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.

Paragraph: Moira O’Neill, director of the Office of the Child Advocate, said the center operated by Granite Pathways was unusual in that it was licensed by the Department of Health and Human Services but was not certified by the division that oversees child welfare. While that’s not a requirement because the Division for Children, Youth and Families didn’t directly place children at the facility, without that certification, it is unclear who had oversight over quality and safety, O’Neill said. “We have issues with the extent of oversight DCYF provides to certified agencies, but at a bare minimum, they know who’s there, they re-certify them every two years, they provide technical assistance. There’s some expectation that someone has an idea of what’s going on in the program,” she said in an interview. Republican Gov. Chris Sununu and the health department announced on Nov. 27 the state was canceling its contract with Granite Pathways, which had been operating the 36-bed facility in Manchester for just over a year. A summary report released by the department Monday said that in a span of less than two weeks, four of the 10 residents were taken to hospitals after taking drugs one of them smuggled in, a fifth took multiple doses of prescription medication in an apparent suicide attempt and a sixth drank a bottle of hand sanitizer. The remaining residents have since been transferred, and the contract officially ends Dec. 27. Some of the residents at the center were known to the child welfare agency, said O’Neill, who has been reviewing their records. “In our preliminary review, we found that there were children who were placed there who have really complicated needs, and we don’t know if that program had the capacity to serve those needs,” she said. O’Neill said she sent the Department of Health and Human Services a list of questions in late November about what the facility knew about the children, its capacity to meet their needs and how the program was supervised. As of Tuesday, she had not received answers. “If we are going to understand the circumstances that prompted seven ambulance transports, we must understand how those children came to be at the facility and what transpired in assessing and treating them,” she said. Jake Leon, spokesman for the Department of Health and Human Services, said the department agrees with O’Neill that it is important to ensure that children get the services they need. He said the department has addressed and continues to address similar questions, but responses must remain confidential to protect clients’ privacy. “DHHS monitored Granite Pathways’ compliance with its contractual obligations and is still compiling information regarding the organization’s noncompliance. There is also an ongoing investigation by DCYF that must be kept confidential,” he said in an email. Patrica Reed, state director at Granite Pathways, said the nonprofit’s leaders and board of directors were still reviewing the health department’s report. “The end of this contract does not end Granite Pathways’ commitment to its mission of supporting individuals with substance use disorders and mental illness in achieving their life goals as valued members of their communities,” she said in a statement. But the trouble at the youth treatment center has raised questions about the state’s approach to funding substance abuse treatment in general and Granite Pathways in particular. Since 2016, it has been a subsidiary of The Fedcap Group, a New York-based nonprofit that focuses on helping people overcome barriers to economic well-being through workforce development, education, occupational health and economic development. With close to $300 million in annual revenue, the parent organization has government contracts in 22 states, and its acquisitions include Easterseals programs New York, Rhode Island and parts of Texas. In New Hampshire, Granite Pathways was a year into a four-year, $15.6 million contract for the youth treatment center. According to the state expenditure register, the organization has been paid $4.1 million since 2012, including just under $900,000 in the current fiscal year. Under the hub-and-spoke system the state launched this year to connect people to opioid addiction resources, Granite Pathways was awarded $5 million in federal funding over multiple years to run the two largest hubs, in Manchester and Nashua. Contracts are approved by the five-member Executive Council, and at least one member has expressed concern about Granite Pathways in the past. In June, when the council approved a $345,000 contract related to treatment for adolescents, Councilor Andru Volinsky noted that the organization already was running the opioid response hubs and called for “continued vigilance” to ensure it could keep up with all its responsibilities. “We’ve had, in particular when trying to quickly build out our substance abuse response, a number of instances where the financial management of private nonprofits was not strong. We haven’t really had strong capacity to oversee that at DHHS,” he said in a recent interview. “My concern at the time of this Granite Pathways contract was that we were again placing what I think are state responsibilities onto a private contractor, and we still haven’t built an infrastructure to oversee those private contractors.” Volinsky, a Democrat, said he doesn’t know whether the state should build out its own capacity to respond to the substance abuse crisis, or whether it’s enough to rely on outside groups and closely monitor them. “I could legitimately understand the arguments either way,” he said. “But to almost blithely continue to invest in outside agencies without oversight doesn’t make sense.” In announcing the closing of the youth treatment center, officials said the state is taking 30 days to review all of its contracts with Granite Pathways and may take further action. The health department also has increased its oversight of substance use disorder treatment centers in the last year after one of the largest facilities closed. Those efforts have included financial audits and the appointment of a new director at the Office of Program Integrity. Claim: Child advocate sees lack of oversight at youth treatment hub.
New Hampshire’s only residential treatment center for teens struggling with addiction operated with an apparent lack of oversight before it was shutdown earlier this month, the director of a state watchdog office said Tuesday.

