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: The article does a good job of noting the cost of the combing salons, as well as cost of the medicinal shampoos and other drug treatments, specifically noting also that insurance may not cover the costs. The article cites data from a recent review article in a medical journal that outlines the effectiveness (or lack thereof) of the medicinal treatments. “The medications have been found to be from 68% to 87% effective after one or two applications. Most don’t require combing,” the story says. We do wish they story explained what “67% effective” means for a typical person, however. The careful reader will note that the evidence for the effectiveness of the featured combing salons is mostly anecdotal, and it would have greatly strengthened the article to have been more explicit about this, as well as including more solid proof that standard lice medications are not as effective as they used to be. The article notes that various organizations and experts consider the chemical/medicinal treatments to be highly safe as well as effective. The story needed to be more explicit about the quality of evidence for each of the treatment options mentioned–combing, going to a delousing salon, over-the-counter treatments, prescription treatments. Only the latter are mentioned in the context of research. The story references a review article that compares the different approaches, but it provides no details on what kind of evidence the review is based on. No disease mongering here, and we were glad the story pointed out that there are no adverse physical health effects from lice. The article does a very good job of noting the conflicts of interest of those quoted. The story explored alternatives. Good job on this. It’s clear that businesses that assist with combing are easy to find, and over-the-counter shampoos are even easier. What appears to be “new” is the explosion of combing salons and newer prescription shampoos, as well as the review article published last week that evaluates them. This story doesn’t appear to rely on a news release. Claim: New Ways to Fight Super Lice
The treatment of childhood cases of head lice infestations is a popular news media perennial at the start of the school year, and this Wall Street Journal story falls into that category. It covers the usual elements — prevalence of the infestations among school age children, over-the-counter and prescription treatments, home remedies (which generally don’t work) and reassurance about the pesky but essentially benign health impact. This story also takes a look at the rise of “lice-combing” salons and newer medications meant to stand in when older medications are ineffective. We were impressed by the depth of the sourcing, along with the details that helped readers assess any potential conflicts of interest among said sources. One thing we wished had been more detailed: How the evidence stacks up for each of the treatments. As the article itself makes clear, head lice infestation is a widespread, unpleasant, and disruptive — albeit relatively benign — condition that costs millions of families money, aggravation and time in efforts to prevent and treat. Adding to the nuisance of ridding scalps, tresses, clothing and home furnishings of the pests, some of the historic over-the-counter medicinal treatments have lost their power owing to drug-resistant mutations in the lice. Newer prescription medicines are effective, but worry an apparently growing number of parents who work hard to avoid what they consider unnecessary chemical exposure. Thus, parents are certain to be looking for the best and latest information about treatments.

Paragraph: The release makes no mention of the cost of the drug in question, Tenofovir. A web search found that the cost for a month’s supply of the antiviral drug averages just over $1,000. For some patients, that cost may be prohibitive. The cost is an issue of particular concern for developing countries, but it is also true that the price may be much lower for them than in the United States. Many pharmaceutical companies offer their drugs at steeply discounted rates in poorer countries to expand access to life-saving medicines. The release clearly says that 68 percent of women receiving the drug reduced their viral load while only 2 percent of the women in the control group had that success. It also says that the transmission of hepatitis B from mother to newborn dropped from 18 percent to 5 percent, an important clinical outcome. The release includes a discussion of harms. It states that “tenofovir was well tolerated; only one participant treated with tenofovir voluntarily withdrew from the study due to nausea.”  It also says that researchers “found no significant differences between the tenofovir-treated group and the control group with regard to fetal development and infant growth.”  Lastly, it calls for longer term, observational studies to confirm the safety of fetal exposure to tenofovir treatment. The release provides a good overview of the randomized, placebo-controlled trial which was undertaken to gauge the efficacy of the drug in both reducing the viral load of hepatitis-B-positive mothers and reducing the rate of transmission of the disease from mother to newborn. It offers solid, numerical evidence of both outcomes. It describes the number of patients (200 pregnant women), defined what constituted a “high” viral load, and described the approximate length of treatment. It did omit a mention of whether the trial was blinded. This release does not commit disease mongering. The release notes that the research is funded by Gilead Sciences. It should also have mentioned that a corresponding author disclosed speaking and advising fees from Gilead, according to the published study. The release is comparing the use of an antiviral drug given to pregnant women versus the normal procedure of giving both a vaccine and immune globulin. The release doesn’t mention that tenofovir (marketed as Viread), the drug being tested, is already an FDA approved drug so many readers may not know that it’s available. It was approved by the FDA in 2001 for HIV and in 2008 for chronic hepatitis B. The release just barely implies novelty with this statement which suggests a change in treating infected women who are pregnant: “Based on the findings, the investigators recommend that women be tested for HBV viral load at week 28 of pregnancy. Those with a high viral load should receive tenofovir treatment starting at gestational week 30 until delivery to reduce the risk of transmission to their infants.” While the drug itself isn’t novel, positive outcomes from a controlled trial on pregnant women carrying the virus does seem to introduce a new treatment approach. This release does not use any unjustifiable language. Claim: Antiviral Treatment During Pregnancy Reduces Mother-to-Child Transmission of Hepatitis B
This news release describes a clinical trial testing whether an antiviral drug given to pregnant women in their third trimester reduces their hepatitis B viral load. The study also examined whether the drug limits the transmission of the virus from mother to baby. The answers to both questions are yes, suggesting a new strategy for dealing with the spread of this disease. The release does a good job describing harms, quantifying benefits and describing the study protocol. Because the cost of hepatitis drugs has been widely debated for the past few years, a mention of the drug’s cost would have made the release stronger. Almost 240 million people are infected with hepatitis B virus and about 780,000 die each year from the disease, according to the World Health Organization. The hepatitis B virus infects the liver and while many recover with treatment, it can become a chronic infection. Babies and young children infected with the virus are more likely to develop chronic hepatitis B. If administering a drug to infected mothers reduces the proportion of newborns getting the disease, it would be a considerable improvement in public health.

