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: We give the story credit for at least citing a $30,000 cost for the “surgeries” but wish it had explained what that included and what it might not. Surgery to change the battery every two years certainly adds to cost. Undoubtedly patients require more intensive expensive followup and perhaps specialized checks to ensure the device is working. With broad strokes across discussion of three different uses for three different conditions, the story did an adequate job quantifiying benefits. As stated in the “Evidence” criterion above, this is where a control group and reporting response rates for treated versus control groups would be very informative. Instead, we only get a qualitative description of benefits which is useful but which might leave careful readers asking for more. This is one area where the story could have been improved. There was no detailed discussion of what can go wrong with deep brain stimulation. There was a brief mention of “if” the electrodes cause neurological side effects. But how often does that happen? And the story noted that the surgery does “sometimes” cause dangerous brain bleeding or infections. How often is “sometimes”? At a very high, overview level, the story explained the current state of the evidence. But more information would have been better. Current evidence for depression/OCD is based on case series. These studies don’t have a control group, making the results more subject to bias. No disease mongering of any of the conditions discussed. The story was repeatedly clear about deep brain stimulation being used when standard medications or behavior therapy had not worked. But it would be helpful to give estimates of the proportion of patients with depression or OCD who aren’t helped by available treatments. Several sources were cited. Dr. Mayberg’s connection to St. Jude Medical was mentioned. The story could have mentioned that Dr. Okun’s center and Dr. Greenberg have received funding from Medtronic. Greenberg’s current funding from the National Institute of Mental Health was noted. We think the sourcing and disclosure was adequate. A strong point of the story was that it repeatedly provided the context for the use of deep brain stimulation — “when standard medications fail…worst-case patients…doesn’t mean patients can abandon traditional therapy…people with intractable (problems)…(people who) failed behavior therapy.” This story already attempted to accomplish a lot, but to be complete, it could have offered explicit description of currently approved options: antidepressant medications (multiple classes); psychotherapy (multiple options); combinations of medications or medications and therapy; transcranial magnetic stimulation (limited availabilty), vagal nerve stimulation, ECT – and estimate of the proportion of patients who fail these treatments. Nonethless, we feel it met the criteria for a satisfactory score. The story states that 70,000 have had deep brian stimulation for Parkinson’s or other movement disorders, and that studies are underway on at least 60 people with intractable obsessive-compulsive disorder and 100 with severe depression. The experimental nature of these approaches is clear from the story. A nice touch would be to give a link to clinicaltrials.gov to allow readers the option of looking up more information on the studies in progress and finding out if recruitment is open and how to access the study. The story did a good job putting the new uses of deep brain stimulation into the context of other research and other therapeutic approaches. It’s clear that the story did not rely on a news release. Claim: Trying brain pacemakers to zap psychiatric disease

