Quackademic medicine in Connecticut

HolyGrail067-450x248

A common topic that I’ve written about since the very beginning of this blog is the infiltration of quackery into what were formerly bastions of science-based medicine. Most recently, I lamented just how far this process has progressed at the Cleveland Clinic, as evidenced by its recent opening of a clinic devoted to the quackery that is functional medicine and, not long before that, its opening a clinic run by a dubious naturopath practicing traditional Chinese medicine. That’s not even counting its long-standing credulous promotion of the faith healing known as reiki and the use of acupuncture on children.

Unfortunately, the Cleveland Clinic is far from the only bastion of what I like to call quackademic medicine. Far from it. I was reminded of this when I saw a story yesterday pop up in my Google Alerts on alternative medicine. It’s entitled Alternative medicine gains steam in Connecticut, an article that's also on the Connecticut NPR website. Where in Connecticut is it gaining steam? Yale University, that’s where. Well, there and the University of Connecticut. Of course, Yale is the home of David Katz, whom we’ve met several times before, such as when he advocated a “more fluid concept of evidence” and claimed that it is necessary to embrace quackery in order not to “abandon patients.” If this article is any indication, it’s only getting worse there.

Now, one thing I have to be clear about here is that I have no objection to studying natural products like black cohosh and capsaicin. Indeed, the appropriation of such substances by “integrative medicine” is, as I’ve said time and time again, a “rebranding” of natural products pharmacology (also known as pharmacognosy) as somehow being “alternative” or “integrative.” It’s not. On the other hand, as I like to say, black cohosh and other herbal remedies like it are drugs, impure drugs with a high degree of lot-to-lot variability, but drugs nonetheless. They also tend to be oversold drugs in “integrative medicine,” with the claims of efficacy made for them far exceeding their actual promise, but, unlike so much else of alternative medicine, they are drugs and therefore not implausible as modalities like “energy healing” are. For example, there’s John Geible, a surgeon at Yale:

Geibel, vice chairman of the Department of Surgery at Yale, noted that genetic screening has been effective in determining whether some women will get breast cancer. “But even if you come in and perform the mastectomy, it’s difficult to impossible to remove every single (cancer) cell,” he said.

Earlier studies have shown capsaicin’s ability “to slow down or even stop the machinery of (cell) division,” he said, pointing to one in which capsaicin stopped the growth of prostate colonic tumors in a dish. What if, he posited, after a surgeon has removed a malignant tumor from a breast, the doctor can “coat the underlying tissue area with a capsaicin-based preparation to prevent any residual cells” from reproducing?

Geibel said he initially tested capsaicin on breast cancer cells in a culture to determine the dose and the best way to deliver it. “The next phase is to now take some tissue from an individual,” he said.

Why capsaicin? Why not any number of other drugs used against breast cancer, like paclitaxel or compounds that are known to slow down or stop brast cancer tumors in a dish? I mean, seriously. Capsaicin can indeed inhibit the growth of breast cancer cells, but it requires a high concentration. For instance, this paper testing its effect on MCF-7 cells (a breast cancer cell line) found that at a concentration of 200 μM, decrease in cell viability is only around 50%. That’s nothing. No wonder Dr. Geibel is talking about topical application in the surgery bed. There’s no way to achieve such high concentrations in the blood by oral ingestion, and even at that high of a level the effects are at best modest. Remember how I discussed IC50? That’s the concentration required for 50% of maximum effect of a drug. Remember how I discussed how an IC50 above 10 μM tends to be problematic for a cancer drug? Well, here we have an estimated IC50 of close to μM for capsaicin for the endpoint of cell survival. For apoptosis (programmed cell death), eyeballing the graph in the paper I estimate the IC50 of around 75-100 μM. All in all, it’s very unimpressive, even in cell culture. Another paper found roughly the same thing for a number of breast cancer cell lines, an IC50 ranging between 50 and 200 μM. Granted, it did a reasonable job inhibiting the growth of breast cancer xenografts.

But I don’t really want to dwell on natural products. As I said before, I have no real objection to studying things like black cohosh and capsaicin. I just doubt that they show much promise and don’t like how “integrative” medicine has co-opted such products as somehow being outside of “conventional medicine” when they aren’t. What I really don’t like is this:

With training in molecular and cellular biology, Dr. Gloria Gronowicz, a professor at the UConn Health Center, has long been looking into the effects of energy healing on tumor growth and metastasis, working most recently with a breast cancer model in mice.

