When Medicare Spending Is Wasteful

MAY 27, 2011

To the Editor:

Dr. Rita F. Redberg highlights the value of an evidence-based approach to medicine — enhancing the quality of patient care and reducing unnecessary cost. However, insurance companies can and do deny care based on a perverse misuse of an evidence-based model.

Not all clinical care can be guided by rigid adherence to evidence-based guidelines. Sometimes evidence involves knowing one’s patient and his particular situation. I have recently had insurance companies refuse to cover medications for patients with histories of severe mood disorders. In one case, it said the dose of medication was “too high,” in another “too low.” The fact that both patients had histories of doing well on these doses was deemed irrelevant.

The problem, of course, is not with evidence-based medicine per se. Difficult decisions need to be made to bring down spiraling costs in health care; insurance companies cannot be expected to support all treatments; and clinicians should strive to provide the best care possible based on the best available evidence. Rather, it’s important that the valuable evidence-based medicine paradigm not be used as a weapon to hurt the very people it was intended to help.

LARRY S. SANDBERG
New York, May 26, 2011