Given a paragraph and a claim, classify it this way: If the claim contradicts the evidence present in the paragraph, classify the claim as '0'. If the claim has multiple supporting *AND* contradicting evidences, classify the claim as '1'. If the claim has supporting evidence and the paragraph is in overall favor of the claim, then classify the claim as '2'.

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Paragraph: The story does not say how much this new procedure costs or compare it with existing treatments for patients who don’t respond to medication. Deep brain stimulation, the current treatment standard, can run anywhere from $30,000 to $70,000, according to various online cost estimates. There also may be additional costs incurred by those patients who have adverse effects. The story is long on description but short on numbers. Saying the treatment “has had an immense impact on patients’ lives,” the story devotes quite a bit of print along with video footage to show rapid functional and quality-of-life improvements experienced by patients, focusing on one women who said her tremor “has almost disappeared” since she had the procedure in June. Video showing this patient before and after treatment–including her attempts to write her name, trace a spiral and pour water from one cup to another–do a great job of conveying the improvements. This is terrific news for this woman, but we’re not told how representative her experience is of overall outcomes. Is she a best-case scenario? Middle of the road? There are also inspiring quotes from a researcher, including a description of the “remarkable moment” patients experience when they realized the tremor has subsided. “They can write their names again, they can feed themselves, they are not embarrassed about being in public. So it really is extraordinarily helpful for people,” he says. In terms of study data, the story says researchers “found that the severity of essential tremor reduced significantly” in patients who underwent the treatment as well as reported improvements in quality of life. But there are no figures. In fact, according to the study, patients experienced a 47 percent improvement in tremor scores, dropping from 18.1 points on a 32-point scale at baseline to 9.6 points three months after the procedure. That data should have been included. Also, the story should have spelled out that 56 patients received the treatment, versus 20 who experienced a fake procedure. Also worth pointing out: We don’t know the meaning or clinical significance of a reduction of this magnitude in the total score. The story addresses adverse effects, and that’s sufficient for a Satisfactory rating. We do wish the story had quantified the harms that were measured in the study. The fourth paragraph says the procedure “brings lasting side effects in some patients” and later the story quotes a physician who is not involved in the research as saying, “It’s a pretty high incidence of side effects.” But nowhere do exact numbers appear. Rather than citing data from the study, the story quotes the physician as saying that “over a third of patients actually experienced either gait disturbance or paresthesia,” or numbness. This information isn’t very useful because the story does not explain when these rates were measured. According to the study, three months after the procedure 36% of patients had gait disturbance and 38% had numbness. After 12 months, the numbers dropped, to 9 percent and 14 percent respectively. Also worth mentioning is that one patient was reported to have permanent diminished sensation of the dominant thumb and index figure, which was categorized as a serious adverse event. That did not appear in the story. The story clearly spells out that there isn’t data on the long-term efficacy of this procedure, and that more study is needed, so we’ll give this a barely passing Satisfactory. Several important study limitations were not included in the story, such as the fact that the treatment did not provide significant improvement for some types of tremors, and the treatment is not appropriate for people who are unwilling or unable to undergo an MRI. We’re also not told that the sham group was only followed for 3 months, while the experimental group was followed for a year. This is not usually recommended in clinical trials and both groups should be followed for the same length of time. The story cites a figure from the International Essential Tremor Foundation, an advocacy group, that an estimated 10 million people in the United States suffer from the condition. However, a 2014 analysis of existing research put the number of cases at around 7 million as of 2012, or about 2.2% of the U.S. population. While this may not qualify as disease mongering, the story could have pointed out that the exact number of cases isn’t clear. Also, the story should have noted that not all people with essential tremor have symptoms severe enough to require treatment. The story only fulfills part of our criteria. It does use one independent source, a physician who was not involved in the study. It also accurately reports the trial’s funding sources: InSightec, which developed the device; along with Focused Ultrasound Foundation, which is funded by device makers and philanthropic organizations; and the Binational Industrial Research and Development Foundation, an Israel-U.S. government partnership that receives corporate support. However, the story falls short because it does not report the fact that nine of the study authors reported conflicts of interest, with most receiving financial compensation of some sort from device makers in the field. Lead researcher G. Rees Cosgrove, M.D. who is quoted in the story, reported receiving consulting fees from InSightec. The story states, “Doctors usually treat essential tremor with medication, but the drugs don’t work well for all patients.” That’s true, and so we’ll give this a Satisfactory rating for at least mentioning alternatives. But it should be noted that other procedural treatment options were not compared or even mentioned in the story and received only a brief mention in one of the videos. The current standard for tremor patients who don’t respond to medication is deep-brain stimulation, in which a probe connected to a pacemaker is implanted in the thalamus to suppress the tremors. Gamma Knife thalamotomy, which delivers precise doses of radiation to the thalamus, is also considered to be a safe and effective therapy for patients who don’t respond to medication. Also, some patients have mild symptoms that can be treated with relaxation techniques and the avoidance of triggers such as caffeine. The story states that the device was approved by the FDA in July. The story could have done readers a service by giving a sense of how many medical centers around the country are geared up to perform the procedure, or will be soon. This is indeed a new treatment option for essential tremor, though the story may leave readers with the false impression that the concept of killing off neurons in the thalamus is new. Rather, it’s the use of focused ultrasound to destroy brain tissue, rather than a probe inserted in the brain, that constitutes an advance. The story does not appear to rely solely on the news release, which we also reviewed. Claim: New treatment offers some hope for an unshakable tremor

