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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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Paragraph: The story says the procedure to insert stents costs from $11,000 to $41,000 in the U.S. The story makes clear there was no significant difference between a sham procedure or stent insertion, but it only describes the benefit as “less pain.” We would like to see how the pain was measured, some numbers on how much pain was reduced, and how many patients benefitted in each group. The story briefly mentions there are potential harms, including death. The story describes the study’s methods in some detail — the sham surgery of the control group, for instance — and mentions the size of the study and the characteristics of the subjects. It adds heft to the sense that this was a very good study with multiple reactions from expert sources — “humbling,” “unbelievable,” “impressive” and “very well conducted.” Importantly, it quotes one source describing a few desired measures that the study didn’t address, such as whether stents would be more effective in patients with more severe disease or who were studied for a longer period of time. The story could have done a better job of explicitly calling attention to the relatively small number of participants and the need for confirmatory follow-up studies. Heart disease is very common in our society and opening up blocked arteries is a common almost routine procedure. No disease mongering occurred in the article. We were pleased to see discussion from many experts, however, the story left out two important potential conflicts of interest. The story states that: Dr. William E. Boden, a cardiologist and professor of medicine at Boston University School of Medicine, called the results “unbelievable.” Readers should have been informed that Boden has received fees from Abbott, a major stent device maker. Also, the story states that: Dr. David Maron, a cardiologist at Stanford University, praised the new study as “very well conducted” but said that it left some questions unanswered. The participants had a profound blockage but only in one artery, he noted, and they were assessed after just six weeks. The story didn’t disclose that Dr. Maron is an “employee of and stockholder in Cardiovascular Services of America, which provides outpatient cardiac catheterization and computed tomography angiography services,” which was disclosed here. The story (and the study) suggest that medication can manage pain from blocked arteries. Stenting procedures are clearly widely available in the U.S. and across the world. What’s less clear, the story says, is whether guidelines or practice for stenting will change in the U.S.: “The idea that stenting relieves chest pain is so ingrained that some experts said they expect most doctors will continue with stenting, reasoning that the new research is just one study.” We thought this was an interesting point and are glad it was included. The many expressions of surprise by practicing cardiologists makes clear that the study offers a novel finding. The story did not rely on the news release. Claim: ‘Unbelievable’: Heart Stents Fail to Ease Chest Pain
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This New York Times story describes startling news that a very common procedure–inserting a stent to open a blocked blood vessel–does not add benefit over medication in patients with angina. Angina is chest pain due to blocked heart arteries, and is common among people with heart disease. Sourcing is a strong point for this story: It features perspective from many American cardiologists who were shocked to learn of the negative results from this study. However, two important potential conflicts of interest among the sources were not disclosed. In addition, the story contains lots of helpful detail on the limitations of the study, the possibility that placebo effects are at play, and how medical practice may or may not change as a result. It also discussed the costs and potential harms of stenting procedures. That said, the story could have provided more information on what the study itself measured–and what, precisely, the results were. The Wall Street Journal story, which we also reviewed, was stronger on this point. Heart disease is still the leading killer of Americans so any news about treating aspects of heart disease, such as blocked arteries, is newsworthy. In addition, this story suggests that stenting — common, but expensive — is a prime example of over-treatment. Also the procedure carries some risk and may be causing complications if overused.


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Paragraph: The 2017 case is the first case of pediatric tetanus in Oregon in more than 30 years and alarmed infectious disease experts who said tetanus is almost unheard of in the U.S. since widespread immunization began in the 1940s. The child received an emergency dose of the tetanus vaccine in the hospital, but his parents declined to give him a second dose — or any other childhood shots — after he recovered, the paper said. “When I read that, my jaw dropped. I could not believe it. That’s a tragedy and a misunderstanding, and I’m just flabbergasted,” said Dr. William Schaffner, an expert in infectious diseases and chair at the Department of Preventive Medicine at the Vanderbilt University School of Medicine in Nashville, Tennessee. “This is an awful disease, but ... we have had a mechanism to completely prevent it, and the reason that we have virtually no cases anymore in the United States is because we vaccinate, literally, everyone.” Doctors in Portland, Oregon, who treated the child declined to provide any further information about the family at a news conference Friday, citing medical privacy laws. It was the first time that Dr. Judith Guzman-Cottrill, the pediatric infectious disease expert who treated the child, had ever seen tetanus because of widespread vaccination against it in the U.S. When the boy arrived at the emergency department, his muscle spasms were so severe he could not talk, could not open his mouth and was struggling to breathe, she said. “We had a hard time taking care of this child — watching him suffer — and it is a preventable