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.

Q: This release doesn’t discuss costs in its comparison of influenza shots versus nasal sprays, although both modes of immunization have been around for a long while and the costs for both are easily known. While flu immunizations are often free through public health clinics and such, some people receive their immunizations from their family physicians and carry a specific cost. Knowing the difference in costs between the two types is useful information both for people and public health officials. The release reports similar rates of vaccine uptake for intranasal vaccine and standard flu shots. But it does not quantify benefits for the main outcome of the study, that is, rates of influenza in communities vaccinated with nasal vs injected vaccine over the course of the study. These rates were statistically no different: 5.2% for the standard vs 5.3% for the nasal vaccine. This release makes no mention of possible harms that my follow the use of either the influenza vaccine injections or nasal spray, even though there are well-known restrictions on whom should and should not receive the nasal spray, and potential negative reactions to the injections among some people. The release points out that the study was the “first blinded randomized controlled trial” done in children within largely closed communities and it found similar efficacy in using the two modes of immunization. However, we do wish the release had addressed limitations, as well as some of the complexity of making these results generalizable to a larger population, as we saw with NPR’s take on the news. While media attention is routinely heightened leading up to and during flu season, this release does not appear to reach the level of disease mongering. The release does identify the chief funder of the study, the Canadian Institutes for Health Research, although it offers no information on possible conflicts of interest among any of the researchers. The abstract of the study does state that two of the researchers do have links to pharmaceutical firms, but not in relation this study. Since the study looked a two forms of influenza vaccine administration, it obviously addresses the question of comparing alternatives. Both forms of immunization — shots and nasal spray — have been around for some time, their availability is widely known, earning the release a Satisfactory in this category. The release makes clear that the novelty of this study is its ability to examine both indirect effects of vaccination on the community as well as direct effects for persons receiving the vaccine. The release does not use any unjustifiable language.

A: Flu nasal spray provides similar protection against influenza as flu shot: Study
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Q: Licenses for hemp cultivation topped a half-million acres (200,000 hectares) last year, more than 450% above 2018 levels, so there’s intense interest in the rules the U.S. government is creating. Critical comments on the draft have poured in from hemp farmers, processors, retailers and state governments. Growers are concerned the government wants to use a heavy hand that could result in many crops failing required tests and being destroyed. The U.S. Department of Agriculture, the agency writing the rules, estimates 20% of hemp lots would fail under the proposed regulations. “Their business is to support farmers — and not punish farmers — and the rules as they’re written right now punish farmers,” said Dove Oldham, who last year grew an acre (0.40 hectares) of hemp on her family farm in Grants Pass. “There’s just a lot of confusion, and people are just looking for leadership.” The USDA did not respond to the criticism but has taken the unusual step of extending the public comment period by a month, until Jan. 29. The agency told The Associated Press it will analyze information from this year’s growing season before releasing its final rules, which would take effect in 2021. Agricultural officials in states that run pilot hemp cultivation programs under an earlier federal provision are weighing in with formal letters to the USDA. “There are 46 states where hemp is legal, and I’m going to say that every single state has raised concerns to us about something within the rule. They might be coming from different perspectives, but every state has raised concerns,” said Aline DeLucia, director of public policy for the National Association of State Departments of Agriculture. Most of the anxiety involves how the federal government plans to test for THC, the high-inducing compound found in marijuana and hemp, both cannabis plants. The federal government and most states consider plants with tiny amounts — 0.3% or less — to be hemp. Anything above that is marijuana and illegal under federal law. Yet another cannabis compound has fueled the explosion in hemp cultivation. Cannabidiol, or CBD, is marketed as a health and wellness aid and infused in everything from food and drinks to lotions, toothpaste and pet treats. Many have credited CBD with helping ease pain, increase sleep and reduce anxiety. But scientists caution not enough is known about its health effects, and the U.S. Food and Drug Administration last year targeted nearly two dozen companies for making CBD health claims. Still, the CBD market is increasing at a triple-digit rate and could have $20 billion in sales by 2024, according to a recent study by BDS Analytics, a marketing analysis firm that tracks cannabis industry trends. About 80% of the 18,000 farmers licensed for hemp cultivation are in the CBD market, said Eric Steenstra, president of the advocacy group Vote Hemp. The remaining 20% grow hemp for its fiber, used in everything from fabric to construction materials, or its grain, which is added to health foods. But hemp is a notoriously fickle crop. Conditions such as sunlight, moisture and soil composition determine its ratio of THC to CBD. Choosing the right harvesting window is critical to ensuring it stays within acceptable THC levels. Under the draft USDA rules, farmers have no wiggle room. They must harvest within 15 days of testing their crop for THC, and the samples must be sent to a lab certified by the U.S. Drug Enforcement Administration. Samples must be from the top of the plant, where THC levels are highest, and the final measurement must include not just THC, but also THCA, a nonpsychoactive component. Crops that test above 0.3% for the two combined must be destroyed. Growers with crops above 0.5% would be considered in “negligent violation,” and those with repeated violations could be suspended from farming hemp. In addition, a pilot program for federal crop insurance that would be available to hemp growers in some states specifies that crops lost because of high THC levels won’t be covered. Those provisions are causing alarm among growers and states with pilot hemp programs allowed under the 2014 Farm Bill. Some states allow THC levels above 0.3%, and not all include THCA in that calculation. Many permit more harvesting time for growers after THC testing. Farmers are lobbying for a 1% THC limit and a 30-day harvest window to give them more flexibility while remaining well under THC levels that can get people high. The draft regulations don’t “seem to be informed by the reality of the crop,” said Jesse Richardson, who with his brother sells CBD-infused teas and capsules under the brand The Brothers Apothecary. “If no one can produce (federally) compliant hemp flower, then there will be no CBD oil on the market.” Growers are also worried about the proposed rule requiring that all THC testing be done in a DEA-certified lab because there are so few of them. Some states have only one, which would serve hundreds of growers in a short harvest window. Samantha Ford, a third-generation farmer in North Carolina, waited two weeks to get back THC results from a lab last fall and then spent 45 days harvesting her 1 acre (0.40 hectares) of hemp by hand. “The 15-day window — that’s not feasible, and that was on a small scale,” she said. “I can’t imagine farmers who have acres and acres and acres of it.” Concerns also have emerged about the workload the draft rules would place on states. Many do random sampling for THC levels, but the USDA would require five samples from every hemp lot — a burden for state agricultural departments, said DeLucia, of the national ag agencies group. If federal rules are too onerous and expensive, some states might drop their hemp programs. In those cases, farmers would have to apply for licenses with the USDA, and at this stage it’s unclear how U.S. officials would manage or pay for a nationwide licensing program, DeLucia said. Under the 2018 Farm Bill, the USDA must approve state plans for hemp programs. Louisiana, Ohio and New Jersey last month were the first to get the green light — but those plans might need to be reworked after final rules are written. “What we don’t want to see is states having to write their rules and then have to change the rules again and rewrite them” after 2021, said Steenstra, of Vote Hemp.

