CZ:Proposals/Medical Disclaimers: Difference between revisions

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== Complete explanation ==
== Complete explanation ==
Proposal to include medical disclaimer phrases on all articles relating to prescription drugs and
Proposal to include medical disclaimer phrases on all articles relating to prescription drugs and
medical conditions.  A suggested possible phrasing:
medical conditions.   


"This page should not be construed as medical advice.  Patients should always discuss medicines and medical conditions with their personal physicians and pharmacists. The intend of this article is to help foster and improve patient/physician discussions."
A final suggested phrasing:
 
: '''This educational article should not be construed as professional advice, but is intended to help foster and improve informed discussions.'''
 
 
I believe the above statement fits all points brought out in the discussion below: 1) simplified 2) remove reference to lay persons 3) fits any professional category, such as accounting, law, etc.
 
==Suggested amendment==
 
: '''This educational article should not be construed as professional advice, but is intended to help foster and improve informed discussions.  Those whose see specific advice, we encourage you to seek it from the appropriate qualified professional, for example, a qualified physician for advice regarding prevention, diagnosis and treatment of symptoms or disease, or for advice relating to personal concerns.'''
 
Did the resolution sponsor write this?  If not, please say so.  Basically, we need to know whether this is the text the Council will be voting on, or instead the earlier text.  I believe the text the Council was asked to comment on was the earlier textIf a Council member wants to suggest an amendment, the proper procedure ''requires'' proposing it on cz-editcouncil, ''not'' on this page. --[[User:Larry Sanger|Larry Sanger]] 08:52, 25 July 2008 (CDT)
 
:: This amendment was not added by me.  I am still in favor of a simple one line tag useful for all professions. I would be in favor of amending the name of the this proposal to Professional Disclaimer.  Any comments on that idea? [[User:David E. Volk|David E. Volk]] 09:07, 25 July 2008 (CDT)
 
::::Well, do you mean that we should as a matter of policy apply the disclaimer to all topics that carry any sort of "professional liability," beyond what appeared in the original resolution?  If so, you'd need to specify exactly which topics the disclaimer will apply to ("professional" is very vague), and of course you'd need to propose an amendment.  Exactly one definite resolution was made, which is as it should be--otherwise, the parliamentary process breaks down. --[[User:Larry Sanger|Larry Sanger]] 09:27, 25 July 2008 (CDT)
 
::::BTW, just out of curiosity, ''have'' you changed the original wording, David?  You're not actually permitted to do so, for the reasons just mentioned.  Once the resolution is made, it can be changed only by the amendment process.  Just bear in mind that the amendment process can itself be perfectly easy (if not always so quick). --[[User:Larry Sanger|Larry Sanger]] 09:29, 25 July 2008 (CDT)
 
 
It might help to look at MedPedia’s disclaimer’s wording:
 
“The Information on Medpedia is not Medical Advice”
 
“MEDPEDIA DOES NOT PROVIDE MEDICAL ADVICE. The information on Medpedia, including text, images, video, graphics, member communications and other information, whether provided by Medpedia or by its members (“Members”) (collectively, the “Content”), does not constitute medical advice of any kind, and is not intended to be, and should not be, used to diagnose or identify treatment for a medical condition. The Content should never be used in place of the advice of your physician or other medical professional, and your use of the Medpedia Service indicates your agreement not to do so.
 
“Medpedia is intended as an educational resource for you to begin learning about health issues. If you are a patient or suspect that you are suffering from a medical condition, see your doctor for medical advice and diagnosis. If you are affected by any potential health or medical emergency, call your local emergency service immediately. Medpedia does not recommend or endorse any treatment, institution, product, professional, physician, procedure or other information that may be mentioned on Medpedia. By using the Medpedia Service, you understand and agree that the Content is written and monitored in a collaborative effort by a large community of people that are neither employees of Medpedia nor controlled by Medpedia and the Content is constantly changing. Medpedia does not validate or otherwise endorse the Content, nor does it validate the credentials of the people contributing to the Site. The Content is provided “as is” and without any representations or warranties of any kind.”
--[[User:Anthony.Sebastian|Anthony.Sebastian]] 22:15, 25 July 2008 (CDT)


== Reasoning ==
== Reasoning ==
Line 16: Line 43:
Whereas, patients should always discuss medical treatment with personal physician or pharmacist, and
Whereas, patients should always discuss medical treatment with personal physician or pharmacist, and


Whereas, the CZ should limit its liability regarding providing medical information to the lay public.
Whereas, the CZ should limit its liability regarding providing medical information to the public.


