IEET > Rights > HealthLongevity > Contributors > FreeThought > Tsvi Bisk > Disability > PostGender
The Case for Circumcision
Tsvi Bisk   Jun 9, 2015   Ethical Technology  

Over the past several years the Jewish custom of male circumcision, in which the foreskin of the penis is removed, has been increasingly compared to female circumcision, in which the clitoris and sometimes the labia are removed, and condemned as genital mutilation. This comparison demonstrates an abysmal ignorance of anatomy. The clitoris is analogous to the penis and the labia to the scrotum which are certainly not removed in male circumcision. The foreskin is comparable to the clitoral hood which is sometimes removed surgically in women in order to enhance sexual pleasure.

And while no international organization recommends and promotes female circumcision, male circumcision is one of the primary weapons against HIV/AIDS in Africa and is promoted by the World Health Organization and UNAIDS (the Joint United Nations Program on HIV/AIDS). Male circumcision reduces the risk of female-to-male sexual transmission of HIV by approximately 60% and provides men with a life-long safeguard against HIV as well as other sexually transmitted infections such as syphilis and gonorrhea.

Given its preventive health benefits, I believe infant circumcision should be considered on a par with infant and childhood vaccinations. Brian Morris, professor of molecular medical science at the University of Sydney in Australia, agrees.  He writes “The World Health Organization, UNAIDS and others have done projections estimating the millions of lives that will be saved by implementation of circumcision, which has been equated to an effective vaccine.”

Female circumcision, on the other hand, increases the risk of HIV transmission, not to mention other diseases and appalling physical ailments. It also deprives women of sexual pleasure, destroys their self-esteem and turns them into a utilitarian vessel of patriarchal societies. Some claim male circumcision lessens a man’s sexual sensitivity. If true, very few Jewish women have ever complained about that. Yet, Professor Morris disagrees even with the lessened sensitivity argument; he says “… the claims that male circumcision somehow leads to impaired sexual function, sensitivity, sensation during arousal or satisfaction has been disproven by just about every good research study.” 

One might, of course, object to the procedure on aesthetic grounds (quite legitimate I am sure), but as Roger Collier writes in the Canadian Medical Association Journal “…women seem to favor the appearance of circumcised penises. In one survey, for example, 90% of women said circumcised penises look better, 92% said they were cleaner and 85% said they were more pleasant to touch”. This explains the increase in voluntary adult circumcisions in America. Girls just want to have fun and boys just want to get lucky.

One could also adopt a position that, despite all of the above, the procedure should ultimately be a decision made volitionally by an adult and not imposed on a defenseless infant. This is a serious proposition carrying much moral weight. But personally, having met men circumcised as adults, I am quite happy that my parents made the decision for me – just as they did for my smallpox and polio vaccinations.

Male circumcision, therefore, is about as morally abhorrent as a nose-job. So if you want to call nose-jobs ‘facial mutilation’ then I will allow that you can describe the removal of the male foreskin ‘genital mutilation’. The difference being that circumcision is a much less painful, complicated and dangerous procedure than a nose-job and much more beneficial health wise. 

Jews do not practice circumcision for any of the health reasons cited above; it is simply our tribal custom (as it is for other tribes around the world – including Muslims).  But since the custom is not detrimental to the health of the child and indeed even beneficial to the long term health of the child there is no reason for Jews to be on the defensive regarding the practice.

Tsvi Bisk (site) is director of the Center for Strategic Futurist Thinking and author of The Optimistic Jew: A Positive Vision for the Jewish People in the 21st Century (Maxanna Press, 2007). He also is Contributing Editor for Strategic Thinking for The Futurist magazine , the official publication of the World Future Society, and he has published over a hundred articles and essays in Hebrew and in English.



COMMENTS

“The foreskin is comparable to the clitoral hood which is sometimes removed surgically in women in order to enhance sexual pleasure.”

This is the first I’ve ever heard of this (dubious) justification for this practice.

“Some claim male circumcision lessens a man’s sexual sensitivity. If true, very few Jewish women have ever complained about that.”

That makes literally no sense. It’s his sense data to report and perceive.

“But personally, having met men circumcised as adults, I am quite happy that my parents made the decision for me – just as they did for my smallpox and polio vaccinations.”

