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 Input:
Paragraph: The story focused on costs, including information about the relative cost comparison between what are called “open” surgeries and those done laparoscopically (with a thin flexible tube.) The release summarized how minimally invasive techniques reduced the length of hospital stay and complication rates for patients. “Researchers also found that, on average, the minimally invasive approach reduced length of hospital stay by approximately two days, and open operations were more than $9,000 more expensive than minimally invasive procedures. The researchers also found that laparoscopic procedures were better for patients in terms of fewer complications. Laparoscopic anti-reflux operations were less likely to result in postoperative blood clots, wound complications, surgical site infection, esophageal perforation (which can be life threatening), bleeding, cardiac failure, and death.” We rate this, but just barely, for citing cost differences between the two types of surgery and the average reduction in the number of days a patient must remain hospitalized. We do wish the release had delved more into the specifics of reduced complications. How common were the surgical complications in each surgical method? The release names complications associated with both types of surgery for GERD, while stating that patients undergoing laparoscopic procedures encountered fewer of them: “postoperative blood clots, wound complications, surgical site infection, esophageal perforation (which can be life threatening), bleeding, cardiac failure, and death.” The news release gave details about how the study examined records of about 75,000 patients from 1,000 hospitals to compare outcomes in the records for open vs. the minimally invasive laparoscopic surgeries. That’s all to the good. However, the news release didn’t mention any of the study’s limitations. The key one is that this is a retrospective, observational review of records that isn’t capable of supporting cause and effect statements such as the minimally invasive approach “reduced length of hospital stay by approximately two days.” Nor should this kind of evidence be used as the basis for statements such as laparoscopic procedures “were better for patients” and “should be the standard of care.” Patients receiving open vs. laparascopic procedures could differ in unknown ways, which is why the superiority of one approach over the other should ideally be established by a prospective, randomized controlled trial. There were other limitations outlined in the journal article that were not mentioned in the release. Because the NIS database doesn’t link to hospital records, researchers weren’t able to track and measure outcomes “including complications, readmission, and mortality, occurring after the initial hospital discharge.” The researchers were also unable to determine which open surgeries were “re-dos” of previous surgeries. The potential for errors in coding which procedures were used was also cited as a possible limitation. There was no disease mongering. The release also provided useful context on the prevalence of GERD and further specified that smaller group of patients, from the many heartburn suffers, might be candidates for the surgery. Well done. The release does not list any funding source for the research and the published study notes that authors had “nothing to disclose.”  We’ll rate this not applicable since this is an examination of existing data, and there may have been no additional outside funding. The news release does a good job here. It compares different surgical methods and it also names alternatives for treating GERD such as medications and changes in the diet. It also states which group of patients the surgery is aimed at: “Anti-reflux surgery should be considered in patients who do not achieve complete control of their symptoms [regurgitation or cough] with medications; who do not want to take medications for the rest of their lives; or who experience complications of medical therapy.” It’s clear from the release that both methods of surgery have been widely available nationally and the outcomes of 75,000 surgeries were tracked by the National Inpatient Sample (NIS) database. The release also notes that “urban academic or teaching hospitals” perform laparoscopic anti-reflux surgery more often than “open” procedures, 54.4 percent versus 45.6 percent. And it recommends that anti-reflux surgery should be performed laparoscopically in specialized centers. The news release was not about a novel procedure and made no claim of novelty. However, this isn’t the first study to examine laparoscopic vs. open surgery. For example, the British Journal of Surgery published results of a randomized trial of the two methods and the Scandinavian Journal of Gastroenterology published research on long-term outcomes following laparoscopic and open procedures for GERD. We did not observe any unjustifiable language. Claim: Laparoscopic anti-reflux operation for GERD linked to fewer postoperative complications

Ex Output:
A new study by the American College of Surgeons, a professional organization, compared records for 75,000 patients who underwent surgery for GERD, or gastrointestinal esophageal reflux disease. The study looked at two different surgical procedures and found the less invasive one seemed equally effective, but kept patients in the hospital a shorter time with fewer complications. The news release did a good job of discussing surgical alternatives and costs, which were estimated to be $9,000 lower for the less invasive laparoscopic procedure. The release would have been better had it spelled out some of the study limitations, the key one being that a retrospective, observational review of hospital records — as this study was — isn’t capable of supporting the cause and effect statements sprinkled throughout the release. Millions of Americans complain of occasional heartburn, sometimes called a burning sensation in the throat from food coming back up from the stomach. But some estimates are that about 20 percent of US adults fit the definition of GERD, which means they suffer symptoms at least every week. If patients consider a surgical fix, this study shows that a less-invasive procedure could reduce their complications and shorten their hospital stay. It’s hard to pin down stats on GERD prevalence. A 2014 review of 16 epidemiological studies of GERD prevalence published in the journal Gut suggest GERD prevalence ranges from “18.1%-27.8% in North America, 8.8%-25.9% in Europe, 2.5%-7.8% in East Asia, 8.7%-33.1% in the Middle East, 11.6% in Australia and 23.0% in South America.”


Ex Input:
Paragraph: Muskegon resident Pamela Anderson said that after hearing about numerous cases, she started a Facebook group about cancer deaths among people who live or have lived near the Butterworth landfill site in Grand Rapids. They plan to bring up the issue at a city commission meeting this week, the Grand Rapids Press reported . The group recently met with Kent County Health Department epidemiologist Brian Hartl, who advised them to collect more information on cancer rates in the area. “If there are rare forms of cancer, or cancers we’re seeing affect a young population, it might trigger further investigation,” Hartl said. But he cautioned that cancer is difficult to study, and that it can take years and multiple triggers to emerge. “Especially in small areas like a neighborhood or a block, it makes it challenging to connect it to environmental exposure,” Hartl said. “Most cancers are due to lifestyle choices, not environmental factors.” The Environmental Protection Agency estimates that theoretical cancer and health risks from the landfill exist, but that they’re limited to regular direct contact with the waste over several decades. The agency conducted a site cleanup in 1999, and removed material contaminated with polychlorinated biphenyl and chromium. The EPA said there is no current exposure at the site. “A lot of those kids in the ’60s and ’70s used to play in the dump,” said Shane Smith, who grew up down the street from Anderson in the Indiana Avenue neighborhood. “It was just starting to alarm to us, because my dad’s entire generation passed away from cancer.” Anderson said she’s having the soil tested for contaminants at a home in the same neighborhood. ___ Information from: The Grand Rapids Press, http://www.mlive.com/grand-rapids Claim: Residents investigate cancer rates near Michigan landfill.

Ex Output:
A group of residents is investigating cancer rates in a western Michigan neighborhood that’s near a contaminated landfill classified as a Superfund site.


Ex Input:
Paragraph: 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. Claim: Antidepressants’ risks to children slim, study says

Ex Output:

The story provides the reader with a comparison of anti-depressants' effectiveness and the risk of suicidal thoughts or actions in young children and teenagers. The story describes results of a recently published meta-analysis and explains why the results of this new study may differ from data on which an FDA warning of increased suicidal behavior in children taking anti-depressants was based. The story provides the number needed to harm as well as other quantitative information on the benefits of anti-depressants for particular mood disorders. The story focuses on only one potential harm of treatment, i.e. suicide and suicidal ideation. It would have been reasonable to report on other common side effects of these medications (e.g. 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 original version of the story by the Associated Press included several items left out by the Cleveland Plain Dealer when it picked up the story:   an interview with a second, independent expert source; mention of other treatment options such as psychotherapy, especially cognitive behavioral therapy. 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. Other clinical and patient perspectives are needed to provide balance to the story and as a means of discussing this treatment option for children and teenagers.