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Global AIDS crisis overblown? Some dare to say so

by critic411 / November 30, 2008 10:49 PM PST
http://www.google.com/hostednews/ap/article/ALeqM5iPxuWgKJF4fy58hpf7YYJHQq_k6wD94PCE880


As World AIDS Day is marked on Monday, some experts are growing more outspoken in complaining that AIDS is eating up funding at the expense of more pressing health needs.

They argue that the world has entered a post-AIDS era in which the disease's spread has largely been curbed in much of the world, Africa excepted.

"AIDS is a terrible humanitarian tragedy, but it's just one of many terrible humanitarian tragedies," said Jeremy Shiffman, who studies health spending at Syracuse University.

Roger England of Health Systems Workshop, a think tank based in the Caribbean island of Grenada, goes further. He argues that UNAIDS, the U.N. agency leading the fight against the disease, has outlived its purpose and should be disbanded.

"The global HIV industry is too big and out of control. We have created a monster with too many vested interests and reputations at stake, ... too many relatively well paid HIV staff in affected countries, and too many rock stars with AIDS support as a fashion accessory," he wrote in the British Medical Journal in May.

"Diarrhea kills five times as many kids as AIDS," said John Oldfield, executive vice president of Water Advocates, a Washington, D.C.-based organization that promotes clean water and sanitation.

"Everybody talks about AIDS at cocktail parties," Oldfield said. "But nobody wants to hear about diarrhea," he said.

Blasphemy!!!!!!!
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I saw recent estimates that as much as...
by grimgraphix / December 1, 2008 12:03 AM PST

... 25 to 30 percent of those infected with HIV were unaware of it. I think it is just a bit glib to say the crisis is overblown, if we do not even know the true numbers of those with the virus.

On the other hand, from other accounts I have read, the "global HIV industry" has been out of control as far as what the cost of producing medicine has been - I said the cost... not the R & D.

Of course, since research into HIV and AIDs is largely funded by government grants, a case could probably be made that the pharmaceutical companies benefit from government money, but don't pass their savings on to the consumer.

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True to form.
by Kiddpeat / December 1, 2008 1:18 AM PST

A fortune is expended developing drugs that work. Once the development is done, the drug companies are the bad guys for trying to recover their costs and earn a profit.

It is, however, always amazing to see more important problems, such as the limited dollars spent on the health of children, totally ignored by the same people.

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gays are more important than children, aren't they?
by James Denison / December 1, 2008 1:22 AM PST
In reply to: True to form.

An innocent child must die so that a gay might live? Strange world we live in.

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wow... homophobic, are we?
by grimgraphix / December 2, 2008 12:11 AM PST

The fact of the matter is that hundreds of children are left orphaned every day, across the planet... because both of their parents have died from AIDS.

AIDS is not a gay disease... it is a human disease.

How do you manage to get your whole foot so deep in your mouth? Were you raised in a carnival side show?

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no such thing as "homophobic"
by James Denison / December 2, 2008 12:32 AM PST

Just some silly words gays created to try and act like people were actually afraid of them in some way, rather than disgusted by their activities. "Foot in mouth"? Is that a new thing they are up to now? They've had everything else in there, so that would be an improvement I guess. As for "carnival", the ones who now most desire such displays, yes, are gays.

I remember the days when AIDS was described originally as "The Gay Men's Disease" because actually it's most often form of transmission is through acts of sodomy. The second most prevalent means of transmission is through IV drug use. The lesser means of transmission is through heterosexual relations that don't include sodomy, and even that is most often where some other sexual disease already exists which aids the transmission, such as syphillis sores, chancres, other breaks in the tissues.

No need to point at Africa, since most prostitutes there insist on sodomy sex as a means of birth control. In fact, if birth control pills were supplied, it's likely that would do more to lower HIV in Africa than any other move, since pregnancy fears removed or alleviated would encourage a move away from sodomy.

Yes, AIDS infects others, but mostly it is a "gay disease", rarely transmitted sexually except by sodomy.

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Sources?
by Bill Osler / December 1, 2008 8:36 PM PST

I don't doubt that a lot of HIV research is funded by government programs, and the patent issues related to results stemming from government research are complex. That said, my impression is that most of the government research is aimed at targets other than development of specific drugs. All of which raises a question of which costs are being paid by whom since that is fundamental to your complaint against the drug companies.

In any event, it is blatantly unfair to blame an entire industry for this problem. For example, this article from the terribly conservative LA Times states:
HIV treatment becoming profitable - Los Angeles Times
It wasn?t long ago that the pharmaceutical industry viewed HIV drugs as more of a public service than possible bestsellers.