I fail to understand how your particular satisfaction with your particular results of this “serious proposition carrying much moral weight” somehow magically obviates the fact that “the procedure should ultimately be a decision made volitionally by an adult and not imposed on a defenseless infant”.

Rather than ceasing a practice that irrevocably brands a person a member of a particular tribe before they can even provide informed consent to having THEIR VERY FLESH so irrevocably branded, in an age where tribalistic tensions threaten to undo civilization, you have satisfied yourself with the fact that it works for you. Forgive me if I find this inadequate.

“Male circumcision, therefore, is about as morally abhorrent as a nose-job.”

I agree.

And it is unethical to perform “nose jobs” on babies unless medically indicated for a pathology or deformity.  A healthy foreskin is not pathological nor a deformity.

Not all Jewish people believe in infant circumcision.  Brit Shalom is an alternative naming ceremony to celebrate the birth of baby boys to Jewish families.  These are just some of the sites run by Jewish people opposed to infant circumcision:

http://www.jewishcircumcision.org
http://www.jewsagainstcircumcision.org
http://www.circumcision.org
http://www.beyondthebris.com
http://www.cutthefilm.com

See also https://www.youtube.com/watch?v=VJ8Kt6Vu4oE  (footage of a bris with commentary from the subject)

The author’s description of female circumcision seems to demonstrate an ignorance of the various types of female genital cutting.  Firstly, some of the most common forms don’t even touch the clitoris.  Even a pinprick is banned in most western countries though, regardless of whether parents think it’s their religious right or obligation to have that done.

Female circumcision also seems not to increase, but rather decrease the risk of HIV:
Stallings 2005
“A lowered risk of HIV infection among circumcised women was not attributable to confounding with another risk factor in these data.”
https://www.aids2014.org/Abstracts/A2177677.aspx

Professor Morris isn’t a pediatrician, a urologist, or even a physician, and his views are way out of line with those of most national medical organizations.  This is what PZ Myers has to say:
“But then, that’s Brian Morris all over the place. He actively tries to suppress work that doesn’t support his conclusions, he inflates any evidence that suggests circumcision might have a few benefits (there are some!), and dismisses any evidence to the contrary…or worse, twists it around to claim it supports the opposite of the author’s interpretations. All this in defiance of worldwide statements from pediatric organizations that say the evidence for health benefits from circumcision are weak, and that routine circumcision is not recommended.”

He also said he was a peer-reviewer for the Royal Australasian College of Physicians when he isn’t even a member of it.  Their policy on male circumcision says this: “After reviewing the currently available evidence, the RACP believes that the frequency of diseases modifiable by circumcision, the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia and New Zealand.”
(“Routine” circumcision is now *banned* in public hospitals in Australia.)

This is what some national medical organizations have to say about routine infant male circumcision:

Canadian Paediatric Society
http://www.cps.ca/en/documents/position/circumcision
“Recommendation: Circumcision of newborns should not be routinely performed.”

http://www.caringforkids.cps.ca/handouts/circumcision
“Circumcision is a ‘non-therapeutic’ procedure, which means it is not medically necessary.”
“After reviewing the scientific evidence for and against circumcision, the CPS does not recommend routine circumcision for newborn boys. Many paediatricians no longer perform circumcisions.”

Royal Australasian College of Physicians
http://www.racp.edu.au/index.cfm?objectid=65118B16-F145-8B74-236C86100E4E3E8E
“After reviewing the currently available evidence, the RACP believes that the frequency of diseases modifiable by circumcision, the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia and New Zealand.”
(almost all the men responsible for this statement will be circumcised themselves, as the male circumcision rate in Australia in 1950 was about 90%.  “Routine” circumcision is now *banned* in public hospitals in Australia.)

British Medical Association
http://bma.org.uk/-/media/Files/PDFs/Practical advice at work/Ethics/Circumcision.pdf
“to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate.”