Paragraph: The article states that acupuncture costs $45 to $100 per session. It does not say how this compares to other treatments and whether the cost of care is the same, more or less than alternatives. The story states the proportion of patients who successfully responded to each therapy, and clearly explains that “real” acupuncture was no better than sham needling. But it does not define success or otherwise quantify how much people improved clinically in either relative or absolute terms. For a treatment to be considered successful, a patient must have reported either a 33% improvement in pain or as little as a 12% improvement in function during an interview conducted over the telephone 6 months after enrollment. Nonethless we’ll grade this criterion as satisfactory. The story did not mention harms from any of the treatments patients received. Previous research suggests that acupuncture poses few risks when performed with sterile, disposable needles. The article describes the largest randomized controlled trial to date investigating the effectiveness of acupuncture for treating chronic low back pain, and reports its published results. It discusses the three treatment groups studied and potential reasons for the outcomes observed. There are no obvious elements of disease mongering. The story explains that the study participants were people with chronic low back pain. These results wouldn’t apply to other back pain conditions. The article cites one of the study’s coauthors and two physicians who appear to be users and/or proponents of complementary therapies. It would have been interesting to hear from a skeptical observer. The story lists the therapies received by patients assigned to the conventional medicine group. The literature suggests that these treatments generally provide very modest benefits. The article does not mention other therapies that may be effective for managing chronic pain and improving flexibility and strength. These include cognitive therapy alone or in combination with intensive exercise and strengthening. Acupuncture is estimated to be the third most popular complementary therapy for chronic low back pain. Though the article does not say much about its availability, readers are likely to be familiar with it. The story notes that this is the largest study yet of acupuncture for chronic back pain, suggesting that the treatment is not new. There is no obvious use of text from a press release. Claim: Acupuncture, real or fake, called best for lower back pain
This article reports on the largest randomized controlled trial to date investigating the effectiveness of acupuncture for treating chronic low back pain. It explains that both acupuncture and sham needling are more effective than conventional medical therapies, but that “fake acupuncture works nearly as well as the real thing.”       In addition to describing the quality of the evidence, the story mentions several other treatment options, tells the reader the cost of acupuncture, and hints at its novelty. The story neglects to mention harms. (A recent systematic review reinforces the study’s finding that acupuncture poses few risks; see Spine 2005;30:944-63). And it also provides an incomplete picture of the treatment’s apparent benefits. Although it notes the proportion of patients who improved with each therapy, it does not define success or otherwise quantify how much people improved clinically–in either relative or absolute terms. For a treatment to be considered successful, for example, a patient could have reported as little as a 12% improvement in function during an interview conducted over the telephone 6 months after enrollment. This is important information if people are to weigh the apparent benefit of a therapy against its cost. The article cites one of the study’s coauthors and two physicians who appear to be users and/or proponents of complementary therapies. They attempt to explain why needling seems to work. To provide some balance, the study’s coauthor suggests that the apparent benefit could merely be the result of patients’ expectations of improvement from acupuncture, on the one hand, and of poor results from conventional medicine on the other. (Unfortunately, the researchers did not measure patients’ expectations.) It would have been interesting to hear from others. Some might point out that the new study shows that acupuncture and sham needling are only more effective than treatments that are not themselves very effective. Others might make the case that acupuncture provides no specific treatment effect and is unethical to use—because it could be construed as prescribing a placebo. People with chronic low back pain are desperate for anything that will help. When a large new study provides apparently strong evidence to buttress a therapy that previously had little high-quality evidence to support it, readers might also benefit from more context. A major systematic review that analyzed 35 randomized trials involving 2861 patients recently concluded that acupuncture appears to confer modest, short-term pain relief, but that the quality of the studies was not very good. The reviewers were careful not to overstate the benefits of acupuncture (Spine 2005;30:944-63). Overall, this was a good article that would have been helped by some more context.