Energy medicine, which includes Reiki, qigong and a practice named Therapeutic Touch, actually involves no direct touching of a patient or an object being studied. Rather, practitioners work with what they say is the energy emitted from their hands, which they call biofields. A paper published in May by Gronowicz and others, in the Journal of Complementary and Alternative Medicine, said that Therapeutic Touch had prevented cancer cells in a breast cancer model from spreading, though it had not shrunk the size of the primary tumor.

“Let us use everything to help patients,” Gronowicz said of the growth in research into alternative treatments.

We’ve met Gronowicz before. It was six years ago. She was doing therapeutic touch on osteoclasts in cell culture and claiming that it could stimulate them to grow. Her results were, as I described, underwhelming. so is this paper, because it’s not a paper at all. It’s an abstract for a poster for the International Research Congress on Integrative Medicine and Health (IRCIMH) in Miami in May. So, what we have here is an abstract for a poster (the lowest form of scientific publication) being misrepresented as an actual scientific paper, but even if it were a paper it would be in a bottom-feeding alternative medicine journal. Anyone wonder why I’m not impressed?

Basically, it looks like an exercise in cherry picking. Breast cancer cells (4T1, a mouse mammary cancer cell line with which I am quite familiar) were injected into the foot pads of mice, which were divided into three groups. One group got therapeutic touch; one got “mock therapeutic touch” (I’d like to see that); and the other got saline injections. At 26 days, tumor volumes were measured and serum collected for 32 different cytokines and chemokines. Metastases were measured, and cells isolated for a number of assays. There’s a big problem, though: Nowhere is it mentioned that the therapeutic touch practitioners were blinded to experimental group or that those collecting the serum, measuring the metastases, or the tumors. and, of course, it’s just an abstract for a poster presentation.

OK, so we know that both Yale and UConn are deep into the woo. Yale has David Katz plus a large integrative medicine program. UConn has Gronowicz and its own integrative medicine program, complete with credulous treatments of homeopathy, Ayurveda, naturopathy, and, of course, traditional Chinese medicine. What’s really irritating about this article is that it is written from the standpoint of pure credulity, full of false balance. Actually, it goes beyond false balance. It’s downright supportive of integrative medicine and goes out of its way to paint critics as close-minded:

But alternative medicine continues to have its critics. They can be found on such websites as Quackwatch.com and The Skeptic’s Dictionary. Dr. Steven Novella, a researcher and assistant professor of neurology at Yale School of Medicine, founded the take-no-prisoners website Science-Based Medicine, of which he is editor. On Sept. 29, the site’s managing editor, Dr. David Gorski, a surgical oncologist, posted his latest attack on alternative medicine: “Quackademia Update: The Cleveland Clinic, George Washington University, and the continued infiltration of quackery into medical academia.”

A growing number of researchers are ignoring that skepticism by using scientific methods to measure and quantify the efficacy of unconventional treatments.

See that? Got the idea? Critics are “unscientific”! So the brave intrepid doctors of “integrative medicine” have just decided to ignore them! They’re “ignoring them” by using scientific methods. Except that they’re not. Not really. They don’t take basic science and prior plausibility into consideration. They study mystical magical faith healing like reiki and its bastard offspring made even more palatable for “Western” consumers, therapeutic touch. All the stuff about diet, exercise, and natural products like black cohosh is the Trojan horse. These modalities seem plausible and follow in the tradition of existing scientific study of natural products. Once the Trojan horse has gained entrance to the fortress of medical academia, the quackery leaps out, in particular traditional Chinese Medicine, the various magical mystical “energy medicine” techniques, and a whole host of other quackery.

Actually, the Trojan Horse has already gained entrance to a number of academic medical centers. Combatting that is why I do what I do.

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Aren't New Englanders supposed to be practical and hard-headed people?

That Trojan Horse clearly needs more capsicum.

