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: The story does not talk about costs, which was disappointing. The costs of intensive medical therapy can easily be identified. Using an online pharmacy we calculated the costs to be about $1,500 to $2,000 annually for medical therapy, using generic drugs. Using the Health Care Blue Book, we found the average cost of coronary artery bypass sugery and hospitalization to be about $62,000. We think that this is important information for readers that should have been included. The quantification here was presented in such a way to make it clear to readers that there was no significant benefit found to surgical intervention, which is a fair conclusion to draw from the study. The story says, “In the Stich study, 41% of patients assigned to treatment with drugs alone died during the follow-up period, which averaged five years. That compared with a mortality rate of 36% among patients who received bypass surgery plus medication. Although the relative reduction in risk of death was 14%, the result didn’t meet tests for statistical significance, meaning it could have resulted from chance alone.” That’s a great way to describe the lack of statistical significance. It would have been even more powerful to show readers the actual number of patients who died in each group. The story provides great information about the study itself and about the overall state of the evidence supporting heart surgery. “How best to treat these patients has been fraught with uncertainty,” is one of the more notable phrases from the story. It also says, “Many patients aren’t evaluated for heart surgery to treat diseased arteries because they don’t suffer classic chest pain or because doctors worry that hearts weakened by heart failure won’t benefit from the procedure. Other doctors recommend immediate bypass surgery despite a lack of vigorous studies to support that strategy.” The story does not engage in disease-mongering and takes a very careful approach to describing the types of patients who would be affected by this study’s results. We also like the way they provided snapshots of patients who were in both arms of the study — surgery and non-surgery — at the end of the story, making it clear, as the study did, that both routes can be equally successful. The story brings in some strong independent voices who help make sense of this complicated study: James Fang, a cardiologist at University Hospitals Case Medical Center in Cleveland, who wrote an editorial accompanying the study, Raymond Gibbons, a cardiologist at the Mayo Clinic, and Clyde Yancy, chief of cardiology at Northwestern University’s Feinberg School of Medicine. Rarely do you see a story that spends as much time with independent experts as it does with the authors of the study. The story does a great job showing how the standard interventions for heart disease stacked up against each other in this study. We wish that some mention had been made of diet and exercise and that at least a sentence had been included about whether there might be differences in outcomes seen as a result of different medication patterns. The story doesn’t make it clear what exactly the patients were taking. The story makes it clear that the range of treatments studied by the authors are widely available. The story makes it clear that there is a great need for more evidence in this field and that this study will be surprising to many clinicians because of a long-held assumption that surgery is the superior option. tudies published in the early 1990s supported the view that bypass surgery provided a better long term outcome. The story does not rely on a news release. Claim: More Options Before Bypass Surgery, Study Finds
[EX A]: The piece gave readers some powerful information to help them sort through the range of factors that should be considered for any medical intervention. The only weakness our reviewers found with the story is the lack of comment about cost. Too often stories present medical options as false choices of best versus worst. They don’t take into consideration the very real differences between patients’ medical histories, diagnoses and expectations. This story should be applauded for giving readers a clear understanding of the complexities of shared decision-making between providers and patients. As noted by one of the experts quoted in the story, “You don’t have a good therapy and a bad therapy, you have a choice.” This is a message that the story gets across very well and is an important one for readers.

[EX Q]: Paragraph: "One theme Sen. Bernie Sanders has repeatedly touched on during his run for the Democratic nomination for president has been the high cost of prescription drugs. His comment during the Feb. 11 Democratic debate at the University of Wisconsin-Milwaukee was typical as he rattled off a list of problems with the U.S. health care system: ""In America, we pay, by far, the highest prices in the world for prescription drugs."" We asked the Sanders campaign for the source of his claim. We didn't get a response. So we searched on our own. One organization that tracks such things is the International Federation of Health Plans, based in London. Their latest price report, from 2013, lists eight common drugs. Compared with England, the Netherlands, Spain, Switzerland and Canada, U.S. prices were far higher, sometimes dramatically so. Consider Nexium, the medicine widely used to treat acid reflux. A prescription that would cost $60 or less in other countries costs, on average, $215 in the United States. And that's just the average. Prices vary widely in this country: In 5 percent of the cases, the cost was $395. ""What Bernie says is true. There's nowhere that pays the same price as America,"" said Tom Sackville, the federation's CEO. In addition, ""there is this huge variation in price across America. Anything above the average is quite unjustified. When you get up to the 95th percentile, you're talking grand robbery."" The findings were similar in an April 2013 study published in the journal Health Affairs, which looked at the prices of brand name drugs in the United States, United Kingdom, Switzerland, Germany, France, Canada and Australia. In each of the three years studied -- 2005, 2007 and 2010 -- U.S. prices were consistently higher. The one exception: Switzerland. In addition, researchers found that, between 2005 and 2010, ""the gap between the United States and other countries seemed to widen."" And it wasn't just new drugs being embraced first in the United States that was driving up costs. They concluded that ""prices for older products rose faster in the United States than in other countries."" But Joel Farley of the University of North Carolina at Chapel Hill's Eshelman School of Pharmacy cautioned that the rule doesn't always apply to generic drugs. A 2008 comparison of 19 generic drugs found that some U.S. prices were lower than Canadian prices. ""In some cases it has to do with availability,"" he said. In other cases, a country may set the