Your email updates, powered by FeedBlitz

Click here to read this mailing online.

 
Here is a sample subscription for you. Click here to start your FREE subscription


"FIDDAMAN BLOG" - 5 new articles

  1. Lundbeck: Possibly, Probably or Certain about Celexa Birth Defects?
  2. New Study Uncovers Paxil's Hidden Toxicity
  3. FDA Shake-Up New Pregnancy Drug Guidelines
  4. Suicide - The Utah Paradox
  5. AC/DC - Rock or Bust Review
  6. More Recent Articles
  7. Search FIDDAMAN BLOG
  8. Prior Mailing Archive

Lundbeck: Possibly, Probably or Certain about Celexa Birth Defects?





Possible or probable, so what is the difference?

I've struggled with these two definitions, really tried to get my head around them both.

First off I used Dictionary.com

Possible:
1. that may or can be, exist, happen, be done, be used, etc
2. that may be true or may be the case, as something concerning which one has no knowledge to the contrary

Probable:
1. likely to occur or prove true
2. having more evidence for than against, or evidence that inclines the mind to belief but leaves some room for doubt.
3. affording ground for belief.

When it comes to prescription medications causing adverse events, the World Health Organisation (WHO) use "causality categories" and define possible and probable as thus...

Possible:
• Event or laboratory test abnormality, with reasonable time relationship to drug intake
• Could also be explained by disease or other drugs
• Information on drug withdrawal may be lacking or unclear

Probable:
• Event or laboratory test abnormality, with reasonable time relationship to drug intake
• Unlikely to be attributed to disease or other drugs
• Response to withdrawal clinically reasonable
• Rechallenge not required

In essence both words have two possible outcomes yet both have different meanings.

I am going to focus on the case of Cheryl Buchanan here and her correspondence with citalopram makers Lundbeck. Citalopram is better known as Cipramil in the UK and Celexa in the US. ( Forest Laboratories)

Cheryl has been at loggerheads with Lundbeck regarding the death of her baby girl. Cheryl made the heart wrenching decision to abort her fetus at 23 weeks because she had been told that scans had detected a series of anomalies in her unborn child, namely...


  • Diaphragmatic hernia or eventration
  • Long bone immobility
  • Cystic hygroma 
  • Unilateral cleft hand
  • Microgynathia


Cheryl had been taking Lundbeck's citalopram prior and during her pregnancy. She wrote a guest post for my blog back in 2013 and has since been trying to get answers from the Danish pharmaceutical giant Lundbeck.

Lundbeck carried out an assessment of Cheryl's claims and forwarded their findings to the MHRA.

Lundbeck, as far as I am aware, also use the World Health Organisation "causality categories".

Here's what they found.

(Foetal death in utero) - drug related - possible
(Pulmonary hypoplasia) - drug related - possible
(Diaphragmatic hernia) - drug related - possible
(Hand deformity) - drug related - possible
(Skin laxity) - drug related - possible
(Skin swelling) - drug related - possible
(Drug exposure in utero) - drug related - possible

Fig 1.




Fig 2. **Initial reporting from Lundbeck to the MHRA did not give any indication for Cheryl's fetus developing Pulmonary hypoplasia**



Fig 3. **Updated assessment by Lundbeck sent to the MHRA regarding a possible connection between citalopram related Pulmonary hypoplasia**






Sometime later Cheryl wrote to Lundbeck and asked if citalopram could cause birth defects?

Here's the reply from Lundbeck's Dr Andrew Jones, Medical Director, Medical Department.

"...there is no evidence to indicate that usage of citalopram in pregnancy increases the risk of birth defects over the background risk in general population (i.e. of mothers not taking citalopram). " 
It was at this point that I wrote to Dr Jones to ask him if this was a personal opinion or an opinion of Lundbeck. He replied...

Dear Mr Fiddaman,
I confirm that this is the position of Lundbeck.
What I am struggling with here takes me back to the definitions of possible and probable.

Lundbeck assess Cheryl's case and write to the MHRA with their findings. They tell the MHRA that the birth defects (listed above) are possibly drug related. Using the WHO criteria this means that...

