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.

[EX Q]: Paragraph: Although Pfizer continues to test the drug, called dacomitinib, in another Phase III study, hopes for its success have now largely faded, according to ISI Group analyst Mark Schoenebaum. “We believe consensus expectations (for the drug) will be close to zero given today’s readout” of unsuccessful trial results, Schoenebaum said in a research note. In one of the failed trials, called ARCHER 1009, patients given Pfizer’s once-daily pill did not show improved survival without the cancer worsening, compared with Roche Holding AG’s widely used Tarceva (erlotinib). Tarceva is the current standard of care in patients with mutated forms of a protein called Epidermal Growth Factor Receptor (EGFR). The protein plays a role in normal regulation of cell growth, but when mutated is believed to cause cells to proliferate and thereby help spur various types of cancer. Dacomitinib is designed to block several types of Epidermal Growth Factor receptors, while Tarceva and similar treatments for lung cancer target only one type of receptor. Cowen and Co had forecast annual sales of $500 million by 2020 for dacomitinib, if it were approved for lung cancer. That would make it a moderate-sized product for Pfizer, the largest U.S. drugmaker, which has annual revenue of $50 billion. Schoenebaum said there has been little investor interest in the drug and that Wall Street had expected it to generate annual sales of only $300 million by 2018. The second failed trial, named BR.26, involved patients that previously had failed to benefit from chemotherapy as well as from treatment with an EGFR inhibitor. Overall survival of patients taking the Pfizer drug was not prolonged in the study, compared with patients given a placebo. Pfizer said adverse events seen with dacomitinib were consistent with those seen in smaller earlier studies. In the meantime, Pfizer said dacomitinib is also being tested in a third late-stage trial, called ARCHER 1050, among patients with advanced non-small cell lung cancer who have not received prior treatment. The study will compare dacomitinib with Iressa (gefitinib), an EGFR inhibitor sold by AstraZeneca Plc. Results from that study are expected in 2015. Pfizer shares were little changed in morning trading on the New York Stock Exchange. Claim: Pfizer lung cancer drug fails in two large studies.
[EX A]: Pfizer Inc on Monday said one of its experimental drugs had failed to meet its goals in two late-stage studies among patients who had received prior treatment for advanced non-small cell lung cancer, the most common form of the disease.

[EX Q]: Paragraph: Dr. Neelu Pal poses for a portrait in New York, July 23, 2010. Pal was fired weeks after authorities at New York University Langone Medical Center Surgical Weight Loss Program learned she had contacted patients about the dangers of Lap-Band surgery in January 2006. REUTERS/Shannon Stapleton Pal had previously raised her concerns with hospital officials, complaining — to no avail — about the lack of care given after surgery and incomplete or inaccurate medical forms that were taken prior to surgery. She was fired weeks after hospital authorities learned she had contacted patients in January 2006. She has filed a wrongful termination lawsuit — the case is pending — and enrolled in law school. Pal, who came to the United States from India a little over a decade ago to practice medicine, says she has been blackballed from her chosen profession. The NYU bariatric surgery practice where she worked is widely considered one of the world’s most experienced. But in an interview with Reuters, Pal described the facility as a hectic Lap-Band factory. “My impression at the time was that the practice was disorganized, but once I knew more about the system, I could see what they were trying to do was get as many patients on to the operating table as possible,” she said. During her three months at NYU Langone Medical Center’s Surgical Weight Loss Program in late 2005 and early 2006, two surgeons — Dr. Christine Ren and Dr. George Fielding, who are married — implanted gastric bands into as many as 20 patients in a single day, according to Pal. Known as pioneers in the field, Fielding and Ren are also paid consultants of Allergan Inc, the Botox and breast implant maker which is the leading manufacturer of the gastric band. Though rivals have been gaining, Allergan’s Lap-Band still commands more than two-thirds of a $300 million to $400 million market. To critics, Pal’s allegations — some of which were corroborated by a New York State Health Department investigation around that time — underline the potential risks that go along with the industry’s rapid growth. And the business could soon swell even more if U.S. regulators grant permission to perform the procedure on the nation’s bulging ranks of overweight teens. Ren was an investigator in an Allergan-sponsored clinical trial studying the use of bands on teens. And the company has an application with the U.S. Food and Drug Administration seeking approval to market the device to teens as young as 14. A decision could come any time. Winning regulatory approval for the gastric band in teenagers would allow the companies that make the devices — Allergan, Johnson & Johnson and others — to target that specific age group. Today, regulators consider