Medical ethics: A long debated issue

Reading Time: 9 minutes
Firoz1
By Firoz Abdul Hamid

On the 4th of April 2013, the Huffington Post carried an article which highlighted doctors do not always get results of clinical research on drugs they prescribe to patients. The article read, “Doctors need the results of clinical trials to make informed choices, with their patients, about which treatment to use. But the best currently available evidence estimates that half of all clinical trials, for the treatments we use today, have never been published. This problem is the same for industry-sponsored trials and independent academic studies, across all fields of medicine from surgery to oncology, and it represents an enormous hidden hole for everything we do. Doctors can’t make informed decisions, when half the evidence is missing. Most people react to this situation with incredulity, because it’s so obviously absurd. How can medics, academics, and legislators have permitted such a huge problem to persist? The answer is simple. This territory has been policed — and aggressively — by the pharmaceutical industry. They have worked hard to shut down public discussion on the topic, for several decades, with great success.” (http://www.huffingtonpost.com/ben-goldacre/prescription-drugs_b_3018272.html)

There are many such arguments on how much do we know about the treatments we are getting from our doctors. How much are we told, how much do we educate ourselves  and how much information is out there for us to investigate an illness and treatment? What happens when we are so reliant on a doctor(s) because of the state of our medical insurance coverage, or lack of it? There are people in the United States of America who cannot get basic treatment for lack of coverage. Is this humane? Is this what medicine is about?

In some countries governments ensure state care for medicine is translated into ensuring patients are guaranteed beds when they walk into a state run hospital. But does guaranteeing a bed equivalent to guaranteeing treatment, never mind the right treatment? Further there is a distinct difference between ensuring hospital care and patient care. The former ensures facilities; the latter provides care one needs. Where are the lines of commerce drawn against the lines of moral instincts of saving a life? Where should we draw the lines of commerce against ethics? This question becomes a lot more distinct if not pressing in private care facilities.

Then there is the argument of qualification of doctors. Where did they receive their certifications and are they recognised by the statutory bodies? Which are the relevant and recognised statutory bodies? How is this process conducted? Are we putting our lives in the hand of doctors with non-recognised degrees? How can degrees be issued to doctors if the institution is not recognised?

KPJ doctorsThe long debated issue of how the medical industry is steered by powerful lobbies of  pharmaceutical companies remains and how does one overcome this? Are we getting the right medicine or the best marketed medicine?

There is also the argument of how far one goes in research and innovation in medicine in looking for a cure? Stem cell research has long been debated from the religious perspective. The donation of organs – on death remains a poignant debate in some cultures and creed. Surrogate parenting has emerged a new debate and upcoming debate. How do you ensure that the babies surrogated are not trafficked or brought up in homes that may not provide it the care of a normal family environment? Euthanasia of course is an area that continues to battle its ground of legitimacy between humanity and morality.

There remain many ethical questions that surround the medical industry. Many that needs tackling, many that needs religious consensus and guidance and many that clearly is not the right thing to do, but is practiced as it is the way business is done in this industry. Yet we say, one can never know the pain of desperation for any forms of cure, until you are at the brink of loss yourself – and at that point you will consider any option.

Or would we?

During the Civil War, it was said that Abraham Lincoln was asked if God was on his side. His reply, “Sir, my concern is not whether God is on our side. My greatest concern is to be on God’s side, for God is always right.”

We need to search our conscience.

Today’s article discusses some aspects of medical ethics with a leading private healthcare provider in Malaysia, KPJ Healthcare.

Interviewee:
Datin Paduka Siti Sa’diah Sheikh Bakir
Corporate Advisor, KPJ Healthcare

Q: How do you define ethics in medical practice and how is this different to the term medically necessary which doctors often use?

A: Ethics in medical practice is a set of principles of what is right or wrong when doctors carry out their duties of healing the sick. It is derived from moral principles which in turn originate from religious teachings. Modern medical ethics principles can be traced back to the Judeo-Christian teachings. Similarly early Islamic scholars have enunciated the proper conduct of doctors as well as their responsibilities. When doctors talk about medically necessary, they probably refer to the need to take certain course of action in respect of providing treatment to the patient. While they may have to make difficult choices regarding treatment, they cannot ignore the four cardinal principles of medical ethics, i.e.

a) Beneficence – that is at all times they must do good. This implies any treatment they offer must benefit the patient.
b) Non Maleficence – this principle says if they cannot do good they should at least do no harm.
c) Autonomy. – the patient has a right to decide to accept or refuse any treatment.
d) Justice – all patients should be treated equally.

