TASK DEFINITION: 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'.
PROBLEM: Paragraph: The story does not say how much this new procedure costs or compare it with existing treatments for patients who don’t respond to medication. Deep brain stimulation, the current treatment standard, can run anywhere from $30,000 to $70,000, according to various online cost estimates. There also may be additional costs incurred by those patients who have adverse effects. The story is long on description but short on numbers. Saying the treatment “has had an immense impact on patients’ lives,” the story devotes quite a bit of print along with video footage to show rapid functional and quality-of-life improvements experienced by patients, focusing on one women who said her tremor “has almost disappeared” since she had the procedure in June. Video showing this patient before and after treatment–including her attempts to write her name, trace a spiral and pour water from one cup to another–do a great job of conveying the improvements. This is terrific news for this woman, but we’re not told how representative her experience is of overall outcomes. Is she a best-case scenario? Middle of the road? There are also inspiring quotes from a researcher, including a description of the “remarkable moment” patients experience when they realized the tremor has subsided. “They can write their names again, they can feed themselves, they are not embarrassed about being in public. So it really is extraordinarily helpful for people,” he says. In terms of study data, the story says researchers “found that the severity of essential tremor reduced significantly” in patients who underwent the treatment as well as reported improvements in quality of life. But there are no figures. In fact, according to the study, patients experienced a 47 percent improvement in tremor scores, dropping from 18.1 points on a 32-point scale at baseline to 9.6 points three months after the procedure. That data should have been included. Also, the story should have spelled out that 56 patients received the treatment, versus 20 who experienced a fake procedure. Also worth pointing out: We don’t know the meaning or clinical significance of a reduction of this magnitude in the total score. The story addresses adverse effects, and that’s sufficient for a Satisfactory rating. We do wish the story had quantified the harms that were measured in the study. The fourth paragraph says the procedure “brings lasting side effects in some patients” and later the story quotes a physician who is not involved in the research as saying, “It’s a pretty high incidence of side effects.” But nowhere do exact numbers appear. Rather than citing data from the study, the story quotes the physician as saying that “over a third of patients actually experienced either gait disturbance or paresthesia,” or numbness. This information isn’t very useful because the story does not explain when these rates were measured. According to the study, three months after the procedure 36% of patients had gait disturbance and 38% had numbness. After 12 months, the numbers dropped, to 9 percent and 14 percent respectively. Also worth mentioning is that one patient was reported to have permanent diminished sensation of the dominant thumb and index figure, which was categorized as a serious adverse event. That did not appear in the story. The story clearly spells out that there isn’t data on the long-term efficacy of this procedure, and that more study is needed, so we’ll give this a barely passing Satisfactory. Several important study limitations were not included in the story, such as the fact that the treatment did not provide significant improvement for some types of tremors, and the treatment is not appropriate for people who are unwilling or unable to undergo an MRI. We’re also not told that the sham group was only followed for 3 months, while the experimental group was followed for a year. This is not usually recommended in clinical trials and both groups should be followed for the same length of time. The story cites a figure from the International Essential Tremor Foundation, an advocacy group, that an estimated 10 million people in the United States suffer from the condition. However, a 2014 analysis of existing research put the number of cases at around 7 million as of 2012, or about 2.2% of the U.S. population. While this may not qualify as disease mongering, the story could have pointed out that the exact number of cases isn’t clear. Also, the story should have noted that not all people with essential tremor have symptoms severe enough to require treatment. The story only fulfills part of our criteria. It does use one independent source, a physician who was not involved in the study. It also accurately reports the trial’s funding sources: InSightec, which developed the device; along with Focused Ultrasound Foundation, which is funded by device makers and philanthropic organizations; and the Binational Industrial Research and Development Foundation, an Israel-U.S. government partnership that receives corporate support. However, the story falls short because it does not report the fact that nine of the study authors reported conflicts of interest, with most receiving financial compensation of some sort from device makers in the field. Lead researcher G. Rees Cosgrove, M.D. who is quoted in the story, reported receiving consulting fees from InSightec. The story states, “Doctors usually treat essential tremor with medication, but the drugs don’t work well for all patients.” That’s true, and so we’ll give this a Satisfactory rating for at least mentioning alternatives. But it should be noted that other procedural treatment options were not compared or even mentioned in the story and received only a brief mention in one of the videos. The current standard for tremor patients who don’t respond to medication is deep-brain stimulation, in which a probe connected to a pacemaker is implanted in the thalamus to suppress the tremors. Gamma Knife thalamotomy, which delivers precise doses of radiation to the thalamus, is also considered to be a safe and effective therapy for patients who don’t respond to medication. Also, some patients have mild symptoms that can be treated with relaxation techniques and the avoidance of triggers such as caffeine. The story states that the device was approved by the FDA in July. The story could have done readers a service by giving a sense of how many medical centers around the country are geared up to perform the procedure, or will be soon. This is indeed a new treatment option for essential tremor, though the story may leave readers with the false impression that the concept of killing off neurons in the thalamus is new. Rather, it’s the use of focused ultrasound to destroy brain tissue, rather than a probe inserted in the brain, that constitutes an advance. The story does not appear to rely solely on the news release, which we also reviewed. Claim: New treatment offers some hope for an unshakable tremor

