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Editor’s Note

A Navigator for the Healthcare Sector

APRIL 2014 - ISSUE 1

Industry

Perspective Priyanka Rohilla MediaMedic Communications

Salil Kallianpur is an executive in the pharmaceutical industry employed with GSK. He tweets at @salilkallianpur

In less than a month of joining my new company, I felt there was something different about it. It wasn't a regular communication agency. From hosting India's first conference on digital communication for healthcare and pharma to meeting pharma veterans, Doctors, scientific content writers, NGOs and heads of various industry associations on a daily basis, I felt the power and value of enormous amount of knowledge around me. Being an ex-journalist myself, I knew the importance of having easy access to information with all angles covered. With THAT being the trigger, here we are, presenting to you the very first monthly Newsletter 'MediaMedic Lente'(lens in Spanish, Italian) especially created for the journalist community primarily involved in covering the Healthcare and Pharma industry. A lot of thought went into deciding the contents of this newsletter. After all, what fresh news could a monthly newsletter offer to a journalist who is on top of every new development in the industry? Yet, there still was quite some scope. While news is available with all, its analysis by industry professionals in a consolidated fashion is what we aim to offer. Experiences, perspectives, knowledge and news, these four words will take their true form with inputs from experts not just from India, but across the world. We trust that in a short amount of time, MM Lente will be your go-to-guide at all times. Your feedback and comments are more than welcome, to help guide and shape us in our quest to serve you. Feedback: priyanka@mediamedichealth.com

To say that the last twelve months were eventful for the Indian pharmaceutical sector would be an understatement; it was nothing short of a roller-coaster ride. The government's grandiose announcements on universal health care (UHC) and distribution of free generic drugs to people through the hugely inadequate public health system were initially welcomed. When it dilly-dallied, what could have become an election-winning plank, fizzled out and was seen internationally, in poor light. To make matters worse, the government strained diplomatic relations with the United States on its ‘weak’ intellectual property regime (IPR) after compulsory licenses were issued and intermittent threats to cap patented drugs were issued probably as a direct result of heightened patient and NGO activism. Apart from leaving public health in shambles, the lack of a strong governance structure directly affected the health industry. India's indecision and weak diplomacy were visible in the lack of strong and pragmatic laws defining the conduct of clinical trials, capping the inflow of foreign direct investment (FDI). Sadly, the government's material efforts to balance through deft diplomacy seemingly received inadequate media coverage. Not much was written about or spoken when India held its own on the European Union Free trade agreement, on how it handled the FDA commissioner's visit to India and the time when the FDA cleared Indian drug imports into the US. Issues that can have devastating impact on India such as the Trans-Pacific Partnership (TPP) agreements are hardly in the public imagination. Broader coverage of these events would have helped to drive up investment sentiment in the sector at a time when the winds of change blew over the Indian subcontinent.

In less than two months, we will see a new government take charge in New Delhi. Assuming that health is taken seriously by any party that comes to power - and keeping in mind that health is a state subject the implications on the industry are tremendous. If the government is serious about its role as health provider, it will - like in Rajasthan, Kerala and Tamil Nadu - emerge as the single-largest purchaser and distributor of pharmaceutical products. Doctors will be directed to prescribe generic and their power of influence will diminish greatly. As the focus on anti-corruption crusaders and the taxman moves to hospitals, doctors and the pharmaceutical sector, companies will adopt 'ethical codes of conduct' with more enthusiasm. As this spills over into the private sector, the industry will be expected to adapt. Consolidation of supply channels and hospital groups may cause key account management (KAM) to replace physician calls to a large extent. Formation of physician groups (in hospital chains that discourage private practice) may mean shifting physician priorities and time. This may entail greater adoption and penetration of digital technology. Patients empowered through easier and cheaper access to information on the internet may force health care to become participative as they seek greater say in their treatment processes. While all this will not happen by the end of 2014, it is likely that greenshoots of change will sprout as a government seeking greater integration for India into the globalized economy adopts open-door policies. To embrace and leverage these changes quickly, it is up to the pharmaceutical industry to ensure that it has trained and equipped talent readily available that can help businesses transition as seamlessly as possible to accommodate for new business models, partnerships, distribution channels and approach to media. With health care in India on the threshold of such transformation, it is only pertinent that issues are raised, discussed, debated and the opinion of people is sought and heard. This has not been the case in the sector until now. We need stronger voices, opinions and leaders in the sector. As journalists and communication specialists, you have great power. To borrow from Spiderman, with that comes great responsibility; the responsibility to serve as watch-dog to the health and well being of the largest democracy in the world. That is definitely something to be proud about.

