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.
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Question: Paragraph: The news release includes information about costs. We would have liked a little more context. The release states: “The costs associated with home infusion were also consistently lower than services provided in a health care facility, with savings ranging between $1,928 and $2,974 per course of treatment.” We need to know what percentage of savings that is per course of treatment. If the whole course costs $100,000, then saving $1,928 is a pretty small percentage. If the whole course is $10,000, than a savings of $1,928 looks more substantial. We found the news release skimmed over giving crucial numbers and metrics for benefits. Separate from the cost benefit to home infusion versus hospital or clinic infusion, the release should have given us some numbers for safety. Here is what the release stated (emphasis ours): “The research showed that patients receiving intravenous therapy at home had as good or better clinical outcomes as those patients who received the same therapy in a traditional health care setting. In addition, patients overwhelmingly preferred receiving their infusion therapies at home, reporting fewer disruptions in personal schedules and responsibilities. We need numbers to demonstrate how “as good” the clinical outcomes were. We need numbers to represent “overwhelmingly preferred.” By what percentage did what number of patients demonstrate preference? This is where the release could have taken some quantitative data from the study. The word “harms” does not appear in the news release. During intravenous infusions there are complications that may arise. The release does not mention harm, even to dismiss the probability as rare. The study being reported is a systematic literature review that only considered 13 prior studies. The release does not address the limitations of a literature review or give us the total number of patients represented by the 13 studies. Only 5 of the 13 studies used in the analysis addressed outcomes. One had no comparison group (“However, no adjustment for confounders was performed, and higher OPAT success rates were likely due to purposeful selection of younger, healthier patients for OPAT therapy,” according to the published study). In another study, “IPAT patients were selected from a time period during which OPAT was not available for any patients, minimizing selection bias by the matching fact.” In any case, less than half of the studies looked at outcome data and those that did involved different diseases from different time periods, some had control groups and some did not. We don’t think the evidence is strong enough to suggest outcomes were improved. The bias inherent in CVS employees culling the studies is also concerning. A better description of the review’s search and selection process may have helped allay any concerns about studies being cherry-picked. There is no disease mongering. The release is clear that the study was done by the CVS Health Research Institute. Since this is a news release from a profit-making company that operates directly to sell services under study, we hope the readers quickly understand there is an inherent conflict. This is the equivalent of a Coca Cola study about the benefits of drinking their product. The release explains the alternatives of clinic or hospital infusion compared to home infusion. Home infusion services are widely available. Their reimbursement is not widely available. The release says “clinical outcomes and quality of care have not previously been systematically evaluated.” The release doesn’t rely on any unreasonable or unjustified language. However, we do not think the news release proves the words used in the headline that say “Home Infusion Care Improves Patient Outcomes and Quality of Life While Reducing Overall Costs.” Based on a literature review, which does not randomize people into apples-to-apples comparison, you cannot claim to show better outcomes. The release does not offer any quantified benefits to support medical outcomes and doesn’t provide quantified information about quality of life improvement. The fact that patients prefer home infusion to travel to a clinic is not by itself a proof that their lives have been improved. As we wrote in the benefits section above — we are not given numbers to prove by what amount patients prefer home infusion. Claim: CVS Health Research Institute Study Shows that Home Infusion Care Improves Patient Outcomes and Quality of Life While Reducing Overall Costs

