Dr. Peter McCulloch is the most published person in his field in the history of medicine, and he s been on the front line of dealing with the COVID epidemic, a battle that has been left in the hands of independent physicians to try to find therapeutic treatments, off-the-shelf treatments, something that is not part of the pharmaceutical paradigm: non- expired patent medicines. And we ve seen this strange conflict really where many of those treatments that could save lives, instead of being promoted and investigated, by the health authorities, are instead being sabotaged and made inaccessible. Why is this happening? And why is that happening? In this episode, Dr. McCulloch talks about how he and his team at Texas A&M University managed to stop the spread of COVID, one of the most lethal viruses in history, from spreading across the globe and killing millions of people in the process. This episode is brought to you by Medical Mysteries, a podcast produced by Johns Hopkins University and the Johns Hopkins Center for Infectious Disease Research and Treatment, and edited by Cardiology and Cardiology, a unit of the National Institute of Neurology and Neurosurgery. Copyright 2019. All rights reserved. This episode was produced for noncommercial use, including use of music and soundtracks. This podcast was used with permission from the composer, John Kennedy. John Kennedy and the original music used in this episode is available under a CC BY-SA license. If you like what you hear, please leave us a rating and review on Apple Podcasts. or wherever else you get your music is available, we'll be listening to this podcast on the next episode of Medical Mysteries. Please be kind enough to send us your feedback and we'll get a copy of the music on the podcast in the next week's next issue of the podcast. Thank you! -- Thank you. -- A big thank you to Dr. John Kennedy for the music we produced by John Kennedy, and the music used on this episode by Dr. Kennedy's new album "A Good Morning America" is available on SoundCloud: Good Morning, Good Life, Goodbye, Goodbye, Goodbye Goodbye, My Dear Mr. Good Death, Good Luck, My Name is Goodbye. -- Thank You, My Love, Mr. -- This is Yours Truly. -- John Kennedy -- This Is My Music is by Joseph McDade by Suneaters, Inc., Inc., Mr. John Rocha
00:00:02.000Peter McCulloch is an intern, he's a cardiologist, he's a professor of medicine At Texas A&M University.
00:00:10.000He's an extraordinary academic physician, as well as a practicing physician.
00:00:15.000He is the editor of two major journals.
00:00:18.000It's a privilege to be able to say this about a guest, that he is the most published person in his field, which deals with heart and kidneys in the history of the world.
00:00:31.000And he's been on the front line of Dealing with the COVID epidemic of really in this battle that we've seen that has been left in the hands of independent physicians to try to find therapeutic treatments, off-the-shelf treatments, something that is not part of the pharmaceutical paradigm that are kind of non or expired patent medicines.
00:00:59.000And we've seen this very strange Conflict really where it appears to many people who are standing on the sidelines like me that many of those treatments that could save lives instead of being promoted and investigated and studied by the health authorities are instead being sabotaged and made They're
00:01:32.000McCulloch has been part of a couple of different groups of physicians who have systematically gone out on the beginning of the pandemic and said, you know, we know these medicines.
00:01:46.000Which ones make sense to treat these patients on?
00:01:49.000And then looking at the literature all over the world and saying, why is it that We have Cuba, which was one of the first places that was infected and had a very, very high level of infection rate, but they have a death rate that was around 14 per 10,000 people, whereas the U.S. has 1,500 people.
00:02:18.000And should we be applauding Tony Fauci and saying that that is a success story that we have among, I think, the two highest death rates in the world?
00:02:32.000You're not only a brilliant physician, but you're a very, very courageous man, because in your profession, it is lethal in some ways professionally.
00:02:41.000It is a question that the paradigms are the kind of questions you've been asking about.
00:03:49.000We were communicating with the Italians very closely on this.
00:03:52.000They were absolutely getting killed in Milan and in the surrounding areas about what could we do to stop these hospitalizations and death.
00:04:01.000And as we learn more about the virus, we learn that the virus replicates very quickly early on It causes what's called cytokine storm or the immune system to go crazy within about a week or two.
00:04:13.000And then the final death sequence actually has to do with blood clotting.
00:04:17.000When people die in the end, there's blood clots in the lungs, there's fatal strokes, fatal heart attacks, blood clots in the major blood vessels.
00:04:23.000And so those three phases of the illness...