The defects could just be coincidental to Cheryl's "drug intake" or

The defects may possibly have been caused by "disease or other drugs" or

The Information Cheryl provided Lundbeck "may be lacking or unclear" 

Let's now take a look at the position of Lundbeck regarding citalopram use and birth defects. Remember, it was their own Dr Jones that told me that the following was the position of Lundbeck...

"...there is no evidence to indicate that usage of citalopram in pregnancy increases the risk of birth defects over the background risk in general population (i.e. of mothers not taking citalopram). " 

So, how do we categorize the position of Lundbeck. Are they suggesting that it's possible that there is no evidence to indicate that usage of citalopram in pregnancy increases the risk of birth defects?

Are they saying it's probable that there is no evidence to indicate that usage of citalopram in pregnancy increases the risk of birth defects?

Or are they saying they are certain that there is no evidence to indicate that usage of citalopram in pregnancy increases the risk of birth defects?

Back to the WHO criteria again.

Certain:
• Event or laboratory test abnormality, with plausible time relationship to drug intake
• Cannot be explained by disease or other drugs
• Response to withdrawal plausible (pharmacologically, pathologically)
• Event definitive pharmacologically or phenomenologically (i.e. an objective and specific medical disorder or a recognised pharmacological phenomenon)
• Rechallenge satisfactory, if necessary


Lundbeck have done nothing more than open the door for debate when sending information back to the MHRA.

Where the mother is concerned they have quite literally slammed the door on her face by telling her that their position is there is no evidence to indicate that usage of citalopram in pregnancy increases the risk of birth defects over the background risk in general population.

Why would they (technically) tell the MHRA otherwise?

Why would Lundbeck tell the MHRA that it was possible that citalopram caused the birth defects in a mother's fetus but tell that same mother something completely different?

I'm confused by it all. Is the WHO criteria merely a set of probabilities with at least two possible outcomes? If so, it doesn't really tell us much does it?

Is the WHO criteria not as stringent as they think and each category open for debate?

What we basically have is two opposing statements of reality intertwined.

The third statement of 'certainty' by Lundbeck to Cheryl Buchannan being an ultimatum, in essence, "our drug does not cause birth defects", forgetting or purposely failing to add that they told the MHRA otherwise.

It's certain that Cheryl Buchanan aborted her fetus at the age of 23 weeks because, she was told, the chances of survival were minimal due to a series of internal defects.

My money is on citalopram being the cause of those defects.

Any good lawyers in the UK?

Bob Fiddaman.

Back Stories

Citalopram Birth Defects (Guest Post)

Are Lundbeck Luring Pregnant Mothers With a Red Apple?








    


New Study Uncovers Paxil's Hidden Toxicity





As if we didn't know already (as if Glaxo didn't know all those years ago)

A new study carried out by the University of Utah has revealed what Glaxo have been hiding from the public for many years. The only people that really know the truth are the US Courts where information has been suppressed as part of settlement agreements made between Glaxo and Plaintiff lawyers.

In a nutshell, GSK attorneys come to a compromise when their case defending Paxil goes pear-shaped. They, of course, use all the tools at their disposal - the statute of limitations, whether or not a fetus is viable, ie, whether or not it can be regarded as a human at the time it was aborted - they also use many other points of law to defend their toxic blockbuster drug.

According to Neurotoxicology and Teratology, Volume 47, January–February 2015, mice exposed during development experienced a multitude of problems: males weighed less, had fewer offspring, dominated fewer territories and died at a higher rate. Females took longer to produce their first litters, had fewer pups and pups that were underweight.

The Paxil doses were relatively close to those prescribed for people.

In the study, researchers gave food laced with Paxil to 20 breeding pairs of mice for several weeks, until all had produced up to four litters. The offspring also ate Paxil-laced chow until they reached breeding age.

This from Newswise...


Researchers then released the exposed offspring into the competitive arena with the offspring of a control group of mice never exposed to Paxil. Groups consisted of eight males and 14 to 16 females, creating population densities comparable to those seen in the wild. The researchers started five such populations and kept them going for six months.
Males exposed to Paxil were about half as likely to control a territory. They also lagged behind control males in body weight throughout the weeks of competition and were more likely to die. Exposed males produced 44 percent fewer offspring. Exposed females showed no significant weight or mortality differences, but they produced half as many offspring as control females at the initial assessment. Their fecundity rebounded at later time points.

