Going Direct: BasicMed: A Huge Disappointment

As the details of the new third class FAA medical came to light, I made the mistake of letting my enthusiasm for the overall concept color my reaction to the actual rule. The new regs, BasicMed, were supposed to represent the FAA’s regulatory translation of what we really wanted: to get rid of the Third Class medical and replace it with our driver’s license as proof we can safely get around in a small transportation vehicle. I think we all wanted to do away with the FAA medical altogether, never think about it again, and just go flying. Like most of you, I was fine with there being limits on the new non-medical, including the size and speed of what we fly, as well as how many passengers we carried. That makes sense.

But instead of putting our long-awaited driver’s license medical into the language of the FARs, the FAA created a whole new kind of medical certification that, for most of us, will be neither easier nor cheaper.

Instead of leaving it essentially up to us whether or not we’re fit to fly—as we do every day of our flying lives regardless of the medical certification we hold—the FAA just replaced its current system with an almost identical system that makes us do even more than we had to do before. To satisfy the requirements of BasicMed, we get put through the ringer. We need to do online testing and we need to see a doctor, one who’s familiar with our medical histories, whatever that means, and one who then fills out an approval for us to go flying, just as our Aviation Medical Examiners used to do. In what way is this better than it used to be?

In terms of cost, it’s not better. My AME charges me $100 for a third class exam. With my high-deductible (is there any other kind?) insurance, I’ll pay around $150 out of pocket for the visit to my doc for BasicMed certification. Yes, “certification,” because that’s what it is. I wasn’t a math major, but $150 is more than $100. Not better.

I need to take an online course—as yet the details of this aren’t public—which will tell me all the things I need to know about not having to worry about my pilot medical. I’m sure it will help me understand that I shouldn’t fly if I’m having a heart attack, if I suffer a stroke, or if I have any one of a number of disqualifying conditions. We all pretty much know this stuff. And it won’t help stop pilots who shouldn’t fly from flying anyway. A pilot who has a coronary, doesn’t disclose it to their AME and then goes flying doesn’t do it because they don’t know that a heart attack is disqualifying (without jumping through a lot of expensive hoops, anyway). They go flying after the heart attack despite the fact that they know it’s disqualifying. Education will do nothing to change that kind of decision.

Let’s talk about anxiety and depression. In many of these cases, people with these conditions who are on medication that helps choose to go flying despite their condition, not because they don’t know it’s disqualifying, but because they believe it shouldn’t be disqualifying. For the vast majority of sufferers of mild depression and anxiety, the treatment is successful in treating a condition that, if left untreated, would still allow them to safely fly airplanes. Taking medication that helps them overcome their condition becomes a choice between flying or living a better life. Many of them choose to keep doing both and don’t reveal their treatment to their AMEs. This is one of many, many conditions about which the FAA is overly cautious. They seem to forget, too, that we pilots are human beings and any of us could become disabled at anytime. It’s a remote possibility, but the FAA needs to remember that it is a possibility.

We also need to be concerned about going to a doctor for our BasicMed signoff who doesn’t know jack about aviation. My AME, who’s a pilot and a great guy, knows flying and pilots inside and out. He knows what it takes to get a medical and he knows what it takes to lose it. He knows how to help his patients stay fit to fly and he knows when it’s time to tell them their health is a bigger concern than flying, which is sometimes the case, I admit. Would a general practitioner who’s not a pilot know any of these things? The answer is no. I’m fairly confident, moreover, that we’ll be the ones educating our doctors on why we’re in their office and what they need to do. Improvement? Hardly.

On top of all that, we’ll still need to ask their permission to go flying, and these non-aviation-savvy docs will be the ones to sign us off, just as it used to be, except this time they won’t have the judgment to know what’s okay to allow and what isn’t. If I were a non-flying doctor new to all of this, my instinct would be to cover my bases and take the conservative path, which is to say no to flying if I were at all unsure about it. With most AMEs, I’m guessing, and with every one I’ve ever been to, the approach was to err on the side of letting pilots go flying. Is this kind of uncertainty over the kind of judgment your doc will have over your flying future an improvement? It is not.

For private pilots flying modest aircraft, the hope for the driver’s license medical was for it to once and for all get the FAA out of our medical business and let us make our own decisions, which we’ve largely been doing ourselves anyway.

