instruction:
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'.
question:
Paragraph: "The story does not note the cost of a typical statin regimen, Zetia or the combination treatment, Vytorin. This is an important oversight as many people who are prescribed these medications take them for life. The story does mention that these new drugs ""raked in 5 billion dollars last year"". The failure of the combination product to be better than simvastatin alone has significant financial implications. Simvastatin (the generic name for Merck’s Zocor) is available for about $1.25 a day. Vytorin costs about $3.35 a day. Most clinicians assumed that the combined product was an advantage if you could not get a patient to an LDL goal with just the statin alone or side effects with the simvastatin prevented an adequate dose. The price for the combination is less than the cost of the components. The story provides no quantitative data and no information on the number needed to treat to show benefit (i.e. prevention of a heart attack or stroke through lowered LDLs) in one patient with the newer medications, with traditional statins or with combination treatment. The story says that there are no real dangers to continuing the drugs Zetia and Vytorin based on the lower drop-out rate and reported side effects in the study. The comments from both parties cast an extraordinarily negative shadow on the study drug and on the company sponsors. Without an appropriate description of the study design, the results cannot be fairly discussed to the public. While the primary endpoint was not obtained with the combination, it did lower LDL and inflammatory markers in excess of that achieved with simvastatin alone. Suggesting the drug did not ""work"" is a bit of a mis-statement. The story encourages patients to keep taking these drugs. The story also does not mention the potential harm of taking statins long-term, especially in high does. Some of these harms are very rare, however, they include: muscle pain and kidney or liver problems. The story provides no real discussion of the data presented at the American College of Cardiology meeting and published in the peer-reviewed New England Journal of Medicine. And the story didn’t assess the quality of the evidence. The study followed people (average age mid-40s) who had an inherited condition (called familial hypercholesterolemia) that is associated with very high cholesterol levels and greatly increased risk of early coronary artery disease. Many of them had been taking statins and other cholesterol-lowering medicines for years. All were randomly assigned to take either a statin (simvastatin, trade name Zocor) alone or a statin combined with another cholesterol-lowering medication, ezetimibe. The study was designed to find out if the combination of the two drugs could slow the growth of plaque in carotid arteries supplying the brain more than the statin alone. Plaque in these arteries is associated with an increased risk of stroke and heart attack. The two drugs together were more effective at lowering cholesterol than simvastatin alone, but adding ezetimibe did not change plaque measurements in the carotid arteries. The story does mention that lowering cholesterol may have other benefits, but we are not sure how those translate to fewer cardiovascular events or increased survival from these events. No overt disease-mongering. There are no interviews with the study authors or with practicing clinicians. The story reported on data presented at a recent American College of Cardiology Meeting, so there were several thousand cardiologists and other specialists available who could have been interviewed for clinical perspective on the results of this study. There was also no mention of the two accompanying editorials in the NEJM. The editorial by Brown and Tayor nicely identifies the issues related to the study and helps put the results into perspective. Unfortunately, this editorial was ignored by both parties involved in the story. Stating that taking more statins is the answer is incomplete at best. Lifestyle changes along with other drugs may be options as well. Interestingly however, this study raises questions about the simple notion that lowering total cholesterol, and LDL are important to lowering cardiovascular risk. People who are not able to lower their cholesterol enough with statins alone (or cannot tolerate the dose of statins needed to lower it) may wish to discuss with their doctor whether other medications (i.e., rather than ezetimibe) may be appropriate. These include niacin, fibrates, and bile acid resins. When added to statins, they can effectively lower cardiovascular risk. It’s clear from the story that the drugs in question are still available to patients, though they should not be considered first-line therapy. The story focuses on new information that there is little to no benefit of newer cholestrol-lowering medications on the prevention of arterial plaque, which translate to little benefit for prevention of heart disease, stroke and cardiovascular-related death. We can’t be sure if the story relied solely or largely on a news release. No researcher or cardiologist is interviewed. Quantified data from the American College of Cardiology presentation or from the New England Journal of Medicine article are not directly cited." Claim: Poor test results for heart drugs
answer:
0


