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.
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Question: Paragraph: The news release includes information about costs. We would have liked a little more context. The release states: "The costs associated with home infusion were also consistently lower than services provided in a health care facility, with savings ranging between $1,928 and $2,974 per course of treatment." We need to know what percentage of savings that is per course of treatment. If the whole course costs $100,000, then saving $1,928 is a pretty small percentage. If the whole course is $10,000, than a savings of $1,928 looks more substantial. We found the news release skimmed over giving crucial numbers and metrics for benefits. Separate from the cost benefit to home infusion versus hospital or clinic infusion, the release should have given us some numbers for safety. Here is what the release stated (emphasis ours): "The research showed that patients receiving intravenous therapy at home had as good or better clinical outcomes as those patients who received the same therapy in a traditional health care setting. In addition, patients overwhelmingly preferred receiving their infusion therapies at home, reporting fewer disruptions in personal schedules and responsibilities. We need numbers to demonstrate how "as good" the clinical outcomes were. We need numbers to represent "overwhelmingly preferred." By what percentage did what number of patients demonstrate preference? This is where the release could have taken some quantitative data from the study. The word "harms" does not appear in the news release. During intravenous infusions there are complications that may arise. The release does not mention harm, even to dismiss the probability as rare. The study being reported is a systematic literature review that only considered 13 prior studies. The release does not address the limitations of a literature review or give us the total number of patients represented by the 13 studies. Only 5 of the 13 studies used in the analysis addressed outcomes. One had no comparison group ("However, no adjustment for confounders was performed, and higher OPAT success rates were likely due to purposeful selection of younger, healthier patients for OPAT therapy," according to the published study). In another study, "IPAT patients were selected from a time period during which OPAT was not available for any patients, minimizing selection bias by the matching fact." In any case, less than half of the studies looked at outcome data and those that did involved different diseases from different time periods, some had control groups and some did not. We don't think the evidence is strong enough to suggest outcomes were improved. The bias inherent in CVS employees culling the studies is also concerning. A better description of the review's search and selection process may have helped allay any concerns about studies being cherry-picked. There is no disease mongering. The release is clear that the study was done by the CVS Health Research Institute. Since this is a news release from a profit-making company that operates directly to sell services under study, we hope the readers quickly understand there is an inherent conflict. This is the equivalent of a Coca Cola study about the benefits of drinking their product. The release explains the alternatives of clinic or hospital infusion compared to home infusion. Home infusion services are widely available. Their reimbursement is not widely available. The release says "clinical outcomes and quality of care have not previously been systematically evaluated." The release doesn't rely on any unreasonable or unjustified language. However, we do not think the news release proves the words used in the headline that say "Home Infusion Care Improves Patient Outcomes and Quality of Life While Reducing Overall Costs." Based on a literature review, which does not randomize people into apples-to-apples comparison, you cannot claim to show better outcomes. The release does not offer any quantified benefits to support medical outcomes and doesn't provide quantified information about quality of life improvement. The fact that patients prefer home infusion to travel to a clinic is not by itself a proof that their lives have been improved. As we wrote in the benefits section above we are not given numbers to prove by what amount patients prefer home infusion. Claim: CVS Health Research Institute Study Shows that Home Infusion Care Improves Patient Outcomes and Quality of Life While Reducing Overall Costs

Answer: This news release describes the cost savings and safety of home infusion services from 13 previously published studies compared with infusion services at a clinic or hospital. Home infusion appears safe and clinically effective while saving money in the studies reviewed, but the release does not address limits in the review. We aren't given any numbers to back up the claims that clinical outcomes were equal and that patients preferred the home setting. The release notes that CVS has a home infusion businessCoramso at least they make this transparent. We applaud CVS for attempting to quantify the cost savings and other potential benefits of the service and the claim that there are advantages are likely valid but some context/background from other, independent studies would be helpful. Besides the lack of quantification, the release doesn't delve into the potential risks from using the home infusion service. Treatments for chronic diseases, which often require drugs administered through infusion, are one of the fastest growing costs in the US health care system. If patients can be served at home, rather than in outpatient clinics or hospitals, it saves both money and time. But outcomes studies, which compare outcomes and safety between locations, are essential to judging whether home infusion is equal to clinic or hospital infusion. This release does not go far enough with numbers to quantify benefits and risks. We also see that CVS has a conflict of interest, because they have a business arm, Coram, that sells home infusion services. It appears this release (and study) are getting attention just as Congress is "discussing how to implement a comprehensive home infusion benefit for Medicare beneficiaries."

