TASK DEFINITION: Given a paragraph, generate a claim that is supported by the given paragraph. 1) The claim must contain information from within the paragraph. 2) A sentence within the paragraph can be used as a claim. 3) The claim should not have contradictions within the paragraph. 4) The claim should be at most one sentence long.
PROBLEM: That could all change with a controversial Nov. 4 ballot initiative in which voters will get to decide for the first time whether to abolish a 1963 state law designed to protect small businesses. The law requires North Dakota pharmacies to be owned by local pharmacists or run by hospitals with a local pharmacist on staff. Supporters of the initiative argue it will remove an embarrassing anachronism, give consumers more choice and lower prescription drug costs. Opponents say that allowing national chains would destroy North Dakota’s tradition of personalized pharmacy care and be yet another example of how the state’s neighborly way of life is changing too fast. Canada, Germany, France and many other countries, they also note, have similar laws requiring local pharmacy ownership. “Independent pharmacies are more apt to focus on customer service,” said Gabe Gretz, who bought Service Drug Pharmacy in Williston last year with his father. “This is our bread and butter. It’s not just a hobby for us.”  “North Dakota Nice” is a truism here, not an irony, and most retail stores are still prohibited from opening before noon on Sunday - a throwback to laws designed to encourage family time. Yet since the oil boom began around 2010, drawing thousands of new residents to jobs where roughnecks can earn more than $100,000 a year, drug use, assault and other violent crimes have jumped. Recent sex-trafficking charges brought against an oil field worker in Williston, a once quiet town that is now the epicenter of the boom, marked the first charges of that type ever filed in the area and has escalated tension between new and old residents. Many newly arrived oil workers, and even some locals, say they hope the ballot measure passes so that they can use the  same chains they’ve grown accustomed to elsewhere. Rite Aid Corp has no outpost in the state, North Dakota’s Walmarts have no in-store pharmacies and the state’s lone Walgreens, on the Minnesota border, is prohibited from selling prescription drugs. CVS is able to operate only a handful of pharmacies in North Dakota thanks to a 2006 buyout of several Osco Drug stores that operated before the 1963 law. “Honestly, it’s not convenient getting my prescriptions here,” said Jan Anseth, a resident of Williston who spends winters in Arizona where she gets her medications from a national chain. In North Dakota, Anseth says, she runs into problems transferring prescriptions and getting anything more than a 30-day supply. The ballot’s primary sponsor, North Dakotans For Lower Pharmacy Prices, was funded with $168,000 in contributions from Walmart, Walgreens, Kmart and others. In campaign materials, the group cites data the Kaiser Family Foundation compiled in 2009 showing North Dakota has one of the highest per capita costs for prescription drug and medical devices in the country. Walmart says North Dakotans are missing out on its popular $4 prescription program, which makes many generic drugs available at the sharply discounted price. Crying foul, the state’s independent pharmacists say they’re able to often meet or beat prices from national chains, most of whom lose money on pharmacy sales as a way to get customers in the door. A random survey by Reuters of North Dakota’s independent pharmacies showed that a 30-day supply of the generic blood thinning drug clopidogrel ranged in price between $10 and $59.95. A CVS in Bismarck, the state capital, quoted a price of $149.95 for the same dosage. “I get to set the prices here at my pharmacy,” said Jenna Wahlstrom, a pharmacist at Larsen Service Drug, which her grandfather founded in Watford City in 1952. “It’s not a corporate decision.”  Like the big chains, Wahlstrom offers her customers a smartphone app and online refill ordering. Her pharmacy has transferred hundreds of prescriptions from retail chains for workers who have moved to the state, she said. Ahead of the vote, the state’s top politicians are declining to take sides. Governor Jack Dalrymple, a Republican who took office in 2010, says he shops at locally owned Aerohead Plaza Drug while in Bismarck and believes it has been able to compete effectively with the nearby CVS. Yet in the 1990s, as a state legislator, Dalrymple voted to keep the pharmacy law intact. “I don’t know,” he now says, “if that was the right vote.”

