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: There is no mention of costs in the story. Although pridopidine is an experimental drug, it may have been useful for the reader to know whether pridopidine could be at least a cheaper alternative to tetrabenazine, the only drug currently approved for Huntington’s disease. The story did not detail the potential benefits of pridopidine. Specifically, how did the patients improve their motor function? The only number provided was that 70% of patients improved. We need to know how this function was measured and to what degree they improved (it is not clear whether the story was talking about statistical significance or clinical significance). The story notes, “Side effects among patients taking the drug were similar to the placebo group.” Dr. Alessandro Di Rocco also agrees with this statement, since the “compound is apparently well tolerated without significant side effects.” However, the story could have been more thorough in letting the reader know exactly what those side effects are. The story makes contradictory statements on the study’s results. At one point, the article reports, “…the drug showed a significant benefit,” while further down in the article, Dr. Alessandro Di Rocco is quoted as saying, “the benefit is modest and limited to the motor symptoms of the disease.” The story could have expanded on Di Rocco’s comment and also could have included some of the study’s limitations. For example, the researchers could not prove their primary hypothesis, for which they wrote in The Lancet: “This study did not provide evidence of efficacy.” The apparent benefits came from the tertiary endpoint, which merits a more cautious interpretation of the results. There is not any disease mongering, but the article does not provide much background information on Huntington’s disease, regarding its epidemiology, risk factors and treatments. However, the story does mention dopamine and its role in movement and coordination. Dr. Alessandro Di Rocco from NYU Langone Medical Center is used as an independent source. The story also adds that the study was funded by European pharmaceuticals company NeuroSearch A/S. The article mentions tetrabenazine – the only drug on the market for Huntington’s disease – and adds that it can “cause serious side effects.” The story mentions that study results are from a phase III clinical trial, but it does not clearly comment on the availability of pridopidine, or the class of dopidine drugs in general. The story could have simply said that this drug is investigational and is not available yet. Pridopidine is an experimental drug candidate for Huntington’s disease and has been in clinical trials for the past several years. The same quotation in the news release is used in the HealthDay story, suggesting that the article was somewhat based off the news release. However, there is some evidence of original reporting, with the inclusion of Dr. Alessandro Di Rocco’s comments. Claim: New Drug Shows Promise Against Huntington’s Disease

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1


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Paragraph: "At a rally in Houston, Democratic presidential candidate Michael Bloomberg apologized for supporting the stop-and-frisk policy he endorsed while serving as mayor of New York City from 2002 to 2013. Bloomberg told the mostly black audience at the rally that he should have ""acted sooner and faster"" to stop the policy and said if he were elected, he’d use ""the power of the presidency to right the wrongs of institutional racism."" He used the rally as an opportunity to unveil a new initiative that he says will address issues specific to the black community in the United States: ""Mike for Black America."" One issue he highlighted in his address was access to health care. ""We will build a future in which we better protect the health of black mothers and their babies,"" Bloomberg said at the rally. ""You should know that black babies die at rates twice as high as white babies because of a lack of access to affordable health care and here, in the wealthiest country in the world, we cannot accept that and we will change that."" Bloomberg’s figure is accurate, but is he right in his assessment of the cause of this disparity? His team did not return a request for more information about his claim. Mortality rate higher for black infants The latest statistics on infant mortality from the Centers for Disease Control and Prevention show that there were 22,341 infant deaths reported in the United States in 2017, putting the mortality rate at 5.79 infant deaths per 1,000 live births. Statistics on infant mortality are compiled based on birth and infant death certificates in cases where infants less than a year died during the calendar year. Generally, the infant mortality rate has trended downward since 1995 and has declined 16% since 2005, when the rate was 6.86 deaths per 1,000 live births. The CDC also analyzes the infant mortality rate by race. In 2017, infants born to black women had the highest mortality rate of 10.97 deaths per 1,000 live births. The mortality rate for infants born to non-Hispanic white mothers was 4.67 deaths per 1,000 live births, meaning infants born to black mothers have an infant mortality rate 2.35 times higher than infants born to white mothers, according to the CDC. Bloomberg’s claim wasn’t limited to Texas, but this trend is also visible at the state level. A 2018 report from the CDC looked at infant mortality data from 2013 to 2015 by state and race and found that, in Texas, the mortality rate for infants born to non-Hispanic white women was 5 deaths per 1,000 live births and was 10.52 for infants born to black women. Exploring causes of disparity It’s true that infants born to black mothers have died at rates twice as high as white babies in recent years, but is it true that it is due to a lack of access to affordable health care? It isn’t that simple. The five leading causes of all infant deaths in 2017 identified by the CDC were all health related: In a 2019 report, the CDC noted that infants born to black women had the highest mortality rates for disorders related to short gestation (premature birth) and low birthweight and maternal complications. Numerous academic studies and media investigations have highlighted correlations between access to health care and the disparity in infant and maternal mortality rates between black and white mothers. But access to health care is widely considered to be one of many contributing factors. One 2017 study published in the American Journal of Public Health identified other factors that contribute to the high black infant mortality rate: socioeconomic status, maternal behavior, ""exposure to protective and risk factors over the course of a woman’s life,"" and certain historical factors like segregation, limited educational opportunities, structural racism, and intergenerational poverty. This is not to say that a lack of access to health care is not a significant cause of this disparity. A study published in the Journal of the American Medical Association in 2019 explored how state Medicaid expansion associated with changes in low birthweight and preterm birth across different races — which are more likely to affect black mothers and infants than white mothers and infants. The study did not explore the link between Medicaid expansion and reducing infant mortality. Researchers found that overall, Medicaid expansion was not associated with differences in rates of low birth weight or preterm births. However, they identified ""significant improvements in relative disparities for black infants compared with white infants in states that expanded Medicaid vs. those that did not."" In other words, states that expanded Medicaid saw rates of low birthweight and preterm births decline among black mothers and infants. In general, black mothers were less likely than white mothers to access prenatal care, according to data from the U.S. Department of Health and Human Services’s Office of Minority Health. In 2017, black mothers were 2.3 times more likely to receive no prenatal care or late prenatal care than non-Hispanic white mothers. The same year, 66.6% of black mothers received prenatal care during the first trimester, compared to 82.4% of white mothers who accessed early care. Our ruling Bloomberg said: ""Black babies die at rates twice as high as white babies because of a lack of access to affordable health care."" Bloomberg’s figures about the black infant mortality rate vs. the white infant mortality rate are accurate. Studies show that access to healthcare is a contributing factor to this disparity, but it is far from being the only issue at play." Claim: Michael Bloomberg Says “black babies die at rates twice as high as white babies because of a lack of access to affordable health care.”

