Old Doctors and New Doctors

Lovely sunny day, and in the afternoon I went and sat in a shady pub garden with a beer and a few cigarettes, and thought about the medical profession.

In the distant past, 50 or so years ago, the medical profession’s task – their calling – was that of curing the sick. If you got sick or injured, you’d go and see a doctor, and he’d examine you, and recommend a course of treatment (e.g. stay in bed for a week, and take a few aspirin every day). If this didn’t fix the problem, you’d go back again.

And doctors back then treated everyone alike. They didn’t mind if the patient was an enemy soldier or a serial killer. They were all treated equally.

Now, however, doctors seem to mostly practise preventative medicine. Instead of just taking people as they come, these new doctors try to prevent them from coming in the first place. The thinking has changed from “Here’s a sick man, so let’s try and set him right,” to “Here’s a sick man, so what did he do to get so sick in the first place?” It isn’t just bad luck for someone to get sick any more. It’s always their fault.

Got lung cancer? That’s because you smoke. Got liver failure? That’s because you drink. Morbidly obese? That’s because you eat too much. Got shot? That’s because you joined the army. Got the clap? That’s because you’ve been sleeping around. Got malaria? Shouldn’t have gone to West Africa. Got Zika? Shouldn’t have visited Brazil. Got Ebola? Shouldn’t have lived in Liberia. There’s always something someone could have done to prevent getting sick or injured.

The old doctors didn’t used to ask. They just saw someone who was sick or injured, and did their best to help them.

In many ways, preventative medicine isn’t anything new. Vaccination is a form of preventative medicine. So also are helmets for soldiers. And railings on staircases. But these kinds of preventative measures are non-intrusive: they don’t try to change the way people behave.

But the new doctors want to change the way people behave in ever more intrusive ways. People must stop smoking. And stop drinking. And cut their food intake. And get some exercise. And stay out of the sun.

The old doctors accepted people as they were, and did their best to help them. But the new doctors want to change the way people behave. They have become moral guardians of ‘healthy’ behaviour, replacing curates and vicars. They see it as their job to tell people how to live their lives.

Why has this happened? Why have these new busybody doctors multiplied, and the old non-judgemental doctors become more or less extinct?

One possible answer is that, if the medical profession is being snowed under by patients, they’re trying to reduce their workload by preventing many of them from getting sick in the first place. This is like army doctors appealing for a war to be stopped because too many soldiers are being killed and injured.

But another (almost opposite) answer is that, now that a great many transmissible diseases can be prevented (by vaccination) or treated (with drugs), most of the classical maladies have lost their danger – and the response of the medical profession has been to discover new diseases to justify the continued existence of their profession. In this respect the WHO’s claim that there is a “smoking epidemic” can only mean that smoking has itself become a disease, no different from cholera or rabies or typhus.

Or maybe it’s simply that the new doctors no longer do what the old doctors were able to do: suspend judgement on those in their care. The new doctors are as moralistic as anyone else, but instead of suppressing criticism, they are quick to voice it.

Or perhaps it’s that when medicine was nationalised (as it has been in the UK), the doctor-patient relationship changed. The patient ceased to be a paying customer, and so his opinion no longer mattered. Once the state started paying the doctor, the patient was still a customer, but he no longer paid (or withheld payment), and exercised no influence over the doctor.

The new doctors are different in other ways. With the old doctors, you told them when you got sick, and you also told them when you recovered. But the new doctors now tell you when you’re sick, and are indifferent to your own opinion how well you are. A couple of blood tests, and they announce that you’ve got cancer or Zika or Ebola.

I can’t say that I got to the bottom of it all this afternoon. But I at least raised a few questions. And proposed a few answers.

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About Frank Davis

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29 Responses to Old Doctors and New Doctors

  1. garyk30 says:

    Doctors used to make house calls too.

    That will never happen these days.

