Peer Review and the MMR-Autism Debacle

When a study is submitted to a scientific journal, it goes through a number of stages, at any of which, its publication could be rejected. The editorial team check the paper. They ensure it fits within the scope of their publication, that it is complete, free of obvious error, and would interest the journal’s readership. As many as 80% of submissions fail to pass this hurdle in the most widely read titles such as Nature. Should the paper survive this stage, it is sent to at least two, but often more, external reviewers to be examined more closely. Ideally, these “peers” are published scientists with expertise in the field that the submission concerns. They assess the quality of the study, its methodology, whether the results justify the conclusions, and as important, that it adds something new to the accumulated knowledge of the topic which it examines. The reviewers will then either recommend the study for publication or not. Generally, a consensus of the “peers” is required, but the final decision on publication lies solely with the journal’s editor.

The House of Commons Science and Technology Committee’s report, Peer Review in Scientific Publications, was released on 28th July, 2011. It focused on peer review to “see whether [the system] is operating effectively.” The report found the peer review system wanting, highlighting the MMR vaccine scare engineered by Andrew Wakefield at the behest of a law firm paying him to find a link between autism and vaccines.

retractedIn 1998, Dr Wakefield, then a researcher in gastroenterology at the Royal Free Hospital, London, and twelve colleagues submitted a paper entitled Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children to the hitherto well respected medical journal, The Lancet. They published it. At the press conference held on publication, Wakefield announced his belief that the MMR vaccine may cause autism (much to the surprise of many of his collaborators as the study found no such thing). He advised that the safest course of action was for children to receive separate shots against measles, mumps and rubella. Coincidentally, of course, the affable doctor had recently patented the measles vaccine he, himself, was developing.

MMR uptake fell sharply. Measles, once declared eradicated in the USA, returned as did its complications along with its triple jab siblings mumps and rubella. The tragedy was only compounded by America’s home-grown vaccine scare over so-called toxins. Measles epidemics broke out in Europe. Children have suffered, been injured, and somehave died. Now, fifteen years on almost 900 children in South Wales have been infected with measles. At least 80 have been hospitalised and measles may be implicated in the death of a 25 year old man.

In January, The Lancet finally retracted Wakefield’s paper. By then, most of his collaborators had asked for their names to be withdrawn from the study and dozens of subsequent investigations had proved its findings impossible to reproduce. Wakefield, himself, had been struck off by the General Medical Council (GMC) who found against him on (among many others) twelve counts of abuse of developmentally impaired children and four of dishonesty – one of which related the statement that “investigations were approved by the Ethical Practices Committee of the Royal Free Hospital …” – A blatant lie.

Much of the evidence against Wakefield as a huckster and abuser of vulnerable children was uncovered by journalist Brian Deer. Writing for the Sunday Times, his tenacity and ingenuity made the outcome of the duplicitous doctor’s GMC hearing wonderfully predictable. Deer should, rightly, be lauded for his work. He is correct: scientists are only human and some do succumb to the temptation to embellish, cherry-pick, re-order or even make up their data. Disappointingly, the Wakefield incident is not unique. Nevertheless, Deer’s calls for a regulatory body overseeing scientific research, as the Science and Technology Committee’s report recommends, raises many objections.

Firstly, science is, essentially, if not self-policing then self-correcting. Fraud does not long go undetected because studies are falsifiable. This is intrinsic to the scientific method. If findings cannot be reproduced, a hypothesis fails to become a theory – as close to a fact as science allows. Science dogma does not stand or fall on the basis of a single study. Even the MMR-autism case substantiates this. An idea was proposed with assumed honest data to support it, but further and better conducted research around the world failed to find that which Wakefield’s group reported. This leads to the second objection: scientific research is an international pursuit. Safeguards and oversight in one country do not apply globally. One only has to look at the laws and conventions governing the use of animals in medical research to see the disparity from nation to nation. Imposing the requirement for monitoring could make international collaborations more bureaucratic, expensive and, potentially, infeasible.

Science, among few human endeavours, has the ability to transcend geographical borders, culture and ideology. Falsifying a hypothesis is not reliant on a single institution in a single country, so the Select Committee’s implications of cronyism fall at this hurdle. Look again at the Wakefield paper. Groups in PolandDenmarkUSA and more conducted research destroying that very hypothesis. Finding reviewers with the requisite level of very specialist knowledge often means drawing from a very small pool indeed. Finding overseers with multi-disciplinary skills and experience to monitor researchers would prove equally challenging.

