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Case against MARK TAYLOR


©2018 Dr Romesh Senewiratne-Alagaratnam

romeshsenewiratne@gmail.com

https://www.facebook.com/HUBForensics

https://www.facebook.com/HUBLegalDepartment

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Charges:
1. Crimes Against Humanity (CAH)
2. Torture (mass)
3. Assault (mass)
4. False Imprisonment (mass)
5. Grievous Bodily Harm (mass)
6. Mass poisoning
7. Suicide Induction
8. Corruption
9. Accessory to Genocide

Mark Taylor

Particulars
1. Mark Taylor trained in the United Kingdom (UK) and is a psychiatrist who is currently
employed by the University of Queensland and Princess Alexandra Hospital.
2. Mark Taylor was previously employed by the Alfred Hospital in Melbourne, where in 2001 he
kept me prisoner and diagnosed me as having “schizophrenia/psychosis” with a previous
personality disorder (which he described as “paranoid” and “narcissistic”) citing my

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allegation that the Australian Government and University of Melbourne (Burnet Institute)
were involved in the development and spread of HIV according to a covert racist eugenics
program (White Supremacist). At the time, and since then, he has not sought or read the
evidence I was able to provide at the time, on which my allegations were based.
3. My research and the evidence of the genocide I uncovered was completed as a thesis titled
“Eugenics and Genocide in the Modern World” in 2001, but Taylor refused to read it and I
was placed under other psychiatrists who also refused to read my work.
4. An edited version of the thesis (reduced from the original 600 pages to less than 300) was
published on Scribd as an e-book in 2010:
https://www.scribd.com/doc/71007453/Eugenics-and-Genocide-in-the-Modern-World-the-
cause-of-the-AIDS-epidemic-by-Dr-Romesh-Senewiratne-Alagaratnam-Arya-Chakravarti

5. In January 2016 Mark Taylor allowed me to leave the locked East Wing Ward of the Princess
Alexandra Hospital after I had been locked up for a week under the Nigerian psychiatrist
Jumoke “Jumi” Banjo, who had misdiagnosed me as having “schizophrenia”. He did not
interview me and did not recognise me from 2001. I recognised him instantly.
6. In 2018 I received a phone call from Raghavan Raman (case manager qualified as a
psychiatric nurse at Griffith University in 2009). Raman said that the appointment that I had
been given with the Pakistani psychiatrist Ghazala Watt for the next day had been cancelled
and that I would instead be seeing Mark Taylor.
7. I attended the appointment with Mark Taylor at the Woollongabba Community Health
Centre on Wednesday 9 May 2018.
8. I told Mark Taylor who is now a professor at the University of Queensland, where I
graduated in Medicine in 1983, that the notes the hospital was relying on were factually
inaccurate and could not be relied on. He said “that wouldn’t surprise me”.
9. He then asked me questions and entered my answers while looking at the computer screen
and not me. I answered his questions honestly, but was disturbed by his line of questioning.
The questions he asked were dictated by what information was requested by the computer
program he was using – about my alcohol and drug consumption, family history of mental
illness and previous diagnoses. He claimed not to remember me from 17 years ago and I told
him “You obviously made a greater impression on me than I did on you”.
10. After about half an hour, Taylor said the time for the consultation was up, that he was happy
by how I was going and said he would see me in three months’ time.
11. I asked him if he thought I had schizophrenia.
12. He said “I think you were psychotic in the past but you aren’t now”.
13. I told him that the injection that was being forced on me was stopping me from ejaculating
and he expressed surprise, though this adverse effect is described in the drug companies
literature. I also told him that the drug was causing me to dribble due to hypersalivation,
made me gain a lot of weight and was sedating me and dulling my creativity and musicality,
causing anhedonia (lack of pleasure, a recognised adverse effect of the class of drugs to
which Paliperidone belongs).
14. I also told him that the drugs used to treat schizophrenia shortened patients’ lives, but he
disputed this, saying that studies showed the best survival of diagnosed “schizophrenics”
was when they were treated with Clozapine (Clozaril). I disagreed but didn’t argue with him.
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15. I asked him if he would stop or at least reduce the drug and he said he would think about it.
16. When I phoned him two weeks later and stressed the adverse effects I was having from the
Paliperidone, he told me he would have to check with the case manager (Raghavan Raman)
before reducing the drug.
17. A week later I was contacted by Raghavan Raman saying that the injection would be kept at
the high dose of 100 mg despite the adverse effects I am suffering from.
18. I asked Raman to make an urgent appointment to see Taylor, due to the dribbling and
hypersalivation I am suffering from.
19. The appointment was made for two weeks later but was cancelled again. A new
appointment has been scheduled for a week’s time.

Dr Romesh Senewiratne-Alagaratnam Arya Chakravarti

17.7.2018

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20.

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https://www.researchgate.net/publication/318799840_A_stitch_in_time_3-monthly_long-
acting_injectable_paliperidone_palmitate_in_schizophrenia

A stitch in time: 3-monthly long-acting

injectable paliperidone palmitate in

schizophrenia

Mark Taylor and Hannah Chu-Han Huang

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Correspondence to:

Mark Taylor

University of Queensland,

Inala Mental Health, 64

Wirraway Pde, Brisbane

QLD 4077, Australia

marktaylor2@nhs.net

Hannah Chu-Han Huang

South London and

Maudsley Trust, London,

UK

721874TPP0010.1177/2045125317721874Therapeutic Advances in PsychopharmacologyM Taylor


and HC-H Huang

editorial2017

Editorial

Table 1. Summary of the pros and cons of LAIs versus oral medications.

Advantages of LAIs over oral medications

Advantages of orals over LAIs

•Early detection of relapse and reduced hospitalization

•Predictable smoother serum concentrations

•Consistency between prescription and delivery

•Reduced risk of overdose or accidental poisoning

•Differentiation between lack of efficacy and lack of adherence

•Enhanced patient autonomy

•Less perceived coercion and stigma


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•Possibility of less frequent clinic attendance

•Can be stopped suddenly if adverse effects arise

LAI, long-acting injection.