  2. jaxthefirst says:

    Interesting thoughts indeed. The one which chimed most strongly with me was the change in the doctor/patient relationship with the onset of the NHS. Now, in theory, I’m quite a fan of the NHS in principle and I think that it’s a great system – or at least it used to be when vestiges of the old ideas of mutual respect still applied. But I think you’re right; the moment it was no longer necessary to pay doctors on a per-visit basis and we all became obliged to pay via our NI contributions, doctors no longer had to be concerned that they’d lose “custom” if they didn’t give the service that their patients – then also paying customers, too – liked. And no-one likes to be given a finger-wagging lecture by anyone, especially when they are expecting a big cheque at the end of it! I don’t have a private GP (although I’m strongly considering getting one), but I certainly feel that I have been treated much more respectfully by those private medical professionals whom I have seen in the past – dentists, physiotherapists, chiropodists, osteopaths, opticians etc. I’ve certainly never had any “lifestyle lectures” from any of them, ever, and if I ever do I’ll simply take my custom elsewhere.

  3. Smoking Lamp says:

    I suspect the major change in how physicians view their patients (at least in the US) is that medicine and pharma. have become for-profit enterprises. Patients are now commodities. It’s time to reverse that global trend and put lifestyle manipulation for generating profit into the trash bin.

  4. waltc says:

    Under your nhs and increasingly here under insurance “networks,” and limited gov’t reimbursements for medicare, medicaid and obamacare, in order to make a living, doctors are forced to see too many patients per day to get as personally involved with them as they did as freelance doctors in the past. Therefore, the ones (and that’s most) who see this as a business rather than an art or an intimate transaction, take the quick easy shortcuts and fall back on “quit smoking” or “stop using salt” instead of probing for answers to sometimes difficult or complex problems. Back then they could also set affordable fees because they didn’t need to hire full time people to deal with insurance paperwork and permissions and their insurance premiums were lower because people didn’t sue. Now add the bureaucratic requirements of keeping computerized records and the one-size-fits-all computerized centrally dictated cures for almost all symptoms and many are paying more attn to their screens than to their patients.

    Among the reasons for some of the change in attitude may be a genuine desire to have their patients avoid getting, say, cancer because the doctor knows how ugly and often futile the treatment will be and has seen too many lousy deaths. The only problem here is that doctors themselves are exposed to the same lifestyle propaganda as the rest of us are, and often in spades, since this stuff is preached in all the medical journals.

    I’ll also add that sometimes doctors do have to ask you where you’ve traveled or, for instance, how much alcohol you drank while you were taking Tylenol, in order to make a correct diagnosis.

    All that said, yes, the old time doctors were better than the new ones and in all the ways you say

    • Some French bloke says:

      This brilliant paragraph from Walt’s comment above bears repeating:

      “Among the reasons for some of the change in attitude may be a genuine desire to have their patients avoid getting, say, cancer because the doctor knows how ugly and often futile the treatment will be and has seen too many lousy deaths. The only problem here is that doctors themselves are exposed to the same lifestyle propaganda as the rest of us are, and often in spades, since this stuff is preached in all the medical journals”.

      … To which I’d only add that even high school biology textbooks these days state that “benzo[a]pyrene is a compound found in tobacco smoke” – period (as if it were the main, or even the only known source of this reputedly oncogenic compound)!

  5. harleyrider1978 says:

    Big Tobacco aims its guns to kill California tobacco tax
    August 21, 2016 8.21pm EDT by Stanton glanz

    Public health and medical advocates have been working for nearly two years to increase California’s tobacco tax, one of the nation’s lowest, by US$2.00. The current tax, a mere 87 cents a pack, ranks close to tobacco-growing states like Kentucky.

    The proposal that will be on the ballot in November as Proposition 56 , the California Healthcare, Research and Prevention Tobacco Tax Act of 2016, allocates most of the revenue to pay for expanded medical services for poor people through Medicaid, known as MediCal in California.

    More important, it includes crucial funds to reinvigorate California’s aggressive and effective, but fading, tobacco control and research programs.

    Heart disease, stroke, lung disease, cancer and other tobacco-induced diseases kill more people than car accidents, murder, suicide, alcohol, illegal drugs and AIDS combined. As director of the University of California San Francisco Center for Tobacco Control Research and Education, I study smoking. I also study – and have felt – the effects of the powerful tobacco lobby. I know what the tobacco companies have done in the past and can see what they are doing in California to block this proposal.

    Californians voters can show the rest of the country how to stand up to out-of-state bullies Philip Morris and RJ Reynolds and improve the lives of millions.

