Who needs facts? These vaccine conspiracy pieces write themselves…

As I write this, Chief PR Man and Publicist of the “New Wave” Vaccines-Cause-Autism-No-They-Really-Do movement, David Kirby, should have done his turn in the House of Lords and be winding up his “free public lecture”. I won’t wish him the stocks and some rotten fruit – that would be churlish – though I might hope his audience includes some of the London-based Badscience fraternity, and/or a few sceptical scientists and doctors.

(Sadly, an audience of rabid mercury obsessives, anti-vaccine nuts, ambulance-chasing lawyers, credulous journalists, nutritionistas, Patrick Holford and Dr John Briffa seems more likely. But let’s hope I’m wrong).

What I am really, really hoping is that Kirby’s turns at the HoP and later do not produce more dismal newspaper articles tomorrow like the one the Daily Telegraph ran last week.

Ah, the Telegraph.

Those snippy satirists over at Private Eye have been running stories for some weeks suggesting that all is not well at the Telegraph, that once esteemed bastion of the more pepper-ish end of the British Establishment.

(For any non-UK based readers, I should explain when I was growing up in the 60s and 70s it was understood that all retired British colonels read The Times. Retired colonels who felt we could have kept the Empire by shooting more indigenous people, and who mourned the abolition of hanging and flogging, also read the Telegraph, as did all Conservative Party voters aged over 60).

Several of the Private Eye stories involve the abolition of posts at the Telegraph for specialist correspondents, all while the number of people there tasked with reporting the minor doings of “Celebs” increases. In the latest piece on this, Private Eye comment on the departure of one of the Torygraphs’s science reporters.

When I read this it reminded me I had meant to do a post about the Telegraph’s deeply lame more MMR “controversy” article, before I got buried under a pile of students’ exam essays.

So now that I have some time, what is the connection between the Telegraph’s latest here-we-go-again chunk of MMR idiocy, and the apparent disappearance of their specialist correspondents?

Wanted: MMR journalists – relevant background strictly optional.

Well, Cassandra Jardine, the journalist credited with the Telegraph story, is not a science or medical correspondent. She is a writer who mainly deals with parenting and parent issues.

If the reporting of the MMR saga taught us one thing, it is that media coverage of medical and scientific topics by non-science-literate journalists is a recipe for slavishly credulous bollocks.

A lot of serious analyses of the media coverage of the original Andrew Wakefield-triggered MMR furore have been written. One scholarly one, written by academics at the Cardiff University School of Journalism , can be found here.

One of the points highlighted is how vast quantities of the coverage was written by news or “feature” writers, and not by specialist medical or science correspondents – who might have had a chance of understanding the issues, or at least of thinking it was important to report that all the science, scientists and doctors were lined up solidly against Wakefield.

Instead, the coverage keyed on parental fears, on the feeling that public health officials and the Government were being evasive – vastly exacerbated by the Blairs’ refusal to reveal what jabs they had given baby Leo – and on the narrative device of the ”Brave Maverick Doctor” (Andrew Wakefield).

A number of the feature journalists writing about MMR seemed to find Wakefield’s undoubted charm and charisma, plus the triple narratives of “tragic parents”, “brave maverick doctor” and “Government conceals the truth” utterly irrestible. Quite a number of them seem to have made virtually entire careers out of it.

Michael Fitzpatrick, GP, author, parent of an autistic child and vaccine scare debunker, wrote an angry piece some time back in which he produced a list – though as he says, a non-exhaustive one – of:

Gullible hacks: journalists duped by the anti-MMR campaign

One of the names that appears on his list is that of Beezy Marsh of the Daily Mail. Many of Marsh’s articles on MMR for the Mail were coauthored with Sally Beck.

…who is credited at the end of the Cassandra Jardine piece for “additional reporting”. A quick Google of:

“Sally Beck” autism MMR

- reveals many previous MMR / autism stories, including the ones co-authored with Beezy Marsh.

So Cassandra Jardine’s “researcher” on the Telegraph story is a journalist with a long history of writing credulous MMR stories. What a surprise.

Who needs balance when you’ve got controversy?

