MD, PhD, MAE, FMedSci, FRSB, FRCP, FRCPEd.

NHS England have published a list of medicines that they propose to stop funding. Items were considered for inclusion if they were:

  • Items of low clinical effectiveness, where there is a lack of robust evidence of clinical effectiveness or there are significant safety concerns;
  • Items which are clinically effective but where more cost-effective products are available, including products that have been subject to excessive price inflation; or
  • Items which are clinically effective but, due to the nature of the product, are deemed a low priority for NHS funding.

The list includes both herbal and homeopathic remedies!!!

The document states that the annual Spend on homeopathy amounts to £92,412. It refers to the report by the House of Commons Science and Technology Committee which found that the use of homeopathy was not evidence based and any benefits to patients was down to placebo effect. The group agreed with the findings of the committee for the lack of evidence and considered homeopathy suitable for inclusion in the proposed list.  They advise CCGs that prescribers in primary care should not initiate homeopathic items for any new patient. They also advise CCGs to support prescribers in deprescribing homeopathic items in all patients and, where appropriate, ensure the availability of relevant services to facilitate this change.

A comment published by PULSETODAY stated: NHS England is planning to stop the prescribing of homeopathy as part of new guidance for CCGs on medicines that can be considered to be of low priority for funding. Homeopathy is a new item on the list of possible low-value medicines that GPs will be banned from prescribing. Originally NHS England said that it would review just 10 items, but it has added eight new treatments, including homeopathy and herbal treatments… The original consultation document failed to include homeopathy in its treatments that should be banned. However, following a consultation, a paper presented at today’s NHS England board meeting said: ‘NHS England’s view is that, at best, homeopathy is a placebo and a misuse of scarce NHS funds which could better be devoted to treatments that work. ‘Data on the residual use and cost of homeopathy on the NHS are hard to come by. A recent Freedom of Information request by a third party suggested that at least £578,000 has been spent on prescribed homeopathy over the past five years, with the total cost being higher than that when the cost of consultations was factored in.’ Talking at the NHS England Board meeting today NHS England medical director Sir Bruce Keogh said: ’I think this (homeopathy) has been an issue which has concerned scientific professionals for a long period of time. We can no longer shy away from addressing this particular issue. If we want our NHS to be evidence based and outcomes focused, then we must expect to have difficult conversations over difficult issues.’

This almost sounds as though Sir Bruce has been following the discussions on this blog. I have felt for a long time that the reimbursement of homeopathy by the NHS made a mockery of evidence-based medicine. It is time to end the mockery and use the money for something useful!

But before we start celebrating a victory of rationality, we should consider what happens next. There will be a consultation, and I would not be surprised to hear that the author of multiple ‘spider memos’ is already at it again. So, maybe we should hold our breath and wait.

65 Responses to The end of homeopathy on the NHS? [but wait for the ‘spider memos’]

  • This topic of homeopathy in the NHS has been going on for a long time, the wheels of the state grind slowly most times but they grind. I can’t see that after so much time of deliberation and consideration of patient rights and public interest etc that this decision will be changed.

    The question now: will the sceptics accept homeopathy being practiced as a private provision?

    Given that there are higher public health priorities: alcohol and drug abuse, tobacco abuse, diabetes and excessive sugar/carbohydrate consumption, obesity, cardiovascular disease (exercise and lifestyle related) etc. Is campaigning against homeopathy still a top of the list topic for the sceptics?

    • Yes, I would accept, that anybody who wants to use homeopathy is allowed to do so – provided they pay the bill for themselves. And provided, they have access to sound information about homeopathy and its lack of efficiency in any more than harmless condition.

  • Homeopathy is likely fake and needs to be exposed but it is not a priority. Prof Peter C. Gotzsche, MD, director of the Cochrane Research centre in Copenhagen opines that prescription drugs are the third leading cause of death after heart disease and cancer. Although Homeopathy’s only power may lie in the powerful placebo effect it should not be banned 0 if only for this reason. Edzard is a man with a mission but he needs a reality check on his ‘own house’

    • ” Edzard … needs a reality check on his ‘own house’”
      WHY?

      • I think it’s because he doesn’t like the curtains.

        • For those who don’t like curtains, blinds can be effective: especially double-blinds.

          …when properly installed and used, of course.