Most science journals employ single-blind peer review, whereby the reviewer knows who made the submission, but the writers do not know who is reviewing it. This contrasts with the double-blind method favoured by social sciences publishers. Simply put, that group which is conducting a particular study or studies would likely already be known to reviewers who work in that area, too. In certain strands of the sciences, there are only a limited number labs (sometimes only one) from which the research could have emanated, be that because of equipment, the effects of a geographical variable being studied, etc. Double-blinding, therefore, becomes impractical and redundant. For these reasons, there are journals who impose no blinding whatsoever, giving researchers the potential to seek redress if they feel a particular reviewer has displayed bias towards them. The Committee on Public Ethics affirms, “it is probably impossible to eliminate all bias … but good editors endeavour to minimize it.”

That the cost to public health resulting from the publication Wakefield’s fabricated work was, and continues to be, so very high, is naturally worrisome. The fault for this, however, is not due to the scientific method or the peer review process. The reason this paper caused uproar and, ultimately, deaths is two-fold. That The Lancet, with so fine an international reputation, should ever have published it is contentious and the edition being heralded with a press conference by Wakefield et al was, undeniably, the spark that ignited the powder keg.

Professor Thomas T. MacDonald is a gastroimmunologist working at Bart’s hospital in London. His testimony at the Omnibus Autism Proceedings in the US Vaccine Courts was unambiguous. He called the 1998 study “probably the worst paper that’s ever been published in the history of [the Lancet].” Professor MacDonald has over 400 publications behind him. He questions Wakefield’s qualifications to conduct such a study and accurately interpret the results. “He is a surgeon,” MacDonald says. “He’s not a paediatrician. He’s not an immunologist. He’s not a histopathologist.”

Wakefield’s charisma has been commented on ad nauseum. He certainly seemed to have had The Lancet’s editor, Richard Horton, rapt. The 1998 study was not the first seriously flawed investigation of Wakefield’s to appear in the journal. Calling press conferences to hold measles (and subsequently, vaccine strain measles) responsible for inflammatory bowel disease was his M.O. Here was a debonair researcher with a penchant for controversy – an appealing combination to an editor like Horton, who clearly saw the role of editor as more journalistic than academic. Horton’s 2004 book,MMR: Science and Fiction – Exploring a Vaccine Crisis, is less the apologia it should be, given the consequences of that single editorial decision, but page after page of excuses for letting a substandard study be published in what is (was?) arguably Britain’s premiere medical journal. Probably correctly, Horton assumes that the study may well have been published elsewhere had he not done so. There is a hierarchy of journals, at the top of which, in the UK at least, was The Lancet. Publication in its hallowed pages lends any study an air of validity. This unofficial ranking of journals is a criticism the Science and Technology committee levels at the peer review system. That this is understood, accepted and utilised by the scientific community is entirely lost on them.

The press love a good scare story. The fact that study after study that refuted Wakefield’s hypothesis barely caused a ripple after the tsunami of that initial study. It took Brian Deer’s muckraking and decrying of Wakefield to finally get the fact that MMR does not cause autism on to the front pages. In this context, muckraking is no slight on Deer, for he uncovered lie after filthy lie, abuse and despicable conduct as he investigated Wakefield’s methods and motives. The science may be difficult to comprehend, but Deer turned this into a  thriller-like story.

Had this travesty of a study not appeared in such a well respected journal, had it not been accompanied by a huge press conference laid on by Wakefield’s institution, the Royal Free, then the hypothesised MMR-autism link, that eventually met the fate of so many other poor and fraudulent pieces of work and drowned in its own irreproducability, would have long since faded into history. Too many commentators and politicians blame the press for the furore surrounding Wakefield’s study. Although partially culpable, this is a drastic oversimplification. Journalists, too few with science training or the ability to comprehend a scientific report, were spoon-fed this story by Wakefield and the Royal Free, who produced a video and a press pack to accompany the now infamous press conference.

