The 1932 American College of Dentists Commission on Journalism and Commercialism
in Dental Journalism
David W. Chambers, EdM, MBA, PhD
Professor of Dental Education
University of the Pacific, Arthur A. Dugoni School of Dentistry
Editor, American College of Dentists
2155 Webster Street
San Francisco, CA 94115
(415) 929-6438
This paper is based on a presentation at the annual meeting of the American
Association of Dental Editors, 8 October 2011, Las Vegas, NV.
Abstract
In 1932 the American College of Dentists published the book-length report of the
Commission on Journalism. This gave
tangible form to an effort begun four years earlier to document the state of
dental journalism at the time, with particular emphasis on its commercial tone
and control by dental industry.
Creation of the American Association of Dental Editors was a direct result of
this process. During the 1930s
significant progress was made in curbing the number and influence of proprietary
dental publications and in public policy statements
opposing industry sponsorship of dental activities.
Part of this success can be attributed to the fact that fellows in the
college also held leadership positions in other organizations and its policy of
sustained, open, and public discussion of the issue.
Numerous specific recommendations of the commission – such as the ADA’s
publishing a journal for all dentists, creation of a prize for dental editors,
publication of a forerunner of evidence-based dentistry, and improving the
quality and quantity of scientific, professional, and editorial content – failed
to materialize or came about in unanticipated ways.
Lessons are drawn regarding ways organizations can influence professional
policy.
The 1932 American College of Dentists Commission on Journalism and Commercialism
in Dental Journalism
At the Minneapolis meeting of the American College of Dentist in 1928, President
Henry Banzhaf called for an investigation of the role of commercialism on the
quality of dental journalism. This
was a significant undertaking for a professional organization that had been
founded eight years earlier and it represented part of the early tradition in
the college of bringing attention to issues that shape the future of the
profession. Other early interests
included licensure, continuing education, and establishment of specialties.
Over a ten-year period beginning with this call to reform dental
journalism, the college completed a comprehensive survey of the status of dental
journalism resulting in the publication of a book-length report, founding of the
American Association of Dental Editors, development of a comprehensive set of
recommendations for the improvement of dental journalism, an unprecedented and
not repeated ten-year public discussion in print regarding dental journalism,
and monitoring and reporting of progress on the issue that continued until the
Second World War. This period saw a substantial decline in the number of
proprietary publications (a change that paralleled the disappearance of
non-university-based dental and medical education), and reductions in industry
presence on dental convention floors and their behind-the-scenes promotion of
continuing education programs.
Context for the Creation of the Commission
The Board of Regents of the American College of Dentists adopted a resolution at
its 1928 meeting that chartered the activities of its Commission on Journalism.
1 There were four
“resolved” clauses: (a) survey the total amount of dental literature, (b)
determine the proportion of the literature not under the control of the dental
profession, (c) identify measures to terminate publication of non-professional
journals, and (d) develop measure to enhance worthwhile dental journalism.
Among the eight “whereas” clauses, two particularly convey the sentiments
of the college at the time: “Whereas a large proportion of the dental literature
and proceedings of dental societies is still published in periodicals controlled
by dental trade houses” and “Whereas such condition is not compatible with the
maintenance of professional dignity, independence, and idealism.”
The commission was not asked to “have a look to see whether dental
journalism might be enhanced through better quality content.”
The intent was to eliminate dental industry's influence over professional
communication because that was felt to represent an affront to dentistry.
As will be discussed below, the college had good reason to believe that
propriety interests participated heavily in dental journalism.
Concern had been growing over industry’s traditionally strong influence in the
affairs of dentistry. This
paralleled medicine’s early nineteenth century successful initiatives to curb
advertising of patent medicine directly to patients 2 and the
conversion of proprietary medical schools to university sponsored,
research-intensive programs called for in Abraham Flexner’s 1910 Carnegie
Commission Bulletin #4. 3 William Gies, a biochemist with a faculty
appointment at Columbia University’s College of Physicians and Surgeons dental
school, was a vocal advocate for independent, science-based dentistry. 4
He founded the Journal of Dental
Research in 1919 and edited and controlling its content and ensured freedom
from commercial influence by personally financing the journal, with support for
the American College of Dentists William John Gies Endowment Fund Committee for
the Journal of Dental Research.