A hallmark of many stories written by the journalists on Mike Fitzpatrick’s list is that they purport to cover the MMR saga in a balanced way, but have been castigated by the Bad Science blog-o-verse for factual errors, for quoting multiple anti-vaccination campaigners without making their allegiances clear, and for presenting the story as if the evidence and informed opinion over MMR and autism was evenly balanced. To give an example, you can find Sally Beck’s and Beezy Marsh’s articles being flayed online by one blogger from the genetic and “neurodiversity” autistic causation / treatment camp (e.g. here).

Jardine’s Telegraph article, with Beck’s “additional reporting”, quotes David Kirby extensively. It also quotes ex-NIH Head Bernardine Healy. It quotes actress and “model” turned autism and anti-vaccination activist Jenny McCarthy It quotes a lawyer for UK parents who want to sue the MMR vaccine manufacturers. It quotes Laura Hewitson of the University of Pittsburgh, whose (very) preliminary study on giving monkeys vaccines is being touted as the new “smoking gun” by anti-vaccination activists.

The only voice on the other side is Sir David King, the former Government Chief Scientist, quoted early on (in one line of an article that runs to nearly 1700 words) as saying that epidemiological studies have found no link between the MMR vaccine and autism.

Everyone else quoted in the article, with the possible exception of Bernardine Healy, is an out-front anti-vaccination voice. There is the parent and campaigner (Jenny McCarthy). There is the spokesperson (David Kirby). There is the lawyer for the parents who are convinced that vaccines damaged their children. Remember that the abandoned UK anti-MMR vaccine litigation depended heavily on lawyers acting for the parents, who secured the legal aid that eventually paid out over £ 15 million pounds to fund the lawsuit. Much of this £ 15 million of taxpayers’ cash went to a motley collection of often ill-qualified or discredited “experts”, most of them connected to Wakefield, almost all of them unashamedly anti-vaccine, and some of them quite clearly bonkers.

Laura Hewitson is described in the Telegraph article as a scientific specialist in obstetrics, gynaecology and reproductive sciences at the University of Pittsburgh. All of that is accurate. However, she is also, as revealed on the autism blogs, a litigant in a vaccine-injury suit. Her partner is the IT man for Andrew Wakefield’s Thoughtful House autism clinic. And Andrew Wakefield is a co-author on her work, which is yet to appear in a peer-reviewed publication and has been scientifically dismantled on the blogs.

[2010 update - as those who follow the MMR story will know, Wakefield is now gone from Thoughtful House, his departure closely following the damning GMC judgement. However, the TH website now tells us that Laura Hewitson "joined Thoughtful House in 2008 as a staff scientist". Hewitson also appears no longer to be employed by the University of Pittsburgh. So Hewitson seems to have replaced Wakefield as TH's senior researcher.]

Of all those quoted, only Bernadine Healy has the slightest claim to be taken in any way seriously. And even she is hardly reliable when the consensus of expert opinion is completely opposite to what she is saying. Healy has recently used her newspaper columns to make rather odd statements lashing out at the “Evidence Based Medicine” movement. It is also a long time since Healy was involved with the NIH – she was director from 1991-3, appointed by George Bush Senior, and in recent years she has been mostly a high-powered administrator. It has brought a wry grimace to the face to see how her remarks about MMR have been hailed by the anti-vaccine lobby, who are usually vociferous in their loathing of any “medical establishment authority figure”, and complain loudly about “argument from authority”. Personally I do not think Healy is terribly credible on the MMR-autism issue. She is, or was, a cardiologist, not an immunologist, paediatrician, epidemiologist or vaccine specialist.

So – was this a balanced article? Hardly.

So what was it?

It’s The Men in Black (Vaccine Branch)

An interesting comment by Sally Beck appeared last summer on the noted Autism blog Left Brain Right Brain (comments thread here), and seems to me to give an insight into the kind of journalistic thinking so much in evidence over MMR:

Sally Beck on July 18th, 2007 23:03:03

Just to throw this into the mix. As a journalist checking this shambles since 1998. It’s interesting that the first two facts thrown at me by government didn’t stand up. The first was that MMR has eradicated measles. Check the ONS figures back to 1890 and you’ll see that the measles problem was solving itself nicely without intervention. The graph had virtually flatlined before any medical intervention, meaning that the single measles jab and the MMR had very little to do with the reduction in deaths. Plot a graph logarithmically and you’ll see that deaths from measles would have ceased quite naturally this year. To put deaths from measles into perspective, the year the MMR was introduced there were 16 deaths. Deaths from asthma currently stand at around 1500 annually…

When the medical profession disected Wakefield’s peer reviewed 1998 study, in a newsletter titled ‘problems in pharmacology’ (monthly newsletter to GPs, interestingly titled) they concluded that they could neither prove nor refute the findings. They felt this was enough to recommend continued use of the MMR. I wonder why they didn’t recommend further research so that they could conclusively prove or refute?