    Aggressive efforts worked, so Big Tobacco fought back

    California anti-smoking ad. California Department of Public Health
    .
    Health advocates had to go to the trouble and expense of putting this on the ballot because tobacco companies dominate the legislature. Despite 35 attempts by health advocates in the last 34 years, the legislature has raised the tobacco tax only once – by just 2 cents, in 1993 – since 1967. With a tax of just 87 cents per pack of cigarettes, California, the country’s most populous state, ranks 37th among the states in its tobacco tax.

    California is one of only three states that has not raised its tobacco tax in the 21st century. California’s cigarette tax is so low that even with a $2 increase it would still only rank only ninth.

    Big Tobacco ponied up $36 million to get started

    On July 12, 2016, Philip Morris and RJ Reynolds finally appeared when they coughed up $17 million to create “No on 56 – Stop the Special Interest Tax Grab. Major Funding by Philip Morris USA Inc. and R.J. Reynolds Tobacco Company, with a Coalition of Taxpayers, Educators, Healthcare Professionals, Law Enforcement, Labor, and Small Businesses.” And on August 5, they put in another $19 million, bringing their total so far to fight Proposition 56 to $36 million.

    The “No” campaign, as usual, is not what it appears to be. To date, not a penny has come from “taxpayers, educators, health care professionals, law enforcement, labor or small businesses.” The only reason Philip Morris and RJ Reynolds included their names in the committee name is that California’s strong campaign finance disclosure law requires top donors – in this case the only donors – be identified. Normally, the tobacco companies stay in the shadows.

    For comparison, North Dakota’s 44-cent tobacco tax is even lower than California’s, ranking 47th. Like California, health advocates have mounted an initiative to raise it to $2.20. But because North Dakota lacks California’s strong public disclosure law, Philip Morris (Altria) and RJ Reynolds left names off “North Dakotans Against the 400% Tax Increase” despite dropping $859,873 so far to oppose that initiative.

    And what is the cigarette companies’ leading argument against the California initiative? They complain, “Prop 56 allocates just 13 percent of new tobacco tax money to treat smokers or stop kids from starting.” And “If we are going to tax smokers another $1.4 billion per year, more should be dedicated to treating them and keeping kids from starting.”

    This is a smart argument for the companies to make. Research has consistently shown it is their smartest argument.

    Yet, while it may be their smartest argument, it does not always work. In 1988, health advocates successfully defended another initiative, Proposition 99, against the industry front group Californians Against Unfair Tax Increases. (That was before California passed the law requiring big money behind initiative campaigns identify themselves in their advertising.)

    Proposition 99 allocated 5 cents of the 25-cent tax to support the largest, most aggressive and effective tobacco control campaign ever done. Unlike past government campaigns, it did not focus on kids or smokers. The California Tobacco Control Program directly confronted Big Tobacco and educated the public about secondhand smoke nicotine addiction. It focused on the nonsmoking majority to reinforce the nonsmoking social norm.

    Industry running scared

    And the results were stunning: Smoking dropped so fast between 1989 and 1997 that 58,900 deaths from heart disease were prevented. And 11,000 cases of lung cancer were prevented by 1999.

    By 2009, the reductions in smoking had saved Californian citizens, taxpayers and businesses $134 billion in health care costs.

    It also cost Big Tobacco $28.5 billion in lost sales.

    Philip Morris and RJ Reynolds know this, which is why they have used their muscle in the legislature to fight every penny spent on tobacco control since voters passed Proposition 99.

    Indeed, they did everything they could to divert money away from tobacco prevention efforts into paying for the very medical services they trumpet in their campaign against Proposition 56. After all, treating heart attacks doesn’t reduce cigarette sales.

    Tax increase needed to help smokers and nonsmokers

    Since 1988, inflation has eroded the value of the five cents a pack that Proposition 99 allocated to California’s tobacco control program. In 1989-90, the program’s first year, the Tobacco Control Program received $242 million (in 2016 dollars) compared to just $70 million now.

    The result is that the program is losing its effectiveness because the impact is directly related to how much money goes to fight Big Tobacco.

    At the same time, the innovative research program Proposition 99 created saw its resources drop from $41 million in 1989-90 (in 2016 dollars) to $13 million now.

    Proposition 56 is the opportunity to restore lost ground on tobacco control programs.

