The Augean stables

For many years it was possible to start a clinical trial, on a drug, without telling anyone that you were doing so. Then, if it turned out to be negative you could just slip it under the carpet and never let anyone know you were doing it. This is what happened with many antidepressant trials. Positive, publish. Negative, bury. Unsurprisingly, the results for antidepressant treatment looked pretty damned good.

Another little trick was to keep the primary end-point of the trial secret. To explain. Say you started a study on statins where you most wanted to look at the effect on overall mortality – whether taking statins meant more people were alive at the end of the study, than those taking a placebo. In this case overall mortality would be the ‘primary end-point’.

You could also measure other outcomes, or end-points. For example, you see how many people were admitted to hospital with angina, or how many people needed an angiogram and/or stent. Or how many people suffered a non-fatal heart attack or stroke. You can, in fact, measure many different things. These would usually be called secondary end-points.

Up until fairly recently, if you failed to reach your primary end-point – the term normally used for this sorry state of affairs would be ‘failed to reach statistical significance’ – you didn’t need to let anyone know. You could just say. ‘Oh look, the number of episodes of angina was significantly reduced, as was hospitalisation for chest pain and the rate of non-fatal strokes.’ Success!

Man on Clapham omnibus:          ‘But, but, I thought you said the trial was going to look at overall mortality.’

Pharmaceutical company:           ‘How do you know that, we never told anyone what the primary end-point would be.’

Yes, I know, pharmaceutical companies cannot speak. But you get the general idea.

Now, if you start trawling around your data, you can almost always find something somewhere got better. And if something else got worse, you can just fail to mention it. Essentially, therefore, unregistered clinical trials are not worth the paper that they are written on. Especially, of course, if they never got written on any paper at all.

In the year 2000 the major US group the National Heart, Lung, and Blood Institute (NHLBI) decided that any studies they were going to fund (these are non pharma company studies) must register all end-point/primary outcomes, before the study started. This means that the trial investigators could not manipulate the results post-hoc.

A group of researchers recently looked at 55 large clinical studies funded by the NHLBI between 1970 and 2012 to see if the transparency rules had made any difference. What they found should shake the foundations of medical research…but it almost certainly won’t:

  • 57% of studies (17/30) published before 2000 showed a significant benefit in the primary outcome
  • 8% (2/25 trials published after 2000 showed a significant benefit in the primary outcome

As the researchers said ‘The requirement of prospective registration in ClinicalTrials.gov is most strongly associated with the trend towards null clinical trials. The prospective declaration of the primary outcome variable required when registering trials may eliminate the possibility of researchers choosing to report on other measures included in a study. Almost half of the trials [published after 2000] might have been able to report a positive result if they had not declared a primary outcome in advance.1

Pharmaceutical companies have been asked to register trials since 2005.

At this point I am going to try and join two thoughts together. Almost every study done on blood pressure lowering, blood sugar lowering and cholesterol lowering was done before the year 2005. I only choose these three areas as they are the three area of maximum drug prescribing in the world. Billions upon billions are spent in these areas, hundreds of millions are ‘treated’.

The evidence used for this mass medication of the Western World is demonstrably, horribly, biased. Had companies been forced to register their trials prior to publication, positive results would have been reduced by at least 49%. Almost certainly far more. You could put this another way around and say that it very likely that only 8% of studies would have been positive.

We do not know which trials would have been positive, or which negative. Yet we have based the entire edifice of drug treatment, of hundreds of millions of people, on unreliable nonsense. The study in PLOS is only the latest demonstration of this fact. The database of medical research – everything until at least 2005 is a gigantic festering mess. It needs to be stripped out and cleansed.

Do you think this is too strong?

Well I shall now quote Dr Marcia Angell, Dr Richard Horton and Dr Richard Smith. Editors of, respectively, the New England Journal of Medicine, the Lancet and the British Medical Journal. The three highest impact factor journals in medical research.

It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgement of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as editor of the New England Journal of Medicine.’ Marcia Angell.

‘The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness.’ Richard Horton

‘The poor quality of medical research is widely acknowledged, yet disturbingly the leaders of the medical profession seen only minimally concerned about the problems and make no apparent efforts to find a solution.’ Richard Smith

Who, in a position of power, will finally wake up and realise that the vast database of medical research stinks of bias and manipulation. Who can we call upon to take up the gigantic and painful task of clearing out the Augean stables?

1: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0132382

97 thoughts on “The Augean stables

  1. Jennifer

    As this latest blog popped into my in box, my husband had just received a request to attend for a Healthy Heart MOT. Being a bouncing 72 year old, he had already decided that he does not wish to know what
    “the true reading of his cholesterol” is,
    so your blog is music to his ears as I read it out to him.
    There seems just one reason to drag him along for blood tests and consultations with Nurses, and it is unlikely to be for his benefit, more likely to fill the coffers of Big Pharma.
    Two appointments which could be far better used by Nurses to provide care for the already sick!
    Come on you Nurses…..get a grip! Speak up for your patients along with the brave doctors who are trying to fight the cause against unnecessary medicalisation of the worried well.

    Reply
    1. Flyinthesky

      “Come on you Nurses…..get a grip! Speak up for your patients along with the brave doctors who are trying to fight the cause against unnecessary medicalisation of the worried well.”
      It would be interesting to know what proportion of the health care profession these “brave” people represent. I would suggest vanishingly small. What do you think.

      Care of inspired fear of the worried well nurses have achieved the status of demi gods and the GPs are enjoying the status of de facto deities. Nothing is going to change until money, status and power is taken out of the equation. The more you try to address the situation the more vociferous and threatening they become.
      Doctoring and nursing used to be vocational professions, now not so much.

      The fundamental problem remains: Care of inspired fear the health care profession is creating a need, and expanding, that it can never hope to service. The conundrum of this phenomenon is it empowers it further.

      My Grandmother had a great saying, apt in these circumstances: “Don’t trouble trouble ’till trouble troubles you.”

      If the health service returned to the needs of the unwell instead of trying to placate those who were well there would be no shortage in health care provision at all and I add we’d all be much happier and healthier.

      My daughter in law is in her second year as a student nurse, she’s totally on board with all the edicts and there’s no chance of persuading her of any other perspectives, at all. She’s very smart, already having a business degree. She doesn’t want to be a “nurse” she wants to be a “health care professional.