The Royal Dutch Medical Association
http://knmg.artsennet.nl/Diensten/knmgpublicaties/KNMGpublicatie/Nontherapeutic-circumcision-of-male-minors-2010.htm
“The official viewpoint of KNMG and other related medical/scientific organisations is that non-therapeutic circumcision of male minors is a violation of children’s rights to autonomy and physical integrity.”

http://www.crin.org/resources/infodetail.asp?id=31830
“[30 September 2013] - At a meeting today in Oslo, the children’s ombudspersons from the five Nordic countries (Sweden, Norway, Finland, Denmark, and Iceland), and the children’s spokesperson from Greenland, in addition to representatives of associations of Nordic paediatricians and pediatric surgeons, have agreed to work with their respective national governments to achieve a ban on non-therapeutic circumcision of underage boys.”

German Pediatric Association
http://www.intactamerica.org/german_pediatrics_statement
(very long, but very much against circumcision, and includes the following)
“Therefore it is not understandable that circumcision of boys should be allowed but that of girls prohibited worldwide. Male circumcision is basically comparable with FGM types Ia and Ib that the Schafi Islamic school of law supports”

http://pediatrics.aappublications.org/content/early/2013/03/12/peds.2012-2896.abstract
“The other claimed health benefits, including protection against HIV/AIDS, genital herpes, genital warts, and penile cancer, are questionable, weak, and likely to have little public health relevance in a Western context, and they do not represent compelling reasons for surgery before boys are old enough to decide for themselves.”
(Written in direct response to the AAP’s position statement on male circumcision, and signed by 38 senior physicians, about half of them presidents or chairs of national paediatric or urological organisations).

I am posting this for the author, Tsvi Bisk:

—-

It is curious that neither respondent related to my greater point, that female genital mutilation, which entails removal of the clitoris and the labia is in anyway equivalent to the removal of the male foreskin which I assure SHaGGGz is anatomically comparable to the clitoral hood (I do not understand the rest of his points).

Most important, neither respondent related to its obvious health benefits (as delineated in the article). I accept VoxInfantorum criticism.  I should not have tried to be cute and should have written “as morally abhorrent as a vaccination”.  It is no way as morally abhorrent as removing the clitoris and the labia – you would have to remove the penis and the scrotum to be as morally abhorrent.

Given its obvious health benefits I can see no moral issue attached to the issue.


Tsvi Bisk
Director
Center for Strategic Futurist Thinking
972-54-558-7940
http://www.tsvibisk.com
Author
The Optimistic Jew
Contributing Editor to The Futurist magazine

Ethicists who write about FGM/C should first learn what “it” is and not naively assume it equals Type III or involves cutting.  http://www.who.int/reproductivehealth/topics/fgm/overview/en/.
The equivalence of FGM/C and MGM/C (and indeed IGM/C as it relates to intersex babies and children ) is in the denial of freedom to choose and the breach of trust and human rights. Of the child. Not the parent.

@Tsvi: You’re correct in pointing out that the foreskin is comparable to the clitoral hood. This has no bearing on the fact that these are still medically unnecessary genital mutilations of infants, done for primarily cultural/tribal reasons. Though, I find it interesting that you bring up the anatomical analogy between the genitals in the context of reasons for the allowability of circumcision. Are you really saying that medically unnecessary female genital mutilation done for primarily cultural/tribal reasons is fine too?

You’re also correct about the health benefits regarding HIV transmission, though that’s a pretty thin basis for equating circumcision with vaccination, with respect to moral abhorrence. Vaccinations are done primarily for health reasons. Circumcisions are done primarily for cultural/tribalistic reasons. To point to a bygone era wherein prevailing medical opinion was that circumcision was medically necessary, to make it seem as if this behavior that violates the bodily integrity of another human is motivated by concern for that human’s health and not by a desire to brand that human with the tribal affiliation of its parents, adds a layer of disingenuous misdirection that I find shameful. Let’s at least be clear as to the underlying motivations at play here.

I think Tsvi’s contention that parents getting their children circumcised is comparable to getting their children vaccinated, is an interesting and possibly valid POV.

Parents do have the legal right to get all kinds of surgical operations and interventions performed on their children’s bodies. Children frequently get their appendixes, tonsils and foreskins chopped off when they’re young, they’re shot full of drugs, lice poison is shampooed in their hair, etc etc. all in the name of health.

Parents are permitted to do this because its assumed they have the child’s health as top priority.

I don’t see a future where parents lose this control over their child’s body, as long as what they’re doing is popularly regarded as healthy. If circumcision gets defined as physically dangerous or a severe social mutilation - it will be outlawed.