Are we surprised anymore?

Question is... Why has it taken so long for such a study to be carried out? In truth, it hasn't.

Here's a bit of history...

3-year-old Lyam Kilker was born with serious heart defects. While pregnant, Kilker's mother took the antidepressant paroxetine [Paxil]. The Jury's decision in this case was that Paxil was the causation of Lyam Kilker being born with heart defects. In other words, Paxil was deemed responsible as the agent that disturbed the development of an embryo or fetus.


The following was taken from the court transcript in the Kilker v GlaxoSmithKline trial. [Verbatim]

"In May of this year, 2009, a study was published by Doctor Sloot. The study said this.
"What Doctor Sloot did is, he took Paxil and all the other reuptake inhibitors and he exposed rat fetuses to these 12 different drugs, including Paxil. And what Shearing Plough was trying to figure out, what they were trying to do was figure out whether one of the drugs that they were going to put on the market to compete with GSK's drug was capable of causing birth defects. And so they took the drug they were going to take to market, and before they took it to market, they did this test. And they compared it to all the other SSRIs. Because, as you will learn, GSK never did this test.
"What Doctor Sloot discovered in May of this year is that out of all the teratogen, out of all the SSRIs, the 12, only one was a clear teratogen, Paxil. He discovered that Paxil in May of this year was actually more powerful a teratogen than cocaine.
"It would be safer, according to Doctor Sloot's study, to take cocaine than it would be to take Paxil while you were pregnant.
"Now, Shearing Plough, quite rightly, took their drug that they were thinking about taking to market to compete with Paxil, and even though it was just a possible teratogen, they scrapped their plans to take it to market and decided the risk was not worth the benefit."

Upon this revelation I emailed both Glaxo and the British drug regulator, the MHRA. All of that correspondence is featured in my book, The evidence, however, is clear, the Seroxat scandal. For those of you that don't have a copy there's an extract featuring that correspondence here.

No doubt medicine regulators around the globe will raise an eyebrow at the latest study by the University of Utah, they may shuffle uncomfortably... then ignore the findings. That's my experience of regulators. Quite why they are called regulators baffles me.

Paxil is just one example of a pill causing birth defects, there are many more, much of which are dished out to women because they have some form of dangerous depression during their pregnancy, a depression, that we are told, if left untreated can be passed on to the fetus.

Genius marketing folks...with the sole aim of making money...and lots of it.

Bob Fiddaman.

Related

Ryan, Glaxo's Non-Viable Fetus - Part I

Ryan, Glaxo's Non-Viable Fetus - Part II - The Twists








    

FDA Shake-Up New Pregnancy Drug Guidelines






I'm all for a shake-up for a more simplistic approach to drug safety drug guidelines for pregnant mothers, so a recent article filled me with hope with the headline 'New Pregnancy Drug Guidelines A Mixed Bag For Consumers'.

Alas, it's not all it's cracked up to be.

The FDA have, for many years, categorized a number of prescription drugs, particularly for use in expectant mothers.

Here's how it currently stands.

Category A

Adequate and well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester of pregnancy (and there is no evidence of risk in later trimesters).

Category B

Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate and well-controlled studies in pregnant women.

Category C

Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

Category D

There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.

Category X

Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience, and the risks involved in use of the drug in pregnant women clearly outweigh potential benefits.

Simple enough but, in my opinion, very vague. Let's take a look at Category C.

Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.
In essence the FDA are telling pregnant mothers that the drug they have in their possession has had an adverse effect on the fetus of animals...they go on to say that there have been "no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks."

It's more or less telling the mother that they should take the drug at their own peril.

So, a shake-up to make these guidelines more crystal clear is welcoming.

Are the FDA going to consolidate all the cases of birth defects that have been settled by pharmaceutical companies throughout US courts and then apply them to the new guidelines?

Nope.

Are the FDA going to read the countless stories on the internet and in the media about mothers giving birth to children with defects after taking a specific prescription drug?

Nope.

