TASK DEFINITION: Given a paragraph, generate a claim that is supported by the given paragraph. 1) The claim must contain information from within the paragraph. 2) A sentence within the paragraph can be used as a claim. 3) The claim should not have contradictions within the paragraph. 4) The claim should be at most one sentence long.
PROBLEM: Berkeley City Council voted unanimously to add the measure in the form of a referendum on the city’s ballot, drawing cheers of support from residents and health advocates, and vows to fight from the U.S. food and beverage industry. “When we pass this measure in November, Berkeley will be the first in the country where such a measure has been passed,” said  Vicki Alexander, a co-chairwoman of a local campaign to put the measure on the ballot. “We are very excited to see that day happen.”  Public health advocates across the country have clamored for ways to reduce consumption of sugary drinks and junk food, but lawmakers and voters have generally opposed enacting taxes or other regulations. Former New York City Mayor Michael Bloomberg’s plan to limit the sale of large sugary drinks was rejected on June 26 by the state’s highest court. A California bill to require sugary soft drinks to carry labels warning of obesity, diabetes and tooth decay died in the California Legislature on June 17. Two California cities, Richmond and El Monte, failed two years ago in their attempts to become the first in the country to impose taxes of a penny per ounce on businesses that sell sugary drinks. Revenues from Berkeley’s tax, if it passes, would go toward the city’s general fund. “It’s disingenuous because there’s nothing in this measure that’s going to education. This goes right into the general account. It’s a money grab,” said Ted Mundorff, CEO of Landmark Theatres, which has movie theaters in Berkeley. A Berkeley vending machine executive said her company would be forced to pass the tax on to consumers in order to stay in business. A city survey of 500 likely voters showed majority support for the tax in April.

SOLUTION: Berkeley residents to vote on soda tax in November.

PROBLEM: The question of cost is cited in the final line of the story, which suggests that the scoring system can “address escalating health care cost issues.” But we didn’t think that was specific enough to warrant a Satisfactory score. The story doesn’t clue readers in to the fact that the financial burden can be measured in billions of dollars — a single screening test recommended for millions of Americans can cost thousands of dollars apiece. The other cost issue specific to this test is that it takes valuable time for providers to retrieve a reputable risk calculator when sitting with a patient and enter in the specific data points, including in this case waist circumference, which clinicians often do not measure as a ‘vital sign’ per se. The story cites a study that credits colonoscopy with reducing the risk of death from colon cancer by about 50 percent, by removing polyps. It would have been helpful for the story to explain what that relative reduction in risk means in absolute terms (e.g. did the rate of cancer death go from 50% to 25% or from 2% to around 1%?) The story also notes that the study found that patients with a low to intermediate risk score “still have a risk between of between 1.9 percent to 9.9 percent of harboring a polyp that can develop into cancer.” We’ll give credit here for the story’s provision of these key statistics, which do give a sense as how well the test accurately identifies truly low-risk individuals. However, we’d note that the benefit here should ideally refer to the ability of the algorithm to classify people at all risk levels (including high-risk), and therefore target the highest-risk patients for colonoscopy. The story doesn’t really get into discussion of the predictive power of the test, referred to as a likelihood ratio, which is in the study manuscript. However, this is a difficult concept for most health care providers and patients, and we think it’s understandable that the story did not include a full discussion of this topic. The harm of a screening test such as this really is “getting it wrong” in terms of predicting someone to be at low risk and finding them to have a higher risk polyp or malignancy. As noted above, the story cautions that “low- to intermediate-risk patients still have a risk between of between 1.9 percent to 9.9 percent of harboring a polyp that can develop into cancer.” This story accurately explains that the research was about predictive modeling, and explains the components of the risk score as well as the study design. There are some cautionary notes in the text, including a statement from outside expert that “the data from this study is not strong enough to spur any changes in current screening recommendations,” an opinion shared by an editorialist on the study. We think this is sufficient for a Satisfactory rating. The story does not hype the incidence or seriousness of the disease. The prevalence statistics cited are consistent with these National Cancer Institute figures. The story contains two independent voices. The perspective they provide is a particular strength of the article. We wish that more stories would reach out to experts not affiliated with the studies being reported on for context. The story notes that a variety of screening tests exist, but the relevant alternative here is actually other risk calculators, which the authors of the study describe and cite but are not routinely used. The story doesn’t mention these other calculators and why they are seldom used — context that would have deepened reader understanding of the issue. Although availability isn’t explicitly addressed, this risk calculator is now available (implicitly) by virtue of publication of the paper. It is a simple scoring system that can be implemented based on the information in the paper, and the story makes this clear. We’ll rate this Satisfactory. The story makes it sound as if this is a first-of-its-kind tool. However, risk calculation tools for colon cancer have been in circulation for many years. We could not find a news release related to this study. But in any case, the comments from two independent experts assure us that the story wasn’t based on a news release.

