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Comment & Response
October 2016

Payments to Physicians, Prescribing Rates, and More Appropriate Conclusions—Reply

Author Affiliations
  • 1Program On Regulation, Therapeutics, And Law (PORTAL), Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
JAMA Intern Med. 2016;176(10):1577. doi:10.1001/jamainternmed.2016.5802

In Reply From examining our Figure 1,1 Dr Fagan incorrectly infers a steep negative relationship between payment amounts in the $0 to $20 000 payment range and branded statin prescribing. In fact, the relationship is flat, with 0.03% additional brand-name prescribing for every $1000 received (95% CI, −0.31 to 0.37; P = .86). Dr Fagan arrives at the same conclusion we originally expressed: that the positive association between publicly reported financial ties to the pharmaceutical industry and higher brand-name statin prescribing was driven by physicians receiving the largest payments. Despite Dr Fagan’s minimization of this finding, we believe it is important, since prescribing a brand-name statin instead of an equally effective generic can lead to worse cardiovascular outcomes.2

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