It is the MD's responsibility to the patient to explain alternatives. It is the patients responsibility to examine tests and decide. A doctor that refuses a patient this test can be sued, though winning that would be difficult due to the patient's ability to drop the doctor like a F'n roock.
Example. Deming vs Thomas Weisman, MD Tucson, AZ. Weisman refused to order basic chest x-ray after Deming complained (had been complaining to doctors for over 4 years). Weisman said he did not order the x-rays because patient(s) did not smoke. Wrong decision for the doc.
Deming was found with a thoracic aortic aneurysm (very serious). Required immediate surgery by Coselli in Houston.
In 2004 Deming was at same hosp that did prior x-ray but it was not reported though it was apparent on the x-ray. Deming was at the hospital late at night when staff is limited and less experienced.
After fact, Weisman was celebrating that "he" had found the problem after many doctors tried. Wrong again doc. Doc was pretty embarrassed after letters were sent to his "peers". Also Deming made sure that the doctors patients knew he lied. He put up a billboard in Tucson (legal).
Point. If the patient is aware (most are not) the patient can request the doctor order the test. If the doctor refuses the patient can drop the #$%$" and go to a professional. There isn't a good reason that this test or tests like it to be declined by the doctor. It saves time and time is a doctors enemy.
The days of the ill informed patient are about over. Most patients have a computer or know someone that does. Therefore the patients have the ability to study their illnesses (and they do).
Patients need to be aware of their rights when it comes to their PCP. A PCP will lie to "save face" as did Weisman.
This whole argument is convoluted and I don't think you work as a professional in this field. What you're describing is highly unethical and illegal. Pathologist and an Oncologist make more than enough. Sure, we have a good share of corrupt individuals in every field, but if a product saves TIME and money at the same time to save a life, why wouldn't they use it?
Your rhetoric is wrong as well. You bash the idea of positive sales whilst minimizing the CUP threshold yet you "buy" into this company and their products. What products? The MiRiview Mets^2 is the pretty much only thing they have going for them. Your ideas are inane. I have spoken with multiple PhD's that work in the diagnostic field and they're very aware of Rosetta. They know the type of technology MicroRNA offers and that the genome future depends on it. Perhaps the price right now as what ROSG should be selling at. Sure. We don't know what the sales are or what the monthly revenues will be. We need more details. But to state that only 20,000 patients would hypothetically needs this test is absurd.
Medicare coverage, as someone else stated, is the epitome to success for any diagnostic company. You can twist the truth and your "professional" analysis, but we shall find out in the next few weeks/months. This can be a monster stock if they release any positive data. With such a skilled sales force and the will to sell, I don't doubt them. I think we will finally see a huge breakout in 2013.