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Any sweeping changes in the way ulcer and heartburn drugs are paid for could hurt the profits of manufacturers who depend on these highly successful drugs - astrazeneca, wyeth, tap pharmaceutical products, eisai and altana and nicotine. IN RESPONSE: Mr. Joshi and Dr. Miller note that both surgeon- and hospital-specific factors may be important predictors of outcome. The articles by Prystowsky and colleagues 1 ; and Ko and associates 2 ; examined the impact of such factors on short-term outcomes, particularly in hospital morbidity and mortality and length of stay. We were particularly interested in looking beyond short-term end points and examining whether the hospital where a colon cancer resection is performed predicts long-term mortality and cancer recurrences. Of interest, the number of surgeries was associated with overall mortality but not recurrences, suggesting that volume is a surrogate for a long-term outcome unrelated to the patient's colon cancer. In our database, we found no association between a hospital's affiliation with a medical school or the number of trainees at a hospital and either overall mortality or cancer recurrences. We did not have information on individual surgeons, although recent reports have demonstrated conflicting relative importance between hospital and surgeon volumes 3, 4 ; . Furthermore, the recent movements toward regionalization and procedure volume thresholds have focused on hospital procedure volumes, thereby underscoring the need to further understand what such volumes truly mean, for example, .

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