Paragraph: The story does not talk about costs, which was disappointing. The costs of intensive medical therapy can easily be identified. Using an online pharmacy we calculated the costs to be about $1,500 to $2,000 annually for medical therapy, using generic drugs. Using the Health Care Blue Book, we found the average cost of coronary artery bypass sugery and hospitalization to be about $62,000. We think that this is important information for readers that should have been included. The quantification here was presented in such a way to make it clear to readers that there was no significant benefit found to surgical intervention, which is a fair conclusion to draw from the study. The story says, “In the Stich study, 41% of patients assigned to treatment with drugs alone died during the follow-up period, which averaged five years. That compared with a mortality rate of 36% among patients who received bypass surgery plus medication. Although the relative reduction in risk of death was 14%, the result didn’t meet tests for statistical significance, meaning it could have resulted from chance alone.” That’s a great way to describe the lack of statistical significance. It would have been even more powerful to show readers the actual number of patients who died in each group. The story provides great information about the study itself and about the overall state of the evidence supporting heart surgery. “How best to treat these patients has been fraught with uncertainty,” is one of the more notable phrases from the story. It also says, “Many patients aren’t evaluated for heart surgery to treat diseased arteries because they don’t suffer classic chest pain or because doctors worry that hearts weakened by heart failure won’t benefit from the procedure. Other doctors recommend immediate bypass surgery despite a lack of vigorous studies to support that strategy.” The story does not engage in disease-mongering and takes a very careful approach to describing the types of patients who would be affected by this study’s results. We also like the way they provided snapshots of patients who were in both arms of the study — surgery and non-surgery — at the end of the story, making it clear, as the study did, that both routes can be equally successful. The story brings in some strong independent voices who help make sense of this complicated study: James Fang, a cardiologist at University Hospitals Case Medical Center in Cleveland, who wrote an editorial accompanying the study, Raymond Gibbons, a cardiologist at the Mayo Clinic, and Clyde Yancy, chief of cardiology at Northwestern University’s Feinberg School of Medicine. Rarely do you see a story that spends as much time with independent experts as it does with the authors of the study. The story does a great job showing how the standard interventions for heart disease stacked up against each other in this study. We wish that some mention had been made of diet and exercise and that at least a sentence had been included about whether there might be differences in outcomes seen as a result of different medication patterns. The story doesn’t make it clear what exactly the patients were taking. The story makes it clear that the range of treatments studied by the authors are widely available. The story makes it clear that there is a great need for more evidence in this field and that this study will be surprising to many clinicians because of a long-held assumption that surgery is the superior option. tudies published in the early 1990s supported the view that bypass surgery provided a better long term outcome. The story does not rely on a news release. Claim: More Options Before Bypass Surgery, Study Finds

The piece gave readers some powerful information to help them sort through the range of factors that should be considered for any medical intervention. The only weakness our reviewers found with the story is the lack of comment about cost. Too often stories present medical options as false choices of best versus worst. They don’t take into consideration the very real differences between patients’ medical histories, diagnoses and expectations. This story should be applauded for giving readers a clear understanding of the complexities of shared decision-making between providers and patients. As noted by one of the experts quoted in the story, “You don’t have a good therapy and a bad therapy, you have a choice.” This is a message that the story gets across very well and is an important one for readers.