drug price low and in that fixed-price market ""there's no incentive to go lower."" The Wall Street Journal published an analysis in December that concluded 98 percent of 40 top branded drugs were more expensive in the United States than in England. In Norway, 93 percent of the 40 top branded drugs cost less than in the United States. And in Ontario, a comparison of 30 drugs showed that U.S. prices were also higher for 93 percent of the products. Why are the brand name prices so much lower in other countries, and why is there so much variation in the United States? Big customers can negotiate big discounts. So the countries with socialized medicine have a lot of leverage at the negotiating table, the experts told us. In the United States, hospitals, wholesalers and insurance companies all do their own negotiations. The Veterans Administration can -- and does -- negotiate dramatically lower prices. Under Medicaid, the drug companies are required to provide their medicines at a price that's as low as it is for any of their regular customers. But Medicare has been prohibited by law from negotiating lower prices since 2006, and that's a huge chunk of the U.S. health care industry. (When Barack Obama was first running for president, he promised to repeal that Bush-era restriction, but then backed off in an attempt to get passage of the Affordable Care Act.) The pharmaceutical industry says it needs the extra income to pay for research to keep new, desperately needed drugs coming. But with everyone getting a bargain, Americans are financing that research for the rest of the world, experts told us. Yet there's another way to look at the issue, said Amitava Dasgupta, a clinical toxicologist at the University of Texas Health Science Center at Houston. The tablet that costs a dollar in the United States may only cost 20 cents in India, but that drug is far more expensive to the average person in India because their income is so much lower. ""The U.S. subsidizes research for the world,"" he said. ""But I would look at that as philanthropy."" Our ruling Sanders said, ""In America, we pay, by far, the highest prices in the world for prescription drugs."" When it comes to brand-name drugs, which yield the highest profit for the pharmaceutical industry, studies support Sanders' claim -- although not always on a drug-by-drug basis. In addition, the differences in price can be dramatic because the U.S. health care system is so splintered, and Medicare is prohibited by law from using its market share to bargain for lower prices. We found one study comparing the United States and Canada that found exceptions for generic drugs, where the profit margin is much lower and which make up a much smaller share of prescription drug spending. But on balance," Claim: In America, we pay, by far, the highest prices in the world for prescription drugs.
[EX A]: "Sanders said, ""In America, we pay, by far, the highest prices in the world for prescription drugs."" When it comes to brand-name drugs, which yield the highest profit for the pharmaceutical industry, studies support Sanders' claim -- although not always on a drug-by-drug basis. In addition, the differences in price can be dramatic because the U.S. health care system is so splintered, and Medicare is prohibited by law from using its market share to bargain for lower prices. We found one study comparing the United States and Canada that found exceptions for generic drugs, where the profit margin is much lower and which make up a much smaller share of prescription drug spending."

[EX Q]: Paragraph: Since this is about affordable and widely available cooking oils, this is N/A. The story does not quantify. We are told the 45-year-old data showed a “lowering” of cholesterol for study participants who swapped animal fats for vegetable fats. But we aren’t given any numbers for by how much or even by what percentage. In a similar shortcoming, one of the most counter-intuitive findings was dismissed. “In fact, the study found that the lower the cholesterol, the greater the risk of death. But that’s a misleading association because a variety of illnesses can also cause drop in cholesterol, which is unrelated to diet.” The story should have given us some numbers for that “greater risk.” Even if it is misleading, we are entitled to know the size of the risk found in the study. The intervention in the study (eating more unsaturated fat) is unlikely to cause adverse side effects, risks, or complications, so we’re rating this N/A. The story did point out the surprising association between lower cholesterol levels and increased risk of death, though that could have been explained more clearly. The story gives us information about both the old Minnesota study and the new British Medical Journal publication. We know the old study was randomized and included 9,000 people. At the end of the story, we also learn the study has “many” limitations and some of these are mentioned. Ideally, the story would have specifically pointed out that the study population included only residents of nursing homes and mental health hospitals, which may affect generalization. Also, given that this is decades-old data, we’re wondering how researchers took that into account, and how it might have impacted the quality of evidence. There was no disease mongering. There don’t appear to be any conflicts of interest, and the story includes an independent source. The story does a good job of talking about the complicated recommendations regarding diet, as well as medications, specifically statins. The different oils are widely available; this is N/A. The story explains that the novelty is not with any treatment or discovery but rather a novel statistical examination of old data. The story does not appear to rely solely on a news release. Claim: Using Vegetable Oils to Lower Cholesterol May Not Improve Longevity
[EX A]:
This story is about new evidence that may diminish the importance of limiting animal fats in people’s diets to reduce risk of deaths from heart disease. A new group of researchers re-examined a 45-year-old randomized controlled study of 9,000 people who were put in two groups: one group replaced animal fats with corn oil in their diet, the other ate animal fats. The risk of death from heart attack was higher in the vegetable-oil group, even though certain markers of cholesterol in their blood did become lower. The story does a good job of explaining the study’s design, and some of the complex issues surrounding dietary habits and heart disease. But this story falls short by not quantifying study elements: no numbers for cholesterol level changes, no numbers for changes in risk. Diet appears to play a role in dozens of chronic diseases, including heart disease. Research that helps tease out which fats are truly better for people helps us further understand the issue, though it is complex and evolving. News coverage should not only be accurate, it should help readers understand how the latest study fits into the greater body of scientific knowledge.