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Acknowledgements The authors thank the Vice-Chancellor for Research and Technology of Kashan University of Medical Sciences and the Research Center for Biochemistry and Nutrition in Metabolic Diseases, Kashan University of Medical Sciences, Kashan, Iran (Grant Number: 98138)

Response: We appreciate MedPAC's concerns, but as MedPAC acknowledges in its comment, the Congress would need to change current law to implement MedPAC's suggestions