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Redefining cancer

Blogging is a rather immediate endeavor. Over the last nine years (nearly), I’ve lost track of how many times I saw something that I wanted to blog about but by the time I got around to it, it was no longer topical. Usually what happens is that my Dug the Dog tendencies take over, as I’m distracted by yet another squirrel, although sometimes there are just too many targets topics and too little time. Fortunately, however, sometimes the issue is resurrected, sometimes in a really dumb way, such that I have an excuse to correct my previous oversight. This is just such a time, and the manner in which the topic has been resurrected is every bit as dumb as the rant by the Food Babe that Mark Crislip so delightfully deconstructed last Friday. Unfortunately, for purposes of snark, I’m not Mark Crislip—but, then, who is?—but fortunately I am known elsewhere (and sometimes here) for being a bit “insolent.” So let’s dig in. We’ll start with the idiocy and then use that as a “teachable moment” about cancer biology. Funny how I manage to do that sort of thing so often.

Abuse of cancer science for political purposes

I realize that we at SBM are supposed to stay, for the most part, apolitical, but the idiocy that’s leading me to revisit a topic is unavoidably political because it involves using a profound misunderstanding of science for political ends. Specifically, I’m referring to the misuse of a legitimate scientific debate about cancer screening and diagnosis for purely political ends. First, however, for those not living in the US or my fellow citizens who might be blissfully unaware (in this case) of recent events, during the first half of October, our nation underwent what can only be described as a self-inflicted crisis that could have caused worldwide economic turmoil if it hadn’t been (sort of) resolved at the last minute. The reason for the crisis boiled down to the extreme resistance of some of our more radically conservative Representatives to the Patient Protection and Affordable Care Act, usually referred to as just the Affordable Care Act (ACA) or, colloquially, Obamacare. Normally when we write about Obamacare here on SBM, it’s to complain about how advocates of unscientific medicine and outright quackery have tried to piggyback their advocacy on the ACA in order to have health insurance plans sold through government exchanges cover modalities like naturopathy, chiropractic, and other so-called “complementary and alternative medicine” (CAM) or “integrative medicine.” In related posts, I’ve examined the evidence with respect to the relationship between health insurance and mortality and whether attacks on Medicaid as not improving the health of patients insured by it have any validity. (Let’s just say they are oversimplifications and distortions.)
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Posted in: Cancer, Diagnostic tests & procedures, Politics and Regulation, Science and the Media

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Yes, Chris beat cancer, but it wasn’t quackery that cured him

Editor’s note: Due to technical difficulties, SBM experienced considerable downtime yesterday. I therefore decided to delay publishing this post until now. Harriet’s normally scheduled Tuesday post will also appear later.

I like to think that one of the more important public services I provide here at Science-Based Medicine is my deconstructions of alternative cancer cure testimonials. After all, one of the most powerful marketing tools purveyors of cancer quackery have in their arsenal is a collection of stories of “real patients” with cancer who used their nostrums and are still alive and well. These sorts of analyses of alternative cancer cure testimonials began right near the very beginning of my not-so-super-secret other blog way back in 2004, metastasized—if you’ll excuse my use of the term—to SBM in 2008, and have continued intermittently to this very day, most recently with a bevy of posts showing why the testimonials of Stanislaw Burzynski’s patients do not constitute good evidence that he can cure cancers considered incurable by “standard” medicine. In other words, Burzynski’s “success stories” aren’t the slam-dunk evidence he and Eric Merola want you to believe them to be regarding the use of antineoplastons to cure brain cancers.

Sometimes, these patients who believe that alternative medicine somehow cured their cancers are so transformed, so energized, that they basically devote their lives to selling, in essence, their story, along with all the stuff they did to “cure” their cancer. I just came across one such person, a man by the name of Chris Wark, whose website and blog Chris Beat Cancer sells the idea that he beat his cancer with nutrition and “natural therapies” that he used to “heal himself.” All of this wouldn’t be quite so horrible—after all, there are lots of people who believe in woo and say so publicly—except that Wark is now also selling all sorts of misinformation about cancer, at $175 for a two hour phone consultation. Regular readers will recognize right away where Mr. Wark goes wrong in his story. Even so, I think it’s worthwhile to take a look because since discovering Mr. Wark’s site I’ve seen his name popping up all over the place promoting “natural” cures, and his site has become a repository of all sorts of “alternative cancer cure” testimonials, as well as credulously promotional material for quackery like Gerson therapy, the Beck protocol, and the Gonzalez protocol.

