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.

Input: Consider Input: The “Asbestos in Talc Symposium,” sponsored by the Food and Drug Administration, was dominated by industry hands: Most of the 21 non-government participants had done work for talc companies, such as testing and serving as expert witnesses and consultants, symposium documents and other records show. Key sessions were led by witnesses for Johnson & Johnson in lawsuits alleging the company failed to warn customers that its Baby Powder was tainted with cancer-causing asbestos, the records show. Others who sought invitations were turned away, including a physician who had testified against J&J in trials that resulted in billions of dollars in damage awards against the company. History was repeating itself. Over the past 50 years, the FDA has relied upon - and often deferred to - industry even as outside experts and consumers repeatedly raised serious health concerns about talc powders and cosmetics, a Reuters investigation found. Again and again since at least the 1970s, the agency has downplayed the risk of asbestos contamination and declined to issue warnings or impose safety standards, according to documents produced in court proceedings and in response to public records requests. The agency said it lacks the authority to require manufacturers to test for asbestos in talc or report any results. And it seldom has ordered its own tests - until recently. Amid heightened scrutiny in Congress, a criminal investigation of J&J and costly jury verdicts against the company, the regulator commissioned tests that found asbestos in 11 talc-based cosmetics, including Johnson’s Baby Powder. J&J recalled 33,000 bottles. Raja Krishnamoorthi, an Illinois congressman who chairs a U.S. House subcommittee investigating talc safety, told Reuters it was time for regulators to stop relying on manufacturers’ safety assurances. “When something as serious as cancer or carcinogens are at issue,” Krishnamoorthi said, “self-regulation doesn’t make a lot of sense.”  In written responses to questions from Reuters, the FDA said its resources and authority to regulate the cosmetic industry are limited. The agency said it has no power to ensure the safety of cosmetics before they are put on store shelves, nor to force companies to pull them off when potential hazards are discovered. “We are dependent on manufacturers to take steps to ensure the safety of their products,” the FDA said after announcing a voluntary recall of tainted cosmetics in March. FDA officials declined to comment on the decisions of former employees over the years, saying only that the agency relies on the best information available and that studies “have improved our understanding of how and why asbestos fibers are hazardous.”  The agency said it now recognizes, as the World Health Organization and other public health agencies did years ago, that there is no known safe level of asbestos. FDA officials said their current policy is to act swiftly - and if necessary encourage recalls - even when small amounts are discovered. The regulator has stood by its recent tests of Johnson’s Baby Powder, despite pushback from the company. J&J, the world’s largest producer of talc powders, said in a statement that it recalled the 33,000 bottles of Baby Powder out of an “abundance of caution.” Eleven days later, the company announced that tests by labs it hired had determined that there was no asbestos - other than some contamination it said came from an air conditioner - in samples from the one bottle tested by the FDA and the batch it came from. In written responses to Reuters, J&J said it systematically tests its talc and has always found its powders to be safe and pure. “Throughout the 1970s and ‘80s, the FDA and other regulatory bodies defended talc,” J&J’s Chief Executive Alex Gorsky testified in an Oct. 3 deposition. “FDA agreed overall with the position that we had taken with the safety of our talc.”  The company told Reuters that it “has long cooperated (with) and supported the FDA in its mission to protect the public health,” and that any suggestion it has unduly influenced the agency to reduce regulation or standards is “just false.”  The FDA now is under increasing pressure to ensure talc powders and cosmetics are free from asbestos. The agency’s testing of talc-based cosmetics this year followed jury verdicts totaling more than $5 billion against J&J in cancer lawsuits, as well as a Dec. 14 Reuters report showing that J&J knew its raw talc and powders sometimes tested positive for asbestos from the 1970s into the early 2000s and did not report those findings to the agency. J&J has disputed the Reuters report as “one-sided, false and inflammatory.”  