TAG of the Week: The Cost for Life
If you are a policymaker and you've read that screening for Lynch Syndrome can save lives and money in the long-run, what pieces of evidence would you like the article from BioTech Now to present to you in order for you to assess whether a program can use this information in the near future? Now as an engineer in a biotech company looking into cancer-related genetic markers, what do you think will support and enhance future research goals? Do you agree or disagree with the court ruling as an engineer? What ways can both financially support the interests of venture capitalists and biotech companies while keeping these tests accessible to those who need it? Do you think a change in health policy planning must be involved in regulating costs?
If you are a policymaker and you've read that screening for Lynch Syndrome can save lives and money in the long-run, what pieces of evidence would you like the article from BioTech Now to present to you in order for you to assess whether a program can use this information in the near future? Now as an engineer in a biotech company looking into cancer-related genetic markers, what do you think will support and enhance future research goals? Do you agree or disagree with the court ruling as an engineer? What ways can both financially support the interests of venture capitalists and biotech companies while keeping these tests accessible to those who need it? Do you think a change in health policy planning must be involved in regulating costs?
http://www.biotech-now.org/
(some background) - http://www.cmaj.ca/cgi/
If I was a policymaker focused on the possibility of implementing a nationwide screening program for Lynch Syndrome, I would like to see evidence that such a program could save lives and money. I would like to see data on the incidence of the disease as well as a cost-benefit analysis of early detection through means of screening. This evidence would allow me to make an informed decision on what is in the population's best interests. If I was an engineer in a biotech company, I would have to agree with Myriad's arguments to uphold their patent. The argument from BIO and AUTM that, “Isolated DNA molecules are freestanding chemical compounds that do not occur in nature, but rather are created by human ingenuity and, accordingly, are patentable” is valid. Myriad manipulated DNA to discover these genes, therefore their efforts should not be disregarded.
ReplyDeleteI think a change in policy is necessary to ensure that these monumental discoveries in the field of genetics keep being made. It is true that financial incentives and claims to information are driving forces in genetic discovery. In order to support these entrepreneurial experiments, I think it's important to allow companies such as Myriad the right to patent their discoveries. However, in order to benefit from the full potential of these discoveries, they should be made available to anyone with a nominal fee. Both sides can compromise to benefit the entire human population.
If I was a policymaker looking at the possibility of implementing the new screening test for Lynch Syndrome I would want to look at the background, advantages and disadvantages for doing the project.
ReplyDeleteFirst, I would like to know what the background of Lynch Syndrome is. Is this a major problem within the US? Should we be allocating the money to this screening test or could our money be better spent elsewhere? Do the costs of implementing this program outweigh the benefits, and vice-versa.
I would then want to know the evidence associated with the screening test and its effectiveness. I would want to see if the costs associated with implementing the program would be less than the costs associated with the disease. Also, I would want to know whether this screening test effectively recognizes the syndrome and does not over-"diagnose" individuals by looking at the specificity and sensitivity. I would then want to look at whether there are any adverse effects of the screening program - is there stress and anxiety associated with the diagnosis? These factors would then have to be analyzed to see whether or not the screening test should be implemented.
I have mixed feelings associated with health policy related to regulating costs. Although I feel that the cost of screening tests should be cheaper, thus allowing more individuals to get screened for numerous diseases, I understand that companies also need incentives to continue to do research. I think there should be some form of agreement in which the government helps to subsidize costs of individuals seeking screening tests. Or, the government could offer incentives to companies like Myriad, which will ultimately make costs cheaper for the consumer.
If I were a policy maker, the most influential evidence that I would like presented to me in order to assess whether a genetic screening program for Lynch Syndrome should be implemented is the cost-effectiveness of the program. Specifically, the results of the mathematical model that found that the average cost effectiveness ratio is $26,000, almost half the amount of the benchmark value. It is important that the testing program is both advantageous to the health of the user, while still remaining affordable. Because of the rising cost of health care, it is imperative when implementing new policies, to consider this information.
ReplyDeleteIf I were a policy maker I would look for things such as Jess Goeters and Miranda said: evidence that such a program could save lives and money, background information, and advantages and disadvantages for doing this project. If this project would spend outrageous amounts of money for a disease that was not very prevalent or curable then I would say absolutely not. However, it seems that this test costs half of what the benchmark is for cost effectiveness and since Lynch Syndrome can increase your chance to develop colon cancer, I would approve of this. As a bio-engineer I would want patents to continue. Without any patent protection no firms would ever spend 1.2 billion dollars just to have everyone copy them. Also, I would be out of a job.