Pharma Plan in Deal Frenzy Is to Be Best, First or Move On

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hat’s the strategy the drug industry is following in a wave of deals where small companies are getting bigger and the big ones are getting smaller. An industrywide recalibration that has been building since 2011 reached a peak this week with a flurry of activity by Pfizer Inc., GlaxoSmithKline Plc and Valeant Pharmaceuticals International Inc. The biggest drugmakers are reshuffling units to get rid of ones that don’t make them leaders in a particular market, while smaller players are buying competitors to add size, lest they be swallowed up themselves. “Everyone wants to focus on where they can have a leadership position, or at least be in the top few,” Jeff Jonas, a portfolio manager at the $50 billion Gabelli Funds LLC, said in a telephone interview. That’s the reason drugmakers like London-based Glaxo are quitting the cancer business as Basel, Switzerland-based Novartis AG bulks up. It also may be why New York-based Pfizer, which has a handful of promising oncology drugs, tried to buy

AstraZeneca Plc, the London-based drugmaker with a complementary cancer portfolio. To that end, Novartis recently agreed to buy Glaxo’s oncology business for as much as $16 billion, to sell Glaxo its vaccines line for as much as $7.1 billion and to sell its animal health business to Eli Lilly & Co. for $5.4 billion. Valeant, meanwhile, announced a bid to buy Allergan Inc. for $45.7 billion, part of its announced strategy to join the ranks of the world’s five biggest drugmakers. Lilly’s Action The three-company transaction reflects the busiest period of industry deals since 2009, with $141 billion in pharmaceutical company acquisitions or divestitures over 12 months, according to data compiled by Bloomberg. The be-first-or-get-out strategy was the justification for Indianapolis-based Lilly’s part of the Novartis-Glaxo deal, said Lilly Chief Executive Officer John Lechleiter. While veterinary medicines weren’t a priority for Novartis, Lilly sought to make them one.

“It’s more important to be in that top tier of global companies,” Lechleiter said yesterday in a telephone interview. “While we haven’t been unnoticed in the space, now we are clearly a major player.” Continue reading Source: washpost.bloomberg.com

Similar Developments in Indian Pharma Industry Pharma consolidation in US hurts mid-sized Indian drug makers Read More Novartis-GSK asset swap offers template for pharma and beyond Read More Sun Pharma to buy Ranbaxy in $3.2 bn deal Read More


A Navigator for the Healthcare Sector

APRIL 2014 - ISSUE 1

Horse’s Mouth

From the

QUICK FACTS:

Dr. Sumit Ghoshal Contributing Editor

1. Even while in medical college, I had started doing talk shows on various scientific subjects in Hindi for All India Radio Bhopal.

A quarter of a century later...

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GLOBAL TALK

kaleidoscope of images floats before my eyes - the first series of cases of angioplasty in India, the first shockwave lithotripsy centre, the first endoscopic cholecystectomy procedures, and so much else that science has brought into our lives during the past 2530 years. Many people in the media today take these stupendous medical advances for granted, as if they were always there. But as someone who has watched many of these happen in front of my eyes, I consider myself privileged to have lived and worked in the media during these decades. That has been the greatest source of satisfaction throughout a lengthy career in healthcare journalism. Another is that the various facets of healthcare journalism: pharmaceuticals, clinical developments, hospitals, and the business aspect of all these, are getting much more coverage in the mainstream media than ever before. This could also be on account of explosive growth of media outlets in the past two decades; I read somewhere recently that there were nearly 125 news channels on television (all languages put together) in the country. As each tries to outdo the other, the race to find new things to cover is relentless and punishing, and healthcare, life sciences and other so-called 'soft' subjects also find their place in the sun. Yet an unfortunate fact of life for healthcare journalists all over India and perhaps elsewhere in the world as well, is that health-related subjects get to the front page of newspapers, the cover of magazines and prime time television only when they piggyback on celebrities, leading politicians, sportspersons, and so on. The only time my stories appeared on the front page of a newspaper for 18 days at a stretch was in December 2005, when megastar Amitabh Bachchan was hospitalised. Interestingly, a day after Bachchan was operated upon, then Chief Minister of Maharashtra, Mr Vilasrao Deshmukh, inaugurated the annual conference of the Cardiological Society of India

