Arecent editorial in the New England Journal of Medicine about a “$1,000 Pap smear” has generated a great deal of discussion in the laboratory community. The Oct. 17 editorial, written by Cheryl Bettigole, M.D., a New Jersey-based family practitioner, states that laboratories sometimes charge her patients $1,000 or more for a Pap smear that until recently cost only $20 or $30. The high charges are mostly due to “add on” tests, such as those for HPV and sexually transmitted diseases, as well as sophisticated lab tests for a variety of yeasts. While Bettigole says clinicians deserve much of the blame for ordering unnecessary tests, she believes that labs are also to blame, arguing that labs have learned that one easy way to increase revenue is to make it easy for clinicians to order more tests. “In the past year, I have been visited by multiple laboratory representatives touting ‘improved’ tests, virtually all of which involve combination panels that can be easily ordered and that contain extensive lists of fairly esoteric tests,” she writes. “The single-vial women’s health test is being heavily marketed by multiple laboratories. It includes not only the Pap and HPV tests but also tests for multiple infections—including…
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