Therapeutic Advances in Psychopharmacology 7(10)

232 journals.sagepub.com/home/tpp

Depot antipsychotic medication, often referred to as long-acting injections (LAIs), are an important
treatment option for mental health problems such as schizophrenia and bipolar disorder.1,2

They were designed over 50 years ago to promote adherence to maintenance antipsychotic
medication, but arguably remain stigmatized and underused.3 Table 1 compares oral formulations
with LAIs.

International guidelines recommend LAIs for both patients with demonstrated poor medication
adherence and those who prefer an LAI.1,2 Both an independent long-term comparative trial by
Subotnik et al.4 and a systematic review by Taylor and Ng5 have highlighted the value of earlier use
of LAI preparations in psychosis, reporting decreased relapse rates through improved medication
adherence, which reduces the risk of toxic relapse and possible subsequent rehospitalisation.4–6
This begs the question, would a cardiologist wait till the second or third heart attack before
instituting the most effective treatment?6

Antipsychotic medication development has stagnated over recent years, so the introduction of the
first 3-monthly or quarterly LAI antipsychotic deserves review.

Paliperidone palmitate 3 monthly (PP3)

Paliperidone palmitate is a benzisoxazole derivative, and the 3-monthly variant (PP3; also known as
INVEGA TRINZA®) is available in prefilled syringes that require vigorous shaking, unlike many other
LAIs or depots. The transport substrate of PP3 has been modified to increase its elimination half-life,
which allow dosing at 3-monthly intervals. PP3 is the first and only currently available quarterly
injectable, and as such, represents a significant advance in the maintenance treatment of
schizophrenia.

PP3 is available in four strengths (175 mg, 263 mg, 350 mg, and 525 mg), which are equivalent to the
original monthly paliperidone LAI strengths of 50 mg, 75 mg, 100 mg, and 150 mg, respectively.
Formulation of PP3 equivalent to a paliperidone monthly dose of 25 mg is not yet available. There is
a 2-week window for administration of PP3.

Importantly, PP3 is only recommended after stability on monthly paliperidone for a minimum of 4
months, where the last two monthly doses are required to be stable prior to switching. PP3 has an
elimination half-life of approximately 85–95 days (when administered as a deltoid injec-

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tion), and 118–139 days (when administered as a gluteal injection). PP3 would likely remain in the
body for a period of 340–695 days, depending on injection site, dose, and individual patient pharma-
cokinetic factors.

The two approval trials for PP3 were both sponsored by the manufacturer. The first trial
demonstrated efficacy compared with placebo for prevention of schizophrenia relapse, and
involved 379 participants who each received a single dose of PP3, with 145 individuals then
receiving placebo and 160 receiving at least one further dose of PP3. The second trial was a
long-term double-blind non-inferiority study, which recruited 1429 participants. All of them
were treated with monthly paliperidone palmitate before 512 people were then randomly
assigned to continue monthly paliperidone, and 504 were randomly assigned to switch to
PP3, with a 48-week continuation phase. Relapse rates over that period were not
significantly different between PP3 (8%) and monthly paliperidone (9%) arms in this study.
No other studies of PP3 are yet in the public domain.

Given that PP3 contains the same active molecule as monthly paliperidone, it has the same
potential adverse effects,7,8 including prolactin elevation; weight gain; and, less frequently,
sedation and extra-pyramidal symptoms. Key differences between PP3 and monthly
paliperidone are the requirement for vigorous shaking of the vial for 15 seconds to ensure
uniform dosing, as well as the increased volume of injection, with the highest PP3 dose (525
mg) being administered over a 2.6 ml injection. Despite the increase in volume of injection,
the non-inferiority study established comparable tolerability between preparations, without
significant increases in local injection site reactions. Dealing with emergent adverse effects
with a 3-monthly preparation could be intrinsically challenging, although stabilization on the
monthly preparation before-hand should reassure clinicians as to the patient’s ability to
tolerate PP3.

Current experience

The authors’ experience (admittedly limited to 12 cases) of switching to PP3 has revealed
that no patients have so far declined to switch, with all indicating a preference for the less
frequent 3-monthly injections. Patients are reassured that the therapeutic molecule is the
same, with a very similar efficacy and tolerability profile, it is simply a ‘slower release’
variant of paliperidone LAI.

There have also been no significant new adverse effects compared with monthly
paliperidone, with a global impression of similar local injection site reactions and pain.

One anticipated concern with it is that the decrease in frequency of injection may result in
decreased patient contact and care. Although the intramuscular administration of PP3 is 3
monthly or ‘seasonal’, that does not mean the frequency of concomitant psychosocial
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interventions or monitoring has to diminish. Indeed, one perspective is that a slow-release


injectable liberates time for other aspects of treatment, such as physical healthcare or
cognitive remediation.

A related concern might be that PP3 facilitates transition away from expert mental health
care providers to primary care, where the multidisciplinary holistic therapy may not be
available. As always, clinical needs should be assessed on a case-by-case basis, and not be
dictated by political or financial constraints.

Clinicians administering PP3 have at times commented that it is more difficult to be aware
of when the next LAI dose is due, resulting in medication charts being checked repeatedly.
PP3 does offer a 2-week window for administration, easing this burden and accommodating
weekends and staff time off.

Looking ahead

With current evidence indicating treatment with antipsychotic medication for at least 18
months following a first episode of psychosis,2 and studies demonstrating poor medication
adherence in this specific population,6 the prospect of a slower-release antipsychotic LAI is
a step forward. Use of a 3-monthly depot early in the schizophrenia disease course would,
however, represent a paradigm shift. Nevertheless, it is noted that 3 monthly (and longer-
acting implantable) contraceptives are widely sought after by the general public.

