Drug quality and global trade
Amir Attaran, Roger Bate, Ginger Zhe Jin, Aparna Mathur 09 October 2014
There is a perception amongst pharmaceutical experts that some Indian manufacturers and/or their distributors segment the global medicine market into portions that are served by different quality medicines. This column finds that drug quality is poorer among Indian-labelled drugs purchased inside African countries than among those purchased inside India or middle-income countries. Substandard drugs – non-registered in Africa and containing insufficient amounts of the active ingredient – are the biggest driver of this quality difference.
Data from the Pharmaceutical Security Institute indicate that poor-quality medicines were found in 124 countries in 2011, with the problem more severe in low- and mid-income countries than in developed countries (IOM 2013). While much attention has been focused on intellectual property rights protection (notably issues surrounding the WTO’s TRIPS1 agreement), poor-quality samples were more prevalent in cheap, generic drugs than in expensive, innovator-branded drugs when we tested drug samples from 18 low-to-mid-income countries (Bate et al. 2011).
Health economics International trade
pharmaceuticals, drugs, medicine, health, trade, drug quality, India, Africa, counterfeiting, regulation, market segmentation
The value of variation in clinical practice under uncertainty
Charles F Manski 01 October 2014
Clinical practice guidelines recommend treating all patients with similar attributes the same way. This column argues that, under conditions of uncertainty or ambiguity, this may be bad advice. Treating similar patients differently provides two benefits. The first is diversification – assigning similar patients to different treatments limits the consequences of choosing an inappropriate treatment. The second benefit is that randomly assigning treatments helps clinicians learn which ones are most effective.
Commentators on delivery of healthcare regularly decry ‘unwarranted’ or ‘inappropriate’ variation in clinical practice and recommend uniform treatment of observationally similar patients. This recommendation, often expressed in clinical practice guidelines, is well-motivated if knowledge of treatment response is strong enough to determine optimal treatments. However, much patient care is delivered with substantial uncertainty.
health, healthcare, medicine, treatment, uncertainty, ambiguity, regret, diversification, learning
Does grief transfer across generations? In-utero deaths and child outcomes
Sandra E. Black, Paul Devereux, Kjell G. Salvanes 20 August 2014
Adverse health or nutrition shocks to pregnant women can have significant and often long-lasting effects on the outcomes of their children, but much less is known about the effects of psychological stresses. This column discusses recent research on the effect of stress induced by the death of a parent while pregnant on the short- and long-run outcomes of children in Norway. Maternal bereavement has small but statistically significant adverse effects on birth outcomes – especially for boys – but there is no evidence of any long-run adverse effects.
What is the effect of stress while pregnant on the health of the baby? This is a question faced by all women – both in developed and developing countries. Indeed, in developed countries, stress may be more prevalent than many physical stressors such as nutritional deficiencies. Despite the pervasiveness of stress in modern society, particularly during pregnancy, we have a very limited understanding of the effect on children’s health when they are born, and whether there are any long-term negative effects in terms of cognitive development and on labour market outcomes.
health, pregnancy, stress, grief, bereavement
Do trans-fat bans save lives?
Brandon Restrepo, Matthias Rieger 16 July 2014
Artificial trans fat is omnipresent in the global food chain, but the medical consensus is that it increases the risk of developing cardiovascular diseases such as heart disease and stroke. Between 2007 and 2011, New York City and six other county health departments implemented bans on trans fat in restaurants. This column presents the first evaluation of the effect of these bans on cardiovascular disease mortality rates.
The use of artificial trans fat or partially hydrogenated oil – which is industrially produced by adding hydrogen gas to liquid vegetable oil – is widespread across the world’s food production chains and service industries. Aside from the fact that it has the same caloric value as any other fat, there are no known health benefits to consuming artificial trans fat. The food industry prefers using trans-fat-containing oils to healthier oils because it is cheap, it increases the shelf life of food products, it promotes flavour stability, and it improves the texture of food.
health, food, diet, trans fat, New York, cardiovascular disease, restaurants
Trust-based working time spurs innovation
Holger Görg, Olivier N. Godart, Aoife Hanley, Christiane Krieger-Boden 08 July 2014
Many firms are replacing traditional working hours with more flexible arrangements, reflecting new thinking on employee motivation. This column presents evidence from Germany that trust-based working time is associated with increased innovation. However, trust-based working hours also contribute to the blurring of workers’ professional and private lives, and may lead to excessive overtime. Careful design of trust-based working arrangements is required to reap the innovations gains while avoiding the health pitfalls.