      • Presumably Edzard will have prescribed pharmaceutics when in practice as an MD. He well knows the meaning of iatrogenesis – this is what I meant by ‘own house’. Of course we must expose fake modalities but we need to be even-handed. The bewildered public is truly caught between a rock and a hard place. Please carry on informing us but maybe after reading Gotzsch’s book, you could inform us better

        • Presumably you presume too much; THIS BLOG IS ABOUT ALT MED!
          I WRITE ABOUT THINGS I UNDERSTAND – you should try it!

        • Brian Lamb

          Reason for problems:

          https://sciencebasedmedicine.org/most-patients-get-no-benefit-from-most-drugs/
          (NNT and NNH where NNH is always greater than NNT)

          Super impose this with:
          http://clinicalevidence.bmj.com/x/set/static/cms/efficacy-categorisations.html

          Add: “We would like to emphasize that our categorization of the effectiveness of treatments does not identify how often evidence-based and non-evidence-based treatments are used in practice. We only highlight how evidence based treatments are for certain indications, based on randomized controlled trials. As such, these data reflect how different treatments stand up evidence-based medicine and are not an audit of the extent to which treatments are used in practice or for other indications not assessed in Clinical Evidence.”

          Possible result for a case: 70% possibility the drug will work x (11% beneficial effect + 24% likely x 0.8) x 50% possibility that evidence applied:

          Net outcome 10.57%

          Edzard:you understand this calculation?

          • Iqbal, I think *you* do not understand the calculation. I guess your 70% probability that the drug will work is the prior probability. If you set that to zero as in homeopathic drug, you get a vastly inferior outcome.

          • Thomas Mohr

            Take Mercurius Cor 30, 3 times a day for 45 days and tell me what happened to you?

            Give Nux Vom Q 5 drops in half cup of water before going to bed to your wife for 30 days and check what changed?

            Locate a person with lung TB duly cured with antibiotics and give him Phosphorous 30 morning and evening for 45 days and we discuss the 0% probability of outcome on all 3.

          • “Take Mercurius Cor 30, 3 times a day for 45 days and tell me what happened to you?”
            I’d be about £15 pounds poorer

          • Edzard

            You have no clue. It would be many times the amount you write. Would Mr. Mohr not like to be cured of the problem he develops?

          • better to have no clue about cost than about effective medicine

          • What was Iqbal’s point, anyway?
            I remember something about somebody being advised to go to bed and visit his wife, but then it all became a bit hazy.

          • Iqbal Krishna

            I would be willing to enter into your trial under one condition: You write down what is going to happen with me while I take the pills, you seal it and deposit in a trustworthy place (with Edzard?). I keep a diary of the symptoms I develop during the time. In the end we compare and see if your prediction is true or not. But please note: symptoms typical for the season do not count (unusual desire for iced drinks, sleeplessness for feeling warm at night, dislike of warm clothing). Same as ordinary symptoms that anybody may develop anytime with some probability (headache in the morning, vertigo, pain in the stomach, cold …). And symptoms that are typical for my age (65) do not count either (stiffness in the joints, increasing irritability, occasional vertigo …)
            If this sounds too difficult, there may be another option. Just indicate how we distinguish between causation and coincidence of the intake of the pills and the symptoms that may occur.

          • Quote: “Take Mercurius Cor 30, 3 times a day for 45 days and tell me what happened to you?”

            Iqbal, are you thick or what ? We have discussed this already. An experiment like that was carried out in 1835, the Nuremberg Salt Trial with not only one but 50 people The homeopath warned profusely, the result destroyed him to the bone. NOTHING WAS OBSERVED.

            Aside that you do not know what prior probability is. Prior probability is the probability that a treatment works based on prior knowledge based on mechanisms of action. The mechanism of action of homeopathy is pseudoscience, hence the prior probability = 0.

    • Reality check:
      An opinion is not solid scientific evidence, even if your claim is true and exact, something both I and the WHO doubt: http://www.who.int/mediacentre/factsheets/fs310/en/

      Since homeopathy’s only power is in the placebo effect, there is every reason it should be banned. Real medicines also have a placebo effect, as do many social activities. It’s hard to hear a doctor say “Medically, I can do nothing to help you” but there’s nothing to stop the same doctor continuing with “but here are some things you can do that might” and listing activities to do (or avoid!).