Patient choice and autonomy need to be upheld, but patients also deserve access to
appropriate evidence-based medication from the outset of their diagnosis, including
information on the benefits of antipsychotic medication; the risks of early cessation or poor
adherence with antipsychotic medication; and available preparations including oral and LAI
antipsychotics. There is evidence that some psychiatrists themselves view LAIs or depot as
stigmatizing or too coercive, and perhaps unconsciously filter out this potential therapeutic
option.9 This is despite a national study indicating the same antipsychotic molecule in LAI

M Taylor and HC-H Huang

journals.sagepub.com/home/tpp 233

formulation reduced relapse rate by 64% compared with the identical oral molecule.6

The unveiling of PP3 serves as a timely reminder that antipsychotic LAIs have a role across
the disease pathway in schizophrenia. Given the evidence noted above, it could be argued
that mental health clinicians should be justifying why they are not using clozapine or an LAI
in established schizophrenia.

Funding
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This research received no specific grant from any funding agency in the public, commercial,
or not-for-profit sectors.

Conflict of interest statement

Mark Taylor has accepted fees and hospitality from Janssen, the manufacturer of PP3. HH
has nil to declare.

References

1. Gelletly C, Castle D, Dark F, et al. Royal Australian and New Zealand college of
psychiatrists clinical practice guidelines for the management of schizophrenia and related
disorders. Aust N Z J Psychiatry 2016; 50: 32–36.

2. Healthcare Improvement Scotland. SIGN 131. Management of Schizophrenia. A National


Clinical Guideline. SIGN. 2013; 131: 18–19.

3. Patel MX, Taylor M and David AS. Antipsychotic long-acting injections: mind the gap. Br J
Psychiatry. 2009; 195: S1–S4.

4. Subotnik KL, Casaus LR, Ventura J, et al. Long-acting injectable risperidone for relapse

prevention and control of breakthrough symptoms after a recent first episode of

schizophrenia. A randomized clinical trial. JAMA Psychiatry. 2015; 72: 822–829.

5. Taylor M and Ng KY. Should long-acting (depot) antipsychotics be used in early

schizophrenia? A systematic review. Aust N Z J Psychiatry 2013; 47: 624–630.

6. Tiihonen J, Haukka J, Taylor M, et al. A nationwide cohort study of oral and depot

antipsychotics after first hospitalization for schizophrenia. Am J Psychiatry 2011; 168:

603–609.

7. Taylor D. Psychopharmacology and adverse effects of antipsychotic long-acting injections:

a review. Br J Psychiatry Suppl 2009; 52: S13–S19.

8. Young SL, Taylor M and Lawrie SM. “First do no harm.” A systematic review of the
prevalence and management of antipsychotic adverse effects. J Psychopharmacol (Oxford,
England). 2015; 29: 353–362.

9. Waddell L and Taylor M. Attitudes of patients and mental health staff to antipsychotic
long-acting injections: systematic review.
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(PDF) A stitch in time: 3-monthly long-acting.... Available from:


https://www.researchgate.net/publication/318799840_A_stitch_in_time_3-monthly_long-
acting_injectable_paliperidone_palmitate_in_schizophrenia [accessed Jul 17 2018].

Objectives: The aim of this study is to provide an opinion paper reviewing the role of depot or long-
acting injectable (LAI) antipsychotic medications, with comments on individual newer LAIs such
aripiprazole maintena and paliperidone palmitate. In particular, we share our recent experience of
using paliperidone three-monthly LAI. We also reflect on the associated benefits and potential
harms of LAIs, and when they may be used. Conclusions: LAI antipsychotics are an important and
arguably under-utilised therapeutic option, particularly where medication adherence is a priority,
and where an informed patient opts for this formulation. Paliperidone is the first three-monthly LAI
antipsychotic, and as such represents a significant advance in the range of treatment choices.
(PDF) Going the distance: reviewing.... Available from:
https://www.researchgate.net/publication/323271189_Going_the_distance_reviewing_antipsychoti
c_depot_or_long-acting_injectable_treatments_in_Australasia [accessed Jul 17 2018].

Professor Mark Taylor is a consultant psychiatrist at the NHS in the UK.


He is also Associate Professor at the University of Queensland in
Brisbane Australia.
He is the coauthor of a paper published in the Journal of
Psychopharmacology: “First do no harm.” A systematic review of the
prevalence and management of antipsychotic adverse effects”.
In this interview we discuss some of his findings and general advice on
the detection and management of antipsychotics adverse effects.
We talk about the following topics:

 Why we must pay attention to treatment nonadherence


 What adverse effects have the greatest impact on schizophrenia
management
 What are the antipsychotics with the highest risk of metabolic side
effects
 What proven strategies can we use to treat antipsychotic-induced
metabolic effects
 The Glasgow Antipsychotic Side-effect Scale (GASS)

Interview conducted by Flavio Guzman, MD


Download audio file

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Downloads and resources

Download the Glasgow Antipsychotic Side-effect Scale (GASS)

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Download the Glasgow Antipsychotic Side Effect Scale for Clozapine

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Download – First do no harm. ” A systematic review of the prevalence and management of antipsychotic adverse effects”

Transcript
What is the relationship between treatment adherence and
antipsychotic side effects?
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If you look at the work of Wolfgang Fleischhacker and Peter Weiden, et


al., you can see that treatment adherence is negatively impacted by
adverse effects of any medication, in this case antipsychotics. It’s worth
reiterating that , the WHO (World Health Organization) states that
adherence is the number 1 problem with chronic disease management.
One in two people don’t take their medicines in the way that we’ve
prescribed.
Adherence is the number 1 problem in the management of psychosis
and schizophrenia.
Can you categorize the treatment adherence problems we see in
our everyday practice?
Quantifying the different elements in the sub-adherence or non-
adherence is a bit more tricky, as you know.
There are some people who say ” You’re the crazy one, Dr. Taylor. You
can stuff your medicine where the sun doesn’t shine.” There are usually
quite a low number in my experience
Secondly, there is partial nonadherence (or covert non-adherence).
Patients say: “Look, Dr. Taylor seems like a nice guy. I don’t want to tell
him his medicines are rubbish.”
The big group is the partial adherence, the ones who “don’t know what
they don’t know”. They are about 90 percent adherent, they think: “Well,
I just had a couple of bottles of beer. I don’t really want to take my tablet
in case there’s a problem”, which of course is a common misconception.
According to your research, what adverse affects have the greatest
impact on treatment adherence?
This is going to sound awfully stereotyped, but the first one is sexual
dysfunction, which is probably under-recognized with antipsychotics as a
whole. At least half of all the men that were surveyed in all the studies
that we reviewed, have some degree of sexual dysfunction. Particularly,
younger men have a big problem with the potential of sexual dysfunction.
Certainly, I’ve been using a Viagra-type drug sometimes as a
consequence for people who are doing well on treatment but have this
problem.
And flipping it around, again, it sounds awfully sexist but some of the
female patients get very troubled by the weight gain potential. These are
both issues of both genders of course.
What about the pathophysiology of sexual side effects?
Good question. You are distinguishing between libido (which we could
conceive as centrally mediated sexual interest) and the more peripheral

