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.

Q: Paragraph: The article states that acupuncture costs $45 to $100 per session. It does not say how this compares to other treatments and whether the cost of care is the same, more or less than alternatives. The story states the proportion of patients who successfully responded to each therapy, and clearly explains that “real” acupuncture was no better than sham needling. But it does not define success or otherwise quantify how much people improved clinically in either relative or absolute terms. For a treatment to be considered successful, a patient must have reported either a 33% improvement in pain or as little as a 12% improvement in function during an interview conducted over the telephone 6 months after enrollment. Nonethless we’ll grade this criterion as satisfactory. The story did not mention harms from any of the treatments patients received. Previous research suggests that acupuncture poses few risks when performed with sterile, disposable needles. The article describes the largest randomized controlled trial to date investigating the effectiveness of acupuncture for treating chronic low back pain, and reports its published results. It discusses the three treatment groups studied and potential reasons for the outcomes observed. There are no obvious elements of disease mongering. The story explains that the study participants were people with chronic low back pain. These results wouldn’t apply to other back pain conditions. The article cites one of the study’s coauthors and two physicians who appear to be users and/or proponents of complementary therapies. It would have been interesting to hear from a skeptical observer. The story lists the therapies received by patients assigned to the conventional medicine group. The literature suggests that these treatments generally provide very modest benefits. The article does not mention other therapies that may be effective for managing chronic pain and improving flexibility and strength. These include cognitive therapy alone or in combination with intensive exercise and strengthening. Acupuncture is estimated to be the third most popular complementary therapy for chronic low back pain. Though the article does not say much about its availability, readers are likely to be familiar with it. The story notes that this is the largest study yet of acupuncture for chronic back pain, suggesting that the treatment is not new. There is no obvious use of text from a press release. Claim: Acupuncture, real or fake, called best for lower back pain

A: This article reports on the largest randomized controlled trial to date investigating the effectiveness of acupuncture for treating chronic low back pain. It explains that both acupuncture and sham needling are more effective than conventional medical therapies, but that “fake acupuncture works nearly as well as the real thing.”       In addition to describing the quality of the evidence, the story mentions several other treatment options, tells the reader the cost of acupuncture, and hints at its novelty. The story neglects to mention harms. (A recent systematic review reinforces the study’s finding that acupuncture poses few risks; see Spine 2005;30:944-63). And it also provides an incomplete picture of the treatment’s apparent benefits. Although it notes the proportion of patients who improved with each therapy, it does not define success or otherwise quantify how much people improved clinically–in either relative or absolute terms. For a treatment to be considered successful, for example, a patient could have reported as little as a 12% improvement in function during an interview conducted over the telephone 6 months after enrollment. This is important information if people are to weigh the apparent benefit of a therapy against its cost. The article cites one of the study’s coauthors and two physicians who appear to be users and/or proponents of complementary therapies. They attempt to explain why needling seems to work. To provide some balance, the study’s coauthor suggests that the apparent benefit could merely be the result of patients’ expectations of improvement from acupuncture, on the one hand, and of poor results from conventional medicine on the other. (Unfortunately, the researchers did not measure patients’ expectations.) It would have been interesting to hear from others. Some might point out that the new study shows that acupuncture and sham needling are only more effective than treatments that are not themselves very effective. Others might make the case that acupuncture provides no specific treatment effect and is unethical to use—because it could be construed as prescribing a placebo. People with chronic low back pain are desperate for anything that will help. When a large new study provides apparently strong evidence to buttress a therapy that previously had little high-quality evidence to support it, readers might also benefit from more context. A major systematic review that analyzed 35 randomized trials involving 2861 patients recently concluded that acupuncture appears to confer modest, short-term pain relief, but that the quality of the studies was not very good. The reviewers were careful not to overstate the benefits of acupuncture (Spine 2005;30:944-63). Overall, this was a good article that would have been helped by some more context.
