Medical R&D differs from other R&D because of a unique linkage between output and input m... more Medical R&D differs from other R&D because of a unique linkage between output and input markets: potential consumers of existing medical products are also potential subjects in clinical trials required to develop new products. Therefore, a quality increase or price reduction for an existing treatment reduces patients’ incentive to participate in trials of new treatments. We label this linkage the “subject supply effect” and provide evidence of it from trials of hepatitis C and AIDS treatments. The subject supply effect has important positive implications for how policies affect the rate of medical R&D and normative implications for whether subjects ought to be compensated for enrolling in clinical trials.
Although the vast majority of confirmed cases of COVID-19 are in low- and middle-income countries... more Although the vast majority of confirmed cases of COVID-19 are in low- and middle-income countries, there are relatively few published studies on the epidemiology of SARS-CoV-2 in these countries. The few there are focus on disease prevalence in urban areas. We conducted state-wide surveillance for COVID-19, in both rural and urban areas of Karnataka between June 15-August 29, 2020. We tested for both viral RNA and antibodies targeting the receptor binding domain (RBD). Adjusted seroprevalence across Karnataka was 46.7% (95% CI: 43.3-50.0), including 44.1% (95% CI: 40.0-48.2) in rural and 53.8% (95% CI: 48.4-59.2) in urban areas. The proportion of those testing positive on RT-PCR, ranged from 1.5 to 7.7% in rural areas and 4.0 to 10.5% in urban areas, suggesting a rapidly growing epidemic. The relatively high prevalence in rural areas is consistent with the higher level of mobility measured in rural areas, perhaps because of agricultural activity. Overall seroprevalence in the state implies that by August at least 31.5 million residents had been infected by August, nearly an order of magnitude larger than confirmed cases.Â
In many species, individuals who experience harsh conditions during development often have poor h... more In many species, individuals who experience harsh conditions during development often have poor health and fitness outcomes in adulthood relative to peers who do not. There are two classes of evolutionary hypotheses for the origins of these early life contributors to inequality in adulthood: developmental constraints (DC) models, which focus on the deleterious effects of low-quality early-life environments, and predictive adaptive response (PAR) hypotheses, which emphasize the cost of mismatches between early and adult environments. Distinguishing DC and PAR models empirically is difficult for both conceptual and analytical reasons. Here, we resolve this difficulty by providing explicit mathematical definitions for DC, PARs, and related concepts, and propose a novel, quadratic regression-based statistical test derived from these definitions. Simulations show that this approach improves the ability to discriminate between DC and PAR hypotheses relative to a common alternative based o...
Medical R&D differs from other R&D because of a unique linkage between output and input m... more Medical R&D differs from other R&D because of a unique linkage between output and input markets: potential consumers of existing medical products are also potential subjects in clinical trials required to develop new products. Therefore, a quality increase or price reduction for an existing treatment reduces patients’ incentive to participate in trials of new treatments. We label this linkage the “subject supply effect” and provide evidence of it from trials of hepatitis C and AIDS treatments. The subject supply effect has important positive implications for how policies affect the rate of medical R&D and normative implications for whether subjects ought to be compensated for enrolling in clinical trials.
Although the vast majority of confirmed cases of COVID-19 are in low- and middle-income countries... more Although the vast majority of confirmed cases of COVID-19 are in low- and middle-income countries, there are relatively few published studies on the epidemiology of SARS-CoV-2 in these countries. The few there are focus on disease prevalence in urban areas. We conducted state-wide surveillance for COVID-19, in both rural and urban areas of Karnataka between June 15-August 29, 2020. We tested for both viral RNA and antibodies targeting the receptor binding domain (RBD). Adjusted seroprevalence across Karnataka was 46.7% (95% CI: 43.3-50.0), including 44.1% (95% CI: 40.0-48.2) in rural and 53.8% (95% CI: 48.4-59.2) in urban areas. The proportion of those testing positive on RT-PCR, ranged from 1.5 to 7.7% in rural areas and 4.0 to 10.5% in urban areas, suggesting a rapidly growing epidemic. The relatively high prevalence in rural areas is consistent with the higher level of mobility measured in rural areas, perhaps because of agricultural activity. Overall seroprevalence in the state implies that by August at least 31.5 million residents had been infected by August, nearly an order of magnitude larger than confirmed cases.Â
In many species, individuals who experience harsh conditions during development often have poor h... more In many species, individuals who experience harsh conditions during development often have poor health and fitness outcomes in adulthood relative to peers who do not. There are two classes of evolutionary hypotheses for the origins of these early life contributors to inequality in adulthood: developmental constraints (DC) models, which focus on the deleterious effects of low-quality early-life environments, and predictive adaptive response (PAR) hypotheses, which emphasize the cost of mismatches between early and adult environments. Distinguishing DC and PAR models empirically is difficult for both conceptual and analytical reasons. Here, we resolve this difficulty by providing explicit mathematical definitions for DC, PARs, and related concepts, and propose a novel, quadratic regression-based statistical test derived from these definitions. Simulations show that this approach improves the ability to discriminate between DC and PAR hypotheses relative to a common alternative based o...
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Papers by Anup Malani