… and how the decisions are made

To the Editor: We have some pretty tough days too, for in addition to the clinical, academic, and administrative functions that are part of our careers, we now have to spend many hours persuading health insurance companies that we are not trying to manipulate them into paying more money than Medicare does for kidney transplants, as Dr. Boren insinuates (Feb. 17 issue)¹. He is making his work unnecessarily difficult by equating understandably difficult decisions about whether to approve autologous bone marrow transplantation for patients with metastatic breast cancer with decisions about approval of predialysis transplantation for patients with end-stage.