back to article Vaping on the NHS? Don't hold your breath

Experts told Parliament that a post-Brexit Britain should think about axing the most draconian EU-wide e-cigarette regulations to encourage people to quit smoking tobacco. The Science and Technology Select Committee heard oral evidence yesterday that the Tobacco Products Directive (TPD2) ban on promoting e-cigs, and its …

  1. graeme leggett Silver badge

    Regulatory approval

    Suspect tobacco industry gave up trying to get something approved under pharma regulations due to all that red tape around proving safety and efficacy.

    Plus dossiers on ingredients, showing GMP and GDP and the requirements for pharmacovigilance

    1. Anonymous Coward
      Anonymous Coward

      Re: Regulatory approval

      @graeme - my understanding is that they actually did manage to get a device approved but dropped it when it became clear that e-cigs were not going to be reclassified as medical devices. There was just no way that it was going to be able to compete with better / cheaper consumer devices

      1. graeme leggett Silver badge

        Re: Regulatory approval

        That does make sense. Why should tobacco company invest all that effort if the consumer device is allowed anyway. There's no advantage in a pharma grade device to retail in Boots if your competition is discounted in a petrol station shop.

        Pharma could produce nicotine replacement patches, sprays, and lozenges because they were already skilled in the delivery systems and the paperwork.

        1. Anonymous Coward
          Anonymous Coward

          Re: Regulatory approval

          A lot of the work tobacco companies did on this was in the 90's - they saw it as a new market following the health warnings around their existing products.

          Unsurprisingly, health services and governments in general weren't that interested in their offerings.

          The tobacco companies then waited for vaping to become mainstream and then tried the pharma approach...

    2. streaky

      Re: Regulatory approval

      TPD was written *for* the Tobacco industry, explicitly. They're the only ones who can. Products the tobacco industry are buying/producing are garbage though.

      The EU is corrupt. But don't take my word for it. http://www.bath.ac.uk/research/news/2015/02/24/tobacco-lobbying-eu-directive/

    3. Hifistud

      Re: Regulatory approval

      Except they DID get an MA for the e-voke, having got through all of that stuff. Just so you know.

  2. Yet Another Anonymous coward Silver badge

    Tobacco is a carcinogen whether or not you burn it

    At some level almost all substances are.

    Especially those which have had millions of years to evolve a defence against mammals eating them

    1. streaky

      Re: Tobacco is a carcinogen whether or not you burn it

      Tobacco is a carcinogen whether or not you burn it

      Vaping isn't tobacco. Has nothing to do with tobacco.

      1. Chronos

        Re: Tobacco is a carcinogen whether or not you burn it

        Aye, but that comment was aimed at HNB products where the tobacco is heated, not vaping. I suspect big 'baccy likes HNB because there's still the opportunity to tweak the balance of nicotine, MAOIs¹ and enhancers to make them even more addictive using methods they've tweaked to perfection over many years, whereas vaping is pure, pharmaceutical grade nicotine, albeit with some trace TSNAs² due to the extraction process being much cheaper than synthesis.

        Of note on that last point is the pharma products such as patches, gum, inhalators and such also use the same nicotine extracted from leaf. The sprays such as "quickmist" also contain nitric acid to simulate "throat hit." I kid you not.

        Nobody is saying vaping is 100% safe. It isn't. It's a damned sight better than smoking, though, and it would appear to be safer than certain pharmaceuticals as well. Lumping HNB and vaping together would be a mistake as people are likely to confuse sound bites aimed at one with the other, as you just did there.

        ¹ Mono Amine Oxidase Inhibitors, a form of anti-depressant and now thought to be a contributor to tobacco's addictiveness

        ² Tobacco Specific Nitrosamines, a key group of carcinogens found in tobacco leaf

        1. handleoclast

          Re: Tobacco is a carcinogen whether or not you burn it

          I suspect big 'baccy likes HNB because there's still the opportunity to tweak the balance of nicotine, MAOIs¹ and enhancers to make them even more addictive using methods they've tweaked to perfection over many years, whereas vaping is pure, pharmaceutical grade nicotine,

          Smoking delivers at least 6 different alkaloids, of which nicotine is known to be addictive and two of the others are suspected to be addictive. I think this may be one reason why many people mix their usage of vaping and real cigarettes. Vaping just isn't quite the same. I use vaping to stretch the time between having a cigarette, and in situations where smoking is not permitted but vaping is. The cigarette is a reward for putting up with the less-than-satisfactory vaping. I've cut my usage of cigarettes and cut my expenditure on nicotine delivery, but that's about as far as I can take it with current formulations.