      My wife who has various ongoing health problems when and is fully aware of prevailing situations, confronted with a cross desk audience with her GP turns into a gibbering idiot.

      The nurse said, the doctor said, to the majority it’s on stone tablets.
      Short of an irrefutable mass medication catastrophe I can’t see anything changing.

      Reply
      1. Ellot

        Nothing will change in my opinion no matter how many scientific facts come out. What I see in the medical world as far as the doctor professsion is concerned, is someone who has been put through the ringer as they say. So you take someone who wants to become a doctor. They already have done 4 years undergrad, then 4 years med school and then1-7 residency. That’s a long time! Especially during residency they can put in over 80 hours a week. Plus in US the avg debt is around $250K. What a start! Plus hardly any time spent learning biochemistry, nutrition or adverse drug effects. So why would a doctor start to question medications? Everything adverse effect is seen as “rare”. They don’t put 2 + 2 together, by that I mean drug trials are short and small in number of people in comparison to when a drug is accepted on the market. Of course there will be a great increase in the number of adverse reactions. But I don’t think doctors think this way. They have a limited number of tools to work with and that’s that. Follow what you’re told to do or be ostracized by other doctors or maybe worse. It has to be a patient revolt. It’s hard to believe that anyone would an ounce of common sense would take most medications with all the known side effects.

      2. Jennifer

        In recent weeks I have spoken with a junior hospital doctor, a Medical Consultant, a Senior Surgical Registra and the Senior GP at a rural practice, along with Registered Nurses and other medics. Not one of them seemed in the least surprised at me turning my back on all medications…..maybe they did not wish to pass judgement in case it could be ——
        a) interpretted as agreeing with me.
        Or,
        b) making them obliged into pressurising me to change my attitude, (thus ‘covering their backs’), in order to meet present NHS dogma.
        Free speech? Went down the plug-hole years ago!

  2. David Winter

    Hi….you won’t remember me per- se but many months back after reading an article of yours i signed up for your posts.
    I had been prescribed STATINS for some time and although fit and well i became tired quickly, had joint pain and felt my libido fall away significantly. After reading your information i stopped. Nine months on, all the old symptoms have gone and for a 67 year old, feel great !!!.
    Now my wife [ whom i have kept in the picture, off course] has recently had a slight thyroid imbalance put straight, but the doctor has suggested that a course of [ NEW IMPROVED] statins might help her. She immediately registered some alarm quoting your findings but he said the NEW statins were different???.
    Have you any knowledge of these new drugs??
    Kind regards…David.

    Sent from my iPad www.http://Davidjwinter.co

    >

    Reply
    1. BobM

      The only “new” drug I know of are the PCSK9 inhibitors. Those don’t have mortality data, though. I personally would not take until they do. See:

      http://www.medscape.com/viewarticle/822814

      Anyone else think this endpoint is the most contrived thing ever?

      “One of the ongoing large-scale morbidity and mortality studies is the Further Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects with Elevated Risk (FOURIER) study. This is a 22 500-patient trial testing evolocumab against statin therapy for the reduction of the primary composite end point of cardiovascular death, MI, hospitalization for unstable angina, stroke, or coronary revascularization. The full results from FOURIER won’t be available until 2018 at the earliest.”

      What about simply death? And why no placebo? (I know, there’s no reason to have a placebo, since statins are very “safe”; this is a trick used also by the vaccine manufacturers — It’s my understanding most vaccines are tested versus other vaccines.)

      Reply
      1. Boundless

        re: And why no placebo?

        In the majority of what passes for drug and nutrition trials, having a placebo arm merely adds more confounding, as the placebo is often anything but inert. One paper out just this month was testing fish oil for psychotic disorders and used coconut oil as the “placebo”. CO might be a “control”, assuming its effects have been independently studied, but it is very far from brain-neutral.

        Sugar pills, rice flour pills, wheat flour compounds, soybean oil capsules and calcium-loaded tablets are also too common as placebos. These are not inert, and that the investigators assume they are, raises serious competence questions. An alternative theory is deliberate distortion or sabotage in such trials.

        And the not-really-a-placebo issue may be relatively minor compared to other steps not taken at all, such as:
        ◊ controlling for or at least logging subject diets,
        ◊ testing and recording phenotypes, and
        ◊ testing and recording gut biome status.
        These all can have massive influence on outcomes for small numbers of subjects, even in cross-over.

        In the fish oil trial, the use of coconut oil might have been a serendipitous confounding, because the outcome was that the FO was more effective than CO, strongly suggesting that the FO really worked. We usually aren’t that lucky.

    2. David Bailey

      The problem is that Dr Kendrick has said that he has to be awfully careful not to appear to be giving specific medical advice over the internet. The easiest way to deal with this, is to ask for the name of the drug, and then you can look it up on the internet to determine what type of action it has.

      My strong feeling – based on personal experience – is that these drugs can seriously mess you up – so now I don’t even have my cholesterol measured! I feel far better now without Simvastatin – as you do – and a whole series of studies have found that people with moderately high cholesterol actually live longest:

      http://vernerwheelock.com/?p=838

      It may help if your wife goes armed with a printout of some of that data – it may even stagger her consultant!

      I would also suggest you read this collection of actual patient experience with simvastatin (zocor). That site also has similar data for other kinds of statins. I described my experience on that site.

      Finally, it sounds as if you recovered fully from statin side effects – as I have – but a number of people who have commented here have not been so lucky.

      Reply
    3. scazzer

      Hi David, as someone with an underative thyroid, and thus, a high cholesterol, I have been badgered by various ‘health care professionals’ to take statins. Remember the mantra ‘there is no link between high cholesterol, ‘good’ or ‘bad’ or heart disease. Women in particular should avoid statins and actually need their cholesterol levels to be high. I am sure the ‘new’ statins are a bastardisation of the old ones, but that is not a medical assessment.

      Reply
  3. Jen

    Typo alert: it’s Marcia Angell. Otherwise, good grief! It should be called “fraud-based” rather than “evidence-based” medicine.

    Reply
  4. pegm57

    As a former academic research laboratory assistant (studying the mechanism of action of thyroid hormones in rats) I found your exposé to be deeply disheartening. I grew up with a strong scientific work ethic, where science was the truth-teller. It’s a shameful situation now. Thank you for posting this article, Dr. K.