== Implementation ==
== Implementation ==
Action item 1: A one week discussion within health sciences workgroup members to:
Action item 1: DONE
 
* refine phrasing
 
* decide if phrasing should appear on each page, or only as a link


* solicite members to write a template for ease of use.
Action item 2: Awaiting EC vote
 
Action item 2: Suggest to proposals manager that this proposal be put to the Editorial Council.


Action item 3: Implement this proposal on all current health science pages.
Action item 3: Implement this proposal on all current health science pages.
Line 35: Line 56:
= Discussion =
= Discussion =
At present, authors/editors [[User:David E. Volk]], [[User:Robert Badgett]], and [[User:Robert W King]] have indicated support this measure.
At present, authors/editors [[User:David E. Volk]], [[User:Robert Badgett]], and [[User:Robert W King]] have indicated support this measure.
:I suggest slight changing of the wording so that the target of the disclaimer is not only the lay public, but health care practitioners as well. - [[User:Robert Badgett|Robert Badgett]] 11:19, 10 March 2008 (CDT)
: My strong support for this[[User:Gareth Leng|Gareth Leng]] 11:27, 10 March 2008 (CDT)
: I sent en email to cz-law today, hoping to get input from lawyers as well as health care professionals. [[User:David E. Volk|David E. Volk]] 11:47, 10 March 2008 (CDT)
::There is no legal requirement that we include disclaimers at all, but if we do it should be kept simple and to the point. The DrugBank example is very good, but we may want to have a simpler link on each page where professional information of any kind is presented, said link leading to a broader general disclaimer page indicating that CZ is not to be regarded as professional advice for medical, legal, accounting, etc. [[User:Brian Dean Abramson|Brian Dean Abramson]] 12:31, 10 March 2008 (CDT)
I wish to ammend this proposal... I would like it to include all supposed medical treatments, not merely prescription medical treatments. Non-prescription treatments are much more of a problem in terms of the reliability of our coverage. The fact is, I would mostly trust our coverage of prescription medicines. But I would not trust our coverage of other supposed medical treatments at all, not even a little bit. [[User:Carl Kenner|Carl Kenner]] 10:32, 11 May 2008 (CDT)
Someone previously suggested that all professional articles, (Law, Medicine, etc) could use this tag.  I see no reason why all articles couldn't use it. [[User:David E. Volk|David E. Volk]] 09:00, 12 May 2008 (CDT)
== Example used on our pages (Life) for approved articles ==
I see this disclaimer exists on the [[life]] article:
* The Citizendium Foundation and Citizendium participants make no representations about the reliability of this article or its suitability for any purpose.
Is that sufficient, especially with our "press" extolling our reliability versus other sites? [[User:David E. Volk|David E. Volk]] 13:09, 10 March 2008 (CDT)
== Example disclaimers used by other websites==
===Canada's Drug Bank ===
This is the disclamier from the Drug Bank:
* Disclaimer: The content of DrugBank is intended for educational and scientific research purposes only. It is not intended as a substitute for professional medical advice, diagnosis or treatment.
[[User:David E. Volk|David E. Volk]] 09:50, 10 March 2008 (CDT)
===American College of Physicians===
See [http://pier.acponline.org/physicians/public/d161/drug.tx/d161-s7.html Obesity: Drug Therapy] - [[User:Robert Badgett|Robert Badgett]] 11:17, 10 March 2008 (CDT)
===Other examples===
* [http://www.spinal-foundation.org/disclaimer.asp Spinal Foundation]
* [http://www.healthcenter.vt.edu/Disclaimer.htm Schiffert Health Center]
* [http://www.mamc.amedd.army.mil/mamc/Included/disclaimer.htm Madigan Army Medical Center]
* [http://www.lunesta.com/medicalDisclaimer/medical-disclaimer.html Lunesta]
* [http://www.paralysis.org/site/c.erJMJUOxFmH/b.1342673/k.C458/Medical_Disclaimer.htm Paralysis Resource Center]
* [http://www.hemophilia.org/NHFWeb/MainPgs/MainNHF.aspx?menuid=0&contentid=196 National Hemophilia Foundation]
* [http://www.myasthma.com/netcare/disclaimer.asp MyAsthma]
* [http://www.seattlechildrens.org/home/disclaimer.asp Children's Seattle]
* [http://www.med.miami.edu/medicalDisclaimer.asp Miller]
* [http://www.nebraskamed.com/legal.aspx Nebraska medical center]
However, once we are ''approving'' any (medical) article, the approving editors are actually vouching for the authenticity of the information on the date of approval! [[User:Supten Sarbadhikari|Supten Sarbadhikari]] 02:05, 12 March 2008 (CDT)
==Discussion==
:''Open to all.''
Of course, of course, of course, for articles being drafted, and this, I'd say, might be just a "bold move" done by medical editors. The proposal's last sentence, however - that is controversial, I'd think.  Even if a medical article is perfectly accurate, we want people relying on medical advise from their own physician(s), who has/have legal responsibility for their care, not encyclopedia articles. [[User:Stephen Ewen|Stephen Ewen]] 02:18, 12 March 2008 (CDT)