          In a sane world we'd be doing research on the addictiveness and harmfulness of those other alkaloids and, if the research warranted it, authorizing formulations including them. And it's almost guaranteed that it would be safer to get nicotine+alkaloids by vaping than by smoking (where you get nicotine+alkaloids+tar+carbon monoxide+witch's brew of other crap).

          For those who vape for the nicotine rather than the taste, LiQuid does 10ml of 18mg nicotine liquid for a pound. Reviews of the flavours are mixed, but they're good enough for me. There are weird breakpoints on postage, so check carefully before ordering (last time I ordered, 80ml came in cheaper per ml than 100ml because of postage breakpoints). Other companies are around £2.50/10ml, so this is a big saving.

          1. Chronos

            Re: Tobacco is a carcinogen whether or not you burn it

            In a sane world we'd be doing research on the addictiveness and harmfulness of those other alkaloids and, if the research warranted it, authorizing formulations including them. And it's almost guaranteed that it would be safer to get nicotine+alkaloids by vaping than by smoking (where you get nicotine+alkaloids+tar+carbon monoxide+witch's brew of other crap).

            Agreed. However, you're confusing politicians with people who give a shit about anything other than their share portfolio, be that big 'baccy or pharmaceuticals. Also, most "studies" these days are using an arse-backwards variant of the scientific method, i.e. start with a premise and scrabble around madly to make the empirical data fit, with one eye always on getting more funding from whatever special interest group this round came from.

            If you get the chance, try either El Toro or Hangsen's Golden Tobacco/RY6. I suspect both of these use extracted flavourings (I know El Toro is a steep) and I have yet to come across more satisfying liquids. The HoL stuff isn't cheap but it's worth it. FWIW, I'm on Golden Tobacco permanently and it has kept me off the ciggies completely. You do wade through some crap before you find something suitable, though.

  3. vagabondo

    Nicotine is an addictive neurotoxin however it is taken.

    This is just the tobacco industry trying to protect its market-share with a derivative product. They are more interested in creating new addicts than helping people give up tobacco. The advantage for the industry in removing the tar is that their market does not die off so rapidly.

    1. AegisPrime
      FAIL

      Re: Nicotine is an addictive neurotoxin however it is taken.

      Are nicotine patches addictive? Nicotine gum? I'll save you a Google search - no. There's no evidence suggesting that nicotine by itself is addictive - what IS addictive is the cocktail of nicotine and additives in tobacco cigarettes which when smoked get the nicotine into the bloodstream far quicker than patches, gum or indeed e-cigarettes.

      Then there's the whole psychosomatic ritual of smoking - lighting up when stressed, after a meal or outside the pub with friends/colleagues - there's multiple factors at play that end up making smoking an incredibly difficult crutch for some people to quit. On of the reasons vaping has been successful for many people is because it better replicates the smoking ritual than patches or gum can.

      1. K

        Re: "does this read more like an ad-icle"

        Are nicotine patches addictive? Nicotine gum?

        Depends on context.. The nicotine contained on those patches and gum is addictive... I should know, I used NRT to quite smoking, only to place the reliance on receiving the nicotine on the gums on lozenges!

        1. streaky

          Re: "does this read more like an ad-icle"

          It's been proven that Nicotine is far less addictive when vaped, Proven. Also it's a "neurotoxin" in the same way as coffee is. And it's about as dangerous in normal consumption levels, which is to say it's not really. Should we also ban coffee? How about alcohol?

          Also your argument is basically that people should just carry on smoking as opposed to finding some safer way to consume nicotine which is pure unadulterated nonsense.

          1. King Jack

            Re: "does this read more like an ad-icle"

            You can ingest pure coffee in large amounts with no risk of death. Pure nicotine will kill you pretty fast.

            They are two completely different things. Why do defenders of smoking always twist things to defend a needless filthy habit?

            1. dansus

              Re: "does this read more like an ad-icle"

              Pure coffee?? XD

              If you mean caffeine, it can kill you just as easily. The LD50 of caffeine in humans is 150–200mg per kilogram of body mass.