    Reply
    1. Tom Welsh

      Dear pegm57, may I offer some consolation? I hasten to say that I have no scientific qualifications (unlike yourself) – but what I have to say is just basic logic. What Dr Kendrick has explained to us does not cast a shadow on science itself; just on those who pay for it, and control the publication of results (and sometimes the writing of papers). In other words, what we need is to set science free again, and find ways of letting scientists do research purely for the sake of finding the truth. Maybe we ought to think of ways of pooling money for use in disinterested research.

      Reply
      1. Dr. Malcolm Kendrick Post author

        It is no simple task to wrest medical science (I use that term loosely) back from where it is now. I think pooling money would be good. But where is the drive, where are the people who care? I feel like Cassandra at times. Blessed to be able to see the future, unable to convince anyone, ever, of what she was seeing. Best to be happily blind, perhaps.

      2. David Bailey

        I think the one good sign is that more and more people are realising the truth in various area of medicine. They are returning to a more balanced diet – consuming butter and the like – and doubting the worth of statins. I even come across people who have learned that cholesterol isn’t a good predictor of heart disease, and doesn’t need lowering.

        This is a change that can only be lead from the patient side.

  5. Gay Corran

    Looks like a Herculean task. I wish I could show this post and your others to my diabetic nurse and GP, who would have me on several drugs for diabetes – related things had I continued to follow their advice rather than Dr Bernstein’s, yours, and others who talk sense instead of nonsense. Bravo yet again, Dr Kendrick!

    Reply
    1. Dr. Göran Sjöberg

      Gay,

      When you have realised the logic in stopping eating things which make you sick as a diabetic and then by the same logic don’t need any drugs, do it in practice on yourself and note the ‘incredible’ effects on the overall health, as my wife did, you realise the very urgent need of the Herculean cleaning up task Malcolm suggests.

      Reply
      1. Gay Corran

        I have mentioned in response to a previous post on this site that sooner or later the doctors who are following NICE and Big Pharma’s lead in prescribing statins, Peskys, blood pressure lowering drugs, anti-depressive drugs and so on will themselves be taking these very same drugs. The ones such as statins that have very pronounced and damaging “side effects” will surely start to affect doctors too, will they not? Even GPs blindly following their leaders could try stopping the drugs to see if symptoms improve, and testing this several times as so many patients already have before them. Or are all GPs immune from being prescribed drugs they don’t need?

      2. Dr. Göran Sjöberg

        Gay,

        My belief is that the most convincing experiment you can carry out from a ‘natural science perspective’ is when you conduct it on yourself. (That about stomach ulcers caused by bacteria and cured by antibiotics is perhaps the most famous and a personal experiment that also rendered a “Nobel Price” if I am not wrong on this point.) And few, even stubborn GP’s can be immune to overwhelming personal outcomes of such experiments which may then cause them to loose their fundamental trust in the very ‘thought system’ they have been fostered into by education.

    2. Kathryn Bosse

      Amen, I doubt the advice my Internist regarding any Pre – Diabetic nonsense or any other Pre this or that. I refuse Statins, Blood sugar meds. I just do not believe in any of the U S Research. I believe in fixing the problem and I refuse any band aid approach to symptoms. Thank you Dr. Kendrick for setting up straight. Kathy Baker

      Reply
    1. Ellot

      It’s too bad that statins are not the only one in the scam category. The list is endless with psych drugs right up there. Probably any category you choose you can find an entire list.

      Reply
      1. amieres

        That reminds me of this quote from The Big Bang Theory:

        “Leonard: You don’t go into science for the money.

        Bernadette: Speak for yourself. Last month my company both invented and cured restless eye syndrome. Ka-ching, ya blinky chumps!”

  6. celia

    I always suspected as much. If we are not in a position to insist on retesting existing drugs, which would be a useful thing to do, where do we now stand with dubious drugs recently approved e.g. PCSK9 Inhibitors?

    Reply
  7. Flyinthesky

    “Do you think this is too strong?” Not at all but it isn’t going to happen.

    “Who, in a position of power” The problem there is the vast majority of the people in “power” usually have no area expertise, they rely on expert testimony to arrive at the conclusion.
    Round we go again, finding untainted experts, bearing in mind they have to be on message to become quotable experts, is like searching for the grail.

    You, to me, always sound like you’d be up for it, trouble is you’ll never get the chance, too much noise and you’ll be Wakefielded in short order.

    We live in a corporate inspired, government, UN, eu and WHO facilitated world, it really does all work the same.

    Reply
    1. angelcove

      I have a feeling that all those possessing critical thinking are also in that trench, because we all have to try and stop the medical madness from continuing to harm our societies.

      Reply
    2. Flyinthesky

      I don’t trust any “establishment”, once established the main objective becomes the expansion of it’s remit and how big and powerful it can become.
      The medical establishment gets to use the prime emotive, fear, it uses it very effectively. The vast majority of the population live in fear and awe of the medical establishment.
      The problem is once in the state of fear it becomes very difficult to think rationally and question anything that arises from the people who instil it. ” take your statins or die”

      Reply
  8. Graham Stephens

    So who changes the future? My guess is that social media has a chance. This can be seen clearly at the moment with the developments within the human endo-cannabinoid system. In particular the treatment of intractable epilepsy in children using cannabis oil extracts in tincture form. The pharma industry was hell bent on avoiding thc (psycho-active) element so that it would be easier to “market” the cbd (non psychoactive… at least that is what you are told) element. This is only as a result of the massive misinformation since the mid 1920’s.

    Now to my point. Families who have been seriously affected by this situation over many years are genuinely “steering” the way forward on a global scale as can be seen by the current situation in the USA regarding the legalisation of medical marijuana or MMJ. It will shortly be seen that cbd only is no where near as effective as whole plant extract.

