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.

Ex Input:
The story makes clear the “big unknown” remains the price and “how much people are willing to spend to cut a day or so off of a bout of flu.” The story reports that Genentech, the drug’s manufacturer, said it’s too early to comment on the drug’s U.S. price. The story also notes that in Japan, where the drug was invented, it “sells for the equivalent of about $43.50.” The story uses terms like “a little more than a day” and “nearly a day” and “substantially” to describe the drug’s reduction in flu symptoms, fever, and coughing and sneezing, respectively. It does not explain, as the news release does, that: “Similar efficacy results were seen between baloxavir marboxil and [Tamiflu] in relation to duration of symptoms and fever reduction.” In other words, on the symptom front, both drugs were the same. According to the news release, a difference was seen in the length of time the virus was shed from the body (presumably through coughing and sneezing): 24 hours for baloxavir marboxil verses 72 hours for Tamiflu. The news release also states that there was also a difference seen in the level of virus in the nose and throat, but it provides no precise numbers. It is not known whether this benefit translates into less infection transmission, and the story should have made that clear. The news release issued by Genentech about the FDA’s decision to grant priority review describes baloxavir marboxil’s most common side effects: diarrhea, bronchitis, nausea and sinusitis. The news release also states that overall incidence of adverse events seen in patients taking baloxavir marboxil were lower than those seen in both the placebo group and the group taking Tamiflu. The STAT News story does not mention any potential harms. This evidence comes from the randomized phase III Capstone-1 study the FDA will review, which included 1,436 people in the US and Japan. It excluded people older than 64. The news story does not note this exclusion, nor does it state a key problem with this study: It has never been published in a peer-reviewed journal (instead, a study abstract was released as part of ID Week 2017). This means the full data analysis has never been seen by anyone other than the researchers. We explained why this is important in February 2018, when we discussed news coverage of the drug’s approval in Japan. The 2017-2018 flu season was the worst the US had experienced in nearly a decade. The flu impacted the entire country, and was responsible for 172 pediatric deaths. The news article did not use these or any other flu-related statistics to increase fear about the flu and, in turn, the need for this medication. The article includes two sources: Mark Eisner, Genentech’s VP of product development for immunology, infectious diseases and ophthalmology and Richard Webby, head of the World Health Organization’s influenza collaborating center at St. Jude Children’s Research Hospital in Memphis. Eisner’s affiliation with Genentech, the drug’s manufacturer, is clearly noted. Webby does not appear to have any conflicts of interest. The article would have been stronger if it had included a third source who commented on what–if anything–is known about whether reducing the duration of symptoms leads to reduced levels of transmission that result in fewer people contracting the flu and fewer deaths. The story explains that the only other drug approved to treat the flu is Tamiflu, which is not widely used. The writer explains that both drugs need to be taken within 48 hours of symptom onset and that baloxavir marboxil is a single one-time dose, while Tamiflu must be taken twice daily for five days. It is clear from the story that the FDA is expected to decide by the end of the year whether to approve this new flu medication. The story explains that it’s been more than 20 years since a new class of flu drug has been developed and marketed. (It is available in Japan.) The catalyst for the story was a news release issued by Genentech about the FDA granting priority review of baloxavir marboxil, but the story does not use direct quotes from the news release.

Ex Output:
A flu drug — shown to reduce the duration of symptoms — could upend treatment in U.S.


Ex 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.

Ex Output:
Lymph Node Study Shakes Pillar of Breast Cancer Care


Ex Input:
Former Assemblyman Mike Gatto, a Democrat, proposed a ballot measure on Thursday aimed at providing services to people who commit crimes like defecating in public or using drugs. “When someone breaks the law, it should be enforced. However, certain criminal acts should be treated not as something meriting harsh punishment, but as a ‘cry for help,’” the introductory text to his proposed ballot measure reads. The text still needs approval from the state for Gatto to start gathering signatures, and it would need signatures of roughly 620,000 Californians to make it onto the ballot. As of now, Gatto has no large donors willing to bankroll a signature collection campaign, but he hopes to attract some. His proposal comes as California is in the throes of a worsening homeless crisis, with a growing number of people living on the streets in cities such as San Francisco and Los Angeles, where Gatto is from. But it met quick criticism from some, who argued it would take away power from counties to decide how best to serve people and would effectively institutionalize people. “The initiative is an embarrassing attempt to make California more visually appealing to those who have no interest or knowledge in addressing the root causes of what is happening to people in our state and country,” the Western Center on Law and Poverty, a nonprofit legal organization, wrote in a statement. Gatto’s proposed measure would require every county with more than 100,000 people to set up a specialized court that can steer people to services. Anyone arrested for committing crimes ranging from indecent exposure to defecating on public transit could be sent through the court if their behavior is determined to be a result of economic hardship, mental health or drug addiction. The courts would then help people access housing, counseling and treatment or mental health services and prescription drug help. Gatto said he views the measure as primarily targeting people who are suffering from mental illness rather than people who are on the streets for other reasons, like economic hardship. He’s proposing taking funding from the “millionaire’s tax” that Californians approved in 2004, which taxes income of more than $1 million at 1%, sending the money toward mental health programs. Twenty percent of that money would go to the county courts under his proposal. The state has faced criticism in part for being slow to deploy money under the Mental Health Services Act, which brings in well over $1 billion annually. The state auditor faulted a commission overseeing the money for inadequately evaluating the effectiveness of county programs. Many California police officers are struggling to enforce laws affecting people living on the streets, he said. “A lot of these police forces are demoralized,” he said. “They want to do something about the problem but it’s a matter of giving them the resources and the place to put those individuals.” Eduardo Vega, a former commissioner on the oversight body, said the idea of diverting homeless people away from the criminal justice system is a good one. “It’s not a crime to be homeless, and it’s not a crime to have a mental health condition,” he said. But he said spending money from the “millionaire’s tax” on county court systems might conflict with the law governing how it can be used. California’s 58 counties are the “front line” providers for mental health services, said Graham Knaus, executive director of the California Association of Counties. The organization is still reviewing and has not taken a position on the proposed ballot measure, but he said counties already work closely with the state and local government to provide services to homeless people with mental health needs. Jonathan Sherin, director of Los Angeles County’s Department of Mental Health, offered a blunter assessment, saying counties need more money, not new requirements on how to spend what they already have. “Tell us the outcomes you want us to achieve with the money and get out of our way or facilitate our success,” he said. “Do not tell us what to do with the money because you’re not down here trying to get it done.”

Ex Output:

California voters may be asked to steer homeless to services.