::I personally '''hate''' this disclaimer:
"The Citizendium Foundation and Citizendium participants make no representations about the reliability of this article or its suitability for any purpose."
::What's the point of even developing an article to the upmost accuracy based on what we know or can find out?  There really should be a completely different wording. --[[User:Robert W King|Robert W King]] 09:14, 12 March 2008 (CDT)
The problem I have with that disclaimer is that some CZ participants DO make representations about the reliability of the articles, in newspaper, TV, radio and webpages, and this is contractory to what the above disclaimer says.
So citizen John Doe, hears a CZ spokesman touting CZ on the radio, looks up the article on drug XXXX, doesn't see any counterindications for herbal extract YYY, takes a bunch and gets very ill.  The pages for XXX and YYY don't list the recently discovered dangerous interaction.  Is anyone liable?  All authors, only the approving editor?
Luckily, I am not a medical editor, so I think my butt is covered.  Who wants to approve medical articles?  Has ANY medical article been approved yet? [[User:David E. Volk|David E. Volk]] 09:51, 12 March 2008 (CDT)
Congratulations for the following :
<blockquote>"The intent of this article is to help foster and improve patient/physician discussions."</blockquote>
I consider that this sentence encapsulates both the legal and CZian imperatives.
I '''love''' this disclaimer!
[[User:Pierre-Alain Gouanvic|Pierre-Alain Gouanvic]] 17:03, 12 March 2008 (CDT)
:I wouldn't say that. Imagine the peeved doctor who's patient comes to him requesting a prescription based on what the patient read on Citizendium. This phrase does not ''disclaim'' anything! It suggests that Citizendium is telling the patient something that the doctor has neglected, and that the advice of Citizendium can be relied upon (exposing us to liability). [[User:Brian Dean Abramson|Brian Dean Abramson]] 22:02, 12 March 2008 (CDT)
My personal Phys. loves that we can have a quick well-informed discussions.  I once brought him a new medical article about a week old that he was unaware of, and he had his resident make copies for the whole group.  So, I don't think most physicians get too upset when the patient has some knowledge. [[User:David E. Volk|David E. Volk]] 08:56, 13 March 2008 (CDT)
:My analysis is legal as opposed to anecdotal; I am not concerned with what "most" physicians may think. The point is to shield Citizendium from potential tort liability arising from the random user's perception that Citizendium is telling them that it is okay to go ahead and use a particular drug. [[User:Brian Dean Abramson|Brian Dean Abramson]] 13:36, 17 March 2008 (CDT)
Hi Brian, David, all,
I found that the National Institutes of Health's [http://www.ncbi.nlm.nih.gov/About/disclaimer.html disclaimer] both promoted patient-physician relationship and properly protected from misinterprations of the intents of knowledge providers. Thus, I suggest:
<blockquote>"The intent of this article is to help foster and improve patient/physician discussions."</blockquote>
plus (and I quote):
<blockquote>It is not the intention of ''the Citizendium'' (NLM) to provide specific medical advice but rather to provide users with information to better understand their health and their diagnosed disorders. Specific medical advice will not be provided, and ''the Citizendium'' (NLM) urges you to consult with a qualified physician for diagnosis and for answers to your personal questions.</blockquote>
[[User:Pierre-Alain Gouanvic|Pierre-Alain Gouanvic]] 23:00, 3 May 2008 (CDT)
I like what Pierre-Alain proposes.  I would amend to ''Citizendium'' encourages you to consult with your physician for question relating to prevention, diagnosis and treatment, and to related personal issues.  --[[User:Anthony.Sebastian|Anthony.Sebastian]] 12:27, 13 July 2008 (CDT)
:It's really very good wording. [[User:Stephen Ewen|Stephen Ewen]] 21:28, 13 July 2008 (CDT)
== Thoughts on amendment ==
In earlier discussions on the proposals page, it was suggested that we keep the phrasing simple so that it could be applied to any professional field, like law, and so forth, and that is what lead to the rather stripped down statement.  So we are faced with two choices in the way of amendments. 1) amend to include other fields and keep the phrasing simple and appropriate for any field, or 2) make it longer and more specific to medical sciences.  Choice #1 would avoid having additional Council Resolutions in the future that would be copycats of this one. for each field.
[[User:David E. Volk|David E. Volk]] 08:27, 22 July 2008 (CDT)
If you need more time to discuss amendments, please ask for it on cz-editcouncil.  Otherwise, the Chair might start us voting soon. --[[User:Larry Sanger|Larry Sanger]] 09:30, 25 July 2008 (CDT)


