Evaluating Claims to Avoid Pseudoscientific and Unproven Practices in Special Education

Abstract

Special education professionals are charged with using evidence-based practices, but various unproven, disproven, and pseudoscientific interventions continue to proliferate. Unproven and ineffective interventions emerge and are adopted for various reasons. Ineffective interventions are inevitably harmful and require professionals to adopt a conservative approach that both minimizes potential for harm and maximizes potential for educational benefit. This is fundamental to the evidence-based movement, but special education professionals may not recognize and avoid ineffective interventions. This article aims to improve recognition of potentially ineffective interventions by shedding light on aspects of science, pseudoscience, and some mistakes frequently made in evaluating claims of intervention effectiveness. By becoming familiar with the distinctions between science and pseudoscience, and by developing an understanding of how errors in thinking are used to promote and defend interventions unsupported by empirical evidence, special education professionals can better protect their students with disabilities from potential harms associated with ineffective practices.

Keywords

comprehension reading language-learning disabilities processing language intervention(s)strategies instruction

The shift toward an evidence-based special education was partly a response to the intrusion of fad, pseudoscientific, and unproven interventions that have plagued the field for decades (Kozloff, 2005). Accordingly, special education professionals are charged with deploying and monitoring the effectiveness of evidence-based practices (EBPs) for their students with disabilities. However, special educators regularly encounter novel challenges educating students with disabilities and may turn to social media, the Internet, and word of mouth for solutions. Such sources may occasionally deliver helpful information about EBPs for students with disabilities, but bogus interventions also thrive in these ways.

Despite advances in the evidence-based special education movement, unproven, disproven, and pseudoscientific interventions have continued to proliferate throughout the field. A stroll through the exposition at many special education conferences reveals vast numbers of booths promoting questionable and downright ridiculous “solutions” to a host of teaching and learning challenges. Sensory integration interventions (e.g., scooter boards, brushing, swings, ball pits) are perhaps a perfect example of a widely popular intervention that is not supported by credible evidence (Barton, Reichow, Schnitz, Smith, & Sherlock, 2015). Nevertheless, sensory integration interventions are among the most commonly used interventions for students with disabilities, costing districts as much as $16,500 per student per year (Zane, Davis, & Rosswurm, 2014). But sensory integration isn’t the only or best example. Past and current popular education interventions that are unsupported by evidence include (a) whole-language reading instruction (i.e., “balanced literacy”; Moats, 2000), (b) learning styles (Pashler, McDaniel, Rohrer, & Bjork, 2008), (c) facilitated communication (i.e., “supported typing” and “rapid prompting method”; Mostert, 2001, 2010; Travers, Tincani, & Lang, 2014), (d) Drug Abuse Resistance Education (i.e., DARE; Ennett, Tobler, Ringwalt, & Flewelling, 1994), (e) auditory integration training (Simpson, 2005), (f) Fast Forword (Gillam et al., 2008), (g) Irlen lenses (Hyatt, Stephenson, & Carter, 2009), (h) Brain Gym (Hyatt et al., 2009), (i) psychomotor patterning (Travers, Ayers, Simpson, & Crutchfield, 2016), (j) DIR/Floortime (National Autism Center, 2015; Zane, Weiss, Dunlop, & Southwick, 2015), and many others. Special educators should abstain from unproven, disproven, and pseudoscientific interventions. However, schools remain places where unproven practices often are relied on heavily (Miller & Sawka-Miller, 2010).

Knowledge of EBPs is a fundamental aspect of special education preparation and professional development. But merely listing EBPs will not ensure that professionals adhere to them (Lilienfeld, Ammirati, & David, 2012; Vyse, 2015). A variety of tactics are used by both well-intentioned and deceptive promoters and publishers to entice special educators to buy materials, equipment, supplies, manuals, and services that are not supported by scientific evidence. If special educators are to adhere to an evidence-based model, they must be prepared with the knowledge and skills to detect and avoid using unproven and pseudoscientific interventions. This requires developing a basic understanding of why this problem persists, the harm associated with using questionable interventions, and knowing how to distinguish between EBPs and those promoted despite adequate empirical evidence.

Why Do Unproven and Pseudoscientific Interventions Persist?