A: We especially appreciate the lack of hype in this story. The reporter clearly worked hard to stick to the evidence – not merely to promote the potential. About 65-70 percent of patients with major depressive disorder improve substantially with 1 to 2 course of standard treatment (medication, psychotherapy or combinations). Subsequent treatment options have progressively lower rates of treatment response. Therefore, a significant number of people need other treatment options. Deep brain stimulation is an invasive treatment, but one that has shown promise in a small number of patients.
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Q: Paragraph: That’s among the findings of the America’s Health Rankings Senior Report released in May by the United Health Foundation. The report ranks the 50 states by assessing data covering individual behavior, the environment and communities where seniors live, local health policy and clinical care. Minnesota took top honors for the second year in a row, ranking high for everything from the rate of annual dental visits, volunteerism, high percentage of quality nursing-home beds and low percentage of food insecurity. This year’s runners-up are Hawaii, New Hampshire, Vermont and Massachusetts. The researchers base their rankings on 34 measures of health. But here’s one you won’t find in the report: state compliance with the Affordable Care Act (ACA). While the health reform law isn’t mainly about seniors, it has one important feature that can boost the health of lower-income older people: the expansion of Medicaid. The ACA aims to expand health insurance coverage for low-income Americans through broadened Medicaid eligibility, with the federal government picking up 100 percent of the tab for the first three years (2014-2016) and no less than 90 percent after that. But when the U.S. Supreme Court affirmed the ACA’s legality in 2012, it made the Medicaid expansion optional, and 21 states have rejected the expansion for ideological or fiscal reasons. And guess what: Most of the states with the worst senior health report cards also rejected the Medicaid expansion. Nearly all Americans over age 65 are covered by Medicare. But the Medicaid expansion also is a key lever for improving senior health because it extends coverage to older people who haven’t yet become eligible for Medicare. That means otherwise uninsured low-income seniors are able to get medical care in the years leading up to age 65 - and they are healthier when they arrive at Medicare’s doorstep. Two studies from non-partisan reports verify this. The U.S. Government Accountability Office reported late last year that seniors who had continuous health insurance coverage in the six years before enrolling in Medicare used fewer and less costly medical services during their first six years in the program; in their first year of Medicare enrollment, they had 35 percent lower average total spending. The GAO study confirmed the findings of a 2009 study report by two researchers at the Harvard Medical School. That study looked at individuals who were continuously or intermittently uninsured between age 51 and 64; these patients cost Medicare an additional $1,000 per person due mainly to complications from cardiovascular disease, diabetes and delayed surgeries for arthritis. Fifty-two percent of Medicaid-rejecting states ranked in the study’s bottom third for senior health, including two very large states, Texas and Florida. Many of these states also can be found in a list of states with the highest rates of poverty among people over 65. What emerges is a north-south divide on senior health. “Many states that haven’t expanded Medicaid are in the South, and there’s a clear link between socioeconomic status and health status,” says Tricia Neuman, senior vice-president at the Henry J Kaiser Family Foundation and director of the foundation’s Medicare policy program. “Insurance may not be the only answer, but it certainly is helpful.”  The United Health Foundation - a non-profit funded by the insurer UnitedHealth Group - didn’t consider insurance coverage in its study, but it did consider poverty. Minnesota’s rate was 5.4 percent - well below the 9.3 percent national rate. Mississippi ranked dead last, with a 13.5 percent poverty rate. In states that rejected the Medicaid expansion, we are witnessing a victory of politics over compassion and morality. Jonathan Gruber, an economics professor at the Massachusetts Institute of Technology and a key architect of health reform in Massachusetts and under the ACA, summed it up in an interview with HealthInsurance.org earlier this year, saying that these states “are willing to sacrifice billions of dollars of injections into their economy in order to punish poor people. It really is just almost awesome in its evilness.” Claim: The state of senior health: It depends on your state.

A: What are the best and worst places to stay healthy as you age? For answers, take out a map and follow the Mississippi River from north to south. The healthiest people over 65 are in Minnesota, the sickest in Mississippi.
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Q: Paragraph: The contaminant, a large complex molecule chemically  similar to heparin, was detected in samples from a Chinese and  a U.S. plant, both owned by Baxter’s supplier, Wisconsin-based  Scientific Protein Laboratories LLC (SPL). “At this point we don’t know how the heparin-like compound  got into the active pharmaceutical ingredient,” Food and Drug  Administration Deputy Commissioner Janet Woodcock told  reporters on a conference call. “We don’t yet have a direct  causal link between the contaminant and the adverse events.”    Nineteen deaths have been reported in patients taking a  version of heparin that appear related to the drug, though it  is unknown if all of those patients were on Baxter’s heparin or  another product. The other major U.S. heparin supplier, APP Pharmaceuticals  Inc, ramped up production to avoid a drug shortage after Baxter  recalled most of its heparin products last week. Tests on APP’s heparin have not turned up any  contamination, Woodcock said. The FDA’s foreign inspection process has been criticized  for years as inadequate and those complaints were stoked when  FDA officials acknowledged recently the agency never inspected  the Chinese plant in question because of confusion over the  company’s Chinese name. FDA has not yet sifted through the 785 total adverse event  reports in heparin patients to determine which are  drug-related, Woodcock said. She cautioned that increased attention to the problem has  led to an influx of side-effect reporting and that may not be  related to the drug. Heparin is derived from pig intestines and is used in  dialysis and heart procedures, among other surgeries, to avoid  blood clots. Last week, the FDA said it found “objectionable conditions”  at the plant. Facility owner Scientific Protein Labs in a  statement said the contaminant theory is “speculation at this  point” and that it is working with the FDA to determine the  cause of the problems. FDA officials also don’t know whether the contaminant was  added intentionally or if it occurred as part of a natural  biological process. “We still don’t know whether this inadvertently got into  the supply or whether it was actually added” deliberately,  Woodcock said. Severe reactions such as anaphylaxis and low blood pressure  are signs of dangerous allergic reactions related to heparin  use. Earlier on Wednesday, Baxter, which has recalled most of  its heparin blood thinning products, said it narrowed down  possibilities for the root causes. Baxter ruled out its Cherry Hill, New Jersey, facility,  where the drug is manufactured in a later step in the process,  as a source of the problem. Claim: FDA says contaminant in some Baxter heparin.

A:
U.S. regulators on Wednesday said  they identified a contaminant in the key ingredient in Baxter  International’s recalled blood thinning drug heparin amid 15  more reports of deaths in patents treated with some version of  the drug.
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