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2


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Paragraph: A woman smokes a cigarette in an undated file photo. REUTERS/File Independent Pharmaceutica, a private company based at Stockholm’s Karolinska Institute and founded in 1997 by Professor Torgny Svensson, joins a growing line-up of biotech companies seeking to develop an anti-nicotine shot. Its researchers say the vaccine eliminates the quick high smokers relish by creating antibodies that bind to nicotine molecules, making them too bulky to enter the brain. Once the high is gone, the argument goes, so is the main cause of addiction. In the Phase II study on 400 people in three Nordic countries, researchers will measure the effect of the vaccine on those who have quit smoking and want to avoid relapse. But they may use it in future to help active smokers quit, according to Independent Pharmaceutica. Several other vaccines against nicotine dependence are under investigation, but Independent Pharmaceutica Chief Executive Lena Degling Wikingsson said her company hopes to produce a more potent product with fewer side effects than competitors. “After this Phase II study, we want to have co-operation with a bigger pharmaceutical company to be able to take this further,” Wikingsson told Reuters on Tuesday. “We are discussing (this) with the world’s biggest pharmaceutical companies.”   Switzerland’s Cytos Biotechnology published results from a Phase II trial in 2005, showing 42 percent of patients who achieved high antibody levels at vaccination stayed smoke-free after 12 months, against 21 percent in the group given a placebo. Bermuda-based private equity firm Celtic Pharma has said it will announce results from its Phase II trial on a nicotine vaccine this quarter, while U.S. company Nabi Pharmaceuticals is developing a similar product. According to the World Health Organization, tobacco use is the number one preventable cause of death in the world, killing 5.4 million people every year, an increasing proportion of those in low-income countries. Claim: Nordic scientists start trial on nicotine vaccine.