Various reasons explain the appeal of unproven and pseudoscientific interventions in special education (Vyse, 2015). It is common for promoters to claim their products are evidence-based, and countless questionable practices find their way onto lists of interventions that are showcased in conference programs, web pages, books, and popular media. Moreover, savvy marketers craft advertisements to lure special education professionals into trial runs of interventions to “see for themselves.” Education publishers and vendors may use convincing albeit empty appeals to emotion (e.g., excitement, convenience, concern, compassion, desperation) to convince educators to try their wares. With the best of intentions, special education professionals might further rationalize this exploration by convincing themselves there is little or no harm in trying them on their students (Smith, 2015). Teachers might initiate an intervention out of curiosity (e.g., “Maybe this intervention will work for Marco”). They also might think, “What if this new reading intervention works better? There’s no harm in trying it for a few weeks.” Such a disposition might be further influenced by a sense of compassion (e.g., “I will do anything to help this kid”), desperation (e.g., “I’m at my wits end and am unsure what to do next”), and/or fear (e.g., “What if I’m refusing to try something that might produce a breakthrough?”).

Unfounded stereotypes about students with disabilities as well as beliefs about teaching and learning also may explain why questionable interventions are frequently used (Smith, 2015). For example, special educators might perceive students with autism as being locked in their mind and in need of a solution to liberate them, though no evidence supports this belief (Sarrett, 2011). Some may incorrectly believe students with learning disabilities simply suffer from a lack of adequate motivation and simply need to try harder (Gwernan-Jones & Burden, 2010), but also wrongly believe that positive reinforcement will negatively affect student motivation (Hattie & Timperley, 2007). Other misguided beliefs about teaching and learning often emanate from education leaders who, despite decades of accumulated evidence, continue to erroneously claim that systematic and explicit instruction is harmful to learning, an eclectic approach is best, and teachers should be creative (Heward, 2003). Such claims create confusion and may lead teachers to adopt ineffective interventions. But what’s the harm in trying a questionable intervention for a short period of time? Should teachers avoid exploring questionable practices? Could teachers who adhere exclusively to EBPs be failing to provide interventions that may produce a breakthrough?

What’s the Harm in Trying?

No EBP is guaranteed to confer benefit and the effects of an intervention will likely vary among students. For example, an intervention found to be generally effective for students with autism (e.g., social narratives) might not produce similar effects for a particular student with autism due to differences in their disability severity, previous learning experiences, or cultural and economic differences. However, many professionals may presume an intervention will (or should) work if it has been deemed an EBP by a trustworthy source (e.g., National Professional Development Center on Autism Spectrum Disorder). Although it is common to portray interventions as being evidence based or not evidence based, this dichotomous portrayal may not illustrate accurately the practical motivation of the evidence-based movement. The identification of EBPs is motivated by the discovery and application of interventions that are most likely to be effective, not guaranteed to be effective. An EBP is an intervention that is more likely to confer benefit than an unproven intervention because it has been subjected to the most stringent scientific tests currently available. In this way, it is clear that adherence to EBPs is just as much about maximizing the probability of educational benefit as it is about preventing potential harm associated with ineffective interventions.

Although many unproven or pseudoscientific interventions might appear relatively benign at first glance, it could be argued that every ineffective intervention is associated with some degree of harm. A main problem is that a tried intervention is only revealed to be a failure after the investment is made; instructional time is permanently lost and educational benefit is not conferred. Implementation of an intervention that failed to confer benefit means resources were wasted and a student’s opportunity to learn (i.e., time) has been permanently lost. Every student with a disability has a finite amount of time to receive special education services; and professionals are ethically obligated to maximize the impact of these limited services. It may seem that a few weeks of time exploring whether an intervention works has only minimal harm, but a small amount of time lost to ineffective instruction can accumulate over time to a significant loss of potential educational benefit.

To illustrate this point, suppose a student loses the equivalent of 4 weeks time due to teacher use of ineffective interventions every school year. This means from age 3 to 22 years (i.e., 19 years), a student could lose as much as 76 weeks (i.e., more than 2 entire academic years) of time due to teacher use of ineffective interventions. This amount of lost instructional time could easily be multiplied if ineffective interventions are used for prolonged periods of time (e.g., whole-language reading interventions) or combined with other ineffective interventions. Given the persistence of poor outcomes of students with disabilities (Newman, Wagner, Cameto, & Knokey, 2009), the harm done to students with disabilities by way of failing to provide effective instruction may be more common than many professionals are willing to acknowledge.