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2


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Paragraph: The plague outbreak has killed 63 people in the Indian Ocean island nation, Madagascar’s government says. For the first time, the disease long seen in the country’s remote areas is largely concentrated in its two largest cities, Antananarivo and Toamasina. Global health officials have responded quickly. The World Health Organization, criticized for its slow response to the 2014 Ebola epidemic in West Africa, has released $1.5 million and sent plague specialists and epidemiologists. The Red Cross is sending its first-ever plague treatment center to Madagascar. On Wednesday, Madagascar’s minister of public health rallied doctors and paramedics in a packed auditorium at the country’s main hospital, saying they’re not allowed to go on vacation. “Let’s be strong, because it’s only us. We’re at the front, like the military,” Mamy Lalatiana Andriamanarivo said. The outbreak could continue until the end of infection season in April, experts warn. Madagascar has about 400 plague cases per year, or more than half of the world’s total, according to a 2016 World Health Organization report. Usually, they are cases of bubonic plague in the rural highlands. Bubonic plague is carried by rats and spread to humans through flea bites. It is fatal about the half the time, if untreated. Most of the cases in the current outbreak are pneumonic plague, a more virulent form that spreads through coughing, sneezing or spitting and is almost always fatal if untreated. In some cases, it can kill within 24 hours. Like the bubonic form, it can be treated with common antibiotics if caught in time. The WHO calls plague a “disease of poverty” caused in part by unsanitary living conditions. Madagascar has a per capita GDP of about $400, and national programs to control the disease have been “hampered by operational and management difficulties,” according to a report by the European Centre for Disease Prevention and Control. But the airborne pneumonic plague, which accounts for about 75 percent of cases in the current outbreak, makes no class distinctions. “Normally, the people who catch the plague are dirty people who live in poor areas, but in this case we find the well-to-do, the directors, the professors, people in every place in society, catching the disease,” said Dr. Manitra Rakotoarivony, Madagascar’s director of health promotion. The current outbreak began in August, earlier than usual, when a 31-year-old man who had spent time in a village in the central highlands, Ankazobe, traveled by bush taxi to the east coast, unaware that he had the plague. He died en route and was buried without any safety precautions in Toamasina. Four people in contact with him also died. Residents of the capital began to relax in recent days amid the global response to the outbreak, but the disease remains a serious threat with the number of new cases per day remaining steady. Madagascar has fought the disease for more than a century. It was introduced to the island in 1898 when steamships from India brought rats infected with the bacteria that causes the disease. The plague nearly disappeared from Madagascar for 60 years, starting in 1930, but re-emerged in recent decades. The black rats that carry the disease in the highlands have gradually developed resistance to it. Unsafe burial practices that involve touching corpses are another reason the disease spreads, according to a 2015 study by scientists at the Pasteur Institute in Madagascar. The outbreak has alarmed neighboring countries. A 34-year-old man in another Indian Ocean island nation, the Seychelles, contracted the pneumonic plague while in Madagascar. He was treated in his own country and no longer has symptoms. It was the first-ever plague case in the Seychelles, said the country’s public health commissioner, Dr. Jude Gedeon. Another Seychellois, a 49-year-old basketball coach, died of the plague last month while in Antananarivo for a tournament. Seychelles authorities have established a plague isolation ward and announced that schools will be closed through Tuesday. Foreign travelers who have recently visited Madagascar are not being allowed into the country. While the WHO says the risk of the epidemic spreading beyond the region is very low and does not advise restrictions on travel to Madagascar, Air Seychelles has canceled all flights to and from the island until further notice. “The situation is still not under control in Madagascar,” Gedeon said. Claim: In Madagascar, plague outbreak now threatens largest cities.

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2


