Frank Knight and pragmatism∗

Abstract

One of many controversies surrounding the work of Frank Knight involves the question of whether, or to what degree, his ideas were consistent with those of American pragmatism. Substantive textual evidence can be found to support almost any simple answer to the question. This paper argues that while Knight was quite (often aggressively) opposed to a particular set of pragmatic ideas alive in the scholarly and social debates of his day, this fact says more about Knight's historical context than it does about the broader relationship between his philosophical position and pragmatism. Knight was opposed to the social control pragmatism of his day, but at the same time his general philosophical position has much in common with the features of the pragmatic tradition that are most emphasized in the recent philosophical literature.     

Electricity Tariff Changes and Consumer Sentiment on Household Consumption Expenditure in Malaysia

Purpose

This study investigates the impact of the current electricity tariff, represented by optimized tariff calculation, on Malaysian household’s consumption across different levels of income.

Design/methodology/approach

The input-output (IO) model has vastly been used in many energy economics literature that presented the matrix of production between various sectors in an economy. This study aggregated the 124 subsectors in IO Price Table 2015 into 12 groups of consumption of goods and services based on Household Expenditure Survey 2019 (HES 2019) to meet the study’ objectives.

Findings

This study found that in all simulations, high-income earners would be highly affected by the tariff changes. The lower the increment level in electricity tariff rate, the lower the magnitude would be on the changes of household expenditure level.

Research limitations/implications

Optimization in electricity tariff consumptions can pattern the Malaysian household’s consumption across different levels of income efficiently.

Practical implications

Useful to all consumer in the Malaysia economic business sector to predict their energy consumption up to optimum level.

Social implications

The study’s findings can benefit the society in optimiza their electricity consumption since everyone requires the energy for basic needs in their life.

     

A cost-utility study of the use of pregabalin added to usual care in refractory neuropathic pain patients in a Swedish setting

Abstract

Objectives:

Patients refractory to older therapies for neuropathic pain (NeP) have few remaining therapeutic options. This study evaluates the cost-utility of pregabalin in the treatment of patients with refractory neuropathic pain in Sweden, from a healthcare and a societal perspective.

Study limitations:

The use of non-randomized (observational) data to determine the effectiveness of treatments for NeP. The use of non-Swedish data for some input parameters in the model.

Methods:

A previously constructed discrete event simulation model was adapted to compare pregabalin combined with usual care to usual care alone in a Swedish setting. Pain profiles were generated using clinical data from five non-randomized pregabalin studies in refractory NeP patients. Utility data were generated from a UK survey of patients with NeP. Cost data were generated from the Swedish Dental and Pharmaceutical Benefits Board (TLV’s) product price database, a national NeP register, and a regional registry study. Indirect costs were estimated from published sources. One-way and probabilistic sensitivity analyses evaluated uncertainty in the model’s output.

Results:

The incremental cost-effectiveness ratio (ICER) for pregabalin plus usual care treatment compared to usual care was 51,616 SEK/€5364 and 123,993 SEK/€12,886 with and without indirect costs, respectively. One-way sensitivity analyses confirmed the clinical input data as the main driver of the model; even considerable changes to all other input parameters had only a modest effect on the ICER. The ICER remained well below a conservative threshold of 347,495 SEK /€36,113/£30,000 in all scenarios modelled.

Conclusions:

This study found pregabalin combined with usual care to be cost-effective compared to usual care in patients with refractory NeP from a Swedish Health Care perspective. Moreover, sensitivity analysis showed pregabalin’s cost-effectiveness to be robust in all scenarios modelled.     

Prevalence and impact of constipation and bowel dysfunction induced by strong opioids: a cross-sectional survey of 520 patients with cancer pain: DYONISOS study

Abstract

Objective:

To describe the prevalence of opioid-induced constipation (OIC) in patients with cancer pain according to the Knowles-Eccersley-Scott symptom score (KESS), the different symptoms of opioid-induced bowel dysfunction (OIBD), and to assess the impact of OIBD on patient’s quality-of-life.

Methods:

A cross-sectional observational study, using the KESS questionnaire and the physician’s subjective assessment of constipation, and other questionnaires and questions on constipation, OIBD, and quality-of-life, carried out on 1 day at oncology day centres and hospitals.

