Given a paragraph and a claim, classify it this way: If the claim contradicts the evidence present in the paragraph, classify the claim as '0'. If the claim has multiple supporting *AND* contradicting evidences, classify the claim as '1'. If the claim has supporting evidence and the paragraph is in overall favor of the claim, then classify the claim as '2'.

[EX Q]: Paragraph: "Much has been made of the United States' success in reducing the amount of drinking and driving over the past few decades. But is there a growing problem with drivers on drugs? During a March 31, 2010, interview on C-SPAN’s Washington Journal, Gil Kerlikowske -- the head of the White House's Office of National Drug Control Policy, and more commonly known as the drug czar -- seemed to suggest as much. ""More people are driving under the influence of drugs than are driving under the influence of alcohol,"" Kerlikowske said. ""A recent roadside survey showed that 16 percent of the people tested, tested positive for illicit or licit drugs. That's significantly higher than alcohol."" This surprised us, so we decided to take a closer look. We located the study that Kerlikowske was referring to -- the National Roadside Survey of Alcohol and Drug Use by Drivers. It was conducted in 2007 for the National Highway Traffic Safety Administration -- part of the federal Department of Transportation -- through a contract with the Pacific Institute for Research and Evaluation. It was the fourth major roadside survey (earlier ones were undertaken in 1973, 1986 and 1996) and was the first to look at drugs as well as alcohol. The 2007 study randomly stopped drivers at 300 U.S. locations on weekend nights (10 p.m. through midnight on Fridays and Saturdays, and 1 a.m. to 3 a.m. on Saturdays and Sundays) and also made some daytime stops for comparisons. Participation in the survey and its testing was voluntary. The stops targeted private vehicles, including motorcycles, but they excluded commercial vehicles such as semitrailer trucks. In all, 11,000 drivers participated, with 86 percent tested by breathalyzer, 71 percent by oral fluid samples and 39 percent by blood samples. (The blood test was for nighttime drivers only.) Because the nighttime sample provides the most complete data on drug use, we'll stick to the nighttime sample for alcohol use as well. During the nighttime tests, 2.2 percent of drivers registered a blood-alcohol content of at least .08 percent -- the level at which a driver is presumed impaired under Florida law. By contrast, a whopping 16.3 percent of drivers tested positive for drugs, defined in the study as ""illegal, prescription, and over-the-counter products, including stimulants, sedatives, antidepressants, marijuana, and narcotic analgesics."" The most commonly detected drugs were marijuana (8.6 percent), cocaine (3.9 percent) and methamphetamine (1.3 percent). If that were the end of the story, Kerlikowske's comment would be resoundingly accurate -- 16.3 percent is indeed ""significantly higher"" than 2.2 percent. But there are two caveats that deserve a mention. •  Legal vs. illegal levels of alcohol. The 2.2 percent of drivers registering .08 or above is, by historical standards, impressively low -- that number has steadily declined since the first survey, from 7.5 percent in 1973 to 5.4 percent in 1986 to 4.3 percent in 1996 before dropping to 2.2 percent in 2007. Still, that number underestimates the total percentage of drivers who registered some alcohol in their bloodstream. In all, the survey found that 12.4 percent of drivers had some alcohol in their bloodstream -- 7.9 percent with levels between .005 and .049 and an additional 2.3 percent with levels between .05 and .079. Low, but detectible, blood-alcohol levels do not impair a driver as much as illegal levels do, but they can have an effect. According to the Federal Aviation Administration, such symptoms as ""mild euphoria, talkativeness, decreased inhibitions, decreased attention, impaired judgment and increased reaction time"" can begin at .03 percent, and numerous countries have set legal thresholds lower than .08. Indeed, the California Department of Motor Vehicles says that blood-alcohol content below .08 percent ""does not mean that it is safe or legal to drive."" The state calls levels from .01 to .04 a ""possible DUI"" (driving under the influence) and .05 to .07 a ""likely DUI."" For drivers under 21, both categories are illegal outright. •  We don't know much about how drugs affect the act of driving. Compared to the effects of alcohol, the impact of drugs on driving is not yet well understood. Some of this has to do with the long head start in research on alcohol and driving, and some has to do with the greater chemical complexity of drugs compared to alcohol. The authors of the study were open about the limitations of today's knowledge. ""In addition to the prevalence of drug use by drivers,"" they wrote, ""several other questions need to be answered in order to assess the drug-impaired driving problem, including: Which drugs impair driving ability? What drug dose levels are associated with impaired driving? Which drugs are associated with higher crash rates?"" They added a strongly worded caveat. ""The reader is cautioned that drug presence does not necessarily imply impairment,"" they wrote. ""For many drug types, drug presence can be detected long