Industry, by s0crates82 via Flickr
What is the most profitable of all industries in the country? Before I looked it up I might have said electronics or movies, or maybe even computer games. But no, I won’t keep you in suspense, Dear Reader. It is pharmaceuticals. Here is an excerpt from the Wikipedia page:
“..the pharmaceutical industry is — and has been for years — the most profitable of all businesses in the U.S. In the annual Fortune 500 survey, the pharmaceutical industry topped the list of the most profitable industries, with a return of 17% on revenue.“
The Wiki article also notes that ” . . . the U.S. accounts for almost half of the global pharmaceutical market, with $280 billion in annual sales . . .” For the arithmetically challenged, that is over a quarter of a Trillion dollars a year. How’s that for impact on the pocketbook?
Drugs, via Wikipedia
One might ask, what are the most profitable drugs sold by this most profitable industry? I found an interesting little article about that in The Village Voice. It begins by mentioning “ibogaine”, an experimental hallucinogen drug that it says is proven to cure, yes cure, meth and heroin addictions. The author says neither the industry nor the government want anything to do with it. Why not? Because, he says, it is a cure.
He says,
When we read that, a light went on. The worst thing for a drug company is a pill you take that completely cures you of your ailment with one dose, right? Where’s the money in that?
So, with that in mind, we thought we’d test Kuehne’s theory, and look at the five most profitable drugs in the United States.
Guess what they all have in common? They never cure you. (Emphasis supplied.)
1) Lipitor (2009 gross revenue: $7.5 billion): Designed to lower cholesterol, Lipitor uses statins to decrease LDL cholesterol and triglyceride levels and increase HDL cholesterol levels. Studies indicate that high cholesterol increases one’s chance for heart disease, the leading health problem in the U.S.
2) Nexium (2009 gross revenue: $6.3 billion): This well-marketed drug decreases the amount of acid produced in the stomach, but it’s not an instant cure for heartburn.
3) Plavix (2009 gross revenue: $5.6 billion): Nobody likes a nasty blood clot, and this drug prevents that from happening, particularly after a stroke or a heart attack. The downside: Plavix increases your chances of small-injury bleeds and, if drinking alcohol, heightens your risk of stomach and intestinal bleeds.
4) Advair Diskus (2009 gross revenue: $4.7 billion): For asthma sufferers, a twice-daily inhaler to reduce the swelling in your respiratory system. Helps keep attacks from being more severe.
5) Seroquel (2009 Gross: $4.2 billion): Rounding out our top 5 is Seroquel, an anti-psychotic drug that treats schizophrenia, severe depression, and bipolar disorder by altering chemical activity in the brain.
So, Dear Reader, what shall we make of this as America’s finances totter on the brink of sliding into default and into Recession or Depression? What role does this play, given that medical-care costs are, as most of my blogging friends seem to agree, central to the fiscal problem? Do you suppose it is significant that president George W. Bush’s Medicare drug prescription plan funneled hundreds of Billions of dollars to the pharmaceutical industry? Do you suppose the pharmaceutical industry has some pretty good lobbyists?
Did you know that the Affordable (Health) Care Act, as originally drafted, contained authority for Medicare (read, the government) to negotiate drug costs directly with companies? That provision was killed by Congress. I see on PolitiFact that industry lobbyists managed to get that changed in return for about $8 Billion a year in fees over the next ten years – a pretty sweet deal if you ask me. Let’s see, $8B compared to $280B in sales. Hmm. Less than 3%. Heck of a deal!
In this post I simply wanted to air some facts about an important element of how medical costs (which are central to the crisis, remember?), are the result of an amoral segment of an amoral industry that, despite its advertising is putting greed ahead of the nation’s welfare. Meanwhile, common and pervasive diseases (like malaria, for example) and needs such as vaccines go begging because there’s not enough profit in them. No, erectile dysfunction drugs provide a lot more bang for the buck. (Say, those don’t cure anything either, do they?)
Modern Robber Barons?, via Wikipedia
Why are we subsidizing this corrupt industry through public policy? Do you think that if we had to pay out of our pockets for drugs like those above that we might be searching harder for generics or alternatives? I do. When the true cost of drugs is obscured by Medicare or other insurance we are left like geese ripe for the plucking. And I haven’t even broached how the patent system is abused to make subtle changes to formularies to keep the prices of drugs elevated.