ReplyDeleteThere should be a change in policy. While patents are the driving force behind new discoveries, monopolies arise and consumers who need these expensive treatments can go bankrupt. If the government compensated companies or offer incentives there may be a way to lower prices for those who really need it.
In regards to being a policy maker, I have to agree with Jess. She brings up a great point in bringing to light the incidence and cost-effectiveness of the screening. If there is a high incidence of Lynch Syndrome and the screening process created by BIO and AUTM can save lives and is cost-effective, then there needs to be an emphasis on promoting this screening test.
ReplyDeleteAs an engineer, I would have to love to have the patent for the Lynch Syndrome screening test. Without it, there is no way the company would be able to continue its research and creation of the screening test. As stated in the article, the DNA molecules were created by humans and therefore patentable. There needs to be some kind of negotiation between policy makers and these types of biotech companies to better the human population at large.
If I were a policy maker and I was trying to decide whether or not I believed a certain genetic test was cost effective I would want to have all the facts. I would start by wanting to know the exact cost of the test, from manufacturing of the equipment to training professionals administering it to the actual cost to the consumer. I would also like to know the research that lead to the estimated number of life years the test was expected to save. With this knowledge I believe I would be able to have a better understanding of the cost effectiveness.
ReplyDeleteIf I were an engineer in this field I think I would be in favor of patenting the discovery of the isolated DNA molecules. As the article mentions it would be nearly impossible for the field to get enough funding without such patents. If I were trying to work in the biomedical industry and wanted to continue research in new areas I would need a ton of money. Patenting any discoveries would lead to more revenue and more funding for my work.
I personally believe that accessibility is one of the most important goals of any form of healthcare. I also believe that if this test is going to be saving potentially productive years in a significant portion of the workforce the government should be taking a special interest in it. With that being said something does need to be done so that genetic testing companies are not forced to make life saving tests unaffordable to the public. This change will need to come from a new policy regarding patenting intellectual property in the biomedical field.
Reading this BIOtech Now article helped me to realize the importance of early investment and obtaining a patent when doing foundational research for creating genetic tests such as Colaris, the genetic test for Lynch Syndrome that is being proven to be cost-effective. Before, I had thought of investment as principally a profit-driven motive, but it is much more than that, which this article begins to explain.
ReplyDeleteAs J.Jessup mentioned, I also believe that one of the most important things to focus on as a policy maker in regards to implementing widespread genetic screening as a prevention technique is the cost-effectiveness of the test. Looking at it from a public health perspective, even the greatest genetic test or prevention method cannot be implemented if it is not cost-effective. Having said that, the recent health economics study that found screening for genetic mutations related to Lynch Syndrome to be cost effective is a huge step in the right direction for that particular genetic test, and will have important implications for its success in the realm of health policy.
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ReplyDeleteIf I am a policymaker and I've read that screening for Lynch Syndrome can save lives and money in the long-run, I would have to agree with Jess and Miranda on approaching the situation with all the facts first. Again, strong data needs to support the cost benefit analysis of early detection though screening as a money saving alternative. The screening itself should be backed by well-conducted studies proving the effectiveness and accuracy of these tests. Social impact and integration into hospitals also needs consideration. The exact implementation and maintenance of these screenings need to be planned and proven able to function within a budget.
ReplyDeleteAs an engineer in a biotech company looking into cancer-related genetic markers, I believe companies should be able to patent their discoveries; therefore I disagree with the court rulings. In this way we can financially support the interests of venture capitalists and biotech companies, but as Miranda mentions, to have government subsidies to keep testing costs low and patent use costs low. Health policy planning should definitely play a role in regulating costs to ensure they are reasonable and allows for more research to come out of these patents.
If I were a policy maker, I would want to know that the screening test for Lynch Syndrome met the Wilson-Jungner criteria. For instance, I would want to know that the condition being screened for was an important health problem, there is a detectable early stage, there is an effective treatment or intervention for patients that get screened positive for the condition, and so forth. I would want to also know the advantages and disadvantages of the screening test.
