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

education

It has been reported that a Vancouver naturopath has been fined and temporarily suspended after a patient complained he failed to notice a rectal tumor during four months of treatment for hemorrhoids.

Jordan Atkinson will have to pay $5,000 and lose his license for 16 days after signing a consent agreement with the College of Naturopathic Physicians of B.C., according to a public notice posted by the COLLEGE OF NATUROPATHIC PHYSICIANS OF BRITISH COLUMBIA.

A former patient had filed the complaint when another medical professional diagnosed a tumor on the rectum following “several appointments” with Atkinson for hemorrhoid treatment. “The patient complained that Dr. Atkinson failed to detect the tumor because he did not perform a competent examination,” the college notice says.  ‘Doctor’ Atkinson disagreed with that allegation but admitted that he didn’t fully document his appointments with the patient.

The college’s inquiry committee, which investigates complaints, found that “Dr. Atkinson’s treatment of the patient fell short of the standard of practice required of a naturopathic doctor in these circumstances.”  Atkinson who is also the subject of a lawsuit from a patient who alleges he seriously injured her while injecting Botox into her face at the base of her nose, has also agreed to a reprimand and “to make reasonable efforts when a language barrier exists to ensure that his patients understand the treatment plan and provide informed consent.” 

Personally, I find it hard to believe that any health professional can administer a prolonged treatment for hemorrhoids, while the patient is actually suffering from a rectal tumor which might well be malign. I find it even harder to believe that, after a complaint had been filed by a victim, the professional body of this professional suspends his license for just 16 days.

In my view, this suggests that this professional body (like so many in the realm of so-called alternative medicine (SCAM)) is not fit for purpose. That is to say, it does clearly not fulfill its main task adequately which is to protect the public from the malpractice of its members. Rather it seems to prioritize the interests of the member over those of the public. Yet, on its website the COLLEGE OF NATUROPATHIC PHYSICIANS OF BRITISH COLUMBIA state that “the College protects the public interest by ensuring that naturopathic physicians in British Columbia practice safely, ethically, and competently.” As so often in SCAM, what is being stated and what is being done differs dramatically.

At the heart of this and many similar cases, I fear, is that consumers find it difficult to differentiate between well-educated healthcare professionals and poorly trained charlatans. And who could blame them? Calling naturopaths ‘doctors’ cannot be helpful, particularly if the ‘Dr.-title’ is used without a clear qualification that the person who carries it has never seen the inside of a medical school; instead he has learned an abundance of nonsense taught by a quack institution.

In summary one is tempted to conclude that this case yet again confirms that naturopaths are medically incompetent graduates of schools of incompetence protected by organizations of incompetence.

The U.S. Food and Drug Administration issued warning letters to seven companies for illegally selling dietary supplements that claim to cure, treat, mitigate or prevent cardiovascular disease or related conditions, such as atherosclerosis, stroke or heart failure, in violation of the Federal Food, Drug, and Cosmetic Act (FD&C Act). The FDA is urging consumers not to use these or similar products because they have not been evaluated by the FDA to be safe or effective for their intended use and may be harmful.

The warning letters were issued to:

“Given that cardiovascular disease is the leading cause of death in the U.S., it’s important that the FDA protect the public from products and companies that make unlawful claims to treat it. Dietary supplements that claim to cure, treat, mitigate or prevent cardiovascular disease and related conditions could potentially harm consumers who use these products instead of seeking safe and effective FDA-approved treatments from qualified health care providers,” said Cara Welch, Ph.D., director of the Office of Dietary Supplement Programs in the FDA’s Center for Food Safety and Applied Nutrition. “We encourage consumers to remain vigilant when shopping online or in stores to avoid purchasing products that could put their health at risk.”

Under the FD&C Act, products intended to diagnose, cure, treat, mitigate or prevent disease are drugs and are subject to the requirements that apply to drugs, even if they are labeled as dietary supplements. Unlike drugs approved by the FDA, the agency has not evaluated whether the unapproved products subject to the warning letters announced today are effective for their intended use, what the proper dosage might be, how they could interact with FDA-approved drugs or other substances, or whether they have dangerous side effects or other safety concerns.

The FDA advises consumers to talk to their doctor, pharmacist or other health care provider before deciding to purchase or use any dietary supplement or drug. Some supplements might interact with medicines or other supplements. Health care providers will work with patients to determine which treatment is the best option for their condition.