The use of unproven and pseudoscientific interventions also wastes valuable resources. Education systems throughout the nation are confronted with increasingly limited financial and human resources accompanied by incessant public demand to improve student academic performance. These conditions mean materials, equipment, teacher time, and support personnel come at a premium. Teachers are known to regularly work overtime (i.e., before and after hours, during holidays, and/or throughout the summer) without compensation. They regularly open their pocketbooks to purchase supplies, materials, and equipment. When pseudoscientific or unproven interventions are used, even for a short period and with the best intentions, precious resources are misdirected from interventions that are more likely to be effective and toward those that are unlikely to confer student benefit. Such imprudence has broad impacts on students with disabilities who receive them, and also may negatively affect other students who have to wait for more resources to become available to receive educational benefit. Related, failed attempts to improve student skills sap teacher optimism and can lead to frustration, burnout, and abandonment of the profession (Billingsley, 2004).

Ethical Obligation to Avoid Unproven and Pseudoscientific Practices

Although lost access to effective instruction and wasted resources serve as adequate justification for abstaining from unproven and pseudoscientific interventions, other legal and ethical reasons are available and worth considering. Van Houten et al. (1988) explained how learners with disabilities are entitled to an education comprising (a) a therapeutic environment, (b) services that prioritize personal welfare, (c) competent professionals, (d) meaningful (i.e., functional) instruction, (e) ongoing assessment and evaluation, and (f) the most effective interventions and procedures available. From an ethical perspective, these entitlements serve as guiding principles in the design and delivery of special education programming.

Because there is no guarantee that a student will benefit from a given intervention, regardless of its status as an EBP, special educators must take steps to ensure they maximize their potential for delivering effective interventions. Special educators are also obligated by federal law to use EBPs (Individuals with Disabilities Education Improvement Act, 2006). The special education professional ethical code set by the Council for Exceptional Children (CEC) listed 12 principles that address issues related to use of interventions proven to be effective, including these 5:

Maintaining a high level of professional competence and integrity and exercising professional judgment to benefit individuals with exceptionalities and their families

Using evidence, instructional data, research, and professional knowledge to inform practice

Protecting and supporting the physical and psychological safety of individuals with exceptionalities

Neither engaging in nor tolerating any practice that harms individuals with exceptionalities

Advocating for professional conditions and resources that will improve learning outcomes of individuals with exceptionalities (CEC, 2010)

In addition to EBP lists and practice guides (e.g., What Works Clearinghouse, National Professional Development Center on Autism Spectrum Disorders), special educators must be able to evaluate claims made about intervention efficacy to adhere to ethical precepts.

Distinguishing Among Effective, Unproven, and Pseudoscientific Interventions

Simply listing interventions to avoid will not ensure that special education professionals adhere to EBPs. Providing special educators with the knowledge and tools for evaluating claims may help prevent adoption of unproven and pseudoscientific interventions in special education (Travers et al., in press). This can be achieved by understanding the qualitative differences between an EBP and unproven or pseudoscientific interventions. Common mistakes in thinking and evaluating arguments also can enhance critical analysis of interventions to more reliably select effective interventions (Sagan & Druyan, 1995). By recognizing the red flags of pseudoscience (Shermer, 2002), special educators might also be better able to avoid potentially harmful interventions and adhere to EBPs. Each of these is discussed next.

Evidence-Based Practice

An EBP is an intervention that has been analyzed via multiple, high-quality experiments and consistently yielded positive findings (Cook, Tankersley, Cook, & Landrum, 2008). Some interventions are supported by research, but may not have been recognized as an EBP for various reasons (e.g., unavoidable flaws in the study, limited participant diversity). An EBP likely will appear in special education textbooks and on the websites of government agencies, special education technical assistance centers, and reputable nonprofit organizations. There also may be step-by-step practitioner guides for implementing an EBP available at no cost to professionals. When this is the case, teachers can be confident the intervention has a very high probability of effectiveness and very low potential for harm.

