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We appreciate Drs. Bubb and Johnson's potential biological inferences to explain the increased mortality shortly after discontinuation of febuxostat or allopurinol in the CARES trial. We also note that the findings could be methodologically explained by "sick-stopper" and "healthy-adherer" effects. Gravely ill or fatally sick individuals are more likely to discontinue preventive treatments (such as urate-lowering therapy) for largely asymptomatic non-fatal conditions. This article is protected by copyright. All rights reserved.