October 2, 2009 (Newswise) - Nutrition scientists led by Young-Cheul Kim at the University of Massachusetts Amherst have identified the molecular pathway that allows foods rich in soy bioactive compounds called isoflavones to lower diabetes and heart disease risk. Eating soy foods has been shown to lower cholesterol, decrease blood glucose levels and improve glucose tolerance in people with diabetes.According to Kim, the study shows that "what we eat can have tremendous impact on health outcomes by interacting with certain genes. Recent research also suggests that diet can even change the copy number of a certain gene, leading to biological changes."

Soy is the most common source of isoflavones in food. In experiments with mouse cells, Kim, a molecular nutrition researcher who studies how fat cells develop in the body, and colleagues, focused on daidzein, one of the two main isoflavones found in soy. Many epidemiological observations and human clinical studies have shown that adding soy to one's diet is associated with lower diabetes risk and improved insulin sensitivity, as well as lower cardiovascular disease risk, Kim notes. However, until now the direct target tissue and molecular pathways by which soy exerts its anti-diabetic effects was not clearly understood.

Kim and colleagues at Southern Illinois University, with others at the universities of Tennessee and Florida, had earlier found that dietary isoflavones reduced the severity of diabetes in an animal model of the disease by increasing the activity of certain transcription regulators in the fat tissue. For the current study, they hypothesized that daidzein and its metabolite, equol, are part of this activation process.

They found that daidzein and equol enhanced adipocyte differentiation, or the formation of fat cells, through activation of a key transcription regulator, the same receptor that mediates the insulin-sensitizing effects of anti-diabetes drugs. Thus, daidzein and equol daidzein and equol seem to work in a similar manner as anti-diabetic drugs currently in the market. Their findings are reported in a September online version of the Journal of Nutritional Biochemistry.

"Our results suggest that soy isoflavones exert anti-diabetic effects by targeting fat cell-specific transcription factors and the downstream signaling molecules that are important for glucose uptake and thus insulin sensitivity," Kim notes. "The new findings help us to understand the cellular mechanisms." That is, how these biologically active compounds in soy interact to regulate and initiate metabolic and biological functions.

Results demonstrate that daidzein and equol enhance adipocyte differentiation by activating a specific receptor. The downstream responses include increased expression of three proteins, resulting in enhanced glucose uptake and insulin sensitivity.

"Although some details remain to be worked out, our data provide an additional molecular basis for the mechanism of insulin-sensitizing action by soy isoflavones," says Kim. "These new findings help fill a critical gap between epidemiological observations and clinical studies on the anti-diabetic benefits of dietary soy."

Future studies will extend the work to primary cultures of human cells through collaboration with researchers at Pioneer Valley Life Science Institute and Baystate Medical Center in Springfield. If replicated, studies can move on to further work in whole body systems.

October 2, 2009 (Newswise) - More than 18-million people in the United States, or 6.3% of the population, have diabetes, according to the American Diabetes Association.Unfortunately, when someone becomes diabetic, chronic non-healing wounds often develop, most often in the legs and feet. These wounds can be uncomfortable and even life-threatening.

There are many types of treatments. One of the most painless and successful is hyperbaric oxygen therapy (HBOT).

Hyperbaric oxygen therapy is a specialized medical treatment inside a pressurized chamber, in which a patient breathes 100 percent oxygen at greater than normal atmospheric pressure.
The Center for Wound Care at Northwest Hospital in Randallstown, Maryland uses HBOT to treat stubborn, non-healing diabetic ulcers.

When the oxygen, which is delivered into the bloodstream, it helps fight certain infections and stimulates the growth of new blood vessels, which generally improves circulation.

"Patients receiving HBOT can see dramatic results as early as two weeks from the start of treatment.
"Another big benefit is that this therapy is noninvasive," says Alan S. Davis, M.D., F.A.C.S, director of the Center for Wound Care and HBOT at Northwest Hospital. "If standard wound therapies prove to be inadequate within a certain time frame, HBOT should be considered and can be done at the same time patients are receiving other treatment."

Once the patient is comfortably positioned inside the HBOT chamber, air pressure is gradually increased.

A patient may experience fullness in the ears as a result. However, a technician instructs him or her about how to help clear the pressure and relieve any discomfort.

Most treatment sessions in the chamber last approximately two hours. During this time, patients watch TV or videos, relax or sleep.

In addition to treating diabetic wounds, HBOT also treats osteomyelitis, post-radiation complications and compromised skin flaps, among other things.