In 1936 JDR was turned over to the International Association for Dental
Research, an organization that Gies earlier founded.
Gies authored a comprehensive report on dentistry that echoed the Flexner
report in scope and recommendations – except that Gies called for dentistry
being independent from and of the same stature as medicine. 5 At the
Fifth Annual Conference of Independent Journalism in Dentistry in Boston on
February 26, 1916, Gies spoke to the position that “professional freedom,
self-respect, and efficiency are incompatible with subserviency to trade
journalism.” 6, page 577
The Commission on Journalism was formed in 1928 and began its work under the
chairmanship of Dr. Bissell B. Parker of New York City, with four other fellows
of the college: Drs. Ervin A Johnson, John T. O’Rourke,
Benjamin S. Partridge, and Edward B. Spalding.
At its 1930 meeting in Denver, the college approved creation of an
organization of editors of non-proprietary journals.
The purpose of the organization was to “promote in a constructive way the
cause of non-proprietary dental journalism, and to facilitate cooperation among
the editors of these journals for the advancement of the professional ideals of
dentistry.” 7 On October 19,
1931, five members of the college – Drs. William J. Gies, John E. Gurley, John
T. O’Rourke, Bissell B. Palmer, and Robert S. Vicsant – registered a charter for
such an organization in the State of Tennessee.
Those who registered the charter agreed not to seek office in the
organization. The organization was
called the American Association of Dental Editors.
The first meeting of AADE was held on 18 January 1932 at the Stevens Hotel in
Chicago (currently the Conrad Hilton).
Thirteen individuals were present.
Dues were set at $5 and committees were established for executive,
nominations, dental literature, cooperation, and advertising.
The report of the Commission on Journalism appeared as a bound volume
running to 238 pages, in 1932. It
was published by the American College of Dentists at the Waverly Press in
Baltimore, MD with the full title: The
Status of Dental Journalism in the United States: Report of the Commission on
Journalism of the American College of Dentists, 1928-1931.
The Report of the Commission
The report proper is contained in the first 56 pages of the book and covered the
charge to the commission, early history of the dental profession, nineteenth
century dental journalism, and the recent evolution of dental and medical
journalism. There is a discussion
of the relationships between medicine and dentistry – still an issue of concern
at the time. Much of the text is
given over to characterizations of the proper rule of dental industry (referred
to as “trade houses” or “proprietary interests”) and how industry had
overstepped its proper place. By
today’s standards, this mostly amounted to high-tone name calling.
Six recommendations, presented in nine pages, are offered.
The majority of the publication consists of tables and commentary depicting the
state of dental journalism in 1928-31.
One hundred and thirty-one publications were identified and classified as
to title, owner, name and address of editor, date of first issue, frequency of
issue, and “class,” and “type.”
Journals were classed according to sponsorship: (a) dental societies, (b)
colleges (apparently meaning dental school alumni publications), (c) national
fraternities, (d) publications for hygienists or assistants, (e) trade-house
publications, (f) corporate publications (owned by publishing firms), and
miscellaneous and unclassified publications.
Trade-house and corporate publications were considered proprietary.
Each publication was also classified by types as being (a) a journal
mostly given to scientific, professional, and editorial content, (b) a bulletin
mostly given to news of the sponsoring organization, or (c) atypical by virtue
of mixed or other content.
One hundred and seventeen publications were in existence in 1931 (almost 11%
turnover in three years), but detailed analyses in the report were based on the
entire 131 publications.
One-quarter of publications were proprietary and 48% were journals.
However, 38% of the non-proprietary publications were journals and 81% of
the proprietary publications were journals.
The dominant format for non-proprietary publications (44%) was bulletins
containing news of the sponsoring organization.
Later, the commission would simplify this classification system to
parallel the one used for schools by the ADA Council on Dental Education where A
= journals controlled and sponsored by dental organizations, B = bulletins
controlled by dental organizations but sponsored privately, and C = proprietary
publications.
The primary target of the commission was the twenty trade-house and corporate
journals represented by the following:
Dental Cosmos (S. S. White),
Items of Interest (its own for-profit
publishing company), The Texas Dental
Journal (P. A. Cary Company), Dental
Digest (Dentists Supply Company of New York),
The American Dental Surgeon (The
Professional Press), The Dental Brief
(L. D. Caulk), Dental Survey
(private, profit-making publication of an individual),
International Journal of Orthodontia,
Oral Surgery, and Radiology (C. V. Mosby Publishing).
