The Gardasil Criminal Enterprise Still Defies Gravity

If thalidomide had been developed in the ’80s, it would have been presented as a vaccine, it would be on all immunisation schedules, all hint of dangerous side effects would be ruthlessly suppressed, and doctors would still be giving it – just look at the Gardasil experience.

HPV vaccines are not indicated, not effective and not safe. There is substantial evidence to show that:

  • HPV vaccines cause, not cure, cervical cancer
  • HPV cause, not cure genital warts. Moreover,
  • Many thousands of children have died, or are paralysed or epileptic or otherwise manifestly damaged because of HPV vaccines

But with government agencies and the mainstream and ‘alternative’ media almost totally on side, and the vaccine industry immune from prosecution in America, the Gardasil train seems unstoppable.

Gardasil 9

The purpose of HPV vaccines is to immunise against the human papilloma viruses that are considered most likely to cause cervical cancer (there are over 100 hpv viruses).

HPV vaccines have been widely approved since 2007 (US 2006). In December 2014, the United States’ Food and Drug Administration (FDA) fast-tracked approval for Gardasil 9 ‘to protect females between the ages of 9 and 26 and males between the ages of 9 and 15 against nine strains of HPV’.

Fast tracking means that the the FDA approved without consultation with VRBPAC (the Vaccines and Related Biological Products Advisory Committee) which is responsible for reviewing and evaluating data concerning the safety, effectiveness, and appropriate use of vaccines and related biological products. (See FDA Approved Gardasil 9: Malfeasance or Stupidity?)

The ingredients

The ingredients, according to the Gardasil 9 package insert, are as follows:

Each 0.5-mL dose of Gardasil 9 contains approximately 20-60 micrograms of nine different HPV proteins, approximately 500 mcg of aluminum, 9.56 mg of sodium chloride (commons salt), 0.78 mg of L-histidine, 50 mcg of polysorbate 80, 35 mcg of sodium borate, <7 mcg yeast protein, and water for injection.

  • Aluminium: is a known toxin, and Gardasil contains more aluminium than any other vaccine.
  • Histadine, an essential amino acid, has been linked to inflammation , and also to autoimmune disease. It is not used for any other vaccine.
  • Yeast is linked to autoimmune disease
  • Sodium borate (Sodium tetraborate, Borax), according to the Material Safety Data Sheet, is an eye, skin, and mucous membrane irritant, that may impair fertility, and may cause harm to the unborn child.
  • Polysorbate 80 causes infertility and anaphylactic shock. The function of polysorbate 80 in vaccines and other pharmaceuticals is to ‘affect’ the blood-brain barrier, in order to facilitate access of toxins to the brain, see here and here.

The insert says there is no preservative in the vaccine. But according to a German study on the presence of heavy metals in vaccines, Gardasil 9 also contains a small amount of

It is frequently argued that the ‘poison is in the dose’, i.e. the amounts of toxins in vaccines are too small to do any damage to the patient, while somehow still being in sufficient quantities to be efficacious.

There is no evidence that HPV vaccines have prevented a single case of cervical cancer

‘the chance of Gardasil actually helping an individual is about the same as the chance of her being struck by a meteorite’. (Diane Harper, Merck scientist and Gardasil developer)

The argument for HPV vaccines is that the virus causes cervical cancer and genital warts. In fact, HPV alone is unlikely to cause cervical cancer.

US Food and Drug Association, 2003: “The HPV DNA test is not intended to substitute for regular Pap screening. Nor is it intended to screen women under 30 who have normal Pap tests. Although the rate of HPV infection in this group is high, most infections are short-lived and not associated with cervical cancer.”

Peter Duisberg, professor of molecular and cell biology at University of California, has declared that HPV does not cause cervical cancer and is both useless and dangerous, asking:

  1. Why would only 1 in 10,000 HPV-infected women develop cervical cancer?
  2. Why would cervical cancers only develop 20 to 50 years after infection? – In other words, why would the virus not cause cancers when it is biochemically active and causing warts, namely before it is neutralized by natural anti-viral immunity?
  3. Why are cervical carcinomas individually very distinct from each other in terms of malignancy, drug-resistance, cell histology, as originally described by Papanicolaou et al. in Science in 1952, although they are presumably caused by the same viral proteins?
  4. Why are cervical carcinomas that are presumably generated by Human Papillomavirus proteins not immunogenic and thus not eliminated by natural antibodies?