The HBOT program at Northwest Hospital has earned accreditation from the influential Undersea and Hyperbaric Medical Society. Fewer than 100 programs in the United States have achieved this designation.

September 28, 2009 (EurekAlert) - Diabetes increases by 26 percent the likelihood that women will develop atrial fibrillation (AF), a potentially dangerous irregular heart rhythm that can lead to stroke, heart failure, and chronic fatigue. These are the findings of a new Kaiser Permanente study, published in the October issue of Diabetes Care, a journal of the American Diabetes Association.While other studies have found that patients with diabetes are more likely to have AF, this is the first large study-involving nearly 35,000 Kaiser Permanente patients over the course of seven years-to isolate the effect of diabetes and determine that it is an independent risk factor for women.

"The most important finding from our study is that women with diabetes have an increased risk of developing this abnormal heart rhythm," said the study's lead author, Greg Nichols, PhD, investigator at the Kaiser Permanente Center for Health Research in Portland, Ore. "Men with diabetes are also at higher risk, but the association between the two conditions is not as strong. For men, obesity and high blood pressure are bigger risk factors from diabetes."

"AF is the most common arrhythmia in the world, and diabetes is one of the most common and costly health conditions. Our study points out that there is a connection between these two growing epidemics-one we should pay closer attention to, especially among women," says Sumeet Chugh, MD, co-author and associate director of the Cedars-Sinai Heart Institute in Los Angeles. "The gender differences need to be looked at more closely because they could have significant implications for how we treat diabetes in men and women."

Atrial fibrillation occurs when the two upper chambers of the heart beat irregularly and too fast, causing blood to pool and clot. If the clot travels out of the heart and becomes lodged in an artery or in the brain, it can cause a stroke. About 2.2 million Americans are diagnosed with AF; however, many more people have the condition but don't know it. Diabetes affects more than 23 million Americans-and, according to the study, nearly 4 percent, or 1 million, have atrial fibrillation.

The study involved 17,372 patients in Kaiser Permanente's diabetes registry in Oregon and Washington and an equal number of non-diabetic patients, matched for age and sex. Researchers used Kaiser Permanente HealthConnect®, the world's largest civilian electronic health records system, to identify the non-diabetic patients. The two groups were followed for an average of 7.2 years until Dec., 31, 2008, or until they died or left the health plan. At the start of the study 3.6 percent of the patients with diabetes had AF, vs. only 2.5 percent of the non-diabetic patients-a difference of 44 percent. During the study period, diabetics were more likely than non-diabetics to develop AF. But after controlling for other factors like obesity, high blood pressure and age, the increased risk was only significant among women. Women with diabetes were 26 percent more likely than their non-diabetic counterparts to develop AF.

September 28, 2009 (EurekAlert) - Current research suggests that the inflammatory molecule TNF-α may contribute to delayed bone fracture healing in diabetics. The related report by Alblowi et al, "High Levels of TNF-α Contribute to Accelerated Loss of Cartilage in Diabetic Fracture Healing" appears in the October 2009 issue of the American Journal of Pathology.Diabetes, a condition where the body either does not produce enough, or respond to, insulin, affects at least 171 million people worldwide, a figure that is likely to double by 2030. Long-term complications of diabetes include cardiovascular disease, chronic renal failure, retinal damage that may lead to blindness, nerve damage, and blood vessel damage, which may cause erectile dysfunction and poor wound healing.

Diabetic patients often experience low bone density, which is associated with increased risk of bone fractures and delayed fracture repair. To examine how diabetes affects bone, Dr. Dana Graves and colleagues of the University of Medicine and Dentistry of New Jersey and the Boston University School of Medicine explored bone repair in a mouse model of diabetes. They observed increased levels of inflammatory molecules, including TNF-α during fracture healing. The diabetic animals had rapid loss of cartilage in the healing bones, which was due to increased numbers of osteoclasts, cells that remove bone and cartilage. Factors that stimulate osteoclast formation were regulated by both TNF-α and a downstream mediator, FOXO1. These results suggest that diabetes-mediated increases in TNF-α and FOXO1 may underlie the impaired healing of diabetic fractures.

Alblowi et al suggest that "TNF-α dysregulation plays a prominent role in the recently identified catabolic events associated with diabetic fracture healing." In future studies, Dr. Graves and colleagues plan to "examine the effect of FOXO1 on mineralized tissue to examine how it may regulate factors that control bone resorption and osteoclastogenesis, in addition to effects it may have on osteoblastic cells."