SOLUTION: 2

PROBLEM: Paragraph: There is no mention of costs in the release, but overuse of medical technology such as MRI scanning is one major reason for soaring health care costs. According to personal finance website Nerdwallet.com, median prices of a brain MRI range from $525 in Atlanta to a whopping $3,310 in Milwaukee. The main contention of the news release is that “imaging findings can help spur beneficial lifestyle changes in patients to reduce risk for Alzheimer’s disease.” But there’s no evidence presented to show that these images have any effect — good or bad — on patients’ adoption of beneficial lifestyle changes. Does performing an MRI increase the likelihood that someone will lose weight, exercise, and stop smoking? The release also states, “institutions… meld these approaches into novel ways to improve patient care,” but the report doesn’t detail what those “novel” therapies are. Experts in the report talk about pinpointing “volume loss in the brain” and characterizing imaging markers, but these are all surrogate endpoints. In other words, how do these translate to tangible health outcomes for patients? Bottom line: The idea that a brain MRI is going to help motivate people to adopt meaningful lifestyle changes — and that those changes will, in turn, lead to an actual reduction in the number of Alzheimer’s disease cases — requires several leaps of logic that have very limited support from evidence. The release owed it to readers either to point out the preliminary nature of the hypothesis or provide some evidence to back it up. The release did neither. Procedures almost always carry risks, and MRI is no exception. Some physicians are concerned with “MRI abuse,” pointing out that MRIs often pick up abnormal – but harmless – findings that muddy up the clinical picture. These so-called “incidentalomas” can lead to more tests and treatments that cause harm and add to costs. Unnecessary imaging is a major contributor to spiraling health care costs in the US, since a single scan on average in the US costs $2,611, according to Medicare data. Beyond stating that it exists, this news release provides no information about the journal article that is the subject of the release. Nor does it detail any of the studies that supposedly support the value of imaging for Alzheimer’s disease prevention. We’d add that the journal article itself provides limited-quality evidence — it doesn’t detail the process for selecting articles that are included in the review (raising the possibility of “cherry-picked” studies) and includes little in the way of critical evaluation of the studies that are cited. Strangely, three physicians, who weren’t listed as authors of the study, are quoted in the release and allowed to tout the benefits of quantitative MRI technology. They make sweeping statements, such as that this technology “will have a huge impact in the future” and that imaging “can have a powerful impact [on patients]” But the report fails to go into detail. One of these experts adds, “Patients seem to enjoy reviewing results of their imaging studies, more so than reading the results of their blood tests or other clinical evaluations.” But one physician’s anecdotal observation is not evidence of enhanced quality or effectiveness of care. Again, supporting data is needed. The news release does not engage in disease mongering and states that as many as three million cases of Alzheimer’s dementia could be prevented with lifestyle changes. However, it does imply that there would be more cases prevented with the addition of brain imaging, a claim that is not supported by the release or the underlying review article. The release does not specify funding sources for the work, which included the National Institute of Biomedical Imaging and Bioengineering and the National Institutes of Health. Many of the authors are consultants for medical device and pharmaceutical companies, including Toshiba (cited as “related” or relevant in the original research report). The release does not disclose this. The main premise of the news release is that MRI imaging can help people lower their risks for cognitive decline by encouraging them to make lifestyle and behavioral changes. It states that risk factors include obesity, diet, sleep, hypertension, diabetes, depression and smoking. However, the release does not address any alternatives — besides brain imaging — that might help people make the desired changes. Behavioral change counseling, which is an established approach to reducing problematic behaviors, is not discussed. The release doesn’t address the availability of quantitative MRIs of the brain. MRI in general has been used since the 1970s, and its availability is not in question. But since the issue is not specifically addressed by the release, we’ll rate it Not Applicable. Using quantitative MRI technology to diagnose Alzheimer’s disease in its early stages is not a new concept. There have been blog posts and numerous studies in the past 10 years devoted to this topic. We’re not really sure what’s new here. The news release refers to “novel ways to improve patient care,” but does not specify what these new approaches are. The language of the release bordered on sensational, with neurologist Majid Fotuhi touting the benefits of quantitative MRI technology and claiming it will have a “huge impact in the future of diagnosis and treatment of Alzheimer’s disease.” The release never clarifies the how and why of this statement. Claim: Preventive neuroradiology: Brain imaging bolsters efforts to lower Alzheimer's risk