Apart from patient care, ethics in medical practice also govern the use of human subjects in research. Here the emphasis is on protection of the human subjects.

IpohQ: Is there a difference between what is morally correct and ethically necessary in medicine?

A: As said earlier ethical principles are derived from moral values. It is quite unlikely that what is ethically necessary will be morally wrong. There are a number areas where morality and ethics continue engender debate. They are often no clear answer. Withdrawing a treatment from a patient who is terminally ill and request that treatment be stopped may be ethically the right thing to do. However morally one may argue that one must preserve life at all cost.

Q: How mature is the medical industry in Malaysia in addressing medical ethics principles in the industry and in what areas are we leading if so?

A: The medical industry consist of different players – the doctors and other allied health professionals, the owners and management of hospitals and the pharmaceutical industry. The doctors have their ethical guidelines and the various other allied health professionals like nurses and pharmacists have theirs as well. The doctors’ ethical guidelines are universal and goes along way back in their history. In Malaysia, the doctors’ ethical behavior are guided by the Malaysian Medical Council’s Code of Professional conduct. This guides them in their relationship with their patients , between themselves and and between them and the pharmaceutical industry. Breaches of the code can subject the doctor to disciplinary action by the council as provided for under the Medical Act of 1971 which was amended recently in 2012, In this respect Malaysia adopt similar approaches like other countries to ensure doctors practice the highest standards of ethical behavior. The Pharmaceutical industry has its code of ethics on dealing with doctors and on marketing their products.

The owners and management of hospitals and other healthcare facilities uphold the principle that the behavior of doctors in their employ or working with them must be of their highest ethical standard. This should not be subservient to business interest of the hospital. All KPJ hospitals appoint a Medical Director who is by law (The Private Healthcare Facilities and Services Act) responsible to ensure that doctors in the institution behave professionally and ethically. There are committees established to assist the medical director in this respect.

The KPJ Healthcare group has gone a step further in establishing a clinical ethics service. This service assist doctors in handling ethical dilemmas in the course of caring for their patients. It draws guidelines on how to handle some of the difficult ethical situations.

Q: Could Malaysia lead in this subject matter amongst OIC countries? And if so in what areas can that be and how?

A: The code of ethics of doctors and healthcare professional is universal and almost all countries would have similar codes. However countries may differ in a number of areas – the education of medical students and continuing education of doctors in ethical issues, the laws that govern ethical behavior, the organisational structure and function of regulatory bodies that govern the professional and ethical conduct of doctors. Malaysia has initiated many measures in these areas. The Medical Act was recently amended to keep abreast of developments. Amongst others it has included lay persons to sit on disciplinary hearings of doctors who the ethical code. This is in keeping with the principle of transparency. In the private healthcare arena, Malaysia has evolved a number of measures including legal and institutional requirements that protect the rights of patients and the need to have systems to address grievances of the clients against doctors or the hospital.

I believe that while we are not perfect we can contribute in many ways to other countries which want to improve their healthcare system in particular on the issue of ethics.

kpjQ: KPJ has been in the forefront in addressing the ethical issues in healthcare.

A: While the measures we take may not be very different from other healthcare groups, we pride ourselves in the emphasis we place on this. We begin the process from the very beginning when we select doctors to join the group. We place importance on their ethical behavior apart from their professional competence. This comes in the form of testimony from the referees and interviews with doctors currently serving in the group. Those selected are given guides on the groups by laws and policies which touches on areas of professional conduct. at each hospital in the group and at the group level, we have Medical Advisory Committees which amongst others handle issues of ethics.

We recently established the Clinical Ethics Committee which has the following functions:

a) draws guidelines on how doctors should address difficult ethical issues
b) train doctors and other healthcare providers on handling ethical dilemmas
c) function as a consultant to doctors in the group who request urgent consultation when faced with a difficult issue.

Amongst some of the issues the committee has addressed include withholding or withdrawing treatment, truth telling, end of life care and termination of pregnancy.

Q: How can medical schools do better in addressing the issue of medical ethics?