September 21, 2009 (EurekAlert) - Middle-aged women with large abdominal fat cells have a higher risk of developing type 2 diabetes later in life compared to women with smaller fat cells. Waist circumference divided by body height can also be used to determine which women are at risk. This is shown in a new study from the Sahlgrenska Academy at the University of Gothenburg, Sweden.The study, which will be published in the next issue of the scientific journal FASEB Journal, is based on the extensive population study of women in Gothenburg Kvinnoundersökningen i Göteborg.

'The results indicate that large fat cells contribute to the development of type 2 diabetes, and we will now begin investigating the mechanisms behind this finding. Increased knowledge about large fat cells and their effects may lead to new preventive and therapeutic alternativs, says Malin Lönn, associate professor in experimental medicine at the Sahlgrenska Academy.

The researchers analysed data on cell size collected from 245 women in 1974-75, and found that the 36 women who developed diabetes over the course of 25 years had larger abdominal fat cells than those who did not develop the disease. The larger the fat cells, the larger the probability of developing type 2 diabetes. Since a person's fat cells vary significantly in size, the researchers used an average for each person.

In addition, the study reveals a simpler and faster way to predict which women are at risk of developing type 2 diabetes: waist circumference divided by body height.

'Our study suggests that this ratio may be even better than fat cell size at estimating who is at risk of developing type 2 diabetes. The higher the waist-to-height ratio, the higher the risk', says Lönn.

The study is based on Kvinnoundersökningen i Göteborg, which was started in 1968 by Professor Emeritus Calle Bengtsson. Since the start, almost 1500 women aged 38-60 have been interviewed about their lives and examined by a physician regularly. New women have been recruited over the years, making it possible to both follow a generation over time and compare different generations.

September 17, 2009 (Newswise) - n innovative drug-delivery system - nanoparticles encapsulating nitric oxide or prescription drugs - shows promise for topical treatment of erectile dysfunction (ED), according to a new study by scientists at Albert Einstein College of Medicine of Yeshiva University.The new system, tested successfully on a small number of animals, could potentially prevent side effects associated with oral ED medications, if study results can be replicated in humans. That could mean safer and more effective ED therapy for millions of men with heart disease and other health problems affecting erectile function. The study is published today in the online edition of the Journal of Sexual Medicine.

Tens of millions of men worldwide have benefited from oral ED medications such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis). However, these medications - which belong to a class of drugs called phosphodiesterase type 5 (PDE5) inhibitors - have limitations. They can cause systemic side effects that can be serious. These side effects include headache, facial flushing, nasal congestion, upset stomach, abnormal vision as well as isolated reports of hearing and vision loss. Men who've recently suffered a heart attack or stroke or have severe heart disease should use these drugs with caution or not at all. In addition, "an estimated 30 to 50 percent of men with ED do not respond to oral use of PDE5 inhibitors," says senior author Kelvin P. Davies, Ph.D., associate professor of urology at Einstein.

The drug-delivery system, developed by Einstein scientists, consists of nanoparticles - each smaller than a grain of pollen - that can carry tiny payloads of various drugs or other medically useful substances and release them in a controlled and sustained manner.

The limited number of topical formulations of ED drugs has so far proven ineffective. This study was done to evaluate whether the Einstein nanoparticles, which have been shown to penetrate the skin, might allow the targeted delivery of compounds that treat ED and thereby avoid the drugs' systemic effects.

An effective topical therapy could be especially significant for those ED patients - particularly men with diabetes - who have reduced levels of nitric oxide (NO), the signaling molecule that dilates blood vessels responsible for erectile activity. These men, who often aren't helped by oral PDE5 inhibitor drugs, may benefit from direct application of NO or the PDE5 inhibitors.

The nanoparticles were tested on a total of 18 rats bred to have age-related ED. The rats were divided into three treatment groups. One group of seven rats received nanoparticles encapsulating NO. A second group of five rats received nanoparticles encapsulating NO plus an experimental ED drug called sialorphin (which has a mechanism of action different from PDE5 inhibitors). A third group of six received nanoparticles encapsulating NO plus tadalafil (Cialis).

Five of the seven rats treated with the NO-containing nanoparticles, and all 11 rats treated with nanoparticles encapsulating NO plus sialorphin or tadalafil showed significantly improved erectile function. None of the seven rats in a control group, which received empty nanoparticles, showed any improvement.