First, let’s take a look at Mr. Wark’s story. Since his story is so simple to deconstruct, I’ll then look at more of the material on his website. Right on the front page of Mr. Wark’s website, there is a brief blurb about him that reads:
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Posted in: Cancer

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Cancer Treatment Centers of America: Revisiting the epitome of “integrative” cancer care

Three weeks ago, I mentioned in a post that the week of October 7 to 14 was declared by our very own United States Senate to be Naturopathic Medicine Week, which I declared unilaterally through my power as managing editor of Science-Based Medicine (for what that’s worth) to be Quackery Week. One wonders where the Senate found the time to consider and vote for S.Res.221, which reads:

S.Res.221 – A resolution designating the week of October 7 through October 13, 2013, as “Naturopathic Medicine Week” to recognize the value of naturopathic medicine in providing safe, effective, and affordable health care.

I know, I know, it probably took all of five minutes to consider and vote for this, thanks to Sen. Barbara Mikulski (D-MD), who sponsored it. In any case, as October 7 approached, I thought about how I could keep my promise to blog about naturopathy this week, and I came up with a way to do it. It’s a bit roundabout, but I think it fits. The idea derives from a discussion I was having a while back about one of my “favorite” hospitals, namely the Cancer Treatment Centers of America, in which a colleague of mine questioned why there were so many CTCA ads on NPR and why CTCA is sponsoring shows on PBS such as the upcoming The Emperor of All Maladies by Ken Burns. Although I can’t wait to see this particular series, I am a bit worried that the infiltration of quackademic medicine will make an appearance, given that CTCA is a major sponsor. (more…)

Posted in: Cancer, Homeopathy, Naturopathy

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Obamacare, the Oregon Experiment, and Medicaid

Tomorrow, as mandated by the Patient Protection and the Affordable Care Act (PPACA, often called just the Affordable Care Act, or ACA, or “Obamacare”), the government-maintained health insurance exchanges will open for business (that is, assuming the likely government shutdown doesn’t stop them temporarily). We here at SBM have written about the ACA quite a few times, but I would like to write about it in perhaps an entirely different context than you’re used to now that the biggest change mandated by the law is here. Just to see the contrast, I’ll mention that Jann Bellamy has written about the ACA in the context of how provisions have been inserted by promoters of “complementary and alternative medicine” (CAM) could potentially provide an “in” for requiring reimbursement of CAM practitioners for their services by insurance plans sold through the exchanges or even how CAM practitioners might promote themselves as primary care providers (PCPs) under Obamacare, as did Matt Roman. I myself warned about legislative meddling that might permit funding of religion-based health care in the exchanges, and Kimball Atwood sounded early warnings about insertion of the provisions that Jann warned about. Instead, view this discussion as a follow-up to a post I did almost a year ago that used a statement by Mitt Romney during the height of the Presidential campaign as a jumping off point to look at the relationship between health insurance status and mortality. While we at SBM try to remain more or less apolitical, in some cases (licensing of naturopaths, for example) it is not possible to disentangle science from politics, and we have to dive in. Also, politics is the art of the possible; so, policy-wise, what is best as determined by science might well not be what is possible politically.

The reason I wanted to revisit this topic is because of a political battle that went on for quite some time over the last several months to expand Medicaid in Michigan according to the dictates of the ACA. The reason that this battle is occurring in many states is because when the Supreme Court ruled last year that the individual mandate requiring that citizens have health insurance was Constitutional, one provision that it ruled unconstitutional was the mandatory expansion of Medicaid in states participating in the Medicaid program to cover all people under 65 up to 133% of the federal poverty level. States thus had to decide whether or not they would accept the Medicaid expansion. In our state, Governor Rick Snyder supported the expansion. Even though he is Republican, he is also a businessman and realized that it was a good deal, with the federal government covering 100% of the cost for the first three years and then phase down to 90% of the cost in 2020. The bill to expand Medicaid managed to pass the House of Representatives, but then it stalled in the Senate. Unfortunately—and this is what got me involved—my state Senator Patrick Colbeck led the opposition to the Medicaid expansion in the Senate, much to my chagrin and disappointment. His argument, which is being repeated elsewhere in the blogosphere, is that Medicaid is worthless and doesn’t improve health outcomes. Instead, he endorsed an alternative that (or so he claimed) places Medicaid-eligible patients into in essence low cost, high deductible concierge practices, with health savings accounts. This was a plan promoted by practices like BlueSky Health. Ultimately Mr. Colbeck lost, and Medicaid was expanded in Michigan in a plan that was characterized by John Z. Ayanian in this week’s New England Journal of Medicine as “a pragmatic pathway to link Republican and Democratic priorities for health care.”