(also in Mumbai), but not a single line of coverage appeared in any newspaper the next day. If I were to recount all such examples that I have personally seen or experienced, I would have to write a book on the subject! I had quite the contrary experience in several instances. In the early 1990s, as a young reporter in the Indian Express, Mumbai, I filed a story saying that nearly 550 nursing homes were unregistered with the Bombay Municipal Corporation and therefore illegal. It appeared on page2 in just one edition of the Indian Express! Years later, while working for the DNA, I produced a story on a Delhi High Court judgment recommending that the weight of any child’s school bag should not exceed 10 per cent of the child's body weight. Considering that children and their school bags were a problem in very family and every home, the story should have walked into the front page of any newspaper. But the DNA carried it at the bottom on page 10 or 12, completely out of sight of most newspaper readers. In other words, editors' priorities have not changed in the past 20 years or even more! This could explain why very few career journalists focus on healthcare; for most, it is merely a stepping stone to a higher position, a more important beat (civic affairs or politics) or something else. There are a few honourable exceptions: Malathy Iyer in the Times of India is one such. Gauri Kamath is another, though she has mainly covered pharmaceuticals in the financial dailies. But even she has now moved into blogging, rather than a mainline newspaper. Another reason is that healthcare journalism requires a great deal of diligent study, unlike other areas of news coverage that can be created like instant noodles. Hence many journalists tend to take the easy route and stay away from healthcare. But the exponential growth of healthcare as an industry fosters hope that many more people would consider it a worthwhile career path in the years to come.

2. I am possibly the only MBBS doctor in India to have worked in mainstream publications like Indian Express and Business India magazine as well as trade publications like Chronicle Pharmabiz. 3. My recent novel titled ‘Unhealthy Practices’ was inspired by a real life incident involving senior doctors at HN Hospital, Mumbai. 4. In 2001-02, my articles on the Indian healthcare scene were published in The Lancet and Canadian Medical Association Journal. For a long time, they could be found on Pubmed. 5. For several years, I served as a guest faculty for a course in Science and Environment Journalism in St. Xavier’s Institute of Communications, Mumbai.

Spain’s Journalists: Happy Professionals Written by Berbes Asociados, Spain 2013 was not a good year for the media in Spain, according to a new annual study of the Madrid Press Association. Last year, a total of 4,434 journalists lost their jobs and 73 media companies closed. The closings included newspapers, TV channels, magazines, corporate communications agencies, free publications, radio stations, digital press and digital agencies. Of course, for those still employed we must also consider reduced salaries, changes in work conditions (full-time to part-time, for example), underemployed workers and other factors. Despite this difficult situation, the 4th

Adecco Study of Workplace Happiness revealed that journalists who kept their jobs were among the happiest employees in their workplaces in 2013, next to firefighters, teachers, pharmacists and engineers. Nearly 82% of Spanish journalists affirmed that they are happy with their profession, despite being some of the hardest hit not only by Spain's economic crisis, but also by the crisis in the industry mentioned in the study. The study results reveal that, regardless of profession, almost 8 out of 10 Spaniards are happy at their jobs. This is 1.8% higher than in 2012. The study found that the keys

to being happy at work were feelings of serving a ‘true calling’, a positive workplace environment, and camaraderie amongst coworkers. Thirty-nine percent of those surveyed thought that the secret to workplace happiness has to do with enjoying what they are doing. As journalists work in a profession where they fulfill their calling and attain a high degree of professional achievement, it's unsurprising that these statistics are as high as they are among journalists.