A Canadian study of 2013 found that ‘the clinical trials data have not demonstrated to date that the vaccines have actually prevented a single case of cervical cancer (let alone cervical cancer death)’.

Merck insiders blow the whistle

Diane Harper, a former Merck scientist and Gardasil researcher who appears to have had a crisis of conscience, has dismissed the possibility of Gardasil being effective: ‘In fact, there is no actual evidence that the vaccine can prevent any cancer.’ Dr Harper also stated that reported side effects of the vaccine prove HPV vaccines are more dangerous than the cervical cancer its makers say it prevents

Dr. Bernard Dalbergue, who has also worked with Merck, described the Gardasil vaccine as ineffective, deadly and very profitable.

‘I predict that Gardasil will become the greatest medical scandal of all times because at some point in time, the evidence will add up to prove that this vaccine […] has absolutely no effect on cervical cancer and that all the very many adverse effects which destroy lives and even kill, serve no other purpose than to generate profit for the manufacturers.’

HPV vaccines cause cancer

This report describes three young Czech women who subsequent to receiving an HPV vaccine showed cervical abnormalities, and had to undergo radical surgery, such as conisation of the cervix or vulvectomy. Michaela comments, ‘After further tests I have been informed that apart from other viruses present on my cervix there were also the ones contained in the vaccine, namely HPV types 16 and 18. It is apparent that the vaccine did not protect me against HPV types 16 and 18.’

A French oncologist has shown while cervical cancer was decreasing in a number of countries due to the implementation of regular pap smears, in some countries where mass Gardasil vaccination took place, the incidence of cervical cancer actually increased. One report indicates that in the case where the patient already has an HPV virus, the vaccine may increase the possibility of cancerous lesions by 44.6%.

See also:

The Gardasil controversy: as reports of adverse effects increase, cervical cancer rates rise in HPV-vaccinated age groups.)

Cervical cancers after human papillomavirus vaccination

HPV vaccines cause genital and other warts

New Zealander Jasmine Renata developed warts on her hands after each Gardasil vaccine -after the second they were under her finger nails. Jasmine eventually died after coming down with a cold, a year after her first Gardasil shot.

In a separate case also from New Zealand, a 19 year old woman developed a severe case of genital warts after completing all three doses, at appropriate intervals, of the quadrivalent HPV vaccine, prior to becoming sexually active. The case study was described in the Healthy Home Economist, and several respondents reported a similar experience – the daughter of one respondent also developed cervical cancer.

‘My daughters is 18 years old and her final doses was on July 2016. On August she observed some genital warts around her vulva. In december 2016 not only her vulva but also inside her canal was full of genital warts. On diciembre 22, 2016 the Doctor decide to cauterize them in the operating room. On January 2017 the genital warts returned and after doing biopsy came the positive result for cervical cancer. On January the doctor freeze the cancerous cells and we need to wait 6 months before he do a new PAP.’

HPV vaccines can destroy ovaries and cause infertility

A large number of studies have shown a link between HPV vaccines and ovarian failure, meaning irregular periods, premature menopause and infertility.

In 2012 the British Medical Journal reported on the case of premature ovarian failure following three years of irregular menstrual periods after being being given the HPV vaccination.

Adolescent Premature Ovarian Insufficiency Following Human Papillomavirus Vaccination: A Case Series Seen in General Practice

Human papilloma virus vaccine and primary ovarian failure: another facet of the autoimmune/inflammatory syndrome induced by adjuvants.

A study published in the Journal of Toxicology and Environmental Health found ‘A lowered probability of pregnancy in females in the USA aged 25–29 who received a human papillomavirus vaccine injection’.

The evidence is so strong that in 2016 even the very pro-vaccine American College Of Pediatricians issued a rare warning that Gardasil could cause premature ovarian failure (original study here).

HPV vaccines have caused death, epilepsy, paralysis and a raft of other illnesses in countless young people.

