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.

[EX Q]: Clearly, the costs involved in cancer treatment already are high. By removing a layer of treatment from an estimated 40,000 patients, those costs would have to drop, but it is unclear from the story by how much. Also, it would have been worth mentioning whether this is likely to affect how insurance companies handle lymph node removals. The story did a good job providing some numbers on benefits, but we wish it had provided more and explained some things a bit more. It says, for example, “In 27 percent of the women who had additional nodes removed, those nodes were cancerous.” How many women had additional nodes removed and, of those, how many had cancerous nodes? A figure like 27% means 1 out of every 4 women had nodes that were, indeed, cancerous, which seems to conflict with other statements in the story about chemotherapy and radiation wiping out the cancer. The story discusses several harms from lymph node removal, and shows that the difference in survival for women who had nodes removed and those who did not was not significant. “Indeed, women in the study who had the nodes taken out were far more likely (70 percent versus 25 percent) to have complications like infections, abnormal sensations and fluid collecting in the armpit. They were also more likely to have lymphedema.” This is where the story really outperformed some of the competition covering the same news. It placed the study into the broader context of a movement in cancer care away from surgeries that don’t provide a clear benefit, and it also explained the study design and the limitations of the study in several ways. “The study, at 115 medical centers, included 891 patients. Their median age was in the mid-50s, and they were followed for a median of 6.3 years. … One potential weakness in the study is that there was not complete follow-up information on 166 women, about equal numbers from each group. The researchers said that did not affect the results. A statistician who was not part of the study said the missing information should have been discussed further, but probably did not have an important impact. It is not known whether the findings also apply to women who do not have radiation and chemotherapy, or to those who have only part of the breast irradiated. Nor is it known whether the findings could be applied to other types of cancer.” It was too bad that it did not mention limitations in terms of lack of enrollment. The targeted enrollment was 1900. There also was an imbalance in the randomization that should have been mentioned. The story is careful to explain to readers that the research findings only apply to a subset of women with breast cancer. “Now, researchers report that for women who meet certain criteria — about 20 percent of patients, or 40,000 women a year in the United States — taking out cancerous nodes has no advantage. It does not change the treatment plan, improve survival or make the cancer less likely to recur. And it can cause complications like infection and lymphedema, a chronic swelling in the arm that ranges from mild to disabling.” The Q&A that ran with the story provided more detail about the different types of cancers and cancer patients, noting, for example, “First of all, 20 percent (the estimate of the study’s lead author, Dr. Armando E. Giuliano) refers to 20 percent of all the newly diagnosed cases of invasive breast cancer each year. This does not include noninvasive breast cancer, or DCIS, ductal carcinoma in situ. The total is about 207,000, so 20 percent is roughly 40,000 women. That is about how many women would match those in the study, in terms of tumor status, affected lymph nodes and course of treatment.”  The story also says, “The results mean that women like those in the study will still have to have at least one lymph node removed, to look for cancer and decide whether they will need more treatment. But taking out just one or a few nodes should be enough.” Good quotes including from Dr. Monica Morrow, chief of the breast service at Sloan-Kettering and an author of the study, but also a few fromindependent experts toward the end. Dr. Grant W. Carlson, a professor of surgery at the Winship Cancer Institute at Emory University, and the author of an editorial accompanying the study, provides some soul-searching context by saying that, in taking out so many lymph nodes, “I have a feeling we’ve been doing a lot of harm.” Dr. Elisa R. Port, the chief of breast surgery at Mount Sinai Medical Center in Manhattan, said, “It’s definitely practice-changing.” And Dr. Alison Estabrook, the chief of the comprehensive breast center at St. Luke’s-Roosevelt hospital in New York said, “In the past, surgeons thought our role was to get out all the cancer. … Now he’s saying we don’t really have to do that.” The story does a great job explaining the history of this form of treatment and how it has evolved over time. “But doctors have continued to think that even microscopic disease in the lymph nodes should be cut out to improve the odds of survival. And until recently, they counted cancerous lymph nodes to gauge the severity of the disease and choose chemotherapy. But now the number is not so often used to determine drug treatment, doctors say. What matters more is whether the disease has reached any nodes at all. If any are positive, the disease could become deadly. Chemotherapy is recommended, and the drugs are the same, no matter how many nodes are involved.” The story goes on to do something that stories like this rarely do, it compares compares the harms from different forms of treatment, saying “After armpit surgery, 20 percent to 30 percent of women develop lymphedema, Dr. Port said, and radiation may increase the rate to 40 percent to 50 percent. Physical therapy can help, but there is no cure.” The story makes it clear that removing all under-arm lymph nodes is the standard of care for women with breast cancer and that feelings about that standard are entrenched. The story establishes that a change in treatment protocol away from removing all the lymph nodes under the arms of women with breast cancer would be novel. There is some nuance, here, though that could be missed by a casual reader. Women who have one to two positive lymph nodes would avoid having additional lymph node surgery. The overall tone of the story may make it appear to some readers that women get to avoid lymph node surgery altogether, but they don’t. The story goes well beyond any news release.
[EX A]: Lymph Node Study Shakes Pillar of Breast Cancer Care

