Dr. Eric Payne Letter To The Alberta College of Physicians and Surgeons—Part 3

6) The mRNA vaccine risk-benefit ratio in children. 

• Children are at very low risk from COVID-19 infection itself, and rarely suffer severe disease and death (43). Data from the American Academy of Pediatrics Children and COVID-19: State Data Report, found that 0.1-1.9% of their child COVID-19 cases resulted in hospitalizations, and 0.00-0.03% of all child covid-19 case resulted in death (43).

• In a pre-COVID-19 vaccine cohort of 1391 children, 171 (12.3%) were confirmed to have SARS-CoV-2 infection and treated at the Wuhan Children’s Hospital from Jan 28 – Feb 26, 2020 (Note this is the only center assigned by the central government for treating infected children under 16 years of age in Wuhan). Median age was 6.7 years. 3 patients required intensive care and invasive mechanical ventilation – all had coexisting conditions. 1 patient died, a 10-month-old with intussusception and multiorgan failure (44).

• Currently in Alberta, the average age of COVID cases that died is 80 years, with a range from 20 -107 years (10). Thankfully, no pediatric patients have thus far died in Alberta. And, contrary to media portrayal, children with COVID-19 are also very rarely susceptible to multisystem inflammatory syndrome (45) and neurological sequelae (46). Since the pandemic, I have seen more devastating neurologic conversion disorders and psychiatric disease, including several heart-breaking teenage suicide attempts, then I have my entire career.  In contrast, I have not encountered a single child with neurological sequelae from COVID-19 itself.

• The American Academy of Pediatrics also confirmed that while Delta is infecting more children, it is not causing increased disease severity (47).

• While many studies suggest pre-symptomatic/asymptomatic spread may comprise > 40% of vertical transmission, numerous large observational population studies show that children are POOR COVID-19 spreaders. This includes studies from Ireland, Iceland, Italy, France, and Australia (48, 49, 50, 51, 52). For a link to a more complete reference list, see Washington University Pediatric & Adolescent Ambulatory Research Consortium: http://wupaarc.wustl.edu/COVID-19-and-Children/Information-about-COVID-19-Transmission-in-Schools-and-Daycares

• The CDC and FDA’s Vaccine Adverse Reporting System (VAERS) “is the nation’s early warning system that monitors the safety of vaccines after they are authorized or licensed for use by the FDA” (53). It is a self-reporting system that does not prove causality but rather is designed to help identify adverse events signals (i.e., COVID-19 vaccine thrombotic events and myocarditis). “VAERS scientists look for unusually high numbers of reports of an adverse event after a particular vaccine or a new pattern of adverse events” (54).  

• While you would certainly expect a spike in the reports submitted during a pandemic where we are using an experimental vaccine technology, it is also true that adverse events reported in VAERS are historically vastly underreported. In the 2009 Harvard Pilgrim Health Care study assessing the VAERS, “fewer than 1% of vaccine adverse events are reported” (55).

• During 1997-2013, VAERS received 2149 death reports and “no concerning pattern” was observed (56). But as Senator Ron Johnson wrote August 22, 2021: “the 12,791 deaths related to Covid-19 vaccines reported on VAERS over the period of 8 months, compares to 8,966 deaths related to all other vaccines reported on VAERS since the inception of VAERS – a period of 31 years”. He continues, “VAERS is also reporting 16,044 permanent disabilities, 51,242 hospitalizations, and 571,831 total adverse events related to the Covid-19 vaccines” (57).  Anyone can verify these numbers, as I have previously done, at the VAERS website.

• Why then, given these clearly unusually high numbers, does the CDC continue to refuse to allow an independent safety panel investigation of outside experts? Consider that on July 16, 1999, the CDC recommended that healthcare providers suspend the use of the licensed…RotaShield – a rotavirus vaccine – after only 15 cases of intussusception were reported in VAERS! (58)

• Recently, despite clear decreased mRNA vaccine effectiveness, Dr. Fauci and President Biden have expressed their desire to start giving the mRNA shots to children aged 6 months – 11 years, and indeed, trials with Pfizer/BioNtech and Moderna are underway. Dr. Fauci stated August 31, 2021: “I believe that mandating vaccines for children to appear in school is a good idea” (59). Further, President Biden said July 21, 2021, that children under age 12 could be eligible for a COVID-19 vaccine within the next few months, as results from clinical trial for ages 6 months to 12-years become available (60).  