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Q: Paragraph: This release makes no mention of the costs of the drugs compared in this study, even though the drugs have been in use for years and are widely available. Since the study is a comparison of various treatments for this form of cancer, it seems relevant to offer a cost comparison as well as a comparison of efficacy. It appears that the high dose methotrexate is given over a 24-hour period, presumably in the hospital, while the standard methotrexate is given as a single dose. Also, the high dose methotrexate is followed by leucovorin administration while the standard dose is not. According to the site GoodRx, the cost for methotrexate in low-dose (2.5 mg) pill form averages out to about $50 for a month’s supply. Newer, injectable variations of the drug cost upwards of $500 a month for the 25 mg dose. The release states that patients receiving high doses of the drug methotrexate “had a significantly better outcome, by 5 to 6 percent” than did patients receiving the current standard of care, which is gradually escalating doses of the drug. The release also explains that patients nine years old or younger who were also treated with a steroid called decadron (dexamethasone) for half as long as normal (14 versus 28 days) benefited from the treatment while patients 10 and older did not. We’re not sure of the meaning behind these results as portrayed in the release. Which outcome was better by 5 or 6 percent? The study has several. Does that mean the relapse rate was reduced or is it the event free survival that was better? It would be more meaningful to readers if the release had included the actual relapse and event free survival rates for each group analyzed in terms most people can understand. For example: “relapse rates were 5 percent lower in Group X compared to Group Y.” We’ll give this category a satisfactory rating largely due to the release including information that patients 10 and older receiving dexamethasone “were at much higher risk for a debilitating bone condition called osteonecrosis,” although we would have been happier if that greater risk would have been quantified. However, the published study explains that there were toxicity problems beyond that of dexamethasone and the release would have been stronger including that information as well. The release stated the study was randomized and controlled, and provides a broad overview of the study design, for which we give the release a borderline satisfactory under this criteria. However, these are the superficial results. On deeper delving into the study methodology, the statistical significances of the results were very close to not statistically significant. This is due to their planned interim stopping of the treatment and the fact that they were looking at multiple outcomes in multiple groups. This release doesn’t demonstrate disease-mongering. While the release does say that this clinical trial was run by the Children’s Oncology Group, which is funded by the National Cancer Institute and the National Institutes of Health, it makes no mention of possible conflicts of interest. Compounding that is the fact that the published study says, “Disclosures provided by the authors are available with this article at www.jco.org,” but that information is behind the journal’s paywall for most readers, so it’s unknown if there is, or is not, a conflict. It appears as though five of the authors (out of a total of about 20) have some conflicts of interest, mostly from several types of drug company payments. The release is comparing the efficacy of treatment regimens using different drugs so alternative treatments for B-acute lymphoblastic leukemia are noted. The release makes clear at the end that the treatment of this disease is improving thanks to refinement of the use of existing drug treatments, meaning that they are readily available for patient use. The release suggests the study findings could change the way childhood leukemia is treated. Modifying existing treatments to enhance a patient’s survival is certainly novel enough to warrant a release. There is no use of unjustifiable language in this release. However, the tone may be a bit overly optimistic given the study findings. Claim: Relapses of childhood leukemia improve with high doses of common chemo drug

A: This release reports the findings of a large clinical trial testing whether alternative dosing regimens of standard chemotherapeutic drugs can improve the treatment of B-acute lymphoblastic leukemia. The study showed that using high doses of the drug methotrexate, rather than the standard regimen of gradually increasing doses, improved the outcomes for patients with the disease. The study also showed that using the steroid dexamethasone increased a debilitating bone condition in patients 10 and older but not in patients nine or younger. While the study results are promising, they are by no means clear-cut in the release. The release needed some qualifiers in order to give a clear picture of the benefits. The release also neglected to discuss costs and potential conflicts of interest among the investigators. This form of cancer — B-acute lymphoblastic leukemia — is the most common cancer in children and a major cause of cancer death in patients under 40 years old. And while the majority of patients survive with appropriate treatment, anywhere from one-fifth to one-quarter of patients do not. This study showed that refining the dosing of standard cancer drugs may improve the outcome for some high-risk patients.
