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.

The question of cost is cited in the final line of the story, which suggests that the scoring system can “address escalating health care cost issues.” But we didn’t think that was specific enough to warrant a Satisfactory score. The story doesn’t clue readers in to the fact that the financial burden can be measured in billions of dollars — a single screening test recommended for millions of Americans can cost thousands of dollars apiece. The other cost issue specific to this test is that it takes valuable time for providers to retrieve a reputable risk calculator when sitting with a patient and enter in the specific data points, including in this case waist circumference, which clinicians often do not measure as a ‘vital sign’ per se. The story cites a study that credits colonoscopy with reducing the risk of death from colon cancer by about 50 percent, by removing polyps. It would have been helpful for the story to explain what that relative reduction in risk means in absolute terms (e.g. did the rate of cancer death go from 50% to 25% or from 2% to around 1%?) The story also notes that the study found that patients with a low to intermediate risk score “still have a risk between of between 1.9 percent to 9.9 percent of harboring a polyp that can develop into cancer.” We’ll give credit here for the story’s provision of these key statistics, which do give a sense as how well the test accurately identifies truly low-risk individuals. However, we’d note that the benefit here should ideally refer to the ability of the algorithm to classify people at all risk levels (including high-risk), and therefore target the highest-risk patients for colonoscopy. The story doesn’t really get into discussion of the predictive power of the test, referred to as a likelihood ratio, which is in the study manuscript. However, this is a difficult concept for most health care providers and patients, and we think it’s understandable that the story did not include a full discussion of this topic. The harm of a screening test such as this really is “getting it wrong” in terms of predicting someone to be at low risk and finding them to have a higher risk polyp or malignancy. As noted above, the story cautions that “low- to intermediate-risk patients still have a risk between of between 1.9 percent to 9.9 percent of harboring a polyp that can develop into cancer.” This story accurately explains that the research was about predictive modeling, and explains the components of the risk score as well as the study design. There are some cautionary notes in the text, including a statement from outside expert that “the data from this study is not strong enough to spur any changes in current screening recommendations,” an opinion shared by an editorialist on the study. We think this is sufficient for a Satisfactory rating. The story does not hype the incidence or seriousness of the disease. The prevalence statistics cited are consistent with these National Cancer Institute figures. The story contains two independent voices. The perspective they provide is a particular strength of the article. We wish that more stories would reach out to experts not affiliated with the studies being reported on for context. The story notes that a variety of screening tests exist, but the relevant alternative here is actually other risk calculators, which the authors of the study describe and cite but are not routinely used. The story doesn’t mention these other calculators and why they are seldom used — context that would have deepened reader understanding of the issue. Although availability isn’t explicitly addressed, this risk calculator is now available (implicitly) by virtue of publication of the paper. It is a simple scoring system that can be implemented based on the information in the paper, and the story makes this clear. We’ll rate this Satisfactory. The story makes it sound as if this is a first-of-its-kind tool. However, risk calculation tools for colon cancer have been in circulation for many years. We could not find a news release related to this study. But in any case, the comments from two independent experts assure us that the story wasn’t based on a news release.
'Scoring System' May Spot Those in Greatest Need of Colonoscopy; But one expert cautions that even 'low risk' patients can still develop suspicious polyps

The story doesn’t mention cost at all. Since Lucentis can cost $2,000 per injection, that’s a significant oversight. It would also be useful to tell readers how Lucentis injections compare with the cost of laser treatment. The benefits are, for the most part, reasonably well explained. But those explanations lack numbers to back them up and are overstated in at least one place. “One benefit discussed in the release is that study participants who received laser treatment were more likely to suffer peripheral vision loss than participants who were treated solely with Lucentis — although this isn’t quantified. A second benefit was that participants who received laser treatment were more likely to require subsequent surgery to remove blood from the eye — and this was quantified. But the release pushes things a bit when it comes to vision, or visual acuity. The release states: “At two years, vision in the Lucentis group improved by an average of about half a line on an eye chart, compared with virtually no change in the laser group.” But here’s how the journal article puts it: “There was no statistically significant visual acuity difference between the ranibizumab and PRP [laser] groups at 2 years. The language in the journal article itself stresses that what was being evaluated was whether Lucentis was at least as good as laser treatment — and they found that, after two years, the visual acuity of patients who took Lucentis (and had no laser treatment) was as good as patients who had the laser treatment. The release could have simply stated this and avoided confusion. In short, this was a close one — but the lack of numbers on peripheral vision and the overstatement of the visual acuity results make this a “Not Satisfactory.” The release mentions that one study volunteer in the Lucentis group developed an eye infection and stated that “serious systemic adverse events,” namely cardiac arrest and stroke, occurred at similar rates among the two groups undergoing the two different procedures. We’ll rate that satisfactory for the disclosure although the release might have gone even further by mentioning the other side effects named in the study including inflammation and elevated intraocular pressure which occurred in both treatment groups. The release does a good job of describing the study design, the number of participants, and the fact that this was a randomized clinical trial. A few words about the limitations of the study — e.g. the investigators and patients could not be masked to which treatment they were getting, would have be useful as well. No disease mongering here. The release does tell readers that the study was funded by the National Eye Institute. However, it does not make clear that Lloyd Paul Aiello — who is quoted in the release — was also a co-author of the journal article. The release also fails to mention that several co-authors receive research funding or consulting fees from Genentech, which developed ranibizumab and markets it in the U.S., and Novartis, which markets the drug outside the U.S. The release does a good job of comparing Lucentis to conventional laser treatment for PDR and we’ll award a Satisfactory rating on that basis. However, we’d note that these are not necessarily the only two options. Lucentis is classed as an “anti-VEGF” (anti- vascular endothelial growth factor) drug — by blocking a protein called VEGF, the drug can reverse abnormal blood vessel growth and decrease fluid in the retina. Other drugs in this category include Avastin and Eylea. Are those drugs under consideration for trials related to PDR treatment? If so, it’s worth mentioning — particularly since Avastin costs around $60 per dose, as compared to Lucentis’s $2,000 per dose. The release notes that Lucentis is already used to treat other diabetes-related eye problems, and “should be considered a viable treatment option for people with PDR.” The clinical trial at issue here appears to be the first to look at the use of Lucentis as a treatment for PDR, particularly in a randomized study with direct comparison to laser treatment. However, the release doesn’t tell readers that. On the other hand, the release does make clear that this is the first significant advance in clinical treatment for PDR since the 1970s — that’s good context. The release does a good job of avoiding hype and explaining what was a complex study.
Lucentis Proves Effective Against Proliferative Diabetic Retinopathy