• Even IF these pediatric RCTs show efficacy and 2-month safety data similar to the initial Moderna and Pfizer-BioNtech trials, are we still going to inject even low risk children? Children seem to be their own best defense against SARS-CoV-2, are poor transmitters of the disease and have exceedingly low risk of death and severe disease from the virus. We now know that the real-world effectiveness of these mRNA vaccines is mediocre at best and continuing to diminish. And we have zero long-term data.  Just because industry funded studies may show “efficacy” in the pediatric trials, I strongly argue that we should not be injected children with these very experimental therapies. At least show us the biodistribution data first.

(7) Following the science?  

• On August 31, 2021, despite several decade long careers with the FDA, the individuals leading the FDA office in charge of approving vaccines (Marion Gruber and Philip Krause), resigned over the Biden administration’s booster-shot plan, saying it insisted on the policy before the agency approved it (61).

• And recently, the UK’s vaccine advisory board REFUSED to approve mRNA vaccines for healthy 12- to 15-year-olds (62). Despite this, the government may overrule and is already telling teenagers they can circumvent their parents. How many of our teenagers are actually making an uncoerced informed decision? Do they really understand their risk-benefit analysis? (63)

• Many censored international experts in public health and virology have long-called for focused protection and the need to carefully weigh the risk-benefit of these experimental mRNA vaccines among those individuals with very low risk from the disease, including children (64).

1) The Great Barrington Declaration (2020) was co-authored by Dr. Martin Kulldorff (Harvard), Dr. Sunetra Gupta (Oxford) and Dr. Jay Bhattacharya (Stanford) – 3 giants in public health, epidemiology, and vaccines surveillance (https://gbdeclaration.org/). This declaration advocates for “focused protections” for COVID-19 and currently has collected > 850,000 signatures worldwide including from > 58,000 medical professionals and scientists. Despite these credentials, and recommendations that were not novel but in fact reflected longstanding public health policy, Dr. Kulldorff, and the others have been heavily attacked and censored. I have provided a link to a fantastic interview with Dr. Kulldorff in the reference section. Towards the end, he addresses the censorship issue directly (65).

(8) Is it possible that antibody dependent enhancement (ADE) is contributing in some people to the aggressive Delta outbreaks seen in Israel, India and … Calgary?

• ADE occurs when antibodies facilitate viral entry into host cells and enhance viral infection in these cells. It is an appreciated concern of coronaviruses as described in a multicenter paper that included Dr. Zhengli Shi from the Wuhan Institute of Virology, known for her work with bat viruses (a.k.a. the “Bat Lady”), entitled “Molecular mechanism for antibody-dependent enhancement of coronavirus entry.” This paper was published in the Journal of Virology on February 14, 2020 (submitted pre-pandemic November 27, 2019) (66).

• Animal model studies of prior SARS-CoV raise potential safety concerns (67). Decades ago, kittens were immunized with a viral recombinant encoding the spike protein of the coronavirus, producing low titres of neutralizing antibodies. After challenge with the feline virus, these animals succumbed earlier than did the control group – “early death syndrome” (68). More recently, the anti-S IgG produced in macaques immunized with a modified viral vector expressing the SARS-CoV protein, enhanced pulmonary infiltration of inflammatory macrophages, and resulted in more severe lung injury compared to unvaccinated animals (69). Similarly, immunized macaques with four B-cell peptide epitopes of the S protein, found that while 3 peptides elicited antibodies that protected the macaques from viral challenge, one of the peptides induced antibodies that enhanced infection in vitro and resulted in more severe lung pathology in vivo (70). Further, pulmonary immunopathology was observed upon a subsequent challenge to the SARS virus, among SARS coronavirus vaccine-treated mice and ferrets (71). However, it appears dependent on the vaccine type. In 2 studies with rhesus macaques, immunization with an inactivated SARS-CoV vaccine, did not show ADE (72, 73).

• A recent study of healthcare workers in Vietnam assessing the transmission of SARS-CoV-2 Delta variant found that the previously mRNA double-vaccinated group had 251 times higher nasopharyngeal viral loads compared to those unvaccinated. AND there was no correlation between vaccine-induced neutralizing antibody levels and viral loads or the development of symptoms (74).