The MMR-autism farrago was not facilitated by flaws in the peer review system, though they do exist. In fact, four of the six reviewers of the study rejected Wakefield’s paper. Were it not for an editor with the longing to be a sensationalist journalist, the lead researcher’s vested interest in clearing the way for his own vaccine, and the publicity required by a law firm hoping to win huge amounts of compensation for its clients, thus guaranteeing a big payday for themselves, the study would most likely have failed to reach such a wide audience. A poor editorial decision was made. Groups trying to reproduce the work failed. The hypothesis failed. This is what the scientific method does so well and has for centuries. That there are still people out there who, as if on an article of faith, believe that vaccines cause autism is the fault of media outlets and shady journals who make, at best, half-hearted attempts at peer review. Science is self-correcting; journalism and editorial egotism, unfortunately, are not.

For my own anecdote on my autistic child receiving his first MMR, here it is : MMR and Autism – Our Story

About M O'Callaghan

I work at home, in Wales and am the proud mother of the adorable Pwdin of my blog. My son is autistic and (let's get it out the way) fully vaccinated. When he's asleep or at school, I contribute to various websites such as Vaccines Today and Seek the Evidence among others. Here at Skeptoid, I intend to write about products, therapies and practices being marketed to parents and families. Give me a bit of wiggle room on this one, though, as I have found that parenting pages and mum magazines promote much woo targeted at women which may well get a good going over from time to time. Follow me @MLOCallaghan
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19 Responses to Peer Review and the MMR-Autism Debacle

  1. Stephen Propatier says:

    Love this post keep it up

  2. gymgoki says:

    This article gives me some faith in jounalism in that another journalist actually took the time and refuted a sensational fraud. I applaud Mr. Deer.
    Dr . Wakefield needs to see some jail time. It can be reasonbly argued that he killed children. I thought Jenny McCarthy was the main criminal….I guess not. The medical journal world has been rocked by several high output (journal articles) frauds as of late. I’m not sure if these other frauds have caused the same amount of damage….but they truley do need to be thrown in jail. I read medical journals frequently and will alter my care by reading medical literature.

    I’ve posted this before but again, it seems poignant.

  3. lilady says:

    The disgraced former medical doctor has relocated to Austin, Texas…where he is still promoting himself and his bogus theories of “vaccine-induced enterocolitis”. He managed to promote another “theory” that there is a higher incidence of autism amongst Somali children who received the MMR vaccine…which caused a huge measles outbreak in Hennepin County, Minnesota. He met secretly with Somali-American parents at least two times before the outbreak and once during the measles outbreak:

    Here, the MMWR issue that details that measles outbreak and identifies the index case as a Somali-American child who was deliberately unvaccinated, who traveled to Africa where he contracted measles and proceeded to transmit measles to other deliberately unvaccinated Somali-American children

    Notes from the Field: Measles Outbreak — Hennepin County, Minnesota, February–March 2011

    April 8, 2011 / 60(13);421

    On March 2, 2011, the Minnesota Department of Health (MDH) confirmed measles in a Hennepin County resident aged 9 months. As of April 1, investigation of contacts and heightened surveillance had revealed a total of 13 epidemiologically linked cases in Hennepin County residents. Of those cases, 11 were laboratory confirmed, and two were in household contacts of confirmed cases and met the clinical case definition for measles.

    The patients included children aged 4 months–4 years and one adult aged 51 years; seven of the 13 were of Somali decent. Eight patients were hospitalized. Vaccination status was known for 11 patients: five were too young to have been vaccinated, and six (all of Somali descent) had not been vaccinated because of parental concerns about the safety of the measles, mumps, and rubella (MMR) vaccine. The most recent rash onset was March 28. An additional, unrelated case of measles was confirmed in a Hennepin County resident aged 34 years who was exposed in Orlando, Florida, sometime during March 1–10.

    The investigation determined that the index patient was a U.S.-born child of Somali descent, aged 30 months, who developed a rash February 15, 14 days after returning from a trip to Kenya. The patient attended a drop-in child care center 1 day before rash onset; measles developed in three contacts at the center and in one household contact. Secondary and tertiary exposures occurred in two congregate living facilities for homeless persons (four patients), an emergency department (two patients), and households (two patients). A virus isolate from the index patient was genotyped at CDC as B3, which is endemic in sub-Saharan Africa….”