A: Medical ethics is all about doing what is right and morally acceptable when faced with a situation in healthcare. In the course of their daily practice doctors faced many ethical issues. Teaching ethics in the form of didactic lectures may be restrictive. I think the best way to involve medical students in ethics education is to let them see through a case where ethical issues arise. Case based learning will allow them to see the real problems some of which may not have clear answers. It is by going through the arguments that the student will learn best about the ethical issues.

KPJ Healthcare University College has a medical school has embarked on its post graduate programme starting with ortholaryngology (head and neck medicine) and will ensure medical ethics is part of the curriculum being taught.

Q: What are your views about combining proven traditional medical practices to modern ones?

A: There are traditional medical practices like acupuncture that have been shown to be useful and have been used alongside modern therapy. The problem as I see it is that doctors today are brought up on the idea that medical practice should be evidence- based. Evidence comes from clinical research, more specifically from randomized clinical trials. Most of the traditional medical practices are not subjected to such rigorous trials and thus doctors find difficult to accept their recommendations. The law presently does not allow the two medical practices to be carried out together, in  any private healthcare facilities.

Q: Is there a global regulation or consensus on ethics in medicine?

A: There is no global regulation, as each country develops its own regulation. There are however many global or international guidelines on ethics both ethics of patient care as well as ethics of medical research involving human subjects. They serve as useful guidance for countries to adopt and adapt to local needs.

 

datinDatin Paduka Siti Sa’diah Sheikh Bakir is Corporate Advisor to the Managing Director of KPJ Healthcare Berhad after she served herself as Managing Director of KPJ Healthcare since March 1, 1993. She graduated with a Bachelor of Economics from University of Malaya and holds an MBA from Henley Management College, University Reading, London. Committed to promoting excellence in healthcare, Datin Paduka also is the President of the Malaysian Society for Quality in Health , elected since its inception in 1997 to date. She is a member of the Malaysia Productivity Council (MPC) Consultative Panel on Healthcare since 2001 and a member of the National Patient Safety Council, Ministry of Health since 2003. In 2009, she was appointed as a member of the Malaysian Healthcare Travel Council, Ministry of Health.

Datin Paduka was a Board member of MATRADE from 1999 to 2010 and was an Independent Non-Executive Director of Bursa Malaysia from 2004 to April 2012.

In 2010, Datin Paduka was named the ‘CEO of The Year 2009’ by The New Straits Times Press and American Express. In 2011, Datin Paduka achieved three more awards, namely the ‘Asia Leading Woman CEO of The Year’ at the Women in Leadership (WIL) Forum Asia, the ‘Masterclass Woman CEO of The Year’ by the Global Leadership Awards and the ‘BrandLaureate Transformational Corporate Leader Brand ICON Leadership Awards 2011’ from The Asia Pacific Brands Foundation.

 

See other posts from our articles series on business ethics:

Ethics in Business: Perception of sleepwalking

Ethics in Business: A take on business ethics in the US

Ethics in Business: Moving Islamic finance from conference rooms to humanity

Ethics in Business: Walking the ethical track in Malaysia a perspective

Ethics in Business: Soul of ethics in the new Dubai

Ethics in Business: A conversation with Professor Tariq Ramadan

Ethics in Business: Where is the education for narcissistic leaders

Ethics in Business. With whom does the heartbeat of a nation lie, Part 1

Ethics in Business: With whom does the heartbeat of a nation lie, Part 2

Ethics in Business: Are we aware of the Iagos in our midst?

Ethics in Business: Fair trade or fair game, who benefits really

Ethics in business: What moves the conscience when mortality is at stake

Please: CSR is not Ethics in Business

Panel discussion: Medical ethics (plus video)

(Firoz Abdul Hamid is an Inside Investor contributor. The opinions expressed are her own.)

