Surgery News - March 2008 - (Page 2) NEWS SURGERY NEWS • M A R C H 2 0 0 8 Findings May Alter Therapy Neurogenesis • from page 1 idence of neurogenesis might be offered chemotherapy, whereas stage III patients without neurogenesis might not require chemotherapy. His talk was followed by a notable pause before any of the assembled surgeons asked questions. One surgeon in the audience commented, “What we witnessed was a stunned silence at the end of your talk. And that’s not for any lack of interest or enthusiasm. These are actually incredibly exciting results, and surprising, and I congratulate you and your team on pursuing this work.” Others were more guarded in their comments. In an e-mail interview, Dr. James Neifeld, an ACS Fellow and chairman of the department of surgery at Virginia Commonwealth University, Richmond, wrote, “This represents a new and previously undescribed finding. It is much too early to get excited about this as either a prognostic factor or a potential target for therapy and will require further validation to determine its usefulness.” Several other experts in colorectal and brain cancers declined to comment on the record, citing lack of expertise in neurogenesis as it relates to cancer. In response to a question from the audience, Dr. Wilks acknowledged that the cause of the neurogenesis remains unclear. Preexisting nerve tissue could be invading the tumor, or the nerve tissue could arise from a stem cell within the tumor, he said. Dr. Wilks stated that he had no financial relationships related to his presentation. ■ from these patients’ tissue samples, and stained them with antibodies against protein gene product (PGP) 9.5, a neuron cytoplasmic marker associated with new nerve growth. At least 5 years of survival data were available for each patient. The investigators looked at cancer-specific overall survival and cancer-specific disease-free survival, dividing the patients into those with no evidence of neurogenesis, those with a high level of neurogenesis (defined as more than 20 nerves per high-powered field), and those with low levels of neurogenesis (defined as 1-20 nerves per high-powered field). Dr. Wilks said that 20-30 patients ended up in the high-neurogenesis group. He described the results as “startling.” For example, in patients with R0 tumors (those with negative surgical margins), patients with high degrees of neurogenesis had significantly worse disease-free and cancer-specific overall survival than did those with no neurogenesis or moderate amounts of neurogenesis. At the 1,800-day mark, cancer-specific overall survival was roughly 45% for patients with high degrees of neurogenesis, 70% for patients with low degrees of neurogenesis, and 90% for patients with no neurogenesis. Dr. Wilks said the study’s unexpected findings could be used for therapy stratification. At his institution, chemotherapy is offered to all patients with stage III disease (those with lymphatic invasion), but to none with stage II disease. He suggested that stage II patients with ev- Bush Administration Pitches Medicare Payment Reforms B Y M A RY E L L E N S C H N E I D E R Else vier Global Medical Ne ws I n response to a warning that the Medicare trust fund is in financial trouble, the Bush administration recently proposed legislation that would tie physician payments to quality, cap medical liability damages, and encourage nationwide adoption of electronic health records. Health and Human Services Secretary Mike Leavitt submitted the proposed legislation to Congress last month, in response to the Medicare Trustees’ warning for the second year in a row that general federal revenue would be needed to pay for more than 45% of program expenditures. Mr. Leavitt was required to submit the proposal under a cost-saving measure included in the Medicare Modernization Act of 2003. “The Medicare program is on an unsustainable path, driven by two principal factors: projected growth in its per-capita costs, and increases in the beneficiary population as a result of population aging,” Mr. Leavitt said in a letter to House Speaker Nancy Pelosi (D-Calif.). “Excess cost growth will not be brought under control until there is comprehensive reform changing Medicare’s underlying structure.” Under the proposal, the HHS secretary would design and implement a system to tie a portion of the Medicare payment to providers to performance on quality and efficiency measures. Implementation would start in areas with well-accepted measures such as hospitals, physician offices, home health agencies, skilled nursing facilities, and renal dialysis facilities. The legislation also would limit the length of time that individuals have to sue for medical malpractice, would cap noneconomic damages at $250,000 and punitive damages at $250,000 or twice the economic damages (whichever is greater), and would limit contingency fees paid to plaintiffs’ attorneys. The HHS estimates that defensive medicine raises the cost of care in federal programs including Medicare, Medicaid, and