Today's paper had a story about a pathologist and a Pap lab being
recommended for criminal indictment by an inquest jury for some form of
homicide in the cases of two women who died of cervical cancer following
reports of negative Pap smears. This apparently happened in Milwaukee or
This is just another item that tends to corroborate my long-held belief
that any pathologist who reads Pap smears (myself included) is certifiably
insane. Consider explaining this to a Harvard-trained M.B.A. who you are
approaching to be a silent partner in setting up your cytology lab:
1. Paps are one of the most labor-intensive tests in laboratory medicine.
2. Paps are one of the cheapest tests in laboratory medicine. Up until
a few years ago, some labs were offering Paps for $3 a piece. Nowadays, Paps
less than $10 are still quite common. Big labs use Paps as loss leaders to
secure accounts which generate demand for other lab services which can be
delivered with a decent profit margin.
3. The liability risk of a false-negative Pap is in the millions of
dollars per case (a $6 million settlement in one of the Milwaukee cases), and
now, as per the Milwaukee cases, you and your staff may be exposed to criminal
indictments as well.
4. No matter how good your lab is, if you obtain any volume at all, you
will have at least several false-negatives each year, which, on
review will clearly show a few high-grade CIN cells.
5. Because of ridiculous and inflated claims made over the last three
decades, the public has been led to believe that a regular Pap smear will
absolutely prevent cervical cancer. The people who have engendered these
claims are academic cytopathologists who are now dead, retired, tenured, or in
the employment of plaintiffs' lawyers. In other words, they can no longer be
held accountable for their actions.
6. The physicians who collect the Pap smear range in ability from those
who know what they are doing to those who couldn't tell a cervix uteri from a
bicuspid aortic valve. If one of the latter interprets "ASCUS" as "a part of a
fungus," you will also probably be held liable.
So, Mr. Harvard M.B.A., wouldn't you just love to put your money in a