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.

Input: Consider Input: Paragraph: The jury in a Philadelphia court awarded the $8 billion to a man who previously won $680,000 over his claims that it failed to warn that young men using Risperdal could grow breasts. J&J called the sum “grossly disproportionate with the initial compensatory award” and said it was confident it would be overturned. Legal experts agreed that the penalty was likely to be slashed. But the verdict, which helped drive J&J’s shares down 2% on Wednesday, is an example of how public outrage at the pharmaceutical industry for high drug prices has contributed to harsher verdicts against drugmakers accused of wrongdoing in recent years, legal experts said. Outsized penalties awarded by some juries highlight risks in a longstanding strategy by drugmakers such as J&J of taking their chances at trial rather then settle product liability lawsuits brought by patients. “Every pharmaceutical company needs to seriously consider if they want to litigate to verdict in the present environment, but with the settlement demands so incredibly high it’s not always clear what their alternative is,” said Barry Thompson, a partner at Baker McKenzie law firm who was not involved in the case. Drugmakers often prefer to litigate rather than settle in hopes of protecting their brands and discouraging future patient lawsuits, Thompson said. Companies also may use a series of early trial verdicts to gauge the size of any settlement it might eventually offer, as Merck & Co (MRK.N) did with its withdrawn Vioxx arthritis pain drug when facing thousands of lawsuits by patients who claimed harm from the drug. A 2003 U.S. Supreme Court decision suggests that the upper limit of a fair punitive penalty in the Risperdal case would be about $6 million based on the earlier compensatory award. J&J could still get a favorable ruling on appeal that would give the company leverage in dealing with the remaining cases, said Benjamin McMichael, a professor at the Alabama School of Law who has researched punitive damage awards. “With such a large punitive damages award at issue, appellate courts may be more willing to come down hard on the plaintiffs,” McMichael said. J&J faces more than 13,000 lawsuits tied to Risperdal alleging that it caused a condition called gynecomastia in boys, in which breast tissue becomes enlarged. The company is also facing lawsuits involving its baby powder, opioids, medical devices and other products. “We’re operating within a very litigious environment, and we must at times be willing to go to trial when the science, facts and law are on our side,” J&J spokesman Ernie Knewitz said in an email. “We also have to remain open to resolving cases through settlement when and where that’s appropriate to do. We have a proven track record of being able to successfully and appropriately manage this balance,” Knewitz added. The company has had its share of legal wins, losses and settlements. An Oklahoma judge in August ordered J&J to pay $572.1 million to that state for its part in fueling the opioid crisis by deceptively marketing addictive painkillers, although the sum was substantially less than investors had expected. Johnson & Johnson has said it plans to appeal the ruling. Earlier this month, the company agreed to pay $20.4 million to settle claims by two Ohio counties, avoiding a federal opioid trial. In 2013, J&J paid more than $2.2 billion to resolve civil and criminal investigations by the U.S. Department of Justice into its marketing of Risperdal and other drugs. Claim: Massive jury award against J&J highlights risks of its legal strategy.

Output: A jury award that hit Johnson & Johnson (JNJ.N) with $8 billion in punitive damages for a case involving its anti-psychotic drug Risperdal highlights the risks of the drugmaker’s all-or-nothing legal strategy, several legal experts told Reuters on Wednesday.


