Note sent to Grayson early 2000s from US campaigner “Bill” with a boxed collection of US plasma company gay donors ads
New campaigners to the Contaminated Blood scandal may be surprised to learn that long standing campaigners had much key evidence decades ago. Haemophiliacs were infected with HIV and hepatitis viruses throughout the 1970s and 80s via factor concentrate blood products used to treat their hereditary condition which was often imported from the US. It wasn’t as if there was a shortage of damning documents detailing how this came about, rather the UK government did not want to address the evidence amd most mainstream media kept telling activists that the “tragedy” as it was referred to in those days by the press was a “dead story”! The reality was, the “scandal” as it was known by campaigners was very much alive and haemophiliacs were dying at a high rate from their exposure to deadly viruses.
At the beginning of the Infected Blood Inquiry set up to investigate the scandal, chaired by Sir Brian Langstaff which began in 2018, haemophiliac Colette Wintle and this author Carol Grayson jointly put forward the name of Paul Cunningham, current Political Correspondent for RTE News and Current Affairs whom Grayson has known for 2 decades as a person to be interviewed. Grayson began to have contact when some of Grayson’s research on the international US side of the blood scandal dovetailed with Cunningham’s documentary work to uncover the distressing details of this story as haemophiliacs in Eire had received some of the same US products as haemophiliacs in the UK. Also from 1996 after following the legal progress in Eire and stories from Cunningham and others, Grayson had initiated her own campaign aim for a public inquiry and “compensation on a parity with Eire.” This appeared to be the best compensation scheme that could be found globally.
Back in the 1990s, Grayson and her haemophiliac husband Peter Longstaff (who was infected with HIV and hepatitis viruses through US blood products) had set up their campaign group Haemophilia Action UK. They had brought about the first legal case to try to overturn a controversial hepatitis waiver in the 1991 HIV haemophilia litigation on the grounds of government and lawyers withholding of key evidence regarding the dangers of hepatitis C and lack of obtaining “informed consent”. The Undertaking or “waiver” as nicknamed by Grayson meant that haemophiliacs had unwittingly signed away their rights to litigate for hepatitis C not knowing they had been infected for years though their lawyers and the government were fully aware that 99% of haemophiliacs with HIV were also infected with hepatitis C. They simply did not tell them!
The late 1990s was also when Longstaff became the first haemophiliac in the UK to initiate a treatment strike refusing human derived factor concentrates until his death in the Spring of 2005. Longstaff was fighting for recombinant synthetic treatment for all haemophiliacs and the Judicial Review of his case was heard in the High Court. Although he did not win, (as the Judge stated it would open the doors on “post code lottery” prescribing way beyond haemophilia into other areas of medicine) it helped to keep the argument for safer treatment in the press and recombinant was eventually phased in by age, youngest first, for all haemophiliacs.
By the early 2000s, Grayson and her husband Peter Longstaff had launched their own Bad Blood media campaign jointly with the Newcastle Journal. They were preparing their first official complaint to the police and complaints to the General Medical Council (GMC) on testing haemophiliacs without permission and withholding of positive test results. At this time also, Wintle was instrumental in persuading journalist Holly Lewis (Meridian TV) to make the documentary Blood Brothers and was interviewed with her husband Steve for the programme on her experience as a female haemophiliac infected with hepatitis C.
Grayson provided research regarding haemophiliacs attending Lord Mayor Treloar College and contacts for Lewis to interview in the Meridian area as the couple were outside of the region. The college for children with disabilities, was where Longstaff was prescribed his first factor concentrates on a treatment trial as a child, the product he was given was Hemofil. She also introduced Holly to Lord David Owen a former junior health minister who had given a commitment in the 1970s for the UK to be self sufficient in blood products which was never carried out after he left office.
Unfortunately however the Haemophilia Society at that time weren’t ready to help expose the abuse and experimentation carried out on haemophiliacs at the college and Grayson’s efforts to show key aspects of this were watered down or omitted altogether once the Society intervened to try to control the narrative of the documentary.