By John Danley (not verified) on 14 Oct 2014 #permalink

@Shay: Yale is an Ivy League university, which means that they can hire pretty much any professor they want, from anywhere in the world. There is some visa paperwork to be done if the person is not a US citizen or permanent resident, to certify that the person really is the best qualified, but this is usually a minor inconvenience when you are hiring at Yale's level. Note also that New Haven is (just barely) part of the metro New York City area, and we know that NYC is a hotbed of alt med, because it is home to many special snowflakes with lots of disposable income. At least one major alt-med guru (Gary Null, IIRC--Denice can correct me if I am wrong) either lives there or has lived there.

I don't know what's up with UConn. The main campus is in a town called Storrs, in a semirural part of eastern Connecticut, but that is not necessarily where the med school is located.

By Eric Lund (not verified) on 14 Oct 2014 #permalink

Dr. Steven Novella [...] founded the take-no-prisoners website Science-Based Medicine

"take-no-prisoners". Ah!

If those entrenched skeptics would only accept to be reasonable.

By Helianthus (not verified) on 14 Oct 2014 #permalink

Oh, and about capsaicin: That's the compound which makes hot peppers hot. I eagerly await the hilarity which is sure to ensue when alt-med types extol the "ancient wisdom" of Indian and Chinese diets that make heavy use of hot peppers. Never mind that all species of hot pepper are native to the Americas, and did not become part of Asian cuisine until about 1700 when Dutch traders brought them across the Pacific. Or that many Chinese regional cuisines, particularly in the east and north (e.g., Cantonese and Mandarin), do not actually make significant use of hot peppers.

By Eric Lund (not verified) on 14 Oct 2014 #permalink

If only it truly were like the Trojan Rabbit where they forgot to get inside of it before sending it in...

"-King Arthur: What happens now?
-Sir Bedevere: Well, now, uh, Launcelot, Galahad, and I, uh, wait until nightfall, and then leap out of the rabbit, taking the French, uh, by surprise. Not only by surprise, but totally unarmed!
-Arthur: Who leaps out?
-Bedevere: U-- u-- uh, Launcelot, Galahad, and I. Uh, leap out of the rabbit, uh, and uh...
-Arthur: Ohh... (he and Lancelot slowly put their hands to their heads at the realization that they messed up)
-Bedevere: Oh. Um, l-- look, i-- i-- if we built this large wooden badger--
(twang of a catapult is heard from the French castle and the Trojan Rabbit comes flying towards where the knights are hiding)
-Arthur: Run away!
-Other knights: Run away! Run away! Run away! Run away! Run away! Run away! Run away!
(Trojan Rabbit lands on one of the pages)"

Eric Lund is correct: Null lives in NYC and owns estates in Florida and Texas ( see his website for photos of the two latter places- filed under health retreats).

Woo-meisters seek out areas where well-to-do people live because they can afford to pay for products and services. NYC and its suburbs are the flames that attract these moths. I'm sure that having large communities from east and south asia doesn't hurt either.

By Denice Walter (not verified) on 14 Oct 2014 #permalink

Come on over to the moments on the NPR article and give my Disqus pseudonym a hand. Or at least wave one . . .

By Pareidolius (not verified) on 14 Oct 2014 #permalink

That location on my last post autocorrected. It was supposed to be "hahd tellin' not knowin'."

By Pareidolius (not verified) on 14 Oct 2014 #permalink

It’s an abstract for a poster

Just wondering, but wouldn't the abstract be even smaller than the poster?

These types of program tend to be the result of rather sizable charitable donations from woo-inclined philanthropists. Non-profits are generally loathe to turn down gifts with lots of zeroes, and so they rationalize their acceptance and creation of fairy studies programs like at Yale and UConn.

And remember, just because you're held aloft as a reputable educational institution doesn't mean that all of your faculty are grounded, science-based folks. Just look at Harvard and John Mack, he of UFO abduction/recalled-memory fame.

One group got therapeutic touch; one got “mock therapeutic touch” (I’d like to see that); and the other got saline injections.

In other words, this is a comparison of three different kinds of placebos. Or maybe only two, since I'm not sure what the difference would be between the first two--in neither case is the subject actually touched.

I realize the standards for studies in lab mice (or other non-human creatures) aren't as strict as for studies involving human subjects, but I am trying to envision a non-conflicted IRB that would consider this proposed study without breaking into fits of uncontrolled laughter, and I'm not succeeding.

By Eric Lund (not verified) on 14 Oct 2014 #permalink

@Eric Lund

UCHC isn't on the Storrs campus, it's located in Farmington, CT, west of Hartford. There's about an hour's drive between the two campuses.