    • “opines” is the correct term for professor Gøtsche’s often exaggerated observations. He seems to enjoy the flares of attention that his provocatively flaming torches cause in the medical debate. His intentions are undoubtedly good, the handling of prescription pharmacotherapy certainly needs improving, not the least in the U.S.

      Being provocative is however not the same as being right and even if professor Gøtsche was right, which is doubtful, that does not justify homeopathy as a worthwhile alternative.

    • In this world if there is anything stupid… it is science, certainly not homeopahty.

      • Hrishikesh Mishra,

        What enabled your asinine comment to be visible to the readers? It is science, certainly not “homeopahty [sic]”.

        Your communications device includes a dictionary and a spellchecker: provided by science, certainly not “homeopahty [sic]”.

        No wonder you despise science: it both highlights and verifies your ineptitude.

      • @HR: Terrific post! Did you have this profundity tattooed across your forehead yet?
        It’s worth taking full credit for such an insight.

  • At least he has a house..

  • No person should be able to sell water to another person (especially children), claiming that it is medicine. In my view, this is a criminal activity and it should therefore be completely banned and criminalised. This applies to many other ‘modalities’ in the CAM world as well.

    • an interesting addition (http://www.bbc.co.uk/news/uk-40683915):
      ‘Low value’ medicines on the list and their annual cost to the NHS:
      £34.8m on Liothyronine, used for underactive thyroid
      £19.8m on the anti-depressant Trimipramine
      £19.3m on Lidocaine plasters for treating nerve-related pain
      £11.5m on Tadalafil Once Daily, similar to Viagra
      £10.9m on Fentanyl immediate release, used to treat breakthrough pain in palliative care
      £9m on the painkiller Co-proxamol
      £7.8m on Doxazosin Modified Release (MR), a drug for hypertension
      £6.3m on omega-3 fatty acid compounds
      £5m on Oxycodone and Naloxone, used to treat severe pain
      £4.5m on travel vaccines
      £4.3m on muscle pain relieving rubs and ointments
      £2.7m on the anti-depressant Dosulepin (formerly dothiepin)
      £2m on Paracetamol and Tramadol Combination product
      £1.5m on Lutein and antioxidants (e.g. vitamin A, C, E and zinc) supplements
      £0.5m on Perindopril Arginine an ACE inhibitor used in heart failure, hypertension, diabetic nephropathy and prophylaxis of cardiovascular events
      £0.4m on Glucosamine and Chondroiton, nutrients taken to improve pain associated with osteoarthritis
      £100,009 on herbal medicines
      £92,412 on homeopathy items

    • Frank
      You’re missing the point here.
      It isn’t just water.
      It’s water that’s been SUCCUSSED.
      Somebody has to pay for the highly-trained succussers. They don’t come cheap I imagine.

      • today mostly done by machines – but they too cost a lot of money.

        • I really wonder how many homeopaths actually do this – does any independent authority actually check on this? It is only water so it should contain nothing, and hence how do you know that it was actually succussed? It is all about money, so I guess skipping this expensive step is a easy way to make more money.

          • In any production of homeopathic remedies there are two individuals I surely do not envy.
            (1) The Quality Manager who is required to make sure that the bottles contain what is written on them and that this stuff is not contaminated by ingredients from other products. How should this poor fellow verify that the bottle labelled Arnica C30 does in fact contain Arnica C30 and not something like Arsenicum album C30 or Arnica C200, when you cannot distinguish them by any means? What would be the fate of the poor patient in that case? I wonder if QM is able to sleep at night.
            (2) The Production Manager. In each and every industry those people are constantly under pressure to reduce cost and increase profit. With a production where you cannot distinguish between raw material and finished product, the optimum ist to all together skip the steps of production and just package those raw sugar pills. Once this potential for cost reduction is realized, there is no more potential (and QM’s life is more bearable into the bargain). Personally, I am convinced that the big producers of homeopathy have allready done just this and just pack and ship the pure unmodified sugar pills – and that they have set up a fake production line or even a garden for the sake of visitors and advertising. So how could Production Manager be happy at his job?