If a consumer thinks that a product might have caused a reaction or an illness, they should immediately stop using the product and contact their health care provider. The FDA encourages health care providers and consumers to report any adverse reactions associated with FDA-regulated products to the agency using MedWatch or the Safety Reporting Portal.

The FDA has requested responses from the companies within 15 working days stating how they will address the issues described in the warning letters or provide their reasoning and supporting information as to why they think the products are not in violation of the law. Failure to correct violations promptly may result in legal action, including product seizure and/or injunction.

Quackery is rife in India. On this blog, I have occasionally reported on this situation, e.g.:

Now the Chief Justice of India (CJI) NV Ramana has pointed out that legislation needs to be brought in to save people “from falling prey to fraudulent practices in the name of treatment”. Speaking at the inaugural National Academy of Medical Sciences on ‘Law and Medicine’, the CJI said: “Quackery is the biggest disease affecting India” and that hospitals are “being run like companies, where profit-making is more important than service to society”. The CJI added, “another side of lack of accessible healthcare is giving space to quacks. Quackery begins where awareness ends. Where there is room for myths, there is room for quackery”. He continued, “Owing to the financial and time constraints, a huge majority of the Indian population approaches these untrained and uncertified doctors. Lack of awareness and knowledge, misplaced belief, and sheer inaccessibility have massive ramifications on the health of the country, particularly the rural and underprivileged Indian … The need of the hour is to bring in legislation to save people from falling prey to fraudulent practices in the name of treatment … Private hospitals are being opened at an exponential rate. This is not necessarily a bad thing, but there is a glaring need for balance. We are seeing hospitals being run like companies, where profit-making is more important than service to society.”

I am sure the CJI is correct; India does have a quackery problem. If nothing else, the fact that one website lists a total of 746 Alternative Medicine Colleges in India, leaves little doubt about it.

A review conducted in 2015 reported community pharmacists are willing to adopt a professional role in counselling consumers about the appropriate and safe use of so-called alternative medicine (SCAM) but faced multiple barriers in doing so. This current review aimed to update and extend these findings, by identifying studies published since 2015 that reported on pharmacists across any setting.

Eligible studies published between January 01, 2016, and December 31, 2021, were identified across 6 databases (PubMed, Scopus, Web of Science, EMBASE, ScienceDirect and MEDLINE). A grounded theory approach was used to thematically synthesize the data extracted.

A total of 64studies representing pharmacists across 30 countries were included for review. The study designs varied and included:

  • cross-sectional surveys (n = 36),
  • qualitative studies (n = 14),
  • pseudo-patient studies (n = 3).

Eight studies reported on practice and/or bioethical responsibilities and 19 studies documented factors that would enable pharmacists to fulfill these responsibilities, while 37 studies reported on both.

The authors concluded that these findings indicate research about pharmacists’ responsibilities associated with SCAM is evolving from gap analysis towards research that is proactive in advocating for change in multiple areas. These findings can be used to inform a consensus discussion among pharmacists and key stakeholders regarding a set of professional responsibilities that would serve in the development of: a clearly defined role and associated practice standards, and competency requirements that inform educational learning objectives for inclusion in undergraduate, post-graduate and continuing professional pharmacy education.

I am puzzled why so many researchers in this specific area seem to avoid clearer language plainly stating the essential, simple, and undeniable facts. I am equally puzzled why so few pharmacists speak out.

It is obvious that community pharmacists are firstly healthcare professionals and only secondly shopkeepers. As such, they have important professional and ethical duties. Foremost, they are obliged to inform their customers responsibly – and responsible means telling them about the evidence for or against the SCAM product they are about to purchase. This duty also entails that pharmacists must inform themselves about the best current evidence. In turn, this means they must stop tolerating the current plethora of under- or post-graduate SCAM courses that are not evidence-based.

As we have discussed ad nauseam on this blog, none of this is actually happening (except in very few laudable cases)!

By and large, pharmacists continue to go along with the double standards of a) evidence for conventional drugs and b) fairy tales for SCAM. In the interest of progress, patient safety, and public health, it is time that pharmacists wake up and remind themselves that they are not commercially orientated shopkeepers but ethical healthcare professionals.

