instruction:
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.
question:
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
answer:
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.


question:
Paragraph: Homebred beef cattle are seen at a local cattle market in Hongseong, about 170 km (106 miles) south of Seoul July 29, 2008. A rare genetic mutation may underlie some cases of mad cow disease in cattle and its discovery may help shed light on where the epidemic started, U.S. researchers reported on Friday. REUTERS/Lee Jae-Won The mutation, in an Alabama cow that tested positive in 2006 for bovine spongiform encephalopathy, or BSE, is identical to one that causes a related brain-wasting disease in humans. This suggests BSE may sometimes arise spontaneously in cattle. Jurgen Richt of Kansas State University said cattle producers must never let down their guard against BSE because cattle anywhere, at any time, can develop the disease. The finding may support a 2005 theory that the BSE epidemic in cattle could be traced to feed contaminated with cattle remains from India, the researchers report in the Public Library of Science journal PLoS Pathogens. BSE or mad cow disease swept through British dairy herds in the 1980s, forcing the destruction of millions of animals. No one ever found where it came from but most experts thought at the time it came from cattle feed that contained the remains of sheep infected with a similar disease called scrapie. Cattle were never known to develop BSE before the epidemic, but some experts have argued they may have. This report lends credence to that idea. BSE, scrapie and a human version called Creutzfeldt-Jakob disease, or CJD, are brain-destroying illnesses called transmissible spongiform encephalopathies. In some cases, animals or people that eat brain and nervous system material from victims of these diseases can develop them, too. They are passed along by misfolded infectious protein fragments called prions. A very rare disease called variant CJD has been found in people who ate infected beef products. Fatal and incurable, it has affected just 167 people so far. Most countries now ban the use of meat and other parts from mammals in food for cattle. They also ban the use of potentially infectious tissues such as brain and spinal cord in human food. “There are tendencies around the world, now that the feed-borne epidemic has gone down, to relax these rules and regulations,” Richt said in a telephone interview. “So if we have these genetic cases popping up here and there and we don’t have our mitigations in place, we will have another epidemic somewhere.”   He suggested breeding the gene out of cattle. “We can clean the world cattle herd of that mutation,” Richt said. CJD is also known to pop up spontaneously in the human population. A genetic mutation causes the disease in one in a million people globally. Richt and colleagues tested the brain of the Alabama cow and found a mutation identical to the prion gene mutation that causes some cases of CJD. It is probably rare in cattle, found in fewer than one in 2,000, they said in the report, published here  But the animal passed along its mutation to its heifer, which suggests it is inherited. Claim: Gene mutation underlies some mad cow disease: study.
answer:
A rare genetic mutation may underlie some cases of mad cow disease in cattle and its discovery may help shed light on where the epidemic started, U.S. researchers reported on Friday.


question:
Paragraph: The story quotes an expert who states that exercise is ‘cheap’, which is generally true, but can vary depending on the type of exercise. The exercises included in most of the studies examined were taught and supervised by trained individuals, which can increase the cost. The story does not provide any data (either relative or absolute) about the benefits of exercise and other approaches to managing these injuries. This was probably appropriate, because outcomes are defined in different ways depending on the study, but the story author might have explained it. We’ll give the story the benefit of the doubt and grade it satisfactory. The potential harms of exercise in the context of repetitive strain injuries, such as making the injury worse, are not mentioned. The story accurately describes the original article as a review of studies, but it misstates the authors’ conclusions and makes it appear that exercise was far more effective than ergonomic approaches. In the original review, 8 of 14 studies looked at the effects of exercise compared with no treatment, and the authors state that here they found conflicting evidence of the effectiveness of exercise. The story inaccurately states that ‘the majority found positive results.’ Although the authors reported that the evidence for ergonomic adjustments such as special keyboards was also conflicting, the story says that evidence of their efficacy was limited. It should also have stated that most of the 22 studies reviewed were rated as poor quality by the reviewers, and that 103 of the 126 references reviewed were rejected for various reasons. The story states that the direct and indirect costs associated with repetitive strain disorders are as much as $100 billion dollars annually in the U.S. The original article actually estimated these costs at about 1/50 that much, or $2 billion. This exaggeration of impact is a form of disease-mongering. Story quotes the lead author of the review as well as other experts, whose affiliations are provided. The article correctly states that many types of exercise have been studied for repetitive strain injuries. However, rather than “hiking, cycling, walking, swimming and yoga,” as stated in the article, the studies examined generally were investigating the effects of prescribed exercises in a supervised context. The story mentions that exercise in various forms has been studied as a potential therapy for repetitive strain injuries for many years and is not new. The story does not appear to have relied solely or largely on a news release. Claim: Exercise may be the Rx for RSI
answer:

This story may leave the reader with the impression that the evidence in support of exercise as a treatment for repetitive motion injuries is more consistently positive than it really is. The lead author of the literature review is quoted as saying that it’s not possible to draw firm conclusions, yet the story depicts exercise as ‘the best medicine’ for these (sometimes) work-related complaints. The evidence for the value of exercise was actually found to be similar to that for the value of ergonomic approaches such as specially designed keyboards. In both cases the authors found conflicting evidence that these strategies help. While the difference in wording (conflicting versus limited evidence) may seem like splitting hairs, limited evidence means that positive outcomes were found in one well-designed trial, or consistently positive findings across multiple trials. On the other hand, conflicting evidence means that outcomes across trials were inconsistent–sometimes positive, sometimes showing no effect at all or perhaps even a negative effect. The story might have done better to highlight how little is actually known about what works for these disorders–particularly in light of how much money is spent to address them. Most of the reviewed studies were poor quality and too small to draw any valid conclusions. While quoting experts who assert that various approaches can help makes for an interesting story, it doesn’t reflect what the available research shows–and so may not be as helpful as the writer may have intended.