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.

Paragraph: Costs are mentioned reasonably early in the story, and with specificity. This was good to see. Benefits of these tests are touted, but not quantified. An officer of the National Ovarian Cancer Research Fund Alliance, an advocacy group, testifies that the outcomes of women who have surgery from a gynecologic oncologist “are much better.” But we don’t know what that means. Is it longer survival? Later the story explains that combining the two blood tests with assessment by a clinician “better determined the patients who should be referred to a [gynecological oncologist], identifying well over 90 percent of the women who actually had cancer.”  (Note that this statistic reflects only referral to a gyn-onc, not patient survival.) But how does that compare to the standard assessment tools? A 2016 study described as publication “of the first clinical utility data” demonstrating that use of OVA1 resulted in referral of ovarian patients to gynecologic oncologists offers similar outcomes but is not mentioned in the story. We’re told that experts fear that these tests could lead to unnecessary surgery or delayed diagnosis, and that’s sufficient for a Satisfactory rating. The story could have delved into a bit more of the specifics: What is the evidence for these concerns? What are the false positive and false negative rates? These details are useful because the point of the story is that clinicians are not using these tests to try to improve outcomes of ovarian cancer patients. Are the possible debits–or uncertainties driven by lack of clinical data–contributing to these decisions? There isn’t sufficient information on the evidence behind these tests. The FDA has approved ROMA and OVA1 for use, but the studies that led to that decision are not discussed. Nor is there sufficient discussion of why the physician groups that write guidelines haven’t endorsed the tests. Their concerns are raised, but the evidence is not presented or analyzed. A late diagnosis of ovarian cancer is way too common, and the outcome is grim. At the same time, the anecdotes seem to highlight the sad aspect of the disease without necessarily providing a relevant case in which the tests described would have helped (any more than a basic blood test would have). The companies responsible for developing and marketing these two tests are front and center in this story, with scientists affiliated with the companies clearly identified. At least two sources in the story—one of them a scientist affiliated with the National Comprehensive Cancer Network—appear to be independent of the companies. The story makes it clear that no effective early detection screening test exists. Existing strategies—the CA125 blood test and vaginal ultrasound—are mentioned and then discounted, in part via a personal narrative of a young woman who received a late diagnosis of cancer. While data-driven specifics aren’t included on why standard methods aren’t sufficient, this is enough to rate Satisfactory. A direct comparison of survival stemming from existing diagnostic tests relative to survival stemming from ROMA and OVA1 would have strengthened the story. If those numbers aren’t available, that should have been pointed out. The story makes it clear that the two blood tests have been available since 2009. The story mentions that the tests are combinations of existing tests with a “proprietary” formula (essentially a risk prediction tool) to translate the results to likelihood of cancer. But, the article should have talked about whether the tests, other than CA-125, have been used before. This appears to be an enterprise story, and does not rely on a news release. Claim: Ovarian cancer blood tests: Available, not widely used
This is a story about the apparent underuse of two blood tests—ROMA and OVA1—that are FDA approved to help clinicians decide whether surgery to investigate abnormal growths should be performed by a gynecologic oncologist (“gyn-onc”) trained to remove malignant ovarian cancer, rather than an obstetrician-gynecologist or a general surgeon. The gist of the story is that the tests have not been widely adopted in the ensuing years, “largely because they haven’t been recommended by the physician groups that write the care guidelines.” The story hit on a lot of important notes–it told readers the cost of these tests, and it included comments from independent sources. What is not clear is the extent to which clinical evidence supports the increased use of the two tests. We’re told they accurately picked up about 90 percent of cancer cases. But we’re not told how that compares to standard methods of detection. As the story notes, surviving ovarian cancer is an uphill battle–it is often a deadly disease caught too late. Any procedure that increases the probability of survival is worth careful consideration.