performing the procedure on teens “experimental” as it has not been approved for that age group. But, like any device, it may be used on teens at a doctor’s discretion. Allergan declined to comment on Pal’s lawsuit or disclose how much it pays the surgeons, though the company did confirm that both remain on the payroll. Through a NYU spokeswoman, Ren and Fielding — who have been the subject of some controversy — declined to be interviewed for this article, also citing the lawsuit. But in some medical circles, concern over gastric banding for teenagers is growing nearly as fast as American waistlines. In particular, some doctors worry about the device’s long-term safety and effectiveness. A gastric band is just what it sounds like: an inflatable silicone band placed around the top portion of the stomach to create a pouch that restricts food intake. It has become increasingly popular in the United States in recent years, and results in reasonable weight loss. The procedure is considered less invasive and risky than gastric bypass. Banding could also be an especially attractive option for teens, say proponents, because it is reversible, whereas bypass is not. The 30- to 60-minute procedure, typically performed with a laparoscope, might require one night in the hospital but can also be done on an outpatient basis. But certain data show gastric bands are less effective and more problematic for teens than adults, said Dr. Thomas Inge, chair of a government study to assess bariatric surgery in adolescents called Teen Longitudinal Assessment of Bariatric Surgery, or Teen-LABS for short. The Teen-LABS study aims to determine if adolescence is the best time to intervene with surgery. It was launched in 2007 and is expected to report results in about five years. In more than one in five teens in another study, Inge noted a high rate of “symmetric pouch dilation” — a complication in which the small pouch created at the top of the stomach by the band gets bigger, allowing patients to consume more food. This issue was reported in the journal Obesity Surgery, and later in the Journal of the American Medical Association. “We await the U.S. trial data, PMS (post-marketing surveillance) data, and confirmation from non-industry-run trials to make final recommendations,” said Inge, who is the surgical director of the weight loss program for teens at Cincinnati Children’s Hospital. As Inge and others are quick to point out, trials that studied how teens fared with a gastric band over the short term have been few, and those that were conducted show the device generally is safe and effective, with a relatively low risk for complications or death. But there is a dearth of long-term data on the outcomes from gastric band surgery. And that worries Dr. Mary Brandt, an investigator in the Teen-LABS study, among other experts. “I think there’s a fundamental problem with putting a rigid plastic object around a moving organ. You’re asking it to stay in place and not erode over a long period of time,” said Brandt, who is also director of the pediatric surgical program at Texas Children’s Hospital in Houston. “I’ll be happy to reverse my position as soon as I see 10 or 20 year data. Unfortunately, that’s not something that industry is excited about funding.”   She acknowledged a bias against gastric bands, citing a Swiss long-term follow-up study of 167 adults that showed the band failed almost a third of the time after 10 years. About a fifth of the patients required another operation. And while fewer than 8 percent reported complications in the 30 days following surgery, more than 40 percent had problems after a decade. Long-term complications included the erosion and slippage of the band, both of which might require another operation, and a dilation of the esophagus, which could result in difficulty swallowing. Infections around the port that sits below the skin and allows the doctor to add or remove saline with a syringe to tighten or loosen the band, as well as leaks, were also common. “Bands are definitely safe in the short term and definitely work in the short term. What we don’t know is about the long term,” Brandt said. “I’m not saying it should never be used. We just have to be more careful about how we’re using it.”   The Swiss study of adults who had gastric banding, published in Obesity Surgery, came to the same conclusion. Because of complications, the need for another operation, and long-term failure rates, gastric banding should be performed in “selected cases only” until more data are available, it said. Another group of 276 adults who underwent gastric band surgery had similarly disappointing results in a long-term Austrian study published in the same journal. Only a little under 54 percent of the patients still had their original band after nine years, with nearly 18 percent having the original replaced with a new one and nearly 29 percent having it removed. Of those who no longer had any band, more than half had a second bariatric operation. Gastric banding demands that teens do something they often aren’t very good at — sticking to a rigorous follow-up routine. Dr. Roberta Maller Hartman, a psychologist and Lap-Band patient herself, counsels teens and adults after receiving the gastric band. “I’ve worked with a lot of high school students and they just want to be like everyone else and go out and eat pizza with their friends,” she said. “They can, but they have to take little bites and chew a lot.”   