Question: Paragraph: There is no discussion of cost in this release. The journal article says several institutions refused to provide their prices. Nevertheless, the high cost of robotic surgery is an important issue. The researchers wrote they were unable to say whether those high costs might be offset [or not] by certain potential benefits (such as shorter hospital stays), but the release should have at least acknowledged the cost issues. The release does report the percentage of patients in the robot-assisted and open surgery groups that were still alive with no signs of disease progression two years after their procedures: 72.3 percent of patients in the robotic surgery group compared with 71.6 percent in the open surgery group and it notes the difference was not statistically significant. It also reports that the robot-assisted surgery patients checked out of the hospital after six days on average, compared to 7 days for those in the open surgery group. The release reports only half as much blood loss in the robot surgery group, but does not report the amounts, which averaged 300 mL in the robot-assisted group vs. 700 mL in the open surgery group that's a difference of less than one pint. The release reports that patients who had robot-assisted surgery spent more time in the operating room than those having open procedures (seven hours vs. six hours). It also reports overall rates of adverse effects (67 percent in the robot group vs. 69 percent in the open group), along with listing the most common problems: urinary tract infections and intestinal obstructions. It would have helped if the release had pointed out that these complication rates were not statistically different. In a way, the release is satisfactory and yet maddeningly unsatisfactory. It tells readers that the study was a randomly controlled trial with 350 patients, but it buries the most important point: that the ability of these researchers to do this sort of rigorous trial comparing robot-assisted surgery with open techniques highlights how few such trials are done. Deep in the release, the researchers are quoted as saying the findings "underscore the need for further high-quality trials to assess surgical innovation before this surgical technique is widely adopted in clinical practice" and further that "It is important to conduct these trials before widespread adoption of technology, as has been the case with robotic prostatectomy (removal of the prostate)." The quality of the evidence should have been the lead. The release does not exaggerate the prevalence of bladder cancer. It does not push treatment on those who are unlikely to benefit. The release could be interpreted as promoting a newer more expensive form of therapy that doesn't provide any advantages over the standard therapy. Although the release reports that the study was supported by the National Cancer Institute, it fails to note the financial disclosures several researchers made about money they have received from companies relevant to this study. The comparison of robot-assisted to open surgery was the main point of the release. The release makes clear that both techniques are available including at the institution that issued the release. The release could have informed readers that, according to the published paper, that all ofthe operators in this study haddone at least 10 robot-assisted cystectomies before being allowed to participate in the study. When widespread adoption of the robot-assisted procedure occurs, it would be possible that many surgeons would not have completed that many robotic cystectomies. While the release does tell readers that what is really new here is the use of randomization to compare robot-assisted surgery to open surgery for bladder cancer, it manages to bury that lead so deep under the poorly worded description of the results of this non-inferiority trial that the thrust of the release is unsatisfactory. The release doesn't employ unjustified, sensational language. Claim: Robotic surgery as effective as open surgery for bladder cancer

Answer: This news release about a trial that randomly assigned people with bladder cancer to either robot-assisted or open surgery buried the real news under a weak lead that garbles the findings. The news here is that, contrary to assertions of many proponents of robot-assisted surgery, it is possible to randomize patients in order to get a valuable comparison instead of relying on weaker study designs that can't answer the fundamental question about how old and new techniques compare. The release is rated as satisfactory on many criteria because key information was included in the body of the release, but the headline proclaiming that robot surgery is "as effective" as open surgery misses the larger point. The headline and lead also put a pro-robot spin on the results, which could also be summarized as robot surgery is "not clearly worse." Also not explained: robot-assisted surgery is more expensive. The final sentence of the release, a quote from a researcher, should have been the lead: "It is important to conduct these trials before widespread adoption of technology, as has been the case with robotic prostatectomy (removal of the prostate)." We are bombarded with releases and news stories trumpeting results from studies of robot-assisted surgery that don't actually compare the new technology to existing practice. These studies often lack any control group or use historical data that may not be truly comparable. The promoters of expensive new devices then claim that they are relying on the best available evidence. This trial shows better evidence can (and should) be gathered. And in this case, good quality evidence indicates little difference in the techniques, despite what all the big hospital billboards about robot surgery proclaim.