[EX Q]: The following item is a good example of the pitfalls of allowing pure skepticism to overwhelm ordinary evidence:  The stupidity of some people in this world never fails to amaze me. This attached picture is real — not doctored in any way — and was taken last week in Waldorf, MD by a Transportation Supervisor for a company that delivers building materials for 84 Lumber. When he saw it there in the parking lot of IHOP, he went and bought a camera to take pictures. The car is still running as can be witnessed by the exhaust. A woman is either asleep or otherwise out in the front seat passenger side. The guy driving it was over jogging up and down on Rt. 925 in the background. The witnesses said their physical state was OTHER than normal and the police just shook their heads in amazement. The driver finally came back after the police were there and was getting down at the back to cut the twine around the load. They told him to get back until it was taken off. The materials were loaded at Home Depot. The Home Depot store manager made the customer sign a waiver before loading. Both back tires are trashed. The back shocks were driven up through the floorboard. On the roof are many 2X4s, 4X4s and OSL sheets of lumber. The load isn’t all that meets the eye either. In the back seat were ten 80-pound bags of concrete! They estimated the load weight at 3000 lbs. The car is a VW Jetta with FL plates and the guy said he was headed for Annapolis! After we originally put this picture and story up with an “Undetermined” status back in December 2000, we received plenty of mail from self-proclaimed digital photo experts offering numerous reasons (both physical and digital) why the picture couldn’t possibly be real. Then we starting hearing from people who were in Waldorf, Maryland, the day the photograph was taken (including employees of the Home Depot store where the building materials were purchased and the IHoP restaurant seen in the background of the photo) and who saw the car in question, some of whom snapped their own pictures of it and sent them along to us, such as the following:
[EX A]: A photograph shows a small car loaded down with hundreds of pounds of lumber and other building supplies.

[EX Q]: Both groups in this study used smoking cessation products, and so it would have been helpful to know how much they cost, even if it was just a quick approximation or discussion of affordability. At the same time, these aren’t high-dollar items, so cost isn’t as important to discuss as say, when reporting findings about a new cancer drug or surgery. The story gives the absolute number of participants (697) who were enrolled in the trial and then reports the percentages of participants who stopped smoking. While it reported reduced cigarette consumption in relative numbers, it did specify that participants smoked at least 15 cigarettes a day, giving somewhat more meaning to these percentages (e.g. “decrease their smoking by an average of 29%”). It told us quit rates at four weeks and six months, too–so we get some sense of change over time on results. It also placed these results in the greater context of what we know about quit rates among smokers. When quitting, heavy smokers can experience withdrawal symptoms–such as depression, insomnia and decreased heart rate–even if they use nicotine replacement products. The article did refer to “withdrawal” and “urge intensities” and so we’ll considered that sufficient. However, the piece would have been stronger had it specifically discussed the withdrawal symptoms mentioned above. The story sufficiently discusses the quality of evidence here, including that participants were assigned to one of two treatment groups. We’re told how far out the the study lasted, too–an indirect measure of quality, since long-term success rates are important for addictive behaviors. We also liked this frank sentence: “The researchers acknowledge that this is hardly the last word on the best way to quit.” The story does not engage in disease mongering–a smoking habit is unhealthy and harmful, and efforts to improve quit rates are important to study. This story does not include any comments from independent sources–or even from one of the researchers themselves. It only refers to the original journal article. Why does this matter? It’s always a good idea to consult an outside source because it’s likely to yield insights and context that otherwise would be lacking. But overall, this is a case where the story is still fairly strong, regardless of the lack of sourcing or interviews. The study is comparing two alternatives when quitting smoking–either cold turkey or gradually. The story discusses these options, along with the use of nicotine replacement in both scenarios. That’s enough to qualify as Satisfactory. However, another alternative the author didn’t mention was medications that can help with cravings–such as bupropion. What does the research say (if anything) about how those medications might augment quitting? That’s important to discuss. The availability of cigarettes or smoking cessation products is not in question. Although the story uses the word “new” when it means “latest” in the lead paragraph, we feel it did a good enough job referring to other studies to merit a Satisfactory rating. Despite the lack of original comments, this LA Times article does not appear to be based on any news releases we found online.
[EX A]:
To quit smoking, it's best to go cold turkey, study finds