A suburban San Francisco pediatric practice says there is ever-more evidence connecting an outbreak of campylobacter among nine of its young patients to Claravale Farm, a producer of raw milk.
What’s been the pediatric practice’s response? Well, it emailed an alert to all the 700 or so families on its patient list a week ago, and gave them a calm heads up. Calm, because this four-physician practice, Pediatric Alternatives, is unusual among pediatricians in that it actually recommends that parents feed their families raw milk.
“We know that many of you give your children raw milk at our recommendation,” the alert began. “Unfortunately, we have several children in the practice who have recently come down with a gastro-intestinal infection we suspect is associated with raw milk from the Claravale Dairy. So, as a precautionary measure, we are asking you not to give your children Claravale milk until this issue is resolved.
“The infection is from a bacteria called Campylobacter which causes a food poisoning type of diarrhea. Campylobacter can be acquired from many different types of foods, but also from other sources, like playing with puppies. Most of the time this infection is not severe, but occasionally children can get fever, chills and or diarrhea with blood in it. Usually the infection is allowed to resolve on its own, but for more severe cases it is treated with a short course of antibiotics. We are happy to report that the children who acquired the bug are all doing fine.”
Absent from the pediatricians’ email was the hyperbole that usually accompanies news of possible illnesses from raw milk trumpeted by the personal injury law firms, the Centers for Disease Control, the U.S. Food and Drug Administration. None of the, “It can kill!” or “Raw milk should never be served to children…” that is the norm.
As the alert noted, it’s not an absolute certainty that Claravale’s milk was responsible. But, according to Lindy Woodard, one of three pediatricians at the practice, of nine children sickened by campylobacter over the past month, “All have been on Claravale raw milk.” “She added that there have been no reports of illness from drinking milk from Organic Pastures or from any of the herd share programs that families from the practice may participate in. Woodard estimates that between 20% and 30% of the approximately 1,000 children who are part of the practice drink raw milk. (Coincidentally, a few people linked to a video with Woodard, following my previous post, taken at a showing of the documentary “Farmageddon” last September.)
I wasn’t able to reach anyone at Claravale, nor is anything about possible illnesses posted on its web site. I wasn’t able to reach anyone a month ago, when word of illnesses came up in comments following my February 17 post. At that time, it was understood that possibly six children had become sick, and Claravale shut down for a week. Since then, another three children in the Pediatric Alternatives practice have become sick.
A number of people on this blog posted information they had in hand about a possible outbreak, and the Marler Blog used those comments to broadcast that illnesses at Claravale had been “outed”.
According to Woodard, the parents of sick children have been fairly calm. One told Woodard she wished the alert had been sent out sooner. And another has been in touch with area health departments to make sure they are aware (though laboratories routinely report newly discovered campylobacter cases to public health officials). One parent still had an unopened bottle of Claravale milk from several weeks ago, and the California Department of Food and Agriculture was understood to be picking it up for testing this coming week. Claravale was understood to have done extensive testing, that yielded negative results, when it closed for a week in February.
The Pediatric Alternatives practice is unusual in that it not only recommends that parents include raw milk as part of children’s diet, but treats children whose parents refrain from vaccination, tries to avoid antibiotics, and offers “a naturopathic approach to allergy elimination through good nutrition and gut health.” Part of its “integrative” philosophy, as stated on its web site, is that “Food is medicine.”
“We’re the rabble rousers” among pediatric practices, says Woodard.
As for the illnesses, “I don’t think it is a big deal,” Woodard told me. By contrast, she noted that some estimates have it that more than half of all the nation’s chicken is tainted with campylobacter. The problems associated with the raw milk illnesses are, in the practice’s experience, far outweighed by the nutritional benefits for the children who drink raw milk. When their parents get rid of processed carbs and include raw milk, the children invariably “are glowing,” she says.
I’ll make a couple predictions: The personal injury law firms will run with this story, and criticize both the pediatricians and the parents who use the pediatric practice. They notion of a calm rational approach to possible illness from raw milk doesn’t square with their fear mongering and desire to ban raw milk. And you know what? Pediatric Alternatives will gain new patients as a result.