Unproven Interventions

An unproven intervention is one that should be avoided because it has not been sufficiently subjected to scientific scrutiny by trained researchers or remains without scientific consensus despite empirical investigation. Journal articles may sometimes be used to support claims that an intervention is supported by research, scientifically validated, an emerging or best practice, or a promising practice. However, these and other terms inappropriately suggest intervention efficacy when they instead are signals to avoid using them outside the protective confines of a scientific experiment. This is because not all published research is of high quality, with some journals publishing questionable research, often for a fee (Beall, 2012; Bohannon, 2013). This means many unproven interventions may give the impression of being effective when they are not. In other cases, an unproven intervention may never have been investigated, but is portrayed as being consistent with other accepted practices. For example, an unproven behavior support curriculum may be promoted as “part of” a schoolwide positive behavior support model to give the impression it is supported by evidence.

Unproven interventions should be avoided due to risks associated with ineffective interventions outlined, but also because professional and ethical obligations require maximizing potential educational benefit to students with disabilities. Accordingly, professionals can better adhere to their obligation to maximize benefit by adopting healthy skepticism about intervention claims. Withholding belief that an intervention works (i.e., admitting “I don’t know” or “I’m not convinced that is true”) does not mean the intervention will not yield some benefit; it simply means the potential for educational benefit does not outweigh the potential risk for ineffectiveness. In other words, when special educators are presented with claims about interventions, they should consider whether a sufficient body of highly rigorous scientific evidence warrants belief. And if they are unconvinced by the evidence, or if evidence indicates it will not be effective, avoid using the intervention.

Pseudoscientific Interventions and Errors in Reasoning

Pseudoscientific interventions can be very difficult to detect, even among the most well-educated and science-minded individuals (Pigliucci & Boudry, 2013). In fact, some special education experts for decades explicitly have supported pseudoscientific and thoroughly discredited practices (Cardinal & Falvey, 2014). This is one reason why special education professionals must be prepared to evaluate claims rather than exclusively rely on authority. Professionals who are equipped with skills to evaluate claims, examine evidence, and consider arguments may be better able to adhere to an evidence-based special education than professionals who rely exclusively on the words of authority figures.

Although difficult, recognizing pseudoscience can be achieved by understanding fundamental differences between science and pseudoscience as well as by improving the ability to recognize common flaws in thinking. Figure 1 provides a side-by-side contrast of the characteristics of scientific and pseudoscientific dispositions. A main feature of pseudoscience is its emphasis on seeking support for an already-held belief, usually through low-grade forms of evidence (e.g., testimonials, anecdotes, coincidences). In other words, pseudoscience tends to focus on confirming what is already believed. Conversely, science requires suspension of belief in a claim until sufficient evidence is available.

Figure 1.

Contrasted Characteristics of Science and Pseudoscience.

Pseudoscience typically is associated with grandiose claims that are not supported by evidence or, in some cases, in direct opposition with evidence. Science is conservative and therefore more likely to result in gradual changes that are informed by the collection of facts. Whereas science values open-mindedness and results in changes in belief based on new evidence, pseudoscience typically is dogmatic in the face of new evidence. Promoters of pseudoscientific interventions typically use convoluted language and borrow jargon to appear more credible (e.g., “brain-based learning”), but scientists use precise terminology with explicit procedures conducive to verification by independent researchers. And while scientists seek out and value criticism from their peers, pseudoscientists view critics as adversaries and often work alone.

Confirmation Bias

Understanding the common mistakes made when considering and defending an intervention also will support teachers in avoiding unproven and pseudoscientific interventions. Confirmation bias (Nickerson, 1998) is a term used to describe the tendency to unintentionally seek evidence for and/or interpret situations in ways that confirm an existing belief or desire, while simultaneously discounting or ignoring evidence that is inconvenient or inconsistent with those beliefs and/or desires. All sorts of other errors in reasoning stem from a tendency to confirm what we want to believe or care deeply about. Rarely is time invested in looking for evidence that our beliefs are wrong. Special education professionals who are emotionally, physically, and financially invested in an intervention are much more likely to perceive a benefit when none actually exists. They also may fail to notice negative side effects associated with the intervention when they have a vested interest. Ironically, confirmation bias can influence professionals to strongly defend an intervention when presented with evidence that it is ineffective or harmful; erroneous beliefs often are strengthened by presentation of conflicting evidence (Lewandowsky, Ecker, Seifert, Schwarz, & Cook, 2012). This problem can sometimes lead to arguments that intervention efficacy depends on believing that it will/does work (i.e., appeal to faith; Damer, 2013). Perhaps the best example of an appeal to faith comes from proponents of facilitated communication, who erroneously claim the method is effective, but fails to work under simple test conditions because the communicator is under pressure to perform by nonbelievers, belief that facilitated communication works being a prerequisite for its effectiveness (Biklen, 1992; Biklen, Morton, Gold, Berrigan, & Swaminathan, 1992).