Results:

Five hundred and twenty patients were enrolled at 77 centres in France; 61.7% of patients (n?=?321) showed a degree of constipation that is problematic for the patient according to KESS (between 9–39). Even more patients, 85.7% (n?=?438), were considered constipated according to the physician’s subjective assessment—despite laxative use (84.7% of patients). Quality-of-life was significantly reduced in constipated vs non-constipated patients for both PAC-QoL (p?<?0.0001 for total score and each dimension) and the SF-12 questionnaires (statistically significant for all dimensions except physical state and role physical). OIC and OIBD led to hospitalization (16% of patients), pain (75% of patients), and frequent changes in opioid and laxative treatment.

Key limitations:

This cross-sectional study, in a selected population of cancer patients, has measured prevalence and impact of OIBD. Further confirmation could be sought through the use of longitudinal studies, and larger populations, such as non-cancer pain patients treated with opioids

Conclusions:

Cancer patients taking opioids for pain are very frequently constipated, even if they are prescribed laxatives. This leads to relevant impairments of quality-of-life.     

Rule-based frameworks in historical perspective: Keynes’ and Friedman's monetary policies versus contemporary policy-rules

Abstract

This note suggests that Fazio's re-interpretation of Ferrara's discussion of distribution as a bilateral monopoly is incorrect. A more natural formalization of the work by Ferrara is proposed.     

Don Patinkin and the origins of postwar monetary orthodoxy

Don Patinkin's Money, Interest, and Prices (1956) set the ground rules of postwar monetary discourse, for better or worse. A close look at the intellectual origins of the book in Patinkin's own life shows it to emerge equally from the Old Chicago School of Simons/Mints/Knight and the Cowles Commission of Lange/Marschak/Haavelmo. Patinkin's conception of money as essentially an outside asset is argued to emerge from the historical context of war finance, and is contrasted with the Gurley-Shaw conception of money as a form of inside credit.     

Intertemporal substitution in import demand and the role of habit formation: an application of Euler equation approach for Pakistan

Introduction

The study examines the importance of intertemporal substitution in import demand considering the role of habit formation. A two-goods version of the permanent income model is used in which time-non-separability in consumers’s preferences is assumed. The model is estimated using annual data for Pakistan at disaggregated level covering the period from 1977 to 2017.

Objectives

The objective of the study is to estimate elasticities of substitution along with parameters of habit formation for consumption goods at a disaggregated level.

Method

The study employs co-integration for the estimation of parameters of elasticities of substitution and generalized method of moments (GMM) for the estimation of the parameters of habit formation from Euler equations.

Findings

The estimates of intertempral elasticity of substitution suggest that the nature of commodity group (necessity/luxury) plays an important role when consumers are making intertemporal choices. Moreover, the study finds that intratemporal elasticity of substitution is larger than intertempral elasticity of substitution in almost all cases in Pakistan, suggesting that imported and domestic goods are best described as substitutes in Edgeworth-Pareto sense. In addition, the inclusion of habit formation delivers results with plausible signs and the habit formation process seems significant for certain commodity groups including tea, beverages, tobacco products and drugs.

Conclusion

The study concludes that there is a possibility of crowding out effect on domestic consumption and the depreciation of local currency may improve Pakistan’s balance of trade.

     

Recovery outcomes of schizophrenia patients treated with paliperidone palmitate in a community setting: patient and provider perspectives on recovery

Objectives:

This study evaluated the effect of paliperidone palmitate long-acting injectable (LAI) antipsychotic on recovery-oriented mental health outcomes from the perspective of healthcare providers and patients during the treatment of patients with schizophrenia or schizoaffective disorders.

Methods:

Archival data for patients with a primary diagnosis of schizophrenia or schizoaffective disorder receiving ≥6 months of paliperidone palmitate LAI were retrieved from the electronic medical records system at the Mental Health Center of Denver. Mental health recovery was assessed from both a provider’s (Recovery Markers Inventory [RMI]) and patient’s (Consumer Recovery Measure [CRM]) perspective. A three-level hierarchical linear model (HLM) was utilized to determine changes in CRM and RMI scores by including independent variables in the models: intercept, months from treatment (slope), treatment time period (pretreatment and treatment), age, gender, primary diagnosis, substance abuse diagnosis, concurrent medications, and adherence to paliperidone palmitate LAI.

