Expediting the approval of vital medicines shows no additional safety risks

Amitabh Chandra

RECENT EVIDENCE suggests that the regulatory process for new drugs can be made more efficient without compromising safety. In a working paper, “Regulatory Incentives for Innovation: The FDA’s Breakthrough Therapy Designation,” researchers including Amitabh Chandra, the Ethel Zimmerman Wiener Professor of Public Policy, investigate the trade-off between speed and thoroughness when regulators such as the U.S. Food and Drug Administration approve new medicines. Using FDA data from 2006 through 2018, the researchers studied 396 drugs, including some that had received the FDA’s breakthrough therapy designation (BTD), which prioritizes therapies that show great promise or address new health issues, and which comes under an expedited approval process. Medicines receiving the BTD went through the final stage of clinical trials 23% quicker than other therapies did, saving research time and funds while showing no evidence of greater safety concerns.

Former President Donald Trump giving a briefing at the White House during the COVID-19 health pandemic.

Doctors’ political views may have influenced COVID-19 treatment recommendations

Julia Minson

IN A REPORT published in the Proceedings of the National Academy of Sciences, “The Political Polarization of COVID-19 Treatments Among Physicians and Laypeople in the United States,” faculty members from the University of Pittsburgh and HKS Associate Professor of Public Policy Julia Minson find that physicians’ political beliefs affect their treatment recommendations when it comes to the coronavirus. The authors write that “conservative physicians were approximately five times more likely than their liberal and moderate colleagues to say that they would treat a hypothetical COVID-19 patient with hydroxychloroquine”—a nonstandard treatment that former president Donald Trump touted.

The authors recruited 592 critical-care physicians and 900 laypeople and surveyed them between April 2020 and April 2022. The physicians were asked to evaluate a vignette about a severely ill COVID-19 patient and make treatment recommendations. The laypeople were asked to share their beliefs about treatment (but not make recommendations). Both groups were asked about their views on COVID-19 vaccines, masks, and related issues, and were also asked what news media they consume.

Government communications should be formal, not fun

Elizabeth Linos

INFORMAL MESSAGING, the thinking goes among academics and practitioners, is more effective than formal letters. But when it comes to government communications, it may be best to put away colorful graphics and casual language, according to “The Formality Effect,” a working paper coauthored by scholars from the Kennedy School’s People Lab. In a series of studies, a group including the lab’s Elizabeth Linos, the Emma Bloomberg Professor of Public Policy and Management, and Jessica Lasky-Fink found that people see formal government communications as more credible and important than informal communications—and are therefore more likely to act on them. The researchers compared how people responded to letters from local government using black-and-white text and formal language to shorter letters using an informal tone and colorful design. They found that the former generated more responses—which was not what experts who were polled predicted.

The researchers write, “These findings have immediate implications for government communicators and open the door for a renewed focus on how the design and presentation of information impacts behavior.”

China as a growing player in international rescue lending

Carmen ReinhartOVER THE PAST TWO DECADES, China has played a growing role in the global financial system, more recently providing rescue lending to developing economies. Carmen Reinhart, the Minos A. Zombanakis Professor of the International Financial System, and her coauthors, Sebastian Horn, Brad Parks, and Christoph Trebesch, have built “the first comprehensive dataset on China’s overseas bailouts between 2000 and 2021 and provide new insights into China’s growing role in the global financial system.” They share their findings in the working paper “China as an International Lender of Last Resort,” writing that “China’s role as an international crisis manager has grown exponentially in recent years following its long boom in overseas lending. Its position is still far from rivaling that of the United States or the IMF, which are at the center of today’s international financial and monetary system, and the effectiveness of its rescue lending operations is not well understood.” China’s flag with superimposed symbols for yenThe researchers note that China’s loan process is markedly more opaque when compared with that of established rescue lenders, and that the loans carry high interest rates. They write, “These findings have implications for the international financial and monetary architecture, which is becoming more multipolar, less institutionalized, and less transparent.”

Understanding and improving support for job training

David Deming

FUNDING FOR JOB TRAINING programs in the United States leaves room for improvement, according to a report by the Kennedy School’s Project on Workforce, coauthored by David Deming, the Isabelle and Scott Black Professor of Political Economy. In “Navigating Public Job Training,” the authors find that federal funding for job training is only a fifth of what is spent on college and university grants. At the same time, the job training landscape is large and complex, with more than 75,000 eligible programs in more than 700 fields. “Performance information at the provider level is very limited and of questionable accuracy,” the researchers write. “The net result is a highly fragmented system, where strong programs are not differentiated from weak ones.” Policymakers can improve job training by making the system easier for participants to navigate, they say, and by increasing funding overall, but particularly for high-quality training options.

Workers being trained in a factory

How a good-jobs strategy can replace neoliberal thinking

Dani Rodrik

ECONOMIC POLICY is shifting away from the neoliberal paradigm. But what will replace it? That is the subject matter of “On Productivism,” an essay by Dani Rodrik, the Ford Foundation Professor of International Political Economy, published as an HKS faculty working paper. Rodrik writes that current levels of economic inequality and the shrinking of the middle class in many nations require a focus on the creation of good jobs to boost productivity. He writes, “Advanced and developing nations alike will need a new breed of coordinated policies aimed at the supply and demand sides of labor markets, combining skill training programs with support for firms.”

Current economic conditions, he writes, may be improved by private-public collaborations and policies that “encourage an increase in the quantity and quality of jobs that are available for the less educated and less skilled members of the workforce, where they choose (or can afford to) live.” However, Rodrik warns, such productivism—as he calls these ideas—is not a one-size-fits-all permanent paradigm. Rather, it is a pragmatic and nonpartisan approach to developing an intentional “good-jobs strategy” and shoring up the middle class at a time when it is shrinking in many countries.

Faculty portraits by Martha Stewart.