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erectile function or orgasmic potential or failure to reach orgasm. You


can’t make too much distinction between these two things.
It seems to be that it is more the peripheral apparatus, i.e., erectile
function and to some extent delayed ejaculation or delayed orgasmia or
anorgasmia. That seems to be what I’m picking up from what I have
seen.
There are multiple variables in the equation: age, comorbidity or co-
prescription of other medication. It seems to be more a peripheral rather
than a central problem, which is why I mentioned the Viagra or sildenafil-
type medications as one way of addressing that.
What other effects are patients and physicians concerned about?
It’s interesting to note that old research showed that the extrapyramidal
side effects or movement disorders were rated less severely by the
patients than the doctors. The doctors used to get quite worried about
EPS or parkisonian side effects more than the patients, although I’m not
sure we can generalize it these days.
The other common one of course is sedation, which you can harness to
good effect. Sometimes, you just employ a sedative antipsychotic at
nighttime because sleep is often the problem.
Sedation becomes a problem in the rural areas where driving is
essential. For example, when I was in Australia, taking someone’s
driving license away from them was like probably the worst insult you
could ever say. If sedation is causing driving issues, that can be a big
problem.
Regarding second generation antipsychotics, which are the
antipsychotics with the greatest and lowest risk of causing type 2
diabetes, weight gain and dyslipidemia?
My take home our research was that clozapine is the worst for metabolic
generally. Olanzapine is the worst for weight gain. There’s a sort of
gradient down from those two where towards the bottom you
got aripiprazole and the new one, lurasidone.
In the middle, you have quetiapine and risperidone and lower down you
have aripiprazole. Haloperidol was quite good for lack of weight gain.
In my mind at least, there is no clear categorical distinction. There is
quite a bit of debate in the UK about how the psychiatric profession was
bewitched by commercial interest into believing that the new drugs that
came out in the mid to late 90s were categorically different in some way
and that appears to be not the case.
Are there any strategies that have been proven effective in the
management of metabolic side effects?
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Sometimes, you have people for example doing well on olanzapine. I’ve
got a few patients at the moment who are doing well on olanzapine but
you worry about the metabolic consequences. So there are clearly some
lifestyle interventions that are crucial here. For example, I always
prescribe a 45- to 60-minute walk a day. I require my patients to go
walking every day.
Another related issue is the diet. The diet is difficult here in the UK. The
best diet as far as I’ve understood is the so-called Mediterranean diet.
Having said that, getting some people with schizophrenia over to a more
healthy diet is a big challenge. We have a colleague in Scotland called
Robin McCravey who switched people over to a healthy diet for six
months. He gave them free vegetables and fruits and what have you for
six months to try and change their dietary habits. They did change with
dietitian advice during that period of the study. But then at the end of the
study when the free food stopped, they just moved back to the fried food
or the junk food.
I would plug off Scottish Guidelines, SIGN 131.
What about the pharmacological management? Do you have any
suggestions?
What I specifically mentioned is use of metformin. I started using that
with clozapine and olanzapine sometimes particularly in younger
individuals. Some clinicians (not me) even use metformin
prophylactically if they feel that clozapine or olanzapine are a good idea.
The dosing is 500 mg or 1 gr of slow-release metformin. Metformin is a
very safe medicine. The diabetologists like it, it improves insulin
sensitivity. It doesn’t send you into a hypo. It’s a very safe medication.
You probably wouldn’t want to take it if you got irritable bowel syndrome.
But aside from that, it’s quite an easy to use medication. So I have been
using metformin a lot more frequently.
The other thing that I’d pass on to your colleagues which they probably
know already is low-dose aripiprazole, 5 mg, possibly 10 mg of going
alongside as a side order to the olanzapine and clozapine. Not really for
its antipsychotic effect but for its corrective metabolic effect.
Those are a couple of medication strategies that I’ve certainly been
using in the last couple of years to go along – don’t get me wrong, to go
alongside the lifestyle and dietary interventions because what we see
from the diabetes world is that if you combine the lifestyle and the
dietary with the medication, that’s when you get the best results.
You are one of the authors of the Glasgow Antipsychotic Side-
effect Scale. What can you tell us about it?

