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.

Input: Consider Input: Paragraph: The story focused on costs, including information about the relative cost comparison between what are called “open” surgeries and those done laparoscopically (with a thin flexible tube.) The release summarized how minimally invasive techniques reduced the length of hospital stay and complication rates for patients. “Researchers also found that, on average, the minimally invasive approach reduced length of hospital stay by approximately two days, and open operations were more than $9,000 more expensive than minimally invasive procedures. The researchers also found that laparoscopic procedures were better for patients in terms of fewer complications. Laparoscopic anti-reflux operations were less likely to result in postoperative blood clots, wound complications, surgical site infection, esophageal perforation (which can be life threatening), bleeding, cardiac failure, and death.” We rate this, but just barely, for citing cost differences between the two types of surgery and the average reduction in the number of days a patient must remain hospitalized. We do wish the release had delved more into the specifics of reduced complications. How common were the surgical complications in each surgical method? The release names complications associated with both types of surgery for GERD, while stating that patients undergoing laparoscopic procedures encountered fewer of them: “postoperative blood clots, wound complications, surgical site infection, esophageal perforation (which can be life threatening), bleeding, cardiac failure, and death.” The news release gave details about how the study examined records of about 75,000 patients from 1,000 hospitals to compare outcomes in the records for open vs. the minimally invasive laparoscopic surgeries. That’s all to the good. However, the news release didn’t mention any of the study’s limitations. The key one is that this is a retrospective, observational review of records that isn’t capable of supporting cause and effect statements such as the minimally invasive approach “reduced length of hospital stay by approximately two days.” Nor should this kind of evidence be used as the basis for statements such as laparoscopic procedures “were better for patients” and “should be the standard of care.” Patients receiving open vs. laparascopic procedures could differ in unknown ways, which is why the superiority of one approach over the other should ideally be established by a prospective, randomized controlled trial. There were other limitations outlined in the journal article that were not mentioned in the release. Because the NIS database doesn’t link to hospital records, researchers weren’t able to track and measure outcomes “including complications, readmission, and mortality, occurring after the initial hospital discharge.” The researchers were also unable to determine which open surgeries were “re-dos” of previous surgeries. The potential for errors in coding which procedures were used was also cited as a possible limitation. There was no disease mongering. The release also provided useful context on the prevalence of GERD and further specified that smaller group of patients, from the many heartburn suffers, might be candidates for the surgery. Well done. The release does not list any funding source for the research and the published study notes that authors had “nothing to disclose.”  We’ll rate this not applicable since this is an examination of existing data, and there may have been no additional outside funding. The news release does a good job here. It compares different surgical methods and it also names alternatives for treating GERD such as medications and changes in the diet. It also states which group of patients the surgery is aimed at: “Anti-reflux surgery should be considered in patients who do not achieve complete control of their symptoms [regurgitation or cough] with medications; who do not want to take medications for the rest of their lives; or who experience complications of medical therapy.” It’s clear from the release that both methods of surgery have been widely available nationally and the outcomes of 75,000 surgeries were tracked by the National Inpatient Sample (NIS) database. The release also notes that “urban academic or teaching hospitals” perform laparoscopic anti-reflux surgery more often than “open” procedures, 54.4 percent versus 45.6 percent. And it recommends that anti-reflux surgery should be performed laparoscopically in specialized centers. The news release was not about a novel procedure and made no claim of novelty. However, this isn’t the first study to examine laparoscopic vs. open surgery. For example, the British Journal of Surgery published results of a randomized trial of the two methods and the Scandinavian Journal of Gastroenterology published research on long-term outcomes following laparoscopic and open procedures for GERD. We did not observe any unjustifiable language. Claim: Laparoscopic anti-reflux operation for GERD linked to fewer postoperative complications

Output: A new study by the American College of Surgeons, a professional organization, compared records for 75,000 patients who underwent surgery for GERD, or gastrointestinal esophageal reflux disease. The study looked at two different surgical procedures and found the less invasive one seemed equally effective, but kept patients in the hospital a shorter time with fewer complications. The news release did a good job of discussing surgical alternatives and costs, which were estimated to be $9,000 lower for the less invasive laparoscopic procedure. The release would have been better had it spelled out some of the study limitations, the key one being that a retrospective, observational review of hospital records — as this study was — isn’t capable of supporting the cause and effect statements sprinkled throughout the release. Millions of Americans complain of occasional heartburn, sometimes called a burning sensation in the throat from food coming back up from the stomach. But some estimates are that about 20 percent of US adults fit the definition of GERD, which means they suffer symptoms at least every week. If patients consider a surgical fix, this study shows that a less-invasive procedure could reduce their complications and shorten their hospital stay. It’s hard to pin down stats on GERD prevalence. A 2014 review of 16 epidemiological studies of GERD prevalence published in the journal Gut suggest GERD prevalence ranges from “18.1%-27.8% in North America, 8.8%-25.9% in Europe, 2.5%-7.8% in East Asia, 8.7%-33.1% in the Middle East, 11.6% in Australia and 23.0% in South America.”


Input: Consider Input: Paragraph: Not applicable. The cost of olive oil is not in question. The story only cited a 41% lower risk of stroke but didn’t give the actual numbers of how many versus how many in the different groups. That may give an inflated sense of benefit or risk reduction. Not applicable. Unlike the LA Times piece, WebMD rurns to an editorial writer and two other independent experts to evaluate the evidence. It mentioned that this was an observational study but didn’t explicitly define that or why that’s a potential limitation. No disease-mongering of stroke in the story. Great sourcing – with 3 independent voices besides the study authors. The story ends, appropriately, with this: “Keeping blood pressure controlled, not smoking, exercising regularly, and eating a healthy diet that is low in salt and rich in fruits and vegetables can also help reduce stroke risk.” Not applicable. The availability of olive oil is not in question. The relative novelty of the study’s focus was clear in the story. It’s clear that the story did not rely on a news release. Claim: Olive Oil Linked to Reduced Stroke Risk

Output: An added nice touch was the discussion of the possible etiology of the olive oil effect (e.g., inflammation). Overall, a solid summary. When an observational study points to a statistical association between one factor and one outcome, it is important to explain why that doesn’t necessarily mean that one factor caused that one outcome. This story did a better job of that than its LA Times competition.


Input: Consider Input: Paragraph: Keytruda is already approved as a cost-effective treatment in melanoma and the National Institute for Health and Care Excellence also on Dec. 2 approved its use in the treatment of lung cancer patients who had started on chemotherapy, after Merck & Co cut the price further for the NHS. But trial data so far on the survival benefit of Keytruda as an initial lung cancer treatment has not been reliable enough,   according to NICE’s draft guidance, which will be subject to public consultation until 21 March. “The exact size of the overall survival gain for Keytruda compared to the current standard of care was uncertain because of the immaturity of the data,” a NICE spokeswoman said. Keytruda has proved effective in fighting non-small cell lung cancer in patients with high levels of a protein called PD-L1, which makes them more receptive to immunotherapy. The average cost of a course of treatment in Britain is around 29,000 pounds ($36,000) at the full list price but the NHS will pay less after getting a confidential discount. ($1 = 0.8042 pounds) Claim: UK rejects Merck's Keytruda as initial treatment for lung cancer.


Output: Britain’s healthcare watchdog NICE, which assesses the cost-effectiveness of medical treatments, has stopped short of recommending the use by the National Health Service (NHS) of Merck & Co Inc’s immunotherapy drug Keytruda in newly diagnosed lung cancer patients, after giving the go-ahead in December for patients who had prior treatment.