This is Gavin Newsom. This is doctor Sanjay Gupta.
Sanja.
It's great to have you. I appreciate the opportunity because I look, all of us are reflecting on whether this is, as it feels to many of us, one of the most sort of challenging and profoundly consequential moments with health care policy in our lifetime, or perhaps putting it more perspective, more historically, even thinking back a little bit to Obamacare and their debates and the sort of fundamental shifts in
health policy we're taking shape there. So I thought i'd just opened up just ask you about the landscape, ask you about your perspective, particularly from the prism of not just a policy expert and a pundit, but also as a practitioner. What world are we living in as it relates to healthcare policy in the United States today?
Well, you know, broadly speaking, I think one of the and we've been talking thinking about this a lot, is sort of what is the United States role when it comes to science, healthcare, science, public health, all of that.
I think for.
Eighty some years we were sort of the world leader, sort of post World War Two. That became part of our DNA and the United States and take great pride in and we recruit the best scientists in the world.
Some of the greatest scientific achievements over the last century have come from the United States, and I think it's been something that certainly people in the scientific community, but I think the population at large really have rallied behind, taken great pride in people coming from other countries for our medical care, new therapies coming out of the United States, all of that.
And I think one of the and.
I don't want to overstate this, but I think one of the worrisome things right now is.
Is that still the case?
Do we still think that that's important? Kind of like maybe how we talked about My parents both worked in the auto industry, and I think there was a time period where people said, should we still be building.
Cars in the United States?
And my parents both ended up leaving the auto industry in two thousand and one because they were fearful that the industry was just going to change. It did not got bailed out, as you know, and all these things happened, and here we are today. I think it sort of feels this has some of those same tones as that are we going to look back twenty years from now and say the United States is still the global leader
when it comes to these things. That's the thing that I worry about, sort of philosophically, sort of more practically speaking. Governor's something you talk about a lot as well. We're not a healthy country. We spend four and a half trillion dollars on healthcare. We don't have a lot to show for it in terms of outcomes, in terms of overall health. I think we saw that ripped off like a band aid during the pandemic. People say, how can a country that spends that kind of money do so
poorly with regard to patient outcomes. We walked in pretty unhealthy into that situation. So I think some of that needs to change. And frankly, most of that problem, I think is in how we nourish ourselves, you know, the foods that we put into our body, the chemicals that we ingest. It's a problem. It's part of the reason I got into medical journalism in the first place. That needs to change, and people have been saying that for a long time.
You talk about it in California. First Lady Obama used to talk about that.
You know, Michael Bloomberg talked about that when as Mayor of New York, so it's not a new discussion, but I think it's one that needs to be had.
So I want to get to both subjects cause I think it's interesting as you start with the larger issue as some of us and I'm not putting words in your mouth, but there's sort of this war on knowledge more broadly speaking, and certainly scientific expression is part of that, this notion of just confidence in trans parency, truth trust. We can get to missing disinformation and how that debate plays out differently through the lens ideological lens on both
sides of the political prism. But the interesting thing I think you underscored is just this trend line that's been decades and decades. It's i think growing headline in some ways because of this Maha movement. And I think if there's one sort of reckoning, it's a recognition with RFK Junior, and we can get to the more controversial aspects of it.
But this whole Maha movement is interesting to me. You brought up Obama first, Ladya Michelle Obama in the Let's Move campaign, her focus on issues of a chronic disease obesity school lunches, which was exceptional at the time, and I was exceptionally engaged in that campaign. I think it was a twenty ten ish plus or minus. But where
are you in this Maha movement. Do you think it's a breakthrough in terms of consciousness, on a wellness frame, on a focus on some of these broader issues that are been under resourced in terms of time and attention.
That's a good question. I do think a lot more people are talking about this.
You know.
I wish it didn't require, you know, sort of really demeaning certain populations of people to do it, But there's no question it has struck a nerve and I hear people talking about it from circles that I had not heard people talking about this before, just in terms of really wanting to have some autonomy over their own health. So there's a lot of kernels of truth, I think to what is happening out of the Maha movement, it is.