disease,” Guzman-Cottrill said. News about the tetanus case comes as lawmakers in Oregon and Washington are considering bills that would end non-medical exemptions for routine childhood vaccines as the Pacific Northwest weathers its third month of a measles outbreak. Seventy people in southwest Washington, most of them unvaccinated children, have been diagnosed with the highly contagious viral illness since Jan. 1, as well as a handful of people in Portland, Oregon. Unlike measles, which is a virus, someone who has survived a case of tetanus is not immune and can get the illness again if they remain unvaccinated. Tetanus also isn’t transmitted person-to-person by sneezing or coughing like the measles, but instead comes from bacterial spores that are found in the environment. Tetanus spores exist everywhere in the soil. When an unvaccinated person gets a deep, penetrating wound, those spores can invade the cut and begin producing the bacteria that causes the illness. The tetanus bacterium secretes a toxin that gets into the bloodstream and latches onto the nervous system. Anywhere from three to 21 days after infection, symptoms appear: muscle spasms, lockjaw, difficulty swallowing and breathing and seizures. The disease can cause death or severe disability in those who survive, Schaffner said. About 30 people contract tetanus each year nationwide, according to the CDC, and 16 people died of it between 2009 and 2015. It’s rare among children; those over 65 are the most vulnerable. In the case in Oregon, the boy cut himself on the forehead while playing, and his family stitched up the wound themselves. Six days later, he began clenching his jaw, arching his neck and back and had uncontrollable muscle spasms. When he began to have trouble breathing, his parents called paramedics and he was transported by air to Oregon Health & Science University’s Doernbecher Children’s Hospital in Portland. When he arrived, he asked for water but could not open his mouth. The child was sedated, put on a ventilator and cared for in a darkened room while wearing ear plugs because any stimulation made his pain and muscle spasms worse. His fever spiked to almost 105 degrees (40.5 Celsius), and he developed high blood pressure and a racing heartbeat. Forty-four days after he was hospitalized, the boy was able to sip clear liquids. Six days later, he was able to walk a short distance with help. After another three weeks of inpatient rehabilitation and a month at home, he could ride a bike and run — a remarkable recovery, experts said. The child’s care — not including the air ambulance and inpatient rehabilitation — cost nearly $1 million, about 72 times the mean for a pediatric hospitalization in the U.S., the paper noted. “The way to treat tetanus is you have to outlast it. You have to support the patient because this poison links on chemically and then it has to be slowly metabolized,” Schaffner said. Cases of tetanus have dropped by 95 percent in the U.S. since widespread childhood vaccination and adult booster shots became routine nearly 80 years ago; deaths have dropped 99 percent. The CDC recommends a five-dose series of tetanus shots for children between the ages of 2 months and 6 years and a booster shot every 10 years for adults. ____ Follow Gillian Flaccus on Twitter at http://www.twitter.com/gflaccus Claim: CDC: Unvaccinated Oregon boy almost dies of tetanus.
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An unvaccinated 6-year-old Oregon boy was hospitalized for two months for tetanus and almost died of the bacterial illness after getting a deep cut while playing on a farm, according to a case study published Friday by the U.S. Centers for Disease Control and Prevention.


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Paragraph: In the first study of its kind to look at the effects of childhood bullying beyond early adulthood, the researchers said its impact is “persistent and pervasive”, with people who were bullied when young more likely to have poorer physical and psychological health and poorer cognitive functioning at age 50. “The effects of bullying are still visible nearly four decades later ... with health, social and economic consequences lasting well into adulthood,” said Ryu Takizawa, who led the study at the Institute of Psychiatry at King’s College London. The findings, published in the American Journal of Psychiatry on Friday, come from the British National Child Development Study which includes data on all children born in England, Scotland and Wales during one week in 1958. It included 7,771 children whose parents gave information on their child’s exposure to bullying when they were aged 7 and 11. The children were then followed up until they reached 50. Bullying is characterized by repeated hurtful actions by children of a similar age, where the victim finds it difficult to defend themselves. More than a quarter of children in the study - 28 percent - had been bullied occasionally, and 15 percent were bullied frequently - rates that the researchers said were similar to the situation in Britain today. The study, which adjusted for other factors such as childhood IQ, emotional and behavioral problems and low parental involvement, found people who were frequently bullied in childhood were at an increased risk of mental disorders such as depression, anxiety and experiencing suicidal thoughts. Victims of bullying were also more likely to have lower educational levels, less likely to be in a relationship and more likely to report lower quality of life. Men who had been bullied were also more likely to be unemployed and earn less. Louise Arseneault, also from the Institute of Psychiatry at King’s and who also worked on the study, said its findings showed how important it is “to move away from any perception that bullying is just an inevitable part of growing-up.”  “Teachers, parents and policy-makers should be aware that what happens in the school playground can have long-term repercussions,” she said. Claim: Forty years on, bullying takes its toll on health and wealth.
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The negative social, physical and mental health effects of childhood bullying are still evident nearly 40 years later, according to research by British psychiatrists.