:: As far as I can tell, my final phrase was set on  March 20th, 2008. We were waiting quite some time for the new Council to be formed.  The voting can start anytime as far as I am concerned, but I am willing to postpone it if other members feel it is necessary. [[User:David E. Volk|David E. Volk]] 09:38, 25 July 2008 (CDT)


:::: OK! --[[User:Larry Sanger|Larry Sanger]] 10:03, 25 July 2008 (CDT)
{{Proposals navigation}}
{{Proposals navigation}}

Latest revision as of 21:15, 25 July 2008

This proposal has been assigned to the Editorial Council, and is now in the Editorial Council proposals queue.


Driver: David E. Volk

Complete explanation

Proposal to include medical disclaimer phrases on all articles relating to prescription drugs and medical conditions.

A final suggested phrasing:

This educational article should not be construed as professional advice, but is intended to help foster and improve informed discussions.


I believe the above statement fits all points brought out in the discussion below: 1) simplified 2) remove reference to lay persons 3) fits any professional category, such as accounting, law, etc.

Suggested amendment

This educational article should not be construed as professional advice, but is intended to help foster and improve informed discussions. Those whose see specific advice, we encourage you to seek it from the appropriate qualified professional, for example, a qualified physician for advice regarding prevention, diagnosis and treatment of symptoms or disease, or for advice relating to personal concerns.

Did the resolution sponsor write this? If not, please say so. Basically, we need to know whether this is the text the Council will be voting on, or instead the earlier text. I believe the text the Council was asked to comment on was the earlier text. If a Council member wants to suggest an amendment, the proper procedure requires proposing it on cz-editcouncil, not on this page. --Larry Sanger 08:52, 25 July 2008 (CDT)

This amendment was not added by me. I am still in favor of a simple one line tag useful for all professions. I would be in favor of amending the name of the this proposal to Professional Disclaimer. Any comments on that idea? David E. Volk 09:07, 25 July 2008 (CDT)
Well, do you mean that we should as a matter of policy apply the disclaimer to all topics that carry any sort of "professional liability," beyond what appeared in the original resolution? If so, you'd need to specify exactly which topics the disclaimer will apply to ("professional" is very vague), and of course you'd need to propose an amendment. Exactly one definite resolution was made, which is as it should be--otherwise, the parliamentary process breaks down. --Larry Sanger 09:27, 25 July 2008 (CDT)
BTW, just out of curiosity, have you changed the original wording, David? You're not actually permitted to do so, for the reasons just mentioned. Once the resolution is made, it can be changed only by the amendment process. Just bear in mind that the amendment process can itself be perfectly easy (if not always so quick). --Larry Sanger 09:29, 25 July 2008 (CDT)


It might help to look at MedPedia’s disclaimer’s wording:

“The Information on Medpedia is not Medical Advice”

“MEDPEDIA DOES NOT PROVIDE MEDICAL ADVICE. The information on Medpedia, including text, images, video, graphics, member communications and other information, whether provided by Medpedia or by its members (“Members”) (collectively, the “Content”), does not constitute medical advice of any kind, and is not intended to be, and should not be, used to diagnose or identify treatment for a medical condition. The Content should never be used in place of the advice of your physician or other medical professional, and your use of the Medpedia Service indicates your agreement not to do so.