    Reply
  9. Andrew Ward

    A doctor who cares about his/her patient? You’ll be fired! to paraphrase a line from The Singing Detective. 🙂 It’s a shame that Monty Python never tackled the pharmaceutical industry…

    Reply
    1. Jennifer

      Andrew, in defence of many who work in the health business, I have certainly come across good, honest folks in my lifetime, both as an NHS employee and as a patient with minor and very serious conditions.
      My real concern is that the workers are feeling gagged, despite upgrading their knowledge. I can tell you that it went on years ago too. I recall getting a round robin in with my pay slip, reminding us that we were breaching our terms and conditions of employment if we spoke to the media regarding anything to do with our place of work. Now, not being a lawyer, that was enough to put fear into us. The note didn’t actually say anything else…..but we interpreted it as an intended threat, and assumed there would be nasty consequences.
      I love the concept of our NHS; I consider it to be a great contribution to our civilised country, along with housing and education, but it is being infiltrated by Big Pharma, just like housing and education have been interfered with from faceless organisations creaming off profits.
      I have said it before, and here goes a repetition….the way the Health business, both public and private, is being managed, is and always has been, a political issue.
      Approving nods and winks from medics, whilst liking how I have implemented much that I have learned from this blog and its contributors, won’t get us out of the rut.
      Only political intervention will do that…..and looking at the way things are today in that area, I don’t hold out much hope in my lifetime.
      Please, someone, tell me I am wrong.

      Reply
  10. Fiona

    Thanks for your title, Dr Kendrick: I had never heard of the Augen stables myth and enjoyed reading about it on the internet. Thanks also, of course, for the blog!

    Reply
  11. Paul v Nguyen

    Who can we call upon to take up the gigantic and painful task of clearing out the Augean stables?

    The BMJ (“In the BMJ, we trust”)

    Reply
  12. John Crane

    Hercules fifth task of clearing out the residual muck from 3,000 oxen in King Augeas’ stables was s nothing compared to your task. Thank you so much. God bless.

    Reply
  13. lindaccd

    Susanbeach12@yahoo.co.uk 

    Sent from Yahoo Mail on Android

    From:”Dr. Malcolm Kendrick” Date:Thu, 27 Aug, 2015 at 2:54 pm Subject:[New post] The Augean stables

    Dr. Malcolm Kendrick posted: “For many years it was possible to start a clinical trial, on a drug, without telling anyone that you were doing so. Then, if it turned out to be negative you could just slip it under the carpet and never let anyone know you were doing it. This is what hap”

    Reply
  14. Gary

    And on this side of the pond, the cesspool that is the CDC. Answer: Nobody. Nobody in a position to do something about it has the moral courage. Pharma is too vastly powerful.

    Reply
    1. BobM

      Wait a month; we’ll be inundated with advice from the CDC to get our flu shots. My wife works at a location where it’s mandatory to have a flu shot…even though she never sees patients (which is the reason for getting a flu shot, to “prevent” transmission of flu). I used to believe in the “experts” and in everything the Government recommended. Sadly, the more I research these areas, the less I believe. And the CDC seem to be the epitome of scaremongers.

      Reply
      1. Gary

        BobM: The flu shot is completely worthless (only 1% of upper respiratory infections in a typical season are influenza-related), and dangerous. The “Vaccine Court,” set up to compensate vaccine-injured children, is now clogged with adults suffering from Guillain-Barre syndrome from the flu shot; however, they are conceding a higher percentage of these than before. Pharma owns our government and media (as I suspect they do in the UK. as well).

  15. Stephen

    Well said. When I tell my friends some of the facts reported here, they look at me in disbelief. It can’t possibly be that bad can it? Yes, I’m afraid it can. All these clever people wasting their brains on worthless biased research to please drug companies. The abysmal picture of medical ‘research’, so well described by Dr Kendrick and Nina Teicholz, continues.

    Reply
  16. OldTech

    Indeed it does seem like science is becoming a slippery slope to incorrect conclusions.

    Just take a look at the number of papers being published. It is simply mind numbing. For example, I did a search on Google Scholar for ‘diabetes’ and got 56,000 hits for papers published so far this year.

    How on earth can anyone really make sense of all of this ‘information’ especially since the papers contradict each other and the only things we remember are the headlines from the last few papers?

    Sadly, this can easily be taken advantage of by the elites to stay in power since papers that go against the establishment are just lost in the noise. So all they have to do is to continue funding and publishing their views to sow doubt in any alternatives.

    On a more optimistic note I do wonder if it would not be possible to turn the tables in some way. For example, using crowdsourcing to filter the fire hose of information. Hmm… on second thought probably not!

    .

    Reply
  17. OldTraveller

    Just hearing on the TV news about a recent NSUW study showing the flu vaccines reduce levels of heart disease EVEN MORE than quitting smoking or taking statins. I can see that the science pretty shoddy on several levels, but what concerns me is the media attention it is getting. Influenced by vested interests no doubt.

    Reply
  18. Tom Welsh

    Competent scientists with an eye to business and politics have been noticing the phenomenon of “retrospective goal setting” for quite some time. I remember this exchange, for example, from nearly 50 years ago:

    ‘There was a derisive laugh from Alexandrov.
    “Bloody argument,” he asserted.
    “What d’you mean ‘bloody argument’?”
    “Invent bloody argument, like this. Golfer hits ball. Ball lands on tuft of grass – so. Probability ball landed on tuft very small, very very small. Millions other tufts for ball to land on. Probability very small, very very very small. So golfer did not hit ball, but deliberately guided on tuft. Is bloody argument. Yes? Like Weichart’s argument”‘.

    – “The Black Cloud” by Fred Hoyle

    Reply
  19. Anna

    David Winter,
    If you signed up for the posts, you should know that there have been 1 or 2 posts very recently on the new statins. Scroll and ye shall find.

    Reply
    1. David Bailey

      By “new statins”, do you mean PCSK9 inhibitors? Even though the new drugs are a bit of a mouthful, I guess we should get the terminology right.

      Reply
  20. Soul

    After reading health books for a few decades now, seeing some of the sometimes brief odd mentions in them, the health care industry and the problems it has reminds me a little of that Sean Connery mention in the 80s movie about Chicago and its gangs, The Untouchables. When telling other new police officers that it was time to go on a liquor raid Connery says in effect, everyone knows were the booze is, it’s just who wants to cross Al Capone. He then leads the new police to the Post Office of all places.

    “The Untouchables – Clip – First Liquor Raid”

    I can imagine it’s easier to keep ones head down. To go against the system is to invite being treated like crap.

    Reply
  21. Stephen

    Dr Kendrick, you ask who cares? You have a dedicated group here who care. Aren’t we in a much better position evidentially than ten years ago?

    Anyway, someone cares in America: Gary Taubes and Dr Attia have started a ‘Nutrition Science Initiative’ (nusi.org) in the U.S. funded by a philanthropist. They are funding proper nutritional research and trials. Potential allies and funders to help with projects you have in mind?

