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.

Input: Consider Input: "Costs and the cost-effectiveness of this strategy are not discussed. Any discussion of a preventive strategy should include comments on cost. Avandia and metformin, at the doses used in the study, cost about $195 a month, according to drugstore.com. We get absolute benefits, relative benefits, and the all-important number needed to treat (NNT). Very nice. While harms weren’t quantified, the story provided a good amount of detail, context, and caveat about the safety of this regimen. We get many important details about the study: the number of patients, the enrollment criteria, randomization, placebo control, half doses, and the length of follow-up. It also describes some limitations of the study, such as its inability to detect rare adverse events due to its size. It’s an important caveat, particularly with a cardiovascular cloud hanging over rosiglitazone. The author also points to the editorial’s observation that the approach didn’t affect the problems in the pancreas that underly diabetes and which must be addressed by such a strategy. The author is very specific about the thresholds for the patient population, and who was considered at high risk to progress to diabetes. We note that it was judiciously limited in its use of the term ""prevention."" Props to the author for citing the editorial written by two independent experts and published in the same issue of the Lancet. This article selects several of their many cogent comments. Ideally, another independent source outside the publication would’ve been consulted, too. The story describes how GSK has a dog in this fight, funding the study and manufacturing Avandia. The story also provides the institutional affiliations of Zinman and the two editorialists. While it’s probably covered in the GSK funding source, we’ll point out that several investigators had other financial ties to GSK, too. The article talks about the effectiveness of lifestyle changes and the challenge of implementing them. It also reviews the barriers to using full-dose rosi because of adverse events. It’s clear Avandia and metformin are currently available. We’re told of similar prior studies and the novelty of attempting a low-dose regimen to block progression. We don’t see evidence that the article relied on any news releases."

Output: Low-dose combination of Avandia and metformin decreases progression to diabetes by two-thirds with few side effects


