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.
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Question: 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

Answer: 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.


Question: Paragraph: The bulk of the money will come from Teva Pharmaceutical Industries Ltd. and its affiliates for paying to delay a generic narcolepsy drug, Provigil, from entering the market for nearly six years. Teva is paying $69 million, which Becerra says is the largest pay-for-delay settlement received by any state. Such agreements let the developer of brand name drugs keep their monopolies over the drugs after their patents expire, thereby letting them continue to charge consumers higher prices. The drug developer pays the generic manufacturer to keep the cheaper version of the drug from entering the marketplace for an agreed period of time. Teva said the money will come from a pre-existing fund that was created in 2015 as part of the company’s settlement with the U.S. Federal Trade Commission over similar claims, and it will not make any additional payments. Becerra said such agreements can force consumers and the health care market to pay as much as 90% more than if there were generic alternatives. More than $25 million of the settlement will go to a consumer fund for California residents who purchased Provigil, Nuvigil or Modafinil between 2006 and 2012. “No one in America should be forced to skip or ration doses of medicine that they need ... and certainly not because a drug company is colluding to keep the price of your drug artificially high even when cheaper options could be available. But that’s what’s happening,” Becerra said. The second, $760,000 settlement is with Teva, Endo Pharmaceuticals and Teikoku Pharma USA over keeping a genetic alternative to the pain patch Lidoderm from entering the market for nearly two years. Teva said it is paying $200,000 to cover the state’s legal costs after settling similar federal claims earlier this year. Neither Endo nor Teikoku responded to requests for comment. Both settlements bar the companies from pay-for-delay agreements for several years. Teva is agreeing to not to enter any such agreements for 10 years, while Endo Pharmaceuticals has an eight-year agreement and Teikoku a 20-year injunction. Teva said the restriction is identical to its federal consent decree. Becerra also backed pending legislation, AB824 by Democratic Assemblyman Jim Wood of Santa Rosa, that would ban such agreements. The measure would require pharmaceutical companies to prove that their agreements are not anticompetitive. It passed the Assembly 56-0 in May and is awaiting a vote in the Senate. Pharmaceutical companies oppose the bill, arguing the Federal Trade Commission already does this monitoring. ___ This story has been corrected to say that while there are four settlement agreements, they involve only three companies. Claim: 3 companies pay California $70 million for delaying drugs.

Answer: Three pharmaceutical companies collectively are agreeing to pay California nearly $70 million to settle allegations that they delayed drugs to keep prices high, California Attorney General Xavier Becerra said Monday.