Mia

In England, Mia Blesky had her first Gardasil injection as a healthy 12 year-old on 21 September 2016, and woke the next morning unable to walk. Within a few week Mia was paralysed from the neck down. Although Mia went was taken first to a doctor and then to a hospital the day after her vaccine, and although there have been many similar cases (see e.g. Ashleigh Cave, 2008), British doctors have decided her paralysis is purely psychological. Her mother told the Daily Mail:

‘They discharged her after a few days. They gave her no treatment. We had to buy her a wheelchair. I had to carry her to the car. It has been absolutely awful, but the doctors say it’s psychological and down to bullying or sexuality issues, which is rubbish. The only thing they have offered to do is section her.’

According to the FDA a serious adverse event must fit one of the following criteria: death, life-threatening, hospitalization, disability or permanent damage, congenital abnormality/birth defect, or the requirement to intervene to prevent permanent impairment.

Clinical trials for Gardasil, described in the package insert, show the following:

Insert Adverse events

The trials also showed autoimmune disorders arising after vaccination.

Insert Autoimmune

(Tables from Norma Erickson, FDA approved Gardasil 9: Malfeasance or Stupidity?)

So Merck’s clinical trials show almost 4.7%, about 1 in 21 girls or young women, experiencing either a serious adverse event, or developing a systemic autoimmune illness.

The dangers of Gardasil shown clearly in the trials have been confirmed subsequently. Since Gardasil was licensed and placed on immunisation schedules, there have been thousands of reports of serious adverse events, including:

‘deaths, convulsions, paralysis, paraesthesia, demyelinating diseases of the central nervous system (i.e., multiple sclerosis and acute disseminating encephalomyelitis), Guillain-Barre syndrome (GBS), transverse myelitis, facial palsy, chronic fatigue syndrome, anaphylaxis, autoimmune disorders, deep vein thrombosis, pulmonary embolisms, pancreatitis, visual impairments and spontaneous abortions’ (Kelly Brogan, Gardasil: Guarding or Gutting Our Youth?)

A study published in the internationally peer-reviewed journal Clinical Rheumatology in 2017 found that that severe harm is suffered with every 140 Gardasil 9 vaccinations (link to study proper here).

A study from Alberta, Canada, identified all reported adverse events following immunization (AEFI) and all emergency department (ED) utilization or hospitalizations within 42 days of immunization, 2006-2014. 195,270 females received at least one dose of vaccine, 192 reported one or more AEFI events, and 958 were hospitalized and 19,351 had an emergency department visit within 42 days of immunization.

Conclusion of the study was that ‘Rates of AEFI after HPV immunization in Alberta are low and consistent with types of events seen elsewhere’.

Let’s just review that, rounding up:

  • 200,000 received received at least one HPV vaccine;
  • 1 in 200 were hospitalised;
  • 10% had an emergency department visit within 42 days. However
  • these numbers are considered low (and untroubling).

Gardasil for boys

13.1 of the Gardasil 9 insert states: ‘GARDASIL 9 has not been evaluated for the potential to cause carcinogenicity, genotoxicity or impairment of male fertility’. Not withstanding, drug oversight authorities insist that Gardasil is licensed, safe, and effective for males ages 9 through 26 years.

In 2013 Merck launched a campaign to have Gardasil 9 scheduled for boys. As New Zealand’s Strategy for Revitalising the National HPV Immunisation Programme makes clear, this was purely a marketing decision, and nothing to do with health outcomes.

Uptake.PNG

There is no indication that Gardasil is safer for boys than it is for girls:

13 year old Joel Gomez of California, healthy and fit, was found dead the morning after his second Gardasil injection on 19 August 2013. His doctor found damage to his heart caused by the first Gardasil injection. The Gomez family are suing for compensation under the Vaccine Injury Compensation programme (vaccine producers are immune from prosecution under American law).

13 year old Christopher Bunch of Illinois died three weeks after his HPV injection.

In Utah, Colton Berrett developed crippling paralysis, beginning from two weeks after his third course of Gardasil. After four years enclosed in a breathing apparatus (the modern equivalent of the iron lung), and with no improvement in sight, he committed suicide.

HPV vaccines are not indicated

The vaccine insert clinical trial showed 2.3% serious adverse events (to say nothing of the risk of autoimmune disease). As Norma Erickson points out:

‘Cervical cancer rates are always quoted as # per 100,000. Given the above information, for every 100,000 people using Gardasil 9 there would be 2,300 serious adverse events. The cervical cancer diagnosis rate in the United States is 7.9/100,000. What health official in their right mind is willing to anticipate 2,300 serious adverse events to try and prevent 7.9 cases of cervical cancer?’