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When we looked at it, the default scale in the UK was one called
LUNSERS, Liverpool University Side Effect Rating Scale, which came
out in 1993 which was a long time ago before most of the newer drugs.
The LUNSERS didn’t really have many of the metabolic questions that
we wondered. It was also quite long, three and a bit pages. So we just
thought we could do better than that.
We validated the GASS, the Glasgow Antipsychotic Side-effect Scale. I
think it seems to have taken off partly because it’s quite short and partly
because the language is quite user friendly. We spent a bit of time
converting difficult words like galactorrhea into plain English. And maybe
partly because it’s free, you don’t have to pay anyone, you can use it if
you like it.
The only thing we copyrighted is the intellectual property, Linda and I. So
if you want to use it and distribute it, please feel free to go ahead.
Certainly in the UK and to some extent Australia, it seems to be the
default scale if you’re going to use a scale for side effects.
Are there any final comments you would like to share?
What I would say is let’s try to be evidence based. Let’s think carefully
about what we would like for ourselves and do onto others as we’d have
done to ourselves. But let’s pay attention to the latest literature and the
latest guidelines, the best guidelines. Clearly, over the last decades,
there hasn’t really been a breakthrough in the treatment of schizophrenia
which is a little bit sad. I know the industry is retrenched or retracted in
some ways from these difficult complex mental illnesses but it’s our duty.
These are common problems and it’s our duty to keep working away,
helping people to the best of our ability.
I think most psychiatrists are not just interested in medications. I’m
particularly interested like many other people, but we went into
psychiatry to look at other treatment modalities whether it’s
psychological therapies, whether it’s lifestyle interventions or whether it’s
family interventions. These are all crucial parts of delivering psychiatric
treatment.
I like to emphasize that medications are clearly crucial and important but
it’s one piece of the jigsaw.
Published in: Antipsychotics, Antipsychotics - Featured articles, Second-
generation antipsychotics
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 Exclusive updates

Promoting the new stigmatising term


term ‘SIDMA’
 Understanding ‘significant impaired decision-
 making ability’ with regard to treatment for mental
 disorder: an empirical analysis
 Evonne Shek,
 1
 Donald Lyons,
 2
 Mark Taylor
 3
 239
 impairment or disability; and active psychotic symptoms
 were listed as clinical reasons underpinning the SIDMA
 criterion along with a judgement by the authors as to
 whether this represented a valid justification for the
 criterion. Finally, specific examples of good and less than
 good free text descriptions of SIDMA by the completing
 psychiatrist were recorded, with a consensus on quality
 being independently achieved by two of the authors (E.S.
 and D.L.). The proforma questionnaire was initially piloted
 on ten reports to test its utility, prior to the full study.
 Results
 The 100 mental health reports for compulsory treatment
 order applications were identified and collected, and were
 made by consultant psychiatrists, specialist registrars and
 staff grade psychiatrists across Scotland. A total of 14% of
 mental health reports were from GPs, i.e. there were 14
 reports from GPs and 86 from psychiatrists.
 The 100 reports were on 59 males and 41 females. The
 mean ages of individuals were as follows: 48 years (range
 13
 -
 94), with male mean age 49 years (range 21
 -
 94) and
 female mean age 46 years (range 13
 -
 91). The geographic
 distribution of compulsory treatment order applications
 largely replicated the population distribution in Scotland,
 with 27 from Greater Glasgow; 16 from Lothian; and 15 from
 Fife; although only 6 came from Grampian (Aberdeen area).
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 A wide range of diagnostic categories were described in


 the 100 reports, as illustrated in Fig. 1. The main reasons
 given for the individual exhibiting SIDMA are classified in
 Tables 1 and 2. Only one report had illegible handwriting
 from the medical practitioner, thus could not be included in
 the interpretation of results.
 It can be seen that a lack of insight into the mental
 disorder (and the treatment needs arising, therefore) is the
 single most common reason given in the reports for SIDMA.
 Examples of commonly occurring ‘other ’ reasons noted in
 20 cases in Table 1 include thinking being distorted by
 severe depression and learning disability leading to
 difficulty processing and retaining information.
 Table 1 also reveals that the authors thought the
 majority of reasons given in free text of the reports for
 SIDMA were valid, although a substantial minority of free
 text reasons were not viewed sufficient justification for
 SIDMA. A trend towards increasingly doubtful or poor
 justification, and increasing number of reasons provided for
 SIDMA was evident in Table 2.
 Discussion
 This study is the first systematic examination of the reasons
 behind impaired decision-making with regard to treatment
 needs for mental disorder for people detained under the Act
 in Scotland.
 The sample consisted mostly of young to middle-aged
 individuals with a psychotic illness and older people with
 dementia. In those with dementia, limited cognitive
 function was the main reason documented for SIDMA.
 The youngest people in this study were two females aged 13
 ORIGINAL PAPERS
 Shek
 et al
 Understanding ‘significant impaired decision-making ability’
 Fig 1 Diagnoses.
 Table 1 Main reason for significant impaired decision-making ability (SIDMA) (i.e.
one reason only) in mental health
 reports
 n (%)
 Vali d j ustification?
 Lack of insight
 (n =44)
 Limited cognitive function
 ( n =9)
 Psychotic symptoms
 (n =10)
 Other
 (n =20)
 Ye s 29 (66) 8 (89) 3 (30) 5 (25)
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 Doubtful 11 (25) 1 (11) 6 (60) 7 (35)


 No 4 (9) 0 (0) 1 (10) 8 (40)
 Table 2 More than one reason for significant impaired decision-making ability
(SIDMA) (i.e. two to three reasons) per
 mental health report (n = 16)
 n (%)
 Vali d j ustification? Lack of insight
 (n =13)
 Limited cognitive function
 ( n =4)
 Psychotic symptoms
 (n =14)
 Other
 (n =6)
 Ye s 5 (38.5) 2 (50) 5 (35.7) 2 (33.3)
 Doubtful 7 (53.8) 2 (50) 8 (57.1) 4 (66.7)
 No 1 (7.7) 0 (0) 1 (7.1) 0 (0)
 240
 years of age with a diagnosis of anorexia nervosa, where one
 report had lack of insight as the main reason for SIDMA and
 the other report was illegible. The sample captured in this
 study represented a fairly good geographic and diagnostic
 spread of the patient population across Scotland (Fig. 1).
 We found that the most common reasons for SIDMA
 were lack of insight (44%), limited cognitive function (9%)
 and/or presence of psychotic symptoms (10%) (Table 1).
 Lack of insight was commonly correlated with psychotic
 symptoms. Other reasons for SIDMA included presence of
 severe depressive symptoms or learning disability (20%).
 Limited cognitive function was the main reason for SIDMA
 in people with dementia. There was no clear evidence of
 cognitive impairment being the main reason for SIDMA in
 individuals with learning disability.
 We also retrieved mental health reports made by GPs
 (14%). From these reports it was clear that most of them did
 not give good justification for their reasons for SIDMA, poor
 examples are given overleaf. Therefore it is evident that
 there is still a continuing need and role for psychiatrists to
 educate GPs with regard to good documentation and
 reasoning when completing the second mental health
 report, in particular the reasons for SIDMA.
 Here, we give free text examples of what we considered
 to be good and less-than-good explanations for the common
 reasons pertaining to SIDMA.
 Lack of insight
 None of the research scales estimating level of insight in
 mental disorder were used in any of the reports. Clinicians
 gave descriptive justifications linking lack of insight to
 SIDMA, for example:
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 ‘. . . does not consider himself to have a mental illness. He is


