Praying to DDT for a miracle that DDT cannot work


Evolution denier Ray Bohlin is in Liberia telling the Liberians their salvation lies with DDT, at least in fighting malaria. Wholly apart from the theological problems of elevating a chlorinated hydrocarbon killer to the level of idolic deity, DDT can’t solve the many problems that conspire to keep Liberia in the grip of DDT as a killer of children and pregnant women.

What an odd conflict of faith and science. Bohlin is a Christian. His strong faith in DDT is a double puzzle.

[And, what is it with all this denial? Creationist/IDist/evolution deniers tend heavily to be HIV deniers as well, and global warming deniers — now DDT deniers? Have they all had close encounters of the third kind, too? Is it a virus? Is it a cult?]

Fighting malaria in Africa requires a concentrated, integrated plan that provides appropriate medical care to cure any human who contracts malaria, thus breaking a key link in the malaria cycle. Malaria kills children under 5 and pregnant women in larger percentages than other people. Bohlin correctly notes that malaria kills, and that the disease disrupts the nation’s economy. But his recommendation that Liberians increase DDT use, in the absence of an integrated pest management plan, is a prescription for dashed hopes at best, and disaster at worst.

Bohlin seems to urge junk science. DDT offers significant dangers, which Bohlin seems blithely to ignore.

Why won’t DDT help much in the fight against malaria?

Wholly apart from the inherent problems of DDT — mosquitoes develop immunity, or already are immune; DDT kills beneficial insect and arachnid predators of malaria vectors, so the mosquitoes come back in geometrically increased numbers; DDT kills the food fish of people who live on fish; DDT kills reptile, mammal and bird predators of mosquitoes, so the mosquito population roars back with increased killing efficiency — DDT cannot solve the other problems that play a greater role in frustrating the fight against malaria. DDT doesn’t treat the disease once humans catch it; DDT is just one, small tool to prevent infection, and perhaps not the most effective.

Some of the problems were highlighted by Liberia’s long civil war. Stories about Liberia around that time highlight the difficulty of fighting malaria, and an outbreak of malaria among U.S. Marines who were sent in to restore and maintain order in 2003 showed that DDT alone can’t do the job. In three articles, the New York Times revealed the problems in 2003.

First, DDT cannot fix Liberia’s broken health care system. Health care is essential in fighting malaria. Humans form a pool of infection, a key link in the life cycle of malaria parasites. If infected humans are not treated to eradicate the parasites, malaria is waiting for the next generation of mosquitoes to reinfect themselves, and spread the disease again. There must be good access to health care facilities for infected people, and those facilities must have the proper medicines and staff to dispense the medicine appropriately to effect a cure.

Before the civil war there were too few health care clinics and hospitals — after the war, existing hospitals and clinics were left in shambles . (“In Torn Liberian Town, Hospital Itself is a Fatality,” July 18, 2003)

Set among sheltering old trees, across the road from a small church with blue stained-glass windows, Ganta United Methodist Hospital took in patients from all over Liberia’s sprawling, rural northeast and from across the river, in Guinea.

Today, the hospital lies in ruins. Its anesthesiology machine is shot up. Grenades have blown off the roof of the eye clinic. The hospital floors are littered with syringes, blue surgical gowns and empty crates that once contained Kalashnikov ammunition.

For three months, as government and rebel forces fought over Ganta, the hospital was turned into a base. It has since been stripped of everything useful — generators, computers, even sterile gauze, surgical clamps and antibiotics.

Liberia’s health care system struggles to get back to merely inadequate levels. Money must be spent to create the equivalent of the old health care system just to get back to a level of health care where malaria was a major problem.

DDT doesn’t build hospitals, it doesn’t train doctors, it doesn’t create medical supplies.

Second, DDT is no more a panacea against all forms of malaria and all malaria-carriers than anything else is. The parasites are drug resistant, the mosquitoes are insecticide resistant, and people get infected even when several steps have been take to prevent it. This is illustrated amazingly well by the fact that an extremely high percentage of the U.S. Marines deployed to Liberia contracted the disease — despite their having drugs to prevent infections, training on how to avoid being bitten, and sleeping quarters that should have protected them from bites. According to a Department of Defense news release, this mystified authorities.