In the chronology of the affair I’ve been noticing that newspapers have continually forgotten to list that the MMR jab was withdrawn here – as it was in Canada and Japan – because the cheap version they introduced was causing encephalitis and meningitis. All the children in Wakefield’s study had received this jab with the Urabe strain of mumps.

The children who’ve allegedly died from measles: So far we have no names, only newspaper reports. What do we really know about these kids? Do we know whether they actually existed – if so, someone put me in touch with a parent so I can interview them. Do we know whether their immune systems were compromised in some way? Do we know whether they were taking immunosuppresant drugs? We know very little about them. What we know after centuries of catching measles is that healthy children do not die of measles. I suspect most of the authors here over 40 have all had measles. I know I certainly have and I don’t seem to be impaired in any way – even at this late hour.

What we can conclude is that we are not being given the full picture. Nothing here is transparent and until the facts from both sides are laid out on the table, we really won’t know. I’m looking forward to following the GMC hearing.

(italics mine)

So basically, it seems Sally Beck is from the “there must be a conspiracy here somewhere” school of journalism that has done so much over the last decade to sustain the MMR-autism link mass delusion.

For a recent example of what can happen to healthy children who catch measles, even if there are no lasting consequences, this is worth a read.

A re-write of some of Sally Beck’s comment above, to re-adjust it closer to reality, might run as follows:

“What we know after centuries of catching measles is that most healthy children do not die of measles, provided we have sophisticated hospital care available for the ones that get really ill. And even then about 1 in every 2000 kids who get measles will be permanently brain damaged, or will die. I suspect most of the authors here over 40 have all had measles. I know I certainly have and I don’t seem to be impaired in any way – even at this late hour. Of course, because the numbers that suffer permanent damage are small with modern advanced care, we are likely not to have personally known anyone who was seriously ill with measles. This tends to make us believe – erroneously – that measles is just uncomfortable, and no more.”

Well, I have some news for Sally Beck:

The doctors who have treated kids with life-threatening acute viral illnesses on the medical wards and ICUs, including Mrs Dr Aust, would disagree.

And I also have a suggested alternative title for the Telegraph article:

“MMR – the “debate” that won’t go away – because journalists don’t understand science, but instinctively see column-inch generating Govt cover-ups everywhere”

PS - one of Andrew Wakefield’s greatest fans among UK columnists has always been that scourge of centre-left orthodoxy Melanie Phillips, who also weighed in again on MMR last week. A special Talking Science “above and beyond” award ought to go to Black Triangle.blog proprietor Anthony (Cox), who can be found on the comments thread below the article trying to explain science and evidence to the anti-vaccine believers. His restraint and calm in the face of flaming, taunting and name-calling, not to mention blinding stupidity and frank obsessional psychoses, is positively superhuman.

26 Responses to “Who needs facts? These vaccine conspiracy pieces write themselves…”

  1. amberstevenson Says:

    Has anyone checked out the new documentary called Recovered: Journeys Through the Autism Spectrum and Back?

    I bought it, saw it – it is absolutewy amazing. There are four children who have fully recovered from autism . It’s like you are a fly on the wall of their therapy sessions, the doctor (Dr. Doreen Granpeesheh) talks about their therapy, and how they came to the point of full recovery. The best is at the end, when we see the kids who are now recovered teenagers talk .

    Anyway, check it out out http://www.recoveredautism.com

  2. draust Says:

    Judging by your centerforautism.com email address and your IP address, “Amber”, Dr Granpeesheh is also your boss. In addition,she seems to keep rather dubious company (Dr G is 2nd from left).

    Though I am no expert, my Bullshit Detectors go to Defcon Two when I hear the words “recovery” or “cure” in relation to ASD.

  3. Sharon Says:

    Has anyone checked out the new article on a miraculous treatment for autism?

