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.

Input: Consider Input: Paragraph: Mentions cost for one year of Herceptin as $40,000-$50,000. Mentions quantitative benefit of 9 weeks of Herceptin vs. no Herceptin with certain chemotherapy. Also, while no women in the Herceptin group had cardiac failure at 3 years, the follow-up period may not be long-enough to determine the effects of chemotherapy and Herceptin on the heart. Mentions potential harms of Herceptin on the heart, especially when given after certain chemotherapy. The story does not mention that there were side effects with certain chemotherapy drugs and doses needed to be decreased during the course of the trial. One aspect of this trial focused on randomization of women with Her2/neu overexpression to 9 weeks of Herceptin or no Herceptin immediately following breast cancer surgery. The drug was given in conjunction with certain types of chemotherapy, but before radiation and chemotherapy regimens known to damage the heart. The journalist states the Herceptin was given “prior to chemotherapy”, which is not completely accurate. There is an adequate mention of the study design and discussion of disease-free survival at 3 years follow-up. Good job putting the results into context of other trials, and into context of how this may or may not change providers’ practice. The story could have better stated the limitations of analysis for such a small subgroup – 116 in each arm. Appropriately discusses the percentage of women who are eligible for Herceptin due to overexpression of HER2/neu. The story would have been helped by some context for the risk these women face. As Herceptin is used earlier and earlier these women have less to gain because they have less risk to begin with. Relative risk reductions may be very high but the absolute is not as big. Sources in addition to study authors are cited. No mention that this trial was funded in part by pharmaceutical companies. Some study investigators also receive research funding drug companies. Other doctors cited express caution about the early results of Herceptin studies, so there is some balance to the piece. The women in this trial had undergone breast cancer surgery and those with ER+ tumors were taking Tamoxifen. This is not explicitly mentioned, only that treatment took place following surgery. Still OK. Herceptin is only FDA approved to treat advanced breast cancer, but is used in clinical trials in early-stage breast cancer. This is not mentioned in the story. Novel use of Herceptin for short-term treatment prior to anthracycline chemotherapy. No evidence that this story relies on a press release. Claim: Short stint of Herceptin holds promise for breast cancer

Output: This story discusses the results of a recent study involving women with high-risk early breast cancer (node positive or >2cm, age younger than 66 – there were 25 year olds on the trial). One aspect of this trial focused on the short-term use of Herceptin with chemotherapy. Women with overexpression of the HER2/neu gene, as measured by the CISH immunohistochemistry, were randomly assigned 9 weeks of Herceptin or no Herceptin immediately following breast cancer surgery and in conjunction with certain types of chemotherapy. This regimen of treatment differed from other trials in which Herceptin was given for 12 months following chemotherapy. In this study, the drug was given in conjunction with certain types of chemotherapy, but before radiation and chemotherapy regimens known to damage the heart. The journalist states the Herceptin was given “prior to chemotherapy,” which is not completely accurate. Herceptin is only FDA approved to treat advanced breast cancer, but it is used in clinical trials in early-stage breast cancer. However, this is not mentioned in the story. There is adequate discussion of the study design and reporting of disease-free survival at 3 years follow-up. There was little discussion in the piece of the side effects of chemotherapy as reported in the trial, but the addition of Herceptin was the main focus of the story. While the journalist provides quantitative benefit of 9 weeks of Herceptin vs. no Herceptin, and notes no cardiac failure in the Herceptin group, the follow-up period of 3 years may not be long-enough to determine the effects of chemotherapy and Herceptin on the heart. Overall, the journalist did a good job describing the randomization, as well as putting the results into context of other trials, and into context of how this may or may not change providers’ practice. The story could have better stated the limitations of analysis for such a small subgroup (116 in each arm). The small sample randomized to Herceptin certainly warrants more study, and although the relative benefits were large, these women still had fairly good recurrence free survival — 80% w/o and 90% with — so although it looks like that will translate to overall survival. The question for women with overexpression of the HER/neu gene is: How much do you want to do to avoid recurrence? Sources in addition to the study investigators are cited, which provides some balance to the piece, however, there is no mention that the trial was funded in part by pharmaceutical companies. Some study investigators also receive research funding from drug companies.


