instruction:
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.
question:
Paragraph: George W. Bush stood with a bullhorn on a pile of rubble after the 9/11 attacks on lower Manhattan and promised that the people who were responsible “will hear all of us soon.” Barack Obama was in office for just a few months when the first reports came in about the H1N1 virus, which would eventually be declared a pandemic  like today’s new coronavirus. Most American presidents will confront a crisis — or crises — before they leave office, whether it is a natural disaster, war, economic downturn, public health threat or terrorism. What matters is how they respond, historians say. “The number one thing a president can do in a moment like this is try to calm the nation,” said Julian Zelizer, a presidential historian at Princeton University. It’s what Franklin D. Roosevelt did during an extraordinary 12 years in office, guiding the nation through a bleak period of Depression-era unemployment, a severe Midwest drought known as the Dust Bowl and battle against the Nazis and Japanese in World War II. During the influenza of Wilson’s time, which killed an estimated 50 million people worldwide, including about 675,000 in America, presidents were not involved in public health issues in the same way that President Donald Trump has become engrossed in the U.S. effort against the new coronavirus. Such issues were left for public health professionals at the state and local level. “Wilson never issued any public statement whatsoever,” said John M. Barry, author of “The Great Influenza,” a book about the 1918 flu. “He was entirely focused on the war. Period.” In fact, Wilson was so focused on the post-war peace talks he was participating in in Paris that he, too, ended up stricken with the flu. He recovered. Trump, on the other hand, seems intent on being the public face of the effort against what has become his most serious challenge in this reelection year. Trump, who has no scientific or medical training, now leads a daily White House briefing on coronavirus efforts by a task force he tapped the vice president to lead. Trump styles himself as a “wartime president” fighting an “invisible enemy” responsible for hundreds of deaths and thousands of infections in the U.S. - numbers that will continue to rise as the virus spreads — and a dramatic upheaval of everyday life. Millions of people have been ordered or urged to stay home for the foreseeable future, cut off from simple pleasures like going to restaurants, shopping malls or movies in a bid to slow the virus. But Trump’s crisis management has earned mixed reviews, with praise from many supporters and criticism from detractors, including mayors and governors who are desperate for Trump to more robustly use his authority to help them get much-needed protective gear and supplies for doctors and nurses. The president’s early attempts to minimize the severity of the situation, and to suggest that it was under control, have been panned, though he recently adopted a more urgent tone. But the damage has been done, said Steve Morrison, of the Center for Strategic and International Studies, citing lack of public trust due to Trump’s early handling of the situation. “Not having trust and confidence is a huge liability heading into something this catastrophic,” said Morrison, senior vice president and director of the Global Health Policy Center at CSIS. Obama was a few months into his first term in 2009 term when reports started coming in that April about the H1N1 flu. He addressed the situation that month, assembled a team and ultimately declared both a public health emergency and a national emergency to deal with the threat. “This is obviously a very serious situation, and every American should know that their entire government is taking the utmost precautions and preparations,” Obama said as he opened a White House news conference that month. He said public health officials had recommended that schools with confirmed cases consider temporarily closing, and that he had asked Congress for $1.5 billion in emergency funding to help monitor and track the virus, and to build a supply of antiviral drugs and other equipment. “Everyone should rest assured that this government is prepared to do whatever it takes to control the impact of this virus,” Obama said. Dr. Howard Markel, director of the University of Michigan’s Center for the History of Medicine, said Obama was “very hands on” during H1N1 — but not as visibly as Trump. Obama’s director of the Center for Disease Control and Prevention conducted daily briefings from Atlanta. “He took a step back because he allowed his experts to run the show,” Markel said of Obama. “He didn’t have to be in front of the podium, but you knew he was there.”  Nearly 12,500 deaths due to the H1N1 flu were reported in the U.S. between April 2009 and April 2010, when the World Health Organization declared an end to the pandemic. Obama spent nearly $1 billion and sent U.S. military personnel to West Africa to help with the response to an outbreak of Ebola  in 2014. Still feeling his way through his first year in office, Bush became a wartime president the instant hijackers recruited by the al-Qaida militant network flew commercial airliners with passengers into the World Trade Center, the Pentagon and a Pennsylvania field on Sept. 11, 2001. Days later, Bush stood atop the rubble and memorably spoke for the nation. “I can hear you!” Bush blared through the bullhorn as emergency responders cheered. “The rest of the world hears you! And the people – and the people who knocked these buildings down will hear all of us soon.”  Weeks after that appearance, Bush authorized military airstrikes against Taliban military installations and al-Qaida training camps in Afghanistan. U.S. military engagement in Afghanistan continues to this day. ___ This story has been corrected to reflect that Morrison’s first name is Steve, not Scott. ___ Bev Banks contributed to this report. Follow Darlene Superville on Twitter: https://www.twitter.com/dsupervilleap ___ The Associated Press receives support for health and science coverage from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content. Claim: Presidents in health crises: Trump more hands-on than many .