Six months ago, I proclaimed that I’d likely taken my last FAA physical. That has changed. I have no intention of going the BasicMed route. There are too many variables and too much risk associated with it for me. I’m in good health and know I can pass a third or second class FAA physical. I’ll do that instead. It will cost me less, it will be with a doc who knows aviation and knows pilots, I won’t need to jump through any Internet hoops to do it, and I’ll know when it comes time to render a verdict on my fitness to fly, my doc will make the right call.

If it got to the point where I was worried I could no longer pass an FAA physical while still being, in my view, safe to go flying, I might then go with BasicMed. My hope would be that it would give me a window to keep flying small planes. But for those of us who believe we can still pass the conventional FAA physical, it’s probably smarter and safer to do that.

In drawing up these supposedly liberalized rules, the FAA essentially replaced one form of governmental oversight for the same level of oversight in another form. The FAA was doing what the FAA does best. It was maneuvering to hold onto the power it had while limiting the rights of pilots, even when the stakes were low and Congress directed it to do something else altogether.

This is a tough time for our member organizations. On the one hand, they have helped achieve what we long hoped would be a great victory for pilots in liberalized medical certification rules. It’s not easy for these same organizations to turn around and say, “Hey, that’s not what we had in mind.” For one, their members, like me and, hopefully, you, will be disappointed when they learn the truth about what was promised and what we got. It’s also a tough argument to make to our friends in Congress to make the FAA go back and start over with these rules. But that’s what needs to happen. And that’s what I’m asking them all to do.

Why John King’s Fight is Not Over

As many of you know, John King, co-founder along with wife Martha, of King Schools, was in a prolonged battle wth the FAA to regain his medical certification after he suffered a seizure in 2014 with no recurrences since. Just as we were going to press, King regained his certificate, the timing of which makes one wonder if the FAA gave in to public pressure to do the right thing. If so, we’re good with that.

The denial of King’s medical was understandable, at least at first. But as time went on, it became harder to see the FAA’s point of view. King had been seizure-free for years, and the majority of people who suffer a seizure for unknown reasons never have another. Despite this data and King’s clean bill of health since, the FAA denied him medical certification.

But King persisted in his attempt to win back his medical, even though the agency seemed to be closing its eyes and digging in its heels. So it was a huge surprise when a certificate showed up in King’s mailbox.

There were more than a few people who advised King to give up, to admit that the FAA had won and be satisfied that he had enjoyed a good run and leave it at that.

I’m glad he didn’t do that, though, admittedly, not as glad as he is. In the spirit of full disclosure, John and Martha are good friends. I’ve known them for 25 years and have passed with flying colors many an FAA exam thanks to their products. As is the case with me and probably with you, too, flying is everything to John and Martha. John would just as soon give up breathing as flying, so for him, fighting to regain his medical was a no-brainer, and it was lucky he had the resources to wage that war.

In the end, regardless of the outcome, the real question is, does the FAA provide fair treatment of pilots in the way it writes rules and issues denials? From a purely organizational point of view, the answer is “no.” The medical branch bases its medical judgments on decades-old ideas about health, illness and recovery, and updates its opinions about as often as Halley’s Comet swings by. The agency is the judge, jury and executioner in these matters, too. When it reviews an enforcement action, the arbiter is the same organization that issued the original finding. The deck is stacked.

Like many of you, I’m tired of putting up with outdated and archaic institutions that abuse the rights of the people they’re supposed to be serving. Can the FAA medical division be reformed? If you’re in doubt, please refer to my discussion of BasicMed above. Our best hope is to dismantle the FAA’s aeromedical branch and start from scratch. If our representatives are being honest about wanting to transform government, I can think of few better places to start the process.

If you want more commentary on all things aviation, go to our Going Direct blog archive.

33 thoughts on “Going Direct: BasicMed: A Huge Disappointment

  1. You’re lucky you’re not on a Special Issuance. I have an eye condition for which the FAA requires me to get an extensive list of eye exams every year that my ophthalmologist says are a complete waste of time and have nothing to do with my condition. I also have a high deductible health plan so these tests costs hundreds of dollars. I spoke to my primary doctor about BasicMed and showed him the exam checklist and declaration and he would have to sign and he said it would be no problem. Now I can go to him and get signed off for 4 years and not have to bother with unnecessary tests. He also said he we would do it as part of my annual physical which is completely covered by health plan. My AME charges $175. AOPA says the online course takes an hour. I would have loved a drivers license medical too, but BasicMed is going to make my life much easier.