A Navigator for the Healthcare Sector

APRIL 2014 - ISSUE 1

BEYOND BOUNDARIES ‘It's against all principles of scientific reporting’: Thousands of medical papers cite Wikipedia, study says Universities ban students from citing Wikipedia in papers, and even the web site itself warns academics against referencing its articles, which any Internet user can alter at any time. But a new Canadian study has found that thousands of peer-reviewed papers in medical journals have cited Wikipedia in recent years and the numbers of references are increasing fast. The trend - apparent even in some of the world's most influential medical publications - raises the possibility of spreading misinformation and ‘could potentially affect care of patients’, researchers from the University of Ottawa say in a paper just published by the British Medical Journal (BMJ). Articles in the BMJ itself have had 13 references to Wikipedia in the last decade, they note. What struck the study authors most, though, is that the citations began to multiply in the last three years. "The biggest surprise was the trend said”, Dr. Sylvain Boet, an Ottawa Hospital anesthetist and health researcher who headed the study with Dr. Dylan Bould, another anesthetist. "It's exponential … It goes against all the principles of scientific reporting and referencing." In academia, Wikipedia may not be an acceptable source The problem is not only the accuracy of the information - which has actually been rated surprisingly high - but that Wikipedia articles are constantly changing, and tend to only summarize primary or secondary information sources, rather than containing original research themselves, the authors say. Some of the ‘high-impact,’ or most influential, journals found to have had Wikipedia references could not be reached for reaction

this week, or declined to comment on the findings. Wikipedia has grown into the sixth most popular website in the world since its inception in 2001 - according to the Alexa Internet analysis service - with millions of articles that span the breadth of human knowledge. Though each article can be edited by users, mistakes tend to be corrected by others relatively quickly, with one 2005 study rating a sample of Wikipedia entries similar in accuracy to Encyclopedia Britannica. What is more, health-related articles are overseen by an expert group, WikiProject Medicine. Indeed, it is common for medical students and young doctors to turn to Wikipedia as an initial source, admitted Dr. Boet. The problem, though, is that there is no guarantee the information at any given time is, in fact, wholly accurate, and a Wikipedia entry cited by a journal paper one day may be quite different soon after, unlike a conventional article or book, he said. That makes it harder for expert readers to assess research or, potentially, try to duplicate it themselves, said Dr. Boet. Also, the International Committee of Medical Journal Editors urges that journal authors reference original, primary research like the results of a clinical trial - not someone else's summary of it. In fact, Wikipedia articles often do provide those kind of primary references, yet some researchers ignore them and still cite the Wiki article instead, the study notes. Doing so is likely ‘quick and easy’, especially if a scientist has limited access to the original source, speculated Dr. Boet. "The possibility for the spread of misinformation from an unverified source is at odds with the principles of robust scientific

methodology and could potentially affect care of patients", his paper concludes. In fact, Wikipedia makes much the same point itself, noting that "for many purposes, but particularly in academia, Wikipedia may not be an acceptable source.” It reminds readers that ‘anyone in the world can edit an article, deleting accurate information or adding false information.’ The possibility for the spread of misinformation …could potentially affect care of patients Some universities frown on even students using it as a source for papers. Cornell University, for instance, warns undergraduates that Wikipedia provides a rudimentary overview of subjects and that it is likely that professors ‘won't let you cite it in a scholarly research paper.’ Dr. Boet and colleagues discovered more than 1,400 journal articles from 2001 to the beginning of 2012 that referenced Wikipedia. The numbers started to soar in 2011, and 1,600 or more Wikipedia-citing papers were published in each of 2012 and 2013. They appeared in some of the world's foremost journals, including Nature, Science, The Lancet Infectious Diseases and The Annals of Internal Medicine. The majority of Wikipedia citations were for definitions or descriptions of medical or scientific terms or concepts, followed by historical and statistical references, the study indicated.