Answer: This news release describes the cost savings and safety of home infusion services from 13 previously published studies compared with infusion services at a clinic or hospital. Home infusion appears safe and clinically effective while saving money in the studies reviewed, but the release does not address limits in the review. We aren’t given any numbers to back up the claims that clinical outcomes were equal and that patients preferred the home setting. The release notes that CVS has a home infusion business–Coram–so at least they make this transparent. We applaud CVS for attempting to quantify the cost savings and other potential benefits of the service — and the claim that there are advantages are likely valid — but some context/background from other, independent studies would be helpful. Besides the lack of quantification, the release doesn’t delve into the potential risks from using the home infusion service. Treatments for chronic diseases, which often require drugs administered through infusion, are one of the fastest growing costs in the US health care system. If patients can be served at home, rather than in outpatient clinics or hospitals, it saves both money and time. But outcomes studies, which compare outcomes and safety between locations, are essential to judging whether home infusion is equal to clinic or hospital infusion. This release does not go far enough with numbers to quantify benefits and risks. We also see that CVS has a conflict of interest, because they have a business arm, Coram, that sells home infusion services. It appears this release (and study) are getting attention just as Congress is “discussing how to implement a comprehensive home infusion benefit for Medicare beneficiaries.”


Question: Paragraph: The bee, once widely found in the upper Midwest and Northeastern United States, was listed after U.S. President Donald Trump’s administration lifted a hold it had placed on a plan for federal protections proposed last fall by the administration of former President Barack Obama. Bumble bees are key pollinators of crops such as blueberries and cranberries, and are almost the only insect pollinator of tomatoes in the United States, according to the U.S. Fish and Wildlife Service. Conservation groups that had called for the new classification welcomed the move. “The listing helps mediate threats for this species and for all of those other animals out on the landscape that are suffering similar setbacks,” Rich Hatfield, senior biologist at the Xerces Society for Invertebrate Conservation, said by phone on Tuesday. The rusty patched bumble bee, or Bombus affinis, is one of 47 varieties of native bumble bees in the United States and Canada, more than a quarter of which face risk of extinction, according to the International Union for the Conservation of Nature. The population and range of the bee, named for the reddish blotch on its abdomen, have declined by more than 90 percent since the late 1990s due to disease, pesticides, climate change and habitat loss, according to wildlife officials. The agency in September proposed safeguarding the bee, but the listing was delayed by Trump’s White House as part of a broader freeze on rules issued by the prior administration. Environmental advocacy group the Natural Resources Defense Council sued last month, arguing that suspending the listing without public notice or comment violated the law. The NRDC said on Tuesday it was evaluating the next steps in its legal fight. Government scientists said the delay, part of a standard review, was not expected to affect the insect’s conservation, Interior Department spokeswoman Heather Swift said in a statement on Tuesday. The agency “will work with stakeholders to ensure collaborative conservation among landowners, farmers, industry, and developers in the areas where the species is native,” she added. Bumble bees pollinate wildflowers and about a third of U.S. crops, according to the Xerces Society. A recent study by the Center for Biological Diversity found that more than 700 of the 4,000 bee species native to North America and Hawaii may be inching toward extinction. Claim: First U.S. bumble bee added to endangered species list.

Answer: The rusty patched bumble bee became the first wild bee in the continental United States to gain federal protection on Tuesday when it was added to the government’s list of endangered and threatened species.