If Congress reads my blog and calls the drug companies’ CEO’s to answer for the issues in this post (it is a blogger’s right to fantasize), I wonder if they will fly in on their corporate jets? Time is money, you know.
Drug costs are merely a part of the medical cost problem, of course. Fees, services, scanners, equipment, hell, band-aids and swabs all cost way too much because the system is broken, as I have posted before. I see no way to fix this system and that is why I have decided that a single-payer government health care system is the only clean solution.
Related articles
- In Bed with Big Pharma (psychologytoday.com)
Still Skeptical After All These Years 
I hesitate to say this, Jim, since it will ruin what’s left of your credibility with the right-wing lurkers, but, Amen.
Duane
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Interesting post. I know that the pharmaceutical companies have long skirted the lines of medical ethics. My Doctor will go on long rants about advertising for medicine on television – which he says leads to patients wanting to ‘self treat’ and demand expensive drugs that are not effective for treatment of their ailment. And you are right that drug companies spend a lot of money on lobbying and donations to politicians (across the board – not just one party).
I also noticed that the most profitable drugs (including #1-2 on your list) are for ailments that can be controlled or entirely prevented (most of the time) by diet and exercise. Again, I’m not saying 100% of the time (I have a healthy friend who went so far as to go Vegan trying to control her cholesterol with no success), but a majority of the sufferers. I think that the pill mentality also speaks to Americans unwillingness to take the harder, less pleasant route (giving up the cheeseburgers and piling on the broccoli) and taking a pill as a ‘quick, albeit temporary remedy.’
You’re right that it’s a large, multi-faceted issue.
Also, Ibogaine, I recall reading (don’t remember the source, I’ll try to find it) that it doesn’t tend to cure ‘addiction’ more dependence, as it doesn’t treat the underlying causes of addiction – most addicts go back to their drug of choice in a few months or just switch to something else (frequently a behavioral addiction – gambling, shopping, sex, etc). I’ll try to find the info on it… I could be wrong on that…
Great post!
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“The pharmaceutical industry is — and has been for years — the most profitable of all businesses in the U.S. In the annual Fortune 500 survey, the pharmaceutical industry topped the list of the most profitable industries, with a return of 17% on revenue.“
Great article Jim and all true! And yes the pharmaceutical industry like healthcare insurers and other health services are sucking the life out of this country. If we only fixed healthcare management and ended the wars in the Middle East we would be well on our way to recovery.
You’ve previously written in other posts that we will never resolve the healthcare issue until we’ve had a crisis. Well that crisis may be lot sooner than expected because without it, the healthcare industry will soon own this country.
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It was a little odd, HL, the way this post kind of fell together, one search leading to another. Like a jigsaw puzzle, the pieces fit.
I agree with your sentiments. The Medical Industrial Complex should be careful though – at the rate they’re going, the prize won’t be worth much by the time they own it.
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First Jennifer,
I seriously doubt Jim’s assertion that the above drug “cures” addiction to anything. Probably it replaces the chemicals in the body causing a “high” with safer chemicals. But ultimately it is the “high” that counts for the addict. Said another way an addict is dependent upon a “high” not a specific chemical in the body which pills can “treat”.
My own experience backed up by a very experienced counselor is as follows. After a year of so of “sobriety” the addiction to alcohol is diminished to a great extent. But living life on life’s terms (not easy for anyone all the time) MAY cause one of three things. First, a relapse or return to alcohol to once again get “high”, simply becasue life is too “hard”. Second another addiction (drugs, food, sex, etc) may replace the original addiction. Third, the former addict may well just kill himself! There is plenty of clinical evidence to support that warning, again by a very good counselor with long experience and research.
So I dispute Jim’s. or whoever’s allegation that some “cure” in the form of a pill is there but….
HLG,
You will JUMP ON anything that “proves” your theory that corporations and war are our ONLY problem, economically. You are obviously now convinced once again of the validity of your views and like Jim’s support.
Frankly, HLG and Jim, I take the blog with a “grain of salt”.
First if it was really true, why do I have to go to a local blog to find the truth. The above should be in front of cameras all over the nation, should it not.
But I will “wait” to read a rebutal from the industry accused of such gimmicks like “withholding cures”.