These journals typically had circulations and featured articles on
diagnosis, restorative techniques, new materials, surgical techniques, cases,
and other scientific topics that were typical of the best
dental-organization-sponsored publications of the time.
Comparing trade-house and society and college journals in 1928 and 1929,
most dentists received more content from the former.
Calculating from Table R in the report, industry published an average of
5,873 pages of articles compared with 4,299 pages in journals sponsored by
dental organizations. The
circulation of these proprietary journals with scientific content was 5.6 times
as large as their non-proprietary counterparts.
Forty percent of pages in proprietary journals were devoted to
advertisements; 37% of pages in non-proprietary journals were ads.
The commission offered no criticism of the scientific or technical content of
the trade journals. The quality of
copy seemed to be similar across sponsorship as illustrated by this quotation:
“That the creation of the Journal of the
American Dental Association [in 1928] failed to bring to dental journalism
the benefits that accrued to medical journalism from the establishment of the
Journal of the American Medical
Association has been a source of great disappointment to the well-wishers of
the dental profession. The failure
to achieve such a result is undoubtedly due to the fact that, accepting the type
of ownership, there has been very little real difference between the
journalistic qualities of the official organ of the American Dental Association
and those of trade houses and other proprietary periodicals.” 1, p. 33
The concern of the commission was nature of sponsorship.
Fifteen such charges against proprietary dental journalism are enumerated
below in bullet form.
·
Component dental societies are sponsors of trade publications.
·
Proprietary journals publish, as a service to the profession, the announcements
and transactions of dental organizations.
·
Dental schools advertise to recruit students in trade journals.
·
Proprietary journals are distributed on a complementary basis in schools and at
dental conventions.
·
Dental societies meet in industry facilities.
·
Trades provide complementary equipment, supplies, and services to organized
dentistry.
·
Industry financially underwrites conventions of dental groups.
·
Manufacturers offer continuing education courses, subsidize speakers, and pay
dentists for endorsements.
·
Officers in dental industry sit on boards of dental organizations and receive
honorary recognitions.
·
Trade journals publish position comments on matters that affect the profession.
·
Trade journals engage in “puff” – complementary shout-outs to those in the
profession whose views they find congenial.
·
Fear that dentists will not pay for subscriptions to publications of organized
dentistry when they receive free journals or journals at reduced rates.
·
Trade publications promote a “status of success” over service.
·
Dental industry is given credit for philanthropy in supporting the profession
when the real nature of their contribution is advertising.
The situation becomes clear when comparing the
Journal of the American Dental
Association with Dental Cosmos.
The Journal of the American Dental
Association was distributed (as part of association dues) to 36,572
practitioners in 1928. It contained
2,340 pages of scientific, professional, and editorial copy and 25% of its pages
were advertisements.
Dental Cosmos charged a fee of $1.50
per year to approximately 28,000 subscribers, contained 5,506 pages of
scientific, professional, and editorial copy, and 17% pages of advertising.
Not only did Dental Cosmos
carry announcements of society and state and specialty meetings and conventions,
it also published minutes, proceedings, and speeches of such organizations.
It printed public notices of interest to dentistry, such as the 1918
announcement that property belonging to the defunct Pennsylvania College of
Dental Surgery was being held in probate and inviting those with a legitimate
interest in that property to contact the court-appointed officers.
Dental Cosmos was the Web page
of the day for dentistry. Very
likely, if a dentist were asked to name the single most useful source of
information on the profession, the answer would have been
Dental Cosmos.
The findings of the commission can be summarized in this quotation: “Dental
journalism was dominated by dental trade-houses, and it was conducted not ‘in
the interest of the dental profession’ as the trade-houses so frequently
proclaimed, but primarily as an effective means to advertise to the profession
the dental products manufactured or sold by the owners of the periodicals.”
1, p. 13
An extensive set of recommendations was offered in the report of the Commission
on Dental Journalism. They are
summarized here, in a slightly different arrangement, under three headings: (a)
squeeze out proprietary publications, (b) replace these with higher quality
dental journalism, and (c) miscellaneous other initiatives.
As we will shortly discover, dentistry succeeded in one of these aims.