ReplyDeleteAs an engineer, I think that the patent for the Lynch Syndrome screening test is important. This is because the patent will result in funding and more research opportunities than are offered now. Without the patent, as stated in the article, there will be no funding. However, I personally believe that patenting always leads to inequalities and disadvantage for specific groups and individuals within the population. However, if the only way to get enough money is through patenting, then that is what I would want done if I was an engineer.
If I were a policy maker I would like to know that the genetic screening or test they establish is effective. I don't understand the current testing for Lynch syndrome because the patient already has to have cancer. I understand testing for the syndrome after the patient has cancer can be effective in treatment but wouldn't the person want to know before they get cancer that they could be at risk for developing cancer. If I were a policy maker I would want to know that the test can be provided before cancer and that it can screen me for the gene of this syndrome. It doesn't make much sense to me to have the test go into effect after a person gets sick. I would also want to know the test is efficient and cost effective because for many people that is very important. I would also want to know that this test could change someones life. It would be important to me for the test to make a difference in the fight against cancer or Lynch syndrome which is associated with cancer. I think as a policymaker I would also need to know this test was well researched and won't be harmful to any person. If I was an engineer in the lab trying to establish a test I would be driven by the fact that this could be life-changing for many people. With the rate of cancer in the world I believe knowing you have a gene for it is extremely life-altering. I would want the legislation on this patent gene to be passed because it could change the face of medicine once again, by adding a genetic screening test. I believe keeping the testing to a minimum cost would be beneficial for everyone. I know from experience the screening BRCA 1 and BRCA 2 is extremely expensive and is not covered by all insurance companies. This does effect who gets the screening and who doesn't. All of these factors go in to whether or not someone will get a cancer screening done. If this screen can be proven effective and is funded by the government it will be beneficial.
ReplyDeleteIf I were a policy maker, I would not put a price tag on the lives of individuals, fully realizing the first test will diagnose other family members at 14% of the cost of that of the "proband."
ReplyDeleteI would realize that early detection of cancers for those who are at high risk is the closest thing to a cure and I would wonder why it isn't used more often now...I would explore more than simply price of the initial test, but why physicians are not diagnosing Lynch syndrome and why, as a policy maker, I ignored other hereditary cancers and individuals died while championing breast cancer. I would look at the whole big picture.
I would wonder why only 5% of 600,000 people projected to have it, in the U.S. alone, were diagnosed and why physicians were not testing individuals. I would wonder how that number correlates with the fact only 6% of all physicians know about Lynch syndrome. I would wonder why they were not looking at the big picture.
I would make certain the tumor of everyone with colon cancer was tested (there is up to an 80% lifetime chance of colon cancer with Lynch syndrome.) I would make certain the tumors of every single person with endometrial cancers, (up to 60% lifetime risk of getting endometrial cancer) ovarian cancers (up to 13% risk of ovarian cancer in one's lifetime) and gastric cancers (15-19% risk of acquiring gastric cancer in one's life time) were tested. By testing those who have cancers, 5-20 individuals' lives can be saved and it is the equivalent of testing them, as well.
I would also make certain universal testing was available for all, taking into consideration, that ONE expensive test paves the way to the diagnosis of 5-20 persons, as well...so, on average, in considerating a family, the test is only $1300 (or the cost of 60,000 mile servicing on your car) for a family of 5, $1200 for a family of ten or $600 per test for a family of 20...the cost of an IPAD.
Finally, for those who can't afford the testing, there is always the government health services...the question I would have as a policy maker is why individuals pay for more their vehicle maintenance and electronics than for their own health?
Finally, I doubt I would ever correlate cost and not provide life saving testing of young people and allow them and their children to get cancers and simply die, because the cost, equivalent to the cost of an IPAD, was too dear to consider for a human life.
If I were a policymaker and I read that screening for Lynch Syndrome can save lives and money in the long-run, I would want further proof from BioTech. In order for a program to use this information, I would want to understand how the screening would be done in newborns. Based on what the article said, they claim that screening for Lynch Syndrome is cost-effective; rather than just believing this, though, I would want to see how they came up with the numbers they did. I would also want to be presented with more evidence of why the screening test program should be implemented; the article made a lot of strong claims, but I would like to be presented with the evidence to back them up.