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Reading Time: 9 minutes

By Firoz Abdul Hamid

On the 4th of April 2013, the Huffington Post carried an article which highlighted doctors do not always get results of clinical research on drugs they prescribe to patients. The article read, “Doctors need the results of clinical trials to make informed choices, with their patients, about which treatment to use. But the best currently available evidence estimates that half of all clinical trials, for the treatments we use today, have never been published. This problem is the same for industry-sponsored trials and independent academic studies, across all fields of medicine from surgery to oncology, and it represents an enormous hidden hole for everything we do. Doctors can’t make informed decisions, when half the evidence is missing. Most people react to this situation with incredulity, because it’s so obviously absurd. How can medics, academics, and legislators have permitted such a huge problem to persist? The answer is simple. This territory has been policed — and aggressively — by the pharmaceutical industry. They have worked hard to shut down public discussion on the topic, for several decades, with great success.” (http://www.huffingtonpost.com/ben-goldacre/prescription-drugs_b_3018272.html)

Reading Time: 9 minutes

Firoz1
By Firoz Abdul Hamid

On the 4th of April 2013, the Huffington Post carried an article which highlighted doctors do not always get results of clinical research on drugs they prescribe to patients. The article read, “Doctors need the results of clinical trials to make informed choices, with their patients, about which treatment to use. But the best currently available evidence estimates that half of all clinical trials, for the treatments we use today, have never been published. This problem is the same for industry-sponsored trials and independent academic studies, across all fields of medicine from surgery to oncology, and it represents an enormous hidden hole for everything we do. Doctors can’t make informed decisions, when half the evidence is missing. Most people react to this situation with incredulity, because it’s so obviously absurd. How can medics, academics, and legislators have permitted such a huge problem to persist? The answer is simple. This territory has been policed — and aggressively — by the pharmaceutical industry. They have worked hard to shut down public discussion on the topic, for several decades, with great success.” (http://www.huffingtonpost.com/ben-goldacre/prescription-drugs_b_3018272.html)

There are many such arguments on how much do we know about the treatments we are getting from our doctors. How much are we told, how much do we educate ourselves  and how much information is out there for us to investigate an illness and treatment? What happens when we are so reliant on a doctor(s) because of the state of our medical insurance coverage, or lack of it? There are people in the United States of America who cannot get basic treatment for lack of coverage. Is this humane? Is this what medicine is about?

In some countries governments ensure state care for medicine is translated into ensuring patients are guaranteed beds when they walk into a state run hospital. But does guaranteeing a bed equivalent to guaranteeing treatment, never mind the right treatment? Further there is a distinct difference between ensuring hospital care and patient care. The former ensures facilities; the latter provides care one needs. Where are the lines of commerce drawn against the lines of moral instincts of saving a life? Where should we draw the lines of commerce against ethics? This question becomes a lot more distinct if not pressing in private care facilities.

Then there is the argument of qualification of doctors. Where did they receive their certifications and are they recognised by the statutory bodies? Which are the relevant and recognised statutory bodies? How is this process conducted? Are we putting our lives in the hand of doctors with non-recognised degrees? How can degrees be issued to doctors if the institution is not recognised?

KPJ doctorsThe long debated issue of how the medical industry is steered by powerful lobbies of  pharmaceutical companies remains and how does one overcome this? Are we getting the right medicine or the best marketed medicine?

There is also the argument of how far one goes in research and innovation in medicine in looking for a cure? Stem cell research has long been debated from the religious perspective. The donation of organs – on death remains a poignant debate in some cultures and creed. Surrogate parenting has emerged a new debate and upcoming debate. How do you ensure that the babies surrogated are not trafficked or brought up in homes that may not provide it the care of a normal family environment? Euthanasia of course is an area that continues to battle its ground of legitimacy between humanity and morality.

There remain many ethical questions that surround the medical industry. Many that needs tackling, many that needs religious consensus and guidance and many that clearly is not the right thing to do, but is practiced as it is the way business is done in this industry. Yet we say, one can never know the pain of desperation for any forms of cure, until you are at the brink of loss yourself – and at that point you will consider any option.

Or would we?

During the Civil War, it was said that Abraham Lincoln was asked if God was on his side. His reply, “Sir, my concern is not whether God is on our side. My greatest concern is to be on God’s side, for God is always right.”

We need to search our conscience.

Today’s article discusses some aspects of medical ethics with a leading private healthcare provider in Malaysia, KPJ Healthcare.

Interviewee:
Datin Paduka Siti Sa’diah Sheikh Bakir
Corporate Advisor, KPJ Healthcare

Q: How do you define ethics in medical practice and how is this different to the term medically necessary which doctors often use?

