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I read with interest the note from Jeff Boyd, PhD, Senior Vice-President for Molecular Medicine at Fox Chase Cancer Center, calling into question my recent commentary about the high costs of partly validated testing in the domain of molecular medicine. One of the oldest tricks in the book is to call into question the qualifications, knowledge, or comprehension of your critics, and it appears that Dr. Boyd has attempted to do that here. That strategy becomes more risky if you potentially have a conflict of interest when entering the debate.

I absolutely agree with Dr. Boyd’s remonstration that I was careless in bracketing gene mutation and expression in a rather casual fashion in my commentary focused on cost and questionable profiteering in his line of work. In fact, if I had been sloppy in a paper focused on the science or application of molecular biology, I would have been embarrassed for paying insufficient attention to detail and for having committed the sin of public conflation. However, I will note parenthetically that some of his note addresses the interface between targeting and tumorigenesis, which I didn’t even mention in my editorial.

That said, my interest was to question a fiscal, social, and ethical set of issues and to pose questions about why our community is prepared to pay the laboratories that perform molecular assays large sums of money for technology that is not yet fully refined and where interpretation of data is still quite uncertain in many instances. I don’t have a conflict of interest in discussing this issue, beyond the fact that I don’t especially want my tax dollars to be expended on an expensive set of lab results that may not be accurate and which my clinicians (and their consulting molecular pathologists) may not yet be able to interpret. Dr. Boyd is correct that the costs are coming down, but many of the tests remain very expensive indeed.

When Dr. Boyd comments that laboratories that do these tests are CLIA certified [Clinical Laboratory Improvement Amendments], that doesn’t make me feel better. That simply tells us that the laboratories and their staff have passed a defined standard; by analogy, not all FACT-certified bone marrow transplant units produce equivalent survival data, nor do all Joint Commission–certified hospitals have the same outcomes.

Dr. Boyd implies—in contrast to the explicit phrasing in my editorial—that I am opposed to carrying out work in this important domain. In fact, my concern is that this is research, and much of it should not be funded by routine health-care payment systems, but rather via research grants or venture capital, as is done in most other domains of science.

VPs of Molecular Medicine are sometimes charged with carrying out science, but sometimes their key role is to run a profitable business. I know nothing of Dr. Boyd’s day job, but I hope he doesn’t have a huge conflict of interest and that concern for his bottom line isn’t the driver of his somewhat inaccurate and diversionary response. This should not detract from the question, “is this the right way to develop molecular oncology and to pay for it?” ■

—Derek Raghavan, MD, PhD, FACP, FRACP, FASCO
President, Levine Cancer Institute
Charlotte, North Carolina

Disclosure: Dr. Raghavan reported no potential conflicts of interest

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