About 80 members of the approximately 200-strong U.S. contingent that served ashore at various times during the Liberian peacekeeping mission developed malaria, noted Dr. Michael E. Kilpatrick, the Defense Department’s deputy director of deployment health support, in an interview with American Forces Radio and Television Service.

The mystery, Kilpatrick said, is that U.S. personnel who’d contracted the disease — a potentially fatal, mosquito-borne malady common in tropical climates — had been provided anti-malarial drugs.

“Very quickly, in a matter of a few weeks, we started to see cases of malaria in those individuals we thought were adequately protected,” Kilpatrick recalled.

Initially, 33 persons came down with malaria in Liberia and were evacuated for treatment, Kilpatrick said. Two were taken to Landstuhl Regional Medical Center in Germany, he noted, while the others were sent to the National Naval Medical Center in Bethesda, Md. Now, however, the total is 80 cases among the people who went ashore, the doctor pointed out.

This rate of infection is considered “incredibly high.”

In contrast to the bombed-out hospitals which can provide no care for Liberians, the U.S. soldiers got the best of care; and still there were problems:

Tests performed aboard the amphibious ships showed that some marines had falciparum malaria, the deadliest form of the parasitic infection. Ordinarily, malaria does not require health workers to don such protective gear because it is spread by mosquitoes and not contagious. But the doctors worried that the variety of symptoms suggested that some marines might also have contracted any of a long list of other infections common in West Africa.

”Our greatest concern was that this was Lassa fever,” said Dr. Gregory J. Martin, a Navy captain and the program director of infectious disease fellowships at Bethesda Naval Medical Center and Walter Reed Army Medical Center. Dr. Martin led the military medical team that examined the marines at Andrews Air Force Base and later cared for them at Bethesda.

Lassa fever is a viral infection that can cause fatal bleeding and that can be spread easily in a hospital setting. Because of the possibility of importing Lassa fever, Bethesda officials activated a seldom-used plan to treat victims of emerging infections and biologic warfare agents.

Before the marines boarded their flight to Andrews, scientists at biologically secure military laboratories began preparing to perform tests to detect the viruses that cause Lassa fever, dengue fever, yellow fever and other microbes.

Every U.S. Marine made a full recovery. Liberians who contract the deadliest form of malaria may not be so lucky. DDT could have done little in these cases.

Third, as the cases among the Marines show, prevention is the key, and education and follow-through are the keys to prevention. Hypothetically, the U.S. Marines had every protection against malaria. It turns out that regular human non-feasance contributed to the disease: Marines, having avoided malaria in Iraq and Afghanistan and other places, did not take the risk seriously, and did not take the preventive medicine as needed to prevent infection.

The 53 marines sickened by malaria after 12 days in Liberia in August caught the disease because they did not take their pills properly, Navy officials said on Thursday [December 4, 2003] at a conference on tropical diseases.

Although many of the marines swore to Navy doctors that they had religiously taken their weekly mefloquine pills, blood levels showed that they had not, a Navy spokesman said. The three sickest marines, who nearly died of brain and lung complications, had almost undetectable levels.

”The reality was that it just fell by the wayside,” said Lt. Cmdr. Tim Whitman, an infectious-disease specialist at the National Naval Medical Center in Bethesda, Md., who spoke to the annual conference of the American Society of Tropical Medicine and Hygiene. ”These men had been in Iraq and Djibouti; if they’d gotten away with not taking their mefloquine there, they assumed they’d get away with not taking it here.’

So, once again we pledge to do better working against malaria.

But to fight the disease, we need education and follow-up programs to make sure the proven methods work. The Marines had not been sleeping under bed nets aboard Navy ships — bed nets have proven to be one of the essential things to do to prevent malaria, with DDT or without it. Appropriate and quick medical care remains the keystone, however.

In the confusion after 53 of the 133 marines became ill, they were first misdiagnosed as having dysentery because so many initially had diarrhea. The chief medical officer on the Iwo Jima had been trained in pediatrics, not tropical diseases, Commander Whitman said.