 insightless into his present difficulties and need for treatment.
 As he considers himself mentally well, he does not appreciate
 his need to remain in hospital and continue medication.’
 Here an explanation of how the illness impairs insight is
 offered, whereas another report simply states the ‘Patient is
 lacking in insight’. This brief statement does not explain
 how and why the person having a lack of insight impairs
 their decision-making ability about medical treatment. It is
 highly likely that the mental health tribunal, when testing
 this latter compulsory treatment order application, would
 require additional oral evidence from the medical practi-
 tioner explaining the detail of the case. Also, research has
 indicated
 5
 that subtle impairments of neuropsychological
 function are often linked to impaired awareness of illness
 (poor insight), and it is perhaps no surprise intellectual
 dysfunction was frequently identified by this study as a
 contributing factor to SIDMA.
 Impaired cognition
 If the reason for SIDMA is that the individual has limited
 cognitive function, the mental health report should ideally
 detail how this impaired cognitive function affects their
 decision-making ability. Consider this example where the
 medical practitioner has mentioned cognitive impairment
 as a reason for SIDMA:
 ‘has a significant degree of cognitive impairment and presents
 as disorientated. He lacks an understanding of his condition or
 his need for hospital treatment, is unable to retain information
 to allow for informed choice, and hence his ability to make
 decisions about his care is significantly impaired’.
 Here, the medical practitioner has given a good reason,
 explaining how the individual’s cognitive impairment has an
 impact on his ability to make decisions about medical
 treatment, thus having SIDMA.
 Another well-documented example justifying cognitive
 impairment is as follows:
 ‘presents a fluctuating mental state... His level therefore of
 fluctuating confusion makes it likely that his decision making
 processes are impaired. He has difficulty retaining information
 for a sufficient time that would allow him to make informed
 decisions regarding his care’.
 A less well-documented reason for SIDMA was: ‘has severe
 impairment in his decision making abilities regarding
 medical treatment and care needs’. Here, the medical
 practitioner has not explained how any impairment affects
 the person’s decision-making abilities. They had merely
 stated the criterion without explaining why it is satisfied.
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 Presence of psychosis
 If the main reason for SIDMA is presence of psychosis, how
 do these psychotic symptoms affect the individual’s
 decision-making ability? Consider this example where the
 medical practitioner has stated the presence of delusions for
 justifying SIDMA: ‘He adamantly rejects the notion that he
 is unwell . . . He is deluded regarding treatment, believing
 that I am trying to kill him rather than treat his psychosis’.
 In this statement, the medical practitioner has stated that
 the patient’s delusions impair his decision-making ability
 about treatment as he firmly believes the psychiatrist is
 trying to kill him. Hence the patient has poor judgement
 about treatment because his delusions mean that he cannot
 interact appropriately with the psychiatrist.
 Another well-documented statement justifying the
 presence of psychosis for SIDMA was:
 ‘at present displays a significant disordered thought process
 with delusional beliefs. . .When trying to talk to her she
 appears unable to focus on a subject being quite incoherent in
 her thinking and flighty in her thoughts’.
 Less well-documented reports included: ‘I have observed
 [X’s] behaviour over some months and her thoughts are
 impaired’. In this report there is lack of clarity about how
 the individual’s impaired thinking has an impact on SIDMA.
 Other reasons for SIDMA (severe depressive
 symptoms and learning disability)
 In the following example, the psychiatrist has described the
 patient’s symptoms and how this has an impact on her
 decision-making ability with regard to medical treatment.
 ‘. . . She demonstrated numerous cognitive distortions which
 are typically found in severe depressive illness. She views the
 future as hopeless and views all interventions as being futile.
 As such, she is unable to appraise information provided to her
 with respect to the provision of medical treatment’.
 The psychiatrist in the following report has stated that it’s
 the individual’s learning disability that limits her ability to
 understand the assessment and treatments and nothing
 ORIGINAL PAPERS
 Shek
 et al
 Understanding ‘significant impaired decision-making ability’
 241
 more. There are no details of which particular aspects of the
 person’s learning disability affects SIDMA:
 ‘ability to understand the purpose of her assessment and
 treatment and make decisions about what is proposed for her
 assessment and treatment is limited by her learning disability’.
 Implications and recommendat ions
 It is necessary for the medical practitioner to justify clearly
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 how the SIDMA criterion is met, rather than simply


 reiterating that SIDMA exists. Points to consider are:
 . what are the actual reasons for SIDMA?
 . how does the individual’s mental disorder (defined in
 the Act as mental illness, personality disorder and
 learning disability, however caused or manifest) affect
 their ability to make decisions about medical treatment?
 . in what way does the mental disorder affect the
 individual’s ability to believe, understand and retain
 information, and to make and communicate decisions
 about treatment?
 Questions for the medical practitioner to consider
 when justifying SIDMA are:
 . does the individual have lack of insight, and if so, how
 does it affect their decision-making ability?
 . is the individual confused or is there evidence of
 cognitive impairment that affects the individual’s
 decisions on medical treatment?
 . is the individual able to understand, retain, make and
 communicate decisions about treatment, and if not,
 why not?
 . does the presence of psychotic or severe depressive
 symptoms affect the individual in such a way that they
 cannot make decisions about treatment?
 . if the indi vidual has a learning disability, how does
 this affect their ability in making decisions a bout
 treatment? What aspect of the learning disability
 gives the individual SIDMA?
 If the medical practitioner can give a good reason or
 answer to any of the above questions, that may be a valid
 justification for answering the SIDMA criterion.
 Future directions and study limitations
 This is the first study to attempt to empirically describe a
 new concept in mental health law
 -
 that of significantly
 impaired decision-making ability. We have demonstrated, by
 analysing 100 consecutive medical reports to the mental
 health tribunal, that the most common clinical reasons for
 SIDMA are a lack of insight; learning disability or cognitive
 impairment; and the presence of psychotic symptoms. We
 have also argued that a detailed clinical explanation
 drawing a nexus between the symptoms and the SIDMA
 is helpful to all parties and arguably precludes extensive
 cross-examination at the mental health tribunal.
 As a guide, we also recommend that doctors completing
 the mental health reports consider the five questions given
 above when justifying their reasons and explanations for
 SIDMA, and it would be useful to repeat this study in a
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 year’s time to see if there has been an improvement in the


