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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

Copyright 2016 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

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