SOLUTION: Big pharmacies knock on door of oil-rich North Dakota.

PROBLEM: The verdict in the lawsuit brought by the California woman, Eva Echeverria, marks the largest sum awarded in a series of talcum powder lawsuit verdicts against Johnson & Johnson in courts around the U.S. Echeverria alleged Johnson & Johnson failed to adequately warn consumers about talcum powder’s potential cancer risks. She used the company’s baby powder on a daily basis beginning in the 1950s until 2016 and was diagnosed with ovarian cancer in 2007, according to court papers. Echeverria developed ovarian cancer as a “proximate result of the unreasonably dangerous and defective nature of talcum powder,” she said in her lawsuit. Echeverria’s attorney, Mark Robinson, said his client is undergoing cancer treatment while hospitalized and told him she hoped the verdict would lead Johnson & Johnson to put additional warnings on its products. “Mrs. Echeverria is dying from this ovarian cancer and she said to me all she wanted to do was to help the other women throughout the whole country who have ovarian cancer for using Johnson & Johnson for 20 and 30 years,” Robinson said. “She really didn’t want sympathy,” he added. “She just wanted to get a message out to help these other women.” The jury’s award included $68 million in compensatory damages and $340 million in punitive damages, Robinson said. The evidence in the case included internal documents from several decades that “showed the jury that Johnson & Johnson knew about the risks of talc and ovarian cancer,” Robinson said. “Johnson & Johnson had many warning bells over a 30 year period but failed to warn the women who were buying its product,” he said. Johnson & Johnson spokeswoman Carol Goodrich said in a statement that the company will appeal the jury’s decision. She says while the company sympathizes with women suffering from ovarian cancer that scientific evidence supports the safety of Johnson’s baby powder. The verdict came after a St. Louis, Missouri jury in May awarded $110.5 million to a Virginia woman who was diagnosed with ovarian cancer in 2012. She had blamed her illness on her use of the company’s talcum powder-containing products for more than 40 years. Besides that case, three other trials in St. Louis had similar outcomes last year — with juries awarding damages of $72 million, $70.1 million and $55 million, for a combined total of $307.6 million. Another St. Louis jury in March rejected the claims of a Tennessee woman with ovarian and uterine cancer who blamed talcum powder for her cancers. Two similar cases in New Jersey were thrown out by a judge who said the plaintiffs’ lawyers did not presented reliable evidence linking talc to ovarian cancer. More than 1,000 other people have filed similar lawsuits. Some who won their lawsuits won much lower amounts, illustrating how juries have wide latitude in awarding monetary damages. Johnson & Johnson is preparing to defend itself and its baby powder at upcoming trials in the U.S., Goodrich said. ___ Associated Press writer Amanda Lee Myers contributed to this report. ___ Follow Michael Balsamo on Twitter at http://twitter.com/MikeBalsamo1 .

SOLUTION: Record $417M award in lawsuit linking baby powder to cancer.