It is I think largely based on precautionary principle, which we can talk about more because I think there's other aspects of what is happening in healthcare that are the opposite of precautionary principle. This demand for more evidence and replication of evidence. And it's not just be careful, it's let's prove this to the nth degree before we make
any movements. But with regard to ultra process foods, with regard to petroleum based die some of these petroleum based dies, Governor should have probably never been approved no nutritional value. They were purely aesthetic. There's many countries around the world that don't have them. These food manufacturers can clearly make these products without them.
I have kids.
I've worried about this for a long time, so people have been talking about it, but no one got it done. You did in California, and now it's starting to happen, I think more to national level.
You know, it's interesting so jays know some of the things we let on. I appreciate you highlighting. I mean, and this has been a passion project for me, going back to my mayor days when you referenced Mayor Bloomberg and I were very competitive in this space as mayor's He with a much larger platform in New York, I
with a little smaller platform in San Francisco. But I've deeply been committed as you have in terms of all your work focusing not on sick care, but healthcare, focusing on social determinants of health, which we'll talk about in a moment, and wellness and prevention. But one of the things that is really you know, came to the four with me through a political ends was this notion of ultra processed food, but specifically as it relates to food dies. And we did something that was referred to on the
far right which was the Great Irony and mocked. I mean, I can't tell you how many with respect to another news network there three news network mocked consistently called the Skittles band because we were moving red dye and we were the first state to do that. Now it seems to be socialized in the political spectrum on the right as sort of you know, endowed leadership from the MAHA movement. But what was the movement towards all this? I mean,
it's it's it's there's chemical chemicals aside, but additives. There's sort of obsession. Is it just it was a taste? Was a texture that we were after? Was it longevity? Freshness? Why the US not the EU? What was it? What is unique about the United States that we became overly indulgent in these additives and chemicals.
I think it's more than more than one thing, but I do think a lot of it had to do with longevity, initially increasing shelf life of food, and that really got it a lot of additives, even going back to hydrogenated corn syrup versus sugar. You know, when you're adding these types of things in there, you're not only adding sweetness to some extent, but you're adding how moist the food is and how long it's going to last on a shelf. I think, trying to remember, you know,
former President Clinton used to talk about this. You can feed a lot of people a lot of calories for cheap if you're having these ultra processed foods. You know, if you have family at McDonald's for twenty five bucks, you know if you have ultra processed foods.
So I think it.
You know, if you increase shelf life, you can decrease costs. I do think the aesthetics of the food is not an issue to be minimized, though it's very I don't know if you heard the story about what happened with fruit loops. I think back about a life years ago, twenty fourteen timeframe, where you know, they basically said, all right, let's remove some of these food dies. There was a lot of pressure to remove the food dyes, and the root loops as a result, were not as brightly colored.
They were kind of bland color.
If you go to Europe and go to a hotel or something, you go to the breakfast buffet and you get fruit loops, they're bland colored fruit loops. They're the same fruit loops otherwise, but they just don't look the same. And what they found when they did that in the
United States was two things. One is that people didn't buy those blandly colored fruit loops, and two is they kind of got accused of the same thing that you were talking about, sort of nanny state, don't take away our brightly colored fruit loops, same thing that Mayor Bloomberg got accused of when he wanted to not sell sixteen out sodas anymore any state. And so it's really it's interesting, Governor,
this balance between personal freedom and health. And what is interesting is that you can be sort of thinking the same thing and approach that in two completely different ways. One hand, I'm going to do precautionary principle. We're not going to have food dies doesn't make sense, no nutritional value. Why would we do that? I kind of agree with that. Again, as a health conscious person myself, I like to eat right, I like to exercise every day. Why would I do something like that to my body?
On the other hand, what is the level.
Of evidence you need to have before making a decision? Prove to me that red dye number three is bad?
Prove it. Maybe some will say, why do you need to prove it causes.
Cancer and animals and we should have never approved it in any ways, But what is the level of evidence? And that's going to extend, I think beyond food and additives to vaccines and therapeutics and other things. I think that's going to be the crux of the.
Issue, and it's important on the precautionary frame and the precautionary principle. I mean, I think that's fundamentally, isn't it The difference between the EU policy where so many of these foods just simply never make the shelf, and fundamental policy that's advanced in the United States.
That is exactly your friend, I think Todd Wagner, who's a friend of mine as well, he talks about this a lot. He started this organization food Fight, and you know, when I spend time talking to these folks and reporting on this, people will always say the same thing, which is, I go to Europe, I hate the same foods, pasta.