Source: www.nationalpost.com

Are you an emotional journalist? Being a health journalist is quite different than being a journalist covering say corporate, finance or consumer goods. Health is a matter of huge emotional distress and being exposed all the time to the grief and agony of patients/ victims and their families can be taxing. The rules say that journalists must be 'objective', but they are humans too. Is it okay then to let these emotions seep into their stories? Is there a difference between being 'sensitive' and 'emotional'? We'll let some interesting excerpts from various sources take us deep into the issue. “Expressing emotions in front of a camera is the easiest way to make the viewers emotional too. Yet, all great reports of the most talented journalists generate a lot of emotion without the reporter being emotional.”

“News reporting is reality and you cannot give me reality as it is if you are so emotionally charged . I may end up having a wrong impression of what transpired and or may not even catch the facts if I am also emotionally weak and is carried away by your emotions.”

“The emotions provide motivation for journalists and encourage public engagement. The deep emotions aroused by tragedy can motivate journalists to dig further into the story. Stories that report the plight and emotional fragility of victims attract the attention of the What a few journalists around world, and summon help.”

"I had to think visually. I am zooming in on a tight shot of the dead guy and a splash of red. Going into his khaki uniform in a pool of blood in the sand. The dead man's face is slightly gray. You are making a visual here. But inside something is screaming, 'My God.' But it is time to work. Deal with the rest later. If you can't do it, get out of the game." - Kevin Carter

“While covering crisis events the journalists need to be "sensitive" and "not emotional". After the crisis reporting is over there will be ample opportunity to express emotions in blog, feature stories, memoirs etc.”

the globe have to say...

“Facts, properly conveyed, are more powerful than a reporter's feelings. They leave the emotion to the mind of the reader. The proper role of the journalist is not to impose a chill on the facts, or a sentiment on the audience, but to understand how events can best be recounted, and then to get out of the way. That doesn't mean that the journalist does not feel, but that their emotion does not masquerade as the news.”

Being stalked by a vulture. That same year, Carter committed suicide. In 1994, South African photojournalist Kevin Carter won the Pulitzer prize for his disturbing photograph of a Sudanese child

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eenagers aren't usually bald, but that is the only look I have seen on 18year-old Michael Friedman. The teenage Ewing sarcoma patient lay in a Sick Kids hospital bed, receiving chemotherapy drip-by-drip, while I furiously recorded observations for my feature on cancer care givers-recently published in the March issue of Reader's Digest Canada. It was my first time seeing cancer as a journalist, but I had witnessed this disease before. My mother was first diagnosed with ovarian cancer in 2008. More than four years later, she was in remission and I had

emotionally recovered enough to examine cancer as a reporter. “Who is Caring for the Care givers?” explores oncology from a physician's perspective and the emotional toll involved with this line of work. However, what the final draft does not reveal is that in the past few months of reporting, my mother's cancer returned. “The closer you can relate to a patient, the harder it is as a doctor,” oncologist Abha Gupta, one of the main voices in the feature, told me during an interview. I realized that as a journalist, being personally connected to a story has similar sideeffects. Continue reading

What do you think? Is there room in journalism for reporters to express emotion and personal experiences when covering human tragedy and emotionally taxing health news? Does this style offer a better story?

We would love to hear from you. Source:

http://j-source.ca/

http://ijnet.org/

http://www.fanpop.com/clubs/photography


A Navigator for the Healthcare Sector

E PERT Comments

I Mr. Anup Soans Editor; MedicinMan

t is natural to fall in love with a successful model and big pharma refuses to give up the broken model of blockbusters and premium prices. There will be winners and losers as the new dynamics reshape the healthcare market in which the government will increasingly play a larger role to fulfill its mandate of affordable healthcare and cheaper drugs.

Tough Time for big pharma Read the Story

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hat has been predicted since last few years is actually been happening now, the sales of top 15 global pharma companies rose by just $ 1 billion from $430 billion in 2012 to $431 billion in 2013. The times are tough for the global pharma companies; this is not so good news because it means fewer new molecules. But if we view it from the perspective of India, it could be good news. In the past, Global pharma companies, excluding GSK, have not given much focus on India, until just last few years. But to give the impetus to their growth, they have no option but to focus on huge market like India. That too a generic market, so they don't have to really focus on R & D. Product development or formulation development would be a much economical and faster option to