  2. Amen Brother! I suspect the May 1st….and July 15th dates will come and go without the Basic Med online exam, or materials for our physicians, being finalized. Yes, the FAA continues down its same plodding path. Even having these changes being required by law doesn’t phase these entrenched bureaucrats.

  3. Fly Sport Pilot instead of 3rd class medical or basic med? Last 3rd class in 2003 with glasses as only restriction.

  4. Where is this on line school, how do I get online and take the course?

    Where is the official doctors check list?

    How can I be ready to fly on may 1st if I can’t get the required information? this is really, REALLY getting frustrating to me!

  5. Thanks for writing this – it needed to be said out loud. I have been wondering why everyone was jumping for joy that we got “BasicMed”. All of the political action committees that we have been donating to have failed us (yes AOPA included) by letting this pass and claiming victory. Like you , I will continue to go to my AME – who is an expert in Aviation Medicine.

  6. Yes, it was not what we’d hoped for. BUT, it is definitely going to help a lot of us out. I’m on a special issuance 3rd class medical which is a royal annual pain in the ****, and there’s nothing in particular wrong with me except that I was too honest on the medical form. Last year my insurance changed and my doctor who’d been providing paperwork for my medical no longer took my insurance, and finding a new doctor and bringing them up to speed was a nuisance which took months. With Basic Med I’ll be back flying with a minimum of fuss and the complete loss of the annual doctor rituals.

  7. Thank You Robert for speaking out on what I immediately saw as just a redressing of the former Third Class Medical requirement. Although I never had a disqualifying condition, I too will stick with my LSA Medical excemption. Dan R.

  8. And if you’re going to fly internationally then you’ll need a 3rd Class medical or better.

  9. Ironic that most of the pilots who will be inclined to use Basic Med will be the ones who are at greater risk for incapacitation. Who does that serve?
    Thank you for your sage analysis.

  10. GREAT job, Robert. You said what -many- are thinking. Many doctors have been driven out of private practices and to “corporate” doctor shops because of the enormous cost of complying with endless regulations and insurance company demands. A private practice doctor might do the exam BasicMed requires but will a corporate shop? …I think many will not.

    I am a huge proponent of Light-Sport and its Sport Pilot certificate with driver’s license privilege, but even while I admit to a bias, I nonetheless believe the Sport Pilot plan is much better, more predictable, and as you noted, likely -less- costly.

  11. As a physician, I agree with everything Robert had to say. In addition this so called third class medical reform has been a great disappointment as it was supposed to bring Rusty (and New) Pilots back into general aviation and prevent its further decline. But by its very definition, Rusty (and New) Pilots haven’t had 3rd class medicals in the past 10 years and so once more will be subject to the bureaucratic morass and uncertainty of Oklahoma.

    All older pilots, by their very nature, have medical problems, most of which do not prevent the pilot from flying safely, yet require that they jump through hoops to obtain the 3rd Class Medical License. Research has shown that having a third class medical does not enhance safety and has no predictive value, and the number incidents caused by medical disability is infinitesimally small.

    Yet many Rusty (and New) Pilots, who happens to be older and could safely fly as private pilots will be prevented from obtaining their private pilots license due to the FAA’s medical department’s unreasonable restrictions. If a Rusty (or New) Pilot fails his third class medical he will forever loses opportunity to fly Light Sport; thus many are not willing to go through the effort to obtain the useless third class medical This has not been third class reform; private pilots do not need a 3rd class medical to fly safely. This will not grow GA.

  12. I think that Ian is correct; the only people BasicMed helps are those on Special Issuance. While the FAA has done some streamlining of that process, it is still ridiculous. It is like going through BasicMed on steriods to get your doctor to sign off on your ability to fly. Afterwards, you still have to go to an AME to get a certificate. If your lucky, the AME signs off and doesn’t find a reason to defer to Oklahoma City which can take months. Moreover, depending on your condition, even though your medical is good for 2+ years, they only issue it for a finite period of time as you have to get more tests to prove you are still OK. That is all fine and well, but you now need to submit them to your AME and get charged the same price for a medical or wait for OKC to respond. Not fun!