Early 2000s was also a time when Grayson had made contact with documentary filmmaker Kelly Duda who was exposing the plasma programme at Arkansas State Peniteniary. Grayson was researching similar at Angola State Penitentiary, Louisiana. At the request of Grayson, the Journal newspaper had engaged early on with Lord David Owen, former Health Minister, to interview him on his commitment to self sufficiency in the 1970s. Grayson and Longstaff were also collaborating with US and Canadian campaigners who had given her and Peter the contact details for the America lawyers they considered “most trustworthy” as they too had experienced unethical behaviour from certain law firms. So the couple made contact with Chuck Kozak of San Francisco Law Firm, Lieff Cabraser Heimann & Bernstein and were jointly initiating their legal case in the US against four pharmaceutical companies with Pete’s legal aid funding not only for themselves but to help other haemophiliacs and their families too.
Grayson and Longstaff had by now obtained evidence from the sister of a prison plasama donor infected with hepatitis C on the alleged dangerous and unlawful practices at Arkansas State Penitentiary and were working on obtaining compensation for hepatitis C. Though compensation was blocked by government, after hearing the couple’s arguements, their then QC Matt Kelly (former head of the Bar Association) worked with the Haemophilia Society on a key report which led to the financial support scheme called the Skipton Fund to be being established. Infuriatingly this was at the expense of Longstaff’s case once again not being heard in court and controversial evidence was again kept out of the public domain. Thanks to Longstaff gaining legal representation and presenting vital evidence, Skipton did however provide a platform going forward for those that had previously been denied any financial help for their HCV infection. As well as lump sum ex-gratia payments, campaigners have since used scheme registration as a platform to fight for increased monthly payments and finally for those registered with the former schemes (now known as English Infected Blood Suppport Scheme, EIBSS) the infected and their affected bereaved partners to receive the first interim compensation payments on 28th October 2022 as recommended by Sir Brian Langstaff.
In the early 2000s, Longstaff and Grayson had also obtained plasma company gay donor advertisements from US campaigner “Bill” used to help those involved in litigation in the UK and were learning of the evidence and depositions of key figures such as Dr Don Francis, Centre for Disease Control (CDC) who were aiding US lawyers for haemophiliacs with their experience and legal testimony.
Regarding the same time period, late 1990s, early 2000s, the following was later highlighted by Wikepedia, regarding the important work of Paul Cunningham, a journalist in Eire who was documenting their contaminated blood scandal.
From 1999 to 2001, Paul Cunningham reported on the infection of Irish people with haemophilia, with HIV, and with Hepatitis C from contaminated blood products. In recognition, he won “National Radio Journalist of the Year” in the ESB National Media Awards in 2000. He followed this up with a documentary exposing the practices of US-based drug firms that exported infected blood products to Ireland. The programme, Bad Blood, won an Irish Film and Television Award. He co-wrote a book, with Rosemary Daly, on the impact of contaminated blood products called A Case of Bad Blood for Poolbeg Press.
Both Cunningham and Daly along with lawyer Raymond Bradley of Malcolmson Law were a font of knowledge regarding the Lindsay Tribunal and the case for compensation in Eire. Not only that, they were helpful and supporting to Grayson, Longstaff and Wintle at a time when they were meeting with ministers at Westminster but they lost, denied or ignored shocking evidence of safety violations and abuses. I had also contacted Bradley asking if Eire haemophiliacs wanted to join us litigating with Leiff Cabraser Heimann Bernstein lawyers in the US but the reply was that Eire didn’t need to as their compensation at court levels was already set up to pay out haemophiliacs for “extraordinary suffering” on the grounds of “loss and need” though there was no legal acceptance of liability.
The Eire government recognized the importance of NOT retraumatizing victims and delaying justice by forcing them into court. Cunningham however recognized the importance of covering the wider picture through the media including the actions or inaction of the US pharmaceutical companies and the types of high risk paid donors used in America and decided to make a documentary in the early 2000s. This is why Cunningham’s documentary and statement is important to the Infected Blood Inquiry.
At that time, Grayson and Longstaff were being ignored by most mainstream media in the UK. Grayson recalls day after day ringing the Times and Telegraph who were not interested in reporting the evidence and never returned her calls, other mainstream media would only go so far incorrectly reporting the story as an “unavoidable accident”, the government line, if they covered this at all. It was the local Newcastle Journal that began to take the risks reporting key stories previously unknown (sometimes seen then as controversial) and often for the first time. The paper worked jointly with the couple called it the Bad Blood campaign. As previous highlighted, Grayson had evidence but no wider platform due to the continued ignorance and avoidance by national media … (the same media now claiming they always supported us) but the reality was their interest waned for very long periods and they refused to engage with any investigation into Grayson’s (then) newly discovered evidence and documents.
