Is a philosophical perspective on health possible?

['docmartin' (Dr Martin Cohen)]

I've just abandoned (for today) my editing efforts on the early stage page 'Alternative Medicine (Theories).

This page was explicitly set up to offer a different way to approach health issues - its aim was to take a broader view than that of contemporary health science, to consider how different ages, different cultures and different groups have looked on human health and how it relates to the universe.

But the page has come under something of an onslaught of criticism on the talk page.

There have been general objections- what is it - why have it - where's it going to go

which I was grateful to see 'common sense' prevailed over, in that pages have to be allowed to develop, and although this one has not had much chance to do so, it clearly had aims quite distinct from the existing pages firmly situated under 'healing arts'. Gareth Leng as a Healing Arts editor added a note to this effect. But the article has not been allowed to develop - it has been trashed.

There were objections to the 'type' of information acceptable on the page - and false suggestions that I had introduced rubbish - for example that the Ancient Egyptians did not consider the onion to have special significance (yes they did, source provided) or that there were not burial excavations 60 00 years ago revealing the use of medicinal plants (yes there were, source provided) ...

But most sinister of all is that there has been huge quantities of irrelevant, confusing and self-consciously 'contrarian' information added. The introductory paragraph turned into a mini essay on the faults of modern advocates of Alternative Medicine  - other sections, I found sprinkled with barbed asides aimed at the other editors and authors such as 'Since that seems to be not enough about Snow's use of evidence, statistics, and causality, let us, then, consider his own words....' and 'He goes on at great length. Is more necessary? '

If you look at the page now, it does not make much sense., I'm afraid. Are we really comfortable with this sort of 'editorial warfare'? Who will be left standing after it all ends?

I have added this plea to the Talk Page just

== What this page is  and what this page is not==

I started this page and set out its aims clearly - it is all in the original first paragraph plus the link differentiating this page from the Complementary and Alternative Medicine page. The focus of this page is on the social, cultural and philosophical aspects and dimensions to health policy, only in the briefest sense with scientific and developmental  questions.

Let me be more clear. It is not concerned with scientific debates. Please do not rehearse them here. Nor is it concerned with detailed historical developments in medical treatments, so do not bring that discussion here either.

What is of interest only is the brief description of the wide range of approaches to 'health and well being' over thousands of years. The page should describe:

what this myriad of theories and approaches are
their historical origins and cultural significance/ roots
the philosophies/ methodologies/ paradigms (if you like) behind the approaches
it does not attempt or need to offer a contemporary scientific evaluation  of their efficacy

Too much of the editing done recently has sought to introduce pseudo technical 'complexities' at the expense of offering a broad sociological/ philosophical insight into health issues

[Paul Wormer]

There were objections to the 'type' of information acceptable on the page - and false suggestions that I had introduced rubbish - for example that the Ancient Egyptians did not consider the onion to have special significance (yes they did, source provided) or that there were not burial excavations 60 00 years ago revealing the use of medicinal plants (yes there were, source provided) ...

You are not honest, I questioned the 60,000 year old excavations and I was the first to come up with a source. I do wonder, though, what some fairly far-fetched speculations about a skeleton that may, or may not, have been a Neanderthal medicine-man,  has to say about modern-day alternative medicine. This Neanderthal factoid would not be misplaced in a history of regular medicine, either,  for it is unlikely that the Neanderthal men distinguished the two kinds of healing.

With regard to the Egyptian onion-model of cosmology (if it is true), I can ask the same question: what do you want to prove with it?   In any case, as I pointed out on the talk page, the onion-model is in sharp contrast to the boat-model described by Kuhn in its book Copernican Revolution.   After I asked you,  you sourced the statement with a reference to a website (and some unspecified entry in the Brittanica).

This brings me to another, more general question: how far can we rely on websites? I seem to remember that we agreed not to use WP as a source, because of its questionable reliability. Can we use websites maintained by private citizens? Or maintained by organizations that are otherwise unknown? To me the answer is very clear, of course not, but Martin Cohen and Pierre-Alain  Gouanvic apparently disagree with me on this.