Input: Consider Input: Paragraph: The state Department of Environmental Conservation says an investigation determined the geese died of the fungal disease Aspergillosis, caused by eating moldy grain or bread. Three dozen Canada geese were found dead in a pond at the Malone Recreation Park in Franklin County near the Canadian border. State wildlife staff in Albany tested the dead birds. The state agency is asking the public not to feed waterfowl to help prevent the fungal disease or cause poor nutrition, delayed migration and other problems. Officials are also asking farmers to dispose of moldy grain and silage by burying it rather than spreading it over fields. Claim: Moldy bread or grain blamed for Canada geese deaths.

Output: Moldy bread or grain has been blamed for the death of dozens of Canada geese in an upstate New York park.


Input: Consider Input: Paragraph: The United States and neighbors in Latin America have suspended flights, banned public gatherings and closed schools. In Mexico City, however, tens of thousands of music fans rocked out to Guns and Roses at a festival at the weekend. President Andres Manuel Lopez Obrador also went on tour, hugging surging crowds of supporters and kissing babies. The gamble is straightforward: Mexico’s economy was stagnating even before the COVID-19 outbreak shuttered factories worldwide and the government has said it wants to limit economic damage by not over-reacting. Some Mexican scientists, receiving news of Europe’s growing lockdown, South Korea’s widespread testing and global travel bans, are increasingly worried that Mexico’s softly-softly approach could lead to a bigger epidemic down the road. “I am worried that we end up in a situation like Italy, where measures weren’t taken on time, and the number of cases started to get away from them,” said Rosa Maria del Angel, who heads the Department of Infectomics and Molecular Pathogenesis at Mexico’s National Polytechnic Institute. In 2009, a new strain of swine flu that emerged in Mexico raised fears of a global pandemic. Authorities acted swiftly, shutting down public life in the densely populated capital, Mexico City, and swathes of the country. The silent streets foreshadowed scenes today in towns under lockdown from China to Europe and the United States. The disease was quickly contained and normal life resumed within weeks, but by some estimates the response shaved a percentage point from that year’s economic activity. The economy, already reeling from the global financial crisis, ended 2009 contracted by more than 5%. The lesson is not lost on the officials running Mexico’s response in 2020, many of whom were also involved in fighting the influenza epidemic. Mexico’s economy last year suffered its first recession since 2009. “The economic loss was directly related, in the most past, to the disruption of tourism, trade and services,” said Deputy Health Minister Hugo Lopez-Gatell, who was a senior official in the epidemiology department during the flu crisis. That is “why it is so important, with very careful precision, not to take pre-emptive actions that do not correspond to the magnitude of the risk,” Lopez-Gatell, who is now the public face of the government’s response, told reporters last week. The finance minister and other senior officials have voiced the same sentiment, while Lopez Obrador has said he will continue public activities until Lopez-Gatell tells him to stop. This week, the government announced initial measures, including more testing. It recommends school closures from next Monday and canceling cultural events with more than 5,000 people. While nations from Canada to Peru have suspended flights or limited free movement, Mexico has yet to propose any restrictions on travel around or in and out of the country. Tourism accounts for about one-sixth of Mexico’s roughly $1.3 trillion economy. Lopez-Gatell said on Tuesday countries around the world were repeating Mexico’s mistake in 2009, making decisions based on anxiety and social pressure rather than science. The lesson from the flu epidemic is that acting too soon is counterproductive, he said. “Acting responsibly, we can’t and should not take measures that exhaust our society. Let’s not use up all the interventions too soon. Let’s keep our calm.” Claim: Mexico, former swine flu hub, tests nerves with coronavirus strategy.


Output: Mexican officials are dragging their feet on border closures and coronavirus containment measures, in what critics call a high risk strategy driven by bad memories of a shutdown a decade ago that deepened the country’s recession during the swine flu epidemic.