**
I guess I’m one of the last to comment about the “pink slime” story that has been all the rage over the past couple weeks. To me, it’s just another example of hidden processing of our food–the kind most people prefer not to know about. But with the national television media practically shoving the pink slime in our faces, it was difficult to avoid. Also difficult to avoid is the reality that the U.S. Department of Agriculture isn’t about to require that labels for ground beef indicate whether it contains pink slime. (That could be an opportunity for some cute art work to indicate the presence of the stuff.) To me, it is just another reason more people are trying to exit the public factory food system, and obtain their meat privately, from known sources.
**
I was able to spend some time at the International Conference on Emerging Infectious Diseases this past week in Atlanta, to try to improve my understanding of food safety issues. One of the things I learned was that, of the 146 illnesses and 31 deaths from listeria in cantaloupe last year, the vast majority of those affected (86%) were over 60 years old. And salmonella is the most common bacterial pathogen, accounting for 40% of all foodborne outbreaks. Outbreaks of salmonella in eggs have been on the decline, while those from norovirus in leafy greens have been on the increase.
There were some presentations I wouldn’t have expected, like one about how a home garden was contaminated by salmonella in manure from the owners’ horses, and another about the growing trend, and supposed dangers, of importing bushmeat from Africa.
To give these pediatricians my affection, I would say that if I lived up there I would seek them out because of their ability to give their patients parents the choice to vaccinate. And a pediatrician who talks traditional food would be near and dear. I’d just ignore them when it comes to the raw milk recommendation.
I hope that with the high percentage of children drinking raw milk in their practice (20-30% is huge compared with the general population) that these pediatricians do not encounter a HUS case (or several) caused by ecoli 0157:H7 tainted raw milk. I wonder if then they would still be so raw milk gung ho. I also wonder if they recommend raw milk exclusively, or let their patients know about the other fantastic milk coming out of that region like St.Benoit’s small vat pasteurized milk or even the gently pasteurized Strauss milk.
Have you seen the recent testing that shows 7% of pork is contaminated with MRSA. Shouldn’t we demand all food be cooked (pastuerized) before we can buy it. Since eating is so dangerous for our health can’t the government come up with a pill. Milky Way should get right on that, save us before we eat ourselves to death!!! Please government protect us from our food!!!
Wayne Craig
I understand your arguement but I definitely don’t think, in the case is Strauss creamery, that they are trying to mislead their customers. Quite the opposite: http://www.strausfamilycreamery.com/?title=pasteurization
Where is the balance in the risk benefit analysis here. Pasteurized milk has killed many in recent years….body count for raw milk is zero. The benefits of raw milk consumption are:
Reduction of side effects from drugs that kill for asthma and the 4000 deaths caused by asthma each year.
The immune strength gained by those that drink raw milk and the illness avoided….not to mention ear infections and colds and flu.
Bone density increases when drinking raw milk.
If sales at OP are any indication of the awakening of CA consumers…..the sleeping giant of the broader consuming population is waking up….sales rage!!! The truth can not be suppressed.
Big deal if Claravale sent a little Campy around. 40 years ago we were all immune to campy…
It is a part of immune strength to carry positive campy Titer. The doctors at pediatric alternatives weigh the risks and benefits….they are well informed and conscious.
This is a legal raw milk state. If you hate raw milk…do not drink it. How dare you try and make decisions for others.
“We are pleased to say that most of the children in our practice have never been on antibiotics and rarely need prescription medications. ” “we promote a back-to-basics diet consisting of whole, unprocessed, locally grown foods to support optimum health. ”
Having most of your patients never taking antibiotics and rarely needing RX is extremely impressive especially when compared to other practices. I have not yet visited an MD who promoted the above nutritional habits….. or anything close to it. I knew a doc in Dallas, an internal medicine specialist, who refused to accept insurance, he said he refused to allow any insurance company to dictate how he ran his practice. He did accept X amount of medicare patients, the rest paid out of pocket and dealt with their own insurance companies. He had an office, did his own blood draws and vital signs, appts were a minimum of 1/2 hour long.
Concierge medicine, is a fee-for-service, it is something like healthcare used to be…the doc came to see you when you were sick and you paid him. No insurance involved. It has been slowly growing over the last 10 or more years. http://www.aapp.org
http://www.nytimes.com/2010/03/26/health/policy/26docs.html?pagewanted=all
Most concierge practices are expensive. Like raw milk, or organic foods, much more $$$ than the cafo dairy or conventional foods you buy in the store. If you can afford it and it’s what you want…go for it.