Question: Paragraph: In February 2017, Shane Patrick Boyle started a GoFundMe campaign to raise money for “a month of insulin.” A few weeks later, he died after developing diabetic ketoacidosis. Although several local outlets reported on Boyle’s death at the time, it wasn’t until November 2017 that Boyle’s story reached many readers, thanks in part to a Facebook post from United States Sen. Bernie Sanders linking to an article in The Nation about the rising cost of insulin: We cannot call ourselves a great country as long our young people are literally dying because they cannot afford life-saving medication. This young man, Shane Patrick Boyle, died on March 18 after his GoFundMe campaign to pay for insulin came up $50 short. Something has got to change. Our job is to stand up to the greed of the pharmaceutical industry and enact policies that make prescription drugs affordable for everyone—not ones that make the CEOs of the pharmaceutical industry rich. In addition to highlighting the sad circumstances surrounding Boyle’s death, The Nation also pointed to Alec Raeshawn Smith, a 26-year-old who died in June after he lost his insurance and started to ration his insulin: Alec Raeshawn Smith, age 26, was found dead in his apartment on June 27. He was rationing his insulin after he aged out of his parent’s insurance coverage. The sad fact is more people would be alive today if insulin was affordable for all Americans. The deaths of Smith and Boyle and their reported struggles with health insurance were met with skepticism by some readers. Others encountered this news on social media, where it was shared with incomplete or incorrect information. For instance, comedian David Anthony conflated the deaths of these two individuals when he wrote that a 26-year-old had started a GoFundMe to get insulin: For the rest of my life I will never forget a 26 year old started a gofundme to get insulin, didn’t get the amount he needed and died rationing his not costly medicine. Just before Thanksgiving. — Dave Anthony (@daveanthony) November 24, 2017  Alec Raeshawn Smith was 26 years old at the time of his death; however, we have not been able to find anything to indicate that he had set up a GoFundMe campaign to raise money for insulin. (A fundraiser was set up after his death to cover funeral costs.) Shane Patrick Boyle, on the other hand, was older when he died, and he did set up a fundraiser for medication. Smith passed away on 27 June 2017. In his obituary, his family asked for donations to the Juvenile Diabetes Foundation, and encouraged everyone to sign a petition for affordable health care: In lieu of flowers memorial donations may be given to Juvenile Diabetes Foundation, www.jdrf.org. We would also like to encourage everyone to go to www.jdrf.org and sign the Coverage 2 Control petition which will provide affordability, choice and coverage for people with Diabetes. Boyle died of the same treatable complication that killed Smith: diabetic ketoacidosis. Before his death on 18 March 2017, he set up a GoFundMe campaign to raise money for one month of insulin:  The only archived version of this campaign is from 23 March 2017, five days after Boyle’s death. Although this copy shows that Boyle had raised $1,590 of a $750 goal, it appears that the majority of this money was raised after his passing. (All eight comments were posted in the days following Boyle’s death and the visible donations, more than $200, were posted within a day of its archival date.) Ted Closson, a comic book artist and friend of Boyle’s, wrote that Boyle was “$50 shy of his goal” for over two weeks:  A second GoFundMe campaign to raise money for a memorial for Boyle and his mother also suggests that the fundraiser was short of the $750 goal at the time of Boyle’s passing (emphasis ours): The world lost a wonderful man due to complications of type 1 diabetes. My cousin, Shane Boyle, put everything into taking care of his ailing mother at the expense of his own needs. Shane’s mother, Judy Boyle, passed away on March 11th and we lost Shane to diabetes exactly a week later on March 18th. After his death, we learned that Shane lost his prescription benefits when he moved to Mena, Arkansas to care for his mom. We found a GoFundMe where he was trying to raise $750 to get just one more month of insulin and supplies. Unfortunately, he didn’t get help in time. Shane died because he was trying to stretch out his life saving insulin to make it last longer. Shane was working hard to take care of his mother’s funeral arrangements when he died. Her service had to be cancelled because of the unexpected financial burden of losing two family members in a week’s time. I am hoping we can raise the funds for a combined funeral service for Shane and Judy Boyle. If we can raise more than is needed for the service, any remaining funds would go to a charity that provides insulin to diabetics like Shane. We don’t want other families to suffer the pain of losing a loved one because they couldn’t afford medications. Thank you for any help you can provide, even if all you can offer is a kind message or sharing a special memory. Vice also mentioned the circumstances surrounding Boyle’s death in a story about the rising price of insulin. Long before Boyle launched a fundraising campaign, he worried about a Trump presidency’s effects on the price of insulin. Immediately after the election, on 9 November 2016, Boyle wrote on Facebook (emphasis ours): Claim: A man named Shane Patrick Boyle died shortly after starting a GoFundMe fundraiser for insulin.

Answer:
Last night/ this morning, I was so depressed I did not want to live in this world anymore (and as a type one diabetic, I honestly don’t know how long I will live if I lose access to affordable healthcare). Today, I feel more optimistic, not because I think everything is going to be okay, but because I have seen so many of your posts, recognizing the fight that is ahead, and talking about organizing, not just sitting back and complaining or planning for the next election.