I do not think that infants and young children are going to get to decide that their body is theirs, instead of their parents, anytime soon. And that’s a good thing. Children aren’t able to rationally decide what’s best for them. They don’t want shots, or trips to the dentist, so parents and doctors and dentists have to force them to take the needle and drill.

ShaaGGz’s contention that young children should be allowed to decide what happens to their bodies? - I don’t agree with that.

I think we’re left with the question - how healthy, or harmful, or horrific, is circumcision? And my opinion on that is that the health benefits in a developed nation are negligible, the dangers are negligible, and the “mutilation” is socially - for now - quite acceptable.

If circumcision is performed for religious reasons - well, that is indeed foisting a belief system’s culture on someone too young to comprehend or give consent to that set of ideas. Just like baptism or enrolling children in a madrassa or parochial school. Richard Dawkins and others have advocated closing all religious educational institutes, because it is a form of brainwashing/child abuse.

I find that discussion more interesting and important than the discussion on circumcision.

To put it in personal terms -

My parents circumcised me, and I’m not the least bit angry about that

My parents raised me Catholic, and that… I’m still a bit resentful.

 

My contention wasn’t that children should be granted sovereignty - merely that parents should wield the awesome responsibility entrusted to them responsibly, and only performing such irreversible procedures for reasons that are actually reasonable, such as instances of medical necessity. Using children as props to validate their parents’ ideologies is the furthest thing from that.

The conversation about religious indoctrination of children is indeed more interesting, but only because it’s basically this same question, writ large.

Actually io9 did a far better treatment of this subject months ago. Their article aimed to be more objective, and it’s clear that the much vaunted claims of ‘health benefits’ are not exactly consensus medical opinion.

http://io9.com/the-troubled-history-of-the-foreskin-1688763143

Axiom - that is a very good essay, you’re right.

Here’s what I’ve written on the topic

http://www.salon.com/1997/08/20/circ970820/

http://www.salon.com/2000/02/28/nakedaids/

http://ieet.org/index.php/IEET/more/pellissier20120720

Some very interesting stuff there Axiom and Hank.

As regards comparing male circumcision and female genital cutting, the worst forms of FGC are unquestionably worse than the usual form of western male circumcision, but the worst forms of male circumcision are also far worse than the lesser forms of female cutting.  Over 100 males died of circumcision in the Eastern Cape Province of South Africa last year, and there were at least two penile amputations and one castration.

This site shows gruesome photos of the results: http://ulwaluko.co.za/

Compare that with this form of FGC (very common in some countries, but illegal in the USA):
http://tinyurl.com/zahras-circumcision

US doctors who were promoting female circumcision till the 1960’s routinely compared it to male circumcision eg
http://www.noharmm.org/circumfemale.htm
Circumcision of the Female
C.F. McDonald, M.D. - Milwaukee, Wisconsin
GP, Vol. XVIII No. 3, p. 98-99, September, 1958
(“If the male needs circumcision for cleanliness and hygiene, why not the female?”)

More recently, the AAP’s Bioethics committee changed its policy on female cutting in 2010 saying “It might be more effective if federal and state laws enabled pediatricians to reach out to families by offering a ritual [clitoral] nick as a possible compromise to avoid greater harm.”
They were forced to retract this about six weeks later:
http://www.medscape.com/viewarticle/722840
Dr Diekema, the chair of the committee said “We’re talking about something far less extensive than the removal of foreskin in a male”.

Even if many westerners see a fundamental difference between cutting girls and boys, the people that cut girls don’t (it’s usually cut women btw, and they get furious if you call it “mutilation”).  There are intelligent, educated, articulate women who will passionately defend it, and as well as using the exact same reasons that are used to defend male circumcision in the US (religious, cultural, hygiene, cosmetic, disease prevention, and allegedly improved sex life), they will also point to male circumcision itself, as evidence of western hypocrisy regarding female circumcision.  The sooner boys are protected from genital mutilation in the west, the sooner those peoples that practice FGM will interpret western objections as something more than cultural imperialism.

“Male circumcision, therefore, is about as morally abhorrent as a nose-job.”

How many children are given a nose-job when they are less than 10 days old?