Cunningham was a different kind of journalist that refused to dismiss the concerns of haemophiliacs. Although Grayson had a limited platform, she was able to share details of her US contacts, their lawyer Chuck Kozak, the violations in the collection of US prison and skid-row blood, what she knew of Don Francis and his whistleblowing and the gay donors ads in her posession all of which could be followed up by an interested documentary team which she believed would be able to confirm allegations Grayson was already making to UK ministers that journalists were ignoring in the UK.
With regard to Cunningham’s statement on his awarded documentary, he writes the following in his Infected Blood Inquiry testimony dated 2020,
I was the reporter on the documentary entitled ‘Bad Blood’, which has been viewed by the investigators. The documentary explores the practices of US-based pharmaceutical companies that exported blood and blood products Ireland in the 1980s. The programme was an independent production by Andec Productions for RTÉ. It won an Irish Film and Television Award in 2002 in the News and Current Affairs category.
I also co-wrote a book with Rosemary Daly on the impact of contaminated blood products called ‘A Case of Bad Blood’ published by Poolbeg Press in 2003. Rosemary was the Administrator of the Irish Haemophilia Society.
It has been approximately fifteen years since the making of the film and the writing of the book. I no longer have complete notes and documentary records of my work. The information contained in this statement is the most accurate information that I can provide.
The exhibits to this statement are précised in a table that follows this statement. This table was created by the investigators using documents that I gave them when we met in Dublin.
He goes on to say,
I began reporting on people with haemophilia who received infected blood in about 1997. At the time, I was a journalist at RTÉ.
There was a demand by Irish haemophiliacs to be given a voice, as they had withdrawn from the 1997 Findlay Inquiry which focussed on the infection of women with Hepatitis C following injections with Anti-D.
When the Lindsay Tribunal was set up in 1999, I became RTÉ’s reporter on the tribunal and related issues. I held this position until the Tribunal’s final report in 2002. I attended every day of the Tribunal.
I became very interested in cross-referencing the evidence given to the Tribunal with evidence from outside it.
As the Tribunal went on, I noticed that many international witnesses testified, especially from the US, but only about the global state of knowledge pertaining to HIV and hepatitis C. There was not, however, much investigation into the practices of the US pharmaceutical companies because the Tribunal deemed this to be outside of its terms of reference.
The Tribunal chose not to delve into the conduct of American pharmaceutical companies. The journalist in me felt that this was a fundamental piece of the puzzle that was not being addressed. From an ethical point of view, it was not problematic for us to investigate issues that the Tribunal had elected not to explore.
Noel Curran, who previously worked at RTÉ Current Affairs but was an Executive Producer with the independent TV company Andec Productions, approached me with the idea to make a documentary that covered the origins of contaminated blood in the UK by investigating the US pharmaceutical world. We saw the film as plugging a gap that the Tribunal was likely to leave.
Noel also approached Fiona Gough who had worked on the BBC One Panorama episode entitled “Contaminated Blood: The Search for the Truth”. It was the three of us who made ‘Bad Blood’.
We began the reporting process by interviewing people in Ireland who were infected through or affected by contaminated blood. We made contact with a range of people. It was important for us to interview a cross-section of people from different age groups and regions of Ireland.
One of the most important aspects of our work was investigating the plasma collection processes of US-based pharmaceutical companies as this was where coagulation products came from. We wanted to dig deeper into plasma collection, as well as what staff members knew about the infectivity rates of the blood that they were collecting and selling. We also wanted to look into what was or was not done when plasma companies became aware of product that was infected.
After some investigation, we decided to visit three locations in the US: Angola Prison in Louisiana, Los Angeles’ Skid Row, and San Francisco. We chose these locations because each of them represented a different facet of the involvement of US pharmaceutical companies in the contaminated blood scandal.
We chose Angola because of its reputation of housing a “blood factory” prison. Skid Row was chosen because of the many accounts of people with drug dependency donating blood and plasma. We chose San Francisco because it was alleged that gay men were targeted as blood donors because many of them carried the Hepatitis B antigen (HBAg).
Probably unsurprisingly, none of the pharmaceutical companies were amenable to participating in the film despite numerous requests from us.