Yet another question: how far should one wander off-topic in an encyclopedia article?  In my view the article on Alternative medicine (theories) is a rambling story from which it is very hard to extract what kinds of alternative medicine are actually practiced nowadays. I would have expected some sort of review of iriscopy, magnetic healing,  acupuncture,  etc., but if it is there, it is hard to find  it among  the many, very verbose, sections,  subsections,  and  paragraphs (the text boxes do not help either in getting the points across). Is it not possible to write a simple review of the different healing practices without taking a stance about their effectiveness?  And to write it factually, encyclopedia-like,  not involving  de duvel en zijn oude moer? (Dutch saying for things that are irrelevant;  literally: the devil and his old mom).

['docmartin' (Dr Martin Cohen)]

Paul, you flatly disparaged my work and suggested that it was, 'after you had checked up', factually wrong. The claims made were very general, intended to make illustrative points for introductory purposes. I provided references after your complain to more conventional book sources.

The substantial issue here is that I started an 'overview' page attempting to introduce some ideas for new pages in the general area of health, as seen from a philosophcial and anthropological perspective, and Citizen's openly declaring themselves unsympathetic to the concept and project have made numerous edits both to the page proper and on the talk page which are negative and destructive - as summarised above.

A constable has advised thus:

"... if you want to take this issue off on a divergent track, consider writing a new article, such as "Alternative Medicine: Experimental evidence" or what ever fits. Doing battle here with strong opinions one way or another will serve little else but to provoke less than collegial responses. A vast range of topics on the primary subject here present themselves and can be further exploited well within the CZ policy framework. ...."

This seems to me to be good advice - can we respect it?

[Paul Wormer]

Martin, you are barking up the wrong tree, the only thing in the present article on "Alternative medicine (theories)" added by me is  reference 11 to a Google book about Shamanism (including a page number).  Why don't you instead address my worries about the use of websites as a source? 

Apparently there is a wide gap between our opinions of how an encyclopedia article should be written. In my view "Alternative medicine"  reads much too much as an essay  that expresses personal opinions; there is  no room for doubt about the feelings of the main authors, you and Pierre-Alain,  on the pros and cons of Alternative versus Regular medicine. (Please be assured that my criticism is not connected to  the points of view of yours and Pierre-Alain's, even if I would share your views one 100% , I would disagree with having them in an encyclopedia article.)   This gap is so wide that lately I have started to ask myself the question whether  I must stay here, at a place that looks to me less and less like an encyclopedia and more and more  like a blogging site  that gives  people the opportunity to launch their ideas and opinions.

[Hayford Peirce]

This gap is so wide that lately I have started to ask myself the question whether  I must stay here, at a place that looks to me less and less like an encyclopedia and more and more  like a blogging site  that gives  people the opportunity to launch their ideas and opinions.

I agree 100% with the above. I am seriously considering leaving the project: I see millions of words being wasted, and hundreds of hours of time wasted, on articles that are essentially, as Paul says, little more than personal opinions more suited for blog sites. Some, or most of the contributors to these sites, have NEVER made a single edit outside of these (sometimes) single sites.  They are obviously pushing their personal agendas and apparently have unlimited time, energy, and the willingness to battle others to a standstill as they try, over, and over, and over again, to add their unorthodox and, to a skeptic like me, entirely laughable views to what is supposed to be an unbiased encyclopedia. I don't mind laughable views being presented in CZ, but they MUST be presented in an unbiased manner.

Martin, however, and various other people are writing what are clearly personal essays representing their own views and research. Gareth is doing yeoman service in trying to rewrite a lot of their editing, but even he, superman that he apparently is, will not be able to single-handedly continue to bring every article in the ency. into CZ specifications.

Larry -- are you reading this thread?  I sure hope so, because there is a lot of anger and resentment that is building up in various parts of the project and it urgently needs to be attended to!

[Pat_Palmer]

This gap is so wide that lately I have started to ask myself the question whether  I must stay here, at a place that looks to me less and less like an encyclopedia and more and more  like a blogging site  that gives  people the opportunity to launch their ideas and opinions.

I agree 100% with the above. I am seriously considering leaving the project: I see millions of words being wasted, and hundreds of hours of time wasted, on articles that are essentially...little more than personal opinions more suited for blog sites

After reading the above, I went straight to the Alternative Medicine article, which I've never visited before, and read it.  I'm afraid I find it very wrong-headed in its current form.  Essentially, I must throw my opinion in this discussion with those who are objecting to its current direction.