00:04:27.000We made it very clear to us that a single drug was not going to work.
00:04:31.000So anybody who came out there and said, aha, this drug works or doesn't do that, was a fool's errand.
00:04:37.000That it was going to be a multi-drug approach, just like it is with HIV and hepatitis C. So we weren't surprised by this.
00:04:46.000Yeah, we organized our findings and submitted it to the American Journal of Medicine in July 1st.
00:04:54.000And at that time, there were 55,000 papers in the peer-reviewed literature.
00:04:59.000Not a single one taught doctors How to treat COVID-19 to avoid hospitalization and death.
00:05:06.000And so when that paper was published in the August 7th issue of the American Journal of Medicine, it was far and away the most widely quoted, cited, downloaded paper.
00:05:15.000Still is the most widely downloaded paper.
00:05:19.000Because the National Institutes of Health didn't have guidelines yet, the Infectious Disease Society of America didn't address how to treat outpatients, and the World Health Organization was missing that piece.
00:05:30.000When the monoclonal antibodies came out, we had data on ivermectin, we had terrific data with colchicine, we updated the protocol, and we published that in the December issue of Reviews in Cardiovascular Medicine in a dedicated issue.
00:05:43.000Again, these are cited by the National Library of Medicine.
00:05:45.000And that paper is now the most widely downloaded paper from that journal.
00:05:50.000So in my view, we've played a role in filling the void.
00:05:54.000Our approach has become the basis for the American Association of Physicians and Surgeons Patient Guide.
00:05:59.000We testified on this in the Senate November 19th.
00:06:03.000Then a follow-up testimony by others December 8th on the Homeland Security and Governmental Affairs.
00:06:10.000There was a big push for early treatment in the fourth quarter of 2020.
00:06:14.000And towards the end of December, early January, before the very first patient was vaccinated, we started to see dramatic drops in hospitalization, new cases, and death altogether.
00:06:24.000It's the first time we saw that in the pandemic.
00:06:25.000And so we know the message of early treatment came in.
00:06:30.000We had two studies, one from Vladimir Zelenko, who I give tremendous credit for in New York, addressing the Orthodox Jewish community in the spring, and then one from Brian Proctor, which is now fully accepted in a peer-reviewed journal, From McKinney, Texas, both studies show that multi-drug early outpatient treatment for COVID-19 reduces hospitalization and death by 85%.
00:06:53.000First of all, what kind of resistance do you get from the medical establishment in terms of publishing this?
00:07:05.000I'm impressed that the Journal of JAMA, the Journal of the American Medical Association, published it all.
00:07:11.000Because they have so much pressure from the pharmaceutical advertisers.
00:07:17.000What kind of pressure did you get from the medical establishment?
00:07:21.000And why do you think that NIH is not doing these kind of studies?
00:07:28.000Isn't that the first thing that should have happened?
00:07:32.000Doctors have been brought together and said, what is the treatment for this?
00:08:08.000These hospitalizations and deaths must be stopped.
00:08:11.000I'm going to put together a panel of expert doctors who are learning and have experience in treating COVID patients and And we're going to get the best and brightest together and we're going to stop these hospitalizations and death.
00:09:57.000Let them hear about their experiences using ivermectin, steroids, blood thinners, and other drugs, and what they've come up with.
00:10:05.000I wanted America to hear two separate sets of opinions, two separate sets of doctors coalescing on the same idea that we can prevent hospitalizations and death.
00:10:17.000Is there any country in the world that did this right?
00:10:22.000I give a lot of credit to countries that just early on did smart things.
00:10:29.000So for instance, there is a Japanese drug called Favipiravir.
00:10:34.000It inhibits the RNA-dependent polymerase of the SARS-CoV-2 virus.
00:10:41.000It's been used for years in Japan for influenza.
00:10:45.000It has a mechanism similar to that of remdesivir.
00:11:21.000They reversed their approach midway, realized their mistake, went back to hydroxychloroquine front-line.
00:11:27.000Greece had hydroxychloroquine front-line.
00:11:31.000Ivermectin came on later with the research, but right now, if you go to Mexico City, it's Ivermectin frontline.
00:11:38.000There are about 30 countries now that have treatment kits where they combine either hydroxychloroquine or Ivermectin plus an intracellular antibiotic, azithromycin, doxycycline, and then steroids, aspirin, as a combination of We tabulate those in our December 2020 paper.
