Bioethics or Biobigotry?

I can explain it to youSeveral of my readers sent me articles about Daniel Callahan, a senior research scholar and president emeritus of The Hastings Center, who is suggesting that what fat people really need is more fat shaming.  No, seriously.  It turns out he quit smoking because of social shame around being a smoker and he feels that smoking and being fat are basically the same thing and that shame will make fat people thinner faster.  He proposes things like public posters saying”“If you are overweight or obese, are you pleased with the way that you look?”

I’m Fatty McFatterson Mayor of Fatterworth and yes Dan (can I call you Dan?) I am pleased with the way I look. Meanwhile, I propose posters around The Hastings Center that say “If you are a bioethicist who can’t grasp the basic tenets of your field, are you pleased with your job performance?”

First of all, let’s be clear that smoking and being fat are not the same thing.  Smoking is a specific behavior – every smoker smokes. Being fat is a body size and when it comes to habits and choices, fat people are as varied as any other group of people who share only a single physical characteristic.

I’m not promoting shaming smokers, but I want to be clear that shaming smokers shames people for something that they do. Shaming fat people shames people for who they are.  If smokers want to continue their habit and avoid public shame, they can hide their smoking.  Fat people would have to hide ourselves. Both of them may be wrong, but trying to get people to be ashamed of a specific habit is a very different than trying to get them to be ashamed of their bodies.

In an article about this [Trigger warning for fat shaming] Deb Burgard, one of my life heroes, said “For him to argue that we need more stigma, I don’t know what world he’s living in,”  My sentiments exactly Deb!  386,170 negative messages about our bodies a year, but the secret to public thinness is more negative messages.  Right. And yes, public thinness – let’s not fool ourselves that this is about public health.  You can identify an evidence-based public health initiative because it is based on evidence and is focused on health.  This is 0 for 2.

In fact, Peter Muennig’s research from Columbia found that most of the same health problems that are correlated with obesity are also correlated with being under a high degree of stress for a long period of time (for example, the stress of constant shaming and stigma).  Muennig found that those who were concerned about their weight experienced more physical and mental illness than those who were ok with their size, regardless of their size.   I guess being a bioethicist doesn’t include doing basic research to see if what you are recommending is likely to have the exact opposite of the intended effect?

I am lucky to know Dr. Tiffany Cvrkel, a brilliant bioethicist who works at UCLA so I immediately e-mailed her for her thoughts.  She said:

I think Callahan is perhaps confused about the mission of bioethics. We are capable of doing many things to increase general public health. We can protect people from one of the leading causes of death and injury in very a straightforward way. All we have to do is forbid people from leaving their houses, for any reason. Maybe we should start a shame-based campaign?

Oh, wait. Just because we can do something doesn’t mean we should. It is the job of the bioethicist to be able to tell the difference. If Callahan thinks that shaming people for how they look is an efficient way to make them healthier — a claim that is simply empirically wrong, by the way — then he still needs an ethical argument for why that shaming is morally permissible. Simply saying “it’s for their own good” is not sufficient. I can forcibly prevent you from riding in automobiles for your own good, or from dating problematic people, or from voting for offensive political parties. Callahan is suggesting something equally ridiculous.

Suggesting that we should shame people for their own good until they hate themselves healthy thin offends me as a fat woman, as a human being, and as someone who appreciates  logical, rational thought and evidence-based public health interventions.  My  hope is that this is the kind of thing that makes more fat people stand up and say that they’ve had enough – that the evils have finally become unsufferable, that this is not a tree and we are not kittens, that it’s time to stand up and fight back and that if they want a war on obesity, then we’ll give them one.

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63 thoughts on “Bioethics or Biobigotry?

  1. Brilliant post.

    Again, if people undestood that what other people think is a reflection of themselves and what they want for themselves, the world would be somewhat a better place for everyone.

    I find it triggering to hear people say ‘I get depressed if I gain a pound’ or ‘You should eat more vegetables’. I do eat them regularly by the way.

    What is really alarming is when bioethicists/scientists such as him make theses statements because heck, he must know what he’s talking about, right?

    Whereas he is being totally biased and subjective, basing his own subjective thoughts about his smoking experience and claiming it’s the same thing. No, it’s not. I was half expecting him to say something like ‘better a smoker than a fat person’. I’ve heard that before from someone.