About one million boys are given a pseudo-medical circumcision in the US every year, almost all done within a day or two of birth, by a doctor who collects a fee of several hundred dollars in exchange for about 10-15 minutes of savage butchery; he enables the hospital where it’s done to collect a fee that is almost always a few dollars more than his. “Use of the circumcision facility” the statement often says; said facility is most often a small space on a counter-top or table-top in a corner of the nursery.

From 15% to 30% are botched seriously enough to require corrective surgery. The costs of these negligence-fixing operations are typically assessed against the parents who either pay or find a malpractice attorney to redirect that effort to collect; but Temple of Medicine does its best to collect at first. Some boys suffer life-long pain at site of circumcision or corrective surgery. A few (100 - 200) die annually in US from bleeding out (the penis is one of the most innervated and vascularized organs on the male body). US medicine’s AAP claims that there are no deaths from circumcision. Judaism has a law that establishes an exemption from circumcision for any boy whose mother has lost two of his older brothers to circumcision death; since the procedure is almost identical as rite or pseudo-medical ritual, it’s unlikely US medicine’s claim is honest.

Relying on the science of one non-expert (a molecular scientist whose field of expertise is “the molecular genetics of hypertension” and whose extra-curricular advocacy for unnecessary circumcision through The Gilgal Society brought him into collaboration with convicted boy-paedophile Vernon Quaintance) is unsafe at best and unprofessional at worst.
Another ethicist’s critique of Morris’ opinions in this field is to be found at:
https://www.skeptic.org.uk/magazine/onlinearticles/711-infant-circumcision
FYI

@RicardoD: “Judaism has a law that establishes an exemption from circumcision for any boy whose mother has lost two of his older brothers to circumcision death”

Wow. That is a very telling special case. Even more telling that the regulated phenomena was enough of a problem to actually explicitly formalize into law. I think of circumcision as even less justifiable after reading this article and comments.

The capacity for otherwise moral and intelligent people to advocate for such clearly unreasonable activity still amazes me. I hope you’ve found the discussion intellectually provocative, Tsvi.

http://www.wsj.com/articles/SB10001424127887324798904578531063301112102

The benefits of circumcision… include a marked reduction in urinary-tract infections, which affect one in 100 uncircumcised boys, mainly during the first two years of life, and inflammation or infection under the foreskin, which affects around 17 in 100 uncircumcised boys before the age of 8. Circumcision reduces the risk of these problems by around 60%. In adulthood, circumcision has been shown to reduce the risk of HIV infection in men by 50% to 60%, and is now recommended by the World Health Organization as an HIV prevention strategy.

Circumcision also lowers the risk of acquiring herpes infection and genital ulcers in men. It reduces infection with human papilloma viruses, or HPV, in both men and their female partners. HPV is one of the most common sexually transmitted infections in the U.S., causing cervical, penile and anal cancers, as well as genital warts. Female partners of circumcised men have lower rates of vaginal infections and genital ulcers.

and here’s some from Uganda:

http://www.avert.org/hiv-aids-uganda.htm

Currently, 7.2 percent of Uganda’s population is living with HIV.  This amounts to an estimated 1.4 million people, which includes 190,000 children.  An estimated 62,000 people died from AIDS in 2011 and 1.1 million children have been orphaned by Uganda’s devastating epidemic.

HIV prevalence has been rising since its lowest rate of 6.4 percent in 2006.  New infections are diagnosed in 150,000 people a year, of whom 20,600 are children. 

———

To Conclude:

circumcision lowers risk of HIV/AIDS by 50%; 62,000 Ugandans die annually of this in Uganda; 31,000 Ugandan lives would be spared if they had been circumcised

If I was an Ugandan parent, I’d get my son circumcised.

I’m not, I’m American… so… I probably wouldn’t… but with this data in mind… is it actually “cruel” to circumcise, or just precautionary?

 

I listed the position statements of several national medical ofrganizations which don’t believe that the benfits of male circumcision outweigh the risks.

Circumcising to prevent HIV seems bizarre.

