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
Links
[1] https://bcmj.org/cover/september-2012
[2] https://bcmj.org/author/frances-rosenberg-md
[3] https://bcmj.org/node/4505
[4] https://bcmj.org/print/letters/re-circumstantial-evidence-based-medicine
[5] https://bcmj.org/printmail/letters/re-circumstantial-evidence-based-medicine
[6] http://www.facebook.com/share.php?u=https://bcmj.org/print/letters/re-circumstantial-evidence-based-medicine&via=BCMedicalJrnl&tw_p=tweetbutton&via=BCMedicalJrnl&tw_p=tweetbutton&via=BCMedicalJrnl&tw_p=tweetbutton&via=BCMedicalJrnl&tw_p=tweetbutton&via=BCMedicalJrnl&tw_p=tweetbutton
[7] https://twitter.com/intent/tweet?text=Re: Circumstantial evidence-based medicine&url=https://bcmj.org/print/letters/re-circumstantial-evidence-based-medicine&via=BCMedicalJrnl&tw_p=tweetbutton&via=BCMedicalJrnl&tw_p=tweetbutton&via=BCMedicalJrnl&tw_p=tweetbutton&via=BCMedicalJrnl&tw_p=tweetbutton&via=BCMedicalJrnl&tw_p=tweetbutton&via=BCMedicalJrnl&tw_p=tweetbutton
[8] https://bcmj.org/javascript%3A%3B
[9] https://bcmj.org/content/prescribing-second-generation-antipsychotic-medications-practice-guidelines-general-practit
[10] https://bcmj.org/modal_forms/nojs/webform/176
[11] https://bcmj.org/%3Finline%3Dtrue%23citationpop