“Medpedia is intended as an educational resource for you to begin learning about health issues. If you are a patient or suspect that you are suffering from a medical condition, see your doctor for medical advice and diagnosis. If you are affected by any potential health or medical emergency, call your local emergency service immediately. Medpedia does not recommend or endorse any treatment, institution, product, professional, physician, procedure or other information that may be mentioned on Medpedia. By using the Medpedia Service, you understand and agree that the Content is written and monitored in a collaborative effort by a large community of people that are neither employees of Medpedia nor controlled by Medpedia and the Content is constantly changing. Medpedia does not validate or otherwise endorse the Content, nor does it validate the credentials of the people contributing to the Site. The Content is provided “as is” and without any representations or warranties of any kind.” --Anthony.Sebastian 22:15, 25 July 2008 (CDT)

Reasoning

Whereas, the CZ is not a physician, and

Whereas, medical information changes very quickly, and

Whereas, patients should always discuss medical treatment with personal physician or pharmacist, and

Whereas, the CZ should limit its liability regarding providing medical information to the public.

Implementation

Action item 1: DONE

Action item 2: Awaiting EC vote

Action item 3: Implement this proposal on all current health science pages.

Action item 4: If feasible, automate the process for all new articles tagged with the Health Science workgroup.

Discussion

At present, authors/editors User:David E. Volk, User:Robert Badgett, and User:Robert W King have indicated support this measure.

I suggest slight changing of the wording so that the target of the disclaimer is not only the lay public, but health care practitioners as well. - Robert Badgett 11:19, 10 March 2008 (CDT)
My strong support for thisGareth Leng 11:27, 10 March 2008 (CDT)
I sent en email to cz-law today, hoping to get input from lawyers as well as health care professionals. David E. Volk 11:47, 10 March 2008 (CDT)
There is no legal requirement that we include disclaimers at all, but if we do it should be kept simple and to the point. The DrugBank example is very good, but we may want to have a simpler link on each page where professional information of any kind is presented, said link leading to a broader general disclaimer page indicating that CZ is not to be regarded as professional advice for medical, legal, accounting, etc. Brian Dean Abramson 12:31, 10 March 2008 (CDT)

I wish to ammend this proposal... I would like it to include all supposed medical treatments, not merely prescription medical treatments. Non-prescription treatments are much more of a problem in terms of the reliability of our coverage. The fact is, I would mostly trust our coverage of prescription medicines. But I would not trust our coverage of other supposed medical treatments at all, not even a little bit. Carl Kenner 10:32, 11 May 2008 (CDT)

Someone previously suggested that all professional articles, (Law, Medicine, etc) could use this tag. I see no reason why all articles couldn't use it. David E. Volk 09:00, 12 May 2008 (CDT)

Example used on our pages (Life) for approved articles

I see this disclaimer exists on the life article:

  • The Citizendium Foundation and Citizendium participants make no representations about the reliability of this article or its suitability for any purpose.

Is that sufficient, especially with our "press" extolling our reliability versus other sites? David E. Volk 13:09, 10 March 2008 (CDT)

Example disclaimers used by other websites

Canada's Drug Bank

This is the disclamier from the Drug Bank:

  • Disclaimer: The content of DrugBank is intended for educational and scientific research purposes only. It is not intended as a substitute for professional medical advice, diagnosis or treatment.

David E. Volk 09:50, 10 March 2008 (CDT)

American College of Physicians

See Obesity: Drug Therapy - Robert Badgett 11:17, 10 March 2008 (CDT)

Other examples

However, once we are approving any (medical) article, the approving editors are actually vouching for the authenticity of the information on the date of approval! Supten Sarbadhikari 02:05, 12 March 2008 (CDT)

Discussion

Open to all.

