Funding of Clinical Trials and Reported Drug Efficacy, second round revise and resubmit, Journal of Political Economy
Abstract: This paper estimates the effect of financial sponsorship of clinical trials on reported drug efficacy, leveraging the insight that the exact same sets of drugs are often compared in different trials conducted by parties with different financial interests. I assemble new psychiatric trial data to estimate that a drug appears substantially more effective when the trial is sponsored by that drug's manufacturer, compared with the same drug in a trial with the same combination of drugs but without sponsorship. This difference is not explained by observable characteristics, but publication bias is important. Pre-registration may be effective in overcoming this bias.
Abstract: In recent decades, death rates from poisonings, suicides, and alcoholic liver disease have dramatically increased in the United States. We show that these “deaths of despair” began to increase relative to trend in the early 1990s, that this increase was preceded by a decline in religious participation, and that both trends were driven by middle-aged white Americans. Using repeals of blue laws as an exogenous shock to religiosity, we confirm that religious practice has significant effects on these mortality rates. Our findings show that social factors such as organized religion can play an important role in understanding deaths of despair.
Selected Work in Progress
Representation in Product Development: Evidence from Insurance and Clinical Trials (with Jennifer Kao)
We investigate the causes and consequences of demographic disparities within product development. We focus on how insurance coverage policies affect elderly enrollment in clinical trials. Beginning in 2000, Medicare expanded coverage for the routine costs of enrolling in clinical trials. We find that this policy shifts the rate and direction of clinical research: there is a significant increase in the number of clinical trials targeting diseases common among the elderly population, relative to diseases common among the non-elderly. In examining mechanisms, we document that pharmaceutical firms modify enrollment criteria to include more elderly participants. Changes in representation during the product development process lead to shifts in product adoption: after the Medicare policy, drug utilization among the elderly increases in elderly diseases.
Abstract: We analyze selection into screening in the context of recommendations that breast cancer screening start at age 40. Combining medical claims with a clinical oncology model, we document that compliers with the recommendation are less likely to have cancer than younger women who select into screening or women who never screen. We show this selection is quantitatively important: shifting the recommendation from age 40 to 45 results in three times as many deaths if compliers were randomly selected than under the estimated patterns of selection. The results highlight the importance of considering characteristics of compliers when making and designing recommendations.
Outpatient Wait Times and Quality of Care for Medicaid Patients (with Amy Finkelstein and Liran Einav), Health Affairs, 36(5), May 2017: 826-832.
Abstract: The time patients spend in a doctor’s waiting room prior to a scheduled appointment is an important component of the quality of the overall health care experience. We analyzed data on twenty-one million outpatient visits obtained from electronic health record systems, which allowed us to measure time spent in the waiting room beyond the scheduled appointment time. Median wait time was a little more than four minutes. Almost one-fifth of visits had waits longer than twenty minutes, and 10 percent were more than thirty minutes. Waits were shorter for early-morning appointments, for younger patients, and at larger practices. Median wait time was 4.1 minutes for privately insured patients and 4.6 minutes for Medicaid patients. After adjustment for patient and appointment characteristics, Medicaid patients were 20 percent more likely than the privately insured patients to wait longer than twenty minutes, with most of this disparity explained by differences in practices and providers they saw. Wait times for Medicaid patients relative to privately insured patients were longer in states with relatively lower Medicaid reimbursement rates. The study complements other work that suggests that Medicaid patients face some additional barriers in the receipt of care.