[HN Gopher] When half a million Americans died and nobody notice...
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When half a million Americans died and nobody noticed (2012)
Author : cempaka
Score : 124 points
Date : 2023-09-22 18:17 UTC (4 hours ago)
(HTM) web link (theweek.com)
(TXT) w3m dump (theweek.com)
| mlhpdx wrote:
| I've never heard of this until seeing it here. I'm dumbfounded.
| sublinear wrote:
| So the math seems to be that for the 25 million people prescribed
| this drug...
|
| FDA claims: 1/5th of a percent died (55k)
|
| TFA claims: 2 percent died (500k)
|
| That's a huge difference of opinion.
| deaddodo wrote:
| I mean, 55k excess deaths is still a pretty massive number.
|
| But, like most of these stats, it probably lies somewhere
| between the minimum and maximum, unless one of the parties was
| outright lying.
| Schiendelman wrote:
| The problem with that line of reasoning is that if I put a
| blog post together that looks believable and claims there
| were 5 million deaths, many reasonable people will assume the
| truth is somewhere in between.
| sublinear wrote:
| > I mean, 55k excess deaths is still a pretty massive number.
|
| So is 25 million. :)
|
| I don't mean to be callous by saying this, but it's often
| stated that even one death is unacceptable, but we also
| expect products to infinitely scale. At some point you will
| have a death from anything including breathing or drinking
| water.
|
| What would be even worse is if we found that threshold of
| "one death" and limited the number of prescriptions below
| that. I think most people who need certain medications would
| prefer to roll the dice than be rejected the treatment.
|
| I've always thought it would be a good compromise if the risk
| of death for the recommended dosage is required to be printed
| on the label along with doctors and pharmacists warning the
| patient ahead of time even for trivial stuff like ibuprofen.
|
| Even more generally, a culture shift towards realistic
| expectations is sorely needed these days.
| mcguire wrote:
| Derek Lowe (https://www.science.org/content/blog-
| post/500-000-excess-dea...):
|
| " _I do not see the effects that Unz is talking about. Not at
| all. A single-cause change in the death rate of the magnitude
| that he 's proposing should most certainly show up in these
| figures (particularly the latter chart), but it isn't there. I
| see no reason to take this claim seriously._"
| mcguire wrote:
| The article concerns allegations made by Ron Unz
| (https://en.wikipedia.org/wiki/Ron_Unz), who currently runs The
| Unz Review (https://www.unz.com/). The Unz Review currently has
| the following article at the top of its page: The Protocols
| Revisited by Karl Haemers, which is a review of _Protocols of the
| Elders of Zion: The Definitive English Edition,_ Edited and
| Translated by Thomas Dalton PhD.
|
| " _Thomas Dalton, PhD has achieved the high claim of his title,
| Protocols of the Elders of Zion: The Definitive English Edition.
| While such reading cannot be considered "entertainment," given
| the urgent and alarming subject matter, I found the variety of
| writing styles, viewpoints and analyses among the many chapters
| compelling in counter-point and also in consensus. I struggle to
| think of any adult and youth today who would not gain crucial
| perspective on history and current events that they can apply to
| their own protection and the defense of the world. Along with
| bringing this knowledge to our attention once again in this new
| form, Dalton's greatest contribution is the simple, clear and
| effective solutions he offers at the end. I am left with a
| persistent peal of passion:_
|
| _We must do this!_ "
|
| The rest of the page is taken by links to anti-semitic articles,
| anti-black articles, anti-feminist articles, neo-confederate
| articles, and various conspiracy theories.
|
| Consider your sources.
| ajhurliman wrote:
| Idk, a $4.85B settlement seems like they really extracted their
| pound of flesh. In the thesis statement where they question if
| Chinese lives are worth more than American lives, I wonder if
| they're specifically looking for capital punishment similar to
| what China administered to the highest-tier offenders.
| whatshisface wrote:
| I interpreted it more as a "when is it okay to pierce the
| corporate veil with criminal charges," question, which is
| usually answered in the affirmative for fraud.
| jaggederest wrote:
| This is just one that was noticed and trackable. How many other
| quiet half-a-percent-contributors-to-mortality are going
| unnoticed? I don't think the epidemiological surveys for
| detecting these kinds of thing are well funded, to say the least.
