Today I got a sign-it sheet from Medco asking me to authorize pharmacogenetic testing for a patient on warfarin. Now I know the Medco CEO wants to eat doctors and wants to tell us how to practice but this is crossing the line I think. Does Mr. Snow realize that pharmacogenetic testing for warfarin though trendy at the moment is not cost effective? How about $200 000 per QALY! Usually we have to be less than $50 000 per year to be cost effective like mammography Pap smears etc. It wasn't even that hard to find an analysis--try Google! Annals of Internal Medicine January 2009 tells the real story. Thanks ACP! I didn't sign the paper didn't authorize genetic testing for my patient and I look forward to discussing this issue with Mr. Snow or anybody he delegates. I would eat you up on just the informed consent issue alone--does the patient know you are ordering genetic testing? Should they? Until then good luck with that Dave.