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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Question: Paragraph: Dr. Neelu Pal poses for a portrait in New York, July 23, 2010. Pal was fired weeks after authorities at New York University Langone Medical Center Surgical Weight Loss Program learned she had contacted patients about the dangers of Lap-Band surgery in January 2006. REUTERS/Shannon Stapleton Pal had previously raised her concerns with hospital officials, complaining — to no avail — about the lack of care given after surgery and incomplete or inaccurate medical forms that were taken prior to surgery. She was fired weeks after hospital authorities learned she had contacted patients in January 2006. She has filed a wrongful termination lawsuit — the case is pending — and enrolled in law school. Pal, who came to the United States from India a little over a decade ago to practice medicine, says she has been blackballed from her chosen profession. The NYU bariatric surgery practice where she worked is widely considered one of the world’s most experienced. But in an interview with Reuters, Pal described the facility as a hectic Lap-Band factory. “My impression at the time was that the practice was disorganized, but once I knew more about the system, I could see what they were trying to do was get as many patients on to the operating table as possible,” she said. During her three months at NYU Langone Medical Center’s Surgical Weight Loss Program in late 2005 and early 2006, two surgeons — Dr. Christine Ren and Dr. George Fielding, who are married — implanted gastric bands into as many as 20 patients in a single day, according to Pal. Known as pioneers in the field, Fielding and Ren are also paid consultants of Allergan Inc, the Botox and breast implant maker which is the leading manufacturer of the gastric band. Though rivals have been gaining, Allergan’s Lap-Band still commands more than two-thirds of a $300 million to $400 million market. To critics, Pal’s allegations — some of which were corroborated by a New York State Health Department investigation around that time — underline the potential risks that go along with the industry’s rapid growth. And the business could soon swell even more if U.S. regulators grant permission to perform the procedure on the nation’s bulging ranks of overweight teens. Ren was an investigator in an Allergan-sponsored clinical trial studying the use of bands on teens. And the company has an application with the U.S. Food and Drug Administration seeking approval to market the device to teens as young as 14. A decision could come any time. Winning regulatory approval for the gastric band in teenagers would allow the companies that make the devices — Allergan, Johnson & Johnson and others — to target that specific age group. Today, regulators consider performing the procedure on teens “experimental” as it has not been approved for that age group. But, like any device, it may be used on teens at a doctor’s discretion. Allergan declined to comment on Pal’s lawsuit or disclose how much it pays the surgeons, though the company did confirm that both remain on the payroll. Through a NYU spokeswoman, Ren and Fielding — who have been the subject of some controversy — declined to be interviewed for this article, also citing the lawsuit. But in some medical circles, concern over gastric banding for teenagers is growing nearly as fast as American waistlines. In particular, some doctors worry about the device’s long-term safety and effectiveness. A gastric band is just what it sounds like: an inflatable silicone band placed around the top portion of the stomach to create a pouch that restricts food intake. It has become increasingly popular in the United States in recent years, and results in reasonable weight loss. The procedure is considered less invasive and risky than gastric bypass. Banding could also be an especially attractive option for teens, say proponents, because it is reversible, whereas bypass is not. The 30- to 60-minute procedure, typically performed with a laparoscope, might require one night in the hospital but can also be done on an outpatient basis. But certain data show gastric bands are less effective and more problematic for teens than adults, said Dr. Thomas Inge, chair of a government study to assess bariatric surgery in adolescents called Teen Longitudinal Assessment of Bariatric Surgery, or Teen-LABS for short. The Teen-LABS study aims to determine if adolescence is the best time to intervene with surgery. It was launched in 2007 and is expected to report results in about five years. In more than one in five teens in another study, Inge noted a high rate of “symmetric pouch dilation” — a complication in which the small pouch created at the top of the stomach by the band gets bigger, allowing patients to consume more food. This issue was reported in the journal Obesity Surgery, and later in the Journal of the American Medical Association. “We await the U.S. trial data, PMS (post-marketing surveillance) data, and confirmation from non-industry-run trials to make final recommendations,” said Inge, who is the surgical director of the weight loss program for teens at Cincinnati Children’s Hospital. As Inge and others are quick to point out, trials that studied how teens fared with a gastric band over the short term have been few, and those that were conducted show the device generally is safe and effective, with a relatively low risk for complications or death. But there is a dearth of long-term data on the outcomes from gastric band surgery. And that worries Dr. Mary Brandt, an investigator in the Teen-LABS study, among other experts. “I think there’s a fundamental problem with putting a rigid plastic object around a moving organ. You’re asking it to stay in place and not erode over a long period of time,” said Brandt, who is also director of the pediatric surgical program at Texas Children’s Hospital in Houston. “I’ll be happy to reverse my position as soon as I see 10 or 20 year data. Unfortunately, that’s not something that industry is excited about funding.”   