        • There are still manufacturers who succuss by hand. Hahnemann originally believed that potentization by dilution could be maximized by succussion: essentially at each dilution step the container needed to be struck several times against an elastic surface. A leather-bound book was ideal. You can see how well this principle from the master is being upheld today in the following YouTube videos (my comments in parentheses).

          https://www.youtube.com/watch?v=oew8mkV1d6Q&t=4m02s (Similisan is a manufacturer who sticks firmly to Hahnemann’s original approach to succussion. Even on a large scale, as you can see at https://www.youtube.com/watch?v=xkabFIcuETg&t=7m37s, Similisan still succsses by hand.)

          https://www.youtube.com/watch?v=ITzmHyPb9TQ (Helios, another manufacturer who bangs their products on a book.)

          https://www.youtube.com/watch?v=2YC9d7yQArI (Enercel-Vet explains the importance of the patient succussing their purchased product to activate it before ingesting each dose.)

          https://www.youtube.com/watch?v=g2WyhsnyPcI (Here’s a machine that bangs a flask on an elastic surface.)

          https://www.youtube.com/watch?v=dWzX_rT9a-o&t=3m40s (Boiron, perhaps the world’s biggest manufacturer of homeopathic medicines, uses a mini paint shaking device, but doesn’t seem to bang dilutions on any firm surface.)

          https://www.youtube.com/watch?v=Zj2_MIPpZus (Another paint shaker-type machine, but this one has the added property of automatically inverting the container after each shake, so the contents almost all run out, then refilling the container automatically with water. Of course, this means that the potencies are not precisely measured at all, but then, who cares?!)

          https://www.youtube.com/watch?v=iGua-wdVtuQ (Here we have a serious advance on the potentization process. Sai vibrionics is a healing process akin to homeopathy, but its products are made by transferring vibrations from source materials in one container to water in a second container.)

          For anyone who is not yet rolling on the floor with laughter at these suggestions for light entertainment, please take a look at this demonstration that ‘potentization’ is not unique to homeopathy: https://www.youtube.com/watch?v=SX5qP-MuGk0. I can’t tell if this guy is a total loony or just taking the mick, but he demonstrates a complex potentizer with sharpened crystals and sticks on the inside surfaces. You put it in a cupboard to “Take away the bad things in your food”.

          • Here is a short film of Deutsche Homöopathie Union (DHU) about their production (in German). Scroll to the bottom and start the video. At 2:30 you find their manual potentization procedure.
            http://www.dhu-globuli.de/die-dhu/herstellung-qualitaet/

            When you see their huge tanks for their mother tinctures you cannot help but wonder what all of this is used for. Surely not in their homeopathic remedies.

          • Thanks, Norbert: it’s the serious looks on the faces of all these people while performing actions that are hilarious to watch that amazes me. Succussion and its importance to the final remedy have never been tested empirically, and with everyone doing it differently, I’m left assuming it’s irrelevant in practice.

            Some time ago, someone posted a link to a truly guffaw-inducing video of large-scale succussion in which flasks are moved horizontally to bang against a vertical surface. I was unable to find this link today: can anyone help?

          • Yes, Frank, the sincerity here is stunning. However, this may not be standard routine. DHU on a more or less regular basis hires students from the nearby universtity to do this job. And they make fun of it. I know that, because I have relatives near Kalsruhe, where DHU has their shop.

            And, I always wonder, what happens if someone of this brigade loses her count. Succussing nine or eleven times instead of ten. They would have to spill it down the drain, wouldn’t they?

            And I know the film you refer to, but cannot lay my hands on it. Its kind of a cart that just smashes into the wall. Must see if I find it. In the meantime you may find some really sluggish potentation methods in the following videos (both in German):

            https://www.youtube.com/watch?v=hYziBvx6uQU
            and
            https://www.youtube.com/watch?v=64GXizFn4lo (starting at 3:20)

          • LOL.

            “I always wonder, what happens if someone of this brigade loses her count. Succussing nine or eleven times instead of ten. They would have to spill it down the drain, wouldn’t they?” Look again at my sixth link, above. The machine inverts the bottle, shakes it, and it is simply assumed (without measurement) that 90% of the volume of contents have been removed. Then the bottle is refilled, providing the next 1C dilution. So, no, this manufacturer neither knows nor cares about the precision of the dilution. They would certainly not throw it down the drain: they clearly realize they’re making stuff so dilute it’s indistinguishable from water.

