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'.
One example: Paragraph: While the financial costs of screening mammography&!1-positive recalls&biopsies were not included in the study,readers would benefit from being reminded that recall mammography&biopsies increase patient financial costs.This article leads with valuable information for all women over age 40 by stating "Getting screening mammograms every two years instead of annually reduces the chance of a!1 alarm,a new study shows." Unfortunately the writer doesn't quantify or elaborate adequately on that reduction.Instead,the writer later focuses on how women undergoing screening mammography shouldn't be anxious if they experience a recall because over half of women who have screening mammograms for 10 years will be recalled.Readers would have been better served if the writer had emphasized the significant reduction in both recall mammograms&!1-positive biopsies in women who are screened every two years rather than annually.Part of the continuing controversy over screening mammography focuses on annual versus biennial screening.Because this study showed a significant reduction in the percentage of those recalled&needing biopsies among women who are screened every other year,with no statistically significant increase in late-stage diagnosis of breast cancer,the article should have emphasized those important findings.The piece states that the researchers noted that "!1 positive recalls may cause inconvenience&anxiety and biopsies can cause pain and scarring." This article fails to include several important facts about the study.1)This is a prospective cohort study of women screened between 1994-2006.2)Most of the mammograms were film rather than digital.3)Few women underwent screening for the entire 10 year period.4)Screening mammography recall rates are influenced by the skill of the radiologists who read the mammograms.There was no disease mongering.No independent experts were quoted.The story did an adequate job comparing at a very high level annual screening versus biennial screening.Screening mammography is widely available throughout the United States.The study did not examine a new procedure.There's no evidence that the story relied solely on a news release.
Claim: Annual Mammograms May Have More False-Positives
Solution is here: 1
Explanation: This article reports on the results of a study of nearly 170,0 women who had screening mammograms beginning between age 40-59.The study found that over ten years of screening mammograms,over half of the women will experience a!1-positive recall for additional mammography.In addition,7%-9%of the women will have a biopsy for a suspicious lump which is not cancerous.Both of those percentages decrease if the woman is screened every other year rather than every year.Even with biennial mammography,41%of women will experience a recall over 10 years of mammography.The study's Principal Investigator emphasized that "in most cases,a recall doesn't mean you have cancer." She hoped this knowledge would reduce the anxiety of women who are recalled.The story never explained the size of the decrease in the number of!1 positives between annual(61.3%) and biennial screening(41.6%).Our first two reviewers were a researcher who specializes in health decisions and a breast cancer survivor trained in evidence by the Natiional Breast Cancer Coalition's Project LEAD.This study is valuable because it helps to quantify and compare the harms of annual and biennial screening,specifically the number of!1 positives and the number of unnecessary biopsies.Prior to this study,estimates of!1 positive screening mammography rates varied widely.The critical question is whether you can do less frequent screening,subject women to fewer harms and get similar results in terms of detection of "early stage" cancer.This study's data seems to suggest that answer is yes.

Now, solve this: 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
Solution:
0