UCONN has, unfortunately, started more sCAM offerings through its medical program in the last decade. It makes me very sad to see they're delving deeper into the woo.

Earlier studies have shown capsaicin’s ability “to slow down or even stop the machinery of (cell) division,” he said, pointing to one in which capsaicin stopped the growth of prostate colonic tumors in a dish.

That doesn't mean capsaicin represents a promising therapy. So does a blow torch.

@ Todd W.:

Oh I know: John Mack. Heh.
I actually read his book based on the experiences of those who were 'abducted'.

By Denice Walter (not verified) on 14 Oct 2014 #permalink

I actually read his book based on the experiences of those who were ‘abducted’.

"Oh, no! He's being alienated!" -
Firesign Theater, "Everything You Know Is Wrong", 1975 or so.

One of their finest works.

By palindrom (not verified) on 14 Oct 2014 #permalink

The banner ad I got is an offer to study holistic nutrition online! I even get a free class if I want!

I wonder what happened to the creepy old guy with the muscles?

By palindrom (not verified) on 14 Oct 2014 #permalink

Even a 9 year old could figure out that therapeutic touch isn't real. It's really quite reminiscent of the Emperor's New Clothes.

John Geible wants to rub capsaicin in the open wound where a toumor was just removed? I know it's more complicated than that, but talk about salt into an open wound! It hurts just to think about. I hope the patients would stay under until the pain wore off.
Eric @13: Mice don't like to be touched or held a whole lot (because you are a giant scary predator), so I can't imagine that they're big fans of any of this "touch" stuff, even if it doesn't involve much touching.

Actually, how would that even work? Do you do it to the whole cage of mice at the same time, or do you take them out one at a time to "not" touch them? Or do you just think really hard at the whole rack?

By JustaTech (not verified) on 14 Oct 2014 #permalink

Eric Lund #5 says ""That’s the compound which makes hot peppers hot.

Rats do not develop a preference for peppers, even after repeated laboratory exposure.

http://www.blogsoop.com/blog/hot-pepper-seeks-spicy-masochist-for-seari…

I should think the rats would not, considering how they were repeatedly *introduced* to peppers within the soft, candlelit laboratory setting.

Incidentally, does anybody remember what the *objective* modified Scoville scale test was that put the pepper on the rat's anus to measure the 'twitch'??

I forgot the magic g-words and just keep getting ads for Rat's Red Ass hot sauce.

By Thethunderbird… (not verified) on 14 Oct 2014 #permalink

Given that capsicum is the active ingredient in pepper spray, rubbing high concentration capsicum on the skin sounds painful. There's a reason I wear gloves when chopping habaneros.

Earlier studies have shown capsaicin’s ability “to slow down or even stop the machinery of (cell) division,” he said, pointing to one in which capsaicin stopped the growth of prostate colonic tumors in a dish.

Correct me if I am wrong, but I imagine that after mastectomy the patient wants the wound to heal, so "stopping the machinery of cell division" is not in itself desirable. Is there any evidence that capsaicin inhibits tumour-cell division more than healthy cells? Geibel isn't showing any.

By herr doktor bimler (not verified) on 14 Oct 2014 #permalink

I don't want to stray too far off topic but begins off topic grumble perhaps this could be a mood of the time. In the USA/Europe, there seems to be a revolt against Enlightenment era ideas such as reason and individuality and also some older traditions in favor of new-agey replacements.

New Age is neither new nor improved, but never is is clearly explicated with a compare and contrast statement.

By Spectator (not verified) on 14 Oct 2014 #permalink

Why would institutions of high repute like Yale and the Cleveland Clinic get involved with these dubious treatments? Does $ have anything to do with it?

Money has a lot to do with it. these non-evidenced based practices are covered under the Affordable Health Care Act and the alternative medicine industry reaps $34 billion annually.

By Eugenie Mielczarek (not verified) on 16 Oct 2014 #permalink

Well, yes and no. Actually, if you look at most "integrative medicine" centers, they tend not to make as much money as a lot of skeptics think they do. Some even have a hard time breaking even. Moreover, as Jann Bellamy has pointed out, despite harping on the ACA, these sorts of quackery are not covered under the ACA unless their practitioners are licensed by a state. In states that do not license naturopaths, for instance, ACA insurance plans are not obligated to cover naturopath services. Why do you think there's been such a renewed drive by quacks to win state licensure?