In the wake of the Reuters report, the company announced it was under investigation by the U.S. Department of Justice and the Securities and Exchange Commission. According to people familiar with the matter, these include a criminal grand jury probe into how forthright J&J has been about the safety of its powders. The FDA began looking into talc safety in 1971 after researchers at Mount Sinai Medical Center in New York found what appeared to be asbestos in unnamed brands of talc powder. Two years later, FDA records show, the agency found asbestos in a sample of Shower to Shower, a J&J powder at the time that was made with the same talc as Johnson’s Baby Powder. The FDA never publicly announced the finding. J&J told Reuters the result was not final, citing findings in an FDA table issued in 1976. But that table, reviewed by Reuters, is ambiguous, listing no result for the type of asbestos found in 1973. J&J told Reuters the gap means no asbestos was found. Assured by J&J and other manufacturers that their talc was safe, the FDA eventually ended its inquiry without taking action because “the potential hazard did not warrant a recall,” Heinz J. Eiermann, a former J&J researcher who at the time ran the agency’s cosmetics division, wrote in a March 1976 memo. That same year, J&J, other talc companies and their trade group, the Cosmetic Toiletry and Fragrance Association, persuaded FDA officials that manufacturers could monitor the safety of their own products, according to records J&J and the group produced in litigation. The FDA dropped plans to impose testing and purity standards for talc powders and cosmetics. The trade group published its own test, which was voluntary for companies to use. The written standard for that test acknowledges that it cannot detect most types of asbestos at low levels, nor one common type - chrysotile - at all. In a statement to Reuters, the trade group said it believed that chrysotile was not commonly linked to talc used in cosmetics. Chrysotile is the type of asbestos the FDA-commissioned test found in Baby Powder this year. It also was found in several tests conducted by labs for J&J on its talc from 1972 through 2003, according to records produced in litigation. J&J has said that some of the tests were on industrial talc and that others, on Baby Powder talc, reflected background contamination. Asbestos is a loose term for a group of six minerals that readily separate into needles or fibers. Easily inhaled, they are known to cause lung, ovarian and other types of cancer. While most people exposed never get cancer, for some even small amounts are enough to trigger the disease. Just how small has not been established. Talc safety concerns resurfaced in 1983 when a graduate  student scouring geology journals for a toxicology class came across information he considered disturbing: Talc deposits are commonly laced with asbestos, a similar mineral. Philippe Douillet immediately thought of the talc powder his sister used on her baby, he recalled in an interview with Reuters. He urged her to stop using it. Then he petitioned the FDA to require an asbestos warning on talc powders. “It was really obvious to me there was a big issue there,” said Douillet, who now runs a biotechnology company in Miami. When the FDA began evaluating Douillet’s petition, it looked to J&J for key information, agency records show. The FDA’s June 1985 risk assessment relied upon a decade-old letter from the company for the agency’s estimate of the amount of dust babies were exposed to during diapering. That 1974 letter from J&J to the FDA said that, hypothetically, even if babies were exposed to talc powder with as much as 1% asbestos, it would be a far lower concentration than allowed at the time for industrial workers. J&J told Reuters in a statement that “at no point has Johnson & Johnson taken the position that it would consider talc containing 1% asbestos appropriate for sale to consumers.”   In the end, the FDA decided there was no need for an asbestos warning on talc powders. In a July 1986 letter to Douillet, acting associate FDA commissioner J.W. Swanson wrote that the quality of cosmetic talc had improved “and that even when asbestos was present, the levels were so low that no health hazard existed.”  What’s more, Swanson wrote, agency officials had come to question earlier reported findings of asbestos in talc powders. Those doubts, he wrote, were based in part on a paper published in the proceedings of a 1977 scientific conference. Both of the paper’s authors had worked for J&J, one as an asbestos testing contractor and the other as its longtime talc supply manager. The authors argued that some testing methods were apt to misidentify microscopic lookalike rock splinters as asbestos. The industry’s test, the paper said, was designed to avoid this confusion. Other U.S. and European public health authorities have come to regard such splinters as presumptive toxins because of their similarity to asbestos. The FDA defended its 1986 decision to reject Douillet’s petition. In a statement, it said the graduate student “did not provide persuasive evidence that the cosmetic talc produced at the time contained significant amounts of asbestos minerals.”  