Success depends most on a patient’s ability to modify their behavior. “The band doesn’t reduce the desire to eat emotionally. That has to be addressed,” said Dr. Maller. “Teens tend to need more hands-on, one-to-one support.”   Indeed, there are many success stories of obese teens losing weight, keeping it off and staving off a host of related illnesses, such as diabetes, arthritis and high blood pressure. Surgery — banding or bypass — has been shown to produce the most sustainable results when compared with diet and exercise. Nevertheless, critics abound. Dr. Susan Woolford, Medical Director of the Pediatric Comprehensive Weight Management Center at the University of Michigan, conducted a study, published in Obesity Surgery, to find out how readily primary care physicians and pediatricians — those in the front lines of obesity treatment — would refer patients for bariatric surgery. Nearly half, or 48 percent of the 381 physicians surveyed, said they would never refer an adolescent for any type of bariatric surgery. The controversies swirling around NYU’s influential bariatric surgery center — as well as its two top surgeons — have done little to ease concerns. An investigation by the New York State Department of Health in 2006 found that Fielding falsified data on Vincent Esposito, a 14-year-old boy who was part of the FDA-authorized study that was looking at the use of the device in obese teens. A week after Esposito’s Lap-Band surgery, he developed an infection with an abscess — a common complication with gastric banding — and returned to the NYU facility, where Fielding performed an appendectomy. The investigation by New York health authorities determined there was no evidence of appendicitis, according to the report. “They told me I was a ticking bomb,” Esposito had told the Daily Times in Salisbury, Maryland in 2007, referring to his obesity. Reached by telephone, his father said his son was “fine” and that they are being represented by an attorney and declined to comment. NYU also declined to comment. In its response to the NYDH report, the university maintained no wrongdoing, saying “the surgeon probably misinterpreted his operative findings.” In a statement at the time, the school added, “...we are persuaded that he assumed that the infection did not begin in the gastric band device.”   The response and NYU’s plan to correct the issues were accepted by state regulators. In the NYSHD report, Fielding was also cited for failing to address a post-operative patient’s persistent lack of urine output. The patient went into cardiac arrest and died 36 hours later. This was the death that alarmed Pal and led her to warn patients. The same report said the program director, Ren, had permitted two surgeons to practice without the appropriate licenses, in violation of the law. For four months, the unlicensed physicians “performed multiple surgical procedures, made pre- and post-op assessments, and wrote orders to be carried out by nursing staff,” the report said. After Ren learned she was being investigated by an internal committee, she went back and removed the name of the unlicensed surgeon from the operative report, according to court testimony. She was found to have committed professional misconduct and received a letter of reprimand that was put in her file for a year. Fielding, who got a gastric band himself in 1999, is from Australia, where he left behind multiple personal injury lawsuits, most of which have been settled. Dr. Robert “Skip” Nelson, a pediatric ethicist at FDA, said he had no specific knowledge about the incident at NYU Medical Center. If the agency did learn that an investigator has entered false data, he said, there would be an investigation. He added that if the FDA doubted the integrity of the data, they would not be considered in the decision-making process. An investigator, as doctors who run clinical trials are called, could also be disqualified as a result. Despite the reports of misconduct, the NYU Langone Weight Management Program has retained its status as a “Center of Excellence,” a designation conferred by the Surgical Review Corp, an entity created by the American Society for Bariatric and Metabolic Surgery. Surgical Review Corp CEO Gary Pratt said that he was unaware of the incidents and the NYSHD report. He said the corporation’s reviews maintain the highest standards with the goal of advancing the safety and efficacy of bariatric surgery. The company intends to put out a new list of approved bariatric clinics that treat teens later this year — which may coincide with the FDA granting approval, or not. If the FDA does greenlight it, insurers would be more likely to pay for the procedure, which costs the insured patient $2,000 to $4,000. The uninsured, making up about a third of patients who have the surgery in the United States, pay about $15,000 for the surgery. Some health professionals worry that band manufacturers will target teens with direct-to-consumer (DTC) ads on television and radio or in subway stations that have proven effective at luring people to doctors’ offices. The FDA said there is no guidance or regulation on DTC ads to young users. For Allergan, based in Irvine, California, the implications are significant. And the company is acting accordingly. It recently launched a campaign with bariatric surgeons to invite their patients to enter an essay contest and win a chance to go to Washington, D.C. to “share their personal stories with legislators and media.”   