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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 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: 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
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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.


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Paragraph: Policymakers and investors are turning up the heat on companies across sectors in the run up to global climate talks in Glasgow in November, demanding they assess the risks and put plans in place to mitigate them. Incoming United Nations climate envoy Mark Carney is pushing all companies to use a risk-assessment framework devised by the G20-backed Financial Stability Board’s Taskforce on Climate-related Financial Disclosures (TCFD). As a leading contributor to global carbon emissions, through deforestation and the methane produced by livestock, the meat sector faced a particularly acute risk, but has yet to act in a meaningful way, the FAIRR Initiative investor group said. “Investors can see the inescapable truth for the meat sector is that it must adapt to climate change or face ruin in the years ahead,” said Jeremy Coller, Founder of FAIRR and Chief Investment Officer at Coller Capital. “Conversely, there is also an appetizing prospect of enormous upside if the world’s meat companies shift their protein mix to align with a climate-friendly path.”  Of 43 listed meat companies assessed, only two had publicly disclosed a climate-related scenario analysis, FAIRR said. The group, which includes Allianz Global Investors and Aberdeen Standard Investments, said it had created an online scenario analysis model, based on the TCFD framework, that investors could use to assess the risk to their portfolios. A ‘climate progressive’ pathway would see companies grow alternative proteins faster, and shift feed and livestock mix towards less climate-influenced crops and species, while a ‘climate regressive’ pathway would keep things as they are. Following the second pathway would lead combined annual earnings before interest, tax, depreciation and amortization at five of the leading assessed companies to be $8 billion lower by 2050 than if they follow the first pathway, FAIRR said. Among the risks factored into the model are the potential hit to profits of higher electricity costs due to carbon pricing; higher costs of feed due to poor crop yields; and increased livestock mortality due to heat stress. In addition, by 2050 alternative proteins such as plant-based burgers will account for at least 16% of the current meat market, FAIRR’s model forecasts, rising to 62% depending on factors such as technology adoption rates, consumer trends and the potential imposition of a carbon tax on meat. Claim: Dead meat: Industry faces 'ruin' if slow on adapting to climate change.
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The world’s meat industry must adapt to the challenges posed by climate change and growing demand for plant-based alternatives or face ruin, according to a group of investors managing $20 trillion in assets.