Dr. Gregory J. Martin, a Navy captain who led the military team that cared for the marines at Bethesda, said the lesson of the episode ”went like a shot” to the top levels of the Department of Defense.

But Commander Whitman seemed slightly more cynical.

”The hard lessons are learned over and over and over again, in Somalia and Vietnam and World War II,” he said, adding jokingly, ”This will go to the top of the list after fuel and bullets and everything else.”

DDT is a suitable part of an integrated pest management program, where DDT is applied indoors, in appropriate places, against appropriate mosquito species. Such applications are recommended by the World Health Organization (WHO) and environmental organizations, and most public health agencies. The programs are expensive, requiring trained people to apply the chemical safely and appropriately. DDT may be inappropriate if trained applicators are not available, if follow up is not possible, and if other parts of the program are not in place, including especially good medical care and bed nets.

Bohlin does not say what type of use of DDT he advocates. If he advocates nothing more than the WHO guidelines, he’s offering nothing new. If he advocates broadcast outdoor spraying, however, he steps into crank science and crackpottery advocacy.

How much of Bohlin’s advocacy for DDT is due to his failure to comprehend the problems, and how much is due to his political agenda, which is opposed to hard science at almost every turn?

13 Responses to Praying to DDT for a miracle that DDT cannot work

  1. mpb says:

    PS– the “white coat” phenomenon? The latest to be caught for it is Jarvik advertising Lipitor on TV. He isn’t a cardiologist and the ad has been withdrawn.

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  2. mpb says:

    Mr Pullman you also might want to move your mouse around to see if you can spot the links (mouse will usually change shape or show the url in the margins of the browser).

    I want to echo EdD as well in that his blog (as well as mine) is designed for people to judge the statements independent of credentials– what everyone should be learning to do in school– but you are correct that sometimes knowing a person’s background can help judge the quality of a statement in addition to the other means of critical thinking.

    I only mention it here because judging what others say is a skill that must be practiced as well as demonstrated and it sure would be nice to know if I or others can improve it. Basing conclusions on credentials alone is very easy and one of the clear markers of ID or creationism or Berry Fell’s followers (or “science” under the Shrubs)

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  3. Ed Darrell says:

    Mr. Pullman,

    You should see blue links in the post; the three NY Times articles are listed in the text, under “First,” “Second,” “Third.” If you’re not getting those hotlinks that take you directly to the articles in the newspaper, you should check your internet browser’s settings. Older versions of Internet Explorer sometimes foul up on those. If you can’t get the URLs above, write in again.

    My qualifications? I’m just a concerned blogger. If you need to plump my qualifications, you might note that I’m an environmental attorney, former staffer to the chairman of the Senate Labor and Human Resources Committee back when the health functions were with the chairman’s staff. I’ve tracked DDT and other environmental issues for more than 30 years, often professionally.

    Not sure what you need exactly; if you need more, check my brief bio under “Why Study Evolution?” just below the masthead.

    If you really need more, e-mail me (the address is in the “about” tag, above).

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  4. George Pullman says:

    You state that “an outbreak of malaria among U.S. Marines who were sent in to restore and maintain order in 2003 showed that DDT alone can’t do the job. In three articles, the New York Times revealed the problems in 2003.”

    Could you reply with the url to the three articles you reference from the New York Times?

    Also, for a school project, I want to cite your blog, I was wondering if you had any qualifications I could also cite to make the source seem more credible?

    Thank You.

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  5. […] Praying to DDT for a miracle that DDT cannot workEvolution denier Ray Bohlin is in Liberia telling the Liberians their salvation lies with DDT, at least in fighting malaria. Wholly apart from the theological problems of elevating a chlorinated hydrocarbon killer to the level of idolic … […]

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  6. Ed Darrell says:

    You’re right. I have no idea how much denial there might be. I hope it’s a lot less than you describe.

    Each of the forms of denial I described is damaging, each form has potential dangers. HIV and AIDS denial is among the most damaging. Having been in the health policy establishment when AIDS was breaking into the consciousness of health care experts, it frustrates me that so many people deny the science. I sincerely wish there were fewer denialists, and more action.