The American system of paid donors
During our research in the US, we were told repeatedly that blood banks had a huge commercial incentive to bleed as many people, as many times as possible.
We collected many adverts publicised by blood banks encouraging donations. While I no longer have copies of these adverts, some of them featured in the film. The investigators have taken two stills from the film that show these adverts. See Exhibit WITN3531002.
Particularly notable is the first of the two adverts. It is a notice stuck up on a wall dated August 1975 stating that “$10 will be paid on the 2nd donation of the week”. I no longer have a copy of this advert nor can I recall from where we sourced the document.
The US blood donation system in place at the time was one of mass donations incentivised by small payments for each donation. The most regular donors were often people desperate for small amounts of money. These people included people with drug dependency problems and homeless people.
‘Bad Blood’ documents a 1975 statement by Dr Jack O’Riordan, Director of the Irish Blood Transfusion Service (hereafter, the ‘Irish BTS’) at the time. He noted “there are dangers inherent in the type of person who comes forward as a donor”. He mentioned that “drug addicts come forward and these people in some cases have passed certain diseases from one to another… such as hepatitis (a form of jaundice), and obviously these wouldn’t be suited to a blood transfusion service’s needs”.
Despite these concerns, the Irish BTS began importing and distributing US blood products, made in part using paid donors. Our investigations at the time of the film revealed that this was because there were insufficient donors and funds available to make local blood product manufacturing a viable option.
Notwithstanding this, haemophiliacs (such as James Fife who features in our film) were told by clinicians that the plasma used to make the blood products was donated by “medical students and civic minded people”.
Donations from intravenous drug users
We interviewed for the film many individuals who regularly donated blood in the 1980s on Skid Row, Los Angeles where many of them still lived at the time.
In one clip from the film, a former donor says “the people I’d shoot dope with; they’d all already be high when they were donating plasma”. She recalls that the donors knew that the blood bank staff could see “the fresh needle marks but they were getting what they wanted. They wanted the blood”.
She continued: “almost all the people I shot dope with have either died from AIDS or are dying from AIDS. I’m not surprised at all that blood donations turned out to be positive because of the people I knew and know are dying from AIDS”.
Another former donor we interviewed knows now that she is HIV positive. She said on camera that prior to being diagnosed, she would “donate, rest, get up, go buy me a fix”.
She told us that she would “shoot up in the same spot they took the plasma from so there were no marks. Or I’d do it in my neck and wear collars to hide the marks. If they knew that you used drugs, they would refuse the plasma”.
That said, she told us that it was up to the donor to answer the pre-donation questionnaire. She said that donors would regularly conceal their habits and that “they didn’t ask questions one on one – it was always on paper”. The implication is that it was easier to omit or obfuscate information or to lie when questions were answered in written form.
Blood donations from prisoners bled in prison
As I mentioned, an important aspect of the film was investigating the prisons from which donations were obtained. We interviewed former inmates of US prisons. Some of these inmates agreed to be interviewed on camera and many of these interviews feature in the film.
We interviewed some former inmates of Angola Prison about the plasma plant that was set up on the prison’s premises.
The plant was FDA approved and had safeguards in place regarding donations.
One former inmate at Angola told us that despite the rules in place at the plasma plant, “there were ways around them”.
He told us that inmates with hepatitis frequently sold blood, as did intravenous drug users. In his words, “You didn’t have to hide it [if you were an IV drug user]. Nobody cared… You wanna sell it? You got it? We’ll buy it. Bottom line”.
The former-inmate told us that “a lot of time, there were people working in the plasma unit who were drug abusers, giving plasma”.
Procedures were often not adhered to. For example, plasma collected from one person may be deliberately recorded as coming from a different individual.
When asked about HIV and AIDS, the former-inmate interviewed on film told us that drug users and homosexual donors “continued to give it [blood donations]” after the HIV outbreak was publicised. This was echoed by other former-inmates.
Through our work on prison plasma centres, we came into contact with people who provided us with documentation related to this area of investigation.
I remember a document from 1982 that stated that plasma from prisons had no higher level of Hepatitis infectivity than blood of other origins. I am no longer in possession of this document.
Targeting of gay men as blood donors
As I said previously, one of the issues that we investigated was the deliberate encouragement of gay men to donate blood and/or plasma by US pharmaceutical companies.
