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Given a paragraph and a claim, classify it this way: If the claim contradicts the evidence present in the paragraph, classify the claim as '0'. If the claim has multiple supporting *AND* contradicting evidences, classify the claim as '1'. If the claim has supporting evidence and the paragraph is in overall favor of the claim, then classify the claim as '2'.
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Paragraph: The story does not mention the costs of screening or follow-up tests or treatment to the individual or, collectively, to society. Those costs are significant. This story uses several different statistics and expert perspectives to explain what the researchers found in their examination of the effects of mammography screening. It not only include the relative risk reduction (10 percent) and an absolute risk reduction statistic (among women in their 50s, a decade of screening would boost the likelihood of avoiding a fatal breast cancer from 995.6 out of 1,000 to 996 out of 1,000), but it also offered comments from different experts about how they would personally value effects of that size. The story notes that screening mammography exposes women to false alarms scares as well as the risks and harms of treating tumors that actually would not have become life-threatening. This story explains how this study is different from earlier research on mammography. It points out both advantages of the study methods (comparing women in regions with screening to those without as Norway rolled out a national program over a 9 year period) and limitations (an observational study like this is not as powerful as a randomized trial, and the study might have found more benefits to screening if it had lasted longer). The story also noted the uncertainty in the numbers the researchers reported and that the real differences might be different. The story does not exaggerate the risk of breast cancer or the need to be screened for it. The story includes comments from several independent sources offering a variety of perspectives. It does not mention that the study was funded by the Cancer Registry of Norway and the Research Council of Norway. The story notes that improved treatments appear to have reduced the breast cancer death rate even among women who did not have regular screening mammograms. Not being screened was clearly acknowledged as an alternative, something not all competing stories explicitly addressed. The availability of mammography screening is not at issue. This story does point out that the women who were screened in Norway had access to special treatment teams. And it noted that these treatments are available at "many major medical centers in the United States." Mammography is not new, but this story does a good job of explaining what is new about the way these researchers examined the effects of screening. The story includes comments from several sources and does not appear to rely on a news release. Claim: Mammograms' Value in Cancer Fight at Issue
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2

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Paragraph: "The story does not note the cost of a typical statin regimen, Zetia or the combination treatment, Vytorin. This is an important oversight as many people who are prescribed these medications take them for life. The story does mention that these new drugs ""raked in 5 billion dollars last year"". The failure of the combination product to be better than simvastatin alone has significant financial implications. Simvastatin (the generic name for Merck's Zocor) is available for about $1.25 a day. Vytorin costs about $3.35 a day. Most clinicians assumed that the combined product was an advantage if you could not get a patient to an LDL goal with just the statin alone or side effects with the simvastatin prevented an adequate dose. The price for the combination is less than the cost of the components. The story provides no quantitative data and no information on the number needed to treat to show benefit (i.e. prevention of a heart attack or stroke through lowered LDLs) in one patient with the newer medications, with traditional statins or with combination treatment. The story says that there are no real dangers to continuing the drugs Zetia and Vytorin based on the lower drop-out rate and reported side effects in the study. The comments from both parties cast an extraordinarily negative shadow on the study drug and on the company sponsors. Without an appropriate description of the study design, the results cannot be fairly discussed to the public. While the primary endpoint was not obtained with the combination, it did lower LDL and inflammatory markers in excess of that achieved with simvastatin alone. Suggesting the drug did not ""work"" is a bit of a mis-statement. The story encourages patients to keep taking these drugs. The story also does not mention the potential harm of taking statins long-term, especially in high does. Some of these harms are very rare, however, they include: muscle pain and kidney or liver problems. The story provides no real discussion of the data presented at the American College of Cardiology meeting and published in the peer-reviewed New England Journal of Medicine. And the story didn't assess the quality of the evidence. The study followed people (average age mid-40s) who had an inherited condition (called familial hypercholesterolemia) that is associated with very high cholesterol levels and greatly increased risk of early coronary artery disease. Many of them had been taking statins and other cholesterol-lowering medicines for years. All were randomly assigned to take either a statin (simvastatin, trade name Zocor) alone or a statin combined with another cholesterol-lowering medication, ezetimibe. The study was designed to find out if the combination of the two drugs could slow the growth of plaque in carotid arteries supplying the brain more than the statin alone. Plaque in these arteries is associated with an increased risk of stroke and heart attack. The two drugs together were more effective at lowering cholesterol than simvastatin alone, but adding ezetimibe did not change plaque measurements in the carotid arteries. The story does mention that lowering cholesterol may have other benefits, but we are not sure how those translate to fewer cardiovascular events or increased survival from these events. No overt disease-mongering. There are no interviews with the study authors or with practicing clinicians. The story reported on data presented at a recent American College of Cardiology Meeting, so there were several thousand cardiologists and other specialists available who could have been interviewed for clinical perspective on the results of this study. There was also no mention of the two accompanying editorials in the NEJM. The editorial by Brown and Tayor nicely identifies the issues related to the study and helps put the results into perspective. Unfortunately, this editorial