I do hope no one leaves the project as a result of this article until more community input can be garnered.  I am not an editor on health fields (only in computers) but I do have a strong belief that this article is written by someone with "an ax to grind".  In other words, if I were to write an article called "Alternative medicine" for CZ, it would be very diffirent indeed.  It would describe AM as the entire body of proposed and possible therapies not specifically endorsed by the American Medical Association or its overseas equivalents.  I would handle the controversies with a great deal more distance, emotionally, than the article does at present.  And also, I think that while some specific therapies could be mentioned only as "examples" of things that might be considered AM, such as massage or acupuncture, each of those things, individually, deserves its own article.

I find the attempt to generalize and classify various so-called alternative medical approaches in some pseudo scientific fashion to be completely unhelpful. 

The writing style is, to me, objectionable.  For example, this statement: "All too often, patients today see both conventional and CAM practitioners..." implies certain value judgements that undermine the neutrality of the article.  "Too often" implies a judgement.  The very phrase "conventional and CAM practitioners" is vague and unhelpful.

I would recommend archiving this entire article (not deleting it, because some authors have put significant effort into it, but allowing it to recede into the background and allowing others--OTHERS!!! not the same authors--to start a different kind of article.

I know this may seem harsh to those who have already worked on the article.  And you may not agree with me.  But that is my actual reaction.

[Howard C. Berkowitz]

This gap is so wide that lately I have started to ask myself the question whether  I must stay here, at a place that looks to me less and less like an encyclopedia and more and more  like a blogging site  that gives  people the opportunity to launch their ideas and opinions.

I agree 100% with the above. I am seriously considering leaving the project: I see millions of words being wasted, and hundreds of hours of time wasted, on articles that are essentially...little more than personal opinions more suited for blog sites

After reading the above, I went straight to the Alternative Medicine article, which I've never visited before, and read it.  I'm afraid I find it very wrong-headed in its current form.  Essentially, I must throw my opinion in this discussion with those who are objecting to its current direction.

I do hope no one leaves the project as a result of this article until more community input can be garnered.  I am not an editor on health fields (only in computers) but I do have a strong belief that this article is written by someone with "an ax to grind".  In other words, if I were to write an article called "Alternative medicine" for CZ, it would be very diffirent indeed. 

Pat, part of the problem is that there was and is an article on [[Complementary and Alternative Medicine]] article in existence, with a real taxonomy that is in use.  Considering that was somewhat biased and antagonistic, I started on [[integrative medicine]], which not only considers the taxonomy from the U.S. [[National Center for Complementary and Alternative Medicine]], but the U.K. Parliament's study to which Gareth pointed me.

There have been articles on indvidual techniques, including, at least, one Approved article ([[chiropractic]]). I've been going through the taxonomies and at least writing sourced stubs on the specific disciplines where there was no article (e.g., there was for [acupuncture]],): [[phytotherapy]], [[reflexology]], etc.; there was already strong work in [[chiropractic]]. I have started an [[integrative medicine]] article that reflects actual practices where people from mainstream and complementary are trying to synthesize, at backwater places like the Mayo Clinic, Johns Hopkins, Columbia, Duke, etc.

This article, I'm afraid, struck me as ignoring previous CZ work, and then starting with an antagonistic position, as if most people were thinking wrongly.

It would describe AM as the entire body of proposed and possible therapies not specifically endorsed by the American Medical Association or its overseas equivalents. 

Take a look at some of the other articles that were in progress before this article started. Further, note how much insistence there was that individuals would set the scope and direction of this article. Note that mention of existing work was dismissed (in the archive now), but with a flavor of "now we will do it right".

I find the attempt to generalize and classify various so-called alternative medical approaches in some pseudo scientific fashion to be completely unhelpful. 

I don't disagree. The problem is that there are, if you will, "operationally" rather than "philosophically" defined systems from the U.S. and U.K, and, for that matter, the Chinese "Three Roads" system. Unfortunately, and perhaps in an attempt to be readable, the systematization in this article comes across as essay, argumentative, and personal opinion.

It is more of a mess because certain assertions were made about medical history, which were simply not correct. Attempts to discuss them on the talk page were not welcome because they didn't fit into the arbitary "what this article is", so, I made a decision with which I wasn't completely happy: I presented counterarguments in the article itself. On Gareth's suggestion, I backed out much of the detail about John Snow and others, the point, perhaps, having been made.