00:11:57.000And so they're treating COVID-19 high-risk patients over 50 with medical problems with some drugs to ease them through the illness.
00:12:06.000We don't cure the infection, but we get patients through the infection and avoid hospitalization and death.
00:12:12.000The disappointing thing I'm sitting here in Texas, two hours south of me by plane in South America, they're handing out treatment kits, but the average person in Texas thinks there's no treatment for COVID-19.
00:13:01.000There's a tremendous variability in death rate, as we mentioned before, between all these other nations.
00:13:07.000You know, what's surprising is one of the kind of the incongruities or anomalies that we see is in our country it is Black populations that are The highest mortality rates, and we can explain that maybe because of chronic vitamin D deficiencies in those populations, but in Africa, there's practically no deaths happening.
00:13:33.000How do you explain these huge anomalies nation by nation?
00:13:39.000Let's just take America, and what you said, Mr.
00:13:42.000Kennedy, is correct, that African Americans and Hispanics have about double the mortality rate And, you know, the risk factors do include certainly vitamin D deficiency, obesity, diabetes, sleep apnea, heart and lung disease.
00:13:57.000But many of these communities, they live in households, multi-generational households, so there's been...
00:14:03.000A much greater degree of spread and probably inoculum, that is the dose of the virus received.
00:14:10.000But they have borne the disproportionate rate of mortality.
00:14:15.000Keep in mind, when you look at mortality rates per million population from country to country, the single greatest variable to account for is the age structure of the country.
00:14:24.000Now, the age structure of some of these other countries you mentioned, let's say in Sub-Saharan Africa, for instance, much younger.
00:14:31.000So it's hard to compare apples to apples.
00:14:34.000But the unique thing in Africa is there's widespread use of hydroxychloroquine.
00:14:38.000They use it for malaria, prophylaxis anyway.
00:14:41.000There is a widespread administration in most third-world countries of the BCG vaccine.
00:14:47.000That's a vaccine that helps prevent tuberculosis.
00:14:50.000But the BCG vaccine is a general vaccine that activates the immune system, and there have been analyses showing really a striking relationship to countries where there's BCG vaccination and markedly reduced number of cases and mortality of COVID-19.
00:15:06.000People probably wonder, how come Haiti isn't wiped out and the Caribbean, Africa, some of these poorer nations, how are they kind of skating through the pandemic?
00:15:15.000Many have thought younger age structure and the BCG vaccine may be associated factors.
00:15:37.000They have tremendous hospital capacity there.
00:15:39.000So they start Favipiravir very early, but they hospitalize patients and observe them.
00:15:44.000They may combine them with antibiotics, then later with steroids, but they have managed to keep their case count down and their mortality rate down, but they have very long hospital stays.
00:15:55.000Favipiravir, like the other antiviral drugs, whether this be an antibody infusion, hydroxychloroquine, ivermectin, they work by speeding the clearance of the virus from the nasopharyngeal tract And also reducing the density of viral replication.
00:16:12.000Now, they don't by any means cure the infection, but in my view, they do play an assistive role.
00:16:19.000And what do you think, if we had done everything right in this country, what do you think the outcomes could have been if we focused on that early intervention as you've been advocating?
00:16:36.000When I testified in the Senate on November 19th, I said that half of the deaths could have been avoided.
00:16:42.000And the data have come in suggesting, again, hindsight being 20-20, that number is probably closer to 85%.
00:16:47.000But what I would have done from the very beginning is I would have been much more balanced on what we call the four pillars of pandemic response.
00:16:57.000The first pillar is contagion control, trying to reduce the spread, and we really had a major focus on this with masks and distancing, etc.
00:17:48.000Let's look for signals of benefit, just like we do in cancer or complicated infections, and start to put together these protocols, test them one after another, and get everybody into research.
00:17:59.000Let's have a national hotline for NIH research.
00:18:24.000And then all efforts were focused on the vaccine.
00:18:27.000So we made a gamble, and I published an op-ed in The Hill in the summer, and the title of the op-ed was The Great Gamble of COVID-19 Vaccine Development, which basically said, you know, we're gambling everything on the vaccine, and we're putting nothing on treatment now that's going to help sick patients right in front of us.
00:18:46.000And it really posed the question, is it going to be worth it?