    According to the California legislature’s nonpartisan Legislative Analyst, Proposition 56 provides $135 million to anti-tobacco education and $50 million to research. This money would bring funding for the anti-tobacco education to $205 million and research to $63 million, restoring 85 percent of the programs’ purchasing power.

    These resources, combined with the price increase that will accompany the tax, will cut smoking. Our analysis of a $1 tobacco tax that the industry (barely) defeated in 2012 estimated that the combined effect of the tax and reinvigorated anti-tobacco campaign would have cost Philip Morris, RJ Reynolds and other tobacco companies a billion dollars a year.

    Improving the economy and creating jobs

    Reducing smoking benefits more than health. Eighty cents of every dollar spent on cigarettes leaves California to tobacco companies (and a few farmers) back East. When people quit smoking, they don’t burn the money, they spend it. And because less leaves the state, more of their money gets recycled in California, where it creates local economic activity and jobs.

    The billion dollars a year that would have not been spent on tobacco had the 2012 tax passed would have led to $1.9 billion in economic activity and 12,000 new jobs.

    Because Proposition 56 is a bigger tax with more money for anti-tobacco education and research it will have a bigger effect on health, reducing medical costs and building the California economy … and cost Big Tobacco even more money.

    So, I doubt that Philip Morris and RJ Reynolds are really investing tens of millions to oppose Proposition 56 because they want to see more spent on smoking reduction.

    Smoke-free society is in reach

    In 2014 only 11.7 percent of Californians smoked, and among them, two-thirds (65 percent) were smoking 10 cigarettes or less daily with one-third (37 percent) not even smoking every day.

    If voters see through Philip Morris and RJ Reynolds’ disingenuous campaign and vote Yes on Proposition 56, they will reinvigorate the state’s tobacco control program. The bottom line? California could become the first state to reach former Surgeon General C. Everett Koop’s vision of a smoke-free society.

    https://theconversation.com/big-tobacco-aims-its-guns-to-kill-california-tobacco-tax-63750#_=_

    Hit it the bastards been deleting my comments all Id think Glantz is moderating it.

    • harleyrider1978 says:

      The Nazis are in full fear mode over taxes being repealed

      http://www.sacbee.com/news/politics-government/capitol-alert/article97238827.html

    • Some French bloke says:

      “more should be dedicated to treating [smokers] and keeping kids from starting. […] This is a smart argument for the companies to make. Research has consistently shown it is their smartest argument”.

      So, “their smartest argument” consists in endorsing the chief arguments of the Tobacco Control & Excise brigade, their purported enemy?? Tell it to the horse marines!

      “The California Tobacco Control Program […] educated the public about secondhand smoke nicotine addiction”.

      Hey, that sounds like a new one on me! in which ‘study’ did they demonstrate that outlandish claim?

  6. harleyrider1978 says:

    The VETERANS ADMINISTRATION has this program they force all the vets into if they can called lifestyles management/preventive medicine program. Its been around about as long as the anti smoking farce agenda like about 1994 or so.

    Basically its a nothing program except to make it appear all their services are being used at a 150% manning level in all their various depts. Its not like normal medicine where you go just when your sick,oh no thatd destroy their reasons and basis for the budgets. They really would save money by shutting down the VA hospital system and just give vets a medical card to use anywhere.

    But the lifestyles program is where they preach at you about everything,needless to say I don’t play ball with them. Never have.

    They made me an appointment for sept 7th I said why,they said for a physical,I said I just saw the doc 5 times in the last 6 weeks said I was fine including heart doc.

    They said well if you want to be still covered you have to show up.
    I said no I don’t Im 100% permamnant and total Im covered regardless.

  7. sackersonwp says:

    I understand that in old China, you paid the doctor on a regular basis when you were well, but not if ill. That gave him an incentive to get you back on your feet.

