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.

Paragraph: The article states that acupuncture costs $45 to $100 per session. It does not say how this compares to other treatments and whether the cost of care is the same, more or less than alternatives. The story states the proportion of patients who successfully responded to each therapy, and clearly explains that “real” acupuncture was no better than sham needling. But it does not define success or otherwise quantify how much people improved clinically in either relative or absolute terms. For a treatment to be considered successful, a patient must have reported either a 33% improvement in pain or as little as a 12% improvement in function during an interview conducted over the telephone 6 months after enrollment. Nonethless we’ll grade this criterion as satisfactory. The story did not mention harms from any of the treatments patients received. Previous research suggests that acupuncture poses few risks when performed with sterile, disposable needles. The article describes the largest randomized controlled trial to date investigating the effectiveness of acupuncture for treating chronic low back pain, and reports its published results. It discusses the three treatment groups studied and potential reasons for the outcomes observed. There are no obvious elements of disease mongering. The story explains that the study participants were people with chronic low back pain. These results wouldn’t apply to other back pain conditions. The article cites one of the study’s coauthors and two physicians who appear to be users and/or proponents of complementary therapies. It would have been interesting to hear from a skeptical observer. The story lists the therapies received by patients assigned to the conventional medicine group. The literature suggests that these treatments generally provide very modest benefits. The article does not mention other therapies that may be effective for managing chronic pain and improving flexibility and strength. These include cognitive therapy alone or in combination with intensive exercise and strengthening. Acupuncture is estimated to be the third most popular complementary therapy for chronic low back pain. Though the article does not say much about its availability, readers are likely to be familiar with it. The story notes that this is the largest study yet of acupuncture for chronic back pain, suggesting that the treatment is not new. There is no obvious use of text from a press release. Claim: Acupuncture, real or fake, called best for lower back pain
This article reports on the largest randomized controlled trial to date investigating the effectiveness of acupuncture for treating chronic low back pain. It explains that both acupuncture and sham needling are more effective than conventional medical therapies, but that “fake acupuncture works nearly as well as the real thing.”       In addition to describing the quality of the evidence, the story mentions several other treatment options, tells the reader the cost of acupuncture, and hints at its novelty. The story neglects to mention harms. (A recent systematic review reinforces the study’s finding that acupuncture poses few risks; see Spine 2005;30:944-63). And it also provides an incomplete picture of the treatment’s apparent benefits. Although it notes the proportion of patients who improved with each therapy, it does not define success or otherwise quantify how much people improved clinically–in either relative or absolute terms. For a treatment to be considered successful, for example, a patient could have reported as little as a 12% improvement in function during an interview conducted over the telephone 6 months after enrollment. This is important information if people are to weigh the apparent benefit of a therapy against its cost. The article cites one of the study’s coauthors and two physicians who appear to be users and/or proponents of complementary therapies. They attempt to explain why needling seems to work. To provide some balance, the study’s coauthor suggests that the apparent benefit could merely be the result of patients’ expectations of improvement from acupuncture, on the one hand, and of poor results from conventional medicine on the other. (Unfortunately, the researchers did not measure patients’ expectations.) It would have been interesting to hear from others. Some might point out that the new study shows that acupuncture and sham needling are only more effective than treatments that are not themselves very effective. Others might make the case that acupuncture provides no specific treatment effect and is unethical to use—because it could be construed as prescribing a placebo. People with chronic low back pain are desperate for anything that will help. When a large new study provides apparently strong evidence to buttress a therapy that previously had little high-quality evidence to support it, readers might also benefit from more context. A major systematic review that analyzed 35 randomized trials involving 2861 patients recently concluded that acupuncture appears to confer modest, short-term pain relief, but that the quality of the studies was not very good. The reviewers were careful not to overstate the benefits of acupuncture (Spine 2005;30:944-63). Overall, this was a good article that would have been helped by some more context.