Are the FDA going to contact pediatricians to ask if they have ever come across instances where children [fetuses] have had to be aborted due to prescription drug medication causing birth defects?

Nope.

Here's what they plan to do.

They are, it seems, going to ask the drug companies to write the warnings.

So, the likes of Paxil, a drug marketed and manufactured by GlaxoSmithKline, a drug that has, on countless occasions, been implicated in hundreds, possibly thousands of birth defects, will now get a new lease of life. Glaxo, who have settled many of these birth defect cases out of court, will now be asked by the FDA to come up with a warning for pregnant mothers to read.

Are we expected to believe that Glaxo are going to have the consumer in mind when writing a warning about ingesting Paxil while you are pregnant?

To my knowledge GlaxoSmithKline have defended the majority of Paxil birth defect lawsuits. Those they win are usually down to absurd state laws [see Ryan, Glaxo's Non-Viable Fetus - Part I and Ryan, Glaxo's Non-Viable Fetus - Part II - The Twists.]

Do we really believe that the likes of Wyeth are going to be anything but truthful when they write a warning for Effexor? [see - Two Hours With Matthew - The Story of "Effexor Baby", Matthew Schultz and Effexor Baby's Grieving Mother Protests Potential MOTHERS Act, Warns Others]

Perhaps Lundbeck will cease the opportunity to cover their drug, citalopram [Celexa] in garlands when there are cases suggesting that it can cause all sorts of problems to the fetus. [see Citalopram Birth Defects and The Lundbeck Emails [Citalopram Birth Defects]


The FDA plan to remove the pregnancy categories A, B, C, D, and X from all human prescription drug and biological product labeling, they are recommending that the labeling include a summary of the risks of using a drug during pregnancy and lactation.. and they are leaving this to the manufacturers of the said drugs, the same manufacturers who have suppressed information surrounding their drugs and birth defects.

On one hand the FDA are looking as if they really do care about the dangers of these drugs in pregnant mothers, on the other hand they are passing the buck back to the pharmaceutical industry whose main priority is to make bucket loads of money out of the supply of these drugs.

It's just like allowing the cannibalistic witch to provide information on candy and food to Hansel and Gretel.

Don't get me started on the British drug regulator, the MHRA, they still insist that Paxil is not a teratogen...despite the fact that it has been proven to be one in US Courts.

There will be many who read this who will claim that they took antidepressants during pregnancy and their babies turned out just fine. To those I ask just one simple thing...please spare a thought for those mothers who, through no fault of their own, don't have the luxury of holding their babies or ever having the chance to hold their babies babies.

Bob Fiddaman.







    


Suicide - The Utah Paradox








Neuroscientist Perry Renshaw, who works out of the University of Utah, is offering a theory to the high rate of suicide that exists in the state of Utah. It's a theory that may surprise many, may make many laugh or leave exasperated.

Theresa Fisher, a Brooklyn-based journalist who writes and edits for 'Brain Mic', has written an article based on Renshaw's findings [theories].

As expected the whole antidepressant/suicide link is not even refered to, quite bizarre given that the opening ramblings of Fisher's article mentions that Utah is, and I quote, "...the No. 1 state for antidepressant use."

Rather than delve into the suicide link between antidepressant use we are taken down a different path of opinion that results in the suggestion that the high rate of suicides in Utah is down to... wait for it... altitude.

Fisher reports that...

"Renshaw believes that altitude has an impact on our brain chemistry, specifically that it changes the levels of serotonin and dopamine, two key chemicals in the brain that help regulate our feelings of happiness. America's favorite antidepressants (and party drugs) work by controlling the level of these chemicals in the brain. The air in Utah, one could say, works just like this."

The above, of course, is supposition but the author of the study believes that he has found "mounting statistical, scientific and anecdotal support for his theory."

Utah, we are told, is not only the No. 1 state for antidepressant use, it also has the highest suicide rates in the country (aside from Alaska)

Putting these two facts together throws up some interesting theories for people like me that writes about the dangers of antidepressants. One would think it would have raised alarm bells for Renshaw - alas, he, it appears, avoids the blindingly obvious, opting instead to lay the blame on altitude.