|
| There's some sort of Drake equation you can do here: prescription
| rate times chance of side effect divided by detectable effect
| size, if the number is below the threshold, it's invisible.
|
| It would be interesting to establish something like a holdout
| group longitudinal study where no new drugs are allowed for 5
| years or something and see if their mortality rate differed
| substantially from the baseline.
| dkbrk wrote:
| Leaving aside whether the number of deaths claimed by the article
| is correct, it is incorrect to directly compare deaths of infants
| with those of the elderly.
|
| It should be done using Life-years lost [0] or Quality-adjusted
| life years [1].
|
| [0]: https://en.wikipedia.org/wiki/Life-years_lost
|
| [1]: https://en.wikipedia.org/wiki/Quality-adjusted_life_year
| ChrisArchitect wrote:
| (2012)
|
| Discussion from then:
| https://news.ycombinator.com/item?id=3954201
| jschveibinz wrote:
| Here is another eye-popping medical number that goes completely
| unnoticed:
|
| 250,000. [1]
|
| This is roughly the number of deaths per year from medical
| accidents (and/or malpractice) each year. Some claim the number
| is closer to 400,000.
|
| [1]
| https://www.hopkinsmedicine.org/news/media/releases/study_su...
| tetris11 wrote:
| > "We find the largest rise in American mortality rates occurred
| in 1999, the year Vioxx was introduced, while the largest drop
| occurred in 2004, the year it was withdrawn," says Unz. "Vioxx
| was almost entirely marketed to the elderly, and these
| substantial changes in the national death-rate were completely
| concentrated within the 65-plus population.
|
| I want to believe there were other factors at the time, but I
| can't see it. It was widely used, in that age group, and the
| company already knew of the risks. I wonder if this will lead to
| more people buying Chinese drugs, given the more harsh reaction
| by the government during their own drug crises.
| mcguire wrote:
| Derek Lowe (https://www.science.org/content/blog-
| post/500-000-excess-dea...):
|
| " _" We find the largest rise in American mortality rates
| occurred in 1999, the year Vioxx was introduced, while the
| largest drop occurred in 2004, the year it was withdrawn," says
| Unz. "Vioxx was almost entirely marketed to the elderly, and
| these substantial changes in the national death-rate were
| completely concentrated within the 65-plus population."_
|
| I found this claim very hard to believe. (For one thing, how
| could all those patients and lawyers suing Merck have let this
| get past them?) Looking at the statistics themselves, I can see
| no evidence for Unz's claim. Here, for example, is the death
| rate in the US, crude and age-adjusted, over this time span:
| And to get more specific, here are the numbers for
| cardiovascular deaths for people 65 and over. (They're in a
| chart comparing them to cancer death rates as well):*
|
| _I do not see the effects that Unz is talking about. Not at
| all. A single-cause change in the death rate of the magnitude
| that he 's proposing should most certainly show up in these
| figures (particularly the latter chart), but it isn't there. I
| see no reason to take this claim seriously._"
| fatfingerd wrote:
| > I wonder if this will lead to more people buying Chinese
| drugs, given the more harsh reaction by the government during
| their own drug crises.
|
| I doubt it, baby formula importing didn't seem to die down in
| China as a result.
|
| I haven't been following the developments there recently, but I
| am skeptical this changed even after the US' chaos over
| allowing a near monopoly to become too big to shut off, too
| unsafe not to, and naturally above criminal consequences for
| fraudulent paperwork.
| nineplay wrote:
| I am in awe of this article. It has two verifiable pieces of
| information - a FDA study indicated that Vioxx was responsible
| for 55,000 deaths and that Merck had known about lethal side
| effects before launching the drug.
|
| The key point in the article? A magazine publisher with no
| background in epidemical studies does a "quick study" of the CDC
| website and says that "perhaps" 500,000 deaths resulted from
| Vioxx.
|
| Then there's about 10 paragraphs of hand writing and alarmism
| before we get to the befuddling conclusion that "in today's world
| and in the opinion of our own media, American lives are quite
| cheap, unlike those in China. "
|
| I hardly know how to unravel that.
| CalChris wrote:
| Looking at the Wikipedia page, it's being returned to the
| market albeit for a different disease/condition.
|
| https://en.m.wikipedia.org/wiki/Rofecoxib
| obblekk wrote:
| This is fascinating because the effect size is so large and so
| discontinuous.