  8. Supergran says:

    Few years ago, they found I had high blood pressure. So doctor sat me down, put loadsa stuff into a computer programme and voilla! I was prescribed B.P. tablets and Statins. I just took em, but after a while I had the most horrendous cramps in my feet (was like a chimpanzee in the night – with cramped curlie toes!!) Researched why on the internet and found that Statins can cause damage to muscles (often much worse than I had) so I decided “nah, not for me”. Went back to Docs and told her they didnt agree with me. She said OK. I said – will I need to do something else to lower my cholesterol then? She said “you dont have high cholesterold!!” I said, why am I on statins then? She said, well we put your age, weight, whether you smoke blah blah blah into the programme and it suggests that you need such and such and so forth!!!!!!!!!!!!!!!!!!! So, even though I DIDN’T have high cholesterol, I was on the tabs JUST IN BLEEDIN CASE!!!!!!!!!!!!!!!!!!!!
    Recently I went to a nice young dentist, have only a few peggies left (poor ole sod) hehe, and he started to tell me about stopping smoking (cos he asked did I, and of course I said YEP). CBA lying and not ashamed of meself anyroad, so he started telling me I should stop, it would save me peggies! haha. I said, hey, I’m an old burd lad, you dont need to go through that rigmarole with me and he said “I have to, that’s what we’re taught!” I just said, well, dont lecture me young man, that’s a good boy! He laughed, I laughed. But it’s just a sad state of affairs innit? He HAS to talk me outta smoking, my gp has to put me statistics into a bleedin computer programme and IT decides what medication I should be prescribed. Perhaps when I’m dead, some doctor will type all the mullarky into a computer and it will be a case of “computer said ……………….. nooooooooooooooo!

    • Frank Davis says:

      we put your age, weight, whether you smoke blah blah blah into the programme and it suggests that you need such and such

      So your doctor isn’t making her own judgement about what you need, but what some central computer programme tells her is needed. And presumably it’s the same everywhere else in the NHS. Your doctor has been reduced to a technician obeying orders. Her medical autonomy has vanished.

      Who decided what goes into the computer programme? Presumably a small clique of doctors (plus pharma company reps). And maybe it’s all done in the WHO in Geneva.

      Total top down control.

      • Frank – that is IT! Doctors have changed because they are now SO constrained by the NHS system, they cannot do what they want, even if they’d like to. If you present with A, they HAVE to prescribe B. It’s what they have to do. They have been completely disempowered.

        The fact that this is so, means that if you hit a crap doctor, you get the same treatment as a good doctor. I think it’s to make sure that everyone on the NHS, gets the same treatment and the doctors tick the same boxes.

        There is no room for brilliance, nor failure. Only arid non-nurturing doctor/patient relationships on both sides.

        • Frank Davis says:

          Yes, everyone gets the same treatment. And that treatment is determined by senior doctors in the NHS, or perhaps even the WHO, with advice from Big Pharma.

          But that’s where all the barking mad doctors (like Margaret Chan, Gro Harlem Brundtland, Sally Davies) are.

          So everyone gets to be treated not by good doctors, or even by bad doctors, but by mad doctors.

          A public health catastrophe is unavoidable.

        • beobrigitte says:

          A public health catastrophe is unavoidable.
          It’s already underway. I watched a documentary on medical errors; i.e. patients being confused with others, thus the wrong diagnosis/operations occurring in Germany. I dread to think about England……

  9. Timothy Goodacre says:

    The correct role of a doctor who we have trained at great expense is to make us better. They should have no role lecturing us on lifestyle.

    • beobrigitte says:

      I agree. Unfortunately those who do want to no longer can. They are looking at 40 years or so to make some sort of carrier – this will be stopped dead if he/she does not conform to what is dictated by dubious sources.

      And then they all wonder why people lose respect.

      I look at some research published but I first read who financed it. And then I bin reading the rest. Tobacco control & friends financed research taught this.

  10. garyk30 says:

    But, can such nannying make much difference?

    No, it can not.

    The 45 million smokers have about 33,000 lung cancer deaths per year.
    That is a rate of 1 per 1,363 and that means that ,per year, 1,362 out of 1,363 do not dir from lung cancer.

    That is, in any given year, 99.93% of smokers will not die from lung cancer.

    It will be difficult to improve on that.

    The 99.93% is a lifetime rate; since, it was true last and 5 years ago and will be true next year and 10 years from now.
    Any given year = all years = lifetime.