A: Ethics in medical practice is a set of principles of what is right or wrong when doctors carry out their duties of healing the sick. It is derived from moral principles which in turn originate from religious teachings. Modern medical ethics principles can be traced back to the Judeo-Christian teachings. Similarly early Islamic scholars have enunciated the proper conduct of doctors as well as their responsibilities. When doctors talk about medically necessary, they probably refer to the need to take certain course of action in respect of providing treatment to the patient. While they may have to make difficult choices regarding treatment, they cannot ignore the four cardinal principles of medical ethics, i.e.

a) Beneficence – that is at all times they must do good. This implies any treatment they offer must benefit the patient.
b) Non Maleficence – this principle says if they cannot do good they should at least do no harm.
c) Autonomy. – the patient has a right to decide to accept or refuse any treatment.
d) Justice – all patients should be treated equally.

Apart from patient care, ethics in medical practice also govern the use of human subjects in research. Here the emphasis is on protection of the human subjects.

IpohQ: Is there a difference between what is morally correct and ethically necessary in medicine?

A: As said earlier ethical principles are derived from moral values. It is quite unlikely that what is ethically necessary will be morally wrong. There are a number areas where morality and ethics continue engender debate. They are often no clear answer. Withdrawing a treatment from a patient who is terminally ill and request that treatment be stopped may be ethically the right thing to do. However morally one may argue that one must preserve life at all cost.

Q: How mature is the medical industry in Malaysia in addressing medical ethics principles in the industry and in what areas are we leading if so?

A: The medical industry consist of different players – the doctors and other allied health professionals, the owners and management of hospitals and the pharmaceutical industry. The doctors have their ethical guidelines and the various other allied health professionals like nurses and pharmacists have theirs as well. The doctors’ ethical guidelines are universal and goes along way back in their history. In Malaysia, the doctors’ ethical behavior are guided by the Malaysian Medical Council’s Code of Professional conduct. This guides them in their relationship with their patients , between themselves and and between them and the pharmaceutical industry. Breaches of the code can subject the doctor to disciplinary action by the council as provided for under the Medical Act of 1971 which was amended recently in 2012, In this respect Malaysia adopt similar approaches like other countries to ensure doctors practice the highest standards of ethical behavior. The Pharmaceutical industry has its code of ethics on dealing with doctors and on marketing their products.

The owners and management of hospitals and other healthcare facilities uphold the principle that the behavior of doctors in their employ or working with them must be of their highest ethical standard. This should not be subservient to business interest of the hospital. All KPJ hospitals appoint a Medical Director who is by law (The Private Healthcare Facilities and Services Act) responsible to ensure that doctors in the institution behave professionally and ethically. There are committees established to assist the medical director in this respect.

The KPJ Healthcare group has gone a step further in establishing a clinical ethics service. This service assist doctors in handling ethical dilemmas in the course of caring for their patients. It draws guidelines on how to handle some of the difficult ethical situations.

Q: Could Malaysia lead in this subject matter amongst OIC countries? And if so in what areas can that be and how?

A: The code of ethics of doctors and healthcare professional is universal and almost all countries would have similar codes. However countries may differ in a number of areas – the education of medical students and continuing education of doctors in ethical issues, the laws that govern ethical behavior, the organisational structure and function of regulatory bodies that govern the professional and ethical conduct of doctors. Malaysia has initiated many measures in these areas. The Medical Act was recently amended to keep abreast of developments. Amongst others it has included lay persons to sit on disciplinary hearings of doctors who the ethical code. This is in keeping with the principle of transparency. In the private healthcare arena, Malaysia has evolved a number of measures including legal and institutional requirements that protect the rights of patients and the need to have systems to address grievances of the clients against doctors or the hospital.

I believe that while we are not perfect we can contribute in many ways to other countries which want to improve their healthcare system in particular on the issue of ethics.

kpjQ: KPJ has been in the forefront in addressing the ethical issues in healthcare.

A: While the measures we take may not be very different from other healthcare groups, we pride ourselves in the emphasis we place on this. We begin the process from the very beginning when we select doctors to join the group. We place importance on their ethical behavior apart from their professional competence. This comes in the form of testimony from the referees and interviews with doctors currently serving in the group. Those selected are given guides on the groups by laws and policies which touches on areas of professional conduct. at each hospital in the group and at the group level, we have Medical Advisory Committees which amongst others handle issues of ethics.