            2. streaky

              Re: "does this read more like an ad-icle"

              You can ingest pure coffee in large amounts with no risk of death

              You *can* kill yourself just by drinking coffee. It happens.

              AFAIK there's no reported cases of anybody vaping themselves to death intentionally or otherwise. If you drank a teaspoon of the 72mg/ml nicotine I have it will kill you but if you drank caffeine that relatively strong that would kill you too. They're both poisons, deadly poisons. There's a long list of reasons they're comparable; not least because the research shows them to be about as dangerous as each other in vivo at normal usage doses, which is to say they're not at all.

              1. Anonymous Coward
                Anonymous Coward

                Re: "does this read more like an ad-icle"

                >They're both poisons, deadly poisons.

                Kids who are believed to have consumed hazardous doses are treated for poisoning as a precaution and you'll find those stats - it's obviously justifiable - but there have been zero nicotine poisoning deaths in UK or US in the past 10 years. You'll find reference to this in the parliament committee hearings around TPD - it came up as a specific question a number of times when experts were quizzed on toxicity.

      2. vagabondo

        Re: Nicotine is an addictive neurotoxin however it is taken.

        @AegisPrime

        I think that you are confusing addiction and habituation. The major difficulty in givving up psychologically modifying drug as is habituation' But nicotine is capable of providing a pharmacological dependency in the same way as opiates.

        @streaky

        Nicotine is definitely a neurotoxin. It used to be used by biologist to slow down neurotransmission and anaesthetise (and kill) invertebrates.

        1. streaky

          Re: Nicotine is an addictive neurotoxin however it is taken.

          Yeah, in high doses. The stuff is nasty lethal, it's one of the strongest poisons there is. It isn't consumed at those levels though. Caffeine is also poisonous if you take enough of it.

          https://www.ncbi.nlm.nih.gov/pubmed/15935584

        2. Anonymous Coward
          Anonymous Coward

          Re: Nicotine is an addictive neurotoxin however it is taken.

          >Nicotine is definitely a neurotoxin

          In the quantities found in vapes, cigs and products it's a cognitive enhancer without toxic effects. Alzheimer's therapies are final trial stage currently - large scale trials have been more than promising.

          There's also now a vast body of research which has established nicotine addiction is not the primary driver in smoking; if it were patches and gum would be far more effective smoking cessation aids - the majority (well over 2/3) of users of these products do not quit smoking but it's a huge tax-payer subsidised business nonetheless

  4. Teiwaz

    I found it stupidly easy to 'give up' with vapes.

    I started using Vapors last June, by August I was mostly off them too.

    Occasionally I get a 'fag' craving - couple of vapes takes the edge off (about four inhales) - it's down to once or twice a month.

    Off for one now, as... well, talking about it....

    My experience, they're nothing like cigs, barely meets the action habit, just about covers the chemical dependency.

    Still, the least stressful avenue to 'giving up' IMO, and it worked, unlike therapy, gum, patches or bans/trying to making it anti-social.

    1. Charlie Clark Silver badge
      Thumb Up

      Re: I found it stupidly easy to 'give up' with vapes.

      Great to hear it worked for you. Never been a smoke myself but I know plenty who've struggled to give it up over the years.

    2. Excellentsword

      Re: I found it stupidly easy to 'give up' with vapes.

      I too have had no difficulty with smoking since picking up a vape (son born, didn't want to stink of smoke for him and missus who had to go cold turkey). Problem is, I vape like it's going out of style, sit there working, puff, puff, puff. I hate addictions.

      1. Anonymous Coward
        Anonymous Coward

        Re: I found it stupidly easy to 'give up' with vapes.

        I haven't smoked for a good few years now. Moved to nicotine patches, gum, lozenges, inhalers, but nothing worked as well as vaping. Like others I have replaced one 'addiction' with another but at least it's generally considered a lot healthier.

        Patches and non-vaping alternatives used to be available on prescription during NHS stopping smoking courses, were also prescribed by hospitals in some cases, but it seems impossible to get a GP to authorise their continued prescription.

        1. graeme leggett Silver badge

          Re: I found it stupidly easy to 'give up' with vapes.