SOLUTION: 0

PROBLEM: Paragraph: Those candidates include Lauren Underwood, a 31-year-old registered nurse from Illinois and part of the Democrats’ master plan to regain control of the House. While Underwood is no fan of President Donald Trump, she said her No. 1 concern — and the top concern of the voters she hopes to will send her to Washington — is access to health care. Attacking the Republican president hard just isn’t necessarily a winning play in Illinois’ 14th congressional district, said Underwood, who served as an adviser to the Department of Health and Human Services under Democratic President Barack Obama. “I don’t talk about him that much. He has a higher approval rating than my congressman does, so we talk about our congressman,” said Underwood, who’s hoping to oust incumbent Republican Rep. Randy Hultgren in a district that narrowly backed Trump two years ago. Other Democrats aiming to flip House seats say they’re also trying to zero in on policy more than the president. The Democratic Congressional Campaign Committee has its hopes pinned on 50-plus candidates looking to upend enough seats — 23 — to wrest control of the chamber from the GOP for the first time in eight years. Republicans have their own plan to retain control, but Democrats are banking they have more than just both momentum and history on their side. U.S. Rep. Denny Heck is helping lead the effort to flip the House. The Washington Democrat said the Democratic Congressional Campaign Committee can assist candidates with a range of tasks — from tapping into a national donor base to aiding with the basic mechanics of building a campaign. But he warned that trash-talking Trump will get a candidate only so far. “What candidates ought to be doing is talking about that crowded freeway that they need to get additional funds to widen or additional funds to provide mass transit for, or that lake that is becoming polluted and they need the EPA to step up,” Heck said. Debbie Mucarsel-Powell is also on the “Red to Blue” list. Mucarsel-Powell, who came from Ecuador as an immigrant with her mother, said Florida’s 26th Congressional District — the state’s southernmost district — is one of the most vulnerable for Republicans in the country. She pointed to a 16-point win by Hillary Clinton there in 2016. The seat is currently held by Republican Rep. Carlos Curbelo. While Mucarsel-Powell doesn’t shy away from talking about Trump, she says she’s more focused on the struggles of local residents. “They don’t have access to health care. They don’t have good quality education,” she said, adding that tens of thousands depend on the Obama 2010 health care law that Republicans have worked to undo. Talk of a Democratic blue wave is overblown, according to Matt Gorman, communication director for the National Republican Congressional Committee. He said the committee — which has its own “Young Guns” program — is raising impressive sums and has battle-tested incumbents who know they’re going to be targets. Gorman said the NRCC is also urging candidates to run on local issues and not focus on the latest headlines on cable new or Twitter. He said polling shows the party is in better shape than many assume. “This is going to be a fight and certainly we’re going to work like we’re 10 points down as we do every day, but for the bedwetters out there who are claiming that all hope is loss I would encourage them to actually look at the data,” he said. “It’s simple math.” Democratic Rep. Katherine Clark, who is also heading up the DCCC’s “Red to Blue” initiative, said many candidates she’s been working with are more eager to dig into what’s on the minds of voters than taking swipes at Trump. “They’re not concerned with talking about Donald Trump as much as they are about talking about how people in their communities want their children to have job opportunities in the communities that they grew up in,” Clark said. While defeating Trump may galvanize the Democratic faithful, the party is still fumbling for a wider unifying message, according to Tobe Berkovitz, a Boston University professor and former political media consultant. And Democrats may have trouble finding issues, local or not, for voters to latch onto in November. “The problem is that unemployment is low, economic confidence is relatively high, so to tell people you’ve never had it so bad when compared to eight years ago they’ve got it pretty good, that’s sort of also a tough road to hoe,” he said. “The Democrats may have history on the side. The question is A, will they blow it? And B, is Trump such an anomaly that history is being rewritten?” Roxane Pirayesh, a 32-year-old from Sacramento, California, who works for an education nonprofit, said in the end, the pitch from Democrats has to be more than just an anti-Trump drumbeat — and she’s not sure everyone’s gotten the message. “I think that’s probably the biggest flaw coming out of the Democratic Party,” she said. Claim: Democrats hoping to flip House not just trash-talking Trump.

SOLUTION:
2