Question: Paragraph: At least 260 workers at Westfleisch’s slaughterhouse in the city of of Coesfeld have tested positive for COVID-19 in recent days, causing alarm at a time when the country is trying to slowly relax the restrictions that were imposed to curb the pandemic. As authorities scrambled to contain the growing outbreak over the weekend, it emerged that many of those infected were Eastern European migrants working for subcontractors who also provide them with accommodation and shuttle buses to work. “If one person is infected then basically everybody else that sits on the bus or lives in the shared houses is infected,” said Anne-Monika Spallek, a Green Party representative in Coesfeld who has campaigned against the meat industry’s practice of outsourcing much of its back-breaking work to migrants working under precarious conditions. Among them is Iulian, a trained carpenter from Bacau in Romania’s poor northeast who previously worked for a German courier company . He recently got a job at Westfleisch that promised several times what he would make back home. The 48-year-old, who declined to give his last name fearing repercussions, said he still must pay his employer rent for a room he shares with a colleague, but he doesn’t know if he will receive pay while he isn’t working. Standing behind a metal fence erected to stop workers from leaving the house they share about a 15-minute drive from Coesfeld, Iulian waited Tuesday for results from a coronavirus test. Residents inside also awaited results from tests taken four days earlier. “Like a jail,” he said of his current situation. “Like a lion in a cage.” Authorities had stopped the men from going to a nearby supermarket but subsequently groceries had been delivered. “Water, food, salami, it’s OK for now,” Iulian said. As for medical care, so far there is none. “If we do have problem, we call,” he said hopefully. Westfleisch declined a request for an interview. But in a statement, the company said it was “deeply affected” by what had happened in recent days. “We are fully aware of our responsibility,” Westfleisch said, adding it now requires workers at facilities that remain open to wear face masks on site, have their temperature taken at the gate and work in clearly separated small groups. The company said it is also trying to impress upon workers “the importance of hygiene and behavior measures in the company and in private settings.” The outbreak has caused consternation in Berlin, where German Chancellor Angela Merkel acknowledged Wednesday the “alarming news” about the situation at Westfleisch. “There are significant shortcomings in accommodation – we have all seen that now – and it has to be seen who is held responsible,” Merkel said. “I can tell you in any case that I am not satisfied with what we have seen there.” The outbreak began shortly before Germany’s federal and state governments agreed to trigger an “emergency brake” on relaxing restrictions when the number of new infections passed 50 per 100,000 inhabitants in a week — a threshold that Coesfeld has far surpassed. Authorities in North Rhine-Westphalia, where Coesfeld is located, have ordered all 20,000 workers in the meat industry tested for the new coronavirus and delayed the reopening of bars and restaurants in the region by another week. Some enraged restaurant owners have threatened to sue for lost earnings, though it is unclear who they would take to court: Westfleisch, the subcontractors, the workers or regional officials now being accused of acting too slowly. Olaf Klenke of the NGG union, which represents workers in the food industry, says the outbreak could be the right moment to clamp down on outsourcing in the meat industry. “The corona crisis simply reveals the situation that exists in this area,” he said. “We often talk about animal welfare in the industry,“but what happens to the people who work there is at least as important.” While the outbreak in Coesfeld has drawn the most attention, there have been smaller clusters of cases at slaughterhouses across the country in recent days. And though there’s been no death yet among abattoir workers, a 57-year-old farm worker from Romania died of COVID-19 in Germany last month. In the United States, which has also seen a spate of infections at meatpacking plants, experts have cited extremely tight working conditions that make factories natural high risk locations for contagion. Klenk blamed a lack of public interest in the issue and price pressure from large supermarket chains for promoting cut-throat competition in the slaughterhouse business. At a market stall in Coesfeld’s town square, a pork cutlet from a pig butchered by hand costs 15.50 euros per kilogram ($7.63 a pound), compared with 3.29 euros per kilogram ($2.32 a pound) for an industrially processed portion of the same cut at a nearby supermarket. Amid mounting pressure to act, Labor Minister Hubertus Heil pledged late Wednesday to “clean up” conditions in German slaughterhouses. “We as a society mustn’t continue to look on as people from Central and Eastern Europe are exploited,” he said, adding that the subcontractors were the “root of the problem.” Spallek, the Green party politician, said the outbreak has prompted sympathy for the migrants among many Germans who had previously taken little notice of the problem. “Everybody wants these miserable conditions to finally end,” she said. “On the other hand the people are really mad at Westfleisch and at the county official for not closing (the factory) sooner.” Spallek voiced fears that a number of workers might develop serious illnesses in the coming days. “I’m convinced that we’ve yet to see the consequences, including in the hospitals,” she said. ___ Kerstin Sopke in Berlin, and Vadim Ghirda in Bucharest, Romania, contributed to this report. ___ Follow AP pandemic coverage at http://apnews.com/VirusOutbreak and https://apnews.com/UnderstandingtheOutbreak Claim: Outbreak at German slaughterhouse reveals migrants’ plight.

Answer:
Big white trailers adorned with pictures of juicy roasts and the wholesome slogan “Straight from the farmer” sit idle in northwestern Germany, their usual pork hauls disrupted by a coronavirus outbreak at one of the country’s biggest meat processing companies that has put the industry in the spotlight.