PROBLEM: Clearly, the costs involved in cancer treatment already are high. By removing a layer of treatment from an estimated 40,000 patients, those costs would have to drop, but it is unclear from the story by how much. Also, it would have been worth mentioning whether this is likely to affect how insurance companies handle lymph node removals. The story did a good job providing some numbers on benefits, but we wish it had provided more and explained some things a bit more. It says, for example, “In 27 percent of the women who had additional nodes removed, those nodes were cancerous.” How many women had additional nodes removed and, of those, how many had cancerous nodes? A figure like 27% means 1 out of every 4 women had nodes that were, indeed, cancerous, which seems to conflict with other statements in the story about chemotherapy and radiation wiping out the cancer. The story discusses several harms from lymph node removal, and shows that the difference in survival for women who had nodes removed and those who did not was not significant. “Indeed, women in the study who had the nodes taken out were far more likely (70 percent versus 25 percent) to have complications like infections, abnormal sensations and fluid collecting in the armpit. They were also more likely to have lymphedema.” This is where the story really outperformed some of the competition covering the same news. It placed the study into the broader context of a movement in cancer care away from surgeries that don’t provide a clear benefit, and it also explained the study design and the limitations of the study in several ways. “The study, at 115 medical centers, included 891 patients. Their median age was in the mid-50s, and they were followed for a median of 6.3 years. … One potential weakness in the study is that there was not complete follow-up information on 166 women, about equal numbers from each group. The researchers said that did not affect the results. A statistician who was not part of the study said the missing information should have been discussed further, but probably did not have an important impact. It is not known whether the findings also apply to women who do not have radiation and chemotherapy, or to those who have only part of the breast irradiated. Nor is it known whether the findings could be applied to other types of cancer.” It was too bad that it did not mention limitations in terms of lack of enrollment. The targeted enrollment was 1900. There also was an imbalance in the randomization that should have been mentioned. The story is careful to explain to readers that the research findings only apply to a subset of women with breast cancer. “Now, researchers report that for women who meet certain criteria — about 20 percent of patients, or 40,000 women a year in the United States — taking out cancerous nodes has no advantage. It does not change the treatment plan, improve survival or make the cancer less likely to recur. And it can cause complications like infection and lymphedema, a chronic swelling in the arm that ranges from mild to disabling.” The Q&A that ran with the story provided more detail about the different types of cancers and cancer patients, noting, for example, “First of all, 20 percent (the estimate of the study’s lead author, Dr. Armando E. Giuliano) refers to 20 percent of all the newly diagnosed cases of invasive breast cancer each year. This does not include noninvasive breast cancer, or DCIS, ductal carcinoma in situ. The total is about 207,000, so 20 percent is roughly 40,000 women. That is about how many women would match those in the study, in terms of tumor status, affected lymph nodes and course of treatment.”  The story also says, “The results mean that women like those in the study will still have to have at least one lymph node removed, to look for cancer and decide whether they will need more treatment. But taking out just one or a few nodes should be enough.” Good quotes including from Dr. Monica Morrow, chief of the breast service at Sloan-Kettering and an author of the study, but also a few fromindependent experts toward the end. Dr. Grant W. Carlson, a professor of surgery at the Winship Cancer Institute at Emory University, and the author of an editorial accompanying the study, provides some soul-searching context by saying that, in taking out so many lymph nodes, “I have a feeling we’ve been doing a lot of harm.” Dr. Elisa R. Port, the chief of breast surgery at Mount Sinai Medical Center in Manhattan, said, “It’s definitely practice-changing.” And Dr. Alison Estabrook, the chief of the comprehensive breast center at St. Luke’s-Roosevelt hospital in New York said, “In the past, surgeons thought our role was to get out all the cancer. … Now he’s saying we don’t really have to do that.” The story does a great job explaining the history of this form of treatment and how it has evolved over time. “But doctors have continued to think that even microscopic disease in the lymph nodes should be cut out to improve the odds of survival. And until recently, they counted cancerous lymph nodes to gauge the severity of the disease and choose chemotherapy. But now the number is not so often used to determine drug treatment, doctors say. What matters more is whether the disease has reached any nodes at all. If any are positive, the disease could become deadly. Chemotherapy is recommended, and the drugs are the same, no matter how many nodes are involved.” The story goes on to do something that stories like this rarely do, it compares compares the harms from different forms of treatment, saying “After armpit surgery, 20 percent to 30 percent of women develop lymphedema, Dr. Port said, and radiation may increase the rate to 40 percent to 50 percent. Physical therapy can help, but there is no cure.” The story makes it clear that removing all under-arm lymph nodes is the standard of care for women with breast cancer and that feelings about that standard are entrenched. The story establishes that a change in treatment protocol away from removing all the lymph nodes under the arms of women with breast cancer would be novel. There is some nuance, here, though that could be missed by a casual reader. Women who have one to two positive lymph nodes would avoid having additional lymph node surgery. The overall tone of the story may make it appear to some readers that women get to avoid lymph node surgery altogether, but they don’t. The story goes well beyond any news release.

SOLUTION:
Lymph Node Study Shakes Pillar of Breast Cancer Care