She acknowledged a bias against gastric bands, citing a Swiss long-term follow-up study of 167 adults that showed the band failed almost a third of the time after 10 years. About a fifth of the patients required another operation. And while fewer than 8 percent reported complications in the 30 days following surgery, more than 40 percent had problems after a decade. Long-term complications included the erosion and slippage of the band, both of which might require another operation, and a dilation of the esophagus, which could result in difficulty swallowing. Infections around the port that sits below the skin and allows the doctor to add or remove saline with a syringe to tighten or loosen the band, as well as leaks, were also common. “Bands are definitely safe in the short term and definitely work in the short term. What we don’t know is about the long term,” Brandt said. “I’m not saying it should never be used. We just have to be more careful about how we’re using it.”   The Swiss study of adults who had gastric banding, published in Obesity Surgery, came to the same conclusion. Because of complications, the need for another operation, and long-term failure rates, gastric banding should be performed in “selected cases only” until more data are available, it said. Another group of 276 adults who underwent gastric band surgery had similarly disappointing results in a long-term Austrian study published in the same journal. Only a little under 54 percent of the patients still had their original band after nine years, with nearly 18 percent having the original replaced with a new one and nearly 29 percent having it removed. Of those who no longer had any band, more than half had a second bariatric operation. Gastric banding demands that teens do something they often aren’t very good at — sticking to a rigorous follow-up routine. Dr. Roberta Maller Hartman, a psychologist and Lap-Band patient herself, counsels teens and adults after receiving the gastric band. “I’ve worked with a lot of high school students and they just want to be like everyone else and go out and eat pizza with their friends,” she said. “They can, but they have to take little bites and chew a lot.”   Success depends most on a patient’s ability to modify their behavior. “The band doesn’t reduce the desire to eat emotionally. That has to be addressed,” said Dr. Maller. “Teens tend to need more hands-on, one-to-one support.”   Indeed, there are many success stories of obese teens losing weight, keeping it off and staving off a host of related illnesses, such as diabetes, arthritis and high blood pressure. Surgery — banding or bypass — has been shown to produce the most sustainable results when compared with diet and exercise. Nevertheless, critics abound. Dr. Susan Woolford, Medical Director of the Pediatric Comprehensive Weight Management Center at the University of Michigan, conducted a study, published in Obesity Surgery, to find out how readily primary care physicians and pediatricians — those in the front lines of obesity treatment — would refer patients for bariatric surgery. Nearly half, or 48 percent of the 381 physicians surveyed, said they would never refer an adolescent for any type of bariatric surgery. The controversies swirling around NYU’s influential bariatric surgery center — as well as its two top surgeons — have done little to ease concerns. An investigation by the New York State Department of Health in 2006 found that Fielding falsified data on Vincent Esposito, a 14-year-old boy who was part of the FDA-authorized study that was looking at the use of the device in obese teens. A week after Esposito’s Lap-Band surgery, he developed an infection with an abscess — a common complication with gastric banding — and returned to the NYU facility, where Fielding performed an appendectomy. The investigation by New York health authorities determined there was no evidence of appendicitis, according to the report. “They told me I was a ticking bomb,” Esposito had told the Daily Times in Salisbury, Maryland in 2007, referring to his obesity. Reached by telephone, his father said his son was “fine” and that they are being represented by an attorney and declined to comment. NYU also declined to comment. In its response to the NYDH report, the university maintained no wrongdoing, saying “the surgeon probably misinterpreted his operative findings.” In a statement at the time, the school added, “...we are persuaded that he assumed that the infection did not begin in the gastric band device.”   