Unlike in the case of cancer or heart disease, where drugs for patients in richer markets such as the United States and Europe can be instantly and startlingly profitable, two-thirds of people infected with HIV are in impoverished regions in Africa.


Despite all the hype and devastation surrounding HIV, the drugs did not sell all that well. Most of the victims of HIV are in countries where a lot of people cannot even afford Tylenol, much less antibiotics or HIV drugs. BTW: that is precisely why we take a lot of 'inexpensive' OTC medication like Tylenol when we go on mission trips.

According to that article in the LA Times a large portion of the profit you are complaining about is being made by one company, Gilead Sciences. That company was started by some people who had some interesting ideas about how to make medications and they apparently have been fairly good at developing those ideas. It would appear that any complaint you have should be directed at that company rather than the industry as a whole. How do they (the people at Gilead) feel about the situation?

Few drug companies saw HIV as a large and viable market a few years ago. Public pressure to keep HIV drug prices low and a trend of foreign countries? ignoring HIV drug patents and making cheaper versions on their own seemed like surefire profit killers.

?A lot of companies were scared off because of all the political and assumed financial pressure? around HIV drugs, Gilead Chief Executive John Martin said.


IOW, most of the big pharma companies were hesitant to put a lot of energy into HIV product development precisely because they foresaw the kind of political response you are showing in your post.

So what can we conclude? If the companies that make HIV drugs are forced to cut their profits then the result will be a confirmation of the fear that political pressure will make development of HIV treatments unprofitable. There will be fewer treatments and less research. Is that what you want?

Now, as it happens, I do agree with you that these companies SHOULD make their products available to poor countries at affordable prices ... if they CAN do so ... but I am absolutely convinced that FORCING the companies to do so will stifle the necessary research on HIV and on other diseases.

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Terribly conservative LA Times?
by EdHannigan / December 1, 2008 8:47 PM PST
In reply to: Sources?

To pick a bone, according to Wikipedia, LA Times was "terribly conservative" at one time, but not recently...

"Some believe the circulation drop was a result of a liberal bias attributed to the paper, which alienated many readers..."

"For most of its first 80 years, the Times had been known as an unabashedly conservative paper, reflecting the stance of Harrison Gray Otis. Under the Chandlers, however, the paper gradually adopted a more centrist tone."

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(NT) Ever hear of irony?
by Bill Osler / December 1, 2008 8:54 PM PST
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No.
by EdHannigan / December 1, 2008 9:37 PM PST
In reply to: Ever hear of irony?

Of course. I just didn't pick up on any ironic tone.

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It's hard to convey tone in text ...
by Bill Osler / December 1, 2008 11:04 PM PST
In reply to: No.

Having forgotten that the LA Times USED to be a more conservative paper it did not occur to me that the irony would be less than obvious.

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I have reread my original post several times...
by grimgraphix / December 2, 2008 12:05 AM PST
In reply to: Sources?

... and for the life of me, can not find where I have made many of the conclusions that several of you have tried to pin me down on.

Current accurate rates of HIV infection are unavailable... yes or no?

Much of the basic research on HIV and AIDs has been funded through government grants... yes or no?

I specifically excluded drug R & D... yes or no?


The bottom line is that much of the research that has gone into HIV-AIDS will be used in future exploration of treating other Virus related illnesses. The basic understanding of virus research was in its' infancy when the HIV-AIDS epidemic was first discovered. We now know much more than we ever did before... and that is because of this epidemic.

You accuse me of bringing a lot of unfair complaints. Frankly, I find it disingenuous that you take me to task for mentioning the cost of of producing HIV-AIDS medicine, and then buttress your own position by mentioning how you take tylenol on mission trips. If you are aware of the lack of OTC meds due to cost, in the 3rd world... then you sure as hell know a Nigerian widow dying from AIDS can not afford a daily cocktail of anti virus medicines.

Now, my original thesis was that it is inappropriate to say an epidemic is over, if you don't know haw many people in the general population still has the disease. In your professional opinion Bill, was this comment incorrect?

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so you agree?
by James Denison / December 2, 2008 12:33 AM PST

Prevention is the best approach!

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I can't comment on others' conclusions ...
by Bill Osler / December 2, 2008 7:04 AM PST

What struck me was this:
I saw recent estimates that as much as... - CNET Speakeasy Forums
Of course, since research into HIV and AIDs is largely funded by government grants, a case could probably be made that the pharmaceutical companies benefit from government money, but don't pass their savings on to the consumer.