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2


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Paragraph: "Hillary Clinton is in the political crosshairs as the author of a new book alleges improper financial ties between her public and personal life. At issue in conservative author Peter Schweizer’s forthcoming book Clinton Cash are donations from foreign governments to the Clinton Foundation during the four years she served as secretary of state. George Stephanopoulos used an interview with Schweizer on ABC This Week to point out what other nonpartisan journalists have found: There is no ""smoking gun"" showing that donations to the foundation influenced her foreign policy decisions. Still, former Republican House Speaker Newt Gingrich says the donations are ""clearly illegal"" under federal law. In his view, a donation by a foreign government to the Clinton Foundation while Clinton was secretary of state is the same as money sent directly to her, he said, even though she did not join the foundation’s board until she left her post. ""The Constitution of the United States says you cannot take money from foreign governments without explicit permission of the Congress. They wrote that in there because they knew the danger of corrupting our system by foreign money is enormous,"" Gingrich said. ""You had a sitting secretary of state whose husband radically increased his speech fees, you have a whole series of dots on the wall now where people gave millions of dollars — oh, by the way, they happen to get taken care of by the State Department."" He continued, ""My point is they took money from foreign governments while she was secretary of State. That is clearly illegal."" PunditFact wanted to know if a criminal case against Clinton is that open and shut. Is what happened ""clearly illegal""? A spokesman for the Clinton Foundation certainly disagreed, calling Gingrich’s accusation ""a baseless leap"" because Clinton was not part of her husband’s foundation while serving as a senator or secretary of state. We did not hear from Gingrich by our deadline. Foundation basics Former President Clinton started the William J. Clinton Foundation in 2001, the year after Hillary Clinton won her first term as a New York senator. The foundation works with non-governmental organizations, the private sector and governments around the world on health, anti-poverty, HIV/AIDS and climate change initiatives. Spokesman Craig Minassian said it’s reasonable for the foundation to accept money from foreign governments because of the global scope of its programs, and the donations are usually in the form of tailored grants for specific missions. Hillary Clinton was not part of her husband’s foundation while she was a senator or secretary of state. Her appointment to the latter post required Senate confirmation and came with an agreement between the White House and Clinton Foundation that the foundation would be more transparent about its donors. According to the 2008 memorandum of understanding, the foundation would release information behind new donations and could continue to collect donations from countries with which it had existing relationships or running grant programs. If countries with existing contributions significantly stepped up their contributions, or if a new foreign government wanted to donate, the State Department would have to approve. Clinton took an active role in fundraising when she left the State Department and the foundation became the Bill, Hillary & Chelsea Clinton Foundation in 2013. But she left the board when she announced her run for the presidency in April 2015. The Emoluments Clause So how does Gingrich come up with the claim that Clinton Foundation donations are ""clearly illegal"" and unconstitutional? The answer is something known as the Emoluments Clause. A few conservative websites have made similar arguments in recent days, including the Federalist blog. The Emoluments Clause, found in Article 1, Section 9 of the Constitution, reads in part: ""No Title of Nobility shall be granted by the United States: And no Person holding any Office of Profit or Trust under them, shall, without the Consent of the Congress, accept of any present, Emolument, Office, or Title, of any kind whatever, from any King, Prince, or foreign State."" The framers came up with this clause to prevent the government and leaders from granting or receiving titles of nobility and to keep leaders free of external influence. (An emolument, per Merriam-Webster Dictionary, is ""the returns arising from office or employment usually in the form of compensation or perquisites."") Lest you think the law is no longer relevant, the Pentagon ethics office in 2013 warned employees the ""little known provision"" applies to all federal employees and military retirees. There’s no mention of spouses in the memo. J. Peter Pham, director of the Atlantic Council’s Africa Center, said interpretation of the clause has evolved since its adoption at the Constitutional Convention, when the primary concern was about overseas diplomats not seeking gifts from foreign powers they were dealing with. The Defense Department memo, in his view, goes beyond what the framers envisioned for the part of the memo dealing with gifts. ""I think that, aside from the unambiguous parts, the burden would be on those invoking the clause to show actual causality that would be in violation of the clause,"" Pham said. Expert discussion We asked seven different constitutional law experts on whether the Clinton Foundation foreign donations were ""clearly illegal"" and a violation of the Emoluments Clause. We did not reach a consensus with their responses, though a majority thought the layers of separation between the foundation and Hillary Clinton work against Gingrich. The American system often distinguishes between public officers and private foundations, ""even if real life tends to blur some of those distinctions,"" said American University law professor Steve Vladeck. Vladeck added that the Emoluments Clause has never been enforced. ""I very much doubt that the first case in its history would be because a foreign government made charitable donations to a private foundation controlled by a government employee’s relative,"" he said. ""Gingrich may think that giving money to the Clinton Foundation and giving money to then-Secretary Clinton are the same thing. Unfortunately for him, for purposes of federal regulations, statutes, and the Constitution, they’re formally — and, thus, legally — distinct."" Robert Delahunty, a University of St. Thomas constitutional law professor who worked in the Justice Department’s Office of Legal Counsel from 1989 to 2003, also called Gingrich’s link between Clinton and the foreign governments’ gifts to the Clinton Foundation as ""implausible, and in any case I don’t think we have the facts to support it."" ""The truth is that we establish corporate bodies like the Clinton Foundation because the law endows these entities with a separate and distinct legal personhood,"" Delahunty said. John Harrison, University of Virginia law professor and former deputy assistant attorney general in the Office of Legal Counsel from 1990 to 1993, pointed to the Foreign Gifts Act, 5 U.S.C. 7432, which sets rules for how the Emoluments Clause should work in practice. The statute spells out the minimal value for acceptable gifts, and says it applies to spouses of the individuals covered, but ""it doesn’t say anything about receipt of foreign gifts by other entities such as the Clinton Foundation."" ""I don’t know whether there’s any other provision of federal law that would treat a foreign gift to the foundation as having made to either of the Clintons personally,"" Harrison said, who added that agencies have their own supplemental rules for this section, and he did not know if the State Department addressed this. Other experts on the libertarian side of the scale thought Gingrich was more right in his assertion. Clinton violates the clause because of its intentionally broad phrasing about gifts of ""any kind whatever,"" which would cover indirect gifts via the foundation, said Dave Kopel, a constitutional law professor at Denver University and research director at the libertarian Independence Institute. Kopel also brought up bribery statutes, which would require that a gift had some influence in Clinton’s decision while secretary of state. Delahunty thought Kopel’s reasoning would have ""strange consequences,"" such as whether a state-owned airline flying Bill Clinton to a conference of former heads of state counted as a gift to Hillary Clinton. Our ruling Gingrich said the Clinton Foundation ""took money from from foreign governments while (Hillary Clinton) was secretary of state. It is clearly illegal. … The Constitution says you can’t take this stuff."" A clause in the Constitution does prohibit U.S. officials such as former Secretary of State Hillary Clinton from receiving gifts, or emoluments, from foreign governments. But the gifts in this case were donations from foreign governments that went to the Clinton Foundation, not Hillary Clinton. She was not part of the foundation her husband founded while she was secretary of state. Does that violate the Constitution? Some libertarian-minded constitutional law experts say it very well could. Others are skeptical. What’s clear is there is room for ambiguity, and the donations are anything but ""clearly illegal."" The reality is this a hazy part of U.S. constitutional law. Claim: "The money the Clinton Foundation took from from foreign governments while Hillary Clinton was secretary of state ""is clearly illegal. … The Constitution says you can’t take this stuff."

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0