Our military uses terms…like “Sanitized the Area” ( ie… carpet bombing with MOABs and napalm )…. REALITY check!!! it is called mass nutrional murder of biology. “Gently” is a feel nice abuse of language. More label lies for the consuming public.
The next time that some tells us that something is gently killed…try trading places with “the thing being killed” and see how the use of the word Gently feels.
As far as Dr. Lindy Woodard is concerned, she understands prevention and applies the known bioactive elements found in raw milk as a tool in nutritional medicine with outstanding results. Other doctors ruin immune systems by abusing antibiotics and when those kids die or get really sick ( 4000 kids per year die from asthma )….oh well….that is modern medicine, we can save them all. Execused illness and death verses intelligent prevention. What a concept??!!
The problem with the CDC and FDA is that they do not accept any value what so ever to the bioactive elements found in raw milk ( colonizing beneficial bacteria, raw whey proteins…etc ) and instead use scare tactics to protect their bed buddies in industry. “Only drugs cure and or prevent disease”. The dairy industry is about to enter into another long term price free fall. Hundreds of dairies in CA will be lost. Thousands of dairies will be lost nationally. The processors will make more money than ever. It is a predatory relationship and the dairies of this country are foolish to sell a drop of milk to a processor at a loss. All at the expense of the farmer and the consumer….the processors win. That is it. Greed before humanity. The truth really hurts. Big lies have big consequencies.
Raw milk is a biologically active food and is a very effective healing medical tool. It is the original medical food. If you do not want to belive this then do not believe this. Do not read the GABRIELA study. Do not read the PARSIFAL study. Both peer reviewed and internationally published. It is a free country. Go believe what ever you want. Just leave us alone to raise super healthy kids and prevent disease and illness through nutrition. We will have the healthy kids with no asthma or Autism….if you want your kids to be riddled with drug side effects and sitting in a corner hitting themselves ( and others ) with autism, suffering repeated colds, the flu, immune depression, ear infections, crohns, IBS, GERD…god help you.
Dr. Lindy Woodard is a pioneering leader and hero…!!! We are blessed and our children are blessed to have her in CA.
Immunity…immunity guys…immunity. That equals health.
Fearing and avoidance of bacteria makes us even more suseptible to them all.
Just reviewed the CA DPH final report on the OPDC recall in November 2012. The bacteria found in our calf area had also sickened many people in the same time period all over America. Those cases happened in the same time period but had not drank OPDC raw milk!!!!!
There were 47 other STEC cases in the same time period in CA not related to raw milk.
I am now really left guessing more than ever. Perhaps Raw Milk was not the origin of illness at all.
I find it fascinating that the official recommendations suggest mass education against raw milk consumption even though no OPDC products tested positive for a pathogen.
I wonder if the official recommendations following the spinach deaths or cantaloupe deaths suggest mass education against consuming cantaloupe or spinach?
Not!!!
I now know once again that government bias is alive and very well. My teaching efforts are now being matched….wit by wit by the agencies of our government.
I guess my teaching efforts will now take it up a notch.
A very careful reading of the report does not make a water tight case against OPDC instead it leaves the reader with serious questions and more doubt than ever. The same bacteria found in our calf pen ( 2 out of ten samples ) had been found all over CA and America and had sickened many in the previous two years….yet none of those people had ever drank raw milk.
I am breathless. Wow….this is not an indictment…this is a witch hunt gone rogue or worse.
Just an oversight the CA DPH left out the part which damns the FDA fearmongering campaign? No : starting to come into focus now is how venal are the adversaries. We won’t be hearing so much about “honey’d words” any more.
[ If someone can give me the HTML language for it, henceforth I’ll post an emoticon warning “sarcasm alert”, for those who are “hard of thinking” or for whom my humor is too subtle ]
I am still dizzy from reading the CA DPH final report. I will not put my brain on a shelf and stop learning or thinking rationally. The report is not slam dunk….in fact it is far from it.
OPDC has changed…OPDC has made major improvements. But….the conclusions, methodologies and conclusions reached by the official agencies concluded are not water tight.
When the same pathogen is found all over the US and CA causing seriuos illness all in the same time period, yet they are all excluded as irrelevant….and only the five scattered ( not clustered at all ) illnesses are considered….there is definite reason for concern.