Veterans Affairs, by about $28 billion a year. The legislative proposal also requires the HHS secretary to develop a system to encourage the nationwide adoption and use of interoperable electronic health records and to make personal health records available to Medicare beneficiaries. Mr. Leavitt urged Congress to adopt the proposed changes in conjunction with the administration’s fiscal year 2009 budget proposal (see story on p. 5). But the administration may have trouble getting its proposals through Congress. Sen. Edward Kennedy (D-Mass.), chair of the Senate Health, Education, Labor, and Pensions Committee, said the administration’s proposed Medicare cuts were dead on arrival. “The administration has trumped up a phony crisis in Medicare to justify proposing deep cuts in quality health care for seniors while giving massive subsidies to HMOs and other insurance companies,” he said in a statement. Notably absent from the legislation is any proposal to address the annual across-theboard reductions in Medicare physician payments that will be produced over the next decade as a result of the sustainable growth rate system. “Adding such significant administrative and practice cost burdens on top of an unstable Medicare payment system will be viewed as a completely irresponsible proposal by surgeons in practice,” said Dr. Thomas R. Russell, a Fellow and executive director of the American College of Surgeons, in a statement. ■ SURGERY NEWS SURGERY NEWS Editor in Chief, SURGERY NEWS Lazar J. Greenfield, M.D., FACS ACS Director of Communications Linn Meyer EDITORIAL ADVISORY BOARD Anesthesiology: Robert Morell, M.D., Clinical Associate Professor of Anesthesia, Fort Walton Beach Medical Center Bariatric: Myriam J. Curet, M.D., FACS, Professor of Surgery, Stanford University Cardiothoracic: Mark S. Allen, M.D., FACS, Professor of Surgery, Mayo Clinic Cardiothoracic: Fred A. Crawford, Jr., M.D., FACS, Chairman, Department of Surgery, Medical University of South Carolina Colorectal: Robert Madoff, M.D., FACS, Professor of Surgery, University of Minnesota Endocrine Surgery: Robert Udelsman M.D., FACS, Chairman, Department of Surgery, Yale University Ethics: James W. Jones, M.D., Ph.D., FACS, Visiting Professor of Medicine and Medical Ethics, Baylor University Information Technology: Patricia L. Turner, M.D., FACS, Assistant Professor of Surgery, University of Maryland Minimally Invasive and Gastrointestinal: Gerald M. Fried, M.D., FACS, Professor of Surgery, McGill University Neurological: Hunt Batjer, M.D., FACS, Michael J. Marchese Professor, Northwestern University Obstetrics and Gynecology: William J. Hoskins, M.D., FACS, Executive Director of Surgical Activities, Memorial Sloan-Kettering Cancer Center Ophthalmology: Natalie C. Kerr, M.D., FACS, Chief, Pediatric Ophthalmology Service, University of Tennessee Orthopedic: Mark R. Belsky, M.D., FACS, Chief of Orthopedic Surgery, Newton-Wellesley Hospital Otolaryngology: Mark Weissler, M.D., FACS, J.P. Riddle Distinguished Professor, University of North Carolina Pediatric Surgery: Thomas F. Tracy, Jr., M.D., FACS, Pediatric Surgeon-in-Chief, Hasbro Children's Hospital Plastic Surgery: Linda Phillips, M.D., FACS, Truman G. Blocker Jr., M.D. Distinguished Professor, University of Texas Resident/Associate Society: Ted A. James, M.D., Assistant Professor of Surgery, University of Vermont Surgical Oncology: James P. Neifeld, M.D., FACS, Chairman, Department of Surgery, Virginia Commonwealth University Transplantation: Jeffrey Punch, M.D., FACS, Associate Professor of Surgery, University of Michigan Trauma (Burns and Mass Casualties): Steven E. Wolf, M.D., FACS, Professor of Surgery, University of Texas Trauma and Critical Care: Grace S. Rozycki, M.D., FACS, Professor of Surgery, Emory University Urology: Badrinath R. Konety, M.D., FACS, Vice Chair, Dept. of Urology, University of California at San Francisco Vascular: Linda Harris, M.D., FACS, Associate Professor of Surgery, Millard Fillmore Hospital SURGERY NEWS is the official newspaper of the American College of Surgeons and provides the practicing surgeon with timely and relevant news and commentary about clinical developments and about the impact of health care policy on the profession and on surgical practice today. Content for SURGERY NEWS is provided by International Medical News Group and Elsevier Global Medical News. Content for the NEWS FROM THE COLLEGE is provided by the American College of Surgeons. The ideas and opinions expressed in SURGERY NEWS do not necessarily reflect those of the College or the Publisher. The American College of Surgeons and Elsevier Society News Group, a division of Elsevier Inc., will not assume responsibility for damages, loss, or claims of any kind arising from or related to the information contained in this publication, including any claims related to the products, drugs, or services mentioned herein. POSTMASTER: Send changes of address (with old mailing label) to Circulation,
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