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Letters
December 23 2009

Indirect Costs of Structural Interventions—Reply

JAMA. 2009;302(24):2661-2662. doi:10.1001/jama.2009.1889

In Reply: Dr Tsai cites Gordon Tullock's economic theory to substantiate that structural interventions may have indirect costs due to entities lobbying or defending these interventions. Indeed, following the ban of the sale of tobacco at pharmacies in San Francisco,1 the county was promptly sued by a tobacco company (Phillip Morris) and by a national pharmacy chain (Walgreens). Phillip Morris claimed that the ban interfered with their first amendment rights to communicate with their customers.2 Walgreens claimed that the ban violated their equal protection rights, because it did not apply to supermarkets and “big box” stores that had pharmacies inside them.2 Although the city prevailed in both cases, the county has incurred costs defending the ban and the Walgreens case is on appeal, so costs may continue.

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