Most concerning was the recommendations at th conclusion of the report. The recommendation to educate the public against consuming a legal food product!!!!
I researched the spinach and cantaloupe final reports….they do not recommend a massive educational initiative in an effort to purswade the public to not eat spinach or cantaloupe or for that matter ground beef.
The government spents fortunes to isolate raw milk illness ( among the huge numbers of STEC illnesses ) from all others and then attack and try to kill it.
No where does our government do his to other foods.
This is a war against raw milk. The declaration has been made in the CADPH report.
Game on….This will be a war of education. The people believe me….to the contrary consumers have no faith in the biased Food Inc sterile food agenda. We will see how this goes.
In one year if OPDC sales are lower…then the government has won…if they grow higher, then the farmer and his people have won.
This math would ring true for the 2006 about break also, but I know how people in the raw milk movement only like the way Ted Beals does math.
How did the same bacteria found in the OPDC calf pen get into the diets of consumers in several other states including the east coast?
Show me any evidence that pathogens were found in any OPDC products? The report says none of se products contained a pathogen. The calf pen had a pathogen….but this is not very unusual. The u then says that this exact pathogen has been found all over the country many times before in a last two years. Prior to this report I was resigned to the connection between our calves and the kids…now I am far from b bias and agenda at the conclusion of the report contaminates the entire report. Mixing t, science and politics in a report that is supposed to be objective…..destroys all objectivity. Calling me a clown is really funny. The markets do not consider this to be funny.
We will see what kind of circus this is next year. We will see when more people than ever drink
raw milk and dollar voting creates something so powerful that it is undeniable. Then we will see who
is laughing and what kind of music is playing. I learn because I want to serve my consumer
better…not because your threats direct me to do anything.
I have huge presentations all next week. 50 graduate students from Penn State University are touring OPDC this week to learn about raw milk.
Teaching…..the state and FDA teach no one… because no one will listen to lies. big lies create big problems. I teach the truth and that includes science that is peer reviewed, published and unadulterated. The state and FDA are in the business of herding and scaring sheepeople.
On your old site, there was an option to be able to edit and repost and also expand the writing area. Are those options available with your new super duper site?
“crazy?” no problem = “you can’t insult me, I’ve been insulted by experts” . Twenty years ago, I was jailed by the ( then) Attorney General of BC … who called me crazy. Today, he’s on my side on that issue ( gender-cide) . That’s what so often happens with political activists ; we’re too far ahead of the herd. It takes guys like you a generation to figure out what we’re saying
Weekly I’m out there seeing shareholders pick up their property, along with their children. Delightful, happy, bright, healthy, calm and sane children … in no small part, due to the nutrients they’re getting in REAL MILK
the sales of raw milk in places where it’s legal, and the growth of cowshares, prove that Americans are at the stage people were in the Soviet union, just before it collapsed … so innured to the duplicity of the Central Party line, they immediately assumed anything the govt. said, to be a lie. Informed consumers here have figured out that whatever the govt. says about raw milk, is the very opposite of the truth.
Back in the 30s, Buckminster Fuller was explaining how a $ spent in a free market, has more impact than an occasional ballot.
When CDFA and CADPH visited OPDC on November 15 2012, they told us that raw milk samples had been taken from three households and that they were all negative. They also said that one was still pending….they later told us that it was also negative. That was the official information given to us at the time.
As with all investigations….more information is always discovered later….like, the fact that the two kids from the same household that were most effected consumed home brewed Kefir and not raw milk….this was buried in the report. Certainly not out front like it should have been….but lost in the papers deep inside. How convenient.
forms involved. With all the time and money involved from our California government this is the best they can provide us? A report summary based entirely on assumptions. Its basis is that so few people drink raw milk that if five children are sickened who drink raw milk it must be the raw milk.
Given that only 3% of California general population reported consuming raw milk, the probability of all five case-patients consuming raw milk is less than one in 10 million.
Hundreds of man hours of testing and investigating only to find E Coli in a calf pen?
I feel so much safer in the Land of Milk and Honey!
California Department of Public Health E.coli 0157:H7 Supplemental Questionnaire version 1111
Milk supplement
RAW / UNPASTEURIZED MILK AND MILK PRODUCT FOLLOW UP QUESTIONS.
Under this heading it states.