I do whatever, and I feel great.
Great, I lose weight. I all that. Now, some of that may be that you're you're active more over there as well. There could be other things, but I think there's something definitely to that.
And that I think that so it's it's a little bit.
More than precautionary principle. You have these large cohorts of the population that say, I have lived in both those worlds, I've eaten both these foods, and I can feel the difference in my own body.
I think you can't.
You can't ignore that, again with the backdrop that those petroleum based eyes don't have any nutritional value, not losing anything by stripping them out other than aesthetics, which.
You know, maybe may be important.
People people do like their brightly colored fruit loops. As it turns out.
So you talk about you're talking in the terms of precautionary principles, sort of the the two ends of this, and you reference the issue of vaccines. Is that a reference to m r NA vaccines? Is that in what respect is a precautionary principle sort of the one hundred and eighty degree uh flip side of that principle being abused in terms of or is it just moreover on what more evidence do you need of something being bad or good? Is it the same thing?
Yeah, I think it's I think it's a m RNA vaccines, but but but more widely, I think it's vaccines in general. And I think it's maybe even the response to things like a pandemic. You know, when you're dealing with something that is novel. I mean, by the way, uh, you know, COVID was a novel disease. We had never experienced it before. And I know people said said that a lot novel virus. You heard that a lot. But I mean, if you really sit and think about that, it's kind of extraordinary.
I mean, as an.
Adult, we don't get to experience novel things very often. Kids experience novel things all the time. But when is the last time you governor experienced something for the first time. Doesn't happen very often. So now you're dealing with something that is novel and you have to say, okay, look, our response isn't going to be exactly right.
Nothing's exactly right.
Where are we going to tilt? What side we're going to err on? Are we going to air on precautionary principle or going to are we going to err on the side of let's sort of see how things go and you know, figure it out as we go along. And I think, you know, public health, the the training often is to to sort of side with precautionary principle. It's like, let's be careful as we sort of sort this out, how is this virus behaving? Who's it affecting? So I think MR and A vaccines were part of that.
I mean, people, I think understandably would say, we need long term data on these things before we start releasing them. I think that's a really fair sort of thing to say. But you realize that in the middle of a pandemic to get long term data means you have to wait long term or are you're going to wait five years, ten years? What does long term mean? You know, if it's for a kid, is it eighty years? What does it mean in terms.
Of how long you're willing to wait? What struck me.
And again, this is finding the balance between precautionary principle and evidence. Is that we knew that for vaccines, the vast majority of the time, greater than ninety percent of the time of side effects were to occur, they would occur within the first sixty eight days. That was the number,
so just over two months. So then the idea that the FDA would say, well, let's wait three months, let's just let's try and cover as many possible side effects that have come from this as possible before we give emergency use authorization. Is that is an example I think of policy that you have to sort of think about in the throes of something like this. It is still
precautionary because we don't know the long term data. On the other hand, you're using the best evidence that we do have in terms of what history has taught us. And I think, you know, I know it's been a sort of cluster since that, but I think at the time to me as a reporter, a medical reporter, and as a doctor, but also as a dad, that made sense.
Yeah, the side effects are going to occur.
They usually occur within two and a half months. Let's keep a close eye on this thing, watch it like a hawk, wait even longer than that, and at that point, if things look good, then I go ahead and provide an EUA for it.
I mean, it's interesting it continues to this day. I mean, obviously at the state level, when we saw the Surgeon General of Florida come out and recommend against m mRNA vaccines. Obviously the President is spoken from every side on this issue. I mean, considering you, through Operation warp Speed was the
one advancing the platform and the technology. But obviously the new Health and Human Service Secretary has been very critical and has been prone arguably to some sort of wild eyed theories around DNA issues related to the the RMA m RNA vaccine and concerns around DNA concerns obviously around its safety, uh and and in the side effects. What what's where are you now in terms of just your concerns. Our m RNA is not just for COVID vaccine, right, It's also used for other vaccines.
Use for other vaccines, and use for other therapies entirely, including cancer therapies right their clinical trials now trying to use these types of platforms m r and A platforms for very difficult to treat cancers, including pancreative cancer, which we don't have great, great answers for. You know, I
think I'm I think I'm pretty practical on this. I think where we are now in twenty twenty five versus certainly when these vaccines got approved were in a different place, meaning that even though the uptake of vaccines has gone way down, most people did get the initial series of vaccines, and we know that they can, especially for young people, they can provide more durable relief. There hasn't, you know, after the initial what they call ancestral strains of COVID before omicron.
