I read with interest the article “Prescri­bing second-generation antipsychotic medications: Practice guidelines for general practitioners” [BCMJ 2012;54:75-82 [9]]. As a laboratory phy­­sician, my interest was piqued when I noticed that the recommended laboratory eval­uations included fasting insulin under certain circumstances. 

As it was un­clear to me how this investigation could contribute anything other than cost to the assessment, I decided to investigate the basis for this recommendation. As it was based on the Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics in Children (CAMESA) guidelines, I review­ed the relevant guideline. 

During the course of this review I learned “if there is good evidence that a specific side effect occurs with SGA treatment, monitoring for the specific side effect may improve health outcomes in the long term.” This is what I (though I am not a lawyer) would consider circumstantial evidence. As a laboratory physician and the chair of the BCALP Tariff Committee, I can assure you that the Medical Services Plan would not consider this an adequate justifica­tion if we were to submit it in support of a new or otherwise modified fee.
—Frances Rosenberg, MD
Victoria