            If the professional manufacturers of homeopathic products behave so carelessly (and succuss by shaking without the banging on an elastic surface as prescribed by Hahnemann), can supporters of homeopathy not begin to realize they’re being conned?

          • Sorry: bad proofreading. That should have read “…99% of the volume of contents…

          • @Norbert Aust: That cart was shown in “Homöopathie: Heilung oder Humbug?” (3sat). (http://www.3sat.de/mediathek/?mode=play&obj=35076)

          • go to 4:14 in this video for the succussion part. Many thanks FrankM

          • Thanks FrankM, that is what I was looking for (starting 4:10).

      • Yes, you are right. I can remember the first time that I visited a homeopathic production facility where a ‘tour guide’ explained the process to us. In this facility they had, what they called, a “happy room” where the succussors were left in peace and quite because bad thoughts might influence the succusion process. So the company made absolutely sure that their succusors were happy otherwise bad karma might go into the ‘medicine’. At the time they were still doing it manually, but they never showed us the process, or the room. I wonder why?

  • It seems that the comments thus far indicate a mostly neutral position towards private practice of homeopathy. I don’t think that it is anyone’s business to interfere with the wishes of adults that want to consult with acupuncturists, aromatherapists, chiropractors, herbalists, homeopaths, reflexologists and all the other traditional health practices. Civil and criminal law in the UK provides protection against unscrupulous business practices.

    In regard to the rationalisation of NHS spending, considering that the NHS has an enormous budget and pressure to provide healthcare to 10’s of millions of people, it is rational that they focus on essential healthcare provision. A NHS Essential Medicines List of proven, safe medicines is paramount to weeding out medicines that rely more on reputation than proven medical benefit.

    • ” I don’t think that it is anyone’s business to interfere with the wishes of adults that want to consult with acupuncturists, aromatherapists, chiropractors, herbalists, homeopaths, reflexologists and all the other traditional health practices.”
      AS LONG AS THEY PAY THEMSELVES AND ARE NOT MISLED INTO BELIEVING SOMETHING THAT IS NOT TRUE.

    • Your “other traditional health practices” include sadomasochists, witch doctors, snake oil salesmen, voodoo, palm readers, astrologists, and other con artists. And you think this is OK?

  • Homeopathic remedies are cheaper to buy privately than on an NHS prescription, so unless the NHS is only prescribing remedies for people who are exempt from payment, people will be saving money by having to pay privately!

    As for getting homeopathic treatment on the NHS, it’s very difficult these days. My youngest daughter developed symptoms of rheumatoid arthritis most likely triggered by antidepressant medication she had been on, as there is no history of RA in our families at all. Her rheumatologist could only follow standard NHS protocol which is to ‘manage’ the symptoms with medication that had the potential for liver damage. My daughter’s condition continued to worsen, her medication was increased and she had to have steroid injections on top of that.

    Then she came across a blog by a girl who had RA and through the ‘standard treatment’ became wheelchair bound and was on strong and hazardous drugs. She was referred to Dr Peter Fisher at the RLHIM (NHS hospital) and after a relatively short time was able to dispense with her drugs and was up and out of her wheelchair. My daughter asked her GP to refer her, but he refused, even though the RLHIM does not only offer homeopathy. We decided to pay to go there privately and now, some 6 months later, her medications are down to a very low level, her condition has improved enormously and she is expecting to be able to stop her medications completely in the near future.

    It seems that the only way she could have been referred would have been if her condition had got so bad that none of the conventional drugs could help, or if she had had such severe adverse effects that she couldn’t tolerate the conventional treatment. It seems to me that many more cases could be successfully dealt with using complementary therapies before those conditions deteriorate to the point of costing the NHS far more money as a result. All drugs come with adverse effects and none of them are designed to affect a cure. However, many times people who have used homeopathy and other complementary therapies have regressed so much that they are, in effect, cured.

    Finally, if the NHS is trying to save money by no longer prescribing things that are ‘mere placebo’, then they should stop prescribing antidepressants, being as Kirsch et al have shown that those are no better than placebo and come with a whole host of adverse effects and withdrawal symptoms….