I think these still provide pretty good.
Protection, especially for young people whose immune systems really respond to them. So I still think, you know, I said this before. I think this was one of the great scientific achievements of my time as as a human being. I think, you know, when textbooks are written about scientific achievements, the idea that they were able to create a vaccine essentially in nine months and be able to you know, protect so many people.
There's a lot of people who think they don't work. They do work.
I mean, if you looked at the data California or the country as a whole. Who was in the hospital during the huge sort of swings and COVID It was primarily people who were not vaccinated, so it was helping
protect against illness and death. What I think was unfortunate, Frankly, and this was a communications problem, was that they seemed to also intimate that it would protect you from getting COVID at all, from carrying it, and there was not great evidence behind that, And you know, we reported as such that you don't have great evidence that shows that when you have a vaccine that's protecting against illness, it's usually protecting in your lower respiratory and your lungs, so
you're not getting that really really sort of a deep illness, but you might still have it in your mucosa, in your mouth and your nose, in your upper airway, so you could potentially still be carrying it and still potentially spread it. That wasn't I think a communications error, and I think, Frankly, Governor, I think it led to a lot of distrust overall of these MR and A vaccines. You said, you said I couldn't get COVID if I got this, Well I got COVID and I spread it.
So what is this is a vaccine or is it not a vaccine that was that was a problem?
And do you I mean, are we being oversensitive hyperbolic as it relates to how now this is manifested with the new recommendations that for pregnant women and for children they shouldn't even be getting these boosters on COVID or is that overstated or is that a more targeted approach? Do you think it's rational? We can talk about how that was done without the CDC an advisory committee that usually advises in terms of recommendation, but the outcome ultimately
of that decision. Where are you on that?
Yeah?
I mean, first of all, you know, with regard to the CDC and expertise, I mean, you know, it amazed me when I watch people like Tom Frieden during Ebola or Richard Besser during H one n one do their briefings in front of the CDC, and they would say, behind us, we have four thousand of these smartest, most hard working scientists in the world.
They are so good that other.
Infectious to these organizations, and other countries model their organizations after us, even calling their organizations the CDC.
I mean, that was a source of great pride.
I think for people in the public health world, myself included, I think where I am now at this point in twenty twenty five is, first of all, I think what Sexuary Kennedy has said versus what is reality is different. There's daylight between those two things. So he basically said no more boosters for kids, basically no more shots. Even now on the CDC's website, that's not what it says. It says it should be a shared clinical decision between
patient and provider. So for kids, I think that makes sense. I mean, if your kid has asthma, do you want to get your kid a COVID shot? How bad is the asthma, how many times they require an inhaler, Do they have diabetes, do they require insulin? You know these are there's nuance to that decision, and I think, you know, the general approach has always been, instead of trying to stratify all this by risk, which can be difficult as
a country to do, let's just recommend the vaccine. I think what they're saying is let's do risk stratification and let's put it at the hands of the.
Providers, of the doctors, you know, for these kids. I think that makes sense.
You know, you know, if your kid is otherwise healthy, they've had their primary series, which most kids have had.
We haven't had new variants that are worrisome.
For the time being. I think that that makes sense. Pregnant women I would put into a different category. I mean, the thing about pregnancy is that when you're pregnant. When someone is pregnant, they their immune system is compromised intentionally, the way the body works. You don't want to reject this new body inside your body, inside a woman's body. So the idea that you know, you would be more
vulnerable to infections while pregnant is real. In fact, you know, the FDA commissioner wrote before these new recommendations came out, he listed pregnancy as a high risk condition for COVID and then a couple days later said pregnant women don't need it. I mean, if people's heads were spinning, I would understand why.
The second thing.
About pregnant women is that if they get vaccinated, they can actually pass on some of the antibodies to their child, So for the first six months of life, that child may have protection, and they're very young. Kids like that are very, very vulnerable to COVID. Some of the rates of severe illness they approximate what older adults have, so very young, very old, both can get very sick. But young, young, young kids under the age of six months can't get
a vaccine, so mom can provide protection. But now they're sort of recommending against that as well, don't I don't think it'll stick. I think most infectious these doctors, you know, if you go to your doctor as a pregnant woman, will say, hey, look, here's the benefits. You're you're immune compromised as a result of pregnancy, and you can help protect your child after they are born. I think most people will will, you know, at least pay attention to.