Results:

A total of 219 patients were identified and included in the study. Results of the final three-level HLMs indicated an overall increase in CRM scores (p?<?0.05), an overall increase (p?<?0.01), and an increased rate of change (p?<?0.05) in RMI scores during the paliperidone palmitate LAI treatment period vs the pre-treatment period.

Limitations:

This study contained a retrospective, non-comparative design, and did not adjust for multiplicity

Conclusions:

The current study demonstrates that changes in recovery-oriented mental health outcomes can be detected following the administration of a specific antipsychotic treatment in persons with schizophrenia or schizoaffective disorders. Furthermore, patients receiving paliperidone palmitate LAI can effectively improve recovery-oriented outcomes, thereby supporting the drug’s use as schizophrenia treatment from a recovery-oriented perspective.     

On Stephen Parsons' Philosophical Critique of Transcendental Realism

This paper replies to Stephen Parsons' critique of Tony Lawson's Economics and Reality recently published in this journal. The topics addressed include Lawson's critique of empirical realism; Lawson's definition of 'structures'; theories of truth; the relationship between mainstream economics and empirical realism; and the possibility of naturalism .     

Alfred Marshall's use of Adam Smith: Coming to grips with an aspect of Alfred Marshall's citation practice

Abstract

This paper outlines Marshall's use of Smith's writings in his own published work as an aspect of Marshall's citation practice and to demonstrate Marshall's great admiration for Smith as economist. Section 2 reviews the Smith citations in Marshall's Principles of Economics', section 3 those in Marshall's other published work. The conclusion notes that this citation practice matches Marshall's great admiration Smith the economist, because of Smith's great ability to blend fact and theory, for drawing measured conclusions and, above all, for constructing useful arguments in a field of imprecise knowledge.     

Competition policy vs. industrial policy as a growth strategy

ABSTRACT

This paper shows that competition policy, rather than industrial policy, generated the rapid economic growth in post-war Japan. It also reveals that Japan’s growth rate was lowered from the mid-1970s due to newly introduced industrial policies and paucity of further competition policy. The current Abe government recognises the need for competition policies in Japan to recover from the low-growth period. The paper describes the types of competition policy carried out under Abenomics, especially in National Strategic Special Zones.Abbreviations: METI: Ministry of Economy, Trade, and Industry NSSZ: National Strategic Special Zones     

The impact of Fisher's Purchasing Power of Money in the German Language Area

Abstract

The paper focuses on the reception of Fisher's Purchasing Power of Money in the German language area. Despite widespread hostility of German economists to quantity theory, it was Germany where Wicksell's Interest and Prices was published in 1898, and the first foreign language translation of Fisher's book appeared in 1916. The hyperinflation in the early 1920s contributed to a greater interest in Fisher's approach. Among those economists who took the equation of exchange not only as a heuristic device, but also made some notable contributions themselves were Schumpeter, Marschak and Neisser.     

Three macroeconomic syntheses of vintage 1937: Hicks,Haberler, and Lundberg

Abstract

The 1920s and 1930s were years of intensive debate about economic dynamics and stabilisation policies. There was a large variety of explanations of cycles and depressions, and Keynes’ General Theory of Employment, Interest and Money (1936) was pitched against them. In 1937, followed three different attempts to provide synthetic expositions of macroeconomic theory that would deal with the Keynesian challenge: Hicks’ Mr. Keynes and the “Classics”, Haberler's Prosperity and Depression, and Lundberg's Studies in the Theory of Economic Expansion. This paper compares those 1937 syntheses and contrasts them with the “Neoclassical Synthesis” and the current “New Neoclassical Synthesis”.     

Original Research A modified method for estimating volume–outcome relationships: application to percutaneous coronary intervention

Objective: The objective of the current study was to propose an alternative method for measuring individual operator and peer volumes to use as predictors for adverse outcomes.

Study design: A retrospective analysis was performed to assess the volume–outcome relationship for percutaneous coronary intervention (PCI) performed in New York State between 1996 and 1999. This relationship was calculated using a modified method whereby physician volume was calculated using the previous year's volume, and hospital volume was calculated after subtracting the operator of interest's annual volume from the total. The primary outcome of interest was in-hospital mortality.