Question: Paragraph: "It is less surprising that neither story discussed costs, given that so few stories do. But sample costs could have been obtained by calling any of the numerous medical marijuana outlets in states where it is legal. Both stories did a decent job of quantifying the benefits.This story provided more details, though, including the differences in patient experiences between the three different concentrations of marijuana. It also repeated this important bit of information:""There was also no difference in the quality of life or mood scores that participants reported when they were on any of the four treatments."" The story also does a great job of pointing out that the treatment duration of five days in each dosage phase is too short to judge utility for chronic pain, which isa long-term affliction. Neither story actually quantified the harms, but they both noted there were side effects. This story did a better job, though, by noting that the only dose that seemed to work also seemed to produce the most side effects and by raising the issue of long-term safety concerns. It also was the only story to answer the question that readers surely would have when reading about an illegal narcotic being used as medicine. Did these patients feel high as a result? This story says that most did not. Because of the additional information and context, the rating here is satisfactory. This story, unlike the competing WebMD piece, establishes in the first sentence even in the first three words that this was ""a small study."" It then discusses the limitations of the study at several points. The second sentence says, ""The pain reduction was ""modest"" less than 1 point on an 11-point scale for the strongest marijuana and patients reported no overall difference in their quality of life based on what they smoked."" The writer elegantly and succinctly described the study design a complex randomized cross-over trial with double blinding and delved into an important feature of the study, that the subjects in retrospect may have been able to detect during which phase of their experience they inhaled placebo versus the most potent drug. This story avoids disease mongering, and, in fact, goes beyond that to note how few people actually suffer from the type of chronic pain that was the subject of the study:""About 1 to 2 percent of adults in the U.S."" The story quotes two outside experts, one of whom is completely independent from the study and the journal, Dr Andrea Hohmann. Beyond that, we would bet that the reporter spent more time interviewing Dr. Mark Ware, the lead researcher, or at least asked tougher questions. Because Ware is more measured in this story than in the WebMD story. He even goes so far as to say, ""What about long-term safety issues?"" he asked. ""These need to be considered before the drug becomes prescribable."" As with the WebMD story, it would have been nice to see who funded the research. Unlike the WebMD story, this one did not point out the conflicts of interest of Dr. Henry McQuay. This story talks about a range of treatment options and even has the study's lead author suggesting, that ""these patients should also be getting behavioral and physical therapy."" Strangely, neither story we reviewed pointed out that marijuana is illegal in most states and in Canada, where the study took place. The story could have, at a minimum, mentioned which states have medical marijuana laws or talked about whether any other countries currently allow cannabis to be sold in pill form the way it was used in this study. The story alludes to the fact that this study ""supports a limited number of trials that have suggested marijuana may be helpful for people suffering from chronic pain,"" indicating that the treatmentis not very novel at all. It would have been nice to see more context around that. The WebMD story provides a little more information in this regard. If the news release is to be believed, ""This is the first trial to be conducted where patients have been allowed to smoke cannabis at home and to monitor their responses, daily"". That could have been made clear. The story goes well beyond the release. Here's the release." Claim: Pot may provide some chronic pain relief: study

Answer:
The story did a great job evaluating the evidence, providing outside voices, discussing alternatives to marijuana smoking, and presenting both the benefits and the potential harms. It could have done a better job discussing possible costs, availability and conflicts of interest. From the headline to the last sentence, this report avoided overstatement of the applicability of the potential benefit and used clear incisive language that left the reader with a good understanding of the study and its implications. This topic lends itself to jokey, pun-filled writing, but this story played it straight. Chronic pain can ruin lives, and a breakthrough with an alternative approach would be important news. As this story makes clear, until some larger studies with fewer limitations are undertaken, we are far from the point where marijuana can be considered a safe and effective treatment for chronic pain.