    I read it it, – it is absolutewy (sic) amazing. There is a little boy who is well on his way to recovery from autism. It’s like you are a fly on the wall of their life, the mum (Sharon) talks about their therapy, and how they came to the point of approaching full recovery. The best part is when we read about the kid himself talking!

    Anyway, check it out out.

    OK, then.
    Amber, the thing you lot selling dubious, expensive, unproven and unethical “treatments” for autism always miss, is that autistic children can develop with just decent parenting and education, taking their particular strengths, interests and learning style into account. If I’d listened to your type, I’d have believed that my son, non-verbal and extremely demanding at 3 and 4, would never be able to do what he is now capable of. Autism is a condition associated with developmental delay, NOT stasis.

    Dr Aust, what a great summary of the recent mound of what passes for journalism. That Telegraph piece was a shocker.

    Kudos to anyone who tries to engage the discussion comments on Daily Mail articles. Even reading them saps the life force from me.

  4. dvnutrix Says:

    A special Talking Science “above and beyond” award ought to go to Black Triangle.blog proprietor Anthony (Cox)…

    Hear, hear.

    As ever, a fine piece by yourself, Dr Aust. The Telegraph article was lamentable and very obviously an extended version of Beck’s comment.

    Sharon, you’ll have seen Ms Clark’s piece about Dr Fombonne’s recent testimony to the Autism Omnibus. For anyone who hasn’t, Fombonne discussed running a randomised clinical trial of a treatment that involved a language based intervention to improve communication skills in young children with autism.

    it’s an intervention that everybody likes, eh and when we did the trial we had all the impression that it was actually achieving some positive results. The parents were happy and were convinced that the methods were showing some efficacy, and we did too.
    But as we did the study well we didn’t analyze the data before the data were finally collected and when we broke the blind and looked at the results and there is no difference between the two groups—which is breaking my heart, in some ways—but this also shows that our experience as clinicians and as parents can be misleading.

    As pointed out in the comments, either both groups stagnated (unlikely, because both the parents and clinicians were pleased) or the children in the waiting list control group made similar language gains to the group that had the intervention. Which tends to confirm Sharon’s point: “Autism is a condition associated with developmental delay, NOT stasis”.

  5. Rob Hinkley Says:

    I was at Kirby’s lecture on Wednesday evening, (writeup here) and there were
    no journalists. Attendance was low: I’d guess in the 50-100 range but another member of the audience reckons “fifty people at most“.

    Kirby’s talk at Parliament didn’t get much of an audience, and no press, either.

  6. blog-thing : David Kirby in London Says:

    [...] even the Telegraph turned up. Perhaps their previous execrable piece on vaccines and autism that the splenetic Dr Aust deals with so admirably, was a blessing in disguise. They are probably too embarrassed to let a [...]

  7. pv Says:

    So, Dr. Doreen Granpeesheh’s reaction to Dr Aust is to issue a spam response extolling the virtues of her autism “cure”. That’s typical of people who’s science model is based on used-car sales techniques. Quacks and woosters are never ones to miss a sales opportunity.
    Nice article Dr Aust.

  8. Claire Says:

    As an antidote to various forms of fact-denying emotional certainty,I’m eagerly awaiting delivery of this book, discussed here by its author:
    http://www.salon.com/mwt/mind_reader/2008/02/29/certainty/

  9. Tony Says:

    Interesting post. I will be back to read again

    edit: advertising link removed

  10. The “toxins in vaccines” crowd are still with us « Dr Aust’s Spleen Says:

    [...] usual mercury /vaccines conspiracy crazies, and barely anyone at all at the House of Lords), click here and follow the [...]

  11. Helen Parnell-Berry Says:

    I’m a Practice Nurse. I find it very frustrating when parents read articles in the press, particularly news papers such as The Telegraph. They believe every word. Everything we do has to be evidence based; we have to know how to read a research paper, understand it and decide whether the research is valid or not. I don’t believe that the average journalist at the Telegraph, The Times much less the Daily Mail, have that skill. It really beggars belief that given we, as nurses and doctors, DO have this skill, the absolute drivel written by a bunch of sensationalist half wits is taken as the absolute truth. But then……this is the UK.

  12. rattitude Says:

    It is unfortunately (for the rest of us) not a problem limited to the UK.

  13. draust Says:

    Thanks all for the kind comments. And special thanks to Rob Hinkley for the link to his excellent first-hand report of the Kirby UK visitation.