Eight years later, the regulator received a new request for a warning label on talc powders. This one came from Dr. Samuel Epstein, a University of Illinois environmental medicine professor who chaired the Cancer Prevention Coalition, an advocacy group. Epstein’s 1994 petition didn’t concern asbestos. It raised the possibility that talc, by itself, was a hazard worthy of a warning label. His petition was based on research showing that talc, when used as an antiperspirant and deodorant in underwear, was associated with ovarian cancer. In a brief July 1995 letter, FDA acting cosmetics chief John Bailey told Epstein’s coalition that the agency had taken no action because it had other priorities. Bailey told Reuters in a statement that he issued this “interim” response because the petition lacked scientific support. In 2002, having taken no action on the petition, Bailey moved to the cosmetic trade group, now known as Personal Care Products Council. The council considered him a “key employee” because of his “former employment with the FDA,” according to a tax filing by the group. Now a consultant, Bailey serves as a litigation expert witness to J&J and other talc companies. In his statement to Reuters, Bailey said he had been hired at the council “as a scientist responsible for applying sound science to decision making.” He disputed Reuters’ finding that the FDA deferred to industry, saying the agency takes potential health concerns seriously and does its own evaluations. In 2006, the World Health Organization’s International Agency for Research on Cancer classified use of talc powder in the perineum area - the pelvic region between the legs - as “possibly carcinogenic.” Two years later, Illinois medical scientist Epstein filed a second petition to the FDA seeking a cancer warning label on talc products. J&J went to work to defeat it. In a May 2008 email to colleagues, J&J executive Kathleen K. Wille wrote: “Our response could be a potential source of data and information on which the FDA can base their response.”  Together, J&J, its talc supplier and the Personal Care Products Council arranged for a pair of scientists to assess the published studies that linked talc and ovarian cancer, according to emails and other records produced in litigation. The scientists concluded that the evidence was too weak to consider talc as a cause. At a May 2009 meeting, Bailey, Wille and other industry representatives briefed FDA officials on the assessment, according to a meeting memo produced in litigation by J&J’s talc supplier. Three days later, Wille told colleagues in an email, “We have every confidence that the FDA will dismiss this petition once they have reviewed our submission.”  J&J told Reuters in a statement that the company had been confident because it believed the agency would be swayed by science, which it said supported J&J’s position that talc does not cause ovarian cancer. Before the FDA ruled on the warning requests, however, concerns about asbestos contamination flared again. This time, the FDA’s South Korean counterpart reported finding asbestos in talc powders. Acting on that 2009 report, the FDA commissioned talc tests for the first time in 40 years, hiring Maryland-based AMA Analytical Services Inc, which analyzed 34 samples of talc powders and cosmetics, including Johnson’s Baby Powder. It found no asbestos in any of them. The lab had no experience testing for asbestos in talc. Its prior work focused on building materials such as vinyl flooring, according to the deposition testimony of AMA lab director Andreas Saldivar. The FDA has said Saldivar’s lab used “the most sensitive techniques available” but cautioned that the results were limited to the 34 talc powders and cosmetics tested. The testing had other limitations as well. Saldivar’s lab looked at less talc per sample than other labs that have found asbestos in talc powders. And it did its work in a fraction of the time typical for such analyses, according to a Reuters review of the lab report and interviews with experts who test talc for asbestos. Saldivar’s lab was recently rehired by the FDA. This time, it found the asbestos that led to the first recall of J&J’s iconic Baby Powder. Saldivar declined to comment. In the first verdict of its kind, a South Dakota jury found in October 2013 that J&J had a duty to warn women that research had linked its talc powder to ovarian cancer. No damages were awarded. Then the FDA weighed in on the issue. In April 2014, 20 years after Epstein first contacted the agency, the FDA rejected both of his petitions for warning labels. Its announcement said the science wasn’t strong enough to support a cancer warning, echoing the assessment J&J and its industry partners had presented to the agency in 2009. In court, such arguments have not always proved convincing. In early 2016, a Missouri jury concluded J&J’s powders caused a woman’s ovarian cancer death and awarded her survivors $72 million. An appellate court later set that verdict aside, ruling that the woman had filed her suit in the wrong state. In the aftermath, the FDA asked J&J for “safety literature and data regarding talc,” correspondence shows. The company submitted a report saying no asbestos had “ever been found during any testing” of its talc. Since then, lawsuits have compelled J&J to produce internal documents that show the company knew its talc and powders had tested positive for asbestos on occasion for decades. The company now faces more than 16,000 lawsuits alleging that its powders caused ovarian cancer and mesothelioma, an incurable cancer. The vast majority are awaiting trial. In court, there have been mixed