Charles Kozak, an American lawyer we interviewed for the film, told us that “homosexuals had built up a resistance to Hepatitis because of their sexual practices”. The “drug companies” therefore recruited gay men as donors as Hepatitis B antibodies in their blood was desirable.
We contacted Donald Francis, a former employee of the Centers for Disease Control and Prevention of the United States (hereafter, the ‘CDC’), the leading national public health institute. In this capacity, he advised pharmaceutical companies and tracked the development of diseases.
We met with Mr Francis in 2001. He provided us, at this meeting, with a deposition of his, that he had made prior to our meeting (Exhibit WITN3531003). As I understand it, the deposition was a supplemental expert report that is now a public court document in America.
The handwritten annotations on the copy attached to this statement are my notes and comments. The video testimony that we took of Mr Francis for the film closely mirrors the deposition.
He explained that “since 1996”, he learned that Cutter, Baxter and Alpha “collected plasma from urban homosexual men for Hepatitis B immunoglobulin (HBIG) production; used that same plasma in the manufacture of Factor VIII and IX concentrates prescribed for hemophilia; and continued to market this dangerous product after it was well-established that the source plasma presented the worst possible risk of AIDS to haemophiliacs”.
I saw this process as a perfect design for infecting haemophiliacs with HIV.
In Donald Francis’s words, “the same conduct that made urban homosexual men valuable plasma donors caused multiple other diseases that made this population inappropriate donors for any other blood or plasma product”.
We found some newspaper and magazine adverts that evidence the deliberate targeting of homosexual donors. Examples of these were annexed to Donald Francis’s  deposition. The investigators have attached a still from the film that evidences these adverts (Exhibit WITN3531004). I no longer have a copy of these adverts.
We had in our possession at the time of making the firm a number of internal memoranda, particularly from Cutter. The memoranda evidence that blood containing Hepatitis B antigen was used first for extraction of HBIg and then for blood products for haemophiliacs.
One FDA memorandum (dated 20 August 1982) referred to in Donald Francis’s deposition noted, after a meeting with Cutter representative Mr Moore, that “under usual circumstances, these units [of plasma taken from a predominantly male homosexual plasma collection point] … would have been pooled with other units collected for use in Hepatitis B immunoglobulin (HBIG).”
He continued: “The cryoprecipitate would have been removed and pooled with cryoprecipitates obtained from ordinary plasma pools…”. I do not have a copy of this document in my possession, but its contents is covered in paragraph 13 of the deposition of Dr. Francis.
One Cutter memorandum dated 30 August 1982 (Exhibit WITN3531005) notes that “until recently Cutter’s anti-HBs plasma (all collected from centers dealing predominantly with homosexuals) has been used in the manufacture of coagulation products”.
We also obtained a letter (Exhibit WITN3531006) authored by Hyland Vice President, Michael Rodell, to the FDA dated 15 September 1982 in which he stated that Hyland “…is not engaged in any recruitment programs targeting the homosexual community for plasma that may be used in the production of Antihaeophilic Factor (Human)”.
On 9 December 1982, however, Mr Rodell wrote to the National Haemophilia Foundation regarding HBIg production (see Exhibit WITN3531007). He stated that “we no longer allow this plasma to enter those pools leading to AHF [Antihaemophilic Human Factor] manufacture”.
As Donald Francis concluded, “the only reasonable conclusion is that defendants Cutter, Baxter and Alpha used the high-risk plasma to make Factor concentrates until July 1982”.
Donald Francis in his deposition stated that “this document indicates that Baxter did mix high risk Hepatitis B plasma into the Factor concentrate pools, until several months before the December 9 1982 letter.”
He also noted that a meeting was held in July 1982 at the CDC. The meeting was attended by representatives from Cutter and Hyland. Dr Francis stated that “[they] never disclosed to the CDC, at the July 27 1982 meeting, nor at any time during my employment at the CDC, that they used HBIG plasma donated by urban homosexual men for the manufacture of Factor VIII and IX used by haemophiliacs”.
Donald Francis also told us in an interview that is recorded in ‘Bad Blood’ that “if the companies had done what we [the CDC] had recommended, and indeed kept the material collected from high risk donors out of the market forever, we would have saved probably half of the haemophiliacs”.