  11. Was standing out on the street the other day smoking my pipe (long story but I have ordered myself some tartan slippers off ebay and granddaughter has bought me a pack of Werthers Original). An old guy (even older than me) came up and said the following: “You don’t see many people smoking pipes these days. I was a big pipe smoker, I loved it but my dentist told me I HAD to stop for the sake of my health so I went home and chucked my entire pipe and tobacco collection into the wheely bin. Still miss it though, especially when I catch a whiff of the lovely tobacco you’re smoking. What brand is it?”
    I told him (Semois incase anyone is interested) and he went on his way , sunlight glinting off the small, discreet but tasteful “I have parkinsons, please give me time” metal badge on his shirt.
    Don’t know whether tobacco helps prevent parkinsons but it still gave me much to ponder…along the lines of ‘no pleasure is worth giving up for 2 extra years retirement in Norfolk’.

  12. harleyrider1978 says:

  13. garyk30 says:

    No lifestyle change can prevent ‘bad luck’.
    The Scary Reason Many People Get Cancer: Bad Luck

    It turns out that most cancer diagnoses are actually a matter of chance.

    A study published in 2015 and conducted by researchers at the Johns Hopkins Kimmel Cancer Center found that “two-thirds of the variation in adult cancer risk across tissues can be explained primarily by ‘bad luck,’ when these random mutations occur in genes that can drive cancer growth while the remaining third are due to environmental factors and inherited genes.”

  14. garyk30 says:

    Are the new doctors stupid?
    How stupid do you have to be to believe that smoking ’causes’ heart disease when those that have smoked longer have a lower risk for the disease!!

    American Heart Association
    Smoking & Cardiovascular Disease (Heart Disease)

    http://www.heart.org/HEARTORG/HealthyLiving/QuitSmoking/QuittingResources/Smoking-Cardiovascular-Disease_UCM_305187_Article.jsp#.V73wK70YOgw

    ” It produces a greater relative risk in persons under age 50 than in those over 50.”

  15. beobrigitte says:

    One possible answer is that, if the medical profession is being snowed under by patients, they’re trying to reduce their workload by preventing many of them from getting sick in the first place.
    That doesn’t make much sense, simply because no medic can ever promise that a potential patient won’t get a heart attack despite “all-things-prevention” ladelled out to him/her.
    That is increasing the workload!
    Sure, pharmaceutical companies benefit from general public health paranoia; the NHS buckles under it, because it has to pay for all tests + [?preventative] medication.
    Not to mention health staff. I do not believe the number of staff has increased in proportion to the additional workload, they now have to work all sorts of shifts, and Cameron (at the time) thought a 24/7 NHS service was a brilliant (business) idea.
    Expect an increase in burnout syndrome of NHS staff. That costs the taxpayer even more.
    Stress + irregular shift work are far more dangerous to health than anything on this planet. (Well, almost. I must mention the rapidly mutating micro-organisms. And since we warble the alcohol gel when visiting someone in hospital + disinfectants at home, it won’t be long before these little beasts develop resistance to that, too!)

    Prevention of illnesses? Perhaps it is the healthiest step to live by common sense. Work for a living, don’t live for work. Life has so much more to offer, why worry about things (illnesses) that might happen and a thing (death) that will happen. Curb greed, ENJOY life!

    On an anecdotal note; since my retirement I have taken up growing my own vegetables. My first potato harvest beat all expectations; I gave a lot of it away and told these people that if I had interest in business, I could cash in on that ‘Bio’ bullshit!! (Next batch is due to be harvested next month. By then it’s cooler and I can store it.)
    I love my constant supply of courgettes and different types of lettuce, watching the cauliflower, beetroot and broccoli growing. I have white strawberries and some wild ones (birds must have dropped the seeds) growing between my flowers and my tomatoes are getting ready. Best of all, there is no stress when I get up in the morning. I have all the time to tend to my veg and fruit. After that I might go training for an hour before meeting up with new friends (we were colleagues but never had the time to get to know one another because work was always stressful) for yet another pensioner-adventure day or do whatever I feel needs/I want to do.

    I thank God every day that I am the age I am. I’d get depressed knowing I’d have to work another 20 years in my job I once used to love.

  16. cherie79 says:

    My wonderful old school GP took early retirement last year, he was sick of the endless form filling and said he did not go into medicine to lecture his patients and considered withholding treatment for ‘lifestyle reasons’ to be immoral and he could only see it getting worse, specially for smokers. Restrictions were getting worse and he had less control than ever. I can’t blame him but I miss him, my new young lady Dr. is nice but knows nothing of the previous system. As i have said before sometimes I am also glad to be the age I am.

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