    ! I do not wish to be rude and cruel about cancer in what I say below. I know it’s a terrible thing and you don’t necessarily have to be a smoker to get lung cancer !

    Because fat is cancerous, right? *sarcasm*

    1. True enough…I knew a guy in Uni who had half a lung removed when he was quite young because of lung cancer. And he’s never smoke a ciggie in his life…

  2. As an ex-smoker I can say that shaming sure didn’t work for me. I did hide the behavior. Ironically one of the reasons I gave myself for smoking was that it kept my weight down. This man needs a new job.

  3. I hate shame as a supposed incentive to healthier behaviour, and I include smoking in that too. As a cancer registrar, I guarantee you that if anyone mentions a lung cancer patient, the first words out of someone’s mouth will be ‘Smoker, was s/he?’. Yes, sometimes, and they were also a person with a life, family and feelings who did not ‘deserve’ that disease. But beyond this crassness, what people don’t realize is that funding to lung cancer research has plummeted since people began to firmly associate lung cancer with smoking – people don’t want to contribute to what they see as a ‘self-inflicted’ disease.

    Now that being fat as cause of all the ills known to humankind is Something Everybody Knows, I dread the same sort of thing happening to, for example, ovarian and pancreatic cancers (both of which now turn up regularly on ‘fatty diseases’ lists, and both of which sorely need funding as they generally get diagnosed late, so are still big killers) – and although it’s not my field, I wonder what effect it’s already had on funding for Type II diabetes. (And of course, if government and charitable funding drops off in any field, researchers will increasingly turn to commercial funding – which as we know, is not good news for objective science, especially where weight’s concerned.) So while this kind of shaming is pointless and douchey on the personal level, it can have dangerous effects well beyond that.

    1. I’ve had two doctors, one of them my oncologist, tell me that my ovarian cancer was my own fault because of my weight. Shaming of that sort is a hell of a thing to have to deal with while you’re in the battle of a lifetime fighting cancer.

      1. I watched my mom-in-law (whom I loved dearly) waste away from lung cancer. I watched it steal her mobility make her wheelchair bound, spread to other parts of her body and into her bones; listened to her screams of pain in the middle of the night. She had half her jaw removed. I saw her struggle with pain and forget who we were, and her personality changed, while in a drugged haze. I watched her cry as she realized her time was limited. I helped her plan her own funeral. She never smoked EVER in her entire life.

        And you know what? So what if she had. It is a vice. No one is perfect. Yes, people do things that aren’t in their best interest but does that mean we toss them aside when they are sick and when they need us most? I can’t take that attitude. I can’t. People don’t always make the best of choices and sometimes those choices have awful consequences but even if my mom-in-law had been a pack a day smoker, I wouldn’t have said she deserved what she went through. I wouldn’t have said she should be denied treatment.

        For a doctor to first ASSUME a disease is the patients fault is wrong, but then to impress that assumption upon the patient is just beyond wrong. Because no matter if it is the patients fault or not, they deserve compassion–especially if they are struggling to LIVE!!

        But isn’t that the crux of the problem? Conditions! We’ve put conditions on everything. You can get quality medical care IF you meet these certain criteria. You can be seen as a worthy human being if you meet this set of criteria here. You have ovarian cancer and you’re fat? Oh, I’m sorry but that doesn’t fit our criteria so we can’t treat you with compassion.

        Sorry to rant, but some days I’m just sick of all of it.

      2. One of the ladies at my church is in remission from ovarian cancer. She’s been at most ‘overweight’ the entire time I’ve known her… Except for just before she got diagnosed. It turns out one of the symptoms of ovarian cancer can be weight gain and extreme abdominal bloating.

        1. I suspect this assumption (and your friend is not the first person I’ve heard of this happening to) may actually be at the root of at least some of the late diagnoses of ovarian cancer – women get sent away and told to lose weight rather than get sent for more tests. That or the assumption that ‘it’s IBS’, which is also scarily common.

        1. Thank you for the kind wishes. I’m almost 9 years out from my cancer surgery. If you make it five years, you’re considered cancer-free, so hopefully this challenge is all in my past now.

  4. It’s not encouraging that, at the moment, on the poll on that article a whole 37% of people (so far) think that increased stigma and shame would be “worth a try” if it could curb the “obesity epidemic.”