I lack the ability to read your mind, but observations of that sort are typically the opening salvo in attacks on the pharmaceutical industry. Pairing that with the statement about ... the "global HIV industry" has been out of control ... STRONGLY suggests where you wanted to go with that notion.

The problem with observations about the disparity between R&D (which was probably not totally funded by the government) and production costs is that if the company invested in the R&D they HAVE to recover their investment from profits on the sales of product. Those who want the companies to sell their wares at or near cost probably should not complain unless they are willing to pony up funds to cover the R&D.

Now I suppose that the government could insert clauses in research contracts that would require the researchers to license resulting products to 3rd world countries but that would only work if there were guarantees that manufacturers in 3rd world countries wouldn't poach business in the developed world ... a promise that the US government is not in a position to make because a lot of the developed world is outside our jurisdiction. It is NOT a simple problem.

Current accurate rates of HIV infection are unavailable... yes or no?

Personally I think it a bit disingenuous to pretend that we do not have any idea how widespread the disease is. Accuracy is relative and we will never have absolutely precise numbers. Still, the numbers we have available are certainly adequate to make it clear that HIV funding is disproportionately large compared to other problems that have greater public health impact. I would argue that the problem may be primarily one of underfunding the other problems rather than over-funding HIV but either way the funding for HIV is disproportionate.

Much of the basic research on HIV and AIDs has been funded through government grants... yes or no?

I'm not sure how much relevance that question has to the problem of bringing a drug to market. There IS a difference between 'basic research' and product development, product testing, ...

I specifically excluded drug R & D... yes or no?

I have no idea what you meant when you said I said the cost... not the R & D so I really can't say what you think you were excluding 'R&D' from.

Frankly, I find it disingenuous that you take me to task for mentioning the cost of of producing HIV-AIDS medicine, and then buttress your own position by mentioning how you take tylenol on mission trips. If you are aware of the lack of OTC meds due to cost, in the 3rd world... then you sure as hell know a Nigerian widow dying from AIDS can not afford a daily cocktail of anti virus medicines.

You seem to have completely missed my point here. In countries where the citizens cannot even afford the least expensive medications that we use it is virtually inconceivable that the HIV drugs can be manufactured at a cost low enough to be affordable. Furthermore, the efficacy of the HIV medications is inherently limited in environments that lack basic sanitation, clean water and access to care for the myriad of other infectious diseases that HIV patients contract. Selling the HIV medications 'at cost' won't necessarily make them affordable and it will not, by itself, fix much of anything but it WILL reduce the incentive to bring new medications to market.

Now, my original thesis was that it is inappropriate to say an epidemic is over, if you don't know haw many people in the general population still has the disease. In your professional opinion Bill, was this comment incorrect?

I've tried re-reading your post - and I don't see that 'thesis' anywhere in there. That poses a philosophical question: Can a comment that you did not make be either correct or incorrect? Furthermore, even if that were your original motivation in posting it founded on the false premise that we don't have information about how many people are affected by HIV. And in any event I don't think either the OP or the article it referenced or my replies (up until now) made any claims about the epidemic being over.

Strictly speaking, the 'epidemic' MAY BE over at least from an epidemiologic perspective but I have been hesitant to claim that because I don't want to get into hair splitting about lay use vs technical use of the term. I think it would be more accurate to describe HIV as endemic in many countries rather than talking about an epidemic but I'm not going to quibble about the details and in any event there is some ambiguity about the terms. Endemic typically implies relatively low frequency so it is probably accurate in the developed world but I'm not sure any of the typical epidemiologic labels accurately describe the situation in Africa where the current disease burden is arguably at baseline but prevalence is still relatively high.

Epidemic definition - Medical Dictionary definitions of popular medical terms easily defined on MedTerms
The occurrence of more cases of a disease than would be expected in a community or region during a given time period. A sudden severe outbreak of a disease such as SARS.

Endemic definition - Medical Dictionary definitions of popular medical terms easily defined on MedTerms
Endemic: Present in a community at all times but in relatively low frequency. Something that is endemic is typically restricted or peculiar to a locality or region.

Pandemic definition - Medical Dictionary definitions of popular medical terms easily defined on MedTerms
Pandemic: An epidemic (a sudden outbreak) that becomes very widespread and affects a whole region, a continent, or the world.

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You posted quite a bit of content to read through...
by grimgraphix / December 4, 2008 3:15 AM PST

I am busy working 2 jobs at the moment so I haven't had the time to consider some of what you posted. One thing I will address is my original mention of how unsure some officials are re: the actual HIV infection.