However, the whole kerfuffle got me to thinking. In my post a year ago, I basically asked what the evidence was that access to health insurance improves health outcomes, but I didn’t really stratify the question into kinds of health insurance. Rather, I just looked at being uninsured versus having health insurance. After my little Facebook encounter with one of my elected representatives, I wondered what, exactly, was the state of evidence. So I decided to do this post. In the U.S., currently we have in essence three kinds of health insurance, broadly speaking: private insurance, Medicare, and Medicaid. Medicare, for those of our readers from other countries, is a plan that covers the medical care of people 65 and over and those receiving Social Security disability benefits. It is funded through payroll taxes and directly paid for by the federal government. Medicaid, in contrast, is a plan designed for low income people who fall below certain income levels. Also in contrast, it is jointly funded by the states and the federal government with each participating state administering the plan and having wide leeway to decide eligibility requirements within the limits of federal regulations that determine the minimal standards necessary for states to receive matching funds. Indeed, the loss of this leeway to determine the income level at which a person is eligible for Medicaid is one of the reasons the provision for Medicaid expansion was part of the Supreme Court challenge to the ACA. These days, most Medicaid plans hire private health maintenance organizations (HMOs) to provide insurance. Finally, what needs to be understood is that, compared to private insurance, Medicare reimbursement rates tend to be lower and Medicaid reimbursement rates are lower still, which is part of the reason why a lot of doctors don’t accept Medicaid. Increases in reimbursement under the ACA might well help this situation. (more…)

Posted in: Clinical Trials, Epidemiology, Politics and Regulation, Science and the Media

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Obesity, cancer, and chemotherapy

In medicine, particularly oncology, it’s often the little things that matter. Sometimes, however, the “little things” aren’t actually little; they just seem that way. I was reminded of this by a story that was circulating late last week in the national media, often under titles like “Obese cancer patients often shorted on chemo doses”, ”Are obese people with cancer getting chemotherapy doses too small for them?”, and “Obese Cancer Patients Not Getting Full Doses of Chemotherapy Drugs”. It’s also interesting to me because it stands in marked contrast to something I’ve written about a lot on this blog: The overtreatment of cancer. In this case, this story is about the undertreatment of cancer in patients who are obese, and it’s a problem that has definite adverse effects on an obese person’s odds of surviving cancer.

I’ve been aware of this issue for some time and had been thinking of blogging about it for at least three years. The reason is that the oncologist who is best known for sounding the alarm on this issue is Jennifer Griggs at the University of Michigan and, being local and all, I’ve seen her speak on the topic several times at local breast cancer conferences. Now that I work with a statewide breast cancer care quality improvement initiative, I’m becoming more aware of her work. Indeed, I was rather puzzled why this issue bubbled up enough to be reported widely on the national news last week when the Nature Clinical Oncology paper by Gary H. Lyman and Alex Sparreboom that drew attention to the issue was published in August, and the original American Society of Clinical Oncology (ASCO) guidelines were published last year. Whatever the reason this issue has been getting more attention, it’s a good thing.
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Posted in: Cancer

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Is U.S. cancer care “in crisis,” as the Institute of Medicine proclaims?

Americans love to fight, traditionally. All real Americans love the sting and clash of battle…When you, here, everyone of you, were kids, you all admired the champion marble player, the fastest runner, the toughest boxer, the big league ball players, and the All-American football players. Americans love a winner. Americans will not tolerate a loser.