The New Zealand document Revitalising the National HPV Immunisation Programme states, ‘HPV is responsible for a substantial burden of disease in New Zealand women, most importantly in terms of cervical cancer’. In fact, the pap test has virtually eliminated cervical cancer in the Western world, or wherever it is routinely offered. Total registrations for cervical cancer in recent years in New Zealand have been

  • 2014: 142;
  • 2015: 142; and
  • 2016: 180.

For breast cancer, in contrast, registrations have been far higher, for the same years: 3274; 3292 and 3308. Figures for prostate cancer are similarly high: 3160, 3080, 3383.

Litigation

Merck is no stranger to court action and expensive payouts. Studies showed problems with their arthritic treatment Vioxx as early as 2001, but it was not until 2004 that Merck pulled Vioxx from the market, after ignoring evidence that the drug was dangerous, and after reportedly killing 60,000 people.

Under the National Childhood Vaccine Injury Act of 1986, vaccine manufacturers have no liability in the United States, so they cannot be sued for injury from their product. Injuries or death from vaccines can only be recompensed via the National Vaccine Injury Compensation Program (VICP). In 2013 the VICP awarded almost $6,000,000 dollars to 49 victims in claims made against the HPV vaccines., with more claims outstanding.

Merck itself is, however, being sued for vaccine fraud, e.g. with regards to

  • Zostavax: thousands are suing Merck with regards to the shingles vaccine, which causes the very illness it is meant to prevent, as well as other injuries including blindness.
  • MMR: former Merck virologists allege that the efficacy tests for the measles, mumps, rubella vaccine (MMR) were faked.
  • Gardasil: The family of 16 year old girl diagnosed with POTS after her third Gardasil injection are suing Merck for
    1. Fraud and Deceit
    2. Negligent Misrepresentation
    3. Defective Product – Inadequate warnings & information
    4. Medical Malpractice
    5. Medical Battery

While Merck may have have a high degree of immunity in the United States, the company and local health authorities are facing court action regarding Gardasil in a growing number of other countries, including Australia, India, Japan, Colombia and France. In Spain, Merck-Sanofi Pasteur and health authorities are charged with a long list of serious misdemeanors, including:

  • fraudulent marketing and/or administration of an inadequately tested vaccine;
  • failure to inform the public about the potential risks of using Gardasil;
  • ignoring established and new scientific evidence illustrating the potential harmful effects of Gardasil ingredients and manufacturing methods;
  • callous disregard for those suffering new medical conditions post-Gardasil;
  • failure to inform the public of the true facts about HPV and cervical cancer

The New Zealand Safety Record – Thalidomide

Thalidomide was widely marketed as ‘completely non-poisonous’, ‘safe’, ‘non-toxic’ and ‘fully harmless’. Instead, it led to a range of serious complications, among which the most notorious was severe birth defects. By late 1961, at least 10,000 living children from an estimated 46 countries suffered disabilities as a consequence of their mothers’ ingesting thalidomide.

In New Zealand, thalidomide was introduced to doctors and hospitals in 1960, added to the drug tariff in 10961 and available until at least August 1962.

After publication of adverse effects of the drug, manufacturers on 4 December 1961 recalled the drug in New Zealand. Nevertheless, it took the Department of Health until July 27, 1962 – almost eight months – to issue an official a directive to destroy remaining stocks of the drug. It was still available until at least August 1962 when it was seized from chemists’ and hospital shelves under section 12 of the Food and Drugs Act. (From Chemical legacies: Thalidomide in New Zealand)

It is hard to see the New Zealand authorities taking action in the case of Gardasil unless Merck itself withdraws the vaccine, and Merck is unlikely to do this, given its legal immunity in the United States.