SOLUTION: 'Scoring System' May Spot Those in Greatest Need of Colonoscopy; But one expert cautions that even 'low risk' patients can still develop suspicious polyps

PROBLEM: The country’s public health system, the NHS, is ill-equipped to cope with an outbreak that is unprecedented in modern times. Hospitals are now striving to at least quadruple the number of intensive care beds to meet an expected surge in serious virus cases, senior physicians told Reuters, but expressed dismay that preparations had not begun weeks earlier. With serious shortages of ventilators, protective equipment and trained workers, the physicians said senior staff at hospitals were beginning to confront an excruciating debate on intensive care rationing, though Britain may be a long way from potentially having to make such decisions. Rahuldeb Sarkar, a consultant physician in respiratory medicine and critical care in the English county of Kent, said local NHS trusts across the country were reviewing decision-making procedures drawn up, but never needed, during the 2009 H1N1 flu pandemic. They cover how to choose who, in the event of a shortage, would be put on a ventilator and for how long. Decisions would always be based on an individual basis if it got to that point, taking into account the chance of survival, he said. But nevertheless, there would be difficult choices. “It will be tough, and that’s why it’s important that you know, that two or more consultants will make the decisions.”  Sarkar said the choices extended not only to who was given access to a ventilator but how long to continue if there was no sign of recovery. “In normal days, that patient would be given some more days to see which way it goes,” he added. But if the worst predictions about the spread of the virus proved correct, he suspected “it will happen quicker than before”. Britain is by no means the only country that faces having its health system overwhelmed by COVID-19, but the data on critical care beds - a crucial bulwark against the disease - is concerning for UK authorities. Italy, where the coronavirus has driven hospitals to the point of collapse in some areas and thousands have died, had about 12.5 critical care beds per 100,000 of its population before the outbreak. That is above the European average of 11.5, while the figure in Germany is 29.2, according to a widely-quoted academic study here dating back to 2012 which doctors said was still valid. Britain has 6.6. Estimates of the potential death toll in Britain range from a government estimate of around 20,000 to an upper end of over 250,000 predicted by researchers at Imperial College. As of March 19, 64,621 people had been tested, with 3,269 positive. The NHS is preparing for the biggest challenge it has faced since it was founded after the ravages of World War Two, promising cradle-to-grave healthcare for all. It was stretched long before COVID-19, struggling to adapt to the vast increase in healthcare demand in recent years. Some doctors complain that it is underfunded and poorly managed. About a tenth of more than one million staff roles in the health service are vacant while almost nine out of 10 beds are occupied. Prime Minister Boris Johnson was asked at a media conference on Friday, after Reuters reported the concerns of physicians, whether Britain could get to a stage where NHS workers had to choose who to save because there weren’t enough ventilators. He urged people to follow public safety measures. “The objective of this whole campaign is to ensure we flatten the curve, as we have been saying repeatedly over the last couple of weeks, but also that we lift up the line of NHS resilience and capabilities,” he said. “That means there is a massive effort going on right now to make sure we do have enough ventilators and ICUs to cope.”  So how many life-saving ventilators are needed? Health Secretary Matt Hancock said on Sunday that hospitals had around 5,000 but that they needed “many times more than that”. The physicians interviewed by Reuters said, if ventilators were secured, the aim was to increase intensive care beds from around 4200 to over 16,000, partly by using beds in other parts of hospitals. Rob Harwood, a consultant anaesthetist in Norfolk who has worked in the health service for almost four decades, said access to critical care could ultimately have to be determined by patient scoring systems for survivability. Systems developed for SARS, another coronavirus that broke out in 2003, could for example be refined, he added. “Once you have exhausted your capacity and exhausted your ability to expand your capacity you probably have to make other decisions about admission into intensive care.”   