The response and NYU’s plan to correct the issues were accepted by state regulators. In the NYSHD report, Fielding was also cited for failing to address a post-operative patient’s persistent lack of urine output. The patient went into cardiac arrest and died 36 hours later. This was the death that alarmed Pal and led her to warn patients. The same report said the program director, Ren, had permitted two surgeons to practice without the appropriate licenses, in violation of the law. For four months, the unlicensed physicians “performed multiple surgical procedures, made pre- and post-op assessments, and wrote orders to be carried out by nursing staff,” the report said. After Ren learned she was being investigated by an internal committee, she went back and removed the name of the unlicensed surgeon from the operative report, according to court testimony. She was found to have committed professional misconduct and received a letter of reprimand that was put in her file for a year. Fielding, who got a gastric band himself in 1999, is from Australia, where he left behind multiple personal injury lawsuits, most of which have been settled. Dr. Robert “Skip” Nelson, a pediatric ethicist at FDA, said he had no specific knowledge about the incident at NYU Medical Center. If the agency did learn that an investigator has entered false data, he said, there would be an investigation. He added that if the FDA doubted the integrity of the data, they would not be considered in the decision-making process. An investigator, as doctors who run clinical trials are called, could also be disqualified as a result. Despite the reports of misconduct, the NYU Langone Weight Management Program has retained its status as a “Center of Excellence,” a designation conferred by the Surgical Review Corp, an entity created by the American Society for Bariatric and Metabolic Surgery. Surgical Review Corp CEO Gary Pratt said that he was unaware of the incidents and the NYSHD report. He said the corporation’s reviews maintain the highest standards with the goal of advancing the safety and efficacy of bariatric surgery. The company intends to put out a new list of approved bariatric clinics that treat teens later this year — which may coincide with the FDA granting approval, or not. If the FDA does greenlight it, insurers would be more likely to pay for the procedure, which costs the insured patient $2,000 to $4,000. The uninsured, making up about a third of patients who have the surgery in the United States, pay about $15,000 for the surgery. Some health professionals worry that band manufacturers will target teens with direct-to-consumer (DTC) ads on television and radio or in subway stations that have proven effective at luring people to doctors’ offices. The FDA said there is no guidance or regulation on DTC ads to young users. For Allergan, based in Irvine, California, the implications are significant. And the company is acting accordingly. It recently launched a campaign with bariatric surgeons to invite their patients to enter an essay contest and win a chance to go to Washington, D.C. to “share their personal stories with legislators and media.”   Allergan has seen its stock underperform the S&P 500 year to date. Botox remains its key product and has weathered increased competition amid the recession, while obesity intervention was hit hardest by the economy. At the same time, Lap-Band has also been slowly losing market share to Johnson & Johnson’s competing device called Realize. In 2009, Allergan’s obesity products generated revenue of $258 million, down 13 percent from 2008. Management is betting that continued investment in direct-to-consumer advertising will stimulate growth in the obesity segment, said Gleacher & Co analyst Amit Hazan. He estimates there will be 83,500 gastric band procedures in the United States in 2010, up 6 percent from 2009. Sanford Bernstein analyst Aaron Gal said FDA approval of the Lap-Band for teens could increase sales by as much as $20 million for Allergan. Even critics of gastric band surgery acknowledge that there are few good solutions to adolescent obesity. It is a mounting problem, affecting nearly 1 in 5 American teens, and many doctors believe that it should be addressed sooner rather than later when other health problems can develop. Some experts are wary but believe the benefits may outweigh the potential harm. “My conclusion is that it makes sense to intervene sooner because surgery can head off other related problems. Kids are better surgical risks, but the downside is that I suspect most teenagers are doing it less for health and more for social and psychological reasons,” said Dr. Jeffrey Zitsman, who is leading an independently funded teen study at Columbia University. Those who do it out of vanity, he cautioned, may have a harder time. “When health reasons don’t motivate them,” he said, “sometimes there are compliance issues.”   Yet, Dr. Robert Murray, director of Nationwide Children’s Hospital Center for Healthy Weight and Nutrition, argues that the heavy psychological problems obese teens carry should not be ignored. “They’ve been teased out of school, they have social issues, many are depressed, and their quality of life is equal to that of a kid with cancer,” he said. “If you get them at 14 and reverse weight and health problems, they’ve got a shot at a normal life.”   To critics, at least, the question is at how big a price. Claim: Special report: Targeting teens for gastric bands.

Answer: After one patient died and others suffered serious complications following Lap-Band surgery, Dr. Neelu Pal had seen enough. A petite surgical resident now aged 40, she began quietly calling patients about to undergo the weight-loss procedure at New York University’s Medical Center, telling them she feared for their safety.