    1. Whose effing business is it if I’m fat? I really don’t like these faceless people claiming to be “concerned” about my health. Most, if not all of these concerned citizens don’t give a rat’s behind about us. They’re just happy it’s not them and they can bully and shame with impunity and not be called on it, because “it’s for your own good.”

      1. Found this out recently after trying again a online community to advocate fat acceptance. Seems people won’t give a damn until we’re a legally protected group, until then they have the right to belittle fat people who are of the last groups it’s socially approved to hold prejudice against openly.

  5. And, yes, I get that smoking (behaviour) and being fat (body size) are two different things…but while society sees them as equivalent, the same social attitudes are going to have at least some of the same effects.

    Also, ‘healthier’ in that first sentence should have been in quotes, sorry.

  6. Professor, I’m not a scientist. I’m not even particularly educated. I just have my own life experience to go on, and based on my own life experience — and please, pull close and listen carefully because I’m only going to say this once —


    1. Ain’t that the truth. Fat people get it from all sides and what difference has that made. Perhaps they’re not doing the “right” kind of shaming.

      I wish I could go back and see what would have happened if my family had not tried the shaming route and perhaps just tried a little compassion and perhaps gotten involved in my life. I’m sure I wouldn’t have spent the last 25 years hating my body (even when it was closer to a normal size).

      1. Yep, there’s always that gaining it back and then some–I’m all too familiar with that pattern as a former yo-yo dieter. 😦

  7. The thing is, smoking is a behavior that is dangerous to people around you. Being fat isn’t. Even if it were unhealthy to the individual (which we can all agree it’s not), it would have no impact at all on the health of others.

          1. Omg, I think my brain will be exploding. If this was at all true, then my mother, and most of my friends would be huge just from being around me, but nope they still thin, and I am still fat.

            I wanna know how junk ‘science’ is actually published and sees the light of day!

  8. This article made the “What’s Trending” List on MSN. Even the folks who decide how to frame the item that’s “trending” think fat-shaming isn’t a good argument.

    Here’s the blurb:

    !Trigger Warning!

    “Of all the proposals to slow America’s growing obesity epidemic, here’s one unlikely to gain much traction — fat-shaming. This is the argument advanced in a new paper by noted bioethicist Daniel Callahan, who believes making people feel really awful about their body image is going to inspire people to lose weight and help curb Americans’ expanding waistlines. Callahan, 82 and trim, argues that what today’s young whippersnappers need to get them to the gym or refuse seconds is some good old-fashioned stigmatizing — a pinch of intolerance, a dash of ostracization and maybe a dollop of body dysmorphia to top things off. Yeah, good luck with that, Dan.”

      1. I was a little concerned when I saw the trending article that they’d support him. Yea! They think he’s off the mark! Love the sarcastic line… “dollop of body dysmorphia”… 🙂

  9. This is exactly what my girlfriend said to me last night (we really disagree when it comes to body issues/fat). She threw out that me saying being fat was healthy was like saying smoking is healthy just because you happen to know one person who didn’t get lung cancer… I clarified that my belief in HAES is not that being fat makes you healthy anymore than being thin makes you healthy, but that I believe BEHAVIORS make you health (or unhealthy). This is around the time she started tuning me out and said next I was going to tell her the world was flat. AWESOME.

  10. What I’m wondering is what rock Callahan has been living under for the past hundred years that he doesn’t get that shame is already – and pretty much always has been – the number one weapon in the War on Some Body Types.

    (trigger warning)

    I can point to songs from the twenties and thirties that were wildly popular on the theme that if a woman ‘allows’ herself to get fat, she’ll never find a man. I have seen poster after poster from a hundred years ago for quack diet supplements and insane diet plans that promise a short, miserable life for anyone who doesn’t use their products and thus remains fat. I’ve walked into department stores that hide the plus size clothing section in the worst-lit, least convenient corner of the store and then don’t staff it so you have to trudge halfway across the store to find someone to let you into the dressing room to try things on, let alone pay for your shameful purchase. In all the years I wrote for Manolo for the Big Girl and Manolo for the Brides, I got endless comments from readers about how family members and friends warned them not to eat the Thanksgiving feasts they’d cooked or offered up crazed diet plans to women to try before they went wedding gown shopping, because goodness knows the worst thing in the world is a fat bride. You know, one like me.