General George S. Patton, Jr. was famous for his flamboyance and aggressiveness going on the attack, among other things. He was also known for a number of pithy quotes made throughout his lifetime, particularly during World War II, such as the one above in which he declared how much Americans love to fight. I sometimes wonder whether he was more correct in that assessment than he knew in that we seem to view almost everything through the lens of war and a crisis that calls for a war. In medicine, for instance, we have the “war on cancer” and the “war on obesity.” We have a propensity for likening problems and their solutions to war, where the goal is to destroy the enemy.

Similarly, but less dramatic (although only slightly so), we have various crises. Indeed, Americans seem to love to compare problems to crises as much as they love to compare them to war. Of course, the two are closely related, as a crisis of some sort is a necessary prelude to a war. We can argue about the definition of a “crisis,” but one thing is certain. No matter how one defines it the word “crisis” implies an urgent problem and further implies that something must be done now—or at least very soon—to prevent the catastrophic consequences of that problem, which usually involve a breakdown of a current system. It was with these thoughts in mind that I approached the Institute of Medicine (IOM) consensus report released last week, Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis. It’s a behemoth of a report, weighing in at 360 pages, and it does indeed paint a picture of some very serious problems in cancer care that should be addressed. It is subdued in that it doesn’t engage in that oh-so-American tendency to declare “war” on every problem, but is cancer care “in crisis”? Of that, I’m not so sure, but it’s definitely got problems. But, as I’ve said, the system’s had problems for a long time, as the IOM itself documented in its 1999 report Ensuring Quality of Cancer Care, which concluded that “for many Americans with cancer, there is a wide gulf between what could be construed as the ideal and the reality of their experience with cancer care.” The report also recommended steps to improve cancer care and the evidence base for cancer care, and to overcome barriers of access to high-quality cancer care. As the introduction to the current report states:
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Posted in: Cancer

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Naturopathic Medicine Week 2013, or: Quackery Week 2013

[Ed. Note: This is an extra "bonus" post from Dr. Gorski's not-so-super-secret other blog. He thought the topic would be of interest to SBM readers as well. Fear not. There will be a post on Monday, as usual.]

The vast majority of ideas and treatments that make up the “complementary and alternative medicine” (CAM) specialty known as naturopathy are quackery. There, I said it. No doubt I will be castigated for being too “blunt,” “dismissive,” or “insulting,” but I don’t care. It is my opinion based on science, and I’m sticking to it.

The problem with naturopathy, of course, is that it is so diffuse and encompasses so many different forms of quackery that it’s hard to categorize. Basically, it’s anything that can be portrayed as “natural,” be it traditional Chinese medicine, homeopathy (which is an integral component of naturopathy, something that should tell you all you need to know about naturopathy), herbalism, energy healing, Ayurvedic medicine, the four humors, or whatever. Add to that a number of bogus diagnostic modalities, such as applied kinesiology, live blood cell analysis, iridology, tests for imaginary “food allergies” and “nutrient deficiencies” that conventional medicine doesn’t recognize, plus an overwhelming emphasis on purging the body of “toxins,” unnamed and named but all unvalidated by science, and it rapidly becomes apparent that naturopathy is a veritable cornucopia of pseudoscience and quackery. Seemingly, there is no quackery that naturopathy does not credulously embrace, which is why the success of recent efforts of naturopaths to achieve licensure in several states and even obtain limited privileges to prescribe real pharmaceutical drugs is so alarming, as are their efforts to become recognized as primary care providers under the Affordable Care Act. Basically, naturopathy is a hodge-podge of quackery mixed with science-based modalities magically “rebranded” as “alternative” and “natural.” In that, naturopathy is the ultimate in “integrative medicine,” in which quackery is “integrated” with science-based medicine. As I’ve pointed out many times before, integrating quackery and pseudoscience with real medicine does not elevate the quackery and pseudoscience, but it does contaminate the real medicine with quackery to no good benefit. Unfortunately, it’s insinuating itself into the law.

With that introduction in mind, did you know that the week of October 7 through 13 is Quackery Week in the U.S.? No, seriously, it is. The Senate just passed a resolution declaring that this is so. Oh, it’s true that the Senate didn’t actually call it that. Instead, the resolution (S.Res. 221) was passed, and it declares the week of October 7 to 13, 2013 to be Naturopathic Medicine Week, which is the same thing as declaring it Quackery Week:

S.Res.221 – A resolution designating the week of October 7 through October 13, 2013, as “Naturopathic Medicine Week” to recognize the value of naturopathic medicine in providing safe, effective, and affordable health care.