Results: Using the modified method, the odds ratio (OR) of in-hospital mortality was 0.74 (95% confidence interval (CI) 0.55–0.99; p=0.04) for cardiologists who performed 75–174 procedures annually and 0.80 (95% CI 0.61–1.04; p=0.1) for cardiologists who performed ≥175 procedures annually compared with the lowest-volume operators. With the conventional approach to volume measurement, no relationship between cardiologist volume and mortality was found. Patients who underwent PCI in hospitals where their physician's peers had an annual volume of 600–999 or ≥1,000 cases had a significantly reduced odds of mortality (OR = 0.73; 95% CI 0.57–0.92; p=0.01; and OR = 0.77; 95% CI 0.62–0.95; p=0.01) compared with patients treated by physicians with an annual peer volume of <600 cases. The conventional method did not detect any significant correlation between hospital volume and in-hospital mortality.

Conclusion: The alternative approach to measuring cardiologist and peer volumes proposed in this study leads to more precise estimates of volume–outcome relationships than the conventional approach.     

Burden of menstrual symptoms in Japanese women: results from a survey-based study

Abstract

Objective:

Menstrual symptoms are associated with various health problems in women and may also significantly impact their lives. This study aims to assess the current burden of menstrual symptoms in Japanese women.

Methods:

Two online surveys were conducted among women aged 15–49 years, where sampling was designed to approximate the age and geographic distribution in Japan. The first survey collected data on menstrual symptom severity based on a modified, 35-item, Japanese version of the Menstrual Distress Questionnaire (mMDQ), current treatments, and impact on work productivity. The second survey collected costs of outpatient treatment within the previous 3 months. Additional outcomes of the second survey will be presented in a separate paper.

Results:

In this study, 19,254 women had menses, with 74% suffering from menstrual symptoms. A total of 50% reported pain and 19% reported heavy bleeding. Increasing severity of menstrual symptoms and self-reported heavy bleeding were related to more outpatient visits and greater work productivity loss. Among subjects with heavy bleeding, increasing severity of symptoms was related to greater interference with daily life. The estimated annual economic burden extrapolated to the Japanese female population was 683 billion Japanese Yen (JPY) or ～8.6 billion United States Dollars (USD).

Limitations:

The study population may be biased due to the online survey method.

Conclusions:

To the authors’ knowledge, this is the first large-scale research assessing outcomes by severity categories for all menstrual symptoms and women’s perception of bleeding. A large proportion of women suffer from menstrual symptoms, and symptom severity impacts women’s lives. Menstrual symptoms lead to significant economic burden, mainly due to work productivity loss. However, the majority of women do not visit a gynecologist, even when their menstrual symptoms are severe. Thus, increasing public awareness on the recently available medical treatments has the potential to improve the overall burden of menstrual problems.     

Historical clinical and economic consequences of anemia management in patients with end-stage renal disease on dialysis using erythropoietin stimulating agents versus routine blood transfusions: a retrospective cost-effectiveness analysis

Abstract

Objective:

To determine whether Medicare’s decision to cover routine administration of erythropoietin stimulating agents (ESAs) to treat anemia of end-stage renal disease (ESRD) has been a cost-effective policy relative to standard of care at the time.

Methods:

The authors used summary statistics from the actual cohort of ESRD patients receiving ESAs between 1995 and 2004 to create a simulated patient cohort, which was compared with a comparable simulated cohort assumed to rely solely on blood transfusions. Outcomes modeled from the Medicare perspective included estimated treatment costs, life-years gained, and quality-adjusted life-years (QALYs). Incremental cost-effectiveness ratio (ICER) was calculated relative to the hypothetical reference case of no ESA use in the transfusion cohort. Sensitivity of the results to model assumptions was tested using one-way and probabilistic sensitivity analyses.

Results:

Estimated total costs incurred by the ESRD population were $155.47B for the cohort receiving ESAs and $155.22B for the cohort receiving routine blood transfusions. Estimated QALYs were 2.56M and 2.29M, respectively, for the two groups. The ICER of ESAs compared to routine blood transfusions was estimated as $873 per QALY gained. The model was sensitive to a number of parameters according to one-way and probabilistic sensitivity analyses.

Limitations:

This model was counter-factual as the actual comparison group, whose anemia was managed via transfusion and iron supplements, rapidly disappeared following introduction of ESAs. In addition, a large number of model parameters were obtained from observational studies due to the lack of randomized trial evidence in the literature.