A: High anxiety: Proposed US hemp rules worry industry .
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Q: A senior administration official outlined the plan on condition of anonymity ahead of the release of Trump’s 2019 budget plan next week. Pharmaceutical companies now pay rebates to insurers and pharmacy benefit managers to help their medications gain a bigger slice of the market. Insurers apply savings from rebates to keep premiums more manageable. Under Trump’s proposal, seniors covered by Medicare’s popular “Part D” prescription benefit would be able to share in the rebates for individual drugs that they purchase at the pharmacy. Trump’s budget would also expand Medicare’s “catastrophic” drug benefit so that many seniors with very high costs would not face copayments. Seniors with high drug bills are currently still responsible for 5 percent of the cost of their medications. With some new drugs costing $100,000 a year or more, patient costs add up quickly. The White House proposal would put Trump in the middle of a tug-of-war between drug companies on one side and insurers and pharmacy benefit managers on the other, with billions of dollars at stake. Insurers and pharmacy benefit managers say the reason drug costs are so high is that drug companies are free to charge what the market will bear. The pharmaceutical industry says middlemen are the problem, because they keep rebates paid by drug makers instead of passing them on to patients. Insurers counter that rebates are passed on in the form of lower monthly premiums for everybody. The drug industry lobbying group, Pharmaceutical Research and Manufacturers of America, had no immediate reaction. The Trump administration’s new proposals come on top of a long list of Medicare changes in the congressional budget deal. Medicare is the government’s premier health insurance program, covering about 60 million seniors and disabled people. Lawmakers would shift a greater share of Medicare drug costs to the pharmaceutical industry. They also want to eliminate the drug coverage gap known as the “doughnut hole” one year earlier than currently scheduled, in 2019 instead of 2020. “On the whole, I think this is a good bill for people with Medicare,” said Joe Baker, president of the Medicare Rights Center, said of the congressional legislation. “This tilts toward getting a lot of good things done.” But his group opposes a provision that would raise premiums paid by the wealthiest retirees for coverage of outpatient services and prescription drugs. Here’s a look at some of the major Medicare provisions in the budget deal that Republican leaders are trying to push through Congress. Democrats are split over the overall measure, but the Medicare provisions appear to have support from both parties: — PRESCRIPTION DRUGS Originally, beneficiaries in the “doughnut hole” coverage gap were responsible for the full cost of their medications, but the Affordable Care Act passed under former President Barack Obama gradually closes the gap. The budget deal accelerates the timetable by one year, to 2019. Drug makers are already required to provide discounts to close the coverage gap, but the budget deal raises the level of company discounts, which in turn lowers the government’s costs. That should act as a brake on the monthly premiums paid by beneficiaries. “In theory when Medicare spending goes down, premiums would go down, too,” said Tricia Neuman, a Medicare expert with the nonpartisan Kaiser Family Foundation. The drug industry is criticizing the proposal, saying it will mainly benefit insurance companies that act as middlemen providing the benefit. The coverage gap starts when beneficiaries hit $3,750 in total drug costs. — CAPS REPEALED ON REHAB The budget deal permanently repeals limits on therapy services commonly used by stroke patients and people recovering from major surgeries. Those services include physical therapy, occupational therapy and speech therapy. In previous years, Congress had routinely held off on applying the caps. Groups including AARP were pressing for a full repeal. It takes effect this year. __HIGHER PREMIUMS FOR WEALTHIEST RETIREES Premiums for outpatient coverage and prescription drugs would rise for about 1 million wealthy seniors with annual incomes of at least $500,000 for an individual, or $750,000 for a couple filing jointly. Hiking premiums on the well-to-do is an idea that has bipartisan support among lawmakers, but advocates worry that Congress will ultimately start raising costs for middle-class seniors as well. __TELEMEDICINE AND CHRONIC CARE The budget deal expands Medicare’s ability to pay for telemedicine in a wide variety of situations, including for patients with stroke symptoms. It also incorporates a bipartisan Senate bill that is intended to improve care coordination for patients with chronic illnesses, such as heart disease, cancer, and diabetes. —COST CONTROL BOARD REPEALED The deal would repeal the Independent Payment Advisory Board, a Medicare cost-control agency authorized under the Affordable Care Act. It was controversial from the beginning, and the Obama White House did not move forward to set up the board.

A:
Trump aims to reduce drug costs under Medicare.
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