00:18:50.000Is the ends going to justify the means?
00:18:53.000And I can tell you, at about 550,000 deaths, I honestly don't think that the ends justify the means.
00:19:02.000We missed the opportunity to treat the sick patient right in front of us.
00:19:05.000You know, my mother's 93 years old, and she lives in Massachusetts.
00:19:12.000And I talked to her doctor and said, what is the plan if she gets COVID? My whole family, of course, is terrified that she's going to get it.
00:19:22.000And he said, well, you know, if she gets it, the chances are that she'll be okay.
00:19:27.000But if she starts to have depleted oxygen levels or has trouble breathing, and we'll bring her to the hospital.
00:19:36.000And I said, so there's no intervention to prevent her disease from progressing to that point.
00:19:45.000And these are, you know, some of the best doctors in the world, and this is in August.
00:19:52.000What do you, I mean, aren't you kind of astonished by that kind of response from the medical community?
00:20:00.000You know, the word that's been used, it's a sharp word, but it's called therapeutic nihilism, this idea that nothing can be done for patients, and it is the oddest observation.
00:20:11.000That with all the skill and talent that we have in America, that not a single major academic institution got out there and fought the virus.
00:20:21.000You know, where's the Harvard protocol to prevent hospitalization?
00:20:24.000Or how about the Mayo Clinic or Johns Hopkins or Penn or any of these terrific institutions?
00:20:30.000Not a single one actually even had a COVID clinic Not a single one actually tried to prevent a single hospitalization.
00:20:38.000It was almost as if we were gripped in fear and that fear overtook everything.
00:20:44.000And the only thing anybody could think of was playing defense.
00:20:47.000Oh, let's just wait until the oxygen goes down and we'll put patients in the hospitalization.
00:20:52.000That's kind of the innocent explanation for this is that it was just gripping fear.
00:20:56.000For everything else, we have amazing protocols.
00:21:00.000You know, Harvard's got protocols and clinical trials for treating heart attacks and Gallstones, and we have the University of Michigan criterion for cancers.
00:21:07.000We seem to be great for every other disease except for COVID. And then when COVID hit, our academic institutions just went blank.
00:21:16.000Because at that point, it was pretty clear that if you went to the hospital with this disease, that your chances of coming out if you're that age are very, very low.
00:21:27.000And it seemed astonishing to me that You know, that that's the best, that her personal doctor who loves my mother, that's the best he would have come up with.
00:21:37.000And, you know, why isn't this sort of occurring to individual doctors?
00:21:43.000Why aren't they, you know, what would you expect?
00:21:46.000Wouldn't you expect that they'd be going out into the literature and finding people like you and saying, okay, well, we're going to try this?
00:22:39.000We actually stopped giving updates on in-hospital treatment.
00:22:44.000So the poor patients never even had an idea if there's been any advances in the hospital care.
00:22:48.000And what really became incredible is when we had the emergency use authorization approval for antibodies, both the Lilly and the Regeneron products.
00:22:56.000So these are This is, you know, this is the high-tech research that everybody wanted to see happen in high-tech products.
00:23:02.000These antibodies got out there, no word of them.
00:23:05.000There was no FAQs, no doctor reminders.
00:23:09.000When patients got their COVID test, there was no hotline of how you get an antibody infusion, no update on TV. People would go on TV and they'd give their testimonials about how their loved ones would die.
00:23:21.000And no one would think, wow, could my have loved one been treated with an antibody infusion or drugs?
00:25:31.000The testing that became the standard of care, the polymerase chain reaction, Those tests became more and more sensitive.
00:25:38.000And so they could start to pick up fragments of RNA that weren't even COVID-19.
00:25:44.000So if you keep running the cycler over and over again, it'll start to read some code of something up in the nose.
00:25:49.000We have all kinds of different viruses and bacteria in the nose.
00:25:53.000And so we started to have the problem of false positive PCRs.
00:25:56.000So this whole thing started to go pretty crazy out there regarding whether or not contagion control methods made a difference.
00:26:04.000I personally think they did, but the reasonableness was the real gauge of, are we being reasonable?
00:26:11.000We never really had any school outbreaks.
00:26:14.000We never had outbreaks among young doctors and nurses in hospitals.
00:26:17.000We definitely had The spread of the virus from nursing home workers to nursing home patients, that happened.