|
| That the US government has become so detached from actual law
| enforcement makes me wonder if there's anyone thinking about
| reforms to the political system itself. I'm not talking about
| politically charged stuff like redistricting or ranked choice
| that just shifts the party in power.
|
| I mean ways to create more citizen power over their
| representatives. What would today's equivalent to "direct
| election of senators" be?
| peyton wrote:
| It would have to be something that increases independence from
| political parties. As it stands, my representative has simply
| voted in line with the Biden administration's preference 100%
| of the time. I haven't read every bill, but it's hard to
| believe that's what people here would really want.
| darklycan51 wrote:
| Last large company to be broken was in 1982, with Bell
| System... it's been so long and now they literally own the
| entirety of government.
|
| Microsoft's acquisition of ActBlizzard is a perfect example,
| while I must have to admit that as a map maker for Warcraft 3
| for 20 yers, I am glad that the game is out of Bobby Kotick's
| hands, and that's my selfish reason to support the
| acquisition...
|
| In reality it's really scary how easily the US accepted it,
| even worse how they went and threaned Sony when Sony attempted
| to fight them, lol, it became painfully obvious that senators
| are basically just talking heads for Microsoft.
|
| Now there are documents that they want to acquire Nintendo and
| Valve... this would legitimately ruin gaming as a whole.
|
| And yes I get that there are massive differences between
| pharma/food companies corruption and tech, but it just shows
| how much power corporations hold in modern day over modern
| life, it is scary.
| foota wrote:
| For starters, there's the national popular vote interstate
| compact, which would remove the influence that district and
| state boundaries have over the presidential election.
| Fauntleroy wrote:
| Which will unfortunately never happen due to the machinations
| of said influence. Ever since the Citizen's United decision
| we've just been kidding ourselves that normal political
| action will get us anywhere.
| nebula8804 wrote:
| If you look at the map below they've made great progress
|
| [1]:https://en.wikipedia.org/wiki/National_Popular_Vote_Int
| ersta...
|
| Assuming all pending states enact the compact then there
| are only two electoral college votes remaining.
| aidenn0 wrote:
| Looks like all of the blue states are already in; not
| sure where the last 2 votes will come from.
| foota wrote:
| I'm not holding my breath, but it would be nice. The best
| chance would be if democrats won the election while
| losing the popular vote, since that would likely get
| conservative states on board.
| whatshisface wrote:
| It's gone the other way for years and years, so it's not
| likely to be inverted now.
| nebula8804 wrote:
| If you look at the map it really drives home how you only
| need a small collection of purple states to push you
| over. Imagine if democrats could really push hard and
| retain solid control over some of these states. It would
| make this compact foolproof. Imagine if the compact goes
| into effect but the red states just change their minds
| and don't enforce the laws on the books.
|
| By making it so that these few purple states retain solid
| blue control, it help preempt this possible last
| pushback. that would go a long way to changing the
| landscape. All of a sudden it would finally sweep away
| all this conservative nonsense by clearly showing that it
| is not as popular of a position as it seems right now and
| the current democratic position becomes the base level
| conservative position. That will be the lasting legacy of
| this compact I so badly want to see in my lifetime.
|
| My hunch is they need to push harder into turning PA
| solid blue. Maybe AZ long term? Or maybe Iowa. Maybe just
| pick off the small states like Iowa, NH and include PA
| and that should be enough votes to solify the compact.
| ender341341 wrote:
| I feel like term limits would at least help prevent singular
| people from staying in power long enough to collect more power.
| It only really seems controversial with the politicians
| themselves, everyone else seems to be pretty for it from
| wherever they are on the aisle from what I've seen.
| amadeuspagel wrote:
| Term limits mean that there only inexperienced politicians,
| easily guided by lobbyists.
| ender341341 wrote:
| I think it has to be balanced, we definitely don't want
| insanely low where every 2 years all of congress is brand
| new, but according to https://en.wikipedia.org/wiki/List_of
| _members_of_the_United_... there has been 64 members with
| 40+ years of tenure within the house or senate, which I
| think is way to long.
| HKH2 wrote:
| Because the current bunch aren't eager to have their
| fingers in the pie.