The writing style is, to me, objectionable.  For example, this statement: "All too often, patients today see both conventional and CAM practitioners..." implies certain value judgements that undermine the neutrality of the article.  "Too often" implies a judgement.  The very phrase "conventional and CAM practitioners" is vague and unhelpful.

That is awkward, and I wrote it. It was, in my mind, more of a medical disclaimer, because there is a very real problem with herb and drug interactions, which can be managed if everyone involved is aware of what is being done. Please see Gareth's recent additions in [[complementary and alternative medicine]] for a much more flowing and well-sourced discussion, which is then being used collaboratively -- it sets up some ideas for the current practice of [[integrative medicine]]

I would recommend archiving this entire article (not deleting it, because some authors have put significant effort into it, but allowing it to recede into the background and allowing others--OTHERS!!! not the same authors--to start a different kind of article.

I know this may seem harsh to those who have already worked on the article.  And you may not agree with me.  But that is my actual reaction.

I don't disagree at all, Pat.

[Larry Sanger]

I'll definitely weigh in here later -- right now I'm taking a break with family.

Definitely we'll have to make some changes.  I'm not sure what they'll be, because while on the one hand we cannot have people using CZ articles just to state their opinions, on the other hand we cannot set up procedures that in the long run could easily be used to control and punish people based on conformity to mainstream opinion.

[Pat_Palmer]

Everyone, I know from personal experience how painful it is when an outsider wades into a conundrum and crashes around.  However, sometimes it is helpful in breaking an empasse.  So I have gone and archived that article, and its talk page, and placed there instead a short starter stub.

I truly believe that if people carry their discussions of issues to more specific topics, there will be adequate room for agreement on a writing approach.

Anyone wishing to carp, please go to my talk page and let me have it full blast!

[Pat_Palmer]

OK, I hope this truly is my last post tonight...Howard wrote on my talk page:

As long as people coming to "complementary and alternative medicine" can find "integrative medicine", no problem.

Now I'm going to quibble with that. I think that people ought to be able to read about and think about "alternative medicine" (or whatever you want to call it) without also having to think about the idea that official medicine can be combined with unofficial approaches, and often is. Those are different issues. So I do NOT think that "alternative medicine" needs to link to this article. What probably should link to this article is, maybe, plain old "medicine".  But only if people qualified to write about medicine (and I am certainly not) choose to.  In other words, medical practitioners can, and often do, ignore competing viewpoints.

Let me be clear: I don't necessarily disagree with what is in this article, I just think that it is essentially an essay rather than an article. Sorry to be so blunt, Howard, because your mind fascinates me, but this would make a great blog. An entire string of complex blog articles! But is it encyclopedic? I'm not so sure.  Just my two cents worth.

I guess at most, one might mention that the term "integrative medicine" sometimes get used to encompass the idea of combining official approaches with promising unofficial approaches. But it isn't a science or a hard and fast topic, in my view.  It is a commensensical approach which, no matter how passionately I may feel is right, is still really just an approach, an opinion, and not anything endorsed by any official endorsing authorizing policing agency. 

Howard, please start this as a blog!  And reduce its scope in CZ.  At least, that is what my reaction is.  It's interesting but maybe just not useful.  There's so much that we really do KNOW that we can write about, that won't cause controversy, so why go there right now, here?

[Larry Sanger]

Has anyone actually gone so far as to write whole biased essays about any subjects?  If so, could you please privately e-mail me a link to the page in the history?  Also, you think that indeed there are people whose purpose here seems to be entirely or almost entirely to make the world safe for their own cherished views, I have to admit, albeit reluctantly, that that is a problem and directly contradicts our fundamental policies.  Moreover, I am open to putting my foot down in such cases, but I want to revisit our we as a community should deal with those cases.

We do not have many policies regarding topics of interest mostly to people outside of the mainstream of science and scholarship generally.  We welcome people who want to write about such topics, as long as they do so in a way that is in accordance with our policies.  So I'm not sure that that need play any role at all in how we solve these problems.

I'd be very open to brief, to-the-point explanations of what's happened, via e-mail.

This is all I can afford to spend here today--sorry--don't want to abandon guests.