    The announcement today of revision of WHO’s figures carried the good news that there are a few million fewer HIV/AIDS cases than had been calculated. So far my fears that deniers and other anti-reality groups will jump on that for bizarre purposes hasn’t been realized, much. Knowledge is our chief weapon to fight the disease. Ignorance kills, literally.

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  7. Darin Brown says:

    “There are more HIV deniers than that? Whooooeee! It’s worse than we ever imagined.”

    You have NOOOOOO idea, schmuck.

    darin

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  8. Ed Darrell says:

    I suppose it’s possible that the universe of HIV deniers is significantly larger than the overlap with evolution deniers and/or global warming deniers — but I haven’t seen evidence of it.

    If you run down the list of fellows at the Discovery Institute, you’ll run into an almost equal cohort of climate change denial, you’ll find a disturbingly high cohort of HIV denial, and my experience is most creationists think Rachel Carson wore a black hat and personally directed all the activities of Joseph Stalin.

    There are more HIV deniers than that? Whooooeee! It’s worse than we ever imagined.

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  9. Darin Brown says:

    “[And, what is it with all this denial? Creationist/IDist/evolution deniers tend heavily to be HIV deniers as well ”

    I don’t know where you get this idea. You seem to be implying that a large or significant majority of creationists or IDers are dissidents. This is unbelievably ridiculous. The few times that HIV has occurred as a subject at ID blogs or that I have interacted with IDers, they seem to have as much faith in HIV as anyone else, with maybe a handful at most of notable exceptions (there are TWO individuals I can think of, wow, that’s REALLY a lot!!)

    “, and global warming deniers — now DDT deniers? Have they all had close encounters of the third kind, too? Is it a virus? Is it a cult?]”

    You seem to have a vast misunderstanding of the various intersections between these groups of people, no doubt due to your taking what you hear from gossip to be reality, no doubt the same reason you accept the HIV hypothesis, without actually reading the scientific literature. There are a few people who lie in the intersection of HIV dissidents and global warming skeptics (hmmm… it seems I can’t even use a term for those people without potentially committing myself one way or another — what a terrible state of affairs for science!!) and maybe a handful (like, around 5 at most) in the intersection of HIV dissidents and IDers.

    Virtually all (like, 99% or more) of HIV dissidents I know accept evolution as proven. You’re really misinformed. But then again — THAT EXPLAINS WHY YOU BELIEVE THE HIV HYPOTHESIS.

    Darin Brown
    PhD Mathematics
    Webmaster, AIDS Wiki
    http://www.reviewingaids.org/awiki/index.php/User:Revolver

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  10. Ed Darrell says:

    Thanks for dropping by, Ray!

    The newspaper article you refer to says nothing about my clear mention of only indoor residual spraying of DDT which as you mention the WHO and USAID now endorse.

    That’s good to know. One of the two sources I found said it was a press release. I’m suspicious whenever DDT is highlighted, since there is no need to highlight it if we’re talking about an integrated program, and since, other than your mention here, all other mentions of DDT are from people trying to hammer Rachel Carson and nameless “environmentalists” unjustifiably. If you’re advocating DDT use in IRS or IPM, of course, there is no need to advocate any change in policy anywhere in the world. I didn’t get the idea you were endorsing WHO’s program, or the program endorsed by Environmental Defense. It’s good to know otherwise.

    But you know as well as I do that bednets are costly and difficult to get people to use in tropical humid environments. The “hotels” I stayed in did not provide them. I have slept under them and the sultry humid evenings are only worse under a bednet. They certainly are a necessary part of the solution just not very easy to pay for and get people to use.

    Bednets cost under $10.00 per person and last about five years. Spraying with DDT runs between $12.00 and $24.00 per application, and lasts generally no more than six months. If we had to do one and not the other, I’d go for bednets. I’m wary of people who put DDT upfront, also, because DDT can’t solve the “won’t use bednets” issue. DDT without bednets quickly becomes a destructive policy; DDT with bednets is part of an insecticide-with-bednets regimen that changes the insecticide out often enough to avoid resistance and immunity. Because nothing works 100%, we need to use a lot of different tactics, and use them wisely.