Question: Paragraph: The U.N. agency is seeking to balance the need to ensure China continues to share information about the virus while also giving sound scientific advice to the international community on the risks, according to several public health experts and a Western diplomat who tracks the WHO’s work. The WHO has declared five global emergencies in the past decade, including the ongoing Ebola epidemic in the Democratic Republic of Congo. Doing so can hurt host countries because it may lead to flight cancellations and travel or trade restrictions, dragging on the economy. In the latest case, the WHO declined to declare China’s coronavirus a public health emergency of international concern(PHEIC) twice last week, although its Emergency Committee was split “50-50” over whether to do so. “What was lacking for them to declare an international emergency were deaths abroad and human-to-human transmission outside of China,” said the Geneva-based diplomat following the agency. “If there was proof of human-to-human spread among the ‘imported’ cases, the panel would lean toward another finding.”  WHO spokesman Christian Lindmeier declined to comment beyond what he told a news briefing earlier on Tuesday. He restated that the WHO’s criteria for a global emergency include a “serious or unusual” health situation that affects other countries and may require a coordinated international response. In reply to a question, he added: “It is not ‘wildly spreading’ outside of China.”  While the vast majority of the 4,500 or so confirmed cases and all 106 deaths so far have been in China, cases in Germany, Vietnam, Taiwan and Japan where the virus has spread person-to-person have heightened concerns. “As information is coming in, it seems to be confirming our worst fears,” Lawrence Gostin, university professor at Georgetown Law in Washington, DC, told Reuters. “So I do believe that the WHO is going to have to declare an emergency and is going to have to take the lead ... You can’t leave this to China.”  The WHO’s 16-member expert panel is being “kept in the loop” and could be reconvened at any time to reassess the outbreak. “Just because of rising numbers in China now this would not automatically trigger an Emergency Committee,” Lindmeier told the briefing. A declaration would lead to boosting public health measures, funding and resources to prevent and reduce global spread. It could include recommendations on trade and travel, although the WHO generally tries to avoid disruptive trade restrictions. The Emergency Committee deliberations are secret and its members have been told not to speak about their debate, several WHO officials told Reuters. WHO chief Tedros Adhanom Ghebreyesus and Chinese President Xi Jinping met in Beijing on Tuesday to discuss how to protect Chinese citizens and foreigners in areas affected by the virus and “possible” evacuation alternatives, Lindmeier said. China has agreed that the WHO can send international experts there as soon as possible to increase understanding of the new coronavirus and guide the global response to the outbreak, the WHO said at the end of Tedros’ two-day visit. Some experts believe the Geneva-based health agency is in a difficult position, having drawn fire in the past for acting either too quickly or too slowly. “Essentially the WHO is between a rock and a hard place,” said Jeremy Farrar, an expert in infectious disease epidemics and director of the Wellcome Trust global health charity. Farrar noted that the organization was criticised for having called an early emergency in 2009 for the H1N1 flu pandemic, which proved mild, and then for being too late in declaring the Ebola epidemic in West Africa in 2014. Claim: WHO weighs science and politics in global virus emergency decision.

Answer: Most of the World Health Organization’s (WHO) criteria for declaring a global emergency have been met, but it is awaiting clear evidence of a sustained spread of the new coronavirus outside China before doing so, some experts and diplomats said.


