To the Editor:
In reading the recent article by Jinno, et al1, I perceive an inflection in the curve for emergency department (ED) visits per 100,000 people in 2009 (Figure 1). This coincides with the US Food and Drug Administration (FDA), Rockville, Maryland, approval of colchicine in July 2009 and the beginning of the manufacturer’s campaign to drive competing “unapproved” colchicine from the market. These events may have influenced any of the trends observed. The FDA approval gave Mutual Pharmaceutical Company (later URL Pharma) 3 years of market exclusivity for gout and 7 years of market exclusivity for familial Mediterranean fever. The result was an immediate 50-fold price increase from about $0.10 per tablet to $5.00 per tablet2,3. I wonder how much the sharp change in cost and availability of colchicine contributed to the increase in ED visits after 2009.