In the TWO weeks before your symptoms started, what types of raw / unpasteurized milk or milk products did you consume? Please let us know even if you think you may have just had a small taste or sample.
There is a cell on the form that is categorized
Brand Name
(in CA. Organic Pastures & Claravale.
It goes on about Type of raw milk product, how often consumed, Lot number or code, expiration date, purchase date, do you have a receipt, where product obtained, any product left, can we take sample for lab testing?
There is no follow up questionnaire for any other food involved. No questionnaire for hamburger, packaged salads, packaged spinach, sprouts, Juices, or any other products. No implication of a business being responsible (other than Organic Pastures and Claravale) for the outbreak on the form, for example it could say, “Did you eat Ready Pac Salad Mix?” “Did you eat any hamburger from Tyson Fresh Meats Inc.?”
The final recommendation from the California Department of Public Health is:
Continue public education efforts regarding the risks of raw milk and raw milk product consumption, especially the greater risk of severe bacterial diseases among children, pregnant women, the elderly, and persons with weakened immune systems.
The following is a link to the PDF of the Summary from the California Department of Public Health
http://www.marlerblog.com/uploads/image/CA%20EPI%2011_03%20Cluster%20of%20Escherichia%20coli%20O157H7%20associated%20with%20raw%20milk%20Wendt.pdf
There appears to be an all out assault on California raw milk.
were Mr Marler to do that up here in BC, the Law Society would have him in for a chat, probably a discipline hearing … advertising the services of a lawfirm, so blantantly, and especially tied to the prestige of the govt. is a breach of the Canons of Ethics.
Just a hard-driving businessman, or an “ambulance-chaser” ? You be the judge
Mark, I’m not sure about that feature. Best way to find out for sure is to email webmaster@davidgumpert.com. I’ll check on that, too. For those who have wondered about making the typeface in the comments section more readable, we are working on that.
David
I remember my last deposition and the advice of my lawyer:
“you will want to answer the questions just think about this when you have a desire to respond:
-do you love your family
– do you love your kids
– do you love your wife
Think about your family sitting at an intersection with a semi coming at them, this lawyer is driving that semi. She wants to take everything from you, your future, your children’s future etc etc. She will come across as nice and trying to help, yet, think about that semi bearing down on your family and then respond as we have discussed.
Worked like a charm. There are several here that want to take OPDC’s livelihood away and while transparency is good (as I am sure will be the response) there is also information that is none of anyone’s business. They have no “right” to know. Substitute your farm where i have family and then think about your responses.
Read page six….
This is an official admonishment to not drink raw milk. It is in violation of laws passed in 1977 which assured all CA consumers of access to raw milk. http://www.leginfo.ca.gov/cgi-bin/displaycode?section=fac&group=35001-36000&file=35921-35928 read last part ( f )
I haev reviewed the final report on the spinach outbreak, the final report on the cantaloupe outbreak….neither of these final reports publically declare to stop eaating spinach or cantaloupes.
The recommendations should say something like:
Assist raw milk producers in “best management practices and testing proceedures” to further reduce the incidence of illness from drinking raw milk. Nowhere was there a hint about assistance or help to develop or support raw milk.
Mark, there is not going to be any positive anything in regards to raw dairy from tptb. For some strange reason they are opposed to people making their own choices and anyone who goes against what they dictate is wrong, a quack, senile, etc. We all know if it were truly a “health” issue, the tptb would be working with all dairy farmers to ensure safe milk…they would also be coming down on all the other foods/phoods that are carrying pathogens.. like prostitution, it isn’t going away. (Prostitution was legal in Germany in the 80s-don’t know about now, they got their monthly doctor checks and they paid their taxes….)
The time to try the case is NOT in discovery but at trial.
The depositions I have been in usually have the opposing lawyer try to:
-be nice
– be friends
-trying to help
Of course none of the above is true, reminds me of the way some people treat Mark.
Riddle me this…why are there 94,000 cases of HUS ( STEC Cases ) each year in the USA? ( FDA CDC Data ) Where do they come from…sure is not raw milk….that is certain. Raw Milk is in solitary confinement. Any illnesses from raw milk are discovered and exploited for sure.
During the same period that OPDC was considered to be the cause of a CA outbreak, there were at least 47 other cases of STEC in CA that were known, but the history did not connect with any raw milk, so they were ignorred.