• Very recently, researchers found “facilitating” antibodies bound to the NTD region of the Delta spike variant (located behind the contact surface so that it does not interfere with the virus-cell attachment). Their data suggests FcR-independent enhancement of infection induced by anti-NTD antibodies involving lipid rafts. “Inasmuch as neutralizing antibodies overwhelm facilitating antibodies, ADE is not a concern. However, the emergence of SARS-CoV-2 variants may tip the scales in favor of infection enhancement. Our structural and modeling data suggest that it might be indeed the case for Delta variants” (75).

• More data is needed to determine what role is being played by ADE but the evidence that does exists, suggests that we should be concerned and following this carefully.  If ADE is not contributing, then prove the silenced experts wrong!  If it is, the plan to double down on widespread mRNA vaccines and boosters, needs to change.

(9) Relevant Examples of Egregious Censorship and Misinformation.

*** I hesitate to include this section largely because the scientific data itself is so convincing and I do not want to detract from these arguments.  However, you cannot understand why these data are so incongruous with the prevailing narrative, unless you appreciate the medical censorship for yourself. ***

Example 1: SARS-CoV-2 virus origin – manipulated in a lab or jumped species?

• Do you recall when SARS-CoV-2 escaping from a lab in Wuhan – as opposed to jumping from bats to humans – was a demonstrably false conspiracy theory? The Washington Post, among others, was even forced to retract prior statements claiming this was “debunked” (76). Based on the virus’ genetic code, Prof. Montagnier was among the first to state publicly and with extreme certainty that this virus was manipulated in a lab. He was demonized then for that too (77).

• In March 2020, it was Andersen and colleagues’ paper appearing in Nature Medicine: “Proximal origins of SARS-CoV-2” – that framed this discussion early (78). They concluded: “In the midst of the global COVID-19 public-health emergency, it is reasonable to wonder why the origins of the pandemic matter …. Although the evidence shows that SARS CoV-2 is not a purposefully manipulated virus, it is currently impossible to prove or disprove the other theories of its origin described here.”

• While 100% proof of origin is unlikely to arise, the media continuing to paint the issue so nebulously is also disingenuous. I defy you to read this balanced and detailed pro and con argument for each origin theory and still perceive this to be a grey zone. (https://www.zerohedge.com/health/tracing-origins-covid-19).  

• For those with basic science background, a more complex SARS-CoV-2 genetics analysis was provided by the Chinese whistleblower Dr. Li-Meng Yan’s original scientific paper (79). This swayed me enough back in June 2021 when it first appeared on-line to realize that Fauci’s earlier adamant assertions to the contrary were untrue. While there may not have been proof to definitively confirm one theory over the other when he made his statements in Spring 2020, he certainly could not state that the lab manipulation theory was proven false.  So why lie?

• Why care? The evidence undeniably implicates Dr. Fauci’s knowledge and involvement (including the proximal origin paper), and he indirectly continues to help inform policy in Canada.

• It is likely impossible to wrap your head around what I am saying unless you see his duplicity for yourself.  For a succinct, fact-based video of what we know for sure, including his own Senate testimony around his leaked emails at that time, please watch: https://www.theepochtimes.com/five-questions-for-fauci-truth-over-news_3941146.html?&utm_medium=TruthOverNews&utm_source=EET&utm_campaign=FiveQ%20&utm_content=8-13-2021

• Alternatively, Tyler Durdin who wrote the ZeroHedge article above on the virus origins, outlines the Fauci emails and ties to the Wuhan Institute of Virology, with embedded links to original documents and his emails here: https://www.zerohedge.com/covid-19/emails-reveal-how-influential-articles-established-covid-19-natural-origins-theory-were

• If you watched the video, it is difficult to conclude that his actions can be dismissed by ignorance or incompetence.  But even if you give him the benefit of the doubt, how has he maintained his job and remained a guiding voice in the context of these past actions and clear personal and financial conflicts of interest?

Example 2: Nobel Prize winning French Virologist, Professor Luc Montagnier

• There are several impressive experts, including Professor Montagnier, who stated that the COVID-19 vaccine is creating variants and NOT the unvaccinated. He also warned about the risks of trying to vaccinate everyone DURING a pandemic, as you risk secondarily causing harm by perpetuating antibody dependent enhancement.