“It was great to move out because I have my own life now,” said Gregory, who lives in a Pittsburgh-area development where half of the 42 units are for those diagnosed with autism. “I want to be able to come and go as I please,” said Gregory, who likes to draw and take photographs. The complex, called the Dave Wright Apartments, opened in December and is among innovative housing developments popping up across the U.S. to serve those who were diagnosed with autism as children amid increased awareness about the disorder and changes in how it’s defined. The developments are often spearheaded by parents who see their adult children’s desire for independence and wonder who will care for them in the future. According to the A.J. Drexel Autism Institute, 87 percent of adults with autism live with their parents at some point between high school and their early 20s — a far higher percentage than the general population. “They want to live independently and they want to work. They want to be involved. Right now there are just not enough opportunities for them to do those things,” said Debra Caudy, who is working with her husband on a housing development near Dallas inspired by their 19-year-old autistic son, Jon. Gregory’s mother, Connie, said her daughter is “thriving” in her new home. “I think she realizes that she fits in,” Gregory said. “I don’t know that she would feel as secure anywhere else.” Masha Gregory describes herself as having a “little bit of autism,” along with auditory processing disorder, meaning her ears and brain don’t function well together. Autism impairs one’s ability to communicate and interact with others, but there can be a wide range to the symptoms and severity of the disorder. Symptoms could include not speaking, repeating certain behaviors and not wanting change in daily activities. Some people with autism have signs of lower than normal intelligence, but others have normal to high intelligence. The new crop of developments to accommodate autistic adults is varied. Some are in big cities, others in small towns. Some are like the complex where Gregory has an apartment to herself. Others have homes with shared living areas and private bedrooms and bathrooms. Some just have a person on staff who can offer guidance to residents, while others offer an array of supportive services. “What works for one person doesn’t necessarily work for the other,” said Carolyn Klebanoff, a co-founder of Sweetwater Spectrum, a development featuring four shared homes in Sonoma, California. “Having a whole variety of options out there is critical.” Sweetwater, which opened in 2013, is within walking distance of the town square. It has a community center, farm, greenhouse and pool. The homes have noise-dampening ceilings and quiet heating and air conditioning systems for residents who are hypersensitive to loud sounds. Residents include those like Klebanoff’s 23-year-old daughter who aren’t conversational, as well people with high-functioning autism. “It’s more like just a place to live,” said 24-year-old Sweetwater resident Gwen Fisher, while adding that she appreciates its focus on people with autism. Fisher said she participates in activities offered at Sweetwater but also gets out into the community, including working as a dog walker and volunteering at a food bank and animal shelter. Desiree Kameka, director of community engagement and the housing network at Madison House Autism Foundation in Maryland, said such developments can provide more freedom than group homes, where housing is typically tied to a specific provider of support services. “It gives the people that live there the most flexibility and control,” she said, adding that sometimes group home residents end up being required to all do the same outside activities. Many people with autism don’t qualify for government services once they leave school, she noted, and these developments may help bridge the gap, providing enough support that they can live on their own. “Some of these communities could give people opportunities that they otherwise wouldn’t have: They’d be forced to live with family,” she said. Elliot Frank, president of the nonprofit Autism Housing Development Corporation of Pittsburgh, which was behind the Dave Wright Apartments where Masha Gregory lives, has watched as a community has formed there. Frank said he came up with the concept after hearing a businessman talk about employing autistic adults and wondering where they would live. “The whole concept of what we call disability housing, it’s not what we used to think about,” Frank said. ___ Follow Jamie Stengle on Twitter at https://twitter.com/JamieStengle

Housing options help autistic adults find independence.