During the same period of time, consumers in several other states were entered into PULSENET with the exact same STEC Ecoli DNA fingerprint that was found in my calf raising pen!!! The calf pen bacteria had been found in the last year in CA as well….nothing unique at all. It is common and has been found all over America.
Raw Milk Witch Hunt gone high tech….
Ignorring the other 94,000 cases of STEC….that is the crazy part. The origins are know but ignorred. It is the pharma abuse in dairies, chickens and pigs and hospital that created these emerging super bugs…
This origin, the actual cause, is being ignorred.
This is a sick America….literally. The sickest part…the recommendation to mass educate all people against raw milk ( the concluding recommendation of the CA DPH report ). I just can not get my brain arround this concept.
Raw Milk is a 100% legal product in CA…yet the state of CA is singularly seeking it out for death.
This is a freakish weird witch hunt gone rogue. This is a prime example of biased, agenda packed computer technology that is being used to sort through all of the grains of sand on a huge beach….just to find three that are the exacty same size.
* found at http://www.freewebs.com/bovinity/evidenceofexperts.htm
if you’d read it, you’d learn something … but that supposes you want to
The numbers that Beals used were from 1999-2008. Larger numbers of raw milk outbreaks began happening in 2005 so these numbers are skewed. The rise in outbreaks totally correlates with the growth of the WAPF. Here is a reality check, 23 raw milk outbreaks with 300 illnesses since 2010. That adds up to 11 illnesses a month. http://www.realrawmilkfacts.com/PDFs/Dairy-Outbreak-Table.pdf
Guess you don’t mind playing vaccine roulette with your children so much if Big Brother says it’s OK? Ever examined the so-called “science” behind vaccination? It’s worse than laughable. It’s criminal fraud. Explain to us why the govt. carved in stone a law protecting practitioners of vaccination voodoo from liablity for harms done?
Illness. It’s always, ecoli kills people from this other food or pasteurized milk kills more people than raw. Stick with the subject matter. Raw milk.
http://m.vcstar.com/news/2012/mar/19/defendant-in-real-estate-fraud-testifies-at/
Of course you’re all gonna say it is about loan fraud and not raw milk or chicken and egg outsourcing…I know you guys well by now, huh?
I have yet to see one of the proponents of homo milk honestly address the fact that REAL MILK – vital with all sorts of pro-biotics – is wonderfully beneficial to the health of those who drink it. How would you know that though, eh, relentlessly focussed on death and disease ?
BY DAN FLYNN | MAR 20, 2012
“The California Department of Public Health (CDPH) is conducting an epidemiologic investigation, ” according to a statement. “CDPH cannot provide any other details until the investigation is completed.”
Here is the link:
http://www.foodsafetynews.com/2012/03/california-still-investigating-claravale-farm-raw-milk/
Hopefully people will learn from this and ask more questions. Other than actually visiting a farm (many are unable to), on multiple occasions, how would a consumer know if the farmer is telling the truth about how they raise their products? And how would the majority know what to ask, or what to look for?
Word of mouth is a powerful way to educate each other. I would say photos too, but photographing has become taboo and illegal in some states…..
Let me simplify it for you:
1. Why do you focus on raw milk when there are so many more people made sick from other food products that are sold raw? Using your logic all meats, fruit and vegetables, seafood and deli meats should be fully cooked before being made available for sale to anyone including friends and family, and food clubs. Is it because you believe your child was sickened by raw milk? And doesn’t that give every mother out there whose child was sickened by any other food sold anywhere in a raw form, the right to demand that no hamburger, shellfish, spinach or cantaloupe be fully cooked or sterilized, and demand that the those producers and distributors be shut down?
You apparently think a lot like our government officials and regulatory agencies, so please help us understand the general reasoning behind this inherent fatalistic anti personal food choice approach being imposed on us.
So come on Mary, please don’t beat around the bush or go back full circle to your questions, while continuing to ignore our questions yet again. Do your noble duty and contribute to our understanding of how the other side thinks, and maybe even save many lives before it’s too late.
Thank you.
Ora
My old man was a lifeguard. He taught me that when someone is drowning, if you swim out to help them, you have to be very careful. If they’re panicking, they’ll take you down with them
MMMc is locked-in to serving her ‘pain body’. They’re not living in a logical frame of reference.