Please listen to the brief 2.5 min video link here: (https://www.youtube.com/watch?v=RZGuTNhNxOE)

***Not surprisingly, when I reviewed this letter to ensure all links worked, this video had been removed from YouTube for violating their platforms rules. It disappeared within 24 hr of grabbing the link.  So, I found the video again on Vimeo and copied it with Camtasia. I can provide it to you if interested. ***

• As described, there is evidence emerging for ADE and Delta, but regardless of whether Prof Montagnier proves to be correct – the censorship is egregious. Science is about debate, especially during times of uncertainty. While I doubt, I would agree with everything Prof. Montagnier has said or done in his life, to censor the 2008 Nobel Laureate in Virology who helped to discover HIV, at a time when we are dealing with the novel pandemic and all its uncertainty, seems unbalanced. Given the seriousness of this issue – prove him wrong, do not censor!

• It was not just that his videos were removed, BUT WORSE – a demonstrable lie was created on the internet and perpetuated in the media, stating that during the interview he also claimed everyone who took the mRNA vaccines would be dead in 2 years. He never said this, and yet there it remains as the prominent narrative on most internet search engines.

• Consider that while big tech and social media are still aggressively removing any video link to Prof. Montagnier’s comments without evidence to dispute his claims, they are continuing to proliferate the character assignation lie on their platform that discredits him.

• Censoring facts and reasonable expert opinion to prevent vaccine hesitancy, is coercive and unscientific nonsense.

Example 3: Dr. Robert Malone, co-inventor of mRNA vaccine technology

If you search in Google for Dr. Robert Malone, who holds multiple patents for mRNA vaccine technology, you will find that his provable accomplishments are discredited. They state he is an “antivaxxer” and zealot seeking media attention.

I have listened to Dr. Robert Malone speak during numerous interviews, and thus far have found him to be balanced scientifically, insightful, and sharing genuine concern with our course of action. He is not an antivaxxer, he has himself taking the mRNA vaccines but cautions about their widespread use during a pandemic, especially among low-risk groups. Pease judge for yourself – even if you only watch the first 15 minutes of Part II where he responds to the criticism and censorship.

2) Epoch TV, American Thought Leaders, September 2, 2021, interview with Dr. Robert Malone discussing the latest covid-19 data, booster shots and the shattered scientific consensus. Link to full PART 1 video: https://www.theepochtimes.com/dr-robert-malone-mrna-vaccine-inventor-on-latest-covid-19-data-booster-shots-and-the-shattered-scientific-consensus_3979206.html

3) Epoch TV, American Thought Leaders, September 4, 2021, interview with Dr. Robert Malone on ivermectin, escape mutants, and the faulty logic of vaccine mandates. Link to full PART 2 video: https://www.theepochtimes.com/part-2-dr-robert-malone-on-ivermectin-escape-mutants-and-the-faulty-logic-of-vaccine-mandates_3981859.html

10) Without a mRNA vaccine, DOES MY RISK TO PATIENTS increase?

• The mRNA vaccine effectiveness has decreased significantly to SARS-CoV-2. The fully vaccinated can transmit SARS-CoV-2, have similar or higher viral loads compared to the unvaccinated, and are comprising an ever-growing proportion of the symptomatic patients, including need for hospitalization and critical illness support.

• To estimate my current risk to pediatric patients with or without vaccine, consider that to date, 5.98% of Albertans have had COVID-19 (264,539 cases/divided by 4,421,876 total AB population). So, my risk of SARS-CoV-2 infection is about 6% every 12-18 months (but this could increase or decrease). I would have to be a pre-symptomatic spreader since I would not come to work with symptoms, and if I developed symptoms I would get tested. Assume 50% of all transmission is from pre-symptomatic individuals, so now the risk of catching the virus and spreading pre-symptomatically drops to 3% every 12-18 months.   Then you consider all the handwashing, gloving, and PPE that I abide by, and my risk of transmission decreases further. I do not know by what factor all this PPE and hand hygiene lower my risk, but I would think substantially, perhaps even to 1% or less?  If you multiply that by the child’s starting absolute risk using the U.S. State data – of all child COVID-19 cases – 0.1-1.9% hospitalizations, and 0.00-0.03% death (41) – that suggests a hospitalization risk = 0.01 – 0.19%, and mortality = 0.00 – 0.0003%, every 12-18 months.