verdicts, mistrials and some appellate rulings in J&J’s favor. Last year, in response to renewed asbestos concerns, FDA cosmetics chief Dr Linda Katz began organizing the November 2018 symposium and a public hearing on talc testing, now planned for next year. She reached out to J&J for help. J&J vice president Jethro Ekuta responded by sending Katz a letter in June 2018 recommending a list of three talc testing experts. All three had served as defense witnesses or consultants for J&J. Two of the experts Ekuta recommended, as well as a third J&J defense witness, led sessions at the closed-door “Asbestos in Talc Symposium” on Nov. 28, 2018. None of the sessions were led by medical experts who had questioned the safety of talc powders and cosmetics. J&J said that apart from recommending experts, it did not advise the FDA on the symposium. Ekuta, who has left J&J, declined to comment. In a statement to Reuters, the FDA downplayed its role in the symposium, saying the event was “hosted” by the Joint Institute for Food Safety and Applied Nutrition (JIFSAN), a research group co-founded by the FDA. “No formal or regulatory recommendations were expected or made,” the agency said. In fact, records show, the FDA initiated and paid for the meeting, set the agenda and chose the participants. The meeting set the stage for formal recommendations on how to test products used every day by millions of people. The FDA said a government committee tasked with proposing a standard test for asbestos in talc powders and cosmetics is “continuing to work through issues discussed at the JIFSAN symposium.”  Many FDA meetings are held in public and invite comment. Details on the talc symposium were hard to come by, however, even after it was over. The FDA declined Reuters’ requests to provide a list of participants or any information on what transpired. After Reuters filed a public records request with JIFSAN, the research group posted meeting information online and released planning emails. The guest list showed that more than half of the 54 participants were employed by or recently retired from FDA and other agencies. Of the 21 non-government participants, 17 had either worked for talc companies, done lab testing or served as expert witnesses for the industry, Reuters found. Five of the participants affiliated with talc companies also have served as expert witnesses for plaintiffs. Most of the non-government participants were experts in geology or minerals testing. In a statement, the FDA said it would ordinarily avoid having sessions led by defense or plaintiff witnesses. However, the agency said there are a “limited number of experts worldwide with scientific knowledge” on asbestos testing, standards and results analysis. Not everyone was welcome. Among those turned away was Dr. David Egilman, a clinical professor of family medicine at Brown University. He testified last year in a trial that ended in a $4.69 billion verdict for women alleging J&J’s talc powders caused their ovarian cancers. Egilman told Reuters he was concerned that if the FDA was guided by geologists and industry consultants, it might overlook fundamental questions about which mineral fibers cause cancer. He wanted to offer his expertise, as a physician and researcher, on what technicians should look for under the microscope. Testing hinges “on the determination of what particles or elements should be tested for,” he wrote in a November 2018 email to organizers asking to be included in the symposium. “This is a medical question and not a technical question.”  Katz took a different view. In an email forwarded to Egilman, she said: “This meeting is not intended to discuss health-related issues or concerns.”  She met with Egilman later. Katz also told Egilman that the symposium was not intended to reach any consensus. At its conclusion, however, session leaders, including three who have served as defense witnesses for J&J, drafted what they called “consensus” or “concurrence” reports. Two of the reports reviewed by Reuters embraced industry positions on what fibers should be counted as hazardous, an issue of fierce contention in courtrooms across the country. The reports discouraged counting fibers that may or may not be asbestos, saying that doing so might exaggerate the hazard. That view runs contrary to the positions of other U.S. and European public health officials, who presume mineral fibers that even look like asbestos are toxic. As Arnold Brody, a professor emeritus at Tulane University Medical School, told jurors in a talc powder trial last year, “The lung doesn’t care” what it’s called. These issues are likely to be aired at the public hearing the FDA said it is planning for next year. The gathering could signal how the agency intends to navigate between industry and consumer interests in coming years. Krishnamoorthi, the congressman heading the House investigation into talc safety, said the agency needs to bring consumers and their advocates into the discussion. “In light of the public interest around this particular issue,” he said, “we need to find out what’s going on.”

Output: Special Report: Powder Keg - FDA bowed to industry for decades as alarms were sounded over talc.


