I am very disappointed that the federal medical reimbursement folks have not approved the use of genetic tests to make warfarin dosing more precise. This would be an opportunity for CMS to start the personalized medicine revolution, and to make the public aware that we physicians can do better than guessing in the use of dangerous medications. We were part of an effort published in February that showed very clearly that genetics helps predict much more accurate doses of warfarin, and that 40% of patients are at risk for over- or under-dosing without this information. I am not an expert on the CMS approval process, but I would wager that there are MANY things reimbursed for which there is not a similar level of likely cost-effectiveness. Here was an opportunity for the new administration to take leadership, and it was a lost opportunity.