CONCLUSIONS

Please judge the data and interviews for yourself and open your mind to the possibility that the blatant medical censorship is negatively impacting our profession, and our ability to make informed policy! Recall that we are living during a time when original articles in Lancet and the New England Journal of Medicine regarding COVID-19 treatment are being retracted because they were completely fabricated (80, 81).

While I grew to respect and trust long-standing health organizations like the WHO and CDC, financial and political interests have crippled their independence, and during this pandemic, they have egregiously misrepresented facts and helped to censor scientific experts worldwide. This is not surprising, as it has been proven in court that WHO did not act ethically during the 2009 H1N1 swine flu “pandemic” when it came to their global vaccine agreements (82). These organizations that inform Canada health policy are completely compromised by vaccine and big pharma interest money. Unfortunately, we can no longer rely on the global media cabal to be independent and forthcoming. Consider CDC Director Dr. Rochelle Walensky’s July 16, 2021, declaration that we are facing “a pandemic of the unvaccinated” (83) which perpetuated unneeded societal hatred and division, seemed backwards scientifically, and is now contradicted by the global epidemiology as you have read.

Consider that 20-40% of vaccine eligible individuals living in countries with high mRNA vaccine availability like Canada, still REFUSE to take the jab, including many healthcare workers worldwide (84). As this is despite the enormous social backlash, despite the ongoing confusion & hatred received by others including family members, and despite being faced with ongoing and constantly increasing punitive restrictions including the inability to travel, visit family, enjoy a meal at restaurant, and EVEN earn a living. In my case, after 18 years of medical training and a highly specialized consultancy practice, and despite my informed medical decision, I either capitulate to medical tyranny or leave a dream job at the Alberta Children’s Hospital (via the AHS mandate). I strongly urge you to fight back against this wave of medical tyranny and NOT mandate forced mRNA vaccinations among those remaining physicians who have made the informed medical choice to abstain.

Thank you for taking the time to read this. Please don’t hesitate to contact me should you have any questions or concerns with the presented data. I would welcome the opportunity to discuss further. If nothing else, I hope that as you listen to the media and officials prospectively over the next few weeks to months, you consider if what they are saying aligns with the existing scientific data.

Yours Sincerely,

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Eric T. Payne, MD, MPH, FRCP(C)

Pediatric Neurocritical Care & Epilepsy

Alberta Children’s Hospital

Assistant Professor of Pediatrics & Neurology, the University of Calgary

Email: eric.payne@albertahealthservices.ca

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61. “2 top FDA officials resigned over the Biden administrations booster-shot plan, saying it insisted on the policy before the agency approved it, reports say. https://news.yahoo.com/2-top-fda-officials-resigned-103227868.html

62. https://www.huffingtonpost.co.uk/entry/jcvi-childen-covid-12-15_uk_613231c7e4b0aac9c0165142

63. “COVID-19 Vaccines and Kids” link at http://www.19toZERO.ca https://drive.google.com/file/d/17cuUHAFhotVNipLtdAkHIQw4GfP72dUG/view.

64. Dr. Martin Kulldorff (Harvard), Dr. Sunetra Gupta (Oxford) and Dr. Jay Bhattacharya (Stanford). Great Barrington Declaration. 2020.  https://gbdeclaration.org/

65. Epoch TV, American Thought Leaders, August 10, 2021, interview with Dr. Martin Kulldorff. Link to full video: https://www.theepochtimes.com/harvard-epidemiologist-martin-kulldorff-on-vaccine-passports-the-delta-variant-and-the-covid-public-health-fiasco_3942556.html

(Instead of fact checking or using Wikipedia – please listen to Dr. Kulldorff speak!)

66. Wan et al., Molecular mechanisms for antibody-dependent enhancement of coronavirus entry. Journal of Virology. March 2020, Volume 94 (5) e02015-19.

67. Lee et al., Antibody-dependent enhancement and SARS-CoV-2 vaccines and therapies. Nature Microbiology. Oct 2020, Vol 5. 1185-1191.

68. Vennema et al. Early death after feline infectious peritonitis virus challenge due to recombinant vaccinia virus immunization. Journal of Virology. Mar 1990. 64(3): 1407-1409.