I just got this email with sad news: Ken Frazier “died peacefully this morning, three weeks after being diagnosed with acute myeloid leukemia. Judy and I were fortunate to spend time with Ken and Ruth last week and tell Ken personally how much he has meant to us over our entire lives.”

Ken was a part of CFI history quite literally from Day One. In May 1976, writing for Science News, Ken reported on the formation of the Committee for the Scientific Investigation of Claims of the Paranormal (CSICOP). In 1977, Ken joined CSICOP to serve as editor of The Zetetic, which became Skeptical Inquirer in 1978. He held that position ever since, spending the better part of five decades defining and steering the work of the skeptical community in combatting disinformation and pseudoscience. Ken has also published numerous papers and books, e.g.:

Ken’s book Science Under Siege: Defending Science, Exposing Pseudoscience was featured by Science News for its “engaging, insightful, and often surprising essays by researchers and journalists” about “what science is and is not, and what happens when the facts get twisted.” And he was working on yet another book; only a few months ago he wrote to me taking me for help with it:

… I am completing [ a book] on science and pseudoscience, titled Shadows of Science.  It was just accepted by Prometheus Books for publication in Fall 2023.  I am now working on a final chapter on “Pseudomedicine,” pseudoscience in medicine.  This is not my area of expertise so I am relying on many medical professionals who have investigated and written about medical pseudoscience, most prominently you.

My chapter is mainly concerned with broad points and principles in identifying and describing pseudoscience in medicine — SCAM.

I merely ask if you mind if I quote from and paraphrase from a number of your writings—all with full credit to you in the text itself in addition to in the bibliography

I have always been particularly impressed with the Introduction to your So-Called Alternative Medicine (SCAM) for Cancer as well as parts of your earlier book SCAM: So-Called Alternative Medicine (which carries my testimonial to you on the back cover!).  This includes your definition of SCAM and your list of popular therapies and perhaps some of your common assumptions about SCAM. I also would love to draw upon some of the information in your boxes in the opening parts of SCAM…

Ken has on many occasions been most helpful and kind to me, and it goes without saying that I was delighted to assist.

He was a giant amongst the US skeptics, and we will all miss him badly.

Shiatsu is a Japanese form of so-called alternative medicine (SCAM) derived from Traditional Chinese Medicine using deep pressure on the paths of the postulated acupuncture meridians. Clinical observations on this topic are said to be encouraging, especially for the treatment of sleep and conduct disorders, but there is a lack of empirical data.

The objective of this study was to examine the possible therapeutic effects of shiatsu in a clinical population of children treated in child and adolescent psychiatry. It was designed as a qualitative descriptive and non-interventional study, conducted on children treated in day-care hospital units and outpatient clinical settings. Shiatsu was administered, at least during 3 sessions, to children with an autism spectrum disorder or other disorders according to ICD-11 criteria (such as conduct disorders with impulsivity or attention deficit).

The evaluation was performed by two independent researchers (a child psychiatrist and a psychologist who were not the caregivers) based on direct observation of children during the shiatsu sessions, combined with semi-structured non-inductive interviews with their parents, and data collected from focus groups conducted with the children’s caregivers. A phenomenological interpretive analysis (IPA) approach with Nvivo coding software was used to analyze the data.

Based on semi-structured interviews with 13 parents cross-referenced with data from 2 focus groups and direct observations of 7 children during 2 full shiatsu sessions for each observation, the results show that shiatsu has positive effects on

  • internal tension (a relief effect, notably on aggressive behaviors directed against others or self),
  • sleep (including improvement of sleep quality),
  • social interaction,
  • attention,
  • verbalization of affects and traumatic memories of early childhood,
  • perception of bodily limits.

As these children had several other treatments as well, it cannot be proved that the positive effects observed in this study are related specifically to shiatsu practice. Shiatsu may participate and facilitate the effects of other treatments. It is noteworthy that most of the children came willingly to the shiatsu sessions, ask their parents to repeat the shiatsu sessions at home, and indicate to the practitioner, from one session to the next, their elective body points where they wish to receive the application of shiatsu.