But back to these centers. If you look at most of them, you'll see that they tend to be started by funding from a single wealthy donor. I'm not saying money isn't important. However, if there's one thing I've learned, it's that skeptics tend to seriously overestimate the financial motivation for hospitals to open these centers.

Storrs, home of the main UConn campus is just a bit East of the Hartford metro area. Farmington is a closer-in 'burb SW of Hartford proper. So basically, the UConn Integretive Medicine program is operating in the shadows of the head offices of most of the major health insurance companies in the U. S. That's basically all there is to Hartford's economy. If that area is attractive to woo-meisters due to the presence of well-to-do special snowflakes, we would mainly be talking about insurance industry executives. How fun!

There are basically only two things in New Haven -- Yale and poor Black people. The commuter trains to NYC do go to New Haven, but there's no reason for anyone who works in the city to live that far out. But Yale Hospital is totally the Big Dog of medicine in CT, so I'm sure they pull in lots of patients from all the towns between New Haven and NYC where plenty of well-heeled commuters reside -- and just the well-heeled in general who only go into the City now and then. Despite there being huge areas of poverty in all the bigger cities (Hartford, New Haven, Bridgeport...) CT has the higher per capita income of any state.

Hey Orac, Bic here ... Bic Mitchum. Weren't you exposed as Orac the Nipple Twister by some other guy that keeps up with law-suits against you and your (fleeting) colleagues. Answer soon. LOL.

By Bic Mitchum (not verified) on 17 Oct 2014 #permalink

Hey, hey, hey Orac, Bic here ... Bic Mitchum. Weren't you exposed as Orac the Nipple Twister by some other guy that keeps up with law-suits against you and your (fleeting) colleagues. Answer soon. LOL.

By Bic Mitchum (not verified) on 17 Oct 2014 #permalink

Fucktard Orac ... your sleazy game is now exposed. LOL!

By Bic Mitchum (not verified) on 17 Oct 2014 #permalink

Hey Orac!, Bic here ... Bic Mitchum. Weren't you exposed as Orac the Nipple Twister by some other guy that keeps up with law-suits against you and your (fleeting) colleagues. Answer soon. LOL.

By Bic Mitchum (not verified) on 17 Oct 2014 #permalink

Hey hey Bic. I can see why they call you bic, you sure do like to write a lot. America really does have the best education system in the world.

By NumberWang (not verified) on 17 Oct 2014 #permalink

Such eloquence and insight. Wow.

I see that there's a proud representative of the Pattimmy Memorial Society to hand.

@Sadmar

I'd argue that there's more to New Haven than just "Yale and Poor Black People" - Yes, it's on the 95 corridor, but then again so is Bridgeport.

There's actually quite a bit to do in New Haven - jazz festivals, foodie festivals, etc. It's quite culturally diverse.

^ In case that wasn't clear enough,

some other guy that keeps up with law-suits against you and your (fleeting) colleagues.

To wit:

In 2010, "I pointed out earlier, Barrett made some serious mistakes in his Texas campaign, and if I have my way, and I usually do, Barrett is dead meat. If I have my way Barrett is going to get indicted,. and he'll end his days as Big Willie's giggly girlfriend...." (My best guess is that this has something to do with Stemp v. Care Clinics. And what actually usually happens when Patty "has his way," as it were.)

In 2011, "The Maryland Board of Physicians is DEAD MEAT." (Yah, no. Père et fils went out whimpering.)

In 2012, "I have read selected excerpts from Depositions conducted in England. In short, Deer, Godlee, and the BMJ are dead meat." (Heh.)

In 2013, "Barrett, et al, are dead meat. There are specialized companies out there who go and find assets after a judgment." (Patty's rules of "having my way": early, often, and unsatisfyingly.)

Weren’t you exposed as Orac the Nipple Twister

"Exposed"? Tim Bolen calls Orac "the nipple ripper", as a sophisticated and classy* reference to Orac's profession as a breast cancer surgeon. That tells me all I need to know about Bolen.

* Sarcasm, in case anyone takes me literally.