was ignored by both parties involved in the story. Stating that taking more statins is the answer is incomplete at best. Lifestyle changes along with other drugs may be options as well. Interestingly however, this study raises questions about the simple notion that lowering total cholesterol, and LDL are important to lowering cardiovascular risk. People who are not able to lower their cholesterol enough with statins alone (or cannot tolerate the dose of statins needed to lower it) may wish to discuss with their doctor whether other medications (i.e., rather than ezetimibe) may be appropriate. These include niacin, fibrates, and bile acid resins. When added to statins, they can effectively lower cardiovascular risk. It's clear from the story that the drugs in question are still available to patients, though they should not be considered first-line therapy. The story focuses on new information that there is little to no benefit of newer cholestrol-lowering medications on the prevention of arterial plaque, which translate to little benefit for prevention of heart disease, stroke and cardiovascular-related death. We can't be sure if the story relied solely or largely on a news release. No researcher or cardiologist is interviewed. Quantified data from the American College of Cardiology presentation or from the New England Journal of Medicine article are not directly cited." Claim: Poor test results for heart drugs
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0

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Paragraph: "Health insurance has emerged as a defining issue in the Georgia Senate race, and Republican incumbent Sen. David Perdue declared that there is one angle where he can't be attacked. ""I've always believed in protections for Americans with preexisting conditions. Period,"" Perdue tweeted Aug. 18. ""Anyone who says otherwise just isn't telling the truth."" The campaign ad attached to the tweet adds, ""Health insurance should always cover preexisting conditions. For anyone. Period."" That is a sweeping policy guaranteed coverage for anyone, with no penalty for a preexisting condition. If that's Perdue's position now, it doesn't jibe with his record as a lawmaker. He's voted to repeal the Affordable Care Act Obamacare and a bill he cosponsored to guarantee coverage fails to match the ironclad protections under that law. Perdue makes no bones about opposing the ACA, which contains several interlocking provisions that protect people with preexisting conditions. He voted to repeal it in 2015 and backed the Senate's failed repeal-and-replace effort in 2017. Perdue's campaign said that it's possible to be against Obamacare, and in favor of patient protections. It said, ""Perdue co-sponsored legislation to ensure preexisting conditions are covered at no additional cost to those patients."" That bill, called the Protect Act, never came to a vote in the Senate and doesn't match the ACA's guarantees. The current law blocks insurers from using any eligibility rule, list of covered services or pricing to deny anyone coverage. The Protect Act does say that insurance companies can't deny coverage based on ""any preexisting condition."" But it gives a carrier the option to deny certain coverage, if ""it will not have the capacity to deliver services adequately."" Since the bill doesn't define what that clause means, it leaves open the possibility that carriers could use it to drop coverage of certain expensive diseases from all of their policies. To Allison Hoffman, a law professor at the University of Pennsylvania, that's a big loophole. ""Insurers could exclude someone's preexisting conditions from coverage, even if they offered her a policy,"" Hoffman told us in 2018 when the bill was first introduced. ""That fact alone sinks any claims that this law offers preexisting condition protection."" Rodney Whitlock, a health policy expert who worked for Republicans in Congress, told us concerns about loopholes are reasonable. ""Insurers will use the rules available to them to take in more in premiums than they pay out in claims,"" Whitlock said in 2018. ""If you see a loophole and think insurers will use it, that's probably true."" Hoffman notes that the Protect Act's language against insurers discriminating based on genetic information also concerns her. The bill says carriers ""shall not request, require, or purchase genetic information with respect to any individual prior to such individual's enrollment."" But the bill says information collected incidentally can be used by insurers. That could happen, for example, when an employee inadvertently reveals details on a questionnaire, despite being told not to include information that can be linked back to their DNA. Insurers can't use that information for setting premiums, but Hoffman says it could shape the list of covered maladies. ""If an insurer comes across genetic information incidentally, it seems to me that they could exclude any related conditions,"" Hoffman warned. ""This loophole could be huge considering the amount of incidental collection and how broadly it is construed."" The bill has other holes: for instance, permitting insurers to charge women more than men. Perdue's stance on short-term health insurance plans also raises issues. These plans offer limited coverage that's intended to tide people over when they're between jobs. They don't need to follow the strict rules of the ACA. They don't have to cover the package of essential benefits under the law and they can exclude coverage for preexisting conditions. Under the ACA, they were limited to 90 days' coverage. The Trump administration extended that to 364 days, with the option to renew them for up to three years. Perdue voted against a 2018 resolution to oppose Trump's expansion of short-term plans. The measure failed by one vote. The Perdue campaign said that Obamacare isn't the only way to take care of people. ""The best way to protect those with preexisting conditions, lower costs for all Georgians, and expand access to coverage is through free market solutions,"" the campaign said in a statement. The campaign noted that many counties have only one insurance company offering coverage. It argues that if more companies found it profitable to move into those areas, competition would improve the options for consumers. Perdue said that his policy is that ""health insurance should always cover preexisting conditions. For anyone. Period."" Perdue opposes the Affordable Care Act and weighed in on the side of short-term health plans that lack some of the ACA's strong protections for people with preexisting conditions. Perdue's bill to maintain those protections contains loopholes that insurance companies could use to avoid covering certain conditions. Perdue's promise is sweeping and absolute. The policies he has backed offer some limited protections, but don't match that promise." Claim: David Perdue Says his policy is that "health insurance should always cover preexisting conditions. For anyone. Period."
answer:
0