The authors concluded that the findings suggest therapeutic benefits of shiatsu, especially on externalize violence with a relief of aggressive behavior directed against others or self (knowing, moreover, that internal tension, sleep disorders and non-verbalization of affects or traumatic memories, all improved by shiatsu, are also all risk factors for externalize violence). These results highlight, therefore, the need to develop a daily practice of shiatsu in child and adolescent psychiatry. Further research is required to clarify the effects of shiatsu and ascertain better its underlying mechanisms based on this exploratory pilot study.

I do appreciate that, with a treatment that has not been submitted to many controlled clinical trials, researchers feel that they have to start from scratch, e.g. simple observations. However, they also must realize that their observations do not lend themselves to firm conclusions about the effects of the treatment. In the present case, the researchers do seem to be aware of this caveat but nevertheless make statements that go way beyond of what is warranted:

  • the results show that shiatsu has positive effects on …
  • Shiatsu may participate and facilitate the effects of other treatments
  • the findings suggest therapeutic benefits of shiatsu, especially on externalize violence
  • These results highlight, therefore, the need to develop a daily practice of shiatsu in child and adolescent psychiatry

I fear that these statements are not merely exaggerated but suspect they are also untrue. Testing them in properly controlled clinical trials would show whether my suspicion is correct. Meanwhile, I would like to remind

  • researchers,
  • reviewers,
  • and journal editors

of their duty to be truthful and not mislead the public.

 

I was fascinated to find a chiropractor who proudly listed ‘the most common conditions chiropractors help kids with‘:

  • Vision problems
  • Skin conditions
  • Bedwetting
  • Sinus problems
  • ADD/ADHD
  • Stomachaches
  • Asthma
  • Allergies
  • Loss of hearing
  • Ear Infections
  • Hip, leg, or foot pain
  • Constipation
  • Poor coordination
  • Breastfeeding difficulties
  • Arm, hand, or shoulder pain
  • Anxiety and nervousness
  • Colic
  • Scoliosis
The list is so impressive that I felt compelled to read on:

The birth process, even under normal conditions, is frequently the first cause of spinal stress. After the head of the child appears, the physician grabs the baby’s head and twists it around in a figure eight motion, lifting it up to receive the lower shoulder and then down to receive the upper shoulder. This creates significant stress on the spine of the baby.

“Spinal cord and brain stem traumas often occur during the process of birth but frequently escape diagnosis. Infants often experience lasting neurological defects. Spinal trauma at birth is essentially attributed to longitudinal traction, especially when this force is combined with flexion and torsion of the spinal axis during delivery.” ~Abraham Towbin, MD

Growth patterns suggest the potential for neurological disorders is most critical from birth to two years of age, as this time is the most dynamic and important phase of postnatal brain development. Over sixty percent of all neurological development occurs after birth in the child’s first year of life. This is why it is so important to bring your child to a local pediatric chiropractor to have them checked and for your child to get a chiropractic adjustment during the first year of their life. Lee Hadley MD states “Subluxation alone is a rational reason for Pediatric Chiropractic care throughout a lifetime from birth.”

As our children continue to grow, the daily stresses can have a negative impact on an ever growing body. During the first few years of life, an infant often falls while learning to walk or can fall while tumbling off a bed or other piece of furniture. Even the seemingly innocent act of playfully tossing babies up in the air and catching them often results in a whiplash-like trauma to the spine, making it essential to get your baby checked by a pediatric chiropractor every stage of his/her development as minor injuries can present as major health concerns down the road if gone uncorrected.

______________________________

On the Internet, similar texts can be found by the hundreds. I am sure that many new parents are sufficiently impressed by them to take their kids to a chiropractor. I have yet to hear of a single case where the chiropractor then checked out the child and concluded: “there is nothing wrong; your baby does not need any therapy.” Chiropractors always find something – not something truly pathological, but something to mislead the parent and to earn some money.

Often the treatment that follows turns out to be a prolonged and thus expensive series of sessions that almost invariably involve manipulating the infant’s fragile and developing spine. There is no compelling evidence that this approach is effective for anything. In addition, there is evidence that it can do harm, sometimes even serious harm.

And that’s the reason why I have mentioned this topic before and intend to continue doing so in the future:

  • There is hardly a good reason for adults to consult a chiropractor.
  • There is no reason to take a child to a chiropractor.
  • There are good reasons for chiropractors to stop treating children.

But let’s be a bit more specific. Let’s deal with the above list of indications on the basis of the reliable evidence:

I rest my case.