00:26:25.000So if we just follow the science, we would have been okay.
00:26:28.000Some have said we never should have shut down the schools.
00:26:30.000We should have protected the teachers and professors because the kids, if they get COVID-19, they get natural immunity, which is durable and complete.
00:26:38.000Natural immunity is kind of the biggest blessing a kid can have because they're kind of free of that worry.
00:26:44.000Many have said that, if anything, we should have prophylaxed the nursing homes and the nursing home workers, and we definitely should have vaccinated them first.
00:26:54.000And the issue of, you know, kind of these other high-contact jobs and specialties, maybe the right thing was this home office and what we're doing right now.
00:27:32.000And in fact, these questions were asked before you went on airplanes and If you go to a laboratory today, they'll still ask you, are you sick?
00:29:55.000So, you know, I'm really oriented towards oral drugs because of the idea if we treat at home, we reduce the spread.
00:30:01.000The antibody infusions are fine and I use those clinically But the problem is patients have to break containment and they have to go get an antibody infusion.
00:30:10.000And with that, they're going to contaminate the drivers, their family members.
00:30:15.000They can contaminate people in the hallways.
00:30:17.000And when they get to the infusion, they're going to contaminate people there.
00:30:21.000So I'm not so crazy about the infusions.
00:31:01.000And one of the things we started to see in the media, for instance, Is that our CDC, NIH, White House Task Force, World Health Organization, it stopped being a team effort.
00:31:13.000There stopped being any international collaboration.
00:31:16.000There's no peer review on this, and now we're to the point where we pretty much just see one doctor on TV, and we see largely...
00:31:26.000Media doctors that just reinforce what that one doctor has to say.
00:31:50.000And one of the issues, I think most of those doctors that we see on TV are government bureaucrats, or they are academic physicians, and they're not people who are actually on the front line treating patients and, you know, and doing the kind of early interventions that you're talking about, trying to figure out, break the code, and say, how do I keep this patient from ever having to go to the hospital?
00:32:16.000Well, I mean, one of the best questions an interviewer can ever ask is, Doctor, let's just hear it.
00:32:22.000Do you have any experience in treating patients with COVID-19 to prevent hospitalization and death?
00:32:28.000And I can tell you, if you look across the array of White House Task Force members we've had, regular media doctors that we've had, NIH, CDC, FDA, WHO, we haven't had a single doctor Who has considerable experience in treating outpatient COVID-19, not a one.
00:32:49.000And Senator Johnson kind of basically exposed this in the November 19th hearing, where we had a minority witness.
00:32:59.000And that minority witness, who's a media doctor, he's on TV all the time.
00:33:03.000He spent about two hours in his rebuttal of our approach.
00:33:07.000And his rebuttal was largely, you don't have enough evidence.
00:33:09.000And what you're proposing is not good enough for me.
00:34:20.000So when it comes down to personal health, oh, everybody wants that advice.
00:34:23.000But when it comes to advice for the country, there's been an approach of giving no advice.
00:34:29.000Hope, no window for treatment, no advice on treatment, nothing.
00:34:34.000It's almost as if there's a promotion of as much suffering, despair, anxiety, hospitalization, and death as possible in preparation for mass vaccination.
00:34:47.000Let me ask you one final question that probably a lot of people are thinking about that you've just segued into this.
00:34:53.000If you are a listener of this program, And you have a grandparent or an elderly parent and they get sick, what do you, Dr.
00:35:42.000If your doctor is not a treating doctor who treats COVID-19, Then the next question is, can you refer me to somebody who's going to do it if I get it?
00:35:51.000If they said, no, there's nothing there for you, my advice is that that person go to the American Association of Physicians and Surgeons, aapsonline.org, download the home treatment guide, go to the back in the appendix.
00:36:05.000There's all the telemedicine networks that are available that will take on COVID-19 patients by telemedicine.
00:36:13.000Get the medications prescribed and treat them appropriately.
00:36:17.000And these services have had massive throughput and there's been a great treatment.
00:37:37.000And when I ask doctors sometimes, you know, do you treat COVID? And some say, no, there's no treatment.
00:37:41.000I don't treat COVID. And I say, well, when a patient calls and you tell them that, do you call them back in a couple days and check on them?
00:37:50.000And what my concern is through all the fear and isolation and loneliness and division we've had, my fear is actually compassion has been lost.