after any impairment that might affect driving has passed. For example, traces of marijuana can be detected in blood samples several weeks after chronic users stop ingestion. Also, whereas the impairment effects for various concentration levels of alcohol are well understood, little evidence is available to link concentrations of other drug types to driver performance."" To offer a more concrete example, it's unclear how much impact a joint of marijuana inhaled two weeks ago may have on a driver today. It could well be that the two-week-old joint is less of an impairment than a legal level of alcohol in the blood -- even though the study would count the marijuana user as part of that 16 percent ""under the influence of drugs"" yet exclude someone with .07 percent alcohol from the 2.2 percent of alcohol-impaired drivers. Thomas McLellan, deputy director of the Office of National Drug Control Policy, told PolitiFact that the sensitivity of the oral swabs makes it ""highly unlikely"" that marijuana use ""even half a day earlier would have shown up"" in the survey. Still, in addition to the survey authors' written caution, several independent experts we contacted agreed that the lack of data on drug-use-and-driving interactions suggests that the survey's results be taken with a degree of caution. Barbara Harsha, executive director of the Governors Highway Safety Association, added that there's strong evidence that, regardless of the comparative data on substances in drivers' systems, ""drunk driving is still the bigger problem. . . . Alcohol-related crashes were 32 percent of the total in 2008. There’s no comparable data for drug-related crashes, since there are no standards for drug impairment while driving, but the estimates are in the 10 percent to 15 percent range."" If you look no further than the outcome of the survey he cites, Kerlikowske's comment are accurate. But the caveats listed above reduce our confidence that, as he puts it, ""more people are driving under the influence of drugs than are driving under the influence of alcohol."" There's reason to believe that not all of the 16 percent of drivers testing positive for drugs would have been ""under the influence of drugs."" The survey only reveals who has some level of drugs in their system, and does not provide an accurate measure of who was impaired by drugs when they were surveyed. By the same token, it's quite possible that many more than 2.2 percent of the study participants were indeed ""driving under the influence of alcohol"" even if they weren't over the .08 legal threshold. Did these two percentages approach each other in the middle, thus undermining Kerlikowske's statement? Maybe -- or maybe he is right after all. Ultimately, the research isn't yet detailed enough to be sure. With this degree of uncertainty," Claim: More people are driving under the influence of drugs than are driving under the influence of alcohol. A recent roadside survey showed that 16 percent of the people tested, tested positive for illicit or licit drugs. That's significantly higher than alcohol.
[EX A]: 1

[EX Q]: Paragraph: "Although the story didn’t cite the cost of appendectomy – emergency or urgent surgery – and we wish it had, we nonetheless will give it a satisfactory score because it at least cited what the editorial writer wrote, ""A secondary benefit is the savings to the hospital generated by minimizing staff and anesthesiologist presence late in the evening and during the wee hours of the morning."" As with our harms score above, although the story didn’t give absolute numbers, in this case we think it was sufficient for it to report that ""The scientists found no significant difference among the groups in the patients’ condition 30 days after surgery or in the length of their operation or hospital stay."" Although the story didn’t give absolute numbers, in this case we think it was sufficient for it to report that ""The scientists found no significant difference among the groups in the patients’ condition 30 days after surgery or in the length of their operation or hospital stay."" Despite running less than 300 words, this story did an adequate job in explaining the quality of the evidence, including pointing out limitations. No disease-mongering here. The story meets the bare minimum requirement for this criterion in that it at least cited what an editorial stated. The focus of the story was on a study comparing emergency appendectomy with surgery done up to 12 hours later or beyond. This is the whole focus of the story – and one we applaud – when it begins:  ""Appendectomy is the most common emergency surgery in the world, but it doesn’t have to be."" There were no claims made about the novelty of this research, and we may have wished for a bit more context on this. Nonetheless, the potential for guiding future care decisions was made clear. Not applicable. Given that the story only pulled excerpts from the journal article and the accompanying editorial, and didn’t include any fresh quotes from interviews, we can’t be sure of the extent to which it may have been influenced by a news release." Claim: Some appendicitis cases may not require ’emergency’ surgery
[EX A]: 2