The principal goal of the commission was to replace proprietary sponsorship of
dental journalism with sponsorship by dental organizations.
Toward that end, the commission recommended:
·
Urging societies to withdraw participation and sponsorship in proprietary
publications
·
Removing trade publications from dental conventions
·
Urging dentists to drop subscriptions to proprietary publications
·
Blocking the republication of articles originally appearing in proprietary
journals in non-proprietary ones
·
Urging schools to switch their advertising and distribution to students from
proprietary to non-proprietary journals
·
Urging libraries to stop display and circulation of trade publications
·
Urging dentists to discontinue writing for trade publications
·
Seeking policies that would bar industry from participation in dental meetings
and conventions and block participation by dentists in industry, as in serving
on boards or developing product innovations with commercial applications
To compensate for the loss of proprietary publications, there would be
improvements in non-proprietary dental journalisms.
One major thrust would be to increase the number of pages and frequency
of publication of non-proprietary journals.
This would be accomplished by converting proprietary journals to
non-proprietary sponsorship, merging the struggling society publications,
developing more specialty journals, publication by the American College of
Dentists of a handy summary of proven techniques (proto-EBD) to be called
Dental Abstracts, and distribution of
the ADA journal to all dentists regardless of membership.
The other major thrust was to be carried out by the newly formed American
Association of Dental Editors. This
group, to be limited in membership to those affiliated with non-proprietary
journals, would develop standards for content, authorship, advertising, and the
free exchange of material among non-proprietary editors and the exclusion of
propriety ones. They were to
collaborate with the American College of Dentists to award an annual prize to
editors. In particular they were to
protect the profession from commercialism disguised as science and to drive out
the “repetitious and the banal” from the pages of dental journals and to limit
advertising to what is “true, moderate, and dignified.”
The third category of recommendations involved ad hoc changes such as changing
the tiles of publications to reflect the “journal” and “bulletin” distinction,
systematic republication of the most important literature by the American
College of Dentists, and expressions of cordiality toward and openness to
exchange of ideas between the profession and industry on the profession’s terms.
The report of the Commission on Dental Journalism was written in ringing tones
of the highest idealism. It used
the term “pachydermatous” to describe the problems faced by dental journalism.
That does not mean having a trunk like an elephant; it means having a
thick or insensitive skin and clumsy digits that are a handicap for doing proper
work, like an elephant. The authors
of the report accused industry of taking money and influence out of the hands of
the profession through its sponsorship of journalism.
It was the messenger, not the message, that the commission found
objectionable. “Dentistry suffers
to the extent that the boundary between profession and trade is unclear;
progress requires that dentistry defines the boundary” 1, p. 46 and
“only indifference or lack of idealism in the leaders of dentistry makes it
possible for the illicit relationship to continue.” 1, p. 36
And Then . . .
The report of the Commission on Journalism is stupendous in the rigor and extent
of its empirical base, its presumptions, and the scope of its challenge to the
profession. It is in the tradition
of the Flexner 3 and Gies 5 reports and the Surgeon
General’s Report on Dentistry. 8
It exceeds modern efforts such as the Hollingshead, 9
Institute of Medicine, 10 and ADA reports on dentistry. 11
What makes it almost unique is what happened over the ten years following
its publication. It was not
shelved; it was put into active play by the American Association of Dental
Editors and the American College of Dentists.
The report drew very little response in print.
A few individuals associated with proprietary organizations cautioned
against libel, and the ADA Judicial Council raised concerns over comments made
in the report. 12
Virtually all of the recommendations of the commission that could be carried out
by the trade houses were affected.
The Texas Dental Journal was donated
to the Texas Dental Association, Pacific
Dental Gazette was donated to the University of Southern California dental
school, Dental Economics stopped
publication, and other voluntary transfers were made. 13 Beginning in
January 1937, Dental Cosmos combined
its 1055 pages with the 2070 pages of the
Journal of the American Dental Association.
The following year the new JADA publication only included 1465 pages,
demonstrating the trend that the number of overall number of publications
increased during the decade but the overall number of pages of scientific,
professional, and editorial content did not. 14 By 1940, there were
110 non-proprietary dental publications listed in the Index to the Dental
Literature and only 13 trade-house publications.