question:
Paragraph: Abbott executives said the increase in manufacturing capacity will begin in the second half of this year and make room for the expected U.S. launch of the FreeStyle Libre 2. This next-generation device has been approved in Europe and is now under U.S. regulatory review. Abbott’s plans for Libre, its fastest-growing diabetes product, used by 1.5 million people worldwide, will be in focus when the company reports quarterly earnings on Wednesday. Jared Watkin, Abbott’s senior vice president for Diabetes Care, said in an interview that scale is a “huge part” of the company’s strategy for its glucose monitors. “When you’re making disposable diagnostic products, the more you can make, the lower the cost you can produce them at.”  While the Libre 2 has more features, including alarms for when blood sugar levels swing too low or high, Abbott plans to keep the U.S. price the same as its predecessor, Watkin said. Abbott started in diabetes care as a maker of inexpensive test strips and glucose meters. More recently, the company has sought to expand access to its so-called continuous glucose monitoring (CGM) devices - traditionally sold to type 1 diabetics in markets with generous insurance coverage. “It’s not good enough to bring this to a small, wealthy population. Diabetes is such a global epidemic that you need to bring products that can really make a dent in that,” Watkin said. Launched in Europe in 2014 and in the United States three years later, the FreeStyle Libre allows people with diabetes to track blood sugar levels without multiple daily finger sticks. A sensor attached to the back of the upper arm uses a thin filament under the skin to measure glucose every minute. Users check their blood sugar levels throughout the day by waving a reader, or smartphone, over the sensor. Major competitors Medtronic Plc (MDT.N) and Dexcom Inc (DXCM.O) critique the current Libre’s lack of automatic alerts that can help diabetics manage their disease. Yet they also are taking steps to introduce cheaper models themselves, executives told Reuters. Libre’s sales are expected to reach $1.5 billion this year, the company said. In April, Goldman Sachs estimated the global CGM market could reach $5 billion by 2021, up from $3.7 billion in 2019. Goldman projected Abbott’s 2021 sales at $2.7 billion compared to $1.7 billion for Dexcom and $894 million for Medtronic. In the past, CGMs were used almost exclusively by type 1 diabetics, whose bodies do not make insulin and who must inject themselves with the blood-sugar regulating hormone to survive. Increasingly, people with type 2 diabetes - the kind driven by obesity, lack of exercise and genetics - must also closely monitor their blood glucose and use insulin to manage their disease when it is not controlled by other medications and lifestyle changes. For now, Libre users include 1 million type 1 diabetic patients and half a million type 2. That’s a tiny sliver of the 425 million people with diabetes worldwide. Although not all diabetics need glucose monitors, “there is an element of scratching the surface at this point,” Watkin said. “The need to invest and bring up capacity is, we believe, going to be an ongoing activity for us.”   Two 14-day Libre sensors, a month’s supply, retail for $109. Abbott says most of its patients are commercially insured, and many pay as little as $10 out of pocket. In the United States, the company says, more than half of people in commercial health plans are covered, as well as any eligible diabetic person on Medicare, the federal program for the elderly and disabled. The device is also approved in 45 other countries, including Germany, Japan, Brazil, China and the United Arab Emirates. Medtronic told Reuters it offers a discounted price of $345 per month for uninsured patients. The company estimates that the typical insured patient pays $50 a month. Medicare does not cover the device. Dexcom’s G6 sensors retail online, with a discount, at around $350 for a month’s supply. Dexcom says 98 percent of all U.S. private insurers cover the device, and patients covered by commercial insurance pay an average of $50-$80 per month for sensors through pharmacies or durable medical equipment suppliers. It is covered by Medicare. Libre’s 14-day sensor is also longer-lasting. Dexcom’s sensors work for 10 days, and Medtronic’s for up to 7. Abbott was also the first company to introduce a product that can be used without routine finger stick tests to validate the sensor’s readings – a feature Dexcom later matched and Medtronic has not. Dr. Roy Beck, an endocrinologist at the Jaeb Center for Health Research in Tampa, Florida, said that Abbott’s FreeStyle Libre is “an excellent sensor” but not as accurate at detecting very low blood sugar as the devices from Dexcom, Medtronic or an implantable CGM made by Senseonics (SENS.A). That makes it less desirable for patients for whom this is a major issue, he said. Beck’s center has received research funding from Abbott and Dexcom. Medtronic and Dexcom executives say the current Libre does not compare with their devices when it comes to features such as alerting users to dangerous blood sugar changes and providing comprehensive trend data. “It’s the cheapest, but it’s not exactly in the same category,” said Mike Hill, vice president and general manager of Medtronic’s sensor business. Abbott countered that its sensor has best-in-class accuracy, and noted that the next-generation Libre 2 does have optional alarms. Still, Medtronic is considering making a cheaper sensor for patients who don’t need all the features of its current continuous monitor, Hill said. And next year, Dexcom plans to launch a cheaper, smaller, 14-day sensor developed in partnership with Verily, Alphabet Inc’s (GOOGL.O) life sciences division. Dexcom Chief Executive Kevin Sayer acknowledged that Abbott’s pricing strategy will affect the global market over time, and that Dexcom expects its own prices to come down. “We’ve planned for this,” he said. Claim: You see a whole bunch of Korean cars here in the United States, and you don't see any American cars in Korea.
answer:
2


question:
Paragraph: Kenosha County prosecutors said 20-year-old Tyler Huffhines had employees make professionally packaged cartridges. Authorities said the employees filled about 3,000 to 5,000 cartridges per day and were sold for $16 each. “Based on how everything was set up, this was a very high-tech operation that was running for some time,” Andrew Burgoyne, Kenosha County assistant district attorney, said during a Monday court hearing to set bond. Police said the business started in January 2018. Police arrested Huffhines on Thursday. He was being held on a $500,000 cash bond while he awaits charges to be filed. He was due in court Friday. His attorney, Mark Richards, did not respond to an email or a phone message left at his office. The Drug Enforcement Administration, the Kenosha Drug Operations Group and other agencies executed search warrants at two homes. The Kenosha News reports that authorities seized 188 pounds (85 kilograms) of marijuana, THC oil, eight firearms, and about $20,000 in cash. The arrest comes as health officials investigate 450 possible cases in 33 states where vaping was linked to a severe lung disease. Kansas reported its first death tied to the outbreak on Friday. Nationwide, as many as six people have died. Health officials have warned against buying counterfeit vaping cartridges. It’s unknown if the Wisconsin operation has been linked to any illnesses. No single vaping device, liquid or ingredient has been tied to all the illnesses. But recent attention has been focused on devices, liquids, refill pods and cartridges that are not sold in stores. New York state has focused its investigation on an ingredient called Vitamin E acetate, which has been used to thicken marijuana vape juice but is considered dangerous if heated and inhaled. The Centers for Disease Control and Prevention is also investigating Vitamin E acetate, but officials said they’re looking at several other ingredients as well. Last week, the CDC warned against buying vaping products off the street because the substances in them may be unknown. The agency also warned against modifying vaping products or adding any substances not intended by the manufacturer. This isn’t the first time Huffhines has made it into the headlines. Last year, the Kenosha News wrote a feature story about him when he was an 18-year-old Central High School student, selling athletic shoes online. The story’s headline was “Who Wants to Be a Millionaire?” Claim: Wisconsin man accused in illegal THC vaping cartridge scheme.
answer:

2