 quality of reporting.
 Mental Health Act (Section 22) training in Scotland
 involves two parts, the first part is a self-assessment, online
 multiple choice question exam on the National Health
 Service (NHS) website. The pass mark is 100% but unlimited
 attempts are allowed. Once this is achieved, the College
 then contacts the medical practitioner to participate in the
 second part, a training day where all practitioners receive a
 training manual on the Mental Health Act. A survey would
 be useful to see how frequently all approved medical
 practitioners refer to this training manual in particular
 when defining SIDMA. The results from this survey could
 better inform and shape future Mental Health Act training
 sessions.
 Although our findings will be of particular interest in
 Scotland, all psychiatrists should take note of how the
 SIDMA criterion is being applied. The use of SIDMA as a
 criterion for compulsory treatment is controversial, and has
 been rejected by other jurisdictions, for example in England
 and Wales, as it is argued that there is no link between the
 clinical severity of a mental disorder and the individual’s
 decision-making ability.
 6
 In our view, when documented
 well, it provides good evidence to justify taking away a
 person’s right to make their own decisions about care and
 treatment.
 Our study limitations include the small sample size, a
 lack of reference points for the new concept of SIDMA, and
 the subjective elements to our analysis of quality rather
 than using a pre-agreed ‘quality checklist’. However, two of
 the authors independently corroborated each others quality
 judgements, and only where consensus was reached a
 quality judgement was assigned.
 About the authors
 Evonne Shek is a Locum Consultant in General Psychiatry at the Larkfield
 Centre, Glasgow, and Consultant in Liaison Psychiatry, Crosshouse
 Hospital, Ayrshire, Scotland. Donald Lyons is the Director of the Mental
 Welfare Commission for Scotland, Edinburgh. Mark Taylor is a Consultant
 Psychiatrist in the Intensive Home Treatment Team, Edinburgh, UK.
 References
 1 Scottish Executive. Approved Medical Practitioners
 -
 Mental Health (Care
 & Treatment)(Scotland) Act 2003 Training Manual. Appendix 2
 -
 Significantly Impaired Decision-Making Ability. Scottish Executive, 2005.
 2 Office of Public Section Inform ation. The Adults With Incapacity
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 (Scotland) Act 2000. OPSI, 2000 (http://www.opsi.gov.uk/legislation/


 SCOTLAND/acts2000/asp_20000004_en_1).
 3 Office of Public Section Information. Mental Health (Care and Treatment)
 (Scotland) Act 2003. Part 7 Compulsory Treatment Orders Chapter 1 section
 57 (4) (b). OPSI, 2003 (http://www.opsi.gov.uk/legislation/scotland/
 acts2003/asp_20030013_en_7#pt7).
 4 Cairns R, Maddock C, Buchanan A, David AS, Hayward P, Richardson G,
 et al. Prevalence and predictors of mental incapacity in psychiatric
 in-patients. Bri J Psychiatry 2005; 187:379
 -
 85.
 5 Aleman A, Agrawal N, Morgan KD, David AS. Insight in psychosis and
 neuropsychological function. Meta-analysis. Br J Psychiatry 2006; 189:
 204
 -
 12.
 6 Department of Health. Government Response to the Report of the Joint
 Committee on the Draft Mental Health Bill 2004: 16. Departmen

(PDF) Understanding 'significant impaired.... Available from:
https://www.researchgate.net/publication/247807455_Understanding_%27significant
_impaired_decisionmaking_ability%27_with_regard_to_treatment_for_mental_disord
er_An_empirical_analysis [accessed Jul 21 2018].

Sunovion website on Schizophrenia:

How schizophrenia
impacts people's lives
Schizophrenia is a chronic, serious and often severely disabling
brain disorder that affects approximately 1 in 100 American
adults (about 2.4 million people) in the United States.1 It is
characterized by symptoms such as hallucinations, delusions,
disorganized thinking, lack of emotion and lack of energy, as
well as problems with memory, attention and the ability to plan,
organize and make decisions.2

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Mark Taylor on YouTube

https://www.youtube.com/watch?v=v7AFtMgs6bU

Dr Mark Taylor Psychiatrist at RCPsychScot meeting 29Jan16


475 views

2SHARE

Chrys Muirhead

Published on Feb 9, 2016

SUBSCRIBED 19

Dr Mark Taylor speaking at the Royal College of Psychiatrists in Scotland Winter Meeting on 29
January 2016 in Glasgow. http://www.rcpsych.ac.uk/workinpsychi... Dr Taylor said: "you are either
abstinent or promiscuous when it comes to industry (financial links with pharmaceutical companies).
Well you can see which side I fall on ..." Dr Taylor is Chair of SIGN 131 Guideline: Management of
Schizophrenia: http://www.sign.ac.uk/guidelines/full...

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Holistic University of Brisbane (HUB)1 second ago

"Abstinent or promiscuous when it comes to industry (drug companies). You can see which side I
fall". An admission of corruption.