Allergan has seen its stock underperform the S&P 500 year to date. Botox remains its key product and has weathered increased competition amid the recession, while obesity intervention was hit hardest by the economy. At the same time, Lap-Band has also been slowly losing market share to Johnson & Johnson’s competing device called Realize. In 2009, Allergan’s obesity products generated revenue of $258 million, down 13 percent from 2008. Management is betting that continued investment in direct-to-consumer advertising will stimulate growth in the obesity segment, said Gleacher & Co analyst Amit Hazan. He estimates there will be 83,500 gastric band procedures in the United States in 2010, up 6 percent from 2009. Sanford Bernstein analyst Aaron Gal said FDA approval of the Lap-Band for teens could increase sales by as much as $20 million for Allergan. Even critics of gastric band surgery acknowledge that there are few good solutions to adolescent obesity. It is a mounting problem, affecting nearly 1 in 5 American teens, and many doctors believe that it should be addressed sooner rather than later when other health problems can develop. Some experts are wary but believe the benefits may outweigh the potential harm. “My conclusion is that it makes sense to intervene sooner because surgery can head off other related problems. Kids are better surgical risks, but the downside is that I suspect most teenagers are doing it less for health and more for social and psychological reasons,” said Dr. Jeffrey Zitsman, who is leading an independently funded teen study at Columbia University. Those who do it out of vanity, he cautioned, may have a harder time. “When health reasons don’t motivate them,” he said, “sometimes there are compliance issues.”   Yet, Dr. Robert Murray, director of Nationwide Children’s Hospital Center for Healthy Weight and Nutrition, argues that the heavy psychological problems obese teens carry should not be ignored. “They’ve been teased out of school, they have social issues, many are depressed, and their quality of life is equal to that of a kid with cancer,” he said. “If you get them at 14 and reverse weight and health problems, they’ve got a shot at a normal life.”   To critics, at least, the question is at how big a price. Claim: Special report: Targeting teens for gastric bands.
[EX A]: After one patient died and others suffered serious complications following Lap-Band surgery, Dr. Neelu Pal had seen enough. A petite surgical resident now aged 40, she began quietly calling patients about to undergo the weight-loss procedure at New York University’s Medical Center, telling them she feared for their safety.

[EX Q]: Paragraph: Trump trade adviser Peter Navarro championed hydroxychloroquine in television interviews Monday, a day after the president publicly put his faith in the medication to lessen the toll of the coronavirus pandemic. “What do I know, I’m not a doctor,” Trump said Sunday. “But I have common sense.” In promoting the drug’s possibilities, the president has often stated, ”What have you got to lose?” Trump held out promise for the drug as he grasps for ways to sound hopeful in the face of a mounting death toll and with the worst weeks yet to come for the U.S. The virus has killed more than 10,000 in the U.S., and measures meant to contain its spread have taken a painful economic toll and all but frozen life in large swaths of the country. But medical officials warn that it’s dangerous to be hawking unproven remedies, and even Trump’s own experts have cautioned against it. The American Medical Association’s president, Dr. Patrice Harris, said she personally would not prescribe the drug for a coronavirus patient, saying the risks of severe side effects were “great and too significant to downplay” without large studies showing the drug is safe and effective for such use. Harris pointed to the drug’s high risk of causing heart rhythm problems. “People have their health to lose,” she said. “Your heart could stop.” In a heated Situation Room meeting of the White House’s coronavirus task force Saturday, Navarro challenged the top U.S. infectious disease expert, Dr. Anthony Fauci, over his concerns about recommending the drug based only on unscientific anecdotal evidence. Navarro, who has no formal medical training, erupted at Fauci, raising his voice and claiming the reports of studies he had collected were enough to recommend the drug widely, according to a person familiar with the exchange who spoke on the condition of anonymity to describe the blow-up. Fauci has repeatedly said current studies provide only anecdotal findings that the drug works. In response, Navarro told CNN on Monday, “I would have two words for you: ‘second opinion.’” Hydroxychloroquine is officially approved for treating malaria, rheumatoid arthritis and lupus, not COVID-19. Small, preliminary studies have suggested it might help prevent the new coronavirus from entering cells and possibly help patients clear the virus sooner. But those have shown mixed results. Doctors are already prescribing the malaria drug to patients with COVID-19, a practice known as off-label prescribing. Research studies