"Most of the animals, nearly 90 percent, showed a response to treatment with the nanoparticles," says co-author Joel M. Friedman, M.D., Ph.D., professor of physiology & biophysics and of medicine. Dr. Friedman developed the nanoparticles with his son Adam Friedman, M.D., chief resident in the division of dermatology of the department of medicine at Montefiore Medical Center, The University Hospital and Academic Medical Center for Einstein.

"The response time to the nanoparticles was very short, just a few minutes, which is basically what people want in an ED medication," adds Dr. Davies. "In both rats and humans, it can take 30 minutes to one hour for oral ED medications to take effect."

Postmortem examination of the tissues at the site of administration showed no signs of local inflammation or toxicity. "In addition, when we applied the nanoparticles at therapeutic doses, we found no indication of systemic side effects," says Dr. Friedman.

The Einstein research team will carry out safety and dosing studies in rats in the coming months. Clinical studies on humans could begin in a few years if animal studies continue to show that the nanoparticle delivery system is safe and effective. But the investigators caution that the time from a proof-of-concept trial in animals to approved use in humans may be a decade or more.

The paper, "Nanoparticles as a novel delivery vehicle for therapeutics targeting erectile dysfunction," is published in the September 18, 2009 online edition of the Journal of Sexual Medicine. The lead authors are George Han, an M.D.-Ph.D. student at Einstein, and Moses Tar, M.D., assistant professor of urology at Einstein. Dwaraka Srinivasa Rao Kuppam, a technician in the Einstein urology department, Adam Friedman, M.D., of Montefiore Medical Center, and Arnold Melman, M.D., chairman of urology at Einstein, also contributed to the research.

September 3, 2009 (Newswise) - People with type 2 diabetes are not consuming sufficiently healthy diets and could benefit from ongoing nutritional education and counseling, according to a new study by researchers at Wake Forest University School of Medicine and colleagues.The study appears in the August issue of the Journal of the American Dietetic Association.

"The most important thing about controlling diabetes, especially type 2 diabetes, is being able to manage energy in and energy out, and the best way to do that is through the diet," said Mara Z. Vitolins, Dr.P.H., M.P.H., R.D., lead author on the study and an associate professor in the department of epidemiology and prevention, part of the School of Medicine's Division of Public Health Sciences.
The study was done to see what people with type 2 diabetes were eating to make them overweight, Vitolins said. The results were surprising, she added, because researchers found that a majority of the group was not meeting food intake recommendations outlined in national dietary guidelines.

"I thought we were going to find people who, because they have a chronic disease, were more educated about and more motivated than the average American to eat healthy, but that's not the case," she said.
For the study, researchers used a detailed survey to assess the regular food consumption of 2,757 people with type 2 diabetes as they entered into a national study evaluating the effects of a lifestyle intervention, involving weight loss and physical activity, on cardiovascular disease. The goal was to find out what the participants were eating on a regular basis that led them to being overweight before any intervention.

The study showed that 93 percent of participants exceeded the recommended percentage of daily calories from fat, 85 percent exceeded the saturated fat recommendation and 92 percent consumed too much sodium in their regular diets. Additionally, less than half of the participants met the minimum recommended daily servings of fruits, vegetables, dairy products and grains based on the year 2000 version of the Food Guide Pyramid recommendations. Intake of diets rich in fruits and vegetables have been shown to prevent heart disease, the leading cause of death in people with type 2 diabetes.

"The way that the 2000 food guide pyramid was set up is really clever," Vitolins said. "It was meant to be a visual reminder that if you take out one of the blocks, or food groups - if you're missing any of the bricks - the pyramid collapses. It just crumbles. It's important that people with type 2 diabetes follow the recommendations. They can't afford to let their pyramids fall."

Only a limited number of participants met nutrient intake recommendations for total fat, saturated fat, sodium and fiber. Overall, the participants consumed a diet that provided approximately 44 percent of calories from carbohydrates, 40 percent from fat and 17 percent from protein.

Optimizing control of blood sugar, lipids, blood pressure and weight in people with type 2 diabetes is essential to reduce the risk for long-term complications and chronic disease, including cardiovascular disease. Consuming a low-saturated fat, high-fiber diet that includes high quality, nutrient-dense foods can aid in achieving and maintaining that type of metabolic control. Evidence-based nutrition principles and recommendations, as well as national guidelines, have been established to help inform and educate the public on healthy eating practices. Still, the study showed that these participants fell short of consuming foods that would help them meet those guidelines.

"It would seem likely that participants who had managed diabetes over a greater length of time would be more likely to understand the importance of consuming a healthful diet, but this was not supported by the data," the researchers wrote.

