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.

[Q]: 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
[A]: This story describes a recently FDA-approved device to treat essential tremor in patients who have not responded to medication. The ExAblate Neuro, made by Dallas-based InSightec, uses magnetic resonance images taken during the procedure to deliver focused ultrasound that destroys tissue in the thalamus, the part of the brain where tremors are believed to originate. Results of a randomized clinical trial on the device’s safety and efficacy were published this month in the New England Journal of Medicine. The story and accompanying video (seen at right) vividly illustrate rapid symptom improvements, highlighting a 72-year-old woman who says the procedure changed her life by allowing her to “eat like a normal person” and easily perform basic tasks such as signing her name and folding a scarf. This powerful patient anecdote throws the balance off: Imagine how different the story would seem if the video instead showed a patient who had improved, but also was affected by one of the serious adverse effects caused by the treatment. Also, the story needed specific numbers on the measured benefits and harms, along with a discussion of costs and alternative treatment options. Note: We also reviewed the news release that was issued to journalists about this study. While not life threatening, essential tremor can be debilitating, especially affecting people in their advanced years. The ExAblate Neuro, which the FDA calls the first focused ultrasound device to treat essential tremor in patients who have not responded to medication, offers a somewhat less invasive treatment option than traditional surgical approaches. It’s certainly newsworthy. But all of the facts, including long-term efficacy data, are not in. Stories that feature glowing patient anecdotes and positive physician commentary need to be balanced with plenty of data that can help patients and their families decide whether this treatment might be worth seeking out.


[Q]: Paragraph: On Sunday, China’s ambassador to the United States, Cui Tiankai, said in a New York Times opinion piece there had been “unpleasant talk” between the two countries about the virus but that now was the time for “solidarity, collaboration and mutual support.”  “If Ambassador Cui is saying that China is willing to cooperate with the U.S., we would appreciate the opportunity to work directly with their Virology labs in Wuhan to share whatever research they have, since they’ve known about it and have been fighting it for at least a month longer than our scientists here in the U.S.,” the official said. The comments come a day before Wuhan, the Chinese city where the outbreak originated late last year, was poised to lift its lockdown after reporting only two new infections in the past fortnight. “Since the pandemic originated in Wuhan, we think cooperation with PRC medical and disease experts there is critical to saving lives globally,” the administration official added. Claim: U.S. official urges China to allow direct work with Wuhan labs on coronavirus.
[A]: A senior Trump administration official urged China on Tuesday to allow the United States to work directly with laboratories in Wuhan on research into the novel coronavirus, saying this was critical to saving lives globally.


[Q]: Paragraph: Deals being negotiated between drugmakers and the insurers who buy medicines now sometimes include extra rebates — or even full refunds — if drugs don’t help patients as expected. It’s part of an effort driven by insurers and government health programs to align the cost of care with the quality of care, and slow the relentless growth of prescription drug costs. “We’re spending less money on drugs that are less effective,” said Dr. Michael Sherman, chief medical officer for the not-for-profit insurer Harvard Pilgrim, which has several of these deals and is negotiating more. Sherman says one-fourth of every dollar it spends on patient care goes to prescription drugs. For the patient, it doesn’t mean a check in the mail if cancer comes back after a round of treatment. But it does mean patients could get a drug that an insurer might otherwise be unwilling to pay for and that might help them. And insurers, who now can track how patients fare through electronic medical records, will be reducing wasteful spending and making at least a dent in overall health care costs. “It’s going to be part of the solution” to soaring drug prices, predicts Roger Longman, CEO of Real Endpoints, an analytics company that assesses the value of medicines for drugmakers, insurers and other clients. Many new drugs now top $100,000 per year or course of treatment, even though their benefits are unclear or only marginally better than cheaper, older drugs. Buyers of those new drugs, usually insurance companies, are hesitant to pay without assurance the drugs will help patients. Not only is that bad for patients, it makes insurers spend even more on complications and hospital stays if the drugs don’t work. As a result, insurers often restrict access to expensive new drugs. Sometimes that’s achieved by making patients pay more out of their own pockets, or making doctors wade through red tape to get authorization for a patient’s medicine. Sometimes patients have to try cheaper drugs first, and only when they fail — and the patients’ health has deteriorated — are they allowed to get the pricey new drug. Pharmaceutical companies have an incentive here, too: These deals may help them sell more of the new drug they’ve spent hundreds of millions of dollars or more developing. For example, a new generation of injected cholesterol drugs does an impressive job of reducing so-called bad cholesterol. But the drugs, Amgen’s Repatha and Sanofi’s Praluent, cost $14,000 a year, while cheap generic pills do a good job of lowering cholesterol for most people for $300 a year or less. Predictably, insurers often reject prescriptions for these drugs. So Amgen, trying to boost disappointing sales for a drug expected to be a huge seller, is offering full refunds to insurers if patients have a heart attack or stroke while taking its drug. On Tuesday, Amgen announced its first deal to do so, with Harvard Pilgrim. Sanofi has a contract with insurer Cigna to pay extra rebates if patient cholesterol doesn’t fall as much as expected. “It demonstrates the fact that we are standing behind the value the product has, and we’re willing to put some money behind it,” said James Borneman, Sanofi’s head of strategic pricing. Some insurers are now demanding these deals, which are expected to become standard for some drugs: super-expensive medicines for cancer and rare diseases, and others that are used widely enough to cost insurers millions. In addition, the drugs must have a benefit that’s easy to measure, such as keeping kids with asthma out of the emergency room or preventing growth of cancerous tumors for a certain period. Cigna has been pursuing more of these types of deals after finding that some of its earlier efforts “met or exceeded expectations in terms of benefit to our customers, patients,” said Chris Bradbury, who heads Cigna’s prescription benefit program. One of its early deals, with drugmaker Merck for its diabetes pills Januvia and Janumet, dates to 2009, with rebates pegged to how much patients lower blood sugar. “We keep re-signing that agreement, so I think they’re pretty satisfied,” said Bob McMahon, head of U.S. marketing at Merck, which also has such contracts with insurers and hospital systems covering an asthma medicine and is negotiating contracts for an infection drug. Other companies with such deals for one or more medicines include drugmakers Eli Lilly, Johnson & Johnson, Novartis, Novo Nordisk and Roche’s Genentech unit; insurers Aetna and Priority Health, and prescription benefit manager Express Scripts. On their own, these deals are unlikely to reverse the persistent rise in medical spending, experts say. But they improve the chance that the money will at least go to treatments that work best — by making sure insurers and drug companies have something at stake along with the patient. “There’s a risk on both sides with these contracts,” said Dr. Mark Fendrick, director of the University of Michigan’s Center for Value-Based Insurance Design. “Both want to make sure they’ll get the outcome they want.” ___ Follow Linda A. Johnson at https://twitter.com/LindaJ_onPharma . Claim: New deals for drugs: No heart attack or your money back.
[A]:
Warranties and money-back guarantees, long used to entice buyers of products like hand tools and kitchen gadgets, are now being used to sell something more crucial: pricey new-generation drugs for diseases like rheumatoid arthritis and cancer.