ReplyDeleteAs an engineer in a biotech company looking to into cancer-related genetic makers, I think that future research goals will be supported and enhanced by gaining knowledge about the specific genetic markers associated with Lynch Syndrome. The article said that mutations are known, and by possibly studying the exact change in genetic make-up, researchers may be able to use technology to create a treatment. I would also disagree with the court ruling as an engineer. As the article quotes, “invalidation of the patentability of these molecules could stifle future biomedical innovation.” I would probably look at it from this angle, and view the lawsuit as a hindrance to possibly life-saving research.
If I were a policymaker and I've read that screening for Lynch Syndrome can save lives and money in the long-run, I'd like BioTech Now to present how many people are affected by the disease, and more information on how many more life years can be gained by the genetic test in order to assess whether a program can use the information in the near future. The article stated that the benchmark cost would be significantly lower, but that's only one side of cost-effectiveness. I think that it'd be useful to know the the number of average years saved by receiving genetic testing as opposed to waiting until symptoms show and the person is diagnosed with Lynch Syndrome.
ReplyDeleteAs an engineer looking into cancer related genetic markers, I would want the patent for the screening test. If I created the genetic test I'd want to be rewarded for my discovery. Therefore, I disagree with the court's ruling. With the ruling, biotech companies will be harmed and genetic research will decrease. Patents are important in order to invest in more research and development of the engineer's genetic findings.
As a policy maker or a member of Congress on one of the Health committees trying to determine what screenings health insurance companies should be required to pay for there are several things I would want to read about. It is widely accepted that insurance companies should pay for routine pap smears, mammography, colonoscopies, etc. However should we as lawmakers include screening for Lynch Syndrome? Since this syndrome is a rare inherited condition I would like evidence as to what % of the population has this condition. Also what types of cancers other than colon cancer can this condition cause. Next I would want to read about the different methods used for this screening. The article should also present the typical cost of each type of screening. In addition there needs to be percentages of the rate of false positives. Finally present evidence in numbers of lives and money that will be saved if this screening is made available through health insurance.
ReplyDeleteI would want BioTech Now to show me the numbers and how genetic testing for the mutation is truly cost effective. I would also want to know what the company would have the individuals with the mutation do, in terms of behavioral modifications to reduce their risk of developing cancer. I would want to see how effective identification of the gene is at helping to prevent cancer, or reducing the severity of cancer due to earlier diagnosis if i was an engineer. As an engineer i disagree with the court ruling because i understand the importance of being able to patent genes in order the receive funding for my research.I think by having the cost of the test covered by all insurance companies while still allowing the companies to patent genes would be one way to ensure funding and receiving the test was possible for all. I am not sure if a change in policy is necessary but that is because I am unsure of how much effort has been put in by insurance companies and testing companies to resolve the issue but if the issue continues for many year a policy change may become necessary.
ReplyDeleteI agree with many of my colleagues in that if I were a policymaker I too would like to see some more background information to assess how effective these tests would possibly be. Although genetic tests/screenings have become popular and very beneficial, we must be selective in determining which tests are actually effective and are not in it just for the popularity and recognition without any real merit behind the test. In the article, BioTech did not really provide much information that would allow me to assess whether or not if I should decide to implement this test in a nationwide screening program.
ReplyDeleteI think there must be a change in the policy because this current ruling prevents or hinders scientific research and the biotechnology industry. Although finances are an important aspect, it appears that this law is one sided and does not consider the potential benefits that these biotechnological industries could provide. In a way, this ruling is harming people and causing a rise in mortality because it is preventing these screening programs that could potentially save these lives because of funds that are not being provided. It is extremely unfair because it basically putting a "cost on life" and it seems like this ruling is not taking the lives that they are harming into consideration.
As a policymaker, I would need to see empirical proof that the test does in fact save both lives and money. I would want to know how many people may be affected by this gene, and how large of a role the gene plays in cancer development and prognosis. I would need data on comparative survival rates to see whether the genetic test aids in early detection/treatment to improve outcomes and cost-benefit analyses of the test vs. other screening options. As an engineer, I would disagree with the court ruling, as it would limit my company's ability to continue funding its research. While both policymakers and scientists have their reasons for taking the positions and actions they do, it is important that their needs are equally met, since producing genetic tests without a market that can sustain them is useless. I think it's important to consider both the financial concerns of consumers and of the companies producing the tests. Policymaking could aid in this situation by allowing for gene patents, but at the same time put forth measures to ensure that individuals who seek genetic testing can afford it--such as working with both the insurance industry and biotech companies to establish more inclusive guidelines for coverage.