In a 2011 study published in the American Journal of Psychiatry, Renshaw, along with others, analyzed state suicide rates. The criteria they focused on were gun ownership, population density, poverty, health insurance quality and availability of psychiatric care. Once again we see no focus on whether or not the medication could be playing a part in suicide.

According to Renshaw, the 2011 study and a follow-up study found a positive correlation between suicide and altitude, adding that the elevation at which people live, he found, is a strong predictor of their mental health status.

It's an alternative opinion yet one that I find hard to swallow, particularly (and I know I keep saying it) that Renshaw et al seem to totally dismiss the notion that the actual 'cure' for depression could be the cause of the suicide. Even if it's not, the two statistics for the state of Utah would suggest that the antidepressants just aren't working. Dig deeper and you may just find that these pills that have been heavily marketed as 'life-savers' may just be the exact opposite.

Whilst dismissing the antidepressant suicide link Renshaw (on evidence he found regarding altitude and suicide) says that his evidence is "too strong to dismiss as coincidental."

"Hello, McFly, anyone at home?"

Let's just see what he overlooked again...

1. Utah is the No. 1 state for antidepressant use.

2. Utah has the highest suicide rates in the country (aside from Alaska)

Ergo it must be altitude causing the suicides!

The highest city in the world is, according to Wikipedia, La Rinconada in Peru. I'm left wondering if Renshaw et al actually obtained suicide reports from this part of the world?

It would be very interesting if Renshaw and co could go back to their study and through their evidence obtained try to decipher which of those who died by suicide were on an antidepressant medication at the time of their death... or were taking an antidepressant 3 months prior to their death.

Maybe then we can put the altitude theory to bed and focus on trying to save lives.

Bob Fiddaman.










    

AC/DC - Rock or Bust Review





First and foremost, no pussy-footin' around on this one folks. Crank the volume up to an acceptable level, I suggest 11.

Secondly, and most importantly, if you want lyrics that will make you sit and ponder, go listen to Coldplay or any other band of that ilk.

AC/DC's 'Rock or Bust' appears in stores Dec 1 and 2 but the band have given fans a very special, an early, Christmas gift by allowing the whole album to be streamed in its entirety via Itunes, that glunky piece of software that causes more headaches than...well, than any other piece of software I've ever known.

Being an AC/DC nut, I managed to hear the full album before AC/DC launched the 'official stream'. Hey, that's what us Acca Dacca nuts live for.

The one thing, for me at least, that sticks out about AC/DC's new offering, is the vocals. Brian Johnson has been belting out songs for AC/DC since the early days of Back In Black - anyone who has tried to imitate 'BJ' will have found, like me, that it's just plain impossible to sound like him without sounding like Donald Duck.

Johnson, like a fine wine, improves with age - is it down to his actual vocals or the production and mix of the album? - Does anyone really care?

It's almost as if Johnson has been given a new lease of life. "Here's the Mic, just do what you do best."

... and he does.

We hear the standard AC/DC sound throughout with a few little surprises thrown in.

I remember, back in 79, when I read a review in Sounds for the Highway to Hell album, the headline read "AC/DC Discover Harmony" - if they did, indeed, discover it back in 79, Rock or Bust shows how they have perfected it.

Here's a breakdown of the album...along with my thoughts.

1."Rock or Bust" -  3:04
I was fortunate to be present at the video shoot for Rock or Bust back in October [back story] - my views on this ballbuster haven't changed. It's AC/DC rockin out with their cocks out, balls n' all. As title tracks go, it's on a level with 'For Those About To Rock' [minus the cannons]. Their previous title track, 'Black Ice' , didn't really cut it for me - the album was great, the title track didn't really tick all the boxes. 'Rock or Bust' ticks them all.

2."Play Ball"  - 2.47
Another that has been circulating for some time - the song is better than most think, again it's your typical AC/DC riff with some nice picks, nothing too complex, just simple rock n' roll. The accompanying video to 'Play Ball' could have been better. Memo to AC/DC and David Mallett - AC/DC's 6th man is the fan - always include the 6th man in any future videos.