"The findings clearly illustrate a need to provide ongoing nutrition education for people with diabetes regardless of the amount of time they've had the disease," Vitolins said. "We can't continue to assume that people know how to follow an eating pattern that is healthy if they have type 2 diabetes. These people have, within their cupboards and refrigerators, the potential to really manage their diabetes well. Day to day, the foods they are eating should be considered a vital part of their treatment."

Additionally, Vitolins added, research efforts are needed to better understand the types of barriers that overweight people with type 2 diabetes face in their attempts to consume a healthy diet.

Co-authors on the study were Andrea M. Anderson, M.S., of the School of Medicine; Gary D. Miller, Ph.D., R.D., of Wake Forest University; Linda Delahanty, M.S., R.D., of Massachusetts General Hospital Diabetes Center; Hollie Raynor, Ph.D., of the University of Tennessee-Knoxville; Connie Mobley, Ph.D., R.D., of the University of Nevada-Las Vegas School of Dental Medicine; Rebecca Reeves, Ph.D., R.D., of Baylor College of Medicine; Monica Yamamoto, Ph.D., R.D., of the Public Health University of Pittsburgh Graduate School; Catherine Champagne, Ph.D., R.D., of Pennington Biomedical Research Center; Rena R. Wing, Ph.D., of Brown University; Elizabeth Mayer-Davis, Ph.D., R.D., of the University of North Carolina-Chapel Hill; and the Look AHEAD Research Group.

September 2, 2009 (Newswise) - The Peripheral Arterial Disease (P.A.D.) Coalition has launched a petition drive at padcoalition.org to urge President Obama and Congress to increase access to evidence-based health care for individuals with P.A.D.Approximately 9 million Americans, including 1 in 5 men and 1 in 6 women in the Medicare population, have P.A.D. or clogged arteries of the legs. P.A.D. is a red flag that other arteries, including those in the heart and brain, are likely affected - increasing the risk of a heart attack, stroke and even death. It can also cause leg pain when walking and lead to disability, amputation, and poor quality of life.

Fortunately, heart attacks, strokes and deaths can be reduced and quality of life improved through the use of therapies recommended in national cardiovascular guidelines. However, many Americans with P.A.D. don't receive this care until it's too late.

"We have a system that will pay to treat a heart attack or an amputation caused by P.A.D., but will not pay for a simple, non-invasive test to diagnose P.A.D. in those at highest risk for having the disease," stated Joshua Beckman, MD, Assistant Professor of Medicine, Harvard Medical School and Chair, P.A.D. Coalition's Advocacy Committee. "It is critical that individuals with P.A.D. be identified so that cardiovascular risk reduction therapies can be initiated and lives can be saved."

P.A.D. is easily diagnosed through the ankle-brachial index (ABI), a non-invasive, cost-effective test that compares the leg blood pressure to arm blood pressure. Medicare currently offers P.A.D. testing for patients with leg symptoms, however, P.A.D. is most often asymptomatic. P.A.D. care guidelines developed by leading vascular groups recommend testing in individuals at highest risk for having the disease, including adults over age 50 with a history of diabetes or smoking and all adults over 70 years of age.

The P.A.D. Coalition aims to collect at least ten thousand signatures and will deliver the petition to Congressional leadership.

To sign the petition, go to www.padcoalition.org/petition and complete the online form.

August 18, 2009 (Newswise) - Medicare patients with heart conditions and diabetes, or who require cancer screenings, are getting better treatment than ever at the University of Michigan Health System and that care is costing less, according to a new report.These results come from the third year of a five-year national project undertaken by 10 large physician groups, including the U-M Faculty Group Practice.

The results were announced today in Washington, D.C., by the Centers for Medicare and Medicaid Services. CMS oversees the Medicare system and launched this demonstration project to promote investment in care management programs and redesigned care processes that might be used by doctors and hospitals nationwide.

U-M achieved both of the project's aims: to provide the highest-quality care and reduce health care spending growth for all traditional Medicare patients, including those with costly chronic illnesses.
U-M's performance was better than the CMS targets for 29 of the 32 quality measures tracked in the third year of the project. The quality measures focused on diabetes, congestive heart failure, coronary artery disease, hypertension, and breast and colorectal cancer screenings.

In addition, U-M provided care for these Medicare patients at a lower cost than the CMS target, saving Medicare $2.9 million that would have otherwise been spent on the care of U-M patients in that year.

This is the third year in a row that U-M has achieved both sizable savings and high scores on health care quality benchmarks as part of the project. Two more years of data remain to be collected and analyzed.