    Every day on my television, I see dozens of ads informing me that if I only change my body size, then I can FINALLY find love, travel, be pretty, get a good job, and be athletic. I check my email and there’s a nasty bar with ads to the side, four out of five of which are shame-filled diet ads.

    I’ve gone to parties where not one person in the room will talk with me about anything AT ALL other than how to lose weight because being fat is dangerous and ugly and wrong. If I go to a national chain restaurant, the caloric content of every single dish is listed there inescapably so that I become aware that the onion rings and cheeseburgers are BAD choices, as opposed to the skinless, boneless chicken breast with the steamed zucchini. Several major restaurant chains also have a Weight Watchers approved section of the menu, further letting me know how I’m letting down the side by choosing what I wish to eat rather than what will speed my journey to thin the fastest.

    If I read a novel or watch a TV program, chances are there won’t be anyone who shares my body type at all. If there is such a character, (s)he is usually a victim of bullying, a glutton, lazy as shit, whiney, stupid, and/or utterly unable to find a date. Oh, and they usually have either heart disease or diabetes, too. And it’s their fault. The only way they can stop being all these pathetic/disgusting things is… wait for it!… to become thin, which is easy once they realize that all they need to do is get up off the couch, wipe off the Cheetos dust, and eat a damn apple while exercising.

    (end trigger warning)

    Not enough shame my humongous lily-white ass!

    1. I would like to point out I think it was the lovely author Penny Jorden who wrote for Harlequin romance, used plus size women (16+ women too) as well as thin women in her books. I remember reading one book about a women who was working for some hot guy and had come home to find her model boyfriend cheating on her and blamed her weight. Yet in the end she got the hot hunk of a boss she had and never once did he want her to change despite her saying over and over “If only I was thinner, prettier, etc” all things we have more then likely told ourselves many times. Never once did he belittle or shame her, he just kept saying “You’re beautiful just the way you are and I wouldn’t have you any other way.”

      I don’t remember what the book was called because it has been some years since reading it, but it was a good book and even the woman on the cover was plus size as well. I’m gonna have to see if I can find it.

      1. I used to read the Glory St. Clair vampire series (don’t judge me). I picked it up because she was a plus-sized gal. I put it back DOWN because in 2 lousy books I couldn’t find 2 pages together where she didn’t belittle and berate herself for every slightly fuller part of her body – the body that she’d already had 400 years to get used to, mind you. The body that she would have for all eternity. The body that couldn’t be changed, no matter what. Really??? After 400 freaking years she was still bitching about cellulite? I just wanted to holler at her to get the hell over it and get on with her unlife. If you don’t know after 400 years that (1) moaning about crap that you can’t possibly change is utterly useless, (2) that the man you love ADORES your body just as is, and (3) that the world is a fickle place, there’s just no hope left for you. Four hundred years, and she was angsting (that’s a verb now) like a high schooler. I was just so disgusted. What could have been a great series that built women up instead glommed onto our every insecurity and ripped right into it. DONE.

        1. I have to admit I have never met a vampire book (male or female) where someone wasn’t bitching about something. In the series I cam currently reading called “Out of the Box” (erotic romance warning!) it is neither of the main characters, the author didn’t come out and say full stop that the main gal is plus size (or one of the other vampires) but the author does hint at in a way that is actually nice.

          I know there is more to that book other book I was talking about but I haven’t read it since oh… 07-08? Maybe longer… I really need to find that book.

  11. Disturbing, and yet emblamatic of the work that still needs to be done. Someone asked earlier in comments what rock this guy was living under…well, the article in which Deb is quoted answers that actually when they say that he is a “trim” 82 year old man. Thin men of his generation did not experience the kind of intense gaze on their body that women did and that women and men both do today. Our focus on physical beauty as an allegory for physical and mental health is so much more intense than it once was. And that’s the rock he’s been living under.