00:37:59.000And the Hippocratic Oath is being now, is being abrogated.
00:38:34.000I have Zibamax and vitamin D, glutathione, vitamin C, liposomal vitamin C. We have a pulse eczema, which is a little finger mechanism that is really critical to have in your home if you want to prepare for this.
00:38:53.000That looks at your oxygen levels so that you can tell when you go to the hospital.
00:39:09.000I'm 58, but I have some medical problems, and it went into my lungs, so I developed the pulmonary part of COVID, and I felt the anxiety of having trouble breathing.
00:39:20.000I just can't imagine being a senior citizen with heart and lung disease and having it.
00:39:24.000It must be incredibly anxiety-provoking.
00:39:26.000And during my recovery, I made a series of videos of what I did.
00:39:30.000Now, fortunately, of course, I'm a doctor.
00:39:32.000I got myself into a research protocol, and I took the drugs in sequence, and I did all the right things.
00:39:38.000But one of my recovery videos, I did exactly that, what you just described.
00:39:43.000I laid out the various drugs, the pulse oximeter, how to check blood pressure.
00:39:48.000And I actually even had the packages of the medications.
00:39:51.000And, you know, I wore a tie and it was a respectful, decent video.
00:39:57.000I was amazed that YouTube struck that video down within two days and said that it violates the terms of the community.
00:40:04.000My very first YouTube video was just the release of my scientific findings in American Journal of Medicine.
00:40:10.000It was just four slides from the paper was struck down.
00:40:36.000Any word on early treatment, any word at all, there are powerful forces out there that can seek out Our findings and our message and scrub them from ever getting to patients in need.
00:40:50.000What's going on is extraordinary right now, and I think a lot of investigation will be done.
00:40:57.000Historians and investigative historians are going to look at this very carefully.
00:41:12.000One of the most published people in the world.
00:41:14.000Why is it one paper on COVID and trying to disseminate its findings are absolutely scrubbed?
00:41:21.000Why is there such a massive resistance to getting these principles disseminated?
00:41:29.000That is the It's a trillion dollar question on the table.
00:41:33.000It's cost hundreds of thousands, if not millions of lives worldwide.
00:41:36.000And I think people need to understand and get to the bottom of what's going on.
00:41:41.000I mean, don't you think, and I'm not asking you to get into, to explain a conspiracy, I think a lot of people have a feeling that something is happening that is not right, and that is not rational, it is not common sense.
00:41:58.000And that all of these little things are corralling us toward that one vaccine solution and ignoring a lot of just the common sense thing that we would normally do in a democracy, in a community, you know, as medical doctors.
00:42:14.000And that somehow when we talk about these things, they used to be permissible to talk about.
00:42:20.000It's suddenly become impermissible unless it is consistent without orthodoxy that the only solution for this is vaccines.
00:43:01.000I have to tell you, I was invited to give Medicine Grand Rounds, which is common, as an endowed lecturer at a prestigious East Coast University, which I've done my entire career for 30 years.
00:44:45.000So whatever's going on is in the minds of doctors.
00:44:49.000In those doctors' minds, there must have been something that's telling them, no matter what, don't let any information get out there to other doctors anymore.
00:45:26.000And so my testimony in the Texas Senate last week People said that I was a real firebrand, that I really lit a fire.
00:45:36.000And I have to tell you, within 48 hours, there was draft legislation produced on the floor of the Texas Senate that proposed that each patient who gets a COVID positive test result at least gets some information.
00:46:09.000I'm going to make you a bet that virtually all of those infectious disease academics who killed your speech are, if you look at their COIs and their publications, it will show grants for They are on Tony Fauci's payroll, but I'm not going to get you in trouble by asking you to do that research, but I hope that that is the case.
00:46:41.000You're a heroic American, and I want to thank you for Standing up against that tsunami of disapproval, of rebuke by your colleagues and by many, many other people, and really standing up for public health, for good ethics, for morality, and for our country and humanity.
00:47:35.000I think that that mindset is reinforced professionally.
00:47:41.000You know, it's fortified in a variety of ways.
00:47:44.000And the people that, you know, Tony Fauci makes $7.6 billion worth of grants a year, and the people who get those grants are the people who then sit, you look at the ACIP committee, the VRBPAC committee,