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: According to the story, brand-name aromatase inhibitors cost between $340 and $420 a month, but the story also points out that lower-costing, generic versions are available in the U.S. It would have been useful had the story also provided cost information for the other preventive drug options, tamoxifen and raloxifene. A particular strength of this story is its presentation of data. Dr. Winer, an independent source included in the story, translates a 65% risk reduction to mean that exemestane may reduce a woman’s risk of developing breast cancer from 3% to 1%. Not only does the story provide absolute risk, but it also presents the number needed to treat. According to the study authors, 26 women would need to take exemestane for five years to prevent a single case of breast cancer. It should be noted, however, that few women in the study completed five years of therapy. Since this is being used as a preventive measure in healthy women, side effects are very important and data should have been provided. The story indicates that “slightly” more women taking exemastane experienced hot flashes, fatigue, sweating, insomnia, and joint pain, compared to those taking placebo pills. It would have been helpful to note, for example, that 40% in the exemestane group experienced a hot flash versus 32% in the placebo group. Citing older research, the story indicates that that joint pain, muscle aches, problems having sex, and vaginal dryness may be more evident with a longer duration of use. The story makes it clear that the study was a large-scale, placebo-controlled, randomized trial, which enrolled over 4500 women in North America and Europe. The women included had at least one risk factor for breast cancer. It also notes that given the significant risk reduction associated with exemestane, the study was stopped after 3 years to give women in the control arm the option of taking exemestane to prevent possible breast cancers. More information regarding participants’ characteristics, including age and race would have been helpful. This story did not engage in disease-mongering. In addition to including experts not affiliated with the exemestane study, the story also notes that the it was funded by the Canadian Cancer Society, the Avon Foundation, and Pfizer. In addition, the writer points out that the study lead and a few other authors have received speaking fees from Pfizer and other pharmaceutical companies that make cancer drugs. This story compares the benefits and harms of exemestane with tamoxifen; however, a mention of how these compare with raloxifene, would have been useful. The availability of aromatase inhibitors is not in question. It’s clear from the story that aromatase inhibitors are currently used to prevent breast cancer recurrences. It’s also clear that this is the first study evaluating its utility for preventing the first instance of breast cancer in healthy women with a higher risk of developing the disease. The story does not appear to be based on the press release.

SOLUTION: Hormone-blocking drug reduces breast cancer risk

PROBLEM: Though the article does not mention costs or compare costs of garlic and garlic supplements with other treatments, many readers will be familiar with these. The story reports that the consumption of garlic in any of three forms (raw, powdered supplement, aged extract supplement) had no effect on LDL cholesterol or triglycerides. To quantify this non-effect in mm/dL is unnecessary, and would have been numbing for the average health news consumer. A majority (57%) of individuals in the trial who ate garlic-laced sandwiches reported bad breath and body odor, a “harm” the story neglected to mention. The article reflects an appreciation for the hierarchy of evidence, noting that “there was good evidence in test-tube and animal studies” that garlic could lower LDL cholesterol, and explains the randomization methods in the new clinical trial. No obvious elements of disease-mongering. The article cites four sources and provides sufficient information about their potential conflicts of interest. The article fails to mention alternative methods for lowering cholesterol, though many readers may be familiar with these (most prominently exercise, diet, and drugs). Most readers will be familiar with the availability of the health interventions studied—raw garlic and garlic supplements. The story rightly notes that garlic is not a new “treatment” for high cholesterol. No obvious use of text from a press release.

SOLUTION: Garlic powerless against cholesterol

PROBLEM: The cost of anti-depressant medications are not mentioned. Cost of generic prozac is about $16/month. Branded versions are about $80-120/month   The story does provide absolute data on the positive benefit of these medication for several mood disorders. The story also presents the number needed to harm. The story presents an adequate risk to benefit comparison by providing the data. The story focuses on only one potential harm of treatment, i.e. suicide and suicidal ideation. The story does not list the side effects of these medications (stomach problems, insomnia, irritability, and mania in some children). While these medications are considered safe – even with the FDA warning – there is little long-term data on their safety in these groups. The story gives an overview of the meta-analysis and explains why the results of this new study may differ from earlier studies on which an FDA warning of increased suicidal behavior in children taking anti-depressants were based. The story provides the number needed to harm as well as other quantitative information on the benefits and risks of anti-depressants as they relate to improved mood and risk of suicidal thoughts and feelings. The story simply reports the results of a review of many studies looking at suicidal behavior in children and adults who were prescribed anti-depressant medications. The story would be improved by giving information on frequency of the conditions discussed, but there is NO disease mongering The story interviews one of the lead authors of the study. However we are not told if he has financial ties with the pharmaceutical makers of anti-depressant medications. The JAMA article gives conflict of interest info and there are potential conflicts that are not reported in the news story. The version of the story we reviewed was in the Cleveland Plain Dealer. This version does not provide other treatment options for children and teenagers who have anxiety disorders and/or depression such as psychotherapy, especially cognitive behavioral therapy. But the original AP story did include an interview with a Duke expert, unconnected with the JAMA study, who commented on cognitive behavioral therapy. The story does not provide information about the availability of anti-depressant medications for young children and teenagers. However, since this story deals with possible risks from these drugs, this criterion seems less important in this story. Anti-depressant medication treatment is children is a relatively new phenomenon. The story does not mention this. However, the focus of the story was to provide a more up-to-date report of the risk of suicidal ideation and behavior in children taking these medications. Data from this recent systemic review suggest the risk is still there, but not as great as previously thought. The original AP story had interviews with two experts, one of them not connected with the research. So it's safe to assume it did not rely solely or largely on a news release. But the Cleveland Plain Dealer, in which we picked up the story, cut out the quotes from this independent source.

SOLUTION:
Antidepressants’ risks to children slim, study says