That as it code read what's happening with vaccines generally, the sort of growing anxiety around vacs. I was listening to your podcast recently just about you know, people expressing concern they're getting so many shots a young child, newborn, and all of a sudden they're getting four or five shots.
Twenty years ago they may have gotten less shots. But you described a very different construct as it relates to anogens and proteins and dose, which was fascinating to me and obviously calmed I think the nerves of those who were inquiring. But talk to me more broadly about the state of vaccines, your anxiety and pushback against some of this vaccine skepticism that's out there.
Well with regard to the you know, you hear these crazy numbers, you know, seventy two vaccines and all that. First, all those are just made up numbers. It's weird to me, Governor, there's no accountability for people saying stuff that's just absolutely not true. I hope people, you know people they always say, do your own research. I hope people do their own research with regard to some of this. So, yeah, we vaccinated against more diseases than we used to when you
and I our kids were around the same age. But what you're referring to is this something known as the antigenic load, which is really what you know, scientists pay attention to how much of a sort of load of antigens are we giving to the body. And what you find is that nowadays, compared to days when we are still vaccinating against things like smallpox, for example, the load is much much lower, exponentially lower than we used to give.
Even though there's more vaccines. Vaccine technology has gotten better. They use adjuvants to to so you don't have to give as much of the overall whether it be live virus or anything else, as we used to. So we don't sort of cause the immune system to react nearly as much today as we used to in the past because of that anergenetic load. So you know, numbers of shots and all that. Look again, as a dad, I don't like saying my kids get shots.
I get that.
I understand that, but in terms of what it's actually doing to the body compared to what we used to do to the body at a time when, by the way, autism was a much lower rate, so we used to give a much bigger anergentic load and lower autism rates. Now we have a much lower anergenic load and we
have higher autism rates. Make of that what you may those that's the data, that's the facts, and so I don't know that I would call it code red, but I think that this the argument against I think what is a very very effective preventative strategy gain a lot of them, and I think people are becoming increasingly increasingly concerned about vaccines and has it What did.
You make I mean, you were out there in Texas, this measles outbreak. I mean, and you know, folks arguing for more, and look, I'm not belittling it, but it was interesting to me cod liver vitamin as a solution,
not vaccines. I was reading in different sources that you know, a double digit percentage of people that you know had measles ended up in the emergency rooms and people are still arguing for heavy loads of vitamin A. I mean, give me a sense of, you know, on the ground truth seeking that you did, and you know, how does that play in sort of a modern flashpoint with this ideological movement and the practical realities on the ground.
I think for the physicians and nurses and everybody who's caring for patients there, it was incredibly frustrating for them. I mean, you're talking about vaccine preventable disease. We essentially native measles in this country. I think when we say frustrating, it's like, how are we going to make big swings at big important things evolutionarily in science if we can't
get the little things right. It's dying of measles, kids even getting sick of measles, being hospitalized with measles, it doesn't need to happen.
It's a travesty, you know.
And I think most of the people, frankly that we spoke to, and not just people in the medical community, but we spend a lot of time talking to citizens just going around taking the temperature. I think there was a lot of frustration, but at the same time they're being assaulted with all sorts of information that is not accurate.
You know. This seemed to have started in a small.
Community, a Mennonite community, and it's really interesting. There's nothing in the religious doctrine that says they shouldn't take measles vaccine. But what happens is we learned you may know, Governor, is that these very insular communities, they don't get a lot of outside information often so they may have somebody in the community whose child developed the febril seizure or something.
I think that's what happened here. After a vaccine, that can happen and right away that spread, like you know, wildfire through that community, and all of a sudden, nobody wanted to get vaccinated when you're dealing with something as contagious as measles. Then that community as they're walking through the town of gains or wherever you know, the costco or fast food wrestler, whatever it may be, you can start to spread the virus. So that's what was happening there.
I will say to RF case credit, he did go there and he was conciliatory towards vaccines.
He did.