ReplyDeleteIf I were a policy maker, I would first need to see the benefits, disadvantages and effectives of implementing the new screening test for Lynch Syndrome.
ReplyDeleteI would need to understand exactly what Lynch syndrome is and how many individuals are affected in the United States and possibly on an international scale to draw more examples. Also, is this program cost-effective? Is there a better, more pertinent national health issue that should be addressed and funded instead?
It seems that Lynch Syndrome could cause colon cancer which would lead to a heavier burden on the health care system and individuals so I would approve of this test. Although, I would first have to determine factual evidence such as how many lives this could help and how much money is saved if implemented. A patent should be a priority since funding would be nearly impossible without one.
If I were a policymaker thinking about implementing a new screening test for Lynch Syndrome I would want to know more about the disease. I would want a background of information on Lynch Syndrome and of what the screening test would accomplish. I would want to know if the test would be cost-effective and if the test would be accurate in identifying the syndrome. After these results were presented and I found that the disease was common enough in the population to implement, and would be cost effective, I would look into how the screening test would be implemented to make sure the program would be effective in the long run. As an engineer I would have to agree with the company about the patents. Myriad took the DNA and manipulated it in many ways to learn about the genes that cause Lynch Syndrome, and therefore, they should be able to keep their patent. I believe that change in health policy is definitely necessary for regulating costs. Although I believe that a company should be able to benefit from its hard work, I do not think that this hard work overshadows the potential to help save lives and the lack of lives saved simply because the drug was priced too high.
ReplyDeleteIf I were a policymaker, I'd want all the facts before making a decision regarding the feasibility of implementing screening tests for Lynch Syndrome (just as suggested by N. Stump, A. Mak and others). In addition to scientific data and analysis, I would also want information about the public health/social policy implications of the test. It is only when all the facts are known that serious deliberation can commence to assess the advantages and disadvantages of said screening test. The cost-effectiveness of this test in preventing disease and saving lives will have to evaluated for its practicality and usefulness.
ReplyDeleteWith regard to the court ruling, I think there is a real danger in discouraging research and development when the courts rule against companies who are trying to obtain patents for their research. While I recognize that the government has an interest in protecting public health and welfare, and so may refuse to grant patents on bio-molecules that are deemed an intrinsic part of humanity, the denying of patents to companies in biomedical research may stymie the progress of science and innovation. If intellectual property is not protected, there is little incentive for people to create, design, and innovate.
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ReplyDeleteAs a policymaker looking at the potential of implementing a screening test for Lynch syndrome it would be important to be informed about a number of things. Some real data providing a cost-benefit analysis, graphs, visual data to make for easier analysis would be helpful. Also, strong research and studies showing that this screening test would save money and benefit the greater good and why it is reccomended by professionals, researchers, and doctors to be implemented. As an engineer looking at cancer-related genetic markers, I would feel an important force towards supporting and enhancing future research would be to offer incentives for Biotech companaies to compete with eachother for things such as patents and protective rights over their work. This would give them clear goals, and incentives to further their research, and also make it possible for them to recieve funding as private companies. I would disagree with the court ruling for these reasons. Addtionally, being able to claim right over your work and discoveries would only help to encourage new and upcoming biotech companies and give them a chance at success, it would ultimately fuel research in an unhindered and beneficial way for everyones benefit. Cost of the tests ought to be re-examined to adjust them or offer a way that most people could afford them, or offer bundles with insurance companies to allow individuals to get these tests, should they need it, especially becauase they would ultimately save the insurance companies money as well. Health policy ought to be looked at in terms of this and costs should certainly be regulated through various policies in this way to allow people to benefit from these technologies as well as allowing the technologies to continue to flourish and grow in an unhindered way.