    No one believed the unhappy Cassandra in Troy, but there are plenty who believe you and I think the number increases every day. Hercules had to struggle for a long while before those Augean stables were cleansed!

    Reply
    1. angelcove

      Gary Taubes has produced some brilliant lectures, and he is someone who is on the level. Step by step, more and more of these grounded people bravely step forwards, and take on the challenge of ending this madness every day. I have great faith that we will get through this, and back on track, so to speak.

      If all of us in the crowd takes but one shovelful, the stable will be cleared in no time. Every time we can get bits of information out to others, and they accept it, there is a small victory gained for all of humanity.

      Reply
  22. Zydre Pember

    I trained as a nurse, so have always been interested in all things medical. For many years after my training I believed everything my doctor told me, until that is, I became pregnant.

    During my pregnancy I suffered from morning sickness and my doctor prescribed Debendox. I had read all about Thalidomide and the dreadful foetal abnormalities it caused, so was dubious about this medication, but he assured me that it was safe. However, I was not convinced by his assurances, so abandoned the treatment after taking only one or two tablets and thank God I did.
    Subsequent information justified my misgivings. Debendox was not safe and caused quite a few foetal abnormalities. This episode was the turning point in my questioning of medical treatments prescribed by doctors.
    Three years ago I had a real health scare. Chest pains, tingling down the arm and a hugely elevated BP. My husband drove me to the Emergency Department of our nearest hospital.
    The tests showed that I hadn’t had a heart attack, but the doctor ordered a CAT scan of the brain, why I don’t know and demanded that I see my family doctor for further treatment.
    I ignored the CAT scan, but did see the family doctor, who sent me to a cardiologist. An Echo Stress Test was inconclusive, so I was advised to have an angiogram, which I subsequently underwent. Nothing untoward was found.
    The cardiologist insisted that I take medication. However, I declined all medication. He was flabagasted by my decision stating that I would quite likely drop dead if I did nothing. Well I suppose I could also drop dead if I took the medication (in fact perhaps more likely).
    I told him I was going to do something: I would lose weight, I would change my diet, I would exercise more and would cut down on my consumption of alcohol. He was not convinced that my way would work, but what really struck me was that he wasn’t interested enough to ask me to report back to him the result of my gamble (as he saw it) with my life in ignoring the recommended treatment.
    I had already research dietary methods, not only of losing weight, but also lowering BP and decided that the evidence for the efficacy of a LCHF (low carb high fat) way of eating was overwhelming.
    I embarked on this diet, using high amounts of saturated fat, in the form of coconut oil, butter, full cream unhomogenised milk, cream, lots of eggs and loads of cheese. I tried to eat middling amounts of protein and cut my carbohydrates and sugars to a negligible amount (it is almost impossible to cut out all carbs in my experience).
    Well yes you guessed it, the diet works: I have lost 20 kilos in weight and my BP is well within the latest very low range. I don’t worry about my cholesterol, have loads of energy, drink a moderate amount of alcohol and feel healthy and fit.
    People ask me how I have managed to do all this and I tell them my story. They then ask when I am going to come off this diet and my answer is that I am not on a diet, this is the way I am going to eat for the rest of my life. I never feel hungry, so it is no hardship to eat this way.
    To my knowledge not one person, who has asked me for the secret of my success, has embarked on the same endeavour. I don’t wonder why because I believe that they have been so brainwashed by the propaganda about the evils of saturated fats, that despite the evidence of their eyes, they doubt it can be true. I must admit that when I initially embarked on this new way of eating I had my doubts, but the result in my case, is irrefutable, HFLC worked.
    Until I started this way of eating I had never realised how many carbohydrates people consume. It is quite staggering and most people are so proud of their low fat, low salt, high carb, high sugar diets.
    People have been following the recommended food pyramid for about 30 years and still they are in worse health then before. When are they going to question the conventional wisdom and the so called experts?
    These days everyone believes the experts and not the likes of myself, who can demonstrate that an alternative therapy can also work. Thus Dr Kendrick you provide such a valuable alternative, but expert medical point of view, to the mainstream medical believers. I thank you and applaud your efforts.

    Reply
    1. Maureen H

      Zydre, I have very similar experiences. I too am a retired nurse and believed implicitly in the prevailing medical system. I developed GERD a few years ago, and noticed that it was made worse when I ate baked goods. Coincidentally I went on the Atkins diet and the GERD went away within days, (never to return as I still eat LCHF.) The Respirologist that I see for I.P.F. was not impressed with my dietary solution, and said he would prescibe a PPI, so that I could “enjoy baked goods again”. I declined. I looked up the side effects of PPIs and found that there is an increased incidence of pneumonia, osteoporosis, C. Difficile, anemia due to the negative effect on B12 etc etc etc. In effect an induced achlorhydria. And attempts to wean off those drugs are often fail because of the rebound GERD which can be severe. Why on earth would he prescribe something that would increase my chances of having pneumonia when that could cause a fatal exacerbation of IPF? And I already have osteoporosis. Unbelievable.
      Like you, people tell me eating like this is “extreme” and I should be more moderate. Well, to me ill health is extreme, particularly my own problem, IPF, and treating it with moderate measures will have at best moderate effects, and most likely little if any effect. It’s really irritating when they can see how well I am doing and don’t connect the dots.

      Reply
  23. mikecawdery

    Dr Kendrick

    Another brilliant exposé. The title is particularly appropriate!

    In my experience of writing protocols for veterinary drug trials it was necessary to define the hypothesis that it was intended to test (the primary end-point) and then define H0 (the null hypothesis) and the Type 1 error, α, level of significance, usually 0.05. It was also necessary to define the minimum difference expected between treated and non-treated. The “power” of the study, the Type 2 error, β (the probability of being right) has to be defined, usually 0.8 (4 times out of 5) or greater. Group sizes can then be calculated with these values. From these parameters the differences required for secondary end-points can be calculated

    If H0 was > 0.05 H0 was rejected and H1 (the alternative hypothesis i.e, a significant difference between treatments) was accepted.

    In the cited study (can be downloaded) Tables 1, 2 and 3 and Figures 1 and 2 are devastating and everyone should take the time to look at the report.