Paragraph: We’ll rate this “Not Applicable” given the very early nature of the study and the fact that guadecitabine is clearly still far from approval for treating colorectal cancer so it would be difficult to put a precise dollar figure on it. It’s worth noting, however, that guadecitabine is also being considered for use in treating acute myeloid leukemia (AML) — and is much further along in development for that clinical application. In fact, there is already discussion about whether the potential benefits associated with using guadecitabine to treat AML outweigh the fact that other drugs are available in generic form (and are therefore less expensive). In short, while we don’t expect a release to place a dollar amount on the use of guadecitabine, we always like to see the issue of cost addressed in some way. The release does a good job here in two ways. First, the release makes clear that the goal of this study was not to assess benefits, but to assess potential harms. That places the findings — and the study design — in context. Second, the release notes that 15 of the 22 patients had at least one imaging scan to track the extent and location of their cancers. Twelve of those 15 patients had “stable” disease, while one saw a 30 percent decrease in the size of the tumors. The headline is problematic, but we’ll talk about that under the “Unjustifiable Language” criterion. The rest of the release does a good job of describing potential harms. The release discusses eight potential harms, defines them and offers numbers on all of them (e.g., “two patients developed thrombocytopenia, a lowered count of blood-clotting platelets”). That’s very good. Two things would have made it even better. First, the release could have included an explanation of what the observed adverse effects actually mean. For example, how severe was the thrombocytopenia? And how much of a risk does that pose to a patient’s health — are we talking about the potential for bruising easily? Or a high risk of bleeding to death? Second, it wasn’t clear if the dose of guadecitabine was related to observed effects. I.e., were patients who received higher doses of guadecitabine more likely to exhibit adverse effects? The release does a nice job here. The release sets the tone in its first sentence, which begins with: “In a small, phase I clinical trial…”. The release clearly explains the goals of the clinical trial, the number and type of patients involved, and the study design. The only thing that could have made things more clear would be if the release had told readers the size of the doses each of the four study groups received — and whether dose size was related to observed effects. No disease mongering here. The release clearly states that the study was supported by Astex Pharmaceuticals, which manufactures guadecitabine. There are a lot of drugs, and drug combinations, that are approved for use in colorectal cancer chemotherapy. Given that the release explicitly states that the study was not done to assess the potential benefits of guadecitabine, we don’t expect it to compare the drug’s performance to those other drugs. The release makes clear that this was a preliminary trial and that a phase II trial is ongoing. That’s good. In addition, the release states: “Guadecitabine is an experimental drug that has not been approved for use by the U.S. Food and Drug Administration.” That’s great. We wish all releases were this straight-forward about drug/treatment availability. As noted above, there are a lot of drugs and combinations approved for use in colorectal cancer chemotherapy. The release does a good job of explaining how guadecitabine may act against colorectal cancer. There are currently two FDA approved drugs that are classified as DNA methyltransferase inhibitors; decitabine (Dacogen) and azacitidine (Vidaza). Both had been used in clinical trials in the treatment of colon cancer. The bulk of the release is very good in this regard, but the first thing readers see is the headline. That doesn’t mean the headline is more important, but it does mean that the headline is subject to additional scrutiny. And the headline here reaches too far. Here’s the headline: “Experimental drug guadecitabine found safe in patients with colorectal cancer.” Here’s an excerpt from lower down in the release: “16 patients experienced neutropenia, a low count of the infection-fighting white blood cells called neutrophils; five patients with neutropenia had fevers; three patients became anemic; and two patients developed thrombocytopenia, a lowered count of blood-clotting platelets. Other side effects included diarrhea (three patients), fatigue (two patients) and dehydration (two patients). There was one death during the study, possibly resulting from febrile neutropenia caused by the treatment.” The word “safe” is relative when discussing chemotherapy treatment, but when most readers see something described as “safe” they assume that means it won’t harm them. For that reason, it’s a stretch to apply the word “safe” to any treatment in which a sample size of 22 patients is associated with this many adverse outcomes, and may have contributed to a death. Claim: Experimental drug guadecitabine found safe in patients with colorectal cancer

The news release discusses the findings of a small study that was designed to assess the safety of the experimental drug guadecitabine for use in conjunction with the conventional drug irinotecan to treat metastatic colorectal cancer. Phase 1 studies are designed to evaluate safety, observe side effects and identify the maximum tolerated dose (MTD). As such, the toxicity profile would be expected to be rather high. The study found that guadecitabine did cause some adverse side effects. The most concerning being low white blood cell count (neutropenia) in 73% of the subjects. One subject died from infection related to the low white blood cell count. However, the study also reported that there were positive effects with some patients — although the release clearly notes that this study was not designed to assess beneficial outcomes. Calling the drug “safe” in the headline may be a bit of a stretch, but otherwise the release does a good job of explaining the study, describing the fact that the drug is in the earliest stages of clinical testing, potential harms, and the study’s ties to the company that manufactures guadecitabine. According to the National Cancer Institute, colorectal cancer is the third most common type of cancer in the United States for both men and women. And while 5-year survival statistics are good for colorectal cancer patients who are diagnosed while the cancer is still localized (90.1 percent), the 5-year survival rate drops to 13.5 percent for patients whose colorectal cancer has metastasized. The development of new treatment options for patients with metastatic colorectal cancer is worth covering. However, this early trial is small, and so preliminary, that one wonders about the potential value. Presumably the ongoing phase II trial mentioned in the release will shed more substantial light on the potential benefits associated with the guadecitabine-irinotecan combination. Perhaps a news release would be more fitting once those results are in.