[Howard C. Berkowitz]

I guess at most, one might mention that the term "integrative medicine" sometimes get used to encompass the idea of combining official approaches with promising unofficial approaches. But it isn't a science or a hard and fast topic, in my view.  It is a commensensical approach which, no matter how passionately I may feel is right, is still really just an approach, an opinion, and not anything endorsed by any official endorsing authorizing policing agency. 

Howard, please start this as a blog!  And reduce its scope in CZ.  At least, that is what my reaction is.  It's interesting but maybe just not useful.  There's so much that we really do KNOW that we can write about, that won't cause controversy, so why go there right now, here?

Pat, this just is not personal opinion. National Center for Complementary and Alternative Medicine, which is part of the National Institutes of Health. For integrative medicine, see the links, in that article, to programs at the Mayo Clinic, Johns Hopkins, Columbia University School of Nursing, and Duke University.

From the National Library of Medicine, Medical Subject Headings: "Therapeutic practices which are not currently considered an integral part of conventional allopathic medical practice. They may lack biomedical explanations but as they become better researched some ( PHYSICAL THERAPY MODALITIES; DIET; ACUPUNCTURE) become widely accepted whereas others (humors, radium therapy) quietly fade away, yet are important historical footnotes. Therapies are termed as Complementary when used in addition to conventional treatments and as Alternative when used instead of conventional treatment."

World Health Organization, Traditional, complementary and alternative medicine: policy and public health perspectives.

[Matt Innis]

There might be some confusion here.  This thread started talking about the article that Martin (a philosophy editor) started on [[Alternative Medicine (theories)]] http://en.citizendium.org/wiki/Alternative_medicine_%28theories%29, but I think Pat reviewed [[Alternative medicine]] http://en.citizendium.org/wiki/Complementary_and_alternative_medicine and it was subsequently archived.  I would like to hear Pat's impression of the first article as well.

I think the thing that makes us different is that we place experts in the position of making content decisions.  If we don't want them to make these decisions, then take that power away.  Otherwise accept what they have to say or follow the resolution processes that are in place.  If they aren't there, then be a part of building them.  I personally really like the writing style that Martin used, good work Martin (and Pierre-Alain).  I agree that it needs some fact checking and tone adjustments, but nothing that couldn't be cleaned up in a couple of days by the right team.

[Howard C. Berkowitz]

I think the thing that makes us different is that we place experts in the position of making content decisions.  If we don't want them to make these decisions, then take that power away.  Otherwise accept what they have to say or follow the resolution processes that are in place.  If they aren't there, then be a part of building them.  I personally really like the writing style that Martin used, good work Martin (and Pierre-Alain).  I agree that it needs some fact checking and tone adjustments, but nothing that couldn't be cleaned up in a couple of days by the right team.

By all means have expert decisions, but that requires expertise in all of the relevant disciplines. By all means have expert authority, but let's agree what that means.

This article clearly involve healing arts, and also health sciences, since it made assertions of what conventional clinicians and public health people believe. There were things that were outright wrong in the history of medicine, and, when those objections were raised on the talk page, they were generally dismissed with demands for more time, or saying they were out of scope, or simply ignoring them. Now, I may not be a health sciences editor, but my Computers editor experience includes 40-plus years of working with medical decision support systems. That involves being extremely familiar with the medical literature, statistical methodology, and medical literature search. I don't think I was at all out of line when I objected to the assertions of secondary, partisan, non-authortative sources being taken as specific positions from the World Health Organization, U.S. Centers for Disease Control, and New England Journal of Medicine. The citations were from books not readily available. Within minutes, I was able to obtain online links to primary documents, from those three organizations/publications, which had very different positions than the paraphrase. 

Those sourcing issues were just plain Editing, not discipline-specific. When one does make assertions about health sciences topics, as basic as the history of epidemiology, be prepared to defend them. A philosophy editor has no special expertise in the work of John Snow, usually considered the father of epidemiology. For the record, Florence Nightingale has just as good a claim as being the mother, but I'm not sure if the two ever met.     As far as other aspects of lower-case e editing, there seemed so much effort to have vivid prose that the topic flow got very snarled. Rhetorical questions are not a particularly encyclopedic style, especially when used to excess.