Input: Consider Input: Paragraph: The story focused on costs, including information about the relative cost comparison between what are called “open” surgeries and those done laparoscopically (with a thin flexible tube.) The release summarized how minimally invasive techniques reduced the length of hospital stay and complication rates for patients. “Researchers also found that, on average, the minimally invasive approach reduced length of hospital stay by approximately two days, and open operations were more than $9,000 more expensive than minimally invasive procedures. The researchers also found that laparoscopic procedures were better for patients in terms of fewer complications. Laparoscopic anti-reflux operations were less likely to result in postoperative blood clots, wound complications, surgical site infection, esophageal perforation (which can be life threatening), bleeding, cardiac failure, and death.” We rate this, but just barely, for citing cost differences between the two types of surgery and the average reduction in the number of days a patient must remain hospitalized. We do wish the release had delved more into the specifics of reduced complications. How common were the surgical complications in each surgical method? The release names complications associated with both types of surgery for GERD, while stating that patients undergoing laparoscopic procedures encountered fewer of them: “postoperative blood clots, wound complications, surgical site infection, esophageal perforation (which can be life threatening), bleeding, cardiac failure, and death.” The news release gave details about how the study examined records of about 75,000 patients from 1,000 hospitals to compare outcomes in the records for open vs. the minimally invasive laparoscopic surgeries. That’s all to the good. However, the news release didn’t mention any of the study’s limitations. The key one is that this is a retrospective, observational review of records that isn’t capable of supporting cause and effect statements such as the minimally invasive approach “reduced length of hospital stay by approximately two days.” Nor should this kind of evidence be used as the basis for statements such as laparoscopic procedures “were better for patients” and “should be the standard of care.” Patients receiving open vs. laparascopic procedures could differ in unknown ways, which is why the superiority of one approach over the other should ideally be established by a prospective, randomized controlled trial. There were other limitations outlined in the journal article that were not mentioned in the release. Because the NIS database doesn’t link to hospital records, researchers weren’t able to track and measure outcomes “including complications, readmission, and mortality, occurring after the initial hospital discharge.” The researchers were also unable to determine which open surgeries were “re-dos” of previous surgeries. The potential for errors in coding which procedures were used was also cited as a possible limitation. There was no disease mongering. The release also provided useful context on the prevalence of GERD and further specified that smaller group of patients, from the many heartburn suffers, might be candidates for the surgery. Well done. The release does not list any funding source for the research and the published study notes that authors had “nothing to disclose.”  We’ll rate this not applicable since this is an examination of existing data, and there may have been no additional outside funding. The news release does a good job here. It compares different surgical methods and it also names alternatives for treating GERD such as medications and changes in the diet. It also states which group of patients the surgery is aimed at: “Anti-reflux surgery should be considered in patients who do not achieve complete control of their symptoms [regurgitation or cough] with medications; who do not want to take medications for the rest of their lives; or who experience complications of medical therapy.” It’s clear from the release that both methods of surgery have been widely available nationally and the outcomes of 75,000 surgeries were tracked by the National Inpatient Sample (NIS) database. The release also notes that “urban academic or teaching hospitals” perform laparoscopic anti-reflux surgery more often than “open” procedures, 54.4 percent versus 45.6 percent. And it recommends that anti-reflux surgery should be performed laparoscopically in specialized centers. The news release was not about a novel procedure and made no claim of novelty. However, this isn’t the first study to examine laparoscopic vs. open surgery. For example, the British Journal of Surgery published results of a randomized trial of the two methods and the Scandinavian Journal of Gastroenterology published research on long-term outcomes following laparoscopic and open procedures for GERD. We did not observe any unjustifiable language. Claim: Laparoscopic anti-reflux operation for GERD linked to fewer postoperative complications

Output: A new study by the American College of Surgeons, a professional organization, compared records for 75,000 patients who underwent surgery for GERD, or gastrointestinal esophageal reflux disease. The study looked at two different surgical procedures and found the less invasive one seemed equally effective, but kept patients in the hospital a shorter time with fewer complications. The news release did a good job of discussing surgical alternatives and costs, which were estimated to be $9,000 lower for the less invasive laparoscopic procedure. The release would have been better had it spelled out some of the study limitations, the key one being that a retrospective, observational review of hospital records — as this study was — isn’t capable of supporting the cause and effect statements sprinkled throughout the release. Millions of Americans complain of occasional heartburn, sometimes called a burning sensation in the throat from food coming back up from the stomach. But some estimates are that about 20 percent of US adults fit the definition of GERD, which means they suffer symptoms at least every week. If patients consider a surgical fix, this study shows that a less-invasive procedure could reduce their complications and shorten their hospital stay. It’s hard to pin down stats on GERD prevalence. A 2014 review of 16 epidemiological studies of GERD prevalence published in the journal Gut suggest GERD prevalence ranges from “18.1%-27.8% in North America, 8.8%-25.9% in Europe, 2.5%-7.8% in East Asia, 8.7%-33.1% in the Middle East, 11.6% in Australia and 23.0% in South America.”


Input: Consider Input: Paragraph: About 25 students are enrolled in the new pre-veterinary science program at the Tuscaloosa Career & Technology Academy, The Tuscaloosa News reported . As part of the program, the school has acquired six sheep that will be kept on campus. The first sheep brought to the school was 5-month-old Betsy, who came from a farm in Jefferson County. Last week, several people got to know Betsy when she wandered into the school’s conference hall. Agriscience instructor Carl Hughes had taught a veterinary program at the school that did not involve live animals, and interest in the program grew over the years, The Tuscaloosa newspaper reported. “From there, we decided to put together a pre-vet program,” he said. The biggest change is having the sheep as part of the program. “We wanted to have live specimens to care for and deal with,” he said. The school “is all about hands-on experience, and we thought that was a good way to get that experience,” he added. Hughes decided on sheep for this year’s focus because of their docile nature and the way they are fairly easy to handle, compared with other animals. “Students will explore pets and disease management for animals, as well as explore the different breeds of animals, such as livestock and exotic pets,” he said. “We will begin learn how to check the vital signs for animals and learn about treatment of diseases.” The school is also working with veterinary instructors from Tuskegee University and Auburn University to help the program, perhaps by coming into class to teach and offer their expertise to students. ___ Information from: The Tuscaloosa News, http://www.tuscaloosanews.com Claim: Ewe now have sheep in new program at Tuscaloosa school.


Output: A Tuscaloosa school is welcoming several animals onto its campus this year as it launches a program for students interested in veterinary medicine.