 

The authors of this article searched 37 online sources, as well as print libraries, for homeopathy (HOM) and related terms in eight languages (1980 to March 2021). They included studies that compared a homeopathic medicine or intervention with a control regarding the therapeutic or preventive outcome of a disease (classified according to International Classification of Diseases-10). Subsequently, the data were extracted independently by two reviewers and analyzed descriptively.

A total of 636 investigations met the inclusion criteria, of which 541 had a therapeutic and 95 a preventive purpose. Seventy-three percent were randomized controlled trials (n = 463), whereas the rest were non-randomized studies (n = 173). The most frequently employed comparator was placebo (n = 400).

The type of homeopathic intervention was classified as:

  • multi-constituent or complex (n = 272),
  • classical or individualized (n = 176),
  • routine or clinical (n = 161),
  • isopathic (n = 19),
  • various (n = 8).

The potencies ranged from 1X (dilution of -10,000) to 10 M (10010.000). The included studies explored the effect of HOM in 223 different medical indications. The authors also present the evidence in an online database.

The authors concluded that this bibliography maps the status quo of clinical research in HOM. The data will serve for future targeted reviews, which may focus on the most studied conditions and/or homeopathic medicines, clinical impact, and the risk of bias of the included studies.

There are still skeptics who claim that no evidence exists for homeopathy. This paper proves them wrong. The number of studies may seem sizable to homeopaths, but compared to most other so-called alternative medicines (SCAMs), it is low. And compared to any conventional field of healthcare, it is truly tiny.

There are also those who claim that no rigorous trials of homeopathy with a positive results have ever emerged. This assumption is also erroneous. There are several such studies, but this paper was not aimed at identifying them. Obviously, the more important question is this: what does the totality of the methodologically sound evidence show? It fails to convincingly demonstrate that homeopathy has effects beyond placebo.

The present review was unquestionably a lot of tedious work, but it does not address these latter questions. It was published by known believers in homeopathy and sponsored by the Tiedemann Foundation for Classical Homeopathy, the Homeopathy Foundation of the Association of Homeopathic Doctors (DZVhÄ), both in Germany, and the Foundation of Homeopathy Pierre Schmidt and the Förderverein komplementärmedizinische Forschung, both in Switzerland.

The dataset established by this article will now almost certainly be used for numerous further analyses. I hope that this work will not be left to enthusiasts of homeopathy who have often demonstrated to be blinded by their own biases and are thus no longer taken seriously outside the realm of homeopathy. It would be much more productive, I feel, if independent scientists could tackle this task.

Guest post by Norbert Aust and Viktor Weisshäupl

Readers of this blog may remember the recent study of Frass et al. about the adjunct homeopathic treatment of patients suffering from non-small cell lung cancer (here). It was published in 2020 by the ‘Oncologist’, a respectable journal, and came to stunning results about to the effectiveness of homeopathy.

In our analysis, however, we found strong indications for duplicity: important study parameters like exclusion criteria or observation time were modified post hoc, and data showed characteristics that occur when unwanted data sets get removed.

We, that is the German Informationsnetzwerk Homöopathie and the Austrian ‘Initiative für wissenschaftliche Medizin’, had informed the Medical University Vienna about our findings – and the research director then asked the Austrian Agency for Scientific Integrity (OeAWI) to review the paper. The analysis took some time and included not only the paper and publicly available information but also the original data. In the end, OeAWI corroborated our findings: The results are not based on sound research but on modified or falsified data.

Here is their conclusion in full:

The committee concludes that there are numerous breaches of scientific integrity in the Study, as reported in the Publication. Several of the results can only be explained by data manipulation or falsification. The Publication is not a fair representation of the Study. The committee cannot for all the findings attribute the wrongdoings and incorrect representation to a single individual. However following our experience it is highly unlikely that the principal investigator and lead author, but also the co-authors were unaware of the discrepancies between the protocols and the Publication, for which they bear responsibility. (original English wording)

Profil, the leading news magazine of Austria reported in its issue of October 24, 2022, pp 58-61 (in German). There the lead author, Prof. M. Frass, a member of Edzard’s alternative medicine hall of fame, was asked for his comments. Here is his concluding statement:

All the allegations are known to us and completely incomprehensible, we can refute all of them. Our work was performed observing all scientific standards. The allegation of breaching scientific integrity is completely unwarranted. To us, it is evident that not all documents were included in the analysis of our study. Therefore we requested insight into the records to learn about the basis for the final statement.

