Given the task definition and input, reply with output. 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'.

Paragraph: There is no mention of costs in the release, but overuse of medical technology such as MRI scanning is one major reason for soaring health care costs. According to personal finance website Nerdwallet.com, median prices of a brain MRI range from $525 in Atlanta to a whopping $3,310 in Milwaukee. The main contention of the news release is that “imaging findings can help spur beneficial lifestyle changes in patients to reduce risk for Alzheimer’s disease.” But there’s no evidence presented to show that these images have any effect — good or bad — on patients’ adoption of beneficial lifestyle changes. Does performing an MRI increase the likelihood that someone will lose weight, exercise, and stop smoking? The release also states, “institutions… meld these approaches into novel ways to improve patient care,” but the report doesn’t detail what those “novel” therapies are. Experts in the report talk about pinpointing “volume loss in the brain” and characterizing imaging markers, but these are all surrogate endpoints. In other words, how do these translate to tangible health outcomes for patients? Bottom line: The idea that a brain MRI is going to help motivate people to adopt meaningful lifestyle changes — and that those changes will, in turn, lead to an actual reduction in the number of Alzheimer’s disease cases — requires several leaps of logic that have very limited support from evidence. The release owed it to readers either to point out the preliminary nature of the hypothesis or provide some evidence to back it up. The release did neither. Procedures almost always carry risks, and MRI is no exception. Some physicians are concerned with “MRI abuse,” pointing out that MRIs often pick up abnormal – but harmless – findings that muddy up the clinical picture. These so-called “incidentalomas” can lead to more tests and treatments that cause harm and add to costs. Unnecessary imaging is a major contributor to spiraling health care costs in the US, since a single scan on average in the US costs $2,611, according to Medicare data. Beyond stating that it exists, this news release provides no information about the journal article that is the subject of the release. Nor does it detail any of the studies that supposedly support the value of imaging for Alzheimer’s disease prevention. We’d add that the journal article itself provides limited-quality evidence — it doesn’t detail the process for selecting articles that are included in the review (raising the possibility of “cherry-picked” studies) and includes little in the way of critical evaluation of the studies that are cited. Strangely, three physicians, who weren’t listed as authors of the study, are quoted in the release and allowed to tout the benefits of quantitative MRI technology. They make sweeping statements, such as that this technology “will have a huge impact in the future” and that imaging “can have a powerful impact [on patients]” But the report fails to go into detail. One of these experts adds, “Patients seem to enjoy reviewing results of their imaging studies, more so than reading the results of their blood tests or other clinical evaluations.” But one physician’s anecdotal observation is not evidence of enhanced quality or effectiveness of care. Again, supporting data is needed. The news release does not engage in disease mongering and states that as many as three million cases of Alzheimer’s dementia could be prevented with lifestyle changes. However, it does imply that there would be more cases prevented with the addition of brain imaging, a claim that is not supported by the release or the underlying review article. The release does not specify funding sources for the work, which included the National Institute of Biomedical Imaging and Bioengineering and the National Institutes of Health. Many of the authors are consultants for medical device and pharmaceutical companies, including Toshiba (cited as “related” or relevant in the original research report). The release does not disclose this. The main premise of the news release is that MRI imaging can help people lower their risks for cognitive decline by encouraging them to make lifestyle and behavioral changes. It states that risk factors include obesity, diet, sleep, hypertension, diabetes, depression and smoking. However, the release does not address any alternatives — besides brain imaging — that might help people make the desired changes. Behavioral change counseling, which is an established approach to reducing problematic behaviors, is not discussed. The release doesn’t address the availability of quantitative MRIs of the brain. MRI in general has been used since the 1970s, and its availability is not in question. But since the issue is not specifically addressed by the release, we’ll rate it Not Applicable. Using quantitative MRI technology to diagnose Alzheimer’s disease in its early stages is not a new concept. There have been blog posts and numerous studies in the past 10 years devoted to this topic. We’re not really sure what’s new here. The news release refers to “novel ways to improve patient care,” but does not specify what these new approaches are. The language of the release bordered on sensational, with neurologist Majid Fotuhi touting the benefits of quantitative MRI technology and claiming it will have a “huge impact in the future of diagnosis and treatment of Alzheimer’s disease.” The release never clarifies the how and why of this statement. Claim: Preventive neuroradiology: Brain imaging bolsters efforts to lower Alzheimer's risk

0