Here is one reason. Medicare by and large pays for doctors, hospitals and clinics but NOT drugs at least in comparative costs. We spend about $500 Billion per year out of the general fund to pay for Medicare. Most of that again goes to doctors, clinics and hospitals where diseases are diagnosed and treated. Drugs under Medicare come out of a separtate “pot” as I understand it and that “pot” is much smaller than the above described.
I in no way suggest that some industry makes a lot of money by lobbying the federal government. Some profits may SEEM to be obscene as well. But I sure know as an investor if I could get 17% today on my investment I would jump on it. Why don’t you do so? Moral reasons?? Com’on.
Also $280 Billion in sales is indeed a big number. But that does not include the cost of developing and producing the product. Now why are such costs so high (and unstated in the blog)? GOVERNMENT CONTROLS is a huge reason and LAWSUITS another.
Finally, if Joplin, MO could “get” that industry to build and operate here, would it not jump at the opportunity. Wonder what salaries such a company might pay and how many workers it would employ. And those folks would not be “greddy crooks” would they?
Good blog to make a point but I am not ready to accept the point lock stock and barrel for sure.
Anson
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Anson,
First of all, the assertion that ibogaine cures addictions is that of the author of the Village Voice article, not mine, and I provided the link so you could see for yourself. I also made clear that the government hasn’t accepted ibogaine. In writing the post I emphasized the point to introduce the proposition that the most profitable drugs are those that do not cure, as did the author of the article.
As for the facts about addiction, I defer to your greater experience, but nowhere do I accuse the industry directly of withholding cures. I simply let the facts speak for themselves and that does appear to be their message because you got it.
You make the point that the cost of drugs is smaller than the rest of Medicare payouts. While true, I don’t see how that diminishes the significance of an industry leveraged by favorable patent and regulatory laws making huge profits on clients subsidized by the taxpayers. Look, I have no problem with competitive business profits. What I have a problem with is unfair playing fields through lobbying and biased laws, especially patent laws. Are you aware that even human genes are being patented? I will provide a link to a 2005 National Geographic article, but since you have said you don’t usually follow them, here are a couple of excerpts (followed by the link for the convenience of others):
and,
link: http://news.nationalgeographic.com/news/2005/10/1013_051013_gene_patent.html
Yes, I know that such research requires a lot of investment money and that companies deserve to profit from investments that pay off. I like capitalism, honest. But do you not see anything wrong with the idea that a huge multinational corporation might own such fundamental knowledge? And do you not see any problem in that smaller companies might not be excluded thereby from using that knowledge for products that would be more useful to humanity in general than the industry’s more profitable products, as highlighted in the post?
The drug industry, as part of the Medical Industrial Complex has become an oligopoly and the point of the post is that it is neglecting the best needs of humankind in favor of its own profit. And I see it trending worse in the same direction. Because of the Citizens United decision, the drug companies are free to spend some of those gigantic profits producing slick videos to scare and cajole the electorate into voting their way. And by “their” way I don’t mean the stockholders of those companies, but rather their executives and boards of directors.
Stockholders in this system are sheep, individually having nothing to say about how a company operates (save for the extremely rare stockholder revolt). I know, I have been one. I occasionally voted my pitifully small number of shares against corporate on some issue – I leave you to guess how effective that was! Stockholders are easily placated with consistent dividends. Lot’s of people jump on that bandwagon, so many that the stock prices have consistently high P/E’s.
BTW, Anson, I have to point out the fallacy in your gibe here:
Com’on yourself. You don’t get it. The 17% doesn’t go to stockholders, Anson. 🙄 The stockholders get 5% or 6% in good times. The rest goes into the pockets of the people at the top – huge salaries and bonuses, corporate jets, expense accounts, golden parachutes, lobbying funds and plenty of R&D to develop more drugs to provide tiny incremental improvements over the money-maker-drugs whose patents are about to expire. And yes, the occasional drug that actually does benefit many people. That’s the game that’s played and I see it as terribly inefficient.
As for “government controls” being a problem, given that side effects of FDA-approved drugs are a huge problem, and don’t tell me otherwise, I can only begin to imagine how bad it would be if Big Pharma could float new drugs with no oversight.
Jim
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“You will JUMP ON anything that “proves” your theory that corporations and war are our ONLY problem, economically. You are obviously now convinced once again of the validity of your views and like Jim’s support.”