See also:

Big Pharma Irrefutable proof that Big Pharma is a criminal racket: Bribery, scientific fraud, felony crimes and more

Norma Erickson, HPV: time to Follow the Science and Reject the Vaccine

Laura Hayes, Why is This Legal?

and

Over 50 studies relating to HPV vaccines, collected by Chris Kirckof

Acute Disseminated Encephalomyelitis Following Immunization with Human Papillomavirus Vaccines
https://www.jstage.jst.go.jp/…/55/21/55_55.7217/_article

Adolescent Premature Ovarian Insufficiency Following Human Papillomavirus Vaccination: A Case Series Seen in General Practice
https://www.ncbi.nlm.nih.gov/m/pubmed/26425627/

Adverse events following HPV vaccination, Alberta 2006-2014
https://www.ncbi.nlm.nih.gov/m/pubmed/26921782/

Ampiginous choroiditis following quadrivalent human papilloma virus vaccine
http://bjo.bmj.com/content/94/1/137.long

Association of acute cerebellar ataxia and human papilloma virus vaccination: a case report
https://www.ncbi.nlm.nih.gov/m/pubmed/23378179/

Autoimmune hepatitis type 2 following anti-papillomavirus vaccination in a 11-year-old girl
https://www.ncbi.nlm.nih.gov/m/pubmed/21596082/

Behavioral abnormalities in female mice following administration of aluminum adjuvants and the human papillomavirus (HPV) vaccine Gardasil
https://www.ncbi.nlm.nih.gov/m/pubmed/27421722/

Bivalent HPV vaccine safety depending on subtypes of juvenile idiopathic arthritis
http://ard.bmj.com/content/73/12/e75.long

Brachial plexus neuritis following HPV vaccination
https://www.ncbi.nlm.nih.gov/m/pubmed/18602437/

A case-control study of quadrivalent human papillomavirus vaccine-associated autoimmune adverse events
https://www.ncbi.nlm.nih.gov/m/pubmed/25535199/

Cervical cancers after human papillomavirus vaccination
https://www.ncbi.nlm.nih.gov/m/pubmed/19155953/

CNS demyelination and quadrivalent HPV vaccination
https://www.ncbi.nlm.nih.gov/m/pubmed/18805844/

Current Safety Concerns with Human Papillomavirus Vaccine: A Cluster Analysis of Reports in VigiBase® (2017)
https://link.springer.com/article/10.1007/s40264-016-0456-3

Demyelinating disease and polyvalent human papilloma virus vaccination
http://jnnp.bmj.com/content/82/11/1296.long

Demyelinating disease and vaccination of the human papillomavirus
https://www.ncbi.nlm.nih.gov/m/pubmed/21425100/

Development of unilateral cervical and supraclavicular lymphadenopathy after human papilloma virus vaccination
https://www.ncbi.nlm.nih.gov/m/pubmed/18752390/

Erythema multiforme following vaccination for human papillomavirus
https://www.ncbi.nlm.nih.gov/m/pubmed/19887766/

Fibromyalgia-Like Illness in 2 Girls After Human Papillomavirus Vaccination
http://journals.lww.com/…/Fibromyalgia_Like_Illness_in

HPV-negative Gastric Type Adenocarcinoma In Situ of the Cervix: A Spectrum of Rare Lesions Exhibiting Gastric and Intestinal Differentiation
http://insights.ovid.com/crossref

HPV vaccination syndrome. A questionnaire-based study
https://www.ncbi.nlm.nih.gov/m/pubmed/26354426/

Human papilloma virus vaccine and primary ovarian failure: another facet of the autoimmune/inflammatory syndrome induced by adjuvants.
https://www.ncbi.nlm.nih.gov/m/pubmed/23902317/

Human papillomavirus (HPV) vaccines as an option for preventing cervical malignancies: (how) effective and safe?
https://www.ncbi.nlm.nih.gov/m/pubmed/23016780/

Human papillomavirus vaccine and systemic lupus erythematosus
https://www.ncbi.nlm.nih.gov/m/pubmed/23624585/

Human papilloma virus vaccine associated uveitis
https://www.ncbi.nlm.nih.gov/m/pubmed/24191906/
Human papillomavirus vaccines, complex regional pain syndrome, postural orthostatic tachycardia syndrome, and autonomic dysfunction – a review of the regulatory evidence from the European Medicines Agency
https://www.ncbi.nlm.nih.gov/m/pubmed/27867145/

Hypersensitivity reaction to human papillomavirus vaccine due to polysorbate 80
https://www.ncbi.nlm.nih.gov/m/pubmed/22605841/

Hypersensitivity reactions to human papillomavirus vaccine in Australian schoolgirls: retrospective cohort study
https://www.ncbi.nlm.nih.gov/m/pubmed/19050332/