    Now there is a journalist who has published an article on the “New Statesman” blog about providing publicity and a public forum to Wakefield during the ongoing Wales measles outbreak. You may *recognize* some of the posters there

    • Glad you and Matt Carey are there fighting the good fight. As for mr Alber and the Daschelbot – shudder!

      • lilady says:

        The hit-and-run Dachelbot is gone. I’ve been posting back at Mr. Alber…he’ll be gone soon.

        I’m using links to Brian Deer’s excellent website for the JABS poster and for the parent of two children who were part of Wakefield’s “study”.

  4. Rich Murray says:

    I am glad to see vigorous substantial disproof of very bad alarmist “science”.

    May I venture to introduce a new candidate for a toxic cause of autism — briefly, methanol (wood alcohol) (about the same doses from cigarette smoke, aspartame, and unfresh fruits juices vegetables cut up and preserved wet at room temperature in sealed cans jars plastic containers) quickly enters the blood and travels with the blood, with half-life 3 hours, to the whole body and the fetus every minute — only in 20 specific human tissues (humans are the only animal to have no natural cellular defences against this) with high levels of ADH1 enzyme,
    is the methanol rapidly made into free floating formaldehyde right within these cells, which include the inner walls of brain blood vessels at the base of the brain, and also the purkinje cells in the vermis of the cerebellum — “…it has now been discovered the cerebellum is known to be preferentially damaged in human autism, 662 and the vermis 570 and hippocampus are the particular areas of the cerebellum most damaged and reduced in volume by the disease. 571 …” Chapter 12 “Autism and Other Birth Defects, free at http://www.WhileScienceSleeps, Prof. Woodrow C. Monte, Food Science and Nutrition, Arizona State University, retired 2004, with 745 free online full text medical research references —

    I gave many rather long posts in a few days of unresolved debate:

    Rich Murray says:
    April 14, 2013 at 11:16 am

    many strong birth defects in 336 rat fetuses, 3 g/kg bw oral methanol (not toxic dose) in 26 rat litters, thesis done 1987, WC Monte, M Hoque, L Black, CS Johnson: Rich Murray 2013.04.13

    With years of expertise in testing toxins on rats, Prof. Woodrow C. Monte, Arizona State University, had his own lab, where he mentored graduate students.

    Vivid personal reports led him to test the possibility of birth defects from methanol, 11% of aspartame, 22 mg in the 200 mg aspartame in a 12-ounce can diet drink.

    He was unaware that the FDA and Searle Corp. had hidden 6 of their studies that showed birth defects from aspartame in rabbits and mice in 1975.

    This dose was planned to swamp the catalase enzyme defense system, which, effective in rats and all animals, except the uniquely vulnerable human species, protects against harm from methanol being made into free floating formaldehyde inside cells with high levels of ADH1 enzyme, notably the inner walls of brain blood vessels and in retina rods and cones.

    As the smallest organic molecule, methanol readily enters all cells, while it is carried to all parts of the body and the fetus with the bloodstream — in humans with a blood half-life of 3 hours, circulating through the whole body every minute.

    A ten-fold lower dose of 0.3 g/kg body weight was used with 272 fetuses in 21 litters, producing a much lower number of birth defects, compared to 296 fetuses in 22 control litters with no methanol.

    gives all photos and figures in “While Science Sleeps” textbook –
    Figure 12.5 shows a damaged rat pup brain…
    177. Hoque M., Monte WC., Black L., Johnston CS.
    Methanol Neuropathy and Teratology A Histological Study on Long-Evans Rats.
    FASEB 1988;25(2(6)):A513.

    [ See also:

    Methyl alcohol ingestion as a model etiologic agent in multiple
    sclerosis, WC Monte, D Glanzman, C Johnston; Methanol induced
    neuropathology in the mammalian central nervous system, Woodrow C.
    Monte, Renee Ann Zeising, both reports 1989.12.04: Murray 2007.12.28
    posted again Tuesday, May 1, 2012
    Friday, December 28 2007

    WC Monte finally got secret FDA memo 37 years after Searle Co. labs
    found birth defects in rabbits from aspartame (methanol, becomes
    formaldehyde via ADH1 enzyme within human cells) and its
    phenylalanine: Rich Murray 2012.06.02