are now beginning to test if the drugs truly help COVID-19 patients, and the Food and Drug Administration has allowed the medication into the national stockpile as an option for doctors to consider for patients who cannot get into one of the studies. But the drug has major potential side effects, especially for the heart, and Fauci has said more testing is needed before it’s clear that the drug works against the virus and is safe for such use. Navarro told Fox News Channel’s “Fox & Friends” that doctors in New York hospitals are already distributing the drug to COVID-19 patients and that health care workers are taking it in hopes of being protected from infection. Asked about his credentials for pushing the drug, Navarro cited his doctorate in social science and said that “in the fog of war, we might take more risks than we otherwise would.” He added, “I’d bet on President Trump’s intuition on this one.” Administration officials say Trump’s embrace of the drug stems from  his desire to provide “hope” for the American people as the death toll mounts and he looks to avoid political consequences from the outbreak. Some limited studies have been conducted on the use of hydroxychloroquine and antibiotic azithromycin in concert to treat COVID-19, but they have not included critical control groups that scientists use to validate the conclusions. Researchers in China, for instance, reported that cough, pneumonia and fever seemed to improve sooner among 31 patients given hydroxychloroquine compared with 31 others who did not get the drug, but fewer people in the comparison group had cough or fevers to start with. Many questions have been raised about another study in France. Some of the 26 people given hydroxychloroquine in that test were not counted in the final results, including three who worsened and were sent to intensive care, one who died a day after later testing negative for the virus and one who stopped treatment because of nausea. The French study was published in an International Society of Antimicrobial Chemotherapy journal. The society’s president wrote on its website that the report “does not meet the society’s expected standard.” At least one other world leader has also promoted the drugs. Brazil’s President Jair Bolsonaro has touted the benefits of hydroxychloroquine and azithromycin, saying he’s heard reports of 100% effectiveness when administered in the correct dosages. Trump’s interest in the drug was piqued in part by coverage on conservative media. On March 16, Fox News ran a segment on a small French study promoting the effectiveness of hydroxychloroquine in treating the coronavirus. Hours later, attorney Gregory Rigano appeared on a prime-time show and said evidence suggested it could rid the body “completely” of the virus. Almost instantly, just as the projections of the virus’ impact on the nation grew more dire, the drug’s promise bounced around the echo chamber of the conservative media. Just three days later, Trump himself made the first mention of the drug. Among the loudest voices in the president’s ear has been Rudy Giuliani, the president’s personal attorney, who has spoken to Trump about the drug and advocated it in interviews and his new podcast. He has had, as guests, several experts touting the drug and made a few late-night phone calls to the White House residence. “I discussed it with the president after he talked about it,” Giuliani said. “I told him what I had on the drugs. Others around him believe it too.” The president’s son, Donald Trump Jr., on Friday tweeted a link to an article about the drugs’ possible success and added: “Waiting for others to write this up. The Democrats and the media must be really upset because they tried to destroy @realdonaldtrump for being hopeful that this would be the case.” Across Europe, there has also been a recent spike in demand for the drugs even as regulators caution against their unlicensed use. Last week, the European Medicines Agency warned doctors that since there is no proof yet of the drugs’ effectiveness, they should be used only in clinical trials or under emergency use provisions. The jump in demand for the drugs has meant in some instances that patients who rely on hydroxychloroquine for lupus or other conditions are seeing their supplies diverted for COVID-19. If hydroxychloroquine is proven to work well against COVID-19, its sales would jump, but pharmaceutical analysts say they don’t know of any company or individual that stands to make a windfall. That’s because there’s so much competition and the vast majority of prescriptions filled are for generics. For most people, the virus causes mild or moderate symptoms, such as fever and cough that clear up in two to three weeks. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia, and death. ___ Associated Press writers Marilynn Marchione in Milwaukee, Linda A. Johnson in Trenton, N.J., Jonathan Lemire in New York, Maria Cheng in London, Amanda Seitz in Chicago, David Biller in Rio de Janeiro and Jill Colvin in Washington contributed to this report. Claim: White House pushes unproven drug for virus, but doctors wary.
[EX A]:
President Donald Trump and his administration are promoting an anti-malaria drug not officially approved for fighting the new coronavirus, even though scientists say more testing is needed before it’s proven safe and effective against COVID-19.