Re: "Squandering Medicare's Money"

May 26, 2011

To the Editors:

Rita Redberg (Squandering Medicare’s Money, 5/26/2011) highlights the value of an evidence-based approach to medicine (EBM) – 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 – admittedly a weak source of evidence from a scientific perspective but not useless.

I have recently had insurance companies refuse to cover medications for patients with histories of severe mood disorders.  In one case, the dose of medication was 'too high'; in another 'too low'.  In both situations, the fact that both patients had histories of doing well on these doses was 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 possible evidence. Rather, it’s important that the valuable EBM paradigm within medical research not be used as a weapon to hurt the very people it was intended to help. 

Respectfully submitted,

Larry S Sandberg MD

The writer is psychiatrist and psychoanalyst.

7/10/11