    Fwd: Aspartame Submission from Prof. Woodrow C. Monte to EFSA: While
    Science Sleeps: A Sweetener Kills 241 p — Ch 12 Autism and other
    Birth Defects 26 p — 740 references full pdfs: Rich Murray
    Download Chapter 12 of the book “While Science Sleeps”
    “Autism and Other Birth Defects”,
    with 100 free online full text references ]
    [ much more… ]

    Harriet Hall and I exchanged emails, apparently fruitlessly, over a year ago — if you study them, you will see that she never cited any specific details in her remarks — the quotes you give are her opinions, not support by any details from Monte’s writings — say, don’t you think “cherry picking” is an inadequate description of a public free online archive of 745 mostly full text medical research references? Probably, she scanned the text, as the “giant rat” is in Chapter 3 as Figure 1, without checking out any of the 745 references, and dashed off her reactions, which for me indicate fearful avoidance of challenging information — the “giant rat” image shows that Monte’s range of communication includes art and humor…

    Re ADH1, “To me, it says only cells with high levels of the enzyme cause this formaldehyde formation.” is the core of his paradigm, the fact that is relevant to each and all of the 20 chronic methanol formaldehyde toxicity diseases that the paradigm applies to, most of which are known to be partly caused by cigarette smoke, which few indeed know is a strong source of methanol, that is absorbed in the lungs and put right into the bloodstream with a half-life of 3 hours, reaching the entire body about every minute, and easily diffusing into all cells, while being quickly made into free floating formaldehyde only in the minority of cells in 20 specific tissues that have high levels of ADH1 enzyme… yes, repetition, repetition, repetition, a basic principle of pedagogy…

    within the fellowship of service, Rich Murray

    • Got anything even slightly, you know, peer reviewed?

      • Rich Murray says:

        Good question M O’Callaghan…

        short answer, yes, “slightly”…

        of course his free online archive of 745 full text references are mostly peer reviewed mainstream research papers and expert books…

        WC Monte’s 2010 paradigm summary paper in Medical Hypothesis ( a no peer review journal by design) was cited by an eminent team at Harvard University:

        Eva A. Schernhammer cites Woodrow C. Monte methanol-formaldehyde
        paradigm in brave, cautious Harvard team study that confirms more
        cancers in aspartame diet soda users over 22 years — full plain text:
        Rich Murray 2012.10.27

        highly competent, pithy analysis of aspartame cancer study by Eva S.
        Schernhammer at Harvard, William R. Ware, PhD, showing relevance of
        Woodrow C. Monte methanol-formaldehyde toxicity paradigm: Rich Murray 2012.12.03

        Three other qualified experts have praised his textbook “While Science Sleeps”:

        Prof. Resia Pretorius letter re aspartame to EJCN cites Prof. Woodrow C. Monte “While Science Sleeps” text, re methanol/formaldehyde toxicity paradigm: Rich Murray 2012.05.21

        Aspartame: The hidden danger [methanol/formaldehyde] in our midst and how it kills us, 12 page review of While Science Sleeps text (Woodrow C Monte), International Health News, whole June issue, Editor: William R Ware PhD: Rich Murray 2012.06.08

        Paul Thomas MD Pediatrics & Integrative Medicine, Portland OR, praises “While Science Sleeps” at — WC Monte paradigm of methanol formaldehyde toxicity via ADH1 enzyme in 20 human tissues, including fetus: Rich Murray 2013.04.03

        Do ya know, Monte for decades hasn’t been able to get peer review approval for his aspartame and methanol research papers, while publishing many other fine papers based on work in his own laboratory at Arizona State University.

        !! Rich

  5. gymgoki says:

    Interestingly I was pursuing articles in “popular Science” which mentioned and found an article regarding academic on a pathologic scale (and I know of others).
    This lead me to this rather long but well written article in the NY Times:
    Then this lead me to a blog that actually tracks academic fraud!
    I’m sad. But, I guess anybody can be lured by fame ($?).

  6. karlbaba says:

    The human genome was only sequenced in 2003 and it is taking time for science to grasp the implications of our genetic code. This is some time after the controversies listed above. It turns out that many individuals are severely challenged in detoxifying metals, and in many critical biochemical processes than others. Dr Amy Yasko has done ground-breaking work treating autism and linking those treatments to the individual genetics of the patient.