He did, at least in the moment, recommend the measles vaccine to people, which which I thought was really important and really really good. I think since then he sort of he's sort of backtracked on that. Obviously with COVID. I think COVID seems to be sort of low hanging fruit because the uptake has been so low already that the idea of saying we're not recommending it anymore was
sort of I think easy. But I think with regard to MMR and other things, they're critically important, and you know, I think the hopefully that message continues to get out there.
I think it's changing.
Even in West Texas. I think that you know, you did see increase measles uptake. We were at clinics, pop up clinics, and people were showing up to get measles vaccine that had never been vaccinated in their lives. So you know, I think in the throes of something like that, you do see behavior changing a bit.
It's encouraging in the behavior, and I appreciate your reverence.
R Ok.
But it just depends on the day of the week. I mean, he says that when he's there on the ground, and then he gets into the cabinet meeting and says, well, we have outbreaks all the time. And you know, even though this disease was substantially you know what two thousand, it was declared gone right.
Correct, it was declared eliminated at that point. And there have been some measles outbreaks since then. I mean there was one night in twenty nineteen I think it affected Disneyland and that's right as well Minnesota, Brooklyn.
So there have been measles outbreaks.
But you know, this, this this vaccine hesitancy issue has been around for a while. You know, I've been a reporter for twenty five years now almost. And I'll tell you what's interesting to me. And I'm curious if this is interesting to you. But if ten years ago, if you said, who is the most likely person in America to be vaccine hesitant, describe that person, and I think what you would likely have described at that point was a young person liberal and woman usually among right.
Oh, I trust me. I grew up in the Bay Area, so you can appreciate it. In California, I know a lot of them. Yeah, perfectly described.
And now in twenty twenty five, I think the demographics have changed in terms of who's most likely to be vaccine hesitant or resistant, older white conservative men. And I you know, I'm not a politician, but I'll tell you I think that these issues are used as proxy issues for a larger sort of conflict. You know, vaccines are the issue. I think people glom onto. It's understandable, they can sink their teeth into it and all that. But
within ten years, even less than that. Frankly, I think it was twenty nineteen, maybe six years ago you would have said young liberal women and now older conservative man. I think within six years it's completely flipped. And I think there's other proxy issues like that as well. And I think it just sends a signal that these are you can't disentangle anything from politics. I never thought of vaccine hesitancy as a political issue.
I thought thought it was concerned moms.
My wife would have conversations should we get all the vaccines at once or should we spread them out a little bit? And I would sit down and talk to her about anergetic load and all that, and I think she definitely listened to me, but it required a conversation. So I got that. Now it's all politics, it seems, and that's very difficult to sort of confront.
No, And I mean I think it goes to our opening conversation as well. I mean that was this certainly the case with Michelle Obama. I mean, she was just just ridiculed and attacked for, you know, focusing on healthy foods and focusing on our kids and chronic disease and
issues around obesity. And and that's why I think it's important for those that may be critical of the MAGA movement to be at least sensitive to the attributes and the positive components of the MAHA frame that is, focusing on the same issue coming in from different political lens certainly, and not get you know, sort of caught up in this vaccine issue when we focus on the fundamental issues of wellness, which I think we just as a country need to come to grips with.
I think that's the challenge.
People like to look at these and binary ways, Maha bad, Maha good.
There's goods and.
Bads to it, you know, I think there's a lot of stuff that as a health very health conscious person myself, someone who thinks a lot about longevity. I got parents in eighties, I got teenage kids. I think about this all the time. There's a lot of things that the Maha movement says that I totally agree with, and again, things that you have been doing in California with regard to our foods. I think seventy percent of illness chronic disease in this country is preventable, and again we spend
four and a half trillion dollars on it. So preventing seventy percent I mean medically obviously important, but also morally and financially and everything else. The vast majority of those preventable disease I think comes in how we nourish ourselves our food supply. So I totally understand that. Again, I wish it didn't have to be done in a mean spirited way. You know, it's just not my personality to
be vitriolic to get things done. But on the other hand, I think people have been talking about trying to reform our food supply for a quarter century, and it hasn't really been done.
Maybe this will.
It's already leading to some changes with regard to food dies and things like that.
We'll see where that all lands.
So I think some of it is really important, but there's other parts of it that I think. In vaccines, I guess would be the best example where I have real concerns.
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