[EX Q]: Paragraph: There is no mention of costs in the release, but overuse of medical technology such as MRI scanning is one major reason for soaring health care costs. According to personal finance website Nerdwallet.com, median prices of a brain MRI range from $525 in Atlanta to a whopping $3,310 in Milwaukee. The main contention of the news release is that “imaging findings can help spur beneficial lifestyle changes in patients to reduce risk for Alzheimer’s disease.” But there’s no evidence presented to show that these images have any effect — good or bad — on patients’ adoption of beneficial lifestyle changes. Does performing an MRI increase the likelihood that someone will lose weight, exercise, and stop smoking? The release also states, “institutions… meld these approaches into novel ways to improve patient care,” but the report doesn’t detail what those “novel” therapies are. Experts in the report talk about pinpointing “volume loss in the brain” and characterizing imaging markers, but these are all surrogate endpoints. In other words, how do these translate to tangible health outcomes for patients? Bottom line: The idea that a brain MRI is going to help motivate people to adopt meaningful lifestyle changes — and that those changes will, in turn, lead to an actual reduction in the number of Alzheimer’s disease cases — requires several leaps of logic that have very limited support from evidence. The release owed it to readers either to point out the preliminary nature of the hypothesis or provide some evidence to back it up. The release did neither. Procedures almost always carry risks, and MRI is no exception. Some physicians are concerned with “MRI abuse,” pointing out that MRIs often pick up abnormal – but harmless – findings that muddy up the clinical picture. These so-called “incidentalomas” can lead to more tests and treatments that cause harm and add to costs. Unnecessary imaging is a major contributor to spiraling health care costs in the US, since a single scan on average in the US costs $2,611, according to Medicare data. Beyond stating that it exists, this news release provides no information about the journal article that is the subject of the release. Nor does it detail any of the studies that supposedly support the value of imaging for Alzheimer’s disease prevention. We’d add that the journal article itself provides limited-quality evidence — it doesn’t detail the process for selecting articles that are included in the review (raising the possibility of “cherry-picked” studies) and includes little in the way of critical evaluation of the studies that are cited. Strangely, three physicians, who weren’t listed as authors of the study, are quoted in the release and allowed to tout the benefits of quantitative MRI technology. They make sweeping statements, such as that this technology “will have a huge impact in the future” and that imaging “can have a powerful impact [on patients]” But the report fails to go into detail. One of these experts adds, “Patients seem to enjoy reviewing results of their imaging studies, more so than reading the results of their blood tests or other clinical evaluations.” But one physician’s anecdotal observation is not evidence of enhanced quality or effectiveness of care. Again, supporting data is needed. The news release does not engage in disease mongering and states that as many as three million cases of Alzheimer’s dementia could be prevented with lifestyle changes. However, it does imply that there would be more cases prevented with the addition of brain imaging, a claim that is not supported by the release or the underlying review article. The release does not specify funding sources for the work, which included the National Institute of Biomedical Imaging and Bioengineering and the National Institutes of Health. Many of the authors are consultants for medical device and pharmaceutical companies, including Toshiba (cited as “related” or relevant in the original research report). The release does not disclose this. The main premise of the news release is that MRI imaging can help people lower their risks for cognitive decline by encouraging them to make lifestyle and behavioral changes. It states that risk factors include obesity, diet, sleep, hypertension, diabetes, depression and smoking. However, the release does not address any alternatives — besides brain imaging — that might help people make the desired changes. Behavioral change counseling, which is an established approach to reducing problematic behaviors, is not discussed. The release doesn’t address the availability of quantitative MRIs of the brain. MRI in general has been used since the 1970s, and its availability is not in question. But since the issue is not specifically addressed by the release, we’ll rate it Not Applicable. Using quantitative MRI technology to diagnose Alzheimer’s disease in its early stages is not a new concept. There have been blog posts and numerous studies in the past 10 years devoted to this topic. We’re not really sure what’s new here. The news release refers to “novel ways to improve patient care,” but does not specify what these new approaches are. The language of the release bordered on sensational, with neurologist Majid Fotuhi touting the benefits of quantitative MRI technology and claiming it will have a “huge impact in the future of diagnosis and treatment of Alzheimer’s disease.” The release never clarifies the how and why of this statement. Claim: Preventive neuroradiology: Brain imaging bolsters efforts to lower Alzheimer's risk
[EX A]:
0