  13. My girlfriend (mid 60s) started flying lessons last summer. She had to go through the SI process because of some med she takes. It cost her several thousands to get her medical. It also took almost 6 months. The SI was good for only 6 months, at which time she had to repeat part of the process, which still costs a ton. Her AME said that she will likely be able to use BasicMed going forward. It will take days less of her time and save her enough to maintain and buy gas for the the 172 were are considering.

    No, it isn’t the driver’s-license medical that dreamers hoped for. However, Goyer says it won’t be cheaper and easier. For her it will be both — a lot of both.

    Me, in my late 60s? I’ll probably just get another third-class this year for less than $100. What have I lost? How have I been “hosed”?

  14. For all the reasons Goyer described above and more, I have had every intention of continuing with the medical via AME. This year however when I renewed my medical the FAA has demanded additional testing and documentation because I had an ECG and because I got a low dose thyroid prescription. They seem to think I’m about to drop dead. I asked for the ECG as a precaution after a friend who never showed symptoms died on a hiking trail. The thyroid was to treat thinning hair. Being honest on my medical has cost hundreds so far in additional testing, plus many hours of time, and the FAA still isn’t done making me jump through hoops.

  15. I’m a retired doc and have a good relationship with my internist that I see for annual physicals. I mentioned BasicMed at my last physical and his very first comment was, “How in the heck would I know if someone is fit to fly an airplane?” Getting the medical exam is OK, but asking the non-AME doc to “cerify” that the patient is OK to fly an airplane is the kicker. What should have been done is simply require a physical – period!
    Also, AOPA and others say that “they’ll be pro-active and provide educational programs for physicians to inform them about BasicMed.” I can tell you from my career that with the many mandatory continuing education requirements for licensure and hospital privileges, the LAST thing the average physician is looking for is to take another educational program – even if it’s totally free! Why bother with more programs and incur liability?
    I think BasicMed will be much more successful if they would drop the requirement for the non-AME physician to attest to the patient’s fitness to fly and simply require a documented physical.

  16. Thank you Mr. Goyer. Someone in the aviation press finally “gets it.” FAA is still holding all the cards.

  17. I have a Special Issuance that is not valid after 4/30/2017 so the FAA says I can fly under BasicMed rules on 5/1/2017. Not quite. They say they won’t be releasing the final medical checklist or the online course until 5/1/2017. Suppose I can make an appointment with my primary physician, get in to see him the very same day (nope), get him to complete the checklist the same day (nope), and then complete the online course the same day (nope). I admit that BasicMed will make it less costly for me going forward, but this year I’ll be grounded for a couple of weeks. I trusted that I REALLY could fly under BasicMed rules on 5/1/2017. In hindsight I should have had my costly (and useless) test to get my SI good for another year. Why did I trust?

  18. This is why I fly Light Sport. They improved nothing with respect to 3rd class Medical reform. i fly a 1320 pound (MTOW) aircraft. Why could I not fly a Skyhawk with the same restrictions (10,000 MSL, Day VFR etc). How they structured the so called “reform” was a punch in the stomach. Shame on the FAA for improving nothing. The EAA stated it is a victory…I see nothing more than Red Tape. Statistically this should have been easy to construct a plan which benefits, not hinders GA.

  19. While I agree no medical requirement is going to stop people from breaking rules if they’re intent on it anyway, I am suprised to see this. To me, Basic Med is a great improvement. Many Special Issuances like mine go away which is expensive for many to obtain all the needed documentation every time the medical has to be renewed. If you’re over 40 like I am where your 3rd class is now only good for two years…your $150 deductible at your primary doc now gets you 4yrs of flying…sounds like a $50 savings to me. I know my deductible is lower than that so all the better. It’s actually more of a savings because it’s one less Dr I need to see since I’m going to combine it with a regular checkup anyway. And best of all, if your doc is too conservative to sign you off, you get to get another opinion…something that is much harder to do once that AME application is submitted and denied.

    As for the online course…really! We’re going to complain about getting refreshed on a little education that makes us safer, on our own time, at our own pace, in the comfort of our lazy chair, with a test you can retake until you pass it…geesh. Don’t underestimate the value of a little refresher training…AOPA has an entire library based on the concept.