3."Rock the Blues Away" - 3:24
The opening is.... um, fuck me, Georgia Satellites meets The Angels. The verse is the same, I mean exactly the same melody as 'Anything Goes' (Black Ice). The chorus will just grab you buy the Jaffa's, superb harmonies - it's akin to a Geordie chorus [Brian's former band] - The lead break from Angus builds up slowly with some fine rhythm playing from Stevie. This is a crowd pleaser and is, at present, my favourite from the album.

4. "Miss Adventure" - 2:57
Stevie and Cliff have voices! Nice little shout of "Miss Adventure" and "Na na's" thrown in for good measure. I'm not sure about this one yet, for me, at least, it sounds like something that could have come a year or so after they released Rock or Bust, you know, a track that never made the final album, similar to the way 'Down on the Borderline' never made it to the final cut of 'Blow Up Your Video'. I'm sure it will grow on me...it may take some fertilizer though.

5. "Dogs of War" - 3:35
AC/DC fading in a song? Hmmm? Think 'War Machine' (Black Ice) "We be the dogs of war" (Soldier's of fortune") - It has one hell of a groove that will give most hardcore AC/DC fans callouses on their back foot  [left or right, depending how they have emulated Malcolm over the years] - Great harmonies once again, hard to believe that Malcolm is missing on this one - it has his rhythm written all over it. Take a bow Stevie!

6. "Got Some Rock & Roll Thunder" - 3.22
Typical Rudd beat, typical foot-stomping start, typical psychic presence of the Young family just knowing when and when not to hit those strings. AC/DC aren't just about music, they are about knowing when to give us those little pauses in between hitting those strings. Nice guitar work from Angus on this one - fades out too quickly - would have liked to have heard more Angus. If they play it live we probably will.

7. "Hard Times" - 2:44
This little baby is all about the chorus and harmonies. Stevie keeps things rolling in the style of Uncle Mal whilst Cliff's thumping bass holds everything together. It's refreshing to hear backing vocals over lead vocals - makes everything sound like a party.

8. - "Baptism by Fire" - 3:30
Oh baby! I would just love to have been in the studio when they knocked this one out. What fun, what movement (groove) -  it's a train that starts at high speed and keeps its momentum throughout it's 3.30 short journey - it's something you could imagine a younger band doing...but doing it poorly. AC/DC are the past (and present) masters of the locomotive groove. You jump on board the party train and just feel the motion of it all through every part of your body.

9. "Rock the House" - 2:42
A Zep type riff, a 'Faith No More' funky bass riff, a killer vocal, with the help of Cliff and Stevie's shout of "Rock the House". It's the shortest song on the album, not the strongest AC/DC track you will ever hear, not the most memorable either. Another one that will, undoubtedly grow on me over the coming months.

10. "Sweet Candy" - 3.09
Oh yeh, oh yeh... if track 9 [Zep and Faith No More] disappoints then Sweet Candy gives us the return of AC/DC. This could have been lifted straight from the 'Blow Up Your Video' sessions, only with better production, much better!

11. "Emission Control" - 3:41
Like "Rock the House"we have the funky bass riff. What sets this aside is the chorus and harmonies. Stevie brings in a voice to the harmonies that, for most hardcore fans, will be the only sign that Malcolm is missing from this album.

All in all it's an album that will delight the majority of AC/DC fans. Sure, there will be those who may even suggest that AC/DC should hang up their guitars, uniforms and cloth caps - those that suggest such sacrilege should be tried for treason.

AC/DC are, without doubt, the biggest rock act on the planet. They have a style and, for the most part, they have stuck to that tried and tested formula throughout Rock Or Bust.

If you enjoyed Black Ice, you'll enjoy Rock Or Bust. If you compare it with Back In Black or the phenomenal 'Powerage' then it will disappoint.

Never, under any circumstances, compare one AC/DC album with another... just enjoy each one individually.

To stream the album go to Itunes here.

Liverpool and Scottish legend Bill Shankly once said, "Some people believe football is a matter of life and death, I am very disappointed with that attitude. I can assure you it is much, much more important than that."

Same can be said for AC/DC





Bob Fiddaman.






    


More Recent Articles


Click here to safely unsubscribe from "FIDDAMAN BLOG." Click here to view mailing archives, here to change your preferences, or here to subscribePrivacy