    I think those of us in the UK should be thankful our Kirby-tation was so low key. As a contrast, check out this thread, where a US law student blogger made some comments about Kirby being invited to appear at his (New York University) Law School later this month. All the anti-vaccine gang show up like a flock of vultures, including Clifford G. Miller, John Stone and American “daily chelation for everything!” uber-nutcase John Best Jr. The rabid-ness of this lot never ceases to amaze me. One of the minor delights of the thread, for seasoned anti-vaccine-loony watchers, is to see John Best Jr berating David Kirby for being a traitor to the anti-vaccine cause. Kirby’s crime was to defend Neurodiversity blogger Kathleen Seidel’s right to freedom of speech when Seidel was served with a nuisance subpoena by a notorious US anti-vaccine lawyer (more on the Seidel subpoena and its aftermath here).

    I completely agree with Helen Parnell-Berry about the struggles health workers face in trying to deal with this stuff. One of the things you learn teaching in a medical school, and hanging around with people who work in healthcare, is just how much knowledge, experience and skill goes into giving people the key messages and important information in a comprehensible form. But peoples’ susceptibility to the “Aha! Here’s what the doctors aren’t telling you!” line is a real worry.

    I was just talking about this earlier this week with an ex-PhD student of ours who is now a Principal Clinical Biochemist (complete with MRCPath) at a hospital in Northern Ireland. We were contrasting the information on NHS and charity health information sites with the “random internet trawl” stuff. The mainline website stuff often looks simple but in fact reflects production via tens to hundreds of person-hours of data synthesis, fact-chasing, writing, checking by groups of scrutineers and experts, re-writing, etc etc. …While the sort of info on sites produced by one-man conspiracy obsessives like the chap who runs whale.to looks full of fascinating detail, but in fact is garbled and misleading claptrap, often incorrect and almost always wholly out of context.

    Complex does not mean “informed”, and simple does not mean “glossed over”. This comes back in a way to the “tacit knowledge” of experts that we talked about a few posts ago.

    Finally, thanks to dvnutrix for passing on the Eric Fombonne story. It highlights once again how difficult it is to draw conclusions from anecdotes, especially in the case of things like child development where there is a vast variation in developmental rates in both normal and “abnormal” settings. The message once again: proper trials are the only way to tell whether interventions work, and if they don’t work in the proper trials, then anecdotes about secretin, chelation, methyl-B12, omega-3 fish oils and weird diets are just that – anecdotes.

    Or to repeat (again) one of my favourite scientific maxims:

    “The first principle [of scientific integrity] is that you must not fool yourself – and you are the easiest person to fool.” – Richard P. Feynman

  14. Grand Rounds 4:38 | mumps Says:

    [...] From Dr Aust about Vaccine Conspiracy Theorists. (Not from Grand Rounds, just something I read earlier in the year, here is an article from the New York Times about the resurgence of measles and other PREVENTABLE diseases with potentially devastating consequences. [...]

  15. Measles - spot the worrying trend (Updated) « Dr Aust’s Spleen Says:

    [...] And unvaccinated adults can get measles, and the nasty consequences, too. As I said in an earlier post, Mrs Dr Aust treated a few seriously ill adult cases like this in her days in hospital acute [...]

  16. physicsmum Says:

    And so it continues…….

    We recently had a presentation here in Calgary entitled “Vaccine Clarity – get the facts”, given by some sort of “doctor”, and quite well attended. You can imagine what kind of “facts” were presented, and the net result is that no one who attended this event is going to get the H1N1 vaccine which has just become available here. (I did not go, just heard about it on the news after the fact)

    With stuff like this going on, what is the average person to think??
    Someone said on the radio that all the conflicting information is very confusing, but the real problem is all the misinformation! Plus the fact that so many people don’t trust the medical establishment, all very worrying………

  17. Australian Vaccination Network Audited | Atheist Age Says:

    [...] to the dedication and skill of volunteers, Conspiracy Theorist Meryl Dorey’s lethal campaign to sabotage preventative medicine and particularly vaccination [...]

  18. tony Says:

    everything drug companies do is for our health…profit and any orders from the nwo types obviously are not even a factor…thank you for making this so clear….as for the unfortunate spiking in autism…would like to see you point your keen eye towards that and explain please ?

