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: Moira O’Neill, director of the Office of the Child Advocate, said the center operated by Granite Pathways was unusual in that it was licensed by the Department of Health and Human Services but was not certified by the division that oversees child welfare. While that’s not a requirement because the Division for Children, Youth and Families didn’t directly place children at the facility, without that certification, it is unclear who had oversight over quality and safety, O’Neill said. “We have issues with the extent of oversight DCYF provides to certified agencies, but at a bare minimum, they know who’s there, they re-certify them every two years, they provide technical assistance. There’s some expectation that someone has an idea of what’s going on in the program,” she said in an interview. Republican Gov. Chris Sununu and the health department announced on Nov. 27 the state was canceling its contract with Granite Pathways, which had been operating the 36-bed facility in Manchester for just over a year. A summary report released by the department Monday said that in a span of less than two weeks, four of the 10 residents were taken to hospitals after taking drugs one of them smuggled in, a fifth took multiple doses of prescription medication in an apparent suicide attempt and a sixth drank a bottle of hand sanitizer. The remaining residents have since been transferred, and the contract officially ends Dec. 27. Some of the residents at the center were known to the child welfare agency, said O’Neill, who has been reviewing their records. “In our preliminary review, we found that there were children who were placed there who have really complicated needs, and we don’t know if that program had the capacity to serve those needs,” she said. O’Neill said she sent the Department of Health and Human Services a list of questions in late November about what the facility knew about the children, its capacity to meet their needs and how the program was supervised. As of Tuesday, she had not received answers. “If we are going to understand the circumstances that prompted seven ambulance transports, we must understand how those children came to be at the facility and what transpired in assessing and treating them,” she said. Jake Leon, spokesman for the Department of Health and Human Services, said the department agrees with O’Neill that it is important to ensure that children get the services they need. He said the department has addressed and continues to address similar questions, but responses must remain confidential to protect clients’ privacy. “DHHS monitored Granite Pathways’ compliance with its contractual obligations and is still compiling information regarding the organization’s noncompliance. There is also an ongoing investigation by DCYF that must be kept confidential,” he said in an email. Patrica Reed, state director at Granite Pathways, said the nonprofit’s leaders and board of directors were still reviewing the health department’s report. “The end of this contract does not end Granite Pathways’ commitment to its mission of supporting individuals with substance use disorders and mental illness in achieving their life goals as valued members of their communities,” she said in a statement. But the trouble at the youth treatment center has raised questions about the state’s approach to funding substance abuse treatment in general and Granite Pathways in particular. Since 2016, it has been a subsidiary of The Fedcap Group, a New York-based nonprofit that focuses on helping people overcome barriers to economic well-being through workforce development, education, occupational health and economic development. With close to $300 million in annual revenue, the parent organization has government contracts in 22 states, and its acquisitions include Easterseals programs New York, Rhode Island and parts of Texas. In New Hampshire, Granite Pathways was a year into a four-year, $15.6 million contract for the youth treatment center. According to the state expenditure register, the organization has been paid $4.1 million since 2012, including just under $900,000 in the current fiscal year. Under the hub-and-spoke system the state launched this year to connect people to opioid addiction resources, Granite Pathways was awarded $5 million in federal funding over multiple years to run the two largest hubs, in Manchester and Nashua. Contracts are approved by the five-member Executive Council, and at least one member has expressed concern about Granite Pathways in the past. In June, when the council approved a $345,000 contract related to treatment for adolescents, Councilor Andru Volinsky noted that the organization already was running the opioid response hubs and called for “continued vigilance” to ensure it could keep up with all its responsibilities. “We’ve had, in particular when trying to quickly build out our substance abuse response, a number of instances where the financial management of private nonprofits was not strong. We haven’t really had strong capacity to oversee that at DHHS,” he said in a recent interview. “My concern at the time of this Granite Pathways contract was that we were again placing what I think are state responsibilities onto a private contractor, and we still haven’t built an infrastructure to oversee those private contractors.” Volinsky, a Democrat, said he doesn’t know whether the state should build out its own capacity to respond to the substance abuse crisis, or whether it’s enough to rely on outside groups and closely monitor them. “I could legitimately understand the arguments either way,” he said. “But to almost blithely continue to invest in outside agencies without oversight doesn’t make sense.” In announcing the closing of the youth treatment center, officials said the state is taking 30 days to review all of its contracts with Granite Pathways and may take further action. The health department also has increased its oversight of substance use disorder treatment centers in the last year after one of the largest facilities closed. Those efforts have included financial audits and the appointment of a new director at the Office of Program Integrity. Claim: Child advocate sees lack of oversight at youth treatment hub.