Anecdotes, Testimonials, and the Correlation Fallacy

Anecdotal and testimonial evidence constitute a red flag for pseudoscientific and unproven interventions. Importantly, credible evidence about an intervention must be true and representative, but anecdotes cannot be evaluated for accuracy and such reports cannot be generalized to other individuals (Damer, 2013). Nevertheless, testimonials are disseminated largely due to misattributions of causality stemming from a correlation fallacy. A correlation fallacy is a belief that because something occurred after an event, whatever preceded it must have been the cause (Damer, 2013). Perhaps the best known case of correlation fallacy is the unsubstantiated belief that vaccines cause autism (Offit, 2010). For a different example, consider a parent who starts a megavitamin regimen for his or her son with ADHD and, shortly afterward, reports his behavior improved. The correlation fallacy may lead the parents to conclude megavitamins caused changes in behavior when other factors actually caused improvement (e.g., absences by a bothersome peer, better fidelity to a self-monitoring intervention, maturation of the child, perceived changes that didn’t actually occur, a combination of these and/or other factors).

The long-standing axiom “correlation does not imply causation” is worth remembering when drawing any conclusions about the effect of an intervention. Furthermore, anecdotes about intervention effectiveness should not be relied on when selecting interventions for students with disabilities because they are susceptible to confirmation bias, correlational fallacies, and other errors in thinking (see Figure 2 for other common reasoning errors). Special education and related professionals who aspire to adhere to evidence-based approaches that maximize the potential for educational benefit while minimizing risk would benefit from improving their ability to detect flaws in thinking associated with unproven and pseudoscientific claims about intervention efficacy.

Figure 2.

Common Flaws in Thinking With Brief Definition, Example, and Reason Why the Flaw Is a Problem.

Argument From Ignorance and Shifting the Burden of Proof

Arguments from ignorance and shifting of the burden of proof are two common errors in reasoning that may influence teacher beliefs about intervention effectiveness. An argument from ignorance depends on believing that a claim must be true because there is no evidence it isn’t (Damer, 2013). In other words, some professionals might rationalize their use of an intervention based on the absence of evidence that it is ineffective or harmful. For example, despite nearly 40 years of research, the efficacy of sensory integration has not been demonstrated (Smith, Mruzek, & Mozingo, 2015). When confronted with this reality, proponents of sensory interventions may argue there is no evidence their methods will not be effective for a particular student (e.g., “There is no proof this will not work for Jeffrey”). An argument from ignorance often involves shifting the burden of proof, or insisting that a claim be presumed true until disproven; the claim is propped up by a lack of knowledge rather than evidence (Damer, 2013). Shifting the burden of proof in special education is problematic because it invites a credulous disposition that assumes unproven interventions are acceptable until evidence indicates otherwise.

Appeal to Authority and False Authority

Proponents who appear to be authorities on a subject may convince professionals to try an intervention when the evidence for the intervention is lacking. This is known as an appeal to authority and it depends on believing a claim based on the authoritative position of the proponent rather than the merit of their argument or available evidence (Damer, 2013). For example, discovery learning (i.e., problem-based learning, inquiry learning, experiential learning) associated with the constructivist paradigm is popular among many education professionals, but remains without compelling evidence 50 years after originally conceived (Kirschner, Sweller, & Clark, 2006). Nonetheless, education experts (i.e., authority figures) may tell educators that such approaches are not only effective, but superior to guided instruction. Educators may accept this claim as true based on belief in the authority figure who promotes discovery learning rather than an independent and critical examination of the evidence. Then, when an intervention is called into question, the authority figure may defend it by proclaiming the skeptic unqualified to evaluate discovery learning because he or she doesn’t sufficiently understand or subscribe to the constructivist paradigm.