From a USAID report:
“There appears no clear pattern of association between male circumcision and HIV prevalence—in 8 of 18 countries with data, HIV prevalence is lower among circumcised men, while in the remaining 10 countries it is higher.”
http://www.measuredhs.com/pubs/pdf/CR22/CR22.pdf
(this will include men who were circumcised tribally rather than medically, but they and their partners may also believe themselves to be protected, and the whole rationale for the RCT’s into female-to-male transmission was a purported correlation between high rates of male circumcision and low rates of HIV)

It seems highly unrealistic to expect that there will be no risk compensation.  The South African National Communication Survey on HIV/AIDS, 2009 found that 15% of adults across age groups “believe that circumcised men do not need to use condoms”.  This figure seems to have been unchanged in 2012.
http://www.info.gov.za/issues/hiv/survey_2009.htm
http://www.hst.org.za/sites/default/files/ZANationalHIVCommunicationSurvey2012.pdf
http://jhhesa.org/sites/default/files/hiv_survey.pdf

It is unclear if circumcised men are more likely to infect women.  The only ever randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60998-3/abstract

ABC (Abstinence, Being faithful, and especially Condoms) is the way forward.  Promoting genital surgery seems likely to cost African lives rather than save them.

http://www.iasociety.org/Default.aspx?pageId=11&abstractId=2197431
Conclusions: We find a protective effect of circumcision in only one of the eight countries for which there are nationally-representative HIV seroprevalence data. The results are important in considering the development of circumcision-focused interventions within AIDS prevention programs.

http://apha.confex.com/apha/134am/techprogram/paper_136814.htm
Results: … No consistent relationship between male circumcision and HIV risk was observed in most countries.

This 1993 study found that “partner circumcision” was “strongly associated with HIV-1 infection [in women] even when simultaneously controlling for other covariates.”
http://ije.oxfordjournals.org/cgi/content/abstract/23/2/371

Here’s another article, from the very reputable Nature, that generally supports circumcision in Africa.

http://www.nature.com/news/aids-prevention-africa-s-circumcision-challenge-1.14156

Hi Tsvi,

I read IEET often and also think infant male circumcision is unethical after much research and thought. Something about your writing and response makes me think your approach is genuine and in the spirit of seeking truth, so I would like to introduce you to some resources I think you would appreciate.

In a nutshell, the resources are everything by ethicist Brian Earp.
1) http://www.academia.edu/8817976/Female_genital_mutilation _FGM_and_male_circumcision_Should_there_be_a_separat e_ethical_discourse
2) https://www.skeptic.org.uk/magazine/onlinearticles/711- infant-circumcision (A reply to Brian Morris)
3) http://www.academia.edu/5790397/Autonomy_is_not_the _only_game_in_town_…_but_it_is_the_best_game_in_town (I just realized only the abstract is now available, but if you can find the full document it’s really good)
4) https://www.youtube.com/watch?v=sdet-azcx0I (A discussion specifically on religious circumcision, maybe start with this)

He also has an article in a special edition on the ethics of circumcision in the Journal of Medical Ethics. There are 15 good articles in there from 2013, including discussion on religious circumcision. http://jme.bmj.com/content/39/7.toc

Also a fantastic recent article by Robert Darby which was editors pick of the Kennedy Institute of Ethics Journal in March 2015 is here: https://kiej.georgetown.edu/wordpress/wp- content/uploads/2015/03/03_25.1darby.pdf
It’s called “Risks, Benefits, Complications and Harms: Neglected Factors in the Current Debate on Non-Therapeutic Circumcision”

And for a less rigorous slightly condescending youtube video that I think does a pretty good job of framing the differences between male and female circumcision, check out this: https://www.youtube.com/watch?v=98f3IavuEgQ

I am posting this for Tsvi Bisk:

I ask only one question: “how many millions of Africans would have been saved (from dying) if male infant Circumcision were standard religious practice in Africa?”

Compared to: How many millions of Africans would have been saved (from dying) if male condoms were standard sexual practice in Africa?

I’m guessing more than if they sliced half a billion people, but who knows. That’s the beauty of the hypothetical, everyone sees what they want to see.

All children, regardless of gender, culture or parental religion, have a fundamental right to keep all their healthy, functional genitalia.  Since an infant is incapable of religious beliefs, imposing an irreversible body alteration on him violates the freedom to choose his own religion as an adult.  It differs from education, which can be changed.  My body belongs to me!

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