    Everybody is not the same and the vulnerability to Autism is not the same either. It’s not just vaccines for sure but it’s plain that vaccines do harm people, that’s statistically inarguable. The question is why are some people harmed by vaccines, and all the toxins of modern life and others thrive anyway, it’s genetics

    • She is an ultimate quack who has actually written a book filled with nonsensical pseudoscience that flies in the face of everything that is known how the body works. She proposed no reasonable explanations why her model is better. When it was pointed out that chelation therapy does not work and in fact dangerous, she changes to “glutamate receptors” hopping on the worst of the recent gluten clap trap.
      You would be wise to stay well clear of her half baked recommendations.
      Saying it genetic is the only thing that she even half says that is true. Right now the best evidence is that it begins in utero and is a genetically mediated disease. There is ever declining evidence that environmental factors of any kind play a large role in autism.

      • karlbaba says:

        “When it was pointed out that chelation therapy does not work and in fact dangerous, she changes to “glutamate receptors” hopping on the worst of the recent gluten clap trap.” This comment really takes away from being able to assign credibility to your comment. since Yasko makes no association between Gluten and Glutamate Receptors. I can’t see anyone else doing that either so I regard your comment as either mistyped or misinformed.

        It’s true that she, along which much of Functional Medicinal doctors, suggests her patients stay away from Gluten (without saying that some people can’t do fine on it) because experience shows that many people with chronic disease, particularly autoimmunity, have their digestion compromised by Gluten. This has nothing to do with Glutamate receptors.

        Anecdotally, I suffer from Hashimoto’s and when I quite gluten (without reducing calories or increasing exercise at all) lost 30lbs along with 95% of my gas and gerd in one shot so I don’t have much sympathy for the fad of discrediting non-celiac gluten sensitivity.

      • gymgoki says:

        You are 100% correct.
        BTW: I love

        • karlbaba says:

          I beg to differ. I’ve already enumerated why Stephan is at least partially incorrect as he conflated Gluten Sensitivity with Glutamate receptors, some thing Amy Yasko, and everybody else for that matter, does not do. Doesn’t having a scientific approach mean you have to own up where you are wrong?

          Even though the following statement is certainly factually incorrect, I would, as a critical thinker, like to see a link pointing to the debate or discussion related to this:

          “When it was pointed out that chelation therapy does not work and in fact dangerous, she changes to “glutamate receptors” hopping on the worst of the recent gluten clap trap.”

          Yasko’s program is supported by detailed medical testing every step of the way. It’s done quantifiably through the feedback of testing and careful not to introduce chelation when it would be dangerous. In fact, her consideration of the effect of genetic polymorphisms on the action of prescribed medication and supplements heralds the future of medicine, still shunned as experimental, where documented pubmed studies show certain genetics create problems with certain substances which means a person’s genetics provide a individualized map a physician should take into account in treating their patient, but still doctors remain blind to this critical information.

          Stephan says Dr. Yasko is the ultimate quack but has demonstrably misrepresented her views in his comment about them.

          The only mention of her on Quackwatch is in listing her as disreputable because of her study at Clayton College (not mentioning that she also has a PHD from one of the oldest medical schools in the country)

      • karlbaba says:

        Stephen writes: “Right now the best evidence is that it begins in utero and is a genetically mediated disease. There is ever declining evidence that environmental factors of any kind play a large role in autism.”

        Not so fast! The fact that there are genetic factors pointing at autism doesn’t mean that there are no means of ameliorating those genetic issues. This is called Epigenetics. For example, if a person has a homozygous MTHFR defect, their methylation cycle will be impaired and the enzyme will only 40% as effective, resulting in impaired detoxification. This genetically predisposes people to health issues. However, by supplementing with Methylfolate, thus providing the active form of Folate that the enzyme is supposed to create, the genetic problem is bypassed. There are other polymorphisms, related to B12 for instance, that have similar workarounds. Also epigenetically, the environment is always important. The question is what aggravates and triggers the genetic vulnerability. If one is genetically unable to clear metals, they better avoid them.

  7. John Kane says:

    Anyone relying on this post in researching this topic, please see this current (2017) response to the Wakefield/Lancet story This is a thorough and documented critique of the process of peer-reviewed science, using the Wakefield episode as the stepping stone

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