  20. Great article Robert. A few points to add. Disclaimer: family physician and senior AME examiner.

    I’ve advised my flyers that it likely is in their best interest to co true to maintain their 3rd class medical. I know aviation medicine and will always try to keep them flying as long as they don’t have health conditions that could put them or others at risk. I’m also a pilot so understand their passion. It’s important to remember that our passengers often are not privy to the health status of our PIC and I know well of friends who tell me of their flight experiences with pilot X of whom I know their medical history (but cannot disclose) and would surely not board an aircraft with pilot X with a knowledge of their health issues and medication usage. I realize full well that pilots intentionally falsify their medicals not disclosing info to their AME who may not take the time to dig deeper into their medical histories. In these days of systems with shared records I stumble frequently on patient histories that I then confront them with when all the boxes are checked negative but their last hospital discharge summary states otherwise. Most reasonable pilots will work with me to clear up any concerns and many cases are not problematic. Sure beats the unfortunate sequels to having an accident and have your aircraft insurance carrier get all your past records for court resulting in a revocation of all certs for falsification in addition to their unlikelihood of paying your claim.

    Next, if pilots feel that skipping the AME is an easier route and decide to bring their BasicMed forms to their PCP, remember that this is likely the one physician that has ALL of their medical history so not disclosing health issues is not likely to happen. I’m not sure how each primary physician is going to approach these forms but I suspect there may be some scepticism before signing a form for a patient on chronic pain medication and benzodiazepines (sedatives) indicating that they are fit to fly (actual actively flying pilot example). I am hopeful that the docs out there will use some solid common sense.

    Finally, much of the medical certification is for the purpose of insurability. I anticipate that if the insurance companies conclude that those choosing to use BasicMed are likely those with medical issues that may preclude obtaining a 3rd class medical, they may help the decision making by hitting pilots in the wallet. If we don’t self police the health status of our pilot population there will ultimately be an organization that is not going to be willing to assume risks that we may be willing to take.

  21. Totally agree with the BasicMed as failing it intention and purpose, and thus failing the aviators in bureaucratic controls imposed. The Senators who sponsored and pushed the bill through should be appalled and “make” the FAA honor the intention of the approved bill. But they won’t…..
    All I read and hear is that this BasicMed FAA version released, is the best thing since peanut butter!! Even our good old AOPA is chanting that it is great. Who bothered to read the original bill that passed the senate and was approved? Who in turn is holding the FAA’s feet to fire to honor what the purpose and intent of the bill was? No one…..
    Thanks for saying what so many are too timid to say out loud, The FAA has made BasicMed an abomination of bureaucratic requirements far beyond the bill’s intent, not for added safety, but because they can and no one will make them correct their BS interpretation and requirements on BasicMed. For the most part, it will not be of any real help to the pilots who have not flown in a while, or the current pilots. I for one don’t want to be tied down to a Sport Pilot limitations, especially if I am flying my family on a long distance cross country trip,,,,, I will fly a fast highly efficient complex aircraft.

  22. Huge disappointment is an understatement. 20 years ago my personal doctor was a pilot, and of course, My AME. They both knew and understood my fitness for flight. Now they are both gone. I was a perfect candidate for the new rules, from a variety of angles. I allowed my medical to expire in the past 10 years and simply stopped flying. There were financial issues as well, but that was of least concern.

    It’s not the cost. Private pilots should easily be able to handle the extra $50 or $100 or whatever it may be.

    Robert, you nailed it in your 6th paragraph. Despite HIPPA laws preventing prying eyes from looking deep into one’s medical past, your record follows you for your entire life unless you choose to lie. I highly doubt that my current doctor would understand the new rules, let along sign off on the paperwork that I am now imagining.

    And, as a former employer, I know that your private past is not as private as you think it is. As one simple example, I’m not willing to go through the hassle of being disqualified or get special issuance because I take a “banned” prescription anti-diarrhhea medication that has no effect on my mental and visual acuity.

    I can still race cars and motorcycles and even win in by age bracket, although I am keenly aware that my reflexes and physical ability is not as it was when I was in my 20s. Never mind that I sometimes sit by the campfire, drinking water, while my compatriots are guzzling beer after beer and some of them are not racing tomorrow morning – they’re flying. And, that’s legal.

    The FAA is still mired in rules that were outdated in the 1960s and it never surprises me to see them take steps backwards in time rather than forward.