    1. Hmm, that’s interesting. He would have been a growing boy in, let’s see…the 1940s/50s. I have quite a number of old women’s magazines from that era, and I find them fascinating and disturbing – the women in them – some photographed, but many drawn – are not only obsessed with home, hubby and babies (I’d have ended up on ‘mother’s little helpers’ had I lived then, no doubt about it) but very thin (apart from ‘Grandma’ types, usually in the baking ads, and charwomen/cooks, which says something about size and social class even then), plus they’re a most unnatural shape thanks to the corsetry of the time. Furthermore, as Twistie points out above, they absolutely regarded it as their ‘duty’ to stay slim by whatever means – and that included during and after pregnancy. And I’m pretty sure, from the photos also in my collection, that women in the real world back then came in a much wider variety of shapes and sizes.

      I wonder if there’s a subset of straight men in any era who suffer from a tendency – I shall call it ‘Ruskin syndrome’, after the Victorian art critic who famously, though probably apocryphally, rejected his wife because unlike the statues he’d encountered in the art world, she had pubic hair – who are affected enough by the pervasive imagery of women they encounter while growing up that it warps their view of real, living, breathing women forever afterwards. You commonly hear how this is happening to young men today with online porn and other digital imagery, but I suspect it was just as true at any time where the available visual media didn’t correspond to the appearance of most women (like, always, probably).

  12. WHERE IS HIS SCIENCE! I can’t believe he has a degree and is using his ‘feelings’ to decide what is appropriate. I wish I could take back his degree.

    Does he advocate blood letting to release the ‘ill humours’?

  13. Bioethicists? You mean the ones who want to tell people with disabilities they should have been killed at (or just after!) birth?

    Unsurprised to learn they are full of shit in other arenas as well.

    Love the blog!

    1. Bioethics as a whole is not eugenics, though some of them may support that abominable philosophy. It’s pure, unadulterated hubris. It’s STAGGERING.

      Gonna break the underpants rule here and say that I think that everyone – EVERYONE – should read “War Against the Weak: Eugenics and America’s Campaign to Create a Master Race” by Edwin Black. It’s a chilling account of the eugenics movement in America, and how our own scientists gave Hitler the idea of the master race. Sadly, this is not a new concept, merely a rehashing of ideas that are an abomination to science and all life.

      1. Thanks for the book rec. One of the reviews on Amazon was quite detailed. From that I’ve been able to determine that the eugenics movement in Canada was part of this wider mainstream belief. The Famous Five from Alberta who got the vote for women back in the 1910s-20s, were fervent eugenicists. Alberta had teh longest sterilization project that only ended in the early 1980s. Most of those sterilized were Native women, and many were ster. without consent or their knowledge. It’s only recently come to light about these women and the movement, but what a shocker.

        I also believe that the eugenics was the cause of Jews being rejected from Canada in the 1930s – “None is too many”. Rejected here means there weren’t allowed any more in, they didn’t send away those who were already here (at least I think they didn’t).

          1. I read a book a few months back that was written in the 1980s but was set in the early 1900s. It was quite interesting, as the subject was a Russian duchess who had fallen into poverty and had been forced to flee the country. She always referred to her thinness in a derogatory way, particularly when compared to the strong, sturdy, buxom woman who a certain “doctor” always held up as the perfect specimen of a woman.

      2. Yup, there were people in just about every developed country who were all for eugenics in the first half of the 20th century, the UK as well (in fact, Winston Churchill, of all people, warned against the ‘feeble-minded’ being allowed to have children, and attended a eugenics conference in 1912).

        I recall a 1930s Nazi poster that warned Germans how much the care of people with ‘hereditary defects’ was costing them – it was this attitude that led to the T4 killing programme. Today, in parts of the UK media, there’s a general painting of people with disabilities and mental health issues as ‘scroungers’, but also a dangerous, more specific conflation of poor = fat = ‘self-inflicted’ sickness/disability = ‘taking taxes from hard working families’. Still a very, very long way from the atrocities of the past, I know…but any time anyone argues that the lives of some ‘undesirable’ people are costing too much money…well, it should be a reminder of how these things begin, is all.

  14. Just when you think it can’t get any worse and or another case of “you couldn’t make it up”, along comes this! Another great post as always Ragen, really missed your posts when you didn’t for a while recently, hope your partner is realtively ok now and you’ve hopefully got over your bad experience, medically wise(do we ever though?)

    Thought I’d like to share a couple of things in print I saw recently in a relatively respected magazine here in the UK, though one of them, about British hypnotist, Paul McKenna, has been been doing the rounds as he has a book/dvd/whatever out too? You may have seen something about this as he does live in the U.S now.(Los Angeles)This latest one of his is based on his “bestselling”, “I can make you thin” and it’s that he can hypnotise you into believing you have had a gastric band fited!! Wondered what you and others thought of this?