The U-M Faculty Group Practice, part of the U-M Medical School, includes all of the nearly 1,600 U-M faculty physicians who care for patients at the three U-M hospitals and 40 U-M health centers.
Many of the programs and innovations that U-M has put in place for this project involve not only physicians but also pharmacists, nurses, social workers, care managers and others who are involved in the care of Medicare patients at all U-M facilities.

The report is based on data from 18,000 Medicare participants who received most of their care at U-M during the 12-month period that began April 1, 2007.

It does not include those who were enrolled in a Medicare Advantage plan offered by a private health plan, nor Medicare participants who received only limited care at U-M. But the improvements made for the project are helping other patients as well.

"The U-M Faculty Group Practice invested significant time and resources in this project because it provided the opportunity to develop and test potential interventions that could improve clinical outcomes and reduce costs for patients with chronic disease," says David Spahlinger, M.D., senior associate dean for clinical affairs. "Our investments have enabled better coordination of care."

The project's formal name is the Medicare Physician Group Practice Demonstration Project. It is Medicare's first Pay-for-Performance Demonstration Project to work directly with physician groups.
It began by focusing on the quality of care of patients with diabetes, but was expanded in its second year to include congestive heart failure and coronary artery disease - both chronic heart conditions that carry a very high risk of emergency hospitalization and other higher-cost care if not managed appropriately. In the third year, the program was further expanded to include hypertension - another high-risk and costly condition - and breast and colorectal cancer screenings.

Project leader Caroline Blaum, M.D. - associate professor of internal medicine, associate chief of geriatric medicine and a research scientist at the VA Ann Arbor Healthcare System - says the project results provide important input for the national debate on health care cost and quality.

"There are plenty of opportunities to squeeze costs out of the system while also improving quality of care. For example, focusing on how patients transition between care settings and proactively reaching out to ensure they understand the information provided and the next steps can make a substantial impact," she says.

During the three years it has participated in the project, U-M has launched a number of new programs to help improve care for all patients seen at U-M. The U-M Faculty Group Practice was one of the first in the project to implement transitional care programs designed to assist patients with hospital discharge information and follow-up activity.

U-M has also implemented complex care coordination programs designed to reduce unnecessary treatments, readmissions, handoffs and wait times, as well as a medical home program where a patient and his/her personal physician partner to identify, provide, and coordinate all needed services across multiple locations and settings.

U-M's Faculty Group Practice is the only organization in Michigan taking part in the project. It was chosen for several reasons, including demonstrated success in chronic care management, diabetes quality and organizational structure.

August 17, 2009 (Newswise) - The Society for Vascular Surgery® (SVS) represents more than 3,000 practicing vascular surgeons in the United States, dedicated to the prevention and management of vascular disease. The Society is responding to President Barack Obama's remarks on August 11, 2009 at a town hall meeting in New Hampshire. President Obama stated "Right now if we paid a family - if a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they're taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that's $30,000, $40,000, $50,000 - immediately the surgeon is reimbursed." This statement obviously does not accurately reflect the actual reimbursement to the surgeon for this procedure; surgeons receive reimbursement of less than $1,000, which includes follow-up care provided for 90 days after the operation. Furthermore, surgeons perform amputations only as last resort in an effort to save a patient's life, when and only when all attempts at limb salvage are exhausted.SVS is dismayed by those remarks. As vascular surgeons, we have the privilege of caring for a large number of Medicare beneficiaries. We perform minimally invasive intervention and bypass procedures to improve circulation to the lower extremities, thereby preventing amputation in many situations. While caring for their patients, SVS members attempt to use the best available medical evidence on which to make treatment recommendations. Since questions remain regarding optimal treatment of some forms of advanced vascular disease, SVS supports the efforts of the Administration to fund comparative effectiveness research; SVS published a position paper to this effect in the Journal of Vascular Surgery®.

SVS agrees with the Administration that prevention is an important part of health care reform. There is little doubt that death and disability caused by many forms of vascular disease could be alleviated with improved preventive measures such as smoking cessation, better diabetes management, and lipid control. In addition, thousands of Medicare beneficiaries die needlessly each year from ruptured abdominal aortic aneurysms. The Medicare screening benefit for aortic aneurysm is so restrictive that the great majority of at-risk beneficiaries are not eligible for this preventive benefit. We urge the Administration to work with Congress to eliminate the barriers to appropriately target aortic aneurysm screening. Lastly, SVS urges the Administration to include tort reform as a means of controlling health care spending.