    DDT doesn’t offer a great deal of savings in a carefully integrated program, and it’s completely useless at any price where immunity or resistance is widespread among mosquitoes.

    DDT can’t overcome a lack of bednets.

    You also fail to mention the incredible success of DDT use in South Africa, highlighted in the July 2007 National Geographic cover article. When DDT use (IRS) was terminated in 1996, malaria rates skyrocketed from less than 10,000 cases (in 1995) to over 60,000 cases in just two years. When DDT was reinstated in 2000, rates declined 83% and with the introduction of ACT (artemisinin-based combination therapy), rates were reduced further. More information is available at the excellent website, http://www.fightingmalaria.org. (see graph on page 63 of July 2007 issue)

    I think it’s disingenuous to give DDT all the credit where there were several things coming together to make the program successful. South Africa is now using the WHO- and Wellcome Trust-advocated programs of integrated pest management, which relies on no single tool, but emphasizes using appropriate tools wisely and conservatively. (I blogged about the National Geo article here.)

    I’ve had a couple of people allege that South Africa caved to political pressure from greens to reduce their DDT use originally — but I’ve not found any credible source to corroborate. South Africa’s experience with declining DDT effectiveness parallels the experience of Mexico and other nations that have constantly used DDT since 1946, only to find that their malaria rates rose back to historic levels, too. Clearly, DDT isn’t a panacea anywhere. Mexico’s rates are dropping because the Wellcome Trust and others prevailed on Mexico to use an integrated program, and I believe from everything I’ve read, that’s what turned the corner in South Africa, too. DDT wasn’t the savior: Wise use of insecticides, including wise use of DDT, helped a lot. In short, Rachel Carson was right, and we could have saved thousands, if not millions of lives, had we listened to her a few decades earlier.

    I’d be curious to see how much of South Africa’s recent success in fighting malaria is due to DDT, as oppose to the adoption of widespread integrated pest management, and the introduction of combination therapies to replace therapies that had ceased to work in infected humans.

    Africa Fighting Malaria is one of the premier groups fouling up malaria fights, especially with their hyper-charged political chants against Rachel Carson, and their continued strategy to hammer away at the reputation of anyone associated with protecting the environment. I think their attacks on Carson and WHO are scurrilous and scandalous. See Tim Lambert here, and Eli Rabett here.

    Christians certainly should oppose such tactics.

    Also the risk of resistance is greatly reduced by this method of spraying since it largely acts as a repellent. Most mosquitoes simply won’t enter a residence where the indoor walls have been sprayed. Those that do enter are agitated to the degree that they won’t bite and only those that actually land on the walls are killed. This makes resistance much more difficult to develop since those affected are not removed from the mosquito population.

    I thought you didn’t hold that evolution occurred in such cases. Mosquitoes’ evolving new methods to resist DDT or become wholly immune to it are classic cases of evolution. I’m interested to see you even discuss it here.

    DDT is a lousy mosquito repellent, and its repellent effects are so small as to make it one of the more expensive and dangerous repellents ever. The repellent effect famously drove evolution of mosquitoes to avoid resting on hut walls in the 1950s and 1960s. We have better repellents to use, nets are more effective than DDT as a repellent, and using DDT as a repellent is tantamount to spraying DDT on cotton again, the chief cause of DDT’s decreasing effectiveness.

    And again, if your intent is to encourage DDT use in Indoor Residual Spraying programs, there’s little need for such advocacy and no need for any change in policy. That’s what Rachel Carson urged, in fact — something that AFM appears completely unable to learn.

    I think advocacy for DDT use tends to be more destructive than productive. It’s useful only if limited according to the principles Rachel Carson discussed in 1962; it’s already allowed for such limited uses under U.S. law, European law, and the POPs Treaty; and the real work needs to be done in other areas. DDT spraying, for example, cannot overcome Liberia’s need to rebuild health care systems, almost literally from the ground up. In a place like Liberia, DDT is neither cheap nor effective by itself, and increasing its use is probably more dangerous than any benefit that could accrue in the absence of effective medical care extensive use of netting as prophylaxis against mosquito bites.