Question: Paragraph: The story doesn’t specifically address costs, but it does discuss some of the most common types of fiber-rich food — such as fruits, vegetables, legumes and whole grains. Given the diversity, and widespread availability, of these foods, we’ll give this a Satisfactory rating. However, it would have been nice to see some acknowledgment that many people — people particularly people with limited financial resources — live in so-called “food deserts,” which have little access to fresh produce, etc. The story discusses a wide range of benefits, ranging from reduced risk of heart disease to weight loss. But the focus of the story was on weight loss, so that’s what we’ll focus on here. The story refers to two studies, only one of which appears to have been published. The first study is an analysis of people who have used the MyFitnessPal app in an attempt to lose weight. In that case, users who came within 5 percent of their weight loss goal consumed an average of 29 percent more fiber than users who did not come close to their weight loss goals. The second study was actually published (in 2015), and compared weight loss across two groups of study participants who had metabolic syndrome. One group followed the American Heart Association’s recommended diet, while the other was told only to eat 30 grams of fiber per day. Both groups ended up eating the same amount of fiber per day (19 grams), and both groups lost weight. At the end of a year, the AHA diet group lost more (an average of 5.6 pounds), but the second group still lost 4.6 pounds. Neither of these studies are in the mold of a conventional intervention/health-benefit paradigm. But then neither is specifically looking at either a precisely-defined intervention (such as a pharmaceutical trial) or a disease — they’re looking loosely defined dietary guidelines and weight loss (and while weight can be a risk factor, it is not an illness). Bearing that in mind, the story does a satisfactory job of quantifying the relevant benefits in each instance. In general, eating more fiber carries few potential harms. The primary risks are, as the Mayo Clinic notes, “adding too much fiber too quickly can promote intestinal gas, abdominal bloating and cramping.” To minimize that risk, the Mayo Clinic urges people to “Increase fiber in your diet gradually over a period of a few weeks. This allows the natural bacteria in your digestive system to adjust to the change. Also, drink plenty of water. Fiber works best when it absorbs water.” This story does not outline these harms specifically, which is too bad. But the story does tell readers that they should “add fiber slowly and with plenty of water.” That’s enough to rate this as Satisfactory (though it’s clearly not ideal). The two studies, mentioned above under benefits, have some problems: It’s not clear where the unpublished MyFitnessPal data come from or how they were analyzed; and the 2015 study was of only 240 volunteers. These limitations were not noted. Also, the story would have been much stronger if it had addressed one key question: Were there any differences between groups (in either study) in regard to their age, sex, or physical activity? Any of those factors could play a key role in differences in weight loss, and the story sheds no light there. A side note: As we mentioned above, this story discusses a wide range of other benefits associated with eating enough fiber, ranging from reduced risk of heart disease to reduced risk of diabetes. We mention this because the story links to relevant research supporting each of those claims. We applaud that. There is no overt disease mongering. But we did want to point out two things. The story states: “fiber may play an important role in that ever-elusive health goal, weight loss.” First, while being obese may be a disease, simply being overweight is not. Second, many people who aspire to lose weight do so for reasons other than health (and aren’t overweight in the first place). Those are important distinctions, and ones that this story doesn’t make. The story quotes from a wide variety of sources, and clearly labels each source’s affiliation. One issue that’s not addressed in the story is the utility of fiber supplements. Are they good? Bad? Beneficial? Useless? The story doesn’t offer any insight here. It would be useful for readers to know whether such supplements may be useful tools for meeting daily fiber intake goals. Foods that contain fiber have been around longer than humans have, so we’ll rate this N/A. Dietary fiber isn’t new, and the story doesn’t claim that it is. We’ll rate this N/A. The story doesn’t appear to be based on a news release. (In fact, given that the story doesn’t seem to draw on any particularly new studies, guidelines or other external drivers, we’re kind of curious as to what spurred this story. We’re suspecting a pitch from MyFitnessPal.) Claim: It’s Comical. It’s Critical. It Might Even Help You Lose Weight.

Answer:
This story urges people to make sure they’re eating enough dietary fiber, with a focus on fiber’s role in promoting healthy weight loss. And, overall, it does a fairly good job — though giving a high-profile to unpublished data from a privately-owned fitness app (MyFitnessPal) is a little unusual. To draw causal conclusions about a specific food/dietary component, without providing fulsome data is worrisome. Also, we’re unaware of any studies at this point that speak to the veracity of MyFitnessPal dietary record keeping, and the accuracy of its collection is probably worth validating and exploring–or at least noting its limitations. And, on a broader level, focusing on a single ingredient such as “fiber” feeds nutritionism–the notion that the presence or absence of a particular nutrient makes a food healthful or not. We don’t have nutrition drilled down that specifically. This point would have made the story stronger. Fiber–especially from whole fruits and vegetables–is an important part of a healthy diet, with institutions from the Mayo Clinic to Harvard’s T.H. Chan School of Public Health outlining the myriad ways that a fiber-rich diet reduces health risks. And, as this story notes, most people don’t get enough fiber. Recommendations for daily intake of fiber vary, but tend to come in between 25 grams per day to 38 grams per day, depending on age and sex. A 2014 paper from USDA’s Food Surveys Research Group found that Americans consume an average of 16 grams of fiber per day. Given the potential benefit of eating more fiber, this would seem like a conversation worth having. And that appears to be the goal of the story.