Chemist wants to review of order on drug prices Read the Story

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harmaceuticals will always have a very strong social dimension. Lower cost of healthcare will always be on regulators mind, and rightly so. Currently there is a increased pressure to reduce the prices. Retailers and distributors are integral part of the healthcare delivery. Just as the pharma companies share the profit with them, they should be willing to share the cost reduction burden on the industry. Pharma retailers and distributors have enjoyed handsome margin for years and years, this is time they should come forward to share industry's burden. Even the reduced margin of 16% for pharma retailers and 8% for pharma distributors, will still be much better than their counter parts in other industries, where margins are, just 2-4% for distributors and 6-8% for retailers. Let's put patient first. Mr. Milind Mangle

Read the Story

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evising a public-funded health scheme for India is challenging considering the unique healthcare system prevalent. The predominantly self-pay system is indeed the reason why most people in India do not seek treatment unless absolutely necessary. They also avoid regular testing for the fear of detection and the subsequent hassles and costs. Drug pricing Ms. Priti Mohile therefore becomes a critical issue. The introduction Managing Director, of Reimbursement schemes will need close MediaMedic Communications monitoring or else they can become another reason for corrupt practices.

Sun Pharma takes over Ranbaxy business Read the Story

Mr. Ashish Babtiwale Director - Pharma Operations at VIRCHOW

he news on Sunday was an unbelievable at first instance, but that’s what one can expect from Silent Guerrilla Strategist - Shri Dilip Shanghvi

The deal has created an entity with dominating 9.4% market share in Indian Pharma market and position as 5th largest company world over. This size undoubtedly gives SUN, as a single corporate the clout to influence the way marketing will be executed in future by pharma industry in India and also lobby along with likeminded friends for policies beneficial for the Indian Pharma and Indian Patients. Globally, it can bring respect to Indian medicine business and significance to branded generics market exploration. This position is pivotal for SUN to increase the generic market size in geographies penetrated and nurtured by Ranbaxy, avoiding the lag time had it gone alone.

differentiate. This would give boost to the development, and hence manufacturing, industry in India. This will also bring in a lot of activity in the pharma space like mergers and acquisition. Mr. Milind Mangle This will bring triumphs Chief Consultant, Coach & Trainer; as well as turbulence. Angle Consultancy & Services $3.2 billion dollar acquisition of Ranbaxy by Sun Pharma is the latest. This is going to boost the confidence of Indian companies. So tough time for global big pharmas, but better times for India.

Patented drugs less affordable in India, but cheaper, says study

Chief Consultant, Coach & Trainer; Angle Consultancy & Services

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APRIL 2014 - ISSUE 1

Ranbaxy recalls over 64000 bottles of generic Lipitor in US Read the Story

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anbaxy is a classic example of leadership failure. Ever since crisis hit Ranbaxy, there has been very little of its leadership face visible in the media to clarify issues or articulate its vision of the future. Contrast this with GSK's leadership – Andrew Witty has been the face of the company, explaining its stand on all issues as well as setting clear goals for the future. Ranbaxy has to put its house in order beginning with decisive and bold leadership at the helm. Mr. Anup Soans Editor; MedicinMan

4 brands of combined entity in 100 Cr league, 10% brand share of top 300 brands, dominating antibiotic group and foray into OTC business opportunities can help SUN in enhancing the top-line. However, from outside arena one can see the challenges, a) to turn around the stagnated ‘Elephant’ brands, b) controlling the high infrastructure expense of Ranbaxy and c) choose remedial measures to tackle the regulatory issues with USFDA. Handling these and other latent issues less known outside to deliver a positive EBIDTA can only make this deal profitable. The leadership is known to do turnaround, but maybe for the first time it’s such large a business for which the team will need to understand the challenges in totality and execute well.

FDI in Indian Pharma Read the Story

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he policy clarity in allowing FDI in pharma is welcome. It not only brings in scarce capital but enables Indian entrepreneurs to encash the value that they have created and thus creating an incentive for more such ventures. Mr. Anup Soans Editor; MedicinMan

WELL, industry is watching.

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Mediamedic lente april 2014  

Newsletter for Journalists covering Health and Pharma industry

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