[A]: New Hampshire’s only residential treatment center for teens struggling with addiction operated with an apparent lack of oversight before it was shutdown earlier this month, the director of a state watchdog office said Tuesday.


[Q]: Paragraph: Use of such pills, which include Sanofi SA’s Ambien and other similar drugs, was significantly higher for those in their 50s as well as age 80 and older, according to the findings from the Centers for Disease Control and Prevention. Overall about 8.6 million people, or 4 percent of U.S. adults reported recently using sleep medication, CDC’s National Center for Health Statistics said in a report. But data showed higher use among middle-aged adults ages 50 to 59 and the elderly. Six percent of those ages 50 to 59 said they had taken a prescription sleep pill in the last 30 days, and 7 percent of those age 80 and older reported such use. In between, the numbers dip slightly below 6 percent for those in their 60s and 70s. In comparison, just 2 percent of those aged 20-39 said they had recently taken a sleep aid. CDC researcher Yinong Chong said people in their 50s could have trouble sleeping because of work and family stress. “It gives the picture of a sandwiched group who has family, not only children but also probably elderly parents but still you’re likely to be in the workforce, so you get squeezed at both ends in terms of family responsibility and job responsibility,” she said. Sleep may improve when people retire before potential chronic health problems kick in and begin interfering with sleep, Chong said, adding more study is needed. The data also showed that 5 percent of women surveyed said they had recently taken a sleep aid compared to about 3 percent of male respondents, according to CDC’s report. Chong said it was not clear why women were more likely to use the drugs. While previous data have tracked prescriptions dispensed for sleep aids, the CDC said its study is the first based on a survey of actual use of such drugs. Researchers for the Atlanta-based health agency’s National Center for Health Statistics questioned a sampling of adults age 20 and older about whether they had used prescription sleep aids within the last 30 days and asked participants to show interviewers the prescription medication. “You get how many people are actually using them,” Chong said in an interview, noting that prescription data could include multiple prescriptions for one patient or prescriptions that are never filled or even used. “This is actual use.”  Prescription sleep aids have become somewhat controversial because their effect can linger even after some patients wake up. The U.S. Food and Drug Administration has begun taking a closer look at sleep drugs, ordering lower-doses for Ambien and similar pills amid concerns that their active ingredient remained in patients’ blood the following morning at levels high enough to make driving and other activities dangerous. And just last month, the FDA rejected an experimental sleep drug from Merck & Co Inc, saying the proposed doses were not safe but that a lower-dose version might be acceptable. Not surprisingly, respondents to CDC’s study who said they slept five hours or less each night or those diagnosed with a sleep disorder were more likely to report using prescription aids. Additionally, more whites and people with higher levels of education also reported greater use, the agency said. Socioeconomic factors are likely behind those numbers, Chong said, since patients must be able to afford a doctor’s care and the medication. According to prescription data from IMS Health, Ambien and other versions of the drug zolpidem was ranked 15th among the most dispensed medications in the United States. Claim: Use of sleeping pills highest among older Americans: CDC.
[A]: Older U.S. adults, particularly women, are more likely to use prescription sleep medications to try to get the minimum seven hours of sleep experts generally recommend, U.S. data released on Thursday showed.