(Die Vorwürfe sind uns alle bekannt und absolut unverständlich, alle können wir entkräften. Unsere Arbeit wurde unter Einhaltung aller wissenschaftlichen Standards durchgeführt. Der Vorhalt von Verstößen gegen die wissenschaftliche Intergrität enbehrt jeder Grundlage. Für uns zeigt sich offenkundig, dass bei der Begutachtung unserer Studie nicht alle Unterlagen miteinbezogen wurden. Aus diesem Grunde haben wir um Akteneinsicht gebeten, um die Grundlagen für das Final Statment kennenzulernen.)

The OeAWI together with the Medical University Vienna asked the ‘Oncologist’ for a retraction of this paper – which has not occurred as yet.

I almost missed an article that Swiss Hugo Stamm (no, I don’t know him) has written about me. It is not entirely accurate but made me giggle quite a lot. Here are some passages that I translated for you:

… [Charles] wanted to obtain scientific evidence for the efficacy of homeopathy. It was therefore no surprise that Queen Elisabeth’s homeopath also sat on the appointment committee. The choice fell in 1993 on the German physician and scientist Edzard Ernst, who until then had taught and researched at the University of Vienna. The royal expectations were clear: Ernst was to produce the desired results.

But the professor was not prepared … to fulfill the royal expectations blindly. He first wanted to conduct research according to scientific standards and examine the available studies on homeopathy. In the process, doubts soon surfaced in his mind about alternative medicine. When he then set up randomized, placebo-controlled double-blind studies, he saw himself confirmed: The results were devastating and in some cases did not even reach the values of placebo effects.

Ernst felt obliged to his scientific conscience and published his studies against the will of his “client”. Charles was appalled and instructed his personal secretary to intervene. The latter wrote to the university administration that Professor Ernst had violated the agreed confidentiality. The university buckled after the royal scolding and opened disciplinary proceedings against the rebellious professor. The commission cleared him of all charges in 2010, but his department was closed.

“I was researching alternative medicine with my team; Charles, on the other hand, did not want to question it, but to propagate it. As I found more and more evidence that many alternative medicine procedures were not effective and sometimes even dangerous, tensions between me and Charles increased.” Edzard Ernst

Ernst did not allow himself to be muzzled by the prince and current king and, in 2022, published his book “Charles, the Alternative Prince”… In an interview with the Standard, Ernst said: “For as long as homeopathy has existed, the British royal family has been among the homeopathy advocates. However, Charles has not only promoted homeopathy, but also many other alternative medical procedures. What is striking about this is that he always picks out only the most bizarre and implausible ones and leaves aside those that are rudimentarily evidence-based. This may be because he always prefers the mystical and anti-scientific. Even as a young man, he was led down this path by Laurens van der Post, a South African-born esotericist and self-proclaimed guru.”

… For better understanding, it should be added that homeopathy grossly violates four basic scientific findings. It does not take an education in chemistry or medicine to recognize this.

  • Mistake number 1: Cure like with like. Example: Someone who has lead poisoning is given globules made from lead in a diluted form. So, according to homeopathy, lead cures blood contaminated with lead.
  • Mistake number 2: Dilution. The tinctures are diluted to such an extent that they contain only a few to no molecules of the alleged active substance. Nevertheless, a healing effect is attributed to them.
  • Error number 3: Potentiation: The stronger the dilution, the greater the effect. If a globule still contains many molecules of the active substance, it has less effect than if it contains no molecules at all.
  • Misconception number 4: Water absorbs information: By shaking the diluted liquid, information of the active substance supposedly jumps over to the water. This theory also contradicts all scientific findings. If water were to absorb such information, it would be so poisoned that we would no longer be able to drink it.
    What probably few consumers of homeopathic remedies know: Globuli are made from countless substances. For example, from whale droppings, stomped ants, highly poisonous black belladonna or from the poison atropine.

But back to Charles: A prince has become a king overnight. But his attitude towards complementary medicine will not change. As a king, he certainly cannot admit to having been wrong all his life. Even if the scientific facts are clear.

___________

In case you are interested in a full account of this story, you might try my memoir.

 

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