Of course, of course, of course, for articles being drafted, and this, I'd say, might be just a "bold move" done by medical editors. The proposal's last sentence, however - that is controversial, I'd think. Even if a medical article is perfectly accurate, we want people relying on medical advise from their own physician(s), who has/have legal responsibility for their care, not encyclopedia articles. Stephen Ewen 02:18, 12 March 2008 (CDT)

I personally hate this disclaimer:

"The Citizendium Foundation and Citizendium participants make no representations about the reliability of this article or its suitability for any purpose."

What's the point of even developing an article to the upmost accuracy based on what we know or can find out? There really should be a completely different wording. --Robert W King 09:14, 12 March 2008 (CDT)

The problem I have with that disclaimer is that some CZ participants DO make representations about the reliability of the articles, in newspaper, TV, radio and webpages, and this is contractory to what the above disclaimer says. So citizen John Doe, hears a CZ spokesman touting CZ on the radio, looks up the article on drug XXXX, doesn't see any counterindications for herbal extract YYY, takes a bunch and gets very ill. The pages for XXX and YYY don't list the recently discovered dangerous interaction. Is anyone liable? All authors, only the approving editor? Luckily, I am not a medical editor, so I think my butt is covered. Who wants to approve medical articles? Has ANY medical article been approved yet? David E. Volk 09:51, 12 March 2008 (CDT)

Congratulations for the following :

"The intent of this article is to help foster and improve patient/physician discussions."

I consider that this sentence encapsulates both the legal and CZian imperatives.

I love this disclaimer!

Pierre-Alain Gouanvic 17:03, 12 March 2008 (CDT)

I wouldn't say that. Imagine the peeved doctor who's patient comes to him requesting a prescription based on what the patient read on Citizendium. This phrase does not disclaim anything! It suggests that Citizendium is telling the patient something that the doctor has neglected, and that the advice of Citizendium can be relied upon (exposing us to liability). Brian Dean Abramson 22:02, 12 March 2008 (CDT)

My personal Phys. loves that we can have a quick well-informed discussions. I once brought him a new medical article about a week old that he was unaware of, and he had his resident make copies for the whole group. So, I don't think most physicians get too upset when the patient has some knowledge. David E. Volk 08:56, 13 March 2008 (CDT)

My analysis is legal as opposed to anecdotal; I am not concerned with what "most" physicians may think. The point is to shield Citizendium from potential tort liability arising from the random user's perception that Citizendium is telling them that it is okay to go ahead and use a particular drug. Brian Dean Abramson 13:36, 17 March 2008 (CDT)

Hi Brian, David, all,

I found that the National Institutes of Health's disclaimer both promoted patient-physician relationship and properly protected from misinterprations of the intents of knowledge providers. Thus, I suggest:

"The intent of this article is to help foster and improve patient/physician discussions."

plus (and I quote):

It is not the intention of the Citizendium (NLM) to provide specific medical advice but rather to provide users with information to better understand their health and their diagnosed disorders. Specific medical advice will not be provided, and the Citizendium (NLM) urges you to consult with a qualified physician for diagnosis and for answers to your personal questions.

Pierre-Alain Gouanvic 23:00, 3 May 2008 (CDT)

I like what Pierre-Alain proposes. I would amend to Citizendium encourages you to consult with your physician for question relating to prevention, diagnosis and treatment, and to related personal issues. --Anthony.Sebastian 12:27, 13 July 2008 (CDT)

It's really very good wording. Stephen Ewen 21:28, 13 July 2008 (CDT)

Thoughts on amendment

In earlier discussions on the proposals page, it was suggested that we keep the phrasing simple so that it could be applied to any professional field, like law, and so forth, and that is what lead to the rather stripped down statement. So we are faced with two choices in the way of amendments. 1) amend to include other fields and keep the phrasing simple and appropriate for any field, or 2) make it longer and more specific to medical sciences. Choice #1 would avoid having additional Council Resolutions in the future that would be copycats of this one. for each field. David E. Volk 08:27, 22 July 2008 (CDT)

If you need more time to discuss amendments, please ask for it on cz-editcouncil. Otherwise, the Chair might start us voting soon. --Larry Sanger 09:30, 25 July 2008 (CDT)

As far as I can tell, my final phrase was set on March 20th, 2008. We were waiting quite some time for the new Council to be formed. The voting can start anytime as far as I am concerned, but I am willing to postpone it if other members feel it is necessary. David E. Volk 09:38, 25 July 2008 (CDT)
OK! --Larry Sanger 10:03, 25 July 2008 (CDT)

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