| deltarholamda wrote:
| P.J. O'Rourke once quipped about term limits something along
| the lines of "do you want a dog that knows where all the
| bones are buried, or a dog that digs up the entire yard?"
|
| It seems an easy fix, but like a lot of easy fixes you
| replace the known problems with unknown problems. Which
| doesn't mean it's not a good idea per se, but it also doesn't
| mean it will fix anything. For example, with term limits, it
| becomes even cheaper to buy a politician than it is now.
| kevinmchugh wrote:
| Wikipedia has a very dire list of consequences of term
| limits: https://en.wikipedia.org/wiki/Term_limits_in_the_Unit
| ed_Stat...
|
| I'm pretty against them (and not a politician) because it
| takes power from voters and gives it to unelected party
| members. Absent term limits, voters can just vote against any
| politician they feel has served too long.
| whatshisface wrote:
| > _Term limits have been linked to lower growth in revenues
| and expenditures.[105]_
|
| It's always humorous when Wikipedia editorializes. I don't
| think everyone would agree that this sentence belongs in
| the negative impacts paragraph. ;-)
| karaterobot wrote:
| It's not got much to do with America, it's a human problem where
| we don't accurately assess risks, especially when there is a
| level of abstraction, or when emotions are involved. For
| instance, if there were three, highly-publicized cases of
| teenagers dying--somehow--from eating too much toothpaste, there
| would be a hundred news articles about it ("what you need to know
| about the toothpaste eating epidemic", "7 safe alternatives to
| toothpaste for your child"), and cities would pass laws limiting
| the size of toothpaste tubes you can legally sell, and the
| toothpaste would be moved behind locked ballistic glass in
| stores, and you'd have to show ID to buy it. Meanwhile, air
| pollution kills 7 million people a year, and has for decades, and
| it's like "meh, price of doin' business". Humans are dumb about
| this stuff, and there is very little rhyme or reason to the
| proportionality of their responses to different risks.
| bobthepanda wrote:
| This is one of those problems caused/aggravated by America's
| adversarial system, which is basically enforcement by lawsuit.
|
| Very motivated individuals can get powerful results by filing
| suits. On the other hand class actions are notoriously
| difficult, look at the Oxycontin ones.
| WarOnPrivacy wrote:
| > It's not got much to do with America
|
| The executives responsible were at no meaningful risk of being
| charged. They retained all the cash they were paid for
| maximizing elderly-killing drug sales.
|
| It's got much to do with America.
| mattcaywood wrote:
| This number is likely too high by a factor of 10, and there are
| more reliable sources.
|
| Derek Lowe's rebuttal to the article is here:
| https://www.science.org/content/blog-post/500-000-excess-dea...
|
| and a medical press article from 2019 estimates 60,000 excess
| deaths: https://www.statnews.com/2019/10/09/vioxx-relaunched-
| treat-h...
| rossdavidh wrote:
| From Lowe's article:
|
| "I do not see the effects that Unz is talking about. Not at
| all. A single-cause change in the death rate of the magnitude
| that he's proposing should most certainly show up in these
| figures (particularly the latter chart), but it isn't there. I
| see no reason to take this claim seriously."
|
| Note that Derek Lowe has been more than willing to be critical
| of big pharmaceutical companies when they deserve it, on other
| issues, and he's a professional with decades of experience in
| the field.
| whatshisface wrote:
| Here's what this teaches us about getting away with murder:
|
| 1. Kill randomly, so that you are less likely to get caught.
| (Amateur serial killers also know this one.)
|
| 2. Kill thousands and thousands of people so that it is
| difficult to put a face on any of the victims.
|
| 3. Make money from it, so that a lot of people end up
| implicated by virtue of benefiting from the crime.
|
| If you follow all of these steps, instead of horror, people
| will react to discussions of your crimes with phrases like,
| "they didn't kill _that_ many! "
|
| Edit: It's buried in the article so I can forgive some people
| for not noticing it, but the culpability stems from Merck's
| advance knowledge, not disclosed, that the drug would cause
| heart attacks.
| mometsi wrote:
| Some people might react to your mass murder with an even less
| reductive and hostile response. e.g.:
|
| Suppose there were another drug developed in secret, an anti-
| vioxx. It reduces your risk of all-causes mortality by a
| fraction of a percent. But it has these side effects:
|
| 1. Chronic pain. It's with you as long as you're taking your
| anti-vioxx and lets you know it's working.