But he emphasised that, for now, admission criteria would stay unaltered: “We are a country mile from that at the moment.”     While shortages of critical care equipment may be most alarming, the coronavirus has exposed how generally ill-equipped the health system is for a pandemic. The British Medical Association said doctors have been asked to go to hardware stores and building sites to source protective masks. Some doctors are worried about Public Health England’s (PHE) new advice last week which reduces the level of the protective equipment they need to wear. Previously, staff on ward visits were told to wear full protective equipment, comprising high quality FFP3 face masks, visors, surgical gowns and two pairs of gloves. But the new advice recommends only a lower-quality standard paper surgical face mask, short gloves and a plastic apron. PHE referred queries about doctors’ worries to the health department, which did not respond to requests for comment on the matter. A senior NHS epidemiologist, who was not permitted to be named, told Reuters this advice was based on a sensible assessment of the biohazard risk of the virus. “It’s not Ebola,” the doctor said, pointing out the risk to medical staff without underlying medical conditions was low. Matt Mayer, head of the local medical committee covering an area in south of England, said GPs had been sent face masks in boxes that said “best before 2016” and that have been relabelled with new stickers reading “2021”. “If you are going to lead people into a hazardous situation then you need to give them the confidence that they have the kit to do a decent job and they are not just going to become cannon fodder,” said Harwood the anaesthetist. The department of health said that they had tested certain products to see if it is possible to extend their use. “The products that pass these stringent tests are subject to relabelling with a new shelf-life as appropriate and can continue to be used,” a spokesman said. Dr Alison Pittard, dean of the Faculty of Intensive Medicine and a consultant in Leeds, northern England, said there had been chronic underinvestment in critical care in Britain. But she said the country was not yet at the stage where it had to make calls about rationing patient resources. She said, if rationing became necessary, medical ethics should still prevail and guidelines needed to be issued on a national level so that no patient was worse off based on where they lived. The NHS might also need the advice of military leaders, she said, on how to effectively triage. “If we got to a difficult position where we had to exhaust every bit of resource in the country then, yes, we may have to change the way we approach the decision-making.”      Stephen Powis, the National Medical Director of NHS England, said there were plans to issue new guidance to give doctors advice on how to make difficult decisions if there was a surge in coronavirus cases, like in Italy. The National Institute for Health and Care Excellence (NICE) said on Friday it would shortly announce a “series of rapid guidelines” on the management of people with suspected and confirmed COVID-19, including in critical care. The guidelines are not, however, expected to be prescriptive but to suggest leaving key decisions to individual doctors. Pittard said patients with pre-existing conditions who already had life-threatening health difficulties should be having conversations with their family about how they wished to spend their last days, in the event of them being infected. “If I get coronavirus now I’ve got a very high chance of dying of it,” she said, putting herself into the shoes of such a patient. “So do I want to die in hospital and when my relatives can’t come in to visit me because it’s too risky, or would I like to die at home? “And if I do want to go into hospital, do I then want to go to intensive care where my chances of surviving are minimal?”

SOLUTION:
Who gets the ventilator? British doctors contemplate harrowing coronavirus care choices.