Paragraph: "Explaining why he couldn’t support the Texas Senate’s version of the 2012-13 state budget, Sen. John Whitmire said he didn’t know how state agencies can cope with further budget cuts, singling out the Texas Board of Nursing as an example. ""I asked them for their backlog of investigations,"" he said. ""They’ve got 3,000 complaints against nurses, many of them sexual assaults, malfeasance."" Time to crank up the Truth-O-Meter, starting with the board’s unresolved complaints. Some background: The board investigates and adjudicates complaints about Texas nurses who could be violating the Nursing Practice Act, which imposes regulations on nursing education, licensing and practices in the state including rules against unnecessarily exposing patients to the risk of harm or failing to adequately care for them. At the nursing board, spokesman Bruce Holter told us the senator’s count of 3,000 backlogged complaints is too low, accounting solely for unresolved cases from fiscal years 2009 and 2010. In 2010, the board resolved 14,429 of 16,890 complaints filed against nurses, leaving 2,461 unresolved cases. As of this March, another 511 complaints filed in 2009 remained unresolved, bringing the total backlog to nearly 3,000. There also are several hundred lingering complaints dating back to May 2006, board officials said. As of March, the board had about 11,000 open investigations, including the backlog. What are the complaints about? ""In general,"" Holter said, ""criminal conduct, drug-related conduct and failure to follow the minimum standard of care are the main types of complaints."" That covers malfeasance. But what about Whitmire’s other charge — that a chunk of the backlogged cases are sexual assault complaints? Lara Wendler, Whitmire’s chief of staff, told us the senator based his statement on conversations with administrators at agencies, including the nursing board. She added, though, that Whitmire was referring to all regulatory agencies, not just the nursing board, when he said backlogged cases included ""many"" sexual assaults. That was not clear from Whitmire’s floor remarks. Holter said the board checks all nurses licensed in Texas against state and national databases identifying sex offenders. Currently, the board is investigating complaints against four nurses who appear on the Texas Department of Public Safety’s sex offender database, and 12 nurses who appear on a national sex offender registry kept by the National Council of State Boards of Nursing. ""Sexual assault complaints against nurses make up a small percentage of the overall number of complaints investigated by the board,"" Holter said. But he added that other than the nurses found on the sexual offender databases, ""it would be difficult for staff to ‘pin down’ the number of complaints involving sexual assault."" Why? The board doesn’t categorize complaints by type, though when disciplinary action has been taken, Holter said, the board can run a data mining program to identify specific rule violations. But because the board doesn't track the number of sexual assault cases, it would have to review each resolved complaint individually. Lastly, why have complaints stacked up? Board employees are barred from discussing the details of individual complaints, but the board’s general counsel Dusty Johnston told us that generally, complaints don’t get resolved for a variety of reasons. He offered several examples: The investigator may be under-performing; extensive due process is required; the medical records of the patient involved in the complaint are difficult to obtain. So, the board says it has about 3,000 backlogged complaints, as Whitmire said. According to the board, many of the complaints allege malfeasance by nurses, as Whitmire also said, and a smaller number involve sexual assaults. But no one can determine the precise breakout without access to confidential board information." Claim: "John Whitmire Says the Texas Board of Nursing has a backlog of ""3,000 complaints against nurses, many of them sexual assaults, malfeasance."
State Sen. John Whitmire says the Texas Board of Nursing has a backlog of 3,000 complaints, including many cases of sexual assault and malfeasance

Paragraph: "In an announcement, the House of Representatives Subcommittee on Economic and Consumer Policy said that its efforts to persuade Gorsky to testify included “repeated attempts to accommodate the company” over nearly a month. Democrat Raja Krishnamoorthi, chairman of the House panel investigating concerns about cancer-causing asbestos in cosmetic talc and powders, said he was disappointed Gorsky turned down the invitation. “Mr. Gorsky refuses to speak to the Subcommittee under oath, yet he has not refrained from making multiple public comments on the topic,” Krishnamoorthi said in a statement. J&J spokesman Ernie Knewitz said that the subcommittee had rejected the company’s offers to send a talc testing expert or a J&J executive in charge of consumer products. Gorsky “is not, as we have repeatedly told the Subcommittee, an expert in the stated subject of the hearing,” Knewitz said. “We have respectfully declined the invitation for our CEO to testify.”  Knewitz said that the composition of the hearing, which includes two experts who have testified for plaintiffs against J&J, also factored into the company’s decision. Gorsky has played a lead role in J&J’s efforts to reassure consumers and investors that its talc powders are safe and asbestos free. Last year, he issued a statement vouching for the safety of the products after a jury issued a $4.69 billion verdict in favor of 22 women who sued over allegations their ovarian cancers were caused by J&J powders. Gorsky appeared on CNBC's ""Mad Money with Jim Cramer"" and in a video posted on J&J's website to rebut a December 2018 Reuters report here that the company knew for decades about the presence of small amounts of asbestos in its talc and powders. “Since tests for asbestos in talc were first developed, J&J’s Baby Powder has never contained asbestos,” Gorsky said in the video. In October, Gorsky testified in a depositihere in a lawsuit filed by an Indiana man, saying, ""We unequivocally believe that our talc and our baby powder does not contain asbestos."" J&J faces more than 16,000 similar lawsuits. Concerns over asbestos in talc cosmetics have grown in recent months as the U.S. Food and Drug Administration announced that the carcinogen had been found in several products, including a bottle of Baby Powder. J&J said it recalled 33,000 bottles of Baby Powder “out of an abundance of caution.” Later, J&J said labs it hired found no asbestos - other than some contamination it blamed on an air conditioner - in samples from the same Baby Powder bottle and its production lot. The FDA has said it stands by its finding. Chief executives of companies embroiled in controversies routinely comply with lawmakers’ invitations to testify. In recent months, the CEOs of Boeing (BA.N) and Facebook (FB.O) have appeared before congressional committees to answer questions about how their companies were safeguarding consumers. Charles M. Elson, director of the John L. Weinberg Center for Corporate Governance at the University of Delaware, said CEOs have a responsibility to go to Washington when Congress calls, just like other citizens. But Elson said Gorsky’s pass was understandable. He said the CEO and his advisers probably figured that the downside was greater to testifying than not. “It’s being invited in for a punch in the nose,” Elson said. For Gorsky, “nothing good will come out of it.”" Claim: J&J CEO spurns U.S. congressional hearing on carcinogens in talc products.

Johnson & Johnson (JNJ.N) Chief Executive Officer Alex Gorsky has declined to appear at a U.S. congressional hearing set for Tuesday on the safety of the company’s Baby Powder and other talc-based cosmetics.