Given a paragraph and a claim, classify it this way: If the claim contradicts the evidence present in the paragraph, classify the claim as '0'. If the claim has multiple supporting *AND* contradicting evidences, classify the claim as '1'. If the claim has supporting evidence and the paragraph is in overall favor of the claim, then classify the claim as '2'.

[EX Q]: Paragraph: A price range of $200,000 to $250,000 for the device was included in the story. However, there was no mention of physician fees or hospital stay costs. The longest a patient has lived with device was included in the story, but no range was given for the length of time patients survived with the device for reference. While putting a premium on the “one more Christmas, one more birthday” concept, there was no discussion about the differences in quality of life experienced by the patients receiving the device. Only the results from the longest living recipient of the device were included in the article. For balance, it would have been useful to include the average amount of time that people survived with the device as well as some mention of consequences of the treatment that may affect quality of life. Further, it is hard to predict who will live “less than a month.” It is possible that some recipients may have their life shortened (death in surgery or immediately thereafter). The article mentions that the evidence about the device comes from only 14 patients to date who have had it implanted. No overt disease-mongering, although the story contained no information on the prevelance of heart failure or the percentage of individuals with heart failure for whom this treatment might be considered. The article contained quotes from physicians directly involved in the clinical trial leading to the humanitarian device exemption, family members of patients who had, on balance, positive experiences with the device and the director of the FDA division responsible for the decision. The article would have been improved had it contained the views of some individuals slightly more removed from the device itself to help provide a framework in which to consider the ramifications of this treatment. While mentioning that this device is only for patients with advanced heart failure who have no other options and would otherwise die, the story just three sentences later quotes a surgeon stating that the device’s approval “gives tons of hope to people with end-stage heart failure”. This paints a somewhat unrealistic picture about the limited group of patients for whom the device is an option. In addition to only being intended for those who are not eligible for a heart transplant and who would likely live less than a month without the device, it is only for patients whose chest is large enough to hold the device. Although the story didn’t explain that the device was only approved by the FDA using the “Humanitarian Device Exemption,” it did say that sales of only up to 4,000/yr would be allowed and that it is much more likely that far fewer will be sold. The story also explained that the device will be available at only 5 institutions in the U.S. It is valuable for readers to understand the limited availability of this device for appropriate expectations. The story was clear that only 14 people have received this medical device. The article does not appear to rely exclusively on a press release. However, the quotes attributed to Dr. Daniel Schultz, director of the FDA’s Center for Devices and Radiological Health came from the FDA news release on the device, found at http://www.fda.gov/bbs/topics/NEWS/2006/NEW01443.html. Claim: FDA approves AbioCor heart
[EX A]: 1

[EX Q]: Paragraph: The story makes no mention of costs. Instead by saying, “could be on the market and available for thousands of patients in about five years’ time” it leaves readers with the impression that cost is not an issue. This is exactly the kind of device that an insurance company might put on its “ineligible” list. A quick review of the business media suggests the cost of the device will exceed $75,000 if it becomes commercially available. according to this Medical Device Technology Alert. It is hard to imagine why this important fact was overlooked in the story. Beyond saying in the lead that three people were able to “see shapes and objects,” there is not much else in the story to help readers understand the levels of vision improvements that were seen and how those should be compared to the preexisting conditions or other treatments. Then, confusingly, the story narrows its focus to just one patient saying, “one blind patient who had the device implanted was able to identify and find objects placed on a table in front of him, and was able to walk around a room independently. He could even read a clock face and differentiate between seven shades of grey, the researchers said. Tests were conducted starting from seven to nine days after the device was implanted.” It’s tough when writing a story about a study this small to put hard numbers to the benefits, but even some acknowledgment of this limitation would have been better than some of the overly optimistic sentiments expressed. The study itself and the press released provided more ways for the story to quantify the benefits. The story provides absolutely no information on the implant requirements for the device nor the potential downsides associated with this surgical procedure. There are some caveats tossed into this story, but they can’t overcome the hype. The story says in the lead that the implant “allowed three blind patients to see shapes and objects within days of treatment”. The next sentence says, “Experts described the study results as phenomenal”. The story does deserve credit for saying in the lead that only “three blind patients” saw vision improvement, but the story does little else to describe the limitations of the study or to place it in any context. The story engages in disease mongering by throwing in some sketchy numbers about the frequency of the disease. It says the device “could eventually change the lives of up to 200,000 people worldwide who suffer from blindness due to a degenerative eye disease called retinitis pigmentosa.” Later it says, “Retinitis pigmentosa in a genetic eye condition that leads to blindness and affects about 1 in 4,000 people worldwide.” By our math, 200,000 out of 6.8 billion people worldwide means that 1 out of every 34,500 people is affected. And if we’re just talking about adults, that number drops to 1 out of every 22,105 people, a far cry from 1 out of every 4,000. If it were truly one out of every 4,000 people worldwide, that would mean that 1.1 million people have the disease. The story does quote one presumed independent source, Robert Maclaren, a professor of Ophthalmology at Britain’s Oxford University. In the above mentioned Medical Technology Alert, the manufacturer announced that Dr. Maclaren will be the lead investigator on a clinical study expected to enroll six subjects to advance this same retinal implant technology. As a result, Dr. Maclaren can hardly be described as an independent expert. Overall, we felt that the story was missing a strong, independent analysis. Had the reporter talked with more researchers in the field or more clinicians, perhaps the story would have had a more thoughtful tone. The story mentions that there are other implants, saying, “Other types of retinal implants, known as epiretinal implants, sit outside the retina and because they bypass the intact light-sensitive structures in the eyes they require the patient to wear an external camera and processor unit.” But that’s not a true comparison, nor does it provide readers with the true picture of how much R&D is happening right now in this field. As is often the case in medicine, surgical options and devices are not the only solution. Lowly old Vitamin A is often the first step for treating retinitis pigmentosa. The story does a credible job noting that the device is under study and not commercially available. Unfortunately it also suggests, based on the manufacturer’s statement, that the device in a very early stage of development will be available in 5 years. The hyperbole used is indefensible – “the device could become routine for some kinds of blindness in five years” and “could eventually change the lives of up to 200,000 people worldwide.”  This comes after a test in 3 people. The novelty of the device is established. The story does not rely on a news release, and, in fact, this news release from the University of Tubingen contains more interesting information about the study than the story. Claim: Retinal implant trial helps blind people see shapes
[EX A]: 0