Moreover, he stated that “plasma taken from homosexual men should never have been used for any purpose other than the production of HBIG or Hepatitis B Vaccine. The use of such plasma in the manufacture of Factor VIII and IX concentrates for hemophiliacs was unconscionable, particularly after the summer of 1981 when the epidemic of fatal immunosuppressive disease in this population became public knowledge”.
This information did not go before the Lindsay Tribunal given that it did not examine US pharmaceutical companies.
Internal documents of pharmaceutical companies regarding blood products
At the time of making the film, we had in our possession a number of internal documents from various pharmaceutical companies. Unfortunately, I no longer have copies of these documents.
These documents evidenced that by February 1983, the Food and Drug Administration (the ‘FDA’) had received assurances from pharmaceutical firms that prison plasma would no longer be used in haemophilia blood products.
Despite these assurances, Highland continued using plasma from prisons in the manufacture of these products for a further eight years.
An internal memorandum from Armour revealed that senior executives in the company had serious concerns about the safety of all heat-treated products. Despite these concerns, a decision was taken not to tell the FDA about these doubts.
These concerns were based in part on findings by Dr Alfred Prince, who had conducted tests on Armour’s Factor VIII. He concluded that despite being heat treated, virus remained present in the product.
Dr Prince informed us that Armour prevented Dr Prince’s publication of these findings and continued to distribute its products in Ireland, the UK and more widely.
By February 1986, Dr Prince was so concerned about Armour’s heat treated products that he decided to raise his doubts publicly at the UK’s major conference on AIDS.
He had colleagues whose patients had tested positive for HIV after treatment and whom had tested negative before. He told us that “by the time [he] blew the whistle, [he] knew of two definite cases, and two or three suspect cases. [He] decided that the time had come to make this knowledge public”.
He also told us that “manufacturers of the product got together to make a petition to stop [him] from saying [he] was worried”.
Later in 1986, Dr Prince’s findings regarding Armour’s heat-treated product finally made it to print in the Lancet medical journal.
Four months afterwards, Armour recalled its product.
This narrative was aired at the Lindsay Tribunal when Dr Prince gave evidence. It is his view that fault lies with Armour for blocking him from publishing his findings.
Reactions to the film
After the film was aired, I was relieved that the response from the haemophilia community was positive. I felt that we had given a voice to thousands of haemophiliacs who had for years felt like the silenced “small guys” against large corporations. For four or five years after the release of the film, I was contacted numerous times by members of this community, many of whom thanked us for publicising this story.
The release of ‘Bad Blood’ led to a question being asked in the Irish Parliament about why the state had not held the American pharmaceutical companies responsible for their actions.
The film also sparked interest in the possibility of a second tribunal. Paul Gardiner SC wrote an opinion piece on the merits of legal action against the pharmaceutical companies. Ultimately, it was decided not to initiate proceedings .
At the time of filming, I was very much on top of the facts. I was careful to be as fair and as accurate as I could be at all times, not least because I was alive to the risk that the pharmaceutical companies may institute legal action against us. This did not happen.
During our research for the film, we contacted both plasma collection companies and concentrate manufacturers. Neither would comment or be interviewed.
I stand by every claim that we made in the film.
Personally, I think it is a real shame that the pharmaceutical companies were never taken to court. I feel that they were never made to defend their actions despite the fact that many people died as a result.
It is a great pity that the RTE Bad Blood documentary made by Cunningham and the team although seen by the Infected Blood Inquiry was never able to be shown in public in the UK despite repeated requests for this to happen. With regard to public inquiries held in the UK, Archer, Penrose and the Infected Blood Inquiry, it was and is most important that US evidence regarding donors, plasma sourcing, safety violations, ignored warnings and the actions of US pharmaceutical companies were/are considered as part of the Terms of Reference where blood products were imported and used on haemophiliacs otherwise there is an incomplete historical picture and the goal of true justice may be denied to the victims.
Carol Anne Grayson is an independent writer/researcher on global health/human rights/WOT and is Executive Producer of the Oscar nominated, Incident in New Baghdad. She was a Registered Mental Nurse with a Masters in Gender Culture and Development. Carol was awarded the ESRC, Michael Young Prize for Research 2009, and the COTT ‘Action = Life’ Human Rights Award’ for “upholding truth and justice”. She is also a survivor of US “collateral damage”