    • This is not even crazy, this is madness!
      A child with an extremely serious disease is treated with appropriate drugs, albeit “strong and hazardous”. With time and the effects of modern medicine the child improves and can diminish the medication.
      At the same time a well known idiot homeopath was involved who does little more than chat at length with the patient and its relatives and prescribe sugar pills wetted in shaken water and dried. To think that it was the shaken-water peddler who is to thank for the change in the child’s condition can only stem from a severe disturbance of the mind.
      You have indeed a lot to learn dear Jane Spedding. I fear for you and your children. I hope you will wake up from your fairy-tale fantasy belief in make-believe medicine.

  • Just another thought, if the NHS realised how much homeopathy does actually help people, placebo or not, they could save millions on their drugs bill by using homeopathy instead of the vast sums they spend on drugs that are undoubtedly contributing to iatrogenic disease…

    • “realised how much homeopathy”

      maybe the placebo justification could be incorporated into the specialty of psychiatry . But claiming the placebo effect as as credible evidence of the efficacy of a treatment modality can be done with any treatment. What distinguishes homeopathy as unique? I would say that Streptomycin distinguished allopathic medicine as something with a real cause and effect… could you cite some evidence of any homeopathic remedy with such credentials?

    • Wow! There is absolutely no way an antidepressant could cause RA!! Meds have side effects that should be discussed along with the proven benefits, & generally should not be used if risks out way improvements to be expected. RA is known to have unexpected spontaneous remissions & exacerbations. It sounds like this a possibility, which the Alternative fake healer took credit for, especially since he made sure to falsely blame the arthritis on a medicine.

    • I’ve seen this idea that homeopathy saves the NHS money overall floated in several places. I’ve never seen any compelling research to back this up http://facultyofhomeopathy.org/research/safety-and-cost-effectiveness/ lists some of the research that supposedly does.

      It also ignores the notional cost of a GP consultation. Time taken for homeopathic consult should be a lot longer than 5 minutes than GP can be. So, a homeopathic GP would see, what, 10% of the numbers of patients of a normal GP?

  • Small typo in paragraph before last: “mad a mockery” should be “made a mockery”.

    Thanks for the article!

  • Surely if a homeopath can come up with this type of BS given below, not succusing their stuff to make more money cannot be that far-fetched.

    “THE BLUEBOX™ IS A MUST HAVE FOR EVERY HOME:
    It’s simple and easy to use, Treats the whole family from infants to the elderly, Covers most of the common acute ailments that families are faced with, The kit is compact and travels well, Safe for use with other drugs, Safe for babies as well as pregnant and breast feeding mums, Readily taken by children, no alcohol or nasty-tasting syrups, Can’t overdose – even if a child swallows the contents of a bottle it’s the same as one dose, Comes with comprehensive information booklet to guide you, Quick response time with these remedies, A once-off purchase, refills available
    The remedies don’t expire.” http://www.pegasuskits.com/the-bluebox-kit

    But this is really good:
    “How should homeopathic medication be stored?
    All medication should be kept as cool as possible. Homeopathics however, are far more resilient to heat than are allopathic drugs. They are generally packed in quality amber glass bottles, which further ‘insulate’ from heat and light. (Homeopathics should not be stored alongside micowaves, T.V’s, Cellphones and other ‘radiating’ appliances for fear of interfering with the Energetic aspect intrinsic to Homeopathy. Moisture also, will damage the pillules).” http://www.pegasuskits.com/faq

    Moisture also, will damage pillules?????

  • Didn’t Hahnemann himself later change the number of times a potion had to be ‘succussed’? (possibly in an attempt to give the impression of scientific rigour?).

  • Edzard:Take Mercurius Cor 30, 3 times a day for 45 days and tell me what happened to you?”
    I’d be about £15 pounds poorer

    Anyone reading this blog should be told NOT TO DO THIS. You will be very sick.

  • The debate regarding effect of homeopathic remedies is as long as homeopathy itself.

    From the introduction chapter in Boericke & Deweys Biochemic Handbook from 1894 some examples for self-testing is mentioned.

    One is to give ammonium carbonicum to sundew plants (the leaves will react to the remedy at once). Another is to put Belladonna in one of your eyes (the pupilla will expand).

    • ?? Do you understand, what homeopathy is all about? One of the major points of criticism is, that homeopathic remedies do not contain enough active ingredient to produce the results this ingredient usually produces. Try your experiments with potentised homeopathic preparations and you may see the difference. Use C30 for this test.

      And second: Usually the patient ingests the stuff orally and does not apply it to his eyes …

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