Low-Osmolar Contrast Agents

To the Editor. —  We are writing to take issue with Mr Jacobson and Dr Rosenquist's¹ SPECIAL COMMUNICATION in the September 16 issue of JAMA entitled "The Introduction of Low-Osmolar Contrast Agents in Radiology."The authors proposed restricting low-osmolar contrast agents to high-risk patients to contain medical costs. They made three key assertions: (1) that a physician's failure to use the newest technology is not malpractice; (2) that the failure to inform the patient of this new technology is not a breach of the duty to inform; (3) that even if liability is found, the projected tort damages are still lower than the avoided cost.This reasoning is flawed. It is not always possible to identify the high-risk patient. In addition, as conceded by the authors, Judge Hand's formula² balancing risk vs benefit for tort liability is a general guide, not a basis for precise calculation.The plaintiff's bar