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Q: Paragraph: No longer. More than half of the cane in Brazil’s main sugar-producing area of Sao Paulo state was harvested using machines during the 2009/10 season, a historic first that portends greater efficiency in coming years. The shift is occurring so quickly that some producers face a four-month waiting list to get the right equipment. The transition, driven by both increased competition and tougher Brazilian environmental laws, has been a boon for multinational equipment manufacturers supplying the world’s leading producer of sugar and the second largest ethanol producer after the United States. “Brazil’s market is hot,” said Jose Emilio dos Santos, manager of Tratorag Comercio e Representacao, a John Deere dealer based in Piracicaba, the heart of the center-south’s cane growing region in Sao Paulo state. “Many producers are looking to buy a new machine harvester.”   Last year, Cosan, the world’s largest sugar and ethanol producer, spent 30.5 million reais ($17.3 million) on mechanization and expects to train between 180 and 200 harvester operators per year for the next four years, said Luis Carlos Veguin, the company’s human resources director. Adoption of the technology by big firms has forced many smaller producers to follow suit. In the first six months of 2010, 3,186 harvesters of all types were sold in Brazil, up from 478 in the same period of 2006, according to figures from Anfavea, the vehicle manufacturer’s association. It’s not just companies that are benefiting from the switch. Izaura Freitas Souza, 39, has wielded a machete in the sugar cane harvest since she was a 15 year old and once almost sliced off her big toe in the fields. Today, Souza drives a harvester for Cosan in Piracicaba and says she has tripled her earnings to 1,800 reais a month, which allows her to save to buy a house. “It is clean work now,” she said, “without the physical wear and tear.”   Initial investment in a harvester is expensive but over time is a cheaper alternative to manual labor because wages have been rising in tandem with Brazil’s economy, Veguin said. A new cane harvester from John Deere costs an average 880,000 reais, said dos Santos, the tractor dealer. The company’s main competitor in Brazil is Case IH, a subsidiary of CNH Global. For smaller sugar cane producers who are unable to afford the initial investment, the situation can be dire. Unable to compete with the efficiency of the bigger players, some have been forced to enter into partnerships with Cosan or Bunge, or logistics companies, like Julio Simoes. “Banks request guarantees and the cost of a harvester is quite high,” dos Santos said. “Not all producers can provide sufficient collateral.”   Mechanization is given urgency by environmental laws, which will effectively phase out manual cane cutting in Sao Paulo state by 2017. Before manual harvesting begins, workers set fields alight to clear the undergrowth and flush out snakes and insects. Reducing burning is a priority for producers because the method is a blot on otherwise impressive environmental credentials — Brazilian ethanol from cane is about six times more energy efficient than its U.S. corn-derived counterpart — and they have introduced more stringent schedules. “We have a 100 percent target for the elimination of burning (in areas suitable for mechanization in Sao Paulo state) for 2014,” said Antonio de Padua Rodrigues, a director at Unica, the cane industry association. Cane producers fear that environmental reasons might be used as de facto trade barriers to prevent the entry of Brazilian sugar and ethanol into less competitive domestic markets in Europe and North America. This will be important as Brazil seeks to expand in overseas markets. The country’s 2010/11 sugar cane crop will be the ninth record in a row, up 10 percent from the prior year, according to the government’s supply agency, Conab. But the worst hit by mechanization are the cane cutters, many of whom risk losing their jobs if they can’t retrain. A harvester replaces about 100 cane cutters a day, according to Unica, and creates 30 jobs by way of operators and maintenance teams. An operator trainee must be literate and hold a driving license, which excludes many cutters. Although government and producers have stressed retraining, figures from Unica show there were 140,000 manual cane cutters in Sao Paulo state in 2010, down from 190,000 in 2006. Even Souza, the harvester operator, misses the company in the fields. “During the breaks everyone would joke around,” she said. “In the harvester I can only laugh at the memories.”   (Editing by Brian Winter and Kieran Murray) Claim: From machete to machine in Brazil's cane fields.

A:
For nearly five centuries, the classic image of sugar production in Brazil has been one of workers setting cane fields on fire and then descending on the crop with their machetes for harvest.
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