We recently established the Clinical Ethics Committee which has the following functions:

a) draws guidelines on how doctors should address difficult ethical issues
b) train doctors and other healthcare providers on handling ethical dilemmas
c) function as a consultant to doctors in the group who request urgent consultation when faced with a difficult issue.

Amongst some of the issues the committee has addressed include withholding or withdrawing treatment, truth telling, end of life care and termination of pregnancy.

Q: How can medical schools do better in addressing the issue of medical ethics?

A: Medical ethics is all about doing what is right and morally acceptable when faced with a situation in healthcare. In the course of their daily practice doctors faced many ethical issues. Teaching ethics in the form of didactic lectures may be restrictive. I think the best way to involve medical students in ethics education is to let them see through a case where ethical issues arise. Case based learning will allow them to see the real problems some of which may not have clear answers. It is by going through the arguments that the student will learn best about the ethical issues.

KPJ Healthcare University College has a medical school has embarked on its post graduate programme starting with ortholaryngology (head and neck medicine) and will ensure medical ethics is part of the curriculum being taught.

Q: What are your views about combining proven traditional medical practices to modern ones?

A: There are traditional medical practices like acupuncture that have been shown to be useful and have been used alongside modern therapy. The problem as I see it is that doctors today are brought up on the idea that medical practice should be evidence- based. Evidence comes from clinical research, more specifically from randomized clinical trials. Most of the traditional medical practices are not subjected to such rigorous trials and thus doctors find difficult to accept their recommendations. The law presently does not allow the two medical practices to be carried out together, in  any private healthcare facilities.

Q: Is there a global regulation or consensus on ethics in medicine?

A: There is no global regulation, as each country develops its own regulation. There are however many global or international guidelines on ethics both ethics of patient care as well as ethics of medical research involving human subjects. They serve as useful guidance for countries to adopt and adapt to local needs.

 

datinDatin Paduka Siti Sa’diah Sheikh Bakir is Corporate Advisor to the Managing Director of KPJ Healthcare Berhad after she served herself as Managing Director of KPJ Healthcare since March 1, 1993. She graduated with a Bachelor of Economics from University of Malaya and holds an MBA from Henley Management College, University Reading, London. Committed to promoting excellence in healthcare, Datin Paduka also is the President of the Malaysian Society for Quality in Health , elected since its inception in 1997 to date. She is a member of the Malaysia Productivity Council (MPC) Consultative Panel on Healthcare since 2001 and a member of the National Patient Safety Council, Ministry of Health since 2003. In 2009, she was appointed as a member of the Malaysian Healthcare Travel Council, Ministry of Health.

Datin Paduka was a Board member of MATRADE from 1999 to 2010 and was an Independent Non-Executive Director of Bursa Malaysia from 2004 to April 2012.

In 2010, Datin Paduka was named the ‘CEO of The Year 2009’ by The New Straits Times Press and American Express. In 2011, Datin Paduka achieved three more awards, namely the ‘Asia Leading Woman CEO of The Year’ at the Women in Leadership (WIL) Forum Asia, the ‘Masterclass Woman CEO of The Year’ by the Global Leadership Awards and the ‘BrandLaureate Transformational Corporate Leader Brand ICON Leadership Awards 2011’ from The Asia Pacific Brands Foundation.

 

See other posts from our articles series on business ethics:

Ethics in Business: Perception of sleepwalking

Ethics in Business: A take on business ethics in the US

Ethics in Business: Moving Islamic finance from conference rooms to humanity

Ethics in Business: Walking the ethical track in Malaysia a perspective

Ethics in Business: Soul of ethics in the new Dubai

Ethics in Business: A conversation with Professor Tariq Ramadan

Ethics in Business: Where is the education for narcissistic leaders

Ethics in Business. With whom does the heartbeat of a nation lie, Part 1

Ethics in Business: With whom does the heartbeat of a nation lie, Part 2

Ethics in Business: Are we aware of the Iagos in our midst?

Ethics in Business: Fair trade or fair game, who benefits really

Ethics in business: What moves the conscience when mortality is at stake

Please: CSR is not Ethics in Business

Panel discussion: Medical ethics (plus video)

(Firoz Abdul Hamid is an Inside Investor contributor. The opinions expressed are her own.)

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