Generate an explanation for the given claim using the provided supporting material from the paragraph. Please consider the following points while generating an output. 1) The claim will always have supporting proof in the paragraph, and the paragraph will have a clear point of view supporting the claim. 2) There can be instances where direct correlation to the claim is not available. Make use of the sentences in the paragraph to provide a corresponding output supporting the claim. 3) The explanation should be at least one and at most twelve sentences long.

Input: Consider Input: Paragraph: The article did not discuss costs. Screening mammograms impose a significant cost on the U.S. health care system and insurers, particularly Medicare. The story detailed the relative harms of earlier mammograms, but did not translate those percentages into absolute numbers. For instance, women who were diagnosed with breast cancer 25 months or more after their last mammogram were “50 percent more likely” to need chemotherapy, “32 percent more likely” to need mastectomy, and “66 percent more likely” to need lymph nodes removed. However, relative risk can be misleading, sometimes inflating numbers to sound scarier than when absolute numbers are used. Also, we don’t know what kind of risk these women had at baseline, so it’s hard to know if they were higher risk. The story made no mention of the harms of earlier or more frequent screening, which have been documented time and time again. More screening can mean more false positives or more finding of breast changes that lead to more testing, such as biopsies, more costs, and more worry. The story did make clear some of the weaknesses of the study: The study found an association but did not prove causality and the study population was limited to a single health care institution. The story also mentions that the findings were presented at a meeting, which means they have not undergone peer-review. The story does not directly engage in fear-mongering. However, some of the quotes advocating for earlier and more frequent screening play into a scenario that breast cancer is lurking in every woman. A discussion of what a woman’s average lifetime risk is would have been helpful. The story quotes the study author and an outside source. The story makes clear that different advisory groups have differing guidelines for what age to start getting mammograms (40 or 50 years old). It would have been nice if the story had included examples of what makes someone higher risk or not (personal cancer history, family history, history of radiation), but we think this was satisfactory. We believe that mammograms are well-known to be widely available. And the earlier and more frequent screening described here is not earlier or more frequent than what many guidelines recommend, so would not be expected to be denied by health insurers. The story makes clear the distinctive aspects of this study —using avoidance of more aggressive treatment regimens as a deciding factor, as opposed to the more extreme avoidance of cancer death. The story goes beyond what was contained in a news release on the presentation at the American Society of Breast Surgeons annual meeting. Claim: Earlier Mammograms May Mean Less Need for Aggressive Treatments

Output: This HealthDay news story reports on findings among women diagnosed with breast cancer: those who had longer intervals between mammograms end up getting more aggressive treatments, including chemotherapy and surgery. The story would have been stronger had it described the findings using absolute rather than relative numbers. But, we were glad to see an independent source offer some reservations about the small observational study raised. A final note — the image accompanying the story was laughably unrealistic. Mammograms are the primary screening method for detecting breast cancer. However, when to start getting mammograms and how often to get screened have been subjects of controversy for the past decade. That’s because the data on how to balance risk of developing breast cancer and the risk of harms from screening (unnecessary tests and procedures) are interpreted differently by doctors and other experts. A story that adds new data to the field and that might tip current guidelines one way or the other is newsworthy.


Input: Consider Input: Paragraph: There is no discussion of cost in this release. The journal article says several institutions refused to provide their prices. Nevertheless, the high cost of robotic surgery is an important issue. The researchers wrote they were unable to say whether those high costs might be offset [or not] by certain potential benefits (such as shorter hospital stays), but the release should have at least acknowledged the cost issues. The release does report the percentage of patients in the robot-assisted and open surgery groups that were still alive with no signs of disease progression two years after their procedures: 72.3 percent of patients in the robotic surgery group compared with 71.6 percent in the open surgery group… and it notes the difference was not statistically significant. It also reports that the robot-assisted surgery patients checked out of the hospital after six days on average, compared to 7 days for those in the open surgery group. The release reports only half as much blood loss in the robot surgery group, but does not report the amounts, which averaged 300 mL in the robot-assisted group vs. 700 mL in the open surgery group… that’s a difference of less than one pint. The release reports that patients who had robot-assisted surgery spent more time in the operating room than those having open procedures (seven hours vs. six hours). It also reports overall rates of adverse effects (67 percent in the robot group vs. 69 percent in the open group), along with listing the most common problems: urinary tract infections and intestinal obstructions. It would have helped if the release had pointed out that these complication rates were not statistically different. In a way, the release is satisfactory and yet maddeningly unsatisfactory. It tells readers that the study was a randomly controlled trial with 350 patients, but it buries the most important point: that the ability of these researchers to do this sort of rigorous trial comparing robot-assisted surgery with open techniques highlights how few such trials are done. Deep in the release, the researchers are quoted as saying the findings “underscore the need for further high-quality trials to assess surgical innovation before this surgical technique is widely adopted in clinical practice” and further that “It is important to conduct these trials before widespread adoption of technology, as has been the case with robotic prostatectomy (removal of the prostate).” The quality of the evidence should have been the lead. The release does not exaggerate the prevalence of bladder cancer. It does not push treatment on those who are unlikely to benefit. The release could be interpreted as promoting a newer more expensive form of therapy that doesn’t provide any advantages over the standard therapy. Although the release reports that the study was supported by the National Cancer Institute, it fails to note the financial disclosures several researchers made about money they have received from companies relevant to this study. The comparison of robot-assisted to open surgery was the main point of the release. The release makes clear that both techniques are available… including at the institution that issued the release. The release could have informed readers that, according to the published paper, that all of the operators in this study had done at least 10 robot-assisted cystectomies before being allowed to participate in the study. When widespread adoption of the robot-assisted procedure occurs, it would be possible that many surgeons would not have completed that many robotic cystectomies. While the release does tell readers that what is really new here is the use of randomization to compare robot-assisted surgery to open surgery for bladder cancer, it manages to bury that lead so deep under the poorly worded description of the results of this non-inferiority trial that the thrust of the release is unsatisfactory. The release doesn’t employ unjustified, sensational language. Claim: Robotic surgery as effective as open surgery for bladder cancer