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REPLY

Holistic University of Brisbane (HUB)6 days ago

The Case against Mark Taylor: https://www.scribd.com/document/383998725/Case-Against-Mark-


Taylor-HUB-Legal-Department
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REPLY

HUB Legal Department:

The PA Hospital and Drug Companies


Mark Taylor's publications indicate that:
1. He has received "fees and hospitality" from Janssen, the company that produces the toxic
drug Paliperidone that the PA Hospital injects me and many other victims with. He has also
accepted bribes from several other drug companies, including Lundbeck (Denmark) and
Roche (Switzerland). Both sell drugs for the treatment of ‘schizophrenia’. Lundbeck sells
Aripiprazole and Clopixol, which are heavily over-prescribed by Australian hospitals.
Academic psychiatrists in all the universities that train medical students in Australia have
unhealthy links to the drug companies, but Mark Taylor is one of the worst, and most prolific
in his promotion of drugs over non-drug interventions. In the only YouTube clip where he
appears he admits that another psychiatrist has said that “when it comes to industry you are
either abstinent or promiscuous. You can see on which side I fall”, perhaps hoping for a laugh.
He projected a slide showing his conflicts of interest relating to fees and hospitality from
several drug companies, including Janssen (Belgium), Roche (Switzerland), Lundbeck
(Denmark), Otsuka (Japan) and Sunovion (Japan).

2. He ignores criticism of the disease label of schizophrenia by other doctors including


psychiatrists, and also ignores the Anti-psychiatry Movement and Psychiatry Reform
Movement.

2. He is a radical promoter of depot injections (which he calls LAIs or 'long-acting injections')


and says they, and the toxic drug Clozapine are underused. He has even written a paper titled
"Clozapine - dangerous orphan or neglected friend?"

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3. He disparages the concerns of other psychiatrists that LAI's are too coercive and have
unacceptable adverse effects.

4. Rather than stopping the drugs when they cause adverse effects, he has developed a "rating
scale" to measure them and recommends other drugs to counter the known adverse effects of
"antipsychotic" drugs.

5. Though he trained in England (Nottingham University and University College, London) he


currently has academic appointments in both Scotland and Brisbane and is a jetsetter who
also travels to Continental Europe where he has gathered “tourist level” French and Dutch.

6. He is promoting the schizophrenia label as well as personality disorder labels. He labelled


me as having a personality disorder AS WELL AS psychosis for saying that AIDS is man-
made in 2001, when he was working at the Alfred Hospital (now he has been appointed my
"treating doctor" 17 years later in Brisbane, despite the fact that I had named him as a
defendant in my 2002 writ against the Alfred).

7. He routinely judges people to have "impaired decision-making ability" and “lack of insight”
if they disagree with his diagnoses and treatments and has written about this, promoting the
term "SIDMA" among his human rights-abusing, drug-pushing colleagues. SIDMA stands
for "significant impaired decision-making ability".

8. He has promoted and trialled, on his patients, a new 3-monthly Paliperidone depot
injection called "PP3" and has written papers saying how wonderful it is, recommending it
for first episode psychosis.

9. He recommends that people be kept on these drugs for 18 months after a first admission for
"psychosis" and 5 years for subsequent admissions. This is HIGHLY abusive. Drugs should
be used for the least time necessary at the lowest dose that works - attention should always be
paid to adverse effects with a constant evaluation about whether the drug is still necessary.

10. He sees numerous patients every day and charges Medicare for poisoning them with
drugs he is paid by the drug companies to promote.

11. He has co-authored a paper promoting these depot injections with Dr Balaji Motamarri
who is the Director of the MSAHMS (Metro South Addiction and Mental Health Services,
which includes the PA Hospital). Balaji Motamarri has also received "fees and hospitality
from Janssen (and other drug companies)

12. Each of the injections costs the taxpayer between $400 and $600 and they have the effect
of shortening patients' lives and causing a wide range of adverse effects which he is fully
aware of and has developed a "rating scale" to measure (called GASS - Glasgow Adverse-
effect Symptom Scale) for which he claims intellectual copyright.

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13. When patients have sexual problems from the drugs (which he says is reported by 50% of
his patients) rather than stopping the drug he recommends that they take Viagra.

14. He recommends that patients on these drugs also take anti-diabetic drugs (hypoglycaemic
agents) to take away the risk of diabetes from these drugs, though there is no evidence that
this works.

15. He juggles statistics to promote the drugs he is bribed to promote.

Evidence against Associate Professor Mark Taylor

Compiled by Dr Romesh Senewiratne-Alagaratnam

Impression:
1. Some people do medicine to heal people; Mark Taylor did medicine to make money.
2. He admits to accepting bribes from the Belgian drug giant Janssen-Cilag and other drug
companies.
3. His co-authors include other drug company stooges.
4. He is cruelly studying the “adverse effects” of drugs that should be banned for shortening
patients’ lives and causing a wide range of distressing symptoms including akathesia,
galactorrhoea, lethargy and somnolence, cardiac arrhythmias and heart attacks, obesity,
diabetes, sexual dysfunction, movement disorders and metabolic disorders – Taylor knows
this and has developed a “rating scale” to “measure” the “adverse effects” (GASS) for which
he has maintained “intellectual copyright”.
5. Rather than stopping the toxic drugs when adverse effects develop he recommends that
additional, expensive drugs be taken in addition (example Viagra for sexual dysfunction) and
hypoglycaemic agents as a “prevention” for diabetes from the drugs he is promoting.
6. He is grossly negligent and dangerous to the public and the medical profession.
7. He is extremely corrupt.
8. He routinely gets people locked up in the public hospital system in Scotland and Australia if
they refuse to take the drugs he orders and refute the poorly considered mental illness
labels he puts on them.
9. He is articulate and actively promoting the schizophrenia label as well as newer jargon like
‘SIDMA’ that can only be understood by people initiated into the British psychiatric system.
10. He is not capable of being a psychiatrist in Scotland and Brisbane at the same time. It is one
reason that he neglects his public patients who are of value to him only as experimental
subjects.
11. He is arrogant in his extremist opinion.

romeshsenewiratne@gmail.com
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