    What really upset me was the statement:

    Although we focused on cardiovascular trials, null results are common in other areas of medicine. For example, among 221 agents with the potential to modify outcomes for Alzheimer’s disease, all placebo controlled trials registered in clinical trials.gov have failed to identify positive benefits on the declared primary outcome [7 – Cummings JL, Morstorf T, Zhong K. Alzheimer’s disease drug-development pipeline: few candidates, frequent failures. Alzheimers Res Ther 2014; 6: 37. doi: 10.1186/alzrt269 PMID: 25024750].

    And followed by:

    For example, all of the treatments had been approved by the US FDA and these approvals require early phase trial evidence of safety and efficacy.

    Now if one follows the statements from sundry bodies on these subjects, the very opposite would appear to be the case.

    This is about research by the NHLBI, a supposedly independent US Government organization.

    The raises the question: If this is what happens to independent government research what is happening with Big Pharma sponsored research when they have been fined $billions for hiding data, manipulating data and mal-promoting drugs? Prof. Gotzsche’s book tells all – well worth reading.

    Reply
  24. Leigh

    Watch out PCSK9. You’ve got a rival. This time it’s not a pill, but an ‘under-the-skin’ treatment (what’s the problem with ‘inoculation’ I wonder?) with the unnerving title ALN-PCSsc. One ‘shot’ lasts 6 months and will reduce your naughty, bad, wicked, evil LDL levels to unimaginable low amounts.
    Can hardly wait.
    Well I can actually………
    Here’s to you, ALN-PCSsc. Clink, clink.

    Reply
  25. Anna

    Well, Dr. Kendrick, I don’t know about anyone in a position of power coming forward. More like, the populace is slowly becoming educated from beneath, by people like you. There is also Dr. Mercola, Tim Noakes and others. They are taking Noakes to court in S. Africa this fall, and I do hope and anticipate that this will prove to be a big mistake for them.

    Reply
  26. David

    forgive me, but I’m not sure how you reached this conclusion: “The evidence used for this mass medication of the Western World is demonstrably, horribly, biased. Had companies been forced to register their trials prior to publication, positive results would have been reduced by at least 49%. Almost certainly far more. You could put this another way around and say that it very likely that only 8% of studies would have been positive.”

    Just because the prior stated data showed 49%, and 8%, respectively, you cannot simply apply this to the subsequent argument that this applies, unequivocally, to blood pressure lowering, blood sugar lowering and cholesterol lowering drugs.

    That’s just speculation, and should be tempered as such.

    Reply
    1. Dr. Malcolm Kendrick Post author

      David. You are right to pick my up on this point. In my head I was making associations, but not making them clear. My thinking process was thus. We know that pharmaceutical company research is far more likely to be positive/in favour of drug intervention. This has been demonstrated in many, many studies. Therefore, pharmaceutical company studies will have been far more positive than NHLBI research. We know that AllTrails disclosure did not happen until 2005 for the industry. We know that all the studies that underpin the use of cholesterol, blood pressure, and blood sugar lowering agents were done before 2005 (all placebo controlled research for certain). If ‘success’ has dropped nearly 50% for NHLBI research, it will have done far worse than this for the industry. (no positive statin study since 2005, for example). So, my point is, by necessity scientifically not validated, but it is far more than just speculation I feel.

      Reply
      1. David

        Thanks. Just trying to keep weak logical poor fallacies out of the discussion. (but unfortunately there’s lots of them in play here in the posts)
        When you say “no positive statin study since 2005, for example”, do you mean no studies have been published, or that studies have been done but failed to reach statistical significance?

      2. Dr. Malcolm Kendrick Post author

        The latter. Although, of course, merely registering a trial does not mean that you have to publish it if it is negative. It is just a bit more tricky to publish it if it is positive. Although I believe that publication still occurs without a great deal of difficulty. Rules only count if someone, somewhere, can be bothered enforcing them.

  27. STG

    So appreciate your scathing commentary and in depth analysis of the flawed research. Are you familiar with the writing/commentaries of two American physicians: Norton Handler and Gilbert Welch? I am on the second read of your recent book. Too important to just read once!

    Reply
  28. Eric Thurston

    True to Dr. Kendrick’s prediction, today (Aug 30, 2015) in the NY Times was an article by Gina Kolata entitled “New Alternatives to Statins Add to a Quandary on Cholesterol”

    The term ‘statin intolerant’ appears prominently in this article, which is precisely as Dr. Kendrick predicted. My goodness, what a dilemma! Now we have to figure out a way to line the pockets of the Pharma Industry with even more $$$$$ for yet more harmful and worthless drugs.

    Reply
  29. Jolly Roger is my black flag

    There never was a really satisfactory explanation for why anti depressants took 6 weeks to work. Well there is if the pill is inert. Depression tends to lift over time. So after 6 weeks depression might go away. First pill doesn’t work, try another wait six weeks. YOu get it right? I remember thinking, how do they know how much to give a person, if there’s no test for what chemicals are “off” in the brain? I should have trusted my gut. Well then there are the statins, all the people I know had side effects. They say that’s all in our heads. Seems like they want it both ways. Antidepressants have to be working, but Statin side effects are all in your head. hmmm BTW I know people that swear up and down I am a crazy conspiracy theorist when I tell them antidepressants don’t work. I wonder how long that charade will go on before the science gets accepted?

    Reply
    1. Dr. Malcolm Kendrick Post author

      I think that antidepressants do work for some people. Those who (in whom it cannot be measured) have endogenous (chemical imbalance) depression. I think they have nothing more than placebo effect in most people. But yes, it is ironic that, if you say antidepressants are making you feel better, the doctor believes you. But if you say statins make you feel worse, your symptoms are dismissed as all being in the head.

      Reply
      1. Colombo

        If I were a psychiatrist, I would prescribe chicken soup three times a day to all my patientes.

        Regardless of theories, I would like to see a real clinical study between patients that are well noruished and are treated with dignity, versus patients that are just given an antidepressant. In my opinion, depression is just regret and fear and solitude and malnourishment. Solve all those, and then you can search for a “chemical imbalance”.

        It is a big mess, but pills do not solve moral problems, nor life history problems, nor nutritional problems. Wake up.

        People treat pets more humanely than they are willing to treat other humans. This is the cause of depression. A starving, beaten up dog is not so much different than a psychiatric patient.

