Given a paragraph and a claim, classify it this way: If the claim contradicts the evidence present in the paragraph, classify the claim as '0'. If the claim has multiple supporting *AND* contradicting evidences, classify the claim as '1'. If the claim has supporting evidence and the paragraph is in overall favor of the claim, then classify the claim as '2'.
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Question: Paragraph: The story attempted to discuss cost by citing the difference in price between shoulder surgery ($13,000) and the PRP treatment ($1,000, in this case for two injections). This is sufficient enough for a Satisfactory rating, but barely. While this does give readers some idea of the possible cost difference in treatments, there is no assurance that the charges in the author’s case are typical for those for the general public. It is simply one single data point which is fairly useless to the public. And, since there is no evidence of benefit or how many shots one might require, cost could be all over the place. The story gives no information on quantified benefits measured in PRP research, and instead focuses only on the author’s experience. The only mention of potential harms in the story comes in this statement:  “The American Academy of Orthopedic Surgeons — which says PRP ‘holds great promise’ — describes the risk as minimal.”  That’s not acceptable given that there is no explanation of what those risks might be. Readers are left clueless when it comes to questions of potential harms. Simply put, the discussion on the quality of evidence here is at best minimal, just the experience of one patient who happens to be a writer for the Washington Post. The story does cite a “recent pilot study” from a Canadian clinic of just seven rotator cuff injury patients who underwent PRP therapy. It said the study “showed tissue healing in five of seven patients . . . as well as improvements in their pain and function.”  But the story offers no information on how much healing or what degree of pain reduction or function, information readers need to consider a new therapeutic approach. There is no discussion of the growing body of evidence that has yet to show PRP actually improves clinical results. High-quality research, including a Cochrane systematic review, shows no benefit from injecting PRP. As Cochrane’s review noted: “The quality of the evidence is very low, partly because most trials used flawed methods that mean their results may not be reliable….In terms of individual conditions, we were able to pool results from six studies and found no differences in long-term function between those who received PRT during rotator cuff surgery and those who did not.” When it comes to shoulder injuries like rotator cuff tears, the story does not disease monger. However, the author’s claim that a vaccination injection resulted in the shoulder tear was an unusual claim, and one that we’re dubious of. Along with quotes from the author’s physician (who has already posted the story on his website) there are quotes from a researcher who was involved in one small clinical trial on PRP. The inclusion of the researcher just barely squeaks by as sufficient to earn a Satisfactory rating here. However, the story would have been much stronger had the author interviewed an expert who disagrees with these two sources, which wouldn’t be hard to find given the Cochrane review and other systematic reviews that cast a less rosy glow on PRP. The story is basically touting a possible new therapy as an alternative to traditional rotator cuff surgery, but it does a poor job of comparing them in an evidence-based manner. The story explains that platelets are removed from a patient’s blood using a centrifuge, equipment readily available in most practices. It makes the point of advising readers to seek out practitioners who do the procedure frequently. The story suggests that the PRP procedure is becoming more available. The story does not make it clear that PRP is not a new treatment, and that has been studied for many years now, including in rotator cuff tears. This story does not rely on a news release. Claim: I’ll never go through shoulder surgery again, so here’s what I did

Answer: 1


Question: Paragraph: The article doesn’t discuss what the study authors new “way” of assessment might add in the way of costs. The story didn’t provide any data to give a sense of the potential benefit of the new approach. No numbers were given to explain how well it worked. Because there is so little information about the imaging technique and what it requires, it’s hard to say what the harms or benefits might be, but certainly the story might have mentioned the potential risk of drug intervention (or non-intervention) if the inflammatory cell “marker” is valid as a predictor of heart attack risk. Also, it would have been worth discussing if the new imaging technique exposes patients to radiation, which has been shown to increase the risk of cancer if used repeatedly. The story does not adequately establish the quality of the evidence, except to indicate that more research is needed, implying that this is preliminary work. From the journal article itself:  “The main limitation of this study is the lack of data demonstrating a predictive value of these imaging markers for clinical outcomes, which falls beyond the scope of this current work.” There was no such caveat in the news story. Rather, the headline trumpets that it “May Predict Heart Attacks.” No disease mongering here. The story stated that “about 750,000 Americans have a heart attack every year.” The article appears to quote only those who conducted the study. The article does describe current means of assessing heart attack risk, as well as some interventions (surgical and medical) to address those risks. However, the article doesn’t mention how this new technique would stack up against standard tests like stress tests or nuclear perfusion scans. There also is the option of simply treating people with risk factors and not utilizing imaging tests. The story explains that more research is needed before the technology might be available to everyone. The story focuses on the use of inflammatory heart tissue as having potentially better predictive value than current risk assessment tools for heart attack. But it’s a reluctant satisfactory, because the narrative is confusing and no numbers were given to estimate the scope of the potential benefit–how well the new approach worked. We could not locate a release from the University of Oxford or Science Translational Medicine. Claim: New Heart Imaging Method May Predict Heart Attack

Answer: 0


Question: Paragraph: Miami U.S. District Judge Federico Moreno rejected a motion by the South Florida Water Management District to end a decree signed in 1992. Among other things, the order sets thresholds for the amount of phosphorous in the Everglades, an ingredient in fertilizer from the vast sugar-growing regions to the north that promotes unhealthy plant growth in the sprawling marsh. Moreno said among his reasons for denying the water district’s motion is that its governing board is being largely replaced by new Republican Gov. Ron DeSantis, who has made the environment a top priority. The judge also said it would require a full evidentiary hearing on complicated scientific and environmental issues to end the decree. “This is the right thing to do at this time,” Moreno said at a hearing. “There’s really no harm, is there?” The order allows the water district to file the motion again in the future. The decree is not involved with other water problems that plagued Florida coasts last year, including red tide outbreaks and algae blooms. The water district and sugar growers say the decree is outdated, thwarts projects that would benefit the Everglades and has been superseded by subsequent state and federal laws that guarantee restoration would continue. The projects include vast reservoirs that cleanse water flowing south from sugar farms before it flows into the Everglades. “Twenty-seven years is enough. It’s enough because it’s unnecessary,” said water board attorney Brian Accardo. The U.S. government, environmental groups and the Miccosukee Indian tribe disagree, saying the decree is key to pursuing potential violations and ensuring the cleanup projects get built. They say it should remain in place until the Everglades has achieved an environmental balance close to its historical makeup. The Miccosukee reservation is in the Everglades. “The decree is essential to protect the Everglades,” said Anna Upton, attorney for the Florida Audubon Society. “We’re not there yet. We’ve come a long way.” The decree arose out of a 1988 lawsuit filed by the U.S. against the water district claiming high phosphorous discharges were threatening the long-term future of the Everglades. The state and water district contended the U.S. Army Corps of Engineers was equally responsible by moving polluted water into the area. In 1992, the consent decree was signed involving the federal and state entities, setting goals for reducing phosphorous as well as the levels of water at the right times needed to keep the ecosystem healthy. A key point in the settlement talks came with then-Gov. Lawton Chiles, a Democrat, showed up at a court hearing in 1991 and said: “We want to surrender. I want to find out who I can give my sword to.” Florida Department of Environmental Protection attorney Charles DeMonaco said about $2 billion has been spent to date on Everglades projects, with another $1 billion in the pipeline over the next four years. He said the state would also like to see the consent decree end, but only when there is an agreement on how success would be measured. “We don’t want to fight anyone. We want to end it,” DeMonaco said. _____ Follow Curt Anderson on Twitter: http://twitter.com/Miamicurt Claim: Judge won’t end decades-old Everglades cleanup oversight.

Answer:
2