          CCGs have limits on their formularies to minimize prescription expenditure on the less efficacious drugs and get more bang for the buck. And although getting people of cigs is beneficial in cutting health expenditure down the line they are still focussed on the here and now.

          I note also that a weeks supply of patches is about £9 while the patient contribution to a prescription is £8.60. And that smoking cessation services seems to be delivered under public health rather than directly by GPs thought GPs may be contracted as part of the service.

      2. Anonymous Coward
        Anonymous Coward

        Re: I found it stupidly easy to 'give up' with vapes.

        "son born, didn't want to stink of smoke for him and missus who had to go cold turkey"

        What about the poor bastards driving all the cars you've stunk out? The half life of cigarette smells in cars makes plutonium 242 seem a quick decayer.

        Anyway, respect for quitting.

      3. The Real Tony Smith

        Re: I found it stupidly easy to 'give up' with vapes.

        "...Problem is, I vape like it's going out of style, sit there working, puff, puff, puff..."

        That's why I still treat vaping like smoking, i.e. going outside for a vape (yes even in this weather!)

        And to echo others in this thread, yes, stupidly easy to give up, fag free since July 21st last year after about 30 years smoking.

    3. streaky

      Re: I found it stupidly easy to 'give up' with vapes.

      My experience, they're nothing like cigs, barely meets the action habit, just about covers the chemical dependency.

      Mind if I ask what gear you're using? It should easily cover the dependency and habitually is basically an irrelevance when that is the case. Plus the right juices and equipment you'll be happy doing it.

      When I first started I wasn't interested in stopping smoking, tried a bunch of different equipment I wasn't happy with and continued smoking. Found some I was happy with and a juice I liked and I just stopped smoking. Even kept a packet of cigarettes on my desk which is a golden rule of don't do it when you want to quit smoking; switching to vaping like flicking a switch, and since gone down to 6mg/ml nicotine with no issues. My relationship with smoking is fine - I have no issue with people smoking near me because I have no craving for nicotine that I've known people who stopped decades ago longing for. I'm still not bothered about not smoking, I'd do it in a flash but I'm happy vaping and can't think of a single compelling reason to smoke over it; and I certainly don't *need* to smoke.

      It shouldn't be a problem which is why I'm always interested to hear why it is for some people.

      1. Teiwaz

        Re: I found it stupidly easy to 'give up' with vapes.

        Gear?

        Cheapo logic pro - Lady behind the tobacco counter at tescos knew nothing about the product for sale - despite being a smoker herself - Just plumped for whatever looked neither too expensive nor too cheap.

        But I had been doubling up the filters in roll-ups for some months (a little like the cigs on the fifth element).

        1. streaky

          Re: I found it stupidly easy to 'give up' with vapes.

          Lady behind the tobacco counter at tescos

          Yeah that stuff you can buy in a supermarket is no good for this. The juices all taste like ass and the ecigs themselves are no good for anything - and they're a rip off for refills. May I suggest finding a vape shop and asking for advice. Okay your start up costs are going to be higher getting yourself a proper mod and tank but you'll be happier with it in the long run. If anybody tries to sell you an unregulated mod walk out the shop and find another one though..

      2. Anonymous Coward
        Anonymous Coward

        Re: I found it stupidly easy to 'give up' with vapes.

        I agree with Streaky. SWIMBO had to give up after having a stroke. She is heavily nicotine dependent and NRTs weren't working. She wasn't that impressed with e-Cigs either. Worried that she would go back to the death sticks I did some serious research into what liquids she needed, and what equipment.

        Soon enough, she got what she needed. Fag cravings gone completely - she can even smoke one or two socially or if she's run out of vape without any return to cigs: she actually prefers to vape.

        We have met a lot of people who think "oh, I tried vaping but it's a bit rubbish" because they just bought A N Other brand from the corner shop or garage and thought that was that. Some of them find a quick puff on the wife's custom kit an absolute revelation.

  5. Charlie Clark Silver badge

    Public health strawman

    But if vaping is so beneficial for public health, why isn't the health service handing out the products?

    This is a strawman: vaping isn't beneficial, just less harmful than smoking. The on-prescrption argument advanced for proscribed substances is invalid here because the alternatives are freely available.