answer:
Woodrow Wilson was more focused on the end of World War I than a flu virus that was making its way around the globe, ultimately sickening hundreds of thousands of Americans, including the president himself.


question:
Paragraph: The release does not mention cost. The FDA evaluates drugs without consideration of cost, so it’s understandable that they wouldn’t comment on it — and that’s why we’re rating this Not Applicable. But let’s be real here: The value of a new drug is a function not just of how well it works, but its cost-effectiveness. So we look forward to the day when any news release about a new drug — even one from the FDA — will include some mention of cost in its message. This release gives the preliminary results from a single study of 310 patients. Because the drug is experimental, long-term results haven’t been studied. Of the 310 patients enrolled in the lone trial upon which the approval is based, 14.8 percent showed some shrinkage of tumors during the assessment period lasting from 2.1 to about 13.8 months. For a subset of patients who were classified as having a positive response to PD-L1 expression, the response was 26 percent. As noted above, tumor shrinkage doesn’t always lead to improvements in survival or quality of life. It is a surrogate endpoint — a substitute — for the main outcome which is survival. Although this drug looks promising, to be fully transparent about its benefits as currently known, the release should have explained this. As noted in the “Summary,” another larger study is underway to assess the drug’s impact on extending life and improving quality of life. The release includes a description of side effects of this treatment. The most common ones included fatigue, decreased appetite, nausea, urinary tract infection, fever (pyrexia) and constipation. The release also mentions that patients taking the drug have an increased risk of infection and serious side effects that are “immune-mediated.” We would have liked a bit more context on what this term means for patients. The release outlines that this is the very first clinical trial of this compound for safety and efficacy, and under which regulatory paths the drug was assessed, including “breakthrough therapy designation, priority review status and accelerated approval.” We’re giving this release the benefit of the doubt and rating it Satisfactory for its bare bones description of the trial (and since we already addressed the lack of long-term survival data in the “Benefits” section.) As it stands, the results from the small trial were preliminary and short-term and did not reflect long-term survival. We would have liked to see a reference or link to the completed trial where one could look at the results to assess independently or learn more about the outcomes. We think the release should have provided more data on the patient demographics, the treatment regimen (dosing amount and schedule) as well as the range in tumor reduction. There is no disease mongering. This release describes the approval of a new drug by a regulatory agency, but we’d still like to know who sponsored the study that’s the basis for the approval. It’s not enough to state who markets the drug. The release does not give us very much information about alternatives. These patients had already received other therapy and their cancer had recurred, so it is implied that they had no other alternatives. But this isn’t stated very clearly. We can assume (and it seems evident) that the platinum-based therapy that the patients didn’t respond to initially is the usual treatment. The FDA’s approval of a drug clears the way for the drug sponsor to scale up production and begin marketing and selling the product. (The FDA doesn’t state this explicitly but it can be inferred.) A NYT article said the drug would be available in about two months. The release clearly states this product is first of its kind for this type of cancer. We found no unjustifiable language. Claim: FDA approves new, targeted treatment for bladder cancer
answer:
The Food and Drug Administration approved a new immunotherapy drug that acts as a “checkpoint” inhibitor in patients whose bladder cancer (urothelial carcinoma) has not responded to other chemotherapy. The drug, atezolizumab (marketed as Tecentriq), showed effectiveness in about 14 percent of 310 patients in a very preliminary study. The release notes that the trial measured tumor shrinkage as the main outcome. It didn’t note, as a NYT article did, and important for this type of trial, that it is unknown whether the treatment makes a difference in survival. A larger study is being done to examine this. Whether it makes a difference in quality of life is also important and will presumably be examined in the larger trial. The National Cancer Institute (NCI) estimates 76,960 new cases of bladder cancer and 16,390 deaths from this disease in 2016. This approval of a new drug for treating bladder cancer is part of a wider area of research into immunotherapy, in which drugs target mechanisms of the human immune response. Patients with the PD-L1 protein highly expressed in their tumors appear to be responding best to the drug. This drug is an example of targeted chemotherapy which is becoming more important as treatments can be fine-tuned to the cancers of individual patients. In patients with intractable cancers, immunotherapy appears to offer some new hope while also bringing sobering questions about affordability and disparity of access by income. The drugs are typically very expensive — with some estimates putting the treatment cost for a single patient as high as $1 million. When the FDA gives a compound a “breakthrough” designation, some physicians and patients can misunderstand what that means. That’s a topic recently explored in this post.


question:
Paragraph: "The cost of the drugs was not mentioned. And the possible cost-effectiveness ramifications of the research were not mentioned. As is often the case with 70% of the stories we review, cost just doesn’t seem to matter. But we all know it does. The benefits are given only in relative, not absolute terms. See our primer on this topic. So when the story says ""24 percent lower incidence of dementia"" or ""The risk was 19 percent lower"" or ""The risk was nearly halved"" – readers need to know 24% of what? 19% of what? Half of what? One harm was mentioned – ""There are potential hazards, such as too-low blood pressure that can lead to damaging falls."" That’s an incomplete listing, but we’ll give the story the benefit of the doubt in at least nodding in the direction of potential harms. The story did state:  ""The new report describes an observational study, one that lacks the strict controls that are needed for convincing proof."" And it further quoted the lead researcher saying, ""Any study like this is hypothesis-generating. You only know for sure when you have done clinical prospective trials."" So we’ll give it a satisfactory grade. But we do with mixed feelings. That’s because we’re troubled when the story talks about ""a small but protective effect "" and uses active verbs to say the drugs ""may stave off dementia."" That is terribly misleading to the reader. ""Protective effect"" when you state in the story this is not convincing proof of cause and effect? Blogger Emlly DeVoto wrote about the problem with causal language used in a Guardian article on the same study. There is no overt disease-mongering of dementia in the story. The story did quote one independent expert who injected a cautionary note – in addition to the lead researcher. The story did note other observational studies that have ""implicated various molecules"" in dementia. We’ll again give the story the benefit of the doubt on this criterion. Although never explicity stated, the widespread availability of angiotensin inhibiting drugs can be inferred from the story. The story doesn’t frame the new study into the context of past research linking high blood pressure to dementia. There’s no evidence that the story relied on a news release." Claim: Some Blood Pressure Drugs May Stave Off Dementia
answer:

"Generally well done though the story may have been, we’re troubled when a story talks about ""a small but protective effect "" and uses active verbs to say the drugs ""may stave off dementia"" when it also states in the story this is not convincing proof of cause and effect. Then how can you have a protective effect? Association, maybe? Causation and protection, not yet. This is an important and intriguing area of research. But stories that make it sound as though cause-and-effect has been proven – when it hasn’t – don’t do a service to public understanding. See how  blogger Emlly DeVoto wrote about the same problem with causal language used in a Guardian article on the same study."