A related tactic is to appeal to a false authority (Damer, 2013), which depends on asserting a person has expertise in an area that has not been demonstrated to be valid. For example, proponents of a new version of facilitated communication known as “rapid prompting method” (Tostanoski, Lang, Raulston, Carnett, & Davis, 2013; Travers et al., 2014) may use a false authority fallacy to defend the method against critics. The false authority fallacy relies on the proponent’s usually self-developed and dubious credential (e.g., “facilitated communication master trainer”; “certified Irlen screener”). The critic often does not have the credential, which proponents use as a means of dismissing criticism against the unproven intervention. Essentially, the false authority fallacy depends on discounting criticism based on the critic’s lack of credential(s) rather than the merit of their argument and/or the available scientific evidence.

Argument to Moderation

The argument to moderation fallacy is remarkable for its appeal to those who value reason and evidence. This fallacy depends on conclusions that the validity of a claim lies somewhere between two polarized positions (Damer, 2013). Balanced literacy is perhaps the perfect example of how an appeal to moderation fallacy can lead to conclusions about reading instruction that are inconsistent with an overwhelming body of scientific evidence. Balanced literacy emerged as a response to decades-long debates over a holistic approach to reading (e.g., whole language) and systematic and explicit instruction (e.g., a phonics-based approach). Balanced literacy attempts to combine holistic and phonics-based approaches, but there is no compelling evidence to support this approach and it very well may be that a balanced literacy approach is less effective than a whole-language or phonics-based approach alone (Moats, 2000). Although the evidence demonstrating the ineffectiveness of whole-language and the superiority of a phonics-based approach was clear (National Reading Panel, 2000), so-called balanced literacy emerged as viable alternative. This perhaps was a result of an appeal to moderation, or the belief that the truth about the most effective approach to reading instruction must reside somewhere between holistic and explicit approaches. Importantly, professionals should understand that disagreement between two positions does not mean both positions are equally plausible, that both are supported by equally rigorous evidence, or that the most accurate position is somewhere in between.

Conclusion

Special education has advanced toward an evidence-based model, but remains affected by the use of unproven and pseudoscientific interventions (Foxx & Mulick, 2015). Special educators and related professionals may find themselves motivated by compassion and/or desperation to use one or more unproven or pseudoscientific interventions. However, the deployment of these interventions is associated with risks of ineffectiveness and therefore may be harmful to students with disabilities. This justifies a conservative approach to intervention selection and application that aims to minimize potential for harm and maximize potential for educational benefit. This is a fundamental motivation of the evidence-based movement in special education, but professionals may not be adequately prepared to readily recognize and avoid unproven and pseudoscientific interventions that are more likely to be ineffective.

Evidence exists on a continuum and confidence in a claim about an EBP depends on the quality and quantity of the available evidence. An EBP typically has some very high-quality evidence and a large amount of evidence of acceptable quality, but all studies have flaws and the best studies are cost-intensive and extremely difficult to conduct. Many interventions that have not been subjected to experimental study may be the topic of peer-reviewed commentary, conceptual, or theoretical articles in reputable journals and may give the appearance an intervention is supported by evidence when little or none actually exists. Unproven and pseudoscientific interventions that have little to no empirical evidence may still be positively portrayed in reputable peer-reviewed journals (Cardinal & Falvey, 2014) and low-quality research can easily be published in journals (Beall, 2012; Bohannon, 2013). This makes it difficult for professionals, who typically are not trained to evaluate the scientific rigor of an experiment, to determine how much confidence they should place in a particular intervention. Special education professionals therefore would be wise to look for red flags of pseudoscience and scrupulously examine reasons for believing claims of intervention efficacy.

There exist no valid and reliable instruments to easily guide professionals in judging evidence for a claim about intervention efficacy. This means a general understanding of the features of science and pseudoscience, common errors in thinking, and a systematic approach to examining claims is crucial for professionals intent on adhering to an evidence-based profession. Understanding confirmation bias, fallacious arguments, and problems associated with anecdotal reports are ways to protect against erroneous belief in and use of interventions that should be avoided. Collectively, this knowledge can help special education professionals build a repertoire of healthy skepticism. By becoming familiar with the distinctions between science and pseudoscience, and by developing an understanding of how errors in thinking are used to promote and defend unproven interventions, special educators and related professionals can better adhere to an evidence-based approach, while protecting their students with disabilities from potential harms associated with ineffective practices.

Footnotes

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author received no financial support for the research, authorship, and/or publication of this article.

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