    As for the decline in the number of people smoking tailing off, this would have to be studied separately but it doesn't sound surprising. If vaping offers a way to give up for some people then at some point you'll only be left with those who don't want to give up. More important is to see whether fewer people are starting to smoke and, if so, for how long. Anecdotally here in Germany I've started to notice a marked drop in the number of smokers or vapers on the street such that smoking is becoming increasingly less "normal".

    As for dropping the EU regulation, this is increasingly looking like a non-starter as the UK muddles its way sticking with the status quo. Anyway, as with all things European, makes more sense to change things from within by pushing for more evidence-based policy. The tobacco industry has repeatedly discredited itself with fake studies, lobbying, delaying tactics and, if all else fails, taking countries that take public health policy seriously to court. I'll take something from the bureaucrats over their shit anyday!

    1. streaky

      Re: Public health strawman

      Tobacco industry lobbying is how we got in the shit state we are in, stuck inside the EU with the TPD going out of its way to kill as many people as possible. OTOH this gem

    2. Anonymous Coward
      Anonymous Coward

      Re: Public health strawman

      The tobacco industry has repeatedly discredited itself with fake studies, lobbying, delaying tactics

      A bit like the German motor industry then?

      I'll take something from the bureaucrats over their shit anyday!

      In the EU we most certainly do, everyday. Look at energy policy. I'm surprised there's an "a" separating the letters at the centre of "bureaucracy".

  6. codejunky Silver badge

    Meh

    "Manufacturers told MPs that the regulatory process for approval couldn't keep up with the pace of innovation in the industry."

    This should not be a shock to anyone in any industry. When you have many people, worldwide even working on different products and advancements how can a government be expected to keep up? This is why a micromanaging government cannot work.

    As for offering them on the NHS, I dont see why. I dont like cigarette smoke but I also dont like the clamp down on freedom to do as we wish to ourselves. Removing the EU laws that dont work is one of the reasons for brexit so it should be seriously looked at. And if people want one of these devices they will choose to buy one.

  7. Sean o' bhaile na gleann

    No Stalling here

    From the article:

    ...But the great vape revolution seems to be stalling. The number of "switchers" from cigs to alternatives had fallen from 800,000 to 100,000 per year...

    Surely that's to be expected? All the 'low-hanging fruit' - those people who *want* to switch have done so, leaving a core of diehards that will gradually expire...

    There's no 'stalling' here - the effect is perfectly natural

    edit: damn! Ninja'd by Charlie Clark...

    1. streaky

      Re: No Stalling here

      They did analysis of why, including surveys and it's for reasons like the regulation making people think that smoking and vaping are equivalent in terms of risk when they very much are not. I linked the review of legislation, health and behaviour evidence above and it is well worth reading but here it is again.

  8. DCFusor

    I used vapes to quit

    After nearly 40 years of a few packs a day...even buying the most expensive mechs (rDNA) and so on saved me a fortune, too. I used some pretty strong juice - my motivation was failing lungs, after all, so fewer puffs a day was a pretty big deal.

    And what that did for me was to break the habit of smoking an entire cigarette every time you light one. With strong juice, one or two hits gets it done, you put the thing down and maybe even forget about it for an hour or more (even forget where you left it - sometimes creating a panic).

    The extra hassle of re wicking all the time (I used diy coils/wicks) - in my case the taste went south every couple days - was helpful too. This happens even if you have the "good stuff" with active temperature regulation and use the finest ingredients for your juice. Stuff just gets that burnt flavor...and the coil carbonizes.

    After some time of this, I decided to go on a simple discipline - I'm allowed to vape once an hour, from top of the hour to 5 min after. That's it. If I miss the window, wait another hour. (you don't miss many windows, but even if you do, it's barely tolerable).

    After some time at this, I found I did miss an hour - the later in the day you start, the easier that is. And one day, I went all day without really thinking about it too hard.

    So I quit. Done - last March, so it's nearly a year. Yes, it now and then grabs you and shakes you like a leaf - but it doesn't take anywhere near the resolve to just say no, and I'm completely clean since last year. I don't think the weaker juice would have allowed this - I used the strongest available to cut down on the basic motor habit a lot - just didn't even want to do it that often - and that was key to the final success.

    My doctor almost doesn't believe it. She says in all her practice no one else has managed to really quit for good like I have. It's been a big deal with emphysema and hypertension, quitting has added a lot of life to this old fart. Took around a year of vaping to finally taper off to the point of quitting - but my health started getting better on day one of that.