        Food, love and respect. One who cannot give all those three things must not be a physician, specially not a psychiatrist.

        Personally, I’ve spent fifteen years taking all kind of pills, and my evaluation is that it was a huge waste of time and money, and probably it caused some physical harm too. I only got better when I started taking care of myself. Eating real food was a big part of that.

        Granted, not anyone can “take care of themselves” but I’m most depressed can, at least in part. The more emotional and functional shackles are put on people, the more “mentally ill” they become. Psychiatry should be about the true habilitation of persons, not about managing symptoms.

        So, please, don’t give pills and then wash your hands.

      2. Jennifer

        What about low dose amitriptyline being used as an analgesic? No mention if it taking up to 6 weeks to be effective, otherwise surely no one would be prepared to wait all that time.
        Another conundrum in the jigsaw of pharmaceuticals. How does the body interpret the intended use of a drug? They will be telling us soon that meds are psychic!
        Don’t laugh…..it is no more daft than telling us statins are good for us.

      3. David Bailey

        Columbo,

        I have known several people with depression, none of whom were mal-nourished, or were psychologically ill-treated in any way. I am sure that depression can be a real, and serious medical problem, even though some people succumb to depression because of what life throws at them.

        It is worth remembering that some of the most successful people have suffered from depression, and not a few have killed themselves as a result.

      4. Colombo

        @David Bailey
        Dear friend:
        How do you know they were not malnourished?
        Nutrition is not only eating, it is also not eating things that wreak havoc in the body. Most so called depressed people are people that eat or drink something not-so-good and who avoid eating something that is good, because of of fear (like fats or fruit) or because of self neglect due to the hardships of working life.

        And how do you know they were not ill-treated? It is not as much as how they treat us, as how we treat ourselves, especially about how we evaluate ourselves after some disapointment.

        There have been many, many attempts to determine what causes depression. All have failed misserably. For example, it’s been speculated that lower vitamin D production in people in northern places like Scotland, Canada or Scandinavia, where there is not much Sun most of the year, could explain the statistical data that shows more suicides than the suicides in more sunny, southern places. But there is also suicide in sunny places. And another problem with this theory is that it assumes that human behaviour is bound by chemistry. And this in turn opens a path for fraud. “You are not responsible for your behaviour Mrs. Smith, you are just lacking my fabulous patented snake oil, which I have on a special sale right now, just for you!” And the “depressed” can say, “Hey, I’m don’t have to change anything, I can live complaining, and suffering and pitying myself and buying that drink and that drug and then be irresponsible and bug other people, because I have a mental disorder!”

        The suffering is real, but it often happens that real suffering is caused by oneself: memories, bad feelings about something or someone, desire of self-destruction. People are as much capable of harming others as of harming themselves. It is not that they lie about their sadness, it is that they have chosen sadness. But everyone that is able to choose sadness can choose other emotions too.

        It is not a medical issue. It is a moral issue. A medical issue is something like a fractured bone or a kidney stone. Something that has actually happened. But behaviour is something that is happening all the time. Those who suffer from depression have to talk with a philosopher or a priest, not with a doctor, because most doctors do not know one iota about the mind. And the philosopher, or priest, or yogi or whatever will recommend firstly, to take care of your body: hygiene, good food, clean water, good rest, proper breathing. And will also recommend some way to untangle the thoughts, the memories and the emotions. And they would say, do this, and then you will be able to see clearly the real problem, and you will be able to solve that problem, or at least live peacfully with it.

        Unless there is a real bodily malfunction (in the brain or in another organ, something that can be actually found by a physician, in which case some real medical treatment may be useful), the fact is that all moral and behavioural problems must be addresed by the individual. From the exterior, all we can do is to give good and prudent advice, and maybe some cheering now and then. But removing free-agency from people is wrong.

        And even if there was a real problem with brain chemistry, then proper nutrition should be the first course of action. But most psychiatrists know nexto to nothing about nutrition. Why? And I dare anyone to ask a psychiatrist what he or she really knows about brain chemistry. Bring a lie detector with you!

        David, please, read the biography of John F. Nash Jr. At least the parts where he speaks about his schizophrenia and how he beat it without medication. Do not watch the film!

        Do not lament anything. Do not worry about anything. “Sufficient unto the day is the evil thereof”.

        One last advice to anyone suffering from depression: stay away from TV, politics and fear-mongers, and collect all the precious time you waste doing that, and spend it reading uplifting books, listening to good music or simply walking and enjoying the many good things about the world, like playing with a puppy. Do not attempt to make the world fair or to save other people. Just remove the bad, bring in the good, and follow good ethics. Do that for a while, and you will feel much better. This works even better if you drink home made chicken soup!

        ____________

        Dr. Sjöberg:
        I’ve researched this topic extensively: Jung, Hoffer, Breggin, Szasz, Schaller, Hoffman, Frankel. Journalists like Whitaker are very valuable, because they can sneak in and reach people who are being kept in the dark about what is really going on. Then the zealots of science and political correctness spring up from the dark depths of idiocy to difame Whitaker and to defend the machinations of both the corporations and the states, and keep all this charade going. Most of those who have worked in some form of psychological therapy or counseling know intuitively that psychiatry is mostly a hoax, but very few dare to speak up. A million flies cannot be wrong.

        Dr. Kendrick, sorry for writing too much.

      5. Dr. Göran Sjöberg

        Colombo,

        Thanks for ‘thinking’ and extensive scrutinising about mental illness!

        The brain is complex but still a physiological organ though of greatest importance.

        Presently I am reading a book by the neurologist and Nobel Prize laureate Gerald Edelman, ”second nature, brain science and human knowledge”, a book that gives me some deeper understanding about how we think and acquire ‘knowledge’.

        The introduction to the chapter ”Epistemolgy and Its Discontent” quotes the famous French mathematician, theoretical physicist, engineer, and philosopher of science, Jules Henri Poincaré.

        The qoutation goes :

        ”Doubt everything or believe everything: these are two equally convenient strategies. With either we dispense with the need for reflection.”

    2. Kay

      Jolly Roger, I wish I could find a blog I read some time back. A retired psychiatrist wrote about a popular anti-depressant. He remarked that the drug is, indeed, useful for a limited number of people, but the fact that it has been marketed become a “block buster drug” is highly unfortunate. The side effects are not minor. I couldn’t help but notice the parallel to statins. Again, possibly useful for a specific group of people, but of no use and possibly of harm to so many others to whom the drugs are aggressively marketed.

