Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor
Copyright 2001 American Medical Association. All Rights Reserved.
Applicable FARS/DFARS Restrictions Apply to Government Use.2001
In Reply: Our letter was meant to stimulate
debate and was not meant to exhaustively study this matter. The data were
obtained retrospectively and therefore preclude an etiologic link. The best
we can do in suggesting that the increase in prescribing of quetiapine fumarate
was influenced by the grand rounds presentation was to try to rule out alternative
explanations. We believe that we did so.
Dr Lohiya raises 3 questions. To address the first, we examined prescribing
based on attendance. The increase in prescribing among those who attended
was 460% vs 370% among those who did not. There are, however, several problems
interpreting this. The list of attendees was obtained from a sign-in sheet
and may therefore not be accurate. Many of the prescribers are psychiatry
residents and advance practice nurses (APNs) working with one or more staff
psychiatrists. In some instances the staff psychiatrist attended the presentation
while the resident or APN did not. The reverse was also true. This makes it
difficult to determine the lines of influence. A crucial caveat is that one
of the most important determinants of actual clinical practice is the influence
of local opinion leaders,1 a fact we suspect
is well known to pharmaceutical companies. In a closed system such as ours,
the influence of just a few opinion leaders can have far-reaching consequences.
Thus, data comparing those who went to the presentation with those who did
not is probably not informative.
Dieperink ME, Drogemuller L. Effects of Industry Sponsorship of Grand Rounds—Reply. JAMA. 2001;286(8):917-918. doi:10.1001/jama.286.8.917