    Just an anecdote, I know, but a true one by an avid observer.

  9. Anonymous Coward
    Anonymous Coward

    what you never hear talked about...

    Everyone who I know who's switched to vaping has a belief that "there is no second hand smoke concern because there's no carcinogens.

    I've seen kiosks in malls pushing vaping devices with its merchants using the product and blowing the smoke out as you walk by with your children.

    So even if vaping is safer, it's actually becoming more dangerous to those who don't smoke due to misleading advertising.

    1. Anonymous Coward
      Anonymous Coward

      Re: what you never hear talked about...

      I don't like the stench of strawberry "smoke" any more than you do, but let's be clear that the secondhand fumes of vaping must be two order of magnitude less harmful than smoking, and probably an order less harmful than many household cleaning products. But funnily enough, there's minimal research into that problem. Or the miserable air quality on say London's underground.

      There's two MAJOR air quality problems that you never hear talked about, and I'll wager both are far more significant than second hand vaping.

      1. Roland6 Silver badge

        Re: what you never hear talked about...

        >There's two MAJOR air quality problems that you never hear talked about, and I'll wager both are far more significant than second hand vaping.

        That's because we are used to them!

        For decades it was normal to willingly spend whole evenings in pubs etc. enveloped in the 'fug'. Now, I expect many people (smokers/nonsmokers) would turn round and leave if they encountered a traditional pub atmosphere...

        1. streaky

          Re: what you never hear talked about...

          I love hearing from people who haven't read any of the medical research it really makes my day. The threat to second hand vapers as it were is small enough that it's effectively zero. There's reams of research on this, this aint the 1930's, we have the technology to find out what's in the vapour.

      2. John Brown (no body) Silver badge

        Re: what you never hear talked about...

        "But funnily enough, there's minimal research into that problem."

        Yeah, I was filling up the car today and there was a strong waft of perfume, very strong. Looked around and there were no women in sight. Unless it was a bloke nearby filling up, the some woman was emitting a huge cloud of smells. I'm not sure there's much difference between people wearing lots of perfume, deodorant, aftershave etc and someone vaping. At least the vaper will take a few puffs and stop. The over-perfumed person standing in the queue next to you won't stop until they've gone, and even then it can a take a while for the smell to clear.

    2. Hifistud

      Re: what you never hear talked about...

      There is absolutely no risk to bystanders from exhaled vapour. You just don't like it. I don't like heavy perfumes on ladies who brunch, but I don't whinge about it.

      1. Chronos

        Re: what you never hear talked about...

        There is absolutely no risk to bystanders from exhaled vapour. You just don't like it. I don't like heavy perfumes on ladies who brunch, but I don't whinge about it.

        What makes me laugh is all the people who moan about sidestream vapour yet will willingly stand in front of a massive fryer in a fish and chip shop, which is putting out about a lifetime's worth of a vaper's output of acrolein every five minutes or so.

  10. dansus

    I needed 35mg before i even started to forget about smoking. The 20mg limit is too low for heavy smokers.

    1. streaky

      I used to smoke 20 a day and I found 12mg when I first started to be a problem if I was chain vaping for long periods, but people should start at least on what they're comfortable with. I find one of the issues is people trying to combine switching to vaping with cessation, which is trying to quit smoking and vaping at the same time; that's not going to work in most cases. Switch to vaping at whatever is comfortable (the TPD makes this a serious issue in the EU which is exactly part of the issue this article is discussing) but if you can, do it. When you're comfortable vaping you can reduce nicotine, maybe even some day quit but I find the idea of trying to quit smoking and vaping at the same time to be an absurdity in compounding issues - in my view it's why traditional quit aids themselves don't work. Quit smoking and THEN quit nicotine.. if you want to - but you don't really have to.

  11. unwarranted triumphalism

    I don't care whether they're good or bad, ban them.

    1. Hifistud

      What a little ray of sunshine you are.

  12. MaldwynP

    Not cool

    Vaping will never take off because it is not cool. Puffing from a lump of plastic and blowing out copious quantities of made up smoke doesn't appeal to the young (thank goodness). People want to look 'fit' now and smoking is so last century.

    1. Chronos

      Re: Not cool

      Superficial nonsense and nothing to do with the topic at hand. This is El Reg, not Heat.

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