Jim has his own views regarding healthcare and unlike some individuals he makes an effort to get as close to the truth as possible
What I’ve been trying to say over and over again is that there are plenty of savings to be had without causing harm to those who need them. Liberals were stunned when Obama began suggesting cost cuts and tax gains that would amount to $4 trillion over 12 years.
We could be saving more than a $1 trillion annually on health care alone. We’re spending an estimated $12 billion on Iraq (not including Afghanistan) which comes to $144 billion or more annually.
“To date, $459.8 billion dollars has been allocated for the war in Afghanistan since 2001.”
Now if you look at the figures above (by the way my health care estimate was low) and multiply them you will see that healthcare reform alone will net more than $12 trillion in over 12 years which is more than three times what Obama was offering. Before you say it can’t be done do a little research and you will see that numerous countries with single payer systems are paying about half of GDP that we’re paying. On top of that they’re getting better medical outcomes, longer lives, and lower infant mortality rates than we do.
If you’ve read Jim’s well reasoned blog carefully and checked to verify its contents you just might have a change of heart. Even better research the health systems of other countries and then compare them to ours. Entitlements aren’t the only contributors to our national debt. Remove the middlemen out of the equation and you’ll see enormous savings that will secure SS and Medicare for individuals such as you, and its people like me that wants you to have them. Healthcare in this country is expensive because of fragmented healthcare management in the private sector, overuse and redundancy of new technologies, and gouging by drug companies and health insurers. Either take time to learn a little about something before you disagree with it, or recuse yourself from debates that require it.
It’s better to believe in what you know than to know what you believe in.
Here is link that you might want to consider.
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Thanks for the chart, HL, It is dramatic. And the trend is even more so. The story is right there in the numbers: America is cannibalizing itself on medical care and the Industry is leading the feast.
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HL,
Please check out the last quotation in the right margin of my home page. 🙂
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PS,
Just out of curiosity I searched for stats on how Big Pharma is doing now. According to one source, the average P/E is 23.3 and the average dividend is 2.6%. These can be found at the bottom, right hand side of this link:
http://www.tickerspy.com/newswire/?p=2900
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I’ll follow and read it. Here are a few more links for your consideration.
http://abcnews.go.com/Health/WomensHealth/price-preventing-premature-births-skyrockets-drug/story?id=13104588
http://www.pharmatimes.com/Article/08-07-26/US_Senate_slams_orphan_drug_%e2%80%9cprice-gouging%e2%80%9d.aspx
http://www.newsworks.org/index.php/health-science/item/21327-gout
http://klobuchar.senate.gov/newsreleases_detail.cfm?id=305999&
http://seekingalpha.com/article/170898-health-insurance-costs-gouging-the-u-s-economy
http://billlynchforcongress.com/index.php?option=com_content&view=article&id=166%3Aprbill-lynch-calls-for-end-to-price-gouging-by-drug-companies&catid=1&lang=en
http://mccaskill.senate.gov/?p=press_release&id=756
I like to find as many cross-references as possible before posting. HLG
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You have more patience than I, HL. I’m impressed.
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“You have more patience than I, HL. I’m impressed.”
Thanks Jim but patience is needed less than one might imagine. I’ve setup folders along the Bookmarks tool bar in Firefox. I then subdivided that folder into other folders such as healthcare, Economy/SS, climate change, and more. Then I drag and drop links into each forum as I come across them. So by and large most of the work is done except for reading and evaluating.
Sometimes I divide folders with a folder to further index things to find some order in all the information chaos. It makes it much easier to access data when you only have to search your links instead of the entire web.
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hlgaskins,
I have been following Jim’s postings for several week now and have wished I were articulate enough to express my thoughts regarding anson’s rants against our government. I truly beiieve he is so down on the government that he will not accept anything that they do as being good. Thank you for your blunt words to him.
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donvphilly
One doesn’t have to be especially articulate in a debate, but it’s important to be honest, and to use the best available data instead of conjecture and personal beliefs. Anson is a near perfect “sounding board” for FOX and Limbaugh talking points. By engaging Anson and those who think like him in honest debates based on best available data, we hopefully expose them to a process of self-questioning.
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To all,
I know of “two” single payer health care systems in modern times. One was in the Soviet Union. The second is in “Europe” with France and Great Britain coming to mind. OK, Canada as well.