Output: This news release about a trial that randomly assigned people with bladder cancer to either robot-assisted or open surgery buried the real news under a weak lead that garbles the findings. The news here is that, contrary to assertions of many proponents of robot-assisted surgery, it is possible to randomize patients in order to get a valuable comparison instead of relying on weaker study designs that can’t answer the fundamental question about how old and new techniques compare. The release is rated as satisfactory on many criteria because key information was included in the body of the release, but the headline proclaiming that robot surgery is “as effective” as open surgery misses the larger point. The headline and lead also put a pro-robot spin on the results, which could also be summarized as robot surgery is “not clearly worse.” Also not explained: robot-assisted surgery is more expensive. The final sentence of the release, a quote from a researcher, should have been the lead: “It is important to conduct these trials before widespread adoption of technology, as has been the case with robotic prostatectomy (removal of the prostate).”  We are bombarded with releases and news stories trumpeting results from studies of robot-assisted surgery that don’t actually compare the new technology to existing practice. These studies often lack any control group or use historical data that may not be truly comparable. The promoters of expensive new devices then claim that they are relying on the best available evidence. This trial shows better evidence can (and should) be gathered. And in this case, good quality evidence indicates little difference in the techniques, despite what all the big hospital billboards about robot surgery proclaim.


Input: Consider Input: Paragraph: DeSantis said keeping taxes low, improving education and protecting the environment will help Florida continue to grow. He said he wants to build on some of his successes from his first year in office. “In 2019, we took bold steps to expand educational opportunities, protect our environment and natural resources, reform health care, invest in infrastructure and bolster public safety — all while reducing taxes and maintaining healthy budget reserves,” DeSantis said. “While we should look with favor on these bold beginnings, we have much more to do.” The speech marked the opening of the Legislature’s annual 60-day session. He spoke in the House chamber, where lawmakers desks’ were covered in flowers. Members of the Supreme Court and the state’s three Cabinet members also attended the address. While touting a boost in adoption rates, DeSantis told lawmakers he wants them to pass a bill that would require girls under the age of 18 to get their parents’ permission to get an abortion. The state already requires girls’ parents be notified if they have an abortion. DeSantis also said he wants lawmakers to pass a wide-ranging bill to address Florida’s algae problem. The goal is to reduce fertilizers and nutrients flowing into the state’s waterways. “I believe that stewardship of our natural resources is key to our economic well-being — our water is the foundation of our tourism industry, makes Florida the top fishing and boating destination in the world and enhances our property values,” DeSantis said. DeSantis also called for a bill that would require employers to use E-verify, a system that ensures people are legally allowed to work in the United States. “Lower-income workers ... shouldn’t have their wages depressed by cheap foreign labor. Assuring a legal workforce through E-verify will be good for the rule of law, it will protect taxpayers, and it will place an upward pressure on the wages of Floridians who work in blue collar jobs,” DeSantis said. “We need to make sure that our Florida citizens from all walks of life come first.” DeSantis also wants the Legislature to raise the state’s minimum salary for teachers to $47,500, which he says will boost the pay for 100,000 educators. In addition to raises, he wants to make sure students are taught American civics and the U.S. Constitution. “This means understanding the source of our rights, and it means understanding the theory of the Declaration of Independence, understanding the structure of the Constitution and as well as key amendments such as the Bill of Rights, the post-Civil War amendments and the Nineteenth Amendment. This also means developing an appreciation for how these enduring principles animated key points in American history,” DeSantis said. Much of his agenda would build on his policies for education, the environment and immigration. “He’s focused on the vision that he cast last year. This was a ‘We don’t need major course corrections. I understand the direction that we want to take the state. We’re doing many things right. Let’s stay on course’,” said Republican Sen. Jeff Brandes. “Education, the environment, immigration — all of those issues were part of the overall bold vision last year. He’s riding a high after last year.” Democratic Rep. Loranne Ausley said she was pleased the governor spent much of his speech talking about the environment and education. “He is leading on these issues that have strong bipartisan support,” Ausley said. But while she agrees teachers should get raises, she said the governor’s approach doesn’t go far enough. “$600 million is a start, but we need to make a long time commitment to our schools and our teachers,” Ausley said. Claim: Florida governor calls for teacher raises, new abortion law.


Output: Florida Gov. Ron DeSantis called for teacher raises, the eradication of Burmese pythons in the Everglades and a new law to force girls to get their parents’ permission before getting an abortion during his State of the State address on Tuesday.