Input: Consider Input: In 2004, a virulent form of canine influenza surfaced at greyhound racing parks in Florida. In that outbreak, it infected 24 greyhounds and killed 8 more. The contagion has since been confirmed in seven states, having killed greyhounds at tracks in Florida, Massachusetts, Arizona, West Virginia, Wisconsin, Texas and Iowa. It is highly contagious, spreading through shared items (like toys) or human contact (kennel workers have carried the virus home with them), in addition to dog-to-dog encounters. The virus that has been felling greyhounds is an H3N8 flu closely related to an equine flu strain. It is not related to typical human flus or to the H5N1 avian flu that killed about 100 people in Asia. Several states — including Florida, Minnesota, and Louisiana, among others — reported another rash of cases in late June 2017. According to the American Veterinary Medical Association (AVMA), the outbreaks in those states were caused by a strain known as canine H3N2 influenza, which was first reported in Chicago in 2015. An AVMA spokesperson, Sharon Granskog, told us in a phone interview that such outbreaks can be seasonal in nature: There’s a time of year when more dogs are in contact with one another, they’re at dog parks, it’s highly contagious. We suggest that you make sure if your dog is going to a dog park that it’s healthy and talk to a veterinarian about whether or not a vaccine would be right for your dog. The disease was first reported in the U.S. in 2004 after several racing greyhounds in Florida contracted it. The AVMA said that they believed that the dogs became infected by a strain of H3N8 influenza, which is particular to horses. Dr. Ruben Donis, chief of molecular genetics for the influenza branch of the Centers for Disease Control and Prevention, confirmed that the flu jumped from horses to dogs, “a very rare event of considerable scientific interest” and added “at this point, there is no reason to panic.” How that jump occurred is either not known at this point or is not being commented on, so the email’s assertion that the eating of raw meat was to blame should be regarded as speculation rather than as fact. While there is always the possibility the virus might again jump species, this time to humans, this strain of flu has been present in horses for more than 40 years without any documented cases of humans catching it or the related canine flu. But there are vaccines available for both the equine and canine flus. Many readers have been confused (and unnecessarily frightened) by the difference between the terms “morbidity rate” and “mortality rate.” The morbidity rate describes the percentage of animals that will contract the disease after being exposed to the virus, but, despite its name, the term has nothing to do with the death rate associated with the flu. (Nearly 80 percent of dogs exposed to the canine flu virus will contract only a mild form of the disease which mimics kennel cough, a type of canine bronchitis that is rarely serious.) The mortality rate, which describes the percentage of animals that will die after contracting the disease, is in the much lower range of 5 to 8 percent, according to Dr. Cynda Crawford, the veterinary immunologist who first isolated the canine flu virus: The mortality rate is around 5 to 8 percent, says veterinarian Cynda Crawford at the University of Florida’s College of Veterinary Medicine in Gainesville. “I want to stress that despite the rumors that are out on the Internet and other such sources, this disease is not as deadly as people want to make it,” Crawford said. She says she receives more than 30 calls a day from concerned veterinarians. Dr. Crawford describes the contagion as producing in dogs “a moist, productive cough that ends in a gagging response, that will persist for one to four weeks, despite treatment with antibiotics or cough suppressants. Some dogs develop a thick, yellow discharge from the nose. A very few dogs will spike a high fever, between 105 to 107 degrees Fahrenheit. They become lethargic and weak, with rapid, shallow breathing. This is likely to progress to pneumonia.” Other veterinary experts have estimated the potential death rate as between 1 and 10 percent, with the higher percentage applying to very young, very old, or infirm dogs. Presence of the virus in dogs can be confirmed only through blood tests performed at the Cornell University College of Veterinary Medicine. Results of such blood screens take as long as two weeks. Dr. Crawford recommends keeping dogs showing symptoms of respiratory disease at home and away from other dogs for up to two weeks. The CDC, which is tracking the disease, issued no official recommendations. Because the symptoms of this as yet unnamed virus somewhat mimic bordetella, a less virulent illness commonly known as kennel cough, it is hard to ascertain how widespread the flu has become. On the flipside of that confusion, vets in various parts of the country have been thrown into a panic when encountering run-of-the-mill kennel cough in any of their clients, fearing they are instead confronting cases of the new flu. The Animal Health Diagnostic Center at Cornell University inserted a caution against such hair-trigger diagnosis within a larger advisory about the potential for the flu to have spread to the state of New York: “One should not lose sight of the fact that all respiratory infections in dogs are not due to canine influenza virus. Adhering to the ‘band wagon’ approach could result in the failure to appropriately treat dogs with infections previously known to cause respiratory problems in dogs.” We found this good advice for vets and dog owners in our inbox one day: PLEASE DO NOT PANIC, and do NOT assume that every cough is Canine Influenza. Kennel Cough from parainfluenza and Bordetella is more common. However, the Animal Health Diagnostic Center at Cornell is interested in receiving samples from dogs that appear to have kennel cough. Clinical Signs: Since this is a new pathogen in dogs, there is currently no natural immunity present in the unexposed canine population. Almost all exposed dogs will become infected, and nearly 80% have clinical signs. In the mild form the dogs will have a cough that persists for 10 to 21 days. The cough may be soft and moist or dry. Many dogs will have a nasal discharge from a secondary bacterial infection and low grade fever. The nasal discharge responds to broad spectrum antibiotics. In the severe form with pneumonia there is a high fever (104-106 F) and respiratory difficulties. X-rays may show consolidation. These dogs often have secondary bacterial infections and have responded to broad-spectrum antibiotics and supportive care including intravenous hydration. The incubation period is two to five days and dogs may shed virus for seven to 10 days. The disease can spread rapidly throughout a boarding kennel. Dogs that are coughing SHOULD NOT BE BROUGHT TO SHOWS or Performance EVENTS. In a 1 June 2017 advisory to its members, the AVMA suggested that vaccines against the H3N2 virus strain “might be another prevention option” for dogs who were at least 8 weeks old and also recommended isolating dogs who could be infected, as well as not sharing toys between dogs and disinfecting shelter, veterinary, and boarding facilities.

Output: A virus deadly to dogs has been spreading in the canine population of the U.S.