[EX Q]: Paragraph: Such a test could initially be used to select patients for clinical trials of experimental treatments being developed to try to halt progression of Alzheimer’s, the researchers said, and may one day move into routine use in doctors’ clinics. “Alzheimer’s begins to affect the brain many years before patients are diagnosed (and) many of our drug trials fail because by the time patients are given the drugs the brain has already been too severely affected,” said Simon Lovestone of Oxford University, who led this work from King’s College London. “A simple blood test could help us identify patients at a much earlier stage to take part in new trials and hopefully develop treatments,” he said. Alzheimer’s is the most common form of dementia, a brain-wasting disease which in 2010 was estimated to be costing the world $604 billion a year. The fatal disease affects 44 million people worldwide, with the number set to triple by 2050, the campaign group Alzheimer’s Disease International says. Several big pharma firms including Roche, Eli Lilly, Merck & Co and Johnson & Johnson, are pursuing various approaches to get to the root cause of Alzheimer’s and try to find treatments to halt its progression. Yet over the past 15 years, more than 100 experimental Alzheimer’s drugs have failed in trial. Lovestone and other experts believe this may be because drug trials are conducted too late, in patients whose condition has already gone too far. A predictive test for use before people develop symptoms would help researchers select the right people for drug trials, and help show whether the experimental drugs are working. Previous studies have found that PET brain scans and tests of lumbar fluid can be used to predict the onset of dementia from people with a less severe condition known as mild cognitive impairment (MCI), but these tests are expensive and invasive, so scientists are keen to develop a cheaper, simpler blood test. MCI includes problems with day-to-day memory, language and attention. It can be an early sign of dementia, or a symptom of stress or anxiety. Around 10 percent of people diagnosed with MCI develop dementia within a year. Apart from regular assessments to measure memory decline, there is currently no accurate way of predicting who will or won’t develop dementia. For this study, published in the journal Alzheimer’s & Dementia, Lovestone’s team used blood samples from 1,148 people - 476 with Alzheimer’s, 220 with mild cognitive impairment and 452 elderly controls without dementia. They were analyzed for 26 proteins previously found to be linked with Alzheimer’s. The team found 16 of these 26 proteins to be strongly associated with brain shrinkage in either MCI or Alzheimer’s and then ran a second series of tests to see which of these could predict which patients would progress from MCI to Alzheimer’s. With this second series, they found a combination of 10 proteins capable of predicting with 87 percent accuracy whether people with MCI would develop Alzheimer’s disease within a year. Experts in the field welcomed the results but said they should be replicated in larger studies before an Alzheimer’s blood test could be rolled out for use in doctors’ clinics. “The results reported today are interesting, but as the authors point out there is still a very large amount of work remaining until a usable blood test for Alzheimer’s disease becomes available,” said Adrian Pini of the MRC Center for Developmental Neurobiology at King’s College London. James Pickett, head of research at the Alzheimer’s Society, said the research “does not mean that a blood test for dementia is just around the corner”. “These 10 proteins can predict conversion to dementia with less than 90 percent accuracy, meaning one in 10 people would get an incorrect result,” he said. “Accuracy would need to be improved before it could be a useful diagnostic test.” Claim: Study paves the way for a blood test to predict Alzheimer's.
[EX A]:
2