|
| 2. Joint stiffness, often debilitating and sometimes leaving
| you practically chair-bound.
|
| Would you take it? Should everyone take it? Should everyone
| be legally mandated to take it?
| whatshisface wrote:
| To make it a better mirror image, let's add a couple
| details to your anti-vioxx example: anti-Merck has hidden
| all the evidence of chronic pain and joint stiffness as
| side-effects, and taking it once will cause them
| permanently. The anti-FDA has approved the drug under
| fraudulent conditions as they lack the information that
| anti-Merck has. The drug is widely prescribed and now
| between 50 and 500 thousand (the exact number is not known
| due to poor reporting methods) people have new chronic
| joint pain. Should anyone go to anti-jail? ;)
|
| (The latter condition was necessary to simulate the lack of
| knowledge patients had about their increased mortality,
| obviously difficult to reproduce in pain.)
| l33t7332273 wrote:
| I'm pretty confused with all this backwards talk. Can you
| be a little more clear about what actually happened?
| Spooky23 wrote:
| Vioxx was like a super-NSAID. I took it for month in my
| 20s with a degenerative disc.
|
| It was incredible, eliminating chronic pain and
| inflammation. It allowed me to function normally, sleep,
| etc.
|
| The problem is, it causes heart attacks, especially if
| you are at risk for having a heart attack. The key study
| showed a 5x higher rate of heart attack for Vioxx users
| vs Naproxen.
| whatshisface wrote:
| Merck developed a drug to serve as an aspirin alternative
| for arthritis sufferers. Somewhere along the line, they
| discovered it could kill you, but pushed the evidence
| under the rug because they had already invested so much.
| The drug went on to get FDA approval (a process highly
| dependent on studies conducted by the manufacturer
| seeking approval, such that they had the opportunity to
| commit the fraud), and in the end between 50-500k
| individuals got heart attacks and other deadly
| consequences as a result of taking the highly prescribed
| painkiller.
| bugglebeetle wrote:
| i.e. America's pandemic response.
| jandrese wrote:
| Also, it helps to mostly kill old people who are already
| sick. It makes it much harder for people to notice. Your drug
| might have killed them, but chances are they were going to
| die in the next 6 months anyway so the death didn't stand
| out. It also makes the death toll hard to tally.
| whatshisface wrote:
| 65 is really not so old that anyone's likely to die in the
| next 6 months.
| nradov wrote:
| Vioxx was handled terribly by Merck and the FDA. But if you talk
| to practicing physicians who actually prescribed it to their
| patients, many think it shouldn't have been withdrawn from the
| market. For certain patients it was very effective and worth the
| risks. We have other drugs on the market today with equally
| severe side effects. It would have been better to just add a
| prominent "black box" warning to the label.
| macintux wrote:
| My grandmother hoarded her pills after Vioxx was taken off the
| market because it was the only thing available at the time that
| helped her.
| Zak wrote:
| There was a big drop in deaths in 2004, but I'm really curious as
| to what caused the big increase in 2014.
|
| https://www.macrotrends.net/countries/USA/united-states/deat...
| trillic wrote:
| Fentanyl?
|
| https://nida.nih.gov/sites/default/files/images/2023-Drug-od...
| downvotetruth wrote:
| https://www.nytimes.com/2016/06/01/health/american-death-rat...
| mcguire wrote:
| You mean the drop from 8.52/1000 in 2003 to 8.12/1000 in 2008
| that roughly followed the slope of the decrease from 9.59/1000
| in 1968?
| victorbstan wrote:
| Capitalism isn't going to punish capitalists.
| nitwit005 wrote:
| I'll note you can find past Hacker News discussions full of
| people suggesting the FDA's approval processes are overly
| burdensome.
| whatshisface wrote:
| An approval process can be at once burdensome and vulnerable to
| the fraud Merck committed.
| nitwit005 wrote:
| Theoretically, but I don't think the people making those
| comments would be happy with the "fixed" more fraud resistant
| system either.
|
| Some of them expressed that people should be able to take
| unproven drugs (Libertarian philosophy). They're just okay
| with this happening from time to time.
| marcosdumay wrote:
| > but I don't think the people making those comments would
| be happy with the "fixed" more fraud resistant system
| either
|
| Why do you assume this? Do you expect to fix fraudulent
| study results by mandating more studies?