    Mr. McKenna states, “Seven out of 10 people who use the book lose weight, over the long-term, the success is more than six times the success rate of dieting and diet clubs. It’s the most successful weight-loss programme ever and you can use it while continuing to eat any type of food you want.” He was introduced to a Dr. Mark Cohen, an endocrinologist specialising in treating obesity, that partly gave him the idea of the gastric band slant on his previous book/dvd.

    McKenna goes on to say, “Obesity is a growing problem throughout the developed world. Being fat is not just a lifestyle choice; it puts you at serious risk of ill health and an earlier death.” Same old, same old, eh?

    In the same magazine, “The Lady” another week, there is a regular column from a Doctor, who looks at a particular topic and looks at one readers particular query. He was discussing a novelist who went to his local Doctor about a sore throat and was amazed and annoyed to be questioned about his eating and drinking habits and how much he exercised etc., This Doctor writing this article comments that, “There is an assumption that people are too stupid to know what is good for them”! he then goes on to say that the medical advice he would have received about a healthy diet has NEVER been clincially proven to promote a long and healthy life? He goes on to say that following World War 2, here in the UK, people were encouraged to eat more meat and dairy products, drink more milk. That was in the 1950’s-1960’s, then in the 1970’s, peopel were suddenly told this was all bad, full of wicked saturated fats and they should be eating a low fat diet. A Professor Shah Ebrahim of the Royal Free hospital, London analysed studies in which thousands of middle-aged mena nd women adopted this “low-fat” diet. He found that the beneficial effects on their risk of stroke and heart disease to be “insignificant”. Nothing since then has emerged to challenge that conclusion!!1

    Marion, UK

  15. This so-called ‘scientist’ has it the wrong way ’round: shame about my body made me obese. If I had been left alone as a ‘chubby’ teen I wouldn’t be super-duper fat now. Shame made me *bigger*, not smaller and I doubt I am the only person to have experienced this.

    1. Me too. I was actually not fat as a teenager, but I believed I was because I wasn’t super skinny. I became bulimic at 12. I started yo-yo dieting in my early teens.

  16. I read the original article that reported on this, and this so-called “expert” didn’t even offer any science to support his theory. Not even “studies” that contained significant bias or were funded by some diet company. Zero science whatsoever, just “common sense.” I can’t believe any of his peers would take him seriously, but I guess you never know.

  17. What a tool. I wonder if he’s even aware that he’s talking about real, live humans, and not about some figments of his imagination that will act according to his personal models of the world.

    Really, I never want a smoke as much as when I’m harrassed with anti-smoking messages. I don’t know if it’s a reaction to stress, if all this *thinking* about smoking makes me desire a cigarette, or if I just want to annoy people back. And in my teens, fat-shaming sent me straight to the chocolate, because my life was already messed up beyond all repair by being OMG fat, so I could just as well have chocolate to make it all better.

  18. Way back when I was in High School, many of my classmates tried to shame me into getting a tan.

    Damned if my melanin-deficient skin didn’t cooperate, despite all their peer pressure.

    Public shaming presumes a personal-choice cause, whether it’s obesity, being pale, whatever. It also presumes a specific standard with which we should conform, such as being nicely tanned and smaller than a given size. Typically, what I’ve found is the people who establish these standards as the “ideal” are the ones genetically predisposed to meeting them in the first place, and they act morally superior as if their skin’s ability to tan or their metabolism’s tendency to not put on weight was something they chose from the list of available genetic options at the Conception Showroom.

    Silly me. I chose a functioning brain instead.

  19. Ragen, I love your site. Love. It. This very topic of fat-shaming was just discussed on HuffPostLive. I participated via the comments section and I’m glad to say there were a handful of us who were typing fast and furious to inject a little HAES perspective into the discussion. It’s an uphill battle but I’m beginning to think people are actually listening. Or starting to. Thank you for all that you contribute.

  20. “I’m not promoting shaming smokers, but I want to be clear that shaming smokers shames people for something that they do. Shaming fat people shames people for who they are.”

    I love this quote! Thank you, I’ll be using it in future arguements people have against fat acceptance.

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