TASK DEFINITION: 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.
PROBLEM: Siteman Cancer Center at Barnes-Jewish Hospital plans to open a second proton therapy center in 2020, and Mercy Hospital St. Louis expects to open its own proton center two years later, The St. Louis Post-Dispatch reported . Proton therapy zap cancerous cells with precise beams of radiation while sparing surrounding tissue. Unlike traditional X-rays, the proton beams stop at the tumor instead of traveling through the body. The new $32 million proton system planned at Barnes-Jewish Hospital will provide “pencil-beam” precision to target tumors, said Dr. Jeffrey Bradley, director of Siteman’s S. Lee Kling Proton Therapy Center. It will be built next to a $20 million machine, which opened in late 2013, that uses magnets to scatter proton beams across a tumor. Siteman has treated about 800 patients with the proton therapy, close to its projections of 200 patients a year. The first proton centers built in the 1990s were known for their football-field size and up to $200 million price tag. To offset the costs, the centers marketed heavily to men with prostate cancer, despite a lack of evidence that patients have better outcomes or fewer side effects compared to cheaper treatment alternatives. In 2013, Washington University was the first to open a smaller, less-expensive proton system with one treatment room. “That’s very different from other centers that went all in, borrowed money, and put in four-room centers,” Bradley said. “The one room at a time idea is a very viable idea.” Bradley and other radiation oncologists say a major hurdle is insurance companies’ reluctance to cover proton therapy. That can cost 50 percent to 75 percent more than traditional radiation, according to industry groups. “Where the insurers like to say that proton therapy is not beneficial is often because they do not perform an adequate review of the evidence,” said Scott Warwick, executive director of the National Association for Proton Therapy. “We have notified the payers that they have often either misinterpreted data, reviewed older evidence or omitted key evidence in development of their coverage policies.” ___ Information from: St. Louis Post-Dispatch, http://www.stltoday.com

SOLUTION: St. Louis medical organizations plan more proton therapy.

PROBLEM: The story provided no cost estimates for vitamin and mineral supplements. The magnitude of wasted expenditures that could be saved is relevant. The story indicated that there was no cancer risk reduction associated with the vitamin supplements studied. A quote in the story from the author of one of the studies indicated that too little or too much of particular vitamins was associated with increased cancer risk. In addition, the table in the story provided information about vitamins being associated with an increased risk of diabetes and a higher, though not significant increase in the incidence in the case of one cancer. The story did not convey any sense of the quality of the studies on which it was reporting. Were they retrospective observational studies (generally weak designs) or prospective randomized trials (the best type of study). A more insightful explanation about why the current group of studies which find no protective effect are more compelling that the previous studies that found a protective effect of vitamins would have also been useful.. This story did not engage in disease mongering. The story included quotes from one of the study authors, as well as a spokesperson from the American Cancer Society and an expert without connection to the study but who wrote an editorial accompanying the study. The story mentions specific lifestyle interventions which have been shown to be associated with reduction in cancer risk. It inaccurately mentioned screening for colon, cervical, and breast cancer as means of reducing their risk. It should have stated that these screening tests are associated with reduced risk of dying of these cancers, not as means of reducing the chance of developing them. It’s clear that vitamins and mineral supplements are in widespread use. The story correctly indicated that the results of the current study are consistent with the results from several recent studies which demonstrated that vitamin supplementation failed to decrease the chance of developing cancer. The sidebar table, which summarized results and included the journal name and month of publication, provided a resource for interested readers to find more information. Does not appear to rely on a press release.

SOLUTION: Vitamins get ‘F’ in cancer prevention

PROBLEM: The story does not address cost at all. The story is focused primarily on childbirth practices in the U.K., which has a significantly different healthcare system from that in the U.S. However, the story does discuss childbirth practices in the U.S., and speaks to U.S. experts on the subject. Home births are often significantly less expensive than hospital or birth center deliveries, but there are still costs involved. The story would have been stronger if it had addressed this, even in broad terms. The story addresses benefits in only general terms. For example, when summarizing the NICE guidance, the story states “home births are safer than hospital births for women who are having their second or later child with a low-risk pregnancy.” And when describing the findings of the U.K. study that was the basis for the guidance, the story notes that “among low-risk women who chose to have a second or later child at home, there were fewer interventions and complications, such as cesarean sections, forceps delivery, infections and hemorrhage compared with hospital births, while the health of babies didn’t differ.” How much safer are home births under the relevant circumstances? How much lower was the risk of complications? It would be helpful to have at minimum an estimate of a summary figure, such as the frequency of complications and interventions overall for home and/or hospital births. In addition, while the story makes clear that the reduced risk is only for women with low-risk pregnancies — it doesn’t tell readers what that means. Does having had a previous C-section rule out a low-risk pregnancy? Which chronic medical conditions might rule a low-risk pregnancy out? It’s not clear. Potential harms are mentioned at different points in the report: maternal deaths; interventions and complications, such as cesarean sections, forceps delivery, infections and hemorrhage compared with hospital births; “complications” for the babies. But the story does not really explore the difference (if any) between risks that would be of potentially greater concern during home birth versus hospital birth — or vice versa. The story does note that the U.K. study behind the guidance found that there was a slightly increased risk of complications for babies born at home if it was the mother’s first birth. We’ll rule this Satisfactory with suggestions noted for next time. The story reports on an expert guideline published last spring that draws on a high-quality UK cohort study (Birthplace) and a Canadian case-control study.The story offers a broad overview of the cohort study that served as the basis for the NICE guidance. The overview would have been stronger if it had offered some additional details, such as information on the likelihood of complications for mothers and infants in both home and hospital settings. However, the story did include a link directly to the relevant research, which is always laudable. The story also offers limited details about the Canadian case-control study — but again the story linked directly to the study. One thing that’s missing from the discussion is any explanation of the hierarchy of evidence — how these two studies differ from one another and how the evidence they provide might compare to, say, a randomized trial. No disease mongering here. The story was very careful not to over-hype risks associated with giving birth, whether at home or in the hospital. This was a strong point for the story. The story cites multiple sources on both sides of the issue, and clearly notes when a given source has written about the issue and what that source’s position was. The story is, by its nature, about comparing alternatives. The story looks explicitly at home births compared to births in medical centers; and, among medical centers, the story explains the difference between hospitals and birth centers. This is another close one. The story does explain the difference between hospitals and birth centers, but doesn’t let readers know how common birth centers are in the U.S. Nor does it mention the availability of midwife services for home births, which can vary by state. However, the story does cite one U.S.obstetrics expert as saying that more birth centers could be established. Because the story addressed the issue, at least tangentially, we’ll give it the benefit of the doubt. The novelty here, which the story emphasizes, is the evidence-based statement from an expert medical group that hospital births may be riskier than home births for uncomplicated second or later pregnancies. It is unusual to see a medical group recommending against a higher level of medical intervention. With that being said, there is a fairly broad body of work on risks associated with childbirth, and home birth in particular, but the story only mentions the U.K. and Canada studies we noted above. While other research findings may not offer as convenient a comparison to the study used to inform the NICE guidance, they could help readers understand the levels of absolute risk facing mothers and infants at home, in hospitals, or at birth centers. And if the U.K. and Canada studies offer insights that were simply not to be found in other work, that would have been worth mentioning too. But the story earned a Satisfactory here. The story does not seem to be tied a news release, and clearly draws from interviews with multiple sources.

SOLUTION:
New Support for Home Births U.K. board NICE, in a surprise, rules having a baby at home is safer than a hospital in some low-risk pregnancies