    But it’s good to hear you’re not among the Rachel Carson bashers. Do you have any clout with Sen. Coburn in Oklahoma? You could do a lot for fighting malaria by defusing the campaign of calumny against Carson that Coburn is leading. Any chance of that?

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  11. Ray Bohlin says:

    I returned from Liberia just last Monday (11/12. (This was my fourth visit in four years.) The newspaper article you refer to says nothing about my clear mention of only indoor residual spraying of DDT which as you mention the WHO and USAID now endorse. My intent was only to act as a source of information for the Liberian people when the inevitable scaremongers arise about DDT use. Much of your blog post is irrelevant to my statements. Yes we need bednets and yes we need more and better drugs to treat those who are infected. I mentioned as much in the interview but I can’t control what the journalist chooses to include. But you know as well as I do that bednets are costly and difficult to get people to use in tropical humid environments. The “hotels” I stayed in did not provide them. I have slept under them and the sultry humid evenings are only worse under a bednet. They certainly are a necesaary part of the solution just not very easy to pay for and get people to use.

    Your mention of DDT spraying as expensive is a bit disengenuous. It is by far the cheapest insecticide available. Certainly the training and actual spraying programs require extra funding but the money is available from both USAID and President Bush’s 1.2 billion malaria initiative.

    You also fail to mention the incredible success of DDT use in South Africa, highlighted in the July 2007 National Geographic cover article. When DDT use (IRS) was terminated in 1996, malaria rates skyrocketed from less than 10,000 cases (in 1995) to over 60,000 cases in just two years. When DDT was reinstated in 2000, rates declined 83% and with the introduction of ACT (artemisinin-based combination therapy), rates were reduced further. More information is available at the excellent website, http://www.fightingmalaria.org. (see graph on page 63 of July 2007 issue)

    Also the risk of resistance is greatly reduced by this method of spraying since it largely acts as a repellent. Most mosquitos simply won’t enter a residence where the indoor walls have been sprayed. Those that do enter are agitated to the degree that they won’t bite and only those that actually land on the walls are killed. This makes resistance much more difficult to develop since those affected are not removed from the mosquito population.

    DDT’s much heralded environmental effects were largely the result of agricultural overuse and not malarial control efforts. because it was so cheap, farmers used several times more than was necessary. But this is another long story. The amounts used in IRS are so minmal and less able to “leak” into the envioronment that the environmental risk is practicably zero, especially when weighed against the major benefit of reducing malaria cases as demonstrated in South Africa, Zambia, Bangladesh and Sri Lanka.

    While in Liberia I spoke with the interim director of malaria control in the Health Ministry before I did the newspaper interview and he was well aware of the new beneficial uses of DDT and was glad to discuss it with me and use my contacts in Liberia as potential sources of local support for adding DDT to their arsenal of malaria control programs.

    I understand that you only had the one article in The Analyst to work with. Hopefully you can see that my comments and intent were not as reckless as you portrayed them. The hard science supports my recommendations and the only political agenda for me on this issue is saving lives. DDT is simply a cheap, effective and safe stopgap solution as we continue to wait for a vaccine that proves extremely difficult to procure.

    Respectfully,

    Ray Bohlin

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  12. Bill Brieger says:

    Thanks for putting all the issues on the table. As you mention – a key challenge is Liberia’s health system, which is fragile and rebuilding. Without a strong system and controls, DDT will ‘leak’ into the environment through inappropriate agricultural and other uses (http://www.malariafreefuture.org/blog/?p=262). ITNs may be more cost-effective. As suggested, an integrated strategy is best.

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  13. Jackie says:

    How utterly sad. Liberia hardly needs additional problems. As we all know, policy is often made on the basis of junk science…not to mention junk intel, junk promises, etc. Reality has nothing to do with it. Thousands of years of evolution cannot trump the mis-educated desire of pat answers. It’s the sell, using religious terminology. Cautionary tales to the contrary, we have nothing better to offer than the mundane control measures. Of course, a vaccine will be the only way to rid the world of the scourge of malaria. Meanwhile, we can only hope…..

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