We all know what happened to the Soviet Union. No health care alone did not bring it down but I have read many books about the Soviet Union and I would never want to undergo any treatment in that old health care system.
Now Europe. The countries there are going broke faster than we are for now are they not. And look at the riots in Great Britain alone over government cuts, including major changes away from the socialist model of health care for all.
THAT is the way Obama wants to go and most of you support him it seems. Well not me folks.
My family “endured” government health care during my days in the military. No Tricare back then to go into the civilian community for treatment. One had to go to the nearest military hospital when young kids got strep throat, etc. 5 hour waits, a 5 min exam, a bottle of pills and back home again.
To a degree, Medicare is in fact a single payer system (for all people over 65) and it is the single largest burden on our deficit. Go single payer for all and God only knows the cost to government. I don’t need 20 links to tell that story. I have some simple experience to tell it for me.
There is no doubt that if we go strictly to a single payer health care system for everyone, that payer, the government can dictate the costs, for a while. That is exactly what happened in the Soviet Union and is going on in Europe and Canada today. THAT is what you want to see happen, essentially government price controls on health care.
And ANY government price controls ultimately FAIL in the long run. Why? Because it takes away FREEDOM of choice and creates more and more dependancy on government, first by the poor, now the middle class to a degree and then…..?
No sir, not on my watch, thank you very much. Go live in a commune if you like. I’ll take my freedom and liberty instead, make my own choices and go with the consequences.
I don’t need Fox News to tell me any of that and I never listen to Limbaugh and I don’t believe the crap on MSNBC, either. I have lived almost 70 years and read quite a bit over that time. I do not live in a conservative “womb”, ignoring all else, either. Rather, my education, formal and accumulated over many years, my experience and my “gut” tell me that freedom and liberty win out in the end. When I see government restricting freedom and liberty beyond very basic levels, I see bad things result no matter how good the intentions.
None of you were “around” these blogs two or more years ago when I wrote about setting the “stakes (or boundaries) of liberty”. I stand by that concept today. Some boundaries are required to prevent anarchy. But when you try to set them as Obama and others try to do, I see disasters arising. And I go no farther than our economic condition today after 2 1/2 years of his lack of leadership in the right direction.
As for curing addiction, Jim, your first point to me seemed to be that drug companies were withholding drugs that could really be helpful but would not be in their best interests for profit. Whether you believe that or not, that was the point that I indeed “got”. I merely said the “cure” mentioned was bogus in my experience. Got any more examples?
Anson
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Nicely done, Anson. You appear to have ignored most of the specific points made in the post and turned the debate into one of capitalism over communism. “Go live in a commune if you like.” Nice. Hard to compete with that logic. No alternate suggestions for fixing the problems I mention, just accept the system the way it is? Hmm. By the way, just to be clear to others (I doubt you will believe me), I would much prefer to keep a competitive, capitalistic medical system where every patient has skin in the game and an incentive to ask what procedures and medicines cost. The only reason I have been advocating a single-payer system is that I don’t think it is politically feasible to modify the present system to cover all Americans, given the entrenched status of Medicare and Medicaid.
As for other examples of drugs, as I said before, I don’t think any have specifically been “withheld”. I might mention though that very little money has been invested by the drug companies over the decades in treatments for malaria, for example. That of course is one of the enduring scourges of humanity, but there’s little profit in it because it is a tropical disease that affects primarily poor people. As for ibogaine, I looked it up in Wikipedia. Like those of many drugs its track record is not one of complete success, but there is evidence that it is useful in treatment programs. Here’s a link for anyone who might want to use it (see para. 4.1). http://en.wikipedia.org/wiki/Ibogaine#Treatment_for_opiate_addiction
I guess I’ll crawl back into my hole with my fellow-travelers from Canada and Europe now. By the way, I wish you luck with your “FREEDOM of choice” in choosing among the drug ads on the evening news for the cure, oops, I mean treatment, of your choice. I’m sure (aren’t you?) that Big Pharma will do right by you. (Psst. Don’t forget to read the very fine print – there’s a full page of it.)
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“I know of “two” single payer health care systems in modern times. One was in the Soviet Union. The second is in “Europe” with France and Great Britain coming to mind. OK, Canada as well.”
Did you also try searching for Universal Healthcare? It’s not always referred to as single payer since it is handled somewhat differently but they’re all built a similar premise.