By Krebiozen (not verified) on 18 Oct 2014 #permalink

It seems that Pat Tim has united squabling anti-vaxxers ( see Bolen Repor t/ on Health Freedom Congress Oct 2013) so perhaps the autism puzzle will soon be solved. He gathered together such luminaries as Piper-Terry,:Larson, BLF and the Segals to hobnob with Health Freedom Fighters who are legion ( esp in Texas).

So quake in your Ferragamos/ Laboutins, brother and sister sceptics!

By Denice Walter (not verified) on 18 Oct 2014 #permalink

what worries me more about capsaicine is its ld50 being on the same order as nicotine. oh, and iv, ip and sc being about 2 orders of magnitude more toxic than oral or dermal...

http://www.mdidea.com/products/new/new00510.html

afair there were some african arrow poisons containing the stuff, though all of those contained plenty of ouabain, so capsaicine was likely not the main active principle.

By Trottelreiner (not verified) on 14 Nov 2014 #permalink

Err, BTW, sorry for bringing up a herbalism website, but that was the closest one with the LD50 values of capsaicine I was able to find on my tablet. And even if the side is, err, suspect, the numbers are close to the ones I had in mind.

By Trottelreiner (not verified) on 14 Nov 2014 #permalink

@Trottelreiner,

Here is an ncbi article on various capsicum extracts and capsaicin.

The oral values are a bit lower than arsenic trisulfide or caffeine, but 2 or 3 times higher than nicotine.

But, injected LD50 values are supposed to be much lower.

http://www.ncbi.nlm.nih.gov/pubmed/17365137

By squirrelelite (not verified) on 15 Nov 2014 #permalink

@squirrelelite:
Thanks for the article. Sorry for the mistake, but to do some backpedaling, 2-3 times lower is still on the same order of magnitude, e.g. below a factor of 10. Err. ;)

Actually, I was using the numbers from

http://www.lycaeum.org/mv/mu/LD50_list.html

which listed a value of 230 mg/kg for mice orally. The same value is in my Merck Index, 12th edition. Though some other sources give an oral LD50 in mice of only 3.3 mg/kg.

As for capsaicine, I'm quoting from Neuwinger, "Afrikanische Arzneipflanzen und Jagdgifte" (transl.: "African medical plants and hunting poisons),

http://pubs.acs.org/doi/pdf/10.1021/bk-2009-1021.ch001

which gives the following toxicities in mg/kg in mice (solution in DMSO):

intravenous: 0.56
intratracheal: 1.60
intraperitoneal: 7.65
intramuscular: 7.80
subcutan: 9.00
intragastral: 190
intragastral: >218
dermal: >512

Let's stop for an "eek" and some rememberance for the poor mice. The reference is to this article:

http://www.ncbi.nlm.nih.gov/pubmed/7394809

As for nicotine, the same book is giving those values in mg/kg for mice

intravenous: 0.5
subcutan: 30
intramuscular: 8
intraperitoneal: 10
oral: 30

and rats:

intravenous: 3
subcutan: 40
intramuscular: 15
intraperitoneal: 20
oral: 190

references are to "Ryall, R.W., Nicotine in Neuroposions[sic],2,61-97"

tl;dr, there seems to be some variability in the dosages in the literature, but I still think the dosages for capsaicine and nicotine are somewhat similar. Which is not that troubling for oral dosages (where is my tabasco, BTW?), but for parenteral application, quite so. Sorry for the excursion...

By Trottelreiner (not verified) on 15 Nov 2014 #permalink

It's OK, Trottelreiner.

It's a lower range of uncertainty than the Sandia chili pepper I put my guacamole yesterday for National Spicy Guacamole Day!

Those range from 500-2500 on the Scoville scale for capsaicin. My subjective estimate for my sample would be about 1500, medium but not ultra-hot.

And the guacamole was good, especially with chicken fajitas!

By squirrelelite (not verified) on 15 Nov 2014 #permalink

@squirrelelite:
One word: Mjam! And given that pure capsaicin has a Scovile of about 16,000,000

http://en.wikipedia.org/wiki/Scoville_scale

even the top value of 2500 would only be about 0.15 mg/g capsaicine, if I'm interpreting Scoville values right. So as long as you're not in the habit of eating kilograms of the stuff, leave some to your fellow commentariat... ;)

By Trottelreiner (not verified) on 15 Nov 2014 #permalink