  19. draust Says:

    On a kind of ‘Godwin’s Law’ thing, I reckon mentioning ‘the NWO types’ in at least apparent seriousness immediately gets you NOT taken seriously.

    As to the rise in autism diagnoses -which is what we have numbers for, rather than actual autism – I think a lot of it (possibly all of it) is simply explained by better diagnosis and ‘diagnostic creep’ – people who were once thought of as ‘a bit odd’ are now ‘on the spectrum‘. There is an article discussing some of this here.

  20. tony Says:

    “intelligent” people have so much ego they can’t believe they have been fooled (even if it is their own eyes) they will cling to every bit of the 24/7 programming that tells them they are still intelligent and not fools …i.e. draust rebleating “diagnoses is now better” bullshite…have you seen an autistic person ? there is no missing the severity…and in the usa…the “ignorant” amish who do not get vaccines do not get autism….but go ahead and explain your eyes away again in favor of your oversized ego…

  21. draust Says:

    Hey ho. The Amish *do* get autism, tony. But don’t let facts spoil your conspiracy theory.

  22. tony Says:

    brainwashed draust, they get it at the same rates they have always gotten it…don’t worry though, your ego is safe and the 24/7 information industrial complex will keep stroking it as long as you rebleat what they say…i guess ignorance is bliss for fools who trust in the bankster press and government

  23. draust Says:

    For anyone still following, Prof Dorothy Bishop of Oxford University (who is a developmental psychologist) has just addressed ‘diagnostic substitution’ for autism (i.e. the idea that people now given an ASD diagnosis would, in earlier times, have had a label other than autism, or even no label at all), in a new post on her blog:

    The Autism Epidemic and Diagnostic Substitution

    I’m sure it won’t convince Tony, or others who want to see conspiracies everywhere, but it is good reading for those with at least partly open minds.

  24. parent Says:

    not wise to judge parents who dont know what to do for the best or who to listen to, I myself could have been affected for life if my mother had taken the anti morning sickness pill, please dont forget who suffers when Drs get things wrong. I did have my children vacinated, but the nurse commenting didnt have to think about her own children because they are much older. Easy to comment when you’re not making that decision Nurse Berry

  25. Dr Aust Says:

    Sorry, that comment got stuck in the spam filter, and I’ve not been checking it much lately as the blog has been dormant.

    My mother was also offered thalidomide, which I guess is what ‘parent’ is referring to, when pregnant with me. Of course, following the thalidomide tragedy a whole regime of drug safety testing was put in place, the forerunner of the modern regulatory set-up. The success of this is the reason why there has been no repeat of anything similar.

    [Incidentally, the major reason new drugs fail in the final testing stage of clinical trials (called 'Phase 3', when the drug is given to 300-3000 people) is unacceptable unwanted effects - including toxicity. The fact that so many compounds do fail in Phase 3 is an indication as to how high the bar is set nowadays. Many drugs of the past - including some things that 'natural therapy' people like to use, incidentally - would not have got approved under the current regime since they do not have an acceptable safety margin, toxicity or 'side effect profile' by current standards.]

    Getting back to vaccines – as I’ve said before, I don’t think anyone is ‘indicting’ parents for being confused. I am far angrier with all the journalists who should know better, and who were largely responsible for creating a ‘manufactroversy’ about vaccination where none really exists. In medical and scientific terms, the benefit of vaccination in general, and MMR in particular, is a completely open and shut case – but it was presented (and continues to be in some quarters) as a real ‘the jury is still out’ argument.

    I would hope most people in healthcare are sympathetic to parents’ confusion, and ready to offer help and advice. But you can see how people in healthcare and science might get frustrated when that advice is disbelieved in favour of

    ‘What X in my natural childbirth antenatal class told me she read in a leaflet from the health food shop’

    – or similar.

    One of the things that has amazed me is that in my neck of the woods it tends to be the middle-class professional degree-educated parents who don’t vaccinate. None of these (at least the ones I know) are people with scientific degrees or professions, BTW. Anyway, one rather depressing effect of their level of education seems to be that it deceives them into thinking they can judge the evidence on vaccination better than all the people whose job it is to do it. A similar effect can be seen in attitudes to childbirth, which I discussed back here.

  26. draust Says:

    And… just after I penned the above, a story to illustrate it. Sadly.

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