Association Between Drug Characteristics and Manufacturer Spending on Direct-to-Consumer Advertising

Is society caught up in a Death Spiral? Modeling societal demise and its reversal

Just like an army of ants caught in an ant mill, individuals, groups and even whole societies are sometimes caught up in a Death Spiral, a vicious cycle of self-reinforcing dysfunctional behavior characterized by continuous flawed decision making, myopic single-minded focus on one (set of) solution(s), denial, distrust, micromanagement, dogmatic thinking and learned helplessness. We propose the term Death Spiral Effect to describe this difficult-to-break downward spiral of societal decline. Specifically, in the current theory-building review we aim to: (a) more clearly define and describe the Death Spiral Effect; (b) model the downward spiral of societal decline as well as an upward spiral; (c) describe how and why individuals, groups and even society at large might be caught up in a Death Spiral; and (d) offer a positive way forward in terms of evidence-based solutions to escape the Death Spiral Effect. Management theory hints on the occurrence of this phenomenon and offers turn-around leadership as solution. On a societal level strengthening of democracy may be important. Prior research indicates that historically, two key factors trigger this type of societal decline: rising inequalities creating an upper layer of elites and a lower layer of masses; and dwindling (access to) resources. Historical key markers of societal decline are a steep increase in inequalities, government overreach, over-integration (interdependencies in networks) and a rapidly decreasing trust in institutions and resulting collapse of legitimacy. Important issues that we aim to shed light on are the behavioral underpinnings of decline, as well as the question if and how societal decline can be reversed. We explore the extension of these theories from the company/organization level to the society level, and make use of insights from both micro-, meso-, and macro-level theories (e.g., Complex Adaptive Systems and collapsology, the study of the risks of collapse of industrial civilization) to explain this process of societal demise. Our review furthermore draws on theories such as Social Safety Theory, Conservation of Resources Theory, and management theories that describe the decline and fall of groups, companies and societies, as well as offer ways to reverse this trend.

Relationship between cognitive function and weight-adjusted waist index in people ≥ 60 years old in NHANES 2011-2014

BACKGROUND

Widespread attention has been given to the detrimental effects of obesity on cognitive function. However, there is no evidence on the connection between low cognitive performance and the WWI (weight-adjusted waist index). This study looked into the connection between poor cognitive performance and the WWI in senior Americans.

METHODS

A cross-sectional research study was carried out with information from the NHANES 2011-2014. With multivariate linear regression models, the pertinence between the WWI and low cognitive function in persons older than 60 years was examined. The nonlinear link was described using threshold effect analyses and fitted smoothed curves. Interaction tests and subgroup analysis were also conducted.

RESULTS

The study had 2762 individuals in all, and subjects with higher WWI values were at greater risk for low cognitive function. In the completely adjusted model, the WWI was positively connected with low cognitive performance assessed by CERAD W-L (OR = 1.22, 95% CI 1.03-1.45, p = 0.0239), AFT (OR = 1.30, 95% CI 1.09-1.54, p = 0.0029), and DSST (OR = 1.59, 95% CI 1.30-1.94, p < 0.0001). The effect of each subgroup on the positive correlation between the WWI and low cognitive performance was not significant. The WWI and low cognitive performance as determined by CERAD W-L and AFT had a nonlinear connection (log-likelihood ratio < 0.05).

CONCLUSION

Among older adults in the United States, the risk of low cognitive performance may be positively related to the WWI.

Estimated Savings From Using Added Therapeutic Benefit and Therapeutic Reference Pricing in United States Medicare Drug Price Negotiations

OBJECTIVES

US Medicare will begin negotiating prices for top-selling drugs in 2023. This study describes and estimates potential savings from a therapeutic reference pricing approach, linking comparative effectiveness with the costs of existing therapeutic alternatives, that Medicare could use to adjust the starting point for price negotiations.

METHODS

First, we identified target drugs likely to be selected for Medicare negotiation. Second, we identified comparative effectiveness ratings for target drugs based on French Haute Autorité de Santé reports. For target drugs with minor or no added benefit, we identified therapeutic alternatives based on the French reports and US clinical guidelines. For each target drug with minor or no added benefit, we computed the difference between spending based on the drug's estimated statutory ceiling price and spending based on the weighted average cost of therapeutic alternatives or the lowest cost therapeutic alternative. Finally, we calculated potential annual savings from using a starting point in negotiations based on costs of therapeutic alternatives.

RESULTS

Potential drug-level savings to Medicare from using a starting point in negotiations based on average spending across therapeutic alternatives, compared with using the statutory ceiling price alone, ranged from $186 541 340 to $2 173 441 197. Potential savings from using a starting point based on the lowest cost alternative ranged from $199 872 163 to $3 605 904 765.

CONCLUSIONS

Although we do not expect Medicare to rely on French comparative effectiveness assessments, this study demonstrates the potential for additional savings when using comparative effectiveness and costs of therapeutic alternatives to inform the starting price for negotiations.