The same pattern from a decade earlier persisted, however, with 38% of
the non-proprietary publications (the plurality) being bulletins devoted to
society news. Eight of the 13
proprietary publications (62%) remained journals, devoted to scientific,
professional, and editorial content. 15 The American Association of
Dental Editors grew in its first decade to 233 members representing 86
publications (roughly its present size), and it continues to address itself to
the issues identified in its founding charter and the Commission on Journalism
report. 16
A comparable positive response was forthcoming from state dental associations,
state dental boards, dental schools, and specialty organizations. 13, 17
Numerous resolutions were passed at the state level condemning proprietary
journalism and opposing industry sponsorship of educational programs at state
meetings or through participation in dental school programs. 1 Those
who had registered their positions by 1932 included Rhode Island, Tennessee,
Pennsylvania, New York, North Carolina, New Hampshire, Wisconsin, New York
Academy of Dentistry, the Dental Education Council of America (predecessor of
the American Dental Education Association), Harvard (and later many other dental
schools), and a dozen others. The
chair of the Commission on Journalism in 1938 reported that only a single
society continued to publish its proceedings in a proprietary journal, no
schools advertised in proprietary journals, no continuing education courses
sponsored by industry were announced, and virtually all fellows of the college
had resigned their associations with trade companies. 16 The Kentucky
State Dental Association passed the following resolution “prohibiting the
appearance on the program of any of its meetings any salesman or representative
or any person whatsoever regardless of his degrees or qualifications who is in
the employ of a manufacturer or dealer in dental supplies or accessories or who
is directly or indirectly interest in the manufacture or sale of medications or
accessories intended for public use.” 1, p. 28-29
It is likely that the constructive response from industry and state associations
and schools during the decade following the creation of the Commission on
Journalism is a function of the organizational structure of the American College
of Dentists. The college had no
financial interest in the outcome of this debate and its fellows, selected
because they represented the leaders in other components of organized dentistry
were in positions (in those other organizations) to exert influence through
those channels. Four of the editors
of the 20 trade-house or corporate proprietary publications identified in 1930,
including Dr. L. Pierce Anthony of Dental
Cosmos, were fellows of the college. 1
A further mechanism that appears to have been instrumental, and to my knowledge
has not been replicated by other organizations that advances policy positions,
was a ten-year effort to monitor the outcomes of the recommendations and an open
and balanced forum for public discussion on the topic.
The Journal of the American
College of Dentists was created in 1934.
It contains transcriptions of committee meeting over the 1930s where the
contemporary state of dental journalism was documented. There were reports of
efforts on the part of leaders in the college to garner endorsements from state
organizations and conversations with industry leaders.
There was also a public debate reported over several years in the pages
of the journal regarding the issue.
What is unusual about this forum is that positions of industry and other
sponsors of proprietary journalism were printed unedited in order to ensure a
balanced exposition of the issue.
18-19 These open forums continued until 1938 and included pages of
verbatim remarks from editors of proprietary journals.
There were even republications of editorials, such as from Dr. Elmer S.
Best, an early and constant critique. 20 Consistent with the
historical tradition of the American College of Dentists, all sides of the
matter were presented rather than the officers of the college deciding what the
profession should think and then attempting to present only that view.
(See editorial mission of the college printed on the inside front cover
of any issue.)
Despite its success in curbing the commercial influence of industry in dentistry
and launching the American Association of Dental Editors, the Commission on
Journalism failed in most of its other aims.
The American Dental Association absorbed
Dental Cosmos, but did not increase
the number of pages devoted to scholarly articles, nor did it offer a
publication to all members of the profession.
At least until the Second World War, the number of non-proprietary dental
journals increased slightly while scientific content remained unchanged.
There is a miscellany of small promises from the founding days of AADE that did
not come to fruition. The ADA did
not take up the expectation that it would publish the minutes of the AADE (first
the Journal of Dental Research and
then the Journal of the American College
of Dentists did that). The
prize for dental editors that ACD and AADE were to create suffered four years of
torturous development in committee and, despite framing an excellent set of
criteria, 21 died in 1937 (thankfully to be taken up by the
International College of Dentists).
Plans by the AADE for a student publication foundered (to be picked up as it
should have been by the students themselves through the American Dental Student
Association).
And the recommendation that the American College of Dentists create a
publication of scientifically grounded practice tips called
Dental Abstracts . . .