ReplyDeleteIf I were a policy maker, I would want to be sure that there is in fact a cost-benefit ratio and such a test that would be beneficial in the long-run and in the grand scheme of things. When it comes to the court ruling, when we watched the Breast Cancer movie and Myriad technologies had patented the breast cancer test, I did not support them in choosing to patent the test because I thought that it would negatively affect research and would not provide an opportunity to all consumers who want the test (as it may be too costly). But this article showed that to engineers, it is companies such as Myriad that allow them to thrive and function and come up with new and helpful technologies and ideas. From the engineer’s point of view, I now realize that my opinion of Myriad after the movie was not looking at many aspects of the picture, but looking at just the fact that the consumer has to pay a higher cost for testing. It is difficult to decide whether or not the court made the right ruling because there are many factors that come into play. For one, Myriad worked really hard to isolate the DNA and they should in fact get some sort of recognition for that. I think that the court and Myriad should try and find some sort of compromise so as to not limit the biotech side of things, but not to restrict consumers either.
ReplyDeleteIf I were a policy maker thinking about implementing a screening test for Lynch Syndrome, I would assess a number of different factors before making a final decision. First, I would look at the test’s potential to save lives. I would also analyze the cost effectiveness of the test. The article mentions that a major asset of this test is that it brings the benefits of genetic research to the patient at a lower cost, compared to other genetic tests. According to the article, this test has the potential to save lives and do so in a cost effective manner. The test appears to be efficient in multiple aspects and should be available to any interested individual. I do not agree with the act of increasing genetic testing fees simply to make a profit. While Biotech companies compete against one another to get patents on life saving drugs, it is important to remember that the patient is at the center of this push for new discovery. This competition is beneficial to the patient because it drives scientific research to a higher level and produces more drugs on the market. Dilemmas such as this one are all too common in health policy government. It may seem obvious to some people to implement a test that will save lives, but it is important to look under the surface at the scientific data regarding the efficacy and cost effectiveness of their claims. Cost is an extremely important issue to people, and if the test is too expensive, it will be difficult to incorporate into society. For this reason, I think some regulation over scientific research and pricing is necessary, so that patients remain at the core of the research process.
ReplyDeleteIf I were a policy maker determining whether or not to implement a genetic screening program I would like more information on the nature of Lynch syndrome. With knowledge on the incidence of the disease, I would check to see if it affects a large enough population to warrant mandated screening. In addition to this a policy maker would benefit from a cost benefit analysis of a screening program along with projections of incidence and mortality rates from Lynch syndrome in the future. With this I would be able to make a well informed decision about the possible positive impact of the screening.
ReplyDeleteIf I were an engineer additional funding would certainly support future research on the Lynch Syndrome. Issuing a patent for the BioTech company would increase revenue to be used for research. As mentioned above I agree that a change in policy is necessary to protect companies with patents from emerging monoplies. With these changes we can ensure that the genetic screening benefits the population at large.
I agree with most of what was mentioned above so I will broaden my discussion a bit. I think policymakers need to be mindful of the extended use of health care services that would come after a new screening test, such as Colaris, because the impact on the overall health system impact is just as important. If I were a policymaker I would be aware of all components that come with genetic testing services and the results it would have on health. For instance, with a genetic screening test comes genetic counseling. Genetic tests are costly in themselves so the proper counseling becomes an equally important as well as financially significant component of genetic testing. If I were a policymaker, I would also like to know if the test correctly identifies those who are really at high risk of disease so that the amount of "false positives" diminishes. In turn, this could point to the positive predictive value of the test (which can decrease unnecessary testing in the population). This is important because when tests are utilized for the general population, instead of particular risk groups, individuals become misinformed and seek more testing than needed, which is beneficial for venture capitalists (since more tests would be administered/bought, therefore increasing revenue) but harmful for public health (due to unnecessary testing). Therefore, I think public funders of health services should regulate the utilization and population-targeting for new genetic tests instead of money-seeking private companies. This way, policy-makers can achieve cost-effectiveness and savings where it is possible; and any costs would be justified by the positive impact and progress in public health the genetic test could have.
ReplyDeleteI would like to know what the specificity and sensitivity of the test were as well as how many trials the test went through, what where the demographics of the trial population, and what the protocol for administering the test was.
ReplyDeleteChanging health policy planning should not exactly be involved in regulating costs, because I feel that it is a limiting factor in the full extent/ capability of projects venturing out to new levels, and for them to be able to expand through creating innovative solutions to problems like finding reliable cancer screening tests. Although it is not logical nor plausible to create a test or implement a program with out taking into consideration the cost of it, I still believe that cost regulation should not be at the forefront in determining/ deciding whether or not to implement a program or new Biotech device, because this I feel prevents the advancement of new innovations.