69. Liu L et al. Anti-spike IgG causes severe acute lung injury by skewing macrophage responses during acute SARS-CoV infection. JCI Insight. 2019. 4:e123158.

70. Wang Q et al. Immunodominant SARS coronavirus epitopes in humans elicited both enhancing and neutralizing effects on infection in non-human primates. ACS Infectious Disease. 2016. 2:361-376.

71. Tseng et al. Immunization with SARS coronavirus vaccines leads to pulmonary immunopathology on challenge with the SARS virus. PLOS one. 2012. 7(4): e35421.

72. Luo F et al. Evaluation of antibody-dependent enhancement of SARS-CoV infection in rhesus macaques immunized with an inactivated SARS-CoV vaccine

73. Qin et al. Immunogenicity and protective efficacy in monkeys of purified inactivated Vero-cell SARS vaccine. Vaccine. 2006.  24:1028-1034.

74. Chau N, et al. Transmission of SARS-CoV2 Delta variant among vaccinated healthcare workers, Vietnam. Lancet preprints. https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3897733

75. Yahi N, et al. Infection-enhancing anti-SARS-CoV-2 antibodies recognize both the original Wuhan/D6414G strain and Delta variants. A potential risk for mass vaccination? Journal of Infection. Pre-print. On-line August 16, 2021. https://www.journalofinfection.com/action/showPdf?pii=S0163-4453%2821%2900392-3

76. https://www.acsh.org/news/2021/06/03/covid-19-origins-debate-undermines-case-social-media-censorship-15580

77. https://www.ibtimes.sg/france-opposes-nobel-winning-scientist-luc-montagniers-claim-about-coronavirus-origin-wuhan-lab-43325

78. Andersen K et al. The proximal origin of SARS-CoV-2. Nature Medicine. April 2020. Vol 26. 450-455.

79. Yan L-M, Kang S, Hu S. Unusual features of the SARS-CoV2 genome suggesting sophisticated laboratory modification rather than natural evolution and delineation of its probable synthetic route. Available on Research Gate Sept 2020 here: https://www.researchgate.net/publication/344240007_Unusual_Features_of_the_SARS-CoV-2_Genome_Suggesting_Sophisticated_Laboratory_Modification_Rather_Than_Natural_Evolution_and_Delineation_of_Its_Probable_Synthetic_Route

80. RETRACTED – Mehra et al., Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis. Lancet. May 22, 2020.

81. RETRACTED – Mehra M., et al. Cardiovascular disease, drug therapy, and mortality in covid-19. New England Journal of Medicine. June 25, 2020; 382:2582.

82. “Trust WHO” documentary film featuring 7-year investigation into the independent practices of the WHO and infiltration of non-public money. Directed by Lilian Franck. Highlights the 2009 H1NI flu pandemic. Film allegations were proven in court, yet YouTube continues to censor the film. 9 min video trailer link https://www.youtube.com/watch?v=9MvB5hoIQok. (If link removed, search for “vimeo removes our film “trustWHO”).

83. Walensky warns of “pandemic of the unvaccinated”. Friday July 16, 2021. https://www.reuters.com/video/watch/idOVEM3I9R3.

84. Provides link to multiple MSM stories and videos of healthcare workers globally refusing the mRNA shots. https://truthref.wordpress.com/2021/02/19/many-healthcare-workers-worldwide-are-refusing-the-covid-vaccine-let-that-sink-in/

8 thoughts on “Dr. Eric Payne Letter To The Alberta College of Physicians and Surgeons—Part 3

  1. It seems to be almost every evening now. Our family praying for healing for yet another casualty from the experimental gene therapy injection. Will this madness ever end?

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  2. CBC released an article on how Alberta’s college of physicians is now going to persecute doctors that offer vaccine exemptions to patients or “ undermine “ the vaccine mandate. They expect colleagues and the public to snitch on these doctors so the college can address the doctors actions. Is this not governances with Chinese characteristics ? So disappointed in where our fine nation is headed. Our rights and freedoms are being hijacked

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  3. Thank you for this letter. As a neuro-sarcoidosis patient, i have yet to receive a shot but have been pressured too. Is there any hope of being excluded based on some of the information you provided regarding S proteins and CSF transmission, etc?

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