The NY Times reproted on aug 3, 2008...H.I.V. Study Finds Rate 40% Higher Than Estimated

The United States has significantly underreported the number of new H.I.V. infections occurring nationally each year, with a study released here on Saturday showing that the annual infection rate is 40 percent higher than previously estimated

The study, conducted by the Centers for Disease Control and Prevention, found that 56,300 people became newly infected with H.I.V in 2006, compared with the 40,000 figure the agency has cited as the recent annual incidence of the disease.


If we are unsure of the HIV infection rate in a medically advanced country such as the US... then how can we be so sure about the status of HIV/AIDs occurrences throughout the world's population ?

Here is a link to the CDC ... http://www.cdc.gov/hiv/topics/surveillance/resources/factsheets/incidence.htm


I think it was Paul who mentioned the politicization of HIV/AIDS programs. I agree that the effectiveness of overall prevention and treatment programs have been degraded by the "popular" adoption of the cause... and the shysters who are willing to make a buck off of the gullibility of those who think throwing money at a problem will solve it. I also recognize the bitter jealousy and moral indignation of some who speak out against the scope of money spent on a disease that some believe is spread by inappropriate behavior. This latter group would rather see the money go to their causes instead. I am not condemning this group... but I can not condone the idea that this is just a disease of the morally questionable who somehow don't deserve the best effort possible. The reality is that this is not just a disease of any single demographic. Yes, more gay men in the US get this disease than others... but what of it ? This disease is a heterosexual disease passed by common coitus in other countries.

It is estimated that some African countries have close to half their populations infected with HIV. If half of the USA were suffering from a terminal viral infection, then I doubt that anyone would be entertaining the idea that the global AIDS crisis is over blown.


"Now, my original thesis was that it is inappropriate to say an epidemic is over, if you don't know haw many people in the general population still has the disease. In your professional opinion Bill, was this comment incorrect?

I've tried re-reading your post - and I don't see that 'thesis' anywhere in there."


Bill, Bill, Bill... I was referring to my comment... I saw recent estimates that as much as...
by grimgraphix - 12/1/08 8:03 AM

... 25 to 30 percent of those infected with HIV were unaware of it. I think it is just a bit glib to say the crisis is overblown, if we do not even know the true numbers of those with the virus.


I now see that I was not as exact in referring to my original post as I should have been. "Crisis is overblown" and "epidemic is over" are not the same thing. I sometimes make an intuitive jump from one sentence to another when the 2 comments are dealing with almost identical concepts. I will keep this in mind when I post in the future.

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Much of the R&D for AZT was paid for by the NIH with America
by Ziks511 / December 2, 2008 12:00 AM PST

n taxpayers dollars.

It was an experimental drug being developed for use against cancer, and it didn't pan out. The patent was then sold to Bourroghs Wellcome of England who then discovered a couple of years later it was a helpful treatment for AIDS. I actually had a discussion here on SE with Dr Bill Osler over whether Bourroghs Wellcome deserved to charge the high costs (then) of AZT when they hadn't spent the money to develop it, merely to handle the AIDS trials and pilot it through the FDA. We disagreed in a gentlemanly fashion.

Malaria, which is treatable at far less cost, kills more people per year than AIDS. Clean water which is the primary cure for diarrhea could be put in place for less than the cost of AIDS treatment. But having said that, that doesn't mean that AIDS is not a huge killer whose tentacles spread because of ignorance, and poses a continuing challenge to all societies.

This appears to be another case of "Contrarian" thinking, i.e. take what everybody thinks is true and stand the argument on its head. It makes for interesting journalism and bad policy.

Rob

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Bill Gates...
by grimgraphix / December 2, 2008 12:14 AM PST

... is working on a world wide initiative to help treat malaria across the world.

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OF COURSE IT IS OVERBLOWN ...
by Bill Osler / December 1, 2008 8:53 PM PST

It would be silly to pretend that the high priority given to HIV research and development is based solely on the severity and prevalence of the disease. HIV is a nasty disease, and it kills a lot of people, but we need to be realistic: there are worse problems out there that are getting far too little funding.

HIV research is being driven by a political agenda, not by any rational prioritization.

For example, consider this list of priorities for prevention of childhood deaths in Africa (full text requires a subscription to Lancet but the link should get you most of the abstract):
WHO estimates of the causes of death in children : The Lancet
Achievement of the millennium development goal of reducing child mortality by two-thirds from the 1990 rate will depend on renewed efforts to prevent and control pneumonia, diarrhoea, and undernutrition in all WHO regions, and malaria in the Africa region. In all regions, deaths in the neonatal period, primarily due to preterm delivery, sepsis or pneumonia, and birth asphyxia should also be addressed. These estimates of the causes of child deaths should be used to guide public-health policies and programmes.

