Stephen J.LurieMD, PhD, Senior EditorJody W.ZylkeMD, Contributing Editor
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):918. doi:10.1001/jama.286.8.918-JLT0822-4-2