Paragraph: This study was published in December, 2007 in        the Journal of Environmental Health. It was co-authored by Anne        LaGrange Loving and John Perz. The authors collected 76 lemon slices from 21 restaurants on 43 visits in        Patterson, New Jersey. They swabbed both the lemon slice and the        glass on which the slice had been placed and immediately after the glass        had been brought to them. The result was that they found        contamination on both the flesh and the rind of most of the lemon wedges,        although they did not research how it got there. Some of it could        have arrived with the fruit from the field, some of it could have been        through contamination from the hands of employees. Some of it could        have been from contaminated work surfaces. The U.S. Food and Drug        Administration conducted a study in 2004 of both fast food and full        service restaurants. The conclusion was that there was poor personal        hygiene on the part of employees at 31 percent of the fast food        restaurants and more than 41 percent of the full service restaurants. Comments Claim:  The forwarded email appears to be an article        featuring the findings of microbiologist Anne LaGrange Loving who found        that two-thirds of the lemons tested from 21 restaurants were contaminated        with bacteria when added as slices to beverages.   
Contaminated Lemon Slices in Restaurants 

Paragraph: Most people know roughly what a bottle of vitamin D supplements might cost them, so the lack of information on cost is not a significant gap. We appreciate that the story provided data showing the large and growing amount our society is spending on vitamin D supplements ($430 million in 2009), with apparently little health benefit to show for it. The story was mostly concerned with discussing the lack of benefit from taking extra vitamin D and calcium. And in this area it excels. While the story does lack precision when it suggests that adolescent girls should be getting more calcium (it never specifies how much they are getting now, how much more they’d need to meet the recommendations, or what benefits they might expect from this increased intake), it would be difficult for a journalist to come up with any sort of quantifiable benefit or harm estimate from the IOM report. The story captured the overall gist of the problem, which is that the evidence base is complex and still inadequate. The story notes that, contrary to the claims of many advocates for increased supplemental vitamin D, there is evidence that high levels of vitamin D may have adverse effects, such as increased risk for fractures and an increase in the overall death rate. The story also explained that too much calcium has been linked to increased risk of kidney stones and, more tentatively, heart disease. The story did a good job of describing how the expert committee conducted its review and what evidence they found. Importantly, it noted that  claims of benefit from extra vitamin D are based on observational studies that most scientists agree “cannot determine cause and effect.” We also like that the story solicited opinions from a variety of experts with no obvious stake in the controversy. This produced a number of quotes that emphasized the need for restraint when interpreting the research on vitamin D. Examples: “I think this report will make people more cautious” and “The onus is on the people who propose extra calcium and vitamin D to show it is safe before they push it on people.” Although we agree with the story’s skeptical overall message, we think it may have slammed the door just a bit too hard on the possibility of benefit from supplemental vitamin D. While claims of benefit may not be supported by the currently available evidence, they have not been conclusively disproved in randomized controlled studies, either. In fact, research is now underway to determine whether the benefits found in observational studies of vitamin D can be replicated in more rigorously designed trials. The story probably should have mentioned this research, and left the door to potential benefits open just a crack. No disease-mongering here. The diversity of independent voices included in this story is a real strength. Although it solicits the obligatory comment from a supplement industry spokesman, it didn’t go out of its way to find any of the more widely known vitamin D experts, some of whom have been issuing recommendations that are untenable based on current evidence. The enthusiasm of some of these researchers might be explained by their significant career and financial interests in promoting vitamin D. Not applicable for this story. The approaches discussed are not new, and there’s not really any alternative to getting adequate amounts of these essential nutrients. The availability of vitamin D from diet, sunlight and supplements is clear from the story. The novelty of vitamin D and calcium is not really in question, so we’ll call this not applicable. This story was not based on a news release. Claim: Report Questions Need for 2 Diet Supplements

In one particularly effective passage, the story quoted a representative of a supplement industry group who disagreed with the report, saying that higher levels of vitamin D could be beneficial. But it then segued immediately into an explanation of why claims from supplementation advocates “are not supported by the available evidence.” The key problem, as the story points out, is that these claims are based almost exclusively on observational studies that can’t prove cause and effect and are often skewed by factors the researchers haven’t accounted for. Proponents of supplementation also have tended to downplay the possibility that higher doses of vitamin D and calcium might cause harm–a stance which the story notes may not be justified. We applaud this story’s effort to show readers where the weight of the evidence lies on this issue. Vitamin D is the latest in a long line of “miracle” nutrients that people have turned to in the hope of improving their health. As we’ve learned from copious previous experience, these supplements rarely work as advertised and can sometimes cause harm at the higher doses people often think will be beneficial for them. More isn’t necessarily better when it comes to vitamin D–or most other health care interventions for that matter.