Input: Consider Input: Clearly, the costs involved in cancer treatment already are high. By removing a layer of treatment from an estimated 40,000 patients, those costs would have to drop, but it is unclear from the story by how much. Also, it would have been worth mentioning whether this is likely to affect how insurance companies handle lymph node removals. The story did a good job providing some numbers on benefits, but we wish it had provided more and explained some things a bit more. It says, for example, “In 27 percent of the women who had additional nodes removed, those nodes were cancerous.” How many women had additional nodes removed and, of those, how many had cancerous nodes? A figure like 27% means 1 out of every 4 women had nodes that were, indeed, cancerous, which seems to conflict with other statements in the story about chemotherapy and radiation wiping out the cancer. The story discusses several harms from lymph node removal, and shows that the difference in survival for women who had nodes removed and those who did not was not significant. “Indeed, women in the study who had the nodes taken out were far more likely (70 percent versus 25 percent) to have complications like infections, abnormal sensations and fluid collecting in the armpit. They were also more likely to have lymphedema.” This is where the story really outperformed some of the competition covering the same news. It placed the study into the broader context of a movement in cancer care away from surgeries that don’t provide a clear benefit, and it also explained the study design and the limitations of the study in several ways. “The study, at 115 medical centers, included 891 patients. Their median age was in the mid-50s, and they were followed for a median of 6.3 years. … One potential weakness in the study is that there was not complete follow-up information on 166 women, about equal numbers from each group. The researchers said that did not affect the results. A statistician who was not part of the study said the missing information should have been discussed further, but probably did not have an important impact. It is not known whether the findings also apply to women who do not have radiation and chemotherapy, or to those who have only part of the breast irradiated. Nor is it known whether the findings could be applied to other types of cancer.” It was too bad that it did not mention limitations in terms of lack of enrollment. The targeted enrollment was 1900. There also was an imbalance in the randomization that should have been mentioned. The story is careful to explain to readers that the research findings only apply to a subset of women with breast cancer. “Now, researchers report that for women who meet certain criteria — about 20 percent of patients, or 40,000 women a year in the United States — taking out cancerous nodes has no advantage. It does not change the treatment plan, improve survival or make the cancer less likely to recur. And it can cause complications like infection and lymphedema, a chronic swelling in the arm that ranges from mild to disabling.” The Q&A that ran with the story provided more detail about the different types of cancers and cancer patients, noting, for example, “First of all, 20 percent (the estimate of the study’s lead author, Dr. Armando E. Giuliano) refers to 20 percent of all the newly diagnosed cases of invasive breast cancer each year. This does not include noninvasive breast cancer, or DCIS, ductal carcinoma in situ. The total is about 207,000, so 20 percent is roughly 40,000 women. That is about how many women would match those in the study, in terms of tumor status, affected lymph nodes and course of treatment.”  The story also says, “The results mean that women like those in the study will still have to have at least one lymph node removed, to look for cancer and decide whether they will need more treatment. But taking out just one or a few nodes should be enough.” Good quotes including from Dr. Monica Morrow, chief of the breast service at Sloan-Kettering and an author of the study, but also a few fromindependent experts toward the end. Dr. Grant W. Carlson, a professor of surgery at the Winship Cancer Institute at Emory University, and the author of an editorial accompanying the study, provides some soul-searching context by saying that, in taking out so many lymph nodes, “I have a feeling we’ve been doing a lot of harm.” Dr. Elisa R. Port, the chief of breast surgery at Mount Sinai Medical Center in Manhattan, said, “It’s definitely practice-changing.” And Dr. Alison Estabrook, the chief of the comprehensive breast center at St. Luke’s-Roosevelt hospital in New York said, “In the past, surgeons thought our role was to get out all the cancer. … Now he’s saying we don’t really have to do that.” The story does a great job explaining the history of this form of treatment and how it has evolved over time. “But doctors have continued to think that even microscopic disease in the lymph nodes should be cut out to improve the odds of survival. And until recently, they counted cancerous lymph nodes to gauge the severity of the disease and choose chemotherapy. But now the number is not so often used to determine drug treatment, doctors say. What matters more is whether the disease has reached any nodes at all. If any are positive, the disease could become deadly. Chemotherapy is recommended, and the drugs are the same, no matter how many nodes are involved.” The story goes on to do something that stories like this rarely do, it compares compares the harms from different forms of treatment, saying “After armpit surgery, 20 percent to 30 percent of women develop lymphedema, Dr. Port said, and radiation may increase the rate to 40 percent to 50 percent. Physical therapy can help, but there is no cure.” The story makes it clear that removing all under-arm lymph nodes is the standard of care for women with breast cancer and that feelings about that standard are entrenched. The story establishes that a change in treatment protocol away from removing all the lymph nodes under the arms of women with breast cancer would be novel. There is some nuance, here, though that could be missed by a casual reader. Women who have one to two positive lymph nodes would avoid having additional lymph node surgery. The overall tone of the story may make it appear to some readers that women get to avoid lymph node surgery altogether, but they don’t. The story goes well beyond any news release.