  23. Robert is obviously only thinking of himself. BasicMed helps a ton of pilots – a ton!

  24. “The FAA was doing what the FAA does best. It was maneuvering to hold onto the power it had while limiting the rights of pilots, even when the stakes were low and Congress directed it to do something else altogether.”

    The quoted passage above is perhaps the most succinct description of the problem that could ever be written.

  25. The author really does not understand the new rules and how they compare to the Special Issuance process – I have been in that process for so many years and now no more.

    The real change here is that it allows my treating physician to state that my conditions, as medically treated are safe for private flying. Under the old rules my doctor could say that but the FAA decided if ‘as presently treated’ was OK and they generally required medically unnecessary testing to make that opinion. Ask me how I know.

    To the author – I was very involved in following this and will benefit greatly from this. I use one of the top rated complex medical case AMEs you can find.

    I encourage you to reach out to me and discuss the issues. I think you got this all wrong.

  26. Come on Robert! BasicMed will open the skies to thousands of us “old @&$&’s” come May 1. I don’t know about you but my glass is more than half full on this wonderful new rule! Your commentary is one of the very few negative ones that I have read on this subject.

  27. I really don’t understand the FAA’s problem with antidepressants. They are basically encouraging pilots with a problem to hide it or let it go untreated. And people like me need them their entire lives, not just for a few months, so jumping through their hoops is impossible. And I’m fully capable of analyzing my condition on any given day and deciding whether I’m fit to fly or not.

    The irony is that it was the success of antidepressants that allowed me to get into the cockpit in the first place! Without them, despite an intense, lifelong desire, I was too anxious to fly (even commercially). With them, I started taking flying lessons! I kept hoping that AOPA and EAA would come through for me with sensible reform, and they utterly failed. I can drive a giant RV down crowded highways, but can’t fly without a “real” pilot next to me. (In case I go crazy or something? Not sure.)

    Despite periodically looking into LSAs, I just can’t generate any passion for them. All I’ve wanted to do since I was a kid was own and fly a Piper Cherokee 180, and that dream is now officially dead.

    I support EAA in their mission generally, but AOPA will not get another dime from me.

  28. The Veterans Affairs VA need to be able to give BasicMed physicals. I went to an AME to do BasicMed physical and went through the complete process of the physical at the end he said I need a letter from my doctor saying I’m fit to fly. This is why I went to the AME in the first place because I don’t have a regular doctor just the VA AOPA or some Aviation organization needs to educate the VA on the BasicMed program. It seem I am still jumping through hoops to get this. What good is it.

  29. I am on my 105th day of waiting for my “ONE TIME” 3rd class physical and SI, after getting 3 stents an NO MI. Most of us will get older,and willhave to deal with the FAA medical certification backlog which has been 90 to 120 days for the past 20 years. I drive a school bus in New York, medical requirement are identical to class 3 FAA. New York state approved me to transport 120 kids to and from school in less than the 30 days it took AOPA to review my medical paper work before submission to the FAA.I am afraid we traded one bad deal, for another.

  30. Good luck in finding a doctor that will sign you off! A full waste of time just going back to my AME I have spent the last 2 weeks trying to find a doctor that will do basic med they all said NO!!! F unny they ill do a DOT medical on truck drivers driving 80000 pound rigs going 70 mps in traffic with millions of dollars of freight or school buss full of children besides, the DOT medical is more stringent than basic med!

  31. Now that BasicMed has been available for the last 7 months or so, I don’t see what all the hand-wringing is about. I went to my own doctor, who treated the process much the same as a sports physical. He knows me, knows my history and the medications I’m on. My insurance covered the appointment, so no cost there. If you’re not worried about passing a medical, there should be no worries here.

    As for whether the doctor will be comfortable with the process: The form compares flying with driving a car. That might be a bit of a stretch, but it gives a non-pilot doctor something to reference.

    If you passed any kind of pilot-oriented written, the “test” is a piece of cake. The initial course covers everything that is later asked in multiple-choice form. I got 100% on my first try. I mean… come on. “You have the sniffles, took cold medicine and are feeling drowsy. Should you fly or wait”? This kind of stuff shouldn’t bother anyone.

    So… about an hour for the online stuff. About the same at the doc’s office. Nice certificate in the logbook for the trouble.

    Done.

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