There is a tale to tell here. In
the mid-1930s the American College of Dentists informed the editor of
Dental Survey, a personally owned
proprietary journal, that that the publication was classified as Level C
(proprietary). The editor was the
same Dr. Ernest S. Best who had consistently challenged the work of the
Commission on Journalism and had created a short-lived rival Dental Editors
[sic] Club for the propriety publications.
Best informed the American College of Dentists that
Dental Survey was in fact under the
sponsorship of a new academy. As
reported in the Journal of the American
College of Dentists, 15 “The commission being unable to find any
record of the [claimed] organization wrote the editor for further information.”
Best replied that “he would be sending a copy of the constitution and
bylaws and a copy of the agreement between the publisher and the sponsoring
organization, the Pierre Fauchard Academy.”
Best received an upgrade to a B rating – the only one used by the
commission. Soon thereafter,
Dental Survey became
Dental Abstracts, the official
publication of the PFA.
The fight over dental journalism in the 1930s needs to be understood correctly.
It was not a crusade to eliminate commercialism from dentistry or dental
journalism. The goal was to wrest
control of dental journalism from the sponsorship of industry to the sponsorship
of the profession. As Dr. J. Cannon
Black, chair of the Commission on Journalism in 1939 stated: “Our literature is
now virtually in our own hands.” 22
Are We Repeating Ourselves Again?
It may be possible to learn some lessons from this study of a large-scale,
mostly successful professional policy change.
The footprint of industry in dentistry’s affairs was substantially
reduced in journalism and in continuing education, dental conventions, and
dental schools. Factors in that
change appear to include the clarion vision and voice of a leader (John Gies)
who kept it up for ten years before organizations became interested, the open
and interlocking leadership structure of an organization such as the American
College of Dentists, 23 and a long period of balanced and public
debate. These features did not,
however, serve well for bringing about concrete initiatives, such as more and
better content in journals, creation of the journal
Dental Abstracts, a prize for
editors, or a student publication or a journal for all dentists.
The success criterion for such concrete changes may be different.
It is also plausible that the general policy changes affecting dental journalism
in the 1930s were manifestations of larger, societal changes.
Like the tide going out and coming in, it has been noted that the
Carnegie reports on medicine and dentistry did not so much cause the decline of
proprietary professional education as provide the recessional music for an
economic shift that had already largely taken place.
There may well be a pattern in the story of dental journalism in the
1930s as a reflection of historical cycles of government regulation and
professional control of its commercial affairs.
A century earlier, in the 1830s, American had had enough of the Eastern
establishment seeking to manage the country.
Jacksonian Democracy swept into office on a promise of throwing out
regulations to allow scope for individual and corporate entrepreneurism.
Several states repealed laws requiring that physicians be licensed.
2 Jackson paid off the national debt and closed the Second Bank of the
United States and within a few years the banking system collapsed and the debt
tripled in size from Jackson’s starting point.
During the succeeding rebalancing, the
American Journal of Dental Science
was published in 1939, followed the next year by founding of the American
Society of Dental Surgeons and the Baltimore College of Dental Surgery – three
professional firsts of a kind.
The Gilded Era, also known as the Age of the Robber Barons, at the end of the
nineteenth century proved that massive personal wealth could be accumulated by
working around weak regulations.
All numismatists know that the banking system collapsed in 1893 to the tune of
about 37% of the GDP and so much so that the mint could scarcely coin money in
1894. This was rebalanced by the
Progressive Era with the creation of the Food and Drug Administration, the
National Park System, the rise of public health, attacks on proprietary medical
education and enlisting universities to provide a scientific foundation for the
professions. 24
The Roaring Twenties rolled back regulations on everything, including
enforcement of prohibition. It was
a boom time, until the banks collapsed in October of 1929.
This paper reports the progress made by the dental profession in the
rebalancing period of that yo-yo cycle.
We have now experienced the deregulation of the 1990s, creation of the gospel
that corporations exist to serve shareholders, 25 direct marketing to
patients, 26 and a glitch in the banking industry in 2008.
If the pattern repeats itself, these may be very promising times.
Readers are free to draw their own conclusions regarding commercialism in
the pages of our publications or freedom from the banal and the repetitious in
our journals and whether industry has a place at the table or on the convention
floor.
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