Hypothesis: Human papillomavirus vaccination syndrome–small fiber neuropathy and dysautonomia could be its underlying pathogenesis
https://www.ncbi.nlm.nih.gov/m/pubmed/25990003/

Immune thrombocytopenic purpura following human papillomavirus vaccination
https://www.ncbi.nlm.nih.gov/m/pubmed/19464550/

Kikuchi-Fujimoto disease following vaccination against human papilloma virus infection and Japanese encephalitis
https://www.ncbi.nlm.nih.gov/m/pubmed/22476507/

Lichenoid Drug Eruption After Human Papillomavirus Vaccination
http://onlinelibrary.wiley.com/doi/10.1111/pde.12516/full

A link between human papilloma virus vaccination and primary ovarian insufficiency: current analysis
https://www.ncbi.nlm.nih.gov/m/pubmed/26125978/

Neurologic Complications in HPV Vaccination
https://www.ncbi.nlm.nih.gov/m/pubmed/26160812/

Neurologic Complications in HPV Vaccination
https://www.ncbi.nlm.nih.gov/m/pubmed/26160812/

On the relationship between human papilloma virus vaccine and autoimmune diseases
https://www.ncbi.nlm.nih.gov/m/pubmed/24468416/

Orthostatic intolerance and postural tachycardia syndrome as suspected adverse effects of vaccination against human papilloma virus
https://www.ncbi.nlm.nih.gov/m/pubmed/25882168/

Pancreatitis after human papillomavirus vaccination: a matter of molecular mimicry
https://www.ncbi.nlm.nih.gov/m/pubmed/27421720/

Pancreatitis following human papillomavirus vaccination
https://www.mja.com.au/…/pancreatitis-following-human

Panuveitis With Exudative Retinal Detachments After Vaccination Against Human Papilloma Virus
https://www.ncbi.nlm.nih.gov/m/pubmed/26469238/

Peripheral sympathetic nerve dysfunction in adolescent Japanese girls following immunization with the human papillomavirus vaccine
https://www.ncbi.nlm.nih.gov/m/pubmed/25274229/

Pharmaceutical Companies’ Role in State Vaccination Policymaking: The Case of Human Papillomavirus Vaccination
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3483914/

Postural tachycardia syndrome following human papillomavirus vaccination
https://www.ncbi.nlm.nih.gov/m/pubmed/24102827/

Potential cross-reactivity between HPV16 L1 protein and sudden death-associated antigens
https://www.ncbi.nlm.nih.gov/m/pubmed/21699023/

Premature ovarian failure 3 years after menarche in a 16-year-old girl following human papillomavirus vaccination
https://www.ncbi.nlm.nih.gov/m/pubmed/23035167/

Severe manifestations of autoimmune syndrome induced by adjuvants (Shoenfeld’s syndrome).
https://www.ncbi.nlm.nih.gov/m/pubmed/27412294/

Severe somatoform and dysautonomic syndromes after HPV vaccination: case series and review of literature
https://www.ncbi.nlm.nih.gov/m/pubmed/27503625/

A 16-year-old girl with bilateral visual loss and left hemiparesis following an immunization against human papilloma virus
https://www.ncbi.nlm.nih.gov/m/pubmed/20189933/

Small Fiber Neuropathy Following Vaccination
https://www.ncbi.nlm.nih.gov/m/pubmed/27552388/

Syncope and seizures following human papillomavirus vaccination: a retrospective case series
https://www.ncbi.nlm.nih.gov/m/pubmed/21449862/

Telogen effluvium following bivalent human papillomavirus vaccine administration: a report of two cases
https://www.ncbi.nlm.nih.gov/m/pubmed/22584489/

Two Cases of Acute Disseminated Encephalomyelitis Following Vaccination Against Human Papilloma Virus
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5140871/

Two unclear cases of death. Can we still recommend HPV vaccination?].
https://www.ncbi.nlm.nih.gov/m/pubmed/18361151/

An unmasking phenomenon in an observational post-licensure safety study of adolescent girls and young women
https://www.ncbi.nlm.nih.gov/m/pubmed/22580356/

Vaccine-related serious adverse events might have been under-recognized in the pivotal HPV vaccine randomized trial
http://link.springer.com/article/10.1007%2Fs10067-017-3575-z