Conclusions:

This study indicates that Medicare’s coverage of ESAs appears to have been cost effective based on commonly accepted levels of willingness-to-pay. The ESRD population achieved substantial clinical benefit at a reasonable cost to society.     

Burden of Crohn’s disease in the United States: long-term healthcare and work-loss related costs

Abstract

Aims

To quantify the long-term direct and indirect costs among patients with Crohn’s disease (CD) and specific subgroups of these patients in the United States from the private payer’s perspective.     

Cost-effectiveness of continuous subcutaneous apomorphine in the treatment of Parkinson’s disease in the UK and Germany

Abstract

Background:

Parkinson’s disease (PD) is the second most common neurodegenerative disease, affecting ～5.2 million people worldwide. Continuous subcutaneous apomorphine (CSAI) represents an alternative treatment option for advanced PD with motor fluctuation. The purpose of this analysis was to estimate the cost-effectiveness of CSAI compared with Levodopa/carbidopa intestinal gel (LCIG), Deep-Brain-Stimulation (DBS) and Standard-of-care (SOC).

Methods:

A multi-country Markov-Model to simulate the long-term consequences, disease progression (Hoehn & Yahr stages 3–5, percentage of waking-time in the OFF-state), complications, and adverse events was developed. Monte-Carlo simulation accounted for uncertainty. Probabilities were derived from RCT and open-label studies. Costs were estimated from the UK and German healthcare provider’s perspective. QALYs, life-years (LYs), and costs were projected over a life-time horizon.

Results:

UK lifetime costs associated with CSAI amounts to £78,251.49 and generates 2.85 QALYs and 6.28 LYs (€104,500.08, 2.92 QALYs and 6.49 LYs for Germany). Costs associated with LCIG are £130,011.34, achieves 3.06 QALYs and 6.93 LYs (€175,004.43, 3.18 QALYs and 7.18 LYs for Germany). The incremental-cost per QALY gained (ICER) was £244,684.69 (€272,914.58). Costs for DBS are £87,730.22, associated with 2.75 QALYs and 6.38 LYs (€105,737.08, 2.85 QALYs and 6.61 LYs for Germany). CSAI dominates DBS. SOC associated UK costs are £76,793.49; 2.62 QALYs and 5.76 LYs were reached (€90,011.91, 2.73 QALYs and 6 LYs for Germany).

Conclusions:

From a health economic perspective, CSAI is a cost-effective therapy and could be seen as an alternative treatment to LCIG or DBS for patients with advanced PD.     

Modelling the lifetime economic consequences of glaucoma in France

Abstract

Objective: To estimate the lifetime economic consequences of glaucoma in France.

Methods: A Markov model estimated the average discounted outcome and cost of glaucoma treatment over a patient's lifetime. Clinical states were defined as first- to fourth-line drugs, no treatment, laser therapy, surgery, blindness and death. After each failure (always after the fourth-line drug) patients could receive either laser treatment or surgery followed by no treatment, or a new treatment. A societal perspective was adopted. Sensitivity analyses were performed.

Results: Discounted medical costs were €7,322 for ocular hypertension treatment (OHT) and €8,488 for a glaucoma patient. Social costs of OHT and glaucoma patients exceeded medical costs. First-line use of the most effective drug would reduce medical and social costs. Societal willingness to pay for the vision benefit would equal the medical costs. Treatment initiated with the most effective drug is a cost saving strategy.

Conclusions: Public health decisions in glaucoma treatment should take a broad economic view embracing the lifetime duration of the disease. There is still a place both within and outside the healthcare system for therapeutic innovations with important economic consequences that bring high added value to patients.     

Searching for New Jerusalems: P.H. Wicksteed’s “Jevonian” critique of Marx’s Capital

Abstract

In 1884, P.H. Wicksteed published a critique of the first volume of Marx’s Capital, the first detailed analytical encounter in English between Marx’s value theory and the new discourse of “marginalism”. In revisiting that episode, this article has three principal objectives. The first is to show how Wicksteed developed his understanding of political economy, as he moved from initially following Henry George’s Progress and Poverty. The second is to examine why Wicksteed’s defence of George necessitated criticizing the Marxist Social Democratic Federation. The third is to show that Wicksteed’s criticisms of Marx were simply incorrect.