[Q]: Paragraph: The story makes clear that the test is expensive and that Medicare and some other insurance plans cover it. Although the article provides data about the total number of people randomized to the two arms of the study, it does not go beyond what the news release offers about the percentage/relative increases in remission of symptoms and response to drugs. No absolute numbers are given, so it’s impossible to know how many of the patients in each arm actually benefited and to what extent. All it provides is the relative improvement in “response” to medication: “researchers found a 30% greater response to the medicine when the test was applied.” No data is provided for remission. But when you look at the raw numbers regarding remission rates, and compare the results of both groups, they don’t look as impressive: Of those who didn’t receive genetic testing, 10% reached remission. With the tests, it was 15%. This gives the reader perspective that the absolute difference was 5%. Also, the news release hints that at least some of the results might not have been statistically significant, and we’re curious about that and think it should have been explained in the story: “The GeneSight-treated cohort also demonstrated higher symptom improvement which approached statistical significance (Chart 1).” The test itself — using DNA taken from a cheek swab — carries no physical risks. But the story needed more detail about the potential downsides. As noted in more detail in the TIME coverage of the story, the various “scales” that are used to assess drugs aren’t organized by how effective the drugs might be based on genetics, but instead how many adverse events they might cause. So, a person is told to take certain drugs not because they’ll be more effective than other drugs, they’re just less likely to cause problems. Could selecting drugs based on how many problems they cause lead some people to choose drugs that aren’t as effective for treating depression? That would seem to be biggest issue in terms of harms — that the test would simply be wrong for some people. Also, the test appears to show results for drugs beyond antidepressants — including some drugs that are known to cause dependency or can be deadly when taken alone, mixed together or with other drugs, such as hypnotics and benzodiazepines (Ambien and Xanax, for example). This is important to consider in a group of people already at higher risk for suicide. All of this means adverse event data is vital — was it indeed lower in the gene-tested group? If adverse event data were not available from the company or the investigators at the University of Michigan who led the study, the article could have noted the fact. The story did not do enough to establish that this research is still preliminary — it has not been published nor peer-reviewed, and everyone is relying on just a little bit of data released by the company. We should all be skeptical at this point. No disease mongering here; moderate to severe depression is a real and prevalent disorder and danger. We also thought it was wise how the story included a patient narrative with unclear results–she’s feeling better, but not 100%. That is a very powerful way to explain that this new tool isn’t a silver bullet. The story quotes outside experts and notes that the principal investigator is an unpaid consultant to the company that makes the test. We’re also told that the study was funded by the maker of the genetic test. Although quantification is mostly missing, the article properly points out that clinical judgment-based treatment alone misses the mark a lot of the time, and is essentially educated guesswork. The article might have been strengthened even more had it given information about alternatives or adjuncts to drugs, such as behavioral therapy and electroshock therapy. It’s clear from the story that the test, marketed as GeneSight, is available. The story is pretty careful to put the findings of the study — presented at a conference in New York — in the context of overall advances in the use of pharmacogenetics and precision medicine, treatments increasingly tailored to an individual’s genetic makeup. And it notes that the Myriad Genetics test is not the only player in the gene-based medicine field. The story also includes the information that the study was “blinded” and randomized, but (happily) avoids the hyperbole of the news release which calls it a “landmark” study and the largest ever of its kind. As noted above, the article quotes outside sources. Claim: Which Anti-Depressant is Right for You? Your DNA Can Shed Some Light
[A]:
This Wall Street Journal article describes results of an unpublished, non-peer-reviewed study of a gene-based test designed to help physicians prescribe antidepressants in people with moderate-to-severe depression who have failed on at least one of the drugs. The story, both in the narrative and in some quotes, adds some moderating context and healthy skepticism to the enthusiastic “landmark” claims from a company release. It also is clear about the cost ($1,500) of the test offered by Myriad Genetics. But it needed to examine more closely the fact that the test can’t really tell a psychiatrist or other physician which of the dozens of antidepressants may work best–only which are most likely to cause problems and should be avoided. If this is the case, what’s driving the (small) benefit? Is it because people whose treatment was guided by genetic testing experienced fewer side effects and therefore were more likely to adhere to treatment? We’re not told. Federally-funded surveys of mental health in the U.S. consistently estimate that around 15 to 20 million adult Americans have moderate-to-severe depression that warrants treatment. The good news is that there are dozens of antidepressant drugs approved by the FDA for use alone or with other, non-drug therapies. The bad news is that, as the WSJ article underscores, finding the right medicine for any given patient is largely a matter of highly subjective clinical judgment and trial and error, sometimes for years. Moreover, the drugs are often not cheap and may cause side effects. Thus, the application of gene-based “precision medicine” testing — in this case to test for a dozen or so genes that may help predict how classes of drugs are metabolized and used by the body and brain — is potentially big news.