enrollment before September 1, 2021, to analyze how the proportion of women participants in clinical trials varied by principal investigator gender, accounting for the disease being studied and when a trial was conducted (analyses were performed in October 2024). In an analysis of mechanisms, this study assessed whether specific decisions by investigators that could influence enrollment of women (eg, selecting women as study staff or including pregnant patients) varied by principal investigator gender.

Exposure  Principal investigator gender.

Main Outcomes and Measures  Proportion of trial participants who are women.

Results  Across 10 708 trials, 3151 (29.2%) had a woman principal investigator. After adjusting for potential confounders, mean enrollment of women in trials with a woman principal investigator was 54.1% (95% CI, 53.0%-55.1%) compared with 46.9% (95% CI, 46.3%-47.5%) for trials in which the principal investigator was a man (absolute adjusted difference, 7.3% [95% CI, 6.7%-7.9%]; P < .001). Secondary analyses found that trials with a woman principal investigator had a higher proportion of women staff and were less likely to exclude pregnant patients.

Conclusions and Relevance  This cross-sectional study of a large sample of clinical trials found that those with a woman principal investigator enrolled a higher proportion of women participants, had a higher proportion of women study staff, and were less likely to exclude pregnant patients. These results suggest that inequity in clinical trial enrollment, particularly the underenrollment of women, is an ongoing concern in biomedical sciences.

Abstract: Introduction At-home stool tests are an increasingly popular practice for colorectal cancer screening, especially when access to healthcare facilities is challenging. However, there is limited information about whether stool tests provide sufficient coverage when patients must undergo repeat testing. This study evaluates repeat preventative stool tests over 2 year periods in a healthcare system with 51 hospitals and over 1000 clinics across seven western US states, before and after the onset of the COVID-19 pandemic.Methods We conduct a real-world, observational, retrospective and longitudinal study based on electronic medical records. We measure the rate of repeat screening and mean delay in repeat screening among patients who receive an initial stool test. We estimate the changes in the likelihood of colorectal cancer screening using a Cox proportional hazard model. Results Our sample included 4 03 085 patients. The share of patients with an initial negative stool test who received a repeat screening ranged from 38% to 49% across different years. Among patients who received a repeat screening, there is a delay of 3 months on average. The volume of stool tests increased during the pandemic: the HR of screening after the onset of the pandemic to that before the pandemic was 1.18 (95% CI (1.15, 1.20), p<0.001). Conclusions Our findings show that less than 50% of patients received a repeat stool test, creating gaps in their screening coverage. The increase in stool tests during the pandemic is partly due to a substitution away from colonoscopies, underscoring the increasing importance of stool tests in CRC screening. Programmes that aim to increase CRC screening uptake should focus on repeated testing after an initial screening.

Learning from your Past: A Study of Long-term Patent Litigation

 UCLA Undergraduate Dissertation 2019