Here try this list:
Norway 1912 Single Payer
New Zealand 1938 Two Tier
Japan 1938 Single Payer
Germany 1941 Insurance Mandate
Belgium 1945 Insurance Mandate
United Kingdom 1948 Single Payer
Kuwait 1950 Single Payer
Sweden 1955 Single Payer
Bahrain 1957 Single Payer
Brunei 1958 Single Payer
Canada 1966 Single Payer
Netherlands 1966 Two-Tier
Austria 1967 Insurance Mandate
United Arab Emirates 1971 Single Payer
Finland 1972 Single Payer
Slovenia 1972 Single Payer
Denmark 1973 Two-Tier
Luxembourg 1973 Insurance Mandate
France 1974 Two-Tier
Australia 1975 Two Tier
Ireland 1977 Two-Tier
Italy 1978 Single Payer
Portugal 1979 Single Payer
Cyprus 1980 Single Payer
Greece 1983 Insurance Mandate
Spain 1986 Single Payer
South Korea 1988 Insurance Mandate
Iceland 1990 Single Payer
Hong Kong 1993 Two-Tier
Singapore 1993 Two-Tier
Israel 1995 Two-Tier
In a Two-Tier system means that there is both guaranteed pubic health care for most of the people and the option to purchase private care. This way everyone is covered while the wealthy can purchase additional care. In reality many of the single payer systems are also two-tiered systems which makes things confusing. Obama care places in the Insurance Mandate category, although it being challenged on the right, Now take everyone of those countries and compare their healthcare costs to GDP.
For instance in 2005 the percentage of GDP for these countries were: Israel 8%, Australia 8.8%, Canada 9.8%, Finland 7.5%, France 11.2%, Germany 10.5%, and the United States (drum rolls) 15.7%.
In 2010 Australia’s healthcare was 8.7%, France 11%, Canada 10.1%, Germany’s 10.4%, and the United States (more drum rolls and then a canon) 18.5%. So let’s put this in perspective all the other countries healthcare systems remained statistically the same with some slightly more and some slightly less over 5 years. While healthcare costs in the United States rose by more than 16% in that same frame of time. If that’s a trend then in 2015 our healthcare cost will be 21.46% if GDP. Before you start trashing their service also consider that people are living longer have vastly lower infant mortality rates than we do in all of these countries.
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WOW, hlgaskins!
Your info is terrific.
I’d like to add a couple of thoughts.
1st, I am so glad that Anson’s form of “FREEDOM” is not shared by the majority. I prefer my form, which at, 81, allows me to be FREE from imposing on my children for my normal living expenses and my health care. I wonder if he ever visited Branson. When I did a few years ago I suggested that it was a tribute to Social Security. Without Social Security our economy would be in really big trouble.
2nd, I have a friend who was assigned to work in England for three years during which he was covered by their health care. He and his wife returned last year. She recently had a problem with some dental work that she had done over there. He informed me last week that he had found that it was cheaper for him and her to fly to England to have it repaired than to have it done here. I quess they not only provide good service,but they stand behind it.
Thank you for all the research that you provide us.
Unfortunately, people like Anson are so ingrained in their, what many believe to be their selfish ideologies, that no matter what facts you put in front of them they will disregard them.
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“I prefer my form, which at, 81, allows me to be FREE from imposing on my children for my normal living expenses and my health care.”
I prefer your view as well because that’s the it should be in a civilized society.
“I have a friend who was assigned to work in England for three years during which he was covered by their health care. He and his wife returned last year. She recently had a problem with some dental work that she had done over there. He informed me last week that he had found that it was cheaper for him and her to fly to England to have it repaired than to have it done here.”
My wife’s Canadian. I met her there while working professionally. I lived there for a few years and enjoyed the experience immensely and I learned to appreciate the availability and affordability of healthcare. When it came time to return to the U.S.A the number one thing that I was apprehensive about was the return to our healthcare system.
“Thank you for all the research that you provide us.”
You’re welcome, and disregard Anson’s rambling, he simply doesn’t know his way, but if his efforts and those like him succeed he will find himself a victim of his own ideology. HLG
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I haven’t heard anyone discuss Ibogaine since Ed Muskie was accused of being addicted to it. It was an odd and baseless rumor, but it would have explained much of his performance in the 1972 primaries.
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