|
| Any way to add flexibility to drug certification must
| necessarily include some ongoing procedure to verify it
| works. So, it's even hard to come out with a faster process
| that doesn't reduce this problem (but yeah, if you make an
| effort, you can make one).
| mcguire wrote:
| By "fixed", I believe the parent poster meant mandating
| fewer studies, as in zero.
| whatshisface wrote:
| I'm not here to tell anyone else their morals, but I do
| think telling doctors, "here's a chemical we figured out
| how to manufacture, let us know if you want more of it for
| some reason," would be ethically better than cooking the
| books to get FDA approval on that same chemical while
| knowing the side effects. In the former case doctors may
| commit an ethical violation themselves by presenting the
| drug as safe, but what did in fact happen was Merck did
| that, saving them the question.
| mcguire wrote:
| In the second case, you can hold the people who "cook[ed]
| the books to get FDA approval ... while knowing the side
| effects" responsible. In the first you cannot.
| ethanbond wrote:
| "The COVID vaccine was ready after 3 days, FDA must be
| abolished!" - Otherwise reasonably intelligent people
|
| My buddy made a COVID vax, a cure for Alzheimer's, and an age
| reversal suppository in his garage in less than a week. He
| pinky promises that they work -\\_(tsu)_/-
|
| (FWIW the other commenter is right, it is possible the process
| is both excessively burdensome and vulnerable, but in general
| people leveling this "too burdensome" critique actually have no
| clue how drug development works and why it's so hard)
| amadeuspagel wrote:
| In many contexts, the way we deal with potential problems is
| allowing people to do things and punishing them when they fuck
| up.
|
| For example, it's relatively easy to get a drivers license, but
| if you run someone over, even by accident, you're held
| responsible.
|
| Maybe this is how we should deal with pharmacies as well.
| ggm wrote:
| No. Absolutely not. It's being given a drivers licence and
| allowed to kill 20,000 people on your commute to work before
| being stopped.
| amadeuspagel wrote:
| I'm not saying that getting a license to sell a pharmacy
| should be just as easy as getting a drivers license, just
| that there's no contradiction between wanting licensing to
| be easier, and wanting people held responsible for damage.
| [deleted]
| uranusjr wrote:
| I'm really unsure about the Chinese milk scandal analogy. While
| the Vioxx incident is definitely terrible on its own and may
| indicate the US government and merchants do not take enough
| responsibility, the comparison to the melamine is awkward at
| best; one is a new drug with possible negative health
| implications (for whatever reason), while the other is a food
| product with an already illegal additive. It's not particularly
| useful to compare the reactions toward the two.
| whatshisface wrote:
| Merck was aware of the danger of the drug[0] but pushed the
| studies under the rug. It may have been a more effective and
| less likely to be caught scheme than using a chemical which
| people outside the company would have known was poisonous, but
| it retains the essence, which is knowingly causing deaths to
| sell something.
|
| [0] https://theweek.com/us/46535/when-half-million-americans-
| die...
| 99_00 wrote:
| >It soon turned out Merck had known of potential lethal side
| effects even before launching Vioxx in 1999, but had brushed all
| such disturbing tests under the rug.
|
| I don't trust this line.
|
| I suspect that preliminary tests show all kinds of extreme
| possibilities. Positive and negative.
|
| How many dangerous side effects never came to be?
|
| How many supposed benefits never came to be?
|
| Why should they have paid particular attention to this dangerous
| side effect? The article doesn't make it clear.
|
| And for the record, I believe drug companies don't have our best
| interests at heart and that the FDA is captured by industry.
| whatshisface wrote:
| When you're doing preliminary studies, you get a sense of how
| common the side effects are, and if a rare one shows up you
| know your statistical power on bounding its likelihood.
| Multiplying by your expected market will tell you how well
| you've bounded total deaths. Consequently, you'll know when you
| need to extend the study to get a better detection - but to
| tell you the truth, for the issue to have been bad enough for
| them to choose to hide it entirely instead of disclosing it a
| list of terrible rare side effects that all medicines have, it
| must have been common enough in their sample for the large
| number of total deaths to have been predicted.
| [deleted]
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(page generated 2023-09-22 23:01 UTC)