      Reply
      1. merrilie2015

        Kay, Altho’ not the retired psychiatrist that you mentioned, you might find this interesting:
        http://davidhealy.org/psychiatry-gone-astray/
        and also google Peter Gøtzsche and some good sites come up.
        I’m sure one can find similar sites for many different drugs that are being freely perscribed becaust of the manipulation of the trials by Big Pharma!

  30. Kay

    To whom it may concern: I think it’s “. . .put through the wringer. . .” not “. . . put through the ringer. . .”

    Reply
  31. Kay

    Thank you, Merrilie2015. Yes. Similar concerns. I appreciate having that web site brought to my attention. Though my life’s work has been something entirely different, I’ve worked three years in a 1300-patient state hospital (I’m old) and another three years in a university hospital psychiatric unit. I came on board at the state hospital about a decade after the new drugs, such as Thorazine, came into use, and saw first-hand the side effects many patients endured. It is interesting to read of the aggressive marketing of Thorazine early on: “Its [Chlorpromazine] use started sweeping across the United States from its introduction in 1954, fuelled by a huge promotion campaign by Smith, Klein & French, who marketed it as Thorazine.”
    http://www.critpsynet.freeuk.com/Moncrieff.htm
    While the “Augean stables” situation is bad news in many medical fields, I find it particularly despicable when it comes to the field of mental health — especially when it comes to creating a “market” among children.

    Reply
  32. Jo Beaumont

    Dear Dr Kendrick
    Firstly, I am half way through your excellent new book, it is fascinating and, unfortunately, so true of so many other aspects of our lives and the manipulation from “big brother”. Reading it has me nodding my head and thinking yes just the same as in Climate Change, for example.
    One query, and I do understand that you cannot be specific, but on the cholesterol “problem” you talk about mild to medium “raised” levels, up to about 7.5? What about people whose level is higher than that, i.e. 9 or above but are fit, active and healthy? I assume that it could be they are just naturally like that, but can it be a problem? and if so, is there an answer? After all averages are only that, and there are many wide diversities that make up an average. (Like statistics!)

    Reply
    1. Bob Niland

      re: … just the same as in Climate Change …

      For a dissident view on Global Hot Air™, by an aerospace engineer, see:
      http://burtrutan.com/downloads/EngrCritiqueCAGW-v4o3.pdf

      re: What about people whose [cholesterol] level is higher than that, i.e. 9 or above but are fit, active and healthy?

      If you’ve only been given standard lipid panels, you don’t really know what your lipid status is. The TC and LDL-C numbers on the standard panel are particularly useless. Get an advanced lipoprotein panel that reports LDL-P, and get tested for lp(a). If high, then also get a one-time genetic test for Apo E polymorphisms. And yes, there are dietary approaches to dealing with adverse genetics.

      Reply
      1. Jo Beaumont

        Thanks for that, and the link. I will pass the information about the tests on, it was not me with the high reading, I intentionally have not had mine taken.

  33. tranwell2015

    Anecdotal/loose impression: I used to find increasingly that my friends and acquaintances had been put on statins. Today I increasingly find that many of them have stories of discarding the taking of statins. Is the word getting out?

    Dr A.E. Hanwell (non medic) 84 Holgate Road York YO24 4AB Tel 01904 624760 Mob 07973176707

    Reply
    1. Bob Niland

      re: … many of them have stories of discarding the taking of statins. Is the word getting out?

      That’s one explanation. Another is they are weighing frank adverse side effects, about which they were not warned, and which they can easily challenge test, vs. hypothetical future cardiac hazards parroted by a physician whose credibility is now under deep suspicion.

      Reply
      1. Jennifer

        As you say, many have stopped taking statins because of the awful effects they have endured.
        My concern is for the submissive sufferers who get fobbed off by complacent doctors who convince them that the ill health is their own fault and couldn’t possibly be the result of statins. Yes, there are still folks out there who dare not speak up to their ‘omnipotent’ docs, and thus hang onto their every word.
        But things are changing…..more patients are Internet savvy, now that we can read and write to a decent standard. Thanks to the age of decent state-provision education of the masses…..alas, now declining. So, us baby-boomers had better make the most of what we were lucky enough to experience in the 1950’s and 60’s.
        Cynical? Moi?

  34. Sally Macgregor

    There is a similar groundswell of disaffection/anger/astonishment at the manipulation (if you care to use a mild term) of data from clinical trials going on in the psychiatric world: for those who are interested, the BMJ is due to publish a re-interpretation of data from a GSK trial this week (around 17th September). Called Study 329, it purported to show, back in 2000, that paroxetine, an SSRI antidepressant, was safe for use in children/adolescents. A dedicated bunch of stubborn researchers and doctors have been trying to get the paper retracted virtually ever since – for all the reasons which Dr Kendrick outlines in this post. It has been an Augean Stables task – there is a website with a great deal of information: study329.org for anyone who is interested. The parallels with the statin situation are stark:

    Reply
    1. Dr. Malcolm Kendrick Post author

      Yes, David Healy is a great man. But as you can see. Years and years of work, sweat, and effort…. for just one study. Every day hundreds of studies rain down upon us. Can you imagine the effort required to check them all? Tis mind-boggling. I think Hercules would just have said ‘the hell with it, no-one can do that.’

      Reply
      1. Sally Macgregor

        Yes, I’m sure he would. But – don’t you think that someone (and it hasn’t just been Healy) somewhere has to make an example, however small. If they don’t, we might as well all hang up our clogs and nothing will ever, ever change. I don’t think change will happen in my lifetime, but just maybe in time for my grandkids? Add together your work on statins, Healy, Whitaker et al on psychotropics, Margaret McCartney challenging over-medicalisation in the BMJ, scepticism from some oncologists about the necessity of many new cancer drugs – in the teeth of vast corporate powers to hide, lie and harm – then I think that maybe people will learn to be more sceptical, ask more questions and accept medication less readily. It has certainly helped me to stand firm against the diabetic nurse about taking statins (and to decide that I would sooner die than go and see her again – mind you, that’s what she said would happen if I didn’t take statins). But, possibly I’m just in optimistic mode – tomorrow I might be as pessimistic as I often feel!

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