The organisation of work has changed dramatically over the last few decades. In particular, the formerly rigidly regulated working time has been replaced by flexible working hour schemes in numerous firms around the world. Taking Germany as an example, in 2010, 36% of employees were entitled to some form of flexible working hours scheme (Figure 1).
Health economics Labour markets Productivity and Innovation
Germany, working hours, trust, health, innovation, motivation, overtime, flexibility, working time
Determinants of generic medicine adoption
Joan Costa-i-Font, Alistair McGuire, Nebibe Varol 10 May 2014
Generic medicines are cheaper than their branded counterparts, offering potential savings in healthcare budgets. Medicine-price regulation plays an important role in the expansion of the market for generic medicines. This column presents new evidence that higher levels of price regulation, by lowering the expected price to generic manufacturers, lead (ceteris paribus) to greater delays in generic entry.
With healthcare budgets around the world under pressure, switching to generics seems a natural cost saver. Generic drugs are cheaper alternatives to branded medicines, offering an obvious source of efficiency gains to any health system.
Competition policy Health economics
competition, pharmaceuticals, health, regulation, healthcare, drugs, medicine, generics
The great escape from death and deprivation
Angus Deaton 20 March 2014
The world has become healthier and wealthier since 1960, as measured by life expectancy and GDP per capita. In this column Angus Deaton introduces his new book and argues that the world is indeed a better place than it used to be, albeit with big setbacks, and that progress opens up vast inequalities.
Nearly 40 years ago, the demographer Samuel Preston (1975) wrote about changing patterns of life expectancy and income around the world. That paper set the agenda for thinking about global health and global wealth. Its key figure remains useful for describing past and current progress in health and wealth – where we have been and where we are going – as well as for looking at the great health catastrophes of the second half of the twentieth century.
Development Politics and economics
wealth, health, inequalities
Health insurance, innovation, and technology adoption
Joan Costa-i-Font, Alistair McGuire, Victoria Serra-Sastre 19 January 2013
Although healthcare innovation can make treatment cheaper, it can also make policy decisions more difficult by introducing new, better but more expensive technologies. This column argues that, unlike other technologies, healthcare technology is intermediated by insurance mechanisms, both private and public. Although health insurance coverage incentivises expenditure on innovation, it does not seem to heighten technology adoption, a challenge to the idea that innovation increases healthcare costs. Indeed, evidence suggests that technology diffusion is limited by other institutional barriers.
With government budgets under pressure in mature economies, burgeoning healthcare expenditures are under scrutiny. In this light, healthcare innovation can either help by developing new cheaper treatments or make healthcare policy decisions more difficult by introducing new, better but more expensive technologies.
health, technology, research and development
Free to choose?
Marty Gaynor, Carol Propper, Stephan Seiler 13 January 2013
Greater choice and competition in healthcare is a popular reform model. This column discusses recent research suggesting that once restrictions on choice in the UK’s NHS were lifted, patients receiving cardiac surgery became more responsive to the quality of their care. This saved lives and gave hospitals a greater incentive to improve quality.
A central plank of the NHS reforms implemented by the UK Labour government of the 2000s was the introduction of patient choice. For the first time in the history of the NHS it was mandated that patients should have a say in the choice of hospital when being referred for an elective treatment. Rather than relying entirely on their general practitioner (GP), patients were now offered a set of five hospitals to choose from.
health, NHS, patient choice
Lasting effects of childhood health in developing countries
Janet Currie, Tom Vogl 15 November 2012
The global decline in ill health has not been met with greater prosperity. What are we to make of healthier and larger populations undercutting per capita economic progress? This column argues that early-life health changes do, in fact, have a huge effect on economic outcomes over the lifecycle. However, the jury is out on how we can best manage – and measure – the apparent play off between better health, higher populations, and poorer per capita economic outcomes.
Longstanding arguments that ill health impedes economic development hit a snag when evidence emerged that the global decline of infectious disease in the mid-20th century did not bring prosperity to the world’s unhealthiest countries (Acemoglu and Johnson 2007).
health, Height, childhood, birth weight