Output: Lymph Node Study Shakes Pillar of Breast Cancer Care


Input: Consider Input: "Republican Rep. Joe Heck’s record on abortion is fast becoming the subject of many salvos in the unending television ad wars in Nevada’s competitive Senate race. Democrat Catherine Cortez Masto has run several ads attacking Heck on the issue, most recently one featuring a Las Vegas-area gynecologic oncologist who opposes Heck because he voted to strip funding for Planned Parenthood. ""Joe Heck voted 10 times to defund Planned Parenthood, which thousands of women depend on for cancer screenings,"" she says in the ad. ""And Heck opposes a woman's right to choose, even when her health is at risk."" Heck is no stranger to ads attacking his stance on abortion, as Democrats have sought to highlight the Republican military doctor’s adamant anti-abortion stance in both his current Senate race and past congressional races. A review of Heck’s voting record and public statements over the past six years shows that Cortez Masto’s ad is largely accurate, though over-simplified. Ten votes? Heck himself freely admits he voted to defund Planned Parenthood, and his voting record since entering Congress in 2010 reflects that position. It’s more difficult to argue that Heck has voted 10 separate times to defund the program, as that number relies on counting several procedural motions that weren’t strict up-or-down votes on funding for Planned Parenthood. For example, the ad cites five votes taken by Heck in September 2015 to ""shut down the government over Planned Parenthood,"" but not all of them are the same, including: Two procedural votes on Sept. 17 to end debate and adopt rules for floor consideration on a measure defunding Planned Parenthood. A Sept. 18 vote on a bill (Defund Planned Parenthood Act of 2015) barring federal funding to the organization for one year and redirecting the funding to community health centers. A Sept. 30 procedural vote allowing for floor consideration of continuing resolution to fund the government that would also defund Planned Parenthood, and a subsequent vote on that bill itself. All of the votes mentioned in the ad were taken as part of a legislative attempt to strip funding from the program, but they aren’t all strict up-or-down votes. Of the five votes listed above, two are actual roll call votes on barring federal funding the program, while the other three are procedural votes that certainly moved the legislation forward but, again, aren’t direct votes on the bill. Cortez Masto spokesman Zach Hudson said the campaign referenced every vote listed in Congressional Quarterly that references defunding Planned Parenthood. Heck campaign spokesman Brian Baluta told PolitiFact that counting procedural votes unfairly inflates the number. The other votes mentioned in the ad are a mix of procedural and more straightforward votes to defund the program. The ad cites three votes related to the same piece of 2015 defunding legislation, including the initial House vote, a reconciliation vote agreeing to changes made by the Senate, and a veto override vote. And it cites two votes on amending 2011 spending bills clearly designed to bar federal funding from the organization. Our friends at PolitiFact New Hampshire took similar issue with a claim about endangered Republican Sen. Kelly Ayotte voting to defund the group six times, ruling that counting procedural votes is ""accurate but needs clarification."" Health exemptions The second part of the ad claims that Heck opposes ""a woman's right to choose, even when her health is at risk."" Generally, Heck opposes abortion. His campaign said he supports exemptions in cases of rape, incest and if the pregnancy threatens a mother’s life. The Cortez Masto campaign argues, however, that Heck opposes abortion even when the mother’s health is ""at risk."" There is a difference between situations where continuing a pregnancy threatens the life of the mother and pregnancies with serious future health concerns for the mother. Cortez Masto’s campaign pointed PolitiFact to a 2008 Newsweek article detailing the health exemption, in part citing a Supreme Court ruling in Doe v. Bolton that says health can be defined as medical judgment on factors including ""physical, emotional, psychological, familial and the woman's age."" The National Abortion Rights Action League (NARAL), a pro-abortion rights group, provides several examples in a 2016 fact sheet of women whose pregnancies, while not life-threatening, would endanger their future ability to have children or seriously harm the mother if the pregnancy was brought to term. The ad cites as evidence Heck voting for a measure banning abortions after 20 weeks of pregnancy, with exemptions for abortions necessary to save the life of a pregnant woman ""in reasonable medical judgment,"" and limited cases of rape and incest. Heck voted against a Democrat-led ""motion to recommit"" the bill that sought to add an exception to the 20-week ban by allowing abortions that would preserve the health of the mother. Our ruling A Catherine Cortez Masto campaign ad claims Joe Heck ""voted 10 times to defund Planned Parenthood,"" and ""opposes a woman's right to choose, even when her health is at risk."" Heck has voted to defund Planned Parenthood, a fact he publicly admits. The harder question to answer is whether to count procedural votes leading up to formal votes on the defunding measures as votes to defund the group. The ad is mostly accurate, but needs some clarification on the actual number of votes.


Output: "Catherine Cortez Masto Says ""Joe Heck voted 10 times to defund Planned Parenthood ... and Heck opposes a woman's right to choose, even when her health is at risk."