There was plenty of criticism of the cognitive processes in science (not being a Philosophy Expert, I apparently may not use the P-word), but there was surprisingly little about the theories in alternative medicine. Take out the commentary on materialistic and scientific thinking, take out the attacks by Goldberg on medical efficacy, cost-effectiveness, and safety, and  see how much is left about the theories of alternative medicine. Indeed, compare this article, for a discussion of the theories of alternative medicine, as opposed to P-word, with the article on vitalism.  The latter talks significantly about what I'd call theory.

I suppose, if there were an article about gender relations, I could march in (carefully chosen word) and declare that was about the war of the sexes, and thus within my purview as a Military workgroup editor. Abraham Lincoln once asked, "If you call a horse's tail a leg, how many legs does a horse have?"

"Five?"

"No. Calling a tail a leg does not make it one."

Going into arbitrary articles and declaring them things to be discussed from a philosophical standpoint does not make them articles in philosophy. In like manner, if one wants to talk about social and historical perspectives, it might not be a bad idea to involve Sociology and History experts. Incidentally, apropos of the History of Medicine, see A Brief History of Disease, Science and Medicine by Michael Kennedy (clinical professor of medicine at the University of Southern California), for which I was a last-minute editor in the galley proofs. I'll gladly offer that as a reference on experience in medical history. That I'm not coming up with this at the last moment, I will point to my 2004 review at Amazon, or I can scan my autographed copy.

['docmartin' (Dr Martin Cohen)]

Thanks all for the comemnts.

Yes, to clarify, we have AT LEAST two pages in the thread at present. I'm not surprised at the confusion really. I started a page called 'Alternative Medicine' intended to be an overview as Pat says it 'ought to be' .

Barely was the page started, however, Howard renamed it 'Alternative and Complementary Medicine' and took it down a path that Pat I think sums up rather aptly as written by someone with "an ax to grind" and "I find the attempt to generalize and classify various so-called alternative medical approaches in some pseudo scientific fashion to be completely unhelpful.  "

Here is where that page had got to:

http://en.citizendium.org/wiki?title=Complementary_and_alternative_medicine&oldid=100427287

Pat has probably not even seen 'Intergrative Medicine'

http://en.citizendium.org/wiki/Integrative_medicine

which states on its talk page and has done since 18 December) " I would appreciate it if there were no major edits on the article page while it's being constructed. " Howard, one recalls is against essays.

Anyway, the function of my original "Alternative Medicine page 'was to have been' much more as she says:

It would describe AM as the entire body of proposed and possible therapies not specifically endorsed by the American Medical Association or its overseas equivalents.  I would handle the controversies with a great deal more distance, emotionally, than the article does at present.  And also, I think that while some specific therapies could be mentioned only as "examples" of things that might be considered AM, such as massage or acupuncture, each of those things, individually, deserves its own article.

I abandoned the strategy in the face of the onslaught of incompatible edits, and created an explicit split in the 'Alternative Medicine' pages which was indicated through this kind of wording:

"The emphasis on this page is on the scientific, legal and practitioner issues. For an overview of the philosophical and cultural dimensions, see also Alternative medicine (theories). "

http://en.citizendium.org/wiki?title=Complementary_and_alternative_medicine&oldid=100427003

This page was likewise to be an overview from a non-judgemental philosophical perspective, acting as a brief general introduction to issues in  social anthropology, philosophy of medicine, history of  medicine and so on, offering links to new pages where they would be described in more detail with full sourcing.

By December 23rd it looked like this:

http://en.citizendium.org/wiki?title=Alternative_medicine_%28theories%29&oldid=100426029

Matt commented complimentarily on the progress on the talk page that this article was on its way to being completed and approved. However, on Christmas Eve, starting with an edit described as 'Contrasting examples to show the difficulty of obtaining objective information' the page was completely 'transformed' (to put it kindly) into an unintelligible mish-mash of irrelevant asides and even (as mentioned above) barbed comments such as

He continued a discussion of the implausibility of miasmas and the plausibility of disease transmission through contaminated water, using retrospective analysis. He goes on at great length. Is more necessary?

From http://en.citizendium.org/wiki?title=Alternative_medicine_%28theories%29&oldid=100426945

Now I don't know how this fragment got there, it is beyond me to wade through the page to see who wrote what, but how can this sort of thing belong in an online Encylopedia? To stress, this was added to the published article, not put on a talk page.

I would ask for agreement to restore the last 'coherent' version, and that those with 'axes to grind' perform that activity elsewhere.