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Posted in: Homeopathy, Naturopathy, Science and the Media

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Another antivaccine zombie meme: polio vaccine and SV40 and cancer, oh, my!

Another antivaccine zombie meme: polio vaccine and SV40 and cancer, oh, my!

The Internet has produced a revolution with respect to information. Now, people anywhere, any time, can find almost any information that they want, as long as they have a connection to the global network and aren’t unfortunate enough to live in a country that heavily censors the Internet connections coming in. In addition, anyone any time can put his or her opinion out on the Internet and it might be read by people on the other side of the planet. For example, it continually amazes me that my blatherings here are read by people in Australia and New Zealand, as well as Europe and pretty much every other continent. Before the Internet, there was no way I would ever have achieved my current measure of minor celebrity status (and I do mean minor). Now, with enough good (I hope) writing and some links from some popular sources, and I can make my opinion known worldwide.

The dark side of this is that cranks can also make their opinions known worldwide, and, all too frequently, they are much better at it than skeptics are. For example, this very blog used a generic, vanilla WordPress template for the longest time, only updating it a few months ago. Meanwhile crank websites like NaturalNews.com are decked out in the latest, greatest web accoutrements, complete with video. One other problem with the democratization of information is that there now exist what I like to call “zombie memes.” In the world of quackery and pseudoscience, these are pseudoscientific claims on the Internet that never die, no matter how often they are refuted. Generally, such memes/claims pop up, make a fuss, are refuted, and then disappear. Then a few months (or even a year or two) later, something will happen to resurrect them. Maybe it’s a clueless mortician cremating the remains of such a zombie meme during a rainstorm and letting whatever it is that resurrected the dead meme in the first place permeate the soil of a graveyard of dead memes. Maybe it involved injecting a glowing fluid into the corpse of the meme. Who knows? Who cares that much? All I know is that these zombie memes keep popping up again and again as though they were new.

Re-animator-imagem

Now that the World Wide Web (at least as we know it, in its graphically browsable form) is approaching its twentieth birthday, we now have enough perspective to see these things. Steve Novella pointed out one zombie meme just the other day about the MMR, as did a certain person well known to this blog. Just yesterday I noticed another of these zombie memes arising from the dead yet again to feast on the brains of the living and thus make them cranks too. (At least, that is the goal of their continual resurrection.) This one popped up at that online repository of all things quackery, NaturalNews.com, in a post by Mike Adams himself entitled Merck vaccine developer admits vaccines routinely contain hidden cancer viruses derived from diseased monkeys. Other versions of this meme pop up from time to time with titles like CDC Admits 98 Million Americans Received Polio Vaccine In An 8-Year Span When It Was Contaminated With Cancer Virus.

Let’s dive in, shall we?
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Posted in: Vaccines

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The future of “integrative medicine” is too close for comfort

I was the other day. I’ve been on vacation this week (staycation, actually, as I stayed at home and didn’t go on any trips); so you would think it would take a lot to depress me. Unfortunately, today is the last day of that vacation; so the thought of diving back into the fray trying to fund my lab. It didn’t help that I read Scott Gavura’s Thursday post how another once-proud academic medical center, the University of Toronto, is letting the Trojan horse that is “integrative medicine” into the halls of its medical school and school of pharmacy. As I frequently say, much to the annoyance of advocates of “complementary and alternative medicine” (CAM) and “integrative medicine,” what “integrative medicine” does is to “integrate” quackery with real medicine, which neither validates the quackery nor improves the real medicine. Or, as my good bud and fellow SBM blogger Mark Crislip so aptly put it:

If you integrate fantasy with reality, you do not instantiate reality. If you mix cow pie with apple pie, it does not make the cow pie taste better; it makes the apple pie worse.