Input: Consider Input: A bottle of prescription medication rests on a counter at a pharmacy in New York December 23, 2009. REUTERS/Lucas Jackson Medical negligence cases in the United States are typically handled in civil court, with the victim or victim’s family seeking money damages from the doctor. In the case of Jackson’s doctor, Conrad Murray, prosecutors allege his negligence was so extreme that he should be charged with involuntary manslaughter and punished with prison time. Fatal overdoses from prescription painkillers more than tripled to 13,800 in the United States in 1999 through 2006, according to the Centers for Disease Control and Prevention. Consequently, more doctors are finding themselves in the sights of prosecutors as states like Florida and Georgia confront the growth in abuse of prescription drugs. The prosecution of doctors is seen as more effective than bringing cases against their patients. There were just over two dozen reported criminal cases against doctors for malpractice in the two decades from 1981 to 2001, according to Westlaw research by James Filkins, a doctor and lawyer who has written about the criminal prosecution of physicians. Replicating Filkins’ research, Reuters tallied around 37 reported criminal cases in the decade from 2001 to 2011, with most recent cases against doctors for over-prescribing painkillers and other controlled substances. U.S. Drug Enforcement Administration information suggests a similar trend. For 2003, the agency reported 15 physician arrests that resulted in convictions. By 2008, the most recent year with comprehensive data, the number had grown to 43. While the number of criminal malpractice cases is not large, the American Medical Association has cautioned that the trend has interfered with the practice of medicine. Civil prosecutions for monetary damages were sufficient to hold doctors accountable, the organization said. In 1995, the group adopted a resolution opposing the “attempted criminalization of health care decision-making especially as represented by the current trend toward the criminalization of malpractice.”   The trend is, in part, due to an expansion in white-collar criminal law and drug control laws to include unintentional violations by doctors, said Diane Hoffmann, a law professor at the University of Maryland School of Law. Many recent cases have been brought under the Controlled Substances Act, enacted in 1970, and similar state laws. To establish guilt under the act, the prosecution must prove the physician knowingly and intentionally prescribed the medication outside “the usual course of professional practice” or not for a “legitimate medical purpose.”   Prosecutors faced this question in the much-publicized case against Anna Nicole Smith’s physician, Sandeep Kapoor, on charges of violating the controlled substances law. The case hinged on whether Kapoor believed in good faith there was a medical purpose for providing the celebrity with an array of prescription drugs that led to her overdose and death in 2007, according to his lawyer Ellyn Garofalo. The jury acquitted Kapoor last year. In the Michael Jackson case, California prosecutors are not charging Murray with violating a controlled substances law. Propofol, the anesthetic Murray is accused of giving to Jackson, is not a controlled substance. The drug, administered intravenously, is used to induce anesthesia and has rarely been abused as a narcotic. Prosecutors instead allege Murray breached the standard of care when he administered the anesthetic to Jackson at home and that his gross negligence caused the singer’s death at age 50. Murray faces up to four years in prison if convicted. Murray also faces a wrongful death lawsuit filed by Jackson’s father. The legal standards in civil and criminal negligence cases are similar. Jackson’s family and prosecutors must prove Murray deviated from accepted medical practices, although the standard for a criminal conviction is “much greater” than for civil cases, said attorney Ed Chernoff, who represents Murray. Chernoff declined to discuss the Murray case specifically. Observers said one tactic he might take is to argue Jackson was addicted to sedatives and painkillers and could have given himself the fatal dose of propofol when Murray was out of the room. Prosecutors will have to prove Murray’s conduct actually caused Jackson’s death. Florida, which has a reputation as the “epicenter” of prescription drug abuse according to state Attorney General Pam Bondi, has indicted dozens of doctors and clinic operators for unnecessarily prescribing pills. The Drug Enforcement Administration says 28 of its 226 successful convictions of doctors — around 12 percent — were in Florida. Bondi and the state’s governor have launched a strike force to address the problem and, under a new law, Florida doctors generally can no longer dispense pills at clinics. “Our marching orders are that we will not turn down a pill case coming into this office,” said state prosecutor Nick Cox. It is more efficient to pursue the source of the pills — the prescribing doctors — than patients abusing the drugs, he said. Critics say the scorched earth assault glosses over tough questions doctors face, especially physicians who treat patients with chronic pain. Because pain is subjective, doctors must rely on the accounts of patients who are sometimes addicted and seeking drugs. “Doctors are not supposed to be law enforcement agents. They’re supposed to believe their patients,” said Hoffmann, the law professor. Murray’s lawyer Chernoff said it is a mistake to prosecute doctors who are not running pill mills but legitimately trying to help their patients. He blames the trend for having a “chilling effect” on the medical profession as doctors change treatment plans out of fear of facing time in prison.


Output: More U.S. doctors facing charges over drug abuse.