The list of diseases will be different in different countries depending on their specific epidemiology, but even in the part of the world most ravaged by HIV the WORST medical problems are not necessarily related to HIV.

Unfortunately there is no politically effective lobby for research and development related to malnutrition, malaria, dysentery, and so on.

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There?s a very short list
by critic411 / December 1, 2008 9:15 PM PST

Of Hollywood celebrities doing fundraising for the prevention of diarrhea.

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birth control pills
by James Denison / December 1, 2008 9:43 PM PST

that would do more to help the children, within one generation. Each family would have fewer mouths to feed and clothe, and more time might be spent in feeding the fewer offspring, resulting in a better health and life for all of them.

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If they took them...
by EdHannigan / December 1, 2008 9:45 PM PST
In reply to: birth control pills

and didn't do something else with them, like sell them on the black market.

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(NT) then someone would be taking them
by James Denison / December 1, 2008 10:06 PM PST
In reply to: If they took them...
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I guess...
by EdHannigan / December 1, 2008 10:55 PM PST

My concern is that prostitutes might use them, which would lead to more spreadng of AIDS. But I don't know the situation.

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Even if they did ...
by Bill Osler / December 1, 2008 11:03 PM PST
In reply to: I guess...

Preventing accidental pregnancy among prostitutes would still help reduce medical problems and would decrease abortions. It might increase promiscuity a bit but my suspicion is that the overall impact would be positive. Unfortunately, 'the devil is in the details' so it is hard to be sure of the total impact.

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I remember reading that
by Diana Forum moderator / December 2, 2008 12:29 AM PST
In reply to: birth control pills

having more children survive reduces the number of children a woman has.

Diana

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(NT) could you develop that thought a bit more?
by James Denison / December 2, 2008 12:54 AM PST
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Amen, Dr. Bill!
by Paul C / December 2, 2008 9:04 AM PST

AIDS is one of a very small group of what I term "politically correct diseases." Breast cancer is another.

What characterizes these diseases is that they disproportionally affect members of the liberal community, which means that they get disproportionate coverage from its media amen corner.

Ironically - except for those who will die as a result of this perversion of common sense - clean water and basic sanitation are much more affordable than the ever elusive AIDS vaccine (AFAIK, retroviruses are very difficult to vaccinate against.)

Just my opinion...

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breast cancer
by jonah jones / December 2, 2008 7:34 PM PST
In reply to: Amen, Dr. Bill!

disproportionally affects members of the liberal community??


ummmmmmmmmm...say what??


.,

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Let me rephrase that, Jonah,...
by Paul C / December 2, 2008 9:46 PM PST
In reply to: breast cancer

...as I'm guilty of bad proofreading in the first degree. Wink

What I meant was that a core constituency within the liberal establishment are feminists. Breast cancer is overwhelmingly a disease that strikes women. Therefore, seeking to demonize anything that smacks of so-called "patriarchy," feminists are quick to elevate such concerns to a degree that they may not deserve.

Of course, the American media, with its slavish devotion to all things liberal, are quick to aid and abet the politicization of disease.

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So it is your objection to the "politicization" ?
by grimgraphix / December 3, 2008 12:52 AM PST

Yes... this disease has been a cause celebre in the US... in other countries it is just a family killer.

This is not directed at you, Paul...

I can understand the objections of some to the "flavor of the month" mentality that causes the shallow and vein crowd to dictate to the world just what is important and what is not... I can understand that. What I object to is those with the very same, self conceited attitude from the ultra conservative side that "they" know best.

A horrible disease is a horrible disease no matter who gets it. Has some of the money that was intended to solve this issue been wasted? Of course it has. It is sad though that those who don't like the associated ambulance chasers who profit from the politicization and publicity (those who look to get their own slice of the pie, and speak out against something motivated by jealousy)... would go on to declare something like HIV/AIDS as yesterdays news.

As I pointed out above... what we learn from combatting HIV will be used to treat future viral diseases. If the effort has become misdirected, then call for a reexamination of how the research and treatment is being handled, but don't flippantly state that the crisis is over.

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ah!....much better ...thanks
by jonah jones / December 3, 2008 1:24 AM PST

BTW....in a community of 500+/-, we've had at least
3 cases of male breast cancer over the years

Sad


.,

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