Yes, I’ve been trying to come up with a quote that captures the essence of “integrative medicine” better than Mark’s quote. I’ve yet to succeed; so I steal his quote whenever I need to. It’s sort of the same way that I didn’t actually coin the term “quackademic medicine” to describe the infiltration of quackery into academic medicine. (Dr. R. W. Donnell did, as far as I’ve been able to ascertain.) However, I believe I’ve done more than anyone else to use and promote the term, both here and at my not-so-super-secret other blog. As I like to say say, mediocre bloggers borrow. Great bloggers steal.

Be that as it may, Scott’s post reminded me that I hadn’t looked much at quackademic medicine, at least not at the status of its infiltration into medical academia, in a while. Then I saw a review article entitled The Future of Integrative Medicine in The American Journal of Medicine by Victor S. Sierpina, MD, ABFM, ABIHM and James E. Dalen, MD, MPH. (Note that ABIHM stands for the American Board of Integrative Holistic Medicine and ABFM stands for the American Board of Family Medicine.). The article itself has no place in any self-respecting peer-reviewed medical journal, but there it is, much the same way that quackademic woo has been intermittently infiltrating the New England Journal of Medicine. The article itself is one massive apologia for integrative medicine. In fact, it’s useful to look at because it follows a script that virtually all such articles follow, with only relatively minor variations.

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Posted in: Medical Academia, Science and Medicine

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Sharyl Attkisson and CBS News: An epic fail in reporting on the murder of autistic teen Alex Spourdalakis

An antivaccine reporter strikes again

The damaged done by the antivaccine movement is primarily in how it frightens parents out of vaccinating using classic denialist tactics of spreading fear, uncertainty and doubt (FUD). Indeed, as has been pointed out many times before, antivaccinationists are often proud of their success in discouraging parents from vaccinating, with one leader of the antivaccine movement even going so far as to characterize his antivaccine “community, held together with duct tape and bailing wire,” as being in the “early to middle stages of bringing the U.S. vaccine program to its knees.” Meanwhile, just last week Anne Dachel, “media editor” for the antivaccine crank blog Age of Autism, gloated about basically the same thing, how although overall vaccination rates remain high, vaccine exemption rates are up in many areas of the country and how her movement has provided plenty of information to “scare [parents] out of vaccinating.”

And it is the very same antivaccine propaganda blog, Age of Autism, that is promoting a different, more insidious message, specifically how the brutal murder of an autistic teen nearly three months ago “illumines the autism nightmare.” What do I mean by “insidious message”? It’s the hijacking of the autism advocacy movement, which tries to advocate for more services for autistic children and adults and more awareness and understanding of autism, by the antivaccine message that autistic people are somehow “damaged,” be it by vaccines or unnamed “toxins,” that the “real child” has been “stolen” by autism, and that any manner of biomedical quackery to “recover” autistics is justified by the horror of autism. Although Attkisson, the reporter for the story discussed below, never specifically mentions vaccines, if you know the background of the case, that message is quite obvious and not very far under the surface of her report on the murder of Alex Spourdalakis:

Not surprisingly, this story was reported by Sharyl Attkisson, who is CBS News’ resident antivaccine reporter. I’ve known her to promote antivaccine views in a manner that gave Robert F. Kennedy, Jr. a run for his money as far back as 2007. Since then, she’s smeared Paul Offit as a “pharma shill,” very likely fed information to someone at AoA to help them portray Lisa Randall at Voices for Vaccines as an “industry group,” done a puff piece about antivaccine physician and hero to the antivaccine movement Andrew Wakefield, and misreported the significance of the Hannah Poling case (which was really just the rebranding of autism). Most recently, Attkisson promoted a truly execrable “review article” summarizing the evidence relating vaccines to autism. The review article, by Helen Ratajczak, cited lots of pseudoscience from antivaccine literature in the service of supporting a truly dumb hypothesis, namely that DNA from vaccines could recombine in the brains of children to result in autism. Attkisson was quite smitten with the idea. As you might imagine, I was not. Along the way, Attkisson also indulged in promoting breast cancer misinformation. No wonder she is the perfect reporter to do this story promoting the viewpoint that autism is so horrible and the system provides so little help that we should understand why a mother like Alex’s might become so desperate that she would poison her son and then, when that failed to kill him, try to slash his wrist, and then, when that failed, stab him in the heart with a kitchen knife.
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Posted in: Neuroscience/Mental Health, Science and the Media, Vaccines

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